Fibromiyalji Sendromunda Kardiyovasküler Sistemin Değerlendirilmesi: Doku Doppler Ekokardiyografik İnceleme

Year 2010, Volume: 12 Issue: 1, 12 - 17, 01.03.2010

Mehmet Yazıcı Sinan Albayrak Sevim Makarç Melek Kolbaş Enver Erbilen Ramazan Akdemir Safinaz Ataoglu Selma Yazıcı

Abstract

Amaç: Biz Fibromiyalji (FM) hastalarında kardiyak yapı ve fonksiyonların hem geleneksel hemde yeni ve faydalı bir metot olan doku Doppler ekokardiyografik (DDE) yöntemle incelemeyiamaçladık. Ayrıca, hastalığın patogenezinde olası mekanizmalardan biri olarak gösterilenotonom fonksiyon bozukluğunu elektrokardiyografik olarak QT parametrelerini (QT maksimum,QT minimum ve QT dispersiyonu) ölçerek değerlendirdik. Yöntem: Çalışma aynı kliniğe başvuran 42 hasta (ortalama yaş 41, 38 kadın ) ve kontrol grubuolarak alınan tamamen sağlıklı 38 kişi üzerinde yapıldı. Bireylerin her birine tam bir fizikmuayene, elektrokardiyografik (50 mm/s hızla kaydedilen) ve ekokardiyografik (hemgeleneksel, hem de DDE) ile değerlendirme yapıldı.Bulgular: Elektrokardiografik kayıtların analizinde QT dispersiyonunda hafif fakat istatistikselolarak anlamlı olmayan bir artış saptandı. Geleneksel ekokardiyografik parametreler açısındanhasta grubu ile kontrol grubu benzerdi. Bununla birlikte bu çalışmanın önemli bir bulgusu hastagrubunda DDE yöntemi ile saptanan gevşeme bozukluğu idi. Em dalga hızı ve Em/Am oranlarıFM hastalarında kontrollere kıyasla anlamlı düzeyde düşüktü (sırasıyla, p < 0.005, p < 0.01).Sm ve Am dalga hızları ise her iki grupta da benzerdi. Sonuç: Bu çalışmada hasta grubunda DDE yöntemi ile saptanan sol ventrikülün gevşemebozukluğu FM’de görülen yorgunluk ve nefes darlığı gibi bazı semptomları kısmen açıklayabilir.Ayrıca tam bir kardiyak değerlendirme yapılması ile fibromiyaljinin patogenezindeki otonomikdisfonksiyon teorisini destekleyecek bulgular elde edilebilir

Keywords

Fibromiyalji, QT dispersiyonu, ekokardiyografi

Evaluation of Cardiovascular System in Fibromyalgia Syndrome: Tissue Doppler Echocardiographic Investigation

Abstract

Aim: We aim to investigate besides the cardiac structures and functions by both conventionalmethods and Tissue Doppler Echocardiography (TDE) which is a new and useful method inpatients with Fibromyalgia (FM). Additionally, we evaluated QT parameters (QT maximum,QT minimum and QT dispertion) with the use of electrocardiography in order to measure theautonomic dysfunction which is a possible mechanism in the pathogenesis of the disease. Methods: The study was performed on 42 patients (mean age 41 years, 38 female) and 38completely healthy subjects (35 female, mean age of 42 years) who were admitted to the sameclinic were collected as the control group. All the individuals were undergone a completephysical examination, electrocardiography (recordings were displayed at 50 mm/s speed) andechocardiography evaluation (both conventional methods and TDE).Results: Analysis of electrocardiographic recordings revealed mildly increased mean QTdispertion in the patient group, but this difference was statistically insignificant. Analysis ofconventional echocardiographic parameters revealed similar results between the patient groupand the control cases. However, an important finding of this study is that significant diastolicdysfunction was found in the patient group which was recorded with the TDE technique. Emwave velocity and Em/Am ratios were significantly lower in patients with FM compared withcontrols (p

Keywords

Fibromyalgia, QT dispertion, echocardiography

References

• Croft P, Rigby AS, Boswell R, Schollum J, Silman A: The prevalence of chronic widespread pain in the general population. J Rheumatol. 20:710-713, 1993.
• Marder WD, Meenan RF, Felson DT, et al: Editorial: the present and future adequacy of rheumatology manpower: a study of health care needs and physician supply. Arthritis Rheum. 34:1209-1217, 1991.
• Baron R: Causalgia and reflex sympathetic dystrophy: Does the sympathetic nervous system contribute to the generation of pain? Muscle Nevre. 22:678-695, 1999.
• Vaeroy H: Altered sympathetic nervous system response in patients with fibromyalgia. J Rheumatol. 16:1460-1465, 1989.
• Elam M: Do patients with primary fibromyalgia have an altered muscle sympathetic nerve activity? Pain 48:371-375, 1992.
• Martínez-Lavín M, Hermosillo AG, Mendoza C, Ortiz R, Cajigas JC, Pineda C, Nava A, Vallejo M: Orthostatic sympathetic derangement in subject with fibromyalgia. J Rheumatol 24:714-718, 1997.
• Kelemen J, Láng E, Bálint G, Trócsányi M, Müller W: Orthostatic sympathetic derangement of baroreflex in patients with fibromyalgia. J Rheumatol. 25:823-825, 1998.
• Raj SR, Brouillard D, Simpson CS, Hopman WM, Abdollah H: Dysautonomia among patients with fibromyalgia: a noninvasive assessment. J Rheumatol. 27:2660-2665, 2000.
• Bou-Holaigah I, Calkins H, Flynn JA, Tunin C, Chang HC, Kan JS, Rowe PC: Provocation of hypotension and pain during upright tilt table testing in adults with fibromyalgia. Clin Exp Rheumatol. 15:239-246, 1997.
• Martínez-Lavín M, Hermosillo AG, Rosas M, Soto ME: Circadian studies of autonomic nervous balance in patients with fibromyalgia: A Heart Rate Variability Analysis American Collage of Rheumatology. 41:1966-1971, 1998.
• Cohen H, Neumann L, Shore M, Amir M, Cassuto Y, Buskila D: Autonomic dysfunction in patients with fibromyalgia: application of power spectral analysis of heart rate variability. Semin Arthritis Rheum. 29:217-227, 2000.
• Naschitz JE, Slobodin G, Sharif D, Fields M, Isseroff H, Sabo E, Rosner I: Electrocardiographic QT interval and cardiovascular reactivity in fibromyalgia differ from chronic fatigue syndrome. Eur J Int Med. 19: 187–191, 2008.
• Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al: The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the Multicenter Criteria Committee. Arthritis Rheum. 33:160–72, 1990.
• Henry WL, DeMaria A, Gramiak R, King DL, Kisslo JA, Popp RL, Sahn DJ, Schiller NB, Tajik A, Teichholz LE, Weyman AE: Report of the American society of echocardiography committee on nomenclature and standards in two dimensional imaging. Circulation. 62:212–217, 1980.
• Cohen H, Neumann L, Alhosshle A, Kotler M, Abu-shakra M, Bukila D: Abnormal sympatovagal balance in men with Fibromyalgia. J Rheumatol. 28:3 581-588, 2001.
• Algra A, Tijssen JGP, Roelandt JRTC, Pool J, Lubsen J: QTc prolongation measured by standard l2-lead electrocardiography is an independent risk factor for sudden death due to cardiac arrest. Circulation. 83:1888 –1894, 1991.
• Watanabe T, Ashikaga T, Nishizaki M, Yamawake N, Arita M: Association of insulin with QTc dispersion. Lancet. 350:1821– 1822, 1997.
• Zipes DP: The long QT syndrome: a Rosetta stone for sympathetic related ventricular tachyarrhythmias. Circulation. 84:1414 –1419, 1992.
• Marfella R, Guld’ero P, Siniscalhi M: Morning Blood pressure peak QT intervals and sympathetic activity in hypertensive patients Hypertension. 41123-127, 2003.
• Isaaz K: Tissue Doppler imaging for assessment left ventricular systolic and diastolic Function Current Opinion in Cardiology. 17:431-442, 2002.
• Shan K, Bick RJ, Poindexter BJ, Shimoni S, Letsou GV, Reardon MJ, Howell JF, Zoghbi WA, Nagueh SF: Relation Of Tissue Doppler derived myocardial Velocities to myocardial structure and beta adrenergic receptor density in man. J Am. Coll. Cardiol. 36:891-6, 2000.
• Kass DA, Bronzwaer JGF, Paulus WJ. What Mechanisms Underlie Diastolic Dysfunction in Heart Failure? Circ Res. 94:1533-1542, 2004.
• Gutierrez C, Blanchard DG: “Diastolic Heart Failure: Challenges of Diagnosis and Treatment” American Family Physician. 69:2609–16, 2004.