Kalp Yetmezliğinde Etiyolojik ve Prognostik Değerlerin Beklenen Yaşam Süresine ve Mekanik Dolaşım Desteğinin Zamanlamasına Etkisi: Biyonik kalbe mi gidiyoruz?

Öz

Amaç: Bu çalışmanın amacı, kalp yetmezliği olan hastalarda tanı için erken implantasyon kriterlerini, prognostik değerleri, yaşam sürecini ve mekanik dolaşım desteğini belirlemektir. Yöntem: Çalışmaya 40 (Erkek, 33; Kadın, 7) hasta dahil edildi. Hastalar dilate, iskemik ve hipertrofik kardiyomiyopatili olarak gruplandırıldı. New York Kalp Cemiyeti kriterlerine göre sınıfları belirlendi ve kısa form 36 yaşam kalitesi değerlendirme anketi uygulandı. INTERMACS ® tesviye edildi. VO2 max ve 6 dakika yürüme testi, kan sodyum ve pro-BNP düzeyleri, LVEF, RVEF, sağ atriyal dolum basınçları incelendi. Bulgular: Grupta dilate KMP, hipertrofik KMP ve iskemik KMP oranları sırasıyla %75, %5 ve %20 idi. Dört sınıflı NYHA sınıflamasına (I'den IV'e) göre hastaların oranları sırasıyla %5, %25, %47,5 ve %22,5 idi. Ortalama Intermacs seviyeleri 4,90 ± 1,59 ve 3,66 ± 1,22 ve VO2 max değerleri 13,52±6,02, altı dakikalık yürüme testine göre yürüme mesafeleri 280,55 ±131,94 metre, LVEF değerleri 23,10 ±6,73 idi. Yüksek sol ventrikül diyastol sonu çapı ve düşük VO2 max değerleri kötü prognoz ile ilişkilendirildi. Bağımsız değişken olarak sağ ventrikül ejeksiyon fraksiyonu ve altı dakika yürüme testi ölümle ilişkilendirildi. Sonuç: Çalışmamıza göre mortalitesi yüksek olan kalp yetmezlikli seçilmiş hastalarda mekanik dolaşım desteği uygulanarak beklenen yaşam süresi arttırılabilir. Gelecekte giderek artan sayıda hastaya bu cihazların transplantasyona bir alternatif olarak implante edilmesi muhtemeldir ve hasta grubundan iskemik olmayan dilate kardiyomiyopatisi olanların tümü iyileşme için adaydır.

Anahtar Kelimeler

• Kalp yetmezliği
• Yaşam beklentisi
• Kardiyomiyopati
• Mekanik dolaşım desteği
• Biyonik kalp

The Effects of the Aetiologic and Prognostic Values in Heart Failure on Life Expectancy and the Timing of Mechanical Circulatory Support: Are we heading for the bionic heart?

Öz

Objective: The aim of this study was to determine early implantation criteria for diagnosis, prognostic values, life process and mechanical circulatory support in patients with heart failure. Method: 40 (male, 33; female, 7) patients were enrolled in the study. Patients were grouped as having dilated, ischemic and hypertrophic cardiomyopathy. New York Heart Association classes were determined, and a short-form 36 quality-of-life assessment questionnaire was administered. INTERMACS ® has been leveled. VO2 max and 6 minute walk test, blood sodium and pro-BNP levels, LVEF, RVEF, right atrial filling pressures were examined. Results: Rates of the group of dilated CMP, hypertrophic CMP, and ischemic CMP were 75%, 5%, and 20%, respectively. Ratios of the patients according to four classed NYHA classification (I to IV) were 5%, 25%, 47.5%, and 22.5%, respectively. Mean Intermacs levels were 4.90 ± 1.59 and 3.66 ± 1.22 and VO2 max values were 13.52±6, 02, according to six-minute walk test, walking distances were 280.55 ±131.94 meters, LVEF values were 23.10 ±6.73. High left ventricle end diastolic diameter and low VO2 max values were associated with a poor prognosis. Right ventricular ejection fraction as independent variables and six-minute walk test were associated with death. Conclusion: According to our study survey can be corrected by applying mechanical circulation support in selected patients for heart failure with high mortality. An increasing number of patients in the future are likely to have these devices implanted as an alternative to transplantation, and of these, all with nonischemic dilated cardiomyopathy are candidates for recovery.

Anahtar Kelimeler

• Heart failure
• Life expectancy
• Cardiomyopathy
• Mechanical circulatuar support
• Bionic heart

Kaynakça

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