Hemodiyaliz hastalarında sağ kalp fonksiyonlarının ekokardiyografik olarak değerlendirilmesi

Yıl 2019, , 820 - 824, 03.12.2019

İsa Ardahanlı , Okan Akyüz

https://doi.org/10.28982/josam.588248

Öz

Amaç: Volüm yükü değerlendirmesi kronik böbrek yetmezliği (KBY) hastalarında önemli bir sorundur. Klasik volüm değerlendirmesi yöntemleri dışında, sağ kalp fonksiyonlarının ekokardiyografik değerlendirmesi ile ilgili yapılmış çalışma sayısı kısıtlıdır. Bu çalışmada hemodiyaliz (HD) tedavisi alan son dönem böbrek yetmezliği hastalarında sağ kalp fonksiyonlarını ekokardiyografik olarak değerlendirmeyi ve volüm yükü tayininde kullanılabilirliğini amaçladık.

Yöntemler: Bu vaka kontrol çalışmasına, çalışma grubu olarak HD tedavisi alan 49 hasta alındı. Kontrol grubu olarak yaş, cinsiyet uyumu sağlanmış 46 sağlıklı birey alındı. Tüm katılımcıların ekokardiyografik olarak değerlendirmesi yapıldı. Triküspit anüler düzlem sistolik hareketi (TAPSE), sistolik pulmoner arter basıncı (SPAB), triküspit E dalga hızı, A dalga hızı, E/A oranı, sağ ventrikül ejeksiyon fraksiyonu (RVEF) ve sol ventrikül ejeksiyon fraksiyonu (LVEF) ölçüldü. 

Bulgular: Sağ ventrikül diyastolik çapı (sırasıyla 2.55 (0.3) ve 2.30 (0.29), P<0.001) ve SPAP (37.4 (8.3) ve 19 (6.8), P<0.001), çalışma grubunda istatistiksel olarak anlamlı derecede yüksek bulundu. Çalışma grubunda TAPSE (sırasıyla 1.61 (0.35) ve 2.09 (0.27), P<0.001), A oranı, (sırasıyla 0.63 (0.27) ve 0.45 (0.26), P<0.001), E / A oranı (sırasıyla 0.93 (0.25) ve 1.37 (0.24), P<0.001). Çalışma grubunda sağ ventrikül E hızı daha düşüktü ancak istatistiksel olarak anlamlı değildi (P=0.523). Gruplar arasında yaş, cinsiyet ve vücut kitle indeksi açısından istatistiksel olarak anlamlı fark yoktu.

Sonuç: Çalışmamızda, HD hastalarında TAPSE’nin düşük, SBAP’nin ve sağ ventrikül diyastolik çapının ise yüksek olduğunu tespit ettik. HD hastalarında TAPSE ve SPAB'nin, hipervolemiyi değerlendirmede geleneksel yöntemlerle birlikte kullanılabileceğini düşünüyoruz. Bu klinik aracı keşfetmek için daha ileri çalışmalar gereklidir.

Anahtar Kelimeler

Triküspit anüler düzlem sistolik hareketi, Sistolik pulmoner arter basıncı, Hemodiyaliz, Sağ kalp fonksiyonları

Echocardiographic evaluation of right heart functions in hemodialysis patients

Öz

Aim: Volume load assessment is an important problem in patients with chronic renal failure (CRF). Apart from classical volume assessment methods, the number of studies on echocardiographic evaluation of right heart functions is limited. In this study, we aimed to evaluate right heart functions echocardiographically in end-stage renal failure patients receiving hemodialysis (HD) therapy and its utility in volume load determination.

Methods: This case-control study included 49 patients receiving HD treatment as the study group. The control group consisted of 46 healthy individuals whose age and gender were matched. Echocardiographic evaluation was performed for all participants. Tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (SPAB), tricuspid E wave velocity, A wave velocity, E / A ratio, right ventricular ejection fraction (RVEF) and left ventricular ejection fraction (LVEF) were measured.

Results: Right ventricular diastolic diameter (2.55 (0.3) vs 2.30 (0.29) respectively, P<0.001) SPAP (37.4 (8.3) vs 19 (6.8), P<0.001, respectively) were statistically significant higher in the study group, while TAPSE (1.61 (0.35) vs 2.09 (0.27), P<0.001, respectively), A rate, (0.63 (0.27) vs 0.45 (0.26), P<0.001, respectively), E / A ratio (0.93 (0.25) vs 1.37 (0.24), P<0.001, respectively) were significantly lower. Right ventricular (RV) E velocity was insignificantly lower in the study group (P=0.523). There were no statistically significant differences between the groups in terms of age, gender, and body mass index.

Conclusion: In our study, we found that TAPSE was low and SBAP and RV diastolic diameter were high in HD patients. We think that TAPSE and SPAB can be used together with conventional methods for evaluating hypervolemia in HD patients. Further studies are required to explore this clinical tool.

Anahtar Kelimeler

Right heart functions, Tricuspid annular plane systolic excursion, Systolic pulmonary artery pressure, Hemodialysis, Right heart functions

Kaynakça

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