Mitral Darlığı Olan Hastalarda Atriyal Elektiriksel ve Elektromekanik Özellikler

Yıl 2017, Cilt: 20 Sayı: 1, 1 - 6, 03.04.2017

Ahmet Güler Mustafa Bulut Cihan Dündar Kürşat Tigen Tansu Karaahmet Yeliz Güler Uğur Aslantaş Süleyman Efe Emrah Acar Süleyman Barutcu İsmail Balaban Selçuk Pala

Öz

Giriş: Mitral darlığı olan hastalarda atriyal fibrilasyon (AF) önemli bir
mortalite ve morbidite nedenidir ve bu hastalarda perkütan mitral balon
valvüloplasti (PMBV) semptomlarda ve ekokardiyografik parametrelerde önemli
düzelme sağlayan başarılı bir girişimdir. Bu çalışmada mitral darlıklı
hastalarda PMBV’nin AF gelişimini predikte edebilen yeni ekokardiyografik ve
elektrokardiyografik parametreler üzerindeki bir yıllık dönemdeki etkisinin
gösterilmesi amaçlanmıştır.

Hastalar ve
Yöntem: Orta ve ileri mitral darlığı olan 28 hasta (ortalama yaş
37.6 ± 7.4, %50’si erkek) çalışmaya dahil edilmiştir. PMBV girişimine aday olan
hastaların işlem öncesi ve sonrasındaki birinci yılda atriyal ileti zamanı
(ACT) açısından ayrıntılı ekokardiyografik incelemeleri doku Doppler yöntemiyle
yapılmıştır. Ayrıca her hastanın işlemden bir gün önce ve birinci yılda  maksimum ve minimum P dalga süreleri (Pmax ve
Pmin) ve P dalga dispersiyonu (PWD) elektrokardiyografi ile
değerlendirilmiştir.

Bulgular: PMBV işleminden sonra ACT (148.1 ± 20.5 vs. 121.3 ± 20.5, p< 0.001),
Pmax (151.7 ± 15.8 vs. 137.3 ± 15.6, p< 0.001), PWD (84.7 ± 18.8 vs. 71.1 ±
18.5, p< 0.001) değerleri istatistiksel anlamlı olarak düşmüştür. İşlem
öncesi ve sonrası ACT, Pmax, PWD, LAVi ve PAPs parametreleri arasında güçlü
pozitif korelasyon tespit edilmiştir. Ayrıca işlem sonrası ve öncesi değerlerin
çıkarılmasıyla hesaplanan Δ değerleri arasında güçlü korelasyon tespit
edilmiştir. Buna göre; ΔACT’nin ΔPmax ve ΔPWD (r= 0.5, p= 0.007 ve r= 0.55, p=
0.002, sırasıyla) değerleriyle korele olduğu tespit edildi ve  ΔACT, ΔPmax ve  ΔPWD, ekokardiyografik parametrelerden
sadece  ΔLAVi ve ΔPAP ile anlamlı olarak
korele idi.

Sonuç: Bu çalışma mitral darlıklı
hastalarda EKG ve TDI yöntemleriyle değerlendirilen atriyal ileti
özelliklerinin diğer ekokardiyografik parametrelerle önemli derecede korele
olduğunu göstermiştir. Ayrıca işlem sonrası birinci yılda bu parametrelerde
önemli düzeyde düzelme meydana gelmiştir. Yapılacak prospektif özellikte daha
fazla çalışma atriyal elektromekanistik özellikler ve AF gelişimi arasındaki
ilişki açısından daha fazla bilgi sağlayabilir.

Anahtar Kelimeler

Romatizmal mitral darlık, atriyal fibrilasyon, atriyal ileti zamanı, P dalga dispersiyonu, perkütan mitral balon valvüloplasti

Atrial Electrical and Electromechanical Characteristics in Patients with Rheumatic Mitral Stenosis

Öz

Introduction:
AF
in patients with mitral stenosis (MS) causes significant morbidity and
mortality. PMBV, which is a treatment of choice for patients with MS, is a
highly successful procedure that provides significant improvement in symptoms
and echocardiographic parameters. In this study we aimed to demonstrate the
probable effects of PMBV on novel echocardiographic and electrocardiographic
parameters that can predict the development of AF in 1-year period in patients
with MS.

Patients
and Methods: Twenty-eight patients with moderate or severe rheumatic
MS (mean age 37.6 ± 7.4 years; 14 (50%) males) were enrolled this study. All
patients who were eligible for this procedure underwent comprehensive
echocardiographic examinations with evaluation of ACT measured using tissue
Doppler imaging (TDI) before PMBW and repeated at the end of the 1 year after
successful PMBV. In addition, 12-lead ECGs were recorded for each patient 1 day
before PMBV for the evaluation of baseline maximum and minimum P-wave duration
and P-wave dispersion (PWD); this was repeated at the end of the 1 year after
successful PMBV.

Results: ACT (148.1
± 20.5 vs 121.3 ± 20.5 p< 0.001), P-max (151.7 ± 15.8 vs 137.3 ± 15.6 p<
0.001) and PWD (84.7 ± 18.8 vs 71.1 ± 18.5 p< 0.001) were found to be
significantly decreased after PMBV. A strong positive correlation was detected
between ACT, P-max, PWD, LAVi ve PAPs before and after PMBV. In addition, there
was a strong correlation between Δ values that were measured by subtracting the
baseline measurements from the post-PMBV measurements. Accordingly, ΔACT was
correlated with ΔP-max ve ΔPWD (r= 0.5 p= 0.007 and r= 0.55 p= 0.002,
respectively). ΔACT, ΔP-max and ΔPWD correlated significantly with only ΔLAVi
and ΔPAP in echocardiographic parameters.

Conclusion: This study demonstrated
that atrial conduction properties that have also been evaluated with ECG and
TDI studies significantly correlate with other echocardiographic parameters in
patients with MS. In addition, significant improvement occurred in these
parameters at the end of the 1 year after PMBV. Further prospective investigations
may provide useful data for the detection of the relation between atrial
electromechanical characteristics and development of AF in patients with MS.

Anahtar Kelimeler

Rheumatic mitral stenosis, atrial fibrillation, atrial conduction tine P-wave dispersion, percutaneous mitral balloon valvuloplasty

Kaynakça

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