Kronik Asemptomatik Alkolik Hastalarda Subklinik Sol Ventrikül Disfonksiyonu

Yıl 2016, Cilt: 19 Sayı: 3, 154 - 160, 01.12.2016

Arzu Kalaycı Can Yücel Karabay Gönenç Kocabay Vecih Oduncu Taylan Akgün Ruken Bengi Bakkal Ahmet Güler Ayhan Erkol Akın İzgi Cevat Kırma

Öz

Giriş:
Bu çalışmanın amacı, normal sol ventrikül ejeksiyon
fraksiyonu olan asemptomatik kronik alkolik hastalarda subklinik global
sistolik fonksiyon bozukluğu olup olmadığını “speckle tracking ekokardiyografi
(STE)” yöntemini kullanarak araştırmaktır.

Hastalar
ve Yöntem: Çalışmaya, 30 sağlıklı hasta
(ortalama yaş 34.8 ± 5.8 yıl) ve 75 asemptomatik alkolik hasta (ortalama yaş
39.8 ± 6.5 yıl) alındı ve bu hastalar yaşamı boyunca aldığı etanol miktarına
(TLDE) göre iki gruba ayrıldı: grup I (TLDE < 15 kg etanol/vücut
ağırlığı-kg) ve grup II (TLDE ≥ 15 kg etanol/vücut ağırlığı-kg). İki boyutlu
STE analizinde, sol ventrikül (LV) global longitudinal strain (G-LS), sistolde
longitudinal global strain rate (G-SRsys), erken diyastolde longitudinal global
strain rate (G-SRearly) ve geç diyastolde longitudinal global strain rate
(G-SRlate) değerleri hesaplandı.

Bulgular:
Alkolik hastalarda, sistol sonu ve diyastol sonu
çapların daha geniş, interventriküler septum ve posterior duvarın daha kalın ve
LV kitle indeks değerlerinin daha yüksek olduğu saptandı. Ancak, alkolik
hastalar arasında sistol sonu ve diyastol sonu çaplar ve LV kitle indeks
değerleri açısından anlamlı bir farklılık saptanmadı. Gruplar arasında LV
ejeksiyon fraksiyonu açısından farklılık yoktu. Alkolik hastalarda G-LS
değerleri daha düşüktü (p< 0.001). LV kitle indeksi ve LV çaplarında anlamlı
farklılık olmamasına rağmen, G-LS değerlerinin alkolik hastalarda belirgin
düzeyde daha düşük olduğu gösterildi. Kontrol grubu ile kıyaslandığında,
G-SRsys değerlerinin alkolik hastalarda daha düşük olduğu ancak G-SRearly ve
G-SRlate değerlerinde farklılık olmadığı saptandı. G-LS değerleri ile TLDE
arasında anlamlı bir korelasyon olduğu gösterildi (r= 0.49, p< 0.001).

Sonuç: Bildiğimiz kadarıyla çalışmamız literatürde, kronik
alkolik hastalarda 2D-STE ile değerlendirmede longitudinal sistolik
fonksiyonlarda erken bozulmanın olduğunu gösteren ilk çalışmadır. Bu
fonksiyonel mekanikler, alkol tüketiminin artışına paralel olarak
bozulmaktadır.

Anahtar Kelimeler

Alkolik hastalar, sol ventrikül disfonksiyonu, speckle tracking

Subclinical Left Ventricular Dysfunction in Chronic Asymptomatic Alcoholic Patients

Öz

Introduction:
The aim of this study was to use speckle-tracking
echocardiography (STE) for identifying subclinical global systolic function
abnormalities in chronic asymptomatic alcoholic patients with a normal ejection
fraction.

Patients
and Methods: We included 30 healthy subjects (age 34.8 ±
5.8 years) and 75 asymptomatic alcoholic patients (age 39.8 ± 6.5 years) and
divided them into two groups according to their total lifetime dose of ethanol
(TLDE): group I (TLDE < 15 kg ethanol/kg body weight) and group II (TLDE ≥
15 kg ethanol/kg body weight). In the two-dimensional (2D)-STE analysis, the
left ventricular (LV) global longitudinal strain (G-LS), longitudinal global
strain rate in systole (G-SRsys), longitudinal global strain rate in early
diastole (G-SRearly) and longitudinal global strain rate in late diastole
(G-SRlate) values were obtained.

Results:
Alcoholic patients had larger end-systolic and end-diastolic dimensions,
thicker interventricular septal and posterior wall and higher LV mass index.
However, there were no differences in the end-systolic and end-diastolic
dimensions and LV mass index among them. The ejection fraction did not differ
between the groups. The G-LS values were lower in alcoholic patients (p<
0.001). G-LS was found to be significantly lower among alcoholic patients,
although the LV mass index and LV dimensions remained unchanged. Although
G-SRsys was lower in alcoholic patients compared with that in controls (p=
0.03), there were no differences in the G-SRearly and G-SRlate values. There
was a significant correlation between G-LS values and TLDE (r= 0.49, p<
0.001).

Conclusion:
To the best of our knowledge, this is the first
study demonstrating the presence of early functional abnormalities of
longitudinal systolic function by 2D-STE in chronic alcoholic patients. These
functional mechanics have a parallel impairment with the increase in alcohol
consumption.

Anahtar Kelimeler

Alcoholic patients, left ventricular dysfunction, echocardiography, speckle tracking

Kaynakça

• 1. Regan TJ. Alcohol and the cardiovascular system. JAMA 1990;264:377-81.
• 2. Iacovoni A, De Maria R, Gavazzi A. Alcoholic cardiomyopathy. J Cardiovasc Med (Hagerstown) 2010;11:884-92.
• 3. Amundsen BH, Helle-Valle T, Edvardsen T, Torp H, Crosby J, Lyseggen E, et al. Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol 2006;47:789-93.
• 4. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. 2009 Focused update incorporated in to the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. J Am Coll Cardiol 2009; 53:1-90.
• 5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders- DMS-V. 5th ed. Washington, DC: American Psychiatric Association, 2013.
• 6. Vittadini G, Buonocore M, Colli G, Terzi M, Fonte R, Biscaldi G. Alcoholic polyneuropathy: a clinical and epidemiological study. Alcohol and Alcoholism 2001;36:393-400.
• 7. Delbridge LM, Connell PJ, Harris PJ, Morgan TO. Ethanol effects on cardiomyocyte contractility. Clin Sci (Lond) 2000;98:401-7.
• 8. Lazarević AM, Nakatani S, Nesković AN, Marinković J, Yasumura Y, Stojicić D, et al. Early changes in left ventricular function in chronic asymptomatic alcoholics: relation to the duration of heavy drinking. J Am Coll Cardiol 2000;35:1599-606.
• 9. Kupari M, Koskinen P, Suokas A. Left ventricular size, mass and function in relation to the duration and quantity of heavy drinking in alcoholics. Am J Cardiol 1991;67:274-9.
• 10. George A, Figueredo VM. Alcoholic cardiomyopathy: a review. J Card Fail 2011; 17:844-9.
• 11. Askanas A, Udoshi M, Sadjadi SA. The heart in chronic alcoholism: a noninvasive study. Am Heart J 1980;99:9-16.
• 12. Kino M, Imamitchi H, Morigutchi M, Kawamura K, Takatsu T. Cardiovascular status in asymptomatic alcoholics, with reference to the level of ethanol consumption. Br Heart J 1981;46:545-51.
• 13. Dancy M, Bland JM, Leech G, Gaitonde MK, Maxwell JD. Preclinical left ventricular abnormalities in alcoholics are independent of nutritional status, cirrhosis, and cigarette smoking. Lancet 1985;1:1122-5.
• 14. Kupari M, Koskinen P, Suokas A, Ventilä M. Left ventricular filling impairment in asymptomatic chronic alcoholics. Am J Cardiol 1990; 66:1473-7.
• 15. Piano MR. Alcoholic cardiomyopathy: incidence, clinical characteristics, and pathophysiology. Chest 2002;121:1638-50.
• 16. Mathews EC Jr, Gardin JM, Henry WL, Del Negro AA, Fletcher RD, Snow JA, et al. Echocardiographic abnormalities in chronic alcoholics with and without over congestive heart failure. Am J Cardiol 1981;47:570-8.
• 17. Urbano-Marquez A, Estruch R, Navarro-Lopez F, Grau JM, Mont L, Rubin E. The effects of alcoholism on skeletal and cardiac muscle. N Engl J Med 1989; 320:409-15.
• 18. Kupari M, Koskinen P. Relation of left ventricular function to habitual alcohol consumption. Am J Cardiol 1993; 72:1418-24.