HİPERTROFİK KARDİYOMİYOPATİLİ HASTALARDA EGZERSİZ EKOKARDİYOGRAFİ VE NT-PROBNP DÜZEYLERİNİN DEĞERLENDİRİLMESİ

Yıl 2023, , 118 - 122, 03.01.2023

Erol Gürsoy , Onur Baydar

https://doi.org/10.18229/kocatepetip.1192797

Öz

AMAÇ: Hipertrofik kardiyomiyopatili (HKM) hastalarda anormal sol ventrikül diyastolik fonksiyonu ve NT-proBNP seviyeleri gösterilmiştir, ancak egzersiz hemodinamiği hakkında bilgi eksikliği vardır. Bu prospektif çalışmada, HKM hastalarında diyastolik fonksiyonun prognostik değerini ve NT-proBNP düzeylerinin egzersize yanıtını incelemeyi amaçladık.
GEREÇ VE YÖNTEM: Nonobstrüktif HKM tanısı almış 20 hasta (yaş: 52,6±11,3 yıl; n=12 (%60) erkek) ve 11 gönüllüye (yaş: 46,4±13,0 yıl; n=8 (%72,7) erkek) bisiklet ergometrisi ile egzersiz (25 –W, 2 dakika) testi yapıldı. Mitral akım (E/A oranı), septal mitral akım hızları (E/E' oranı) ve NT-proBNP seviyeleri istirahatte ve submaksimal egzersizde ölçüldü. Ayrıca hastalar dört yıl boyunca takip edildi.
BULGULAR: HKM hastalarında istirahatte daha yüksek E/E' oranı ve NT-proBNP seviyeleri tespit edildi (E/E'oran: 15,36 ±4,90 vs 7,97± 1, 44; p< 0,001, NT-proBNP: 348,25±215,71 pg/ml vs 37,27±11,93 pg/ml; p<0,001). Egzersiz ile kontrollerde anlamlı bir yükselme olmadı, ancak HKM'li hastalarda E/E' oranı ve NT-proBNP seviyeleri anlamlı olarak arttı (E/E' oranı: 23,83±10,85 vs 8,01±2,22 p<0,001, NT-proBNP: 591,25±276,28 pg/ml vs 40,0± 12,03 pg/ml; p<0,001). Ayrıca dört yıllık takipte hiçbir hastada ölüm gözlenmedi.
SONUÇ: Nonobstrüktif HKM hastalarında diyastolik disfonksiyon, yüksek dolum basınçları ve NT-proBNP seviyeleri gözlendi ve bu anormalliklerin maksimum egzersiz sırasında kötüleştiği saptandı. Fakat bu bulgularımız mortaliteyi öngörmedi.

Anahtar Kelimeler

Hipertrofik kardiyomiyopati, Stres ekokardiyografi, Beyin natriüretik peptid, Hypertrophic cardiomyopathy, Stress echocardiography, Brain natriuretic peptide

EVALUATION OF EXERCISE ECHOCARDIOGRAPHY AND NT-PROBNP LEVELS IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY

Öz

OBJECTIVE: Abnormal left ventricular diastolic function, and NT-proBNP levels have been demonstrated in patients with hypertrophic cardiomyopathy (HCM), but there is lack of information about exercise hemodynamics. In this prospective study, we aimed to examine the prognostic value of diastolic function, and NT-proBNP levels response to exercise in HCM patients.
MATERIAL AND METHODS: Twenty patients (age: 52.6±11.3 years; n=12 (60%) men) with diagnosis of nonobstructive HCM and 11 volunteers (age: 46.4±13.0 years; n=8 (72.7%) men) serving as controls performed incremental cycle ergometry (25 –W, 2 minutes). Mitral inflow (E/A ratio), septal mitral annulus velocities (E/E’ ratio), and NT-proBNP levels were measured at rest and at submaximal exercise. Furthermore, patients were followed for four years.
RESULTS: Higher E/E’ ratio and NT-proBNP levels were detected at rest in HCM patients (E/E’ratio : 15.36 ±4.90 vs 7.97± 1, 44; p< 0.001, NT-proBNP: 348,25±215.71 pg/ml vs 37.27±11.93 pg/ml; p< 0.001). With exercise there was no significant elevation in controls, however E/E’ ratio and, NT-proBNP levels incresed significantly in patients with HCM ( E/E’ ratio: 23.83±10.85 vs 8.01±2.22; p< 0.001, NT-proBNP: 591.25±276.28 pg/ml vs 40.0± 12.03 pg/ml; p<0.001 ). Also, four-year follow-up, none of the patients had died.
CONCLUSIONS: Nonobstructive HCM patients have diastolic dysfunction, elevated filling pressures and NT-proBNP levels and these abnormalities worsen during maximal exercise. but our findings did not predict mortality.

Anahtar Kelimeler

Hypertrophic cardiomyopathy, Stress Echocardiography, Nt-proBnp, Hipertrofik kardiyomiyopati, Stres ekokardiyografi, Beyin natriüretik peptid, Hypertrophic cardiomyopathy, Stress echocardiography, Brain natriuretic peptide

Kaynakça

• 1. Maron BJ. Hypertrophic cardiomyopathy: a systematic review. JAMA. 2002;(287):1308-20.
• 2. Nagueh SF, Mahmarian JJ. Noninvasive cardiac imaging in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 2006;(48):2410-22.
• 3. Paulus WJ, Lorell BH, Craig WE, et al. Comparison of the effects of nitroprusside and nifedipine on diastolic properties in patients with hypertrophic cardiomyopathy: altered left ventricular loading or improved muscle inactivation? J Am Coll Cardiol. 1983;(2):879-86.
• 4. Bonow RO, Dilsizian V, Rosing DR, et al. Verapamil-induced improvement in left ventricular diastolic filling and increased exercise tolerance in patients with hypertrophic cardiomyopathy: short- and long-term effects. Circulation. 1985;(72):853-64.
• 5. Wu WC, Bhavsar JH, Aziz GF, Sadaniantz A. An overview of stress echocardiography in the study of patients with dilated or hypertrophic cardiomyopathy. Echocardiography. 2004;(21):467-75.
• 6. Peteiro J, Bouzas-Mosquera A, Fernandez X, et al. Prognostic value of exercise echocardiography in patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr. 2012;(25):182-9.
• 7. Argulian E, Chaudhry FA. Stress testing in patients with hypertrophic cardiomyopathy. Prog Cardiovasc Dis. 2012;(54):477-82.
• 8. Thaman R, Esteban MT, Barnes S, et al. Usefulness of N-terminal pro-B-type natriuretic peptide levels to predict exercise capacity in hypertrophic cardiomyopathy. Am J Cardiol. 2006;(98):515-9.
• 9. Coats CJ, Gallagher MJ, Foley M, et al. Relation between serum N-terminal pro-brain natriuretic peptide and prognosis in patients with hypertrophic cardiomyopathy. Eur Heart J. 2013;34(32):2529-37.
• 10. Maron MS, Olivotto I, Betocchi S, et al. Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J Med. 2003;(348):295-303.
• 11. Douglas PS, Khandheria B, Stainback RF, et al. ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American Society of Echocardiography, American College of Emergency Physicians, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance endorsed by the American College of Chest Physicians and the Society of Critical Care Medicine. J Am Coll Cardiol. 2007;50(2):187-204.
• 12. Wang J, Buergler JM, Veerasamy K, et al. Delayed untwisting: the mechanistic link between dynamic obstruction and exercise tolerance in patients with hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol. 2009;(54):1326-34.
• 13. Saura D, Marín F, Climent V, et al. Left atrial remodelling in hypertrophic cardiomyopathy: relation with exercise capacity and biochemical markers of tissue strain and remodelling. Int J Clin Pract. 2009; (63):1465-71.