Düşük Ejeksiyon Fraksiyonlu Kalp Yetersizliği Hastalarında Spironolaktonun Atriyal İleti Üzerine Etkisi

Yıl 2018, Cilt: 40 Sayı: 3, 53 - 60, 01.09.2018

Taner Ulus Sayyed Hamed Moghanchızadeh Muhammet Dural Kadir Uğur Mert Muzaffer Bilgin Fezan Mutlu

Öz

Atriyal
fibrilasyon (AF) kronik kalp yetersizliği (KY) hastalarında sık görülen bir
ritim bozukluğu olup, kötü prognoz ile ilişkilidir. Mineralokortikoid reseptör
antagonistlerinin KY olan hastalarda AF gelişme riskini azaltabileceği yönünde
bazı bulgular olmasına rağmen, bu konudaki kanıtlar yetersizdir.
Elektrokardiyografide (EKG) atriyal ileti zamanının ölçümü AF gelişme riskini
değerlendirmede sık kullanılan bir yöntemdir. Bu çalışma düşük ejeksiyon
fraksiyonlu (EF) KY hastalarında spironolaktonun EKG’de ölçülen atriyal ileti
üzerine olan etkisini değerlendirmeyi amaçlamaktadır.  Çalışmaya
kompanse, sinüs ritminde, düşük EF’li KY olan 23 hasta alındı ve altı ay
boyunca takip edildi (spironolakton grubu: 12 hasta, kontrol grubu: 11 hasta).
Hastaların temel klinik ve laboratuar özellikleri saptandı. Başlangıç ve altı
aylık takip sonunda EKG ve ekokardiyografik özellikler hem grup içi, hem de
gruplar arasında karşılaştırıldı.  Spironolakton
grubunda altı aylık takip sonunda P maksimum ve P dispersiyon değerlerinde
başlangıca göre anlamlı azalmalar bulundu (sırasıyla p=0.001 ve <0.001). Kontrol
grubunda ise bu ölçümler başlangıçta ve altı aylık takip süresi sonunda benzerdi.
İki yönlü tekrarlı ölçüm sonuçlarına göre spironolakton grubunda altı aylık
takip süresi sonunda P maksimum ve P dispersiyonu değerleri kontrol grubu ile
karşılaştırıldığında anlamlı azalmalar gösterdi (sırasıyla p=0.011 ve 0.002).  Sinüs
ritmindeki kompanse düşük EF’li KY hastalarında spironolakton AF için artmış
riski gösteren atriyal ileti zamanında önemli iyileşmeler sağlar.  

Anahtar Kelimeler

Kalp yetersizliği, spironolakton, atriyal ileti

The Effect of Spironolactone on Atrial Conduction in Patients with Heart Failure with Reduced Ejection Fraction

Öz

Atrial fibrillation (AF) is a common arrhythmia in patients with chronic
heart failure (HF), and it is associated with worse prognosis.
Although there is some evidence that mineralocorticoid receptor antagonists may
reduce the risk of developing AF in such patients, the evidence in this regard
is insufficient. Measurement of atrial conduction time on electrocardiography (ECG)
is a commonly used method to evaluate the risk of developing AF. This study
aims to evaluate the effect of spironolactone on atrial conduction in ECG in
patients with HF with reduced ejection fraction (EF). Twenty-three patients with compensated HF with reduced
EF and sinus rhythm were included and they were monitored for six months
(spironolactone group: 12 patients, control group: 11 patients). The basic clinical and laboratory characteristics of
the patients were detected. At baseline and at the end of
six-month follow-up, ECG and echocardiographic characteristics were compared
within and between the groups. After six-month follow-up in the spironolactone group, P maximum and
P dispersion values ​​decreased significantly compared to baseline (p=0.001 and
<0.001, respectively). In the control group, these measurements were similar at baseline and at
the end of the six-month follow-up period. According to the two-way repeated measurement results,
P max and P dispersion values ​​decreased significantly compared to the control
group at the end of the six-month follow-up period in the spironolactone group (p=0.011
and 0.002, respectively). In patients with compensated HF with reduced EF and sinus rhythm,
spironolactone provides significant improvements in atrial conduction time,
which presents an increased risk for AF.

Anahtar Kelimeler

Heart failure, spironolactone, atrial conduction

Kaynakça

• Referans1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016; 37(27): 2129-200.
• Referans2. Değertekin M, Erol C, Ergene O, Tokgözoğlu L, Aksoy M, Erol MK, et al. Heart failure prevalence and predictors in Turkey: HAPPY study. Turk Kardiyol Dern Ars 2012; 40: 298-308.
• Referans3. Carson PE, Johnson GR, Dunkman WB, Fletcher RD, Farrell L, Cohn JN. The influence of atrial fibrillation on prognosis in mild to moderate heart failure. The V-HeFT studies. The V-HeFT VA Cooperative Studies Group. Circulation 1993; 87: VI102–10.
• Referans4. Middlekauff HR, Stevenson WG, Stevenson LW. Prognostic significance of atrial fibrillation in advanced heart failure. Circulation 1991; 84: 40–8.
• Referans5. Agostoni P, Emdin M, Corrà U, Veglia F, Magrì D, Tedesco CC, et al. Permanent atrial fibrillation affects exercise capacity in chronic heart failure patients. Eur Heart J 2008; 29: 2367–72.
• Referans6. Clark DM, Plumb VJ, Epstein AE, Kay GN. Hemodynamic effects of an irregular sequence of ventricular cycle lengths during atrial fibrillation. J Am Coll Cardiol 1997; 30: 1039–45.
• Referans7. Swedberg K, Zannad F, McMurray JJ, Krum H, van Veldhuisen DJ, Shi H, et al. Eplerenone and Atrial Fibrillation in Mild Systolic Heart Failure. J Am Coll Cardiol 2012; 59: 1598–603. Referans8. Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999; 341(10): 709-17.
• Referans9. Neefs J, van den Berg NW, Limpens J, Berger WR, Boekholdt SM, Sanders P, et al. Aldosterone Pathway Blockade to Prevent Atrial Fibrillation: A Systematic Review and Meta-Analysis. Int J Cardiol. 2017; 231: 155-61.
• Referans10. Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopoulos GK, Kyriakidis M, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J. 1998; 135: 733-8.
• Referans11. Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, et al; American Society of Echocardiography. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 2004; 17: 1086-19.
• Referans12. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: A Global Burden of Disease 2010 Study. Circulation 2014; 129: 837–47.
• Referans13. van Deursen VM, Urso R, Laroche C, Damman K, Dahlström U, Tavazzi L, et al. Co-morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Eur J Heart Fail. 2014; 16(1): 103-11.
• Referans14. Deedwania PC, Lardizabal JA. Atrial fibrillation in heart failure: a comprehensive review. Am J Med 2010; 123: 198–204.
• Referans15. Nerheim P, Birger-Botkin S, Piracha L, Olshansky B. Heart failure and sudden death in patients with tachycardia-induced cardiomyopathy and recurrent tachycardia. Circulation 2004; 110: 247–52.
• Referans16. Neuberger HR, Mewis C, van Veldhuisen DJ, Schotten U, van Gelder IC, Allessie MA, et al. Management of atrial fibrillation in patients with heart failure. Eur Heart J 2007;28: 2568–77.
• Referans17. Reil JC, Hohl M, Selejan S, Lipp P, Drautz F, Kazakow A, et al. Aldosterone promotes atrial fibrillation. Eur Heart J 2012; 33: 2098–108.
• Referans18. Dąbrowski R, Szwed H. Antiarrhythmic potential of aldosterone antagonists in atrial fibrillation. Cardiology Journal 2012; 19(3): 223-9.
• Referans19. Daubert JC, Pavin D, Jauvert G, Mabo P. Intra- and interatrial conduction delay: Implications for cardiac pacing. PACE 2004; 27: 507–25.