Böbrek nakli adaylarında transtorasik ekokardiyografi ile sol atriyal apendiks fonksiyonlarının değerlendirilmesi ve sol atriyal strain değerleri ile karşılaştırılması

Öz

Amaç: Kronik böbrek hastalığı (KBH) olan hastalarda inme insidansı, atriyal aritmilerden bağımsız olarak yüüksektir. Bu çalışmanın amacı, sinüs ritmindeki son dönem böbrek hastalığı (SDBY) olan böbrek nakli adaylarında transtorasik ekokardiyografi (TTE) ile sol atriyal apendiks (SAA) fonksiyonlarını değerlendirmek ve sol atriyal (SA) gerilme değerleri ile karşılaştırmaktır. . Gereç ve Yöntemler: Çalışmaya 52 böbrek nakli adayı hasta ve yaş ve cinsiyet uyumlu, KBH olmayan 60 katılımcı dahil edildi. Parasternal kısa eksenden pulse wave Doppler ile SAA boşalma hızı (BH), doku Doppler görüntüleme kullanılarak erken diyastolik (SAA Em), kasılma (SAA Am) ve sistolik (SAA Sm) hızları ölçüldü. Atriyal pik longitudinal strain (PLS), pik kontraksiyon strain (PKS) ve konduit strain (KdS), iki boyutlu benek takibi ekokardiyografi kullanılarak hesaplandı. Bulgular: SAA BH, Am ve Sm ve SA PLS, PKS, KdS ölçümleri hasta grubunda kontrollere göre anlamlı olarak daha düşük bulundu. SAA BH ölçümleri, sol atriyal volüm indeksi (SAVİ), SA PLS ve SA PKS değerleri ile güçlü bir pozitif korelasyon ve sol ventrikül (SV) çapları ve E/e' değeri ile de anlamlı negatif korelasyon gösterdi. Çok değişkenli regresyon analizinde SA PLS ve SAVİ’nin SAA BH için bağımsız faktörler olduğu bulundu. Sonuçlar: Bulgularımız, TTE ile SAA fonksiyonlarının değerlendirilmesinin böbrek nakil adaylarında artmış atriyal aritmiler ve iskemik inme gelişme riskinin belirlenmesine yardımcı olabileceğini düşündürmektedir. Mevcut bulguların daha büyük çalışmalarla desteklenmesi bu hastalarda takip ve tedavi yaklaşımlarını değiştirebilir.

Anahtar Kelimeler

• Sol atriyal strain
• sol atriyal apendiks fonksiyonu
• son dönem böbrek yetersizliği
• böbrek nakli.

Evaluation of left atrial appendage functions by transthoracic echocardiography and comparison with left atrial strain values in renal transplant candidates

Öz

Aim: The incidence of stroke in patients with chronic kidney disease (CKD) is increased independent of atrial arrhythmias. The goal of this study is to evaluate, left atrial appendage (LAA) functions by transthoracic echocardiography (TTE) and comparison with left atrial (LA) strain values in patients with in renal transplant candidates with end stage renal disease (ESRD) with sinus rhythm. Material and Methods: Fifty two renal transplant candidates and 60 age- and sex-matched healthy participants were included in the study. LAA emptying velocity (EV) was measured with pulse wave Doppler, early diastolic (LAA Em), contraction (LAA Am) and systolic (LAA Sm) velocities were measured using tissue Doppler imaging from parasternal short axis view. Atrial peak longitudinal strain (PLS), peak contraction strain (PCS) and conduit strain (CdS) were calculated using two dimensional speckle tracking echocardiography. Results: LAA EV, Am and Sm and LA PLS, PCS, CdS measurements were found to be significantly lower in the patient group compared to controls. LAA EV measurements showed a strong positive correlation with left atrial volume index (LAVI), LA PLS and LA PCS values, and a negative correlation with left ventricular (LV) diameters, and E/e' value. In the multivariate regression analysis LA PLS and LAVI were found to be independent factors for LAA EV. Conclusion: Our findings suggest that the evaluation of LAA functions with TTE may help determine the increased risk of developing atrial arrhythmias and ischemic stroke in renal transplant candidates. Supporting the current findings with larger studies may change the follow-up and treatment approaches in these patients.

Anahtar Kelimeler

• Left atrial strain
• left atrial appendage functions
• end stage renal disease
• kidney transplantation.

Kaynakça

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