Assessment of diastolic function in children and adolescents with beta thalassemia major by tissue Doppler imaging

Abstract

Aim: First degree relatives of patients who have had an acute myocardial infarction prior to age of 55 years have 2 7 times the risk that their peers have The aim of this study was to investigate some haemostatic and inflammatory markers in children whose parents had early onset lt;55 years coronary artery disease CAD and whether those markers were effective to show CAD risk

Keywords

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Beta talasemi majorlu çocuk ve ergenlerde doku Doppler yöntemiyle diyastolik işlevlerin değerlendirilmesi

Öz

Amaç: Bu çal›flmada belirgin kardiyomiyopati tablosu geliflmemifl beta talasemi majorlu çocuk ve ergenlerde doku Doppler yöntemi ile miyokard›n diyastolik ifllevlerini incelemek ve bu verileri geleneksel Doppler verileri ile karfl›laflt›rmak amaçland›.

Gereç ve Yöntem: Sol ventrikül sistolik ifllevleri normal olan 61 beta talasemi major olgusu (4-20 yafl, ortalama: 10,7±4,1 y›l; 32 k›z, 29 erkek) ile yafl ve cinsiyet aç›s›ndan hasta grubu ile uyumlu 52 kontrol olgusu çal›flmaya al›nd›. Hasta ve kontrol grubunda M-mode ekokardiyografi, sol ventrikülün sistolik ifllevi ölçüldü; sa¤ ve sol ventrikülün diyastolik ifllevleri doku Doppler ve geleneksel Doppler tekni¤i ile de¤erlendirildi. ‹statistik analizler SPSS for Windows 13.0 program› kullan›larak yap›ld›, veriler student-t testi ile karfl›laflt›r›ld›. Bu çal›flma ‹stanbul T›p Fakültesi Etik Komitesi’nce onayland›.

Bulgular: Hasta grubunda vücut yüzey alan› (1,0±0,2 m2) kontrol grubundan (1,2±0,3 m2) daha küçük idi p<0,01). Hastalar›n trans-mitral erken ak›m zirve h›z› ve erken ak›m zirve h›z›n›n geç ak›m zirve h›z›na oran› kontrollerden anlaml› olarak yüksek saptand› (s›ras›yla p<0,01 ve p=0,039). Mitral kapak geç ak›m zirve h›z› ve tüm triküspit kapak Doppler ak›m h›zlar› gruplar aras›nda farkl›l›k göstermedi (p>0,05). Beta talasemi major hastalar›n›n miyokard erken diyastolik ak›m h›zlar› sa¤ ventrikül ve sol ventrikül bazalinde, sa¤ ventrikül, sol ventrikül ve interventrikül septumun orta segmentinde kontrolden yüksek bulundu (p<0,05). Geç diyastolik ak›m h›zlar› sa¤ ventrikül bazal ve orta segmentlerde, Erken ve geç diyastolik ak›m oran› ise sa¤ ventrikül bazal ve sa¤ ventrikül, sol ventrikül ve interventrikül orta segmentlerde kontrolden anlaml› yüksek bulundu (p<0,05).

Çıkarımlar: Normal ventrikül sistolik ifllevleri olan genç yafltaki beta talasemi major hastalar›ndan edinilen bu bulgular, gerçek ventrikül restriksiyonundan ziyade kronik anemiye ba¤l› hiperdinamik yan›t ve yüklenmeyi düflündürmektedir. Doku Doppler ile beta talasemi major hastalar›n›n uzun süreli izlemlerini içeren çal›flmalar›n yap›lmas› ile, doku Doppler görüntülemenin bu hasta grubunda kalbin erken etkilenmesini yans›tmadaki güvenilirli¤inin de¤erlendirilebilece¤i kan›s›nday›z. (Türk Ped Arfl 2011; 46: 26-32) 

Anahtar Kelimeler

• Beta-talasemi
• diyastolik kalp yetersizliği
• doku Doppler görüntüleme
• ekokardiyografi
• kardiyomiyopati
• konjestif kalp yetersizliği

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