Kronik kalp yetmezliği hastalarında ivabradin tedavisinin atriyal ileti sürelerine etkisinin değerlendirilmesi
Küçük Resim Yok
Tarih
2014
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Bolu Abant İzzet Baysal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: İvabradin tedavisiyle kalp hızının azaltılması diyastol süresinin uzaması neticesinde sol ventrikül dolumunu arttırır ve bu durum da kalbin atım hacmini arttırır. İvabradinin atrial ileti sürelerine ve atrial mekanik fonksiyonları üzerindeki etkisi yeterince çalışılmamıştır. Bu çalışmada biz stabil kalp yetersizliği bulunan hastalarda ivabradin tedavisinin atrial ileti süreleri ve atrial mekanik fonksiyonları üzerindeki kısa dönem etkisini (3 ay) incelemeyi amaçladık. Yöntem: Çalışmaya Abant İzzet Baysal Üniversitesi Tıp Fakültesi Hastanesi' nin kardiyoloji polikliniğine başvuran hastalar dahil edildi. Hastalar yaş ve cinsiyete göre sınıflandırıldıktan sonra azalmış sol ventrikül ejeksiyon fraksiyonu (? 35 %), NYHA 2- 3 kalp yetersizliği olan ve en az 5 dakika istirahat neticesinde çekilen 12 derivasyonlu elektrokardiyografide kalp hızı 70/ dk ve üzerinde olan hastalar çalışmaya dahil edildi. 34 erkek ve 9 kadın hasta olmak üzere toplamda 43 hastayı inceledik. Tedavi öncesinde ve 3 aylık tedavi sonrasında hastaların transtorasik M mode, iki boyutlu, noktasal akım, devamlı akım, renkli akım ve doku doppler ölçümleri yapıldı. Tedavi öncesinde ve sonrasında sol atriyum hacimleri hesaplandı. Doku doppler ölçümleriyle intraatrial ve interatrial elektromekanik gecikme süreleri hesaplandı. Sonuçlar: Çalışmaya yaş ortalamaları 64.7 ± 9.9 olan, 33 erkek ve 9 kadın hasta dahil edildi. Bütün hastalar çalışmaya dahil edilme sürecinde NYHA 2- 3 sınıfındaydı. İstirahat sırasında çekilen elektrokardiyografilerinde hastaların hepsi sinüs ritmindeydi ve ortalama kalp hızları dakikada 84.4 ± 12.2 atım olarak hesaplandı. Vmax ve Vp değerlerinin ivabradin tedavisi sonrasında anlamlı olarak azaldığı gözlendi (94.6 ± 37.7, 85.9 ± 28.6, p = 0.04, 75.6 ± 34.3, 67.7 ± 28.6, p = 0.012). Ayrıca sol atriyum boşalma fraksiyonunun da tedavi sonrası azaldığı gözlendi (22.4 ± 10.6, 17.6 ± 9.1, p= 0.03). İnteratriyal elektromekanik gecikme süresinin (PA lateral-PA tricuspit) ivabradin tedavisi sonrasında anlamlı olarak azaldığı tespit edildi (33.7 ± 12.7, 26.2 ± 10.1 , p = 0.001). Tartışma: Çalışmamızın sonuçları göstermektedir ki, üç aylık ivabradin tedavisi sonrasında atrial ileti süreleri anlamlı olarak kısalmaktadır ve atrial elektromekanik fonksiyonlar anlamlı olarak düzelmektedir.
Aim: HR reduction with ivabradine improves left ventricle filling by the prolongation of the diastolic time and increases stroke volume. However, it remains unclear what ivabradine's effect is on atrial conduction time and mechanical atrial function. The aim of our study was to evaluate in stable outpatients with systolic HF the short-term (3 months) effect of ivabradine on atrail conduction time and mechanical function. Method: This study population consists of outpatients who came to the Cardiology Clinic of Abant Izzet Baysal University Hospital. Patients were recruited if they were men or women with more than 18 years of age with a established diagnosis of stable heart failure (HF) with reduced left ventricular ejection fraction (?35%) in New York Heart Association functional classes II to III and at least 5 minutes after resting 12-lead electrocardiogram (ECG) as measured by the baseline heart rate per minute to 70 beats/min or higher. We evaluated prospectively 43 (34 males, 9 females) patients with HF. Before and after treatment all patients were evaluated by transthoracic M mode, two dimensional (2D), pulsed-wave (PW), continuous wave (CW), color flow and tissue Doppler imaging (TDI). Before and after treatment LA volumes were measured using the biplane area length method and LA active and passive emptying volumes and fraction were calculated. Intra- and interatrial electromechanical delay (EMD) were measured by tissue Doppler imaging (TDI). Results: 33 men and 9 women with mean ± SD age of 64.7 ± 9.9 years were included in this study. All patients were in the NYHA class II and III and resting heart rates were 84.4 ± 12.2 bpm on average with sinus rhythm. Vmax and Vp were significantly reduced after ivabradine treatment (94.6 ± 37.7, 85.9 ± 28.6, p = 0.04, 75.6 ± 34.3, 67.7 ± 28.6, p = 0.012). Also, left atrial active emptying fraction significantly reduced after treatment (22.4 ± 10.6, 17.6 ± 9.1, p= 0.03). Interatrial electromechanical delay interval (PA lateral-PA tricuspit) was significantly reduced after ivabradine treatment (33.7 ± 12.7, 26.2 ± 10.1 , p = 0.001). Conclusion: Our study demonstrated that, atrial conduction time was significantly abbreviated and mechanical atrial functions were considerably improved after 3 months ivabradine treatment.
Aim: HR reduction with ivabradine improves left ventricle filling by the prolongation of the diastolic time and increases stroke volume. However, it remains unclear what ivabradine's effect is on atrial conduction time and mechanical atrial function. The aim of our study was to evaluate in stable outpatients with systolic HF the short-term (3 months) effect of ivabradine on atrail conduction time and mechanical function. Method: This study population consists of outpatients who came to the Cardiology Clinic of Abant Izzet Baysal University Hospital. Patients were recruited if they were men or women with more than 18 years of age with a established diagnosis of stable heart failure (HF) with reduced left ventricular ejection fraction (?35%) in New York Heart Association functional classes II to III and at least 5 minutes after resting 12-lead electrocardiogram (ECG) as measured by the baseline heart rate per minute to 70 beats/min or higher. We evaluated prospectively 43 (34 males, 9 females) patients with HF. Before and after treatment all patients were evaluated by transthoracic M mode, two dimensional (2D), pulsed-wave (PW), continuous wave (CW), color flow and tissue Doppler imaging (TDI). Before and after treatment LA volumes were measured using the biplane area length method and LA active and passive emptying volumes and fraction were calculated. Intra- and interatrial electromechanical delay (EMD) were measured by tissue Doppler imaging (TDI). Results: 33 men and 9 women with mean ± SD age of 64.7 ± 9.9 years were included in this study. All patients were in the NYHA class II and III and resting heart rates were 84.4 ± 12.2 bpm on average with sinus rhythm. Vmax and Vp were significantly reduced after ivabradine treatment (94.6 ± 37.7, 85.9 ± 28.6, p = 0.04, 75.6 ± 34.3, 67.7 ± 28.6, p = 0.012). Also, left atrial active emptying fraction significantly reduced after treatment (22.4 ± 10.6, 17.6 ± 9.1, p= 0.03). Interatrial electromechanical delay interval (PA lateral-PA tricuspit) was significantly reduced after ivabradine treatment (33.7 ± 12.7, 26.2 ± 10.1 , p = 0.001). Conclusion: Our study demonstrated that, atrial conduction time was significantly abbreviated and mechanical atrial functions were considerably improved after 3 months ivabradine treatment.
Açıklama
Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Kardiyoloji Ana Bilim Dalı, Kardiyoloji Bilim Dalı
Anahtar Kelimeler
Kardiyoloji, Cardiology
