Pulmoner emboli geçirmiş olan hastalarda ekokardiyografi ile sağ ventrikül fonksiyonlarının değerlendirilmesi
Evaluation of right ventricle functions with echocardiography in patients with pulmonary embolism
Yazar: RAUF AVCI
Danışman: DOÇ. DR. NERMİN BAYAR
Sağlık Bilimleri Üniversitesi / Antalya Eğitim ve Araştırma Hastanesi​ / Kardiyoloji Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2020
Konu: Kardiyoloji = Cardiology
Dizin: Ekokardiyografi = Echocardiography ; Emboli = Embolism ; Emboli ve tromboz = Embolism and thrombosis ; Pulmoner emboli = Pulmonary embolism ; Trombolitik terapi = Thrombolytic therapy ; Ventriküler fonksiyon = Ventricular function

Özet:
Giriş: Pulmoner emboli(PE), ciddi mortalite ve morbiditeye neden olabilen kardiyovasküler hastalıktır. Yüksek riskli PE de trombolitik tedavi öncelikli tercih olarak önerilirken orta-yüksek riskli PE de trombolitik tedavi verilmesi konusunda hala tartışmalar vardır.
Amaç : Bu çalışmada submasif (orta yüksek riskli) PE tanısı olan hastalarda trombolitik tedavinin uzun dönem sağ ventrikül fonksiyonlarına etkisinin değerlendirilmesi amaçlandı.
Gereç ve yöntem: Bu çalışmaya ocak-2017 ile haziran 2019 tarihleri arasında orta-yüksek riskli PE tanısı konulan 36 hasta alındı. PE tanısı bilgisayarlı tomografik anjiografi ya da ventilasyon-perfüzyon sintigrafisi ile doğrulandı. Hastalar kardiyoloji polikliniğine davet edildiler. Rutin incelemelerin yanı sıra ekokardiyografik olarak sağ ventrikül fonksiyonları strain ekokardiografi ile değerlendirildi. Çalışmanın birincil sonlanım noktası, trombolitik tedavi uygulanan grup ile uygulanmayan grup arasında sağ ventrikül GLS değerlerinin karşılaştırılması olarak belirlendi. İkincil sonlanım noktası ortalama 6 dakikalık yürüme mesafesi olarak belirlendi.

Abstract:
Introduction: Pulmonary embolism (PE) is a cardiovascular disease that can cause serious mortality and morbidity. While thrombolytic therapy is recommended as the primary choice in high-risk PE, there is still controversy about giving thrombolytic therapy in moderate to high risk PE.
Objective: In this study, it was aimed to evaluate the effect of thrombolytic therapy on long-term right ventricular functions in patients with a diagnosis of submassive (moderate to high risk) PE.Materials and methods: 36 patients diagnosed with moderate to high risk PE between January-2017 and June 2019 were included in this study. The diagnosis of PE was confirmed by computed tomographic angiography or ventilation-perfusion scintigraphy. The patients were invited to the cardiology outpatient clinic. In addition to routine examinations, echocardiographic right ventricular functions were evaluated with strain echocardiography. The primary endpoint of the study was the comparison of right ventricular GLS values between the group treated with thrombolytic therapy and the group not treated. The secondary endpoint was determined as the mean 6-minute walking distance. Results: Thrombolytic treatment was applied to 58.3% (n: 21) of 36 patients diagnosed with moderate to high risk PE, while thrombolytic treatment was not applied to 41.7% (n: 15). Average values of right ventricular GLS were -29.76% in the group receiving thrombolytic therapy and -22.8% in the group not receiving thrombolytic therapy (p = 0.012). The average six-minute walking distance was 434 meters (m) in the group receiving thrombolytic therapy and 357 m in the group not receiving thrombolytic therapy. Although the 6-minute walking distance was observed to be higher in the group receiving thrombolytic therapy, this difference was not statistically significant (p = 0.179). ventilation-perfusion scintigraphs was performed after at least 3 moths of optimal medical treatment. It was observed that pulmonary embolism dissolved in 68.4% of the patients who were given thrombolytic therapy and in 40% of those who did not. The rate of patients with CTEPH (CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION) was 10.5% and the rate of CTEP (CHRONIC THROMBOEMBOLIC PULMONER) disease was 21.1% in patients who received thrombolytic therapy. The rate of patients with CTEPH was 26.7% and the rate of CTEP disease was 33.3% in patients not receiving thrombolytic.Although the rate of dissolved PE was higher in patients who received thrombolytic therapy, there was nostatistically significant difference in terms of the distribution of treatment results according to the groups (p = 0.264). Conclusion: In patients with moderate to high risk pulmonary embolism, taking into account the risk of bleeding, the administration of thrombolytic therapy may contribute to the preservation of right ventricular systolic functions in the long term.