Pulmoner hipertansiyona özgül tedavi altındaki olgularda strain ekokardiyografinin klinik ve prognostik önemi
Clinical and prognostic importance of strain echocardiograpy in patients under specific treatment for pulmonary hypertension
Yazar: HATICE SONER KEMAL
Danışman: YRD. DOÇ. DR. LEVENT HÜRKAN CAN
Ege Üniversitesi / Tıp Fakültesi / Kardiyoloji Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2015
Konu: Kardiyoloji = Cardiology
Dizin: Ekokardiyografi = Echocardiography ; Hipertansiyon-pulmoner = Hypertension-pulmonary ; Kalp hastalıkları = Heart diseases ; Kalp yetmezliği = Heart failure ; Prognoz = Prognosis ; Ventriküler fonksiyon-sağ = Ventricular function-right

Özet:
GiriĢ: Pulmoner rteriyel hipert nsiyon (PAH); pulmoner v sk ler yeniden ekillenme s
k lp yetmezli i ve s n rl s k l m ile seyreden ir h st l kt r. S ventrik l (S V)
disfonksiyonu pulmoner hipert nsiyon (PH) ol n h st l rd klinik seyir ve s k l m n nemli
 ir elirleyi isi olm s n r men S V fonksiyonunun optim l de erlendirilmesi için kesin
 ilgiler t n ml nm m t r. Bu ç l m n n m S V ser est duv r speckle izlem strain
ekok rdiyogr finin PAH zg l ted visi lm kt ol n olgul rd konv nsiyonel
ekok rdiyogr fipr metrelerine k y sl S V i levini de erlendirmedeki yrrn orty
koym ktr.
Yöntem: Prospektif olarak SaV serbest duvar longitudinal sistolik str in (LS) lç m PAH
merkezimizde t kip edilen 92 h st d (62 k d n ort l m y : 41.4 16 y l 49 do u t n k lp
h st l ile ili kili PAH 21 idiyop tik PAH 11 dokusu h st l ili kili PAH ve 11
kronik tromboembolik pulmoner hipertansiyon) gerçekle tirildi. S V ser est duv r
longitudin l spe kle ekok rdiyogr fi str in de eri ser est duv r n her ç lgesel zirve
sistolik de erlerinin ort l m s l n r k hes pl nd . Ort l m izlem s resi 222 133 g nd .
Konvansiyonel ekokardiyografik p r metrelerden S V fr ksiyonel l n de i imi (FAD)
Trik spit n ler pl n sistolik esneme mes fesi (TAPSE) ve Trik spit nuler pik sistolik h z
ve hemodin mik p r metrelerden fonksiyonel s n f 6-DYM ve NT-proBNP d zeyi
de erlendirildi. Veriler uygun ist tistiksel n lizler kull n l r k de erlendirildi.
65Bulgular: Tmh stlrn ortl mSV ser est duv rLS de eri % -13 16 6.3 idi. S V
ser est duv r LS ile fonksiyonel s n f (Rho= 0.312 p=0.01) ve NT-proBNP d zeyi (Rho=
0.423 p=0.0001) r s nd pozitif nl ml ili ki v rken FAD (Rho = -0,637 p = 0.0001),
TAPSE (Rho = -0 524 p = 0.0001) ve Trik spit nuler pik sistolik h z (Rho = -0,450, p =
0.0001) ve 6-DYM (Rho =-0.333 p=0.002) ile neg tif nl ml ili ki v rd . Ayr S V
ser est duv r LS de eri loop di retik kull n m ile ili kili ulunmu du (p=0.0001). T kipte
geli en istenmeyen ol yl r l m ve klinik s k lp yetersizli i ile SAV ser est duv r LS
rsnd nl ml ili ki s pt nd (p=0.04 p=0.03 p=0.02 s r s yl ).
Sonuç: SaV serbest duvar LS PAH zg l ted visi lt ndkihst lrd sklp yetersizlii
klinik ozulm ve sklmnn de erlendirilmesi için g çl ve uygun ir y ntemdir

Abstract:
Background: Pulmonary arterial hypertension (PAH) is a devastating illness with progressive
pulmonary vascular remodeling, right-sided heart failure, and limited survival. Although right
ventricular (RV) dysfunction is a major determinant of outcome in patients with pulmonary
hypertension (PH), the optimal assesment of RV function is poorly defined. The objectives of
this study was first; to test the utility of RV free wall speckle-tracking strain as an assessment
tool for RV function in patients with PAH under specific medical treatment and to compare
with conventional echocardiographic parameters. Secondly; to investigate the relationship of
the findings obtained with RV speckle-tracking strain with the hemodynamic parameters of
RV performance.
Methods: Prospective RV free wall longitudinal systolic strain (LS) measurement was
performed on 92 PAH (62 women, mean age: 41.4 years, 49 with PAH associated with
congenital heart disease, 21 idiopathic PAH, 11 PAH associated with connective tissue
disease and 11 chronic thromboembolic pulmonary hypertension) patients who were
followed-up at our PAH center. RV free wall longitudinal speckle-tracking strain was
calculated by averaging each of three regional peak systolic strains along the entire right
ventricle free wall. The mean interval of follow-up was 222 133 days. The conventional
echocardiographic parameters-RV fractional area change (FAC), tricuspid annular plane 

systolic excursion (TAPSE) and tricuspid annular peak systolic velocity, hemodynamic
parameters (functional class, six minute walk test, and NT-proBNP levels) were also studied.
Data were comparatively evaluated using appropriate statistical analyses.
Results: Mean RV free LS was (%-13.16 6.3) in whole group. There w s signifi nt
positive correlation between RV free wall LS and functional class (Rho = 0.312, p=0.01) and
NT-proBNP (Rho = 0.423, p=0.0001) levels, whereas there was a significant negative
correlation with FAC (Rho =-0.637, p=0.0001), TAPSE (Rho =-0.524, p=0.0001), Tricuspid
annular peak systolic velocity (Rho =-0.450, p=0.0001), 6 minute walking test (Rho =-0.333,
p=0.002). RV free wall LS was also associated with loop diuretic use (p = 0.0001). There was
a significant relationship between RV free wall LS when correlated with all follow-up adverse
events, death and clinical right heart failure (p=0.04, p=0.03, p=0.02, respectively).
Conclusions: Noninvasive assessment of RV free wall LS is a feasible and powerful
predictor of right-sided heart failure, clinical deterioration, and mortality in patients under
PAH specific treatmen