Mitral Darlığı Olan Hastalarda Atriyal Elektiriksel ve Elektromekanik Özellikler

Atrial Electrical and Electromechanical Characteristics in Patients with Rheumatic Mitral Stenosis

Mustafa BULUT, Ahmet GÜLER, Selçuk PALA, Emrah ACAR, Cihan DÜNDAR, Tansu KARAAHMET, Uğur ASLANTAŞ, İsmail BALABAN, Süleyman EFE, Yeliz GÜLER, Kürşat TİGEN, Süleyman BARUTCU

Abstract

Introduction: AF in patients with mitral stenosis (MS) causes significant morbidity and mortality. PMBV,which is a treatment of choice for patients with MS, is a highly successful procedure that provides significantimprovement in symptoms and echocardiographic parameters. In this study we aimed to demonstrate theprobable effects of PMBV on novel echocardiographic and electrocardiographic parameters that can predictthe development of AF in 1-year period in patients with MS.Patients and Methods: Twenty-eight patients with moderate or severe rheumatic MS (mean age 37.6 ± 7.4years; 14 (50%) males) were enrolled this study. All patients who were eligible for this procedure underwentcomprehensive echocardiographic examinations with evaluation of ACT measured using tissue Dopplerimaging (TDI) before PMBW and repeated at the end of the 1 year after successful PMBV. In addition, 12-lead ECGs were recorded for each patient 1 day before PMBV for the evaluation of baseline maximum andminimum P-wave duration and P-wave dispersion (PWD); this was repeated at the end of the 1 year aftersuccessful PMBV.Results: ACT (148.1 ± 20.5 vs 121.3 ± 20.5 p< 0.001), P-max (151.7 ± 15.8 vs 137.3 ± 15.6 p< 0.001) andPWD (84.7 ± 18.8 vs 71.1 ± 18.5 p< 0.001) were found to be significantly decreased after PMBV. A strongpositive correlation was detected between ACT, P-max, PWD, LAVi ve PAPs before and after PMBV. Inaddition, there was a strong correlation between ? values that were measured by subtracting the baselinemeasurements from the post-PMBV measurements. Accordingly, ?ACT was correlated with ?P-maxve ?PWD (r= 0.5 p= 0.007 and r= 0.55 p= 0.002, respectively). ?ACT, ?P-max and ?PWD correlatedsignificantly with only ?LAVi and ?PAP in echocardiographic parameters.Conclusion: This study demonstrated that atrial conduction properties that have also been evaluated withECG and TDI studies significantly correlate with other echocardiographic parameters in patients with MS.In addition, significant improvement occurred in these parameters at the end of the 1 year after PMBV.Further prospective investigations may provide useful data for the detection of the relation between atrialelectromechanical characteristics and development of AF in patients with MS.

Özet

Giriş: Mitral darlığı olan hastalarda atriyal fibrilasyon (AF) önemli bir mortalite ve morbidite nedenidir ve bu hastalarda perkütan mitral balon valvüloplasti (PMBV) semptomlarda ve ekokardiyografik parametrelerde önemli düzelme sağlayan başarılı bir girişimdir. Bu çalışmada mitral darlıklı hastalarda PMBV'nin AF gelişimini predikte edebilen yeni ekokardiyografik ve elektrokardiyografik parametreler üzerindeki bir yıllık dönemdeki etkisinin gösterilmesi amaçlanmıştır.Sonuç: Bu çalışma mitral darlıklı hastalarda EKG ve TDI yöntemleriyle değerlendirilen atriyal ileti özelliklerinin diğer ekokardiyografik parametrelerle önemli derecede korele olduğunu göstermiştir. Ayrıca işlem sonrası birinci yılda bu parametrelerde önemli düzeyde düzelme meydana gelmiştir. Yapılacak prospektif özellikte daha fazla çalışma atriyal elektromekanistik özellikler ve AF gelişimi arasındaki ilişki açısından daha fazla bilgi sağlayabilir.