Mitral Yetersizliği Derecesi İle Doku Doppler Parametreleri ve Sol Ventrikül Diyastol Sonu Basıncı Arasındaki İlişki

Abstract

ÖZET AMAÇ: Daha önceki çalışmalar, sol atriyal basıncın değerlendirilmesinde mitral anulus velositesi gibi ön yükten bağımsız parametrelerin transmural E dalga velositesi ile beraber kullanılabilirliğini göstermiştir. Biz, çalışmamızda mitral yetersizliği (MY) olan hastalarda transmitral E dalga velositesi ile mitral anulus doku Doppler indekslerinin sol ventrikül diyastol sonu basıncının (LVEDP) belirlenmesindeki önemini araştırdık GEREÇ VE YÖNTEMLER: Çalışmaya çeşitli derecelerde mitral yetersizliği olan 67 hasta ve MY olmayan 29 hasta alındı. Hastalar 3 gruba ayrıldı. İskemik (sekonder) mitral yetersizliği olan 5 1 hasta (yaş ortalaması 63±9 yıl) grup I, non-iskemik (primer) mitral yetersizliği olan 16 hasta (yaş ortalaması 58±12 yıl) grup II, mitral yetersizliği olmayan 29 hasta (yaş ortalaması 53±10 yıl ) ise grup III olarak tanımlandı. Tüm hastaların transmitral akım velositeleri (Pik E-dalga velositesi, A-dalga velositesi, deselerasyon zamanı ve E/A oranı), mitral anulus doku velositeleri (Ea, Aa ve Sa) ve MY dereceleri belirlendi. MY derecelendirmesi için hem semi-kantitatif hem de kantitatif (EROA, RV ve RF) MY parametreleri hesaplandı. Daha sonra erken diyastolik dalganın transmitral ve anüler velositelerinin oranı hesaplandı (E/Ea) ve kateter sırasında ölçülen LVEDP ile karşılaştırıldı. BULGULAR: Primer MY grubunda MY derecesinin tüm evrelerinde E/Ea ile LVEDP arasında belirgin korelasyon tespit edildi, (hafif MY E/Em r =0,8; p=0,09, E/EL r =0,29; p=0,6, orta MY E/Em r =0,8; p=0,l, E/EL r =0,9; p=0,7; ileri MY E/Em r =0,6; p=0,l, E/EL r=0,78; p=0,039). E/Em değerinin 14'ün üzerinde olmasının LVEDP'nin>15mmHg olacağını ön görmesindeki duyarlılığı %90, özgüllüğü %80, pozitif öngörü değeri %90 idi. Diğer taraftan E/EL değerinin 10,5'un üzerinde olmasının LVEDP'nin>15mmHg olacağım ön görmesindeki duyarlılığı %81 özgüllüğü %60, pozitif öngörü değeri %81 idi. Sekonder MY olan hastalarda ise E/Ea oranı ile LVEDP arasında anlamlı korelasyon bulunamadı. Pik E dalga velositesi > İm/sn olmasının orta-ileri MY belirlemesinde olan duyarlılığı, özgüllüğü ve pozitif öngörü değeri EF'si normal olan hastalarda sırasıyla %72, %72.5 ve %75 bulundu. EF'si düşük olan hastalarda ise bu değerler sırasıyla %80,%70 ve %84 olarak hesaplandı. SONUÇ: Sadece primer MY'si olan hastalarda anulusun her iki tarafından ölçülen E/Ea oranı, LVEDP'nin belirlemesinde güvenilir bir yöntemdir. Ayrıca, özellikle EF'si düşük VIIolan hastalarda.E dalga velositesi, MY'nin ciddiyetini belirlemede tarama testi olarak kullanılabilir. ABSTRACT AİM; Previous studies showed that the measurement of E/Ea ratio [transmural E wave velocities, the velocity of motion of the mitral annulus (Ea) ] is useful in estimating of left atrial pressure with preload - independent manner. In this study we evaluated whether Doppler tissue imaging (DTI) diastolic indices obtained at both level of left ventricular lateral and septal annulus and trarnsmitral E wave flow velocity can provide the accurate estimation of left ventricular end diastolic pressure (LVEDP) in different grades of mitral regurgitation (MR). METHODS: Mitral annulus velocities derived from tissue Doppler echocardiography and LVEDP which measured during cardiac catheterization were obtained in 16 patients (age 58±12 years) with non-ischemic (primary) MR, 51 patients (age 63±9 years) with MR secondary to ischemic, and 29 patients (age 53±10 years) without MR as control group were included in the study. MR was evaluated both semi-quantitatively and quantitatively using EROA, RV, and RF. Peak E-wave velocity, A-wave velocity, and E-wave deceleration time were measured and the E/A ratio was calculated. Then E/Ea ratio was used to compare its results with LVEDP which measured invasively during cardiac catheterization. Different MR groups classified by RF were also compared with each other. RESULTS: E/Ea obtained on both sides of mitral annulus correlated with LVEDP in all grades of primary MR patients and it was statistically significant in severe MR (mild MR E/Em r = 0,8; p = 0,09, E/EL r = 0,29; p = 0,6, moderate MR E/Era r = 0,8; p = 0,1, E/EL r = 0,9; p = 0,7; severe MR E/Em r = 0,6; p = 0,1, E/EL r = 0,78; p = 0,039). An E/Em ratio >14 predicted LVEDP >15 mm Hg (sensitivity 90%, specificity 80%, positive predictive value 90% ) while E/El ratio >10.5 predicted LVEDP>15 mm Hg (sensitivity 81%, specificity 60%, positive predictive value 81%). No correlation was found between E/Ea and LVEDP neither on lateral side nor on septal side of mitral annulus in patients with secondary MR. Sensitivity, specificity, and positive predictive value of peak E-wave velocity >1.0 m/s suggesting moderate to severe MR were found VIIIolan hastalarda.E dalga velositesi, MY'nin ciddiyetini belirlemede tarama testi olarak kullanılabilir. ABSTRACT AİM; Previous studies showed that the measurement of E/Ea ratio [transmural E wave velocities, the velocity of motion of the mitral annulus (Ea) ] is useful in estimating of left atrial pressure with preload - independent manner. In this study we evaluated whether Doppler tissue imaging (DTI) diastolic indices obtained at both level of left ventricular lateral and septal annulus and trarnsmitral E wave flow velocity can provide the accurate estimation of left ventricular end diastolic pressure (LVEDP) in different grades of mitral regurgitation (MR). METHODS: Mitral annulus velocities derived from tissue Doppler echocardiography and LVEDP which measured during cardiac catheterization were obtained in 16 patients (age 58±12 years) with non-ischemic (primary) MR, 51 patients (age 63±9 years) with MR secondary to ischemic, and 29 patients (age 53±10 years) without MR as control group were included in the study. MR was evaluated both semi-quantitatively and quantitatively using EROA, RV, and RF. Peak E-wave velocity, A-wave velocity, and E-wave deceleration time were measured and the E/A ratio was calculated. Then E/Ea ratio was used to compare its results with LVEDP which measured invasively during cardiac catheterization. Different MR groups classified by RF were also compared with each other. RESULTS: E/Ea obtained on both sides of mitral annulus correlated with LVEDP in all grades of primary MR patients and it was statistically significant in severe MR (mild MR E/Em r = 0,8; p = 0,09, E/EL r = 0,29; p = 0,6, moderate MR E/Era r = 0,8; p = 0,1, E/EL r = 0,9; p = 0,7; severe MR E/Em r = 0,6; p = 0,1, E/EL r = 0,78; p = 0,039). An E/Em ratio >14 predicted LVEDP >15 mm Hg (sensitivity 90%, specificity 80%, positive predictive value 90% ) while E/El ratio >10.5 predicted LVEDP>15 mm Hg (sensitivity 81%, specificity 60%, positive predictive value 81%). No correlation was found between E/Ea and LVEDP neither on lateral side nor on septal side of mitral annulus in patients with secondary MR. Sensitivity, specificity, and positive predictive value of peak E-wave velocity >1.0 m/s suggesting moderate to severe MR were found VIIIto be different in patients with normal and low EF (72% vs 80%, 72.5% vs 70%, 75% vs 84%, respectively). CONCLUSION: The combination of DTI diastolic indices of the mitral annulus and mitral inflow velocities provide reliable parameters to predict LV filling pressure only in patients with primary MR. Also peak E-wave velocity is a screening method that could be frequently used in determining the severity of MR semi-quantitatively, especially in patients with low EF. IX