Mitral darlığının ciddiyetinin değerlendirilmesinde akciğer ultrasonografisinin önemi
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Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmamızda amacımız kardiyoloji kliniğinde takipli olan hafif ve orta-ciddi mitral
darlığı (MD) bulunan hastaların rutin kontrolleri sırasında non-invaziv şekilde
ekokardiyografik (EKO) olarak ölçülebilen rutin ekokardiyografik parametreler ile birlikte
bazal akciğer ultrasonu ve efor testi sonrası bakılan akciğer ultrasonundaki (LUS) B çizgilerinin
sayı ve dağılımındaki değişikliğin standart EKO parametreleri dışında MD ciddiyetini
değerlendirmede öngördürücü değerinin araştırılması olacaktır.
Yöntem: Çalışmaya kliniğimizde takipli 70 MD hastası alındı. MD hastaları hafif ve orta-ciddi
MD olmak üzere 2 gruba ayrıldı. Kardiyoloji polikliniğinde muayene olup kalp yetersizliği
(KY) ve ek kapak patolojisi olmayan 35 kontrol grubu hasta olmak üzere toplam 105 vaka
alındı. Ekokardiyografik değerlendirme konvansiyonel ekokardiyografi yöntemleri ile yapıldı.
Efor testi öncesinde hastaların bazal LUS yapıldı, B çizgilerinin sayı ve dağılımı kaydedildi.
Efor öncesi kalp hızı ve oksijen saturasyonu kaydedildi. Hastalara bazal kalp hızının %85 ine
ulaşacak şekilde efor testi yapıldı. Efor sonrası kalp hızı ve oksijen satürasyonunun ardından
EKO ile mitral kapak gradyentleri ve pulmoner arter basıncı tekrar değerlendirildi. Efor sonrası
LUS tekrarlanarak B çizgilerinin dağılımı ve sayısı tekrar kaydedildi. Her üç grup arasında efor
öncesi ve sonrası B çizgilerinin sayı ve dağılımındaki değişiklikle MD ciddiyeti arasındaki ilişki
değerlendirildi.
Bulgular:
Yaş, cinsiyet, diyabet, hipertansiyon, koroner arter hastalığı (KAH) ve vücut kitle indeksini
(BMI) içeren temel demografik özellikler MD ve kontrol grubunda benzerdi. Efor sonrası B
çizgilerinin sayısı sağ ve sol hemitoraksta kontrol grubuna göre daha fazla artış gösterdi. [(8
(11,5), 0,5 (3)), p<0,0001; (4(13), 0(2)), p<0,0001]. Her iki hemitoraksta toplam B çizgi sayısı
MD grubunda belirgin olarak daha fazla artış gösterdi [14(19,25), 2(4,25); p<0,0001]. MD
grubunda B çizgisi sayısındaki artış kontrol grubuna göre anlamlı derecede artış izlendi. Ancak
orta-ciddi MD ve hafif MD grupları arasında anlamlı farklılık izlenmedi. [(9(12), 7(10,5), 0(1);
p<0,001) ; (10,5(24,7), 4 (9,5) , 0 (1); p<0,001)]. Orta-ciddi MD grubunda semptomatik olan hastalarda asemptomatiklere göre B çizgisi sayısı hem efor öncesinde hem de efor sonrasında anlamlı olarak daha fazla izlendi [(11(42), 5(10); p:0,02 ); (45(92), 12(21); p:0,002)]. Sol
hemitoraksta yapılan değerlendirmede efor öncesi ve sonrası >3 B çizgisi sayısı farkı bulunması
%85,7 sensitivite (%95 GA %57,2-98,2), %66,2 spesifite (%95 GA %55,5-76,0) ile mitral balon
valvüloplastiyi (MBVP) öngördürmektedir. Pozitif prediktif değeri % 28,6 (%95 GA 21,8-
36,5), negatif prediktif değeri %96,7 (%95 GA 89-99,1) dır. AUC: 0,69 (%95 GA 0,59-0,78)
p:0,006.
Sonuç:
Eforla birlikte B çizgi sayısındaki artış MD grubunda kontrol grubuna göre daha fazla izlendi.
Ancak artış kapak ciddiyeti ile korelasyon göstermedi. Orta-ciddi MD grubunda ise
semptomatik olanlarda asemptomatiklere göre B çizgisi sayısı hem efor öncesi hem de efor
sonrası belirgin olarak daha yüksek izlendi. Çalışmamız LUS’un MD si bulunan hastaların
takibinde ve girişim zamanının değerlendirilmesinde tamamlayıcı rol alması açısından önem
arz etmektedir.
Objective: Our aim in this study is to evaluate the routine echocardiographic parameters that can be measured non-invasively using echocardiography (ECHO) during the routine check-ups of patients with mild and moderate-severe mitral stenosis (MD) who are followed up in the cardiology clinic, as well as the lung ultrasound (LUS) measured after the baseline lung ultrasound and the stress test. The predictive value of the change in the number and distribution of B lines in evaluating the severity of MD, other than standard echo parameters, will be investigated. Method: 70 MD patients followed in our clinic were included in the study. MD patients were divided into 2 groups: mild and moderate-severe MD. A total of 105 cases were included, including 35 control group patients who were examined at the cardiology outpatient clinic and did not have heart failure (HF) or additional valve pathology. Echocardiographic evaluation was performed using conventional echocardiography methods. Before the exercise test, patients underwent baseline LUS and the number and distribution of B lines were recorded. Heart rate and oxygen saturation were recorded before exercise. The patients were subjected to an exercise test to reach 85 % of their basal heart rate. Following post-exertion heart rate and oxygen saturation, mitral valve gradients and pulmonary artery pressure were re-evaluated with ECHO. After exercise, LUS was repeated and the distribution and number of B lines were recorded again. The relationship between the change in the number and distribution of B lines before and after exercise and the severity of MD was evaluated among all three groups. Results: Baseline demographic characteristics, including age, gender, diabetes, hypertension, coronary artery disease (CAD), and body mass index (BMI), were similar in the MD and control groups. After exercise, the number of B lines increased more in the right and left hemithorax than in the control group. [(8 (11.5), 0.5 (3)), p<0.0001; (4(13), 0(2)), p<0.0001]. The total number of B lines in both hemithoraxes increased significantly more in the MD group [14(19,25), 2(4,25); p<0.0001]. A significant increase in the number of B lines was observed in the MD group compared to the control group. However, no significant difference was observed between the moderate-severe MD and mild MD groups. [(9(12), 7(10.5), 0(1); p<0.001) ; (10.5(24.7), 4 (9.5) , 0 (1); p<0.001)]. In the moderate-severe MD group, the number of B lines was significantly higher in symptomatic patients than in asymptomatic patients, both before and after exercise [(11(42), 5(10); p:0.02); (45(92), 12(21); p:0.002)]. In the evaluation performed on the left hemithorax, there was a difference of >3 B lines before and after exercise, indicating 85.7% sensitivity (95% CI 57.2-98.2%), 66.2% specificity (95% CI 55.5-76%, 0) predicts mitral balloon valvuloplasty (MBVP). The positive predictive value is 28.6% (95% CI 21.8- 36.5), the negative predictive value is 96.7% (95% CI 89-99.1). AUC: 0.69 (95% CI 0.59-0.78) p:0.006. Conclusion: The increase in the number of B lines with effort was observed more in the MD group than in the control group. However, the increase did not correlate with valve severity. In the moderate-severe MD group, the number of B lines was significantly higher in symptomatic patients than in asymptomatic patients, both before and after exercise. Our study is important in that LUS plays a complementary role in the follow-up of patients with MD and in the evaluation of intervention time
Objective: Our aim in this study is to evaluate the routine echocardiographic parameters that can be measured non-invasively using echocardiography (ECHO) during the routine check-ups of patients with mild and moderate-severe mitral stenosis (MD) who are followed up in the cardiology clinic, as well as the lung ultrasound (LUS) measured after the baseline lung ultrasound and the stress test. The predictive value of the change in the number and distribution of B lines in evaluating the severity of MD, other than standard echo parameters, will be investigated. Method: 70 MD patients followed in our clinic were included in the study. MD patients were divided into 2 groups: mild and moderate-severe MD. A total of 105 cases were included, including 35 control group patients who were examined at the cardiology outpatient clinic and did not have heart failure (HF) or additional valve pathology. Echocardiographic evaluation was performed using conventional echocardiography methods. Before the exercise test, patients underwent baseline LUS and the number and distribution of B lines were recorded. Heart rate and oxygen saturation were recorded before exercise. The patients were subjected to an exercise test to reach 85 % of their basal heart rate. Following post-exertion heart rate and oxygen saturation, mitral valve gradients and pulmonary artery pressure were re-evaluated with ECHO. After exercise, LUS was repeated and the distribution and number of B lines were recorded again. The relationship between the change in the number and distribution of B lines before and after exercise and the severity of MD was evaluated among all three groups. Results: Baseline demographic characteristics, including age, gender, diabetes, hypertension, coronary artery disease (CAD), and body mass index (BMI), were similar in the MD and control groups. After exercise, the number of B lines increased more in the right and left hemithorax than in the control group. [(8 (11.5), 0.5 (3)), p<0.0001; (4(13), 0(2)), p<0.0001]. The total number of B lines in both hemithoraxes increased significantly more in the MD group [14(19,25), 2(4,25); p<0.0001]. A significant increase in the number of B lines was observed in the MD group compared to the control group. However, no significant difference was observed between the moderate-severe MD and mild MD groups. [(9(12), 7(10.5), 0(1); p<0.001) ; (10.5(24.7), 4 (9.5) , 0 (1); p<0.001)]. In the moderate-severe MD group, the number of B lines was significantly higher in symptomatic patients than in asymptomatic patients, both before and after exercise [(11(42), 5(10); p:0.02); (45(92), 12(21); p:0.002)]. In the evaluation performed on the left hemithorax, there was a difference of >3 B lines before and after exercise, indicating 85.7% sensitivity (95% CI 57.2-98.2%), 66.2% specificity (95% CI 55.5-76%, 0) predicts mitral balloon valvuloplasty (MBVP). The positive predictive value is 28.6% (95% CI 21.8- 36.5), the negative predictive value is 96.7% (95% CI 89-99.1). AUC: 0.69 (95% CI 0.59-0.78) p:0.006. Conclusion: The increase in the number of B lines with effort was observed more in the MD group than in the control group. However, the increase did not correlate with valve severity. In the moderate-severe MD group, the number of B lines was significantly higher in symptomatic patients than in asymptomatic patients, both before and after exercise. Our study is important in that LUS plays a complementary role in the follow-up of patients with MD and in the evaluation of intervention time
Açıklama
Anahtar Kelimeler
Mitral darlığı, Subklinik konjesyon, Akciğer ultrasonografisi, B çizgileri, Mitral stenosis, Subclinical congestion, Lung ultrasonography, B line
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Aydın, N. (2023). Mitral darlığının ciddiyetinin değerlendirilmesinde akciğer ultrasonografisinin önemi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Kardiyoloji Anabilim Dalı, Konya.
