Kronik karaciğer hastalığı olan çocuklarda kardiyak fonksiyonların değerlendirilmesi
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Date
2010
Authors
Semizel, Evren
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Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Sirozlu hastalarda, istirahatte iken kardiyak yetersizliğin klinik bulguları belirgin olarak görülmemekle beraber, kardiyak fonksiyonel anormalliklerin varlığı son zamanlarda özellikle dikkat çekmektedir. Sirotik kardiyomiyopati, sistolik ve diyastolik disfonksiyon ve elektrofizyolojik anormallikleri kapsamaktadır. Klinik olarak latent olmakla beraber, fiziksel veya farmakolojik yüklenmelerle, sirotik kardiyomiyopati meydana çıkabilir. Mekanizması tam olarak anlaşılamyan bu durumun erken tanısı önemlidir. Bu çalışma, istirahat halindeki sirozlu çocuklarda, elektrokardiyografi ve ekokardiyografiyi kullanarak, sistolik ve diyastolik fonksiyonların, kardiyak boyutların ve elektrokardiyografik anormalliklerin invazif olmayan değerlendirmesini yapmak amacı ile gerçekleştirildi.Çalışmaya 33 sirozlu hasta ve 28 sağlıklı kontrol dahil edildi. Karaciğer yetersizliğinin derecesini belirlemek için Child-Pugh sınıflaması kullanıldı. Kan basınçları supin pozisyonda ölçüldü ve ortalama kan basıncı hesaplandı. Elektrokardiyografi çekilerek QT dispersiyonu ile QTc dispersiyonu hesaplandı. Doku Doppler görüntülemenin de dahil edildiği tam bir ekokardiyografik inceleme yapıldı.Sirozlu çocukların %93.9'unun Child-Pugh skoru sınıf A olarak bulundu. Ortalama arteriyel kan basıncı sirozlu hastalarda 70.470 ± 7.960 mmHg'dı ve bu değer anlamlı olarak kontrol grubundaki değerden daha düşüktü (p=0.031). Sistolik kan basıncı sirozlu hastalarda 100.000 ± 9.270 mmHg ve kontrol gubunda 124.678 ± 17.518 mmHg idi (p=0.082). Sol atriyum çapı sirozlularda kontrol grubuna oranla daha genişti (p=0.076). Sol ventrikül ejeksiyon fraksiyonu iki grupta da benzerdi. Sol ventrikül arka duvar diyastolik kalınlığı sirozlularda 0.652 ± 0.140 cm ve kontrol grubunda 0.561 ± 0.174 cm'di (p=0.011). Diyastolik fonksiyon parametreleri ise gruplar arasında fark yaratmıyordu. Sol ventrikül miyokard performans indeksi iki grupta da farklı değildi.İleri dönem karaciğer hastalığı tipik hemodinamik bulgularla birliktelik gösterir. Hatta erken evre karaciğer sirozunda bile, burada olduğu gibi, düşük ortalama kan basıncı, genişlemiş sol atriyum çapı ve artmış sol ventrikül duvar kalınlığı gibi bazı kardiyovasküler değişiklikler izlenebilir. Sirozun bu evresinde anlamlı sistolik ve diyastolik disfonksiyon mevcut değildir. Ancak bütün bunlar bir araya konulduğunda, sirozu olan tüm çocukların, erken evre olsalar bile, kardiyovasküler değerlendirmelerinin yapılması gerekliliği ortaya çıkmaktadır.
The occurrence of cardiac function abnormalities in cirrhotic patients has gained recent attention, although clinical symptoms of cardiac impairment at rest are often not apparent. Cirrhotic cardiomyopathy implies systolic and diastolic dysfunction and electrophysiological abnormalities. Being clinically latent, cirrhotic cardiomyopathy can be unmasked by physical or pharmacological strain. Although the mechanisms are not fully understood, early detection of this condition is crucial. By using electrocardiography and echocardiography, this study has carried out a noninvasive assessment of electrocardiographic abnormalities, cardiac dimension and of systolic and diastolic function in cirrhotic patients at rest.The study included 33 cirrhotic patients and 28 healthy controls. The Child-Pugh classification was applied to define the degree of liver failure. Blood pressures were measured in supine position and mean arterial blood pressures were calculated. Electrocardiographies were obtained and QT and QTc dispersions were calculated. A complete echocardiographic study including tissue Doppler imaging was performed.The Child-Pugh score of 93.9% of the cirrhotic children were found to be class A. Mean arterial blood pressure in cirrhotic patients was measured to be 70.470 ± 7.960 mmHg and it was significantly lower than in controls (p=0.031). Systolic blood pressure was 100.000 ± 9.270 mmHg in cirrhotics and 124.678 ± 17.518 in controls (p=0.082). Left atrial diameter in cirrhotics was greater than in controls (p=0.076). Left ventricular ejection fraction was similar in both groups. Left ventricular posterior wall diastolic thickness was 0.652 ± 0.140 cm in cirrhotics and 0.561 ± 0.174 cm in controls (p=0.011). Diastolic function parameters were identical in the groups. Left ventricle myocardial performance index was found to be not different in both groups.Advanced liver disease is associated with typical hemodynamic. Even in early stage liver cirrhosis, there are some cardiovascular alterations including lower mean blood pressure, enlarged left atrial diameter, and increase in left ventricular wall thickness. At this stage of cirrhosis, no significant systolic and diastolic dysfunction is present. But, when all these put together, cardiovascular evaluation of all the cirrhotic children, even at early stage, should be undertaken.
The occurrence of cardiac function abnormalities in cirrhotic patients has gained recent attention, although clinical symptoms of cardiac impairment at rest are often not apparent. Cirrhotic cardiomyopathy implies systolic and diastolic dysfunction and electrophysiological abnormalities. Being clinically latent, cirrhotic cardiomyopathy can be unmasked by physical or pharmacological strain. Although the mechanisms are not fully understood, early detection of this condition is crucial. By using electrocardiography and echocardiography, this study has carried out a noninvasive assessment of electrocardiographic abnormalities, cardiac dimension and of systolic and diastolic function in cirrhotic patients at rest.The study included 33 cirrhotic patients and 28 healthy controls. The Child-Pugh classification was applied to define the degree of liver failure. Blood pressures were measured in supine position and mean arterial blood pressures were calculated. Electrocardiographies were obtained and QT and QTc dispersions were calculated. A complete echocardiographic study including tissue Doppler imaging was performed.The Child-Pugh score of 93.9% of the cirrhotic children were found to be class A. Mean arterial blood pressure in cirrhotic patients was measured to be 70.470 ± 7.960 mmHg and it was significantly lower than in controls (p=0.031). Systolic blood pressure was 100.000 ± 9.270 mmHg in cirrhotics and 124.678 ± 17.518 in controls (p=0.082). Left atrial diameter in cirrhotics was greater than in controls (p=0.076). Left ventricular ejection fraction was similar in both groups. Left ventricular posterior wall diastolic thickness was 0.652 ± 0.140 cm in cirrhotics and 0.561 ± 0.174 cm in controls (p=0.011). Diastolic function parameters were identical in the groups. Left ventricle myocardial performance index was found to be not different in both groups.Advanced liver disease is associated with typical hemodynamic. Even in early stage liver cirrhosis, there are some cardiovascular alterations including lower mean blood pressure, enlarged left atrial diameter, and increase in left ventricular wall thickness. At this stage of cirrhosis, no significant systolic and diastolic dysfunction is present. But, when all these put together, cardiovascular evaluation of all the cirrhotic children, even at early stage, should be undertaken.
Description
Keywords
Siroz, QT dispersiyon, QTc dispersiyon, Kardiyak fonksiyonlar, Kardiyak boyutlar, Cirrhosis, QT dispersion, QTc dispersion, Cardiac functions, Cardiac dimensions
Citation
Semizel, E. (2010). Kronik karaciğer hastalığı olan çocuklarda kardiyak fonksiyonların değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.