Subklinik hipertiroidili hastalarda sol ventrikül fonksiyonlarının pulsed wave doku Doppler ile değerlendirilmesi
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Date
2009
Authors
Aydın, Özlem
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Tiroid hormonları kalp kasının kasılma ve gevşeme hızını arttırırlar, aynı zamanda otonom sinir sisteminde sempatik tonusu değiştirler ve periferde hemodinamik değişikliklere neden olurlar. Bu değişiklikler kalbin iş yükünü artırarak kalpte disfonksiyona yol açabilir.Subklinik hipertiroidizm toplumda sık görülen bir durumdur. Kronik subklinik hipertiroidili hastalarda yapılan çalışmalarda kalp hızında ve sol ventrikül kitlesinde artma, sistolik fonksiyonlarda hafifçe artma ve diyastolik disfonksiyon saptanmıştır.Bu çalışmada yeni tanı konmuş subklinik hipertiroidinin sol ventrikül fonksiyonları üzerine olan etkisinin konvansiyonel ekokardiyografi ve yeni bir yöntem olan doku Doppler ekokardiyografi ile değerlendirilmesi amaçlanmıştır.Çalışmaya 30 (22 kadın, 8 erkek) yeni tanı konmuş subklinik hipertiroidili hasta ve yaş açısından eşleştirilmiş 19 (14 kadın, 5 erkek) sağlıklı gönüllü alındı. Hastalardan anamnez ve fizik muayene sonrasında kan örnekleri alındı. Konvansiyonel ve pulsed wave doku Doppler ekokardiyografi yapılarak sol ventrikülün sistolik ve diyastolik fonksiyonları ve miyokard performans indeksi değerlendirildi.Yeni tanı konmuş subklinik hipertiroidili hastalarda pulmoner ven retrograd A dalga hızı (p:0.038) ve miyokard performans indeksi (p:0.019) kontrol grubuna kıyasla anlamlı olacak şekilde daha yüksek saptanmıştır. Her iki grup arasında kalp hızı, sol ventrikül sistolik ve pulmoner ven retrograd A dalga hızı hariç diğer diyastolik fonksiyon parametreleri açısından anlamlı fark saptanmamıştır.Yeni tanı konmuş subklinik hipertiroidili hastalarda yapılan bu çalışmada pulmoner ven retrograd A dalga hızı artışı diyastolik disfonksiyonun erken bir bulgusu olan sol atriyum basınç artışını, miyokard performans indeksi artışı ise global sol ventrikül fonksiyonlarında bozulma olduğunu göstermektedir.Sonuç olarak yeni tanı konmuş subklinik hipertiroidili hastalarda konvansiyonel ekokardiyografi yöntemi ile sol ventrikül global fonksiyonlarında bozulma ve diyastolik disfonksiyonun erken bir bulgusu olan sol atriyum basıncında artış olduğu saptanmış olup her iki grup arasında doku Doppler yöntemi ile bakılan parametreler açısından anlamlı fark saptanmamıştır. Çalışmamız subklinik hipertiroidili hastalarda sol ventrikül fonksiyonlarını değerlendirmede doku Doppler yönteminin kullanıldığı ilk çalışmadır. Subklinik hipertiroidinin sol ventrikül fonksiyonları üzerine etkisini doku Doppler yöntemi ile araştıran daha geniş çaplı yeni çalışmalara ihtiyaç vardır.
Thyroid hormones increase the myocardial contraction and relaxation rate, at the same time they change the tonus of sympathetic nervous system and cause hemodynamical changes in the periphery. These changes may lead to cardiac dysfunction by increasing the cardiac workload.Subclinical hyperthyroidism is a common condition in general population. Increase in heart rate and left ventricular mass, mild increase in systolic function and diastolic dysfunction were detected in studies enrolled patients with chronic subclinical hyperthyroidism.In this study, evaluation of the effect of newly diagnosed subclinical hyperthyroidism on left ventricular function by conventional echocardiography and tissue Doppler echocardiography, which is a new method, was aimed.Study includes 30 patients with newly diagnosed subclinical hyperthyroidism (22 women, 8 men) and age matched 19 healty subjects (14 women, 5 men). Following history and physical examination, blood samples were taken. Conventional and pulsed wave tissue Doppler echocardiography has been applied, systolic and diastolic functions of left ventricule and myocard performance index were evaluated.Pulmonary vein reverse A wave rate (p:0.038) and myocardial performance index (p:0.019) were found significantly higher in newly diagnosed subclinical hyperthyroid patients compared to controls. No significant change was found between groups in terms of heart rate, parameters of systolic function and diastolic function except pulmonary vein reverse A wave rate.In this study that enrolled patients with newly diagnosed subclinical hyperthyroidism, increase in pulmonary vein reverse A wave rate indicates left atrial pressure increase that is an early sign of diastolic dysfunction, increase in myocardial performance index indicates deterioration of global left ventricular function.In conclusion, in newly diagnosed subclinical hyperthyroid patients, deterioration of global left ventricular function and increase in left atrial pressure which is an early sign of diastolic dysfuncion were detected by conventional echocardiography, no significant change was detected between two groups in terms of tissue Doppler parameters. Our study is the first one which uses the tissue Doppler echocardiography for the evaluation of effect of subclinical hyperthyroidism on left ventricular function. New studies with larger scale to detect the effect of subclinical hyperthyroidism on left ventricular function with tissue Doppler echocardiography are needed.
Thyroid hormones increase the myocardial contraction and relaxation rate, at the same time they change the tonus of sympathetic nervous system and cause hemodynamical changes in the periphery. These changes may lead to cardiac dysfunction by increasing the cardiac workload.Subclinical hyperthyroidism is a common condition in general population. Increase in heart rate and left ventricular mass, mild increase in systolic function and diastolic dysfunction were detected in studies enrolled patients with chronic subclinical hyperthyroidism.In this study, evaluation of the effect of newly diagnosed subclinical hyperthyroidism on left ventricular function by conventional echocardiography and tissue Doppler echocardiography, which is a new method, was aimed.Study includes 30 patients with newly diagnosed subclinical hyperthyroidism (22 women, 8 men) and age matched 19 healty subjects (14 women, 5 men). Following history and physical examination, blood samples were taken. Conventional and pulsed wave tissue Doppler echocardiography has been applied, systolic and diastolic functions of left ventricule and myocard performance index were evaluated.Pulmonary vein reverse A wave rate (p:0.038) and myocardial performance index (p:0.019) were found significantly higher in newly diagnosed subclinical hyperthyroid patients compared to controls. No significant change was found between groups in terms of heart rate, parameters of systolic function and diastolic function except pulmonary vein reverse A wave rate.In this study that enrolled patients with newly diagnosed subclinical hyperthyroidism, increase in pulmonary vein reverse A wave rate indicates left atrial pressure increase that is an early sign of diastolic dysfunction, increase in myocardial performance index indicates deterioration of global left ventricular function.In conclusion, in newly diagnosed subclinical hyperthyroid patients, deterioration of global left ventricular function and increase in left atrial pressure which is an early sign of diastolic dysfuncion were detected by conventional echocardiography, no significant change was detected between two groups in terms of tissue Doppler parameters. Our study is the first one which uses the tissue Doppler echocardiography for the evaluation of effect of subclinical hyperthyroidism on left ventricular function. New studies with larger scale to detect the effect of subclinical hyperthyroidism on left ventricular function with tissue Doppler echocardiography are needed.
Description
Keywords
Subklinik hipertiroidi, Pulsed wave ekokardiyografi, Doku Doppler ekokardiyografi, İzovolümik akselerasyon, Sol ventrikül fonksiyonu, Subclinical hyperthyroidism, Pulsed wave echocardiography, Tissue Doppler echocardiography, Isovolumic acceleration, Left ventricular function
Citation
Aydın, Ö. (2009). Subklinik hipertiroidili hastalarda sol ventrikül fonksiyonlarının pulsed wave doku Doppler ile değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.