Prekordiyal ST segment çökmesi olan inferior miyokard infarktüslülerin sol ventrikül global ve bölgesel sistolik ve diyastolik işlevlerinin nabız dalgalı doku doppler ile incelenmesi
Küçük Resim Yok
Tarih
2001
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
ÖZET Çalışmamızın amacı, inferior AMÎ' de görülen prekordiyal ST segment çökmesinin fizyopatoloj isini açıklamak; prekordiyal ST segment çökmesi olan Inferior AMÎ' lü hastalar ile ST segment çökmesi olmayan hastaların, sağ ve sol ventrikül işlevlerini karşılaştırmak; miyokardın bölgesel işlevlerini inceleyerek prekordiyal ST segment çökmesi olan inferior AMÎ' lü hastalarla, ST segment çökmesi olmayan hastaların, miyokardiyal tutulum yaygınlığı açısından aralarındaki farklılığı nabız dalgalı DDG yöntemi ile ortaya koymaktır. Çalışmaya, kontrol grubu ve hasta grubu olarak; Diabetes Mellitus, hipertansiyon, kardiyomiyopati ya da valvüler kalp hastalığı olmayan 42 olgu alındı. Kontrol grubu (Grup A) 20 (14'ü kadın, yaş ortalaması 51,1 ± 5,4), ilk defa AMÎ geçiren ve prekordiyal ST segment çökmesi olmayan (Grup B) 7 (2' si kadın, yaş ortalaması 53,5 ± 5,7) ve ST segment çökmesi olan (Grup C) 15 (2' si kadın, yaş ortalaması 55,6 ± 6,4) hasta alındı. Hastaların ilk ekokardiyografik incelemeleri, prekordiyal ST segment çökmesinin bulunduğu dönemde (ortalama saat Grup B 9,1 ± 1,6 ; Grup C 10,1 ± 2,3 ), ikinci ekokardiyografik incelemeleri de ST segment çökmesinin olmadığı dönemde (ortalama gün Grup B 8,2 ± 1,8 ; Grup C 8,4 ±1,7) yapıldı. Her ekokardiyografik incelemede LVEDÇ, EF, MD, TD ve ayrıca global ventrikül işlevleri için nabız dalgalı DDG yöntemi ile mitral ve triküspit halkanın lateral endomiyokardiyal sınırından elde edilen Ew, Aw, Ew/Aw, ÎVRT-w, EwDT, Q-Sw ve Sw parametreleri değerlendirildi. Ük ve ikinci ekokardiyografik incelemede beş anterior (bazal ve mid anterior-septum, bazal ve mid anterior, mid septal), dört posterior ve lateral (bazal ve mid posterior, bazal ve mid lateral) ve üç inferior (bazal septum, bazal ve mid inferior) bölgede Ew, Aw, Ew/Aw, ÎVRT-w, EwDT, Q-Sw ve Sw parametreleri değerlendirilmeye alındı. 68Grup A' nın TD' sinden, Grup B' nin 1. ve 2. TD' leri anlamlı olarak azalmıştı. Grup A' nın EF, MD, TD' sinden, Grup C nin l.ve 2. EF, MD ve TD' leri anlamlı olarak azalmıştı. Global sol ventrikül DDG parametrelerinden Grup A ile B arasında sadece ilk ÎVRT-m farklı olarak uzamış bulundu. Grup A ile C arasında arasında 1. ve 2. Em, Em/Am, İVRT-m ve Q- Sm farklı bulundu. Global sağ ventrikül DDG parametrelerinden Grup A ile B arasında 1.tVRT-t, Q-St, St farklı bulundu. Grup A ile C arasında 1. ve 2. Et, tVRT-t, Q-St ve St farklı bulundu. Bölgesel DDG parametrelerinden Ew, Ew/Aw, ÎVRT-w, Q-Sw ve Sw parametreleri anterior ve posterior-lateral bölgede Grup A ile B, Grup A ile C karşılaştuıldığmda Grup C farklı çıktı. Grup B ve Grup C, 1. ve 2. DDG parametreleri arasında istatistiksel olarak anlamlı fark olmadı. Gruplarda EF ile MD arasında, EF ile Q-Sm arasında, EF ile Sm arasında, MD ile Sm arasında, MD ile Q-Sm arasında, TD ile Q-St arasında, TD ile St arasında korelasyon tespit ettik. Sonuç olarak; inferior AMÎ' de görülen prekordiyal ST segment çökmesinin flzyopatoljisinde geçici iskemik durumun değil, vektörel değişikliğin etkili olabileceğini; prekordiyal ST segment çökmesi olan inferior AMÎ' lü hastaların sağ ve sol ventrikül işlevlerinin diğer hasta grubuna göre daha kötü ve AMÎ sonrası dönemde daha uzun süre devam ettiğini; bölgesel DDG incelemesinde, prekordiyal ST segment çökmesi olan hasta grubunda anterior ve posterior-lateral bölgelerde sistolik ve diyastolik işlevlerin diğer hasta grubuna göre daha kötü olduğunu bulduk. Bu bulgumuz ST segment çökmesi olan hastalarda yaygın koroner arter tutulumunu düşündürmektedir. 69
SUMMARY ASSESMENT OF LEFT VENTRİCULAR GLOBAL AND REGİONAL SYSTOLİC AND DIASTOLIC FUNCTIONS BY PULSED WAVE TISSUE DOPPLER EMAGİNG IN PATIENTS WÎTH INFERIOR MYOCARDIAL INFARCTION AND PRECORDIAL ST SEGMENT DEPRESSION The aim of our study is explain the physiopathology of ST segment depression in precordial leads seen in inferior wall myocardial infarction, compare right and left ventricular functions between patients with inferior wall myocardial infarction with ST segment depression in precordial leads and patients without ST segment depression, comparing the patients with inferior myocardial infarction having ST segment depression in precordial leads with the patients having no ST segment depression by exarnining the regional myocardial functions, to bring up the difference in myocardial involvement using pulsed wave TDI method. Fourtytwo cases were enrolled to the study as control group and patient group with no history of diabetes mellitus, hypertension, cardiomyopathy or valvular heart disease. The groups were desinged as control group, consisted of 20 patients (14 women, mean 51,1 ± 5,4 years old); Group B, consisted of 7 patients (2 women, mean 53,5+-5,7 years) with first acute myocardial infarction without ST segment depression in precordial leads and Group C, consisted of 15 patients (2 women, mean 55,6 ± 6,4 years) with ST segment depression. The first echocardiographic examination was performed during the time ST segment depressions occur in precordial leads (mean time for Group B 9,1 ± 1,6 h; for Group C 10,1 ± 2,3 h) and second was performed after the ST segments have become isoelectric (mean time 70for Grup B 8,2 ± 1,8 days; for Group C 8,4 ±1,7 days). In both echocardiographic evaluations LVEDD, EF, MD,TD and for global ventricular function assesment Ew, Aw, Ew/Aw, IVRT- w, EwDT, Q-Sw and Sw parameters obtained by using pulsed wave TDI method from the lateral endomyocardial border of mitral and tricuspit annulus were used for evaluation. At the first and the second echocardiographic evaluations at five anterior (basal and midanterior- septum, basal and midanterior, midseptal), four posterior and lateral (basal and midposterior, basal and midlateral) regions Ew, Aw, Ew/Aw, IVRT-w, EwDT, Q-Sw and Sw parameters were assesed. The first and the second TD's in Group B were significantly decreased than the TD in Group A. The first and the second EF,MD and TD's in Group C were significantly decreased than the Ef, MD and TD in Group A. Among the global left ventricular DDG parameters only the first rVRT-m was found to be increased between Group A and B. Between Group A and C the first and the second Em, Em/ Am, IVRT-m and Q-Sm were found to be different. Among the global left ventricular DDG parameters the first IVRT-t, Q-St, St was found to be different between Group A and B. Between Group A and C the first and the second Et, IVRT-t, Q-St and St were found to be different. When Group A and B were compared with Group A and C, among the regional DDG parameters Ew, Ew/Aw, IVRT-w, Q-Sw and Sw in anterior and posterior-lateral region Group C was found to be different. There was no statistical variation at the first and the second DDG parameters in Goup B and C. In groups we determined correlations between EF-MD, EF- Q-Sm, EF- Sm, MD- Sm, MD- Q-Sm, TD- Q-Sm and TD- St. Our results, vectoral variations can be effective in physiopathology of ST segment depression in precordial leads seen in acute inferior wall myocardial infarction instead of ischemic conditions. The right and left ventricular functions in patients with ST segment depression in precordial leads are much more bad than the other groups and after AMI this condition lasts for a much more time. In regional TDI evaluation, in patients with ST segment depression in precordial leads we found the systolic and diastolic functions in anterior and posterior-lateral regions to be much more bad than the other patients. Our findings suggests diffused coronary artery involvement in patients with ST segment depression. 71
SUMMARY ASSESMENT OF LEFT VENTRİCULAR GLOBAL AND REGİONAL SYSTOLİC AND DIASTOLIC FUNCTIONS BY PULSED WAVE TISSUE DOPPLER EMAGİNG IN PATIENTS WÎTH INFERIOR MYOCARDIAL INFARCTION AND PRECORDIAL ST SEGMENT DEPRESSION The aim of our study is explain the physiopathology of ST segment depression in precordial leads seen in inferior wall myocardial infarction, compare right and left ventricular functions between patients with inferior wall myocardial infarction with ST segment depression in precordial leads and patients without ST segment depression, comparing the patients with inferior myocardial infarction having ST segment depression in precordial leads with the patients having no ST segment depression by exarnining the regional myocardial functions, to bring up the difference in myocardial involvement using pulsed wave TDI method. Fourtytwo cases were enrolled to the study as control group and patient group with no history of diabetes mellitus, hypertension, cardiomyopathy or valvular heart disease. The groups were desinged as control group, consisted of 20 patients (14 women, mean 51,1 ± 5,4 years old); Group B, consisted of 7 patients (2 women, mean 53,5+-5,7 years) with first acute myocardial infarction without ST segment depression in precordial leads and Group C, consisted of 15 patients (2 women, mean 55,6 ± 6,4 years) with ST segment depression. The first echocardiographic examination was performed during the time ST segment depressions occur in precordial leads (mean time for Group B 9,1 ± 1,6 h; for Group C 10,1 ± 2,3 h) and second was performed after the ST segments have become isoelectric (mean time 70for Grup B 8,2 ± 1,8 days; for Group C 8,4 ±1,7 days). In both echocardiographic evaluations LVEDD, EF, MD,TD and for global ventricular function assesment Ew, Aw, Ew/Aw, IVRT- w, EwDT, Q-Sw and Sw parameters obtained by using pulsed wave TDI method from the lateral endomyocardial border of mitral and tricuspit annulus were used for evaluation. At the first and the second echocardiographic evaluations at five anterior (basal and midanterior- septum, basal and midanterior, midseptal), four posterior and lateral (basal and midposterior, basal and midlateral) regions Ew, Aw, Ew/Aw, IVRT-w, EwDT, Q-Sw and Sw parameters were assesed. The first and the second TD's in Group B were significantly decreased than the TD in Group A. The first and the second EF,MD and TD's in Group C were significantly decreased than the Ef, MD and TD in Group A. Among the global left ventricular DDG parameters only the first rVRT-m was found to be increased between Group A and B. Between Group A and C the first and the second Em, Em/ Am, IVRT-m and Q-Sm were found to be different. Among the global left ventricular DDG parameters the first IVRT-t, Q-St, St was found to be different between Group A and B. Between Group A and C the first and the second Et, IVRT-t, Q-St and St were found to be different. When Group A and B were compared with Group A and C, among the regional DDG parameters Ew, Ew/Aw, IVRT-w, Q-Sw and Sw in anterior and posterior-lateral region Group C was found to be different. There was no statistical variation at the first and the second DDG parameters in Goup B and C. In groups we determined correlations between EF-MD, EF- Q-Sm, EF- Sm, MD- Sm, MD- Q-Sm, TD- Q-Sm and TD- St. Our results, vectoral variations can be effective in physiopathology of ST segment depression in precordial leads seen in acute inferior wall myocardial infarction instead of ischemic conditions. The right and left ventricular functions in patients with ST segment depression in precordial leads are much more bad than the other groups and after AMI this condition lasts for a much more time. In regional TDI evaluation, in patients with ST segment depression in precordial leads we found the systolic and diastolic functions in anterior and posterior-lateral regions to be much more bad than the other patients. Our findings suggests diffused coronary artery involvement in patients with ST segment depression. 71
Açıklama
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Tıpta Uzmanlık
Tıpta Uzmanlık
Anahtar Kelimeler
Kardiyoloji, Cardiology
