Metoprolol ve Diltiazemin Mitral Darlıklı Olgularda p Dalga Dispersiyonuna Etkisi
Recep Demirbağ1, Niyazi Güler2, Beyhan Eryonucu2, Ayhan Sinci2, Ahmet Güneş21Van Yüksek ihtisas Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği2Yüzüncü Yıl Tıp Fakültesi, Kardiyoloji Anabilim Dalı,
Atriyum büyümesi ve kalp debisinin azalmasına bağli artmış sempatik aktivite sonucu mitral darlığında P dispersiyonu ( P dis) artmaktadır. P dis artnıası ile atriyal fibrilasyon gelişimi arasında yakın bir ilişki olduğu bilinmektedir. Bu çalışmada ise mitral darliklı olgularda P di s. maksimum P dalga süresi ( P max) ve minimum P dalga süresi ( P min) üzerine metoprolol ve dilliazemin etkisi araşrmldı . Metod: Mitral darlik/ı 84 olgu me toprolol grubu 44 hasta ( 36 'sı kadı11. yaş ortalaması 38±1 2 yıl) ve diltiazem grubu 40 hasta (35 kadın. yaş ortalaması 40±9 yıl) olarak iki gruba randamize edildi. Tedavi öncesi ve sonras ı tramtorasik ekokardiyorafik inceleme ile sol atriyum boyutu. sol ventrikiil çap/an. mitral kapağa ait zirve ve ortalama gradiyentler. mitral kapak alam ve sol ventrikül ejeksiyonjraksiyonlan hesaplandı. Elektrokardiyografilerde tedavi öncesi ve sonrasında P dalga süreleri büyüteç yardumyla ölçüldü. Bulgular: Her iki grubun başlangıç ekokardiyografik değerleri ile P 1 max, P min ve P d is değerleri arasında anlamli fark yoktu (p>0.05) . Bir ay/tk metoprolol tedavisi ile P max. P min ve P dis ile transmitral ortalama gradiyenfle (TMOG) belirgin azalma gö:;.lendi (p
Effects of Metoprolo and Diltiazem on P Wave Dispersion in Patients with Mitral Stenosis
Recep Demirbağ1, Niyazi Güler2, Beyhan Eryonucu2, Ayhan Sinci2, Ahmet Güneş212
Objective: In mitral stenosis. higher P wave dispersion has been shown to exist due to atrial dilatation and sympathetic overactivity because of reduced cardiac output. P wave dispersion is also closely related to atrial fibrillation. Our aim was to evaluate the effects of metoprolol and diltiazem on P wave dispersion (PWD), and on maximum and minimum P wave duration in patients with mitral stenosis (MS). Methods: All patients with MS in sinus rhythm were randomized into two groups, one of which was composed of 44 patients (36 women, aged 36±12 years) treated with metoprolol, and the other composed of 40 patients (35 women, aged 40 ±9 years) treated with diltiazem. Left atrial and left ventricular diameters, mean and peak transmitral gradientsdnitral valve area, and left ventricular ejection fractions were measured by transthoracic echocardiographic examination. Before and one month after treatment, P wave durations were measured manually under magnifying glass in twelve -lead ECG. Results: No significant difference was recorded between group I and group II in terms of baseline echocardiographic values. maximum P wave duration. minimum P wave duration. and PWD. In the metoprolol-treatment-group. we observed that maximum P ware duration. mininuun P wave duration. PWD and mean transmitral gradient were significantly reduced (p<0.0I ). In the diltiazem-treatment-group. a significant decrease was detected in PWD. mean transmitral gradient and maximum P wave duration but not in minimum P wave duration (p>0.05). In the two groups, the significant decreases in maximtun P wave duration. PWD and mean transmitral gradient were more pronounced in the metoprolol-treatment-group (p<0.00/). There were no statistically significant differences between the other parameters. Conclusion: Treatment with either diltiazem or metoprolol decreased in PWD and maximum P wave duration in patients with MS significantly, yet, this was more pronounced in the metoprolol-treatment-group
Keywords: P wave dispersion. mitral stenosis. metoprolol and diltiazem| ARAÇLAR |
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