Metoprolol Tedavisinin Sinüs Ritimli Hafif-Orta Mitral Darlıklı Hastalarda Transözofajiyal Ekokardiyografi ile Elde Edilen Pulmoner Venöz Akım Paternleri Üzerine Etkisi

AYDIN, Mustafa; ÖZEREN, Ali; BiLGE, Mehmet; DEMİRKIRAN, Mustafa; CAM, Fatih; Dursun, Aydın; ELBEY, Mehmet Ali; ONUK, Tolga

Mustafa AYDIN¹, Ali ÖZEREN², Mehmet BiLGE², Mustafa DEMİRKIRAN³, Fatih CAM⁴, Aydın Dursun², Mehmet Ali ELBEY², Tolga ONUK¹

¹Department of Cardiology, Medical Faculty, Zonguldak Karaelmas University, Zonguldak, Turkey
²Department of Cardiology, Medical Faculty, Zonguldak Karaelmas University, Zonguldak, Turkey Department ofCardiology, Department of Cardiology, SSK Zonguldak Hospital
³Department of Cardiology, SSK Zonguldak Hospital, Zonguldak, Turkey Department ofCardiology, Department of Cardiology, SSK Zonguldak Hospital
⁴Department of Cardiology, Medical Faculty, Zonguldak Karaelmas University, Zonguldak, Turkey Department ofCardiology, Department of Cardiology, SSK Zonguldak Hospital

Bu çalışma metoprolol tedavisi verilen sinüs ritimli hafif-orta mitral darlıklı hastalarda metoprololün pulmoner venöz dalga ölçümleri üzerine etkisini araştırma amacıyla yapıldı. Çalışmaya izole hafif-orta şiddette mitral darlığı (mitral kapak alanı 1.6±0.3 cm2) olan 23 hasta alındı. Tüm hastalara 1 ay süreyle günde 100 mg oral metoprolol verildi. Tedavi öncesi ve tedavinin birinci ayında transözofajiyal ekokardiyografi uygulandı. Zirve sistolik pulmoner venöz akım hızı (PVs), PVs hız-zaman integrali (VTI), zirve diyastolik pulmoner venöz akım hızı (PVd), PVd-VTI, zirve pulmoner venöz atriyal geri akım hızı (PVa), PVa-VTI ve PVa süresi ölçüldü. Zirve ve ortalama transmitral gradiyent, pulmoner arter basıncı, sistolik-diyastolik kan basıncı, ve kalp hızı anlamlı derecede azaldı. Pulmoner venöz zirve sistolik akım hızı, ve pulmoner venöz atriyal geri akım süresi anlamlı düzeyde arttı (sırasıyla 0.55 ± 0.19 m/s’ye karşın 0.66 ± 0.12 m/s, p<0.05, ve 84 ± 27 to 11 2± 31 msn p<0.01). PVs-VTI, 10.8±3.2 cm’den 11.9±4.3 cm’ye yükseldi (p<0.01), PVd-VTI, 5.1± 2.4 cm’den 5.4±2.5 cm’ye yükseldi (p<0.05), ve PVa- VTI 2.8±1.1 cm’den 3.1±1.3 cm’ye yükseldi, (p<0.05). Sonuç olarak, metoprolol tedavisi sinüs ritmindeki mitral darlığı hastalarında pulmoner venöz akımlarda artışa neden olmaktadır. Bu artış sol atriyal fonksiyonlarda düzelmenin bir göstergesi olabilir. Bu sonuçlar mitral darlıklı hastalarda metoprolol tedavisinin faydalı etki mekanizmasının anlaşılmasına katkı sağlayabilir.

Anahtar Kelimeler:

Effect of Metoprolol Treatment on Pulmonary Venous Flow Pattern Studied by Transesophageal Pulsed Doppler Echocardiography in Mild to Moderate Mitral Stenosis in Sinus Rhythm

Mustafa AYDIN¹, Ali ÖZEREN², Mehmet BiLGE², Mustafa DEMİRKIRAN³, Fatih CAM⁴, Aydın Dursun², Mehmet Ali ELBEY², Tolga ONUK¹

¹
²
³
⁴

This study was conducted to evaluate the effect of metoprolol therapy on pulmonary venous flow pattern in patients with mild to modarete mitral stenosis in sinus rhythm. We studied 23 patients with isolated mild to moderate mitral stenosis (mitral valve area 1.6±0.3 cm2). All patients received metoprolol 100 mg once daily orally for 1 month. Pulsed wave Doppler transesophageal echocardiograpic examination of the pulmonary venous flow was performed at the beginning of the study and after 1 month of treatment. Peak systolic pulmonary venous flow (PVs) velocity, PVs velocity time integral (VTI), peak diastolic pulmonary venous flow (PVd) velocity, PVd-VTI, peak pulmonary venous atrial reversal flow (PVa) velocity, PVa-VTI, and PVa duration time were measured. Peak and mean transmitral gradient, pulmonary artery pressure, systolic and diastolic blood pressure, and heart rate, reduced significantly after metoprolol treatment. The pulmonary venous peak systolic velocity, and pulmonary venous atrial reversal flow velocity duration time increased significantly from 0.55 ± 0.19 m/s to 0.66 ± 0.12 m/s, p<0.05, and from 84 ± 27 to 11 2± 31 msec, p<0.01, respectively). Regarding VTI, PVs-VTI increased from 10.8±3.2 cm to 11.9±4.3 cm (p<0.01), PVd-VTI increased from 5.1± 2.4 cm to 5.4±2.5 cm (p<0.05), and PVa- VTI increased from 2.8±1.1 cm to 3.1±1.3 cm, p<0.05. Conclusion: Metoprolol treatment increased pulmonary venous flow as an indicator of improved left atrial function in patients with mitral stenosis and sinus rhythm. These results may contribute to disclosing the underlying mechanisms of the favourable effects of beta blockade in mitral stenosis.

Keywords:

Mustafa AYDIN, Ali ÖZEREN, Mehmet BiLGE, Mustafa DEMİRKIRAN, Fatih CAM, Aydın Dursun, Mehmet Ali ELBEY, Tolga ONUK. Effect of Metoprolol Treatment on Pulmonary Venous Flow Pattern Studied by Transesophageal Pulsed Doppler Echocardiography in Mild to Moderate Mitral Stenosis in Sinus Rhythm. . 2004; 32(4): 239-245