Kalp Yetersizliği Hastalarında Kardiyak Resenkronizasyon Tedavisinin Nabız Dalga Hızı Üzerindeki Akut Dönem Etkisi

Abstract

Heart failure is a complex clinical syndrome characterized by impaired myocardial performance and neuroendocrine system activation. Heart failure, appears to result not only from cardiac overload or injury but also from a complex interplay among genetic, neurohormonal, inflammatory, and biochemical changes acting on cardiac myocytes, the cardiac interstitium, or both. Cardiac Resynchronization Therapy (CRT), has been used as a method of great importance and benefit in much of patients with heart failure, in recent years. However, pulse wave velocity (PWV), an arterial stiffness parameter that is measured non-invasively, fastly and oscillometrically by Arteriograph appliance, has earned much more attention recently. The preditctive value of PWV on cardiovascular mortality and coronary artery disease beyond classical risk factors, has been showed in previous trials. In the present study, we investigated the acute effects of CRT on PWV parameter. Mean Blood Pressure (MBP), Central Systolic Blood Pressure (CSBP), Diastolic Blood Pressure (DBP), Central Diastolic Blood Pressure (CDBP), Augmentation Index (Aix), Pulse Pressure (PP), Cardiac Output (CO), Peripheric Vascular Impedance (PVI) and Reflection Size (RS) parameters were also assessed by Arteriograph appliance beyond PWV. These paramaters were measured before and during the first 24 hours after CRT implantation. Levels of MBP, PP, CSBP, Aix, CO, PVI, RS and PWV have been significantly changed after CRT implantation [97mmHg vs 94mmHg, p=0.026; 45mmHg vs 40mmHg, p=0.011; 110mmHg vs 104mmHg, p=0.002; 22.5 vs 28,09, p=0.001; 3,9lt/min vs 4,1lt/min, p=0.003; 1.3 vs 1.2 p=0.015; 61.08 vs 53.36, p=0.001; 8,07m/s vs 7,69m/s, p=0.001, respectively]. However, in the levels of DBP and MDBP, there have not been noticed significant changes. In conclusion, CRT has led to hemodynamically improvement in acute period by significant decrease in PWV levels.