Pulmoner Hipertansiyonlu Çocuklarda Doku Doppler Ekokardiyografi Görüntüleme Bulgularının Değerlendirilmesi

Abstract

Pulmonary hypertension (PH) is defined as a mean pulmonary artery pressure of at least 25 mmHg or above at rest in right heart catheterization. Because of treatment is very difficult and costly, the attention is directed to early diagnosis and prognostic factors that facilitate monitoring of disease. Tissue Doppler echocardiographic (TDI) examination have started to hold an important place in determination of prognostic markers that can be used to determine the severity of the disease and follow-up in these patients. In this study, 34 patients and 43 healthy children who have been followed in our Pediatric Cardiology Department were included. Patient’s and control group’s TDI findings were compared. As a result of the study we found that, tricuspid annular plane systolic excursion (TAPSE) (p<0.001), mitral septal annulus Ea (p<0.001), tricuspid septal and lateral annulus Ea (p<0.001) and interventricular septum (IVS) Ea (p<0.001) values were significantly lower in patients group. On the other hand mitral lateral annulus E/Ea (p=0.024), mitral lateral annulus Tei (p=0.001), mitral septal annulus E/Ea and Tei ( p <0.001), tricüspid lateral and septal annulus E/Ea and Tei (p<0.001), IVS E/Ea (p<0.001) and IVS Tei (p=0.003) values were significantly higher than the control group. E/A, Tei and E/Ea parameters were the best parameters that differs between patients and control group among the analyzed 5 region. Among patients with Eisenmenger syndrome and idiopathic PH, TDI parameters were mostly similar. In patients with NYHA (New York Heart Association) functional class 3, mitral septal annulus E/Ea (p=0.050) and mitral lateral annulus Tei index (p=0.009) were higher, IVS Ea and IVS E/A (p values were 0.042 and 0.039 respectively) values were lower than NYHA functional class 2 patients. In patients with higher BNP (brain natriüretik peptid) level, mitral lateral annulus and tricuspid septal annulus Ea/Aa values were measured lower (p values 0.046 and <0.001 respectively); tricuspid septal annulus E/Ea and IVS Tei index values were measured higher than patients with normal BNP level (p values 0.006 and 0.006 respectively). In patients with low (under 500 meter) 6-minute walk distance (6MWD) tricuspid septal and lateral annulus E/Ea values were measured v significantly higher than patients with high 6MWD (p values 0.016 and 0.023 respectively). At the end of study we conclude that TDI findings were significantly impaired in children with PH than control group; TDI findings in patients with idiopathic PH or Eisenmenger syndrome were similarly; mitral lateral annulus Tei, mitral septal annulus E/Ea, IVS Ea and IVS E/A values may have a prognostic importance due to the significant associations with poor functional class. Also, we would like to mention that due to the significant associations between mitral lateral annulus and tricuspid septal annulus Ea/Aa, tricuspid septal annulus E/Aa, IVS Tei values and BNP levels and between tricuspid septal- lateral annulus E/Ea values and 6MWD, this parameters can be used the evaluation of response to therapy.