Dvodimenzionalna ehokardiografska evaluacija obolelih od ciroze jetre u predviđanju cirotične kardiomiopatije
Sažetak
Uvod/Cilj. Cirotična kardiomiopatija predstavlja klinički sindrom obolelih od ciroze jetre, koji karakteriše nenormalno usporen odgovor na fiziološke, patološke, ili farmakološke draži, uz normalno povećan minutni volumen srca i kontraktilnost u mirovanju. Cilj istraživanja je bio identifikacija strukturnih i funkcionalnih promena miokarda, kao prediktora cirotične kardiomiopatije, kod bolesnika sa cirozom jetre različite etiologije u odmaklim fazama bolesti. Metode. Istraživanje je sprovedeno po tipu prospektivne studije slučaja, na odabranih 40 bolesnika u odmakloj fazi ciroze jetre sa negativnom ličnom medicinskom istorijom na kardiovaskularne bolesti i 40 zdravih ispitanika kao kontrolom, u periodu od januara 2012. do decembra 2014. godine. Pomoću trans-torakalne dvodimenzionalne dopler ehokardiografije određivani su parametri od značaja za razvoj i/ili prisustvo cirotične kardiomiopatije. Rezultati. Većina obolelih bila je sa alkoholnom cirozom jetre (80%), dominantno u Child-Pough C stadijumu bolesti (70%). Prosečne vrednosti QT intervala kod obolelih od ciroze bile su značajno više (0,44 ± 0,03 ms vs 0,42 ± 0,01 ms; p < 0,001), kao i serumske vrednosti moždanog natriuretskog peptida (BNP) (284,61 ± 181,44 ng/L vs 69,41 ± 31,08 ng/L; p < 0,001), u poređenju sa onima kod zdravih ispitanika. Oboleli od ciroze jetre imali su značajnu povezanost između serumskih vrednosti BNP i dijametra leve pretkomore (p = 0,031), ejekcione frakcije leve komore (p = 0,014), sistolnog pritiska u pulmonalnoj arteriji (p = 0,000) i prisustva regurgitacije trikuspidne valvule od 2+ (p = 0,000), koji su uticali na promenu vrednosti BNP za 41,6%. Zaključak. Rezultati ovog istraživanja sugerišu da oboleli od ciroze jetre imaju značajne ehokardiografske znake miokardne disfunkcije, uz povećan serumski nivo BNP. Dijametar leve pretkomore, ejekciona frakcija leve komore, pritisak u pulmonalnoj arteriji i prisustvo regurgitacije trikuspidalne valvule, predstavljaju važne ehokardiografske prediktore cirotične kardiomiopatije.
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