Tirozin kinaz inhibitörü alan hastalarda sol ventrikül sistolik-diyastolik fonksiyonlarının konvansiyonel ve yeni ekokardiyografik parametrelerle değerlendirilmesi
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Tarih
2010
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Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
İlk kez küçük moleküllü tirozin kinaz inhibitörü (TKİ) tedavisi alacak hastalarda konvansiyonel ve doku Doppler ekokardiyografik değerlendirme ile bu sınıftaki ilaçlara bağlı muhtemel gelişebilecek kardiyotoksisiteyi erken dönemde belirlemek, böylece kardiyotoksisitenin önlenmesi ve tedavisi konusunda hasta takibini sağlayabilmektir Materyal ve Metod: Çalışmaya malignensi tanısı konulan, kardiyotoksisite yönünden bilinen risk faktörlerinin dışlandığı ve ilk kez küçük moleküllü tirozin kinaz inhibitörü verilmesi planlanan 30 hasta (kadın-erkek oranı, 17:13; ortalama yaş, 49±16 median 52; minimum:22, maksimum:76 yıl) dahil edildi. Bütün hastalara tedaviye başlamadan hemen önce ve tedavi başlangıcından 2 ay sonra, hem konvansiyonel hemde kardiyak fonksiyonlardaki minimal değişiklikleri saptamada hassas bir yöntem olan doku Doppler görüntüleme tekniği kullanılarak ekokardiyografik değerlendirmeler yapıldı. Ayrıca ventrikül sistolik ve diyastolik fonksiyonlarını değerlendirme amacıyla, konvansiyonel ekokardiyografi ile elde edilen miyokardiyal performans indeksi (MPİ) ve doku Doppler ile elde edilen MPİ (DDMPİ) ölçümleri değerlendirildi. Bulgular: Çalışmamızda hastalarda bazal ve 2. ayın sonundaki değerler karşılaştırıldığında; konvansiyonel yöntemle elde edilen SVSSH ort. değerinde anlamlı artış, SVEF ort. değerinde (64±3, 62±4, p=0,000) ve SV atım hacminde (67±13, 61±13, p=0,000) ise anlamlı azalma tespit edildi. Doku Doppler görüntülemede ise anterior duvar Em/Am değerinde anlamlı düşme (0,99± 0,49, 0,90 ± 0,41, p=0,03) saptandı, ayrıca Sm değerinde gerek ayrı ayrı SV dört duvarında, gerekse bunların ortalamalarını yansıtan Sm ort. değerinde düşme saptanırken, bu düşüş sadece lateral duvar Sm değeri için istatistiki anlamlılığa ulaştı (12,8±2,9, 11,6±2,3, p=0,004). Sadece inferior DDMPİ değerinde anlamlı artış (53,7±7,4, 56,4 ± 7,7, p=0,03) saptanırken, diğer 3 duvar DDMPİ ve konvansiyonel yöntemle elde edilen MPİ değerinde anlamlı değişiklik gözlenmedi. Sonuç: Elde ettiğimiz veriler: 1- Kardiyotoksisite yönünden predispozan faktörlere sahip olmayan hasta grubunda kısa tedavi intervallerinde bu ajanların güvenle kullanılabileceğini, 2-Risk faktörlerinin dışlandığı hastalarda bile her şeye rağmen KMTKİ ile ilişkili ilerde klinik veya subklinik kardiyotoksisite gelişebileceğini ve tedavinin devam eden periodunda dikkatli olunması gerektiğini göstermektedir
The aim of this study is to determine possible cardiotoxicity to occur during this kind of therapy in an early phase in patients to be administered tyrosine kinase inhibitors (TKIs) treatment for the first time, by using conventional and tissue Doppler imaging echocardiography. And in this manner, we thought that we may provide adequate health care for preventing or treating this cardiotoxicity. Material and Methods: Thirty consecutive patients (female-to-male ratio, 17:13; mean age, 49±16 years, median:52; minimum:22; maximum:76 years) who met the exclusion criterias and were diagnosed as having malignancy were enrolled in this study. All patients underwent conventional echocardiography and tissue Doppler imaging (TDI), a very accurate technique for detecting minimal changes in cardiac function, shortly before the treatment and after nearly 2 months while the therapy was going on. In addition, the Myocardial Performance Index (MPI) obtained by conventional echocardiography and also obtained by TDI tecnique were used to evaluate left ventricular (LV) systolic and diastolic functions. Results: In our study, statistically significant increase occured in mean LV end systolic volum (LVESV) value. However, there was significant decrease in both mean LV ejection fraction and LV stroke volum values (64±3, 62±4, p=0,000 and 67±13, 61±13, p=0,000, respectively). Anterior wall Em/Am ratio measured by using the TDI technique was significantly decreased at the end of two months (0,99± 0,49, 0,90 ± 0,41, p=0,03). In addition, decreases were determined in Sm values obtained from all of four LV walls and also in mean Sm value, but this decrease was significant only for the lateral wall Sm measurement (12,8±2,9, 11,6±2,3, p=0,004). Although inferior wall DDMPI value was significantly increased (53,7±7,4, 56,4 ± 7,7, p=0,03), no significant changes were observed in other MPI values obtained by both conventional and TDI methods. Conclusions: Our data suggest that; 1-TKI therapy can safely administer to the patients not having predisposing factors for cardiotoxicity in short treatment interval, 2- even in these patients, small molecule TKIs may cause subtle or clinically significant cardiotoxicity in following treatment period, so the clinicians should always take into consideration this possibility.
The aim of this study is to determine possible cardiotoxicity to occur during this kind of therapy in an early phase in patients to be administered tyrosine kinase inhibitors (TKIs) treatment for the first time, by using conventional and tissue Doppler imaging echocardiography. And in this manner, we thought that we may provide adequate health care for preventing or treating this cardiotoxicity. Material and Methods: Thirty consecutive patients (female-to-male ratio, 17:13; mean age, 49±16 years, median:52; minimum:22; maximum:76 years) who met the exclusion criterias and were diagnosed as having malignancy were enrolled in this study. All patients underwent conventional echocardiography and tissue Doppler imaging (TDI), a very accurate technique for detecting minimal changes in cardiac function, shortly before the treatment and after nearly 2 months while the therapy was going on. In addition, the Myocardial Performance Index (MPI) obtained by conventional echocardiography and also obtained by TDI tecnique were used to evaluate left ventricular (LV) systolic and diastolic functions. Results: In our study, statistically significant increase occured in mean LV end systolic volum (LVESV) value. However, there was significant decrease in both mean LV ejection fraction and LV stroke volum values (64±3, 62±4, p=0,000 and 67±13, 61±13, p=0,000, respectively). Anterior wall Em/Am ratio measured by using the TDI technique was significantly decreased at the end of two months (0,99± 0,49, 0,90 ± 0,41, p=0,03). In addition, decreases were determined in Sm values obtained from all of four LV walls and also in mean Sm value, but this decrease was significant only for the lateral wall Sm measurement (12,8±2,9, 11,6±2,3, p=0,004). Although inferior wall DDMPI value was significantly increased (53,7±7,4, 56,4 ± 7,7, p=0,03), no significant changes were observed in other MPI values obtained by both conventional and TDI methods. Conclusions: Our data suggest that; 1-TKI therapy can safely administer to the patients not having predisposing factors for cardiotoxicity in short treatment interval, 2- even in these patients, small molecule TKIs may cause subtle or clinically significant cardiotoxicity in following treatment period, so the clinicians should always take into consideration this possibility.
Açıklama
Anahtar Kelimeler
Diastol, Diastole, Ekokardiyografi, Echocardiography, Miyokard, Myocardium, Sistol, Systole
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Alihanoğlu, Y. İ ,(2010). Tirozin kinaz inhibitörü alan hastalarda sol ventrikül sistolik-diyastolik fonksiyonlarının konvansiyonel ve yeni ekokardiyografik parametrelerle değerlendirilmesi. Selçuk Üniversitesi, Yayımlanmış tıpta uzmanlık tezi, Konya.
