The Journal of Shahid Sadoughi University of Medical Sciences
مجله علمي پژوهشي دانشگاه علوم پزشكي شهید صدوقی يزد
JSSU
Medical Sciences
http://jssu.ssu.ac.ir
20
journal20
2228-5741
2228-5733
fa
jalali
1397
4
1
gregorian
2018
7
1
26
4
online
1
fulltext
fa
اثر PercutaneousCoronary Intervention Elective بر بهبودی نارسایی ایسکمیک میترال
Impact of Elective Percutaneous Coronary Intervention on Improvement of Ischemic Mitral Regurgitation
قلب
Cardiovascular
پژوهشي
Original article
<strong><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">مقدمه:</span></span></span></strong><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> نارسایی ایسکمیک میترال</span></span></span> <span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">(</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">IMR</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">) یکی از پیچیدهترین جنبههای بیماری ایسکمیک میوکارد هست که اثر مداخله کرونری از راه پوست (</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">PCI</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">) بر بهبودی شدت </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">IMR</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> تاکنون به خوبی بررسی نشده است. بیماران با </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">IMR</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> پیشآگهی بدتری در مقایسه با بیماران بدون </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">IMR</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> دارند. هدف پژوهش ما تعیین ارزش </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">Revascularization</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> کامل به وسیله </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">PCI</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> بر بهبودی </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">IMR</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> و مقایسه شاخصهای اکوکاردیوگرافی بیماران با و بدون بهبودی </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">IMR</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> بعد از این مداخله هست.</span></span></span><br>
<strong><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">روش بررسی:</span></span></span></strong><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> در این مطالعه مقطعی گذشتهنگر، گزارش اکوکاردیوگرافی قبل از </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">PCI</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> و 12 ماه بعد از </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">PCI</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> بیمارانی که از فروردین سال 1391 تا اسفند سال1393، برای آنها </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">Revascularization</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> کامل با </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">Elective PCI</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> انجامشده بود و شدت </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">IMR</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> آنها بیشتر یا مساوی با +2 بود استخراج شد و داده</span></span></span> <span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">های اکوکاردیوگرافی قبل از </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">PCI</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> بیماران </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">IMR</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> بهبود یافته بود با بیماران </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">IMR</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> بهبود نیافته، مقایسه شد دادهها با استفاده از نرم افزار </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;"> SPSS 21</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">و آزمونهای آماری متناسب تجزیه و تحلیل شدند..</span></span></span><br>
<strong><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">نتایج:</span></span></span></strong> <span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">این مقایسه نشان داد که در 15 بیمار (16%) میزان </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">IMR</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> کاهشیافته بود (002/0 </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">P =</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">). هم چنین کسر جهشی بطن چپ (010/0 </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">P =</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">)، دیامتر انتهای دیاستولی بطن چپ (003/0 </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">P =</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">)، دیامتر انتهای سیستولی بطن چپ</span></span></span> <span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">(001/0 </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">P <</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">)، </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">Wall </span></span></span></span> <span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;"> Motion Score Index</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">(003/0 </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">P =</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">)، مساحت دهلیز چپ (001/0 </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">P <</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">) و فشار سیستولی شریان ریوی (046/0 </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">P =</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">) بین دو گروه با </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">IMR</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> بهبود یافته و بهبود نیافته متفاوت بودند</span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">.</span></span></span><br>
<strong><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">نتیجهگیری:</span></span></span></strong> <span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;">اگرچه </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">PCI</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> میتواند منجر به بهبودی میزان </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">IMR</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> شود، اما بهبودی در میزان </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">IMR</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> در بیشتر بیماران رخ نمیدهد. میزان ناهنجاریهای ساختاری در بطن چپ و دهلیز چپ در دو گروه با </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">IMR</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:12.0pt;"> بهبود یافته و بهبود نیافته ، متفاوت است.</span></span></span>
<strong>Introdution:</strong> Ischemic mitral regurgitation (IMR) remains one of the most complex and unresolved aspects of ischemic heart disease that the impact of percutaneous coronary intervention (PCI) on improvement of intensity of ischemic mitral regurgitation is not well clarified. Patients with coronary artery diseases and ischemic mitral regurgitation have a worse prognosis than the patients with coronary artery disease (CAD) and those without ischemic mitral regurgitation. We sought to investigate the impact of complete revascularization by percutaneous coronary intervention PCI on improvement of IMR in patients with CAD and comparisons of echocardiography indices in patients with and without improvement of ischemic mitral regurgitation.<br>
<strong>Methods:</strong> In this cross sectional retrospective study, echocardiographic reports in pre- percutaneous coronary intervention time and 12 months after PCI of patients with moderate (≥2+) ischemic mitral regurgitation who underwent complete revascularization by percutaneous coronary intervention from Farvardin 1391 to Esfand 1393 were included in the study. Then, echocardiographic data of the patients with improved ischemic mitral regurgitation compared with the patients with non-improved ischemic mitral regurgitation.<br>
<strong>Results:</strong> Comparison of echocardiographic indices before and after percutaneous coronary intervention revealed that after percutaneous coronary intervention (P = 0.002) in 15 patients (16%), improvement in ischemic mitral regurgitation was occurred. Also, left ventricular ejection fraction (P = 0.010), left ventricular end- diastolic (P = 0.003) and end-systolic diameters (P < 0.001), wall motion score index (P = 0.003), left atrial area (P = 0.001) and systolic pulmonary artery pressure (P = 0.046) in pre- percutaneous coronary intervention echocardiography were different between improved and none-improved IMR group.<br>
<strong>Conclusion:</strong> Although, percutaneous coronary intervention can lead to improvement of ischemic mitral regurgitation but most patients did not show improvement of ischemic mitral regurgitation after percutaneous coronary intervention. The structural abnormality of left ventricle and atrium were different between improved and none-improved IMR group
نارسایی دریچه میترال, ایسکمی, مداخله کرونری از راه پوست
Mitral regurgitation, Ischemia, Percutaneous coronary intervention
286
293
http://jssu.ssu.ac.ir/browse.php?a_code=A-10-3201-1&slc_lang=fa&sid=1
Hakimeh
Sadeghian
حکیمه
صادقیان
s@yahoo.com