Subklinik hipotiroidili hastalarda aortik elastik özellikler ve ekokardiyografik parametrelerin değerlendirilmesi
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Tarih
2020
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Yayıncı
Dicle Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Hipotiroidi, doku düzeyinde tiroid hormonu eksikliği veya nadiren de olsa etkisizliği sonucu meydana gelen, metabolik yavaşlama ile giden bir hastalıktır. Hipotiroidi kardiyovasküler morbidite ve mortaliteyi etkilemektedir. Subklinik hipotiroidi ise serumda serbest tiroid hormon seviyeleri normal iken yüksek TSH düzeylerinin saptandığı biyokimyasal bir tanımlamadır. Amacımız yaşadığımız populasyonda en sık rastlanılan endokrin sistem hastalıklarından biri olan ancak çoğunluğunun semptom oluşturmadığı için tanı konulamadığı ve atlandığı subklinik hipotiroidinin, arteriyel sertlik gibi yapılan birçok çalışmada kardiyovasküler morbidite ve mortalite için risk faktörü olduğu kabul edilen bir süreçle ilişkisinin olup olmadığını iki farklı yöntemle non-invaziv olarak incelemektir. Materyal ve Metod: Çalışmaya yeni tanı almış 33 subklinik hipotiroidili hasta ile cinsiyet ve yaş bakımından birbirine yakın olacak şekilde rastgele seçilen 34 kişilik sağlıklı kontrol grubu eklendi. 2D Transtorasik Ekokardiyografi ile aortun sistolik ve diyastolik çapları ve elastik parametreleri hesaplandı. Epikardiyal yağ dokusu (EFT) kalınlığı ve diğer basic ekokardiyografi parametreleri ölçüldü. Hasta gruplarının santral kan basınçları ve aortik sertlik (stiffness) değerleri brakiyal arterden Mobil-O-Graph arteriyograf cihazı ile non-invazif olarak ölçüldü. Arteriyel sertlik göstergeleri olarak nabız dalga hızı (PWV) ve Augmentasyon indexi (Aix) kullanıldı. Bulgular: Kontrol grubu ile subklinik hipotiroidi arasında cinsiyet, yaş ve vücut kütle indeksi açısından fark yoktu. Aortun elastik parametrelerinden olan aortik strain ve aortik distensibilite, subklinik hipotiroidi grubunda kontrol grubuna göre istatistiksel olarak anlamlı düzeyde düşük bulundu (p<0,001). 2D Transtorasik Ekokardiyografi ile ölçülen Interventriküler septum (IVS) kalınlığı, sol ventrikül ejeksiyon fraksiyonu (LVEF), sol ventrikül sistol sonu çap (LVESD), sol ventrikül diyastol sonu çap (LVEDD), parasternal uzun eksen (PSLAX) sol atriyum çapı (LA), Mitral E/A, sol ventrikül septal E'/A', sol ventrikül lateral E'/A', deselerasyon zamanı (DT), aortun sistolik çapları, AP4 boşlukta bakılan sağ atriyum (RA) ve sağ ventrikül (RV) çapları ve triküspid annular plane systolic excursion (TAPSE) değerleri arasında istatistiksel açıdan anlamlı bir fark gözlenmedi (p>0,05). 2D Transtorasik Ekokardiyografi ile ölçülen epikardiyal yağ dokusu kalınlığı ise subklinik hipotiroidi grubunda kontrol grubuna kıyasla istatistiksel açıdan anlamlı düzeyde artmış bulundu (p<0,05). Osilometrik yöntem olan Mobil-O-Graph arteriyograf cihazı ile ölçülen ve arteriyel sertlik göstergesi olarak kabul edilen PWV ve Aix subklinik hipotiroidi grubunda kontrol grubuna kıyasla istatistiksel açıdan anlamlı düzeyde yüksek saptandı (p<0,05). Sonuç: Diğer kardiyovasküler risk faktörleri ekarte edilecek şekilde subklinik hipotiroidili hastalarda aortun elastik parametrelerinde bozulma ve epikardiyal yağ dokusunda artış mevcuttur.
İntroduction and Aim: Hypothyroidism is a disease that occurs as a result of thyroid hormone deficiency or rarely ineffectiveness at tissue level, and that goes by metabolic slowdown. Hypothyroidism affects cardiovascular morbidity and mortality. Subclinical hypothyroidism is a biochemical definition in which serum free thyroid hormone levels are normal and high TSH levels are detected. Our aim is the subclinical hypothyroidism, which is one of the most common endocrine system diseases in the population we live in, but it is not diagnosed and missed because the majority of it does not cause symptoms, In many studies such as arterial stiffness, it is non-invasively to examine whether it is related to a process considered to be a risk factor for cardiovascular morbidity and mortality by two different methods. Material and Method: The study included 33 newly diagnosed subclinical hypothyroid patients and 34 healthy control groups randomly selected to match gender anda age. Systolic and diastolic diameters and elastic parameters of the aorta were calculated by 2D Transthoracic Echocardiography. EFT (epicardial fatty tissue) thickness and other basic echocardiography parameters were measured. Central blood pressure and aortic stiffness values of patient groups were measured non-invasively from the brachial artery using the Mobil-O-Graph arteriograph device. Pulse wave velocity (PWV) and augmentation index (Aix) were used as arterial stiffness indicators. Findings: There was no difference between subclinical hypothyroidism and control group in terms of age, gender and body mass index. Aortic strain and aortic distensibility, one of the elastic parameters of the aorta, were statistically significantly lower in the subclinical hypothyroid group than in the control group (P <0.001). Interventricular septum (IVS) thickness, left ventricular ejection fraction (LVEF), left ventricular end systole diameter (LVESD), left ventricular end diastole diameter (LVEDD), parasternal long axis (PSLAX) left atrium (LA) diameter, Mitral E / A, left ventricular septal E '/ A', left ventricular lateral E '/ A', deceleration time (DT), systolic diameters of the aorta, right atrium (RA) and right ventricle (RV) diameters and tricuspid annular plane systolic excursion (TAPSE) values in AP4 cavity measured by 2D Transthoracic Echocardiography no statistically significant difference was found between them (P> 0.05). Epicardiyal fatty tissue (EFT) thickness measured by 2D Transthoracic Echocardiography was found to be statistically significantly increased in the subclinical hypothyroid group compared to the control group (p<0.05). In the PWV and Aix, which was measured by the oscillometric method, the Mobil-O-Graph arteriograph device, and was accepted as an indicator of arterial stiffness, it was found statistically significantly subclinical hypothyroid group higher than the control group (p <0.05). Conclusion: Patients with subclinical hypothyroidism have impaired elastic parameters and an increase in epicardial adipose tissue so that other cardiovascular risk factors are excluded.
İntroduction and Aim: Hypothyroidism is a disease that occurs as a result of thyroid hormone deficiency or rarely ineffectiveness at tissue level, and that goes by metabolic slowdown. Hypothyroidism affects cardiovascular morbidity and mortality. Subclinical hypothyroidism is a biochemical definition in which serum free thyroid hormone levels are normal and high TSH levels are detected. Our aim is the subclinical hypothyroidism, which is one of the most common endocrine system diseases in the population we live in, but it is not diagnosed and missed because the majority of it does not cause symptoms, In many studies such as arterial stiffness, it is non-invasively to examine whether it is related to a process considered to be a risk factor for cardiovascular morbidity and mortality by two different methods. Material and Method: The study included 33 newly diagnosed subclinical hypothyroid patients and 34 healthy control groups randomly selected to match gender anda age. Systolic and diastolic diameters and elastic parameters of the aorta were calculated by 2D Transthoracic Echocardiography. EFT (epicardial fatty tissue) thickness and other basic echocardiography parameters were measured. Central blood pressure and aortic stiffness values of patient groups were measured non-invasively from the brachial artery using the Mobil-O-Graph arteriograph device. Pulse wave velocity (PWV) and augmentation index (Aix) were used as arterial stiffness indicators. Findings: There was no difference between subclinical hypothyroidism and control group in terms of age, gender and body mass index. Aortic strain and aortic distensibility, one of the elastic parameters of the aorta, were statistically significantly lower in the subclinical hypothyroid group than in the control group (P <0.001). Interventricular septum (IVS) thickness, left ventricular ejection fraction (LVEF), left ventricular end systole diameter (LVESD), left ventricular end diastole diameter (LVEDD), parasternal long axis (PSLAX) left atrium (LA) diameter, Mitral E / A, left ventricular septal E '/ A', left ventricular lateral E '/ A', deceleration time (DT), systolic diameters of the aorta, right atrium (RA) and right ventricle (RV) diameters and tricuspid annular plane systolic excursion (TAPSE) values in AP4 cavity measured by 2D Transthoracic Echocardiography no statistically significant difference was found between them (P> 0.05). Epicardiyal fatty tissue (EFT) thickness measured by 2D Transthoracic Echocardiography was found to be statistically significantly increased in the subclinical hypothyroid group compared to the control group (p<0.05). In the PWV and Aix, which was measured by the oscillometric method, the Mobil-O-Graph arteriograph device, and was accepted as an indicator of arterial stiffness, it was found statistically significantly subclinical hypothyroid group higher than the control group (p <0.05). Conclusion: Patients with subclinical hypothyroidism have impaired elastic parameters and an increase in epicardial adipose tissue so that other cardiovascular risk factors are excluded.
Açıklama
Anahtar Kelimeler
Arteriyel sertlik, Nabız dalga hızı, Augmentasyon indeksi, Aortik strain, Aortik distensibilite, Epikardiyal yağ dokusu, Arterial stiffness, Pulse wave velocity, Augmentation index, Aortic strain, Aortic distensibility, Epicardial fatty tissue
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Künye
Evsen, A. (2020). Subklinik hipotiroidili hastalarda aortik elastik özellikler ve ekokardiyografik parametrelerin değerlendirilmesi. Uzmanlık tezi, Dicle Üniversitesi, Diyarbakır.
