Značaj hemodinamskih parametara izmjerenih prilikom rutinske biopsije endomiokarda desne klijetke u prognozi vaskulopatije srčanog presatka

master's thesis

• Title (english): The role of hemodynamic parameters obtained during surveillance endomyocardial biopsy of the right ventricle in the prognosis of cardiac allograft vasculopathy
• Author: Antonio Agić
• Mentor: Boško Skorić (mentor)
• Committee member: Davor Miličić (predsjednik povjerenstva)
• Committee member: Martina Lovrić Benčić (član povjerenstva)
• Committee member: Boško Skorić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Vaskulopatija srčanog presatka (CAV) je komplikacija koja se najčešće podmuklo razvija, a njene posljedice na vidjelo dolaze često tek kada su terapijske opcije već ograničene, te je ona glavni uzrok smrtnosti u kasnom poslijetransplantacijskom periodu. Transplantirani bolesnici imaju denervirano srce, pa ne osjećaju anginozne simptome što CAV čini još težom za prepoznati. Identificirani su različiti imunološki i neimunološki faktori rizika za razvoj CAV-a. Farmakološka terapija doprinijela je smanjenju incidencije CAV-a, no jednom kad se CAV razvije ishodi su najčešće nepovoljni. Dijagnoza dijastoličke disfunkcije je osjetljivija u
otkrivanju subkliničkog zatajivanja presatka za razliku od sistoličke funkcije koja ostaje dugo kompenzirana. Budući da uslijed pogoršavanja funkcije dolazi do povišenja tlakova u srčanim šupljinama, za očekivati je da bi mjerenje tlaka u desnoj klijetki kroz uvodnicu koja se u tu klijetku postavlja prilikom biopsija endomiokarda u rutinskom poslijetranplantacijskom praćenju bolesnika, moglo pomoći u ranijem prepoznavanju subkliničkog popuštanja srčanog presatka. Na srčanu hemodinamiku u poslijetransplantacijskom periodu osim razvoja CAV-a, može nepovoljno utjecati i odbacivanje presatka, a povišeni tlak punjenja desne klijetke može zbog kongestije uzrokovati oštećenje bubrežne funkcije, čemu su ovi bolesnici inače podložni zbog prethodnog kardio-renalnog sindroma, često prisutne šećerne bolesti, nefrotoksičnosti kalcineurinskih inhibitora u imunosupresivnom liječenju i sl. Cilj ovog istraživanja je u prvom redu utvrditi postoji li povezanost između razvoja CAV-a i
hemodinamskih abnormalnosti zabilježenih tijekom poslijetransplantacijskog praćenja. Također, ispitat ćemo postojanje povezanosti između odbacivanja presatka i hemodinamskih pokazatelja zatajivanja desne klijetke, odnosno povezanost povišenog tlaka punjenja desne klijetke i razvoja bubrežnog zatajivanja u bolesnika nakon transplantacije srca.

Abstract (english)

Cardiac allograft vasculopathy is the complication that most often develops insidiously and its consequences usually come to light when therapeutic options are already limited, thus it is the major cause of mortality in late post transplantation period. Transplanted patients have denervated hearts, therefore they don't perceive anginal symptoms which make CAV even more difficult to recognize. Various immunological and non-immunological risk factors for CAV development have been identified. Pharmacological therapy has contributed to the reduction of CAV incidence, however once when CAV develops, outcome is generally unfavorable. Diagnose of diastolic dysfunction is more sensitive in discovering subclinical graft failure in contrast to systolic function that remains compensated for a long time. Since worsening of graft's function leads to an increase of pressures in heart chambers, it is to be expected that measurement of right ventricle pressure trough sheath which is placed in that chamber for endomyocardial biopsy during routine post transplantation patients follow up, could aid in the early recognition of the subclinical cardiac graft dysfunction. Besides development of CAV, graft rejection may also have detrimental effects on cardiac hemodynamics in post transplantation period and the increased filling pressure of right
ventricle leading to congestion, may cause a deterioration of renal function to which are these patients highly susceptible owing to prior cardio-renal syndrome, frequently present diabetes, nephrotoxic effect of calcineurin inhibitors in the immunosuppressive therapy etc. The primary goal of this research is to determine the correlation between the development of CAV and hemodynamic abnormalities registered during the post transplantation follow up. In addition, the association between the graft rejection and hemodynamic parameters of right ventricle dysfunction is going to be investigated as well as an association between the increased pressure in the right ventricle and the development of renal dysfunction in patients
after heart transplantation.

• Keywords: vaskulopatija srčanog presatka; hemodinamika; tlak desne klijetke; odbacivanje presatka; bubrežna insuficijencija
• Keywords (english): cardiac allograft vasculopathy; hemodynamics; right ventricule pressure; graft rejection; renal dysfunction
• Language: croatian
• URN:NBN: urn:nbn:hr:105:770652
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-03-30 08:41:44