Dijagnostička vrijednost ultrazvuka srca u evaluaciji arterijske hipertenzije

professional thesis

• Title (english): Diagnostic value of heart sonography in the evaluation of arterial hypertension
• Author: Nikola Kočet
• Mentor: Višnja Nesek Adam (mentor)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2022-07-19, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Emergency Medicine

Abstract

Cilj istraživanja. Cilj istraživanja jest utvrditi povezanost stupnja i duljine trajanja arterijske hipertenzije (AH) s debljinom stjenke lijeve klijetke (DSLK) i istisnom frakcijom (EF) srca.

Ustroj studije. Provedeno je prospektivno kohortno istraživanje. Ispitanici i metode. Istraživanje je uključivalo 50 bolesnika pregledanih u kardiološkoj ambulanti Kliničke bolnice „Sveti Duh“ s vodećom dijagnozom arterijske hipertenzije postavljene tijekom obrade kroz Objedinjeni hitni bolnički prijam (OHBP). Ultrazvučno se određivala debljina stijenke lijeve klijetke (LK) sačinjena od debljine intraventrikularnog septuma (IVS) i stražnje stijenke lijeve klijetke (SSLK) izražene u centimetrima (cm) te istisna frakcija (EF) srca. Analizirani su demografski podatci bolesnika (dob, spol), pridružene bolesti, kronična terapija i vrijednosti arterijskog tlaka. U istraživanje su bili uključeni svi bolesnici stariji od 18 godina pregledani u kardiološkoj ambulanti nakon preporučene dijagnostičke obrade prilikom pregleda u OHBP-u, a pod glavnom dijagnozom arterijske hipertenzije, dok su iz istraživanja bili isključeni bolesnici s patološkim stanjima koja mijenjaju arhitekturu i narušavaju kontraktilnost srca.

Rezultati. Arterijska hipertenzija je učestalija u osoba ženskog spola (52%) u odnosu na muškarce (48%) dok je prosječna dob ispitanika 58.7 godina. Prosječno trajanje AH u naših ispitanika je više od 6 godina. Najveći je udio ispitanika s prvim stupnjem AH (44%), a slijede ih ispitanici s trećim stupnjem AH (36%). Najveći broj ispitanika uzimao je više pojedinačnih antihipertenzivnih lijekova, a od ostale kronične terapije najviše ispitanika je uzimalo statine i antidijabetike. Hipertrofija lijeve klijetke (HLK) prisutna je u više od polovice ispitivanih bolesnika (54%) dok nešto više od polovice ispitanika sa HLK ima dislipidemiju, a slijedi šećerna bolest i adipozitet.Ultrazvučna mjerenja su pokazala kako je prosječna debljina intraventrikularnog septuma (IVS) i stražnje stijenke lijeve klijetke (SSLK) deblja kod muškaraca u usporedbi sa ženama. Stijenka IVS zadebljana je u nešto više od polovice naših ispitanika, a 30% ispitanika ima zadebljanu stražnju stijenku lijeve klijetke. Istisna frakcija je u prosjeku iznosila 64.2%.
Pronađena je statistički značajna povezanost između stupnja i duljine trajanja arterijske hipertenzije i razvoja hipertrofije lijeve klijetke. Ne postoji statistički značajna povezanost stupnja arterijske hipertenzije niti duljine trajanja AH s istisnom frakcijom srca.

Zaključak. U našem istraživanju dokazana je statistički značajna međuovisnost između stupnja i duljine trajanja arterijske hipertenzije i razvoja hipertrofije lijeve klijetke, dok ista nije utvrđena u odnosu na istisnu frakciju. Najveći broj ispitanika imao je navedene pridružene bolesti (dislipidemija, šećerna bolest, adipozitet) koje su ujedno i rizični čimbenici za pojavu arterijske hipertenzije. Orijentacijska primjena ultrazvuka srca u hitnoj službi pokazuje kliničku značajnost, jer je u svakog drugog bolesnika (≥ 50%) otkrivena hipertrofija lijeve klijetke neovisno o uzimanju antihipertenzivnih lijekova.

Abstract (english)

Aim. The aim of the study is to determine the relationship between the degree and length of arterial hypertension with the left ventricle wall thickness (LVWT) and the ejection fraction (EF) of the heart.Type of study. A prospective cohort study was conducted.

Subjects and methods. The study included 50 patients examined in the cardiology clinic of the Clinical Hospital „Sveti Duh“ with a leading diagnosis of arterial hypertension made during processing through emergency department. The left ventricle wall thickness (LVWT) made up of thickness of intraventricular septum (IVS) and left ventricular rear wall expressed in centimeters (cm) and the ejection fraction (EF) of the heart were determined ultrasonically. Demographic data of patients (age, gender), associated diseases, chronic therapy and arterial pressure values were analyzed. The study included all patients over the age of 18 examined in a cardiac clinic after recommended diagnostic treatment during the emergency department, and under the main diagnosis of arterial hypertension, while patients with other pathological conditions that alter the architecture and impair heart contractility were excluded from the study.

Results. Arterial hypertension is more common in females (52%) compared to men (48%) while the average age of subjects is 58.7 years. The average duration of AH in our subjects is more than 6 years. The highest proportion of first-tier AH respondents (44%), followed by respondents with third grade AH (36%). The largest number of subjects took several individual antihypertensive drugs, and of the other chronic therapy, the majority of subjects took statins and antidiabetic drugs. Left ventricular hypertrophy (LVH) is present in more than half of the patients studied (54%) while just over half of LVH subjects have dyslipidemia, followed by diabetes mellitus and adiposity. Ultrasound measurements have shown that the average thickness of the intraventricular septum (IVS) and the posterior wall of the left ventricle is thicker in men compared to women. The IVS wall is thickened in just over half of our subjects, and 30% of respondents have a thickened back wall of the left ventricle. The ejection fraction averaged 64.2%. A statistically significant association between the degree and length of arterial hypertension and the development of left ventricular hypertrophy was found. There is no statistically significant correlation between the degree of arterial hypertension or the length of AH duration with the ejection fraction of the heart.

Conclusion. In our study, a statistically significant interdependence between the degree and length of arterial hypertension and the development of left ventricular hypertrophy was demonstrated, while the same was not established in relation to the ejection fraction. The largest number of subjects had these associated diseases (dyslipidemia, diabetes mellitus, adiposity) which are also risk factors for the appearance of arterial hypertension. Orientational use of heart ultrasound in the emergency department shows clinical significance, since in every other patient (≥ 50%) left ventricular hypertrophy was detected independently of taking antihypertensive drugs.

• Keywords: arterijska hipertenzija; hipertrofija lijeve klijetke; istisna frakcija; ultrazvuk; hitna medicinska služba
• Keywords (english): arterial hypertension; left ventricule hypertrophy; ejection faction; ultrasound; emergency medical services
• Language: croatian
• URN:NBN: urn:nbn:hr:105:665194
• Study programme: Title: Emergency medicine; Study programme type: university; Study level: postgraduate specialist; Academic / professional title: sveučilišni/a magistar/magistra hitne medicine (sveučilišni/a magistar/magistra hitne medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-04-05 12:20:47