Prognostičko značenje hipertrofije lijeve klijetke u kardiovaskularnom kontinuumu

master's thesis

• Title (english): Prognostic significance of left ventricular hypertrophy in the cardiovascular continuum
• Author: Lorena Bosnar
• Mentor: Mislav Vrsalović (mentor)
• Committee member: Zdravko Babić (predsjednik povjerenstva)
• Committee member: Martina Lovrić Benčić (član povjerenstva)
• Committee member: Mislav Vrsalović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Kardiovaskularni (KV) kontinuum lanac je događaja precipitiranih brojnim kardiovaskularnim faktorima rizika: dislipidemija, hipertenzija, dijabetes, pušenje i nedovoljna fizička aktivnost. Bez adekvatne terapijske intervencije, ovaj lanac neizbježno dovodi do ateroskleroze, koronarne bolesti srca, infarkta miokarda, hipertrofije i dilatacije lijeve klijetke, sistoličke i dijastoličke ventrikularne disfunkcije te u konačnici do zatajenja srca i smrti. Arterijska hipertenzija stanje je trajno povišenih vrijednosti sistoličkog (≥140 mmHg) i/ili dijastoličkog (≥90 mmHg) krvnog tlaka. Prevalencija arterijske hipertenzije je oko 30-45% ukupne populacije i raste proporcionalno s porastom dobi populacije. Hipertrofija lijeve klijetke (HLK) karakteristični je ishodišni patofiziološki mehanizam i nezavisni prediktor nepovoljnih KV događaja (infarkt miokarda, inzult, revaskularizacija karotida, fibrilacija atrija, zatajenje srca, smrt). Elektrokardiografski utvrđena HLK značajan je prognostički pokazatelj kardiovaskularnog morbiditeta i mortaliteta u populaciji hipertoničara kao i u klinički zdravih bolesnika. Procjena mase lijeve klijetke (LK) pomoću ehokardiografije pruža točnije prognostičke informacije nego evaluacija tradicionalnih KV rizičnih čimbenika. Veliku prognostičku važnost ima ehokardiografski determiniran uzorak HLK, pri čemu se najviši rizik povezuje sa koncentričnim tipom HLK. Redukcija mase LK usko je povezana sa smanjenjem krvnog tlaka. Europske smjernice iz 2013. godine preporučuju primjenu sljedećih skupina antihipertenziva u terapiji bolesnika s HLK: inhibitori angiotenzin konvertirajućeg enzima, blokatori angiotenzinskih receptora, blokatori kalcijskih kanala, beta blokatori i diuretici. Elektrokardiografski i ehokardiografski zabilježena regresija HLK tijekom antihipertenzivne terapije povezana je sa smanjenim KV morbiditetom i mortalitetom. Zaključno, pravovremena detekcija osoba pod rizikom ili otkrivanje već postojeće bolesti u njenom ranom stadiju preduvjet je za uspješnu prevenciju nastanka nepovoljnih kardiovaskularnih događaja.

Abstract (english)

Cardiovascular continuum is a sequence of events precipitated by a number of cardiovascular risk factors: dyslipidemia, hypertension, diabetes, smoking and physical inactivity. Without an adequate therapeutic intervention, it inevitably leads to atherosclerosis, coronary heart disease, myocardial infarction, hypertrophy and dilatation of the left ventricle (LV), systolic and diastolic dysfunction and eventually end-stage heart failure and death. Arterial hypertension is a state of permanently increased values of systolic (≥140 mmHg) and/or diastolic (≥90 mmHg) blood pressure. Prevalence of arterial hypertension is around 30-45% of total population and increases proportionally with to its age. Left ventricular hypertrophy (LVH) is a specific underlying pathophysiological mechanism and an independent predictor of adverse cardiovascular events (myocardial infarction, stroke, carotid revascularization, atrial fibrillation, heart failure, death). Electrocardiographically confirmed left ventricular hypertrophy is a significant prognostic indicator of cardiovascular morbidity and mortality in hypertensive as well as healthy patients. Estimation of left ventricular mass using echocardiography provides more accurate prognostic information than the traditional cardiovascular risk factors evaluation. Echocardiographically confirmed LVH pattern has a large prognostic importance, and the highest risk is associated with the concentric type. Reduction of LV mass is closely associated with the blood pressure decrease. The 2013 European guidelines recommend the use of the following antihypertensive agents: angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and diuretics. Electrocardiographically and echocardiographically confirmed LVH regression during antihypertensive therapy is associated with cardiovascular morbidity and mortality reduction. In conclusion, timely detection of patients at risk or detection of already existing disease at its earliest stage is a prerequisite for successful prevention of adverse cardiovascular events.

• Keywords: hipertrofija lijeve klijetke; kardiovaskularni kontinuum; elektrokardiografija; ehokardiografija; kardiovaskularni ishod
• Keywords (english): left ventricular hypertrophy; cardiovascular continuum; electrocardiography; echocardiography; cardiovascular outcome
• Language: croatian
• URN:NBN: urn:nbn:hr:105:686141
• 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: 2017-11-23 12:29:57