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İLERİ KONJESTİF KALP YETERSİZLİKLİ HASTALARDA KARVEDİLOLÜN SOLVENTRİKÜL FONKSİYONLARI VE ARİTMİ ÜZERİNE ETKİSİ

THE EFFECTS OF CARVEDILOL ON LEFT VENTRICULAR FUNCTIONS AND ARRHYTHMIAS IN PATIENTS WITH SEVERE CARDIAC FAILURE

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Abstract (2. Language): 
Objective: Arrhythmia are seen frequently in patients with heart failure (HF). Carvedilol which has both beta-blocker and alfa-blocker properties has led to new expectations in the treatment of HF. Our aim is to explore the effect of carvedilol on left ventricular (LV) function and development of arrhythmia in patients with HF. Materials and method: Thirty-one patients (60±10 years, F/M:11/20) were enrolled for the study who had advanced HF in sinus rhythm. After echocardiography, 24 hour Holter, heart rate variability analysis (HRV), signal averaged ECG, carvedilol was added to their treatment(diuretic and ACEI). Carvedilol dosage was increased to the upper tolerable limit. The same analysis were repeated in 12th and 24th week. Results: Marked improvement was found in LV function in 12 and 24th week (respectively; EF %30.1 ± 6.3 vs 33.8 ± 6.8, p:0.005, Tei index: 0.50 ± 0.21 vs 0.40 ± 0.15, p:0.006 and EF % 30.1 ± 6.3 vs 33.7 ± 6.6, p:0.01, Teiindex: 0.50 ± 0.21 vs 0.41 ± 0.19, p:0.03). Before carvedilol, arrhythmias including VT were found in eight patients in holter , whereas they were observed in five patients at 12th week. While late potential positivity was found in 10 patients initially and was found in 7 patients at 24th week. Total QRS was decreased significantly (120.6 ± 28.8 vs 116.3 ± 24.3, p:0.03). Significant increases were observed in SDNN both at 12th week and 24th week (respectively 64.2±30.3, 89.5±36.2, 93.5±37, p<0.001) and SDANN (16.1±8.3, 22.8±16.5, 20.6±8.8, p:0.02, p:0.003). Conclusion: Carvedilol causes improvement in LV systolic function, decreases the frequency of arrhythmia, decreases late potential positivity and improves HRV parameters in HF patients.
Abstract (Original Language): 
Amaç: ‹leri evre kalp yetersizli¤i(KY) olan hastalarda sempatik sistemde art›fla ba¤l› aritmi ve ani ölüm s›kd›r. Beta bloker ve alfa-bloker özelli¤i olan karvedilol, KY tedavisinde beklentilere neden olmufltur. Çal›flmam›z›n amac› ileri evre KY olan hastalarda tedaviye eklenen karvedilolün sol ventrikül fonksiyonlar› ve aritmi geliflimine etkisini araflt›rmakt›r. Gereç ve yöntem: Çal›flmaya sinüs ritminde ileri evre KY olan, beta bloker kullanmayan 31 hasta (ortalama yafl: 60 ± 10 y›l, K /E:11/20) al›nd›. Hastalara ekokardiyografi, 24 saatlik ritm Holteri ve kalp h›z› de¤iflkenlik analizi (HRV), sinyal ortalamal› EKG analizi yap›ld›ktan sonra, almakta olduklar› (diüretik ve ACEI) tedaviye ilaveten, karvedilol 2 x 3.125 baflland›. Karvedilol dozu tolere edebildikleri üst s›n›ra ç›k›ld›, 12. ve 24. haftada tetkikler tekrarland›. Bulgular: 12.ve 24. haftan›n sonunda sol ventrikül sistolik fonksiyonlar›nda belirgin düzelme saptand› (s›ras›yla; EF %30,1 ± 6,3 vs 33,8 ± 6,8, p:0,005, Tei index: 0,50 ± 0,21 vs 0,40 ± 0,15, p:0,006 ve EF % 30,1 ± 6,3 vs 33,7 ± 6,6, p:0,01, Tei index: 0,50 ± 0,21 vs 0,41 ± 0,19, p:0,03). Holterde 8 hastada saptanan VT dahil kompleks aritmi, 12. haftada 5 hastada saptand›. Sinyal ortalamal› EKG’de 10 hastada saptanan geç potansiyel pozitifli¤i 12. haftada 8, 24. haftada 7 hastada gözlendi. Total QRS de anlaml› azalma oldu¤u saptand›(120,6 ± 28,8 vs 116,3 ± 24,3, p:0,03). HRV parametrelerinden SDNN (12. haftada, 64,2 ± 30,3 vs 89,5 ± 36,2, p<0,001, 24. haftada; 64,2 ± 30,3 vs 93,5 ± 37, p<0,001) ve SDANNda hem 12. haftada hem de 24. haftada anlaml› artma gözlendi (16,1 ± 8,3 vs 22,8 ± 16,5, p:0,02, 24. haftada; 16,1 ± 8,3 vs 20,6 ± 8,8, p:0,03). Sonuç: ‹leri evre KY olan hastalarda tedaviye eklenen karvedilol, sol ventrikül sistolik fonksiyonlar›nda düzelme sa¤lamaktad›r. Ani ölüme neden olan kompleks aritmi s›kl›¤›n›, geç potansiyel pozitifli¤ini azaltmakta, HRV parametrelerini düzeltmektedir.
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