Dokument: Validierung der Handgrip-Belastung im Kontext der echokardiografischen Beurteilung einer dynamischen Mitralklappeninsuffizienz
| Titel: | Validierung der Handgrip-Belastung im Kontext der echokardiografischen Beurteilung einer dynamischen Mitralklappeninsuffizienz | |||||||
| Weiterer Titel: | Validation of the Handgrip Method in the context of echocardigraphic evaluation of dynamic mitral regurgitation | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=66741 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20240917-110609-9 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Lagarden, Hannah Lea [Autor] | |||||||
| Dateien: |
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| Beitragende: | Spieker, Maximilian [Gutachter] Prof. Dr. med Boeken, Udo [Gutachter] | |||||||
| Stichwörter: | Mitralklappeninsuffizienz, Belastung, Echokardiographie, Handgrip | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Die Mitralklappeninsuffizienz (MI) ist nach der OxValve Kohortenstudie das häufigste Vitium in der westlichen Bevölkerung bei Patienten über 65 Jahren. Die genaue Quantifizierung der Insuffizienz ist allerdings nicht trivial, da Veränderungen von Vor- und Nachlast den Schweregrad der MI relevant beeinflussen können. Um diese Veränderungen nachzuweisen und in die Diagnostik mit einfließen zu lassen, braucht es Untersuchungen unter körperlicher Belastung. Bisher ist der Goldstandard hierfür die Fahrrad-Echokardiographie, welche sich allerdings im klinischen Alltag komplex darstellt und für viele, vor allem ältere Patienten körperlich nicht zu bewältigen ist. Die Handgrip-Echokardiographie stellt hierbei eine bisher nicht validierte Alternative dar, die schneller und physisch einfacher für die Patienten umzusetzen ist. Da bisher kaum vergleichende Daten vorliegen, strebten wir mit dieser Arbeit durch einen Vergleich der beiden Belastungsmodalitäten eine Validierung der Handgrip- Echokardiographie an. Um zu eruieren, ob eine dynamische MI mit einem ungünstigen klinischen Outcome assoziiert ist und sich hieraus therapeutische Implikationen ableiten lassen, führten wir follow-up Untersuchungen nach einem Jahr durch. Hierzu haben wir bei 101 Patienten mit degenerativer MI (DMR) und bei 154 Patienten mit funktioneller MI (FMR) eine Ruhe- und Belastungsechokardiographie mittels 3-minütigem Handgrip-Manöver durchgeführt und echokardiographische sowie hämodynamische Parameter während beiden Untersuchungen erhoben. Hierbei zeigte sich eine dynamische MI, definiert als Anstieg der effective regurgitant orifice area um g 0,1cm2 bei jedem sechsten DMR Patienten (17%) und jedem siebten FMR Patienten (14%). Ein Vergleich der beiden Belastungsmethoden zeigte in einer Gruppe von 21 Patienten keine Unterschiede. In diesem Sinne suggerieren unsere Ergebnisse in diesem einmaligen, direkten Vergleich der Handgrip- und Fahrradechokardiographie eine Vergleichbarkeit der beiden Belastungsmodalitäten hinsichtlich der Auswirkungen auf die Hämodynamik und MI.
In einem Follow-up bei 231 Patienten in einem Zeitraum von 275 ±103 Tagen zu den Endpunkten Mortalität, Herzinsuffizienz-Hospitalisierung, Operationen oder Interventionen an der Mitralklappe und Herztransplantation/ Left Ventricular Assist Device Implantation zeigten sich in der Kohorte der DMR Patienten keine Unterschiede im endpunktfreien Überleben bei Patienten mit und ohne dynamische MI. Bei Patienten mit einer dynamischen FMR zeigte sich eine erhöhte Mortalität, eine erhöhte Rate an Herzinsuffizienz- Hospitalisierungen und eine erhöhte Rate an Operationen oder Interventionen an der Mitralklappe. Dementsprechend zeigten wir erstmals, dass es unter Handgrip-Belastung zu einer Zunahme der MI kommt, welche bei FMR Patienten mit einem ungünstigen klinischen Outcome vergesellschaftet ist.According to the OxValve Cohort-Study mitral regurgitation (MR) is the most common heart murmur among the western population in patients over the age of 65. Exact quantification, however, is far from trivial, since changes in pre- and after load can have a relevant impact on the severity of the MR. To detect those changes in a diagnostic setting an examination under physical exercise is required. Current gold standard in this regard is bicycle echocardiography which in a clinical context has proven to be complex and highly demanding for many, especially for elderly patients. In this context handgrip echocardiography in this context seems to be a non-validated alternative so far, which appears to be more feasible and quicker to perform for most patients. Since very little data compares the two approaches so far, we aimed to validate the handgrip method by means of our comparative study. Moreover, to evaluate whether dynamic MR is associated with worse clinical outcomes and whether therapeutical implications could be deducted therefrom, we performed a follow-up after one year. To achieve this goal, we performed an echocardiographic assessment at rest and after three minutes of handgrip exercise in 101 Patients with degenerative MR (DMR) and in 154 Patients with functional MR (FMR) and evaluated several echocardiographic- as well as hemodynamic parameters accordingly. These examinations revealed a dynamic component, defined as an increase in effective regurgitant orifice area (EROA) g 0,1 cm2 in every 6th patient with DMR (17%) and every 7th patient with FMR (14%). In a group of 21 patients the two methods of physical exercise did not show significant differences. Therefore, our unique, direct comparison between the two methods of exercise suggests good concordance and comparability concerning their effects on hemodynamics and MR. A follow-up among 231 patients in a timeframe of 275±103 days concerning the endpoints all-cause mortality, heart failure hospitalization, operations or interventions on the mitral valve, heart transplants or left ventricular assist device implantation showed no significant difference in the survival of DMR patients with or without dynamic MR. In patients with dynamic FMR a higher mortality, higher rate of heart faliure hospitalizations, a higher rate in operations or interventions on the mitral valve have been observed. Correspondingly, we were able to show for the first time that an increase in MR can be detected during handgrip exercise, which is linked to worse clinical outcomes among FMR patients. | |||||||
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| Lizenz: |  Dieses Werk ist lizenziert unter einer Creative Commons Namensnennung 4.0 International Lizenz | |||||||
| Bezug: | 2019-2024 | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 17.09.2024 | |||||||
| Dateien geändert am: | 17.09.2024 | |||||||
| Promotionsantrag am: | 26.02.2024 | |||||||
| Datum der Promotion: | 27.08.2024 |
