Dokument: Diagnostischer und prognostischer Nutzen der Handgrip-Echokardiographie bei Patienten mit ischämischer Mitralklappeninsuffizienz

Titel:

Diagnostischer und prognostischer Nutzen der Handgrip-Echokardiographie bei Patienten mit ischämischer Mitralklappeninsuffizienz

Weiterer Titel:

Diagnostic and Prognostic Value of Handgrip Echocardiography in Patients with Ischemic Mitral Regurgitation

URL für Lesezeichen:

https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=68970

URN (NBN):

urn:nbn:de:hbz:061-20250414-111903-2

Kollektion:

Dissertationen

Sprache:

Deutsch

Dokumententyp:

Wissenschaftliche Abschlussarbeiten » Dissertation

Medientyp:

Text

Autor:

Sidabras, Jonas [Autor]

Dateien:

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Dateien vom 10.03.2025 / geändert 10.03.2025

Beitragende:

Spieker, Maximilian Claus [Gutachter]
Prof. Dr. med. Payam Akhyari [Gutachter]

Stichwörter:

Ischämische Mitralklappeninsuffizienz, Dynamische Mitralinsuffizienz, Handgrip-Echokardiographie

Dewey Dezimal-Klassifikation:

600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit

Beschreibungen:

Hintergrund: Die Mitralklappeninsuffizienz (MI) stellt in den Industrieländern die zweithäufigste Herzklappenerkrankung bei Patienten über 65 Jahren dar. Die sekundäre ischämische MI kann sich nach einem stattgehabten Myokardinfarkt entwickeln und ist mit einer erhöhten Mortalität assoziiert. Da sich die Insuffizienz abhängig von der hämodynamischen Situation variabel präsentieren kann, kommt der Belastungsuntersuchung eine wichtige Bedeutung zu, um eine Insuffizienz auf ihre hämodynamische Relevanz auch unter Belastung zu überprüfen. Die Handgrip-Belastung bietet neben dem Goldstandard, der fahrradergometrischen Belastung, eine weitere Möglichkeit, die Dynamik der MI unter Belastung zu provozieren.
Hypothese: Die Handgrip-Belastung steigert den diagnostischen und prognostischen Nutzen der echokardiographischen Bewertung einer MI.
Methode: In diese klinisch-prospektive Studie wurden insgesamt 205 Patienten mit ischämischer MI, die eine transthorakale Echokardiographie in Ruhe und unter Handgrip-Belastung erhalten haben, eingeschlossen. Die Studie wurde anhand detaillierter und umfassender echokardiographischer Auswertungen durchgeführt, wobei ein hochstandardisiertes Protokoll angewendet wurde. Die Patienten wurden ein Jahr nach Studieneinschluss nachverfolgt und die Ein-Jahres-Mortalität erfasst.
Ergebnisse: Die Prävalenz der dynamischen MI (Anstieg der EROA >0,1 cm²) unter isometrischer Handgrip-Belastungsuntersuchung betrug 16 %. Bei 28 % der Patienten konnte ein Anstieg des Schweregrades der MI um eine Stufe beobachtet werden.
Prädiktoren für eine dynamische MI waren: der WMSi, der endsystolische sowie enddiastolische Annulusdiameter und die Länge des AML.
Zusätzlich zeigte sich bei Patienten mit reduzierter linksventrikulärer systolischer Funktion eine Korrelation zwischen den Veränderungen der EROA, des effektiven LVSVi ‘ und des CI‘. Die Patienten mit dynamischer hochgradiger MI unter Belastung zeigten höhere kombinierte Ereignisraten und wiesen die gleiche Häufigkeit hinsichtlich Mitralklappenoperationen und Interventionen wie die Patienten mit hochgradiger MI in Ruhe auf.
Zusammenfassung: Die Handgrip-Belastungsuntersuchung zeigte einen diagnostischen und prognostischen Nutzen bei Bewertung der ischämischen MI. Die Handgrip-Belastungsuntersuchung sollte bei Patienten mit leichtgradiger oder mittelgradiger ischämischer MI durchgeführt werden, um die Dynamik dieser Insuffizienz zu detektieren. Um den weiteren diagnostischen und prognostischen Nutzen der Handgrip-Echokardiographie bei Patienten mit sekundärer ischämischer MI zu beurteilen, müssen noch weitre prospektive multizentrische Studien durchgeführt werden.

Background: Mitral regurgitation (MR) is the second most common heart valve disease in industrialized countries among patients over 65 years old. Secondary ischemic MR can develop
after a myocardial infarction and is associated with increased mortality. As the insufficiency can present variably depending on the hemodynamic situation, exercise testing plays a crucial
role in assessing its hemodynamic relevance under exercise. In addition to the gold standard of bicycle ergometry, handgrip exercise testing provides another means to provoke the dynamics of MR during exercise.
Hypothesis: Handgrip exercise testing enhances the diagnostic and prognostic value of echocardiographic evaluation of mitral regurgitation.
Method: This clinically prospective study included a total of 205 patients with ischemic MI who underwent transthoracic echocardiography at rest and during handgrip exercise. The study employed detailed and comprehensive echocardiographic evaluations using a highly standardized protocol. Patients were followed up one year after study enrolment, and one-year
mortality was recorded.
Results: The prevalence of dynamic MR (increase in EROA >0.1 cm²) during isometric handgrip exercise testing was 16%. In 28% of patients, an increase in the severity of MI by one
stage was observed. Predictors for dynamic MR included WMSi, end-systolic and end-diastolic annulus diameter,
and length of the AML. Additionally, patients with reduced left ventricular systolic function showed a correlation between changes in EROA, effective LVSVi, and CI.
Patients with dynamic severe MI under exercise exhibited higher combined event rates and had the same frequency of mitral valve surgeries and interventions as patients with severe MI at
rest.
Summary: Handgrip exercise testing demonstrated diagnostic and prognostic benefits in assessing ischemic MR. Handgrip exercise testing should be performed in patients with mild or
moderate ischemic MR to detect the dynamics of this regurgitation. Prospective multicentre future studies are needed to evaluate the diagnostic and prognostic benefits of handgrip
echocardiography in patients with secondary ischemic MR further.

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Dieses Werk ist lizenziert unter einer Creative Commons Namensnennung 4.0 International Lizenz

Fachbereich / Einrichtung:

Medizinische Fakultät

Dokument erstellt am:

14.04.2025

Dateien geändert am:

14.04.2025

Promotionsantrag am:

06.03.2025

Datum der Promotion:

10.03.2025

Heinrich-Heine-Universität Düsseldorf

Dokument: Diagnostischer und prognostischer Nutzen der Handgrip-Echokardiographie bei Patienten mit ischämischer Mitralklappeninsuffizienz