Xronik ishemik yurak yetishmovchiligi holatida yurakning bosqichma-bosqich remodellashtirilishini baholashda spekl-treking exokardiografiyasining o‘rni
Annotatsiya
Maqsad. Ikki o‘lchovli exokardiografiya asosida miokard deformatsiya ko‘rsatkichlarini tahlil qilgan holda, chap qorinchaning chiqarish fraksiyasi (ChQF) kamayish darajasiga qarab, ishemik kelib chiqishli surunkali yurak yetishmovchiligi (SYY) bo‘lgan bemorlarda yurak bo‘lmalarining global bosqichma-bosqich remodellashtirilishining xususiyatlarini baholash.
Materiallar va usullar. Tadqiqotga zamonaviy mezonlarga muvofiq tashxis qo‘yilgan 96 nafar SYY bemorlari kiritildi. Ular ChQF miqdoriga ko‘ra uch guruhga ajratildi: I guruh – ChQF > 50% (n = 46), sistolik funksiyasi saqlangan bemorlar; II guruh – ChQF 40–49% (n = 24), sistolik funksiyasi mo‘’tadil pasaygan bemorlar;
III guruh – ChQF < 40% (n = 26), sistolik funksiyasi sezilarli darajada pasaygan bemorlar. Chap qorinchaning global uzunlamasına deformatsiyasi (GLS) chiqarish fraksiyasi past bo‘lgan bemorlarda ancha past ko‘rsatkichlarni namoyon etdi.
Natijalar. ChQF > 50% bo‘lgan guruhda GLS ning o‘rtacha qiymati 17,0 ± 2,8% ni tashkil etdi. ChQF 40–49% va <40% bo‘lgan bemorlarda esa bu ko‘rsatkich mos ravishda 12,6 ± 2,1% va 9,4 ± 2,2% gacha kamaydi (p < 0,001). Shu kabi tendensiya GLS ning 4, 2 va 3 kamerali proyeksiyalarida ham kuzatildi. Bu ma’lumotlar GLS ko‘rsatkichining miokardning qisqarish funksiyasining pasayishiga yuqori sezuvchanligini ko‘rsatadi va chap qorinchaning funksional holatini baholashda klinik ahamiyatini tasdiqlaydi. Chap bo‘lmacha funksiyasi ikki o‘lchovli spekl-treking exokardiografiya orqali rezervuar, konduktor va qisqaruvchi fazalarda o‘rganilganda quyidagi ishonchli kamayishlar aniqlandi: – LASr (rezervuar faza): 35,5 ± 8,3% (ChQF > 50%) → 17,8 ± 11,2% (ChQF < 40%), p < 0,001; – LASct (konduktor faza): 17,6 ± 5,4% → 8,8 ± 6,5%, p < 0,001; – LAScd (qisqaruvchi faza): 18,7 ± 5,9% → 8,7 ± 4,6%, p < 0,001. Chap qorincha chiqarish fraksiyasi >50% bo‘lgan bemorlarda o‘ng qorinchaning uzunlamasına deformatsiya ko‘rsatkichlari eng yuqori bo‘ldi (RVFWLS — 21,3 ± 4,0%, RV GLS — 18,1 ± 3,2%). ChQF 40–49% bo‘lganlarda bu ko‘rsatkichlar mos ravishda 19,9 ± 2,8% va 16,0 ± 2,7% ni tashkil etgan bo‘lsa, ChQF < 40% bo‘lgan guruhda eng sezilarli pasayish qayd etildi (RVFWLS — 14,0 ± 4,1%, RV GLS — 10,5 ± 3,1%), guruhlar o‘rtasida statistik ahamiyatli farq mavjud edi (p = 0,001).
Xulosa. Ishemik kelib chiqishli surunkali yurak yetishmovchiligi bo‘lgan bemorlarda chap qorincha (ChQ), chap bo‘lmacha (ChB) va o‘ng qorinchaning (OQ) bosqichma-bosqich remodellashtirilishi va chiqarish fraksiyasi kamaygan sari funksional buzilishlarning kuchayishi kuzatildi. Chap qorinchaning global uzunlamasına strain (GLS) ko‘rsatkichlari, shuningdek chap bo‘lmacha (LASr, LASct, LAScd) va o‘ng qorinchaning (RVFWLS, RV GLS) deformatsion parametrlari yurak gemodinamikasidagi o‘zgarishlarga yuqori sezuvchanlikni ko‘rsatadi va SYY rivojlanishining erta belgilari sifatida xizmat qilishi mumkin. Spekl-treking exokardiografiya yurak miokardining subklinik disfunktsiyasini baholashda informativ, invaziv bo‘lmagan usul bo‘lib, SYY ning turli darajadagi og‘irlik holatida xavfni baholash va davolash samaradorligini monitoring qilishda foydali bo‘lishi mumkin.
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Copyright (c) 2025 Ф.М. Бекметова , Х.Г. Фозилов , Р.Ш. Бекбулатова , Ш.У. Хошимов , Ш.А. Оринбаев (Автор)
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