Evaluation of cardiac tissue doppler examination, exercise capacity and endothelin levels in patients with bronchiectasis

Bronchiectasis (BE) is a characterized progressive disease with irreversible dilatation of the airways which is seen together with inflammatory destruction of bronchial peribronchial tissue depending on recurrent infections in pediatric age group. The most important reason of morbidity and mortality in BE is progressive respiratory failure. Chronic lung changes developing independent of etiology cause emergence of cardiac symptoms. The number of large scale study about cardiac function and effort capacity in patients with BE in pediatric age group is limited. Our goal is to enable early detection of pulmonary and cardiac dysfunction developing due to BE and prevention of irreversible damage. In Akdeniz University School of Medicine, Pediatric Allergy Immunology Pulmonology Department, Total 70 patients including 40 patient observed with BE diagnosis and 30 healthy children as control group have been included in the study. Patients have been evaluated in two groups that are non-KF BE (n=20) and KF-BE (n=20) and have been compared with the control group. Three groups included in the study are similar in terms of age, gender and body mass index. PFT and HRCT of the patients have been recorded from the file. M-mode, two dimensional (2D), color 2D, Doppler, color Doppler echocardiography and pulsed wave color tissue Doppler (PWDD) echocardiography reviews and 6MWT have been applied to patients. 5 cc venous blood sampling has been performed for ET levels. ET-1 levels have been determined as 5,92±2,30 in non-KF, 16,01±16,80 in KF group and 2,74±0,80 in control group. ET-1, ET-2 and ET-3 levels have been determined as statistically significant among all three groups (p=0.001). Average walking distance is 616,00±67,00 m in non KF-BE group, 602,00±75,00 m in KF-BE group, 593,00±71,00 m as for control group and significant difference among the groups have not been determined. When HRCT of the patients are evaluated, number of average lung lobes involved in non KF-BE group is 1,70±1,00; in KF group it is 1,50±1,00. Significant difference among the groups have not been determined. Statistically significant difference has not been observed in values of left ventricular systolic function in conventional echocardiographic examination. Statistically significant difference has been seen in just (p=0.020) and A (p=0.010) wave velocity in diastolic function. PA diameters have been determined in non- KF group as 1.65±0.10, in KF group as 1.71±0.20 and in control group as 1.54±0.20 and it has been statistically significant (p=0.040). TAPSE value has been determined in non- KF group as 2,11±0,10, in KF group as 2,11±0,10 and in control group as 2,11±0,10 and it has been statistically significant (p<0.05). In right ventricle PWDD evaluation, inter-groups change in IVCT and ET values has been found as statistically significant (p=0.010, p=0.010). In the evaluation made between non KF and KF groups, it has been seen that RV-MPI, the both groups have been statistically, significantly long (p=0.010). Similar to the findings of the right ventricle, just IVCT and ET have been evaluated as statistically significant in the evaluation of left ventricular PWDD (p=0.030, p= 0.020). In the comparison which has been made between KF group and control group, it has been seen that LVMPI has been statistically, significantly long (0.35±0.01). As a result, conventional echocardiographic evaluations in patients with BE may be insufficient in demonstrating cardiac dysfunction in early period. Advanced techniques are needed to evaluate in more advanced level. PWDD echocardiographic imaging is also one of these techniques. In our study, we have determined that there have been subclinical impairment of the right ventricular systolic and diastolic function in patients with BE followed in our hospital whose cardiac complications belonging to BE has not been diagnosed by conventional methods. Early detection of complications and taking preventive measures, prevention of morbidity and mortality are important in terms of improving quality of life. BE is a disease which shall be managed in a multidisciplinary way. In patients follow-ups, they must be seen by department of pediatric cardiology at regular intervals. In patients follow-ups, PWRDD imaging echocardiographic shall be included in examination in order to evaluate subclinical systolic and diastolic dysfunction in initial stage. There is a need for studies which have a great number of multicenter patients in order to determine normal values of 6MWT in children