Sol ventrikül sistolik kalp yetersizliğinin tanısı ve değerlendirilmesinde serum fetuin-a düzeyinin yeri
Loading...
Date
2012
Authors
Keçebaş, Mesut
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Kalp yetersizliği, miyokardın sistolik ve/veya diyastolik fonksiyonlarında bozulma ve nörohormonal aktivite artışı ile karakterize klinik bir sendromdur. Etkin tedavisi yapılmazsa ilerleyici olup kardiyovasküler hastalıkların başlıca morbidite ve mortalite nedenini oluşturmaktadır. Son yıllarda koroner arter hastalığı, diyabetes mellitus, kronik renal yetersizlik ve obezite gibi kardiyovasküler komplikasyonlara neden olabilecek hastalıkların etiyolojisinde karaciğerden salınan negatif akut faz reaktanı ve sistemik kalsifikasyon inhibitörü olan fetuin-A'nın (a2-Heremans Schmid glikoprotein) etkisinin olduğu saptanmıştır. Fetuin-A'dan yoksun fare kalplerinde yapılan bir çalışmada kardiyak fibrozis ve kalsifikasyonun arttığı, kalpte diyastolik ve sistolik fonksiyonların bozulmasına neden olduğu saptanmıştı. Çalışmamızda sol ventrikül sistolik kalp yetersizliğinin tanısı ve değerlendirmesinde serum fetuin-A düzeyinin önemini saptamak ve serum pro-BNP düzeyi ile karşılaştırmak amaçlanmıştır.Uludağ Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalı'na Temmuz 2011 ile Ocak 2012 tarihleri arasında kalp yetersizliği tanısı ile başvuran 66 hasta kalp yetersizliği grubunu ve kalp yetersizliği tanısı olmayan 31 olgu kontrol grubunu oluşturdu. Biyokimyasal tetkikler için aydınlatılmış onam alındıktan sonra kontrol ve kalp yetersizliği hastalarından venöz kan örnekleri alındı ve hemogram, üre, kreatinin, sodyum (Na), Lipid profili [total kolesterol, yüksek ve düşük dansiteli lipoprotein kolesterol (HDL-K, LDL-K), trigliserid], açlık kan şekeri, CRP, proBNP ve fetuin-A çalışıldı. Ekokardiyografik incelemeleri ayrıntılı olarak yapıldı.Serum fetuin-A düzeyi kontrol grubuna göre kalp yetersizliği grubunda anlamlı olarak düşük bulundu (sırasıyla 526,36 (282,98-726,58)'a 72,94(14,11-648,88) g/ml, p<0,001). Serum CRP ve pro-BNP düzeyleri kontrol grubuna göre kalp yetersizliği grubunda anlamlı olarak daha yüksek (p<0,001) saptandı. Serum pro-BNP ve CRP değerleri fonksiyonel kapasitesi sınıf I-II olanlara göre sınıf III-IV olan hastalarda anlamlı olarak daha yüksek saptandı (p<0,001). Serum fetuin-A düzeyi fonksiyonel kapasitesi sınıf I-II olanlara göre sınıf III-IV olan hastalarda daha düşük saptanmasına rağmen iki grup arasında anlamlı farklılık izlenmedi. Tüm olgular değerlendirildiğinde fetuin-A düzeyi ile sol ventrikül ejeksiyon fraksiyonu arasında pozitif korelasyon; pro-BNP ve CRP arasında negatif korelasyon saptandı (sırasıyla r: 0,732 p<0,001; r: -0,542 p<0,001; r: -0,352 p<0,001). Çalışmaya alınan olgularda serum fetuin-A düzeyi kontrol grubuna göre kalp yetersizliği olan hastalarda, dilate kardiyomiyopati hasta grubuna göre iskemik kardiyomiyopatili hasta grubunda anlamlı olarak daha düşük saptandı. Çalışılan örneklemde serum pro-BNP için ROC analizi yapıldığında ROC eğrisinde çizgi altında kalan alanın %96,9 olduğu ve 184,1 pg/ml pro-BNP değeri ``cut off'' olarak alındığında %95,45 duyarlılık ve %96,77 özgüllük ile sol ventrikül sistolik kalp yetersizliğini öngördüğü saptandı (p<0,001). Serum fetuin-A düzeyi için ROC analizi yapıldığında ROC eğrisinde çizgi altında kalan alanın %96 olduğu ve 270,45 g/ml fetuin-A değeri ``cut off'' olarak alındığında %86,36 duyarlılık ve %96,77 özgüllük ile sol ventrikül sistolik kalp yetersizliğini öngördüğü saptandı (p<0,001).Sonuç olarak, çalışmamız sistolik kalp yetersizliği olan hastalarda serum fetuin-A düzeyinin azaldığını gösteren ilk çalışmadır. Sol ventrikül sistolik kalp yetersizliğini öngörmede fetuin-A'nın ``cut off'' değeri 270,45 pg/ml olarak saptandı. Serum fetuin-A düzeyinin sistolik kalp yetersizliği olan hastaları yüksek duyarlılık ve özgüllük ile saptayabildiğini ve pro-BNP kadar güçlü tanısal belirteç olduğu gösterildi. Ancak serum fetuin-A çok fonksiyonlu bir protein olması nedeniyle birçok olaydan etkilenmektedir. Serum fetuin-A ile kalp yetersizliğini değerlendirmek için hasta gruplarının iyi irdelendiği ve örneklem sayısının fazla olduğu çalışmalara ihtiyaç vardır.
Heart failure is a clinical syndrome characterized by the increased neurohormonal activity and systolic and/or diastolic dysfunction of the myocardium and without effective treatment, it is progressive and constitutes the major cause of morbidity and mortality of the cardiovascular diseases. In recent years, the effect of the fetuin-A (a2-Heremans Schmid glycoprotein) ,a negative acute phase reactant released by the liver, was found to be the etiology of diseases that can cause cardiovascular complications, such as coronary artery disease, obesity and diabetes mellitus. In a study of the hearts of mice lacking fetuin-A, it was noted that cardiac fibrosis and calcification was increased, diastolic and systolic functions of the heart was deteriorated. In our study, it was aimed to evaluate the importance of serum fetuin-A levels in the diagnosis and assessment of left ventricular systolic heart failure and to compare with the level of serum pro-BNP.We enrolled 66 patients with a diagnosis of heart failure and 31 patients without a diagnosis of heart failure forming a control group who admitted to the Department of Cardiology at Uludag University Medical Faculty, Bursa, between July 2011 to January 2012. After informed consent for biochemical examinations had been obtained, venous blood samples were collected from the controls and the patients with chronic heart failure. In seperated sera; hemogram, urea, creatinine, sodium (Na), lipid profile [total cholesterol, high and low density lipoprotein cholesterol (HDL-C, LDL-C), triglycerides], fasting blood glucose, CRP, pro-BNP and fetuin-A were studied. Both study and control group patients had detailed echocardiographic examination.Median serum fetuin-A levels of the heart failure group was significantly lower than the control group (p<0,001) [respectively 72.94 (14.11 to 648.88) ?g/ml, 526.36 (282.98 to 726.58) g/ml]. Serum CRP and pro-BNP levels in the heart failure group was detected significantly higher than the control group (p <0.001). Serum pro-BNP and CRP levels of the patients with functional capacity class III-IV was significantly higher according to those with functional capacity class I-II (p <0.001). Serum fetuin-A level of the patients with functional capacity class III-IV was detected lower than those with class I-II. However, there was no significant differences between the two groups. In all cases, fetuin-A levels positively correlated with left ventricular ejection fraction (EF) and negatively correlated with pro-BNP and CRP (respectively, r: 0.732 p <0.001, r: -0.542 p <0.001, r: -0.352 p <0.001). Serum fetuin-A levels in patients with heart failure compared with control group and patients with ischemic cardiomyopathy according to patients with dilated cardiomyopathy was revealed significantly lower. ROC analysis was done for the studied sample of serum pro-BNP, the area under the ROC curve was 96,9% and the `cut off level was determined as 184.1 pg / ml for pro-BNP giving a sensitivity of 95,45% and specificity of 96,77% for the diagnosis of the left ventricular heart failure (p<0,001). ROC analysis was done for the serum fetuin-A, the area under the ROC curve was 96% and the `cut off level was determined as 270,45 ug / ml for fetuin-A giving a sensitivity of 86,36% and specificity of 96,77% for the diagnosis of the left ventricular heart failure (p<0,001).In conclusion, our study was the first study showing decreased serum fetuin-A levels in patients with left ventricular systolic heart failure. For the diagnosis of the left ventricular heart failure, the `cut off level of the serum fetuin-A was determined as 270,45 ug/ml (p<0,001). Serum fetuin-A was a diagnostic marker with high sensitivity and specificity for the patients with systolic heart failure and showed that it was as powerful marker as serum pro-BNP. However, due to a multifunctional protein, serum fetuin-A is affected by many factors. Well-designed and more sample sized studies are needed to elucidate the relationship between serum fetuin-A level and heart failure.
Heart failure is a clinical syndrome characterized by the increased neurohormonal activity and systolic and/or diastolic dysfunction of the myocardium and without effective treatment, it is progressive and constitutes the major cause of morbidity and mortality of the cardiovascular diseases. In recent years, the effect of the fetuin-A (a2-Heremans Schmid glycoprotein) ,a negative acute phase reactant released by the liver, was found to be the etiology of diseases that can cause cardiovascular complications, such as coronary artery disease, obesity and diabetes mellitus. In a study of the hearts of mice lacking fetuin-A, it was noted that cardiac fibrosis and calcification was increased, diastolic and systolic functions of the heart was deteriorated. In our study, it was aimed to evaluate the importance of serum fetuin-A levels in the diagnosis and assessment of left ventricular systolic heart failure and to compare with the level of serum pro-BNP.We enrolled 66 patients with a diagnosis of heart failure and 31 patients without a diagnosis of heart failure forming a control group who admitted to the Department of Cardiology at Uludag University Medical Faculty, Bursa, between July 2011 to January 2012. After informed consent for biochemical examinations had been obtained, venous blood samples were collected from the controls and the patients with chronic heart failure. In seperated sera; hemogram, urea, creatinine, sodium (Na), lipid profile [total cholesterol, high and low density lipoprotein cholesterol (HDL-C, LDL-C), triglycerides], fasting blood glucose, CRP, pro-BNP and fetuin-A were studied. Both study and control group patients had detailed echocardiographic examination.Median serum fetuin-A levels of the heart failure group was significantly lower than the control group (p<0,001) [respectively 72.94 (14.11 to 648.88) ?g/ml, 526.36 (282.98 to 726.58) g/ml]. Serum CRP and pro-BNP levels in the heart failure group was detected significantly higher than the control group (p <0.001). Serum pro-BNP and CRP levels of the patients with functional capacity class III-IV was significantly higher according to those with functional capacity class I-II (p <0.001). Serum fetuin-A level of the patients with functional capacity class III-IV was detected lower than those with class I-II. However, there was no significant differences between the two groups. In all cases, fetuin-A levels positively correlated with left ventricular ejection fraction (EF) and negatively correlated with pro-BNP and CRP (respectively, r: 0.732 p <0.001, r: -0.542 p <0.001, r: -0.352 p <0.001). Serum fetuin-A levels in patients with heart failure compared with control group and patients with ischemic cardiomyopathy according to patients with dilated cardiomyopathy was revealed significantly lower. ROC analysis was done for the studied sample of serum pro-BNP, the area under the ROC curve was 96,9% and the `cut off level was determined as 184.1 pg / ml for pro-BNP giving a sensitivity of 95,45% and specificity of 96,77% for the diagnosis of the left ventricular heart failure (p<0,001). ROC analysis was done for the serum fetuin-A, the area under the ROC curve was 96% and the `cut off level was determined as 270,45 ug / ml for fetuin-A giving a sensitivity of 86,36% and specificity of 96,77% for the diagnosis of the left ventricular heart failure (p<0,001).In conclusion, our study was the first study showing decreased serum fetuin-A levels in patients with left ventricular systolic heart failure. For the diagnosis of the left ventricular heart failure, the `cut off level of the serum fetuin-A was determined as 270,45 ug/ml (p<0,001). Serum fetuin-A was a diagnostic marker with high sensitivity and specificity for the patients with systolic heart failure and showed that it was as powerful marker as serum pro-BNP. However, due to a multifunctional protein, serum fetuin-A is affected by many factors. Well-designed and more sample sized studies are needed to elucidate the relationship between serum fetuin-A level and heart failure.
Description
Keywords
Kalp yetersizliği, Sistolik kalp yetersizliği, Ejeksiyon fraksiyonu, Serum pro-BNP, Serum fetuin-A, Heart failure, Systolic heart failure, Ejection fraction
Citation
Keçebaş, M. (2012). Sol ventrikül sistolik kalp yetersizliğinin tanısı ve değerlendirilmesinde serum fetuin-a düzeyinin yeri. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.