Sol ventrikül sistolik kalp yetersizliğinin tanısı ve değerlendirilmesinde serum lektin-like okside ldl reseptör-1 düzeyinin yeri
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Date
2012
Authors
Beşli, Feyzullah
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Kalp yetersizliği sıklığı giderek artan, önemli morbidite ve mortaliteye sahip ciddi bir sağlık problemidir. Kalp yetersizliği tanısının erken dönemde saptanması ve tedaviye başlanması morbidite ve mortalitenin azalmasını sağlar. Kalp yetersizliğinde ortaya çıkan semptomlar birçok hastalıkta bulunabilmekte ve tanıyı güçleştirmektedir. Bu nedenle kalp yetersizliği tanısı için yardımcı testler kullanılmaktadır. Bu tanısal testler içerisinde üzerinde en çok çalışılan molekül B tip natriüretik peptid (BNP)'dir. Ayrıca kalp yetersizliğinin tanısında faydalı olabileceği düşünülen birçok molekül üzerinde de çalışılmaktadır. Son yıllarda Lektin-like okside LDL reseptörü-1 (LOX-1) ile ilgili bir çok çalışma yapılmıştır. Yapılan bir çalışmada; sağlıklı farelere göre, kalp yetersizliği olan farelerde LOX-1 mRNA düzeyleri anlamlı olarak daha yüksek saptanmıştır. Bu çalışmada sol ventrikül sistolik kalp yetersizliğinin tanısı ve değerlendirilmesinde serum LOX-1 düzeyinin yeri ve pro-BNP ile ilişkisini değerlendirmeyi amaçladık.Uludağ Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalı'na Ekim 2011 ile Nisan 2012 tarihleri arasında başvuran, kalp yetersizliği olan 55 kişi hasta grubu ve kalp yetersizliği tanısı olmayan 25 kişi kontrol grubu olarak, kabul edilme ve dışlama kriterleri doğrultusunda çalışmaya alındı. Olgulardan ayrıntılı anamnez alındı ve fizik muayeneleri yapıldı. Tüm olgulara elektrokardiyografi çekildi ve ekokardiyografi yapıldı. Hastalardan rutin biyokimyasal tetkikler, CRP, pro-BNP ve LOX-1 çalışıldı.Çalışmamızda LOX-1 ve pro-BNP düzeyi; kontrol grubuna göre, kalp yetersizliği olan hastalarda anlamlı olarak daha yüksek bulundu ve sol ventrikül EF ile negatif korelasyon göstermekteydi. Fakat LOX-1 düzeyi ile pro-BNP düzeyleri arasında anlamlı bir ilişki saptanmadı. Ayrıca LOX-1 düzeyi, dilate kardiyomiyopatili (DKMP) hasta grubuna göre iskemik kardiyomiyopatili (İKMP) hasta grubunda anlamlı olarak daha yüksek saptandı. LOX-1 düzeyi 1,31 ng/ml cut off değerinde DKMP'li hastaları göstermede %41,7 duyarlılık, %96 özgüllüğe sahipken; İKMP'li hastaları göstermede %67,7 duyarlılık, %96 özgüllüğe sahipti. LOX-1 düzeyi ile hastaların fonksiyonel kapasiteleri arasında anlamlı bir ilişki saptanmadı.Sonuç olarak çalışmamız sol ventrikül sistolik kalp yetersizliği olan hastaların tanısında serum LOX-1 düzeyinin kullanılabileceğini gösteren ilk çalışmadır. LOX-1'in özellikle İKMP'li hastaların tanısında önemli bir yeri olabileceği gösterilmiştir.Çalışmamız tek merkezli, sınırlı sayıda hastada ve sınırlı sürede yapılmıştır. Serum LOX-1 düzeyinin, kalp yetersizliğinin tanı ve değerlendirilmesinde kullanımı için; daha geniş popülasyonda, çok merkezli randomize, prospektif çalışmalara ihtiyaç vardır.
The heart failure, increasing incidence, is a serious health problem with significant morbidity and mortality. Early detection of heart failure diagnosis and beginning treatment reduces morbidity and mortality. Symptoms of the heart failure can be found many diseases and this makes it difficult to diagnosis. For this reason, for the diagnosis of the heart failure, other diagnostic tests are used to help. In recent years, the most extensively studied diagnostic tests is the B-type natriuretic peptide (BNP). In addition, many molecules, which might be useful in the diagnosis of heart failure have been also studied. In recent years a lot of research has been done with lectin-like oxidized LDL receptor-1 (LOX-1). In a study; it was noted that mice with heart failure had significantly higher LOX-1 mRNA levels than the healthy mice. In the study, we aimed to evaluate the importance of the serum LOX-1 levels in the diagnosis and assessment of left ventricular systolic heart failure and relationship with the level of serum pro-BNP.It was enrolled 55 patients with a diagnosis of heart failure forming patient group and 25 patients without a diagnosis of heart failure forming a control group who admitted the Department of Cardiology at Uludag University Medical Faculty between October 2011 to April 2012 according to admission and exclusion criteria. Detailed history was taken and physical examination of the cases was performed. Echocardiography was performed in all cases. In patients serum CRP, pro-BNP and LOX-1 were studied.In our study, serum LOX-1 and pro-BNP levels in the heart failure group were detected significantly higher than the control group and showed negative correlations with the left ventricular ejection fraction (EF). However, there was no significant relationship between serum LOX-1 and pro-BNP levels. In addition, LOX-1 level in patients with ischemic cardiomyopathy was significantly higher than the patients with dilated cardiomyopathy. ROC analysis was done for the studied sample of serum LOX-1, the `cut off level was determined as 1,31 ng / ml for LOX-1 giving a sensitivity of 41,7 % and specificity of 96 % for the diagnosis of the dilated cardiomyopathy; giving a sensitivity of 67,7 % and specificity of 96 % for the diagnosis of the ichemic cardiomyopathy. There was no significant association between LOX-1 level and the functional capacity of patients.Our study was the first study showing the utility of the serum LOX-1 levels in the diagnosis of the patients with left ventricular systolic heart failure. LOX-1 was shown to be important place in the diagnosis of the patients with the ischemic cardiomyopathy.Our study was made in a single center with a limited number of the patients and a limited period. For the usage of the serum LOX-1 level in the diagnosis and assessment of left ventricular systolic heart failure; multicenter, more sample sized prospective studies are needed.
The heart failure, increasing incidence, is a serious health problem with significant morbidity and mortality. Early detection of heart failure diagnosis and beginning treatment reduces morbidity and mortality. Symptoms of the heart failure can be found many diseases and this makes it difficult to diagnosis. For this reason, for the diagnosis of the heart failure, other diagnostic tests are used to help. In recent years, the most extensively studied diagnostic tests is the B-type natriuretic peptide (BNP). In addition, many molecules, which might be useful in the diagnosis of heart failure have been also studied. In recent years a lot of research has been done with lectin-like oxidized LDL receptor-1 (LOX-1). In a study; it was noted that mice with heart failure had significantly higher LOX-1 mRNA levels than the healthy mice. In the study, we aimed to evaluate the importance of the serum LOX-1 levels in the diagnosis and assessment of left ventricular systolic heart failure and relationship with the level of serum pro-BNP.It was enrolled 55 patients with a diagnosis of heart failure forming patient group and 25 patients without a diagnosis of heart failure forming a control group who admitted the Department of Cardiology at Uludag University Medical Faculty between October 2011 to April 2012 according to admission and exclusion criteria. Detailed history was taken and physical examination of the cases was performed. Echocardiography was performed in all cases. In patients serum CRP, pro-BNP and LOX-1 were studied.In our study, serum LOX-1 and pro-BNP levels in the heart failure group were detected significantly higher than the control group and showed negative correlations with the left ventricular ejection fraction (EF). However, there was no significant relationship between serum LOX-1 and pro-BNP levels. In addition, LOX-1 level in patients with ischemic cardiomyopathy was significantly higher than the patients with dilated cardiomyopathy. ROC analysis was done for the studied sample of serum LOX-1, the `cut off level was determined as 1,31 ng / ml for LOX-1 giving a sensitivity of 41,7 % and specificity of 96 % for the diagnosis of the dilated cardiomyopathy; giving a sensitivity of 67,7 % and specificity of 96 % for the diagnosis of the ichemic cardiomyopathy. There was no significant association between LOX-1 level and the functional capacity of patients.Our study was the first study showing the utility of the serum LOX-1 levels in the diagnosis of the patients with left ventricular systolic heart failure. LOX-1 was shown to be important place in the diagnosis of the patients with the ischemic cardiomyopathy.Our study was made in a single center with a limited number of the patients and a limited period. For the usage of the serum LOX-1 level in the diagnosis and assessment of left ventricular systolic heart failure; multicenter, more sample sized prospective studies are needed.
Description
Keywords
Kalp yetersizliği, Sol ventrikül sistolik kalp yetersizliği, Pro-BNP, Serum Lektin-like okside LDL reseptör-1, Ejeksiyon fraksiyonu, Heart failure, Left ventricular systolic heart failure, Lectin-like oxidized LDL receptor-1, Ejection fraction
Citation
Beşli, F. (2012). Sol ventrikül sistolik kalp yetersizliğinin tanısı ve değerlendirilmesinde serum lektin-like okside ldl reseptör-1 düzeyinin yeri. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.