ST segment elevasyonlu miyokard enfarktüsü' nde N -terminal pro - brain natriüretik peptid'in prognostik önemi
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Date
2006
Authors
Eryılmaz, Ufuk
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Amaç: Natriüretik peptidlerin dolaşımdaki konsantasyonları miyokard enfarktüsü sonrası sağkalım ile yakın ilişkilidir. Bizler bu çalışmada natriüretik peptid ailesinden N Terminal ( NT ) proBNP’ nin ST segment elevasyonlu miyokard enfarktüslü olgularda prognostik değerini araştırmayı amaçladık. Gereç ve Yöntem: Çalışmaya Uludağ Üniversitesi Tıp Fakültesi Kardiyoloji Kliniği yoğun bakımına akut ST segment elevasyonlu miyokard enfarktüsü tanısı ile yatan ve dahil edilme kriterlerini karşılayan 57 hasta alındı. Yoğun bakımda standart tedavi başlanan olgulardan 6 ve 36’ncı saatte plazmada NT – proBNP bakılmak üzere venöz kan örnekleri alındı. Hastaların eş zamanlı EKG’leri çekildi ve kardiyak enzimleri çalışıldı. Üçüncü ayda poliklinik kontrolüne çağrılan hastalar istenmeyen major kardiyak olaylar ( ölüm, revaskülarizasyon, tekrarlayan miyokard enfarktüsü ve angina ) açısından değerlendirildi ve NT – proBNP değerleri ölçüldü. Her üç NT – proBNP değeri ile istenmeyen major kardiyak olaylar arasındaki ilişki araştırıldı. Bulgular: Çalışmaya dahil edilen hastalar ST segment elevasyonuna göre anterior MI geçiren ( Grup A ) ve inferior MI geçiren ( Grup B ) hastalar şeklinde iki gruba ayrıldı. Her ne kadar istatistiksel olarak anlamlı fark oluşturmasa da Grup A’ da sol ventrikül ejeksiyon fraksiyonunun daha düşük, duvar hareket skor indeksinin daha yüksek olduğu saptandı ( p>0,05 ). Üçüncü ay sonunda en az bir istenmeyen major kardiyak olay geçirenlerle hiç geçirmeyenler arasında NT – proBNP seviyeleri açısından anlamlı istatistiksel fark elde edilemedi ( p>0,05 ). 36’ ncı saatte saptanan ortalama NT – proBNP düzeyi 6’ ncı saat ortalama NT – proBNP düzeyi ile kıyaslandığında Grup A olgularında 10,6 ± 26,2 kat artış gösterdiği, Grup B olgularında 3,6 ± 4,7 kat artış gösterdiği saptandı ve bu değer her iki grup arasında istatiksel olarak anlamlı fark oluşturdu ( p=0,016 ). Sol ventrikül ejeksiyon fraksiyonu ile NT – proBNP seviyeleri arasında korelasyon gözlenmedi. İstatiksel olarak anlamlı bir fark oluşturmasa da özellikle 36’ ıncı saat NT – proBNP değerleri 300 pg/ml’ nin üzerinde olduğunda daha fazla sayıda olgunun istenmeyen major kardiyak olaylar geçirdiği tespit edildi. Sonuç: Çalışma sonucunda NT – proBNP seviyelerinin her ne kadar istatistiksel anlamlılığa ulaşmasa da istenmeyen major kardiyak olayları öngörmede önemli veriler sağlayacağı kanısındayız. Özellikle 36’ ıncı saat NT – proBNP değerlerinin 300 pg/ml’ nin üzerinde olması istenmeyen major kardiyak olayların önceden tespitinde ve önlem alınmasında önemli katkı yapabilir.
Objective: Concentration of natriuretic peptid in the circulation is related with survival after myocardial infarction. We investigated the prognostic value of N Terminal ( NT ) proBNP in patients with ST segment elevation myocardial infarction. Material and Methods: We included 57 patients from Uludağ University Cardiology Department Intensive Care Unit with ST segment elevation myocardial infarction if they matched the inclusion criteria after the standart treatment was began to patients. We measured the NT – proBNP in plasma specimens in the 6th and 36th hours after admission. The cardiac markers were measured and taken ECG records at the same times. After follow up of third month the major advers cardiovascular events (MACE) were evaluated and NT – proBNP was measured. The relation between MACE and each of NT – proBNP levels were searched. Results: The patients which were included to the study were divided in two groups by looking their ST segment elevation. These groups are anterior MI (Group A) and inferior MI (Group B) patients. In Group A the left ventricle ejection fraction was found lower and wall motion score index was found higher but they were not statistically significant ( p>0,05 ). After the third month there was no statistically difference in NT – proBNP levels between the group which had minimally one MACE and the other group which had no MACE ( p>0,05 ). The 36th hours mean NT – proBNP levels compared with sixth hours mean NT – proBNP levels was statistically different in two groups. In Group A, NT - proBNP levels increased 10,6± 26,2 times and in Group B NT – proBNP levels increased 3,6± 4,7 times ( p=0,016 ). There was no correlation between left ventricle ejection fraction and NT – proBNP levels. Especially we found that the petients which had 36th hours NT – proBNP levels over 300 pg/ml showed better prognosis depending on major cardiovascular advers events. Conclusion: Although the NT – proBNP levels did not reach a statistically significant at the result of the study, we are of the opinion that it will provide us with important data in anticipating the MACE. Particularly 36th hours NT – proBNP values being over 300 pg/ml will contribute much in determining and taking measures aganist MACE.
Objective: Concentration of natriuretic peptid in the circulation is related with survival after myocardial infarction. We investigated the prognostic value of N Terminal ( NT ) proBNP in patients with ST segment elevation myocardial infarction. Material and Methods: We included 57 patients from Uludağ University Cardiology Department Intensive Care Unit with ST segment elevation myocardial infarction if they matched the inclusion criteria after the standart treatment was began to patients. We measured the NT – proBNP in plasma specimens in the 6th and 36th hours after admission. The cardiac markers were measured and taken ECG records at the same times. After follow up of third month the major advers cardiovascular events (MACE) were evaluated and NT – proBNP was measured. The relation between MACE and each of NT – proBNP levels were searched. Results: The patients which were included to the study were divided in two groups by looking their ST segment elevation. These groups are anterior MI (Group A) and inferior MI (Group B) patients. In Group A the left ventricle ejection fraction was found lower and wall motion score index was found higher but they were not statistically significant ( p>0,05 ). After the third month there was no statistically difference in NT – proBNP levels between the group which had minimally one MACE and the other group which had no MACE ( p>0,05 ). The 36th hours mean NT – proBNP levels compared with sixth hours mean NT – proBNP levels was statistically different in two groups. In Group A, NT - proBNP levels increased 10,6± 26,2 times and in Group B NT – proBNP levels increased 3,6± 4,7 times ( p=0,016 ). There was no correlation between left ventricle ejection fraction and NT – proBNP levels. Especially we found that the petients which had 36th hours NT – proBNP levels over 300 pg/ml showed better prognosis depending on major cardiovascular advers events. Conclusion: Although the NT – proBNP levels did not reach a statistically significant at the result of the study, we are of the opinion that it will provide us with important data in anticipating the MACE. Particularly 36th hours NT – proBNP values being over 300 pg/ml will contribute much in determining and taking measures aganist MACE.
Description
Keywords
Akut miyokard enfarktüsü, NT- proBNP, Acute myocardial infarction
Citation
Eryılmaz, U. (2006). ST segment elevasyonlu miyokard enfarktüsü' nde N -terminal pro - brain natriüretik peptid'in prognostik önemi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.