Kardiyopulmoner baypas ile koroner arter cerrahisi hastalarında pre ve postoperatif BNP seviyeleri ile postoperatif atriyal fibrilasyon gelişme sıklığı arasındakı ilişkinin değerlendirilmesi
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Date
2012
Authors
Gayıbov, Musa
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Publisher
Uludağ Üniversitesi
Abstract
Çalışmamızın amacı, koroner arter hastalığı sebebiyle kardiyopulmoner bypass (KPB) kullanılarak izole koroner arter bypass cerrahisi (KABC) uygulanan hastalarda brain natriüretik peptidin (BNP) postoperatif dönemde nasıl etkilendiği ve preoperatif BNP düzeyinin postoperatif dönemde atriyal fibrilasyon (AF) gelişimi açısından prediktif değerini araştırmaktır. Kliniğimizde ve Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi Kalp ve Damar Cerrahisi Servisi’nde elektif olarak ilk kez KPB eşliğinde izole KABC uygulanan 7 kadın, 23 erkek toplam 30 hastanın preoperatif, operatif ve postoperatif bulguları toplanarak prospektif olarak çalışmaya alındı. Olguların plazma BNP düzeylerine 5 kez (T0: preoperatif, T1: kardiyopulmoner bypass sonrası, T2: postoperatif 4. saat, T3: postoperatif 12. saat, T4: postoperatif 24 saat) bakılmak üzere venöz kan örnekleri alındı. Hastalar preoperatif BNP T0 düzeyleri ≤100 pg/ml olanlar (Grup A), BNP T0 düzeyleri >100 pg/ml olanlar (Grup B) şeklinde iki gruba ayrıldı. Postoperatif atriyal fibrilasyon (AF) gelişen hastalar AF grubu olarak adlandırıldı. Grup A’nın ortanca BNP T0 düzeyleri 43 pg/ml, BNP T1 35,4 pg/ml, BNP T2 231,4 pg/ml, BNP T3 740,8 pg/ml, BNP T4 873,3 pg/ml olarak bulundu. Grup B’nin ortanca BNP T0 düzeyleri 302,7 pg/ml, BNP T1 288,3 pg/ml, BNP T2 609,4 pg/ml, BNP T3 1415 pg/ml, BNP T4 1627 pg/ml olarak bulundu. Postoperatif AF 9 (%30) hastada gelişti. Grup AF’nin ortanca BNP T0 düzeyleri 689,4 pg/ml, BNP T1 481,6 pg/ml, BNP T2 1040 pg/ml, BNP T3 1574 pg/ml, BNP T4 1687 pg/ml olarak bulundu. Grup AF’de univaryant analizi sonucunda ortanca preoperatif BNP T0, ortanca preoperatif ejeksiyon fraksiyonu ve ortanca postoperatif BNP T3, BNP T4 değeri anlamlı derecede yüksek idi ( 689,4 pg/ml vs 171,5 pg/ml, P=0,022; 40 vs 55, P=0,032; 1574 pg/ml vs 1415 pg/ml, P=0,004; 1687 pg/ml vs1627 pg/ml, P=0,001). iv Bu anlamlılık lojistik regresyon analizi sonucunda da Logistic Regression modelinin istatiksel anlamını sürdürdü (P=0,005). Preoperatif BNP T0 değerinin postoperatif AF gelişimi açısından tanısal değeri Receiver Operating Characteristics eğrisi çalışıldığında eğri altında kalan alan 1,000; P<0,001olarak ve preoperatif >102,9 pg/ml ve üzeri BNP T0 değerinin postoperatif AF gelişmesi açısından %88,89 duyarlılık, %100 özgüllük, %100 pozitif kestirim değeri, % 87,5 negatif kestirim değeri gösterdiği görüldü. BNP düzeyleri kardiyopulmoner bypass kullanılarak uygulanan izole KABC sonrası anlamlı seviyede yükselmektedir. Yüksek preoperatif BNP düzeyi ve düşük ejeksiyon fraksiyonu ile birlikte postoperatif dönemde AF gelişmesi açısından istatistiki olarak anlamlı prediktörlerdir.
Assessment of Relation Between Preoperatif and Postoperative BNP Levels and Incidance of Atrial Fibrilation Development in Patients with Cardiopulmonary Bypass and Coronary Artery Surgery Our aim was in patients that undergoing cardiopulmonary bypass (CPB) using the isolated coronary artery bypass grafting (CABG) due to coronary artery disease to investigate how brain natriuretic peptide (BNP) is affected in postoperative period, and the predictive value for atrial fibrilation (AF) development of postoperative BNP levels in postoperative period. 7 female, 23 male patient’s that undergoing electively isolated CABG with CPB for the first time, preoperative, operative and postoperative findings were prospectively collocted in our clinic and Bursa Training and Research Hospital’s Cardiovascular Surgery Service, and included in the study. For detection of plasma BNP levels in patients, venous blood samples were taken 5 times (T0: preoperative, T1: after cardiopulmonary bypass surgery, T2: postoperative 4 th hours, T3: postoperative 12 th hour, T4: postoperative 24 hours). Patients were divided into two groups as preoperative T0 BNP levels ≤ 100 pg/ml (Group A), T0 BNP levels > 100 pg/ml (Group B). Postoperative atrial fibrillation (AF) was called as a group of patients who developed AF. In group A the median levels of BNP T0 43 pg/ml, BNP T1 35,4 pg/ml, BNP T2 231,4 pg/ml, BNP T3 740,8 pg/ml, BNP T4 873,3 pg/ml was found. In Group B, the median levels of BNP T0 302,7 pg/ml, BNP T1 288,3 pg/ml, BNP T2 609,4 pg/ml, BNP T3 1415 pg/ml, BNP T4 1627 pg/ml was found. Postoperative AF was developed in 9 patients (30%). In AF Group the median levels of BNP T0 689,4 pg/ml, BNP T1 481,6 pg/ml, BNP T2 1040 pg/ml, BNP T3 1574 pg/ml, BNP T4 1687 pg/ml was found. In Group AF vi ejection fraction, and the median postoperative BNP T3, T4 value of BNP univariate analysis revealed that the median preoperative BNP T0, the median preoperative was significantly higher (689,4 pg/ml versus 171,5 pg/ml, P = 0,022; 40 versus 55, P = 0,032; 1574 pg/ml versus 1415 pg/ml, P= 0,004; 1687 pg/ml vs 1627 pg/ml, P = 0,001). Logistic Regression model of logistic regression analysis as a result of this significance remained the meaning of statistical (P = 0,005). The diagnostic value of preoperative BNP T0 value of the Receiver Operating Characteristics curve for the development of postoperative AF area under the curve when attempting to 1,000, P<0,001, and the preoperative >102,9 pg/ml and higher, cut-off BNP value of T0 for the development of postoperative AF sensitivity of 88,89 %, specificity 100 %, positive predictive value 100 %, negative predictive value of 87,5 % was observed. BNP levels rise significantly lower after isolated CABG performed using cardiopulmonary bypass. With higher preoperative BNP levels and low ejection fraction, a statistically significant predictors for the development of postoperative AF.
Assessment of Relation Between Preoperatif and Postoperative BNP Levels and Incidance of Atrial Fibrilation Development in Patients with Cardiopulmonary Bypass and Coronary Artery Surgery Our aim was in patients that undergoing cardiopulmonary bypass (CPB) using the isolated coronary artery bypass grafting (CABG) due to coronary artery disease to investigate how brain natriuretic peptide (BNP) is affected in postoperative period, and the predictive value for atrial fibrilation (AF) development of postoperative BNP levels in postoperative period. 7 female, 23 male patient’s that undergoing electively isolated CABG with CPB for the first time, preoperative, operative and postoperative findings were prospectively collocted in our clinic and Bursa Training and Research Hospital’s Cardiovascular Surgery Service, and included in the study. For detection of plasma BNP levels in patients, venous blood samples were taken 5 times (T0: preoperative, T1: after cardiopulmonary bypass surgery, T2: postoperative 4 th hours, T3: postoperative 12 th hour, T4: postoperative 24 hours). Patients were divided into two groups as preoperative T0 BNP levels ≤ 100 pg/ml (Group A), T0 BNP levels > 100 pg/ml (Group B). Postoperative atrial fibrillation (AF) was called as a group of patients who developed AF. In group A the median levels of BNP T0 43 pg/ml, BNP T1 35,4 pg/ml, BNP T2 231,4 pg/ml, BNP T3 740,8 pg/ml, BNP T4 873,3 pg/ml was found. In Group B, the median levels of BNP T0 302,7 pg/ml, BNP T1 288,3 pg/ml, BNP T2 609,4 pg/ml, BNP T3 1415 pg/ml, BNP T4 1627 pg/ml was found. Postoperative AF was developed in 9 patients (30%). In AF Group the median levels of BNP T0 689,4 pg/ml, BNP T1 481,6 pg/ml, BNP T2 1040 pg/ml, BNP T3 1574 pg/ml, BNP T4 1687 pg/ml was found. In Group AF vi ejection fraction, and the median postoperative BNP T3, T4 value of BNP univariate analysis revealed that the median preoperative BNP T0, the median preoperative was significantly higher (689,4 pg/ml versus 171,5 pg/ml, P = 0,022; 40 versus 55, P = 0,032; 1574 pg/ml versus 1415 pg/ml, P= 0,004; 1687 pg/ml vs 1627 pg/ml, P = 0,001). Logistic Regression model of logistic regression analysis as a result of this significance remained the meaning of statistical (P = 0,005). The diagnostic value of preoperative BNP T0 value of the Receiver Operating Characteristics curve for the development of postoperative AF area under the curve when attempting to 1,000, P<0,001, and the preoperative >102,9 pg/ml and higher, cut-off BNP value of T0 for the development of postoperative AF sensitivity of 88,89 %, specificity 100 %, positive predictive value 100 %, negative predictive value of 87,5 % was observed. BNP levels rise significantly lower after isolated CABG performed using cardiopulmonary bypass. With higher preoperative BNP levels and low ejection fraction, a statistically significant predictors for the development of postoperative AF.
Description
Keywords
Koroner arter bypass cerrahisi, Kardiyopulmoner bypass, Beyin natriüretik peptid, Atriyal fibrilasyon, Coronary artery bypass surgery, Cardiopulmonary bypass, Brain natriuretic peptide, Atrial fibrillation
Citation
Gayıbov, M. (2012). Kardiyopulmoner baypas ile koroner arter cerrahisi hastalarında pre ve postoperatif BNP seviyeleri ile postoperatif atriyal fibrilasyon gelişme sıklığı arasındakı ilişkinin değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.