Akut inferiyor miyokard infarktüsü ile ilişkili klinik sağ ventrikül disfonksiyonu tanısında Brain natriüretik peptidin değeri
Yükleniyor...
Dosyalar
Tarih
2010
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmamızda sağ ventrikül tutulumu olan ve olmayan inferiyor miyokard infarktüslü hastalarda brain natriüretik peptid seviyesi ile sağ ventrikül disfonksiyonu arasındaki ilişki varlığı araştırıldı. Çalışmaya inferiyor miyokard infarktüsü (n=34) ve inferiyor+sağ ventrikül miyokard infarktüsü (n=27) ile başvuran toplam 61 hasta alındı. Hastaların yaş ortalaması inferiyor+sağ ventrikül miyokard infarktüsü grubunda 59.48±11.46, inferiyor miyokard infarktüsü grubunda 61.06±11.83 idi. Hastalar brain natriüretik peptid seviyesine göre ?400 pg/ml ve <400 pg/ml olarak iki gruba ayrıldı. Brain natriüretik peptid seviyesi ?400 pg/ml olan hastaların sol ventrikül diyastol sonu çap (p=0.001), sol ventrikül sistol sonu çap (p=0.004), sağ atriyum çapı (p=0.059) daha büyük, sol ventrikül ejeksiyon fraksiyonu (p=0.018), sistolik kan basıncı (p=0.023), diyastolik kan basıncı (p=0.075), triküspit anulus düzlemsel sistolik hareket (p=0.042) değerleri daha düşük idi. Stepwise lojistik regresyon analizinde inferiyor+sağ ventrikül miyokard infarktüsünde sistolik kan basıncı azaldıkça beyin natriüretik peptid seviyesinin 0.972 kat (%95 Güven Aralığı=0.947-0.996), sol ventrikül diyastol sonu çap arttığında beyin natriüretik peptid seviyesinin 1.324 kat arttığı (%95 Güven Aralığı =1.090-1.607) tespit edildi. Hastalar sağ ventrikül tutulumu olan ve olmayan akut inferiyor miyokard infarktüsü olarak gruplandığında sağ ventrikül miyokard infarktüsü olan hastaların sağ ventrikül sistolik fonksiyonları bozuk ve sol ventrikül diyastolik disfonksiyon oranı daha sık saptandı. Hastaların brain natriüretik peptid seviyesi ile ekokardiyografik parametreleri arasında korelasyon analizi yapıldığında brain natriüretik peptidin triküspit anulus düzlemsel sistolik hareketi ve triküspit sistolik dalga ile negatif, sol ventrikül kitle indeksi ile pozitif korele olduğu tespit edildi. Sonuç olarak bu çalışma akut inferiyor miyokard infarktüsü hastalarının başlangıç değerlendirmesinde bakılan brain natriüretik peptid seviyesi ile sağ ventrikül sistolik fonksiyonları arasında ilişki olduğunu gösterdi. Ek olarak brain natriüretik peptid ?400 pg/ml olan hastalarda daha fazla hipotansiyon, sağ ventrikül sistolik disfonksiyonu ve sol ventrikül çaplarında artış olduğunu gösterdi. Anahtar Kelimeler: İnferiyor miyokard infarktüsü, sağ ventrikül disfonksiyonu, beyin natriüretik peptid.
Abstract
The relation between the right ventricule dysfunction and serum levels of brain natriuretic peptide in inferior myocardial infarction patients with or without right ventricule involvement has been evaluated in the present study. 61 patients with acute inferior myocardial infarction alone (n=34) and acute inferior and right ventricular myocardial infarction (n=27) has been enrolled. The mean age of acute inferior myocardial infarction and right ventricular involvement group was 59.48±11.46, while it was 61.06±11.83 in lone inferior myocardial infarction group. The patients were also divided into two groups according to serum brain natriuretic peptide levels as ?400 pg/ml and <400 pg/ml. In the brain natriuretic peptide ?400 pg/ml group, left ventricule end diastolic diameter (p=0.001), left ventricule end systolic diameter (p=0.04), right atrial diameter (p=0.059) were observed to be greater while left ventricule ejection fraction (p=0.018), systolic blood pressure (p=0.023), diastolic blood pressure (p=0.075), and tricuspid annulus planimetric systolic excursion values (p=0.042) were observed to be subdued. With the stepwise logistical regression analysis, in patients with inferior myocardial infarction and right ventricular involvement, Brain natriuretic peptide levels and systolic blood pressure levels were found to be correlated (Brain natriuretic peptide increased by 0.972 times %95 Confidence Interval=0.947-0.996), while the levels of left ventricule enddiastolic diameter and brain natriuretic peptide levels were positively correlated (Brain natriuretic peptide increased by 1.324 times (%95 Confidence Interval =1.090-1.607). With patients were classified into two groups as acute inferior myocardial infarction and acute inferior myocardial infarction with right ventricule involvement, the right ventricular systolic functions were observed to be impaired while the rate of left ventricule diastolic dysfunction were increased in inferior myocardial infarction and right ventricular involvement group. When the correlation analysis between the brain natriuretic peptide levels of patients and echocardiographic parameters was made, brain natriuretic peptide levels were found to be negatively correlated with the values of tricuspid annulus planimetric systolic excursion and RSm, and positively correlated with the index of left ventricular mass. In conclusion, in acute inferior myocardial infarction, initial brain natriuretic peptide levels are observed to be valuable in predicting the right ventricule involvement in patients with right ventricule involvement diagnosed with electrocardiography and clinical evaluation. In addition, higher rates of hypotension, right ventricular dysfunction and increase in left ventricule diameters were observed in patients with brain natriuretic peptide levels ?400 pg/ml. We concluded that initial brain natriuretic peptide levels ?400 pg/ml in patients presenting with acute inferior MI does predict right ventricular dysfunction. Key words: Inferior myocardial infarction, right ventricular dysfunction, brain natriuretic peptide.
Abstract
The relation between the right ventricule dysfunction and serum levels of brain natriuretic peptide in inferior myocardial infarction patients with or without right ventricule involvement has been evaluated in the present study. 61 patients with acute inferior myocardial infarction alone (n=34) and acute inferior and right ventricular myocardial infarction (n=27) has been enrolled. The mean age of acute inferior myocardial infarction and right ventricular involvement group was 59.48±11.46, while it was 61.06±11.83 in lone inferior myocardial infarction group. The patients were also divided into two groups according to serum brain natriuretic peptide levels as ?400 pg/ml and <400 pg/ml. In the brain natriuretic peptide ?400 pg/ml group, left ventricule end diastolic diameter (p=0.001), left ventricule end systolic diameter (p=0.04), right atrial diameter (p=0.059) were observed to be greater while left ventricule ejection fraction (p=0.018), systolic blood pressure (p=0.023), diastolic blood pressure (p=0.075), and tricuspid annulus planimetric systolic excursion values (p=0.042) were observed to be subdued. With the stepwise logistical regression analysis, in patients with inferior myocardial infarction and right ventricular involvement, Brain natriuretic peptide levels and systolic blood pressure levels were found to be correlated (Brain natriuretic peptide increased by 0.972 times %95 Confidence Interval=0.947-0.996), while the levels of left ventricule enddiastolic diameter and brain natriuretic peptide levels were positively correlated (Brain natriuretic peptide increased by 1.324 times (%95 Confidence Interval =1.090-1.607). With patients were classified into two groups as acute inferior myocardial infarction and acute inferior myocardial infarction with right ventricule involvement, the right ventricular systolic functions were observed to be impaired while the rate of left ventricule diastolic dysfunction were increased in inferior myocardial infarction and right ventricular involvement group. When the correlation analysis between the brain natriuretic peptide levels of patients and echocardiographic parameters was made, brain natriuretic peptide levels were found to be negatively correlated with the values of tricuspid annulus planimetric systolic excursion and RSm, and positively correlated with the index of left ventricular mass. In conclusion, in acute inferior myocardial infarction, initial brain natriuretic peptide levels are observed to be valuable in predicting the right ventricule involvement in patients with right ventricule involvement diagnosed with electrocardiography and clinical evaluation. In addition, higher rates of hypotension, right ventricular dysfunction and increase in left ventricule diameters were observed in patients with brain natriuretic peptide levels ?400 pg/ml. We concluded that initial brain natriuretic peptide levels ?400 pg/ml in patients presenting with acute inferior MI does predict right ventricular dysfunction. Key words: Inferior myocardial infarction, right ventricular dysfunction, brain natriuretic peptide.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Kardiyoloji, Cardiology, İnferiyor Miyokard İnfarktüsü, Sağ Ventrikül Disfonksiyonu, Beyin Natriüretik Peptid, Inferior Myocardial Infarction, Right Ventricular Dysfunction, Brain Natriuretic Peptide
