Atriyal fibrilasyon hastalarında nabız basıncı indeksinin kardiyoembolik olaylar ve mortalite ile ilişkisi

Year 2022, Volume: 27 Issue: 2, 142 - 149, 24.05.2022

Serhat Karadavut , Murat Çetin İsmail Altıntop

https://doi.org/10.21673/anadoluklin.1024948

Abstract

Amaç: Nabız basınç indeksi (NBİ), nabız basıncının (NB) sistolik kan basıncına oranı ile elde edilir. Arteriyel sertlik ve kardiyovasküler hastalıkların (KVH) değerlendirilmesinde NB ölçümlerine göre daha güvenilir ve daha objektif bilgi verir. Bilindiği üzere atriyal fibrilasyonda (AF) vasküler hastalık mevcudiyeti emboli riskini artırmaktadır. Bu çalışmada, KVH prediktörü olan NBİ değerlerini kullanarak AF hastalarında gelişen kardiyoembolik olaylar (KEO) ve/veya mortalite ile ilişkisini incelemeyi amaçladık.

Yöntemler: Çalışma, Şubat 2019 ile Haziran 2020 arasında prospektif olarak 191 AF hastası alınarak yapıldı. Hastalar; inme, geçici iskemik atak, periferik emboli ve bunlara bağlı ölüm gerçekleşmeyen (Grup-1, n=156) ve gerçekleşen (Grup-2, n=35) şeklinde ikiye ayrıldı.

Bulgular: Grup-2’nin NBİ değerleri Grup-1’e göre anlamlı derecede yüksek olarak tespit edildi (0,38±0,05 ve 0,41±0,04, p<0,001). Çoklu regresyon analizi sonrası NBİ AF hastalarında KEO
açısından bağımsız öngörücü olarak bulundu (Olasılık oranı: 2,82 [%95 Güven Aralığı: 1,68-4,71], p<0,001). Ayrıca, yapılan ROC analizinde NBİ, NB’ye göre KEO tahmin etmede daha güçlü bir parametre olarak saptandı (sırasıyla, eğri altındaki alan [AUC]=0,734 ve AUC=0,661).

Sonuç: AF hastalarında NBİ istenmeyen KEO ve buna bağlı ölümleri predikte etmek için kullanılabilecek non-invaziv ve ucuz bir fizik muayene bulgusudur.

Keywords

atriyal fibrilasyon, emboli;, nabız basıncı

The relationship of pulse pressure index with cardioembolic events and mortality in atrial fibrillation patients

Abstract

Aim: Pulse pressure index (PPI) is the ratio of pulse pressure (PP) to systolic blood pressure. PPI measurements yield more reliable and objective data than PP in evaluating arterial stiffness and cardiovascular diseases. It is well known that the presence of vascular disease increases embolism in atrial fibrillation (AF). The present study investigated the relationship between cardioembolic events and mortality with PPI, a predictor of cardiovascular disease, in AF patients.

Methods: This study was conducted prospectively between February 2019 and June 2020 in 191 AF patients. The patients were divided into two groups based on the cardiovascular outcomes’ nonpresence (Group 1, n=156) or presence (Group 2, n=35).

Results: PPI values of Group 2 were significantly higher than Group 1 (0.38±0.05 and 0.41±0.04, p <0.001). PPI was also independently associated with cardiovascular outcomes after adjusting for potential covariates (OR = 2.82, 95%CI = 1.68 to 4.71, P < 0.001). Additionally, in the ROC analysis, PPI was more powerful in predicting cardioembolic events than PP (AUC= 0.734 vs. 0.661, respectively).

Conclusion: PPI is a non-invasive and low-cost physical examination finding that may be used to predict undesirable cardioembolic outcomes and related mortality in AF patients.

Keywords

atrial fibrillation, embolism;, pulse pressure

References

• Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837–47.
• John RM, Michaud GF, Stevenson WG. Atrial fibrillation hospitalization, mortality, and therapy. Eur Heart J. 2018;39(44):3958-60.
• Aparicio LS, Thijs L, Asayama K, Barochiner J, Boggia J, Gu Y-M, et al. Reference frame for home pulse pressure based on cardiovascular risk in 6470 subjects from 5 populations. Hypertens Res. 2014;37(7): 672–8.
• Tanindi A, Erkan AF, Alhan A, Töre HF. Central pulse pressure amplification is associated with more extensive and severe coronary artery disease. Scand Cardiovasc J. 2014;48(3):167–75.
• Blacher J, Staessen JA, Girerd X, Gasowski J, Thijs L, LiuL, et al. Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch Intern Med. 2000;160(8):1085–9.
• Safar ME, Levy BI, Struijker-Boudier H. Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation. 2003;107(22):2864–9.
• Peng-Lin Y, Yue-Chun L. Pulse pressure index (pulse pressure/systolic pressure) may be better than pulse pressure for assessment of cardiovascular outcomes. Med Hypotheses. 2009;72(6):729–31.
• Cai A, Mo Y, Zhang Y, Li J, Chen J, Zhou Y, et al. Relationship of pulse pressure index and carotid intima-media thickness in hypertensive adults. Clin Exp Hypertens. 2015;37(4):267–70.
• Safar ME, Jankowski P. Central blood pressure and hypertension: role in cardiovascular risk assessment. Clin Sci (Lond). 2009;116(4):273–82.
• Tanaka H, Dinenno FA, Monahan KD, Clevenger CM, DeSouza CA, Seals DR. Aging, habitual exercise, and dynamic arterial compliance. Circulation. 2000;102(11):1270–5.
• Strandberg TE, Pitkala K. What is the most important component of blood pressure: systolic, diastolic or pulse pressure? Curr Opin Nephrol Hypertens. 2003; 12(3):293–7.
• Franklin SS. Pulse pressure as a risk factor. Clin Exp Hypertens. 2004; 26(7–8):645–52.
• Kothai G, Janani A, Malathy AR, Suthakaran PK. Evaluation of pulse pressure and proportional pulse pressure as predictors of severity among patients having heart failure with reduced ejection fraction. Ann Afr Med.2020;19(3):188–90.
• Pareek M, Vaduganathan M, Biering-Sørensen T, Byrne C, Qamar A, Almarzooq Z, et. al. Pulse Pressure, Cardiovascular Events, and Intensive Blood-Pressure Lowering in the Systolic Blood Pressure Intervention Trial (SPRINT). Am J Med. 2019; 132(6): 733–9.
• Schram MT, Kostense PJ, Van Dijk RA, Dekker JM, Nijpels G, Bouter LM, et. al. Diabetes, pulse pressure and cardiovascular mortality: the Hoorn Study. J Hypertens. 2002; 20(9):1743–51.
• Hales S. Statical Essays: Containing Haemostaticks, vol. II. London, Engl Innys Manby. 1997;1733.
• Tateishi Y, Tsujino A, Hamabe J, Tsuneto A, Maemura K, Tasaki O, et. al.. Cardiac diastolic dysfunction predicts in-hospital mortality in acute ischemic stroke with atrial fibrillation. J Neurol Sci. 2014;345(1–2):83–6.
• Dons M, BieringSørensen T, Jensen JS, Fritz-Hansen T, Bech J, de Knegt MC, et. al.. Systolic and Diastolic Function by Tissue Doppler Imaging Predicts Mortality in Patients with Atrial Fibrillation. J Atr Fibrillation. 2015:8(1):1241.
• Ede H, Derya MA, Ardahanlı İ, Akgün O, Erbay AR. Hipertansif Hastalarda Nabiz Basinci Araliği Ile Sol Ventrikül Diastolik Fonksiyon Ilişkisi. Bozok Tıp Derg. 5(2):24–30.
• Lee K-J, Kim BJ, Han M-K, Kim J-T, Choi K-H, Shin D-I, et. al.. Effect of Heart Rate on Stroke Recurrence and Mortality in Acute Ischemic Stroke With Atrial Fibrillation. Stroke. 2020;51(1):162–9.
• Li S, Barywani S, Fu M. Impact of heart rate in atrial fibrillation versus sinus rhythm on mortality in octogenarian patients with acute coronary syndrome. Pan Afr Med J. 2017;28:89.