Kalp yetmezliği hastalarında tahmini tam kan viskozitesi ile uzun vadeli iskemik inmenin öngörülmesi

Abstract

Amaç: Kalp yetmezliği (KY) ve inme sıklıkla bir arada bulunur ve atriyal fibrilasyon gibi ortak risk faktörlerini paylaşır. Endotel stresinin en önemli göstergelerinden biri olan tam kan viskozitesi (WBV), kan akışının temel bir belirleyicisidir, ateroskleroz ve tromboz etiyolojisinde rol oynar. Bu çalışmanın amacı, akut KY nedeniyle hastaneye yatırılan hastalarda tahmini WBV ile uzun vadeli iskemik strok (IS) riski arasındaki ilişkiyi değerlendirmektir. Yöntemler: Akut KY nedeniyle hastaneye yatırılan ejeksiyon fraksiyonu düşük toplam 409 hasta çalışmaya dahil edildi. Birincil sonuç taburculuk sonrası takipte İS gelişimidir. Sonuçlar: Takip süresince 26 (%6) hastada İS meydana geldi. İS grubunda ileri yaş, diabetes mellitus daha sık ve WBV daha yüksek, sol ventrikül diyastol sonu ve sol atriyum ön-arka çapı artmış ve sol ventrikül ejeksiyon fraksiyonu daha düşüktü. Çok değişkenli regresyon analizinde, WBV uzun dönem İS'nin bir ön gördürücüsü olarak tespit edilmiştir(OR, 2.68; %95 GA, 1.96 - 3.12, p=0.008). Alıcı işletim karakteristik eğrisinde, bir yıllık İS için WBV'nin optimal kesme değeri %61,5 duyarlılık ve %70,2 özgüllük ile 6,28 idi (eğri altındaki alan: 0,748). Sonuç: WBV, geleneksel risk faktörlerinden bağımsız olarak KY hastalarında uzun vadeli İS'nin öngörülmesi için yeni, kolay ölçülebilir, maliyet etkin, invazif olmayan bir risk belirtecidir.

Keywords

• iskemik inme
• tam kan viskozitesi
• kalp yetersizliği

Prediction of long-term ischemic stroke with estimated whole blood viscosity in heart failure patients

Abstract

Aims: Heart failure (HF) and stroke often coexist and share common risk factors, including atrial fibrillation. Whole blood viscosity (WBV), one of the most significant indicators of endothelial stress, is a fundamental determinant of blood flow and is involved in the aetiology of atherosclerosis and thrombosis. The purpose of this study was to assess the association between estimated WBV and long-term ischemic stroke (IS) risk in patients hospitalized for acute HF. Methods: A total of 409 patients with reduced ejection fraction HF hospitalized with acute HF were included. The primary outcome was IS post-discharge follow-up. Results: IS occurred in 26 (6%) patients during a follow-up. In the IS group, older age, diabetes mellitus frequency and WBV were higher, left ventricular end-diastolic and left atrial anteroposterior diameter were increased and left ventricular ejection fraction was lower. In multivariate regression analysis, WBV was found to be a predictor of long-term IS (OR, 2.68; 95% CI, 1.96-3.12, p=0.008). In the receiver operating characteristic curve, the optimal cut-off value of WBV for one-year IS was 6.28 with 61.5% sensitivity and 70.2% specificity (area under the curve: 0.748). Conclusion: WBV is a novel, easily measurable, cost-effective, non-invasive risk marker for the prediction of long-term IS in patients with HF, independent of traditional risk factors.

Keywords

• Heart failure
• ischemic stroke
• whole blood viscosity

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