Non Q, Non ST Elevasyonlu Myokard Enfarktüslü ve Stabil Olmayan Anjina Pektorisli (USAP) Hastalarda Miyokard Performans İndeksi (MPİ) ile C-reaktive Protein (CRP) ve Ortalama Trombosit Hacmi (MPV) Arasındaki İlişkinin İncelenmesi

Abstract

Amaç: Kardiyovasküler açıdan prognozu etkileyici bir risk faktörü olarak düşünülen (myokard performans indeksi) MPİ’nin CRP ve MPV ile arasındaki ilişkisini araştırmak. Materyal ve Metot: Çalışmaya koroner yoğun bakım ünitesine kabul edilen non Q non ST elevasyonlu MI tanısıyla yatırılan 35 hasta alındı.

Bulgular: Kadın hastaların CRP değerleri, erkek hastaların boyları ve bayan hastaların EF değerleri istatiksel anlamlı olarak daha yüksek bulundu (p=0.030). Ayrıca tüm bu sonuçların dışında sonuç değişkenin MPI olarak ele alındığı, çalışmada ölçülmüş olan tüm değişkenlerin birlikte veya değişik kombinasyonlarda denendiği çoklu doğrusal regresyon modellerinin hiçbirinde anlamlı bir ilişkiye rastlanmadı. Sonuç: MPİ ile CRP ve MPV arasında korelasyon bulunmamıştır. Aynı zamanda MPİ ile HT, diyabet, yaş, EF, boy arasında anlamlı bir ilişki bulunmadı. Bunun nedeni olarak hastaların akut dönemde takip edilmiş olup, kronik dönemde takip edilmemiş olması ya da hasta sayısı ön planda ana neden olarak düşünülmektedir. 

Keywords

• miyokard performans indeksi; C reaktif protein; ortalama trombosit hacmi

Investigation of Relation Between Myocardial Performance Index (MPI), C Reactive Protein (CRP), Mean Platelet Volume (MPV) at Non Q Non ST Elevated Myocard Infection and Unstable Angina Pectoris (USAP) Patients

Abstract

Aim: Aim of this study is to investigate the relationship between myocardium performance index (MPI) which is considered as cardiovascular prognosis effecting factor and CRP, MPV. Material and Method: 35 patients with non Q non ST elevation MI diagnosis who admitted to coronary intensive care unit has been participated at this study. Results: Women patients’ CRP, men’s height and EF values of women were statistically relevant (p=0.030). Multiple linear regression models with MPI as result variable did not show stastically relevant relations. Conclusion: In this study there is no correlation between MPI, CRP and MPV. Also there was no stastically relevant correlation between MPI, HT, DM, age and EF. Patients’ follow up was made at acute period but chronic period follow up had not been continued, this condition could cause these correlations, also patient number could have an effect.

Keywords

• myocard performance index
• C reactive protein
• mean platelet volume

References

1. 1. Onat A, Keleş İ, Çetinkaya A, Başar Ö, Yıldırım B, Erer B, et al. On yıllık TEKHARF çalışması verilerine göre Türk erişkinlerinde koroner kökenli ölüm ve olayların prevalansı yüksek. Tr Kardiyol Dern Arş 2001;29(1):8–19.
2. 2. Killip T, Kimball JT. Treatment of myocardial infarction in a coronary care unit: a two year experience with 250 patients. Am J Cardiol 1967;20(4):457–64.
3. 3. Takasaki K, Otsuji Y, Yoshifuku S, Kuwahara E, Yuasa T, El Rahim A, et al. Noninvasive estimation of impaired hemodynamics for patients with acute myocardial infarction by Tei index. J Am Soc Echocardiogr 2004;17(6):615–21.
4. 4. Møller JE, Søndergaard E, Poulsen SH, Appleton CP, Egstrup K. Serial Doppler echocardiographic assessment of left and right ventricular performance after a first myocardial infarction. J Am Soc Echocardiogr 2001;14 4:249–55.
5. 5. Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function a study in normals and dilated cardiomyopathy. J Cardiol 1995;26:357–66.
6. 6. Kılıçlı N, Konuralp C. Could mean platelet volume be a predictive marker for acute myocardial infarction. Med Sci Monitor 2005;11 8:387–92.
7. 7. Murat SN, Duran M, Kalay N, Gunebakmaz O, Akpek M, Doger C, et al. Relation between mean platelet volume and severity of atherosclerosis in patients with acute coronary syndromes. Angiol 20132;64(2):131–36.
8. 8. Haverkate E, Thompson SG, Pyke D, Gallimore JR, Group MBP. Production of C-reactive protein and risk of coronary events in stable and unstable angina. The Lancet 1997;349 9050:462–66.

9. 9. Ascione L, De Michele M, Accadia M, Granata G, Sacra C, D’Andrea A. Myocardial global performance index as a predictor of in-hospital cardiac events in patients with first myocardial infarction. J Am Soc Echocardiogr 2003;16:1019–23.
10. 10. Schiller, Nelson B. Two-dimensional echocardiographic determination of left ventricular volume, systolic function, and mass. Summary and discussion of the 1989 recommendations of the American Society of Echocardiography. Circulation 1991;84 3: I280–7.
11. 11. Poulsen SH, Jensen SE, Tei C, Seward JB, Egstrup K. J Value of the Doppler index of myocardial performance in the early phase of acute myocardial infarction. J Am Soc Echocardiogr 2000;13:723–30.
12. 12. Rohde, Luis EP, Charles H. Hennekens, nPaul M. Ridker. Survey of C-reactive protein and cardiovascular risk factors in apparently healthy men. Am J Cardiol 1999;84 9:1018–22.
13. 13. Ridker PM. Clinical Application of C-Reactive Protein for Cardiovascular Disease Detection and Prevention. Circulation 2003;107:363–69.
14. 14. Lin R, Liu J, Peng N, Yang G, Gan W, Wang W. Lovastatin reduces nuclear factor kappaB activation induced by C-reactive protein in human vascular endothelial cells. Biol Pharm Bull 2005;9:1630–4.
15. 15. Devaraj S, Rogers J, Jialal I. Statins and biomarkers of inflammation. Curr Atheroscler Rep 2007;9(1):33–41.
16. 16. Ikonomidis I, Andreotti F, Economou E, Stefanadis C, Toutouzas P, Nihoyannopoulos P. Increased proinflammatory cytokines in patients with chronic stable angina and their reduction by aspirin. Circulation 1999 Aug 24;100(8):793–8.
17. Anzai T, Yoshikawa T, Shiraki H, Asakura Y, Akaishi M, Mitamura H, Ogawa S. C-reactive protein as a predictor of infarct expansion and cardiac rupture after a first Q-wave acute myocardial infarction. Circulation 1997;96(3):778–84.
18. 18. Retterstol L, Eikvar L, Bohn M, Bakken A, Erikssen J, Berg K. C-reactive protein predicts death in patients with previous premature myocardial infarction--a 10 year follow-up study. Atherosclerosis 2002;160(2):433–40.
19. 19. Mueller C, Buettner HJ, Hodgson JM, Marsch S, Perruchoud AP, Roskamm H, Neumann FJ. Inflammation and long-term mortality after non-ST elevation acute coronary syndrome treated with a very early invasive strategy in 1042 consecutive patients. Circulation 2002;105(12):1412–5.
20. 20. Sabatine MS, Morrow DA, de Lemos JA, Gibson CM, Murphy SA, Rifai N, McCabe C, Antman EM, Cannon CP, Braunwald E. Multimarker approach to risk stratification in non-ST elevation acute coronary syndromes: simultaneous assessment of troponin I, C-reactive protein, and B-type natriuretic peptide. Circulation 2002;105(15):1760–3.
21. 21. Yamashita H, Shimada K, Seki E, Mokuno H, Daida H. Concentrations of interleukins, interferon, and C-reactive protein in stable and unstable angina pectoris. Am J Cardiol 2003;91(2):133–6.
22. 22. Tataru MC, Heinrich J, Junker R, Schulte H, von Eckardstein A, Assmann G, Koehler E. C-reactive protein and the severity of atherosclerosis in myocardial infarction patients with stable angina pectoris. Eur Heart J 2000;21(12):1000–8.
23. 23. Verheggen PW, de Maat MP, Cats VM, Haverkate F, Zwinderman AH, Kluft C, Bruschke AV. Inflammatory status as a main determinant of outcome in patients with unstable angina, independent of coagulation activation and endothelial cell function. Eur Heart J 1999;20(8):567–74.
24. 24. Jialal I, Devaraj S, Venugopal SK. C-reactive protein: risk marker or mediator in atherothrombosis? Hypertension 2004;44(1):6–11.
25. 25. Pasceri V, Willerson JT, Yeh ET. Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation 2000;102(18):2165–8.
26. 26. Hansson, Göran K. Inflammation, atherosclerosis, and coronary artery disease. New England Journal of Medicine 2005;352(16):1685–95.
27. 27. Griselli M, Herbert J, Hutchinson WL, Taylor KM, Sohail M, Krausz T, Pepys MB. C-reactive protein and complement are important mediators of tissue damage in acute myocardial infarction. J Exp Med 1999;190(12):1733–40.
28. 28. Moens AL, Claeys MJ, Timmermans JP, Vrints CJ. Myocardial ischemia/ reperfusion-injury, a clinical view on a complex pathophysiological process. Int J Cardiol 2005;100(2):179–90.
29. 29. Buerke M, Prüfer D, Dahm M, Oelert H, Meyer J, Darius H. Blocking of classical complement pathway inhibits endothelial adhesion molecule expression and preserves ischemic myocardium from reperfusion injury. J Pharmacol Exp Ther 1998;286(1):429–38.
30. 30. Nyandak T, Gogna A, Bansal S, Deb M. High sensitive C-reactive protein (hs-CRP) and its correlation with angiographic severity of coronary artery disease (CAD). Indian Academy Clin Med 2007;8(3):217–21.
31. 31. Kim YJ, Shin YO, Bae JS, Lee JB, Ham JH, Son YJ, Kim JK, Kim C, Lee BK, Oh JK, Othman T, Min YK, Yang HM. Beneficial effects of cardiac rehabilitation and exercise after percutaneous coronary intervention on hsCRP and inflammatory cytokines in CAD patients. Pflugers Arch 2008;455(6):1081–8.
32. 32. Nomoto K, Oguchi S, Watanabe I, Kushiro T, Kanmatsuse K. Involvement of inflammation in acute coronary syndromes assessed by levels of high-sensitivity C-reactive protein, matrix metalloproteinase-9 and soluble vascular-cell adhesion molecule-1. J Cardiol 2003;42(5):201–6
33. 33. Hwang SJ, Ballantyne CM, Sharrett AR, Smith LC, Davis CE, Gotto AM Jr, Boerwinkle E. Circulating adhesion molecules VCAM1, ICAM-1, and E-selectin in carotid atherosclerosis and incident coronary heart disease cases: the Atherosclerosis Risk In Communities (ARIC) study. Circulation 1997;96(12):4219–25.
34. 34. Davies MJ, Gordon JL, Gearing AJ, Pigott R, Woolf N, Katz D, Kyriakopoulos A. The expression of the adhesion molecules ICAM-1, VCAM-1, PECAM, and E-selectin in human atherosclerosis. J Pathol 1993;171(3):223–9.
35. 35. Oemar BS, Tschudi MR, Godoy N, Brovkovich V, Malinski T, Lüscher TF. Reduced endothelial nitric oxide synthase expression and production in human atherosclerosis. Circulation 1998;97(25):2494–8.
36. 36. Kawashima S, Yokoyama M. Dysfunction of endothelial nitric oxide synthase and atherosclerosis. Arterioscler Thromb Vasc Biol 2004;24(6):998–1005.
37. 37. Takaya T, Hirata K, Yamashita T, Shinohara M, Sasaki N, Inoue N, Yada T, Goto M, Fukatsu A, Hayashi T, Alp NJ, Channon KM, Yokoyama M, Kawashima S. A specific role for eNOS-derived reactive oxygen species in atherosclerosis progression. Arterioscler Thromb Vasc Biol 2007;27(7):1632–7.
38. 38. Harrington JR. The role of MCP-1 in atherosclerosis. Stem Cells 2000;18(1):65–6.
39. 39. Nabata A, Kuroki M, Ueba H, Hashimoto S, Umemoto T, Wada H, Yasu T, Saito M, Momomura S, Kawakami M. C-reactive protein induces endothelial cell apoptosis and matrix metalloproteinase-9 production in human mononuclear cells: Implications for the destabilization of atherosclerotic plaque. Atherosclerosis 2008;196(1):129–35.
40. 40. Verma S, Wang CH, Li SH, Dumont AS, Fedak PW, Badiwala MV, Dhillon B, Weisel RD, Li RK, Mickle DA, Stewart DJ. A self-fulfilling prophecy: C-reactive protein attenuates nitric oxide production and inhibits angiogenesis. Circulation 2002;106(8):913–9.
41. 41. Cirillo P, Golino P, Calabrò P, Calì G, Ragni M, De Rosa S, Cimmino G, Pacileo M, De Palma R, Forte L, Gargiulo A, Corigliano FG, Angri V, Spagnuolo R, Nitsch L, Chiariello M. C-reactive protein induces tissue factor expression and promotes smooth muscle and endothelial cell proliferation. Cardiovasc Res 2005;68(1):47–55.
42. 42. Karatzis EN. The role of inflammatory agents in endothelial function and their contribution to atherosclerosis. Hellenic J Cardiol 2005;46(3):232–9.
43. 43. Wang CH, Li SH, Weisel RD, Fedak PW, Dumont AS, Szmitko P, Li RK, Mickle DA, Verma S. C-reactive protein upregulates angiotensin type 1 receptors in vascular smooth muscle. Circulation 2003;107(13):1783–90.
44. 44. Karvounis HI, Papadopoulos CE, Zaglavara TA, Nouskas IG, Gemitzis KD, Parharidis GE, et al. Evidence of left ventricular dysfunction in asymptomatic elderly patients with non-insulin-dependent diabetes mellitus. Angiol 2004;55:549–55.
45. 45. Orem C, Küçükosmanoğlu M, Hacihasanoğlu A, Yilmaz R, KasapH, Erdoğan T, Kaplan S, Celik S. Association of Doppler-derivedmyocardial performance index with albuminuria in patients withdiabetes. J Am Soc Echocardiogr 2004;17(11):1185–90.
46. 46. Bruch C, Schmermund A, Marin D, Katz M, Bartel T, Schaar J, Erbel R. Tei-index in patients with mild-to-moderate congestive heart failure. Eur Heart J 2000;21(22):1888–95.
47. 47. Zhang H, Otsuji Y, Matsukida K, Hamasaki S, Yoshifuku S,Kumanohoso T, Koriyama C, Kisanuki A, Minagoe S, Tei C.Noninvasive differentiation of normal from pseudonormal/restrictivemitral flow using TEI index combining systolic and diastolic function.Circ J 2002;66(9):831–6