Kardiyovasküler İmplante Edilen Elektronik Cihaz Takılması Sonrası Erken Dönem İnflamatuar Biyo-Belirteçlerin Seyri

Abstract

Amaç: Güncel literatürde kardiyovasküler implante edilen elektronik cihaz (KİEC) takılması sonrası inflamatuar biyo-belirteçlerin seyri ile ilgili yeterli veri yoktur. Çalışmamızda KİEC takılması sonrası 5 gün içerisinde C- reaktif protein (CRP)ve beyaz kan hücresi (BKH) değişimlerini ortaya çıkarmayı amaçladık
Yöntem: Kalp merkezimizde 2012-2016 yılları arasında KİEC takılan toplam 235 hastayı geriye dönük olarak araştırdık. CRP ve BKH sayımı düzeylerinin işlemden 1 gün önce ve işlemden sonraki 5 gün içerisindeki toplamda 4 seri ölçümleri not edildi. CRP ve BKH’nin zaman içerisindeki seyri ve farklı değişkenler ile olan ilişkisi tekrarlayan ölçümler için linear mix model yöntemi kullanılarak analiz edildi.
Bulgular: Toplamda 235 hasta tarandı; 36 hasta işlem sonrası seri CRP ve WBC düzeyleri olamaması, 44 hasta CRP ve WBC düzeylerini etkileyebilecek potansiyel bir neden olması sebebiyle çalışma dışı bırakıldı. Sonuç olarak çalışmaya median yaşı 67 (IQR 58-74) 41’i (%26,8) kadın olan toplamda 153 hasta dahil edildi. CRP düzeyleri belirgin değişim gösterdi ve işlem sonrası ikinci ölçümde (48-72 saatler arası) en yüksek değerine ulaştı (Beta[β]: 0,208; Standart Hata [S.H] 0,015; p<0,001). Yaş ve işlem süresinin 1 saatten uzun olması yüksek CRP düzeylerine neden olan faktörler olarak ortaya çıktı (sırası ile β: 0,004; S.H 0,002; p=0,05 ve β:0,208; S.E:0,015; p= 0,02). Zaman ve BKH arasında istatistiksel anlamlı bir ilişki saptanmadı. (β: -0,129; S.E: 0,06; p=0,06).
Sonuç: KIEC takılması sonrası CRP seyri anlamlı bir değişim gösterir. Yaş ve işlem süresinin 1 saatten uzun olması yüksek CRP düzeylerine neden olan faktörlerdir. İşlem sonrası 5 gün içerisinde zaman ve BKH arasında istatistiksel olarak anlamlı olmayan bir ilişki vardır. 

Keywords

• Kalp pili,implante edilen defibrillator,c-reaktif protein,inflamasyon,biyo-marker

Progression of Inflammatory Biomarkers Early after Cardiovascular Implantable Electronic Device Placement

Abstract

Objective: There is a lack of data in the current literature regarding the spontaneous progression of inflammatory biomarkers early after cardiovascular implantable electronic device (CIED) placement. In our study we aimed to detect C-reactive protein (CRP) and white blood cell count (WBC) trends in the 5 days following CIED implantation.
Methods: We retrospectively investigated a total of 235 patients who received CIEDs between 2012 and 2016 in our heart center. The levels of CRP and WBC for one day before and for the following 5 days after the procedure were noted in 4 serial measurements. The longitudinal course of CRP and WBC and their association with various parameters were analyzed with linear mix model of repeated measurements.
Results: Totally 235 patients were screened; 36 patients excluded due to lack of serial CRP and WBC measurements, 44 patients excluded due to occurrence of a factor that may potentially affect CRP and WBC level. Finally 153 patients with a median age of 67 (IQR 58-74), 41 (26.8%) of whom were female, were included in the study. CRP values indicated a significant trend and made a peak in the second estimation (between 48-72 hours) after the procedure (Beta[β]: 0.208; Standard Error [S.E]: 0.015; p< 0.001). Age and procedure duration longer than 1 hour emerged as leading factors for high level of CRP (β:0.004; S.E: 0.002; p=0.05 and β: 0.208; S.E: 0.015; p= 0.02, respectively). The relation between time and WBC count was not statically significant (β: -0.129; S.E: 0.06; p=0.06).
Conclusion: Progression of CRP after CIED implantation demonstrates a significant trend. Age and procedure duration longer than 1 hour are leading factors for high levels of CRP. There is statistically non-significant relation between WBC levels and time in 5 days of procedure. 

Keywords

• Pacemaker,implantable defibrillators,C-reaktive protein,inflammation,biomarkers

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