ST SEGMENT YÜKSELMELİ MİYOKARD ENFARKTÜSÜ'NDE N–TERMİNAL PRO–BRAİN NATRİÜRETİK PEPTİD DÜZEYİNİN PROGNOSTİK ÖNEMİ

Year 2014, Volume: 15 Issue: 1, 21 - 27, 01.04.2014

Ufuk Eryılmaz Osman Akın Serdar Tevfik Fikret İlgenli Sezgin Albayrak Melahat Dirican Zehra Serdar Dilek Yeşilbursa

Abstract

AMAÇ: B tipi Natriütetik peptid düzeyi akut koroner sendromlu hastalarda prognozu belirlemede kullandığımız belirteçlerdendir. Bu çalışmada natriüretik peptid ailesinden N Terminal (NT) proBNP' nin ST segment yükselmeli miyokard enfarktüslü olgulardaki prognostik değerini araştırmayı amaçladık.GEREÇ ve YÖNTEM: Uludağ Üniversitesi Tıp Fakültesi Kardiyoloji Kliniği yoğun bakım ünitesinde akut ST segment yükselmeli miyokard enfarktüsü tanısı ile izlenen 57 hasta incelendi. Olgulardan 6 ve 36. saatte plazmada NT-proBNP bakılmak üzere venöz kan örnekleri alındı. Eş zamanlı EKG'leri çekildi ve kardiyak enzimleri çalışıldı. Üçüncü ayda hastalar, istenmeyen major kardiyak olaylar (ölüm, revaskülarizasyon, tekrarlayan miyokard enfarktüsü ve angina) açısından değerlendirilirken NT-proBNP değerleri ölçüldü. Her üç NT-proBNP değeri ile istenmeyen major kardiyak olaylar arasındaki ilişki araştırıldı.BULGULAR: Hastalar ST segment yükselmesine göre anterior MI geçiren (Grup A) ve inferior MI geçiren (Grup B) hastalar olarak iki gruba ayrıldı. Grup A' da sol ventrikül ejeksiyon fraksiyonunun daha düşük, duvar hareket skor indeksinin daha yüksek olduğu saptandı. Üçüncü ay sonunda en az bir istenmeyen major kardiyak olay geçirenlerle hiç geçirmeyenler arasında NT-proBNP seviyeleri açısından anlamlı istatistiksel fark elde edilemedi (p>0,05). 36. saatte saptanan ortalama NT-proBNP düzeyi 6. saat ortalama NT-proBNP düzeyi ile kıyaslandığında grup A olgularında 10,6±26,2 kat artış gösterdiği, grup B olgularında 3,6±4,7 kat artış gösterdiği saptandı ve bu değer her iki grup arasında istatiksel olarak anlamlı farklılık saptandı (p=0,016). Sol ventrikül ejeksiyon fraksiyonu ve NT-proBNP düzeyleri arasında ilişki saptanmadı. 36. saat NT-proBNP düzeylerinin 300 pg/ml'nin üzerinde olması kötü prognozun öngörücüsüydü.SONUÇ: NT-proBNPdüzeyleri istenmeyen major kardiyak olayları öngörmede önemli katkı sağlayabilir. Özellikle 36. saat NT-proBNP değerlerinin 300 pg/ml'nin üzerinde olması istenmeyen major kardiyak olayların önceden tespitinde ve önlem alınmasında yararlı olabilir

Keywords

Akut miyokard enfarktüsü, NT- proBNP

The Prognostic Value of N- Terminal Pro-Brain Natriuretic Peptide in Patients with ST Segment Elevation Myocardial Infarction

Abstract

Objective: B-type natriuretic peptide levels has been used as a biological marker for prognosis in patients with acute coronary syndrome (ACS). We sought to determine the prognostic value of N-Terminal (NT) proBNP in patients with ST segment elevation myocardial infarction. Materials and Methods: 57 patients from Uludağ University Cardiology Department Intensive Care Unit with ST segment elevation myocardial infarction if they matched the inclusion criteria after the standart treatment was began to patients were enrolled. We measured the NT-proBNP in plasma specimens in the 6th and 36th hours after hospitalization. The cardiac markers were measured and taken ECG records at the same times. After follow up of third month the major advers cardiovascular events (MACE) were evaluated and NTproBNPwas measured again. The relation between MACE and each of NT-proBNP levels were analysed. Results: The patients which were included to the study were divided in two groups in terms of ST segment elevation. These groups are anterior MI (Group A) and inferior MI (Group B) patients. In Group A the left ventricle ejection fraction was found lower and wall motion score index was found higher but they were not statistically significant (p>0,05). After the third month there was no statistically difference in NT-proBNPlevels between the group which had minimally one MACE and the other group which had no MACE (p>0,05). The 36th hours mean NT-proBNP levels compared with sixth hours mean NT-proBNP levels was statistically different in two groups. In Group A, NT-proBNPlevelsincreased 10,6±26,2 timesand in Group B NT-proBNPlevels increased 3,6±4,7 times (p=0,016). There was no correlation between left ventricle ejection fraction and NTproBNP levels. Especially we found that the patients which had 36th hours NT-proBNP level sover 300 pg/ml showed worse prognosis depending on major cardiovascular advers events. Conclusion: Circulating NT-proBNP levels appear elevated in patients with ST Elevation ACS. 36th hours NT-proBNP value sover 300 pg/ml, are associated with worse prognosis depending on major cardiovascular events.

Keywords

Acute myocardial infarction, NT-ProBNP

References

• 1. Levin ER, Gardner DG, Samson WK. Natriuretic peptides. N Eng J Med 1998;339:321-8.
• 2. Swedberg K, Cleland J, Dargie H, Drexler H. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary. Eur Heart J 2005; 26:1115–40.
• 3. Winter RJ, Stroobants A, Koch KT, Bax M. Plasma Nterminal Pro-B-type natriuretic peptide for prediction of death or non fatal myocardial infarction following percutaneous coronary intervention. Am J Cardiol 2004;94:1481-5.
• 4. Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, Mautner B, Corbalan R, Radley D, Braunwald E. The TIMI risk score for unstable angina/non ST elevation MI: a method for prognostic and therapeutic decision making. JAMA 2000; 284:835-42.
• 5. Goyal BM, Sharma SM, Walia M. B-type natriuretic peptide levels predict extentand severity of coronary artery disease in non-ST elevation acute coronary syndrome and normal left ventricular function. Indian Heart J 2014 Mar-Apr;66(2):183-7.
• 6. Omland T, de Lemos JA, Morrow DA, Antman EM. Prognostic value of N-terminal pro-atrial and pro-brain natriuretic peptide in patients with acute coronary syndromes. Am J Cardiol 2002;89:463-5.
• 7. Wagner GS. Ischemia and injury due to insufficient blood supply. Marriott's practical electrocardiography 10th ed. Lippincott Williams &Wilkins, Philadelphia, 2001:163-78.
• 8. Wi v i o t t a SD, Lemo s JA, Mo rr ow DA. Pathophysiology, prognostic significance and clinical utility of B-type natriuretic peptide in acute coronary syndromes. Clin Chim Acta 2004;346:119-28.
• 9. Omland T, Aakvaag A, Bonarje VVS, Caidahl K. Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction comparision with plasma atrial natriuretic peptide and N-terminal proatrial natriuretic peptide. Circulation 1996;93:1963-9.
• 10. Galvani M, Ottani F, Oltrona L, Ardissino D, Gensini GF, Maggioni AP, Mannucci PM, Mininni N, Prando MD, Tubaro M, Vernocchi A, Vecchio C; Italian Working Group on Atherosclerosis, Thrombosis, and Vascular Biology and the Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO). N-terminal pro-brain natriuretic peptide on admission has prognostic value across the whole spectrum of acute coronary syndromes. Circulation 2004;13:123-4.
• 11. Seo SM, Kim S, Chang K, Min J, Kim TH, Koh YS, Park HJ, Shin WS, Lee JM, Kim PJ, Chung WS, Seung KB. Plasma B-type natriuretic peptide level can predict myocardial tissue perfusion in patients undergoing primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction. Coron Artery Dis 2011;22(6):405-10.
• 12. Neyou A, O'Neil B, Berman AD, Boura JA, McCullough PA. Determinants of markedly increased B-type natriuretic peptide in patients with ST-segment elevationmyocardialinfarction.Am J Emerg Med 2011 Feb;29(2):141-7.
• 13. Omland T, Persson A, Ng L, O'Brien R, et al. Nterminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes. Circulation 2002;106:2913-8.
• 14. Clerico A, Emdin M. Diagnostic accuracy and prognostic relevance of the measurement of cardiac natriuretic peptides: a review. Clin Chem 2004;50:33- 50.
• 15. Ndrepepa G, Braun S, Mehilli J, Beckerat NV. Plasma levels of N-terminal pro-brain natriuretic peptide in patients with coronary artery disease and relation to clinical presentation, angiographic severity, and left ventricular ejection fraction. Am J Cardiol 2005;95:553-7.
• 16. Pfister R, Schneider CA. Natriuretic peptides BNP and NT-pro-BNP: established laboratory markers in clinical practice or just perspectives? Clinical Chimica Acta 2004;349:25-38.