Romatizmal mitral darlık hastalarında mitral kapak yaprakçık kalsifikasyonu ile prognostik nütrisyonel indeks ilişkisi

Abstract

Amaç: Romatizmal mitral darlığı ve malnütrisyon, gelişmekte olan ülkelerde halen önemli bir sağlık sorunudur. Mitral kapak yaprakçık kalsifikasyonu, mitral darlığı hastalarının prognozlarını kötü yönde etkileyen klinik bir durumdur. Bu çalışmada, malnütrisyonun genel bir göstergesi olan prognostik nütrisyonel indeks (PNİ) ile mitral darlığı bulunan hastalarda mitral kapak yaprakçık kalsifikasyonu ilişkisi incelenmiştir. Yöntem: Mitral darlığı tanısı bulunan 675 hasta retrospektif olarak çalışmaya dahil edilmiştir. Mitral darlığı bulunan hastalar mitral kapak yaprakçık kalsifikasyonu bulunup bulunmamasına göre ve mitral kapak darlığının ciddiyetine göre sınıflandırılmıştır. Laboratuvar bulguları ve PNİ değerleri gruplar arası karşılaştırılmıştır. Bulgular: Mitral kapak yaprakçık kalsifikasyonu varlığına bağlı olarak yapılan sınıflamada gruplar arasında diabetes mellitus ve hipertansiyon sıklığı benzerdi. Serum albümin düzeyleri ve PNİ, mitral yaprakçık kalsifikasyonu bulunan grupta istatistiksel anlamlılığa erişecek şekilde düşük saptandı (sırasıyla 4.1±0.5’e karşı 3.9±0.5 p<0.001 ve 51.3±7.85’e karşı 48.5±7.4 p<0.001). Yapılan regresyon analizinde mitral kapak yaprakçık kalsifikasyonunun en önemli ön gördürücü belirteçleri olarak PNİ ve mitral kapak alanı saptandı. Sonuç: Mitral kapak yaprakçık kalsifikasyonu bulunan hastalarda, PNİ anlamlı olarak düşük saptanmıştır. Ayrıca düşük PNİ düzeyleri, mitral kapak yaprakçık kalsifikasyonunun ön gördürücülerinden biridir.

Keywords

• Romatizmal mitral darlık
• inflamasyon
• prognostik nütrisyonel indeks

Relationship between mitral valve leaflet calcification and prognostic nutritional index in patients with rheumatic mitral stenosis

Abstract

Aim: Rheumatic mitral stenosis and malnutrition are still important health problems in developing countries. Mitral valve leaflet calcification is a clinical condition that adversely affects the prognosis of patients with mitral stenosis. Thus we sought to investigate the relationship between the prognostic nutritional index (PNI), which is a general indicator of malnutrition, and mitral valve leaflet calcification in patients with mitral stenosis. Method: Retrospectively, 675 patients with a diagnosis of mitral stenosis were included. Patients with mitral stenosis were classified according to the coexistence of mitral valve leaflet calcification and the severity of mitral valve stenosis. Laboratory findings and PNI calculations were compared. Results: The frequency of diabetes mellitus and hypertension was similar between the groups based on mitral valve leaflet calcification. Mean serum albumin levels and PNI were lower in the mitral valve leaflet calcification group (4.1±0.5 vs. 3.9±0.5 p<0.001 and 51.3±7.85 vs. 48.5±7.4 p<0.001, respectively). Regression analysis revealed that PNI and mitral valve area are the strongest independent predictors of mitral valve leaflet calcification. Conclusion: PNI was found significantly lower for mitral valve leaflet calcification group and PNI was one of the strongest independent predictors of mitral valve leaflet calcification.

Keywords

• Rheumatic mitral stenosis
• inflammation
• prognostic nutritional index

References

1. 1. Bland EF, Duckett Jones T. Rheumatic fever and rheumatic heart disease; a twenty year report on 1000 patients followed since childhood. Circulation. Dec 1951;4(6):836-43. doi:10.1161/01.cir.4.6.836
2. 2. Chandrashekhar Y, Westaby S, Narula J. Mitral stenosis. Lancet. Oct 10 2009;374(9697):1271-83. doi:10.1016/s0140-6736(09)60994-6
3. 3. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. Feb 2 2021;143(5):e35-e71. doi:10.1161/cir. 0000000000000932
4. 4. Zühlke L, Engel ME, Karthikeyan G, et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study). Eur Heart J. May 7 2015;36(18):1115-22a. doi:10.1093/eurheartj/ehu449
5. 5. Kulprachakarn K, Ounjaijean S, Wungrath J, Mani R, Rerkasem K. Micronutrients and Natural Compounds Status and Their Effects on Wound Healing in the Diabetic Foot Ulcer. Int J Low Extrem Wounds. Dec 2017;16(4):244-250. doi:10.1177/1534734617737659
6. 6. Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. Feb 2011;8(2):514-27. doi:10.3390/ijerph8020514
7. 7. Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. Jan 1980;139(1):160-7. doi:10.1016/0002-9610(80)90246-9
8. 8. Onodera T, Goseki N, Kosaki G. [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai Zasshi. Sep 1984;85(9):1001-5.

9. 9. Narumi T, Arimoto T, Funayama A, et al. Prognostic importance of objective nutritional indexes in patients with chronic heart failure. J Cardiol. Nov 2013;62(5):307-13. doi:10.1016/j.jjcc.2013.05.007
10. 10. Cheng YL, Sung SH, Cheng HM, et al. Prognostic Nutritional Index and the Risk of Mortality in Patients With Acute Heart Failure. J Am Heart Assoc. Jun 25 2017;6(6)doi:10.1161/jaha.116.004876
11. 11. Hayashi J, Uchida T, Ri S, et al. Clinical significance of the prognostic nutritional index in patients undergoing cardiovascular surgery. Gen Thorac Cardiovasc Surg. Aug 2020;68(8):774-779. doi:10.1007/s11748-020-01300-x
12. 12. Tanık V EPH. Mitral anüler kalsifikasyon ile prognostik nutrisyonel indeks arasındaki koreleasyon. TJCL. 2019;10(4):452-458.
13. 13. Mahnken AH, Mühlenbruch G, Das M, et al. MDCT detection of mitral valve calcification: prevalence and clinical relevance compared with echocardiography. AJR Am J Roentgenol. May 2007;188(5):1264-9. doi:10.2214/ajr.06.1002
14. 14. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. Oct 2012;42(4):S1-44. doi:10.1093/ejcts/ezs455
15. 15. Guilherme L, Cury P, Demarchi LM, et al. Rheumatic heart disease: proinflammatory cytokines play a role in the progression and maintenance of valvular lesions. Am J Pathol. Nov 2004;165(5):1583-91. doi:10.1016/s0002-9440(10)63415-3
16. 16. Davutoglu V, Celik A, Aksoy M. Contribution of selected serum inflammatory mediators to the progression of chronic rheumatic valve disease, subsequent valve calcification and NYHA functional class. J Heart Valve Dis. Mar 2005;14(2):251-6.
17. 17. Alyan O, Metin F, Kacmaz F, et al. High levels of high sensitivity C-reactive protein predict the progression of chronic rheumatic mitral stenosis. J Thromb Thrombolysis. Jul 2009;28(1):63-9. doi:10.1007/s11239-008-0245-7
18. 18. Polat N, Yildiz A, Yuksel M, et al. Association of neutrophil-lymphocyte ratio with the presence and severity of rheumatic mitral valve stenosis. Clin Appl Thromb Hemost. Nov 2014;20(8):793-8. doi:10.1177/1076029613514131
19. 19. Fanali G, di Masi A, Trezza V, Marino M, Fasano M, Ascenzi P. Human serum albumin: from bench to bedside. Mol Aspects Med. Jun 2012;33(3):209-90. doi:10.1016/j.mam.2011.12.002
20. 20. Münzel T, Gori T, Keaney JF, Jr., Maack C, Daiber A. Pathophysiological role of oxidative stress in systolic and diastolic heart failure and its therapeutic implications. Eur Heart J. Oct 7 2015;36(38):2555-64. doi:10.1093/eurheartj/ehv305
21. 21. Korantzopoulos P, Kolettis TM, Galaris D, Goudevenos JA. The role of oxidative stress in the pathogenesis and perpetuation of atrial fibrillation. Int J Cardiol. Feb 7 2007;115(2):135-43. doi:10.1016/j.ijcard.2006.04.026
22. 22. Paar M, Rossmann C, Nusshold C, et al. Anticoagulant action of low, physiologic, and high albumin levels in whole blood. PLoS One. 2017;12(8):e0182997. doi:10.1371/journal.pone.0182997
23. 23. Halliwell B. Albumin--an important extracellular antioxidant? Biochem Pharmacol. Feb 15 1988;37(4):569-71. doi:10.1016/0006-2952(88)90126-8
24. 24. Oner T, Ozdemir R, Genc DB, et al. Parameters indicative of persistence of valvular pathology at initial diagnosis in acute rheumatic carditis: the role of albumin and CD19 expression. J Pediatr (Rio J). Nov-Dec 2016;92(6):581-587. doi:10.1016/j.jped.2016.01.013
25. 25. Moldawer LL, Copeland EM, 3rd. Proinflammatory cytokines, nutritional support, and the cachexia syndrome: interactions and therapeutic options. Cancer. May 1 1997;79(9):1828-39.
26. 26. Terrier N, Senécal L, Dupuy AM, et al. Association between novel indices of malnutrition-inflammation complex syndrome and cardiovascular disease in hemodialysis patients. Hemodial Int. Apr 2005;9(2):159-68. doi:10.1111/j.1492-7535.2005.01127.x
27. 27. Chien SC, Lo CI, Lin CF, et al. Malnutrition in acute heart failure with preserved ejection fraction: clinical correlates and prognostic implications. ESC Heart Fail. Oct 2019;6(5):953-964. doi:10.1002/ehf2.12501
28. 28. Buzby GP, Williford WO, Peterson OL, et al. A randomized clinical trial of total parenteral nutrition in malnourished surgical patients: the rationale and impact of previous clinical trials and pilot study on protocol design. Am J Clin Nutr. Feb 1988;47(2 Suppl):357-65. doi:10.1093/ajcn/47.2.357