Düşük ejeksiyon fraksiyonlu kalp yetersizliği, atriyal fibrilasyon ve natriüretik peptidler: retrospektif kapalı kohort verileri

Year 2020, Volume: 13 Issue: 1, 155 - 162, 21.01.2020

Ebru İpek Turkoglu , Emine Cigdem Kırcicegi Cicekdag

https://doi.org/10.31362/patd.647900

Abstract

Amaç: Düşük ejeksiyon fraksiyonlu kalp yetersizliği
(DEF-KY), kalp yetersizliği (KY) kliniği ile birlikte sol ventrikül ejeksiyon
fraksiyonunun (SoVEF) < %40 olması olarak tanımlanır ve bu grupta eşlik eden
atriyal fibrilasyon (AF) daha kötü bir prognozla birliktedir. Biz bu
çalışmamızda, kendi kohortumuzda bulunan DEF-KY ve AF hastalarının özelliklerini
ve NT-proBNP düzeylerini incelemeyi amaçladık.

Yöntem ve Metod: Çalışmaya Ocak-Haziran 2018
tarihleri arasında .......... kardiyoloji polikliniğine başvuran SoVEF<%40
olan AF eşlik eden ve kompanse KY fazında en az bir kere NT-proBNP değeri
bulunan ayaktan hastalar çalışmaya alındı. Hastaların bazal özellikleri
ile  stabil ve dekompanse fazdaki
NT-proBNP düzeyleri araştırıldı.

Bulgular: DEF-KY ve eşlik eden AF bulunan 48 hasta
analize alındı. Ortalama yaş

71.8±9.1 yıl, 
SoVEF % 35.9± 2.3, CHA₂DS₂ ve CHA₂DS₂VASc
skorları sırasıyla 3.3±1.3 ve 4.8±1.4 idi. Stabil fazdaki ortalama NT-proBNP
2657.6±2675.9 pg/ml bulundu. Dekompanse fazda NT-proBNP, 15 hastada mevcuttu ve
ortalama 4433.5±3219.6 (% 111.1±.74.5) idi. NT-proBNP düzeyindeki değişim ne CHA₂DS₂
ne de CHA₂DS₂VASc skorları ile korele değildi.

Sonuç: Natriüretik peptidlerin KY tanısındaki önemi
bilinmektedir ancak her ne kadar AF varlığında daha yüksek olduklarına dair
temel bir bilgi olsa da AF ile birlikte olan DEF-KY hasta grubunda üst sınırlar
bilinmemektedir. Bu çalışma, AF olan DEF-KY hastalarında stabil fazdaki NT-proBNP
düzeyinin sinüs ritminde önerilen üst sınırların çok üstünde olduğunu ve bazal
değerlere göre minimum %40.7  artışın
dekompansasyon ile ilişkili olduğunu göstermiştir. Çalışmamız, AF olan DEF-KY
hastalarında kompanse fazdaki NT-proBNP’nin bilinmesinin bireyselleştirilmiş
tedavinin bir parçası olarak dekompansasyon tanısı için önemini
vurgulamaktadır. 

Keywords

Kalp yetersizliği, atriyal fibrilasyon, NT-proBNP

Supporting Institution

yok

Project Number

Çalışmanın etik onamı, 14.11.2018 tarihinde Sağlık Bilimleri Üniversitesi, İzmir Tepecik Sağlık Uygulama Araştırma Merkezi Girişimsel Olmayan Etik Kurulundan alındı ve karar numarası 2018/13-13’dür.

Thanks

Çalışmanın istatistikleri konusunda yardımları için İstatistik danışmanı sayın Ömer Kaplan’a teşekkür ederiz.

Heart failure with reduced ejection fraction, atrial fibrillation and natriuretic peptides: retrospective data from a closed cohort.

Abstract

Purpose:
Heart failure with reduced ejection fraction (HFrEF) is defined as clinical
heart failure (HF) with an left ventricle ejection fraction (LVEF)
<40%.  Cooccurrence of atrial
fibrilation (AF) is associated with a worse prognosis in this group of patients
and N-terminal-pro B type natriuretic peptide (NT-proBNP) levels are not widely
investigated. İn the present study we aimed to investigate patients from a
closed cohort with HFrEF and AF and their NT-proBNP levels.

Materials
and Methods: Data of patients  who applied to the cardiology outpatient
clinic of xxxhospital between January and June 2018 are reviewed
retrospectively. Patients who diagnosed with HF and AF with an LVEF<40% and
NT-proBNP level in stable phase of chronic HF are included to the study.
Demographics of patients with HFrEF and AF and their NT-proBNP levels are
investigated.

Results:
According to the inclusion criteria, 48 patients are enrolled to the study.
Mean age was 71.8±9.1 years, LVEF was 35.9± 2.3%, CHA₂DS₂
and CHA₂DS₂VASc scores were 3.3±1.3 and 4.8±1.4
respectively. Mean NT-proBNP level in stable chronic phase of HF was
2657.6±2675.9 pg/ml. NT-proBNP level in decompansated phase of HF was present
in 15 patients and the mean level and the change of NT-pro BNP level were
4433.5±3219.6 and % 111.1±.74.5 respectively. There was no correlation between
the change of NT-proBNP level and CHA₂DS₂ or CHA₂DS₂VASc
scores.

Conclusion: The
clinical value of NT-proBNP in the HF is well known. AF is another condition
which may cause higher levels. Although higher levels of NT-proBNP are expected
with the co-presence of HFrEF and AF, the upper limit is not known. The
knowlegde of the NT-proBNP level in stable chronic HF and AF patients may help
for the diagnosis of decompansation in part of individualised treatment

Keywords

Heart failure with reduced ejection fraction, atrial fibrillation, NT-proBNP

Project Number

Çalışmanın etik onamı, 14.11.2018 tarihinde Sağlık Bilimleri Üniversitesi, İzmir Tepecik Sağlık Uygulama Araştırma Merkezi Girişimsel Olmayan Etik Kurulundan alındı ve karar numarası 2018/13-13’dür.

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