acta med nicomedia Acta Medica Nicomedia 2717-8994 2717-8994 Kocaeli Üniversitesi 10.53446/actamednicomedia.1109613 Cardiovascular Surgery Kalp ve Damar Cerrahisi AKUT OLMAYAN DİSPNEDE N-TERMİNAL PROHORMON BEYİN NATRİÜRETİK PEPTİT SEVİYESİ İLE EKOKARDİYOGRAFİK SOL VENTRİKÜL SİSTOLİK VEYA DİYASTOLİK İŞLEV BOZUKLUĞU İLİŞKİSİ ASSOCIATION OF N-TERMINAL PROHORMONE BRAIN NATRIURETIC PEPTIDE LEVEL AND ECHOCARDIOGRAPHIC LEFT VENTRICULAR SYSTOLIC OR DIASTOLIC DYSFUNCTION IN NON-ACUTE DYSPNEA https://orcid.org/0000-0002-1085-5462 Karaca Özer Pelin İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, KARDİYOLOJİ ANABİLİM DALI https://orcid.org/0000-0002-6595-4812 Ayduk Govdelı Elif İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, KARDİYOLOJİ ANABİLİM DALI 02 28 2023 6 1 1 9 04 27 2022 10 19 2022 Copyright © 2020, Acta Medica Nicomedia 2020 Acta Medica Nicomedia

Amaç: Bu çalışmanın amacı, akut olmayan nefes darlığı şikayeti olan, obez olmayan hastalarda serum N-terminal prohormon beyin natriüretik peptit (NT-proBNP) düzeyinin ve sol ventrikül (SV) sistolik disfonksiyonunun (SD) veya diyastolik disfonksiyonunun (DD) kanıtlarını değerlendirmektir.Yöntem: Bu çalışmada, Ekim 2020 ile Ekim 2021 arasında akut olmayan nefes darlığı şikayeti ile başvuran hastalarda transtorasik ekokardiyografi (TTE) ile değerlendirilen SV SD veya DD varlığı ile serum NT-proBNP düzeyi geriye dönük olarak değerlendirildi. Serum NT-proBNP düzeyi için normal sınır (125 pg/ml) cut-off değeri olarak kullanıldı.Bulgular: Toplamda 435 hasta çalışmaya dahil edildi. Hastaların %61'inde (n=264), NT-proBNP düzeyi yüksekti (≥ 125 pg/ml). ≥ 125 pg/ml olan hastaların %56'sında (n=147) SD veya DD kanıtı yoktu. NT-proBNP’ si artmış ancak SD veya DD' si olmayan hastalarda, H2FPEF skoru ≥ 6, atriyal fibrilasyon, malignite, önceki COVID-19 ve hastaneye yatış ihtiyacı olan hastalar, NT-proBNP' si normal olan ve SD veya DD olmayan hastalara göre anlamlı olarak daha yüksekti (sırasıyla %13'e karşı %4; %5'e karşı %1; %16'ya karşı %9; %29'a karşı %5; ve %25'e karşı %11). NT-proBNP değerinin < 752,1 pg/ml oluşu SD’ u %72,5 duyarlılık ve %83,1 özgüllük ile ve < 350,3 pg/ml oluşu DD’ u %71,3 duyarlılıkla ve %75,5 özgüllük ile dışladı.Sonuç: Yüksek bir NT-proBNP değeri her zaman SD veya DD' yi göstermez. NT-proBNP ölçümü, akut olmayan dispnede prognostik önem eklemenin yanı sıra, çeşitli klinik durumlarda sadece aşikar kalp yetersizliğini değil, aynı zamanda subklinik SV disfonksiyonunu da saptayabilir.

Objective: The aim of the study was to evaluate serum N-terminal prohormone brain natriuretic peptide (NT-proBNP) level and evidence of left ventricular (LV) systolic dysfunction (SD) or diastolic dysfunction (DD) in non-obese patients with non-acute dyspnea. Methods: This study retrospectively evaluated the serum NT-proBNP level and LV SD or DD from transthoracic echocardiography (TTE) in patients with non-acute dyspnea between October 2020 and October 2021. The normal limit for the serum NT-proBNP level (125 pg/ml) was used as the cut-off value. Results: Ultimately, 435 patients were included in the study. In 61% of the patients (n=264), the NT-proBNP level was elevated (≥ 125 pg/ml). There was no evidence of SD or DD in 56% of the patients (n=147) with ≥ 125 pg/ml. The patients whose NT-proBNP ≥ 125 but who had no SD or DD had a significantly higher H2FPEF score ≥ 6, atrial fibrillation, malignancy, previous COVID-19, and need for hospitalization than the patients whose NT-proBNP < 125 and who had no SD or DD (13% vs. 4%; 5% vs. 1%; 16% vs. 9%; 29% vs. 5%; and 25% vs. 11%, respectively). An NT-proBNP value < 752.1 pg/ml excluded SD with 72.5% sensitivity and 83.1% specificity and < 350.3 pg/ml excluded DD with 71.3% sensitivity and 75.5% specificity. Conclusion: A high NT-proBNP value does not always indicate SD or DD. NT-proBNP measurement may detect not only overt heart failure but also subclinical LV dysfunction in various clinical entities, in addition to adding prognostic significance in non-acute dyspnea.

 dyspnea heart failure NT-proBNP kalp yetmezliği NT-proBNP dispne Ibrahim NE, Gaggin HK, Konstam MA, Januzzi JL. Established and emerging roles of biomarkers in heart failure clinical trials. Circ Heart Fail. 2016;9(9):e002528. doi:10.1161/CIRCHEARTFAILURE.115.002528 Kramer F, Sabbah HN, Januzzi JJ, et al. Redefining the role of biomarkers in heart failure trials: expert consensus document. Heart Fail Rev. 2017;22(3):263-277. doi:10.1007/s10741-017-9608-5 Ibrahim NE, Januzzi JL. Beyond natriuretic peptides for diagnosis and management of heart failure. Clin Chem. 2017;63(1):211-222. doi:10.1373/clinchem.2016.259564 Smith SA, Mentz RJ, Roessig L, et al. Using Natriuretic Peptides for Selection of Patients in Acute Heart Failure Clinical Trials. Am J Cardiol. 2015;116(8):1304-10. doi:10.1016/j.amjcard.2015.07.049 McDonagh TA, Metra M, Adamo M, et al. ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-3726. doi:10.1093/eurheartj/ehab368 Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e876-e894. doi:10.1161/CIR.0000000000001062 Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019;32(1):1-64. doi:10.1016/j.echo.2018.06.004 Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29(4):277-314. doi:10.1016/j.echo.2016.01.011 Paulus WJ. H2FPEF Score: At Last, a Properly Validated Diagnostic Algorithm for Heart Failure With Preserved Ejection Fraction. Circulation. 2018;138(9):871-873. doi:10.1161/CIRCULATIONAHA.118.035711 Cowie MR, Struthers AD, Wood DA, et al. Value of natriuretic peptides in assessment of patients with possible new heart failure in primary care. Lancet. 1997;350(9088):1349-53. doi:10.1016/S0140-6736(97)06031-5 Zaphiriou A, Robb S, Murray-Thomas T, et al. The diagnostic accuracy of plasma BNP and NTproBNP in patients referred from primary care with suspected heart failure: results of the UK natriuretic peptide study. Eur J Heart Fail. 2005;7(4):537-41. doi:10.1016/j.ejheart.2005.01.022 Kelder JC, Cramer MJ, Verweij WM, Grobbee DE, Hoes AW. Clinical utility of three B-type natriuretic peptide assays for the initial diagnostic assessment of new slow-onset heart failure. J Card Fail. 2011;17(9):729-34. doi:10.1016/j.cardfail.2011.04.013 Gardner RS, Ozalp F, Murday AJ, Robb SD, McDonagh TA. N-terminal pro-brain natriuretic peptide. A new gold standard in predicting mortality in patients with advanced heart failure. Eur Heart J. 2003;24(19):1735-43. doi:10.1016/j.ehj.2003.07.005 Januzzi JL Jr. Natriuretic peptide testing: a window into the diagnosis and prognosis of heart failure. Cleve Clin J Med. 2006;73(2):149-52, 155-7. doi:10.3949/ccjm.73.2.149 Castiglione V, Aimo A, Vergaro G, Saccaro L, Passino C, Emdin M. Biomarkers for the diagnosis and management of heart failure. Heart Fail Rev. 2022;27(2):625-643. doi:10.1007/s10741-021-10105-w Thavendiranathan P, Poulin F, Lim KD, Plana JC, Woo A, Marwick TH. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. J Am Coll Cardiol. 2014;63(25 Pt A):2751-68. doi:10.1016/j.jacc.2014.01.073 Selçuk M, Keskin M, Çınar T, et al. Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure. J Cardiovasc Thorac Res. 2021;13(2):141-145. doi:10.34172/jcvtr.2021.26 Mahajan S, Kunal S, Shah B, et al. Left ventricular global longitudinal strain in COVID-19 recovered patients. Echocardiography. 2021;38(10):1722-1730. doi:10.1111/echo.15199. Epub 2021 Sep 23 Italia L, Ingallina G, Napolano A, et al. Subclinical myocardial dysfunction in patients recovered from COVID-19. Echocardiography. 2021;38(10):1778-1786. doi:10.1111/echo.15215 McCullough PA, Nowak RM, McCord J, et al. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study. Circulation. 2002;106(4):416-22. doi:10.1161/01.cir.0000025242.79963.4c Januzzi JL Jr., Camargo CA, Anwaruddin S, et al. The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study. Am J Cardiol. 2005;95(8):948-54. doi:10.1016/j.amjcard.2004.12.032 Januzzi JL Jr., Chen-Tournoux AA, Christenson RH, et al. N-Terminal Pro-B-Type Natriuretic Peptide in the Emergency Department: The ICON-RELOADED Study. J Am Coll Cardiol. 2018;71(11):1191-200. doi:10.1016/j.jacc.2018.01.02