Kardiyak Resenkronizasyon Tedavisine Yanıtın Öngörülmesinde Sistemik Bağışıklık-İnflamatuvar İndeksinin Rolü

Yıl 2022, , 145 - 154, 31.08.2022

Mehmet Çelik , Ayhan Küp , Serdar Demir , Kamil Gülşen , Servet İzci , Ahmet Seyda Yılmaz , Yusuf Yılmaz , Fatma Betül Çelik , Fatih Kahraman , Muhammed Raşit Tanırcan , Mehmet Özgeyik , Abdulkadi Uslu

https://doi.org/10.36516/jocass.1139629

Öz

Amaç: Kardiyak resenkronizasyon tedavisi (KRT), sistolik disfonksiyonu olan hastalarda güvenilir bir tedavi yöntemidir. Ancak, KRT'nin faydası belli hasta grupları ile sınırlıdır. Sistemik immün inflamatuvar indeks (SII), çeşitli kardiyovasküler bozuklukların kötü prognozu ile ilişkilidir. Bununla birlikte, dilate kardiyomiyopati hastalarında SII'nin KRT'ye yanıtı belirlemede prediktif değeri olup olmadığını araştıran bir çalışma bulunmamaktadır. Bu nedenle, bu çalışmada SII ile KRT'ye yanıt arasındaki ilişkiyi araştırmak amaçlandı.
Yöntemler: Bu çalışmaya KRT implante edilen toplam 220 hasta (ortalama yaş 61.2±10.8 yıl; 120 erkek) dahil edildi. KRT öncesi ekokardiyografi ve laboratuvar ölçümleri değerlendirildi. KRT'ye yanıt, bir yıllık takipte sol ventrikül sistol sonu hacminde ≥ %15 azalma olarak belirlendi.
Bulgular: Hastalar, KRT'ye yanıt verenler ve yanıt vermeyenler olarak gruplandırıldı. Bunlardan 143'ü (%64,6) KRT'ye yanıt veren olarak kabul edilirken, kalan 77'si (%33,4) yanıt vermeyendi. Kadın cinsiyet (OR: 3.823, CI: 1.568-9.324 p=0.003), QRS süresi (OR: 1.224, CI: 1.158-1.335 p<0.001) ve SII (OR: 0.996 CI: 0.995-0.997 p<0.001) çok değişkenli analizde KRT yanıtının bağımsız öngörücüleri olarak bulundu. SII >825'lik bir sınır değeri, %80 duyarlılık ve %75 özgüllük ile KRT'ye yanıt olmadığını öngördürmüştür.
Sonuçlar: Bu çalışmada SII’nin KRT'ye yanıtsızlığı öngördüğü gösterilmiştir. Bu nedenle SII rutin klinik uygulamada KRT implantasyonu için optimal hasta seçimini belirlemede kullanılabilir.

Anahtar Kelimeler

Kardiyak resenkronizasyon tedavisi, Sistemik immün-inflamatuvar indeks, Kalp yetmezliği

The Role of the Systemic Immune-Inflammation Index in Predicting Response to Cardiac Resynchronization Therapy

Öz

Objective: Cardiac resynchronization therapy (CRT) is a reliable treatment modality in patients with systolic dysfunction. However, not every patient appears to benefit from CRT. The systemic immune inflammation index (SII) is closely linked to the poor prognosis of various cardiovascular disorders. However, there is no study investigating whether SII has predictive value in determining response to CRT in dilated cardiomyopathy patients. Therefore, we intend to investigate the association between SII and response to CRT.
Methods: A total of 220 patients (mean age 61.2±10.8 years; 120 men) implanted with CRT were involved in this study. Echocardiographic and laboratory measurements were evaluated prior to CRT. Response to CRT was determined as a≥ 15% decrease in left ventricular end-systolic volume at one-year follow-up.
Results: Patients grouped as CRT responders and non-responders. Of these, 143 (64.6%) were considered to be CRT responders, while the remaining 77 (33.4%) were non-responders. Female sex (OR: 3.823, CI: 1.568-9.324 p=0.003), QRS duration (OR: 1.224, CI: 1.158-1.335 p<0.001), and SII (OR: 0.996 CI: 0.995-0.997 p<0.001) were shown to be independent predictors of CRT response in multivariate analysis. A cut-off value of SII >825 estimated no response to CRT with 80% sensitivity and 75% specificity.
Conclusions: SII was associated with unresponsiveness to CRT. Therefore, it may be used to determine optimal patient selection for CRT implantation in routine clinical practice.

Anahtar Kelimeler

Cardiac resynchronization therapy, Systemic immune-inflammation index, Heart failure

Kaynakça

• 1. Bristow MR, Saxon LA, Boehmer J, et al. Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350(21):2140-50.
• 2. Linde C, Leclercq C, Rex S, et al. Long-term benefits of biventricular pacing in congestive heart failure: results from the MUltisite STimulation in cardiomyopathy (MUSTIC) study. J Am Coll Cardiol. 2002;40(1):111-8.
• 3. Goldenberg I, Moss AJ, Hall WJ, et al. Predictors of response to cardiac resynchronization therapy in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT). Circulation. 2011;124(14):1527-36.
• 4. Abraham WT, Fisher WG, Smith AL, et al. Multicenter InSync Randomized Clinical Evaluation. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002;346(24):1845-53.
• 5. Vasan RS, Sullivan LM, Roubenoff R, et al. Inflammatory markers and risk of heart failure in elderly subjects without prior myocardial infarction: the Framingham Heart Study. Circulation. 2003;107(11):1486-91.
• 6. Dick SA, Epelman S. Chronic Heart Failure and Inflammation: What Do We Really Know? Circ Res. 2016;119(1):159-76.
• 7. Agacdiken A, Celikyurt U, Sahin T, et al. Neutrophil-to-lymphocyte ratio predicts response to cardiac resynchronization therapy. Med Sci Monit. 2013;19:373-7.
• 8. Balci KG, Balci MM, Sen F, et al. The role of baseline indirect inflammatory markers in prediction of response to cardiac resynchronisation therapy. Kardiol Pol. 2016;74(2):119-26.
• 9. Boros AM, Széplaki G, Perge P, et al. The ratio of the neutrophil leucocytes to the lymphocytes predicts the outcome after cardiac resynchronization therapy. Europace. 2016;18(5):747-54.
• 10. Liquori ME, Christenson RH, Collinson PO, et al. Cardiac biomarkers in heart failure. Clin Biochem. 2014;47(6):327-37.
• 11. Wang BL, Tian L, Gao XH, et al. Dynamic change of the systemic immune inflammation index predicts the prognosis of patients with hepatocellular carcinoma after curative resection. Clin Chem Lab Med. 2016;54(12):1963-1969.
• 12. Yang YL, Wu CH, Hsu PF, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest. 2020;50(5):e13230.
• 13. Agus HZ, Kahraman S, Arslan C, et al. Systemic immune-inflammation index predicts mortality in infective endocarditis. JSaudi Heart Assoc. 2020;32(1):58-64.
• 14. Tosu AR, Kalyoncuoglu M, Biter Hİ, et al. Prognostic Value of Systemic Immune-Inflammation Index for Major Adverse Cardiac Events and Mortality in Severe Aortic Stenosis Patients after TAVI. Medicina (Kaunas). 2021;57(6):588.
• 15. Tang Y, Zeng X, Feng Y, et al. Association of Systemic Immune-Inflammation Index With Short-Term Mortality of Congestive Heart Failure: A Retrospective Cohort Study. Front Cardiovasc Med. 2021;8:753133.
• 16. Verdonschot JAJ, Merken JJ, van Stipdonk AMW, et al. Cardiac Inflammation Impedes Response to Cardiac Resynchronization Therapy in Patients With Idiopathic Dilated Cardiomyopathy. Circ Arrhythm Electrophysiol. 2020;13(11):e008727.
• 17. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14.
• 18. Hayıroğlu Mİ, Çınar T, Çinier G, et al. Evaluating systemic immune-inflammation index in patients with implantable cardioverter defibrillator for heart failure with reduced ejection fraction. Pacing Clin Electrophysiol. 2022 Feb;45(2):188-195.
• 19. Sert ZS, Bulbul R. A. Predictive value of systemic immune-inflammation index in patients with preterm labor. Cukurova Med J 2022;47(2):697-703.