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

Öz

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

Anahtar Kelimeler

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

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

Öz

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. 

Anahtar Kelimeler

• Kalp yetersizliği,atriyal fibrilasyon,NT-proBNP

Kaynakça

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