SOL VENTRİKÜL YETMEZLİĞİ OLAN HEMODİYALİZ HASTALARINDA BİR NATRİÜRETİK PEPTİT OLAN NT-ProBNP’NİN TANISAL DEĞERİ

Öz

Amaç: Sağlıklı popülasyonda, atriyal ve beyin natriüretik peptit (ANP ve BNP) gibi natriüretik peptitlerin plazma seviyeleri, sol ventrikül (LV) hipertrofisini ve LV yetmezliğini tahmin etmek için yararlı belirteçlerdir. Kronik böbrek yetersizliğinde (KBY) LVH son derece sıktır ve bu hastalarda mortaliteyi öngördürür. Bu popülasyonda yüksek koroner arter hastalığı (KAH) prevalansı nedeniyle LV yetmezliği de sıktır. Çalışmamızın amacı; son evre KBY hastalarında LV yetmezliği ve sol ventrikül kütlesi (LVM) için bir gösterge olarak, N-terminal pro-beyin natriüretik peptidin (NT-proBNP) teşhis potansiyelini belirlemektir. Gereç ve Yöntemler: Çalışmaya son evre böbrek yetersizliği olan ve haftada iki veya üç kez düzenli hemodiyaliz yapılan 76 hasta (54 erkek ve 22 kadın, ortalama yaş 60.51±13.96 yıl) alındı. Hastalar LV ejeksiyon fraksiyonuna (LVEF) göre iki gruba ayrıldı. LV sistolik disfonksiyonu, LVEF ≤%40 olarak kabul edildi. Temel biyokimyasal parametreler, NT-proBNP, LVM ve sol ventrikül kütle indeksi (LVMI) dahil olmak üzere ekokardiyografik parametreler ölçüldü. Bulgular: Ortalama serum NT-proBNP konsantrasyonu 8333 (208-35000) pg/ml idi ve bu parametre iki grup arasında anlamlı farklılık göstermedi [13136 (361-35000) pg/ml'ye karşılık 6617 (20-33805) pg/ml, p: 0.16]. Logaritmik olarak dönüştürülmüş NT-proBNP çok değişkenli analiz sonuçlarında sadece LVEF ile korelasyon göstermiştir. Sol ventrikül sistol sonu çapı normal LV fonksiyonu olan grupta anlamlı olarak daha düşüktür (35.4±8.2'ye karşı 31.3±7.1 mm, p: 0.04). Sonuç: Bulgularımız, NT-proBNP'nin diyaliz tedavisi alan KBY'li hastalarda sol ventrikül yetmezliğini saptamada yetersiz olduğunu düşündürmektedir.

Anahtar Kelimeler

• Hemodiyaliz
• NT-proBNP
• sol ventrikül yetmezliği

Diagnostic Efficacy of Natriuretic Peptide: NT-ProBNP in Hemodialysis Patients with Left Ventricular Failure

Öz

Objective: In the general population, plasma concentrations of natriuretic peptides such as brain natriuretic peptide (BNP), are useful markers to predict left ventricular hypertrophy and left ventricular (LV) systolic dysfunction. Left ventricular hypertrophy in dialysis patients is exceedingly frequent and predicts mortality in these patients. LV systolic dysfunction is also frequent due to high coronary artery disease (CAD) prevalence in this population. The present study aimed to evaluate the clinical diagnostic potential of N-terminal pro-brain natriuretic peptide (NT-proBNP); as an indicator for left ventricular (LV) systolic dysfunction and left ventricular mass (LVM), in chronic hemodialysis patients. Material and Method: 76 patients with end-stage renal disease (54 males and 22 females, mean age 60.51±13.96 years) who had been on regular hemodialysis treatment twice or three times a week were enrolled in this study. Patients were divided into two groups based on left ventricular ejection fraction (LVEF). Left ventricular systolic dysfunction was defined as LVEF ≤40%. Basic biochemical parameters, NT-proBNP, and echocardiographic parameters including left ventricular mass (LVM) and left ventricular mass index (LVMI) were measured. Results: Mean concentration of serum NT-proBNP was 8333 (208-35000) pg/ml, and this parameter was not significantly different between the two groups (13136 (361-35000) pg/ml vs. 6617 (20-33805) pg/ml, p:0.16). Multivariate analysis results of logarithmic transformed NT-proBNP showed correlation only with RVEF. The left ventricular end-systolic diameter was significantly lower in the normal LV systolic function group (35.4±8.2 vs. 31.3±7.1 mm, p:0.04). Conclusion: Our findings suggest that NT-proBNP is inadequate to determine LV systolic dysfunction in chronic hemodialysis patients.

Anahtar Kelimeler

• Hemodialysis
• NT-proBNP
• left ventricular systolic dysfunction

Kaynakça

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