zole romatizmal mitral stenozu olan hastalarda plazma proadrenomedullin seviyesi ile hastalık ciddiyeti arasındaki ilişki

The relationship between plasma proadrenomedullin level and severity of the disease in patients with isolated rheumatic mitral stenosis

Ali Kemal Kalkan, Mehmet Ertürk, Emre Yılmaz, Begüm Uygur, Ali Rıza Demir, İlyas Çetin, Yalçın Avcı, Mehmet Altunova

Özet

Amaç: Bu çalışmanın amacı romatizmal mitral stenozu (MS) olan hastalarda plazma proadrenomedullin (ProADM) düzeylerini saptamak, ProADM konsantrasyonu ile stenoz ciddiyetinin göstergesi olan ekokardiyografik parametreler ve semptom düzeyi arasındaki ilişkiyi incelemek ve kendini daha önce bu alanda ispatlamış N-terminal pro-brain natriuretic peptide (NT-proBNP) ile ProADM’yi kıyaslamaktır. Yöntemler: Çalışmaya izole romatizmal MS tanısı ile takip ve tedavi altında olan ardışık 53 hasta ile bu hastalarla benzer yaş ve cinsiyet özelliklerine sahip 45 gönüllü dahil edildi. MS haslarında kendi içinde girişim endikasyonu olanlar ve olmayanlar olarak iki gruba ayrıldı. Tüm deneklere detaylı ekokardiyografi yapılıp, NT-proBNP ve ProADM düzeylerinin tespit edilebilmesi için kan örneği alındı. Bulgular: Romatizmal MS’i olan hasta grubunda NT-proBNP ve ProADM seviyesi kontrol grubuna göre anlamı düzeyde daha yüksekti. Benzer şekilde romatizmal MS’i olan hastalar içerisinde girişim endikasyonu olan hastalarda, girişim endikasyonu olmayanlara göre bu iki parametre daha yüksek saptandı (p

Abstract

Objective: In this study, we aimed to determine the plasma proadrenomedullin (ProADM) levels in patients with rheumatic mitral stenosis (MS), to evaluate the relationship between ProADM levels and the echocardiographic parameters that represent the severity of stenosis and symptoms, and to compare the ProADM and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, which is a well-known marker for rheumatic MS. Methods: Our study included 53 consecutive patients with isolated rheumatic MS and 45 volunteers with similar age and gender features. Patients with MS were divided into two groups based on the presence of an indication for intervention. Detailed echocardiographic examinations were performed on all participants, and blood samples were collected to detect the NT-proBNP and ProADM levels. Results: NT-proBNP and ProADM levels were significantly higher in the rheumatic MS group compared with the control group. In rheumatic MS groups, patients with an indication for intervention had higher levels of NT-proBNP and ProADM compared with patients without an indication for intervention. Moreover, NT-proBNP and ProADM levels were found to be significantly correlated with echocardiographic parameters, which revealed the severity of stenosis in various degrees. Both parameters increased as the New York Heart Association (NYHA) class increased, and this increase had a statistical significance. Additionally, the cutoff values of both parameters (NT-proBNP: 119.9 pg/mL, ProADM: 6.15 nmol/L) could detect patients with an indication for intervention with high sensitivity and specificity rates. NT-proBNP was found to be slightly more effective in this regard. Conclusion: The increased NT-proBNP and ProADM levels in patients with isolated rheumatic MS can help clinicians in distinguishing patients with an indication for intervention by providing additional information to echocardiography.