Sol ventrikül destek cihazı implantasyonu yapılan son dönem kalp yetmezliği hastalarında dolaşımdaki neprilisin molekül düzeyinin belirlenmesi
Küçük Resim Yok
Tarih
2018
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ: Kalp yetmezliğiyle nörohormonal mekanizmalar aktive olmakta ve dolaşımda fibrozisi artırıcı, natriüretik peptitleri yıkarak diürezi engelleyici neprilisin'in düzeyi artmaktadır. Sol ventrikül destek cihazı (LVAD) implantasyonundan sonra norohumoral aktivasyon çoğunlukla azalmaktadır ancak normale dönüp dönmediği bilinmemektedir. Bununla birlikte, LVAD implantasyonu sonrası neprilisin plazma seviyesinde ki değişiklikler daha önce incelenmemiştir ve ayrıca LVAD implantasyonu öncesi yükselmiş neprilisin seviyeleri ve bunun kısa dönem sonuçlarla ilişkisiyle ilgili veriler eksiktir. AMAÇ: Çalışmamızda dolaşımdaki neprilisin molekülü düzeyinin sol ventrikül destek cihazı implantasyonu sonrası değişimini ve implantasyon öncesi neprilisin düzeyinin kısa dönem mortalite ve morbiditeyle ilişkisini belirlemeye çalıştık. METOD : prospektif olarak Ocak 2017 ile Ekim 2017 arasında LVAD implantasyonu uygulanmış hastalar çalışmaya dahil edildi. Ameliyat öncesi ve sonrası 3. ayda plazma neprilisin düzeyleri ölçüldü. Hastalar; mortalite, inme, pompa trombozu, gastrointestinal kanama ve sağ ventrikül yetmezliği gibi advers olaylar için ilk 3 ayda gözlemledi. BULGULAR: toplamda 47 hasta (40:erkek, ortalama yaş: 54±11yıl, BMI: 25,70±3,89 kg/m2) çalışmaya dahil edildi. %42,6(n:20) hasta kalp yetmezliği açısından iskemik etiyolojiye sahipti. 3.ayın sonunda operasyon öncesine göre neprilisin düzeylerinde anlamlı düşüş izlendi. (75,28 pg/ml – 75,30 pg/ml p:0,007) 3 aylık izlemde 7 hasta exitus oldu, bu hastaların operasyon öncesi neprilisin düzeyleri yüksek saptanmasına rağmen istatiksel anlamlılığa mortalite az olduğu için ulaşmadı( 1798,51 ± 1935,5pg/ml, 371,59 ± 506,68pg/ml p:0,134). Neprilisin düzeyleri yaş,cinsiyet, BMI, kalp yetmezliği etiyolojisi ve renal fonksiyonlarla ilişkisiz bulundu. Operasyon öncesi neprilisin düzeylerinde 431pg/ml; ilk 3 aydaki advers olaylar açısından %71 sensitivite, %77 spesifiteyle sınır değer olarak saptandı(EAA:0,682; %95 CI:0.387-0.977; p:0,128). Operasyondan sonraki 3 ay içinde komplikasyon gelişenlerin 3.aydaki neprilisin düzeyi, gelişmeyenlere göre daha yüksek bulundu.(p:0,05) SONUÇ: LVAD implantasyonu sonrası nörohormonal sistem aktivasyonu azalsa da normale dönmemektedir. Ameliyattan sonra 3 ay içinde komplikasyon gelişen hastalarda halen yüksek nörohormonal aktivasyon saptandı. Bu nedenle, LVAD implantasyonundan sonra halen yüksek neprilisin seviyelerine sahip hastalarda optimal tıbbi tedaviye devam edilmesi önerilmektedir
INTRODUCTION:Neprilysin plasma levels tend to increase with neurohormonal activation seen in heart failure inducing degradation of natriuretic peptides which in turn increases fibrosis and decreases diuresis. After left ventricular assist device(LVAD) implantation norohumoral activation mostly declines. However neprilysin plasma level changes after LVAD implantation is not studied before and also there is lack of data on association with pre-LVAD elevated neprilysin levels and short term outcomes after implantation. PURPOSE:We aimed to evaluate changes in neprilysin plasma levels after LVAD implantation and association of short term advers events METHODS:Patient whom had LVAD implantation procedure between January 2017 and October 2017 prospectively included in the study. Plasma Neprilysin levels measured before and 3 months after operation. Patients monitorised for advers events including mortality, stroke, pump thrombosis, gastrointestinal bleeding and right ventricular failure in the 3 months. RESULTS:Totally 47 patients (40 were male, average age was 54±11years, BMI was 25,70±3,89 kg/m2) were included the study. 42.6%(20) of the patients had ischemic etiology. Neprilysin levels significantly decreased from 175,28pg/ml to 75,30 pg/ml 3 months after LVAD implantation(p:0,007) Seven patients who had died after LVAD implantation has elevated neprilysin levels but weren't the statistically significant cause of limited mortality event (1798,51 pg/ml, 371,59 pg/ml p=0,134). Neprilysin levels were unrelated with age, gender, body mass index, renal function and etiology of heart failure. A cut-off value of 431 pg/ml was found to be predictive of adverse events within 3 months after the implantation with 71% sensitivity and 77% specificity (EAA: 0,682; %95 CI:0.387-0.977; p=0.128). -Patients with LVAD complication in first three months had liminal higher neprilysin levels and statistically significance (p=0,05). CONCLUSION: Although neurohormonal system activation decreases after LVAD implantation, it never returns to normal. Those patients who had complications within 3 months after the operation still had high levels of neurohormonal activation. For this reason, it is recommended to continue optimal medical therapy in patients who still have high levels of neprilysin after LVAD implantation.
INTRODUCTION:Neprilysin plasma levels tend to increase with neurohormonal activation seen in heart failure inducing degradation of natriuretic peptides which in turn increases fibrosis and decreases diuresis. After left ventricular assist device(LVAD) implantation norohumoral activation mostly declines. However neprilysin plasma level changes after LVAD implantation is not studied before and also there is lack of data on association with pre-LVAD elevated neprilysin levels and short term outcomes after implantation. PURPOSE:We aimed to evaluate changes in neprilysin plasma levels after LVAD implantation and association of short term advers events METHODS:Patient whom had LVAD implantation procedure between January 2017 and October 2017 prospectively included in the study. Plasma Neprilysin levels measured before and 3 months after operation. Patients monitorised for advers events including mortality, stroke, pump thrombosis, gastrointestinal bleeding and right ventricular failure in the 3 months. RESULTS:Totally 47 patients (40 were male, average age was 54±11years, BMI was 25,70±3,89 kg/m2) were included the study. 42.6%(20) of the patients had ischemic etiology. Neprilysin levels significantly decreased from 175,28pg/ml to 75,30 pg/ml 3 months after LVAD implantation(p:0,007) Seven patients who had died after LVAD implantation has elevated neprilysin levels but weren't the statistically significant cause of limited mortality event (1798,51 pg/ml, 371,59 pg/ml p=0,134). Neprilysin levels were unrelated with age, gender, body mass index, renal function and etiology of heart failure. A cut-off value of 431 pg/ml was found to be predictive of adverse events within 3 months after the implantation with 71% sensitivity and 77% specificity (EAA: 0,682; %95 CI:0.387-0.977; p=0.128). -Patients with LVAD complication in first three months had liminal higher neprilysin levels and statistically significance (p=0,05). CONCLUSION: Although neurohormonal system activation decreases after LVAD implantation, it never returns to normal. Those patients who had complications within 3 months after the operation still had high levels of neurohormonal activation. For this reason, it is recommended to continue optimal medical therapy in patients who still have high levels of neprilysin after LVAD implantation.
Açıklama
Anahtar Kelimeler
Kardiyoloji, Cardiology, Kalp destek cihazları, Heart assist devices, Kalp hastalıkları, Heart diseases, Kalp yetmezliği, Heart failure, Kardiyovasküler sistem, Cardiovascular system, Natriüretik ajanlar, Natriuretic agents, Neprilisin, Neprilysin
