AKUT OLMAYAN DİSPNEDE N-TERMİNAL PROHORMON BEYİN NATRİÜRETİK PEPTİT SEVİYESİ İLE EKOKARDİYOGRAFİK SOL VENTRİKÜL SİSTOLİK VEYA DİYASTOLİK İŞLEV BOZUKLUĞU İLİŞKİSİ

Amaç: Bu çalışmanın amacı, akut olmayan nefes darlığı şikayeti olan, obez olmayan hastalarda serum N-terminal prohormon beyin natriüretik peptit (NT-proBNP) düzeyinin ve sol ventrikül (SV) sistolik disfonksiyonunun (SD) veya diyastolik disfonksiyonunun (DD) kanıtlarını değerlendirmektir. Yöntem: Bu çalışmada, Ekim 2020 ile Ekim 2021 arasında akut olmayan nefes darlığı şikayeti ile başvuran hastalarda transtorasik ekokardiyografi (TTE) ile değerlendirilen SV SD veya DD varlığı ile serum NT-proBNP düzeyi geriye dönük olarak değerlendirildi. Serum NT-proBNP düzeyi için normal sınır (125 pg/ml) cut-off değeri olarak kullanıldı. Bulgular: Toplamda 435 hasta çalışmaya dahil edildi. Hastaların %61'inde (n=264), NT-proBNP düzeyi yüksekti (≥ 125 pg/ml). ≥ 125 pg/ml olan hastaların %56'sında (n=147) SD veya DD kanıtı yoktu. NT-proBNP’ si artmış ancak SD veya DD' si olmayan hastalarda, H2FPEF skoru ≥ 6, atriyal fibrilasyon, malignite, önceki COVID-19 ve hastaneye yatış ihtiyacı olan hastalar, NT-proBNP' si normal olan ve SD veya DD olmayan hastalara göre anlamlı olarak daha yüksekti (sırasıyla %13'e karşı %4; %5'e karşı %1; %16'ya karşı %9; %29'a karşı %5; ve %25'e karşı %11). NT-proBNP değerinin < 752,1 pg/ml oluşu SD’ u %72,5 duyarlılık ve %83,1 özgüllük ile ve < 350,3 pg/ml oluşu DD’ u %71,3 duyarlılıkla ve %75,5 özgüllük ile dışladı. Sonuç: Yüksek bir NT-proBNP değeri her zaman SD veya DD' yi göstermez. NT-proBNP ölçümü, akut olmayan dispnede prognostik önem eklemenin yanı sıra, çeşitli klinik durumlarda sadece aşikar kalp yetersizliğini değil, aynı zamanda subklinik SV disfonksiyonunu da saptayabilir.

Anahtar Kelimeler:

kalp yetmezliği, NT-proBNP, dispne

ASSOCIATION OF N-TERMINAL PROHORMONE BRAIN NATRIURETIC PEPTIDE LEVEL AND ECHOCARDIOGRAPHIC LEFT VENTRICULAR SYSTOLIC OR DIASTOLIC DYSFUNCTION IN NON-ACUTE DYSPNEA

Objective: The aim of the study was to evaluate serum N-terminal prohormone brain natriuretic peptide (NT-proBNP) level and evidence of left ventricular (LV) systolic dysfunction (SD) or diastolic dysfunction (DD) in non-obese patients with non-acute dyspnea. Methods: This study retrospectively evaluated the serum NT-proBNP level and LV SD or DD from transthoracic echocardiography (TTE) in patients with non-acute dyspnea between October 2020 and October 2021. The normal limit for the serum NT-proBNP level (125 pg/ml) was used as the cut-off value. Results: Ultimately, 435 patients were included in the study. In 61% of the patients (n=264), the NT-proBNP level was elevated (≥ 125 pg/ml). There was no evidence of SD or DD in 56% of the patients (n=147) with ≥ 125 pg/ml. The patients whose NT-proBNP ≥ 125 but who had no SD or DD had a significantly higher H2FPEF score ≥ 6, atrial fibrillation, malignancy, previous COVID-19, and need for hospitalization than the patients whose NT-proBNP < 125 and who had no SD or DD (13% vs. 4%; 5% vs. 1%; 16% vs. 9%; 29% vs. 5%; and 25% vs. 11%, respectively). An NT-proBNP value < 752.1 pg/ml excluded SD with 72.5% sensitivity and 83.1% specificity and < 350.3 pg/ml excluded DD with 71.3% sensitivity and 75.5% specificity. Conclusion: A high NT-proBNP value does not always indicate SD or DD. NT-proBNP measurement may detect not only overt heart failure but also subclinical LV dysfunction in various clinical entities, in addition to adding prognostic significance in non-acute dyspnea.

Keywords:

dyspnea, heart failure, NT-proBNP,

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