Akut anterior miyokard infarktüslü hastalarda geliş miyokardiyal performans indeksi ile lökositoz arasındaki ilişki

Anterior akut miyokard infarktüslü hastalarda inflamasyonla ilişkili olarak, sıklıkla lökositoz mevcuttur. Bu durumun, infarktüs sonrası sol ventrikül fonksiyonları ile ilişkisi yeterince araştırılmamıştır. Miyokardiyal performans indeksi (MPİ) ventriküllerin sistolik ve diyastolik fonksiyonları ile ilişkilidir. Bu çalışmada, anterior AMİ'ü olgularında geliş lökosit değerleri ile miyokardiyal performans indeksi arasındaki ilişki araştırılmıştır. Çalışmaya toplam 129 hasta alındı. Olguların hastaneye gelişinde kan örnekleri alınarak lökosit sayımı yapıldı. Ayrıca, hastaların ilk 24 saatte ekokardiyografileri yapılarak geliş MPİ'leri ölçüldü. Anterior akut miyokard infarktüsü tanısıyla koroner yoğun bakım ünitesine yatırılan hastaların ilk 24 saatte bakılan ekokardiyografilerinde MPİ'i >0.45 olan hastaların %89'unda lökositoz, %88'inde rölatif nötrofili saptandı. Ancak MPİ'i

Anahtar Kelimeler:

Miyokard enfarktüsü, Ekokardiyografi, Lökositoz

Relation between leukocytosis and myocardial performance index in patients with a first acute anterior myocardial infarction

Inflammation associated with acute myocardial infarction is frequently marked by a peripheral leukocytosis and relative neutrophilia. The objective of this study was to examine the association between hospital admission peripheral total leukocyte count and the left ventricular myocardial performance index (MPI) in patients with a first acute anterior myocardial infarction (AMI). The subjects were 129 patients (104 men, 25 women, 59±12 years) with a first acute AMI. We recorded admission total leukocyte count in the peripheric whole blood. Echocardiograms were used to determine left ventricular MPI within 24 hours after the onset of AMI. Left ventricular MPI was greater than 0.45, 89% of the patients who have leukocytosis (Group 1, n=92). However, left ventricular MPI was lower than 0.45, only 11% of the patients who have leukocytosis (Group 2, n=37) Left ventricular MPI was significantly higher group 1 patients than group 2 patients (p<0.05). Leukocytosis on admission to the hospital in patients with acute AMI is significantly associated with higher MPI and the early development of CHF.

Keywords:

Myocardial Infarction, Echocardiography, Leukocytosis,

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1. Braunwald E. Heart disease: a textbook of cardiovascular medicine.5th edition. Philadelphia: WB Saunders Co; 2001. 2. Thomson SP, Gibbons RJ, Smars PA, et al. Incremental value of the leukocyte differential and the rapid creatine kinase-MB isoenzyme for the early diagnosis of myocardial infarction. Ann Intern Med, 1995;122:335-41. 3. Entman ML, Micheal L, Rosen R, et al. Inflammation in the course of early myocardial ischemia. FASEB J, 1991;5:2529-37. 4. Werns SW, Lucchesi BR. Inflammation and myocardial infarction. Br Med Bull, 1987;43:460-71. 5. Kostis JB, Turkevich D, Sharp J. Association between leukocyte count and the presence and extent of coronary atherosclerosis as determined by coronary arteriography. Am J Cardiol, 1984;53:997-9. 6. Ernst E, Hammerschmidtt DE, Bagge U, et al. Leukocytes and the risk of ischemic disease. JAMA, 1987;257:2318-24. 7. DeLabry L, Campion E, Glynn R, et al. White blood cell count as a predictor of mortality: results over 18 years from the normative aging study. J Clin Epidemiol, 1990;43:153-7. 8. Grimm RH, Neaton JD, Ludwig W. Prognostic importance of the white blood cell count for coronary, cancer, and all-cause mortality. JAMA, 1985;254:1932-7. 9. Gillum RF, Ingram DD, Makuc DM. White blood cell count, coronary heart disease, and death: the NHANES 1 Epidemiologic Follow-up Study. Am Heart J, 1993;125:855- 63. 10. Heart failure guidelines. Agency for Health Care Policy and Research Publication No. 94-06612, Rockville, Md): US Department of Health and Human Services; June 1994. 11. Emanuelsson H, Karlson BW, Herlitz J. Characteristics and prognosis of patients with acute myocardial infarction in relation to occurrence of congestive heart failure. Eur Heart J, 1994;15:761-8. 12. Kober L, Torp-Pedersen C, Offesen M, et al, on behalf of the TRACE Study Group. Influence of age on the prognostic importance of left ventricular dysfunction and congestive heart failure after acute myocardial infarction. Am J Cardiol 1996;78:158-62. 13. Dhalla AR, Hill MF, Singal PK. Role of oxidative stress in transition of hypertrophy to heart failure. J Am Coll Cardiol 1996;28:506-14. 14. Hill MF, Singal PK. Right and left myocardial antioxidant responses during heart failure subsequent to myocardial infarction. Circulation 1997;96:2414-20. 15. Mann DL, Young JB. Basic mechanisms in congestive heart failure: recognizing the role of proinflammatory cytokines. Chest, 1994;105:897-90. 16. Kelly RA, Smith TW. Cytokines and cardiac contractile dysfunction. Circulation, 1997;95:778-81. 17. Tei C, Nishimura RA, Seward JB , et al: Noninvasive Doppler derived myocardial performance index: correlation with simultaneous measurement of cardiac catheterization measurements. J Am Soc Echocardiogr, 1997; 10: 169-78. 18. Kawaguchi H, Mori T, Kawano T, et al. Band neutrophil count and the presence and severity of coronary atherosclerosis. Am Heart J, 1996;132:9-12. 19. Kyne L, Hausdorff JM, Knight E et al. Neutrophilia and congestive heart failure after acute myocardial infarction . Am Heart J 2000;139:94-100. 20. Marx N, Neuman FJ, Ott I, et al. Induction of cytokine expression in leukocytes in acute myocardial infarction. J Am Coll Cardiol 1997;30:165-70. 21. Yokoyama T, Vaca L, Rosen RD, et al. Cellular basis for the negative inotropic effects of tumor necrosis factor-alpha in the adult mammalian heart. J Clin Invest, 1993;92:2303- 12. 22. Andreassen AK, Nordog I, Simonsen S, et al. Levels of circulating adhesion molecules in congestive heart failure and after heart transplant. Am J Cardiol, 1998;81:604-8. 23. Bartosz M, Kedziora J, Bartosz G. Antioxidant properties of captopril and enalapril. Free Radic Biol Med, 1997;23:729- 35.