Kenan İLTÜMÜR, Aziz KARABULUT, Nizamettin TOPRAK

İzole diyastolik disfonksiyonda NT-proBNP

B tipi natriüretik peptid (BNP), özellikle sol ventriküldeki basınç ve volüm yükselmesi sonucu dolaşıma salgılanan bir nörohormondur. Diyagnostik ve prognostik özelliği olan bu peptid dispnenin ayırıcı tanısında bir tanı aracı olarak gündeme gelmiştir. Bu çalışmada, sistolik fonksiyon bozukluğu gelişmeyen hipertansif hastalarda NT pro-BNP ile diyastolik parametreler arasındaki ilişkinin incelenmesi amaçlandı. Çalışmaya ilk defa hipertansiyon tanısı almış ve daha önce herhangi bir kardiyak problemi olmayan 51 hipertansif (29 E,yaş 48 ± 9) hasta ile, 31 sağlıklı birey (18 E,yaş 44 ±9) alındı. BNP immünoassey metodu ile ölçüldü. Standart ekokardiyografik ölçümlere ek olarak doku doppler ölçümleride yapıldı. Hipertansif grupta NT-proBNP düzeyi kontrol grubuna göre yüksekti ( 56 ± 44 ve 32 ±22 p=0,003). Sol ventrikül (SV) ejeksiyon fraksiyonu her iki grupta normaldi (p>0,05). Oysa, hipertansif hastaların 23’ünde (%45) diyastolik fonksiyon bozukluğu (DFB) saptandı (relaksasyon bozukluğu). Aynı zamanda hipertansif hastaların sol ventrikül kütle indeksi (LVKİ) artmıştı. Sol ventrikül DFB olanlarda olmayanlara göre NT-proBNP’nin anlamlı olarak yükselmiş olduğu görüldü (66,1 ± 44,3 ve 38,4 ± 33,2 p=0,003). NT-proBNP ile LVKİ (r=0,32 p=0,003) ve diyastolik fonksiyon parametreleri (mitral E/A için; r= -0,3 p=0,006 ve mitral doku E/A ; r= -0,22 p

Anahtar Kelimeler:

Nefes darlığı, Tanı, ayırıcı, Hipertansiyon, Ventriküler fonksiyon, sol, Ekokardiyografi, Natriüretik peptid, beyin

NT-proBNP in isolated diastolic dysfunction

B-type natriuretic peptide (BNP) is a neurohormone secreted mainly in the cardiac ventricles in response to volume expansion and pressure overload. This peptide, which is diagnostic and prognostic, has been known as a diagnosis toll in distinguishing diagnosis This study aimed the search of the relation between NT-proBNP and diastolic parameters in hypertensive patients whose systolic dysfunction does not develop. This study included 31 healthy individuals (18 M, age; 44 ± 9) and 51 hypertensive patients (29 M, age; 48 ± 9) who had hypertension diagnosis for the first time and were free of cardiovascular disease. NT-proBNP was measured with immünoassey method. Tissue doppler was also measured in addition to the standard echocardiography. In hypertensive group plasma NT-proBNP level was significantly higher than control group. (56 ± 44 and 32 ± 22 p=0,003). Left ventricular ejection fraction (LVEF) was normal in both groups (p>0,05). However, in 23 (45%) of the hipertensive patients diastolic dysfunction (DDF) was found. At the same time left ventricular mass index(LVMI) of the patients had increased. It was found that NT-proBNP was significantly higher in patients with left ventricular DDF than those without (66,1 ± 44,3 ve 38,4 ± 33,2 p=0,003). There was a significant correlation between NT-proBNP and LVMI (r=0,32 p=0,003) and diastolic function parameters (for mitral E/A; r= -0,3 p=0,006 and for mitral tissue E/A ; r= -0,22 p<0,05). As a result, in isolated diastolic dysfunction NT-proBNP level increases. Especially thecorrelation between NT-proBNP and LVMI and DDF can reflect the increase of afterloadin hypertension.

Keywords:

Dyspnea, Diagnosis, Differential, Hypertension, Ventricular Function, Left, Echocardiography, Natriuretic Peptide, Brain,

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