Angina Pektoris Hastalarında B-Tipi Natriüretik Peptit ve Kalsiyum Skoru

Amaç: Bu çalışmanın amacı, çok kesitli bilgisayarlı tomografi (ÇKBT) bulguları ile değerlendirilen koroner arter hastalığı ile B tipi natriüretik peptit (BNP) ve kalsiyum skoru (KaS) arasındaki ilişkiyi incelemektir. Gereç ve Yöntem: Merkezimize başvuran asemptomatik ve stabil angina pektorisli 83 hasta çalışmaya alındı. BNP testi için kan örnekleri alındı ve ölçümler için Abbott AxSYM Sistem kiti kullanıldı. Dört ana koroner arterin her biri için kalsiyum skorlaması yapıldı ve sonuçlar toplanarak her hasta için toplam “Agatston” skoru hesaplandı. ÇKBT anjiyogramları, üç boyutlu işlem tabanında çalışıldı. Bulgular: 51 (%61,4) hastada koroner arter hastalığı (KAH) saptanırken, 32 (%38,6) hastanın koroner arterleri normaldi. 17 hastada (%20,5) tek damar tutulumu, 18 hastada (%21,7) iki damar tutulumu, 16 hastada (%19,3) üç damar tutulumu saptandı. KAH olan hastaların medyan BNP'si 33,9 (0-834) iken, KAH olmayanların medyan değeri 19,2 (0-185) idi ve bu istatistiksel olarak anlamlıydı (p=0,011). Ayrıca tutulan damar sayısı ile BNP arasında pozitif bir korelasyon vardı (r=0,364, p=0,001). Hipertansif hastalarda BNP düzeyleri anlamlı olarak yüksek bulundu (p=0,008). Üç damar tutulumu olan grubun KaS ve BNP medyanı anlamlı olarak daha yüksekti (sırasıyla p<0,001 ve p=0,007). Çok değişkenli lojistik regresyon sonuçlarına göre BNP ve yaş KAH varlığı ile ilişkili bulunmazken CaS ilişkili bulundu. Sonuç: CaS, KAH varlığı ile ilişkili bulundu. Yukarıda belirtilen ilişkileri doğrulamak için daha fazla çalışma yapılmalıdır.

Anahtar Kelimeler:

Koroner arter hastalığı, B tipi natriüretik peptit, Koroner arter kalsiyum

Multislice Computed Tomography Angiography, B-Type Natriuretic Peptide and Calcium Score in Coronary Artery Disease

Objective: The purpose of this study is to look into the relationship between coronary artery disease evaluated with multislice computed tomography (MSCT) findings and B-type natriuretic peptide (BNP) and calcium score (CaS). Material and Method: The study included 83 patients who were administered to our center and who had asymptomatic and stable angina pectoris. Blood samples were collected for BNP testing, and the Abbott AxSYM System kit was used for measurements. Calcium scoring was performed on each of the four main coronary arteries, and the total “Agatston” score was calculated for each patient by summing up the results. MSCT angiograms were studied at the three-dimensional operating base. Results: Coronary artery disease (CAD) was found in 51 (61.4%) patients, while the coronary arteries of 32 (38.6%) patients were deemed normal. Single-vessel involvement was detected in 17 (20.5%) patients, two-vessel involvement in 18 (21.7%) patients, and three-vessel involvement in 16 (19.3%) patients. While patients with CAD had a median BNP of 33.9 (0–834), those without CAD had a median of 19.2 (0–185), which was statistically significant (p=0.011). Furthermore, there was a positive correlation between the number of vessels involved and BNP (r = 0.364, p=0.001). BNP levels were found to be significantly higher in hypertensive patients (p=0.008). The CaS and BNP median of the group with three-vessel involvement were significantly higher (p < 0.001 and p=0.007, respectively). Conclusion: As a result, high CaS and BNP levels were discovered to be a marker for the presence and severity of CAD.

Keywords:

Coronary artery disease, B-type natriuretic peptide, Coronary artery calcium,

PDF

___

1. Nowbar AN, Gitto M, Howard JP, Francis DP, Al-Lamee R. Mortality from ischemic heart disease: Analysis of data from the World Health Organization and coronary artery disease risk factors From NCD Risk Factor Collaboration. Circ Cardiovasc Qual Outcomes 2019;12(6):e005375.
2. Mensah GA, Roth GA, Fuster V. The global burden of cardiovascular diseases and risk factors: 2020 and beyond. American College of Cardiology Foundation Washington, DC; 2019.
3. Kishi S, Magalhaes TA, Cerci RJ, et al. Total coronary atherosclerotic plaque burden assessment by CT angiography for detecting obstructive coronary artery disease associated with myocardial perfusion abnormalities. J Cardiovasc Comput Tomogr 2016;10(2):121-7.
4. Shumakov I, Sukhova M. MSCT Coronary Angiography in Diagnosis of Chronic Coronary Occlusions. Современные технологии в медицине 2018;10(2):118-24.
5. Budoff MJ, Achenbach S, Blumenthal RS, et al. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 2006;114(16):1761-91.
6. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990;15(4):827-32.
7. Neves PO, Andrade J, Monção H. Coronary artery calcium score: current status. Radiol Bras 2017;50(3):182-9.
8. Morrow DA, De Lemos JA, Sabatine MS, et al. Evaluation of B-type natriuretic peptide for risk assessment in unstable angina/non–ST-elevation myocardial infarction: B-type natriuretic peptide and prognosis in TACTICS-TIMI 18. J Am Coll Cardiol 2003;41(8):1264-72.
9. Kagiyama N, Kitai T, Hayashida A, et al. Prognostic value of BNP reduction during hospitalization in patients with acute heart failure. J Card Fail 2019;25(9):712-21.
10. Itakura R, Inoue Y, Ogawa K, et al. A highly-sensitized response of b-type natriuretic peptide to cardiac ischaemia quantified by intracoronary pressure measurements. Sci Rep 2020;10(1):1-11.
11. Berthelot E, Mas R, Damy T, et al. NTproBNP and BNP level in acute heart failure patients aged 75 or older are higher than in non-cardiac dyspnoea. Arch Cardiovasc Dis 2020;12(1):44.
12. Goetze JP, Bruneau BG, Ramos HR, Ogawa T, De Bold MK, Adolfo J. Cardiac natriuretic peptides. Nat Rev Cardiol 2020;17(11):698-717.
13. Al Awadi M, Eltahlawi M, Gad M, Ismail H. Prognostic Value of Serum BNP in Patients with NSTEMI and Its Correlation with Extent of Coronary Artery Disease. Zagazig University Medical Journal 2021.
14. Nagaya N, Nishikimi T, Goto Y, et al. Plasma brain natriuretic peptide is a biochemical marker for the prediction of progressive ventricular remodeling after acute myocardial infarction. Am Heart J 1998;135(1):21-8.
15. Arnson Y, Rozanski A, Gransar H, et al. Comparison of the coronary artery calcium score and number of calcified coronary plaques for predicting patient mortality risk. Am J Cardiol 2017;120(12):2154-9.
16. Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS. Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area: a histopathologic correlative study. Circulation 1995;92(8):2157-62.
17. Sangiorgi G, Rumberger JA, Severson A, et al. Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology. J Am Coll Cardiol 1998;31(1):126-33.
18. Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Coronary calcium score and cardiovascular risk. J Am Coll Cardiol 2018;72(4):434-47.
19. Budoff MJ, Young R, Burke G, et al. Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J 2018;39(25):2401-8.
20. Polonsky TS, Mcclelland RL, Jorgensen NW, et al. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA 2010;303(16):1610-6.
21. Yano Y, O’donnell CJ, Kuller L, et al. Association of coronary artery calcium score vs age with cardiovascular risk in older adults: an analysis of pooled population-based studies. JAMA Cardiol 2017;2(9):986-94.