Mıkro af'li hastalarda natriüretik peptid düzeyleri ve ekokardiyografi bulgularının incelenmesi
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Tekirdağ Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Kısa süreli irregüler atrial aktivite olarak tanımlanan mikro-AF, önemli bir mortalite ve morbidite nedeni olan atriyal fibrilasyon (AF) için prediktördür. Fakat mikro-AF tanısı poliklinik şartlarında gözden kaçabilmektedir. Çalışmamızın amacı laboratuvar, elektrokardiyografik ve ekokardiyografik bulguların mikro-AF için tahmin edilebilirliğinin araştırılmasıdır. Mikro-AF, 30 saniyeden kısa süren, ?5 ardışık supraventriküler atım epizotları ve p dalgalarının tamamen yokluğu ile ani başlayan düzensiz taşikardi olarak tanımlandı. 24 saatlik ritim Holter analizinde Mikro-AF saptanan ve olmayan hastalar olarak iki grup oluşturuldu. İki grubun laboratuvar parametreleri, elektrokardiyografik ve ekokardiyografik bulguları karşılaştırıldı. Mikro AF saptanan 45 hasta ve kontrol grubuda 45 hasta olmak üzere toplam 90 hasta çalışmamıza dahil edildi. Serum Troponin T (13,09±11,45 ng/dl ve 4,41±2,46 ng/dl; p<0,001 ) ve pro-BNP (375,57±636,68 pg/ml ve 63,19±56,82 pg/ml; p<0,001) Mikro AF grubunda daha yüksek saptandı. Serum ANP değerleri ise (160,19±83,94 ng/L ve 278,63±196,51 ng/L; p<0,001) kontrol grubunda daha yüksek saptandı. Mikro-AF tanısı için %91,1 sensivite ve %73,3 spesifite ile 63,4 pg/dl Pro-BNP cut-off değerini bulduk. Serum Pro-BNP düzeyindeki her 1 pg/dl artış Mikro-AF riskini %1.8 arttırıyordu. EKG değerlendirilmesinde P-max (113,00±10,25 ve 98,00±10,47; p<0,001), P-min (73,89±5,53 ve 70,00±6,39; p<0,001) ve P-dd (39,11±7,93 ve 28,00±7,64; p<0,001) sürelerinin Mikro-AF grubunda daha uzun olduğu görüldü. Ekokardiyografi bulgularında ise Mikro-AF grubunda sol ventrikül septum duvar kalınlığı (11.14±1.37 and 9.65±2.65 mm; p=0.003), arka duvar kalınlığı (12,13±6,58 and 9,78±2,63 mm; p=0.002) ve sol atriyum çapı ( 35,92±1,30 and 34,62±1,77mm; p<0.001) daha fazla saptandı. Mikro-AF grubunda mitral A dalga hızı (0,79±0,18 and 0,71±0,13 cm/h; p=0.019) daha yüksek, 6 bölgeden ölçülen e' ve s' dalga hızları daha düşük ve E/e' oranları daha yüksek izlendi.Atriyal elektro-mekanik gecikme süreleri Mikro AF grubunda belirgin daha yüksek saptandı.Mikro-AF için %93,3 sensivite ve %91,1 spesifite ile 18,5 saniyelik Lateral triküspit PA cut-off değeri saptandı; %95,6 sensivite ve %75,6 spesifite ile 11,5 saniyelik Lateral Septal PA cut-off değeri saptandı. Sonuç olarak polikliniğe çarpıntı şikayeti ile başvuran hastalarımızda serum pro-BNP, troponin seviyeleri, EKG değerlendirilmesinde P-max, P-dd süreleri, ekokardiyografik değerlendirmede sol atriyum çapı, E dalga hızı, A dalga hızı, e' ölçümü, E/e' oranı ve AEMD sürelerinin ölçümü AF hastalarını erken tanımamıza olanak sağlayabilir.
Micro-AF, defined as brief episodes of rapid irregular atrial activity, is a predictor for atrial fibrillation (AF), which is an important cause of mortality and morbidity. However, micro-AF may be overlooked diagnosis. The aim of our study is to investigate the predictability of laboratory, electrocardiographic and echocardiographic findings for the diagnosis of micro-AF. Micro-AF was defined as sudden onset of irregular tachycardia with episodes of ?5 consecutive supraventricular beats and total absence of p-waves, lasting less than 30 s. Two groups were formed as patients with and without Micro-AF detected in 24-hour rhythm Holter analysis. Laboratory parameters, electrocardiographic and echocardiographic findings of the two groups were compared. A total of 90 patients, 45 patients with micro AF and 45 patients in the control group, were included in our study. Serum Troponin T (13,09±11,45 ng/dl and 4,41±2,46 ng/dl; p<0.001) and pro-BNP (375,57±636,68 pg/ml and 63,19±56,82 pg/ml; p<0.001) Micro It was found to be higher in the AF group. Serum ANP values (160,19±83,94 ng/L and 278.63±196.51 ng/L; p<0.001) were higher in the control group.We found a 63.4 pg/dl Pro-BNP cut-off value for the diagnosis of micro-AF with a sensitivity of 91.1% and a specificity of 73.3%. Each 1 pg/dl increase in serum Pro-BNP level increased the risk of Micro-AF by 1.8%. In ECG evaluation, P-max (113,00±10,25 and 98,00±10,47 ms; p<0,001), P-min (73,89±5,53 and 70,00±6,39 ms; p<0,001 ) and P-dd (39,11±7,93 and 28,00±7,64 ms; p<0,001) were longer in the Micro-AF group. In echocardiographic findings, interventricular septum wall thicness (11,14±1,37 and 9,65±2,65 mm; p=0,003), posterior wall thicness (12,13±6,58 and 9,78±2,63 mm;p=0,002) and left atrial diameter ( 35,92±1,30 and 34,62±1,77mm; p<0,001) were found to be higher in the Micro-AF group. In the micro-AF group, mitral A wave velocity was higher (0,79±0,18 and 0,71±0,13 cm/h; p=0,019). e' and s' wave velocities measured were lower, and E/e' ratios were higher from 6 regions. Atrial electro-mechanical delay times (PA) were significantly higher in the Micro AF group. Lateral tricuspid PA cut-off value of 18,5 seconds was determined for micro-AF with a sensitivity of 93,3% and a specificity of 91,1%; Lateral Septal PA cut-off value of 11,5 seconds was determined with 95,6% sensitivity and 75,6% specificity. In conclusion, in our patients who applied to the outpatient clinic with the complaint of palpitation, serum pro-BNP, serum troponin T levels, P-max, P-dd times in ECG evaluation, left atrial diameter in echocardiographic evaluation, E wave velocity, A wave velocity, e' measurement, E/e ' rate and measurement of AEMD durations may allow us to identify AF patients early.
Micro-AF, defined as brief episodes of rapid irregular atrial activity, is a predictor for atrial fibrillation (AF), which is an important cause of mortality and morbidity. However, micro-AF may be overlooked diagnosis. The aim of our study is to investigate the predictability of laboratory, electrocardiographic and echocardiographic findings for the diagnosis of micro-AF. Micro-AF was defined as sudden onset of irregular tachycardia with episodes of ?5 consecutive supraventricular beats and total absence of p-waves, lasting less than 30 s. Two groups were formed as patients with and without Micro-AF detected in 24-hour rhythm Holter analysis. Laboratory parameters, electrocardiographic and echocardiographic findings of the two groups were compared. A total of 90 patients, 45 patients with micro AF and 45 patients in the control group, were included in our study. Serum Troponin T (13,09±11,45 ng/dl and 4,41±2,46 ng/dl; p<0.001) and pro-BNP (375,57±636,68 pg/ml and 63,19±56,82 pg/ml; p<0.001) Micro It was found to be higher in the AF group. Serum ANP values (160,19±83,94 ng/L and 278.63±196.51 ng/L; p<0.001) were higher in the control group.We found a 63.4 pg/dl Pro-BNP cut-off value for the diagnosis of micro-AF with a sensitivity of 91.1% and a specificity of 73.3%. Each 1 pg/dl increase in serum Pro-BNP level increased the risk of Micro-AF by 1.8%. In ECG evaluation, P-max (113,00±10,25 and 98,00±10,47 ms; p<0,001), P-min (73,89±5,53 and 70,00±6,39 ms; p<0,001 ) and P-dd (39,11±7,93 and 28,00±7,64 ms; p<0,001) were longer in the Micro-AF group. In echocardiographic findings, interventricular septum wall thicness (11,14±1,37 and 9,65±2,65 mm; p=0,003), posterior wall thicness (12,13±6,58 and 9,78±2,63 mm;p=0,002) and left atrial diameter ( 35,92±1,30 and 34,62±1,77mm; p<0,001) were found to be higher in the Micro-AF group. In the micro-AF group, mitral A wave velocity was higher (0,79±0,18 and 0,71±0,13 cm/h; p=0,019). e' and s' wave velocities measured were lower, and E/e' ratios were higher from 6 regions. Atrial electro-mechanical delay times (PA) were significantly higher in the Micro AF group. Lateral tricuspid PA cut-off value of 18,5 seconds was determined for micro-AF with a sensitivity of 93,3% and a specificity of 91,1%; Lateral Septal PA cut-off value of 11,5 seconds was determined with 95,6% sensitivity and 75,6% specificity. In conclusion, in our patients who applied to the outpatient clinic with the complaint of palpitation, serum pro-BNP, serum troponin T levels, P-max, P-dd times in ECG evaluation, left atrial diameter in echocardiographic evaluation, E wave velocity, A wave velocity, e' measurement, E/e ' rate and measurement of AEMD durations may allow us to identify AF patients early.
Açıklama
Tıp Fakültesi, Kardiyoloji Ana Bilim Dalı
Anahtar Kelimeler
Kardiyoloji, Cardiology
