NATRIURETIC PEPTIDE AS A MARKER OF PROGNOSIS IN PATIENTS WITH VENTRICULAR ASYNCHRONY

Karpenko Yu. I., Hanafi Mоhamed

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The purpose of this study was to evaluate the dynamics of NT-pro BNP in patients with ventricular asynchrony after the installation of IVP.The research was carried out on the basis of Odessa regional clinical hospital (Odessa). Twenty patients with ventricular asynchrony were screened for Biotronik Talos DR (USA). Among surveyed men prevailed – 65%. The age of patients ranged from 48 to 75 years, an average of 57.5±2.2 years. II functional class CH was established in 65.0% of patients, III functional class CH – in 35%. Patients were examined according to the requirements of the current clinical protocol, regulated by the order of the Ministry of Health of Ukraine from 03.07.2006 № 436 “On the approval of protocols for the provision of medical care in the specialty “Cardiology”. All patients underwent an assessment of the degree of circulatory failure in NYHA, exercise tolerance with a 6-minute walk test, and ECG. Echocardiography was conducted on the apparatus Phillips HD15 XE (Great Britain). Linear parameters of the heart cavities, presence of tricuspid and mitral regurgitation, the ejection fraction according to Teicholz and Simpson were measured. Determination of NT-pro BNP was carried out in a certified laboratory using the method of solid phase enzyme immunoassay. Statistical processing was carried out with the help of Statistica 10.0 software (StatSoft Inc., USA). The average test scores with a 6-minute walk amounted to 277.5±12.5 m, the restitution time after exercise was 32.3±3.7 s. In the ECG study, the elongation of the QRS complex was determined in all patients to an average of 131±7 ms. The NT-pro BNP content at the time of treatment in all patients exceeded 1000 pg/ml and averaged 2476±42 pg/ml. Before treatment, the mean values of left ventricular CRD were 7.3±9.3 cm, and the DAC – 6.2±0.2 cm, which corresponds to PV 30.5±2.7%. After setting the IIA, the left ventricular CRD decreased to 6.5±0.2 cm, and the DAC decreased to 4.9±0.3 cm, the VF was 48.3±4.3%. The described changes were accompanied by an increase in tolerance to physical activity – up to 277.5±12.5 m according to the results of the test with 6-minute walking. The level of NT-pro BNP decreased after the installation of the IIA to 562±22 pg/ml. It has been shown that NT-pro BNP is a valuable predictive biomarker in patients with ventricular desynchrony and can be used as a criterion for the effectiveness of an IWR installation.

heart failure, ventricular asynchrony, artificial pacemaker, natriuretic peptide

1. Vasiuk YuA, Khadzehova AB, Yvanova SV, Amyrbyheshvyly YM, Yushchuk EN, Krykunov PV, i dr. Natryiuretycheskye peptydy y khronycheskaia serdechnaia nedostatochnost u bolnykh arteryalnoi hypertenzyei. Zhurnal serdechnaia nedostatochnost. 2007;8(3):142-3. [in Russiаn].
2. Mytkov VV, redaktor. Klynycheskoe rukovodstvo po ultrazvukovoi dyahnostyke [Internet]. E-data. M.: Vydar-M; 2001. 1 CD-ROM: 5(2).713s. [in Russiаn].
3. Mozghovoi natryiuretycheskyi propeptyd (NT-pro BNP). Dostupno: http://dila.ua/rus/catalog/a11/pr-3105.[in Russiаn].
4. Nakaz MOZ Ukrainy vid 03.07.2006 № 436 Pro zatverdzhennia protokoliv nadannia medychnoi dopomohy za spetsialnistiu «Kardiolohiia» [Internet]. Dostupno: http://www.moz.gov.ua/ua/portal/dn_20060703_436[in Ukrainian].
5. Petry A, Sebyn K. Nahliadnaia statystyka v medytsyne. M.: HEOTAR-MED.; 2003. 143 s. [in Russiаn].
6. Temnykova EA. Khronycheskaia serdechnaia nedostatochnost u ambulatornykh patsyentov 75 let y starshe. Zhurnal serdechnaia nedostatochnost. 2011. 12(6):339-43.[in Russiаn].
7. Huang YT, Tseng YT, Chu TW, Chen J, Lai MY, Tang WR, et al. N-terminal pro b-type natriuretic peptide (NT-pro-BNP) – based score can predict in-hospital mortality in patients with heart failure. Sci Rep. 2016 Jul;14(6):29590.
8. Magne J, Dubois M, Champagne J, Dumesnil JG, Pibarot P, Philippon F, et al. Usefulness of NT-pro BNP monitoring to identify echocardiographic responders following cardiac resynchronization therapy. Cardiovasc Ultrasound. 2009 Aug;20(7):39.
9. McLellan J, Heneghan CJ, Perera R, Clements AM, Glasziou PP, Kearley KE, et al. B-type natriuretic peptide-guided treatment for heart failure. Cochrane Database Syst Rev. 2016 Dec;22(12):CD008966.
10. Rossi E, Cinconze E, Nica M, Colombo D, Maggioni AP. Real World Evidence And Costs Of Chronic Heart Failure: Findings From 41,413 Patients Of The Arno Database. Value Health. 2015 Nov;18(7):A388.

«Bulletin of problems biology and medicine» Issue 1 Part 1 (142), 2018 year, 121-124 pages, index UDK 616.12-008.46-036.12-07

10.29254/2077-4214-2018-1-1-142-121-124