Dijagnostički i prognostički značaj kardijalnih biomarkera kod asimptomatskih bolesnika sa hroničnom bubrežnom insuficijencijom
Diagnostic and prognostic significance of cardiac biomarkers in asymptomatic patients with chronic kidney disease
Author
Tirmenštajn Janković, Biserka H.Mentor
Dimković, NadaCommittee members
Peruničić Peković, GordanaLežaić, Višnja
Kalimanovska Oštrić, Dimitra
Mitić, Igor
Metadata
Show full item recordAbstract
Kardiovaskularne bolesti su najčešći uzrok smrti bolesnika sa terminalnom fazom
hronične bubrežne bolesti (HBB) i smatraju se odgovornim za više od 50% svih smrtnih
ishoda. Zbog toga se stratifikacija kardiovaskularnog rizika sve češće razmatra kao
osnovni preduslov za razvoj strategije koja bi unapredila kliničko vođenje i ishod
bolesnika sa HBB. Radi brze i jednostavne identifikacije visokorizičnih bolesnika,
poslednjih godina je započelo ispitivanje potencijalnog značaja kardijalnih biomarkera
kod asimptomatskih bolesnika sa različitim stepenima renalne disfunkcije. Kao
biomarkeri od posebnog interesa izdvojeni su: biomarkeri miokardne nekroze -
kardijalni troponini T i I (cTnT i cTnI); markeri srčane insuficijencije - B tip
natriuretskog peptida (BNP) i amino-terminalni deo njegovog prohormona (NTproBNP);
i marker sistemske inflamacije visokosenzitivni C-reaktivni protein (hsCRP).
Cilj naše studije je bio ispitivanje a) povezanosti nivoa kardijalnih biomarkera sa
kardiovaskularnim ...statusom asimptomatskih bolesnika u IV i V stadijumu HBB; b)
prognostičkog značaja kardijalnih biomarkera za neželjene kardiovaskularne dogadjaje,
smrtni ishod i progresiju ka terminalnom stadijumu HBB.
U studiju su uključeni bolesnici u predijaliznom periodu HBB (stadijum IV-V, jačina
glomerularne filtracije <30 ml/min), bez kliničkih dokaza srčane insuficijencije i/ili
koronarne bolesti (n=61, 34M, prosečne starosti 62.9±12.5 godina) i zdravi dobrovoljci
srodni po starosti i polu (n=22, 12M, prosečne starosti 63.7±9.0 godina) kao kontrolna
grupa. Prilikom inicijalne kliničke procene, pregledana je medicinska dokumentacija
svakog ispitanika, uradjen je fizički pregled i popunjen upitnik o demografskim
podacima, istoriji bolesti i korišćenim lekovima. Izmeren je krvni pritisak, telesna težina
i visina i uzeti su uzorci venske krvi za laboratorijske analize. Svim ispitanicima uradjen
je standardni ehokardiografski pregled, kao i pregled metodom tkivnog Dopplera (TDI –
Tissue Doppler Imaging). Od strukturnih ehokardiografskih parametara, mereni su
enddijastolni dijametar leve komore (LVEDD), endsistolni dijametar leve komore
(LVESD), debljina zadnjeg zida leve komore u dijastoli (PWTd) debljina
interventrikularnog septuma u dijastoli (IVSTd) i dijametar leve pretkomore (LA), i
izračunati su masa leve komore (LVmass), indeks mase leve komore (LVMI) i relativna
debljina zida leve komore (RWT)...
Cardiovascular diseases are the leading cause of death in patients with end stage chronic
kidney disease (CKD) and are considered to be responsible for over half of all deaths.
Therefore, the stratification of cardiovascular risk is increasingly considered as a basic
requirement for the development of a strategy to improve the clinical management and
outcome of patients with CKD. For rapid and easy identification of high-risk patients, in
recent years there has begun the examining of the potential importance of cardiac
biomarkers in asymptomatic patients with varying degrees of renal dysfunction. As
biomarkers of particular interest the following have been indicated: biomarkers of
myocardial necrosis - cardiac troponins T and I (cTnT and cTnI), markers of heart
failure - B type natriuretic peptide (BNP) and the amino-terminal fragment of its
prohormone (NT-proBNP), along with the marker of systemic inflammation highsensitivity
C-reactive protein (hsCRP).
This study aimed to investigate... a) the relationship between the levels of cardiac
biomarkers and cardiovascular status of asymptomatic patients with CKD stages IV-V;
b) the prognostic value of cardiac biomarkers for adverse cardiovascular events, death,
and progression to end-stage CKD.
The study involved 61 pre-dialysis CKD patients (glomerular filtration rate <30 ml/min)
with no clinical evidence of heart failure and/or coronary artery disease (34M, mean age
62.9±12.5 years) and 22 age- and sex-matched healthy volunteers (12M, mean age
63.7±9.0 years) as a control group. During the initial clinical assessment, we reviewed
medical records of each subject, performed physical examinations and completed
questionnaires on demographic parameters, medical history and medication use. On the
very day, blood pressure, body weight and height were measured and venous blood was
drawn for laboratory examinations. All participants underwent both conventional and
Doppler Tissue Imaging (TDI) echocardiography. Cardiac structure was estimated by
the following echocardiographic parameters: left ventricular end-diastolic diameter
(LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular posterior
wall thickness in diastole (PWTd), interventricular septal thickness in diastole (IVSTd),
left atrial diameter (LA), left ventricular mass (LVmass), left ventricular mass index
(LVMI) and relative wall thickness (RWT)...