članak: 1 od 1  
Srpski arhiv za celokupno lekarstvo
2010, vol. 138, br. 3-4, str. 162-169
jezik rada: srpski
originalan članak
doi:10.2298/SARH1004162B
Da li su de novo akutna insuficijencija srca i akutno pogoršanje hronične insuficijencije srca dve podgrupe istog sindroma?
Banović Markoa, Vasiljević-Pokrajčić Zoranaa, Vujisić-Tešić Bosiljkaa, Stanković Sanjab, Nedeljković Ivanaa, Petrović Olgaa, Otašević Petarc, Boričić-Kostić Marijaa, Petrović Milana, Trifunović Danijelaa, Ostojić Miodraga
aInstitut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd
bKlinička laboratorija, Urgentni centar, Klinički centar Srbije, Beograd
cUniverzitet u Beogradu, Medicinski fakultet, Institut za kardiovaskularne bolesti 'Dedinje'

e-adresa: bamark@yubc.net

Sažetak

Uvod. Akutna insuficijencija srca (AIS) je jedna od najčešćih bolesti u urgentnoj medicini, s lošom prognozom i visokom stopom intrahospitalnog i jednogodišnjeg mortaliteta. Cilj rada. Cilj rada je bio da se ispita klinička slika novonastale AIS i akutnog pogoršanja hronične insuficijencije srca (HIS), te utvrde međusobne razlike u ehokardiografskom nalazu i nivoima biomarkera u krvi. Metode rada. Prospektivna studija je obuhvatila 64 bolesnika koja su prema vremenu nastanka bolesti svrstana u dve grupe: prvu grupu je činilo 25 ispitanika s novonastalom AIS (45,3%), a drugu 39 bolesnika s akutnim pogoršanjem HIS (54,7%). Rezultati. Najčešća klinička manifestacija kod ispitanika prve grupe bila je akutna kongestija (60%), a u drugoj grupi edem pluća (43,1%). Kod ispitanika druge grupe zabeležene su statistički značajno veće vrednosti kreatinina (147,10 prema 113,16 μmol/l; p<0,05), uree (12,63 prema 7,82 mmol/l; p<0,05), BNP (1440,11 prema 712,24 pg/ml; p<0,01) i NTproBNP (9097,00 prema 2827,70 pg/ml; p<0,01) u krvi na prijemu i niže vrednosti ejekcione frakcije leve komore (49,44% prema 42,94%; p<0,05), mereno u M-modu, u prvih 48 sati bolničkog lečenja. Kontrolni pregled posle godinu dana pokazao je da su vrednosti BNP u krvi i dalje statistički značajno veće (365,49 prema 164,02 pg/ml; p<0,05), a vrednosti ejekcione frakcije značajno niže i u M-modu i po Simpsonovoj biplane metodi (46,62% prema 54,41% i 39,52% prema 47,88%; p<0,05) kod bolesnika s akutnim pogoršanjem HIS. Zaključak. Uzimajući u obzir razlike u težini kliničke slike na prijemu, odnosno ehokardiografskom nalazu i vrednostima natriuretskih peptida u krvi pri prijemu i posle godinu dana kliničkog praćenja bolesnika, može se smatrati da su de novo AIS i akutno pogoršanje HIS dve različite podgrupe istog sindroma.

Ključne reči

akutna insuficijencija srca; ehokardiografija; natriuretski peptide

Reference

CrossRefPubMedKoBSON

Anand, I.S., Latini, R., Florea, V.G., Kuskowski, M.A., Rector, T., Masson, S., Signorini, S., Mocarelli, P., Hester, A., Glazer, R., Cohn, J.N. (2005) C-reactive protein in heart failure: prognostic value and the effect of valsartan. Circulation, 112(10): 1428-34

CrossRefPubMedKoBSON3

Bettencourt, P.M. (2005) Clinical usefulness of B-type natriuretic peptide measurement: Present and future perspectives. Heart, 91(11), str. 1489-1494

Braunwald, E., Colucci, W.S. (2005) Pathophysiology of heart failure. u: Braunwald E. (ur.) Heart disease, Philadelphia: Elsevier Saunders, p. 509-538

CrossRefPubMedKoBSON

Cowie, M.R., Wood, D.A., Coats, A.J., Thompson, S.G., Poole-Wilson, P.A., Suresh, V., Sutton, G.C. (1999) Incidence and aetiology of heart failure: A population-based study. European heart journal, 20(6): 421-8

CrossRefPubMedKoBSON1

Gheorghiade, M., Zannad, F., Sopko, G., Klein, L., Piña, I.L., Konstam, M.A., Massie, B.M., Roland, E., Targum, S., Collins, S.P., Filippatos, G., Tavazzi, L. (2005) Acute heart failure syndromes: Current state and framework for future research. Circulation, 112(25): 3958-68

KoBSON

Haldeman, G.A., Croft, J.B., Giles, W.H., Rashidee, A. (1999) Hospitalization of patients with heart failure: National Hospital discharge survey, 1985-95. Am Heart J., 137, str. 352-60

CrossRefPubMedKoBSON1

Jessup, M., Brozena, S. (2003) Heart failure. N Engl J Med, 348(20): 2007-18

CrossRefPubMedKoBSON

Jourdain, P., Funck, F., Bellorini, M., Guillard, N., Loiret, J., Thebault, B., Desnos, M., Duboc, D. (2003) Bedside B-type natriuretic peptide and functional capacity in chronic heart failure. European journal of heart failure, 5(2): 155-60

CrossRefPubMedKoBSON

Krishnaswamy, P., Lubien, E., Clopton, P., Koon, J., Kazanegra, R., Wanner, E., Gardetto, N., Garcia, A., de Maria, A., Maisel, A.S. (2001) Utility of B-natriuretic peptide levels in identifying patients with left ventricular systolic or diastolic dysfunction. American journal of medicine, 111(4): 274-9

CrossRefPubMedKoBSON1

Maisel, A.S., Krishnaswamy, P., Nowak, R.M., McCord, J., Hollander, J.E., Duc, P., Omland, T., Storrow, A.B., Abraham, W.T., Wu, A.H.B., Clopton, P., Steg, P.G., Westheim, A., Knudsen, C.W., Perez, A. (2002) Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. New England journal of medicine, 347(3): 161-7

CrossRefPubMedKoBSON2

Mcalister, F.A., Ezekowitz, J., Tonelli, M., Armstrong, P.W. (2004) Renal insufficiency and heart failure: Prognostic and therapeutic implications from a prospective cohort study. Circulation, 109(8): 1004-9

CrossRefPubMedKoBSON

Mcclellan, W.M., Feanders, W.D., Langston, R.D., Jurkovitz, C., Presley, R. (2002) Anemia and renal insufficiency are independent risk factors for death among patients with congestive heart failure admitted to community hospitals: A population-based study. Journal of the American Society of Nephrology, 13(7): 1928

CrossRefPubMedKoBSON

Metra, M., Nodari, S., Parrinello, G., Bordonali, T., Bugatti, S., Danesi, R., Fontanella, B., Lombardi, C., Milani, P., Verzura, G., Cotter, G., Dittrich, H., Massie, B.M., Dei, C.L. (2008) Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance. European journal of heart failure, 10(2): 188-95

CrossRefKoBSONScindeks

Mladenović, Z., Angelkov-Ristić, A., Kalimanovska-Oštrić, D., Mijailović, Z., Gligić, B., Obradović, S., Tavčiovski, D., Jovelić, A. (2008) Rani ehokardiografski prediktori poboljšanja funkcije leve komore u kasnijem periodu posle akutnog infarkta miokarda. Vojnosanitetski pregled, vol. 65, br. 1, str. 9-14

CrossRefPubMedKoBSON

Mosterd, A., Hoes, A.W. (2007) Clinical epidemiology of heart failure. Heart, 93(9): 1137-46

KoBSON1

Nieminen, M., Böhm, M., Cowie, M., Drexler, H., Filippatos, G., Jondeau, G., i dr. (2005) Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: The Task force on acute heart failure of the European Society of cardiology. Eur Heart J., 26, str. 384-416

KoBSON

Nieminen, M.S. (2006) Key issues of European society of cardiology guidelines on acute heart failure. Eur Heart J, 8(Suppl E):E6-E11

CrossRefPubMedKoBSON

Nieminen, M.S., Brutsaert, D., Dickstein, K., Drexler, H., Follath, F., Harjola, V., Hochadel, M., Komajda, M., Lassus, J., Lopez-Sendon, J.L., Ponikowski, P., Tavazzi, L. (2006) EuroHeart Failure Survey II (EHFS II): A survey on hospitalized acute heart failure patients: description of population. European heart journal, 27(22): 2725-36

CrossRefPubMedKoBSON1

Nijland, F., Kamp, O., Karreman, A.J., Eenige, M.J., Visser, C.A. (1997) Prognostic implications of restrictive left ventricular filling in acute myocardial infarction: A serial Doppler echocardiographic study. Journal of the American College of Cardiology, 30(7): 1618-24

Otto, C.M. (2000) Echocardiographic evaluation of ventricular diastolic filling and function. u: Otto C.M. (ur.) Textbook of Clinical Echocardiography, Philadelphia: WB Saunders Co, str. 132-153

PubMedKoBSON1

Pocock, S.J., Wang, D., Pfeffer, M.A., Yusuf, S., McMurray, J.J.V., Swedberg, K.B., Ostergren, J., Michelson, E.L., Pieper, K.S., Granger, C.B. (2006) Predictors of mortality and morbidity in patients with chronic heart failure. European heart journal, 27(1): 65-75

CrossRefPubMedChemPortKoBSON13

Ridker, P.M., Hennekens, C.H., Buring, J.E., Rifai, N. (2000) C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. New England journal of medicine, 342(12): 836-43

CrossRefPubMedKoBSON1

Rudiger, A., Harjola, V., Müller, A., Mattila, E., Säila, P., Nieminen, M., Follath, F. (2005) Acute heart failure: Clinical presentation, one-year mortality and prognostic factors. European journal of heart failure, 7(4): 662-70

PubMedKoBSON7

Schiller, N.B., Shah, P.M., Crawford, M., DeMaria, A., Devereux, R., Feigenbaum, H., Gutgesell, H., Reichek, N., Sahn, D., Schnittger, I. (1989) Recommendations for quantitation of the left ventricle by two-dimensional echocardiography: American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr, 2(5): 358-67

CrossRefPubMedKoBSON1

Siirilä-Waris, K., Lassus, J., Melin, J., Peuhkurinen, K., Nieminen, M.S., Harjola, V. (2006) Characteristics, outcomes, and predictors of 1-year mortality in patients hospitalized for acute heart failure. European heart journal, 27(24): 3011-7

CrossRefPubMedKoBSON1

Steg, P.G., Dabbous, O.H., Feldman, L.J., Cohen-Solal, A., Aumont, M., López-Sendón, J., Budaj, A., Goldberg, R.J., Klein, W., Anderson, F.A. (2004) Determinants and prognostic impact of heart failure complicating acute coronary syndromes: Observations from the Global Registry of Acute Coronary Events (GRACE). Circulation, 109(4): 494-9

KoBSON1

Tavazzi, L., Maggioni, A.P., Lucci, D., Cacciatore, G., Ansalone, G., Oliva, F., i dr. (2006) Nationwide survey on acute heart failure in cardiology ward services in Italy. Eur Heart J., 27, str. 1207-15

PubMedKoBSON1

Wieczorek, S.J., Wu, A.H.B., Christenson, R., Krishnaswamy, P., Gottlieb, S., Rosano, T., Hager, D., Gardetto, N., Chiu, A., Bailly, K.R., Maisel, A. (2002) A rapid B-type natriuretic peptide assay accurately diagnoses left ventricular dysfunction and heart failure: A multicenter evaluation. American heart journal, 144(5): 834-9

KoBSON

Zannad, F. (2005) Acute heart failure syndromes: The Cinderella of heart failure research. Eur Heart J., 7(Suppl B): B8-B12