ST Segment Yükselmeli Miyokardial Enfarktüs İle Başvuran Hastalarda Asimetrik Dimetilarjinin Düzeyinin Kisa Ve Uzun Dönem Prognoz İle İlişkisi

Year 2020, Volume: 8 Issue: 2, 225 - 233, 23.08.2020

Ayça Türer Cabbar , Mehmet Eren

https://doi.org/10.37696/nkmj.729057

Abstract

Amaç: ST segment yükselmeli miyokard infarktüsü (STYMI) bir akut koroner sendrom türü olarak kabul edilir. Bununla birlikte, STYMI hastalarının ölüm oranı yüksektir. Asimetrik dimetilarjinin (ADMA), insanlarda nitrik oksit biyosentezinin ana inhibitörüdür. Araştırmalar, artmış plazma ADMA seviyelerinin endotel disfonksiyonu ve artmış aterogenez ile ilişkili olduğunu göstermiştir. Bu çalışmada saptanan ADMA düzeyinin STYMI hastalarında prognoz ile ilişkisi gösterilmeye çalışılacaktır.
Materyal ve Metod: Çalışma primer perkütan koroner girişim (PKG) yapılan STYMI tanısı konmuş 45 (40 erkek, 5 kadın) hastaydı. Demografik veriler, kan testleri ve hastaların tıbbi öyküleri kaydedildi. Sheat uygulamasından hemen sonra 10 cc kan örneği alındı. ADMA seviyeleri ELISA kiti ile incelendi. Anlamlılık derecesi% 95 olarak belirlendi.
Bulgular: Takip süresi 42.837±14.343 aydı. Ortalama yaş 52.4 ± 7.8 idi. Ortalama taburculuk süresi 7.5 ± 3.3 gündü. ADMA düzeyleri ile kalp hızı arasında anlamlı bir ilişki gözlendi (p = 0,025). Demografik verilerle diğer ilişkiler, STYMI için risk faktörleri, major advers kardiyovasküler olay, kalp yetmezliği, hedef damar revaskülerizasyonu, reenfarktüs, devam eden miyokardial iskemi gibi takipteki olaylar, hastane içi olaylar, müdahale yapılan arter, girişim tipi, pre-TIMI, ejeksiyon fraksiyonu, tirobufan, anterior veya inferior miyokard enfarktüsü için istatistiksel olarak anlamlı değildi (p> 0.05). ADMA düzeyleri ile kronik kalp yetmezliği arasında pozitif bir ilişki gözlense de, anlamlı değildi.
Sonuçlar: Kalp yetersizliği ile bir ilişki olmasına rağmen, tek anlamlı ADMA düzeyleri ile kalp hızı arasında ilişki bulundu. Daha kesin sonuçlar varmak için daha büyük ölçekte çalışmalar yapılmalıdır.

Keywords

ADMA, ADMA, STYMI, 42 ay takip, mortalite ve morbidite

Thanks

Makalenin yazımında ve düzenlenmesindeki yardımlarından ötürü Dr. Öğr. Üyesi Fatih Cabbar’a teşekkürlerimizi sunarız.

The Relationship Between Asymmetric Dimethylargin Level and Short and Long Term Prognosis In Patients Presented with ST Segment Elevated Myocardial Infarction

Abstract

objecitves: ST segment elevation myocardial infarction (STEMI) is regarded as a type of acute coronary syndrome. However, the mortality of STEMI patients is substantial. Asymmetric dimethylarginine (ADMA) is the major inhibitor of nitric oxide biosynthesis in humans. Studies have shown that increased ADMA levels are associated with endothelial dysfunction and increased atherogenesis. It is aimed to show the relationship between ADMA and prognosis of ST elevation MI.
Materials and methods: The study population was 45 (40 male, 5 female) patients with diagnosis of STEMI, who underwent primary percutaneous coronary intervention (PCI). Demographic data, blood tests and medical history of the patients were recorded. Ten cc of blood samples were collected right after sheat application. ADMA levels were studied by ELISA kit.
Results: The follow-up period was 42.837±14.343 months. The mean age was 52.4±7.8. Only significant relation was observed between ADMA levels and heart rate (p=0.025). Other relations with demographic data, risk factors for STEMI, follow-up events such as major adverse cardiovascular events, heart failure, target vessel revascularization, reinfarction, ongoing myocardial ischemia, in-hospital events, intervention artery, type of intervention, Pre-TIMI, ejection fraction, use of tirobufan, anterior or inferior MI were not statistically significant (p>0.05). Although, a positive relation was observed between ADMA levels and chronic heart failure, it was not significant.
Conclusions: Although, there was a relation with heart failure, the only significant relation was found between ADMA levels and heart rate. Further studies with greater number of participants should be performed for drawing strict conclusions.

Keywords

STEMI, 42 months follow-up, mortality and morbidity

References

• 1. Bulluck H, Hoole SP. Management of ST segment elevation myocardial infarction. Medicine 2018;46:540-6.
• 2. Steg G, James SK, Atar D, et al. Guía de práctica clínica de la ESC para el manejo del infarto agudo de miocardio en pacientes con elevación del segmento ST. Revista española de cardiología 2013;66:53. e1-. e46.
• 3. Anderson JL, Morrow DA. Acute Myocardial Infarction. N Engl J Med 2017;376:2053-64.
• 4. Smolina K, Wright FL, Rayner M, Goldacre MJ. Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: linked national database study. BMJ 2012;344:d8059.
• 5. Pedersen F, Butrymovich V, Kelbaek H, et al. Short- and long-term cause of death in patients treated with primary PCI for STEMI. J Am Coll Cardiol 2014;64:2101-8.
• 6. Fokkema ML, James SK, Albertsson P, et al. Population trends in percutaneous coronary intervention: 20-year results from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). J Am Coll Cardiol 2013;61:1222-30.
• 7. Palmer RM, Ferrige AG, Moncada S. Nitric oxide release accounts for the biological activity of endothelium-derived relaxing factor. Nature 1987;327:524-6.
• 8. Boger RH. The emerging role of asymmetric dimethylarginine as a novel cardiovascular risk factor. Cardiovasc Res 2003;59:824-33.
• 9. Cooke JP. ADMA: its role in vascular disease. Vasc Med 2005;10 Suppl 1:S11-7.
• 10. Chan NN, Chan JC. Asymmetric dimethylarginine (ADMA): a potential link between endothelial dysfunction and cardiovascular diseases in insulin resistance syndrome? Diabetologia 2002;45:1609-16.
• 11. Miyazaki H, Matsuoka H, Cooke JP, et al. Endogenous nitric oxide synthase inhibitor: a novel marker of atherosclerosis. Circulation 1999;99:1141-6.
• 12. Schnabel R, Blankenberg S, Lubos E, et al. Asymmetric dimethylarginine and the risk of cardiovascular events and death in patients with coronary artery disease: results from the Athero Gene Study. Circulation research 2005;97:e53-e9.
• 13. Schulze F, Lenzen H, Hanefeld C, et al. Asymmetric dimethylarginine is an independent risk factor for coronary heart disease: results from the multicenter Coronary Artery Risk Determination investigating the Influence of ADMA Concentration (CARDIAC) study. American heart journal 2006;152:493. e1-. e8.
• 14. Sen N, Ozlu MF, Akgul EO, et al. Elevated plasma asymmetric dimethylarginine level in acute myocardial infarction patients as a predictor of poor prognosis and angiographic impaired reperfusion. Atherosclerosis 2011;219:304-10.
• 15. Shivkar RR, Abhang SA. Ratio Of Serum Asymmetric Dimethyl Arginine (ADMA)/ Nitric Oxide in Coronary Artery Disease patients. J Clin Diagn Res 2014;8:CC04-6.
• 16. Achan V, Broadhead M, Malaki M, et al. Asymmetric dimethylarginine causes hypertension and cardiac dysfunction in humans and is actively metabolized by dimethylarginine dimethylaminohydrolase. Arterioscler Thromb Vasc Biol 2003;23:1455-9.
• 17. Saitoh M, Osanai T, Kamada T, et al. High plasma level of asymmetric dimethylarginine in patients with acutely exacerbated congestive heart failure: role in reduction of plasma nitric oxide level. Heart Vessels 2003;18:177-82.
• 18. Vallance P, Collier J, Moncada S. Effects of endothelium-derived nitric oxide on peripheral arteriolar tone in man. Lancet 1989;2:997-1000.
• 19. Van de Werf F, Bax J, Betriu A, et al. ESC guidelines on management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. Revista espanola de cardiologia 2009;62:293.