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HYPOTHESIS

TROPONIN-T, PRO-BNP(BRAIN NATRIURETIC PEPTID),CRP(C-REAKTIVE PROTEIN) ,ERITROCYTE SEDIMENTATION RATE(ESR) AND D-DİMER LEVEL, PROGNOSIS AND RIGHT VENTRICULAR DYSFUNCTION IN PULMONARY THROMBOEMBOLISM PATIENTS.

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HYPOTHESIS

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  1. TROPONIN-T, PRO-BNP(BRAIN NATRIURETIC PEPTID),CRP(C-REAKTIVE PROTEIN) ,ERITROCYTE SEDIMENTATION RATE(ESR) AND D-DİMER LEVEL, PROGNOSIS AND RIGHT VENTRICULAR DYSFUNCTION INPULMONARY THROMBOEMBOLISM PATIENTS Yasin Abul 1 Sait Karakurt 1 Şehnaz Tandoğdu Olgun 1 Emel Eryüksel 1 Ahmet Toprak 2 Beste Özben 2 Turgay Çelikel 1

  2. HYPOTHESIS Pulmonary Embolism (PE) Pulmonary Arterial Hypertension İschemia Hypoxia Interaction between thrombus and endothelium RIGT VENTRICULAR OVERLOAD Troponin-T ?, pro-BNP ? ? RIGHT VENTRICULAR DYSFUNCTION ? INFLAMMATORY RESPONSE PROGNOSIS ESR ?, CRP ? Stenmark et al 1997;59:89 Annu.Rev. Physiol

  3. STUDY AIM • To investigate relationship between right ventricular dysfunction and Troponin-T, Pro-BNP, D-dimer, ESR, ve CRP in patients with pulmonary embolism

  4. Pro-BNP, Troponin-T, ESR ve CRP • BNP(Brain natiuretic peptide) is released from cardiac ventricules in response to stretching and high pressure. • Troponin-T is released from damaged heart tissue as a sensitive ve spesific marker for ischemia. • Troponin-T may increase in severe pulmonary embolism. • ESR and CRP are inflammatory markers.

  5. METHOD • V/P sintigraphy ,CT-anjiography was used as a diagnostic modalities besides the laboratory and clinical findings. • Within 12 hours of admission blood samples were taken • Within 24 hours of admission echocardiography was performed.

  6. Demographical and clinical features of the patients CharacteristicsPatient number (%) MeanSD Age 64.4 ± 14.8 Gender Male 22 (39.3) Female 34 (60.7) Smoking Hx Never smoked 31 (55.4) Active 25 (44.6) Clinical semptoms and signs Dyspnea 56 (100) Tacypnea 54 (96.4) Hemoptysis 6 (10.7) Wheezing 12 (21.4) Syncope 4 (7.1) Angina 3 (5.4) Fever 14 (25) Tachycardia 43 (76.8) Leg Pain 3 (5.4) Chest Pain 10 (17.9) Cough 20 (35.8) Cyanosis 16 (28.6)

  7. PE GRADING

  8. ECHO FINDINGS

  9. Pro-BNP Findings p<0.05

  10. Pro-BNP Findings p<0.05

  11. Pro-BNP Logistic Regression Analysis • Grouping of thepatientswith RVD orwithout RVD withthehelp of pro-BNP is statisticallysignificant (p=0.008)

  12. RVD&BNP ROC ANALYSIS AUC=0.37

  13. pro-BNP(cutoff 500 pg/ml) comparison of survival (Wilcoxon-Gehan Test) pg/ml p=0.001 FOLLOW-UP PERIOD(MONTH)

  14. RIGHT VENTRICULAR DYSFUNCTION&CRP kkk kkk CRP mg/L CRP in 3 category RIGHT VENTRICULAR DYSFUNCTION >100 kkk absent kkk present Pearson Chi-Square (p=0.045)

  15. CRP Findings p<0.05

  16. CRP Logistik Regression Analysis • Grouping of thepatientswith RVD orwithout RVD withthehelp of CRP is statisticallysignificant (p=0.020).

  17. RVD&CRP ROC ANALYSIS AUC=0.34

  18. CRP values and Survival (Wilcoxon-Gehan Testi) mg/L p>0.05 FOLLOW –UP(MONTH)

  19. ESR Findings p>0.05 64 50 n=28 n=19 mm/sa

  20. Troponin-T Findings p>0.05 p>0.05 n=31 n=22 ng/ml

  21. D-DimerFindings p>0.05 n=30 n=26 µg/ml

  22. RESULT • ESR,Troponin-T and D-dimerincrease in PE patientswith RVD but this is not statisticallysignificant.

  23. RESULT • RelationshipbetweenPro-BNP and RVD is statisticallysignificant. • Relationshipbetween CRP and RVD is statisticallysignificant

  24. RESULT • Especially both of these markers decrease the survival significantly for pro-BNP but not significant for CRP.

  25. RESULT • Thesefindingsmayhelp us to define theclinicalandtreatmentapproachtonormotansivepatientswith RVD andalsotrombolytic/surgicalapproaches.

  26. TEŞEKKÜRLER

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