| Sažetak | Polazište.Srčanoţilne bolesti spadaju u najčešće istovremene bolesti u bolesnika s kroničnom opstruktivnom plućnom bolesti (KOPB). Pravovremena dijagnoza srčanog popuštanja kao uzroka pogoršanja ili kao prateće bolesti u bolesnika s KOPB-om, osobito je vaţna za optimalnu obradu i liječenje bolesnika.Cilj.U bolesnika s akutnim pogoršanjem KOPB-a (apKOPB) ţeljeli smo ustanoviti učestalost disfunkcije lijeve klijetke i odrediti ulogu kardijalnih laboratorijskih biomarkera u diferencijalnoj dijagnostici apKOPB-a, te ocijeniti rizik ponovne hospitalizacije.Metode.U prospektivno istraţivanje uključili smo 127 bolesnika (70±10 godina, 70% muški), koji su imali većinom teţak ili vrlo teţak KOPB (110 bolesnika –87%). Bolesnicima smo pri prijemu napravili ehokardiografiju, te pri prijemu, otpustu i 7-10 dana po otpustu uzeli krv za odreĎivanje koncentracije biomarkera: N-terminalnog moţdanog natriuretičnog peptida (NT-proBNP), troponina i cistatina. Iz bolesnikove dokumentacije prikupili smo podatke o demografskim značajkama, istovremenim bolestima i farmakološkom liječenju. Ponovne smo hospitalizacije pratili 180 dana po otpustu. Numeričke varijablepredstavili smo s aritmetičkom sredinom i standardnom devijacijom. Atributivne varijablesmo predstavili kao broj i udjel u postotcima. Razlike meĎu varijablama analizirali smo pomoću Studentovog t-testa za neovisne uzorke, parnim t-testom i hi-kvadrattestom. Učestalost ponovnih hospitalizacija i moţebitne čimbenike analizirali smo pomoćumetode preţivljavanja po Kaplan Meieru i Coxovim modelom proporcionalnih rizika. Značaj ehokardiografije i NT-proBNP-a u bolesnika s akutnim pogoršanjem kronične opstruktivne plućne bolesti. IVRezultati.Normalnu ejekcijsku frakciju lijeve klijetke imalo je 110 (87%) bolesnika. Disfunkciju lijeve klijetke ustvrdili smo u 70 (55%) bolesnika, od kojih je većina imala smetnje punjenja lijeve klijetke. NT-proBNP je pri prijemu bio povišen u 76 (60%) bolesnika, a pri otpustu u 46 (36%) bolesnika. Troponin je pri prijemu bio povišen u 35 (28%) bolesnika, a pri otpustu u 24 (19%) bolesnika. Bolesnici s disfunkcijom lijeve klijetke su u svim uzorcima imali višu koncentraciju NT-proBNP (p=0,004, 0,007 i 0,019). U obje skupine bolesnika je došlo do značajnog sniţenja koncentracije NT-proBNP od prijema do otpusta, odnosno 7-10 dana po otpustu (p=0,006 i 0,019). Koncentracija troponina T nije bila značajno različita tijekom obrade bolesnika (p=0,518, 0,185 i 0,299), ali je do značajnog sniţenja tijekom hospitalizacije došlo u skupini s disfunkcijom lijeve klijetke (p=0,043). Bolesnike smo pratili 6 mjeseci po otpustu i u tom su vremenu ponovno hospitalizirana 53 (42%) bolesnika. Rizik za rehospitalizaciju nije bio povezan sa stupnjem bolesti po GOLD-u, disfunkcijom lijeve klijetke i s nalazima NT-proBNP. Koncentracija troponina pri otpustu je bila jedini prognostički čimbenik za rehospitalizaciju (omjer rizika 1,95, 95% granica pouzdanosti 1,04 –3,64). Od 31 bolesnika s prethodnom diagnozom srčanoga popuštanja, 19 (61%) bolesnika je primalo inhibitore konvertaze angiotenzina, a 14 (45%) bolesnika beta blokatore. Ciljnu dozu od ≥50% inhibitora konvertaze angiotenzina primalo je 12 (63%) bolesnika, a ciljnu dozu od ≥50% beta blokatora 7 (50%) bolesnika.Zakljuĉci.U bolesnika s apKOPB-a česta je disfunkcija lijeve klijetke. OdreĎivanje koncentracije kardijalnih laboratorijskih biomakera je vaţno zbog procjene uzroka kliničkoga pogoršanja bolesnika s KOPB-om. Koncentracija troponina pri otpustu je bila jedini neovisni prognostički čimbenik za ponovnu hospitalizaciju. Liječenje srčane disfunkcije u bolesnika s KOPB-om nije bilo u skladu sa smjernicama. |
| Sažetak (engleski) | Baseline. Cardiovascular diseases are among the most important diseases that cause common co-morbidities in patients with chronic obstructive pulmonary disease (COPD). Diagnosis of heart failure as a cause of deterioration or as an associated disease in patients with COPD is very important for the proper and optimal patient management.Objectives.We aimed to determine the frequency of left ventricular dysfunction in patients with acute exacerbation of COPD. We wanted to evaluate the role of cardiac biomarkers in differential diagnosis of acute exacerbation and risk assessment for re-hospitalization. Method.Our prospective study included 127 consecutive patients (70 10 years, 70% male) with severe or very severe COPD (110 patients –87%). Upon admission of patients echocardiography was performed. On admission, discharge and 7-10 days after discharge blood was drawn to determineN-terminal brain natriuretic peptide (NT-proBNP), troponin and cystatin. Information about demographic characteristics, concomitant disease, and pharmacological management was retrieved from medical records. Re-hospitalisations were observed 180 days after discharge. Numeric variables were presented with mean and standard deviation. Attribute variables were presented as number and percentage shares. Differences between variables were analyzed using Student’s t-test for independent samples, paired t-test and χ2 test. Frequency and possible factors of re-hospitalization were analyzed with Kaplan Meier method and Cox proportional risk model. Značaj ehokardiografije i NT-proBNP-a u bolesnika s akutnim pogoršanjem kronične opstruktivne plućne bolesti. VIResults.Normal left ventricular ejection fraction had 110 (87%) patients. Left ventricular dysfunction was observed in 70 (55%) patients, where most of them had abnormal left ventricular filling. NT-proBNP was elevated at admission in 76 (60%) patients and in remission in 46 (36%) patients. Troponin was elevated at admission in 35 (28%) patients and at discharge in 24 (19%) patients. Higher concentration of NT-proBNP (p=0.004, 0.007 and 0.019) was observed in patients with left ventricular dysfunction. There was a significant reduction in concentration of NT-proBNP in both groups of patients; from admission until discharge, or 7-10 days after discharge (p=0.006 and 0.019). Concentration of troponin T was not significantly different during the treatment of patients (p=0.518, 0.185 and 0.299), however significant reduction occurred in the group with left ventricular dysfunction (p=0.043). Patients were assessed 6 months after discharge and 53 (42%) patients were re-hospitalized. The risk of hospitalization was not associated with the level of disease by Gold, left ventricular dysfunction or concentration of NT-proBNP. Concentration of troponin at discharge was the only factor to predict adverse prognosis (hazard ratio 1.95, 95% confidence interval 1.04 –3.64). Of 31 patients with a prior diagnosis of heart failure 19 (61%) patients were receiving ACE inhibitors and 14 (45%) patients beta–blocker. Target dose of ≥50% of the ACE inhibitor received 12 (63%) patients, target dose of ≥50% of beta-blocker received 7 (50%) patients.Conclusions.In patients with acute exacerbation of COPD, left ventricular dysfunction is frequent. Determination of cardiac biomarkers is important to identify the cause of clinical deterioration in patients with COPD. Concentration of troponin at discharge was the only independent prognostic factor for re-hospitalization. Treatment of cardiac dysfunction in patients with COPD is at the moment not in accordance with guidelines. |
