Öz
Amaç: Vagal nöroimmünomodülasyon (NIM) indeksi, birçok klinik durumda olduğu kadar sağlıklı bireylerde de kolinerjik inflamatuar tonusun bir yansımasıdır. Biz bu çalışmada NIM indeksinin pulmoner arteriyel hipertansiyon (PAH) hastalarının klinik seyri üzerindeki ilişkisini araştırmayı amaçladık.
Gereç ve Yöntem: Bu çalışmaya pulmoner arteriyel hipertansiyon (PAH) tanısı alan toplam 31 hasta dahil edildi. Elektrokardiyografi (EKG) ve C-reaktif protein (CRP) verileri geriye dönük olarak hastaların elektronik dosyalarından elde edildi. Vagal NIM indeksi, kalp hızı değişkenliği (HRV) ile CRP oranı (HRV/CRP) olarak hesaplandı.
Bulgular: Klinik takip sırasında, hastaların çoğunda en az bir kez hastaneye yatış gerekmiştir (21'e karşı 10 hasta). BNP değerlerinde güncel literatürle uyumlu ve beklendiği gibi gruplar arasında anlamlı fark vardı (394 ng/L'ye karşı 55 ng/L, p=0,005). HRV, CRP ve NIM-indeks değerleri açısından gruplar arasında anlamlı fark bulunmadı.
Sonuç: NIM-indeksi ile PAH hastalarında hastaneye yatış ihtiyacı arasında ilişkili bulunamamıştır.
Anahtar Kelimeler
kalp hızı değişkenliği pulmoner arteriyel hipertansiyon C-reaktif protein (CRP) nöroimmünomodülasyon
Kaynakça
- Lau EMT, Giannoulatou E, Celermajer DS, Humbert M. Epidemiology and treatment of pulmonary arterial hypertension. Nat Rev Cardiol 2017; 14: 603-14.
- Humbert M, Kovacs G, Hoeper MM, et al 2022 esc/ers guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2022; 43: 3618-731.
- Jarczok MN, Koenig J, Thayer JF. Lower values of a novel index of vagal-neuroimmunomodulation are associated to higher all-cause mortality in two large general population samples with 18 year follow up. Scientific Reports 2021; 11: 2554.
- Simonneau G, Robbins IM, Beghetti M, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2009; 54: S43-S54.
- Gidron Y, De Couck M, Schallier D, De Greve J, Van Laethem JL, Marechal R. The relationship between a new biomarker of vagal neuroimmunomodulation and survival in two fatal cancers. J Immunol Res 2018; 2018: 4874193.
- Barst RJ, Chung L, Zamanian RT, Turner M, McGoon MD. Functional class improvement and 3-year survival outcomes in patients with pulmonary arterial hypertension in the reveal registry. Chest 2013; 144: 160-8.
- Kovacs G, Avian A, Foris V, et al. Use of ecg and other simple non-invasive tools to assess pulmonary hypertension. PloS one 2016; 11: e0168706.
- Bonderman D, Wexberg P, Martischnig AM, et al. A noninvasive algorithm to exclude pre-capillary pulmonary hypertension. Eur Respir J 2011; 37: 1096-103.
- Henkens IR, Mouchaers KT, Vonk-Noordegraaf A, et al. Improved ecg detection of presence and severity of right ventricular pressure load validated with cardiac magnetic resonance imaging. American journal of physiology. Heart Circulatory Physiology 2008; 294: H2150-57.
- Quarck R, Nawrot T, Meyns B, Delcroix M. C-reactive protein: a new predictor of adverse outcome in pulmonary arterial hypertension. J Am Coll Cardiol 2009; 53: 1211-8.
- Arvanitaki A, Giannakoulas G, Baumgartner H, Lammers AE. Eisenmenger syndrome: diagnosis, prognosis and clinical management. Heart 2020; 106: 1638-45.
- Scognamiglio G, Kempny A, Price LC, et al. C-reactive protein in adults with pulmonary arterial hypertension associated with congenital heart disease and its prognostic value. Heart 2014; 100: 1335-41.
- Lammers AE, Munnery E, Hislop AA, Haworth SG. Heart rate variability predicts outcome in children with pulmonary arterial hypertension. Int J Cardiol 2010; 142: 159-65.
- Yi HT, Hsieh YC, Wu TJ, et al. Heart rate variability parameters and ventricular arrhythmia correlate with pulmonary arterial pressure in adult patients with idiopathic pulmonary arterial hypertension. Heart Lung J Crit Care 2014; 43: 534-40.
- Can MM, Kaymaz C, Pochi N, Aktimur T. Impact of pulmonary arterial hypertension and its therapy on indices of heart rate variability. Med Glas (Zenica) 2013; 10: 249-53.
- Yoshida K, Saku K, Kamada K, et al. Electrical vagal nerve stimulation ameliorates pulmonary vascular remodeling and improves survival in rats with severe pulmonary arterial hypertension. JACC. Basic Translational Sci 2018; 3: 657-71.
- Hamilton RM, McKechnie PS, Macfarlane PW. Can cardiac vagal tone be estimated from the 10-second ecg? Int J Cardiol 2004; 95: 109-15.
- Shaffer F, Ginsberg JP. An overview of heart rate variability metrics and norms. Frontiers in public health 2017; 5: 258.
- Cooper TM, McKinley PS, Seeman TE, Choo TH, Lee S, Sloan RP. Heart rate variability predicts levels of inflammatory markers: Evidence for the vagal anti-inflammatory pathway. Brain, behavior, and immunity 2015; 49: 94-00.
- Williams DP, Koenig J, Carnevali L, et al. Heart rate variability and inflammation: a meta-analysis of human studies. Brain Behavior Immunity 2019; 80: 219-26.
- Alen NV, Parenteau AM, Sloan RP, Hostinar CE. Heart rate variability and circulating inflammatory markers in midlife. Brain Behavior Immunity Health 2021: 15.
Öz
Aim: The vagal neuroimmunomodulation (NIM) index is reflective of the cholinergic inflammatory tone in many clinical circumstances as well as in healthy individuals. We aimed to investigate the relationship of NIM-index on the clinical course patients with PAH.
Material and Method: A total of 31 patients diagnosed with pulmonary arterial hypertension (PAH) were included in this study. Data on electrocardiography (ECG) and C-reactive protein (CRP) were retrospectively obtained from patients’ electronic files retrospectively. The vagal NIM index was calculated as heart rate variability (HRV) to CRP ratio (HRV/CRP).
Results: During clinical follow-up, most patients required hospitalization at least once (21 vs. 10 patients). Consistent with the current literature and as expected, there was a significant difference between the groups in BNP values (394 ng/L vs 55 ng/L, p=0.005). HRV, CRP, and NIM-index values were not found to be significant between the groups.
Conclusion: NIM-index values were not associated with the need for hospitalization in patients with PAH.
Anahtar Kelimeler
heart rate variability pulmonary arterial hypertension C-reactive protein (CRP) neuroimmunomodulation
Kaynakça
- Lau EMT, Giannoulatou E, Celermajer DS, Humbert M. Epidemiology and treatment of pulmonary arterial hypertension. Nat Rev Cardiol 2017; 14: 603-14.
- Humbert M, Kovacs G, Hoeper MM, et al 2022 esc/ers guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2022; 43: 3618-731.
- Jarczok MN, Koenig J, Thayer JF. Lower values of a novel index of vagal-neuroimmunomodulation are associated to higher all-cause mortality in two large general population samples with 18 year follow up. Scientific Reports 2021; 11: 2554.
- Simonneau G, Robbins IM, Beghetti M, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2009; 54: S43-S54.
- Gidron Y, De Couck M, Schallier D, De Greve J, Van Laethem JL, Marechal R. The relationship between a new biomarker of vagal neuroimmunomodulation and survival in two fatal cancers. J Immunol Res 2018; 2018: 4874193.
- Barst RJ, Chung L, Zamanian RT, Turner M, McGoon MD. Functional class improvement and 3-year survival outcomes in patients with pulmonary arterial hypertension in the reveal registry. Chest 2013; 144: 160-8.
- Kovacs G, Avian A, Foris V, et al. Use of ecg and other simple non-invasive tools to assess pulmonary hypertension. PloS one 2016; 11: e0168706.
- Bonderman D, Wexberg P, Martischnig AM, et al. A noninvasive algorithm to exclude pre-capillary pulmonary hypertension. Eur Respir J 2011; 37: 1096-103.
- Henkens IR, Mouchaers KT, Vonk-Noordegraaf A, et al. Improved ecg detection of presence and severity of right ventricular pressure load validated with cardiac magnetic resonance imaging. American journal of physiology. Heart Circulatory Physiology 2008; 294: H2150-57.
- Quarck R, Nawrot T, Meyns B, Delcroix M. C-reactive protein: a new predictor of adverse outcome in pulmonary arterial hypertension. J Am Coll Cardiol 2009; 53: 1211-8.
- Arvanitaki A, Giannakoulas G, Baumgartner H, Lammers AE. Eisenmenger syndrome: diagnosis, prognosis and clinical management. Heart 2020; 106: 1638-45.
- Scognamiglio G, Kempny A, Price LC, et al. C-reactive protein in adults with pulmonary arterial hypertension associated with congenital heart disease and its prognostic value. Heart 2014; 100: 1335-41.
- Lammers AE, Munnery E, Hislop AA, Haworth SG. Heart rate variability predicts outcome in children with pulmonary arterial hypertension. Int J Cardiol 2010; 142: 159-65.
- Yi HT, Hsieh YC, Wu TJ, et al. Heart rate variability parameters and ventricular arrhythmia correlate with pulmonary arterial pressure in adult patients with idiopathic pulmonary arterial hypertension. Heart Lung J Crit Care 2014; 43: 534-40.
- Can MM, Kaymaz C, Pochi N, Aktimur T. Impact of pulmonary arterial hypertension and its therapy on indices of heart rate variability. Med Glas (Zenica) 2013; 10: 249-53.
- Yoshida K, Saku K, Kamada K, et al. Electrical vagal nerve stimulation ameliorates pulmonary vascular remodeling and improves survival in rats with severe pulmonary arterial hypertension. JACC. Basic Translational Sci 2018; 3: 657-71.
- Hamilton RM, McKechnie PS, Macfarlane PW. Can cardiac vagal tone be estimated from the 10-second ecg? Int J Cardiol 2004; 95: 109-15.
- Shaffer F, Ginsberg JP. An overview of heart rate variability metrics and norms. Frontiers in public health 2017; 5: 258.
- Cooper TM, McKinley PS, Seeman TE, Choo TH, Lee S, Sloan RP. Heart rate variability predicts levels of inflammatory markers: Evidence for the vagal anti-inflammatory pathway. Brain, behavior, and immunity 2015; 49: 94-00.
- Williams DP, Koenig J, Carnevali L, et al. Heart rate variability and inflammation: a meta-analysis of human studies. Brain Behavior Immunity 2019; 80: 219-26.
- Alen NV, Parenteau AM, Sloan RP, Hostinar CE. Heart rate variability and circulating inflammatory markers in midlife. Brain Behavior Immunity Health 2021: 15.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Research Articles [en] Araştırma Makaleleri [tr] |
| Yazarlar | |
| Yayımlanma Tarihi | 27 Mart 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 4 Sayı: 2 |
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