Department of Cardiology, University of Health Science, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey.
Department of Cardiology, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey.
Turk Kardiyol Dern Ars. 2021 Oct;49(7):522-532. doi: 10.5543/tkda.2021.39232.
In this study, we aimed to determine the plasma proadrenomedullin (ProADM) levels in patients with rheumatic mitral stenosis (MS), to evaluate the relationship between ProADM levels and the echocardiographic parameters that represent the severity of stenosis and symptoms, and to compare the ProADM and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, which is a well-known marker for rheumatic MS.
Our study included 53 consecutive patients with isolated rheumatic MS and 45 volunteers with similar age and gender features. Patients with MS were divided into two groups based on the presence of an indication for intervention. Detailed echocardiographic examinations were performed on all participants, and blood samples were collected to detect the NT-proBNP and ProADM levels.
NT-proBNP and ProADM levels were significantly higher in the rheumatic MS group compared with the control group. In rheumatic MS groups, patients with an indication for intervention had higher levels of NT-proBNP and ProADM compared with patients without an indication for intervention. Moreover, NT-proBNP and ProADM levels were found to be significantly correlated with echocardiographic parameters, which revealed the severity of stenosis in various degrees. Both parameters increased as the New York Heart Association (NYHA) class increased, and this increase had a statistical significance. Additionally, the cut-off values of both parameters (NT-proBNP: 119.9 pg/mL, ProADM: 6.15 nmol/L) could detect patients with an indication for intervention with high sensitivity and specificity rates. NT-proBNP was found to be slightly more effective in this regard.
The increased NT-proBNP and ProADM levels in patients with isolated rheumatic MS can help clinicians in distinguishing patients with an indication for intervention by providing additional information to echocardiography.
本研究旨在测定风湿性二尖瓣狭窄（MS）患者的血浆前肾上腺髓质素（ProADM）水平，评估 ProADM 水平与代表狭窄严重程度和症状的超声心动图参数之间的关系，并比较 ProADM 和 N 末端脑钠肽前体（NT-proBNP）水平，后者是风湿性 MS 的一个知名标志物。
本研究纳入了 53 例连续的风湿性 MS 患者和 45 例年龄和性别特征相似的志愿者。根据是否存在介入指征，将 MS 患者分为两组。所有参与者均进行详细的超声心动图检查，并采集血样检测 NT-proBNP 和 ProADM 水平。
风湿性 MS 组的 NT-proBNP 和 ProADM 水平明显高于对照组。风湿性 MS 组中，有介入指征的患者的 NT-proBNP 和 ProADM 水平高于无介入指征的患者。此外，NT-proBNP 和 ProADM 水平与超声心动图参数显著相关，这些参数反映了不同程度的狭窄严重程度。随着纽约心脏协会（NYHA）心功能分级的增加，两个参数均升高，且差异具有统计学意义。此外，两个参数的截断值（NT-proBNP：119.9 pg/ml，ProADM：6.15 nmol/L）均能以较高的灵敏度和特异性率检测出有介入指征的患者。NT-proBNP 在这方面的效果略优于 ProADM。
风湿性 MS 患者的 NT-proBNP 和 ProADM 水平升高，可为超声心动图提供补充信息，有助于临床医生区分有介入指征的患者。
