INFLUENCE OF ELECTRICAL CARDIOVERSION ON TROPONINE I AND BRAIN NATRIURETIC PEPTIDE (NT-PROBNP) LEVELS IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION/FLUTTER
Autori:
Mislav Puljević, Branimir Nevajda, Mario Sičaja, Davor Puljević, Davor Miličić
Sažetak
Sažetak. Cilj istraživanja bio je utvrditi kako elektrokonverzija fibrilacije atrija (FA) utječe na vrijednosti troponina I i moždanoga natriuretskog peptida (NT-proBNP) kod bolesnika bez srčanog zatajivanja. Kod 20 bolesnika s perzistentnom FA, prije i 24 sata poslije elektrokonverzije mjerene su vrijednosti troponina I, kreatin-kinaze (CK), laktat-dehidrogenaze (LDH) i NT-proBNP-a. Prosječna ukupno primijenjena energija bila je 344,2±268,9 J (džula). CK je nakon elektrokonverzije neznačajno porastao (113,3:259,0), dok se vrijednosti troponina I nisu mijenjale (0,185:0,202). NT-proBNP se nakon elektrokonverzije značajno smanjio (1095:432). Postojala je značajna povezanost trajanja aritmije i NT-proBNP-a. Elektrokonverzija standardno preporučenom energijom ne dovodi do značajne lezije miokarda. Porast CK je posljedica lezije skeletne muskulature. Eventualni porast troponina nakon elektrokonverzije treba tumačiti drugom etiologijom. Povišeni NT-proBNP kod bolesnika s FA uzrokovan je povećanim tlačnim i volumnim opterećenjem atrija, neovisno o globalnoj srčanoj funkciji. Posljedično tomu bi kod bolesnika s FA diskriminacijske vrijednosti NT-proBNP-a u dijagnozi srčanog zatajivanja trebalo korigirati na više vrijednosti.
Summary
Summary. The goal of our research was to determine how electrical cardioversion influences troponine I and brain natriuretic peptide (NT-proBNP) levels in patients with persistent atrial fibrillation (AF), without heart failure. Reaserch was conducted on 20 patients with AF. Before and after cardioversion levels of troponine I, creatine-kinase (CK), lactate-dehydrogenase (LDH) and brain natriuretic peptide (NT-proBNP) were measured. Average total applied energy was 344,2±268,9 Joule. After cardioversion CK level was insignificantly higher (113,3:259,0). Levels of troponine I did not change significantly after cardioversion (0,185:0,202). By measuring levels of NT-proBNP significantly lower levels of NT-proBNP were found after cardioversion (1095:432). There was a strong correlation between the duration of arrhythmia and the NT-proBNP level. Electrical cardioversion with standard recommended energy does not cause significant myocardial lesion. CK level elevation is a consequence of skeletal muscle lesion. Possible elevation of troponine I should be interpreted by another etiology. Increased production of BNP is caused by increased pressure and volume overload of the atrium, in patients with AF, independent of global cardiac function, according to that we think that in patients with AF discriminatory values of BNP in heart failure diagnostics should be corrected to higher levels.
