| Abstract | Ciljevi istraživanja: Primarni ciljevi istraţivanja bili su utvrditi meĊusobnu
povezanost pojavnosti dijastoliĉke disfunkcije lijeve klijetke (LVDD), kardiovaskularnog
(KV) rizika procijenjenog SCORE2 ljestvicom i plazmatskih koncentracija biljega NTproBNP i ADMA. Sekundarni ciljevi bili su utvrditi povezanost indeksiranog volumena lijeve
pretklijetke (LAVI) s plazmatskom koncentracijom NT-proBNP i ADMA te utvrditi
uĉinkovitost biljega NT-proBNP i ADMA u predviĊanju LVDD kod ispitanika opće
populacije.
Nacrt studije: Presjeĉno istraţivanje opće populacije ispitanika koji su u razdoblju od
studenog 2019. do svibnja 2022. godine dolazili na pregled u internistiĉku ambulantu pri
Domu zdravlja Osjeĉko-baranjske ţupanije i kardiološku ambulantu Kliniĉkog bolniĉkog
centra Osijek.
Ispitanici i metode: U istraţivanju je sudjelovalo 178 ispitanika (99 muškaraca i 79
ţena) dobi 40 – 65 godina, kojima je na temelju anamneze, sociodemografskih,
antropometrijskih karakteristika i laboratorijske analize procijenjen KV rizik. Funkcionalni
kapacitet i pojavnost ishemijskih promjena ispitani su testom opterećenja. Za utvrĊivanje
plazmatske koncentracije ADMA korištena je ELISA metoda, a za NT-proBNP ECLIA
metoda. Transtorakalnom ehokardiografijom procijenjena je dijastoliĉka funkcija lijeve
klijetke (LVDF), nakon ĉega su ispitanici podijeljeni u 4 skupine: 1. uredna LVDF (44
ispitanika), 2. LVDD 1. stupnja (46 ispitanika), 3. LVDD 2. stupnja (46 ispitanika) i 4. LVDD
3. stupnja (42 ispitanika).
Rezultati: Proporcionalno porastu stupnja teţine LVDD rastu KV rizik procijenjen
SCORE2 algoritmom i plazmatska koncentracija NT-proBNP, dok plazmatska koncentracija
ADMA pada. Porastom LAVI, mase i indeksirane mase lijeve klijetke (LVM i LVMI)
proporcionalno raste i plazmatska koncentracija NT-proBNP, dok plazmatska koncentracija
ADMA pada. Na smanjenje plazmatske koncentracije ADMA utjeĉu sljedeće skupine
lijekova: ACEI, ARNI, BB, diuretici, MRA, statini, SGLT2 inhibitori, inzulin i ASK, meĊu
kojima najznaĉajniji utjecaj imaju politerapija i statini. U usporedbi s uĉinkom na plazmatsku
koncentraciju ADMA, promatrane skupine lijekova ne utjeĉu na isti naĉin na plazmatsku
koncentraciju NT-proBNP.
8. SAŢETAK
78
Zakljuĉak: LVDD i NT-proBNP dobri su predkazatelji KV rizika. U usporedbi s
ADMA, NT-proBNP superiorni je biljeg procjene teţine stupnja LVDD, KV rizika i srĉanog
zatajenja (HF), moguće djelomiĉno zbog utjecaja lijekova. ADMA moţe posluţiti kao dobar
biljeg procjene uĉinkovitosti lijeĉenja na reverzibilnost endotelne disfunkcije (ED). |
| Abstract (english) | Objectives: The primary objectives of the study were to determine the relationship
between the incidence of left ventricular diastolic dysfunction (LVDD), cardiovascular (CV)
risk assessed by the SCORE2 scale, and plasma concentrations of NT-proBNP and ADMA
biomarkers. The secondary objectives were to determine the association of indexed left atrial
volume (LAVI) with plasma concentrations of NT-proBNP and ADMA, and to determine the
effectiveness of NT-proBNP and ADMA biomarkers in predicting LVDD in subjects of the
general population.
Study design: A cross-sectional study that included subjects from the general
population who came for examination to the internist ambulance of the Health Center of
Osijek-Baranja County and the Cardiology Clinic of Clinical Hospital Center Osijek in the
period from November 2019 to May 2022.
Participants and methods: 178 subjects (99 men and 79 women) aged 40-65 years
participated in the study, who were assessed for CV risk based on the medical history, sociodemographic, anthropometric characteristics and laboratory analysis. Functional capacity and
the occurrence of ischemic changes were examined by a stress test. The ELISA method was
used to determine the plasma concentration of ADMA, and the ECLIA method was used for
NT-proBNP. Left ventricular diastolic function (LVDF) was assessed by transthoracic
echocardiography, after which the subjects were divided into 4 groups: 1. normal LVDF (44
subjects), 2. 1
st degree LVDD (46 subjects), 3. 2
nd degree LVDD (46 subjects) and 4. LVDD
of the 3rd degree (42 subjects).
Results: In proportion to the increase in the severity of LVDD, the CV risk assessed
by the SCORE2 scale and the plasma concentration of NT-proBNP increase also, while the
plasma concentration of ADMA decreases. With an increase in LAVI, mass and indexed mass
of the left ventricle (LVM and LVMI), the plasma concentration of NT-proBNP increases
proportionally, while the plasma concentration of ADMA decreases. The following groups of
9. SUMMARY
80
drugs affect the lowering of ADMA plasma concentration: ACEI, ARNI, BB, diuretics,
MRA, statins, SGLT2 inhibitors, insulin and ASA, among which polytherapy and statins have
the most significant influence. Compared to the effect on the plasma concentration of ADMA,
the observed groups of drugs do not affect the plasma concentration of NT-proBNP in the
same way.
Conclusion: LVDD and NT-proBNP are good predictors of CV risk. Compared with
ADMA, NT-proBNP is a superior biomarker for assessing severity of LVDD, CV risk, and
heart failure (HF), possibly due to drug effects in part. ADMA can serve as a good biomarker
for assessing the effectiveness of treatment on the reversibility of endothelial dysfunction
(ED). |
