Povezanost ventrikulske tahikardije i endotelne disfunkcije u bolesnika s koronarnom bolešću

Škerk, Vedrana (2011) Povezanost ventrikulske tahikardije i endotelne disfunkcije u bolesnika s koronarnom bolešću. PhD thesis, Sveučilište u Zagrebu.

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Abstract

The objectives of this study were as follows: 1. to examine whether there is an association between individual markers of endothelial dysfunction (ED) with the occurrence of ventricular tachycardia (VT) as a consequence of coronary heart disease (CHD), 2. to analyze possible differences between ED factors in patients with VT as a consequence of CHD compared to those with CHD but without so far recorded VT, 3. to investigate possible association between changes in the levels of serum markers of ED and the incidence of certain forms of VT in patients with proven CHD. The study included a total of 90 subjects who were grouped into three groups of 30 subjects: 1. with documented VT as a result of proven CHD (VT + STEMI), 2. with proven CHD STEMI, and without recorded VT, 3. the control group without CHD and without VT. Patients with diabetes mellitus, congenital disorders, patients with idiopathic VT or family hypertrophic cardiomyopathy, and patients with malignant and infectious diseases were not included in the study. In all examinees medical history was collected, physical examination performed, laboratory hematology and biochemical tests done including certain soluble markers of ED-with adhesion molecules sICAM-1 and sVCAM-1, selectins sP-selectin and sE-selectin and growth factors VEGF and CRP. ECG was performed in all subjects, ergometry in the control group subjects and in the first two groups of patients coronarography and monitored telemetry during the first 24 hours after coronary artery opening. The results of our research have shown significant differences in certain clinical and laboratory parameters, as well as in markers of endothelial dysfunction between patients with STEMI, VT+STEMI and the control group of patients. Clinical and laboratory parameters: 1. LDL, triglycerides and the total number of leukocytes have been significantly increased in patients with STEMI and VT+STEMI compared to the control group, while, between the two groups no significant difference was recorded; 2. Significantly higher values of cQT and glucose have been recorded in patients with VT2 compared to VT-1 group; 3. Significantly higher number of cigarettes smoked have been recorded in groups with STEMI and VT+STEMI compared to the control group. This parameter was significantly higher also in examinees with VT3 compared to examinees with VT4; 4. It is interesting that examinees from the control group had higher BMI than examinees with STEMI or VT+STEMI. BMI was significantly lower in VT3 group, compared to VT4 group; 5. Values of systolic and diastolic pressure have been significantly lower in patients with VT+STEMI compared to patients with STEMI or the control group. Also, the value of systolic pressure was significantly lower in patients with VT1 compared to VT2 group and in VT4 group compared to VT3 group. Markers of endothelial dysfunction: 1. By analyzing the markers of endothelial dysfunction we have demonstrated statistically significant differences between the levels of sE-selectin, sVCAM-1, VEGF and CRP in all investigated groups; 2. The values of CRP have been significantly higher in the control group compared to the group with STEMI, as well as in the group VT+STEMI, although the difference was not statistically significant; 3. The values of sE-selectin have been significantly lower in the group VT+STEMI compared to the other two examined groups, and significantly lower values have been recorded also in the group with STEMI compared to the control group; 4. Similarly lower levels of VEGF have been recorded in both groups compared to the control group, and statistically significant difference has been recorded between STEMI group and the control group; 5. The levels of sVCAM-1 have been higher in the groups with STEMI and/or VT compared to the control group, and significant difference was recorded between the control group and the group with STEMI; 6. We have demonstrated a sigificant correlation between CRP and sVCAM-1 in patients with VT+STEMI; 7. No differences have been found in tested markers of endothelial dysfunction between different types of STEMI+VT.

Abstract in Croatian

Ciljevi ovog istraživanja bili su sljedeći: 1. ispitati da li postoji povezanost pojedinih markera endotelne disfunkcije (ED) s pojavnošću ventrikulske tahikardije (VT) kao posljedice koronarne bolesti (KB), 2. analizirati moguće razlike u čimbenicima ED u bolesnika koji imaju VT kao posljedicu KB u odnosu na one u samom KB bez do sada zabilježene VT, 3. istražiti moguću povezanost između promjena u razini serumskih markera ED i pojavnosti pojedinih oblika VT u bolesnika s dokazanom KB. U istraživanje je bilo uključeno ukupno 90 ispitanika koji su grupirani u tri skupine od po 30 ispitanika: 1. sa zabilježenom VT kao posljedicom dokazane KB (VT + STEMI), 2. s dokazanom KB STEMI, a bez zabilježene VT, 3. kontrolna skupina bez KB i bez VT. Nisu uključeni bolesnici sa šećernom bolesti, kongenitalnim poremećajima, bolesnici s idiopatskom VT ili obiteljskom hipertrofičnom kardiomiopatijom, te bolesnici s malignim i zaraznim bolestima. Svim ispitanicima uzeta je anamneza, učinjen fizikalni pregled, laboratorijske hematološke i biokemijske pretrage te određeni solubilni markeri ED – adhezijske molekule sICAM-1 i sVCAM-1, selektini sP-selektin i sE-selektin, faktor rasta VEGF i CRP. U svih je ispitanika učinjen EKG, u ispitanika kontrolne grupe ergometrija, a u prve dvije skupine bolesnika koronografija i monitorirana telemetrija tijekom prva 24 sata po otvaranju koronarne arterije. Rezultati naših istraživanja pokazuju da postoje značajne razlike u pojedinim kliničkim i laboratorijskim parametrima, kao i markerima endotelne disfunkcije između bolesnika sa STEMI, VT+STEMI i kontrolne skupine. Klinički i laboratorijski parametri: 1. Vrijednosti LDL-a, triglicerida i ukupnog broja leukocita su bile značajno povišene u bolesnika sa STEMI i VT+STEMI u odnosu na kontrolnu skupinu, dok između ove dvije skupine nije bilo značajne razlike; 2. Značajno više vrijednosti cQT-a i GUK-a su zabilježene u bolesnika s VT2 u odnosu na VT-1 skupinu; 3. Također se bilježi značajno veći broj popušenih cigareta u skupinama sa STEMI i VT+STEMI u odnosu na kontrolnu skupinu. Ovaj parametar je značajno viši i u ispitanika s VT3 u odnosu na ispitanike s VT4; 4. Zanimljivo je da su ispitanici iz kontrolne skupine imali viši BMI nego ispitanici sa STEMI ili VT+STEMI. BMI je značajno niži i u VT3 skupinu, u odnosu na VT4 skupinu; 5. Vrijednosti sistoličkog i dijastoličkog tlaka su bile značajno niže u bolesnika s VT+STEMI u odnosu na bolesnike sa STEMI ili kontrolnu skupinu. Također je vrijednost sistoličkog tlaka bila značajno niža u bolesnika s VT1 u odnosu na VT2 skupinu i u VT4 u odnosu na VT3 skupinu. Markeri endotelne disfunkcije: 1. Analizom markera endotelne disfunkcije pokazali smo da postoje statistički značajne razlike u razinama sE-selektina, sVCAM-1, VEGF i CRP-a između svih ispitivanih skupina; 2. Vrijednosti CRP-a su bile značajno više u kontrolnoj skupini u odnosu na skupinu sa STEMI, kao i u skupini VT+STEMI, iako razlika nije bila statistički značajna; 3. Vrijednosti sE-selektina su bile značajno niže u skupini VT+STEMI u odnosu na ostale dvije ispitivane skupine, a značajno niže vrijednosti su i u skupini sa STEMI u odnosu na kontrolnu skupinu; 4. Slično su vrijednosti VEGF-a bile niže u obje skupine u odnosu na kontrolnu, a statistički značajna razlika je pokazana između skupine sa STEMI i kontrolne skupine; 5. Razine sVCAM-1 su bile više u skupinama sa STEMI i/ili VT-om u odnosu na kontrolnu skupinu, a značajna razlika je bila između kontrolne i skupine sa STEMI; 6. Pokazali smo značajnu korelaciju između CRP-a i sVCAM-1 u bolesnika s VT+STEMI; 7. Nisu nađene razlike u testiranim markerima endotelne disfunkcije između različitih oblika STEMI+VT.

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