THE URINARY ALBUMIN EXCRETION RATE IN THE PREDICTION OF EARLY MORTALITY IN PATIENTS WITH ACUTE MYOCADIAL INFARCTION
Journal Name:
- İstanbul Tıp Fakültesi Dergisi
Key Words:
Keywords (Original Language):
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Abstract (2. Language):
Objective: Urinary albumin excretion rate (AER) increases in acute myocardial infarction (MI). The purpose of
this study was to evaluate whether the increase of urinary AER was an important factor for predicting early mortality
and heart failure in patients with acute MI.
Materials and methods: 116 patients with acute MI (Male / Female: 96/20, mean age 59.8 ± 11.3 years) and 21
patients (Male / Female:17/4, mean age 60.2 ± 11.9 years) with ischemic heart disease but without MI were included
in this study. The patients were divided into two groups according to whether left ventricular ejection fraction
(LVEF) was >50% or <50%. Urinary AER was measured on the first and third days after admission to the hospital.
Results: Urinary AERs on the first and third days were significantly higher in patients with acute MI than in those
without acute MI (1st day: 75.30 vs 13.00 mg/day, p<0.0001; 3rd day: 21.50 vs 6.80 mg/day, p<0.0001). Eleven
patients with acute MI died in the first week. In these patients, urinary AERs on the 1st and 3rd days were significantly
higher than in those who survived (1st day: 124.00 vs 69.30 mg/day, p<0.001; 3rd day: 89.40 vs 18.90
mg/day, p<0.001).It was also found that AERs on the 1st and 3rd days were higher in patients with LVEF <50%
than those in patients with LVEF >50% (1st day: 81.90 vs 26.45 mg/day, p=0.003; 3rd day: 22.70 vs 8.45 mg/day,
p=0.001). Conclusion: Urinary AER increases in the early phase of acute MI. The increase observed in patients who had left
ventricular dysfunction was more prominent. We can conclude that urinary AER might be an important factor for
predicting early mortality during acute MI, based on the findings that urinary AERs were higher in those who died
during the early phase of acute MI than in those who survived.
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Abstract (Original Language):
Amaç: Akut miyokard infarktüsünün (MI) seyri s›ras›nda üriner albümin at›l›m (ÜAA) miktar› artmaktad›r. Çal›flmam›
z›n amac› akut MI geçiren hastalarda ÜAA’n›n kalp yetersizli¤i ve erken dönem mortaliteyi belirlemede etkili
olup olmad›¤›n› araflt›rmakt›r.
Gereç ve yöntem: Çal›flmaya akut MI geçiren 116 hasta (Erkek / Kad›n: 96/20, yafl 59,8 ± 11,3 y›l) ile iskemik
kalp hastal›¤› olan akut MI geçirmeyen 21 hasta (Erkek / Kad›n :17/4, yafl 60,2 ± 11,9 y›l) al›nd›. ÜAA yo¤un bak›
ma al›nd›ktan itibaren ilk gün ve üçüncü gün olmak üzere 24 saatlik idrar toplanarak ölçüldü. Ekokardiyografi
yap›labilen hastalar sol ventrikül ejeksiyon fraksiyonuna (LVEF) göre LVEF < %50 (n=61) ve LVEF > %50 (n=32)
olmak üzere 2 gruba ayr›ld›.
Bulgular: 1. ve 3. gün ÜAA akut MI geçiren hastalarda kontrol grubuna göre anlaml› olarak daha yüksek bulundu
(1. gün 75,30 ve 13,00 mg/gün p<0.0001; 3. gün 21,50 ve 6,80 mg/gün, p<0,0001). Akut MI geçiren 11 hasta
ilk bir hafta içerisinde kaybedildi. Bu hastalar›n 1. ve 3. günde ÜAA oranlar› MI geçiren ve sa¤ kalan hastalara göre
anlaml› olarak daha yüksek bulundu (1.gün 124,00 ve 69,30 mg/gün, p<0.001; 3. gün 89,40 ve 18,90 mg/gün,
p<0,001). Akut MI geçiren hastalardan LVEF si <%50 olanlarda 1. ve 3. gün ÜAA oran›, LVEF si >%50 olanlara
göre anlaml› olarak daha yüksek bulundu (1. gün 81,90 ve 26,45 mg/gün, p=0,003; 3.gün 22,70 ve 8,45 mg/gün,
p=0,001).
Sonuç: Akut MI erken döneminde ÜAA oran› artmaktad›r. Bu art›fl sol ventrikül sistolik fonksiyonlar› bozuk
olan hastalarda daha fazla olmaktad›r. Erken dönemde kaybedilen hastalar›n ÜAA oranlar›n›n daha yüksek
bulunmas› akut MI seyrinde ÜAA oran›n›n erken mortaliteyi belirlemede önemli olabilece¤ini düflündürmektedir.
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