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Ischemia-modified albumin levels in patients with acute decompensated heart failure treated with dobutamine or levosimendan: IMA-HF study [Anatol J Cardiol]
Anatol J Cardiol. 2015; 15(8): 611-617 | DOI: 10.5152/akd.2015.6156  

Ischemia-modified albumin levels in patients with acute decompensated heart failure treated with dobutamine or levosimendan: IMA-HF study

Yüksel Çavuşoğlu1, Şule Korkmaz2, Selda Demirtaş3, Erkan Gencer4, Hatice Şaşmaz5, Fezan Mutlu6, Hakan Güneş7, Uğur Kadir Mert1, Sedat Özdemir3, Süleyman Kalaycı5, Mehmet Birhan Yılmaz7
1Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University; Eskişehir-Turkey
2Department of Cardiology, Faculty of Medicine, Ufuk University; Ankara-Turkey
3Department of Biochemistry, Faculty of Medicine, Ufuk University; Ankara-Turkey
4Cardiology Clinic, Kilis State Hospital; Kilis-Turkey
5Cardiology Clinic, Türkiye Yüksek İhtisas Hospital; Ankara-Turkey
6Department of Biostatistic, Faculty of Medicine, Eskişehir Osmangazi University; Eskişehir-Turkey
7Department of Cardiology, Faculty of Medicine, Cumhuriyet University; Sivas-Turkey

Objective: Ischemia-modified albumin (IMA) is a sensitive biomarker of myocardial ischemia. However, data on IMA levels in acute heart failure (HF) are still lacking. In this study, we aimed to evaluate serum IMA levels in acute decompensated HF and the effects of dobutamine and levosimendan treatments on IMA levels. Methods: This was a prospective, multicenter study that included 70 patients hospitalized with acute decompensated HF and left ventricular ejection fraction <35%. Blood samples for IMA measurements were obtained on admission and 24-48 h after the initiation of HF therapy. Twenty-nine patients were treated with standard HF therapy, 18 received levosimendan, and 23 received dobutamine in addition to standard of care. A single serum specimen was also collected from 32 healthy individuals each. IMA concentrations were measured by the albumin cobalt binding colorimetric assay, and the results were given in absorbance units (AU). Independent and paired sample t-tests, Mann-Whitney U test, and Wilcoxon signed-rank test were used for the analysis. Results: In patients with acute decompensated HF, the serum concentration of IMA was significantly higher than those of healthy subjects (0.894±0.23 AU vs. 0.379±0.08 AU, p<0.001). Overall, the IMA levels significantly decreased after 24-48 h of HF therapy (0.894±0.23 AU and 0.832±0.18 AU, p=0.013). Furthermore, the IMA levels were also found to significantly decrease with standard HF therapy (1.041±0.28 vs. 0.884±0.15 AU, p=0.041), with levosimendan (0.771±0.18 vs. 0.728±0.18 AU, p=0.046) and also with dobutamine (0.892±0.18 vs. 0.820±0.13 AU, p=0.035). Conclusion: Patients with acute decompensated HF had elevated IMA levels, and appropriate HF therapy significantly reduced the serum IMA levels. Dobutamine or levosimendan did not increase the IMA levels, suggesting a lower potential in inducing myocardial ischemia when used in recommended doses.

Keywords: ischemia modified albumin, heart failure, acute


Levosimendan veya dobutamin tedavisi alan akut dekompanse kalp yetersizliği olgularında iskemi modifiye albümin düzeyleri: IMA-HF çalışması

Yüksel Çavuşoğlu1, Şule Korkmaz2, Selda Demirtaş3, Erkan Gencer4, Hatice Şaşmaz5, Fezan Mutlu6, Hakan Güneş7, Uğur Kadir Mert1, Sedat Özdemir3, Süleyman Kalaycı5, Mehmet Birhan Yılmaz7
1Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University; Eskişehir-Turkey
2Department of Cardiology, Faculty of Medicine, Ufuk University; Ankara-Turkey
3Department of Biochemistry, Faculty of Medicine, Ufuk University; Ankara-Turkey
4Cardiology Clinic, Kilis State Hospital; Kilis-Turkey
5Cardiology Clinic, Türkiye Yüksek İhtisas Hospital; Ankara-Turkey
6Department of Biostatistic, Faculty of Medicine, Eskişehir Osmangazi University; Eskişehir-Turkey
7Department of Cardiology, Faculty of Medicine, Cumhuriyet University; Sivas-Turkey

Amaç: İskemi modifiye albumin (IMA), miyokardiyal iskeminin duyarlı bir göstergesidir. Akut kalp yetersizliğinde (KY) IMA düzeylerine ilişkin veri bulunmamaktadır. Bu çalışmada, akut dekompanse KY’de IMA düzeyleri ile levosimendan ve dobutamin tedavilerinin IMA düzeylerine etkisinin değerlendirilmesi amaçlandı. Yöntemler: Çok merkezli, prospektif yürütülen bu çalışmaya akut dekompanse KY ile hastaneye yatırılan ve EF <%35 olan 70 hasta alındı. IMA düzeylerine, hastaneye kabul sırasında ve tedavinin başlanmasından 24-48 saat sonra alınan kan örneklerinden bakıldı. 29 olgu standart akut KY tedavisi, 18 olgu standart tedaviye ilave levosimendan ve 23 olgu dobutamin tedavisi aldı. Ayrıca 32 sağlıklı olgudan IMA için tek kan örneği alındı. IMA düzeyi, albumin cobalt bağlama yöntemine göre ölçüldü ve değerleri absorban unite (AU) olarak verildi. İstatistik analizlerde bağımsız ve eşleştirilmiş t testi, Mann-Whitney U ve Wilcoxon Signed Rank testi kullanıldı. Bulgular: Serum IMA düzeyleri akut dekompanse KY olgularında, sağlıklı olgulara göre anlamlı yüksek bulundu (0,894±0,23 AU'a karşı 0,379±0,08 AU, p<0,001). Akut KY tedavisinin başlanmasından 24-48 saat sonra IMA düzeyleri anlamlı azaldı (0,894±0,23 AU ve 0,832±0,18 AU, p=0,013). Ayrıca, IMA düzeylerinin hem standart tedavi grubunda (1,041±0,28'e karşı 0,884±0,15 AU, p=0,041), hem levosimendan grubunda (0,771±0,18'e karşı 0,728±0,18 AU, p=0,046), hem de dobutamin grubunda anlamlı azaldığı saptandı (0,892±0,18'e karşı 0,820±0,13 AU, p=0,035). Sonuç: Akut dekompanse KY’de IMA düzeyleri artmıştır. Uygun KY tedavisi ile IMA düzeyleri azalma göstermektedir. Günlük uygulamada önerilen dozlarda kullanılan dobutamine ve levosimendan, IMA düzeylerinde artışa neden olmamaktadır.

Anahtar Kelimeler: iskemi modifiye albumin, kalp yetersizliği, akut


Yüksel Çavuşoğlu, Şule Korkmaz, Selda Demirtaş, Erkan Gencer, Hatice Şaşmaz, Fezan Mutlu, Hakan Güneş, Uğur Kadir Mert, Sedat Özdemir, Süleyman Kalaycı, Mehmet Birhan Yılmaz. Ischemia-modified albumin levels in patients with acute decompensated heart failure treated with dobutamine or levosimendan: IMA-HF study. Anatol J Cardiol. 2015; 15(8): 611-617


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