Ta'lim innovatsiyasi va integratsiyasi

EVALUATION OF A NATRIURETIC PEPTIDE TO OPTIMIZE THE MANAGEMENT OF COMORBID PATIENTS WITH THYROTOXICOSIS AND HEART FAILURE

Khusainova Munira Alisherovna

Uzokov Ma’rufjon Yaxshiboyevich

Bozorov Abdullo Yigitaliyevich

Keywords: Key words: natriuretic peptides, chronic heart failure, comorbid patients, coronary heart disease, thyrotoxicosis, threshold level.

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Abstract

Objective: to determine the threshold level of natriuretic peptide to optimize the
diagnosis of heart failure in comorbid patients with thyrotoxicosis, to evaluate the
dynamics of the indicator against the background of therapy. Materials and methods:
111 patients aged 58.3± 5.6 years were divided into 4 groups: the main group — 25
patients with coronary heart disease (CHD), chronic heart failure (CHF) and
thyrotoxicosis; the first comparison group — 30 patients with CHD and CHF, without
thyrotoxicosis; the second group — 30 patients with thyrotoxicosis without CHF; The
third group consisted of 26 patients with thyrotoxicosis and coronary heart disease
without signs of CHF. Thyroid function and the level of the N-terminal fragment of the
precursor of the cerebral natriuretic peptide (NT-proBNP) were evaluated initially and
after 6 months of treatment for thyrotoxicosis, coronary heart disease and CHF. Using
ROC analysis, the threshold level of NTproBNP for the diagnosis of CHF in comorbid
patients was calculated. Results: in patients of all groups, an increased concentration
of NT-proBNP (more than 125 pg/ml) was determined, in the second group it was
225.5 (180.1; 376.1) pg/ml. Values NT-proBNP did not significantly differ in patients
of the first and third groups. The highest level of NT-proBNP was determined in the
main group — 712.1 (434.3; 893.9) pg/ml. The cut-off marker for CHF screening in
patients with coronary heart disease and thyrotoxicosis was calculated at 556.4 pg/ml
(sensitivity — 72%, specificity — 100%, accuracy — 87.2% (p<0.001)). After 6
months of treatment, the level of NT-proBNP in the second comparison group
decreased by 74% (p<0.0001), reached a normal value (64.6 (42.2;76.3)), decreased by
43% in the main group and amounted to 406.7 (309.1; 498.6) pg/ml. Conclusions: in
patients of all groups, an increased concentration of NT-proBNP was detected, the
highest in the group of patients with CHF on the background of coronary heart disease
and thyrotoxicosis. A new threshold level of NT-proBNP has been determined, which makes it possible to diagnose CHF in patients with a combination of coronary heart
disease and thyrotoxicosis – 556.4 pg/ml. 

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