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Burcu Oktay MD , Sadık Ardıç MD, Hikmet Firat MD, Erdem Akbal MD, Ramazan Akdemir MD

EVALUATION OF THE RELATIONSHIP BETWEEN H-FABP LEVELS AND THE RISK OF CARDIAC DAMAGE IN PATIENTS WITH OSAS. Burcu Oktay MD , Sadık Ardıç MD, Hikmet Firat MD, Erdem Akbal MD, Ramazan Akdemir MD Diskapi Yildirim Beyazit Training and Research Hospital

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Burcu Oktay MD , Sadık Ardıç MD, Hikmet Firat MD, Erdem Akbal MD, Ramazan Akdemir MD

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  1. EVALUATION OF THE RELATIONSHIP BETWEEN H-FABP LEVELS AND THE RISK OF CARDIAC DAMAGE IN PATIENTS WITH OSAS Burcu Oktay MD, Sadık Ardıç MD, Hikmet Firat MD, Erdem Akbal MD, Ramazan Akdemir MD Diskapi Yildirim Beyazit Training and Research Hospital Ministry of Health/Ankara

  2. Obstructive Sleep Apnea Syndrome • Male % 4 medical condition!! • Female %2 * Young T, Palta M, Dempsey J et al. The occurrence of sleep-disordered breathing among middle-aged adults. N. Engl. J. Med. 1993; 328(17): 1230–1235.

  3. OSAS(1) - OSAS is an independent risk factor for Ischemic Heart Disease. - CAD was evident in 50% of patients with clinically important OSAS. Severity of OSAS Nocturnal ST Oxyhemoglobin desaturation segment changes 1,Mayo Clin Proc. August 2004;79(8):1036-1046 2.Andreas S, Schultz R, Werner GS, Kreuzer H. Prevalence of obstructive sleep apnea in patient with coronary artery disease. Coron Artery Dis. 1996;7:541-545 3.Hanly P, Sasson Z, Zuberi N, Lunn K. ST segment depression during sleep in obstructive sleep apnea. Am J Cardiol.1993;71:1341-1345

  4. OSAS(4) Recurrent hypoxemia ST-T segment changes and nocturnal angina SEROLOGIC MARKER???

  5. Heart Type Fatty Acid Binding Protein (h-fabp)(1) • 15 kDAweight. • Small cytoplasmic protein. • It is released from myocytes into circulation in large amounts in the event of acute myocardial ischemia. • This marker is extremely specific and sensitive to myocardial ischemia. Tomoaki Nakata at all. Human Heart type fatty acid binding protein as an eary diagnostic and prognostic marker in Acute coranary syndromeCardiology 2003:99:96-104

  6. Heart Type Fatty Acid Binding Protein (2) . Today it’s superiority is shown over the other cardiac markers in the early phase of acute myocardial infarction. 1.5 h 6 h 12-24 h H.A. Alhadı and K:A:A FOX. Do we need additional markers of myocyte necrosisi: the potential value of heart fatty acid binding protein . QJ Med 2004; 97:187-198

  7. AIM • In view of these findings, this study aims at detecting the cardiac damage occurring due to nocturnal ischemia by using h-fabp in patients with OSAS.

  8. MATERIAL-METHOD(1) • Prediagnosis of OSAS • Absence of previous CAD diagnosis 21:00 CPK,CKMB,AST,troponinI,h-fabp Polysomnography 09:00 CPK,CKMB,AST,troponinI,h-fabp

  9. MATERIAL-METHOD(2) AHI≥5Electrocardiography Echocardiography Myocardium perfusion syntigraphy Rule out CAD 50 cases Patient Group

  10. MATERIAL-METHOD(3) • Control group; -No symptom of OSAS -Any history and risk factor of CAD -PSG -EKG, EKO -19 cases

  11. MATERIAL-METHOD(4) • SPSS software (Version 11.5) was used for data analysis.

  12. RESULTS(1) • Overall 69 cases (22f/47m) were included in the study. • Control group ; 19 cases / Patient group ; 50 cases • Mean age was 48.02±9.5 • None of patients had diabetes mellitus, congestive cardiac failure, cardiomyopathia, coronary artery disease, renal failure, hypertension, and other systemic diseases.

  13. RESULTS(2) • Patient and control groups; • Age • Sex • Smoking status p>0.05 • BMI

  14. RESULTS(3) Before SleepAfter sleep CPK CPK CK-MB CK-MB AST AST Troponin-I Troponin-I h-fabp h-fabp p > 0.05 In patient and control group

  15. RESULTS(4) - All the other cardiac markers (CPK, CKMB, Troponin I, AST) remain insignificant between patient and control groups.

  16. RESULTS(5) • When arithmetical mean of the h-fabp levels before and after sleep was taken in the patient group , it was found that; • Mean value of the h-fabp is correlated with the desaturated period ( SaO2< %80 ) during sleep (p=0.04) .

  17. RESULTS(6) • No significant relation was found between mean value of h-fabp and AHI, the number of apneas, hypopneas and oxygen desaturation (p>0.05) .

  18. RESULTS(7) • When patients were divided into three groups according to their AHI, no significant difference was found between groups in terms of h-fabp levels (p>0.05) .

  19. DISCUSSION(1) • There is still no marker that will predict cardiovascular morbidity and mortality or reveal increased cardiac disease risk in patients with OSAS.

  20. DISCUSSION(2) OSAS Hypoxia Myocardial ischemia SaO2<80%H-FABP

  21. DISCUSSION(3) • In patient group h-fabp levels were high, but none of the patients had cardiac diseases that are detectable by electrocardiography, echocardiography and even myocardium perfusion syntigraphy.

  22. DISCUSSION(4) • This condition suggests that myocardial ischemia occurring due to hypoxia caused by apnea/hypopnea leads to increase in the h-fabp levels.

  23. DISCUSSION(5) • High h-fabp levels might show us the patients who are in the asymptomic stage , before disease appears.

  24. DISCUSSION(6) • Absence of a difference in the patient group between h-fabp levels before and after sleep suggests that; • Ishemic process induced by hypoxia continues throughout the day.

  25. CONCLUSION • H-fabp seems to be a marker which allows the detection of the cardiac damage in the early stage in OSAS patients. • Further studies that investigate the long term development of cardiac dysfunction in relation with increasing levels of h-fabp in asymptomatic patients are required.

  26. Thank you……..

  27. Thank you………….. THANK YOU…..

  28. *p = 0.006 **p = 0.022

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