Relation of serum Immunoglobulin E level with coronary artery disease and SYNTAX score

Year 2020, , 25 - 28, 20.03.2020

Arif Oğuzhan Çimen , Derya Öztürk

https://doi.org/10.25000/acem.692829

Abstract

Aim: Inflammation has a significant role in the pathogenesis of atherosclerosis and allergic inflammation has also an important impact on atherosclerosis progression. In this study, we investigated
whether the serum IgE levels are associated with coronary artery disease (CAD) and
SYNTAX score as a parameter for severity of the disease.

Methods: A total of 171 patients who were planned
coronary angiography were recruited consecutively into this study. The patients
who had a diagnosis of asthma, autoimmune diseases, allergic dermatitis,
history of allergic diseases, parasitic infections, malignancy, severe renal
failure (estimated glomerular filtration rate <30 mL/min), chronic hepatic disease,
rheumatic and valvular heart diseases were excluded from the study. The patients
were divided into two groups according to the presence of CAD as called CAD and
non-CAD groups. CAD was diagnosed according to the presence of more than 50%
stenosis at least in one main coronary artery. Two expert cardiologists who were
blinded to the patients’ clinical and laboratory data reviewed the coronary
angiography and evaluated the coronary atherosclerotic lesion severity
independently. The SYNTAX score is calculated using the algorithm on the
baseline diagnostic angiogram. Serum samples for determining total serum levels
of IgE were collected from the patients were at the admission just prior to
coronary angiography.

Results: Based on the coronary angiography, 88 patients
(51.5%) were in the non-CAD and 83 patients (48.5%) were in the CAD group. CAD
patients tend to be older (61.9±11.6 years vs 56.7±9.7years, p=0.002) and male (67.5%
vs.47.7%, p=0.009) with a higher prevalence of hypertension (80.7% vs 63.6%, p=0.013),
and hyperlipidemia (63.9% vs 28.4%, p<0.001) compared to non-CAD patients.
The serum IgE levels were significantly higher in the CAD group than those in
the non-CAD group (99.05 IU/ml (51-192) vs. 24.25 IU/ml (13.8-55), p<0.001).
By multivariate logistic regression analysis, serum IgE levels were found as an
independent predictor for CAD (OR 1.003; 95% CI 1.000–1.005; p=0.041). In
addition, there was a positive moderate correlation between SYNTAX score and Ig
E levels (r:0,483, p<0.001).

Conclusion: In this trial, we showed that the serum IgE levels
are positively associated with the presence of CAD even after adjusting for
traditional cardiovascular risk factors. Furthermore, serum IgE levels are
correlated with the SYNTAX score and the complexity of coronary artery disease.

Keywords

Immunoglobulin E, coronary artery disease, atherosclerosis, SNYTAX score, allergic inflammation

Serum immunoglobulin E seviyesi ile koroner arter hastalığı ve SYNTAX skoru arasındaki ilişki

Abstract

Amaç: İnflamasyon aterosklerozun patogenezinde
önemli bir role sahiptir. Alerjik inflamasyonun da aterosklerozun ilerlemesinde
önemli bir etkisi mevcuttur. Çalışmamızda IgE düzeyi ile koroner arter
hastalığı (KAH) arasında ilişki olup olmadığına baktık. Ayrıca KAH ciddiyetini
gösteren SYNTAX skoru arasındaki ilişkiyi de değerlendirdik.

Metot: Çalışmaya ardışık olarak 171 tane koroner
angiografi planlanan hasta alındı. Astım, oto immun hastalık, alerjik dermatit,
alerji öyküsü, parazit infestasyonu, kanser, ciddi böbrek yetmezliği (glomeriüler
filtrasyon hızı <30 ml/min), kronik karaciğer hastalığı, romatizmal kalp hastalığı,
kalp kapak hastalığı olanlar dışlandı. Hastalar KAH varlığına göre olan ve
olmayan diye iki gruba ayrıldı. En az bir ana koroner arterde %50 ve üzeri
darlık KAH olarak değerlendirildi. Hastaların klinik ve laboratuvar sonuçlarından
bağımsız olarak 2 kardiyoloji uzmanı tarafından KAH ciddiyeti SYNTAX skoru
algoritmasına göre değerlendirildi. IgE düzeylerine ilk başvuruda, koroner
angiografi öncesinde alınan venöz kan tahlillerinde bakıldı.

Sonuçlar: Koroner angiografi sonuçlarına göre 88 hasta
(%51,5) KAH olan ve 83 hasta (%48,5) ise KAH olmayan olarak değerlendirildi.
KAH olan grupta olmayan gruba göre yaş ortalaması daha yüksek (61,9±11,6 yıl vs
56,7±9,7 yıl, p:0,002), erkek cinsiyet daha fazla (67,5% vs.47,7%, p:0,009), hipertansiyon
(80,7% vs 63,6%, p:0,013) ve hiperlipidemi (63,9% vs 28,4%, p<0,001)
prevelansları daha fazla idi. Serum IgE düzeyleri KAH olan grupta olmayan gruba
göre (99,05 IU/ml (51-192) vs. 24,25 IU/ml (13,8-55), p<0.001) daha yüksek
idi. Çoklu logistik regresyon analizine göre IgE düzeyleri KAH için bağımsız bir
faktör olarak bulundu (OR 1,003; 95% CI 1,000–1,005; p=0,041). Ek olarak, serum
IgE düzeyleri ile SYNTAX skoru arasında orta derecede pozitif bir korelasyon
tespit edildi (r:0,483, p<0,001).

Sonuç: Çalışmamızda geleneksel risk faktörleri düzenlendikten
sonra, serum IgE düzeylerinin KAH varlığı açısından bağımsız pozitif bir faktör
olduğu gösterildi. KAH ciddiyetini gösteren SYNTAX skoru ile serum IgE
düzeyleri arasında orta derecede pozitif bir korelasyon tespit edildi. 

Keywords

Immunoglobulin E, koroner arter hastalığı, aterosklerozis, SYNTAX skoru, alerjik inflamasyon

References

• 1.Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352:1685–95.
• 2. Libby P. Inflammation in atherosclerosis. Arterioscler Thromb Vasc Biol. 2012;32:2045–51.
• 3.Farb A, Sangiorgi G, Carter AJ, Walley VM, Edwards WD, Schwartz RS, et al. Pathology of acute and chronic coronary stenting in humans. Circulation. 1999;99:44–52.
• 4. Virmani R, Guagliumi G, Farb A, Musumeci G, Grieco N, Motta T, et al. Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent: should we be cautious? Circulation. 2004;109:701–5.
• 5. Niccoli G, Montone RA, Sabato V, Crea F. Role of Allergic Inflammatory Cells in Coronary Artery Disease. Circulation. 2018;138:1736–48.
• 6. Shi GP, Bot I, Kovanen PT. Mast cells in human and experimental cardiometabolic diseases. Nat. Rev Cardiol. 2015;12:643–58.
• 7. Guo X, Yuan S, Liu Y, Zeng Y, Xie H, Liu Z, et al. Serum IgE levels are associated with coronary artery disease severity. Atherosclerosis. 2016;251:355-60.
• 8. Serruys PW, Onuma Y, Garg S, Sarno G, van den Brand M, Kappetein AP, et al. Assessment of the SYNTAX score in the Syntax study. EuroIntervention 2009;5:50-6
• 9.Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36:953-2041.
• 10. Kerner W, Brückel J. Definition, classification and diagnosis of diabetes mellitus. Exp Clin Endocrinol Diabetes.2014;122:384-6.
• 11. Pastorello EA, Morici N, Farioli L, Di Biase M, Losappio LM, Nichelatti M, et al. Serum tryptase: a new biomarker in patients with acute coronary syndrome? Int. Arch Allergy Immunol. 2014;164:97–105.
• 12. Kovanen PT. Mast Cells as Potential Accelerators of Human Atherosclerosis-From Early to Late Lesions. Int J Mol Sci. 2019 Sep 11;20(18). doi: 10.3390/ijms20184479.
• 13. Bot I, Biessen EA. Mast cells in atherosclerosis. Thromb Haemost. 2011;106:820-8.
• 14. Wang J, Cheng X, Xiang MX, Alanne-Kinnunen M, Wang JA, Chen H, et al. IgE stimulates human and mouse arterial cell apoptosis and cytokine expression and promotes atherogenesis in Apoe-/- mice. J Clin Invest. 2011;121:3564-65.
• 15 Criqui MH, Lee ER, Hamburger RN, Klauber MR, Coughlin SS. IgE and cardiovascular disease. Results from a population-based study. Am J Med. 1987;82:964-8.
• 16. Szczeklik A. Mast cell, IgE and atherothrombosis. Int Arch Allergy Immunol. 1998;116:166.
• 17. Morici N, Farioli L, Losappio LM, Colombo G, Nichelatti M, Preziosi D, et al. Mast cells and acute coronary syndromes: relationship between serum tryptase, clinical outcome and severity of coronary artery disease Open Heart. 2016;3:e000472.