Kronik total oklüzyonlu hastalarda iyi koroner kollateral dolaşımın bağımsız belirteçleri olarak serbest testosteron indeksi ve biyoyararlanabilir testosteron

Abstract

Arka plan: Kronik total oklüzyon (CTO), koroner arter hastalığının klinik olarak önemli bir formunu temsil eder ve bu durumda kollateral dolaşım, miyokard perfüzyonunun korunmasında kritik rol oynar. Testosteronun vasküler fonksiyon ve anjiyogenezi etkileyebileceği öne sürülmüş olsa da, androjenik parametreler ile koroner kollateral gelişim arasındaki ilişki belirsizliğini korumaktadır. Yöntemler: Bu kesitsel vaka-kontrol çalışmasına koroner anjiyografi ile CTO tanısı konulan 230 erkek hasta dahil edildi. Koroner kollateral dolaşım Rentrop sınıflaması ile değerlendirildi ve iyi (skor 2–3) veya zayıf (skor 0–1) kollateral dolaşım olarak sınıflandırıldı. Serum total testosteron, serbest testosteron, SHBG, dehidroepiandrosteron sülfat (DHEAS) ve dihidrotestosteron (DHT) düzeyleri ölçüldü; biyoyararlanabilir testosteron (BioT) ve serbest testosteron indeksi (FTI) hesaplandı. Androjenik parametreler ile kollateral dolaşım arasındaki ilişkiler korelasyon analizi, lojistik regresyon ve ROC eğrisi analizi ile incelendi. Bulgular: Çalışma popülasyonunda 142 hastada iyi, 88 hastada zayıf kollateral dolaşım saptandı. İyi kollaterali olan hastalarda total testosteron (p<0.001), DHEAS (p=0.048), BioT (p<0.001), BioT yüzdesi (p<0.001) ve FTI (p<0.001) düzeyleri daha yüksek iken, SHBG düzeyi zayıf kollateral grubunda daha yüksekti (p<0.001). Serbest testosteron ve DHT gruplar arasında farklı değildi. Çok değişkenli lojistik regresyon analizinde BMI (aOR=1.163, %95 GA: 1.044–1.296, p=0.006) ve FTI (aOR=1.573, %95 GA: 1.345–1.841, p<0.001) iyi kollateral dolaşım ile bağımsız olarak ilişkili bulundu. ROC analizi FTI (AUC=0.815, %95 GA: 0.727–0.884, p<0.001) ve BioT’nin (AUC=0.804, %95 GA: 0.715–0.875, p<0.001) güçlü prediktif performans gösterdiğini ortaya koydu; her ikisi de total veya serbest testesterondan daha üstündü. Sonuç: Serum testosteron ile ilişkili indeksler, özellikle FTI ve BioT, CTO’lu erkek hastalarda iyi koroner kollateral dolaşımın bağımsız belirteçleri olarak öne çıkmaktadır. Bu parametrelerin klinik değerlendirmeye dahil edilmesi, ek prognostik değer sağlayabilir ve tedavi stratejilerinin şekillendirilmesine katkıda bulunabilir.

Keywords

• Kronik total oklüzyon
• koroner kollateral dolaşım
• testosteron
• biyoyararlanabilir testosteron
• serbest testosteron indeksi

Free testosterone index and bioavailable testosterone as independent predictors of good coronary collateral circulation in CTO patients

Abstract

Aims: Chronic total occlusion (CTO) represents a clinically important form of coronary artery disease in which collateral circulation plays a critical role in maintaining myocardial perfusion. Although testosterone has been suggested to influence vascular function and angiogenesis, the relationship between androgenic parameters and coronary collateral development remains uncertain. Methods: This cross-sectional case-control study included 230 male patients diagnosed with CTO by coronary angiography. Coronary collateral circulation was graded using the Rentrop classified categorized as good CCF (score 2–3) or bad CCF (score 0–1). Serum levels of total testosterone, free testosterone, SHBG, dehydroepiandrosterone sulfate (DHEAS), and dihydrotestosterone (DHT) were measured, and bioavailable testosterone (BioT) and free testosterone index (FTI) were calculated. Associations between androgenic parameters and collateral circulation were analyzed using correlation analysis, logistic regression, and ROC curve analysis. Results: Of the study cohort, 142 patients had good CCF and 88 had bad CCF. Patients with good CCF had higher levels of total testosterone (p<0.001), DHEAS (p=0.048), BioT (p<0.001), BioT percentage (p<0.001), and FTI (p<0.001), whereas SHBG was higher in the bad CCF group (p<0.001). Free testosterone and DHT did not differ between groups. In multivariable logistic regression, BMI (aOR=1.163, 95% CI:1.044 to 1.296, p=0.006) and FTI (aOR=1.573, 95% CI:1.345 to 1.841, p<0.001) were independently associated with good CCF. ROC analysis demonstrated strong predictive performance for FTI (AUC=0.815, 95% CI:0.727 to 0.884, p<0.001) and BioT (AUC=0.804, 95% CI:0.715 to 0.875, p<0.001), both superior to total or free testosterone. Conclusion: Serum testosterone–related indices, particularly FTI and BioT, emerged as independent predictors of good coronary collateral circulation in male patients with CTO. Incorporating these parameters into clinical evaluation may provide additional prognostic information and help guide therapeutic strategies.

Keywords

• Chronic total occlusion
• coronary collateral circulation
• testosterone
• bioavailable testosterone
• free testosterone index

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