Koroner Kronik Total Oklüzyonu Olan Hastalarda Serum Endokan Düzeyi ile Koroner Kollateral Dolaşım Arasındaki İlişki

Abstract

Giriş: Bir dermatan sülfat proteoglikan olan endokan, vasküler endotelyum tarafından sentezlenir ve salgılanır ayrıca vasküler hastalıkların, organ-spesifik inflamasyon ve anjiyogenezin patogenezinde rol oynar. Çalışmamızda, stabil angina pektorisli hastalarda serum endokan düzeyiyle koroner kollateral dolaşım (KKD) gelişimi arasındaki ilişkiyi araştırmayı amaçladık.

Hastalar ve Yöntem: Çalışmamıza en az bir kronik total tıkanıklığı olan stabil angina hastaları (n= 44) ve normal koroner arteri olan kontrol grubu (n= 29) dahil edildi. Kollateral derecesi, Rentrop ve Cohen sınıflandırmasına göre değerlendirildi. Evre 0-1 kollateral doluşa sahip olan hastalar zayıf gelişmiş KKD grubuna (n= 19) , evre 2-3 kollateral doluşa sahip olan hastalar iyi gelişmiş KKD grubuna (n= 29) dahil edildi.

Bulgular: İyi gelişmiş KKD grubunda, zayıf gelişmiş KKD grubuna ve kontrol grubuna göre endokan düzeyleri anlamlı olarak yüksek bulundu (p< 0.001). Zayıf gelişmiş KKD olan hastalarda endokan düzeyi kontrol grubuna göre daha yüksektir. Endokan düzeyi, regresyon analizinde iyi gelişmiş KKD için tek bağımsız öngördürücü idi (OR 1.002, 95% güven aralığı (GA) 1.001-1.005; p= 0.001). İyi gelişmiş KKD öngörmede endokan düzeyi optimal kestirim değeri ≥ 1773, 9 ng/L olarak bulundu. Endokan düzeyi ≥ 1773.9 ng/L olması halinde iyi gelişmiş kollateral varlığını %84 duyarlılık ve %63 özgüllükle öngörmekteydi (AUC: 0.749, 95% GA: 0.654-0.849, p< 0.001).

Sonuç: Koroner kronik total oklüzyonu olan hastalarda KKD artmış endokan düzeyi ile ilişkilidir. KKD gelişiminde endokanın önemli rolü olabilir.

Keywords

• Endokan,koroner kollateral dolaşım,anjiyogenez,koroner arter hastalığı

The Relationship Between Coronary Collateral Circulation and Serum Endocan Levels in Patients with Coronary Chronic Total Occlusions

Abstract

Introduction: Endocan, a dermatan sulfate proteoglycan, is synthesized and secreted by the vascular endothelium. It is involved in the pathogenesis of vascular diseases, organ-specific inflammations, and angiogenesis. The aim of the present study was to investigate the relationship between serum endocan level and development of coronary collateral circulation (CCC) in patients with stable angina pectoris.

Patients and Methods: Patients with stable angina with at least one chronic total coronary occlusion (CTO) (n= 44) and who had normal coronary artery (n= 29) were included in the study. Collateral degree was evaluated according to the Rentrop and Cohen’s classification. Patients who had grade 0 or 1 collateral filling were included in the poorly developed collateral group (n= 19), and those with grade 2 or 3 collateral filling were included in the well-developed collateral group (n= 23).

Results: Endocan levels were significantly higher in patients in the well CCC group than in those in the poor CCC and control groups (p< 0.001). Endocan level is higher in patients with poorly developed CCC than in the control group. Endocan was only found as an independent predictor of well CCC in regression analysis (odds ratio 1.002, 95% confidence interval (CI) 1.001-1.005, p= 0.001). Receiver operating characteristic curve analysis detected an optimal cut-off value for endocan level of 1773.9 ng/L that predicted the presence of well development of CCC with a sensitivity of 84% and specificity of 63% (area under the receiver operating characteristic (ROC) curve: 0.749, 95% CI: 0.654-0.849, p< 0.001).

Conclusion: Elevated endocan level is associated with better CCC in patients with CTO. Endocan may play an important role in the development of CCC.

Keywords

• Endocan,coronary collateral circulation,angiogenesis,coronary artery disease

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