Is There Any Correlation Between The Grade of Coronary Collaterals and Vitamin D Levels In Patients with Coronary Chronic Total Occlusion?

Year 2019, Volume: 10 Issue: 3, 206 - 211, 20.09.2019

Çağın Mustafa Üreyen Kahraman Coşansu

https://doi.org/10.22312/sdusbed.567536

Abstract

Objective:
There
have been studies which revealed a possible relation with the grade of coronary
collateral circulation (CCC) and the level of Vitamin D in the literature. The
objective of this study was to assess whether there is a correlation between
the grade of CCC and the level of Vitamin D according to both Rentrop and
Werner classifications in patients with coronary chronic total occlusion (CTO)
who underwent percutaneous coronary intervention.

Material-Method:
The
present study is a single-centre, retrospective cohort study. A total of 101
consecutive patients, who were hospitalized to undergo coronary CTO procedure,
were enrolled in the study. The patients were classified into 3 groups with
regard to the grade of CCC according to both Rentrop and Werner classifications.
These groups were compared with each other according to the 25(OH)VitD₃ levels.

Results:
There
was no significant difference among 3 groups with regard to 25(OH)VitD₃ levels
when the patients were classified according to the Rentrop classification
[Rentrop 1: 15.7 ng/ml (7.0-77.0 ng/ml), Rentrop 2: 16.9 ng/ml (7.0-71.3),
Rentrop 3: 16.6 ng/ml (7.0-28.7), p=0.925]. Moreover, there was no significant
difference among 3 groups with regard to 25(OH)VitD₃ levels when the
patients were classified according to the Werner classification. [Werner 0:
19.6 ng/ml (7.0-77.0 ng/ml), Werner 1: 16.6 ng/ml (7.0-71.3), Werner 2: 17.0
ng/ml (7.0-28.3), p=0.411].

Conclusion:
We
deem that there may not be a direct correlation (one-to-one relationship)
between the level of 25(OH)VitD₃ and the grade of CCC in clinical
practice.  

Keywords

Collateral circulation, Coronary occlusion, Percutaneous coronary intervention, Vitamin D

Thanks

We would like to thank to Işın ÜREYEN, MD for her contribution to the statistical analysis of the present study.

The Relation Between The Grade of Coronary Collaterals and Vitamin D Levels

Abstract

Amaç:
Literatürde
koroner kollateral dolaşımın (KKD) derecesi ile D vitamini seviyesi arasında
muhtemel bir ilişki olabileceğine dair yayınlar mevcuttur. Bu çalışmanın amacı
kronik total oklüzyon (KTO) nedeniyle perkütan koroner girişim yapılan
hastalarda hem Rentrop hem de Werner sınıflandırmasına göre KKD ile D vitamini
seviyesi arasında bir ilişki olup olmadığının araştırılmasıdır.

Materyal-Metot:
Mevcut
çalışma tek-merkezli, retrospektif kohort çalışmasıdır. KTO işlemi için
hastaneye yatırılan ardışık 101 hasta çalışmaya alınmıştır. Hastalar KKD
derecesine göre hem Rentrop hem de Werner sınıflandırmasına göre üçer gruba
ayrılmıştır. Her bir grup 25(OH)VitD₃ seviyesine göre birbiriyle
kıyaslanmıştır.

Bulgular:
Hastalar
Rentrop sınıflandırmasına göre üç
gruba ayrıldığında gruplar arasında
25(OH)VitD₃ seviyesi açısından fark saptanmamıştır [Rentrop 1: 15,7
ng/ml (7,0-77,0 ng/ml), Rentrop 2: 16,9 ng/ml (7,0-71,3), Rentrop 3: 16,6 ng/ml
(7,0-28,7), p=0,925]. Hastalar Werner sınıflandırmasına göre tekrar üç gruba sınıflandırıldığında
yine gruplar arasında 25(OH)VitD₃ seviyesi açısından fark
saptanmamıştır [Werner 0: 19,6 ng/ml (7,0-77,0 ng/ml), Werner 1: 16,6 ng/ml
(7,0-71,3), Werner 2: 17,0 ng/ml (7,0-28,3), p=0,411].

Sonuç: Çalışma sonucuna göre 25(OH)VitD₃ seviyesi ile KKD derecesi arasında klinik
pratikte bire bir ilişki olmadığı kanaatindeyiz. 

Keywords

Kollateral dolaşım, Koroner oklüzyon, Perkütan koroner girişim, D vitamini

References

• Referans 1: Holick MF. Vitamin D: importance in prevention of cancers, type 1 diabetes, heart disease and osteoporosis. Am J Clin Nutr 2004; 79: 362-71.
• Referans 2: Burgaz A, Orsini N, Larsson SC, Wolk A. Blood 25-hydroxyvitamin D concentration and hypertension: a meta-analysis. J Hypertens 2011; 29: 636-45.
• Referans 3: Giovannucci E, Liu Y, Hollis BW, Rimm EB. 25-hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med 2008; 168: 1174-80.
• Referans 4: Pilz S, Marz W, Wellnitz B, Seelhorst U, Fahrleitner-Pammer A, et al. Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography. J Clin Endocrinol Metab 2008; 93: 3927-35.
• Referans 5: Dobnig H, Pilz S, Scharnagl H, Renner W, Seelhorst U, Wellnitz B, et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med 2008; 168: 1340-9.
• Referans 6: Sabia PJ, Powers ER, Ragosta M, SarembockI J, Burwell LR, Kaul S. An Association between collateral blood flow and myocardial viability in patients with recent myocardial infarction. N Engl J Med 1992; 327: 1825–31.
• Referans 7: Ishihara M, Inoue I, Kawagoe T, Shimatani Y, Kurisu S, Hata T, et al. Comparison of the cardioprotective effect of prodromal angina pectoris and collateral circulation in patients with a first anterior wall acute myocardial infarction. Am J Cardiol 2005; 95: 622–5.
• Referans 8: Rentrop KP, Thornton JC, Feit F, Van Buskirk M. Determinants and protective potential of coronary arterial collaterals as assessed by an angioplasty model. Am J Cardiol 1988; 61: 677-84.
• Referans 9: Werner GS, Ferrari M, Heinke S, Kuethe F, Surber R, Richartz BM, et al. Angiographic assessment of collateral connections in comparison with invasively determined collateral function in chronic coronary occlusions. Circulation 2003; 107: 1972-7.
• Referans 10: Carmeliet P. Mechanisms of angiogenesis and arteriogenesis. Nat Med 2000; 6: 389-95.
• Referans 11: Werner GS, Ferrari M, Betge S, Gastmann O, Richartz BM, Figulla HR. Collateral function in chronic total coronary occlusions is related to regional myocardial function and duration of occlusion. Circulation 2001; 104: 2784-90.
• Referans 12: Seiler C, Engler R, Berner L, Stoller M, Meier P, Steck H, et al. Prognostic relevance of coronary collateral function: confounded or causal relationship? Heart 2013; 99: 1408-14.
• Referans 13: Meier P, Hemingway H, Lansky AJ, Knapp G, Pitt B, Seiler C. The impact of the coronary collateral circulation on mortality: a meta-analysis. Eur Heart J 2012; 33: 614-21.
• Referans 14: Cai WJ, Kocsis E, Luo X, Schaper W, Schaper J. Expression of endothelial nitric synthase in the vascular wall during arteriogenesis. Mol Cell Biochem 2004; 264: 193-200.
• Referans 15: Pittarella P, Squarzanti DF, Molinari C, Invernizzi M, Uberti F, Reno F. NO-dependent proliferation and migration induced by vitamin D in HUVEC. J Steroid Biochem Mol Biol 2015; 149: 35-42.
• Referans 16: Grundmann M, Haidar M, Placzko S, Niendorf R, Darashchonak N, Hubel CA, et al. Vitamin D improves the angiogenic properties of endothelial progenitor cells. Am J Physiol Cell Physiol 2012; 303: 954-62.
• Referans 17: Holick MF. Vitamin deficiency. N Engl J Med. 2007; 357: 266-81.
• Referans 18 :Zehnder D, Bland R, Chana RS, Wheeler DC, Howie AJ, Williams MC, et al. Synthesis of 1,25-dihydroxyvitamin D-3 by human endothelial cells is regulated by inflammatory cytokines: a novel autocrine determinant of vascular cell adhesion. J Am Soc Nephrol 2002; 13: 621-9.
• Referans 19: Rebsamen MC, Sun JX, Norman AW, Liao JK. 1 Alpha, 25-dihydroxyvitamin D-3 induces vascular smooth muscle cell migration via activation ofphosphatidylinositol 3-kinase. Circ Res 2002; 91: 17-24.
• Referans 20: Cardus A, Parisi E, Gallego C, Aldea M, Fernandez E, Valdivielso JM. 1,25-dihydroxyvitamin D3 stimulates vascular smooth muscle cell proliferation through a VEGF-mediated pathway. Kidney Int 2006; 69: 1377-84.
• Referans 21: Sahin I, Okuyan E, Gungor B, Elitok A, Umman S, Umman B, et al. Lower vitamin D level is associated with poor coronary collateral circulation. Scand Cardiovasc J 2014; 48: 278-83.
• Referans 22: Dogan Y, Sarli B, Baktir AO, Kurtul S, Akpek M, Sahin O, et al. 25-Hydroxy-vitamin D level may predict presence of coronary collaterals in patients with chronic coronary total occlusion. Postepy Kardiol Interwencyjnej 2015; 11: 191-6.
• Referans 23: Werner GS. The role of coronary collaterals in chronic total occlusions. Curr Cardiol Rev 2014; 10: 57-64.
• Referans 24: Shen Y, Ding FH, Dai Y, Wang XQ, Zhang RY, Lu L, et al. Reduced coronary collateralization in type 2 diabetic patients with chronic total occlusion. Cardiovasc Diabetol 2018; 17: 26.
• Referans 25: Sezer M, Ozcan M, Okcular I, Elitok A, Umman S, Umman B, et al. A potential evidence to explain the reason behind the devastating prognosis of coronary artery disease in uraemic patients: renal insufficiency is associated with poor coronary collateral vessel development. Int J Cardiol 2007; 115: 366-72.
• Referans 26: Turhan H, Yasar AS, Erbay AR, Yetkin E, Sasmaz H, Sabah I. Impaired coronary collateral vessel development in patients with metabolic syndrome. Coron Artery Dis 2005; 16: 281-5.
• Referans 27: Uysal OK, Sahin DY, Duran M, Turkoglu C, Yildirim A, Elbasan Z, et al. Association between uric acid and coronary collateral circulation in patients with stable coronary artery disease. Angiology 2014; 65: 227-31.
• Referans 28: Waltenberger J. Impaired collateral vessel development in diabetes: potential cellular mechanisms and therapeutic implications. Cardiovasc Res 2001; 49: 554-60.