Ailevi Akdeniz Ateşi olan erişkin hastalarda koroner arter hastalığının belirteci olarak epikardiyal yağ doku kalınlığının değerlendirilmesi

Öz

Amaç: Ailevi Akdeniz Ateşi (FMF), ataklar halinde giden kronik otoinflamatuvar bir hastalıktır. Ataklar arası dönemde subklinik düzeyde inflamasyonun devam etmesi nedeniyle bu hastalarda artmış ateroskleroz riski mevcuttur. Epikardiyal yağ doku yeni bir kardiyometabolik risk faktörü olup aterosklerotik riskin belirlenmesinde kullanılmaktadır. Bu çalışmanın amacı FMF tanısı ile takip edilen erişkin hastalarda epikardiyal yağ doku kalınlığının ölçülmesi ve subklinik aterosklerotik hastalık riskinin değerlendirilmesidir. Gereç ve yöntemler: Tel-Hashomer kriterlerine göre tanı almış 18 yaş ve üzeri FMF hastası ile yaş ve cinsiyet uyumlu sağlıklı kontrol bu kesitsel çalışmaya dahil edilmiştir. Hastalık özellikleri, FMF gen mutasyonları ve eritrosit sedimentasyon hızı, C-reaktif protein, serum amiloid-A, fibrinojen, lipid düzeyleri ve tam kan sayımları çalışmaya dahil edilme esnasında kaydedilmiştir. Epikardiyal yağ doku kalınlığı, iki boyutlu transtorasik ekokardiyografi ile ölçülmüştür. P değeri<0,05 istatistiksel olarak anlamlılık sınırı olarak kabul edilmiştir. Bulgular: Çalışmaya toplam 50 FMF (%58 kadın) hastası ile 50 sağlıklı kontrol (%54 kadın) alınmıştır (p=0,69). Sağlıklı kontrol grubunda ortanca yaş 45 yıl iken FMF hastalarında 33 yıl olup yaş ve cinsiyet açısından iki grup arasında fark yoktur (p=0,13). FMF hastalarında epikardiyal yağ doku kalınlığı (5,4 mm [4,7-5,8]) sağlıklı bireylere (3,0 mm [2,8-3,2]) göre istatistiksel olarak anlamlı bir şekilde daha yüksek bulunmuştur (p<0,001). Epikardiyal yağ doku kalınlığı ile akut faz değerleri arasında istatistiksel olarak anlamlı ilişki gösterilmemiştir. Epikardiyal yağ doku kalınlığı kestirim değeri belirlemek için yapılan ROC analizinde ideal sınır 4 mm olup; bu değer için duyarlılık %86, özgüllük %94, pozitif olabilirlik oranı 14,3 Youden indeksi ise 0,80’dir (EAA: 0,962 %95 GA 0,924-0,999 p≤ 0,001). Sonuç: Epikardiyal yağ doku kalınlığı FMF hastalarında sağlıklı bireylere göre anlamlı bir şekilde daha yüksek olup bu durum, FMF hastalarında artmış kardiyovasküler risk ile ilişkilidir. Ekokardiyografik olarak epikardiyal yağ dokunun ölçümü pratik, ucuz ve güvenilir bir yöntemdir. Erken dönemde aterosklerotik riskin belirlenmesi bu hastalarda uzun vadede mortalite ve morbiditenin azalmasına imkan sağlayabilir.

Anahtar Kelimeler

• Ailesel Akdeniz Ateşi
• Koroner Arter Hastalığı
• Ekokardiyografi
• İnflamasyon

Epicardial adipose tissue thickness in adult patients with Familial Mediterranean Fever as a predictor of coronary artery disease

Öz

Aim: Familial Mediterranean Fever (FMF), is a chronic auto-inflammatory disease characterized with recurrent attacks. In between attacks, subclinical inflammation persists which results in increased risk of atherosclerosis. Epicardial adipose tissue is a novel cardiometabolic risk factor which predicts the risk of atherosclerosis. The aim of this study was to measure the epicardial adipose tissue thickness (EATT) and to evaluate the risk of subclinical atherosclerosis in patients with FMF. Materials and Methods: 18 years old and older FMF patients diagnosed according to Tel-Hashomer criteria and age and sex matched healthy individuals were recruited for this cross-sectional study. Disease characteristics, gene mutations, erythrocyte sedimentation rate, C-reactive protein, serum amyloid-A, fibrinogen, lipid levels and complete blood counts were recorded at the time of inclusion. EATT was measured by a two-dimensional transthoracic echocardiography. A p value <0.05 was accepted as significant. Results: A total of 50 FMF patients (58% female) and 50 healthy controls (54%female) were involved in the study (p=0.69). The median age of healthy controls were 45 years and FMF patients were 33 years which were statistically insignificant (p=0.13) Epicardial adipose tissue was statistically significantly higher in FMF patients (5,4 mm [4,7-5,8]) in comparison to healthy controls (3,0 mm [2,8-3,2]) (p<0.001). There were no correlations between EATT and inflammatory markers. The ROC analysis to predict the best cut-off value for EATT showed 4 mm with a sensitivity of 86%, specificity 94%, positive likelihood ratio 14.3 and Youden Index 0.80 (AUC:0.962, 95%CI 0.924-0.999, p≤0.001) Conclusion: EATT is significantly higher in FMF patients compared to healthy individuals which results in increased cardiovascular risk in FMF. The measurement of epicardial adipose tissue with echocardiography is a practical, cheap and an accurate method. Determining the atherosclerotic risk in the early stages of the disease may reduce long-term mortality and morbidity in FMF patients.

Anahtar Kelimeler

• Familial Mediterranean Fever
• Coronary Artery Disease
• Echocardiography
• Inflammation

Kaynakça

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