Stabil anjina pektoris ile başvuran hastalarda koroner yavaş akımın klinik ve laboratuvar belirleyicileri

Abstract

Giriş ve Amaç: Koroner yatağın gecikmiş kontrast boyanmasıyla tanımlanan koroner yavaş akımın fenomeninin (KYA) patogenezinde endotelyal disfonksiyon olduğu düşünülmektedir. Bu çalışmamızda, stabil anjina pektoris ile başvuran ve yapılan koroner anjiografi sonrası KYA saptanan hastaların genel klinik özelliklerini ve risk faktörlerini bulmayı hedefledik. Gereç ve Yöntemler: Çalışmaya koroner anjiografi yapılarak KYA tespit edilen 121 hasta ve koroner damarlarında normal akım saptanan 164 hasta olmak üzere, toplam 285 hasta alındı. Bütün hastaların demografik ve klinik özellikleri geriye dönük olarak tarandı ve bu iki grup klinik özellikleri bakımından karşılaştırıldı. Bulgular: KYA olanların çoğu sigara içen, hipertrigliseridemisi olan ve çoğunlukla erkek cinsiyette olan hastalardı. Biyokimyasal parametreler, elektrokardiyografik ve ekokardiyografik özellikler açısından her iki grup arasında anlamlı farklılık izlenmedi. Çok değişkenli regresyon analizlerinde erkek cinsiyet (olasılık oranı [OO]:0.434, %95 güven aralığı : [0.252-0.856], p = 0.014) ve hipertrigliseridemi (OO : 1.001, %95 güven aralığı :[1.001 – 1.007], p = 0.035), KYA için bağımsız birer risk faktörü olarak saptandı. Sonuç: KYA, sigara içen, trigliserid değerleri yüksek ve erkek hastalarda daha sık idi. Erkek cinsiyet ve trigliserit yüksekliği KYA için bağımsız bir faktörü olarak bulundu. Trigliserid düzeyinin tahmini kesim değerinin > 138.5 mg/dL olması KYA ile ilişkili bulundu.

Keywords

• koroner yavaş akım
• hiperlipidemi
• erkek cinsiyet

Clinical and laboratory determinants of coronary slow flow in patients presenting with stable angina pectoris

Abstract

Objective: Endothelial dysfunction is thought to be involved in the pathogenesis of coronary slow flow phenomenon (CSFP) defined which is an angiographic phenomenon characterised by the slow passage of contrast in the absence of obstructive coronary artery disease. In this study, we aimed to find the clinical characteristics and risk factors of patients with CSFP after coronary angiography in those presenting with stable angina pectoris. Materials and Methods: A total of 285 patients were included in the study, 121 of whom were diagnosed with CSFP and 164 patients with normal flow on coronary angiography. In this study, we aimed to find the clinical characteristics and risk factors of patients with CSFP after coronary angiography in patients presenting with stable angina pectoris. Results: Most of the patients with CSFP were smokers, having hypertriglyceridemia, and mostly male gender. There was no significant difference between the two groups in terms of biochemical parameters, electrocardiographic and echocardiographic characteristics. In multivariate regression analyzes, male gender (odds ratio [OO]:0.434, 95% confidence interval: [0.252-0.856], p = 0.014) and hypertriglyceridemia (OO: 1.001, 95% confidence interval [1.001 - 1.007], p = 0.035) were found to be independent risk factors for CSFP. Conclusion: CSFP was more common in smoker male patients and those that had high triglyceride levels. Male gender and high triglyceride levels were found to be an independent risk factor for CSFP. A cut-off value > 138.5 mg/dL of serum triglyceride level was found to be associated with CSFP.

Keywords

• coronary slow flow
• hyperlipidemia
• male gender

References

1. Wang, X, Nie, S.P, The coronary slow flow phenomen: characteristics, mechanism and implications, Cardiovascular Diagnosis. Therapy, 2011, 1(1), 37-43.
2. Wang, X, Geng, L.L, Nie, S.P, Coronary slow flow phenomenon: a local or systemic disease? Medical Hypotheses, 2010, 75(3), 334-337.
3. Amasyali, B, Turhan, H, Kose, S, et al., Aborted sudden cardiac death in a 20-year-old man with slow coronary flow, International Journal of Cardiology, 2006, 109(3), 427-429.
4. Slevin, M, Krupinski, J, A role of C-reactive protein in the regulation of angiogenesis, endothelial cell inflammation and thrombus formation in cardiovascular disease, Histology and Histopathology, 2009, 24(11), 1473-8.
5. Li, J.J, Qin, X.W, Li, Z.C, et al., Increased plasma C-reactive protein and interleukin-6 concentrations in patients with slow coronary flow, Clinica Chimica Acta, 2007, 385(1-2), 43-47.
6. M.S, Kuyumcu, Özbay, M.B, Özen, Y, et al., Evaluation of frontal QRS-T angle in patients with slow coronary flow, Scandinavian Cardiovascular Journal, 2020, 54(1), 20-25.
7. Gibson, C.M, Cannon, C.P, Daley, W.L, et al, for the TIMI 4 Study Group: TIMI frame count: a quantitative method of assessing coronary artery flow, Circulation, 1996, 93(5), 879–888.
8. Mitchell, C, Rahko, S, Blauwet, L.A, et al., Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in adults: Recommendation from the American Society of Echocardiography, Journal of American Society of Echocardiography, 2019, 32(1), 1-64.

9. Yesin, M, Çağdaş, Karabağ, Y, et al., Assessment of the relationship between C-reactive protein-to-albumin ratio and slow coronary flow in patients with stable angina pectoris, Coronary artery disease, 2019, 30(7), 505-510.
10. Kayapinar, O, Ozde, C, Kaya, A, Relationship Between the Reciprocal Change in Inflammation-Related Biomarkers (Fibrinogen-to-Albumin and hsCRP-to-Albumin Ratios) and the Presence and Severity ofCoronary Slow Flow, Clinical and Applied Thrombosis Hemostasis, 2019, 25, 1076029619835383.
11. Phillips, A, Shaper, A.G, Whincup, P.H, Association between serum albumin and mortality from cardiovascular disease, cancer, and other causes, Lancet,. 1989, 2(8677), 1434-1436.
12. Udovcic, M, Pena, R.H, Patham, B, et al., Hypothyroidism and Heart, Methodist Debakey Cardiovascular Journal, 2017, 13(2), 55-59.
13. Sara, J.D, Zhang, M, Gharib, H, et al., Hypothyroidism Is Associated With Coronary Endothelial Dysfunction in Women, Journal of the American Heart Association, 2015, 29(8), e002225.
14. Evrengül, H, Tanrıverdi, H, Enli, Y, et al., Interaction of Plasma Homocysteine and Thyroid Hormone Concentrations in the Pathogenesis of the Slow Coronary Flow Phenomenon. Cardiology, 2007, 108(3), 186-192.
15. Madak, N, Nazlı, Y, Mergen, H, et al., Acute phase reactants in patients with coronary slow flow phenomenon, Anadolu Kardiyol Dergisi, 2010, 10(5), 416-420.
16. Oehler, A, Feldman, T, Henrikson, C.A, Tereshcenko, L.G, QRS-T angle: a review, Annals of Noninvasive Electrocardiology, 2014, 19(6), 534-542.
17. Peng, J, Luo, F, Ruan, G, et al., Hypertriglyceridemia and atherosclerosis, Lipids Health Disease, 2017, 16(1), 233.
18. Lucero D, Lopez, G.I, Gorzalczany, S, et al., Alterations in triglyceride rich lipoproteins are related to endothelial dysfunction in metabolic syndrome, Clinical Biochemistry, 2016, 49(12), 932–935.
19. Zhu, X, Shen, H, Gao, F, et al., Clinical Profile and Outcome in Patients with Coronary Slow Flow Phenomenon, Cardiology research and practise, 2019, 9168153.
20. Ghaffari, S, Tajlil, A, Aslanabadi, N, et al., Clinical and laboratory predictors of coronary slow flow in coronary angiography, Perfusion, 2017, 32(1), 13-19.
21. Sanghvi, S, Mathur, R, Baroopal, A, et al., Clinical, demographic, risk factor and angiographic profile of coronary slow flow phenomenon: A single centre experience, Indian Heart Journal, 2018, 70(3), 290-294.