Koroner yavaş akım fenomeni olan hastalarda plazma aterojenik indeksinin incelenmesi

Öz

Öz Amaç: Koroner yavaş akım fenomeni (KYAF), patofizyolojisi halen net olmasa da koroner arter hastalığı (KAH) öncüsü ve diffüz ateroskleroz ile ilişkili olarak kabul edilmektedir. Plazma aterojenik indeksi (PAİ) yüksek kardiyovasküler risk ile ilişkilidir. Bu çalışmada KYAF ile PAİ arasındaki ilişkinin araştırılması amaçlanmıştır. Gereç ve yöntem: Retrospektif olarak Ocak 2019 ile Kasım 2021 tarihleri arasında koroner anjiyografi (KAG) uygulanan ve KYAF saptanan hastalar ile normal koroner arterleri (NKA) olan toplam 214 hastanın hastane kayıtları ve KAG görüntüleri incelenmiştir. Bulgular: Hastalar KYAF (n=107) ve NKA (n=107) olmak üzere iki gruba ayrıldı. Yaş ortalaması 59.3 olup %50.9’u erkekti. İki grup arasında cinsiyet dağılımı, yaş, HT sıklığı ve sigara öyküsü dışında diğer demografik özellikler benzerdi. Glomerüler filtrasyon hızı (GFH), serum kreatinin düzeyi, LDL-K, HDL-K, non HDL-K ve trigliserid düzeyleri dışında laboratuvar bulguları arasında fark yoktu. PAİ değeri, KYAF olan hastalarda yüksek ve istatiksel olarak anlamlı bulundu (p<0.001). Backward lojistik regresyon analizinde yaş, sigara kullanımı, GFH ve PAİ, KYAF için bağımsız prediktör olarak saptanmıştır. ROC eğrisi analizinde KYAF’yi öngörmede PAİ cut-off değeri 0.068 olarak saptanmıştır [sensitivite %72, spesifite %42, eğri altında kalan alan (AUC)= 0.630; p=0.045]. Sonuç: Aterojenik dislipideminin değerlendirilmesinde hızlı, ucuz, günlük klinik pratikte uygulanabilir bir indeks olan PAİ, KYAF olan hastalarda geleneksel risk faktörleri olan yaş, sigara kullanımı, LDL-K düzeyi ve GFH ile birlikte bağımsız prediktör olarak bulunmuştur.

Anahtar Kelimeler

• Koroner yavaş akım fenomeni
• plazma aterojenik indeksi
• koroner arter hastalığı

Evaluation of plasma atherogenic index in patients with coronary slow flow phenomenon

Öz

Purpose: Coronary slow flow phenomenon (CSFP) is considered a precursor of coronary artery disease (CAD) and associated with diffuse atherosclerosis, although its pathophysiology is still unclear. The atherogenic index of plasma (AIP) is associated with high cardiovascular risk. In this study, it is aimed to investigate the relationship between AIP and CSFP.
Material and method: Hospital records and coronary angiography (CAG) images of 214 patients with normal coronary arteries (NCA) and CSFP patients who underwent CAG between January 2019 and November 2021 have been retrospectively reviewed.
Results: The patients were divided into two groups, CSFP (n=107) and NCA (n=107). The mean age was 59.3 years and 50.9% were male. Other demographic characteristics were similar between the two groups, except for gender distribution, age, frequency of HT, and smoking history. There was no difference in laboratory findings except glomerular filtration rate (GFR), serum creatinine level, LDL-C, HDL-C, non-HDL-C, and triglyceride levels. The AIP value was found high and statistically significant in patients with CSFP (p<0.001). In the backward logistic regression analysis, age, smoking, GFR, and AIP were determined as independent predictors for CSFP. In ROC curve analysis, the cut-off value of AIP was found 0.068 in predicting CSFP [sensitivity 72%, specificity 42%, area under the curve (AUC)=0.630; p=0.045].
Conclusion: AIP, a rapid, inexpensive, and applicable index in daily clinical practice for the evaluation of atherogenic dyslipidemia, was found an independent predictor together with the traditional risk factors of age, smoking, LDL-C level, and GFR in patients with CSFP.

Anahtar Kelimeler

• Coronary slow flow
• atherogenic index of plasma
• coronary artery disease

Kaynakça

1. 1. Wang X, Nie SP. The coronary slow flow phenomenon: characteristics, mechanisms and implications. Cardiovasc Diagn Ther. 2011;1(1):37-43. https://doi.org/10.3978/j.issn.2223-3652.2011.10.01
2. 2. Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E. Angina pectoris and slow flow velocity of dye in coronary arteries--a new angiographic finding. Am Heart J. 1972;84(1):66-71. https://doi.org/10.1016/0002-8703(72)90307-9
3. 3. Wang X, Geng LL, Nie SP. Coronary slow flow phenomenon: a local or systemic disease? Med Hypotheses. 2010;75(3):334-7. https://doi.org/10.1016/j.mehy.2010.03.016
4. 4. Canpolat U, Cetin EH, Cetin S, et al. Association of Monocyte-to-HDL Cholesterol Ratio with Slow Coronary Flow is Linked to Systemic Inflammation. Clin Appl Thromb Hemost. 2016;22(5):476-82. https://doi.org/10.1177/1076029615594002
5. 5. Cin VG, Pekdemir H, Camsar A et al. Diffuse intimal thickening of coronary arteries in slow coronary flow. Jpn Heart J. 2003;44(6):907-19. https://doi.org/10.1536/jhj.44.907
6. 6. Pekdemir H, Cin VG, Cicek D, et al. Slow coronary flow may be a sign of diffuse atherosclerosis. Contribution of FFR and IVUS. Acta Cardiol. 2004;59(2):127-33. https://doi.org/10.2143/AC.59.2.2005166
7. 7. Lee BK, Lim HS, Fearon WF, et al. Invasive evaluation of patients with angina in the absence of obstructive coronary artery disease. Circulation. 2015;131(12):1054-60. https://doi.org/10.1161/CIRCULATIONAHA.114.012636
8. 8. Ivanova EA, Myasoedova VA, Melnichenko AA, Grechko AV, Orekhov AN. Small Dense Low-Density Lipoprotein as Biomarker for Atherosclerotic Diseases. Oxid Med Cell Longev. 2017;2017:1273042. https://doi.org/10.1155/2017/1273042

9. 9. Dobiasova M, Frohlich J. The plasma parameter log (TG/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FER(HDL)). Clin Biochem. 2001;34(7):583-8. https://doi.org/ 10.1016/s0009-9120(01)00263-6
10. 10. Bolego C, Poli A, Cignarella A, Catapano AL, Paoletti R. Novel statins: pharmacological and clinical results. Cardiovasc Drugs Ther. 2002;16(3):251-7. https://doi.org/10.1023/a:1020656607497
11. 11. Niroumand S, Khajedaluee M, Khadem-Rezaiyan M, et al. Atherogenic Index of Plasma (AIP): A marker of cardiovascular disease. Med J Islam Repub Iran. 2015;29:240. https://www.ncbi.nlm.nih.gov/pubmed/26793631
12. 12. Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255-323. https://doi.org/10.1093/eurheartj/ehz486
13. 13. Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93(5):879-88. https://doi.org/10.1161/01.cir.93.5.879
14. 14. Conversion factors of Conventional units to SI units. Kidney International Supplements. 2013;Volume 3(Issue 3):Page ix. https://doi.org/10.1016/S2157-1716(16)30001-6.
15. 15. Chalikias G, Tziakas D. Slow Coronary Flow: Pathophysiology, Clinical Implications, and Therapeutic Management. Angiology. 2021;72(9):808-18. https://doi.org/ 10.1177/00033197211004390
16. 16. Dai YX, Li CG, Huang ZY, et al. [Clinical and angiographic characteristics of patients with slow coronary flow]. Zhonghua Xin Xue Guan Bing Za Zhi. 2011;39(7):642-6. https://www.ncbi.nlm.nih.gov/pubmed/22088246
17. 17. Fineschi M, Gori T. Coronary slow-flow phenomenon or syndrome Y: a microvascular angina awaiting recognition. J Am Coll Cardiol. 2010;56(3):239-40; author reply 40. https://doi.org/10.1016/j.jacc.2009.09.082
18. 18. Yilmaz H, Demir I, Uyar Z. Clinical and coronary angiographic characteristics of patients with coronary slow flow. Acta Cardiol. 2008;63(5):579-84. https://doi.org/10.2143/AC.63.5.2033224
19. 19. Stahel P, Xiao C, Hegele RA, Lewis GF. The Atherogenic Dyslipidemia Complex and Novel Approaches to Cardiovascular Disease Prevention in Diabetes. Can J Cardiol. 2018;34(5):595-604. https://doi.org/10.1016/j.cjca.2017.12.007
20. 20. Onat A, Can G, Kaya H, Hergenc G. "Atherogenic index of plasma" (log10 triglyceride/high-density lipoprotein-cholesterol) predicts high blood pressure, diabetes, and vascular events. J Clin Lipidol. 2010;4(2):89-98. https://doi.org/10.1016/j.jacl.2010.02.005
21. 21. Dobiasova M. [AIP--atherogenic index of plasma as a significant predictor of cardiovascular risk: from research to practice]. Vnitr Lek. 2006;52(1):64-71. https://www.ncbi.nlm.nih.gov/pubmed/16526201
22. 22. Cai G, Shi G, Xue S, Lu W. The atherogenic index of plasma is a strong and independent predictor for coronary artery disease in the Chinese Han population. Medicine (Baltimore). 2017;96(37):e8058. https://doi.org/10.1097/MD.0000000000008058
23. 23. Wu TT, Gao Y, Zheng YY, Ma YT, Xie X. Atherogenic index of plasma (AIP): a novel predictive indicator for the coronary artery disease in postmenopausal women. Lipids Health Dis. 2018;17(1):197. https://doi.org/10.1186/s12944-018-0828-z
24. 24. Won KB, Jang MH, Park EJ, et al. Atherogenic index of plasma and the risk of advanced subclinical coronary artery disease beyond traditional risk factors: An observational cohort study. Clin Cardiol. 2020;43(12):1398-404. https://doi.org/10.1002/clc.23450
25. 25. Nam JS, Kim MK, Nam JY, et al. Association between atherogenic index of plasma and coronary artery calcification progression in Korean adults. Lipids Health Dis. 2020;19(1):157. https://doi.org/10.1186/s12944-020-01317-4
26. 26. Wang L, Chen F, Xiaoqi C, Yujun C, Zijie L. Atherogenic Index of Plasma Is an Independent Risk Factor for Coronary Artery Disease and a Higher SYNTAX Score. Angiology. 2021;72(2):181-6. https://doi.org/10.1177/0003319720949804
27. 27. Cai G, Liu W, Lv S, et al. Gender-specific associations between atherogenic index of plasma and the presence and severity of acute coronary syndrome in very young adults: a hospital-based observational study. Lipids Health Dis. 2019;18(1):99. https://doi.org/10.1186/s12944-019-1043-2
28. 28. Zheng Y, Li C, Yang J, et al. Atherogenic index of plasma for non-diabetic, coronary artery disease patients after percutaneous coronary intervention: a prospective study of the long-term outcomes in China. Cardiovasc Diabetol. 2022;21(1):29. https://doi.org/10.1186/s12933-022-01459-y