KRONİK TOTAL OKLÜZYONU OLAN HASTALARDA ÜRİK ASİT YÜKSEK YOĞUNLUKLU LİPOPROTEİN KOLESTEROL ORANI VE SERUM ÜRİK ASİT DÜZEYLERİNİN KORONER KOLLATERAL DOLAŞIM ÜZERİNDE KARŞILAŞTIRILMASI

Yıl 2023, Cilt: 6 Sayı: 1, 1 - 9, 28.02.2023

Derya Baykız Zeynep Gizem Demirtakan Elif Ayduk Govdelı Samim Emet Ali Elitok

https://doi.org/10.26650/JARHS2023-1199242

Öz

Amaç: Koroner kollateral dolaşım (KKD) kardiyovasküler prognoz üzerinde önemli bir rol oynar ve iyi gelişmiş KKD surviyi iyileştirir. Bu çalışmanın amacı, serum ürik asit ve yüksek yoğunluklu lipoprotein kolesterol oranının (ÜA/ HDL-K) koroner kollateral gelişimi ile ilişkili olup olmadığını araştırmaktır. Gereç ve Yöntem: Bu retrospektif çalışmaya stabil koroner arter hastalığı ve invaziv koroner anjiyografide en az bir kronik total oklüzyonu (KTO) olan 111 hasta dahil edildi. Anjiyografi işlemi öncesi tüm hastalardan kan örnekleri alındı. Kollateral derecesi Rentrop sınıflamasına göre belirlendi. Hastalar kötü KKD grubu (Rentrop derece 0-1, n=47) veya iyi KKD grubu (Rentrop derece 2-3, n=64) olarak sınıflandırıldı. ÜA/HDL-K oranları iki grup arasında karşılaştırıldı. Bulgular: ÜA/HDL-K oranları, kötü KKD’si olan hastalarda, iyi KKD’si olan hastalarla karşılaştırıldığında anlamlı olarak daha yüksekti (0,18 [0,06- 0,49] vs 0,14 [0,05-0,31], sırasıyla; p<0,001). Korelasyon analizinde, KKD, ÜA/HDL-K ve ÜA seviyeleri ile anlamlı bir negatif korelasyon gösterdi (r=- 0,333, p<0,001; r=-0,502, p<0,001, sırasıyla). ROC analizinde, ÜA/HDL-K oranı için > 0,17’lik bir kesme değeri, %54,3 duyarlılık ve %79,3 özgüllük ile zayıf kollateral gelişimini öngördü (AUC=0,711, 95% CI 0,617–0,794, p<0,001). Çok değişkenli regresyon analizinde, serum ÜA kötü kollateral gelişiminin bağımsız bir prediktörü olarak bulundu (OR=2,818, p=0,022). Sonuç: Bu çalışma göstermiştir ki, ÜA/HDL-K oranı zayıf kollateral gelişimi ile ilişkili olabilse de, serum ÜA seviyeleri, KTO’lu hastalarda ÜA/HDL-K oranlarından kötü KKD’nin daha iyi bir öngördürücüsü olarak görünmektedir.

Anahtar Kelimeler

Kronik total oklüzyon, koroner kollateral dolaşım, ürik asit, yüksek yoğunluklu lipoprotein kolesterol

COMPARISON OF URIC ASID HIGH DENSITY LIPOPROTEIN CHOLESTEROL RATIO AND SERUM URIC ASID LEVELS ON CORONARY COLLETERAL CIRCULATION IN PATIENTS WITH CHRONIC TOTAL OCCLUSION

Öz

Objective: Coronary collateral circulation (CCC) plays a significant role in cardiovascular prognosis, and well-developed CCC improves survival. The aim of this study was to investigate whether the serum uric acid to highdensity lipoprotein cholesterol ratio (UA/HDL-C) is associated with coronary collateral development. Materials and Methods: This retrospective study enrolled 111 patients with stable coronary artery disease and at least one chronic total occlusion (CTO) at invasive coronary angiography. Blood samples were obtained from all patients before the angiography procedure. The collateral degree was determined according to the Rentrop scoring system. Patients were classified into a poor CCC group (Rentrop grades 0-1, n=47) or a good CCC group (Rentrop grades 2-3, n=64). The UA/HDL-C ratios were compared between the two groups. Results: The UA/HDL-C ratios were significantly higher in patients with poor CCC compared with the patients with good CCC (0.18 [0.06-0.49] vs 0.14 [0.05-0.31], respectively; p<0.001). In correlation analysis, the CCC was significantly negatively correlated with UA/HDL-C and UA levels (r=- 0.333, p<0.001; r=-0.502, p<0.001, respectively). According to the ROC analysis, a cut-off value of > 0.17 for the UA/HDL-C ratio predicted poor collateral development with 54.3% sensitivity and 79.3% specificity (AUC=0.711, 95% CI 0.617–0.794, p<0.001). In multivariate regression analysis, serum UA was found to be an independent predictor of poor collateral development (OR=2.818, p=0.022). Conclusion: The present study showed that although the UA/HDL-C ratio may be associated with poor collateral development, serum UA levels seem to be a better predictor of poor CCC than UA/HDL-C ratios in patients with CTO.

Anahtar Kelimeler

Chronic total occlusion, coronary collateral circulation, uric acid, high-density lipoprotein cholesterol

Kaynakça

• 1. Kalkan M, Sahin M, Kalkan A, Guler A, Tas M, Bulut M, et al. The relationship between the neutrophil-lymphocyte ratio and the coronary collateral circulation in patients with chronic total occlusion. Perfusion 2014;29(4):360-6. google scholar
• 2. Kurtul A, Duran M. The correlation between lymphocyte/monocyte ratio and coronary collateral circulation in stable coronary artery disease patients. Biomark Med 2017;11(1):43-52. google scholar
• 3. Nacar AB, Erayman A, Kurt M, Buyukkaya E, Karakas MF, Akcay AB, et al. The relationship between coronary collateral circulation and neutrophil/lymphocyte ratio in patients with coronary chronic total occlusion. Med Princ Pract 2015;24(1):65-9. google scholar
• 4. Hein TW, Singh U, Vasquez-Vivar J, Devaraj S, Kuo L, Jialal I. Human C-reactive protein induces endothelial dysfunction and uncoupling of eNOS in vivo. Atherosclerosis 2009;206(1):61-8. google scholar
• 5. Teixeira BC, Lopes AL, Macedo RCO, Correa CS, Ramis TR, Ribeiro JL, et al. Inflammatory markers, endothelial function and cardiovascular risk. J Vasc Bras 2014;13:108-15. google scholar
• 6. Hakimzadeh N, Verberne HJ, Siebes M, Piek JJ. The future of collateral artery research. Curr Cardiol Rev 2014;10(1):73-86. google scholar
• 7. El Ridi R, Tallima H. Physiological functions and pathogenic potential of uric acid: A review. J Adv Res 2017;8(5):487-93. google scholar
• 8. Saito Y, Tanaka A, Node K, Kobayashi Y. Uric acid and cardiovascular disease: A clinical review. J Cardiol 2021;78(1):51-7. google scholar
• 9. Yu W, Cheng JD. Uric Acid and Cardiovascular Disease: An Update From Molecular Mechanism to Clinical Perspective. Front Pharmacol 2020;11:582680. google scholar
• 10. Liu GY, Meng XX, Zhang Z. Triglyceride to HDL-cholesterol ratio as an independent risk factor for the poor development of coronary collateral circulation in elderly patients with ST-segment elevation myocardial infarction and acute total occlusion. Medicine (Baltimore) 2018;97(39):e12587. doi: 10.1097/ MD.0000000000012587 google scholar
• 11. Monette JS, Hutchins PM, Ronsein GE, Wimberger J, Irwin AD, Tang C, et al. Patients with coronary endothelial dysfunction have impaired cholesterol efflux capacity and reduced HDL particle concentration. Circ Res 2016;119(1):83-90. google scholar
• 12. Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 2016;37(39):2999-3058. google scholar
• 13. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983;51(3):606. google scholar
• 14. Rentrop KP, Cohen M, Blanke H, Phillips RA. Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol 1985;5(3):587-92. google scholar
• 15. Sharaf El Din UAA, Salem MM, Abdulazim DO. Uric acid in the pathogenesis of metabolic, renal, and cardiovascular diseases: A review. J Adv Res 2017;8(5):537-48. google scholar
• 16. Mandurino-Mirizzi A, Crimi G, Raineri C, Pica S, Ruffinazzi M, Gianni U, et al. Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2018;19(5):240-6. google scholar
• 17. Katsiki N, Dimitriadis GD, Mikhailidis DP. Serum uric acid and diabetes: from pathophysiology to cardiovascular disease. Curr Pharm Des 2021;27(16):1941-51. google scholar
• 18. Borghi C, Rodriguez-Artalejo F, De Backer G, Dallongeville J, Medina J, Nuevo J, et al. Serum uric acid levels are associated with cardiovascular risk score: A post hoc analysis of the EURIKA study. Int J Cardiol 2018;253:167-73. google scholar
• 19. Wang Y, Zhang XY, Gao WH, Du MF, Chu C, Wang D, et al. Association of uric acid in serum and urine with arterial stiffness: Hanzhong Adolescent Hypertension Study. Dis Markers 2020;2020:1638515. google scholar
• 20. Aydın C, Emlek N. The relationship between uric acid to high-density lipoprotein cholesterol ratio and collateral index in patients with chronic total occlusion. Kardiologiia 2021;61(9):61-5. google scholar
• 21. Schaper W, Sharma HS, Quinkler W, Markert T, Wünsch M, Schaper J. Molecular biologic concepts of coronary anastomoses. J Am Coll Cardiol 1990;15(3):513-8. google scholar
• 22. Chen X, Lin Y, Tian L, Wang Z. Correlation between ischemia-modified albumin level and coronary collateral circulation. BMC Cardiovasc Disord 2020;20(1):326. google scholar
• 23. Akbuga K, Ferik O K, Yayla KG, Aslan T, Eren M, Karanfil M, et al. Prognostic nutritional index as a new prediction tool for coronary collateral development. Acta Cardiol Sin 2022;38(1):21-6. google scholar
• 24. Acar G, Kalkan ME, Avci A, Alizade E, Tabakci MM, Toprak C, et al. The relation of platelet-lymphocyte ratio and coronary collateral circulation in patients with stable angina pectoris and chronic total occlusion. Clin Appl Thromb Hemost 2015;21(5):462-8. google scholar
• 25. Kasapkara HA, Topsakal R, Yarlioglues M, Yarlioglues G, Dogdu O, Ardic I, et al. Effects of serum uric acid levels on coronary collateral circulation in patients with non-ST elevation acute coronary syndrome. Coron Artery Dis 2012;23(7):421-5. google scholar
• 26. 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(3):227-31. google scholar
• 27. Wan GX, Xia WB, Ji LH, Qin HL, Zhang YG. Triglyceride to high density lipoprotein cholesterol ratio may serve as a useful predictor of major adverse coronary event in female revascularized ST-elevation myocardial infarction. Clin Chim Acta 2018;485:166-72. google scholar
• 28. Luscher TF, Tanner FC, Noll G. Lipids and endothelial function: effects of lipid-lowering and other therapeutic interventions. Curr Opin Lipidol 1996;7(4):234-40. google scholar
• 29. Liu R, Peng Y, Wu H, Diao X, Ye H, Huang X, et al. Uric acid to high-density lipoprotein cholesterol ratio predicts cardiovascular mortality in patients on peritoneal dialysis. Nutr Metab Cardiovasc Dis 2021;31(2):561-9. google scholar
• 30. Kocak MZ, Aktas G, Erkus E, Sincer I, Atak B, Duman T. Serum uric acid to HDL-cholesterol ratio is a strong predictor of metabolic syndrome in type 2 diabetes mellitus. Rev Assoc Med Bras (1992) 2019;65(1):9-15. google scholar
• 31. Ganjali S, Gotto AM, Jr., Ruscica M, Atkin SL, Butler AE, Banach M, et al. Monocyte-to-HDL-cholesterol ratio as a prognostic marker in cardiovascular diseases. J Cell Physiol 2018;233(12):9237-46. google scholar
• 32. Jiang M, Yang J, Zou H, Li M, Sun W, Kong X. Monocyte-to-high-density lipoprotein-cholesterol ratio (MHR) and the risk of all-cause and cardiovascular mortality: a nationwide cohort study in the United States. Lipids Health Dis 2022;21(1):30. google scholar
• 33. Pohl T, Seiler C, Billinger M, Herren E, Wustmann K, Mehta H, et al. Frequency distribution of collateral flow and factors influencing collateral channel development. Functional collateral channel measurement in 450 patients with coronary artery disease. J Am Coll Cardiol 2001;38(7):1872-8. google scholar