Koroner kronik total oklüzyon saptanan hastalarda aterojenik indeksin kollateral gelişimi üzerine olan etkisi
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Tarih
2019
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Yayıncı
Dicle Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Koroner arterlerin kronik total oklüzyonu (KTO), damar lümeninin en az 3 ay boyunca tamamen tıkanması olarak tanımlanır. Koroner kollateral dolaşım (KKD) normal kalpte bulunan ve kan akımını bozan kritik bir darlık veya total tıkanma oluştuğunda, lezyonun distalinde kalan miyokart dokusunun perfüzyonunu ve canlılığını korumak için iskemik miyokart dokusuna kan akışını sağlamak amacı ile, aynı koroner arterin bölümleri arasında veya farklı koroner arterler arasında kronik, uyum sağlayıcı bir cevap olarak oluşan vasküler yapılar olarak tanımlanabilir. Birtakım kardiyovasküler risk faktörlerinin koroner kollateral dolaşımının gelişiminde olumsuz rol oynadığı gösterilmiş olsa da, yeterli bir kollateral ağı oluşması açısından, hastalar arasında neden farklılıklar olduğu konusu halen netlik kazanmamıştır. Bu çalışmamızda kollateral gelişimi üzerine etkili faktörlerden biri olan aterojenik plazma indeksi (AİP) ile koroner kollateral dolaşım (KKD) gelişimi arasındaki iliskiyi göstermeyi hedefledik. Gereç ve Yöntem: Dicle Üniversitesi Tıp Fakültesi Kalp Hastanesi kardiyoloji kliniğinde 03/2014-11/2018 tarihleri arasında gerçekleştirilen koroner anjiografi serisinde, hastaların verileri retrospektif olarak tarandı. En az bir koroner arterinde kronik total oklüzyon (%100 darlık olması) saptanan hastaların hastane kayıtları incelendi. Çalışma kriterlerine uyan 451 hastanın koroner anjiyografi öncesi; trigliserid düzeyleri, HDL düzeyleri, trigliserid / HDL oranları ve aterojenik plazma indekslerine bakıldı. Kollateral dolaşım ise Rentrop kollateral sınıflamasına göre değerlendirildi. Rentrop grade 0 ve 1 olanlar zayıf kollateral, grade 2 ve 3 olanlar iyi kollateral şeklinde gruplandırıldı. Hastaların rutin bakılan kan tetkikleri, klinik risk faktörleri, koroner kollateral dolaşım sınıfı ve aterojenik plazma indeksleri ile birlikte dökümante edildi. Bulgular: Kollateral sınıflamasına göre hastaların demografik ve klinik özellikleri ile yapılan analizde; zayıf kollateral grubunda, diyabetes mellitus (p<0,001) ve sigara öyküsü (p<0,001) ortalamaları istatistiksel olarak anlamlı derecede daha fazla saptanırken, hipertansiyon (p=0,123) ve aile öyküsü (p=0,059) ortalamaları ise istatistiksel olarak anlamlı olmasa da daha fazla saptandı. Anjiyografik bulgular ile yapılan analizde; her üç koroner arter kıyaslandığında genel olarak RCA'da daha fazla kronik total oklüzyon (KTO) saptanmıştır. RCA'daki KTO lezyonlarına karşı, istatistiksel olarak anlamlı saptanmasa da iyi kollateral gelişimi daha fazla saptandı (p=0,133). LAD (p=0,397) ve CX'teki (p=0,724) KTO lezyonlarına karşı ise, istatistiksel olarak anlamlı saptanmasa da zayıf kollateral gelişimi daha fazla saptandı. Laboratuvar ve ekokardiyografi bulguları açısından iki grup karşılaştırıldığında ise; zayıf kollateral grubunda, açlık glukoz değeri (158,5±75,60'e karşı 132,3±55,23, p<0,001), trigliserid değeri (186,7±86,75'e karşı 143,9±69,16, p<0,001), total kolesterol değeri (183,9±47,95'e karşı 173,4±46,63, p=0,019), trigliserid / HDL oranı (5,04±3,13'e karşı 3,56±2,12, p<0,001) ve aterojenik plazma indeksi (AİP) (0,63±0,25'e karşı 0,48±0,25, p<0,001) açısından istatistiksel olarak anlamlı oranda daha yüksek saptandı. Kollateral gelişimi ile aterojenik plazma indeksi (AİP) arasında korelasyon analizi yapıldıg?ında, zayıf derecede negatif korelasyon olup istatistiksel olarak anlamlı bulundu (rs= -0,299, p<0.001). Aterojenik plazma indeksi (AİP) ile kollateral gelişimi arasındaki ilişkiyi incelemek için yapılan multivariate logistik regresyon analizinde, diğer faktörlerden bağımsız olarak (OR: 0,083, %95 CI: 0,035-0,196, p=0,000) istatistiksel olarak anlamlı saptandı. Buna göre aterojenik plazma indeksindeki (AİP) düşüklük, iyi kollateral arter gelis?iminin bag?ımsız o?ngo?rdürücüsü oldug?u saptandı. Yapılan ROC analizinde; aterojenik plazma indeksi için 0,58 cut-off deg?eri alındığında, %64,7 sensitivite, %66,2 spesifite ile zayıf kollateral varlığı ile ilişkili olduğunu tespit ettik. Sonuç: Kardiyovasküler hastalıklar açısından riskli bireylerin tespit edilmesinde, özellikle aile bireylerinde koroner kalp hastalıkları öyküsü bulunan kişilerde, basit, non-invaziv, hızlı sonuç alınabilen, ekonomik ve aynı zamanda önemli bir değere sahip olan aterojenik plazma indeksi dikkatlice değerlendirilmelidir. Bu çalışma ile aterojenik plazma indeksindeki yüksekliğin zayıf kollateral gelişimiyle ilişkili bağımsız bir faktör olduğunu ortaya koyduk. Bu nedenle aterojenik plazma indeksini oluşturan parametrelerin sıkı takibi ve bu değerin düşürülmesine yönelik yaklaşımlarla, kardiyovasküler hastalıkların gelişmesi azaltılabilir. Ayrıca hastalık gelişenlerde, kollateral gelişimi üzerindeki olumsuz etkilerini azaltmak açısından oldukça önem taşımaktadır.
Introduction and Objective: Chronic total occlusion (CTO) in coronary arteries is defined as the total blockage of the vascular lumen for at least 3 months. Coronary collateral circulation (CCC) may be defined as a natural feature of the heart consisting of vascular structures that develop between different segments of the same coronary artery or between separate coronary arteries as a chronic adaptive response to allow blood supply to the ischemic myocardium in order to maintain perfusion and viability of the myocardial tissue at the distal portion of a lesion in the presence of total occlusion or critical stenosis disrupting normal blood flow. While a series of cardiovascular risk factors have been shown to play negative roles in the development of coronary collateral circulation, the reasons of differences noted in formation of an adequate collateral network across patients remain unclear. The present study aims to demonstrate the correlation between CCC and atherogenic plasma index (AİP), one of the factors associated with the formation of collateral vessels. Materials and Method: Data were retrospectively screened through a series of coronary angiography procedures performed at Dicle University Faculty of Medicine Heart Hospital, Cardiology Clinic during 03/2014-11/2018. Hospital records of patients with chronic total occlusion (100% stenosis) in at least one coronary artery were evaluated. Triglycerides, HDL level, triglyceride/HDL ratio and atherogenic plasma index before coronary angiography were assessed for the 451 patients who met the study criteria. Collateral circulation was evaluated according to the Rentrop collateral classification. Those with Rentrop grade 0 and 1 were stratified as 'weak collateral' while grade 2 and 3 were stratified as 'good collateral' circulation. Routine blood tests, clinical risk factors and coronary collateral circulation classification of the patients were documented together with their atherogenic plasma indexes. Results: The analysis on demographics and clinical characteristics of patients by collateral classification revealed higher mean rates of diabetes mellitus (p<0.001) and smoking history (p<0.001) with statistical significance in the weak collateral group, and rates of hypertension (p=0.123) and family history (p=0.059) were also higher, although without statistical significance. The analysis of angiography findings showed an overall higher CTO rate in RCA in the comparison of all three coronary arteries. As a response to the CTO lesions in RCA, a higher rate of good collateral formation was observed, although not statistically significant (p=0.133). For the CTO lesions in LAD (p=0.397) and Cx (p=0.724), weak collateral formation appeared to have a higher rate, although not meeting statistical significance. Comparison of the two groups in terms of laboratory and echocardiography findings showed that fasting glucose level (158.5±75.60 vs 132.3±55.23, p<0.001), triglycerides (186.7±86,75 vs 143.9±69.16, p<0.001), total cholesterol level (183.9±47.95 vs 173.4±46.63, p=0.019), triglyceride/HDL ratio (5.04±3.13 vs 3.56±2.12, p<0.001) and AİP (0.63±0.25 vs 0.48±0.25, p<0.001) were higher with statistical significance in the weak collateral group. The correlation analysis between collateral formation and AİP revealed a weak yet statistically significant negative correlation (rs= -0.299, p<0.001). The multivariate logistic regression analysis performed to explore the association between AİP and development of collateral vessels demonstrated statistical significance as a standalone factor (OR: 0.083, 95% CI: 0.035-0.196, p=0.000). Accordingly, low AİP was found to be a standalone predictor of good collateral artery formation. The ROC analysis revealed an association between weak collateral formation and atherogenic plasma index with 64.7% sensitivity and 66.2% specificity using a cut-off value of 0.58 for AİP. Conclusion: When determining subjects at risk of cardiovascular disease, especially those with family history of coronary heart disease, atherogenic plasma index should be carefully considered since it offers a simple, non-invasive, cost-effective method providing rapid results as well as substantial predictive value. The present study has demonstrated that a high atherogenic plasma index is a standalone factor associated with weak collateral formation. Therefore, close monitoring of parameters that constitute the atherogenic plasma index and attempts to lower this index may help reducing development of cardiovascular disease. It is also important in terms of decreasing the unfavorable effects on collateral formation in cardiovascular patients.
Introduction and Objective: Chronic total occlusion (CTO) in coronary arteries is defined as the total blockage of the vascular lumen for at least 3 months. Coronary collateral circulation (CCC) may be defined as a natural feature of the heart consisting of vascular structures that develop between different segments of the same coronary artery or between separate coronary arteries as a chronic adaptive response to allow blood supply to the ischemic myocardium in order to maintain perfusion and viability of the myocardial tissue at the distal portion of a lesion in the presence of total occlusion or critical stenosis disrupting normal blood flow. While a series of cardiovascular risk factors have been shown to play negative roles in the development of coronary collateral circulation, the reasons of differences noted in formation of an adequate collateral network across patients remain unclear. The present study aims to demonstrate the correlation between CCC and atherogenic plasma index (AİP), one of the factors associated with the formation of collateral vessels. Materials and Method: Data were retrospectively screened through a series of coronary angiography procedures performed at Dicle University Faculty of Medicine Heart Hospital, Cardiology Clinic during 03/2014-11/2018. Hospital records of patients with chronic total occlusion (100% stenosis) in at least one coronary artery were evaluated. Triglycerides, HDL level, triglyceride/HDL ratio and atherogenic plasma index before coronary angiography were assessed for the 451 patients who met the study criteria. Collateral circulation was evaluated according to the Rentrop collateral classification. Those with Rentrop grade 0 and 1 were stratified as 'weak collateral' while grade 2 and 3 were stratified as 'good collateral' circulation. Routine blood tests, clinical risk factors and coronary collateral circulation classification of the patients were documented together with their atherogenic plasma indexes. Results: The analysis on demographics and clinical characteristics of patients by collateral classification revealed higher mean rates of diabetes mellitus (p<0.001) and smoking history (p<0.001) with statistical significance in the weak collateral group, and rates of hypertension (p=0.123) and family history (p=0.059) were also higher, although without statistical significance. The analysis of angiography findings showed an overall higher CTO rate in RCA in the comparison of all three coronary arteries. As a response to the CTO lesions in RCA, a higher rate of good collateral formation was observed, although not statistically significant (p=0.133). For the CTO lesions in LAD (p=0.397) and Cx (p=0.724), weak collateral formation appeared to have a higher rate, although not meeting statistical significance. Comparison of the two groups in terms of laboratory and echocardiography findings showed that fasting glucose level (158.5±75.60 vs 132.3±55.23, p<0.001), triglycerides (186.7±86,75 vs 143.9±69.16, p<0.001), total cholesterol level (183.9±47.95 vs 173.4±46.63, p=0.019), triglyceride/HDL ratio (5.04±3.13 vs 3.56±2.12, p<0.001) and AİP (0.63±0.25 vs 0.48±0.25, p<0.001) were higher with statistical significance in the weak collateral group. The correlation analysis between collateral formation and AİP revealed a weak yet statistically significant negative correlation (rs= -0.299, p<0.001). The multivariate logistic regression analysis performed to explore the association between AİP and development of collateral vessels demonstrated statistical significance as a standalone factor (OR: 0.083, 95% CI: 0.035-0.196, p=0.000). Accordingly, low AİP was found to be a standalone predictor of good collateral artery formation. The ROC analysis revealed an association between weak collateral formation and atherogenic plasma index with 64.7% sensitivity and 66.2% specificity using a cut-off value of 0.58 for AİP. Conclusion: When determining subjects at risk of cardiovascular disease, especially those with family history of coronary heart disease, atherogenic plasma index should be carefully considered since it offers a simple, non-invasive, cost-effective method providing rapid results as well as substantial predictive value. The present study has demonstrated that a high atherogenic plasma index is a standalone factor associated with weak collateral formation. Therefore, close monitoring of parameters that constitute the atherogenic plasma index and attempts to lower this index may help reducing development of cardiovascular disease. It is also important in terms of decreasing the unfavorable effects on collateral formation in cardiovascular patients.
Açıklama
Anahtar Kelimeler
Kollateral gelişimi, Kronik total oklüzyon, Aterojenik pazma indeksi, Trigliserid/HDL oranı, Collateral formation, Chronic total occlusion, Atherogenic plasma index, Triglyceride/HDL ratio
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Sayı
Künye
Güzel, T. (2019). Koroner kronik total oklüzyon saptanan hastalarda aterojenik indeksin kollateral gelişimi üzerine olan etkisi. Uzmanlık tezi, Dicle Üniversitesi, Diyarbakır.
