Koroner Kronik Total Oklüzyonu Olan Hastalarda Serum Endokan Düzeyi ile Koroner Kollateral Dolaşım Arasındaki İlişki

Year 2019, Volume: 22 Issue: 1, 25 - 29, 11.04.2019

Ahmet Seyfeddin Gürbüz , Yakup Alsancak Semi Öztürk Süleyman Çağan Efe Ali Yaman Cevat Kırma

Abstract

Giriş: Bir dermatan sülfat proteoglikan olan endokan, vasküler endotelyum tarafından sentezlenir ve salgılanır ayrıca vasküler hastalıkların, organ-spesifik inflamasyon ve anjiyogenezin patogenezinde rol oynar.
Çalışmamızda, stabil angina pektorisli hastalarda serum endokan düzeyiyle koroner kollateral dolaşım (KKD)
gelişimi arasındaki ilişkiyi araştırmayı amaçladık.

Hastalar ve Yöntem: Çalışmamıza en az bir kronik total tıkanıklığı olan stabil angina hastaları (n= 44) ve
normal koroner arteri olan kontrol grubu (n= 29) dahil edildi. Kollateral derecesi, Rentrop ve Cohen sınıflandırmasına göre değerlendirildi. Evre 0-1 kollateral doluşa sahip olan hastalar zayıf gelişmiş KKD grubuna (n= 19) ,
evre 2-3 kollateral doluşa sahip olan hastalar iyi gelişmiş KKD grubuna (n= 29) dahil edildi.

Bulgular: İyi gelişmiş KKD grubunda, zayıf gelişmiş KKD grubuna ve kontrol grubuna göre endokan düzeyleri
anlamlı olarak yüksek bulundu (p< 0.001). Zayıf gelişmiş KKD olan hastalarda endokan düzeyi kontrol grubuna
göre daha yüksektir. Endokan düzeyi, regresyon analizinde iyi gelişmiş KKD için tek bağımsız öngördürücü idi
(OR 1.002, 95% güven aralığı (GA) 1.001-1.005; p= 0.001). İyi gelişmiş KKD öngörmede endokan düzeyi optimal kestirim değeri ≥ 1773, 9 ng/L olarak bulundu. Endokan düzeyi ≥ 1773.9 ng/L olması halinde iyi gelişmiş
kollateral varlığını %84 duyarlılık ve %63 özgüllükle öngörmekteydi (AUC: 0.749, 95% GA: 0.654-0.849, p<
0.001).

Sonuç: Koroner kronik total oklüzyonu olan hastalarda KKD artmış endokan düzeyi ile ilişkilidir. KKD gelişiminde endokanın önemli rolü olabilir.

Keywords

Endokan, koroner kollateral dolaşım, anjiyogenez, koroner arter hastalığı

The Relationship Between Coronary Collateral Circulation and Serum Endocan Levels in Patients with Coronary Chronic Total Occlusions

Abstract

Introduction: Endocan, a dermatan sulfate proteoglycan, is synthesized and secreted by the vascular
endothelium. It is involved in the pathogenesis of vascular diseases, organ-specific inflammations, and
angiogenesis. The aim of the present study was to investigate the relationship between serum endocan level
and development of coronary collateral circulation (CCC) in patients with stable angina pectoris.

Patients and Methods: Patients with stable angina with at least one chronic total coronary occlusion (CTO)
(n= 44) and who had normal coronary artery (n= 29) were included in the study. Collateral degree was
evaluated according to the Rentrop and Cohen’s classification. Patients who had grade 0 or 1 collateral filling
were included in the poorly developed collateral group (n= 19), and those with grade 2 or 3 collateral filling
were included in the well-developed collateral group (n= 23).

Results: Endocan levels were significantly higher in patients in the well CCC group than in those in the poor CCC
and control groups (p< 0.001). Endocan level is higher in patients with poorly developed CCC than in the control
group. Endocan was only found as an independent predictor of well CCC in regression analysis (odds ratio 1.002,
95% confidence interval (CI) 1.001-1.005, p= 0.001). Receiver operating characteristic curve analysis detected
an optimal cut-off value for endocan level of 1773.9 ng/L that predicted the presence of well development of
CCC with a sensitivity of 84% and specificity of 63% (area under the receiver operating characteristic (ROC)
curve: 0.749, 95% CI: 0.654-0.849, p< 0.001).

Conclusion: Elevated endocan level is associated with better CCC in patients with CTO. Endocan may play
an important role in the development of CCC.

Keywords

Endocan, coronary collateral circulation, angiogenesis, coronary artery disease

References

• 1. Hansen JF. Coronary collateral circulation: clinical significance and influence on survival in patients with coronary artery occlusion. Am Heart J 1989;117:290-5.
• 2. Nathoe HM, Koerselman J, Buskens E, van Dijk D, Stella PR, Plokker TH, et al. Determinants and prognostic significance of collaterals in patients undergoing coronary revascularization. Am J Cardiol 2006;98:31-5.
• 3. 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;38:1872-8.
• 4. Seiler C. The human coronary collateral circulation. Eur J Clin Invest 2010;40:465-76.
• 5. Hakimzadeh N, Verberne HJ, Siebes M, Piek JJ. The future of collateral artery research. Curr Cardiol Rev 2014;10:73-86.
• 6. Sarrazin S, Adam E, Lyon M, Depontieu F, Motte V, Landolfi C, et al. Endocan or endothelial cell specific molecule-1 (ESM-1): a potential novel endothelial cell marker and a new target for cancer therapy. Biochim Biophys Acta Rev Cancer 2006;1765:25-37.
• 7. Bechard D, Scherpereel A, Hammad H, Gentina T, Tsicopoulos A, Aumercier M, et al. Human endothelial-cell specific molecule-1 binds directly to the integrin CD11a/CD18 (LFA-1) and blocks binding to intercellular adhesion molecule-11. J Immunol 2001;167:3099-106.
• 8. Menon P, Kocher ON, Aird WC. Endothelial cell specific molecule-1 (ESM-1), a novel secreted proteoglycan stimulates vascular smooth muscle cell proliferation and migration. Circulation 2011;124:A15455.
• 9. Kose M, Emet S, Akpinar TS, Kocaaga M, Cakmak R, Akarsu M, et al. Serum endocan level and the severity of coronary artery disease: a pilot study. Angiology 2015;66:727-31.
• 10. Emet S, Elitok A, Onur I, Kocaaga M, Bilge AK, Oflaz H, et al. Endocan: a novel biomarker associated with well-developed coronary collateral circulation in patients with stable angina and chronic total occlusion. J Thromb Thrombolysis 2017;43:60-7.
• 11. Gok M, Kundi H, Kiziltunc E, Topcuoglu C, Ornek E. Endocan Levels and coronary collateral circulation in stable angina pectoris: a pilot study. Angiology 2018;69:43-8.
• 12. Rentrop KP, Thornton JC, Feit F, Van Buskirk M. Determinants and protective potential of coronary arterial collaterals as assessed by an angioplasty model. Am J Cardiol 1988;61:677-84.
• 13. Stone GW, Kandzari DE, Mehran R, Colombo A, Schwartz RS, Bailey S, et al. Percutaneous recanalization of chronically occluded coronary arteries: a consensus document: part I. Circulation 2005;112:2364-72.
• 14. Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 2005;1:219-27.
• 15. Lassalle P, Molet S, Janin A, Heyden JV, Tavernier J, Fiers W, et al. ESM-1 is a novel human endothelial cellspecific molecule expressed in lung and regulated by cytokines. J Biol Chem 1996;271:20458-64.
• 16. Aparci M, Isilak Z, Uz O, Yalcin M, Kucuk U. Endocan and endothelial dysfunction. Angiology 2015;66:488-9.
• 17. Zakynthinos E, Pappa N. Inflammatory biomarkers in coronary artery disease. J Cardiol 2009;53:317-33.
• 18. Ye MF, Zhao ZW, Luo YK, Dong XF, Yan YM. Elevated endocan concentration is associated with coronary slow flow. Scand J Clin Lab Invest 2016;76:345-8.
• 19. Turan T, Akyuz AR, Aykan AC, Kul S, Cirakoglu OF, Aslan AO, et al. Plasma endocan levels in patients with ısolated coronary artery ectasia. Angiology 2016;67:932-6.
• 20. Efe SC, Demirci K, Ozturk S, Gurbuz AS, Poci N, Kilicgedik A, et al. Serum endocan levels in patients with cardiac syndrome X. Herz 2018;43:359-63.
• 21. Gulec S, Ozdemir A, Maradit Kremers H, Dincer I, Atmaca Y, Erol C. Elevated levels of C-reactive protein are associated with impaired coronary collateral development. Eur J Clin Invest 2006;36:369-75.