Abstract
Objective
It has been recently shown that cardiac syndrome X (CSX) patients with slow coronary flow (SCF) have a worse long-term prognosis than those with normal coronary flow. Increased uric acid levels were shown to be associated with atherosclerosis, oxidative stress, and endothelial dysfunction. The purpose of the study was to investigate the relationship between coronary flow assessed with TIMI frame count (TFC) and serum uric acid (SUA) levels in patients with CSX.
Methods
The study population consisted of 113 consecutive patients with typical cardiac CSX and 41 controls without cardiac CSX. Frequencies of risk factors as well as biochemical and hematological data were recorded for all participants. Coronary blood flow was evaluated by TFC. All patients with a TFC greater than two standard deviations from the published normal range for any one of the three vessels were accepted as having slow coronary flow (SCF group), while those whose TFC values fell within the standard deviation of the published normal range for all of the three vessels were considered to have normal coronary flow.
Results
Of the 113 CSX patients enrolled, 40 (35.4%) had SCF. The mean TFC value was strongly positively correlated with SUA level, but weakly correlated with male sex, hypertension, diabetes, smoking, serum creatinine level, and hemoglobin. Multivariate regression analysis showed that only the SUA level was independently associated with SCF. The cut-off value for uric acid obtained by the ROC curve analysis was 4.55 mg/dl for the prediction of SCF (sensitivity, 77.5%; specificity, 73.6%).
Conclusion
The SUA level is independently associated with SCF in patients with CSX.
Zusammenfassung
Ziel
Kürzlich wurde nachgewiesen, dass Patienten mit kardialem Syndrom X (CSX) und verlangsamtem Koronarfluss („slow coronary flow“, SCF) eine schlechtere Langzeitprognose als Patienten mit normalem Koronarfluss haben. Ein erhöhter Harnsäurespiegel war nachweislich mit Atherosklerose, oxidativem Stress und endothelialer Dysfunktion vergesellschaftet. Ziel der vorliegenden Studie war es, die Beziehung zwischen dem mittels TIMI-Frame-Count (TFC, Einzelbildzählung; TIMI: „thrombolysis in myocardial infarction“) gemessenen Koronarfluss und dem Serumharnsäurespiegel bei CSX-Patienten zu untersuchen.
Methoden
Die Studienpopulation bestand aus 113 aufeinanderfolgenden Patienten mit typischem CSX und 41 Kontrollen ohne CSX. Die Häufigkeit von Risikofaktoren, biochemische und hämatologische Daten wurden bei allen Teilnehmern dokumentiert. Der koronare Blutfluss wurde mit TFC gemessen. Sämtliche Patienten mit einem TFC von mehr als 2 Standardabweichungen vom publizierten Normbereich für eines der 3 Gefäße wurden in die Gruppe mit verlangsamtem Koronarfluss (SCF-Gruppe) aufgenommen, während die Patienten, deren TFC innerhalb der Standardabweichung des publizierten Normbereichs für alle 3 Gefäße lag, als Patienten mit normalem Koronarfluss angesehen wurden.
Ergebnisse
Von den 113 in die Studie aufgenommenen CSX-Patienten wiesen 40 (35,4%) einen SCF auf. Der durchschnittliche TFC-Wert war stark positiv mit dem Serumharnsäurespiegel, aber nur schwach mit männlichem Geschlecht, Hypertonie, Diabetes, Rauchen, Serumkreatininspiegel und Hämoglobin korreliert. Die multivariate Regressionsanalyse zeigte, dass nur der Serumharnsäurespiegel unabhängig mit SCF vergesellschaftet war. Der Grenzwert für Harnsäure, der sich aus der Receiver-Operator-Characteristic(ROC)-Kurven-Analyse ergab, betrug 4,55 mg/dl für die Vorhersage von SCF (Sensitivität: 77,5%; Spezifität: 73,6%)
Schlussfolgerung
Der Serumharnsäurespiegel ist unabhängig mit SCF bei CSX-Patienten vergesellschaftet.
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Elbasan, Z., Şahin, D., Gür, M. et al. Serum uric acid and slow coronary flow in cardiac syndrome X. Herz 38, 544–548 (2013). https://doi.org/10.1007/s00059-012-3735-5
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DOI: https://doi.org/10.1007/s00059-012-3735-5