Esra POLAT, Mehmet Murat SUCU, İbrahim Halil İNANÇ, Orhan ZENGİN

Koroner arter hastalığının şiddeti ile tırnak yatağı kapiller dolaşımının videokapilleroskopik bulguları arasındaki ilişki

Amaç: Ateroskleroza bağlı olarak gelişen ve önemli morbidite ve mortalite nedeni olan koroner arter hastalığının (KAH) etiyolojisinde endotel disfonksiyonu önemli rol oynar. Tırnak dibinin videokapilleroskopik (NVC) değerlendirilmesi endotel disfonksiyonun dolaylı bir göstergesidir. NVC ile değerlendirilen mikrosirkulasyona ait verilerle endotel disfonksiyonunun önemli rol oynadığı koroner arterlerdeki aterosklerozun yaygınlığı arasında bir ilişki olup olmadığı daha once araştırılmamış bir konudur. Biz bu çalışmada sistemik endotel hasarının dolaylı bir göstergesi olan NVC ile tırnak yatağının kapiller dolaşımını değerlendirererek koroner arter hastalığının yaygınlığı gösteren SYNTAX ve Gensini skorları ile muhtemel ilişkiyi araştırmayı amaçladık.Yöntemler: Bu çalışma retrospektif Kohort çalışması olarak tasarlanmıştır. Koroner anjiyografi (KAG) yapılan ve epikardiyal koroner arterlerde lümeni %50’den fazla daraltan lezyon tespit edilmiş olan ardışık 100 hasta çalışmaya alınmıştır. Çalışmaya katılan hastaların KAG görüntüleri deneyimli iki invaziv kardiyoloji uzmanı tarafından değerlendirilerek SYNTAX ve Gensini skorları hesaplanmıştır. Hastalar SYNTAX skoruna göre ≤22, 23-32 arası ve ≥33 olmak üzere 3 gruba ve Gensini skoruna göre Gensini skoru ≥30 ve <30 olan hastalar olmak üzere 2 gruba ayrılmıştır. Çalışmaya katılan hastaların NVC incelemeleri bu konuda deneyimli olan bir romatoloji uzmanı tarafından yapılmıştır ve dev kapiller arter varlığı, mikrohemoraji, dallanma, disorganizasyon, tortiyozite, avasküler alan, extravazasyon, neogenezis, kapiller dansitede azalma ve dilate kapiller damar varlığı araştırılmıştır.Bulgular: Diyabetes mellitusu olan hastalarda (%85) dilate kapiller diyabetes mellitusu olmayan hastalardan (%66,7) daha yaygındı (P=0,041). Diyabetes mellitusu olan/olmayan (hepsi için P>0,05), hipertansiyonu olan/olmayan hastalar arasında NVC parametreleri bakımından anlamlı bir fark saptanmadı (hepsi için P>0,05). SYNTAX skoruna göre gruplar arasında NVC parametreleri bakımından anlamlı bir fark saptanmadı (hepsi için P>0,05). Gensini skoruna göre gruplar arasında benzer NVC bulguları saptandı (hepsi için P>0,05). Sonuç: Koroner arter hastalığının yaygınlığını belirlemede kullanılan SYNTAX ve Gensini skorları ile NVC parametreleri arasında ilişki yoktur. Bu yüzden NVC parametrelerinin koroner arter hastalığının şiddetini belirlemede kullanılması uygun değildir.

Anahtar Kelimeler:

Koroner arter hastalığı, Tırnak yatağı videokapilleroskopi, SYNTAX, Gensini skoru

Association between coronary artery disease severity and videocapillaroscopic findings of nail fold capillary circulation

Aim: Endothelial dysfunction plays a significant role in the etiology of coronary artery disease (CAD), which develops due to atherosclerosis, and is a major cause of morbidity and mortality. Nail fold videocapillaroscopy (NVC) assessment is a surrogate marker of endothelial dysfunction. To the best of our knowledge, the relationship between the microcirculation features on NVC and the severity of coronary atherosclerosis has not previously been investigated. In this study, we aimed to investigate the relationship between severity of coronary atherosclerosis (shown by SYNTAX and Gensini scores) and NVC findings which is an indirect indicator of systemic endothelial damage.Methods: The study was designed as a retrospective cohort. One-hundred consecutive patients who underwent coronary angiography (CAG) and had at least one lesion in the epicardial coronary arteries, narrowing the lumen by more than 50%, were included. Coronary angiographic images of the patients were evaluated by two experienced interventional cardiologists and SYNTAX and Gensini scores were calculated. Patients were divided into three groups according to the SYNTAX scores (SYNTAX score ≤22, between 23-32, and ≥33) and two groups according to Gensini scores (Gensini score ≥30 and ˂30). The NVC examinations were performed by a rheumatologist who was experienced in this field, and the reduction in capillary density, presence of dilated capillaries, giant capillary, microhemorrhage, branching, disorganization, tortuosity, avascular area, extravasation, and neoangiogenesis were investigated.Results: Dilated capillary vessels were more common in diabetic patients (85%) than in non-diabetics (66.7%) (P=0.041). Besides, there was no significant difference in NVC parameters between patients with and without diabetes mellitus (P>0.05 for all), with and without hypertension (P>0.05 for all). There was no significant difference between the SYNTAX groups in terms of NVC findings (P>0.05 for all). The NVC findings were similar between Gensini groups (P>0.05 for all). Conclusion: The severity of atherosclerosis surrogated by SYNTAX and Gensini scores was not related to the NVC findings. Therefore, NVC is inappropriate for determining the severity of CAD.

Keywords:

Coronary artery disease, Nail fold videocapillaroscopy, SYNTAX, Gensini Score,

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