Şeyda GÜNAY, Emre SARANDÖL, Ali AYDINLAR

Subklinik Aterosklerozun Serum Endotelin-1 Düzeyi ile Değerlendirilmesi

Ateroskleroz ve ilişkili hastalıklar tüm dünyada en önde gelen ölüm nedenidir. Koroner arterlerde aterosklerotik tutulumun başlamasından daha önce endotel işlev bozukluğu ortaya çıkar. Aterosklerozu organ tutulumu ortaya çıkmadan teşhis etmek önemlidir. Bu çalışmada, subklinik aterosklerozun serum endotelin-1 (ET-1) düzeyi ile değerlendirilmesi amaçlandı. Göğüs ağrısı şikayeti ile başvuran ve koroner iskemi açısından egzersiz stres testi (EST) veya miyokard perfüyon sintigrafisi (MPS) planlanan hastalar çalışmaya alındı. Öyküsünde anjiyografik olarak kanıtlanmış koroner arter hastalığı (KAH) olan hastalar çalışmaya dahil edilmedi. İskemi testi öncesinde hastalardan serum ET-1 ölçümü için kan örneği alındı. İskemi saptananlar koroner anjiyografi (KAG) ile değerlendirilidi. KAG sonuçlarına göre hastalar, klinik olarak anlamlı KAH olanlar (grup-1) ve olmayanlar (grup-2) olarak gruplandı. İskemi saptanmayanlar ise grup-3 olarak tanımlandı. Bilinen KAH öyküsü olmayan 48 hasta (ortalama yaş:57,4±10,9 ve 23’ü (%48) kadın) çalışmaya alındı. Hastaların 13’ü (%27) diyabetik, 26’sı (%54) hipertansif ve 10’u (%20) hiperlipidemikti. 17 hastada (%35,4) EST veya MPS ile iskemi saptanmazken (grup-3), 31 hastada iskemi mevcuttu. İskemi saptanarak KAG yapılan hastaların 21’inde (%67,7) klinik olarak anlamlı KAH saptandı (grup-1), 10’unda (%32,3) klinik olarak anlamlı KAH saptanmadı (grup-2). Medyan [min-maks] serum endotelin-1 seviyesi grup-1’de 15,9 [8,8-93,4] ng/L, grup-2’de 26,9 [8,5-55,5]ng/L, grup-3’te 21,8 [8,6-97,4] ng/L saptandı. Serum ET-1 düzeyleri açısndan gruplar arasında istatiksel açıdan anlamlı farklılık saptanmadı (p=0,127). Koroner arter hastalığı şüphesi olan hastalarda serum ET-1 düzeyleri subklinik ateroskleroz için öngördürücü değildir.

Anahtar Kelimeler:

iskemi, endotelin, ateroskleroz, subklinik

Evaluation of Subclinical Atherosclerosis with Serum Endothelin-1 Levels

Atherosclerosis and related diseases are the leading causes of death worldwide. Endothelial dysfunction occurs before the onset of atherosclerotic involvement in coronary arteries. It is important to diagnose atherosclerosis before organ involvement occurs. In this study, it was aimed to evaluate subclinical atherosclerosis by serum endothelin-1 (ET-1) levels in the subclinical period. Patients who presented with a complaint of chest pain and were scheduled for an exercise stress test (EST) or myocardial perfusion scintigraphy (MPS) in terms of coronary ischemia were included in the study. Patients with known angiographically proven coronary artery disease (CAD) were excluded from the study. Before the ischemia test, blood samples were taken from the patients for serum ET-1 measurement. Those with ischemia were evaluated by coronary angiography (CAG). According to the CAG results, those with clinically significant CAD (group-1) and those without clinically significant CAD (group-2) were grouped. Those without ischemia were defined as group-3. A total of 48 patients (mean age: 57.4 ± 10.9 years, and 23 (48%) females) without a known history of CAD were included in the study. 13 (27%) of the patients were diabetic, 26 (54%) of the patients were hypertensive hypertensive and 10 (20%) of the patients were hyperlipidemic. While ischemia was not detected in 17 patients (35.4%) with EST or MPS (group-3), 31 patients had ischemia and underwent CAG. Among those, clinically significant CAD was detected in 21 (67.7%) patients (group-1), and clinically significant CAD was not detected in 10 (32.3%) patients (group-2). Median [min-max] serum endothelin-1 level in group-1 was 15.9 [8.8-93.4] ng / L, in group- 2 it was 26.9 [8.5 -55.5] ng / L , and in group-3 it was 21.8[8.6-97.4] ng / L. There was no statistically significant difference between the groups in terms of serum ET-1 levels (p = 0.127). Serum ET-1 levels are not predictive of subclinical atherosclerosis in patients with suspected coronary artery disease.

Keywords:

ischemia, endothelin, atherosclerosis, subclinical,

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