Løgstrup Brian B, Høfsten Dan E, Christophersen Thomas B, Møller Jacob E, Bjerre Mette, Flyvbjerg Allan, Bøtker Hans E, Egstrup Kenneth
Department of Medical Research, Funen Svendborg Hospital, University of Odense, Svendborg, Denmark.
Coron Artery Dis. 2013 Sep;24(6):487-92. doi: 10.1097/MCA.0b013e328363242e.
Osteoprotegerin (OPG) is a glycoprotein that inhibits nuclear factor-κB's regulatory effects on inflammation, skeletal, and vascular systems, and is a potential biomarker of atherosclerosis and seems to be involved in vascular calcifications. The objective of this study was to assess the relationship between OPG, left ventricular function, and microvascular function in patients with acute myocardial infarction (AMI).
After successful revascularization, noninvasive assessment of coronary flow reserve (CFR) was performed in the distal part of the left anterior descending artery in 183 patients with first AMI. We performed low-dose dobutamine stress echocardiography to assess viability and finally we assessed the ventriculoarterial coupling (VAC). Plasma OPG was determined by ELISA.
Plasma OPG concentrations were higher in patients with impaired microcirculation (CFR<2) than in patients without [median (first; third quartile), 1.939 (1.366; 2.724) vs. 1.451 (0.925; 2.164) ng/l; P=0.001]. OPG was associated with CFR both in linear regression single-variable analysis (P=0.001) and in multivariable analysis adjusting for possible confounders (P=0.024).Eighty-seven patients had resting wall motion abnormalities and 28 patients fulfilled the criteria for viability. In the group with low OPG 20 patients had viability, and in patients with high OPG only eight patients had viability (P=0.03).Both the E/A ratio (1.22±0.65 vs. 1.06±0.39; P=0.04) and the E/e' ratio (10.4±3.1 vs. 12.2±4.6; P=0.002) indicated worse diastolic function in patients with increased levels of OPG.Overall, an increase in the VAC point was observed in the population (1.11±0.6). The VAC point was higher in patients with increased OPG compared with low OPG (1.01±0.51 vs. 1.2±0.67; P=0.03).
This is the first study to show an association between OPG levels and CFR, decreased diastolic function, and increased VAC in the setting of AMI. Our results indicate a relationship between OPG and the degree of microvascular dysfunction.
骨保护素（OPG）是一种糖蛋白，可抑制核因子-κB对炎症、骨骼和血管系统的调节作用，是动脉粥样硬化的潜在生物标志物，似乎也参与血管钙化过程。本研究的目的是评估急性心肌梗死（AMI）患者中OPG、左心室功能和微血管功能之间的关系。
在183例首次发生AMI的患者成功进行血运重建后，对左前降支远端进行无创性冠状动脉血流储备（CFR）评估。我们进行了低剂量多巴酚丁胺负荷超声心动图检查以评估心肌存活情况，最后评估心室动脉耦联（VAC）。采用酶联免疫吸附测定法（ELISA）测定血浆OPG水平。
微循环受损（CFR<2）的患者血浆OPG浓度高于未受损患者[中位数（第一四分位数；第三四分位数），1.939（1.366；2.724）对1.451（0.925；2.164）ng/l；P=0.001]。在单变量线性回归分析（P=0.001）和对可能的混杂因素进行校正的多变量分析中（P=0.024），OPG均与CFR相关。87例患者静息时存在室壁运动异常，28例患者符合心肌存活标准。在OPG水平低的组中，有20例患者存在心肌存活，而在OPG水平高的患者中只有8例患者存在心肌存活（P=0.03）。OPG水平升高的患者，其E/A比值（1.22±0.65对1.06±0.39；P=0.04）和E/e'比值（10.4±3.1对12.2±4.6；P=0.002）均提示舒张功能较差。总体而言，该人群中观察到VAC点增加（1.11±0.6）。与OPG水平低的患者相比，OPG水平升高的患者VAC点更高（1.01±0.51对1.2±0.67；P=0.03）。
这是第一项显示在AMI情况下OPG水平与CFR、舒张功能降低及VAC增加之间存在关联的研究。我们的结果表明OPG与微血管功能障碍程度之间存在关系。
