Satılmışoğlu Muhammet Hulusi, Örnek Diker Vesile, Taşbulak Ömer, Diker Mustafa, Birand Ali, Kaya Mehmet, İyigün Taner, Eksik Abdurrahman
Department of Cardiology, Mehmet Akif Education and Research Hospital, Istanbul, Turkey.
Kardiol Pol. 2017;75(10):1020-1026. doi: 10.5603/KP.a2017.0123. Epub 2017 Jul 17.
Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase.
We aimed to determine plasma ADMA levels in patients with ascending aorta dilatation in comparison to those without aorta dilatation, and to evaluate the diagnostic, predictive, and prognostic value of serum ADMA level for aorta dilatation.
This was a cross-sectional case-control study. A total of 104 consecutive patients (female/male, 35/69; mean age, 62.75 ± 13.11 years) diagnosed with ascending aorta dilatation (≥ 4.5 cm) on echocardiography (case group), and 52 age-and gender-matched patients (female/male, 17/35; mean age, 63.44 ± 7.56 years) with normal aorta dimensions (≤ 3.8 cm) (control group) were included. Routine biochemical and haematological analysis in addition to measurement of serum ADMA level were performed.
The mean diameter of ascending aorta measured on echocardiography was 4.95 ± 0.57 cm and 3.34 ± 0.36 cm in patients with aorta dilatation and those without aorta dilatation, respectively (p < 0.001). Serum ADMA level was significantly higher in patients with aorta dilatation than in the control group (1.70 ± 1.12 μmol/L vs. 0.79 ± 0.76 μmol/L, respectively, p < 0.001). There was significant positive correlation between ADMA level and aortic diameter in Spearman correlation analysis (r = 0.317, p < 0.001). In linear regression analysis, ADMA was found to be a significant independent predictor of aorta diameter (Beta = 0.26, p < 0.001). Receiver-operator characteristic curve analysis also revealed that serum ADMA cut-off level over 0.29 μmol/L predicts aorta dilatation (≥ 4.5 cm) with 94% sensitivity and 92% specificity and with high ac-curacy (area under curve: 0.786; 95% confidence interval: 0.709-0.863, p < 0.001).
Serum ADMA level is diagnostic for ascending aorta dilatation with high sensitivity and specificity, and should be considered for use in clinical diagnosis of aorta dilatation.
不对称二甲基精氨酸（ADMA）是一氧化氮合酶的内源性抑制剂。
我们旨在比较升主动脉扩张患者与无主动脉扩张患者的血浆ADMA水平，并评估血清ADMA水平对主动脉扩张的诊断、预测和预后价值。
这是一项横断面病例对照研究。纳入了104例连续的经超声心动图诊断为升主动脉扩张（≥4.5 cm）的患者（病例组，女性/男性，35/69；平均年龄，62.75±13.11岁），以及52例年龄和性别匹配的主动脉尺寸正常（≤3.8 cm）的患者（对照组，女性/男性，17/35；平均年龄，63.44±7.56岁）。除了测量血清ADMA水平外，还进行了常规生化和血液学分析。
超声心动图测量的升主动脉平均直径在主动脉扩张患者和无主动脉扩张患者中分别为4.95±0.57 cm和3.34±0.36 cm（p<0.001）。主动脉扩张患者的血清ADMA水平显著高于对照组（分别为1.70±1.12 μmol/L和0.79±0.76 μmol/L，p<0.001）。Spearman相关性分析显示ADMA水平与主动脉直径之间存在显著正相关（r = 0.317，p<0.001）。线性回归分析发现，ADMA是主动脉直径的显著独立预测因子（β = 0.26, p<0.001）。受试者工作特征曲线分析还显示，血清ADMA截断水平超过0.29 μmol/L预测主动脉扩张（≥4.5 cm）的敏感性为94%，特异性为92%，准确性高（曲线下面积：0.786；95%置信区间：0.709 - 0.863，p<0.001）。
血清ADMA水平对升主动脉扩张具有高敏感性和特异性的诊断价值，应考虑用于主动脉扩张的临床诊断。
