Khalfallah Mohamed, Draz Enas, Shalaby Khaled, Hafez Yasser Mostafa
Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.
Department of Internal Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.
Glob Cardiol Sci Pract. 2019 Sep 20;2019(2):e201910. doi: 10.21542/gcsp.2019.10.
The development of coronary collaterals is variable among patients with coronary artery disease and remains incompletely understood. We aimed to demonstrate the predictors of poorly developed coronary collateral circulation (CCC) in patients with subclinical hypothyroidism suffered from chronic stable angina. The study was conducted on 226 patients with subclinical hypothyroidism suffered from chronic stable angina, coronary angiography documented total occlusion at any major coronary artery or coronary artery lumen diameter stenosis >90%. Patients were divided into two groups according to grade of CCC, group A: 138 patients with (good collaterals) and group B: 88 patients with (poor collaterals). To classify CCC, we used Rentrop's classification. Multivariate regression analysis was performed and identified the independent predictors of poor coronary collaterals: N/L ratio (OR 0.413, CI 95% [0.172-0.993], p = 0.048), and TSH (OR 2.511, CI 95% [1.784-3.534], p = 0.001). The ROC analysis provided a cut-off value of >4.6 for N/L ratio, and >9 µIU/mL for TSH to predict poor coronary collaterals. An elevated level of N/L ratio >4.6 and TSH level >9 µIU/mL were the independent predictors of poorly developed CCC in patients with subclinical hypothyroidism suffered from chronic stable angina.
在冠心病患者中,冠状动脉侧支循环的发育情况因人而异,目前仍未完全了解。我们旨在证明患有慢性稳定型心绞痛的亚临床甲状腺功能减退患者冠状动脉侧支循环发育不良(CCC)的预测因素。该研究针对226例患有慢性稳定型心绞痛的亚临床甲状腺功能减退患者进行,冠状动脉造影记录显示任何主要冠状动脉完全闭塞或冠状动脉管腔直径狭窄>90%。根据CCC分级将患者分为两组,A组:138例(侧支循环良好),B组:88例(侧支循环不良)。为了对CCC进行分类,我们采用了伦托普分类法。进行多变量回归分析并确定冠状动脉侧支循环不良的独立预测因素:N/L比值(OR 0.413,95%CI[0.172 - 0.993],p = 0.048)和促甲状腺激素(TSH)(OR 2.511,95%CI[1.784 - 3.534],p = 0.001)。ROC分析得出预测冠状动脉侧支循环不良的N/L比值临界值>4.6,TSH临界值>9 µIU/mL。N/L比值>4.6和TSH水平>9 µIU/mL升高是患有慢性稳定型心绞痛的亚临床甲状腺功能减退患者CCC发育不良的独立预测因素。