Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
J Cardiol. 2020 Jun;75(6):654-658. doi: 10.1016/j.jjcc.2020.01.002. Epub 2020 Jan 25.
Tendon xanthoma, represented as Achilles tendon xanthoma (ATX), is one of the important diagnostic criteria for familial hypercholesterolemia (FH). However, there are some cases with ATX who do not meet these criteria. This study aimed to investigate the severity of coronary artery disease (CAD) in patients with ATX.
A total of 394 patients with CAD undergoing percutaneous coronary intervention (PCI) at Chiba University Hospital between June 2016 and February 2018 were enrolled. Soft X-ray radiography of Achilles tendon was performed, and a maximum thickness of 9 mm or more was regarded as ATX. Heterozygous FH was diagnosed according to the diagnostic criteria proposed by the Japan Atherosclerosis Society in 2017. CAD severity was assessed by SYNTAX score before the first PCI during the study period.
There were 43 (10.9%) patients with ATX, and 16 (4.1%) were diagnosed as FH (15 with ATX and 1 without ATX). The ATX group showed greater body mass index, lower high-density lipoprotein cholesterol level, and the higher prevalence of FH, diabetes, prior myocardial infarction, acute coronary syndrome, multivessel disease, hemodialysis, and prior statin administration. SYNTAX score and the rate of SYNTAX score ≥23 were significantly higher in the ATX group compared with the non-ATX group (p < 0.001 for each). When patients were divided into quartiles according to Achilles tendon thickness, SYNTAX score and the prevalence of SYNTAX score ≥23 were progressively increased in favor of greater Achilles tendon thickness (p < 0.001 for each). Multivariate analysis determined male, diabetes, and ATX as independent predictors for higher SYNTAX score.
In CAD patients undergoing PCI, ATX was independently associated with severity of CAD. Detecting ATX may be useful not only for diagnosing FH, but also for identifying patients with advanced CAD.
腱黄瘤，表现为跟腱黄瘤（ATX），是家族性高胆固醇血症（FH）的重要诊断标准之一。然而，有一些 ATX 患者不符合这些标准。本研究旨在探讨 ATX 患者冠状动脉疾病（CAD）的严重程度。
共纳入 2016 年 6 月至 2018 年 2 月期间在千叶大学医院接受经皮冠状动脉介入治疗（PCI）的 394 例 CAD 患者。对跟腱进行软 X 射线照相，最大厚度为 9 毫米或以上被认为是 ATX。根据 2017 年日本动脉粥样硬化学会提出的诊断标准诊断杂合子 FH。在研究期间，在第一次 PCI 前通过 SYNTAX 评分评估 CAD 严重程度。
有 43 例（10.9%）患者有 ATX，16 例（4.1%）被诊断为 FH（15 例有 ATX，1 例无 ATX）。ATX 组的体重指数更大，高密度脂蛋白胆固醇水平更低，FH、糖尿病、既往心肌梗死、急性冠状动脉综合征、多血管疾病、血液透析和既往他汀类药物治疗的患病率更高。与非 ATX 组相比，ATX 组的 SYNTAX 评分和 SYNTAX 评分≥23 的比例显著更高（p<0.001）。当根据跟腱厚度将患者分为四组时，SYNTAX 评分和 SYNTAX 评分≥23 的患病率均逐渐增加，有利于跟腱厚度更大（p<0.001）。多变量分析确定男性、糖尿病和 ATX 是 SYNTAX 评分较高的独立预测因素。
在接受 PCI 的 CAD 患者中，ATX 与 CAD 的严重程度独立相关。检测 ATX 不仅有助于诊断 FH，还可识别 CAD 严重程度较高的患者。
