Liu Yang, Chen Si, Liu Shaoyan, Sun Guoqiang, Sun Zhijun, Liu Hongbin
Medical School of Chinese People's Liberation Army, Beijing, China.
Department of Cardiology, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China.
Front Cardiovasc Med. 2022 Sep 8;9:950102. doi: 10.3389/fcvm.2022.950102. eCollection 2022.
The endothelial glycocalyx (EG) is essential for maintaining microvascular homeostasis. However, the relationship between the EG and coronary microcirculation remains to be elucidated. One of the main components of EG is syndecan-1, and its shedding has been claimed to represent the state of the EG. In this study, we aimed to analyze the association between syndecan-1 and the coronary microcirculation.
We enrolled suspected coronary artery disease (CAD) patients who consecutively underwent coronary angiography (CAG) and angiography-based analysis of physiological indices in the left anterior descending artery (LAD). Serum syndecan-1 was measured by enzyme-linked immunosorbent assay (ELISA). The coronary microcirculation was evaluated by the presence of coronary microvascular dysfunction (CMD) and an impaired microvascular vasodilatory capacity (IMVC), which were quantified by an angiography-derived index of microcirculatory resistance (IMRangio) in the maximum hyperemic state (H-IMRangio) induced by adenosine triphosphate and the ratio (RRRangio) of IMRangio in the non-hyperemic phase to H-IMRangio, respectively.
A total of 528 patients were enrolled in this study. There was no difference in epicardial coronary complexity between patients with high syndecan-1 (HSG) and low syndecan-1 (LSG) levels grouped by the median concentration of syndecan-1 (SYNTAX: 7[3, 10] vs. 9[4, 12], = 0.15). However, H-IMRangio and RRRangio were different between the LSG and HSG groups (H-IMRangio: 23.64 ± 6.28 vs. 27.67 ± 5.59, < 0.01; RRRangio: 1.74[1.46, 2.08] vs. 1.55[1.34, 1.72], < 0.01). Patients with CMD (H-IMRangio > 25) and patients with IMVC (RRRangio below the median value) both had higher syndecan-1 levels (CMD: 86.44 ± 54.15 vs. 55.2 ± 43.72, < 0.01; IMVC: 83.86 ± 55.41 vs. 59.68 ± 45.06, < 0.01). After adjustment for confounding factors, HSG remained associated with the presence of CMD and IMVC (CMD: odds ratio [OR]: 2.769, < 0.01; IMVC: OR: 1.908, < 0.01).
High levels of syndecan-1 are independently associated with the presence of CMD and IMVC among patients with suspected CAD.
内皮糖萼（EG）对于维持微血管稳态至关重要。然而，EG与冠状动脉微循环之间的关系仍有待阐明。EG的主要成分之一是Syndecan-1，其脱落被认为代表了EG的状态。在本研究中，我们旨在分析Syndecan-1与冠状动脉微循环之间的关联。
我们纳入了连续接受冠状动脉造影（CAG）以及基于造影的左前降支（LAD）生理指标分析的疑似冠状动脉疾病（CAD）患者。通过酶联免疫吸附测定（ELISA）测量血清Syndecan-1。通过冠状动脉微血管功能障碍（CMD）的存在和微血管舒张能力受损（IMVC）来评估冠状动脉微循环，这两者分别通过在三磷酸腺苷诱导的最大充血状态（H-IMRangio）下基于造影的微循环阻力指数（IMRangio）以及非充血期IMRangio与H-IMRangio的比值（RRRangio）进行量化。
本研究共纳入528例患者。根据Syndecan-1的中位数浓度分组，高Syndecan-1（HSG）组和低Syndecan-1（LSG）组患者的冠状动脉复杂性无差异（SYNTAX评分：7[3, 10]对9[4, 12]，P = 0.15）。然而，LSG组和HSG组之间的H-IMRangio和RRRangio不同（H-IMRangio：23.64±6.28对27.67±5.59，P < 0.01；RRRangio：1.74[1.46, 2.08]对1.55[1.34, 1.72]，P < 0.01）。患有CMD（H-IMRangio > 25）的患者和患有IMVC（RRRangio低于中位数）的患者均具有较高的Syndecan-1水平（CMD：86.44±54.15对55.2±43.72，P < 0.01；IMVC：83.86±55.41对59.68±45.06，P < 0.01）。在调整混杂因素后，HSG仍与CMD和IMVC的存在相关（CMD：比值比[OR]：2.769，P < 0.01；IMVC：OR：1.908，P < 0.01）。
在疑似CAD患者中，高水平的Syndecan-1与CMD和IMVC的存在独立相关。
