| Chapter1Correlation between plasma free fatty acid levels and types of coronary artery disease, coronary stenosis severity in patients with coronary artery diseaseAbstract:Background:Previous studies showed plasma free fatty acids (Free fatty acid, FFA) was an independent predictor of sudden cardiac death, myocardial infarction mortality, cardiovascular mortality and all-cause mortality. Moreover FFA was significantly elevated in patients with acute myocardial infarction. However, there was almost no study analyzing FFA levels in patients with different types of coronary artery disease and the relationship between FFA and coronary stenosis severity.Method:From June1,2012to December31,2013a total of1235patients undergoing coronary angiography and meeting the study criteria were included in this study. Negative control group included131patients, stable angina group included136patients, unstable angina pectoris group included676patients, acute myocardial infarction group included292patients. Information were collected including gender, age, history of smoking, hypertension and diabetes history, family history of coronary artery disease, left ventricular ejection fraction, and plasma concentrations of total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein Al, apolipoprotein B, free fatty acid, high sensitive C reactive protein in blood samples. According to results of coronary angiography, we calculated GENSINI score, numbers of stenosed coronary vessels and triple vessel stenosis to evaluate coronary stenosis severity. Then we analyzed the difference of FFA levels in different types of coronary artery disease, which in detail contained comparison between control group and coronary artery disease group, and comparison between acute myocardial infarction group and non-acute myocardial infarction coronary artery disease group. Multivariate stepwise linear regression was carried out to screen possible risk factors of FFA according to different gender. ROC curve analysis was used to analyze the diagnosis ability of FFA on acute myocardial infarction in coronary artery disease patients. In addition we compared the difference of GENSINI score, numbers of stenosed coronary vessels and triple vessel stenosis proportion according to tertiles of FFA in different gender. Two-sided p<0.05was considered statistically significant in our study.Results:Levels of FFA were significantly variant according to different gender, which were0.46±0.26mmol/L in male and0.52±0.33mmol/L in female. Multivariate stepwise regression analysis showed the influencing factors of FFA in male were apolipoprotein Al, low density lipoprotein cholesterol, apolipoprotein B, type of coronary artery disease and triglyceride, while in female were apolipoprotein Al, apolipoprotein B, low density lipoprotein cholesterol and diabetes. The levels of FFA in patients with different types of coronary artery disease were significantly different in both gender, and were highest in acute myocardial infarction groups, which was0.54±0.33mmol/L in male and0.69±0.39mmol/L in female. No significant difference in FFA levels was found between coronary artery disease groups and control groups in both gender. But FFA levels in acute myocardial infarction groups were significantly elevated than in non-acute myocardial infarction groups, which were0.42±0.21mmol/L in acute myocardial infarction group and0.54±0.33mmol/L in non-acute myocardial infarction group (p<0.001) in male, and0.48±0.29mmol/L in acute myocardial infarction group,0.69±0.39mmol/L in non-acute myocardial infarction group (p<0.001) in female. In male, ROC of FFA in patients with coronary artery disease for diagnosing acute myocardial infarction was0.640(95%CI0.592-0.685, p<0.001), reaching the best cut off value when FFA was0.415mmol/L, with sensitivity0.487and specificity0.707. And in male, odds ratio of acute myocardial infarction in group which FFA≥0.415mmol/L is2.60times higher than group which FFA<0.415mmol/L (95%CI1.34-5.03, p=0.005). In female, ROC of FFA in patients with coronary heart disease for acute myocardial infarction was0.684(95%CI0.596-0.750, p<0.001), reaching the best cut off value when FFA was0.695mmol/L, with sensitivity0.483and specificity0.846. And in female odds ratio of acute myocardial infarction in group which FFA≥0.695 mmol/L is6.73times higher than group which FFA<0.695mmol/L (95%CI2.12-21.32, p=0.005). Finally, GENSINI score, numbers of stenosed coronary vessels and triple vessel stenosis proportion had no significant difference between FFA tertiles in either gender (p>0.05).Conclusion:No significant difference is found in FFA levels between coronary angiography negative population and patients with coronary artery disease. While FFA level in patients with acute myocardial infarction is significantly higher than in patients with non-acute myocardial infarction, and cut off points of FFA in diagnosing acute myocardial infarction is much higher in female than in male. In patients with acute myocardial infarction, FFA and coronary stenosis severity have no statistical relationship. Chapter2Correlation between plasma beta2-microglobulin levels and coronary stenosis severity in patients with acute coronary syndromeAbstract:Background:Previous studies showed plasma B2M (beta2-microglobulin, B2M) could predict all cause mortality and cardiovascular mortality in general population and coronary artery disease population. However, almost no study explored the relationship between B2M and coronary stenosis severity in patients with acute coronary syndrome.Method:During2013January to2013December,484coronary angiography confirmed acute coronary syndrome patients who met the study criteria were included in this study. We collected patients’ information including gender, age, history of smoking, hypertension and diabetes history, family history of coronary artery disease, resting heart rate, left ventricular ejection fraction, and plasma concentrations of total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, creatinine clearance rate, high sensitive C reactive protein, beta2-microglobulin according to blood samples. According to results of coronary angiography, we calculated GENSINI score, numbers of stenosed coronary vessels and triple vessel stenosis to evaluate coronary stenosis severity. Patients were divided into four groups according to quartiles of B2M (<1.42mg/L,1.43-1.86mg/L,1.87-2.34mg/L,≥2.35mg/L). One-way analysis of variance (ANOVA) was used to compare continuous variables between different groups and chi square test was used to compare categorical variables. Stepwise linear regression analysis was carried out to screen independent risk factors of B2M. Multivariable linear regression analysis and logistic regression analysis were used to analyze the relationship between B2M and each indice of coronary stenosis severity. Two-sided p<0.05was considered statistically significant in our study.Results:In multivariate regression analysis, influencing factors of B2M were estimated glomerular filtration rate, male and resting heart rate. In both univariate and multivariate regression analysis, B2M remained an independent risk factor of GENSINI score, numbers of stenosed coronary vessels and triple vessel stenosis proportion. After adjustment for gender and age, GENSINI score in the fourth quartile increased13.26+7.06than the first quartile, numbers of stenosed coronary vessels increased0.28±0.09in the fourth quartile than the first quartile and triple vessel stenosis proportion was2.07times (CI95%0.17-2.68) higher in the fourth quartile than the first quartile. Furthermore GENSINI score, numbers of stenosed coronary vessels and triple vessel stenosis showed a gradually increasing trend in the four quartiles of B2M after further adjustment for hypertension, diabetes, smoking, family history of coronary artery disease, resting heart rate, total cholesterol, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol, estimated glomerular filtration rate and high sensitive C reactive protein. Compared to the first quartile, the second, third and fourth quartile of B2M increased2.45±7.57,2.75±7.93,28.11±9(p=0.002) in GENSINI score respectively, numbers of stenosed vessels increased0.12±0.10,0.15±0.11,0.38±0.12and odds ratios of triple vessel stenosis were1.25(0.67,2.32),1.36(0.71,2.61),3.94(1.72,9.03) respectively compared to the first quartile.Conclusion:Our data indicate B2M is an independent risk factor for coronary stenosis severity in patients with acute coronary syndrome. After adjustment for other risk factors, with the increasing quartiles of B2M, GENSINI score, numbers of stenosed coronary vessels and triple vessel stenosis proportion increase correspondingly. A high correlation between B2M and coronary artery severity may infer B2M could be a new indicator reflecting coronary stenosis severity. |
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