ENDOTHELIAL DYSFUNCTION MARKERS IN PATIENTS WITH NON-ST ELEVATION ACUTE CORONARY SYNDROME AND MULTIFOCAL ATHEROSCLEROSIS

Aim. To investigate the association between endothelial dysfunction markers and multifocal atherosclerosis in non-ST elevation acute coronary syndrome (NSTE- ACS). 

Material and methods. The study included 82 patients with NSTE-ACS, who underwent coronary angiography, colour duplex ultrasound of brachiocephalic arteries (BCA) and lower extremity arteries (LEA), and a complex assessment of endothelial function during their hospitalisation. Vasodilating endothelial function was assessed by endothelium-dependent vasodilatation (EDVD) in a reactive hyperemia test. Vasoconstrictory and adhesive endothelial function was assessed by the blood levels of endothlin-1, sP-selectin, and sE-selectin in a solid-phase enzyme immunoassay. Statistical analyses were performed using the STATISTICA 6.0 software package. 

Results. Isolated coronary artery (CA) atherosclerosis was registered in 46,3% of the patients, while isolated BCA atherosclerosis was observed in 9,7%, and the combination of CA and peripheral artery atherosclerosis was registered in 19,5%. 

No cases of isolated LEA atherosclerosis were observed. According to the visualisation results, 24,3% of the patients had no signs of atherosclerotic stenosis (>30%) in any vascular basin. The highest levels of endothelin-1 were registered in patients with isolated BCA atherosclerosis and with the combination of peripheral and CA atherosclerosis. No significant differences were observed between the groups by the blood levels of sP-selectin and sE-selectin; moreover, these levels were within the reference range. All groups demonstrated similar levels of vasodilating endothelial function. 

Conclusion. In NSTE-ACS patients, vasoconstrictory endothelial function was clearly associated with the atherosclerosis parameters. At the same time, there was no link between the atherosclerosis severity and localisation and the parameters of vasodilating and adhesive endothelial function. Endothelin-1, as a vasoconstriction marker, was most informative in patients with peripheral and multifocal atherosclerosis.

1. Poredos P, Jug B. The prevalence of peripheral arterial in high risk subjects and coronary or cerebrovascular patients. Angiology 2007; 58 (3):309–15.

2. Petrishchev NN. Diagnostic value of determination of the desquamated endothelial cells in the blood. Clinical Laboratory Diagnostics, 2001; 1:50–2. Russian (Петрищев Н. Н. Диагностическая ценность определения десквамированных эндотелиальных клеток в крови. Клин. лабораторная диагностика 2001; 1:50–2)

3. Barbarash LS, Kartashyan ES, Kashtalap VV, et al. The clinical significance and the prevalence of “unchanged” coronary arteries in patients with acute coronary syndrome. Pathology of the Circulatory and Cardiac Surgery 2001, 2:43–8. Russian (Барбараш Л. С., Карташян Э. С., Кашталап В. В. и др. Клиническая значимость и распространенность “неизмененных” коронарных артерий у больных с острым коронарным синдромом. Патология кровообращения и кардиохирургия 2001; 2:43–8)

4. Barbarash OL, Zykov MV, Kashtalap VV, et al. The prevalence and clinical significance of multifocal atherosclerosis in patients with coronary heart disease. Cardiology 2011; 8:66–71. Russian (Барбараш О. Л., Зыков М. В., Кашталап В.В и др. Распространенность и клиническая значимость мультифокального атеросклероза у пациентов с ишемической болезнью сердца. Кардиология 2011; 8:66–71.)

5. Mischuk NE, Shustal NF. The cardiac syndrome X (microvascular angina). Distance Education. Specialty Cardiology 2010; 10 (1):8–14. Russian (Мищук Н. Е., Шусталь Н. Ф. Кардиальный синдром Х (микрососудистая стенокардия). Дистанционное обучение. Специальность кардиология 2010; 10 (1):8–14.)

6. Belotserkovtseva LD, Kovalenko LV, Korneeva EV et al. Endothelial dysfunction as a predictor of metabolic syndrome in women during perimenopause. Journal of New Medical Technologies 2010, 1:91–3. Russian (Белоцерковцева Л. Д., Коваленко Л. В., Корнеева Е. В. и др. Дисфункция эндотелия как предиктор развития метаболического синдрома у женщин в периоде перименопаузы. Вестник новых медицинских технологий 2010; 1:91–3.)

7. Kazmierski R, Watala C, Lukasik M et al. Common carotid artery remodeling studied by sonomorphological criteria. J Neuroimaging 2004; 14:258–64.

8. Kuijk JP, Flu WJ, Welten GM et al. Long-term prognosis of patients with peripheral arterial disease with or without polyvascular atherosclerotic disease. European heart journal 2009; 32 (11):992–9.

9. Khare A, Shetty S, Ghosh K. Evaluation of markers of endothelial damage in case of young myocardial infarction. Atherosclerosis 2005; 18:375–80.

10. Almazov VA, Berkovich OA, Sytnikova MY et al. Endothelial dysfunction in patients with debut of coronary heart disease in different ages. Cardiology 2001; 5:26–9. Russian (Алмазов В. А., Беркович О. А., Сытникова М. Ю. и др. Эндотелиальная дисфункция у больных с дебютом ишемической болезни сердца в разном возрасте.

11. Кардиология 2001; 5:26–9)

12. Storozhakov GI, Vereshchagina GS, Malysheva NV. Endothelial dysfunction in the elderly patients with hypertension. Clinical Gerontology 2003; 1 (9):23–8. Russian (Сторожаков Г. И., Верещагина Г. С., Малышева Н. В. Эндотелиальная дисфункция при артериальной гипертонии у пациентов пожилого возраста. Клиническая геронтология 2003; 1 (9):23–8)

13. Zakirova NE, Organov RG, Zakirova AN, et al. Endothelial dysfunction in coronary heart disease. Rational Pharmacotherapy in Cardiology 2008; 4:23–27. Russian (Закирова Н. Э., Органов Р. Г., Закирова А. Н. и др. Дисфункция эндотелия при ишемической болезни сердца. Рациональная фармакотерапия в кардиологии 2008;

14. :23–7.)

15. Lutai MI. Atherosclerosis: a modern view on the pathogenesis. Ukr. Cardiology Journal 2004, 1:22–34. Russian (Лутай М. И. Атеросклероз: современный взгляд на патогенез. Укр. кардиол. журн. 2004; 1:22–34)