Η συσχέτιση της αντιδραστικής υπεραιμίας δακτύλου με τη στεφανιαία εφεδρεία ροής, την αρτηριακή σκληρία και τη λιποπρωτεϊνική φωσφολιπάση Α2 (Lp-PLA2), σε ασθενείς με διαγνωσθείσα χρόνια στεφανιαία νόσο

Background: Lipoprotein-associated Phospholipase A2 (Lp-PLA2), has apowerful inflammatory and atherogenic action in the vascular wall and is anindependent marker of poor prognosis in coronary artery disease (CAD). Weinvestigate the association of Lp-PLA2 with markers of vascular dysfunction andatherosclerosis with proven prognostic value in CAD.Methods: In 111 patients with angiographically documented chronic CAD, wemeasured 1) carotid intima-media thickness (CIMT), 2) reactive hyperemia usingfingertip peripheral arterial tonometry (RH-PAT), 3) coronary flow reserve (CFR), byDoppler echocardiography 4) pulse wave velocity (PWV) and 5) blood levels of Lp-PLA2.Results: Patients with Lp-PLA2 concentration >234.5 ng/ml (50th percentile)had higher CIMT (1.44 ±0.07 vs. 1.06 ±0.06 mm), PWV (11.0±2.36 vs. 9.7±2.38 m/s)and lower RHI-PAT(1.24±0.25 vs. 1.51 ±0.53) and CFR (2.39 ± 0.75 vs. 2.9 ±0.86)compared to those with lower Lp-PLA (p < 0.05 for all comparisons). Lp-PLA2 waspositively associated with CIMT (regression coefficient b: 0.30 per unit of Lp-PLA2,p = 0.02), PWV (b:0.201, p = 0.04) and inversely with RHI-PAT (b: -0.371, p < 0.001)and CFR (b: -0.32, p = 0.002). In multivariate analysis, Lp-PLA2 was an independentdeterminant of RHI-PAT, CFR, CIMT and PWV in a model including age, sex,smoking, diabetes, dyslipidemia and hypertension (p < 0.05 for all vascular markers).Lp-PLA2, RHI-PAT and CFR were independent predictors of cardiac events during a3-year follow-up.Conclusions: Elevated Lp-PLA2 concentration is related with endothelialdysfunction, carotid athero-sclerosis, impaired coronary flow reserve and increasedarterial stiffness and adverse outcome in CAD patients. These findings suggest thatthe prognostic role of Lp-PLA2 in chronic CAD may be explained by a generalizeddetrimental effect of this lipase on endothelial function and arterial wall properties. ; Εισαγωγή: Η λιποπρωτεϊνική φωσφολιπάση A2 (Lp-PLA2), παρουσιάζει μιαισχυρή φλεγμονώδη και αθηρογόνο δράση στο αγγειακό τοίχωμα και αποτελεί ...