The Relationship Between Serum Thyroid Hormone Levels And Coronary Collateral Circulation In Patients With Chronic Total Occlusion

Background and ObjectiveIn the progression of coronary heart disease,the ultimate state of coronary artery stenosis is chronic total occlusion(CTO).Most CTO patients have coronary collateral circulation(CCC),which is potential blood flow channel congenitally present and normally closed.The collateral vessels open up and access to functional vascular when the coronary artery is severely stenotic or occluded.As a compensatory response to myocardial ischemia,CCC plays an important role in CTO patients.CTO lesions are mainly treated with: interventional therapy;surgical treatment;simple drug treatment.Whether it is PCI or CABG,the precondition for the benefit of opening occlusive lesions is the survival of cardiomyocytes.Due to the protective effect of CCC,the distal myocardium of the occlusion can survive.Therefore,whether the development of CCC is good or not determines the number of viable myocardium,and thus determines the efficacy of revascularization.For patients with older age,poor left ventricular function,unwillingness or unfitness for surgical treatment,good development of CCC is the last straw to save lives.Thyroid hormone(TH)is the basic hormone that maintains the functional activities of the body and acts on almost all tissues.Secretion of TH is regulated precisely by the hypothalamic-adenohypophysial-thyroid axis.This delicate negative feedback regulation is damaged by a variety of factors that cause thyroid function to hyperthyroidism or hypothyroidism.In the cardiovascular system,hyperthyroidism and hypothyroidism can significantly affect the systolic and diastolic and electrophysiological properties of heart and lead to related cardiovascular dysfunction.A large number of studies have shown that hypothyroidism(SH),subclinical hypothyroidism(SCH)are closely related to the occurrence and development of coronary heart disease and increase the prevalence and severity.So far,many factors that may affect the development of CCC have been evaluated,but whether the TH level is a risk factor for the development of CCC is not clearly assessed.The aim of this study was to find the relationship between serum TH levels and CCC development.Materials and methods1 Research object: Select elective coronary angiography in the Department of Cardiology,Second Affiliated Hospital of Zhengzhou University from 2015-09-01 to 2017-02-28 showed that 86 patients with coronary artery disease with at least one major coronary artery were chronically occluded.The inclusion criteria based on The 2013 American College of Cardiology Foundation(ACCF)/American Heart Association(AHA)/American Society of Cardiovascular Angiography and Intervention(SCAI)CTO diagnostic criteria.Detailed records of the patient’s sex,age,smoking,diabetes,hypertension,hyperlipidemia,heart failure,application of statin,aspirin,β-blockers,angiotensin-converting enzyme inhibitors/angiotensin receptors blockers,calcium channel blockers during hospitalization.Blood pressure was measured immediately after admission.Echocardiograms were performed on the same day and left ventricular ejection fractions were recorded.Fast for more than 8 hours and collect blood samples at 8 o’clock in the morning on the following day,measure blood glucose(GLU),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),and triglyceride lipid(TG),creatinine(Cre),white blood cell count,hemoglobin,platelet count,TSH,FT3,FT4 and other indicators.2 Grouping method: Based on coronary angiographic results,2 experienced cardiovascular interventionalists evaluated the extent of CCC development in at least 1 major coronary artery in patients with CTO lesions and graded according to the Cohen-Rentrop method,assigning 0 and 1 levels into the poor group(23 cases),assigning 2 and 3 levels into the poor group(63 cases).Interventional experts conducted independent assessments and conducted comparative reviews.If there were disagreements in the evaluation,the third physician gave the final decision.3 Statistical methods: SPSS 22.0 was used for statistical analysis.Measured data were expressed as mean±standard deviation(x±s).An independent t test was used to compare the homogeneity of the two groups,and a t-corrected test was used when the variance was not uniform.The count data is represented by the frequency(composition ratio),the chi-square test is used for comparison between the two groups,and the Mann Whitney U test is used for the non-parametric test.In a one-way analysis of variance,P<0.25 was considered as a potential risk and was used as an independent variable in the multivariate model.Logistic regression model was used for multivariate analysis,P<0.05 was statistically significant and as a correlation factor in multiple linear regression model.Result(1)One-way analysis of variance showed diabetes(P=0.013),hyperlipidemia(P=0.014),smoking(P=0.010),TSH(P=0.016),FT3(P=0.001),and FT4(P=0.006).Differences between groups were significantly different(P <0.05),while other factors had no statistical significance(P> 0.05).(2)One-way analysis of variance showed that the proportion of diabetes in the non-adverse group,the proportion of hyperlipidemia,the proportion of smoking,TSH levels,and the proportion of SCH were higher than those in the good group.The levels of FT3 and FT4 were lower than those in the good group(x2=6.192,6.031,6.720,t).=-2.410,x2=4.976,t=-3.586,-2.802,P<0.05).(3)Multivariate logistic regression model 1 showed diabetes(OR=3.923,95% CI(1.019,15.098)),smoking(OR=7.365,95%CI(1.614,33.606)),and SCH(OR=20.905,95% CI(3.054,143.112))were risk factors for poor CCC development(P<0.05).(4)Multivariate logistic regression model 2 showed diabetes(OR=7.022,95%CI(1.314,37.526)),smoking(OR=7.628,95%CI(1.161,52.735)),TSH(OR=1.955,95%CI(1.247,3.066))were risk factors for the development of CCC;FT3(OR=0.170,95%CI(0.043,0.671))was a good protective factor for CCC(P<0.05).(5)Linear regression showed that diabetes,smoking and TSH were negatively correlated with CCC development,and FT3 was positively correlated with CCC development.Conclusion(1)SCH,high TSH,and low FT3 are risk factors for poor collateral circulation development in patients with chronic coronary occlusion.(2)TSH is negatively correlated with the development of collateral circulation in patients with chronic coronary occlusion.FT3 is positively correlated with the development of collateral circulation in patients with chronic coronary occlusion.