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The relationship between L-arginine/ADMA ratio and coronary collateral development in patients with low glomerular
Murat Celik1, Atila Iyisoy, Turgay Celik
1Department of Cardiology, Van Army District Hospital, Van, Turkey. drcelik00@hotmail.com
Insights
Reduced kidney function (GFR < 60 mL/min) is linked to poorer coronary collateral development (CCD) due to a lower L-arginine/ADMA ratio, impacting angiogenesis.
Area of Science:
- Cardiology
- Nephrology
- Vascular Biology
Background:
- Coronary artery disease (CAD) patient outcomes vary despite similar disease severity.
- Coronary collateral development (CCD) is a key factor influencing outcomes in CAD.
- Factors influencing inter-individual differences in CCD remain unclear.
Purpose of the Study:
- To investigate the relationship between glomerular filtration rate (GFR) and coronary collateral development (CCD) in patients with significant coronary artery stenosis.
- To evaluate the role of asymmetric dimethylarginine (ADMA) and L-arginine levels in modulating CCD in relation to kidney function.
Main Methods:
- Patients with >=95% stenosis in a major coronary artery were grouped by GFR (<60 mL/min vs. >60 mL/min).
- CCD was assessed using Rentrop grades.
- Plasma concentrations of L-arginine and ADMA were measured, and the L-arginine/ADMA ratio was calculated.
Main Results:
- Higher Rentrop grades (indicating better CCD) were more frequent in patients with GFR > 60 mL/min.
- A statistically significant difference in the L-arginine/ADMA ratio was observed between groups, particularly between low GFR/poor CCD and high GFR/good CCD.
- The L-arginine/ADMA ratio was the sole significant predictor of CCD in multivariate analysis.
Conclusions:
- Impaired kidney function (GFR < 60 mL/min) is associated with reduced coronary collateral development.
- A decreased L-arginine/ADMA ratio in patients with lower GFR may adversely affect endothelial function and angiogenesis, contributing to poor CCD.
Background:
It is yet to be established which factors are responsible for differences among patients with the same degree of coronary artery disease in terms of coronary collateral development (CCD).
Methods:
Patients who had a greater than or equal to 95% stenosis in at least one epicardial coronary artery were classified into two groups according to their glomerular filtration rate (GFR) level. Afterwards, the degree of CCD was evaluated according to their plasma concentration of asymmetric dimethylarginine (ADMA) and GFR levels.
Results:
Rentrop grade 2-3 was found more frequently in patients with GFR > 60 mL/min than in patients with GFR < 60 mL/min (68.6% vs 41.4%, p = 0.032). Then we divided patients into four groups according to their GFR levels and Rentrop grades; whereas we did not find any significant difference for L-arginine or ADMA levels (respectively p = 0.629 and p = 0.076), we did find a statistically significant difference between groups for L-arginine/ /ADMA ratio (p = 0.003) and this statistically significant difference was evident between patients with GFR < 60 mL/min and Rentrop 0-1 and patients with GFR > 60 mL/min and Rentrop 2-3 (1.23 vs 1.69, p < 0.001). Multivariate logistic regression analysis revealed that L-arginine/ADMA ratio was the only variable which had a significant effect on CCD (OR = 1.016; 95% CI 1.001-1.031, Wald = 4.565; p = 0.033).
Conclusions:
These results showed that CCD was poor in patients with GFR < 60 mL/min, presumably because of the adverse effect of decreased L-arginine/ADMA ratio on endothelial cells and angiogenesis.
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