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Diagnostic value and method of soluble transferrin receptor for suspected coronary artery disease: a case-control
Zheng Wang1, Banglong Xu1, Yan Tan1
1Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
Insights
Soluble transferrin receptor (sTfR) shows a "J" shape correlation with coronary artery disease (CAD) risk. sTfR aids in diagnosing CAD in patients with symptoms, outperforming cardiac troponin I.
Area of Science:
- Cardiology
- Iron Metabolism
- Biomarkers
Background:
- The relationship between iron metabolism and coronary artery disease (CAD) remains unclear, with conflicting evidence regarding iron overload and deficiency.
- Existing research lacks consensus on how iron metabolism influences CAD development and progression.
Purpose of the Study:
- To analyze the association between iron metabolism indexes and CAD.
- To evaluate the diagnostic utility of soluble transferrin receptor (sTfR) in suspected CAD.
- To establish a diagnostic model for CAD using iron metabolism indexes.
Main Methods:
- Retrospective study of 268 patients with CAD-like symptoms undergoing coronary angiography.
- Categorization of iron metabolism indexes by tertiles to assess CAD risk.
- Utilized restricted cubic spline (RCS) to model the sTfR-CAD risk relationship and logistic regression for diagnostic models.
Main Results:
- A "J"-shaped correlation was observed between sTfR and CAD risk.
- The age/sTfR ratio demonstrated high diagnostic efficiency in the low sTfR subgroup (AUC=0.690).
- sTfR showed superior diagnostic efficacy (AUC=0.701) compared to cardiac troponin I (AUC=0.674) in the high sTfR subgroup.
Conclusions:
- sTfR is a valuable biomarker correlating with CAD morbidity in a "J"-shaped manner.
- sTfR exhibits superior diagnostic performance over cTnI for CAD detection in symptomatic individuals.
- sTfR can guide management of body iron levels in CAD patients.
Background:
Many studies have pointed out that iron overload in the body is a risk factor for coronary atherosclerosis (AS), while there are also studies that show that iron deficiency is associated with coronary AS. There is still no consensus on how iron metabolism affects coronary artery disease (CAD). This study aimed to analyze the relationship between iron metabolism indexes and CAD, investigate the diagnostic value of soluble transferrin receptor (sTfR) in suspected CAD, and establish a diagnostic model.
Methods:
This was a retrospective study. A total of 268 people with CAD-like symptoms who underwent coronary angiography in the Department of Cardiovascular Medicine, The Second Affiliated Hospital of Anhui Medical University from September 2022 to May 2023 without other chronic diseases or related medication history were included in the study and formed a continuous series including 188 CAD patients and 80 control subjects. Each iron metabolism index was divided into a grade variable according to tertile. The comparison of CAD morbidity between the tertiles and nonlinear correlation test was conducted to investigate the relationship between iron metabolism indexes and CAD risk. We used restricted cubic spline (RCS) to plot the relationship curve between sTfR and CAD risk and to determine the sTfR value corresponding to the minimal odds, according to which we divided the total sample into the "sTfR low level" subgroup and the "sTfR high level" subgroup. Logistic regression analyses were used to establish diagnostic models in both subgroups. The diagnostic efficiency of the indexes and models was compared by receiver operating characteristic (ROC) analysis.
Results:
There is a "J" shape correlation between sTfR and CAD risk. Age/sTfR ratio [area under the curve (AUC) =0.690, 95% confidence interval (CI): 0.598-0.782, specificity 0.488 and sensitivity 0.842] has the best diagnostic efficiency in the "sTfR low level" subgroup. The diagnostic efficiency of sTfR (AUC =0.701, 95% CI: 0.598-0.803, specificity 0.541 and sensitivity 0.797) in the "sTfR high level" subgroup was higher than that of cardiac troponin I (cTnI) (AUC =0.674, 95% CI: 0.564-0.784, specificity 0.719 and sensitivity 0.653). The specific diagnostic methods were as follows: (I) When sTfR ≤1.087 mg/L, calculate the age/sTfR ratio, which indicates the diagnosis of CAD when the result is >58.595; (II) We can directly make a preliminary clinical diagnosis of CAD when sTfR >1.205 mg/L. Except for the above 2 cases, we can initially rule out a diagnosis of CAD.
Conclusions:
The iron metabolism index sTfR correlates with CAD morbidity in a "J" shape. With superior diagnostic efficacy than cTnI, sTfR can assist in diagnosing CAD in patients with CAD-like symptoms. In addition, sTfR can provide guidance for the management of body iron levels in CAD patients.
