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Objective To investigate the correlation between serum asymmetric dimethylarginine (ADMA) and cystatin C (CysC) in degenerative calcific aortic valvular disease and its clinical application value.Methods One hundred and eighty patients with degenerative calcific aortic valvular disease who were treated in Beijing Luhe Hospital Affiliated to Capital Medical University from June 2016 to June 2018 were selected as the study subjects,and another 82 healthy subjects from the same hospital in the same period were selected as the control group.Serum ADMA and CysC levels were detected by enzyme-linked immunosorbent assay and latex-enhanced immunoturbidimetric assay.Risk factors of degenerative calcific aortic valvular disease were analyzed by Logistic regression analysis.Evaluation of the diagnostic efficacy of serum ADMA and CysC for degenerative calcific aortic valvular disease was used by receiver operating characteristic curve.Results There were no significant differences in the general data between the two groups in terms of age,gender,body mass index,drinking history,smoking history,and history of hypertension (P＞ 0.05).The systolic blood pressure(SBP),diastolic blood pressure (DBP),heart rate (HR),total cholesterol (TC),triglyceride (TG),low density lipoprotein cholesterin(LDL-C),CysC and ADMA levels of the study group were significantly higher than those of the control group [(131.51 ± 19.09) mmHg (1 mmHg=0.133 kPa) vs.(126.48 ± 16.68) mmHg,(91.11 ± 16.35) mmHg vs.(86.89 ± 10.71) mmHg,(74.39 ± 15.22) beats/min vs.(70.09 ± 13.01)beats/min,(4.51 ± 1.12) mmol/L vs.(4.15 ± 0.92) mmol/L,(1.91 ± 0.63) mmol/L vs.(1.60 ± 0.65) mmol/L,(2.59 ± 1.13) mmol/L vs.(2.27 ± 0.85) mmol/L,(1.01 ± 0.22) mg/L vs.(0.79 ± 0.16) mg/L,(20.17 ± 6.38)ng/L vs.(11.88 ± 4.22) ng/L],and left ventricular ejection fraction (LVEF),high density lipoprotein cholesterin (HDL-C) levels were significantly lower than those of the control group [(56.45 ± 9.21)％vs.(60.87 ± 10.02)％,(1.56 ± 0.63) mmol/L vs.(1.76 ± 0.62) mmol/L],there were significant differences (P ＜ 0.05).Logistic multivariate regression analysis showed that serum CysC and ADMA were independent risk factors for degenerative calcific aortic valvular disease (P ＜ 0.05).Receiver operator characteristic (ROC) curve analysis showed that area under curve (AUC) of serum CysC for degenerative valvular heart disease was 0.785,with a sensitivity of 71.67％,and a specificity of 73.17％.The AUC of serum ADMA for degenerative valvular heart disease was 0.862,with a sensitivity of 71.67％,and a specificity of 87.80％.The AUC of serum CysC combined with ADMA in the diagnosis of degenerative valvular heart disease was 0.910,with a sensitivity of 85.56％,and a specificity of 84.15％,which was significantly higher than the two alone (Z =4.897 and 3.335,P ＜ 0.05).Conclusions Serum ADMA is positively correlated with CysC in patients with degenerative valvular heart disease,and can be used as diagnostic serum markers for degenerative calcific aortic valvular disease.It has clinical reference value for improving the diagnosis of degenerative calcific aortic valvular disease.
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Objective@#To investigate the correlation between serum asymmetric dimethylarginine (ADMA) and cystatin C (CysC) in degenerative calcific aortic valvular disease and its clinical application value.@*Methods@#One hundred and eighty patients with degenerative calcific aortic valvular disease who were treated in Beijing Luhe Hospital Affiliated to Capital Medical University from June 2016 to June 2018 were selected as the study subjects, and another 82 healthy subjects from the same hospital in the same period were selected as the control group. Serum ADMA and CysC levels were detected by enzyme-linked immunosorbent assay and latex-enhanced immunoturbidimetric assay. Risk factors of degenerative calcific aortic valvular disease were analyzed by Logistic regression analysis. Evaluation of the diagnostic efficacy of serum ADMA and CysC for degenerative calcific aortic valvular disease was used by receiver operating characteristic curve.@*Results@#There were no significant differences in the general data between the two groups in terms of age, gender, body mass index, drinking history, smoking history, and history of hypertension (P>0.05). The systolic blood pressure(SBP), diastolic blood pressure (DBP), heart rate (HR), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterin(LDL-C), CysC and ADMA levels of the study group were significantly higher than those of the control group [(131.51 ± 19.09) mmHg (1 mmHg=0.133 kPa) vs. (126.48 ± 16.68) mmHg, (91.11 ± 16.35) mmHg vs. (86.89 ± 10.71) mmHg, (74.39 ± 15.22) beats/min vs. (70.09 ± 13.01) beats/min, (4.51 ± 1.12) mmol/L vs. (4.15 ± 0.92) mmol/L, (1.91 ± 0.63) mmol/L vs. (1.60 ± 0.65) mmol/L, (2.59 ± 1.13) mmol/L vs. (2.27 ± 0.85) mmol/L, (1.01 ± 0.22) mg/L vs. (0.79 ± 0.16) mg/L, (20.17 ± 6.38) ng/L vs. (11.88 ± 4.22) ng/L], and left ventricular ejection fraction (LVEF), high density lipoprotein cholesterin (HDL-C) levels were significantly lower than those of the control group [(56.45 ± 9.21)%vs. (60.87 ± 10.02)%, (1.56 ± 0.63) mmol/L vs. (1.76 ± 0.62) mmol/L], there were significant differences (P<0.05). Logistic multivariate regression analysis showed that serum CysC and ADMA were independent risk factors for degenerative calcific aortic valvular disease (P<0.05). Receiver operator characteristic (ROC) curve analysis showed that area under curve (AUC) of serum CysC for degenerative valvular heart disease was 0.785, with a sensitivity of 71.67%, and a specificity of 73.17%. The AUC of serum ADMA for degenerative valvular heart disease was 0.862, with a sensitivity of 71.67%, and a specificity of 87.80%. The AUC of serum CysC combined with ADMA in the diagnosis of degenerative valvular heart disease was 0.910, with a sensitivity of 85.56%, and a specificity of 84.15%, which was significantly higher than the two alone (Z=4.897 and 3.335, P<0.05).@*Conclusions@#Serum ADMA is positively correlated with CysC in patients with degenerative valvular heart disease, and can be used as diagnostic serum markers for degenerative calcific aortic valvular disease. It has clinical reference value for improving the diagnosis of degenerative calcific aortic valvular disease.
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El Fondo Nacional de Recursos (FNR) es un sistema nacional de financiación de medicina altamente especializada; financia 380 reemplazos valvulares aórticos (RVA) anualmente. Objetivo: evaluar la mortalidad a los 30 días de la cirugía y los factores de riesgo preoperatorios en los RVA realizados en Uruguay entre el 1 de enero de 2003 y el 31 de diciembre de 2007. Métodos: se incluyeron todos los pacientes operados de RVA aislado y combinado (RVAC) con by pass coronario. La base de datos del FNR registra todas las cirugías cardíacas realizadas en Uruguay. Realizamos un análisis de regresión logística binaria para desarrollar un modelo de riesgo.Resultados: incluimos 1.930 pacientes (edad promedio 68,4 años, masculino 60,2%); mortalidad a 30 días 6,6% (127), RVA aislado 5,6% (59/1061) y RVAC 7,8% (68/869). Las variables retenidas en el modelo fueron género femenino y edad entre 60-69 años (OR 4,96; IC95% 1,33-18,55), femenino entre 70-79 años (OR 3.6; IC95% 0,99-13,13) femenino y ³ 80 años (OR 4,86; IC95% 1,09-21,72), masculino y ³ 80 años (OR 6,97; IC95% 1,60-30,37), endocarditis infecciosa activa (OR 4,1; IC95% 1,28-13,11), fracción de eyección del ventrículo izquierdo (FEVI) disminuida: fracci{on de eyección (FE) 30%-50% (OR 1,84; IC95% 1,20-2,81) y FEVI < 30%, (OR 2,23; IC95% 1,32-3,78), cirugía cardíaca previa (OR 3,79; IC95% 2,25-6,36), situación crítica pre-operatoria (OR 6,18; IC95% 2,34-16,32) e insuficiencia cardíaca clase IV (OR 2,13; IC95% 0,97-4,66). La discriminación y la calibración interna del modelo fueron buenas (índice-C= 0,72 y p=0,928 en la prueba de Hosmer-Lemeshow, respectivamente). Conclusiones: la mortalidad a 30 días en el RVA fue 6,6% y estuvo asociada a factores propios del paciente ...
FNR is a national system to grant financing for highly specialized medical services; finances 380 aortic valve replacements (AVR) annually. Objective: to evaluate 30-day mortality and preoperative risk factors in AVR made in Uruguay between 1st January 2003 and 31st December 2007. Methods: all consecutive isolated AVR and combined with coronary bypass (AVRC) were included. Register of FNR database included data about all cardiac surgeries in the country. Multivariable logistic regression analysis was used for develop a risk model. Results: 1.930 patients (age 68,4 years, male 60,2%) were included. 30-day mortality was 6,6% (127), isolate AVR 5,6% (59/1.061) and AVRC 7,8% (68/869). Variables in the model were female and age between 60-69 years (OR 4,96; IC95% 1,33-18,55), female and age between 70-79 years (OR 3,6; IC95% 0,99-13,13), female and age 80 years (OR 4,86; IC95% 1,09-21,72), male and age 80 years (OR 6,97; IC95% 1,60-30,37), active endocarditis (OR 4,1; IC95% 1,28-13,11), diminished ejection fraction (EF): EF 30 to 50% (OR 1,84; IC95% 1,20-2,81) and EF <30% (OR 2,23; IC95% 1,32-3,78), previous cardiac surgery (OR 3,79; IC95% 2,25-6,36), preoperative critical state (OR 6.18; IC95% 2.34-16.32) and class IV cardiac failure of NYHA (OR 2.13; IC95% 0,97-4,66). The discrimination of logistic risk model was good (c-index: 0,72) and the internal calibration also (Hosmer-Lemeshow test, p=0,928).Conclusions: 30-day mortality in AVR was 6,6% and was associated to patient factors (age, sex), cardiovascular disease factors (active endocarditis, previous cardíac surgery, class IV of cardíac failure, EF) and to preoperative clinical state. The risk model could be useful for clinical decisions and patient information.