The Relationship Between Coronary Collateral Circulation and Serum Endocan Levels in Patients with Coronary Chronic Total Occlusions
Ahmet Seyfeddin Gürbüz, Yakup Alsancak, Semi Öztürk, Süleyman Çağan Efe, Ali Yaman, Cevat Kırma
Keywords: Endocan, coronary collateral circulation, angiogenesis, coronary artery disease
Introduction: Endocan, a dermatan sulfate proteoglycan, is synthesized and secreted by the vascular endothelium. It is involved in the pathogenesis of vascular diseases, organ-specific inflammations, and angiogenesis. The aim of the present study was to investigate the relationship between serum endocan level and development of coronary collateral circulation (CCC) in patients with stable angina pectoris. Patients and Methods: Patients with stable angina with at least one chronic total coronary occlusion (CTO) (n= 44) and who had normal coronary artery (n= 29) were included in the study. Collateral degree was evaluated according to the Rentrop and Cohen's classification. Patients who had grade 0 or 1 collateral filling were included in the poorly developed collateral group (n= 19), and those with grade 2 or 3 collateral filling were included in the well-developed collateral group (n= 23). Results: Endocan levels were significantly higher in patients in the well CCC group than in those in the poor CCC and control groups (p< 0.001). Endocan level is higher in patients with poorly developed CCC than in the control group. Endocan was only found as an independent predictor of well CCC in regression analysis (odds ratio 1.002, 95% confidence interval (CI) 1.001-1.005, p= 0.001). Receiver operating characteristic curve analysis detected an optimal cut-off value for endocan level of 1773.9 ng/L that predicted the presence of well development of CCC with a sensitivity of 84% and specificity of 63% (area under the receiver operating characteristic (ROC) curve: 0.749, 95% CI: 0.654-0.849, p< 0.001). Conclusion: Elevated endocan level is associated with better CCC in patients with CTO. Endocan may play an important role in the development of CCC.