Correlation Between Serum Bilirubin Level and Coronary Microvascular Integrity in Diabetic Patients
BACKGROUND AND OBJECTIVE: Bilirubin is a potent physiological antioxidants, it has been suggested that it may have a protective role in suppressing atherosclerosis and coronary artery disease. There has not been comparative studies for the relation of bilirubin level and coronary microvascular function in diabetes. This study investigates whether bilirubin can preserve coronary microvascular integrity in diabetes, by assessing thecoronary flow velocities after successful percutaneous coronary intervention (PCI). METHODS: Thirty-seven patients (25 males and 12 females, mean age 60 ± 10) who received elective PCI for significant coronary artery disease, were studied. Using an intracoronary Doppler wire, coronary flow velocity (CFR), hyperemic microvascular resistance index (hMVRI) and phasic coronary flow velocity patterns were measured after PCI. On admission, blood sample was acquired to evaluate the glucose level, glycated hemoglobin A1c (HbA1c) and total bilirubin in patients without evidence of definitive liver disease. RESULTS: The mean values were fasting blood glucose level 209 ± 90mg/dL, HbA1c 8.3 ± 1.6%, total bilirubin 0.59 ± 0.21mg/dL, CFR 2.86 ± 1.27, bDDT 653 ± 201msec, hDDT 812 ± 291 and hMVRI 2.05 ± 0.59mmHg·cm-1·sec. Serum total bilirubin was significantly correlated with CFR (r=0.439, p=0.007), bDDT (r=0.387, p=0.020), hDDT (r=0.390, p=0.019) and hMVRI (r=-0.404, p=0.024), and HbA1c, known as factors affecting coronary microvascular function, was also significantly correlated (r=-0.367, p=0.025). In multivariate analysis, serum total bilirubin was variable with a significant correlation with the coronary microvascular dysfunction while age, fasting blood glucose level, HbA1c, hypertension, dyslipidemia and left ventricular hypertrophy had no significant correlation. CONCLUSIONS: These results suggest that serum bilirubin, via its antioxidant potential, may protect from coronary microvascular dysfunction and could be as a usefuland independent predictor of microvascular integrity in diabetic patients.
빌리루빈, microvascular integrity, 당뇨, 당화혈색소, 관상동맥 혈류예비력, DDT, 미세 혈류 저항지수, Bilirubin, Diabetes, HbA1c, Microvascularintegrity, CFR, MVRI
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