Journal List > Korean Circ J > v.38(8) > 1016367

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Choi, Yoon, Choi, Lim, Yang, Woo, Hwang, Kang, Choi, Hwang, Shin, Park, Park, Lee, Lee, and Tahk: Correlation Between the Serum Bilirubin Level and the Coronary Microvascular Integrity in Diabetic Patients
Original Article
Korean Circulation Journal

Korean Circulation Journal 2008; 38(8): 425-431.

Published online: 31 August 2008

DOI: https://doi.org/10.4070/kcj.2008.38.8.425

Correlation Between the Serum Bilirubin Level and the Coronary Microvascular Integrity in Diabetic Patients

Un-Jung Choi, MD, Myeong-Ho Yoon, MD, So-Yeon Choi, MD, Hong-Seok Lim, MD, Hyoung-Mo Yang, MD, Seong-Ill Woo, MD, Jung-Won Hwang, MD, Soo-Jin Kang, MD, Byoung-Joo Choi, MD, Gyo-Seung Hwang, MD, Joon-Han Shin, MD, Jin-Sun Park, MD, Se-Joon Park, MD, You-Hong Lee, MD, Yoon-Seok Lee, MD, Seung-Jea Tahk, MD

Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea.

Correspondence: Seung-Jea Tahk, MD, Department of Cardiology, School of Medicine, Ajou University, San 5 Woncheon-dong, Yeongtong-gu, Suwon 443-721, Korea. Tel: 82-31-219-5723, Fax: 82-31-219-5708, sjtahk@ajou.ac.kr

Received 25 March 2008       Accepted 18 May 2008

Copyright © 2008 The Korean Society of Cardiology

Abstract

Background and Objectives

Bilirubin has a protective role in suppressing atherosclerosis and coronary artery disease by its potent physiological antioxidant properties. There has been no comparative study on the relation between the bilirubin level and the coronary microvascular function in diabetic patients. This study investigated whether the bilirubin level correlates with the coronary microvascular integrity in diabetes by assessing the coronary flow velocities after successful percutaneous coronary intervention (PCI).

Subjects and Methods

Fifty patients (31 males and 19 females, mean age 60±11) with angina and who received elective PCI were studied. Using an intracoronary Doppler wire, the coronary flow velocity reserve (CFR), the hyperemic microvascular resistance index and the phasic coronary flow velocity patterns were measured after PCI.

Results

The mean value of the fasting blood glucose was 211±88 mg/dL, the man value of glycated hemoglobin A1c (HbA1c) was 8.1±1.6% and the mean serum total bilirubin level was 0.59±0.21 mg/dL. CFR was significantly correlated with the serum bilirubin level (r=0.485, p<0.001), HbA1c (r=-0.432, p=0.003) and the fasting blood glucose (r=-0.361, p=0.011). On multivariate analysis, HbA1c, bilirubin and left ventricular hypertrophy showed independent relationships with coronary microvascular dysfunction (p=0.003, p=0.004, p=0.033, respectively).

Conclusion

These results suggest that glycemic control and elevated serum bilirubin may protect diabetic patients from coronary microvascular dysfunction.

Keywords: Bilirubin, Diabetes mellitus, Microvasculature

Figures and Tables

Fig. 1
The relationship among the microvascular indices, HbA1c and bilirubin. Serum bilirubin is plotted against CFR (A), bAPV (B), bDDT (C) and HbA1c (D). The correlation coefficients are shown. CFR: coronary flow reserve, bAPV: baseline average peak velocity, bDDT: baseline diastolic deceleration time, HbA1c: glycated hemoglobin A1c.
kcj-38-425-g001
Fig. 2
The receiver operating characteristic (ROC) curve analysis and the adequate cut-off values of bilirubin and HbA1c for a CFR <2. The best cut-off values (BCVs) for a CFR <2 are 0.5 mg/dL (A) and 8.2% (B). HbA1c: hemoglobin A1c, AUC: area under the curve.
kcj-38-425-g002
Fig. 3
Comparison of the CFR according to the median value of bilirubin and HbA1c. The CFR was higher for a bilirubin level >0.5 mg/dL and a HbA1c=8.1%. CFR: coronary flow reserve, HbA1c: hemoglobin A1c.
kcj-38-425-g003
Table 1
Baseline clinical characteristics of the patients
kcj-38-425-i001

BMI: body mass index, TC: total cholesterol, AST: aspartate transaminase, ALT: alaninie transaminase, HbA1c: glycated hemoglobin A1c, CK: creatine kinase, CK-MB: creatine kinase-myocardial band, LVH: left ventricular hypertrophy

Table 2
Baseline angiographic findings of the patients
kcj-38-425-i002

LAD: left anterior descending artery, LCx: left circumflex artery, RCA: right coronary artery, PCI: percutaneous coronary intervention, MLD: minimal luminal diameter, DS: diameter stenosis

Table 3
Univariate and multivariate predictors of CFR among the clinical variables
kcj-38-425-i003

CFR: coronary flow reserve, CI: confidence interval, HbA1c: glycated hemoglobin A1c, CK: creatine kinase, CK-MB: creatine kinase-myocardial band, LVH: left ventricular hypertrophy, SBP: systolic blood pressure, DBP: diastolic blood pressure, HR: heart rate, bpm: beats per minute, MLD: minimal luminal diameter

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