Cystatin C, arterial stiffness, and echocardiography parameters in patients with respiratory diseases

The aim of the study was to investigate the content of cystatin C, indicators of arterial stiffness and echocardiography parameters in patients with respiratory diseases.

Methods. A total of 138 patients aged 22 to 85 years with respiratory diseases were examined (90 – chronic obstructive pulmonary disease (COPD), 48 – bronchial asthma (BA)). Echocardiographic examination (EchoCG), registration of arterial stiffness parameters, lipid profile test, and kidney function tests were performed. The glomerular filtration rate (GFR) was calculated in all patients using the cystatin C concentration according to the F.Hoek method.

Results. In the subgroup of patients with COPD compared with BA patients, the median cystatin C plasma concentration was significantly higher [1.26 (1.11; 1.47) mg/L vs 1.17 (0.91; 1.24) mg/L; p < 0.05)], the estimated GFR was significantly lower [59.4 (50.3; 68.0) mL/min vs 64.3 (60.1; 83.4) mL/min; p < 0.05)], the median vascular age [17.30 (4.80; 26.30)% vs 8.95 (0.10; 21.80)%; p < 0.05)] and the vascular age itself [58.0 (50.0; 68.0) years vs 50.00 (42.00; 61.00) years; p < 0.05)] were significantly higher. The cystatin C index positively correlated with the size of the left atrium, signs of left ventricular hypertrophy, indicators of diastolic dysfunction of the ventricles, systolic excursion of the tricuspid annulus, and systolic pulmonary arterial pressure.

Conclusion. The population of patients with respiratory diseases is characterized by a high incidence of comorbidities. An increase in plasma cystatin C concentration, a decrease in HDL cholesterol, inhibition of GFR, and an increase in arterial stiffness contribute to the development of cardiorenal relationships in COPD.

1. Chuchalin A.G., Avdeev S.N., Aisanov Z.R. et al. [Russian Respiratory Society. Federal guidelines on diagnosis and treatment of chronic obstructive pulmonary disease]. Pul’monologiya. 2014; (3): 15–54. DOI: 10.18093/0869-0189-2014-0-3-15-54 (in Russian).

2. Avdeev S.N. [Pathologic physiology of exacerbations of chronic obstructive pulmonary disease]. Vestnik anesteziologii i reanimatologii. 2019; 16 (2): 75–82. DOI: 10.21292/2078-5658-2019-16-2-75-82 (in Russian).

3. Lozano R., Naghavi M., Foreman K. et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematiс analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380 (9859): 2095–2128. DOI: 10.1016/S0140-6736(12)61728-0.

4. Golpe R., Suárez-Valor M., Martín-Robles I. et al. Mortality in COPD patients according to clinical phenotypes. Int. J. Chron. Obstruct. Pulmon. Dis. 2018; 13: 1433–1439. DOI: 10.2147/COPD.S159834.

5. Plutinsky M., Brat K., Svoboda M. et al. Prognostic accuracy of three COPD classification systems in relation to long-term mortality of COPD patients: a prospective multicenter study. Lung. 2019; 197 (2): 173–179. DOI: 10.1007/s00408-019-00196-6.

6. Ovcharenko S.I., Nersesyan Z.N., Morozova T.E. [Correction of systemic inflammation and endothelial dysfunction in patients with chronic obstructive pulmonary disease in combination with arterial hypertension under the influence of the therapy]. Pul’monologiya. 2020; 30 (3): 278–284. DOI: 10.18093/0869-0189-2020-30-3-278-284 (in Russian).

7. Gaynitdinova V.V., Avdeev S.N., Neklyudova G.V. et al. [An impact of cardiovascular comorbidity on course and prognosis of chronic obstructive pulmonary disease]. Pul’monologiya. 2019; 29 (1): 35–42. DOI: 10.18093/0869-0189-2019-29-1-35-42 (in Russian).

8. Murkamilov I.T., Aytbaev K.A., Fomin V.V., Mukarmilova Zh.A. [Cystatin С as a marker of chronic kidney disease]. Terapiya. 2019; (4): 57–62. DOI: 10.18565/therapy.2019.4.57-62 (in Russian).

9. Murkamilov I.T., Sabirov I.S., Fomin V.V. et al. [Correlations between parameters of central hemodynamics and cytokine profile in chronic kidney disease in combination with cerebrovascular diseases]. Zhurnal nevrologii i psikhiatrii im. S.S.Korsakova. 2019; 119 (6): 65–71. DOI: 10.17116/jnevro201911906165 (in Russian).

10. Hoek F.J., Kemperman F.A.W., Krediet R.T. A comparison between cystatin C, plasma creatinine and the Cockcroft and Gault formula for the estimation of glomerular filtration rate. Nephrol. Dial. Transplant. 2003; 18 (10): 2024–3031. DOI: 10.1093/ndt/gfg349.

11. Flachskampf F.A., ed. [Practical echocardiography: Handbook]. Translated from German. 2nd Edn. Moscow: MEDpress-inform; 2019 (in Russian).

12. Devereux R.B., Alonso D.R., Lutas E.M. et al. Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findings. Am. J. Cardiol. 1986; 57 (6): 450–458. DOI: 10.1016/0002-9149(86)90771-X.

13. Williams B., Mancia G., Spiering W. et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur. Heart J. 2018; 39 (33): 3021–3104. DOI: 10.1093/eurheartj/ehy339.

14. Sin D.D., Man S.F.P. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc. Am. Thorac. Soc. 2005; 2 (1): 8–11. DOI: 10.1513/pats.200404-032MS.

15. Bolotova E.V., Dudnikova A.V. [Chronic kidney disease in patients with chronic obstructive pulmonary disease: a role of exacerbations]. Pul’monologiya. 2016; 26 (5): 578–583. DOI: 10.18093/0869-0189-2016-26-5-578-583 (in Russian).

16. Dolgopolova D.A. [Predictors of chronic kidney disease development in patients with chronic obstructive pulmonary disease]. Klinitsist. 2016; 10 (3): 51–57. DOI: 10.17650/1818-8338-2016-10-3-51-57 (in Russian).

17. Agranovich N.V., Pilipovich L.A., Albotova L.V. [Prognostic significance of some markers of endothelial dysfunction in the development of chronic kidney pathology in chronic obstructive pulmonary disease]. Nefrologiya. 2018; 22 (5): 25–30. DOI: 10.24884/1561-6274-2018-22-5-25-30 (in Russian).

18. Bolotova E.V., Dudnikova A.V. [Particular risk factors for chronic kidney disease in patients with chronic obstructive pulmonary disease]. Nefrologiya. 2015; 19 (5): 28–33 (in Russian).

19. Laurent S., Boutouyrie P., Lacolley P. Structural and genetic bases of arterial stiffness. Hypertension. 2005; 45 (6): 1050–1055. DOI: 10.1161/01.HYP.0000164580.39991.3d.

20. Karoli N.A., Dolishnyaya G.R., Rebrov A.P. [Arterial rigidity in patients with chronic obstructive pulmonary disease]. Klinicheskaya meditsina. 2012; 90 (9): 38–42 (in Russian).

21. Men’shikova I.G., Kvasnikova Yu.V., Magalyas E.V., Sklyar I.V. [Cardiorenal interrelationships in chronic obstructive pulmonary disease]. Byulleten’ fiziologii i patologii dykhaniya. 2018; (68): 29–33. DOI: 10.12737/article_5b1894ebea7e63.33544844 (in Russian).

22. Men’shikova I.G., Kvasnikova Yu.V., Vokhmintseva I.V., Sklyar I.V. [Ultrasonic diagnostics of early signs of renal hemodynamics in patients with chronic pulmonary heart]. Dal’nevostochnyy meditsinskiy zhurnal. 2014; (4): 12–15 (in Russian).

23. Ovcharenko S.I. [Cardiovascular disease in patients with chronic obstructive pulmonary disease: how do we treat?]. Russkiy meditsinskiy zhurnal. 2018; 26 (10-1): 36–39 (in Russian).

24. Murkamilova Zh.A., Sabirov I.S., Fomin V.V. et al. [Cystatin c and vascular stiffness as markers of nephroand cerebrovascular diseases in the elderly]. Vestnik Kyrgyzsko-Rossiyskogo Slavyanskogo universiteta. 2020; 20 (5): 34–44 (in Russian).

25. Aisanov Z.R., Chuchalin A.G., Kalmanova E.N. [Chronic obstructive pulmonary disease and cardiovascular comorbidity]. Kardiologiya. 2019; 59 (8, Suppl.): 24–36. DOI: 10.18087/cardio.2572 (in Russian).

26. Nikitin V.A., Vasilieva L.V., Gosteva E.V., Pishnograeva L.V. [Influence of losartan on structural and functional remodelling of cardiovascular system in comorbidity of chronic obstructive lung disease and arterial hypertension]. Kardiovaskulyarnaya terapiya i profilaktika. 2016; 15 (5): 11–16. DOI: 10.15829/1728-8800-2016-5-11-16 (in Russian).

27. Yeh J.J., Wei Y.F., Lin C.L., Hsu W.H. Association of asthma–chronic obstructive pulmonary disease overlap syndrome with coronary artery disease, cardiac dysrhythmia and heart failure: a population-based retrospective cohort study. Br. Med. J. Open. 2017; 7 (10): e017657. DOI: 10.1136/bmjopen-2017-017657.

28. Matarese A., Sardu C., Shu J., Santulli G. Why is chronic obstructive pulmonary disease linked to atrial fibrillation? A systematic overview of the underlying mechanisms. Int. J. Cardiol. 2019; 276: 149–151. DOI: 10.1016/j.ijcard.2018.10.075.

29. Chen C.Y., Liao K.M. Chronic obstructive pulmonary disease is associated with risk of chronic kidney disease: a nationwide case-cohort study. Sci. Rep. 2016; 6: 25855. DOI: 10.1038/srep25855.

30. Trudzinski F.C., Alqudrah M., Omlor A. et al. Consequences of chronic kidney disease in chronic obstructive pulmonary disease. Respir. Res. 2019; 20 (1): 151. DOI: 10.1186/s12931-019-1107-x.