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Assessment of serum trace element levels in rheumatic heart disease: A case-control study

Year 2019, Volume: 4 Issue: 1, 1 - 5, 15.03.2019
https://doi.org/10.25000/acem.451394

Abstract

Aim: Some trace elements play important roles in
various heart diseases. In this study, we aimed to determine the changes in
some trace element concentrations in the serum of patients with rheumatic heart
disease (RHD).

Methods: Sixty-one patients with RHD and 60
healthy subjects were included in the study. Six subgroups were defined in the
study group according to the Wilkins score, the degree of aortic involvement,
and the presence or absence of pulmonary hypertension. Selenium (Se), Zinc (Zn),
and Cupper (Cu) levels were measured, and transthoracic echocardiography was
performed in all participants.

Results: Serum Se and Zn concentrations were
significantly lower in the patients compared to the controls (mean±SD and p 43.08±1.83
µg/dL vs. 60.75±2.44 µg/dL; t=-5.305‎, p=0.001 and 64.65±2.77 µg/dL vs.
87.34±3.33 µg/dL; t=-5.458, p=0.001, respectively). However, the serum Cu
concentration was significantly higher in the patient group than in the control
group (84.50±3.50 µg/dL vs. 74.23±3.08 µg/dL; t=2.309, p=0.023). Similarly, the
Cu/Zn ratio in the patient group was found to be significantly higher than the
control group (1.4±0.09 µg/dL vs. 0.9±0.04 µg/dL; t=5.267, p=0.001). In the
patient group, there was no significant relationship between the Wilkins score,
aortic involvement, pulmonary hypertension, the serum trace element
concentrations, and Cu/Zn ratio (p>0.05 for all).







Conclusions:
We conclude that the changes in the concentrations of the measured trace
elements can predispose ‎to RHD and play a role in the formation of certain
factors that leads to the development of the ‎disease. Besides, serum Cu levels
and Cu/Zn ratio can be used as inflammatory process markers.

References

  • 1. Amigo MC, Martinez-Lavin M, Reyes PA. Acute rheumatic fever. Rheum Dis Clin North ‎Am. 1993;19:333–50. ‎
  • ‎2. ‎ Licciardi F, Scaioli G, Mulatero R, Marolda A, Delle Piane M, Martino S, et al. ‎Epidemiologic Impact of the New Guidelines for the Diagnosis of Acute Rheumatic Fever. J ‎Pediatr. 2018;198:25-8.
  • ‎3. ‎ Barandier C, Tanguy S, Pucheu S, Boucher F, De Leiris J. Effect of antioxidant trace ‎elements on the response of cardiac tissue to oxidative stress. Ann N Y Acad Sci. 1999;874:138–55. ‎
  • ‎4. ‎ Kosar F, Sahin I, Acıkgöz N, Aksoy Y, Kucukbay Z, Cehreli S. Significance of Serum Trace ‎Element Status in Patients with Rheumatic Heart Disease: A Prospective Study. Biol Trace ‎Elem Res. 2005;107:1-10
  • ‎5. ‎ Alissa EM. Antioxidants and Cardiovascular Disease: A summary of the Evidence. J ‎Cardiovasc Dis. 2015;3:347–56. ‎
  • ‎6. ‎ Song Y, Cook NR, Albert CM, Van Denburgh M, Manson JE. Effects of vitamins C and E ‎and β-carotene on the risk of type 2 diabetes in women at high risk of cardiovascular disease: ‎a randomized controlled trial–. Am J Clin Nutr. 2009;90:429–37. ‎
  • ‎7. ‎ Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The ‎Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) ‎statement: Guidelines for reporting observational studies. PLoS Med. 2007;4:1623–7. ‎
  • ‎8. ‎ Rhodes KL, Rasa MM, Yamamoto LG. Acute Rheumatic Fever: Revised Diagnostic Criteria. ‎Pediatr Emerg Care. 2018;34:436–40. ‎
  • ‎9. ‎ Wilkins GT, Weyman AE, Abascal VM, Block PC, Palacios IF. Percutaneous balloon ‎dilatation of the mitral valve: An analysis of echocardiographic variables related to outcome ‎and the mechanism of dilatation. Heart. 1988;60:299–308. ‎
  • ‎10. ‎ Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, et al. Guidelines on ‎the management of valvular heart disease: The Task Force on the Management of Valvular ‎Heart Disease of the European Society of Cardiology. Eur Heart J. 2007;28:230–68. ‎
  • ‎11. ‎ Yamamoto K, Masuyama T, Tanouchi J, Uematsu M, Doi Y, Mano T, et al. Peak early ‎diastolic filling velocity may decrease with preload augmentation: effect of concomitant ‎increase in the rate of left atrial pressure drop in early diastole. J Am Soc Echocardiogr. ‎‎1993;6:245–54. ‎
  • ‎12. ‎ Karpuz H, Ikitimur B. [Echocardiographic evaluation of aortic stenosis]. Ana Kar Der. ‎2002;2:65-9.
  • ‎13. ‎ Godley RW, Green D, Dillon JC, Rogers EW, Feigenbaum H, Weyman AE. Reliability of ‎two-dimensional echocardiography in assessing the severity of valvular aortic stenosis. Chest. ‎‎1981;79:657–62. ‎
  • ‎14. ‎ Stoddard MF, Hammons RT, Longaker RA. Doppler transesophageal echocardiographic ‎determination of aortic valve area in adults with aortic stenosis. Am Heart J. 1996;132:337–42. ‎
  • ‎15. ‎ Yeager M, Yock PG, Popp RL. Comparison of Doppler-derived pressure gradient to that ‎determined at cardiac catheterization in adults with aortic valve stenosis: Implications for ‎management. Am J Cardiol. 1986;57:644–8. ‎
  • ‎16. ‎ Bai AD, Steinberg M, Showler A, Burry L, Bhatia RS, Tomlinson GA, et al. Diagnostic ‎accuracy of transthoracic echocardiography for infective endocarditis findings using ‎transesophageal echocardiography as the reference standard: a meta-analysis. J Am Soc ‎Echocardiogr. 2017;30:639–46. ‎
  • ‎17. ‎ Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3:A flexible statistical power analysis ‎program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–91.
  • ‎18. ‎ Oster O, Prellwitz W. Selenium and cardiovascular disease. Biol Trace Elem Res.1990;24:91-103.
  • ‎19. ‎ Bai-Song N, Chung-Seng L, Li-Hua C. Significance of low levels of blood selenium in ‎dilated cardiomyopathy‎. Bio Trace Elem Res. 1986 Dec;99(12):948-9.
  • ‎20. ‎ Klevay LM. The role of copper, zinc and other chemical elements in ischemic heart disease . ‎eds. CRC, Boca Raton, ‎FL, pp. 1984;129–157.‎. In: Rennert OM, Chan WY, editors. ‎Metabolism of trace metals in man. Boca Raton: CRC; 1984. p. 129–57. ‎
  • ‎21. ‎ Yu X, Huang L, Zhao J, Wang Z, Yao W, Wu X, et al. The Relationship between Serum Zinc ‎Level and Heart Failure: A Meta-Analysis. Biomed Res Int. 2018;2018:2739014‎.
  • ‎22. ‎ Govindaraju V, Prabhudev N, Gurappa M, Jawali VS, Chandrasekhara PM, Manjunath CN. ‎Zinc in rheumatic heart valves. J Assoc Physicians India. 1993;41:653–4. ‎
  • ‎23. ‎ Durak I, Akyol Ö, Es MU, Canbolat O, Akpoyraz M. Element structure in stenotic mitral ‎valves. Am J Cardiol. 1993;71:355. ‎
  • ‎24. ‎ Chandra RK. Trace Element Regulation of Immunity and Infection. J Am Coll Nutr. ‎‎1985;4:5–16. ‎
  • ‎25. ‎ Rotruck JT, Pope AL, Ganther HE, Swanson AB, Hafeman DG, Hoekstra WG. Selenium: ‎biochemical role as a component of glutathione peroxidase. Science. 1973;179:588–90. ‎
  • ‎26. ‎ El-Ghazaly MA, Fadel N, Rashed E, El-Batal A, Kenawy SA. Anti-inflammatory effect of ‎selenium nanoparticles on the inflammation induced in irradiated rats. Can J Physiol ‎Pharmacol. 2017;95:101–10. ‎
  • ‎27. ‎ Galante A, Pietroiusti A, Vellini M, Piccolo P, Possati G, De Bonis M, et al. C-reactive protein ‎is increased in patients with degenerative aortic valvular stenosis. J Am Coll Cardiol. 2001;38:1078–82. ‎
  • ‎28. ‎ Nystrom-Rosander C, Lindh U, Friman G, Lindqvist O, Thelin S, Ilback N-G. Trace element ‎changes in sclerotic heart valves from patients are expressed in their blood. Biometals. 2004;17:121–8. ‎
  • ‎29. ‎ Goldstein I, Halpern B, Robert L. Immunological relationship between streptococcus A ‎polysaccharide and the structural glycoproteins of heart valve. Nature. 1967;213:44–7. ‎
  • ‎30. ‎ Nyström-Rosander C, Lindh U, Ilbäck NG, Hjelm E, Thelin S, Lindqvist O, et al. ‎Interactions between Chlamydia pneumoniae and trace elements: A possible link to aortic ‎valve sclerosis. Biol Trace Elem Res. 2003;91:97–110. ‎
  • ‎31. ‎ Funseth E, Lindh U, Friman G, Ilbäck NG. Relation between trace element levels in plasma ‎and myocardium during coxsackievirus B3 myocarditis in the mouse. BioMetals. ‎‎2000;13:361–7. ‎
  • ‎32. ‎ Levander OA, Ager ALJ, Beck MA. Vitamin E and selenium: contrasting and interacting ‎nutritional determinants of host resistance to parasitic and viral infections. Proc Nutr Soc. ‎‎1995;54:475–87. ‎
  • ‎33. ‎ Chen X, Yang G, Chen J, Chen X, Wen Z, Ge K. Studies on the relations of selenium and ‎Keshan disease. Biol Trace Elem Res. 1980;2:91–107.

Romatizmal kalp hastalığında serum eser element seviyelerinin değerlendirilmesi: Bir vaka kontrol araştırması

Year 2019, Volume: 4 Issue: 1, 1 - 5, 15.03.2019
https://doi.org/10.25000/acem.451394

Abstract

Amaç: Değişik kalp
hastalıklarında bazı eser elementlerin önemli olduğu bilinmektedir. Bu
çalışmada Romatizmal Kalp Hastalığı (RKH) olan hastaların serumunda bazı eser
element konsantrasyonlarındaki değişiklikleri belirlemek ve bunun kronik RKH
ve kapak tutulumunun şiddetiyle olan ilişkisinin ortaya konması
amaçlanmıştır.

Metod: RKH olan 61 hasta ve
60 sağlıklı birey çalışma kapsamına alındı. Bu çalışmaya alınan hasta
grup, Wilkins skoruna, aort tutulumunun derecesine ve ayrıca pulmoner
hipertansiyonun varlığı ve yokluğuna göre olmak üzere toplam altı alt gruba
daha ayrıldı. Hastalara ayrıntılı fizik muayene ve laboratuvar incelemesinin
yanında kan Se, Zn ve Cu analizleri yapıldı. Hasta ve kontrol guruplarına
transtorasik ekokardiografi ile ölçümler standart görünümleri üzerinden
yapıldı.

Bulgular: Hasta grubunda
serum Se ve Zn konsantrasyonu kontrol grubuna göre anlamlı ölçüde düşük
bulundu (sırasıyla 43,08±1,83 µg/dL; 60,75±2,44 ‎µg/dL; p<0,001) ve
64,65±2,77‎ µg/dL; 87,34±3,33 µg/dL; p<0.001). Serum Cu konsantrasyonu hasta
grubunda kontrol grubuna göre anlamlı ölçüde yüksek bulunmuştur (84,5±3,5
‎µg/dL’ye karşılık 74,23± 3,08 µg/dL, p<0.05). Benzer şekilde Cu/Zn oranı
hasta grubunda kontrol grubuna göre anlamlı ölçüde yüksek bulunmuştur
(1,4±0,09 µg/dL’ye karşılık 0,9±0,04 µg/dL, p<0.001). Hasta grubunda serum
eser element konsantrasyonları ve Cu/Zn oranı ile hastalığın tutulum
şiddetini gösteren Wilkins skoru, aort tutulumu ve pulmoner hipertansiyon
arasında anlamlı bir ilişki bulunmamıştır (p>0,05).







Sonuç: Eser element
konsantrasyonundaki değişiklikler RKH’nı predispoze edebileceği gibi
hastalığın gelişimine yol açan bazı faktörlerin ortaya çıkmasına da katkı
sağlayabilir. Ek olarak artmış serum Cu seviyesi ve Cu/Zn oranı devam eden
inflamatuvar proçes markırları olarak kullanılabilir.

References

  • 1. Amigo MC, Martinez-Lavin M, Reyes PA. Acute rheumatic fever. Rheum Dis Clin North ‎Am. 1993;19:333–50. ‎
  • ‎2. ‎ Licciardi F, Scaioli G, Mulatero R, Marolda A, Delle Piane M, Martino S, et al. ‎Epidemiologic Impact of the New Guidelines for the Diagnosis of Acute Rheumatic Fever. J ‎Pediatr. 2018;198:25-8.
  • ‎3. ‎ Barandier C, Tanguy S, Pucheu S, Boucher F, De Leiris J. Effect of antioxidant trace ‎elements on the response of cardiac tissue to oxidative stress. Ann N Y Acad Sci. 1999;874:138–55. ‎
  • ‎4. ‎ Kosar F, Sahin I, Acıkgöz N, Aksoy Y, Kucukbay Z, Cehreli S. Significance of Serum Trace ‎Element Status in Patients with Rheumatic Heart Disease: A Prospective Study. Biol Trace ‎Elem Res. 2005;107:1-10
  • ‎5. ‎ Alissa EM. Antioxidants and Cardiovascular Disease: A summary of the Evidence. J ‎Cardiovasc Dis. 2015;3:347–56. ‎
  • ‎6. ‎ Song Y, Cook NR, Albert CM, Van Denburgh M, Manson JE. Effects of vitamins C and E ‎and β-carotene on the risk of type 2 diabetes in women at high risk of cardiovascular disease: ‎a randomized controlled trial–. Am J Clin Nutr. 2009;90:429–37. ‎
  • ‎7. ‎ Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The ‎Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) ‎statement: Guidelines for reporting observational studies. PLoS Med. 2007;4:1623–7. ‎
  • ‎8. ‎ Rhodes KL, Rasa MM, Yamamoto LG. Acute Rheumatic Fever: Revised Diagnostic Criteria. ‎Pediatr Emerg Care. 2018;34:436–40. ‎
  • ‎9. ‎ Wilkins GT, Weyman AE, Abascal VM, Block PC, Palacios IF. Percutaneous balloon ‎dilatation of the mitral valve: An analysis of echocardiographic variables related to outcome ‎and the mechanism of dilatation. Heart. 1988;60:299–308. ‎
  • ‎10. ‎ Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, et al. Guidelines on ‎the management of valvular heart disease: The Task Force on the Management of Valvular ‎Heart Disease of the European Society of Cardiology. Eur Heart J. 2007;28:230–68. ‎
  • ‎11. ‎ Yamamoto K, Masuyama T, Tanouchi J, Uematsu M, Doi Y, Mano T, et al. Peak early ‎diastolic filling velocity may decrease with preload augmentation: effect of concomitant ‎increase in the rate of left atrial pressure drop in early diastole. J Am Soc Echocardiogr. ‎‎1993;6:245–54. ‎
  • ‎12. ‎ Karpuz H, Ikitimur B. [Echocardiographic evaluation of aortic stenosis]. Ana Kar Der. ‎2002;2:65-9.
  • ‎13. ‎ Godley RW, Green D, Dillon JC, Rogers EW, Feigenbaum H, Weyman AE. Reliability of ‎two-dimensional echocardiography in assessing the severity of valvular aortic stenosis. Chest. ‎‎1981;79:657–62. ‎
  • ‎14. ‎ Stoddard MF, Hammons RT, Longaker RA. Doppler transesophageal echocardiographic ‎determination of aortic valve area in adults with aortic stenosis. Am Heart J. 1996;132:337–42. ‎
  • ‎15. ‎ Yeager M, Yock PG, Popp RL. Comparison of Doppler-derived pressure gradient to that ‎determined at cardiac catheterization in adults with aortic valve stenosis: Implications for ‎management. Am J Cardiol. 1986;57:644–8. ‎
  • ‎16. ‎ Bai AD, Steinberg M, Showler A, Burry L, Bhatia RS, Tomlinson GA, et al. Diagnostic ‎accuracy of transthoracic echocardiography for infective endocarditis findings using ‎transesophageal echocardiography as the reference standard: a meta-analysis. J Am Soc ‎Echocardiogr. 2017;30:639–46. ‎
  • ‎17. ‎ Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3:A flexible statistical power analysis ‎program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–91.
  • ‎18. ‎ Oster O, Prellwitz W. Selenium and cardiovascular disease. Biol Trace Elem Res.1990;24:91-103.
  • ‎19. ‎ Bai-Song N, Chung-Seng L, Li-Hua C. Significance of low levels of blood selenium in ‎dilated cardiomyopathy‎. Bio Trace Elem Res. 1986 Dec;99(12):948-9.
  • ‎20. ‎ Klevay LM. The role of copper, zinc and other chemical elements in ischemic heart disease . ‎eds. CRC, Boca Raton, ‎FL, pp. 1984;129–157.‎. In: Rennert OM, Chan WY, editors. ‎Metabolism of trace metals in man. Boca Raton: CRC; 1984. p. 129–57. ‎
  • ‎21. ‎ Yu X, Huang L, Zhao J, Wang Z, Yao W, Wu X, et al. The Relationship between Serum Zinc ‎Level and Heart Failure: A Meta-Analysis. Biomed Res Int. 2018;2018:2739014‎.
  • ‎22. ‎ Govindaraju V, Prabhudev N, Gurappa M, Jawali VS, Chandrasekhara PM, Manjunath CN. ‎Zinc in rheumatic heart valves. J Assoc Physicians India. 1993;41:653–4. ‎
  • ‎23. ‎ Durak I, Akyol Ö, Es MU, Canbolat O, Akpoyraz M. Element structure in stenotic mitral ‎valves. Am J Cardiol. 1993;71:355. ‎
  • ‎24. ‎ Chandra RK. Trace Element Regulation of Immunity and Infection. J Am Coll Nutr. ‎‎1985;4:5–16. ‎
  • ‎25. ‎ Rotruck JT, Pope AL, Ganther HE, Swanson AB, Hafeman DG, Hoekstra WG. Selenium: ‎biochemical role as a component of glutathione peroxidase. Science. 1973;179:588–90. ‎
  • ‎26. ‎ El-Ghazaly MA, Fadel N, Rashed E, El-Batal A, Kenawy SA. Anti-inflammatory effect of ‎selenium nanoparticles on the inflammation induced in irradiated rats. Can J Physiol ‎Pharmacol. 2017;95:101–10. ‎
  • ‎27. ‎ Galante A, Pietroiusti A, Vellini M, Piccolo P, Possati G, De Bonis M, et al. C-reactive protein ‎is increased in patients with degenerative aortic valvular stenosis. J Am Coll Cardiol. 2001;38:1078–82. ‎
  • ‎28. ‎ Nystrom-Rosander C, Lindh U, Friman G, Lindqvist O, Thelin S, Ilback N-G. Trace element ‎changes in sclerotic heart valves from patients are expressed in their blood. Biometals. 2004;17:121–8. ‎
  • ‎29. ‎ Goldstein I, Halpern B, Robert L. Immunological relationship between streptococcus A ‎polysaccharide and the structural glycoproteins of heart valve. Nature. 1967;213:44–7. ‎
  • ‎30. ‎ Nyström-Rosander C, Lindh U, Ilbäck NG, Hjelm E, Thelin S, Lindqvist O, et al. ‎Interactions between Chlamydia pneumoniae and trace elements: A possible link to aortic ‎valve sclerosis. Biol Trace Elem Res. 2003;91:97–110. ‎
  • ‎31. ‎ Funseth E, Lindh U, Friman G, Ilbäck NG. Relation between trace element levels in plasma ‎and myocardium during coxsackievirus B3 myocarditis in the mouse. BioMetals. ‎‎2000;13:361–7. ‎
  • ‎32. ‎ Levander OA, Ager ALJ, Beck MA. Vitamin E and selenium: contrasting and interacting ‎nutritional determinants of host resistance to parasitic and viral infections. Proc Nutr Soc. ‎‎1995;54:475–87. ‎
  • ‎33. ‎ Chen X, Yang G, Chen J, Chen X, Wen Z, Ge K. Studies on the relations of selenium and ‎Keshan disease. Biol Trace Elem Res. 1980;2:91–107.
There are 33 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section Original Research
Authors

Mehmet Hakan Öncel 0000-0002-1003-2845

Cemal Tuncer This is me

Publication Date March 15, 2019
Published in Issue Year 2019 Volume: 4 Issue: 1

Cite

Vancouver Öncel MH, Tuncer C. Assessment of serum trace element levels in rheumatic heart disease: A case-control study. Arch Clin Exp Med. 2019;4(1):1-5.