CLOSE ASSOCIATION OF CHLAMYDIA PNEUMONIAE IgA SEROPOSITIVITY BY ELISA WITH THE PRESENCE OF CORONARY ARTERY STENOSIS IN HEMODIALYSIS PATIENTS

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Slide 1 : CLOSE ASSOCIATION OF CHLAMYDIA PNEUMONIAE IgA SEROPOSITIVITY BY ELISA WITH THE PRESENCE OF CORONARY ARTERY STENOSIS IN HEMODIALYSIS PATIENTS Masato Nishimura, Tetsuya Hashimoto, Hiroyuki Kobayashi, Toyofumi Fukuda, Koji Okino, Hiroshi Fujita, Naoto Inoue, and Toshihiko Ono. Cardiovascular Division, Division of Urology, Division of Surgery, Toujinkai Hospital, Kyoto, Japan; Department of Interventional Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
Slide 2 : Background Traditional risk factors of the cardiovascular disease do not fully explain the accelerated atherosclerosis present in patients with end-stage renal disease (ESRD). The goal of this study was to identify the association of clinical and laboratory factors including seropositivity for Chlamydia pneumoniae (C. pneumoniae) determined by a specific enzyme linked immunosorbent assay (ELISA) with the presence of coronary artery disease identified by coronary angiography in ESRD patients.
Slide 3 : Methods We prospectively enrolled consecutive 161 ESRD patients undergoing hemodialysis for more than 6 months (106 men, 55 women; mean age: 63.1 ± 10.2 years; mean dialysis duration: 91.3 months). All patients underwent coronary angiography within 1 week after blood sampling. The associations of coronary artery disease with clinical parameters including C. pneumoniae IgA and IgG seropositivity were analyzed using multiple logistic regression models.
Slide 4 : Results of coronary angiography
Slide 5 : Differences between the groups with and without coronary stensis
Slide 6 : Results of ELISA for C. pneumoniae IgA seropositivity all dialysis patients 87/161 (54.1%) coronary stenosis (+) 77/102 (75.5%) coronary stenosis (-) 10/59 (16.9%) IgG seropositivity all dialysis patients 91/161 (56.5%) coronary stenosis (+) 67/102 (65.7%) coronary stenosis (-) 24/59 (40.7%)
Slide 7 : Odds ratios for the presence of coronary artery stenosis in hemodialysis patients (all coronary arteries)
Slide 8 : Odds ratios for the presence of coronary artery stenosis in hemodialysis patients (each coronary artery)
Slide 9 : Crude and adjusted odds ratios of C. pneumoniae IgA seropositivity for the presence of coronary artery stenosis in hemodialysis patients
Slide 10 : ROC analysis for detecting coronary stenosis AUC IgA: 0.854 IgG: 0.709 CRP: 0.584
Slide 11 : Results Coronary stenosis >50% was found in 102 of 161 hemodialysis patients (63.4%). Of the 102 patients, 75.5% were asymptomatic. Seropositivity for C. pneumoniae IgA was found in patients with coronary stenosis (77/102, 75.5%) more frequently (p<0.001) than in patients without coronary stenosis (10/59, 16.9%). Seropositivity for C. pneumoniae but not IgG was strongly associated with the presence of coronary stenosis in multiple logistic regression analysis (odds ratio: 18.440), independently of the Framingham coronary risk factors, factors peculiar to ESRD, or serum C-reactive protein levels.
Slide 12 : Conclusions C. pneumoniae IgA seropositivity determined by ELISA is an independent laboratory factor indicating the presence of coronary artery stenosis in ESRD patients undergoing maintenance hemodialysis.

 


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