Disruption of the endothelial glycocalyx layer is associated with idiopathic complete atrioventricular block in the elderly population: An observational pilot study

Abstract

Ididopathic atrioventricular block (iCAVB) is the most common reason for the need for a permanent pacemaker in the elderly population. The fibrotic process that occurs in the conduction system of the heart with aging is the main pathogenesis in the development of iCAVB. However, the processes that trigger the development of iCAVB in the elderly population have not been fully elucidated. In this study, we aimed to reveal the possible relationship between the endothelial glycocalyx layer and idiopathic complete atrioventricular block. A group of 68 consecutive patients who developed iCAVB and 68 healthy subjects matched for age, sex, and cardiovascular risk factors were included in the study. A group of 68 consecutive patients who developed iCAVB and a group of 68 healthy subjects matched for age, sex and cardiovascular risk factors were included in the study. The groups were compared for clinical, laboratory and levels of Syndecan-1 (SDC1), an endothelial glycocalyx layer marker. In the study, SDC1 levels were found to be significantly higher in the iCAVB group compared to the control group (23.7±7.5 vs 16.7±5.2; p=0.009). In multivariable regression analysis, SDC1 was determined as an independent potential predictor for iCAVB (OR: 1.200; 95%CI: 1.119-1.287; p<0.001). In the ROC curve analysis, SDC1 predicted iCAVB with 74% sensitivity and 72% specificity at the best cut-off value of 18.5 ng/mL (AUC: 0.777; CI: 0.698-0.856; p<0.001). Disruption of the endothelial glycolix layer may be one of the main triggering factors for the process leading to iCAVB.