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Baskaran G, Heo RH, Wang MK, Meyre PB, Park L, Blum S, Devereaux PJ, Conen D. Associations of inflammatory biomarkers with morbidity and mortality after noncardiac surgery: A systematic review and meta-analysis. J Clin Anesth 2024; 97:111540. [PMID: 38959697 DOI: 10.1016/j.jclinane.2024.111540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/22/2024] [Accepted: 06/23/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Noncardiac surgery is associated with an inflammatory response. Whether increased inflammation in the perioperative period is associated with subsequent morbidity and mortality is unknown. METHODS MEDLINE, EMBASE, and CENTRAL were systematically searched from date of inception until May 2023. Longitudinal studies were included if they reported multivariable adjusted associations of biomarkers measured preoperatively and/or within 10 days after surgery with at least one prespecified adverse outcome in noncardiac surgery patients. Data were extracted independently and in duplicate. Risk estimates were pooled using DerSimonian-Laird random-effects models and reported as summary odds ratios (ORs) with 95% CIs. The outcomes were all-cause mortality and major adverse cardiovascular events. RESULTS Fifty-two studies with a total of 121,849 patients were included. The median follow-up was 56 [IQR, 28-63] months and the average age was 57 (±3) years. Elevated preoperative C-reactive protein (CRP) levels were associated with a higher risk of mortality (OR 1.57, 95% CI 1.29-1.90, I2 = 93%, 28 studies). This association was stronger in non-cancer surgery populations (OR 2.10, 95% CI 1.92-2.31, I2 = 0%, 4 studies) when compared to cancer surgery populations (OR 1.51, 95% CI 1.26-1.81, I2 = 83%, 24 studies) (p for subgroup difference = 0.001). Similarly, higher postoperative CRP levels were associated with all-cause mortality (OR 1.61, 95% CI 1.17-2.20, I2 = 90%, 7 studies). Higher preoperative CRP levels were associated with major cardiovascular events (OR 2.11, 95% CI 1.51-2.94, I2 = 0%, 2 studies). Other preoperatively measured biomarkers associated with all-cause mortality were fibrinogen (OR 1.48, 95% CI 1.05-2.09, I2 = 52%, 5 studies), interleukin-6 (OR 1.17, 95% CI 1.07-1.28, I2 = 27%, 3 studies), and tumour necrosis factor-alpha (OR 1.37, 95% CI 1.16-1.61, I2 = 0%, 2 studies). CONCLUSION AND RELEVANCE Inflammatory biomarker levels in the perioperative period were associated with all-cause mortality and adverse cardiovascular events in patients undergoing noncardiac surgery.
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Affiliation(s)
- Geethan Baskaran
- Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada; Population Health Research Institute, 20 Copeland Ave, Hamilton, Ontario L8L 2X2, Canada; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada
| | - Rachel H Heo
- Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada
| | - Michael K Wang
- Population Health Research Institute, 20 Copeland Ave, Hamilton, Ontario L8L 2X2, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada
| | - Pascal B Meyre
- Division of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Louis Park
- Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada
| | - Steffen Blum
- Division of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - P J Devereaux
- Population Health Research Institute, 20 Copeland Ave, Hamilton, Ontario L8L 2X2, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada; Department of Health Research Methods, Evidence & Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada
| | - David Conen
- Population Health Research Institute, 20 Copeland Ave, Hamilton, Ontario L8L 2X2, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada; Department of Health Research Methods, Evidence & Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada
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2
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Heo RH, Wang MK, Meyre PB, Birchenough L, Park L, Vuong K, Devereaux PJ, Blum S, Lindahl B, Stone G, Conen D. Associations of Inflammatory Biomarkers With the Risk of Morbidity and Mortality After Cardiac Surgery: A Systematic Review and Meta-analysis. Can J Cardiol 2023; 39:1686-1694. [PMID: 37495205 DOI: 10.1016/j.cjca.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/05/2023] [Accepted: 07/20/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Although inflammatory biomarkers have been associated with cardiovascular events in nonsurgical settings, these associations have not been systematically addressed in patients undergoing cardiac surgery. This review aimed to evaluate the relationships of inflammatory markers with mortality and adverse cardiovascular events in patients undergoing cardiac surgery. METHODS Medline, Embase, and Central databases were systematically searched for studies reporting pre- or postoperative levels of inflammatory biomarkers in patients undergoing cardiac surgery. Outcomes of interest were postoperative mortality, nonfatal myocardial infarction, stroke, congestive heart failure, and major adverse cardiovascular events (MACE). Studies reporting multivariable adjusted risk estimates were included. Risk estimates were pooled with the use of random-effects models and reported as summary odds ratios (ORs). RESULTS Among 14,465 citations identified, 29 studies including 29,401 participants met the eligibility criteria. The average follow-up time after surgery was 31 months. Preoperative C-reactive protein (CRP) levels were associated with an increased risk of all-cause mortality (OR 1.88, 95% CI 1.60-2.20; I2 = 19%; 11 studies) and MACE (OR 1.73, 95% CI 1.34-2.24; I2 = 0%; 3 studies). CRP levels measured on postoperative day 6 (OR 7.4, 95% CI 2.90-18.88, 1 study) and day 10 (OR 11.8, 95% CI 3.50-39.78, 1 study) were associated with a higher risk of all-cause mortality. Less, but overall similar, information was available for other inflammatory biomarkers. CONCLUSIONS In this large meta-analysis, inflammatory biomarkers measured before or after cardiac surgery were associated with mortality and adverse cardiovascular outcomes in patients undergoing cardiac surgery.
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Affiliation(s)
- Rachel Haeeun Heo
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Michael Ke Wang
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Pascal B Meyre
- Division of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Lauren Birchenough
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Louis Park
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kiven Vuong
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - P J Devereaux
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Steffen Blum
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Division of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University and Uppsala Clinical Research Center, Uppsala, Sweden
| | - Gregg Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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3
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Stotts C, Corrales-Medina VF, Rayner KJ. Pneumonia-Induced Inflammation, Resolution and Cardiovascular Disease: Causes, Consequences and Clinical Opportunities. Circ Res 2023; 132:751-774. [PMID: 36927184 DOI: 10.1161/circresaha.122.321636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Pneumonia is inflammation in the lungs, which is usually caused by an infection. The symptoms of pneumonia can vary from mild to life-threatening, where severe illness is often observed in vulnerable populations like children, older adults, and those with preexisting health conditions. Vaccines have greatly reduced the burden of some of the most common causes of pneumonia, and the use of antimicrobials has greatly improved the survival to this infection. However, pneumonia survivors do not return to their preinfection health trajectories but instead experience an accelerated health decline with an increased risk of cardiovascular disease. The mechanisms of this association are not well understood, but a persistent dysregulated inflammatory response post-pneumonia appears to play a central role. It is proposed that the inflammatory response during pneumonia is left unregulated and exacerbates atherosclerotic vascular disease, which ultimately leads to adverse cardiac events such as myocardial infarction. For this reason, there is a need to better understand the inflammatory cross talk between the lungs and the heart during and after pneumonia to develop therapeutics that focus on preventing pneumonia-associated cardiovascular events. This review will provide an overview of the known mechanisms of inflammation triggered during pneumonia and their relevance to the increased cardiovascular risk that follows this infection. We will also discuss opportunities for new clinical approaches leveraging strategies to promote inflammatory resolution pathways as a novel therapeutic target to reduce the risk of cardiac events post-pneumonia.
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Affiliation(s)
- Cameron Stotts
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (C.S., K.J.R).,Centre for Infection, Immunity, and Inflammation, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (C.S., V.F.C.-M.).,University of Ottawa Heart Institute, Ottawa, ON, Canada (C.S., K.J.R)
| | - Vicente F Corrales-Medina
- Centre for Infection, Immunity, and Inflammation, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (C.S., V.F.C.-M.).,Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (V.F.C-M).,Ottawa Hospital Research Institute, Ottawa, ON, Canada (V.F.C.-M)
| | - Katey J Rayner
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (C.S., K.J.R).,University of Ottawa Heart Institute, Ottawa, ON, Canada (C.S., K.J.R)
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4
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Lawler PR, Bhatt DL, Godoy LC, Lüscher TF, Bonow RO, Verma S, Ridker PM. Targeting cardiovascular inflammation: next steps in clinical translation. Eur Heart J 2021; 42:113-131. [PMID: 32176778 DOI: 10.1093/eurheartj/ehaa099] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/30/2019] [Accepted: 02/03/2020] [Indexed: 12/31/2022] Open
Abstract
Systemic vascular inflammation plays multiple maladaptive roles which contribute to the progression and destabilization of atherosclerotic cardiovascular disease (ASCVD). These roles include: (i) driving atheroprogression in the clinically stable phase of disease; (ii) inciting atheroma destabilization and precipitating acute coronary syndromes (ACS); and (iii) responding to cardiomyocyte necrosis in myocardial infarction (MI). Despite an evolving understanding of these biologic processes, successful clinical translation into effective therapies has proven challenging. Realizing the promise of targeting inflammation in the prevention and treatment of ASCVD will likely require more individualized approaches, as the degree of inflammation differs among cardiovascular patients. A large body of evidence has accumulated supporting the use of high-sensitivity C-reactive protein (hsCRP) as a clinical measure of inflammation. Appreciating the mechanistic diversity of ACS triggers and the kinetics of hsCRP in MI may resolve purported inconsistencies from prior observational studies. Future clinical trial designs incorporating hsCRP may hold promise to enable individualized approaches. The aim of this Clinical Review is to summarize the current understanding of how inflammation contributes to ASCVD progression, destabilization, and adverse clinical outcomes. We offer forward-looking perspective on what next steps may enable successful clinical translation into effective therapeutic approaches-enabling targeting the right patients with the right therapy at the right time-on the road to more individualized ASCVD care.
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Affiliation(s)
- Patrick R Lawler
- Peter Munk Cardiac Centre, University Health Network, 190 Elizabeth Street, Toronto, ON M5G 2C4, Canada.,Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada.,University of Toronto, 27 King's College Cir, Toronto, ON M5S 1K1, Canada
| | - Deepak L Bhatt
- Brigham and Women's Hospital, Division of Cardiovascular Medicine, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Lucas C Godoy
- Peter Munk Cardiac Centre, University Health Network, 190 Elizabeth Street, Toronto, ON M5G 2C4, Canada.,Instituto do Coracao (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, 44, Doutor Enéas Carvalho de Aguiar Avenue, São Paulo, SP 05403-900, Brazil
| | - Thomas F Lüscher
- Royal Brompton & Harefield Hospital, Imperial College, 77 Wimpole Street, London W1G 9RU, UK
| | - Robert O Bonow
- Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 251 E Huron, Chicago, IL 60611, USA
| | - Subodh Verma
- University of Toronto, 27 King's College Cir, Toronto, ON M5S 1K1, Canada.,Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON M5B 1W8, Canada
| | - Paul M Ridker
- Brigham and Women's Hospital, Division of Cardiovascular Medicine, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.,Brigham and Women's Hospital, Center for Cardiovascular Disease Prevention, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA
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5
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Hofer F, Perkmann T, Gager G, Winter MP, Niessner A, Hengstenberg C, Siller-Matula JM. Comparison of high-sensitivity C-reactive protein vs. C-reactive protein for diagnostic accuracy and prediction of mortality in patients with acute myocardial infarction. Ann Clin Biochem 2021; 58:342-349. [PMID: 33715444 DOI: 10.1177/00045632211004651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The role of chronic inflammation in the pathogenesis of atherosclerosis has been unequivocally proven. However, the prognostic impact of C-reactive protein, a marker of inflammatory response in patients with acute myocardial infarction has not been fully clarified. Furthermore, there is no direct comparison of the diagnostic accuracy of C-reactive protein and high sensitivity C-reactive protein in the acute myocardial infarction population. METHODS In this prospective observational cohort study, 344 patients with acute myocardial infarction were enrolled. All-cause mortality was a primary endpoint. Patients were followed prospectively for a median of six years. RESULTS The correlation between high sensitivity C-reactive protein and C-reactive protein (r = 0.99; P < 0.001) and the diagnostic accuracy (98.6%) was high. The ROC analysis revealed that C-reactive protein and high sensitivity C-reactive protein had a low AUC for prediction of mortality (C-reactive protein: 0.565, 95% CI [0.462-0.669], vs. high sensitivity C-reactive protein: 0.572, 95% CI [0.470-0.675]) or major adverse cardiac events (C-reactive protein: AUC 0.607, 95% CI [0.405-0.660], vs. high sensitivity C-reactive protein: AUC 0.526, 95% CI [0.398-0.653]) when assessed at time point of acute myocardial infarction. In contrast, longitudinal inflammatory risk assessment with serial C-reactive protein measurements in the stable phase of the disease revealed a 100% specificity, 100% negative predictive value, 32% sensitivity and 12% positive predictive value of C-reactive protein to predict long-term mortality. The Kaplan Meier analysis showed a significant survival benefit for patients at low residual inflammatory risk (P = 0.014). CONCLUSION C-reactive protein and high sensitivity C-reactive protein provide a similar diagnostic accuracy, highlighting that C-reactive protein might replace high sensitivity C-reactive protein in routine assessments. Furthermore, low inflammatory status during the stable phase after acute myocardial infarction predicts favourable six-year survival.
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Affiliation(s)
- Felix Hofer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Gloria Gager
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Max-Paul Winter
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Jolanta M Siller-Matula
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.,Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland
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6
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McKnight AH, Katzenberger DR, Britnell SR. Colchicine in Acute Coronary Syndrome: A Systematic Review. Ann Pharmacother 2020; 55:187-197. [PMID: 32659104 DOI: 10.1177/1060028020942144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of this review is to evaluate the efficacy and safety of colchicine after acute coronary syndrome (ACS). DATA SOURCES English-language searches were made of MEDLINE and EMBASE from database inception through mid-June 2020. STUDY SELECTION AND DATA EXTRACTION Randomized trials characterizing the effects of colchicine in ACS were considered. Of 627 title and abstracts identified, nine trials were included. Two reviewers extracted data and rated study quality. DATA SYNTHESIS Four studies showed colchicine did not attenuate C-reactive protein production. Colchicine did modulate the NOD-like receptor family pyrin domain containing 3 inflammasome in 3 studies and reduced production of chemokine ligand 2 (CCL2), CCL5, and C-X3-C motif chemokine ligand 1 in 1 study. Major adverse cardiovascular events (MACE) were not significantly different at 30 days in 3 studies, administered as 1.8 mg preprocedurally or scheduled 1 mg daily. One study found a significant reduction in MACE with colchicine 0.5 mg daily over median 22.6 months (hazard ratio = 0.77; 95% CI = 0.61-0.96). Colchicine is associated with increased gastrointestinal adverse events but was generally well tolerated. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Colchicine is likely to reduce MACE in an ACS population if administered for greater than 30 days but does not improve MACE when administered only preprocedurally. CONCLUSIONS Adjunctive colchicine 0.5 mg daily for greater than 30 days is reasonable for an ACS population on guideline-directed medical therapy treated with PCI. Additional studies are needed to validate and determine the durability of these benefits.
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7
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Butt N, Bache-Mathiesen LK, Ushakova A, Nordrehaug JE, Jensen SE, Munk PS, Danchin N, Dubois-Rande JL, Hansen HS, Paganelli F, Corvoisier PL, Firat H, Erlinge D, Atar D, Larsen AI. Pentraxin 3 in primary percutaneous coronary intervention for ST elevation myocardial infarction is associated with early irreversible myocardial damage : Kinetic profile, relationship to interleukin 6 and infarct size. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:302-312. [PMID: 32403934 PMCID: PMC7549329 DOI: 10.1177/2048872620923641] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The inflammatory marker long pentraxin 3 (PTX3) has been shown to be a strong
predictor of 30-day and one-year mortality after acute myocardial
infarction. The aim of this study was to evaluate the kinetic profile of
PTX3 and its relationship with interleukin 6 (IL-6), high-sensitive
C-reactive protein (hs-CRP) and infarct size. Methods PTX3, IL-6 and hs-CRP were measured at predefined time points, at baseline
(before percutaneous coronary intervention (PCI)), at 12 and 72 hours after
PCI in 161 patients with first-time ST elevation myocardial infarction
(STEMI). Results PTX3 and IL-6 levels increased in the early phase, followed
by a gradual decrease between 12 and 72 hours. There were statistically
significant correlations between PTX3 and IL-6 in general, for all time
points and for changes over time (0–72 hours). In a linear
mixed model, PTX3 predicted IL-6 (p < 0.001). PTX3 is
also correlated with hs-CRP in general, and at each time point post PCI,
except at baseline. PTX3, IL-6 and hs-CRP were all significantly correlated
with infarct size in general, and at the peak time point for maximum
troponin I. In addition, there was a modest correlation between IL-6 levels
at baseline and infarct size at 72 hours after PCI
(ρ = 0.23, p = 0.006). Conclusions PTX3 had a similar kinetic profile to IL-6, with an early increase and
decline, and was statistically significantly correlated with markers of
infarct size in STEMI patients post primary PCI. Baseline levels of IL-6
only predicted infarct size at 72 hours post PCI.
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Affiliation(s)
- Noreen Butt
- Department of Clinical Science, University of Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Norway
| | - L K Bache-Mathiesen
- Department of Research, Section of Biostatistics Stavanger, University Hospital, Norway
| | - A Ushakova
- Department of Research, Section of Biostatistics Stavanger, University Hospital, Norway
| | - J E Nordrehaug
- Department of Clinical Science, University of Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Norway
| | - S E Jensen
- Cardiology, Aalborg University Hospital, Denmark
| | - P S Munk
- Department of Cardiology, Sørlandet Hospital, Norway
| | - N Danchin
- Cardiology, Hôpital Européen Georges Pompidou, Université Paris Descartes, France
| | - J L Dubois-Rande
- Cardiology and Clinical Investigation Center, University Hospital Henri Mondor, France
| | | | | | - P Le Corvoisier
- Cardiology and Clinical Investigation Center, University Hospital Henri Mondor, France
| | | | | | - D Atar
- Department of Cardiology, Oslo University Hospital Ullevål and University of Oslo, Norway
| | - A I Larsen
- Department of Clinical Science, University of Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Norway
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8
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Fioranelli M, Bottaccioli AG, Bottaccioli F, Bianchi M, Rovesti M, Roccia MG. Stress and Inflammation in Coronary Artery Disease: A Review Psychoneuroendocrineimmunology-Based. Front Immunol 2018; 9:2031. [PMID: 30237802 PMCID: PMC6135895 DOI: 10.3389/fimmu.2018.02031] [Citation(s) in RCA: 179] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 08/17/2018] [Indexed: 01/08/2023] Open
Abstract
Recent findings have deeply changed the current view of coronary heart disease, going beyond the simplistic model of atherosclerosis as a passive process involving cholesterol build-up in the subintimal space of the arteries until their final occlusion and/or thrombosis and instead focusing on the key roles of inflammation and the immune system in plaque formation and destabilization. Chronic inflammation is a typical hallmark of cardiac disease, worsening outcomes irrespective of serum cholesterol levels. Low-grade chronic inflammation correlates with higher incidence of several non-cardiac diseases, including depression, and chronic depression is now listed among the most important cardiovascular risk factors for poor prognosis among patients with myocardial infarction. In this review, we include recent evidence describing the immune and endocrine properties of the heart and their critical roles in acute ischaemic damage and in post-infarct myocardial remodeling. The importance of the central and autonomic regulation of cardiac functions, namely, the neuro-cardiac axis, is extensively explained, highlighting the roles of acute and chronic stress, circadian rhythms, emotions and the social environment in triggering acute cardiac events and worsening heart function and metabolism in chronic cardiovascular diseases. We have also included specific sections related to stress-induced myocardial ischaemia measurements and stress cardiomyopathy. The complex network of reciprocal interconnections between the heart and the main biological systems we have presented in this paper provides a new vision of cardiovascular science based on psychoneuroendocrineimmunology.
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Affiliation(s)
- Massimo Fioranelli
- Department of Nuclear Physics, Sub-Nuclear and Radiation, Guglielmo Marconi University, Rome, Italy
- Società Italiana di Psiconeuroendocrinoimmunologia, Rome, Italy
| | - Anna G. Bottaccioli
- Società Italiana di Psiconeuroendocrinoimmunologia, Rome, Italy
- Department of Internal Medicine, Sapienza University, Rome, Italy
| | - Francesco Bottaccioli
- Società Italiana di Psiconeuroendocrinoimmunologia, Rome, Italy
- Department of Clinical Medicine, University of l'Aquila, L'Aquila, Italy
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Rome, Italy
| | - Maria Bianchi
- Department of Nuclear Physics, Sub-Nuclear and Radiation, Guglielmo Marconi University, Rome, Italy
| | - Miriam Rovesti
- Department of Dermatology, University of Parma, Parma, Italy
| | - Maria G. Roccia
- Department of Nuclear Physics, Sub-Nuclear and Radiation, Guglielmo Marconi University, Rome, Italy
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9
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Patelis N, Kouvelos GN, Koutsoumpelis A, Moris D, Matsagkas MI, Arnaoutoglou E. An update on predictive biomarkers for major adverse cardiovascular events in patients undergoing vascular surgery. J Clin Anesth 2016; 33:105-16. [PMID: 27555142 DOI: 10.1016/j.jclinane.2016.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 09/27/2015] [Accepted: 03/05/2016] [Indexed: 10/21/2022]
Abstract
Cardiovascular complications signify a major cause of morbidity and mortality in patients undergoing vascular surgery adversely affecting both short- and long-term prognosis. During the last decade, unmet needs for a distinct cardiovascular risk assessment have led to an intensive research for establishment of biomarkers with sufficient predictive value. This literature review aims in examining the value of several biomarkers in predicting the incidence of major adverse cardiac events in vascular surgery patients. We reviewed the English language literature and analyzed the biomarkers as independent predictors or in correlation with other factors. We found several biomarkers showing a significant predictive value for a major adverse cardiovascular event in patients undergoing vascular surgery. These biomarkers can be used in clinical practice as outcome predictors, although sensitivity and specificity varies. Detection of subclinical cardiovascular damage may improve total risk estimation and facilitate clinical assessment of patients at risk for future cardiovascular events. The wide variety of sensitivity and specificity in predicting a MACE of these biomarkers exert the need for future trials in which these markers will be tested as adjunctive tools of cardiovascular risk estimation scoring systems.
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Affiliation(s)
- Nikolaos Patelis
- First Department of Surgery, Vascular Surgery Division, National & Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
| | - George N Kouvelos
- Department of Surgery, Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece
| | - Andreas Koutsoumpelis
- First Department of Surgery, Vascular Surgery Division, National & Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Demetrios Moris
- First Department of Surgery, National & Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Miltiadis I Matsagkas
- Department of Surgery, Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece
| | - Eleni Arnaoutoglou
- Department of Anesthesiology, Medical School, University of Ioannina, Ioannina, Greece
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10
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Hickson LJ, Rule AD, Butler KR, Schwartz GL, Jaffe AS, Bartley AC, Mosley TH, Turner ST. Troponin T as a Predictor of End-Stage Renal Disease and All-Cause Death in African Americans and Whites From Hypertensive Families. Mayo Clin Proc 2015; 90:1482-91. [PMID: 26494378 PMCID: PMC4636977 DOI: 10.1016/j.mayocp.2015.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 08/10/2015] [Accepted: 08/12/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate cardiac troponin T (cTnT) as a predictor of end-stage renal disease (ESRD) and death in a cohort of African American and white community-dwelling adults with hypertensive families. PATIENTS AND METHODS A total of 3050 participants (whites from Rochester, Minnesota; African Americans from Jackson, Mississippi) of the Genetic Epidemiology Network of Arteriopathy study were followed from baseline examination (June 1, 1996, through August 31, 2000) through January 22, 2010. Cox proportional hazards regression models were used to examine the association of cTnT with ESRD and death after adjusting for traditional risk factors. RESULTS Cohort demographic characteristics and measurements included 1395 whites (45.7%), 2174 hypertensive (71.3%), 992 estimated glomerular filtration rate of less than 60 mL/min per 1.73 m(2) (32.5%), 1574 high-sensitivity C-reactive protein level of greater than 3 mg/L (51.6%), and 66 abnormal cTnT level of 0.01 ng/mL or higher (2.2%). The estimated cumulative incidence of ESRD at 10 years was 27.4% among those with abnormal cTnT levels compared with 1.3% for those with normal levels. Similarly, the estimated cumulative incidence of death at 10 years was 47% among those with abnormal cTnT compared with 7.3% among those with normal cTnT. Abnormal cTnT levels were strongly associated with ESRD and death. This effect was attenuated but was still highly significant after adjustment for demographic characteristics, estimated glomerular filtration rate, and traditional risk factors for ESRD (unadjusted hazard ratio [HR], 23.91; 95% CI, 12.9-44.2; adjusted HR, 2.81; 95% CI, 1.3-5.9) and death (unadjusted HR, 8.43; 95% CI, 6.0-11.9; adjusted HR, 3.46; 95% CI, 2.3-5.1). CONCLUSION Cardiac troponin T makes an independent contribution to the prediction of ESRD and all-cause death in community-dwelling individuals beyond traditional risk markers. Further studies may be needed to determine whether cTnT screening in individuals with hypertension or in a subset of hypertensive individuals would help identify those at risk of ESRD and all-cause death.
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Affiliation(s)
- LaTonya J Hickson
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Kenneth R Butler
- Division of Geriatric Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Gary L Schwartz
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Allan S Jaffe
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Adam C Bartley
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Thomas H Mosley
- Division of Geriatric Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Stephen T Turner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
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Biomarkers in Cardiology - Part 2: In Coronary Heart Disease, Valve Disease and Special Situations. Arq Bras Cardiol 2015; 104:337-46. [PMID: 26083777 PMCID: PMC4495448 DOI: 10.5935/abc.20150061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/01/2015] [Indexed: 01/25/2023] Open
Abstract
Cardiovascular diseases are the main causes of mortality and morbidity in Brazil.
Their primary and secondary preventions are a priority for the health system and
require multiple approaches for increased effectiveness. Biomarkers are tools used to
identify with greater accuracy high-risk individuals, establish a faster diagnosis,
guide treatment, and determine prognosis. This review aims to highlight the
importance of biomarkers in clinical cardiology practice and raise relevant points
regarding their application and perspectives for the next few years. This document
was divided into two parts. This second part addresses the application of biomarkers
in coronary heart disease, valvular diseases, cardio-oncology, pulmonary embolism,
and cardiorenal syndrome.
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Labarrere CA, Woods JR, Hardin JW, Jaeger BR, Zembala M, Deng MC, Kassab GS. Early inflammatory markers are independent predictors of cardiac allograft vasculopathy in heart-transplant recipients. PLoS One 2014; 9:e113260. [PMID: 25490200 PMCID: PMC4260824 DOI: 10.1371/journal.pone.0113260] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/21/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Identification of risk is essential to prevent cardiac allograft vasculopathy (CAV) and graft failure due to CAV (GFDCAV) in heart transplant patients, which account for 30% of all deaths. Early CAV detection involves invasive, risky, and expensive monitoring approaches. We determined whether prediction of CAV and GFDCAV improves by adding inflammatory markers to a previously validated atherothrombotic (AT) model. METHODS AND FINDINGS AT and inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP) were measured in heart biopsies and sera of 172 patients followed prospectively for 8.9±5.0 years. Models were estimated for 5- and 10-year risk using (1) the first post-transplant biopsy only, or (2) all biopsies obtained within 3 months. Multivariate models were adjusted for other covariates and cross-validated by bootstrapping. After adding IL-6 and CRP to the AT models, we evaluated the significance of odds ratios (ORs) associated with the additional inflammatory variables and the degree of improvement in the area under the receiver operating characteristic curve (AUROC). When inflammatory markers were tested alone in prediction models, CRP (not IL-6) was a significant predictor of CAV and GFDCAV at 5 (CAV: p<0.0001; GFDCAV: p = 0.005) and 10 years (CAV: p<0.0001; GFDCAV: p = 0.003). Adding CRP (not IL-6) to the best AT models improved discriminatory power to identify patients destined to develop CAV (using 1st biopsy: p<0.001 and p = 0.001; using all 3-month biopsies: p<0.04 and p = 0.008 at 5- and 10-years, respectively) and GFDCAV (using 1st biopsy: 0.92 vs. 0.95 and 0.86 vs. 0.89; using all 3-month biopsies: 0.94 vs. 0.96 and 0.88 vs. 0.89 at 5- and 10-years, respectively), as indicated by an increase in AUROC. CONCLUSIONS Early inflammatory status, measured by a patient's CRP level (a non-invasive, safe and inexpensive test), independently predicts CAV and GFDCAV. Adding CRP to a previously established AT model improves its predictive power.
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Affiliation(s)
- Carlos A. Labarrere
- CBL Partners for Life, Indianapolis, Indiana, United States of America
- California Medical Innovations Institute, San Diego, California, United States of America
- * E-mail:
| | - John R. Woods
- Methodist Research Institute at Indiana University Health and Richard M. Fairbanks School of Public Health, Indiana University-Purdue University, Indianapolis, Indiana, United States of America
| | - James W. Hardin
- University of South Carolina, Columbia, South Carolina, United States of America
| | | | | | - Mario C. Deng
- Ronald Reagan UCLA Medical Center, Los Angeles, California, United States of America
| | - Ghassan S. Kassab
- California Medical Innovations Institute, San Diego, California, United States of America
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13
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Agabiti-Rosei E, Manolis A, Zava D, Omboni S. Zofenopril plus hydrochlorothiazide and irbesartan plus hydrochlorothiazide in previously treated and uncontrolled diabetic and non-diabetic essential hypertensive patients. Adv Ther 2014; 31:217-33. [PMID: 24415271 PMCID: PMC3930838 DOI: 10.1007/s12325-013-0090-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Indexed: 01/13/2023]
Abstract
INTRODUCTION In most treated patients with hypertension, a two or more drug combination is required to achieve adequate blood pressure (BP) control. In our study we assessed whether the combination of zofenopril + hydrochlorothiazide (HCTZ) was at least as effective as irbesartan + HCTZ in essential hypertensives with at least one additional cardiovascular risk factor, uncontrolled by a previous monotherapy. METHODS After a 2-week placebo washout, 361 treated hypertensive patients [office sitting diastolic BP (DBP), ≥90 mmHg], aged 18-75 years, were randomized double blind to 18-week treatment with zofenopril 30 mg plus HCTZ 12.5 mg or irbesartan 150 mg plus HCTZ 12.5 mg once daily, in an international, multicenter study. After the first 6 and 12 weeks, zofenopril and irbesartan doses could be doubled in non-normalized subjects. The primary study end point was the office sitting DBP reduction after 18 weeks of treatment. Secondary end points included office systolic BP (SBP), ambulatory BP and high sensitivity C-reactive protein (hs-CRP). RESULTS The between-treatment difference for office DBP averaged to +1.0 (95% CI -0.4, +0.8) mmHg (P = 0.150), the upper limit of the 95% confidence interval being inferior to the protocol-defined non-inferiority limit (3 mmHg). In the subset of patients with valid ambulatory BP, no difference in 24-h average DBP [n = 181; 6.7 (8.7, 4.6) zofenopril + HCTZ vs. 6.3 (8.8, 3.7) mmHg irbesartan + HCTZ, P = 0.810] and SBP reductions [11.7 (15.4, 8.0) vs. 12.6 (17.2, 8.0) mmHg, P = 0.758] were observed between the two treatment groups. hs-CRP was reduced by zofenopril + HCTZ [-0.52 (-1.05, 0.01) mg/L], while it was increased by irbesartan plus HCTZ [0.97 (0.29, 1.65) mg/L, P = 0.001 between treatments]. CONCLUSION In previously monotherapy-treated, uncontrolled patients with hypertension, zofenopril 30-60 mg + HCTZ 12.5 mg is as effective as irbesartan 150-300 mg plus HCTZ 12.5 mg, with the added value of a potential protective effect against vascular inflammation.
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Affiliation(s)
- Enrico Agabiti-Rosei
- Division of Medicine and Surgery, Spedali Civili and University of Brescia, Brescia, Italy
| | - Athanasios Manolis
- Asklepeion General Hospital of Voula, University of Athens, Athens, Greece
| | - Dario Zava
- Istituto Lusofarmaco d’Italia, Milan, Italy
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Škerk V, Markotić A, Delić Brkljačić D, Manola S, Krčmar T, Gabrić ID, Stajminger G, Pintarić H. The association of ventricular tachycardia and endothelial dysfunction in the setting of acute myocardial infarction with ST elevation. Med Sci Monit 2013; 19:1027-36. [PMID: 24253420 PMCID: PMC3852622 DOI: 10.12659/msm.884026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Ventricular tachycardia (VT) is frequently seen in ischemic settings like acute myocardial infarction with ST segment elevation (STEMI). Endothelial dysfunction (ED) represents inflammation and the loss of all protective features of the endothelium. We aimed to examine the association between VT and ED in patients with STEMI. Material/Methods The study included 90 subjects (30 with VT and acute STEMI, 30 with STEMI without VT, and 30 controls). Sera of all subjects were tested on ED markers by enzyme immunoassay: sICAM-1 (intracellular adhesive molecule-1), sVCAM-1 (vascular adhesive molecule-1), P- and E-selectins, and VEGF (vascular endothelial growth factor). In addition, CRP (C-reactive protein) was detected. Results Significantly increased values of low-density lipoprotein, triglycerides, leukocytes, creatinine, and the number of cigarettes smoked were observed among patients with VT+STEMI in comparison to controls. The levels of E-selectin were significantly lower in the VT+STEMI group than in the other groups, while the levels of VCAM-1 were significantly higher in the groups with STEMI and VT+STEMI compared to the controls. Lower levels of VEGF were recorded in STEMI and VT+STEMI groups compared to the control group. A significant correlation between CRP and VCAM-1 in patients with VT +STEMI was demonstrated. Conclusions We showed that ED may have a role in the immunopathogenesis of VT in patients with STEMI. The role of sE-selectin and correlation of sVCAM-1 with CRP as possible ED predictive markers in patients with VT+STEMI should be further investigated in a large cohort of patients.
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Affiliation(s)
- Vedrana Škerk
- Cardiology Department, Internal Medicine Clinic, Clinical Hospital Centre "Sisters of Charity", Zagreb, Croatia
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15
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Kishk YT, Youssef AA, Bafadhl TA. Prognostic significance of high sensitivity C-reactive protein in patients with angina pectoris underwent percutaneous coronary intervention. J Saudi Heart Assoc 2012. [DOI: 10.1016/j.jsha.2012.06.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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16
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de Jager SCA, Bongaerts BWC, Weber M, Kraaijeveld AO, Rousch M, Dimmeler S, van Dieijen-Visser MP, Cleutjens KBJM, Nelemans PJ, van Berkel TJC, Biessen EAL. Chemokines CCL3/MIP1α, CCL5/RANTES and CCL18/PARC are independent risk predictors of short-term mortality in patients with acute coronary syndromes. PLoS One 2012; 7:e45804. [PMID: 23029252 PMCID: PMC3448678 DOI: 10.1371/journal.pone.0045804] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 08/24/2012] [Indexed: 12/25/2022] Open
Abstract
Cytokines play an important role in ischemic injury and repair. However, little is known about their prognostic value in cardiovascular disease. The aim of this study was to investigate the prognostic importance of chemokines CCL3/MIP-1α, CCL5/RANTES and CCL18/PARC for the risk of future cardiovascular events in patients with acute coronary syndromes (ACS). Baseline levels of CCL3/MIP-1α, CCL5/RANTES and CCL18/PARC were determined in ACS patients from the Bad Nauheim ACS II registry (n = 609). During the following 200 days, patients were monitored for the occurrence of fatal and non-fatal cardiovascular events. Patients with CCL3/MIP1α, CCL5/RANTES and CCL18/PARC concentrations in the highest tertile were associated with an increased risk of a fatal event during follow-up (HR: 2.19, 95%CI: 1.04–4.61 for CCL3/MIP1α, HR: 3.45, 95%CI: 1.54–7.72 for CCL5/RANTES and HR: 3.14, 95%CI: 1.33–7.46 for CCL18/PARC). This risk was highest for patients with all three biomarkers concentrations in the upper tertile (HR: 2.52, 95%CI: 1.11–5.65). Together with known risk predictors of cardiovascular events, CCL3/MIP-1α, CCL5/RANTES and CCL18/PARC combined improved the c-statistics from 0.74 to 0.81 (p = 0.007). In conclusion, CCL3/MIP-1α, CCL5/RANTES and CCL18/PARC are independently associated with the risk of short-term mortality in ACS patients. Combining all three biomarkers further increased their prognostic value.
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Affiliation(s)
- Saskia C. A. de Jager
- Division of Biopharmaceutics, Leiden Amsterdam Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Brenda W. C. Bongaerts
- Department of Pathology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Maastricht, The Netherlands
- * E-mail:
| | - Michael Weber
- Department of Cardiology, Kerckhoff Heart Centre, Bad Nauheim, Germany
| | | | - Mat Rousch
- Department of Pathology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Maastricht, The Netherlands
| | - Stefanie Dimmeler
- Institute for Cardiovascular Regeneration, Centre of Molecular Medicine, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | | | - Kitty B. J. M. Cleutjens
- Department of Pathology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Maastricht, The Netherlands
| | - Patty J. Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Theo J. C. van Berkel
- Division of Biopharmaceutics, Leiden Amsterdam Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Erik A. L. Biessen
- Department of Pathology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Maastricht, The Netherlands
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Abstract
This review emphasizes the effects of resveratrol on factors involved in the mechanism of atherosclerosis and risk factors for atherosclerosis. The effects of wine and resveratrol on atherosclerosis are also discussed. Resveratrol is a potent antioxidant and an anti-inflammatory agent. It reduces the expression of cell adhesion molecules, monocyte colony stimulating factors, matrix metalloproteinases, and growth factors; and inhibits platelet aggregation and vascular smooth muscle cell proliferation. It reduces the serum levels of total cholesterol, triglycerides (TG), and raises high-density lipoprotein cholesterol, inhibits expression of C-reactive protein and lowers the levels of advanced glycation end products and its receptor in the vascular tissue. It lowers the risk factors for plaque rupture. Epidemiological data show that moderate consumption of alcohol has an inverse association with carotid atherosclerosis while high consumption has a positive association with carotid atherosclerosis. Wine reduces the extent of atherosclerosis in animal model. The antiatherosclerotic effect of wine is mainly due to it resveratrol content. Resveratrol reduces the extent of atherosclerosis in animal model of atherosclerosis (apolipoprotein [Apo] E-deficient and Apo E(-/-)/low-density lipoprotein receptor-deficient mice and macrophage). In rabbit model of atherosclerosis, both reduction and acceleration of atherosclerosis have been reported with resveratrol. There are no data for regression and slowing of progression of atherosclerosis. Robust clinical trials for suppression of atherosclerosis are lacking. In conclusion, resveratrol has potential but experimental studies in depth and robust clinical trials are lacking for this agent to be of any value in the primary and secondary prevention of coronary and peripheral artery disease.
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Affiliation(s)
- Kailash Prasad
- Department of Physiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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18
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Aldous SJ. Cardiac biomarkers in acute myocardial infarction. Int J Cardiol 2012; 164:282-94. [PMID: 22341694 DOI: 10.1016/j.ijcard.2012.01.081] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 12/16/2011] [Accepted: 01/26/2012] [Indexed: 01/11/2023]
Abstract
Each year, a large number of patients are seen in the Emergency Department with presentations necessitating investigation for possible acute myocardial infarction. Patients can be stratified by symptoms, risk factors and electrocardiogram results but cardiac biomarkers also have a prime role both diagnostically and prognostically. This review summarizes both the history of cardiac biomarkers as well as currently available (established and novel) assays. Cardiac troponin, our current "gold standard" biomarker criterion for the diagnosis of myocardial infarction has high sensitivity and specificity for this diagnosis and therapies instituted in patients with elevated troponin have been shown to influence outcomes. Other markers of myocardial necrosis, inflammation and neurohormonal activity have also been shown to have either diagnostic or prognostic utility, but none have been shown to be superior to troponin. The measurement of multiple biomarkers and the use of point of care markers may accelerate current diagnostic protocols for the assessment of such patients.
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McCoy SS, Crowson CS, Gabriel SE, Matteson EL. Hypothyroidism as a risk factor for development of cardiovascular disease in patients with rheumatoid arthritis. J Rheumatol 2012; 39:954-8. [PMID: 22337246 DOI: 10.3899/jrheum.111076] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the frequency of hypothyroidism in patients with rheumatoid arthritis (RA), and to elucidate the association of hypothyroidism and development of cardiovascular disease (CVD) in these patients. METHODS A retrospective medical record review was performed using all incident cases of adult-onset RA from Olmsted County, MN, USA, that fulfilled criteria for RA in the years 1988-2007. Patients with and without thyroid disease were followed longitudinally for the development of CVD. RESULTS A cohort of 650 patients with RA and an age and sex-matched comparison cohort of 650 patients without RA was assembled (both cohorts mean age 55.8 yrs; 69% were women). There was no significant difference between cohorts in the presence of hypothyroid disease or subclinical hypothyroidism at time of RA diagnosis. No significant difference was found in the cumulative incidence of hypothyroid disease between the 2 cohorts. Hypothyroid disease was found to be significantly associated with CVD in patients with RA (hazard ratio 2.0; 95% CI 1.1, 3.6). This difference remained significant and unchanged after adjustment for traditional CV risk factors (HR 2.0; 95% CI 1.1, 3.6). CONCLUSION No significant difference was found in either incidence or prevalence of hypothyroidism between patients with and those without RA. Hypothyroid disease was significantly associated with CVD in patients with RA, even after adjustment for other traditional CV risk factors.
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Affiliation(s)
- Sara S McCoy
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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20
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Nseir W, Shalata A, Marmor A, Assy N. Mechanisms linking nonalcoholic fatty liver disease with coronary artery disease. Dig Dis Sci 2011; 56:3439-49. [PMID: 21655948 DOI: 10.1007/s10620-011-1767-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 05/18/2011] [Indexed: 02/08/2023]
Abstract
The most common cause of death in patients with nonalcoholic fatty liver disease (NAFLD) is coronary artery disease (CAD), not chronic liver disease. Fatty liver increases cardiovascular risk by classical (dyslipidemia, hypertension, diabetes) and by less conventional mechanisms. Common pathways involved in the pathogenesis of fatty liver and CAD includes hepatic insulin resistance and sub clinical inflammation. The hepatic insulin resistance state of fatty liver infiltration is characterized by increased FFA, which causes lipotoxicity and impairs endothelium-dependent vasodilatation, increases oxidative stress, and has a cardio toxic effect. Additional metabolic risk factors include leptin, adiponectin, pro inflammatory cytokines [such as IL-6, C-reactive protein and plasminogen activator inhibitor-1 (PAI-1)], which together lead to increased oxidative stress and endothelial dysfunction, finally promoting coronary artery disease (CAD). When classical risk factors are superimposed on fatty liver accumulation, they may further increase the new metabolic risk factors, exacerbating CAD. The clinical implication is that patients with NAFLD are at higher risk (steatohepatitis, diabetes, obesity, atherogenic dyslipidemia) and should undergo periodic cardiovascular risk assessment including the Framingham score, cardiac effort test, and measurement of intimae-media thickening of the carotids arteries. This may improve risk stratification for CAD.
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Affiliation(s)
- W Nseir
- Department of Internal Medicine, Holy Family Hospital, Nazareth, Israel
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Nagesh CM, Roy A. Role of biomarkers in risk stratification of acute coronary syndrome. Indian J Med Res 2011; 132:627-33. [PMID: 21150016 PMCID: PMC3028962 DOI: 10.4103/0971-5916.73419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Diagnosis of acute coronary syndrome (ACS) encompasses a wide spectrum of myocardial ischaemia varying from assuredly benign to potentially fatal. Cardiac biomarkers have had a major impact on the management of this disease and are now the cornerstone in its diagnosis and prognosis. In this review we discuss both the established and the newer emerging biomarkers in ACS and their role in highlighting not only myocardial necrosis but also different facets of the pathophysiology of ACS. The future of cardiac biomarker testing may be in multimarker testing to better characterize each patient of ACS and thus tailor both short-term and long-term therapy accordingly. This novel concept, however, needs to be tested in clinical trials for its incremental value and cost-effectiveness.
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Affiliation(s)
- C M Nagesh
- Department of Cardiology, Cardio-Thoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Cardinal H, Brophy JM, Bogaty P, Joseph L, Hébert MJ, Boyer L, Madore F. Usefulness of soluble fas levels for improving diagnostic accuracy and prognosis for acute coronary syndromes. Am J Cardiol 2010; 105:797-803. [PMID: 20211322 DOI: 10.1016/j.amjcard.2009.10.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 10/28/2009] [Accepted: 10/28/2009] [Indexed: 10/19/2022]
Abstract
Although both inflammation and apoptosis occur in acute coronary syndromes (ACSs), previous studies have not tested the diagnostic and prognostic utility of an approach that measures circulating markers of these pathways. The aim of the present study was to assess whether measuring soluble Fas (sFas) and high-sensitivity C-reactive protein (hs-CRP), as markers of apoptosis and inflammation, improve ACS diagnostic and prognostic accuracy. In a prospective cohort of consecutive subjects admitted to the hospital for suspicion of ACS, we measured sFas, hs-CRP, and troponin T in those who had a final noncardiac chest pain diagnosis (n = 100), those who had an ACS diagnosis and experienced (n = 218) or did not experience (n = 170) recurrent cardiac events during 1 year of follow-up. sFas was strongly and independently associated with a discharge diagnosis of an ACS versus noncardiac chest pain during the index hospitalization (odds ratio 16.16 for the second vs first tertile, 95% confidence interval [CI] 7.07 to 36.91; and odds ratio 25.40 for the third vs first tertile, 95% CI 9.38 to 68.75). However, hs-CRP was not. sFas significantly improved the diagnostic accuracy for ACSs (C statistic increased from 0.85 to 0.93, difference +0.08, 95% CI for the difference 0.05 to 0.11). The sFas levels were high and did not vary with time in the subjects having early versus late measurements (beta 0.00 ln pg/ml/hour, 95% CI -0.01 to 0.01). In contrast, troponin increased with time since the beginning of the symptoms (beta 0.07 ln microg/L/hour, 95% CI 0.04 to 0.10). Baseline sFas and hs-CRP did not predict recurrent cardiac events. In conclusion, our results suggest that in suspected ACS cases, sFas, but not hs-CRP, helps to improve the diagnostic accuracy and timeliness over and above standard diagnostic criteria.
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Schiele F, Meneveau N, Seronde MF, Chopard R, Descotes-Genon V, Dutheil J, Bassand JP. C-reactive protein improves risk prediction in patients with acute coronary syndromes. Eur Heart J 2009; 31:290-7. [PMID: 19578164 DOI: 10.1093/eurheartj/ehp273] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS Elevated C-reactive protein level is a risk marker in patients with acute coronary syndromes (ACSs), but current risk score systems do not consider this factor. We studied the incremental predictive value of adding C-reactive protein to the Global Registry of Acute Coronary Events (GRACE) risk score. METHODS AND RESULTS Characteristics, treatments and 30-day mortality were recorded for 1408/1901 consecutive ACS patients. Changes in global model fit, discrimination, calibration, and reclassification were evaluated upon addition of C-reactive protein to the GRACE risk score. High-C-reactive protein patients (C-reactive protein >22 mg/L, 4th quartile of C-reactive protein) were older, had more comorbidities and worse haemodynamic conditions, received less recommended treatment, and had a four-fold higher 30 day mortality. Multivariable analysis demonstrated high-C-reactive protein as an important and independent predictor of mortality. Addition of high-C-reactive protein in the GRACE model modestly improved global fit, discriminatory capacity (c-statistic from 0.795 to 0.823), and calibration. Patients were divided into four groups according to GRACE risk score prediction: <1, 1 to <5, 5 to <10, and >or=10%. The model with high-C-reactive protein allowed adequate reclassification in 12.2%. CONCLUSION Elevated C-reactive protein level is a modest but independent predictive factor of 30-day mortality in ACS patients, even after adjustment for co-morbidities, haemodynamic conditions, and treatment. Combined with the GRACE risk score, C-reactive protein information improves risk classification.
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Affiliation(s)
- François Schiele
- Department of Cardiology, Centre Hospitalier Universitaire Jean Minjoz, Université de Franche Comte, EA 3920 Boulevard Fleming, 25000 Besançon, France
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Loria V, Leo M, Biasillo G, Dato I, Biasucci LM. Biomarkers in Acute Coronary Syndrome. Biomark Insights 2008; 3:453-468. [PMID: 19578525 PMCID: PMC2688349 DOI: 10.4137/bmi.s588] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Evaluation of patients who present to the hospital with acute undifferentiated chest pain or other symptoms and signs suggestive of Acute Coronary Syndrome (ACS) is often a clinical challenge. The initial assessment, requiring a focused history (including risk factors analysis), a physical examination, an electrocardiogram (EKG) and serum cardiac marker determination, is time-consuming and troublesome. Recent investigations have indicated that increases in biomarkers of necrosis, inflammation, ischemia and myocardial stretch may provide earlier assessment of overall patient risk, help in identifying the adequate diagnostic and therapeutic management for each patient and allow for prevention of substantial numbers of new events. APPROACH AND CONTENT: The purpose of this review is to provide an overview of the characteristics of several biomarkers that may have potential clinical utility to identify ACS patients. Patho-physiology, analytical and clinical characteristics have been evaluated for each marker, underlying the properties for potential routine clinical use. SUMMARY: The biomarkers discussed in this review are promising and might lead to improved diagnosis and risk stratification of patients with ACS, however their clinical application requires further studies. It is important to define their clinical role as diagnostic markers, their predictive value and the specificity, standardization and detection limits of the assays.
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Affiliation(s)
- Valentina Loria
- Institute of Cardiology Catholic University 8 Largo Gemelli 00168 Rome, Italy
| | - Milena Leo
- Institute of Cardiology Catholic University 8 Largo Gemelli 00168 Rome, Italy
| | - Gina Biasillo
- Institute of Cardiology Catholic University 8 Largo Gemelli 00168 Rome, Italy
| | - Ilaria Dato
- Institute of Cardiology Catholic University 8 Largo Gemelli 00168 Rome, Italy
| | - Luigi M. Biasucci
- Institute of Cardiology Catholic University 8 Largo Gemelli 00168 Rome, Italy
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Kuch B, von Scheidt W, Kling B, Heier M, Hoermann A, Meisinger C. Differential impact of admission C-reactive protein levels on 28-day mortality risk in patients with ST-elevation versus non-ST-elevation myocardial infarction (from the Monitoring Trends and Determinants on Cardiovascular Diseases [MONICA]/Cooperative Health Research in the Region of Augsburg [KORA] Augsburg Myocardial Infarction Registry). Am J Cardiol 2008; 102:1125-30. [PMID: 18940277 DOI: 10.1016/j.amjcard.2008.06.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 06/09/2008] [Accepted: 06/09/2008] [Indexed: 11/18/2022]
Abstract
The present study investigated the association between C-reactive protein (CRP) on admission independently and in combination with troponin and short-term prognosis in an unselected sample of patients with acute myocardial infarction (AMI) from the community. The study population consisted of 1,646 patients aged 25 to 74 years who were consecutively hospitalized with AMI within 12 hours after symptom onset. They were divided into the 2 groups of CRP positive (n = 919) or CRP negative (n = 727) with respect to admission CRP (cutoff < or =0.3 mg/dl). CRP-positive patients had significantly more in-hospital complications and a higher 28-day case-fatality rate (9.6% vs 3.4%; p <0.0001). Troponin at admission (n = 1,419) also correlated with 28-day case-fatality rate (troponin-negative 3.4% vs troponin-positive patients 8.0%; p <0.002). Multivariable analysis showed that both troponin positivity and CRP positivity were associated with a 2-fold (adjusted odds ratio 1.99, 95% confidence interval 1.15 to 3.44; adjusted odds ratio 2.05, 95% confidence interval 1.09 to 3.84, respectively) increased risk of dying within 28 days after the acute event for all patients with AMI. Stratifying by AMI type showed that in patients with ST-elevation myocardial infarction (STEMI), troponin positivity, but not CRP positivity, independently predicted 28-day case fatality. In patients with non-STEMI, CRP positivity, but not troponin positivity, predicted outcome. In conclusion, admission CRP was a powerful parameter for risk stratification of patients with AMI. Stratification by AMI type and troponin showed that CRP was a better short-term risk predictor for patients with non-STEMI, and troponin was, for patients with STEMI.
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Affiliation(s)
- Bernhard Kuch
- I. Medizinische Klinik, Hospital of Augsburg, Teaching Hospital of the Ludwig Maximilians University München, Augsburg, Germany.
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Clinical utility of C-reactive protein measured at admission, hospital discharge, and 1 month later to predict outcome in patients with acute coronary disease. The RISCA (recurrence and inflammation in the acute coronary syndromes) study. J Am Coll Cardiol 2008; 51:2339-46. [PMID: 18549920 DOI: 10.1016/j.jacc.2008.03.019] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 03/03/2008] [Accepted: 03/04/2008] [Indexed: 01/29/2023]
Abstract
OBJECTIVES This study was designed to prospectively determine, in patients with an acute coronary syndrome, whether the inflammatory marker, C-reactive protein (CRP), measured at hospital admission, discharge, and 1 month later has incremental value to predict outcomes at 1 year. BACKGROUND The clinical utility of CRP measurements in patients with acute coronary syndromes remains uncertain. Limitations of previous studies have been retrospective design and incomplete adjustment for readily available clinical prognosticators. METHODS The CRP marker was measured at admission, hospital discharge, and 1 month later in consecutive patients hospitalized for acute coronary syndromes in 8 tertiary and secondary hospitals. The primary outcome was a composite of death, nonfatal myocardial infarction (MI), and unstable angina (UA) with electrocardiogram (ECG) changes at 1 year. RESULTS A total of 1,210 patients, age 62 +/- 12 years, 64% with acute myocardial infarction (MI) and 36% with unstable angina (UA), were recruited. At 1 year, the primary outcome occurred in 142 patients (11.7%) and included 58 deaths (4.8%), 79 nonfatal MIs (6.5%), and 26 UA episodes with ECG changes (2.1%). The unadjusted odds ratios (ORs) (95% confidence intervals) of CRP values at admission, hospital discharge, and 1 month later for the occurrence of the primary outcome were 1.20 (1.06 to 1.36), 0.98 (0.85 to 1.14), and 1.23 (1.00 to 1.50), respectively. After multivariate adjustment, ORs were 1.04 (0.91 to 1.20), 0.90 (0.77 to 1.06), and 1.12 (0.93 to 1.34), respectively. The individual components of the primary outcome were also not independently associated with any of the 3 CRP measurements. CONCLUSIONS The modest predictive ability of CRP following admission for an acute coronary syndrome disappeared after adjusting for common clinical variables. This large prospective study does not support the incremental value of measuring CRP in this clinical setting.
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Crossman DC, Morton AC, Gunn JP, Greenwood JP, Hall AS, Fox KAA, Lucking AJ, Flather MD, Lees B, Foley CE. Investigation of the effect of Interleukin-1 receptor antagonist (IL-1ra) on markers of inflammation in non-ST elevation acute coronary syndromes (The MRC-ILA-HEART Study). Trials 2008; 9:8. [PMID: 18298837 PMCID: PMC2289802 DOI: 10.1186/1745-6215-9-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Accepted: 02/25/2008] [Indexed: 12/18/2022] Open
Abstract
Background Acute Coronary Syndromes account for 15% of deaths in the UK, and patients remain at significant risk of re-admission for future complications and death. Pathologically the underlying process of atherosclerosis is driven by inflammatory mechanisms, which are activated in ACS patients. Previous studies have investigated the role of inflammatory markers in this process, including interleukin 1 (IL-1) and C Reactive Protein (CRP). Pre-clinical studies indicate that IL-1 may be a primary driver of ACS and that the naturally occurring interleukin-1 receptor antagonist (IL-1ra) may inhibit the atherosclerotic process. This study will investigate the effects of IL-1ra on inflammatory markers in man. Methods/design Three centres in the UK are planning to recruit 186 Non-ST elevation myocardial infarction patients to receive either interleukin-1 receptor antagonist (Anakinra) or matching placebo. Patients will receive a daily subcutaneous injection of either study drug or placebo over a 14 day period. The primary outcome is area under the curve of high sensitivity C-Reactive Protein (CRP) over the first 7 days. Discussion The MRC-ILA-HEART Study is a proof of concept clinical trial investigating the effects of IL-1ra upon markers of inflammation in patients with Non-ST elevation myocardial infarction. It is hoped this will provide new and exciting information in relation to an "anti-inflammatory" strategy for patients with acute coronary syndrome. Trial registration ISRCTN89369318
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Affiliation(s)
- David C Crossman
- Cardiovascular Research Unit, School of Medicine & Biomedical Sciences, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK.
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Ulucay A, Demirbag R, Yilmaz R, Unlu D, Gur M, Selek S, Celik H. The Relationship Between Plasma C-Reactive Protein Levels and Presence and Severity of Coronary Stenosis in Patients With Stable Angina. Angiology 2007; 58:657-62. [DOI: 10.1177/0003319707309118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
High-sensitivity C-reactive protein (hsCRP) is an inflammation marker and potential predictor of cardiovascular events. However, there is no consensus on the relationship between plasma hsCRP levels and angiographically documented severe coronary lesions in patients with stable angina pectoris. In this study we aimed to assess whether plasma levels of hsCRP can indicate the severity of the coronary artery disease (CAD) in patients with stable angina. A total of 52 subjects, who had undergone coronary angiography were divided into two groups as follows: those with stable angina (group 1, at least one coronary arteries stenosis >50%, n = 26) and normal (group 2, n = 26). Severity of CAD was evaluated by using the Gensini score index. For each group, the levels of hsCRP were measured. HsCRP levels were compared in the subjects with normal coronary arteries, and in those with one-, two-, and three-vessel CAD, and no significant differences among the groups were found (analysis of variance, p>0.05). There was no significant correlation between hsCRP levels and Gensini score index (r = 0.278, p = 0.169). We conclude that there is no relationship between hsCRP levels and the presence and severity of CAD in patients with stable angina.
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Affiliation(s)
| | | | | | | | | | - Sahabettin Selek
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Hakim Celik
- Department of Clinical Biochemistry, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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Abstract
Among patients with cardiac disease, the identification of those who are at low risk and those who are at high risk for major cardiac events is crucial for a rational clinical management of individual patients. A correct noninvasive risk stratification of cardiac patients, in particular, has relevant clinical implications because it would avoid unnecessary exposure to potentially risky invasive diagnostic or interventional procedures in low-risk patients, whereas it would allow an appropriate aggressive diagnostic and therapeutic approach in high-risk patients. Furthermore, the appropriate identification of low- and high-risk patients would also have social and economic implications by favoring optimization of resource distribution and costs. A large number of studies in previous decades provided evidence that several methods and variables derived from the analysis of the electrocardiogram (ECG) are powerful predictors of major cardiac events in several clinical conditions. Despite that, there has been limited attention about how several of these findings can be used in clinical practice. Furthermore, in recent years, most studies about risk stratification of cardiac patients have mainly been focused on the use of a number of serum/plasma biomarkers with reduced attention to ECG variables. Surprisingly, however, there have been few attempts to establish whether the various proposed risk markers add any significant information to that obtainable from ECG methods. In this article, the evidence for the prognostic value of variables derived from the assessment of the ECG signal by several methods and techniques will be briefly reviewed. Because of the largeness of the topic, this review will be necessarily incomplete. Because most of the clinical research in this field concerned risk stratification of patients with coronary artery disease, the article will be largely focused on this population of patients. The role of ECG methods in specific cardiac diseases and, in particular, in the general population of asymptomatic subjects will be briefly discussed when believed appropriate and helpful. Furthermore, only major clinical events (ie, cardiac death, arrhythmic events, acute myocardial infarction) will be taken into account as end points in this article. Minor clinical events (eg, coronary revascularization procedures, coronary artery restenosis, recurrences of symptoms) are indeed less robust as end points because they are widely biased by subjective judgments.
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Ferroni P, Rosa A, Di Franco M, Palmirotta R, Guadagni F, Davì G, Bertazzoni G, Basili S. Prognostic significance of interleukin-6 measurement in the diagnosis of acute myocardial infarction in emergency department. Clin Chim Acta 2007; 381:151-6. [PMID: 17408606 DOI: 10.1016/j.cca.2007.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 03/01/2007] [Accepted: 03/01/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Markers of inflammation may predict both coronary artery disease (CAD) and adverse outcomes in patients with known CAD. Here, we investigated the role of interleukin-6 (IL-6) in the "triage" and risk assessment of patients admitted to emergency department (ED). METHODS Serum IL-6 and high sensitivity C-reactive protein (hs-CRP) levels were prospectively evaluated in 88 patients with a history of precordial chest pain or shortness of breath of recent onset (<6 h). RESULTS Of the 88 patients, 21% were discharged from the ED with diagnosis of non-ischemic chest pain (NICP), 39% had a final diagnosis of unstable angina (UA) and 40% experienced an acute myocardial infarction (AMI). Median IL-6 (p<0.001) and hs-CRP (p<0.01) levels on admission were significantly increased in patients with AMI compared with patients with NICP or UA. IL-6 levels correlated with hs-CRP (p<0.01). Multivariate analyses including known risk factors showed that elevated creatine kinase-MB (p<0.05) and IL-6 levels (p<0.01) were independently associated with a final diagnosis of AMI. Elevated IL-6 levels significantly predicted the risk of AMI (OR=2.47, p=0.006) in chest pain-enzyme negative patients. CONCLUSIONS IL-6 may behave as an adjunctive diagnostic tool to assist in the risk assessment of enzyme-negative patients with precordial chest pain of recent onset.
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Affiliation(s)
- Patrizia Ferroni
- Department of Laboratory Medicine & Advanced Biotechnologies, IRCCS San Raffaele Pisana, Rome, Italy.
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Morrow DA, Cannon CP, Jesse RL, Newby LK, Ravkilde J, Storrow AB, Wu AHB, Christenson RH. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes. Circulation 2007; 115:e356-75. [PMID: 17384331 DOI: 10.1161/circulationaha.107.182882] [Citation(s) in RCA: 207] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David A Morrow
- Brigham and Women's Hospital, Harvard University, Boston, MA, USA
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Osman R, L'Allier PL, Elgharib N, Tardif JC. Critical appraisal of C-reactive protein throughout the spectrum of cardiovascular disease. Vasc Health Risk Manag 2007; 2:221-37. [PMID: 17326329 PMCID: PMC1993979 DOI: 10.2147/vhrm.2006.2.3.221] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Clinicians involved in the care of patients with cardiovascular conditions have recently been confronted with an important body of literature linking inflammation and cardiovascular disease. Indeed, the level of systemic inflammation as measured by circulating levels of C-reactive protein (CRP) has been linked to prognosis in patients with atherosclerotic disease, congestive heart failure, atrial fibrillation, myocarditis, aortic valve disease and heart transplantation. In addition, a number of basic science reports suggest an active role for CRP in the pathophysiology of cardiovascular diseases. This article explores the potential role of CRP in disease initiation, progression, and clinical manifestations and reviews its role in the prediction of future events in clinical practice. Therapeutic interventions to decrease circulating levels of CRP are also reviewed.
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Palazzuoli A, Deckers J, Calabrò A, Campagna MS, Nuti R, Pastorelli M, Pasqui AL, Bruni F, Auteri A, Puccetti L. Brain natriuretic peptide and other risk markers for outcome assessment in patients with non-ST-elevation coronary syndromes and preserved systolic function. Am J Cardiol 2006; 98:1322-8. [PMID: 17134622 DOI: 10.1016/j.amjcard.2006.06.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2006] [Revised: 06/13/2006] [Accepted: 06/13/2006] [Indexed: 10/24/2022]
Abstract
Several emerging cardiac markers constitute strong predictors among patients with coronary artery disease. In particular, brain natriuretic peptide (BNP), troponin T (TnT), and C-reactive protein (CRP) are related to increased risk of recurrent ischemic events and death. However, little is known about the utility of these biomarkers in combination. This study examined risk assessment in patients with coronary artery disease and preserved systolic function. We studied 208 consecutive patients (138 men, 70 women) with stable angina, unstable angina, and non-Q-wave myocardial infarction whose plasma BNP, TnT, and CRP levels were measured at hospital admission. All recruited patients underwent echocardiographic examination, and selective coronary angiography was performed. After adjusting for clinical presentation, age, gender, and common risk factors, BNP was demonstrated as a strong predictor of heart failure (6 months, odds ratio [OR] 2.03, 95% confidence interval [CI] 1.24 to 2.9, p <0.01; 12 months, OR 2.65, 95% CI 1.69 to 3.5, p <0.001) and mortality at 3, 6, and 12 months (p <0.001). BNP was also significantly related to extent of coronary artery disease and left anterior descending artery involvement (p <0.01). Patients with a BNP level >80 pg/ml in all 3 groups had a significantly poorer prognosis with increased incidence of heart failure and death. CRP was related to recurrent ischemic events (infarct or recurrent angina, OR 1.4, 95% CI 1.14 to 2.08, p <0.01) and was associated with major cardiac revascularization at 12 months (OR 1.51, 95% CI 1.29 to 1.73, p <0.001). TnT demonstrated a mild correlation with recurrent infarct or angina at 12 months (OR 1.1, 95% CI 0.96 to 1.22, p <0.05) but appeared related to multivessel coronary artery disease (OR 1.47, 95% CI 1.05 to 1.99, p <0.01). In conclusion, BNP appears to be associated with a long-term increased risk of mortality and heart failure in patients with apparently mild risk. BNP is also associated with a larger extent and greater severity of myocardial ischemia. Early BNP measurement could provide incremental information to TnT and CRP, and it may be the strongest independent predictor of cardiac outcome in subjects without left ventricular dysfunction or enlargement.
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Affiliation(s)
- Alberto Palazzuoli
- Department of Internal Medicine and Metabolic Diseases, Section of Cardiology, University of Siena, Siena, Italy.
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Yeh ETH, Khan BV. The potential role of antiplatelet agents in modulating inflammatory markers in atherothrombosis. J Thromb Haemost 2006; 4:2308-16. [PMID: 16961584 DOI: 10.1111/j.1538-7836.2006.02202.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Atherothrombosis is the process that links atherosclerotic lesion development with unpredictable and life-threatening ischemic vascular events such as angina, myocardial infarction, transient ischemic attack, and stroke. Atherothrombosis is triggered when an unstable atherosclerotic lesion is ruptured, leading to platelet activation and thrombus formation. Inflammatory mediators are responsible for lesion instability leading to rupture, and in recent years atherothrombosis and its underlying condition of atherosclerosis have come to be recognized as manifestations of inflammatory disease. Inflammatory mediators may therefore serve as early markers of atherothrombosis. Measurement of early markers may be used to predict future ischemic events and improve risk stratification in patients following diagnosis of atherothrombotic disease. In addition, detection of such markers may help to optimize the use of current therapies to manage atherothrombosis. Molecules that may serve as early markers of atherothrombotic disease include C-reactive protein, CD40 ligand, myeloperoxidase, pregnancy-associated plasma protein and plasminogen activator inhibitor-1. Early indications are that levels of these markers are influenced by therapies currently in use in the treatment of atherothrombotic conditions, including antiplatelet agents. Ongoing studies will provide further insight into routine assessment of inflammatory markers as a guide to the management of patients with atherothrombosis.
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Affiliation(s)
- E T H Yeh
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, and Coronary Care Unit and Vascular Research, Grady Memorial Hospital, Atlanta, GA, USA.
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Hsu HHT, Culley NC. Accumulation of low density lipoprotein associated cholesterol in calcifying vesicle fractions correlates with intimal thickening in thoracic aortas of juvenile rabbits fed a supplemental cholesterol diet. Lipids Health Dis 2006; 5:25. [PMID: 17042957 PMCID: PMC1618834 DOI: 10.1186/1476-511x-5-25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Accepted: 10/16/2006] [Indexed: 11/17/2022] Open
Abstract
Background It has been shown that calcifying vesicles play an important role in aortic calcification and that cholesterol content in the isolated vesicle fraction is increased when rabbits are fed supplemental cholesterol diets. Whether lipoprotein-associated cholesterols and other lipids are also increased in the vesicle fraction and whether the increase correlates with atherosclerosis remain unknown. Results Fourteen juvenile male rabbits fed an atherogenic diet containing 0.5% cholesterol and 2% peanut oil for 3 months developed varying degrees of hypercholesterolemia and intimal thickening in the ascending thoracic aorta. The correlation between these two parameters was insignificant, and likely attributable to the use of small numbers of rabbits in this study. Despite this lack of correlation, we demonstrate that the accumulation of cholesterol in calcifying vesicle fractions obtained from the collagenase-digested aorta fragments correlates well with intimal thickening (r2 = 0.98, p < 0.0001). To a smaller degree, the correlation was also significant between intimal thickening and the cholesterol accumulation in the microsomal and post-vesicle fractions. The cholesterol supplemental diet increased the low density lipoprotein-cholesterol (LDL-C) content in calcifying vesicle fractions by 3-fold but did not affect the triglyceride content. High density lipoprotein-cholesterol (HDL-C) and very low-density lipoprotein cholesterol (VLD-C) were absent in calcifying vesicle fractions. Conclusion When limited numbers of rabbits are used, LDL-C accumulation in calcifying vesicle fractions is a better biomarker for atherosclerosis than LDL-C levels in the serum. The close association of LDL-C with calcifying vesicles may play an important role in atherosclerosis and calcification.
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Affiliation(s)
- Howard HT Hsu
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Division, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Nathan C Culley
- Laboratory Animal Resources, University of Kansas Medical Center, Kansas City, KS, 66160, USA
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Fukushima M, Seino Y, Kumita SI, Nakajo H, Cho K, Takano T. Dual-isotope myocardial SPECT in patients with redefined myocardial infarction. Int J Cardiol 2006; 104:204-12. [PMID: 16168815 DOI: 10.1016/j.ijcard.2004.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2004] [Revised: 10/13/2004] [Accepted: 12/30/2004] [Indexed: 11/27/2022]
Abstract
BACKGROUND According to the redefinition of myocardial infarction (MI) by the ESC/ACC Committee, patients with unstable angina (UA) without significant elevation of creatine kinase (CK) but with elevation of troponin T should be diagnosed as MI. METHODS One hundred and forty-six consecutive patients formerly diagnosed as UA, with peak CK levels<twice upper normal level, who underwent myocardial Thallium-201 (Tl; perfusion tracer) and (123)I-15-iodophenyl 3-methyl pentadecanoic acid (BMIPP; metabolism tracer) dual isotope single-photon emission computed tomography (SPECT), were retrospectively reclassified into redefined MI and UA groups according to the redefinition (troponin T: rapid bedside assay positive or quantitative level >0.10 ng/ml). Dual SPECT findings were analyzed qualitatively and quantitatively in blinded manner. RESULTS Forty-seven patients (32%) were redefined as MI and 99 patients (68%) were redefined as UA. On admission, there were small but statistically significant elevations in laboratory parameters such as white blood cell count, C-reactive protein, CK and CK-MB in the redefined MI group compared with the redefined UA group. The proportion of patients with perfusion and metabolic abnormalities was significantly higher in the redefined MI group (Tl defect 36% vs. 4%, odds ratio: 13.5, p<0.001; BMIPP defect 64% vs. 23%, odds ratio: 5.8, p<0.001). Semi-quantitative evaluation revealed that the total Tl and BMIPP scores were significantly higher in the redefined MI patients (p<0.001). CONCLUSIONS In the redefined MI patients, perfusion and metabolic abnormalities occurred frequently and more extensively. However, Tl/BMIPP dual SPECT had limited ability to detect minor myocardial infarcts classified as redefined MI. A more sensitive stratification combined with troponin T directed assignment should be established to incorporate the ongoing minor infarcts which could not be assessed by serial dual-scintigraphic evaluations.
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Affiliation(s)
- Masato Fukushima
- First Department of Internal Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, 113-8603 Tokyo, Japan
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Roy D, Quiles J, Avanzas P, Arroyo-Espliguero R, Sinha M, Kaski JC. A comparative study of markers of inflammation for the assessment of cardiovascular risk in patients presenting to the emergency department with acute chest pain suggestive of acute coronary syndrome. Int J Cardiol 2006; 109:317-21. [PMID: 16046018 DOI: 10.1016/j.ijcard.2005.06.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Revised: 06/06/2005] [Accepted: 06/10/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The role of inflammation in the pathogenesis of acute coronary syndrome (ACS) is established. Little is known however, regarding the use of inflammatory markers as predictors of future cardiovascular events in patients presenting to the emergency department (ED) with suspected ACS. HYPOTHESIS To assess whether biomarkers that predict cardiovascular risk in apparently healthy individuals and coronary artery disease patients are useful predictors of future cardiovascular events in patients presenting to the ED with chest pain suggestive of ACS. METHODS We compared the abilities of serum C-reactive protein (hs-CRP), albumin and leukocyte count to identify subjects with ACS and those who are at high risk of developing events during a 30-day follow-up. RESULTS 144 patients (mean age 62+/-13 years, 45 female) presenting to the ED <3 h after the onset of symptoms suggestive of ACS were evaluated. Final hospital diagnoses were non-ischemic chest pain in 43 (30%) and ACS in 101 (70%) patients. Patients with ACS had significantly higher leukocyte count (p<0.0001) and hs-CRP levels (p<0.02) and lower albumin concentrations, compared to patients with NICP (p<0.0001). Lower albumin concentrations (p=0.03) and hs-CRP (p=0.049) were predictors of recurrent events at 30 days. On multivariate analysis, however, only leukocyte count was a predictor of ACS (OR 20.9; 95% CI: 3.7-19.5; p=0.01) and high hs-CRP levels were a predictor of clinical outcome (OR 2.8; 95% CI: 1.5-5.2; p=0.001). CONCLUSIONS Leukocyte count is an independent predictor of ACS in patients presenting to the ED with chest pain suggestive of ACS and high hs-CRP levels are an independent predictor of clinical outcome in ACS patients.
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Affiliation(s)
- Debashis Roy
- Coronary Artery Disease Research Unit, St George's Hospital Medical School, London, United Kingdom
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Maisel AS, Bhalla V, Braunwald E. Cardiac biomarkers: a contemporary status report. ACTA ACUST UNITED AC 2006; 3:24-34. [PMID: 16391615 DOI: 10.1038/ncpcardio0405] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 07/26/2005] [Indexed: 11/09/2022]
Abstract
The field of cardiac biomarkers has grown by leaps and bounds in the past two decades. In this review we try to summarize the explosion of emerging knowledge and address the roles of some of the biomarkers that have either proven or potential utility. We detail some of the markers of ischemia, hemodynamic markers of heart failure, inflammatory markers, and the novel and innovative approach of combining these for a multimarker strategy. At the end of this review we highlight some of the biomarker-guided approaches and strategies that might lead to better and more-effective care of patients.
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Affiliation(s)
- Alan S Maisel
- Department of Medicine, Veterans Affairs San Diego Healthcare System and University of California, San Diego, CA 92161, USA.
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Biasucci LM, Giubilato G, Graziani F, Piro M. CRP is or is not a reliable marker of ischaemic heart disease? Lupus 2005; 14:752-5. [PMID: 16218481 DOI: 10.1191/0961203305lu2214oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In recent years a growing body of evidence has emphasized the role of C-reactive protein (CRP) as a marker of future cardiovascular events. CRP is a pentameric molecule widely utilized as a marker of infections and inflammation. The evidence that inflammation plays an important role in the pathogenesis of coronary artery disease and in plaque destabilization has lead to use of CRP as a marker of cardiovascular disease as well. First described as a component of the inflammatory pathway in acute coronary syndromes, CRP has been consistently found to be associated with the risk of future events in no-ST elevation acute coronary syndromes, independently of other risk factors, including troponine. Subsequently CRP has been described as a powerful marker of risk of future events in large populations of apparently healthy subjects. So far there is very little doubt that CRP represents a reliable marker of cardiovascular events, but some issues remain unanswered such as why CRP is a good marker of cardiovascular events and whether or not a better inflammatory marker exists. It must be stressed that CRP, because of its analytical and biological properties and the large amount of available data, is the only inflammatory marker accepted for clinical use.
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Affiliation(s)
- L M Biasucci
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
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Huelmos A, Jiménez J, Guijarro C, Belinchón JC, Puras E, Sánchez C, Casas ML, López-Bescos L. Enfermedad arterial periférica desconocida en pacientes con síndrome coronario agudo: prevalencia y patrón diferencial de los factores de riesgo cardiovascular tradicionales y emergentes. Rev Esp Cardiol 2005. [DOI: 10.1016/s0300-8932(05)74070-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ala-Kleme T, Mäkinen P, Ylinen T, Väre L, Kulmala S, Ihalainen P, Peltonen J. Rapid Electrochemiluminoimmunoassay of Human C-Reactive Protein at Planar Disposable Oxide-Coated Silicon Electrodes. Anal Chem 2005; 78:82-8. [PMID: 16383313 DOI: 10.1021/ac051157i] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Electrochemiluminescence (ECL) of aromatic Tb(III) chelates at thin insulating film-coated electrodes provides a means for extremely sensitive detection of Tb(III) chelates and also of biologically interesting compounds if these chelates are used as labels in bioaffinity assays. The suitability of silicon electrodes coated with thermally grown silicon dioxide film as disposable working electrodes in sensitive time-resolved ECL measurements is demonstrated, and a rapid electrochemiluminoimmunoassay (ECLIA) of human C-reactive protein (hCRP) is described. Tb(III) chelate labels can be detected almost down to picomolar level, and the calibration curve of these labels covers more than 6 orders of magnitude of chelate concentration. The calibration curve of the present immunometric hCRP assay was found to be linear over a wide range, approximately 4 orders of magnitude of hCRP concentration, the detection limit of the protein being 0.3 ng mL(-1) (mean background + 2SD) on CV values of about 10-30%, depending on the immunoassay incubation time. In the ECLIA measurements, different incubation times were tested from 15 min (giving above-mentioned performance) to as short as only 2 min, which still gave successful results with approximately 20,000 times better detection limit levels than traditional commercial assay methods. During the ECLIA process, also the Si electrode surface morphology was also investigated by atomic force microscope monitoring.
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Affiliation(s)
- Timo Ala-Kleme
- Department of Chemistry, University of Turku, FIN-20014 Turku, Finland.
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Abstract
BACKGROUND Postoperative myocardial infarction is a rare, but potentially severe complication after coronary artery bypass grafting (CABG). Early markers for coronary bypass graft failure or native vessel occlusion are required, because immediate intervention could prevent major myocardial damage. METHODS One thousand patients with coronary artery disease consecutively underwent CABG. Postoperative coronary angiography was performed in 40 patients with suspected myocardial ischemia. Creatine kinase (CK), CK-MB, leukocyte count, C-reactive protein (CRP), lactate dehydrogenase (LDH), and glutamate-oxalacetate transaminase (GOT) were assessed at 0, 6, 12, 24, 48, and 72 hours after CABG as well as 12-lead standard electrocardiography (ECG). RESULTS Postoperative angiography of 40 patients with suspected myocardial infarction revealed graft failure or occluded native vessels in 13 (32.5%) individuals. Patients with graft or vessel occlusion presented elevated (P < .005) leukocyte counts (17,215 +/- 6632 vs 10,773 +/- 3902 G/L) immediately after CABG. CK-MB concentrations differed ( P < .05) at 6 hours after CABG (54 +/- 48 vs 30 +/- 18 U/L). CK, CRP, LDH, and GOT did not show any differences between both groups. Frequency of ECG ST-segment elevation was increased (P < .05) in ischemic patients (69.2% vs 29.6%). CONCLUSIONS Common signs of myocardial ischemia usually allow to diagnose unstable angina or myocardial infarction under native conditions. In contrast, these criteria frequently fail after CABG. Combined diagnostic criteria of elevated leukocytes (>14,000 G/L, at hour 0) and either ST elevation or CK-MB concentrations >35 U/L (at hour 6) at least seem to be very useful in detecting myocardial infarction after bypass grafting. In parallel, CK-MB elevation (>70 U/L, at hour 6) alone seems to predict ischemia. Both criteria should indicate angiography and potential revascularization. If these conditions were not fulfilled, the risk of perioperative myocardial infarction appears to be moderate.
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Lanza GA, Bencardino G, Sestito A, Shaw S, Sgueglia GA, Infusino F, Lüscher TF, Crea F. Association of endothelin-1 with transient myocardial ischemia in patients with unstable angina pectoris. Am J Cardiol 2005; 95:492-4. [PMID: 15695136 DOI: 10.1016/j.amjcard.2004.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2004] [Revised: 10/06/2004] [Accepted: 10/06/2004] [Indexed: 11/17/2022]
Abstract
In this study we assessed whether serum endothelin-1 levels were associated with indexes of disease severity in unstable angina, including troponin I, C-reactive protein, and transient myocardial ischemia. Endothelin-1 levels were higher in patients who had transient myocardial ischemia and in those who had 3-vessel disease on angiography but were not significantly correlated with levels of C-reactive protein and troponin I.
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Mach F. Inflammation is a crucial feature of atherosclerosis and a potential target to reduce cardiovascular events. Handb Exp Pharmacol 2005:697-722. [PMID: 16596820 DOI: 10.1007/3-540-27661-0_26] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Contrary to popular opinion, atherosclerosis is not a disease unique to modern civilization. In fact, atherosclerotic lesions have been found in the arteries of mummies dating back to 1,500 B.C., and yet our understanding of this complex process is still evolving. A fusion of basic science advances and clinical research findings has radically altered our traditional concepts about the pathogenesis and treatment of the clinical complications of atherosclerosis. Most physicians previously regarded the artery as a being merely a blood conduit that became encrusted with lipid detritus as part of the aging process. Modern-day treatment of atherosclerosis has arisen primarily from an understanding of the epidemiology of the disease rather than its pathophysiology, in that risk factors have traditionally been targeted. Our concepts of atherogenesis have evolved from vague ideas of inevitable degeneration to a much better defined scenario of molecular and cellular events. As we enhance our understanding of its fundamental mechanism, we can begin to approach atherogenesis as a modifiable rather than ineluctable process. Indeed, as we recognize now that inflammation plays a pivotal role in the process of atherosclerosis, it is noteworthy to evaluate the effect of modern therapies on this facet of the disease.
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Affiliation(s)
- F Mach
- Division of Cardiology, Department of Medicine, University Hospital Geneva, Switzerland.
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Abstract
Inflammation is a recognized key component of acute coronary syndromes. Such pathogenetic achievement has led to the use of inflammatory cells and proteins as prognostic markers in these syndromes. A number of markers have been proposed, including proinflammatory cytokines such as interleukin-6, interleukin-1RA, and tumor necrosis factor-α, adhesion molecules such as intracellular adhesion molecule-1 and vascular adhesion molecule-1 and markers of cell activation. Although all are of scientific interest, the clinical use of these markers is limited by their high cost, low availability, and unfavorable biological profile. Conversely, common markers of inflammation such as C-reactive protein (CRP), the prototypic acute phase protein, and to a lesser extent fibrinogen, have been proven to be reliable and important markers of risk in ischemic heart disease. CRP, in particular, has been found to be associated with short- and long-term prognosis in acute coronary syndromes, including ST-elevation myocardial infarction, and in stable angina, and to predict the risk of restenosis and major events, including death, after revascularization procedures. CRP has been consistently found to be independent from other risk factors and to have an incremental value beyond the common risk factors and biochemical markers of risk, including troponin. Whether CRP also should be used as a guide to therapy is still a matter of discussion that deserves further, properly designed studies.
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Smith SC, Anderson JL, Cannon RO, Fadl YY, Koenig W, Libby P, Lipshultz SE, Mensah GA, Ridker PM, Rosenson R. CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease. Circulation 2004; 110:e550-3. [PMID: 15611380 DOI: 10.1161/01.cir.0000148981.71644.c7] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gao X, Bermudez OI, Tucker KL. Plasma C-Reactive Protein and Homocysteine Concentrations Are Related to Frequent Fruit and Vegetable Intake in Hispanic and Non-Hispanic White Elders. J Nutr 2004. [DOI: 10.1093/jn/134.4.913 [doi]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Xiang Gao
- The Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Odilia I. Bermudez
- The Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Katherine L. Tucker
- The Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA
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Labarrere CA, Zaloga GP. C-reactive protein: from innocent bystander to pivotal mediator of atherosclerosis. Am J Med 2004; 117:499-507. [PMID: 15464707 DOI: 10.1016/j.amjmed.2004.03.039] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2003] [Revised: 03/16/2004] [Accepted: 03/16/2004] [Indexed: 10/26/2022]
Abstract
There is compelling evidence that C-reactive protein is a sensitive marker for the development of cardiovascular disease in the general population. Recent studies suggest that C-reactive protein is not only a biomarker but also an active mediator in the pathogenesis of atherosclerosis. We review the evidence and suggest mechanisms by which C-reactive protein can damage arterial endothelium and promote the development of atherosclerotic lesions, including the effects of C-reactive protein on arterial endothelial activation, macrophage recruitment, and foam cell generation. The direct role of C-reactive protein in sustaining a proinflammatory and procoagulant milieu within the arterial neointima is emphasized. We also discuss the evidence that C-reactive protein can injure arterial endothelium. Finally, we review therapies that target C-reactive protein for primary prevention and for the treatment of atherosclerotic diseases.
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Affiliation(s)
- Carlos A Labarrere
- Methodist Research Institute, Clarian Health Partners, Inc., Indianapolis, Indiana 46202, USA.
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Geppert A, Huber K. Inflammation and cardiovascular diseases: lessons that can be learned for the patient with cardiogenic shock in the intensive care unit. Curr Opin Crit Care 2004; 10:347-53. [PMID: 15385750 DOI: 10.1097/01.ccx.0000139364.53198.fd] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In the past 12 years, atherosclerosis and the acute coronary syndromes have turned out to be thromboinflammatory diseases. Recent data suggest that inflammation also plays an important role in the pathogenesis and outcome of cardiogenic shock. This review will summarize recent advances in the understanding of the pathophysiology of cardiogenic shock related to the inflammatory network and will discuss recent findings in the treatment of patients with cardiogenic shock in relation to these new insights. RECENT FINDINGS The glycoprotein IIb/IIIa antagonist abciximab has recently been found to be especially useful in the treatment of patients with cardiogenic shock undergoing coronary revascularization with stent implantation, reducing mortality in retrospective analyses from 40 to 50% down to 18 to 26%. Although it remains to be proved whether this is really due to their antiinflammatory effects, other drugs with clear antiinflammatory properties, like the nitric oxide synthase inhibitors L-NAME/L-NMMA, have recently been tested in small series of patients with refractory shock despite coronary revascularization based on the hypothesis that inflammation and impaired vasoreactivity are crucial for the pathogenesis and outcome of cardiogenic shock, with promising results. Other drugs, like a recently developed antibody fragment directed against C5 (pexelizumab) or high-dose statins, await testing in this population with a very high mortality rate. CONCLUSION The promising results of studies that tested a potential benefit of drugs with clear or potential antiinflammatory/immunomodulatory properties in patients with cardiogenic shock underscores the importance of the inflammatory network in the pathogenesis and outcome of this devastating complication of cardiovascular disease.
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Affiliation(s)
- Alexander Geppert
- Cardiovascular Intensive Care Unit, 3 Department of Medicine, Wilhelminenhospital, Vienna, Austria.
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Gao X, Bermudez OI, Tucker KL. Plasma C-reactive protein and homocysteine concentrations are related to frequent fruit and vegetable intake in Hispanic and non-Hispanic white elders. J Nutr 2004; 134:913-8. [PMID: 15051846 DOI: 10.1093/jn/134.4.913] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Elevated C-reactive protein (CRP) and plasma total homocysteine (Hcy) were recently identified as risk factors for cardiovascular disease. However, few studies have related fruit and vegetable consumption to these markers of inflammation and B vitamin deficiency, particularly in the Hispanic population. We examined the relation of fruit and vegetable intake with plasma CRP and Hcy concentrations in a cross-sectional study. Subjects were 445 Hispanic elders and 154 neighborhood-based non-Hispanic white elders living in Massachusetts. Diet was assessed with a FFQ designed for this population. There were significant inverse dose-response associations between fruit and vegetable intake and plasma CRP (P for trend = 0.010) and Hcy (P for trend = 0.033) concentrations, after adjustment for potential confounders. The prevalence of high plasma CRP (> 10 mg/L), and high Hcy (>10.4 micromol/L for women and >11.4 micromol/L for men), was significantly greater among subjects in the lowest quartile of fruit and vegetable consumption relative to those in the highest quartile, 17.9 vs. 9.1% and 58.7 vs. 44.4%, respectively. With each additional serving of fruit and vegetable intake, adjusted odd ratios for high plasma CRP and Hcy were 0.79 (95% CI: 0.65 to 0.97) and 0.83 (95% CI: 0.72 to 0.96), respectively. Greater frequency of fruit and vegetable intake was associated with significantly lower plasma CRP and Hcy concentrations. Because both of these metabolites are known risk factors for CVD, these findings contribute to the evidence that a higher intake of fruit and vegetables may reduce the risk of CVD.
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Affiliation(s)
- Xiang Gao
- The Jean Mayer U S Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
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