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Kim S, Kim BH, Han K, Kong M, Song SJ. Association Between Three Atopic Triad and Retinal Vein Occlusion Risk: A Nationwide Population-Based Study. Ophthalmic Epidemiol 2024; 31:301-310. [PMID: 37899646 DOI: 10.1080/09286586.2023.2276193] [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: 07/18/2023] [Accepted: 10/23/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE To evaluate the association between three allergic diseases (allergic dermatitis, allergic rhinitis, and asthma) and the development of retinal vein occlusion (RVO), a major retinal disease that causes visual impairment. METHOD This study used data obtained from the Korean National Health Insurance Claims database between 2009 and 2018. The association between the three atopic triads (allergic dermatitis, allergic rhinitis, and asthma) and the occurrence of sight-threatening RVO, as determined by diagnostic and treatment codes, were analyzed. Multivariate adjusted Cox regression analysis was used to determine the hazard ratios (HRs) and 95% confidence intervals for RVO development in the presence of allergic disease. RESULTS In this population-based study, 2,160,195 (54.6%) individuals were male, 1,794,968 (45.4%) were female, and 620,938 (15.7%) were diagnosed with allergic diseases. Patients with either asthma or allergic rhinitis had a greater risk of RVO (adjusted hazard ratio (aHR) = 1.101, 95% confidence interval [CI] = 1.029-1.178 for asthma; aHR = 1.181, 95% CI = 1.147-1.215 for allergic rhinitis) compared to those without asthma or allergic rhinitis; however, patients with atopic dermatitis did not show a significant association with RVO (aHR = 1.071, 95% CI = 0.889-1.290), after adjusting for other risk factors. CONCLUSION Our study revealed that allergic rhinitis, asthma, and coexisting multiple allergic conditions were associated with an increased risk of RVO. Thus, it may be advisable to suggest an ophthalmological examination for patients with allergies due to the increased possibility of the occurrence of retinal vascular disease.
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Affiliation(s)
- Seongho Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bo Hee Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Mingui Kong
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Su Jeong Song
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Biomedical Institute for Convergence (BICS), Sungkyunkwan University, Suwon, Republic of Korea
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Wang Y, Ma X, Yang Z, Li Q, Zhou Y, Gao F, Wang Z. Value of Absolute Eosinophil Count in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Int J Gen Med 2024; 17:1025-1038. [PMID: 38525068 PMCID: PMC10959244 DOI: 10.2147/ijgm.s451900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Background and Aims Elevated eosinophils typically indicate hypersensitive inflammation; however, their involvement in cardiovascular events remains incompletely understood. We investigated the association between the absolute eosinophil count (AEC) and major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Additionally, we determine whether the integration of AEC with the SYNTAX II score could improve predictive ability. Methods and Results The AECs of 1711 patients with ACS undergoing PCI from June 2016 to November 2017 were analyzed on admission. All recruitments were splitted into three groups based on AEC tertiles and 101 participants underwent one or more noteworthy outcomings. The association between AEC and MACCEs (defined as a composite of cardiovascular death, myocardial infarction [MI], and stroke) was tested by Cox proportional-hazards regression analysis. After adjusting for confounders, AEC was independently associated with MACCEs (HR 11.555, 95% CI: 3.318-40.239). Patients in the lowest AEC tertile (T1) as a reference, those in the higher tertiles had an incrementally higher risk of MACCEs (T3: HR 1.848 95% CI: 1.157-2.952; P for trend=0.008). Inclusion of AEC enhanced the predictive accuracy of the SYNTAX II score for MACCEs (AUC: from 0.701 [95% CI: 0.646-0.756] to 0.728 [95% CI: 0.677-0.780]; DeLong's test, P = 0.020). Conclusion AEC is independently linked to MACCEs in ACS patients who underwent PCI, and adds incremental predictive information to the SYNTAX II score.
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Affiliation(s)
- Yufei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
| | - Xiaoteng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
| | - Zhiqiang Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
- Cardio-Metabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Qiuxuan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
- The Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, People’s Republic of China
| | - Fei Gao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
- The Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, People’s Republic of China
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
- The Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, People’s Republic of China
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Meng Z, Zhang S, Li W, Wang Y, Wang M, Liu X, Liu CL, Liao S, Liu T, Yang C, Lindholt JS, Rasmussen LM, Obel LM, Stubbe J, Diederichsen AC, Sun Y, Chen Y, Yu PB, Libby P, Shi GP, Guo J. Cationic proteins from eosinophils bind bone morphogenetic protein receptors promoting vascular calcification and atherogenesis. Eur Heart J 2023; 44:2763-2783. [PMID: 37279475 PMCID: PMC10393071 DOI: 10.1093/eurheartj/ehad262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 02/28/2023] [Accepted: 04/17/2023] [Indexed: 06/08/2023] Open
Abstract
AIMS Blood eosinophil count and eosinophil cationic protein (ECP) concentration are risk factors of cardiovascular diseases. This study tested whether and how eosinophils and ECP contribute to vascular calcification and atherogenesis. METHODS AND RESULTS Immunostaining revealed eosinophil accumulation in human and mouse atherosclerotic lesions. Eosinophil deficiency in ΔdblGATA mice slowed atherogenesis with increased lesion smooth muscle cell (SMC) content and reduced calcification. This protection in ΔdblGATA mice was muted when mice received donor eosinophils from wild-type (WT), Il4-/-, and Il13-/- mice or mouse eosinophil-associated-ribonuclease-1 (mEar1), a murine homologue of ECP. Eosinophils or mEar1 but not interleukin (IL) 4 or IL13 increased the calcification of SMC from WT mice but not those from Runt-related transcription factor-2 (Runx2) knockout mice. Immunoblot analyses showed that eosinophils and mEar1 activated Smad-1/5/8 but did not affect Smad-2/3 activation or expression of bone morphogenetic protein receptors (BMPR-1A/1B/2) or transforming growth factor (TGF)-β receptors (TGFBR1/2) in SMC from WT and Runx2 knockout mice. Immunoprecipitation showed that mEar1 formed immune complexes with BMPR-1A/1B but not TGFBR1/2. Immunofluorescence double-staining, ligand binding, and Scatchard plot analysis demonstrated that mEar1 bound to BMPR-1A and BMPR-1B with similar affinity. Likewise, human ECP and eosinophil-derived neurotoxin (EDN) also bound to BMPR-1A/1B on human vascular SMC and promoted SMC osteogenic differentiation. In a cohort of 5864 men from the Danish Cardiovascular Screening trial and its subpopulation of 394 participants, blood eosinophil counts and ECP levels correlated with the calcification scores of different arterial segments from coronary arteries to iliac arteries. CONCLUSION Eosinophils release cationic proteins that can promote SMC calcification and atherogenesis using the BMPR-1A/1B-Smad-1/5/8-Runx2 signalling pathway.
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Affiliation(s)
- Zhaojie Meng
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Shuya Zhang
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
- Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research & Key Laboratory of Emergency and Trauma of Ministry of Education, Institute of Cardiovascular Research of the First Affiliated Hospital, Hainan Medical University, Haikou 571199, Hainan, China
| | - Wei Li
- College of Chinese Medicinal Materials, Jilin Agricultural University, Changchun 130118, Jilin, China
| | - Yunzhe Wang
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
- Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Minjie Wang
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Xin Liu
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Cong-Lin Liu
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
- Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Sha Liao
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Tianxiao Liu
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Chongzhe Yang
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
- Department of Geriatrics, National Key Clinical Specialty, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510000, Guangdong, China
| | - Jes S Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Elite Research Centre of Individualized Treatment for Arterial Disease, University Hospital, Odense, Denmark
| | - Lars M Rasmussen
- Elite Research Centre of Individualized Treatment for Arterial Disease, University Hospital, Odense, Denmark
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
| | - Lasse M Obel
- Elite Research Centre of Individualized Treatment for Arterial Disease, University Hospital, Odense, Denmark
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
| | - Jane Stubbe
- Cardiovascular and Renal Research unit, Institute for Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Axel C Diederichsen
- Elite Research Centre of Individualized Treatment for Arterial Disease, University Hospital, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Yong Sun
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Birmingham VA Medical Center, Research Department, Birmingham, AL 35294, USA
| | - Yabing Chen
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Birmingham VA Medical Center, Research Department, Birmingham, AL 35294, USA
| | - Paul B Yu
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Peter Libby
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Guo-Ping Shi
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Junli Guo
- Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research & Key Laboratory of Emergency and Trauma of Ministry of Education, Institute of Cardiovascular Research of the First Affiliated Hospital, Hainan Medical University, Haikou 571199, Hainan, China
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Yang C, Li J, Deng Z, Luo S, Liu J, Fang W, Liu F, Liu T, Zhang X, Zhang Y, Meng Z, Zhang S, Luo J, Liu C, Yang D, Liu L, Sukhova GK, Sadybekov A, Katritch V, Libby P, Wang J, Guo J, Shi GP. Eosinophils protect pressure overload- and β-adrenoreceptor agonist-induced cardiac hypertrophy. Cardiovasc Res 2023; 119:195-212. [PMID: 35394031 PMCID: PMC10022866 DOI: 10.1093/cvr/cvac060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 02/01/2022] [Accepted: 03/23/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Blood eosinophil (EOS) counts and EOS cationic protein (ECP) levels associate positively with major cardiovascular disease (CVD) risk factors and prevalence. This study investigates the role of EOS in cardiac hypertrophy. METHODS AND RESULTS A retrospective cross-section study of 644 consecutive inpatients with hypertension examined the association between blood EOS counts and cardiac hypertrophy. Pressure overload- and β-adrenoreceptor agonist isoproterenol-induced cardiac hypertrophy was produced in EOS-deficient ΔdblGATA mice. This study revealed positive correlations between blood EOS counts and left ventricular (LV) mass and mass index in humans. ΔdblGATA mice showed exacerbated cardiac hypertrophy and dysfunction, with increased LV wall thickness, reduced LV internal diameter, and increased myocardial cell size, death, and fibrosis. Repopulation of EOS from wild-type (WT) mice, but not those from IL4-deficient mice ameliorated cardiac hypertrophy and cardiac dysfunctions. In ΔdblGATA and WT mice, administration of ECP mEar1 improved cardiac hypertrophy and function. Mechanistic studies demonstrated that EOS expression of IL4, IL13, and mEar1 was essential to control mouse cardiomyocyte hypertrophy and death and cardiac fibroblast TGF-β signalling and fibrotic protein synthesis. The use of human cardiac cells yielded the same results. Human ECP, EOS-derived neurotoxin, human EOS, or murine recombinant mEar1 reduced human cardiomyocyte death and hypertrophy and human cardiac fibroblast TGF-β signalling. CONCLUSION Although blood EOS counts correlated positively with LV mass or LV mass index in humans, this study established a cardioprotective role for EOS IL4 and cationic proteins in cardiac hypertrophy and tested a therapeutic possibility of ECPs in this human CVD.
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Affiliation(s)
| | | | | | | | | | - Wenqian Fang
- Department of Medicine, Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Feng Liu
- Department of Geriatrics, National Key Clinical Specialty, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510000, China
| | - Tianxiao Liu
- Department of Medicine, Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Xian Zhang
- Department of Medicine, Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Yuanyuan Zhang
- Department of Medicine, Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
- Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research & Key Laboratory of Emergency and Trauma of Ministry of Education, Institute of Cardiovascular Research of the First Affiliated Hospital, Hainan Medical University, Haikou 571199, China
| | - Zhaojie Meng
- Department of Medicine, Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Shuya Zhang
- Department of Medicine, Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
- Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research & Key Laboratory of Emergency and Trauma of Ministry of Education, Institute of Cardiovascular Research of the First Affiliated Hospital, Hainan Medical University, Haikou 571199, China
| | - Jianfang Luo
- Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangzhou 510000, China
| | - Conglin Liu
- Department of Medicine, Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Dafeng Yang
- Department of Medicine, Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Lijun Liu
- Department of Biochemistry and Cancer Biology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, USA
| | - Galina K Sukhova
- Department of Medicine, Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Anastasiia Sadybekov
- Department of Chemistry, Bridge Institute, USC Michelson Center for Convergent Biosciences, University of Southern California, Los Angeles, CA 90089, USA
- Department of Biological Sciences, Bridge Institute, USC Michelson Center for Convergent Biosciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Vsevolod Katritch
- Department of Chemistry, Bridge Institute, USC Michelson Center for Convergent Biosciences, University of Southern California, Los Angeles, CA 90089, USA
- Department of Biological Sciences, Bridge Institute, USC Michelson Center for Convergent Biosciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Peter Libby
- Department of Medicine, Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Jing Wang
- Corresponding authors. Tel: +1 617 525 4358, E-mail: (G.-P.S.); Tel: +86 10 6915 6477, E-mail: (J.W.); Tel: +86 1868983 5101, E-mail: (J.G.)
| | - Junli Guo
- Corresponding authors. Tel: +1 617 525 4358, E-mail: (G.-P.S.); Tel: +86 10 6915 6477, E-mail: (J.W.); Tel: +86 1868983 5101, E-mail: (J.G.)
| | - Guo-Ping Shi
- Corresponding authors. Tel: +1 617 525 4358, E-mail: (G.-P.S.); Tel: +86 10 6915 6477, E-mail: (J.W.); Tel: +86 1868983 5101, E-mail: (J.G.)
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Hu W, Jiang J. Hypersensitivity and in-stent restenosis in coronary stent materials. Front Bioeng Biotechnol 2022; 10:1003322. [PMID: 36185438 PMCID: PMC9521847 DOI: 10.3389/fbioe.2022.1003322] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Coronary heart disease (CHD) is a type of cardiovascular disease with the highest mortality rate worldwide. Percutaneous transluminal coronary intervention (PCI) is the most effective method for treating CHD. However, in-stent restenosis (ISR), a long-term complication after PCI, affects the prognosis of patients with CHD. Previous studies have suggested that hypersensitivity reactions induced by metallic components may be one of the reasons of this complication. With the emergence of first- and second-generation drug-eluting stents (DES), the efficacy and prognosis of patients with CHD have greatly improved, and the incidence of ISR has gradually decreased to less than 10%. Nevertheless, DES components have been reported to induce hypersensitivity reactions, either individually or synergistically, and cause local inflammation and neointima formation, leading to long-term adverse cardiovascular events. In this article, we described the relationship between ISR and hypersensitivity from different perspectives, including its possible pathogenesis, and discussed their potential influencing factors and clinical significance.
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Affiliation(s)
- Wansong Hu
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jun Jiang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- *Correspondence: Jun Jiang,
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Li S, Qiu H, Lin Z, Fan L, Guo Y, Zhang Y, Chen L. The Early Predictive Value of Circulating Monocytes and Eosinophils in Coronary DES Restenosis. Front Cardiovasc Med 2022; 9:764622. [PMID: 35274009 PMCID: PMC8902143 DOI: 10.3389/fcvm.2022.764622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/03/2022] [Indexed: 12/18/2022] Open
Abstract
Background Monocytes and eosinophils are involved in intracoronary inflammatory responses, aggravating coronary artery plaque instability and in-stent restenosis (ISR). Aims To investigate an early prediction of ISR in patients undergoing stenting by circulating monocytes and eosinophils. Methods The single-center data of patients undergoing successful drug-eluting stents (DES) implantation from January 1, 2017 to April 30, 2020 were retrospectively analyzed. Of the 4,392 patients assessed, 140 patients with restenosis and 141 patients without restenosis were enrolled. A scheduled postoperative follow-up was proceeded in four sessions: 0-3 months, 3-6 months, 6-12 months, and >12 months. The hematological and biochemical measurement was collected. The angiographic review was completed within two postoperative years. Results Significant associations of monocyte count and percentage with ISR were evident [odds ratio (OR): 1.44, 95% CI: 1.23-1.68, P < 0.001; OR: 1.47, 95%CI: 1.24-1.74, P < 0.001, respectively], which began at 3 months postoperatively and persisted throughout the follow-up period. Eosinophil count and percentage were associated with ISR (OR: 1.22, 95%CI: 1.09-1.36, P = 0.001; OR: 1.23, 95%CI: 1.07-1.40, P = 0.003, respectively), with ISR most significantly associated with the baseline eosinophils. The receiver operating characteristic (ROC) curve analysis showed that the cutoff points of monocyte count and percentage in the ISR prediction were 0.46× 109/L and 7.4%, respectively, and those of eosinophil count and percentage were 0.20 × 109/L and 2.5%, respectively. Conclusion This study, with a long-term follow-up, first provides evidence that the elevated monocytes at three postoperative months and baseline eosinophils may be strong early predictors of ISR after drug-eluting stent implantation. Persistent elevation of monocytes may also be a signal of ISR after percutaneous coronary intervention (PCI).
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Affiliation(s)
- Shumei Li
- Department of Cardiology, Fujian Institute of Coronary Heart Disease, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hong Qiu
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Zhaorong Lin
- Department of Cardiology, Fujian Institute of Coronary Heart Disease, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lin Fan
- Department of Cardiology, Fujian Institute of Coronary Heart Disease, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yongzhe Guo
- Department of Cardiology, Fujian Institute of Coronary Heart Disease, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yujie Zhang
- Department of Cardiology, Fujian Institute of Coronary Heart Disease, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lianglong Chen
- Department of Cardiology, Fujian Institute of Coronary Heart Disease, Fujian Medical University Union Hospital, Fuzhou, China
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7
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Jakubiak GK, Pawlas N, Cieślar G, Stanek A. Pathogenesis and Clinical Significance of In-Stent Restenosis in Patients with Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211970. [PMID: 34831726 PMCID: PMC8617716 DOI: 10.3390/ijerph182211970] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 12/13/2022]
Abstract
Diabetes mellitus (DM) is a strong risk factor for the development of cardiovascular diseases such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease (PAD). In the population of people living with DM, PAD is characterised by multi-level atherosclerotic lesions as well as greater involvement of the arteries below the knee. DM is also a factor that significantly increases the risk of lower limb amputation. Percutaneous balloon angioplasty with or without stent implantation is an important method of the treatment for atherosclerotic cardiovascular diseases, but restenosis is a factor limiting its long-term effectiveness. The pathogenesis of atherosclerosis in the course of DM differs slightly from that in the general population. In the population of people living with DM, more attention is drawn to such factors as inflammation, endothelial dysfunction, platelet dysfunction, blood rheological properties, hypercoagulability, and additional factors stimulating vascular smooth muscle cell proliferation. DM is a risk factor for restenosis. The purpose of this paper is to provide a review of the literature and to present the most important information on the current state of knowledge on mechanisms and the clinical significance of restenosis and in-stent restenosis in patients with DM, especially in association with the endovascular treatment of PAD. The role of such processes as inflammation, neointimal hyperplasia and neoatherosclerosis, allergy, resistance to antimitotic drugs used for coating stents and balloons, genetic factors, and technical and mechanical factors are discussed. The information on restenosis collected in this publication may be helpful in planning further research in this field, which may contribute to the formulation of more and more precise recommendations for the clinical practice.
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Affiliation(s)
- Grzegorz K. Jakubiak
- Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland; (G.K.J.); (G.C.)
| | - Natalia Pawlas
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Jordana 38 St., 41-800 Zabrze, Poland;
| | - Grzegorz Cieślar
- Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland; (G.K.J.); (G.C.)
| | - Agata Stanek
- Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland; (G.K.J.); (G.C.)
- Correspondence:
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8
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Karakus A, Okutucu S. High Eosinophil Rates in Patients With Right-to-Left Shunts: An Expected Role, or an Unexpected Risk? Cureus 2021; 13:e12849. [PMID: 33643730 PMCID: PMC7885739 DOI: 10.7759/cureus.12849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective Eosinophils are associated with thromboembolic events. Since eosinophils are eliminated in the pulmonary vasculature, right-to-left shunt (RLS) through patent foramen ovale may increase eosinophils in the peripheral blood. In this report, we evaluated the eosinophils of patients with regard to the presence of RLS and its quantity. Patients and methods In this retrospective observational study, we analyzed the complete blood cell count (CBC) of patients with RLS (n=47) and without RLS (n=31) diagnosed by contrast echocardiography (CE). RLS was identified as mild (5-10 bubbles) and moderate shunt (10-25 bubbles). Results Age and CBC were not significantly different between the groups, with the exception of eosinophils. Patients with RLS had higher eosinophils percentage compared to patients without RLS (3.1 ±1.5 vs. 1.7 ±0.7, p=0.001). Additionally, eosinophils percentage was significantly higher in the mild RLS group (2.4 ±0.9 vs. 1.7 ±0.7, p=0.016) and the moderate RLS group (4.3 ±1.6 vs. 1.7 ±0.7, p=0.001) compared to normal subjects. Also, it was significantly higher in the moderate RLS group compared to the mild group (4.3 ±1.6 vs. 2.4 ±0.9, p=0.001). Conclusions Eosinophils percentage was higher in patients with mild and moderate RLS compared to normal individuals. Moreover, the eosinophil rate was higher in patients with moderate RLS than in patients with mild RLS.
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Eosinophils improve cardiac function after myocardial infarction. Nat Commun 2020; 11:6396. [PMID: 33328477 PMCID: PMC7745020 DOI: 10.1038/s41467-020-19297-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023] Open
Abstract
Clinical studies reveal changes in blood eosinophil counts and eosinophil cationic proteins that may serve as risk factors for human coronary heart diseases. Here we report an increase of blood or heart eosinophil counts in humans and mice after myocardial infarction (MI), mostly in the infarct region. Genetic or inducible depletion of eosinophils exacerbates cardiac dysfunction, cell death, and fibrosis post-MI, with concurrent acute increase of heart and chronic increase of splenic neutrophils and monocytes. Mechanistic studies reveal roles of eosinophil IL4 and cationic protein mEar1 in blocking H2O2- and hypoxia-induced mouse and human cardiomyocyte death, TGF-β-induced cardiac fibroblast Smad2/3 activation, and TNF-α-induced neutrophil adhesion on the heart endothelial cell monolayer. In vitro-cultured eosinophils from WT mice or recombinant mEar1 protein, but not eosinophils from IL4-deficient mice, effectively correct exacerbated cardiac dysfunctions in eosinophil-deficient ∆dblGATA mice. This study establishes a cardioprotective role of eosinophils in post-MI hearts. Blood eosinophil (EOS) counts may serve as risk factors for human coronary heart diseases. Here the authors show that increased circulating and myocardial EOS after myocardial infarction play a cardioprotective role by reducing cardiomyocyte death, cardiac fibroblast activation and fibrosis, and endothelium activation-mediated inflammatory cell accumulation.
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10
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IL-33 induces type-2-cytokine phenotype but exacerbates cardiac remodeling post-myocardial infarction with eosinophil recruitment, worsened systolic dysfunction, and ventricular wall rupture. Clin Sci (Lond) 2020; 134:1191-1218. [PMID: 32432676 DOI: 10.1042/cs20200402] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/02/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
Abstract
Myocardial infarction (MI) is the leading cause of mortality worldwide. Interleukin (IL)-33 (IL-33) is a cytokine present in most cardiac cells and is secreted on necrosis where it acts as a functional ligand for the ST2 receptor. Although IL-33/ST2 axis is protective against various forms of cardiovascular diseases, some studies suggest potential detrimental roles for IL-33 signaling. The aim of the present study was to examine the effect of IL-33 administration on cardiac function post-MI in mice. MI was induced by coronary artery ligation. Mice were treated with IL-33 (1 μg/day) or vehicle for 4 and 7 days. Functional and molecular changes of the left ventricle (LV) were assessed. Single cell suspensions were obtained from bone marrow, heart, spleen, and peripheral blood to assess the immune cells using flow cytometry at 1, 3, and 7 days post-MI in IL-33 or vehicle-treated animals. The results of the present study suggest that IL-33 is effective in activating a type 2 cytokine milieu in the damaged heart, consistent with reduced early inflammatory and pro-fibrotic response. However, IL-33 administration was associated with worsened cardiac function and adverse cardiac remodeling in the MI mouse model. IL-33 administration increased infarct size, LV hypertrophy, cardiomyocyte death, and overall mortality rate due to cardiac rupture. Moreover, IL-33-treated MI mice displayed a significant myocardial eosinophil infiltration at 7 days post-MI when compared with vehicle-treated MI mice. The present study reveals that although IL-33 administration is associated with a reparative phenotype following MI, it worsens cardiac remodeling and promotes heart failure.
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11
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Abstract
Inflammation is an important player both for the initiation and progression of coronary artery disease and for coronary plaque instability. Moreover, inflammation contributes to stent thrombosis and in-stent restenosis after percutaneous coronary intervention. In the past several decades, most studies evaluated the involvement of cellular effectors of classic inflammatory responses, such as monocytes/macrophages, neutrophils, and T cells. Yet, besides classic inflammation, mounting evidence derived from both experimental and clinical studies suggests an important, often unrecognized, role for effector cells of allergic inflammation in both the pathogenesis of coronary artery disease and adverse events following stent implantation. In this review, we discuss the role of effector cells of allergic inflammation in the setting of coronary artery disease progression and instability, and in the occurrence of adverse events following stent implantation, as well. Moreover, we discuss possible therapeutic approaches targeting different specific pathways of allergic inflammatory activation.
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Affiliation(s)
- Giampaolo Niccoli
- Giampaolo Niccoli and Filippo Crea: Dipartimento di Scienze Cardiovascolari eToraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia (G.N., F.C.).,Università Cattolica del Sacro Cuore, Roma, Italia (G.N., F.C.)
| | - Rocco A Montone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (R.A.M.)
| | - Vito Sabato
- Immunology-Allergology-Rheumatology, University of Antwerp and Antwerp University Hospital, Belgium (V.S.)
| | - Filippo Crea
- Giampaolo Niccoli and Filippo Crea: Dipartimento di Scienze Cardiovascolari eToraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia (G.N., F.C.).,Università Cattolica del Sacro Cuore, Roma, Italia (G.N., F.C.)
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12
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Gorbet M, Sperling C, Maitz MF, Siedlecki CA, Werner C, Sefton MV. The blood compatibility challenge. Part 3: Material associated activation of blood cascades and cells. Acta Biomater 2019; 94:25-32. [PMID: 31226478 DOI: 10.1016/j.actbio.2019.06.020] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/03/2019] [Accepted: 06/13/2019] [Indexed: 01/09/2023]
Abstract
Following protein adsorption/activation which is the first step after the contact of material surfaces and whole blood (part 2), fibrinogen is converted to fibrin and platelets become activated and assembled in the form of a thrombus. This thrombus formation is the key feature that needs to be minimized in the creation of materials with low thrombogenicity. Further aspects of blood compatibility that are important on their own are complement and leukocyte activation which are also important drivers of thrombus formation. Hence this review summarizes the state of knowledge on all of these cascades and cells and their interactions. For each cascade or cell type, the chapter distinguishes statements which are in widespread agreement from statements where there is less of a consensus. STATEMENT OF SIGNIFICANCE: This paper is part 3 of a series of 4 reviews discussing the problem of biomaterial associated thrombogenicity. The objective was to highlight features of broad agreement and provide commentary on those aspects of the problem that were subject to dispute. We hope that future investigators will update these reviews as new scholarship resolves the uncertainties of today.
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Affiliation(s)
- Maud Gorbet
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Claudia Sperling
- Institute Biofunctional Polymer Materials, Max Bergmann Center of Biomaterials, Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
| | - Manfred F Maitz
- Institute Biofunctional Polymer Materials, Max Bergmann Center of Biomaterials, Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
| | - Christopher A Siedlecki
- Departments of Surgery and Bioengineering, The Pennsylvania State University, College of Medicine, Hershey, PA 17033, United States
| | - Carsten Werner
- Institute Biofunctional Polymer Materials, Max Bergmann Center of Biomaterials, Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
| | - Michael V Sefton
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.
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13
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Gao S, Deng Y, Wu J, Zhang L, Deng F, Zhou J, Yuan Z, Wang L. Eosinophils count in peripheral circulation is associated with coronary artery disease. Atherosclerosis 2019; 286:128-134. [PMID: 31154080 DOI: 10.1016/j.atherosclerosis.2019.05.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/24/2019] [Accepted: 05/26/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Allergic asthma can accelerate atherosclerosis, a disease in which plaque is deposited onto arterial walls and that may lead to coronary artery disease (CAD). Eosinophils are the most important effector cells in allergic asthma and are likely to become novel biomarkers for risk stratification of patients with CAD, but the relationship between eosinophil count and CAD remains unclear. We aimed to evaluate this relationship and the use of eosinophils in predicting CAD. METHODS A total of 5287 patients who underwent coronary angiography were recruited. Their biochemical parameters, including eosinophil count, were measured and their correlation with the severity of coronary artery stenosis, as quantified by the Gensini score system, was evaluated. RESULTS The percentages of eosinophils in leukocytes (PELs) were lower in CAD patients (p < 0.001), and had a significant negative correlation with Gensini scores (r = -0.112, p < 0.001). PELs were also significantly lower in acute myocardial infarction patients (p < 0.001). After adjusting for baseline differences, low PELs remained strongly associated with severe CAD and acute coronary arterial thrombotic event. Receiver-operating characteristic curve analysis showed that combining PELs with traditional risk factors in predictive models for CAD severity (z = 4.470, p < 0.001) or acute coronary arterial thrombotic event (z = 9.435, p < 0.001) improved the predictive capabilities of those models. CONCLUSIONS PELs, at least in patients undergoing coronary angiography, may be strongly related to the subtype and severity of CAD and, therefore, eosinophil count may be an accurate and independent biomarker to predict CAD severity and acute coronary arterial thrombotic events.
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Affiliation(s)
- Shanshan Gao
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, China
| | - Yangyang Deng
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, China
| | - Jun Wu
- Department of Neurology, Xi'an Gaoxin Hospital, China
| | - Lisha Zhang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, China
| | - Fuxue Deng
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, China
| | - Juan Zhou
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, China; Key Laboratory of Molecular Cardiology, Shannxi Province, China
| | - Zuyi Yuan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, China; Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, China; Key Laboratory of Molecular Cardiology, Shannxi Province, China.
| | - Lijun Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, China; Key Laboratory of Molecular Cardiology, Shannxi Province, China.
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Xu JY, Xiong YY, Lu XT, Yang YJ. Regulation of Type 2 Immunity in Myocardial Infarction. Front Immunol 2019; 10:62. [PMID: 30761134 PMCID: PMC6362944 DOI: 10.3389/fimmu.2019.00062] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/11/2019] [Indexed: 12/12/2022] Open
Abstract
Type 2 immunity participates in the pathogeneses of helminth infection and allergic diseases. Emerging evidence indicates that the components of type 2 immunity are also involved in maintaining metabolic hemostasis and facilitating the healing process after tissue injury. Numerous preclinical studies have suggested regulation of type 2 immunity-related cytokines, such as interleukin-4, -13, and -33, and cell types, such as M2 macrophages, mast cells, and eosinophils, affects cardiac functions after myocardial infarction (MI), providing new insights into the importance of immune modulation in the infarcted heart. This review provides an overview of the functions of these cytokines and cells in the setting of MI as well as their potential to predict the severity and prognosis of MI.
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Affiliation(s)
- Jun-Yan Xu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yu-Yan Xiong
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiao-Tong Lu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Jin Yang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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15
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Zhao HM, Qin WQ, Wang PJ, Wen ZM. Eosinopenia is a predictive factor for the severity of acute ischemic stroke. Neural Regen Res 2019; 14:1772-1779. [PMID: 31169195 PMCID: PMC6585555 DOI: 10.4103/1673-5374.258411] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Previous data have revealed an association between eosinopenia and mortality of acute ischemic stroke. However, the relationship of eosinopenia with infarct volume, infection rate, and poor outcome of acute ischemic stroke is still unknown. The retrospective study included 421 patients (273 males, 65%; mean age, 68.0 ± 13.0 years) with first acute ischemic stroke who were hospitalized in the Second Affiliated Hospital of Soochow University, China, from January 2017 to February 2018. Laboratory data, neuroimaging results, and modified Rankin Scale scores were collected. Patients were divided into four groups according to their eosinophil percentage level (< 0.4%, 0.4–1.1%, 1.1–2.3%, ≥ 2.3%). Spearman’s correlation analysis showed that the percentage of eosinophils was negatively correlated with infarct volume (rs = −0.514, P < 0.001). Receiver operating characteristic analysis demonstrated that eosinopenia predicted a large infarct volume more accurately than neutrophilia; the area under curve was 0.906 and 0.876, respectively; a large infarct was considered as that with a diameter larger than 3 cm and involving more than two major arterial blood supply areas. Logistic regression analysis revealed that eosinophil percentage was an independent risk factor for acute ischemic stroke (P = 0.002). Moreover, eosinophil percentage was significantly associated with large infarct volume, high infection rate (pulmonary and urinary tract infections), and poor outcome (modified Rankin Scale score > 3) after adjusting for potential confounding factors (P-trend < 0.001). These findings suggest that eosinopenia has the potential to predict the severity of acute ischemic stroke. This study was approved by the Ethics Committee of the Second Affiliated Hospital of Soochow University, China (approval number: K10) on November 10, 2015.
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Affiliation(s)
- Hui-Min Zhao
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Wen-Qian Qin
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Pei-Ji Wang
- Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Zhong-Min Wen
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
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Montone RA, Niccoli G. Predictive value of C-reactive protein after drug-eluting stent implantation: an update view. Future Cardiol 2018; 14:355-358. [DOI: 10.2217/fca-2018-0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Rocco A Montone
- Department of Cardiovascular & Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular & Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
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17
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Sundström J, Söderholm M, Borné Y, Nilsson J, Persson M, Östling G, Melander O, Orho-Melander M, Engström G. Eosinophil Cationic Protein, Carotid Plaque, and Incidence of Stroke. Stroke 2017; 48:2686-2692. [DOI: 10.1161/strokeaha.117.018450] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Johannes Sundström
- From Department of Clinical Sciences in Malmö, Clinical Research Centre, Lund University, Sweden
| | - Martin Söderholm
- From Department of Clinical Sciences in Malmö, Clinical Research Centre, Lund University, Sweden
| | - Yan Borné
- From Department of Clinical Sciences in Malmö, Clinical Research Centre, Lund University, Sweden
| | - Jan Nilsson
- From Department of Clinical Sciences in Malmö, Clinical Research Centre, Lund University, Sweden
| | - Margaretha Persson
- From Department of Clinical Sciences in Malmö, Clinical Research Centre, Lund University, Sweden
| | - Gerd Östling
- From Department of Clinical Sciences in Malmö, Clinical Research Centre, Lund University, Sweden
| | - Olle Melander
- From Department of Clinical Sciences in Malmö, Clinical Research Centre, Lund University, Sweden
| | - Marju Orho-Melander
- From Department of Clinical Sciences in Malmö, Clinical Research Centre, Lund University, Sweden
| | - Gunnar Engström
- From Department of Clinical Sciences in Malmö, Clinical Research Centre, Lund University, Sweden
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18
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Niccoli G, Menozzi A, Capodanno D, Trani C, Sirbu V, Fineschi M, Zara C, Crea F, Trabattoni D, Saia F, Ladich E, Biondi Zoccai G, Attizzani G, Guagliumi G. Relationship between Serum Inflammatory Biomarkers and Thrombus Characteristics in Patients with ST Segment Elevation Myocardial Infarction. Cardiology 2016; 137:27-35. [PMID: 27988513 DOI: 10.1159/000452705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 10/19/2016] [Indexed: 02/05/2023]
Abstract
Objectives: To compare angiographic and optical coherence tomography (OCT) data pertinent to thrombi, along with the histologic characteristics of aspirated thrombi in patients presenting with ST elevation myocardial infarction (STEMI) with or without inflammation, as assessed by C-reactive protein (CRP) and myeloperoxidase (MPO). Methods: In the OCTAVIA (Optical Coherence Tomography Assessment of Gender Diversity in Primary Angioplasty) study, 140 patients with STEMI referred for primary percutaneous intervention were enrolled. The patients underwent OCT assessment of the culprit vessel, along with blood sampling of CRP and MPO, and histologic analysis of the thrombus. Results: Biomarkers were available for 129 patients, and histology and immunohistochemistry of the thrombi were available for 78 patients. Comparisons were made using the median thresholds of CRP and MPO (2.08 mg/L and 604.124 ng/mL, respectively). There was no correlation between CRP and MPO levels in the whole population (p = 0.685). Patients with high CRP levels had higher thrombus grades and more frequent TIMI flow 0/1 compared with those with low CRP levels (5 [1st quartile 3; 3rd quartile 5] vs. 3.5 mg/L [1; 5], p = 0.007, and 69.3 vs. 48.5%, p = 0.04, respectively). Patients with high MPO levels more commonly had early thrombi than had those with low MPO levels (42.5 vs. 20.0%, p = 0.04). Conclusions: CRP and MPO were not correlated in STEMI patients, possibly reflecting different pathogenic mechanisms, with CRP more related to thrombus burden and MPO to thrombus age.
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Affiliation(s)
- Giampaolo Niccoli
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
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Niccoli G, Calvieri C, Flego D, Scalone G, Imaeva A, Sabato V, Schiavino D, Liuzzo G, Crea F. Allergic Inflammation Is Associated With Coronary Instability and a Worse Clinical Outcome After Acute Myocardial Infarction. Circ Cardiovasc Interv 2016; 8:e002554. [PMID: 26243785 DOI: 10.1161/circinterventions.115.002554] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The role of allergic inflammation in acute coronary syndromes (ACS) has not been clearly defined to date. Aim of this study was to assess eosinophil and basophil activation in ACS and the prognostic role of eosinophil cationic protein in ST-segment-elevation myocardial infarction. METHODS AND RESULTS In a cross-sectional study, we prospectively enrolled 51 patients undergoing percutaneous coronary intervention (60.8% patients with ACS and 39.2% with stable angina). Flow cytometry analysis assessed CD66b, CD69, and CD203c median fluorescence intensity expression. In a follow-up study, 181 patients presenting with ST-segment-elevation myocardial infarction, undergoing primary percutaneous coronary intervention, were prospectively enrolled with a follow-up of 24 months. Eosinophil activation (CD66b) was similar in patients with ACS and stable angina (6.61 [4.91-7.72] versus 6.62 [5.27-8.73], P=0.63), whereas eosinophil degranulation (CD69) and basophil activation (CD203c) were higher in ACS patients compared with stable angina patients (1.38 [1.16-1.52] versus 1.17 [1-1.31], P=0.01); 0.97 [0.89-1.11] versus 0.92 [0.87-0.95], P=0.03, respectively). Eosinophil cationic protein serum levels were significantly higher in ST-segment-elevation myocardial infarction patients with major adverse cardiac events as compared with those without (21.1 [10.37-25.65] versus 7.83 [3.37-12.8] μg/L, P=0.01) and in patients with thrombus score >3 compared with those with thrombus score ≤3 (15.0 [9.8-24.7] versus 5.2 [3.5-22.9] μg/L, P=0.006). Eosinophil cationic protein serum levels predicted major adverse cardiac events during follow-up (odds ratio =1.041, 95% confidence interval 1.012-1.071, P=0.005). C-reactive protein serum levels showed a borderline statistical significance (odds ratio =0.904, 95% confidence interval 0.806-1.014, P=0.085). CONCLUSIONS These findings are the first demonstration of in vivo eosinophil degranulation and basophil activation during ACS and of the prognostic role of eosinophil cationic protein in ST-segment-elevation myocardial infarction.
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Affiliation(s)
- Giampaolo Niccoli
- From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.).
| | - Camilla Calvieri
- From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.)
| | - Davide Flego
- From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.)
| | - Giancarla Scalone
- From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.)
| | - Asya Imaeva
- From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.)
| | - Vito Sabato
- From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.)
| | - Domenico Schiavino
- From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.)
| | - Giovanna Liuzzo
- From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.)
| | - Filippo Crea
- From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.)
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Miura K, Kadota K, Habara S, Miyawaki H, Shimada T, Ohya M, Amano H, Izawa Y, Hyodo Y, Otsuru S, Hasegawa D, Tada T, Tanaka H, Fuku Y, Goto T, Mitsudo K. Ten-year clinical outcomes after sirolimus-eluting stent implantation: Impact of an in-stent restenosis target lesion. Am Heart J 2016; 175:47-55. [PMID: 27179723 DOI: 10.1016/j.ahj.2016.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 02/12/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED Little is known about the long-term outcomes after first-generation sirolimus-eluting stent (SES) implantation. We aimed to investigate the clinical outcomes up to 10 years after SES implantation. METHODS The study population comprised 342 patients (504 lesions) who underwent SES implantation between January 2002 and December 2004. The median duration of follow-up was 3816 days (interquartile range [Q1-Q3], 3,705-3,883 days). RESULTS The cumulative event rate of definite stent thrombosis was 3.9%. The cumulative rate of target lesion revascularization (TLR) at 1, 5, and 10 years was 8.7%, 18.8%, and 31.1%, respectively, and the annual rate of TLR was 3.1%. Clinically driven TLR occurred at relatively constant rate during 10 years (2.0% per year). In a multivariate analysis, higher body mass index, hemodialysis, in-stent restenosis (ISR) target lesion, and total stent length >30 mm were independent risk factors of TLR within 5 years. An independent risk factor of TLR beyond 5 years was ISR target lesion. CONCLUSIONS Late TLR after SES implantation is a long-term hazard, lasting up to 10 years. The ISR target lesion is a risk factor of TLR during 10 years.
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The Correlation of Serum Myeloid-Related Protein-8/14 and Eosinophil Cationic Protein in Patients with Coronary Artery Disease. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4980251. [PMID: 27022611 PMCID: PMC4789061 DOI: 10.1155/2016/4980251] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/22/2015] [Accepted: 12/06/2015] [Indexed: 02/06/2023]
Abstract
Objective. To investigate the changes in serum Myeloid-Related Protein 8/14 (MRP8/14) and Eosinophil Cationic Protein (ECP) levels in patients with different types of coronary artery diseases (CAD) and assess the value of MRP8/14 and ECP detection in predicting CAD. Methods. 178 patients were divided into CAD group including unstable angina pectoris (UAP), acute myocardial infarction (AMI), and stable angina pectoris (SAP). Thirty-six individuals with normal coronary artery served as the control group. Serum MRP8/14 and ECP were measured by ELISA. The severity of coronary artery stenosis was assessed by the numbers of involved coronary artery branches and the sum of Gensini scores. Results. The MRP8/14 levels were significantly higher in AMI and UAP group than SAP and control group (P < 0.05). The levels of MRP8/14 in AMI group were also obviously higher than UAP group (P < 0.05). The ECP levels were obviously increased in AMI group, but there was no difference between SAP and UAP group (P > 0.05). The ECP was significantly increased in three impaired coronary arteries and obviously correlated with Gensini score (P < 0.01), whereas the MRP8/14 was obviously positively correlated with CRP (P < 0.01). Conclusions. Increased MRP8/14 levels suggest the instability of the atherosclerotic plaque. ECP reflects the severity of coronary arteries stenosis, predicting atherosclerosis burden. They may become the new biomarkers of CAD.
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Fracassi F, Niccoli G, Scalone G, Di Gioia G, Conte M, Bartunek J, Sgueglia GA, De Bruyne B, Montone RA, Wijns W, Crea F, Barbato E. Prognostic role of multiple biomarkers in stable patients undergoing fractional flow reserve-guided coronary angioplasty. J Cardiovasc Med (Hagerstown) 2015; 17:687-93. [PMID: 26627500 DOI: 10.2459/jcm.0000000000000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI), along with optimal medical therapy, improves clinical outcome by targeting ischemia-inducing stenosis. Yet, plaque progression or stent failure may cause recurring cardiac events. We assessed the potential prognostic role of different inflammatory biomarkers, known to be associated with plaque progression or stent failure, in patients undergoing FFR-guided PCI. METHODS We prospectively enrolled 169 stable angina patients with intermediate coronary stenosis at angiography undergoing FFR-guided PCI. PCI was performed if FFR was 0.80 or less, deferred if FFR was more than 0.80. Serum baseline levels of high-sensitivity C-reactive protein (hs-CRP), eosinophil cationic protein (ECP), cystatin-C (Cys-C), and thromboxane A2 (TXA2) were assessed. Rate of major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, recurrent myocardial infarction, and target vessel revascularization (TVR), was evaluated. RESULTS PCI was performed in 78 patients (46%) (mean age 69 ± 10 years, men 73%) and deferred in 91 patients (54%) (mean age 64 ± 11 years, men 53%). Mean clinical follow-up was 31 ± 11 months. Within the PCI group, patients with MACE (n = 14 [18%]) had significantly higher ECP levels than those without (14.4 [9.3-19.5] vs. 4.9 [2.8-10.9] mg/l, P < 0.001), and ECP was a significant predictor of MACE (hazard ratio: 1.05, 95% confidence interval [1.01-1.09], P = 0.021). Within the deferred group, patients with MACE (n = 8 [9%]) had significantly higher CRP levels than those without (15 [6.5-31.9] vs. 1.6 [0.9-2.9] mg/l, P < 0.001) and CRP was a significant predictor of MACE (hazard ratio: 1.04, 95% confidence interval [1.01-1.07], P = 0.015). Cys-C and TXA2 were not significantly different between the two groups. CONCLUSION Assessing inflammatory biomarkers allows the identification of patients remaining at residual higher risk of MACE after FFR-guided PCI.
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Affiliation(s)
- Francesco Fracassi
- aInstitute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy bCardiovascular Center Aalst, OLV Hospital, Aalst, Belgium cDepartment of Advanced Biomedical Sciences, Federico II University, Naples dInterventional Cardiology, Sant'Eugenio Hospital, Rome eDepartment of Cardiology, IRCCS Policlinico San Donato, Milan, Italy *Giampaolo Niccoli and Emanuele Barbato contributed equally to the writing of this article
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Altas Y, Kurtoglu E, Yaylak B, Baysal E, Ucaman B, Ugurlu HM, Karahan MZ, Altintas B, Adiyaman MS, Kaya İ, Erdolu U, Ozen K, Cakir C, Sevuk U. The relationship between eosinophilia and slow coronary flow. Ther Clin Risk Manag 2015; 11:1187-91. [PMID: 26316763 PMCID: PMC4542408 DOI: 10.2147/tcrm.s87761] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim The pathophysiology of slow coronary flow (SCF) involves atherosclerosis, small vessel dysfunction, platelet function disorders, and inflammation. It has been known that eosinophils also play a significant role in inflammation, vasoconstriction, thrombosis, and endothelial dysfunction. We propose to evaluate the relationship between eosinophilia and SCF. Methods All patients who underwent coronary angiography between January 2011 and December 2013 were screened retrospectively. Of 6,832 patients, 102 patients with SCF (66 males, mean age 52.2±11.7 years) and 77 control subjects with normal coronary angiography (50 males, mean age 50.7±8.1 years) were detected. Baseline characteristics, hematological test results, and biochemical test results were obtained from the hospital database. Results Baseline characteristics of the study groups were comparable between groups. There was no significant difference between groups regarding leukocyte count, paletelet count, and mean platelet volume. However, patients with SCF had a higher eosinophil count than the controls (0.24±0.17×103/μL vs 0.16±0.15×103/μL, P=0.002). In addition, eosinophil count was found to be correlated with thrombolysis in myocardial infarction (TIMI) frame count in the SCF group (r=0.3, P<0.01). There was no significant correlation between eosinophil count and the number of coronary arteries showing slow flow. Conclusion Patients with SCF have higher blood eosinophil count, and this may play an important role in the pathogenesis of SCF. Elevated baseline eosinophil count may indicate the presence of SCF.
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Affiliation(s)
- Yakup Altas
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | | | - Baris Yaylak
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Erkan Baysal
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Berzal Ucaman
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Hasan Murat Ugurlu
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Mehmet Zülkif Karahan
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Bernas Altintas
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Mehmet Sahin Adiyaman
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - İlyas Kaya
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Umut Erdolu
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Kaya Ozen
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Malatya, Turkey
| | - Cayan Cakir
- Department of Cardiology, Memorial Diyarbakir Hospital, Diyarbakir, Turkey
| | - Utkan Sevuk
- Department of Cardiovascular Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
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Niccoli G, Calvieri C, Minelli S, Copponi G, Montone RA, Imaeva A, Roberto M, Cosentino N, Crea F. Permanent polymer of drug eluting stents increases eosinophil cationic protein levels following percutaneous coronary intervention independently of C-reactive protein. Atherosclerosis 2014; 237:816-20. [DOI: 10.1016/j.atherosclerosis.2014.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 10/01/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
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Yagi H, Amiya E, Ando J, Watanabe M, Yanaba K, Ikemura M, Fukayama M, Komuro I. In-stent restenosis exacerbated by drug-induced severe eosinophilia after second-generation drug-eluting stent implantation. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:397-400. [PMID: 25227966 PMCID: PMC4168766 DOI: 10.12659/ajcr.891106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Patient: Male, 83 Final Diagnosis: In-stent restenosis Symptoms: Chest discomfort Medication: — Clinical Procedure: Cardiac catheterization Specialty: Cardiology
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Affiliation(s)
- Hiroki Yagi
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Jiro Ando
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masafumi Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Koichi Yanaba
- Department of Dermatology, Jikei University School of Medicine, Tokyo, Japan
| | - Masako Ikemura
- Department of Pathology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Kounis NG, Soufras GD, Tsigkas G, Hahalis G. White blood cell counts, leukocyte ratios, and eosinophils as inflammatory markers in patients with coronary artery disease. Clin Appl Thromb Hemost 2014; 21:139-43. [PMID: 24770327 DOI: 10.1177/1076029614531449] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Inflammation is a key feature of atherosclerosis and its clinical manifestations. The leukocyte count has emerged as a marker of inflammation that is widely available in clinical practice. Since inflammation plays a key role in atherosclerosis and its end results, discovering new biomarkers of inflammation becomes important in order to help diagnostic accuracy and provide prognostic information about coronary cardiac disease. In acute coronary syndromes and percutaneous coronary intervention, elevated levels of almost all subtypes of white blood cell counts, including eosinophils, monocytes, neutrophils, and lymphocytes, and neutrophil-lymphocyte ratio and eosinophil-leukocyte ratio constitute independent predictors of adverse outcomes. Eosinophil count and eosinophil-leukocyte ratio, in particular, emerge as novel biomarkers for risk stratification in patients with coronary artery disease. Since the presence of eosinophils denotes hypersensitivity inflammation and hypersensitivity associated with Kounis syndrome, this reality is essential for elucidating the etiology of inflammation in order to consider predictive and preventive measures and to apply the appropriate therapeutic methods.
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Affiliation(s)
- Nicholas G Kounis
- Medical Sciences, Patras Highest Institute of Education and Technology, Patras, Greece
| | - George D Soufras
- Departments of Cardiology, University of Patras Medical School, Patras, Greece
| | - Grigorios Tsigkas
- Departments of Cardiology, University of Patras Medical School, Patras, Greece
| | - George Hahalis
- Departments of Cardiology, University of Patras Medical School, Patras, Greece
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27
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Niccoli G, Dato I, Imaeva AE, Antonazzo Panico R, Roberto M, Burzotta F, Aurigemma C, Trani C, Gramegna M, Leone AM, Porto I, Crea F. Association between inflammatory biomarkers and in-stent restenosis tissue features: an Optical Coherence Tomography Study. Eur Heart J Cardiovasc Imaging 2014; 15:917-25. [PMID: 24618655 DOI: 10.1093/ehjci/jeu035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Inflammatory reaction after stent implantation is associated with in-stent restenosis (ISR). We assessed the association of optical coherence tomography (OCT) features of neointima with systemic levels of high-sensitivity C-reactive protein (hs-CRP) and eosinophil cationic protein (ECP) measured at the time of ISR detection. METHODS AND RESULTS Patients presenting with symptomatic angiographically documented ISR (diameter stenosis ≥ 50% by visual estimation) were included. Quantitative OCT analysis included the measurement of minimal lumen diameter, minimal luminal area, stent and neointimal area, stent and restenosis length, restenotic tissue burden, and symmetry ratio. Qualitative OCT analysis included the assessment of ISR plaque type, neointimal tissue structure, lumen shape, presence of microvessels and calcific nodules. At the time of ISR detection hs-CRP and ECP levels were measured, and statistical analysis was performed using as cut-off 3 mg/L and 4.5 µg/L, respectively. Our population included 40 patients, 24 bare metal stents and 16 drug-eluting stents. Patients with high hs-CRP levels had a higher restenostic tissue symmetry ratio (0.56 ± 0.17 vs. 0.42 ± 0.13, P = 0.01) when compared with patients with low hs-CRP levels. Patients with high ECP levels had a higher neointimal burden (70 ± 14 vs. 64 ± 11, P = 0.05) in comparison with patients with low ECP levels. CONCLUSIONS Inflammatory biomarkers assessed at the time of ISR detection are associated with different aspects of neointimal tissue. While hs-CRP seems to have a role in neointimal tissue shape, ECP is related to a neointimal burden.
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Affiliation(s)
- Giampaolo Niccoli
- Cardiovascular Science Department, Sacred Heart University, L.go Gemelli 8, 00168 Rome, Italy
| | - Ilaria Dato
- Cardiovascular Science Department, Sacred Heart University, L.go Gemelli 8, 00168 Rome, Italy
| | | | | | - Marco Roberto
- Cardiovascular Science Department, Sacred Heart University, L.go Gemelli 8, 00168 Rome, Italy
| | - Francesco Burzotta
- Cardiovascular Science Department, Sacred Heart University, L.go Gemelli 8, 00168 Rome, Italy
| | - Cristina Aurigemma
- Cardiovascular Science Department, Sacred Heart University, L.go Gemelli 8, 00168 Rome, Italy
| | - Carlo Trani
- Cardiovascular Science Department, Sacred Heart University, L.go Gemelli 8, 00168 Rome, Italy
| | - Mario Gramegna
- Cardiovascular Science Department, Sacred Heart University, L.go Gemelli 8, 00168 Rome, Italy
| | - Antonio Maria Leone
- Cardiovascular Science Department, Sacred Heart University, L.go Gemelli 8, 00168 Rome, Italy
| | - Italo Porto
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy
| | - Filippo Crea
- Cardiovascular Science Department, Sacred Heart University, L.go Gemelli 8, 00168 Rome, Italy
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Niccoli G, Sgueglia GA, Montone RA, Roberto M, Banning AP, Crea F. Evolving management of patients treated by drug-eluting stent: prevention of late events. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:100-8. [PMID: 24603193 DOI: 10.1016/j.carrev.2014.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 01/19/2014] [Accepted: 01/23/2014] [Indexed: 01/21/2023]
Abstract
SUMMARY Drug eluting stents (DES) were introduced in clinical practice to overcome the problem of in-stent restenosis (ISR) that limited the overall efficacy of percutaneous coronary revascularization with bare metal stent (BMS). Long-term outcome data confirm a sustained benefit of DES as compared with BMS. However, this benefit is mainly evident in the first year of follow-up. Indeed, DES-related events may extend over this time, due to late events (late ISR and/or very late stent thrombosis). Prevention of late failure of DES may become a specific therapeutic target.
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Affiliation(s)
- Giampaolo Niccoli
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
| | | | - Rocco A Montone
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Roberto
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Adrian P Banning
- Oxford Heart Centre, The John Radcliffe Hospital, Oxford, United Kingdom
| | - Filippo Crea
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
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Chen SL, Liu Y, Lin L, Ye F, Zhang JJ, Tian NL, Zhang JX, Hu ZY, Xu T, Li L, Xu B, Latif F, Nguyen T. Interleukin-6, but not C-reactive protein, predicts the occurrence of cardiovascular events after drug-eluting stent for unstable angina. J Interv Cardiol 2014; 27:142-54. [PMID: 24588086 DOI: 10.1111/joic.12103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Evidences concerning the predictive value of baseline inflammatory biomarkers after drug-eluting stent (DES) placement are controversial, mainly because the use of statin was not precisely defined. OBJECTIVES The aim was to compare the differences between interleukin (IL)-6 and high-sensitivity C-reactive protein (hs-CRP) in predicting cardiovascular events 2 years after stenting in patients with unstable angina (UA) who had not received statin pretreatment. METHODS There were 1,896 patients included in this study. The primary end-point was the occurrence of cardiac death or myocardial infarction (MI). Secondary endpoints included all-cause death, stent thrombosis (ST), target lesion revascularization (TLR), target vessel revascularization (TVR), or a composite of major adverse cardiac events (MACE) at 2 years after the procedure. RESULTS During the median follow-up of 2.77 years, 96 patients experienced cardiac death (n = 37, 1.95%) or MIs (n = 70, 3.69%), 94 TLRs, 123 TVRs, 215 MACEs, and 21 definite or probable STs. In multivariable Cox proportional-hazards models and discrimination analysis, elevated IL-6 levels were superior to hs-CRP in predicting the occurrence not only of cardiac death or MI (HR 1.337, 95% CI 1.234-1.449, P < 0.001), but also of MACE and late-occurring definite/probable ST. Incorporation of IL-6 into conventional variables resulted in significantly increased c statistic for the prediction of end-points, with the exception of TLR and TVR. CONCLUSION Elevated IL-6 levels were independent predictors of cardiac death or MI, MACE, and late ST in patients with UA who had not received statin pretreatment, suggesting a role for IL-6 in the inflammatory risk assessment. Pathological studies have confirmed that atherosclerosis is a chronic inflammatory disease. Serum levels of high-sensitivity C-reactive protein (hs-CRP), matrix metalloproteinase, plasminogen activator inhibitor-1, the complement components C3a or C5a, and interleukin(IL)-6 were reported to provide strong and independent indications of the risk for future cardiovascular (CV) events, even among individuals who are thought to be free of vascular disease.
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Affiliation(s)
- Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Gansu Provincial People's Hospital, Lanzhou, China
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Demir M, Şentürk M, Kuzeytemiz M. The relationship between eosinophil and cardiac syndrome X. Clin Appl Thromb Hemost 2013; 21:325-8. [PMID: 24057398 DOI: 10.1177/1076029613502256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIM The pathophysiology of cardiac syndrome X (CSX) has not been clearly identified, although multiple abnormalities including microvascular spasm, endothelial dysfunction, and atherothrombosis have been reported. It is known that eosinophils play an important role in vasoconstruction and thrombosis. We aimed to compare the eosinophil counts in patients with CSX versus controls. MATERIALS AND METHODS This study included 50 patients with CSX (20 male, mean age 50.42 ± 9.6 years) and 30 control persons (10 male, mean age 49.16.11 ± 9.2 years). These participants underwent concurrent routine biochemical tests, and their eosinophil counts were obtained on whole blood count. These parameters were compared between groups. RESULTS Baseline characteristics of the study groups were comparable. Patients with CSX had a higher eosinophil count and mean platelet volume (MPV) value than the controls (339.4 ± 188 vs 132.7 ± 75 and 8.8 ± 0.2 vs 7.2 ± 0.1 fL; P < .001, respectively). CONCLUSION As a result, our study revealed a relationship between eosinophil count and MPV in patients with CSX.
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Affiliation(s)
- Mehmet Demir
- Department of Cardiology, Bursa Yüksek İhtisas Education and Research Hospital, Bursa, Turkey
| | - Muhammed Şentürk
- Department of Cardiology, Bursa Yüksek İhtisas Education and Research Hospital, Bursa, Turkey
| | - Mustafa Kuzeytemiz
- Department of Cardiology, Bursa Yüksek İhtisas Education and Research Hospital, Bursa, Turkey
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Keçoğlu S, Demir M, Uyan U, Melek M. The effects of eosinophil on the left atrial thrombus in patients with atrial fibrillation. Clin Appl Thromb Hemost 2013; 20:285-9. [PMID: 23539673 DOI: 10.1177/1076029613483208] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac rhythm disorder. Atrial fibrillation causes a 5-fold increased risk for thromboembolic stroke. It is known that eosinophils play an important role in thrombosis. We aimed to compare the number of eosinophil counts of the patients with and without thrombi in the left atrium (LA) or in the left atrial appendage (LAA) and to ascertain the association of eosinophil counts with the presence of thrombi. METHOD The study included 89 patients diagnosed with persistent AF who underwent transesophageal echocardiography and designated to undergo cardioversion. The patients were divided into 2 groups: group 1 consisted of 40 patients (18 male; average age 63.27 ± 1.4) who had thrombus formation in the LA or LAA, and group 2 consisted of 49 patients (23 male; average age 66.53 ± 1.56) who did not have any thrombus in the LA or LAA. These patients underwent concurrent routine biochemical tests and eosinophil count on whole blood count was also performed. RESULTS Baseline characteristics of the study groups were comparable. Group 1 patients had higher eosinophil and mean platelet volume values than group 2 (233.0 ± 30.7 vs 118.9 ± 11.8 and 9.77 ± 0.20 vs 8.27 ± 0.12 fL, P < .001, respectively). In group 1, the patients' LA diameter is higher than that in group II. CONCLUSION As a result, our study revealed a relationship between eosinophil count and LA thrombus in patients with nonvalvular AF.
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Affiliation(s)
- Serdar Keçoğlu
- 1Cardiology Department, Bursa Yüksek İhtisas Education and Research Hospital, Bursa, Turkey
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Cosentino N, Montone RA, Niccoli G. Eosinophils and risk stratification of patients treated by coronary stenting. Thromb Res 2012; 130:571-3. [DOI: 10.1016/j.thromres.2012.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 06/12/2012] [Accepted: 06/27/2012] [Indexed: 10/28/2022]
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Siegel G, Ermilov E. Hs-CRP may be associated with white blood cell count in metabolic syndrome patients treated with Ginkgo biloba. Atherosclerosis 2011; 218:250-2. [DOI: 10.1016/j.atherosclerosis.2011.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 05/04/2011] [Accepted: 05/07/2011] [Indexed: 10/18/2022]
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Niccoli G, Sgueglia GA, Cosentino N, Piro M, Toma A, Cataneo L, Fracassi F, Porto I, Leone AM, Burzotta F, Trani C, Crea F. Impact of gender on clinical outcomes after mTOR-inhibitor drug-eluting stent implantation in patients with first manifestation of ischaemic heart disease. Eur J Prev Cardiol 2011; 19:914-26. [PMID: 21840968 DOI: 10.1177/1741826711420001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Women have a worse outcome than men after percutaneous coronary intervention (PCI). However, in the drug-eluting stent (DES) era, limited data are available about the impact of gender-related differences on clinical outcome. Furthermore, many series have also included patients previously treated by coronary-artery bypass grafts or PCI, which may bias the evaluation of DES-related clinical events at follow up. We aimed to assess the impact of gender on clinical outcomes in a consecutive series of patients at first manifestation of coronary artery disease (CAD) undergoing PCI with mTOR-inhibitor DES. METHODS AND RESULTS A total of 138 consecutive patients (age 64 ± 13 years, female gender 29%) undergoing successful mTOR-inhibitor DES implantation [sirolimus-eluting stent (SES); zotarolimus-eluting stent (ZES); and everolimus-eluting stent (EES)] for the treatment of stable chronic angina or an acute coronary syndrome, as their first clinical manifestation of CAD, were prospectively enrolled between February 2008 and May 2009. Major adverse cardiac events (MACE), defined as a combination of cardiac death, myocardial infarction (MI), and clinically driven target lesion revascularization (TVR) at 12-month follow up, constituted the endpoint of the study. Fifty-one (37%) patients received SES; 46 (33%) patients received ZES; and 41 (30%) patients received EES. At follow up, 21 (15%) patients experienced a MACE. Three (2%) patients had cardiac death, five (4%) had MI, while 13 (9%) patients underwent clinically driven TVR. MACE occurred more frequently in females than males [10 (25%) vs. 11 (11%), p = 0.05]. At Cox regression analysis, the only independent predictors of MACE were female gender and implantation of more than one stent [hazard ratio (HR) 3.70, 95% confidence interval (CI) 1.46-9.36, p = 0.006; HR 1.26, 95% CI 0.99-2.74, p = 0.01, respectively]. CONCLUSIONS In conclusion, our finding suggests that women may have a worse outcome as compared with men after mTOR-inhibitor DES implantation.
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Affiliation(s)
- Giampaolo Niccoli
- Istituto di Cardiologia, Catholic University of Sacred Heart, Rome, Italy.
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Crea F, Niccoli G. Outcomes following coronary stenting and a role for eosinophils: evidence from eosinophil cationic protein. Interv Cardiol 2011. [DOI: 10.2217/ica.11.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Coronary stent implantation, eosinophils and the Kounis hypersensitivity associated acute coronary syndrome. Atherosclerosis 2011; 217:67-9. [DOI: 10.1016/j.atherosclerosis.2011.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 02/01/2011] [Indexed: 02/06/2023]
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Kounis NG, Giannopoulos S, Tsigkas GG, Goudevenos J. Eosinophilic responses to stent implantation and the risk of Kounis hypersensitivity associated coronary syndrome. Int J Cardiol 2011; 156:125-32. [PMID: 21700348 DOI: 10.1016/j.ijcard.2011.05.052] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 05/08/2011] [Accepted: 05/13/2011] [Indexed: 01/02/2023]
Abstract
The use of drug eluting stents constitutes a major breakthrough in current interventional cardiology because it is more than halves the need of repeat interventions. It is incontrovertible that coronary stents, in general, have been beneficial for the vast majority of patients. A small increase in thrombosis, following DES implantation, is offset by a diminished risk of complications associated with repeat vascularization. However, late and, especially, very late stent thrombosis is a much feared complication because it is associated with myocardial infarction with increased mortality. Despite that stent thrombosis is thought to be multifactorial, so far clinical reports and reported pathology findings in patients died from coronary stent thrombosis as well as animal studies and experiments, point toward a hypersensitivity inflammation. The stented and thrombotic areas are infiltrated by interacting, via bidirectional stimuli inflammatory cells including eosinophils, macrophages, T-cells and mast cells. Stented regions constitute an ideal surrounding for endothelial damage and dysfunction, together with hemorheologic changes and turbulence as well as platelet dysfunction, coagulation and fibrinolytic disturbances. Drug eluting stent components include the metal strut which contains nickel, chromium, manganese, titanium, molybdenum, the polymer coating and the impregnated drugs which for the first generation stents are: the antimicrotubule antineoplastic agent paclitaxel and the anti-inflammatory, immunosuppressive and antiproliferative agent sirolimus. The newer stents which are called cobalt-chromiun stents and elute the sirolimus analogs everolimus and zotarolimus both contain nickel and other metals. All these components constitute an antigenic complex inside the coronary arteries which apply chronic, continuous, repetitive and persistent inflammatory action capable to induced Kounis syndrome and stent thrombosis. Allergic inflammation goes through three phases, the early phase, the late phase and the chronic phase and these three phases correspond temporally with early (acute and sub acute), late and very late stent thrombosis. Bioabsorbable allergy free poly lactic acid self expanding stents, nickel free stainless steel materials, stent coverage with nitric oxide donors and antibodies with endothelial progenitor cell capturing abilities as well as stents eluting anti-inflammatory and anti-allergic agents might be the solution of this so feared and devastating stent complication.
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Affiliation(s)
- Nicholas G Kounis
- Department of Medical Sciences, Patras Highest Institute of Education and Technology, Patras, Greece.
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Gabbasov ZA, Kozlov SG, Imaeva AE, Saburova OS, Zykov KA, Masenko VP, Smirnov VN. In-stent restenosis after revascularization of myocardium with drug-eluting stents is accompanied by elevated level of blood plasma eosinophil cationic protein. Can J Physiol Pharmacol 2011; 89:413-8. [DOI: 10.1139/y11-038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The aim of this study was to assess the involvement of eosinophil cationic protein, a marker of eosinophil activation, in the development of in-stent restenosis after drug-eluting stent implantation. Follow-up angiography at 6 to 12 months was performed in 32 patients who were treated with percutaneous coronary intervention and implantation of sirolimus-eluting stents. Blood plasma levels of eosinophil cationic protein (ECP) and total immunoglobulin E (IgE) were measured by enzyme-linked immunosorbent assay and the level of C-reactive protein (hs-CRP) by high-sensitivity nephelometry. According to angiography data, in-stent restenosis occurred in 13 patients, while 19 patients did not develop it. There were no differences between the hs-CRP and IgE levels in patients with or without restenosis. In contrast, ECP level was higher in patients with restenosis compared with that in patients without restenosis [17.7 ng/mL (11.2–24.0) vs. 9.0 ng/mL (6.4–12.9), p = 0.017]. The incidence of in-stent restenoses was 63% in patients with ECP level higher than or equal to 11 ng/mL, and 19% in patients with an ECP level lower than 11 ng/mL (p = 0.019). These findings suggest that elevated eosinophil activation may play an important role in the pathogenesis of in-stent restenosis after implantation of drug-eluting stents.
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Affiliation(s)
- Zufar A. Gabbasov
- Cardiology Research Center, 3rd Cherepkovskaya Street, 15A, Moscow, 121 552, Russia
| | - Sergei G. Kozlov
- Cardiology Research Center, 3rd Cherepkovskaya Street, 15A, Moscow, 121 552, Russia
| | - Asiya E. Imaeva
- Cardiology Research Center, 3rd Cherepkovskaya Street, 15A, Moscow, 121 552, Russia
| | - Olga S. Saburova
- Cardiology Research Center, 3rd Cherepkovskaya Street, 15A, Moscow, 121 552, Russia
| | - Kirill A. Zykov
- Cardiology Research Center, 3rd Cherepkovskaya Street, 15A, Moscow, 121 552, Russia
| | - Valery P. Masenko
- Cardiology Research Center, 3rd Cherepkovskaya Street, 15A, Moscow, 121 552, Russia
| | - Vladimir N. Smirnov
- Cardiology Research Center, 3rd Cherepkovskaya Street, 15A, Moscow, 121 552, Russia
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The emerging role of allergic inflammation in adverse reactions after coronary stent implantation. Atherosclerosis 2011; 217:70-1. [PMID: 21459383 DOI: 10.1016/j.atherosclerosis.2011.02.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 02/23/2011] [Indexed: 12/26/2022]
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Niccoli G, Montone RA, Ferrante G, Crea F. The evolving role of inflammatory biomarkers in risk assessment after stent implantation. J Am Coll Cardiol 2011; 56:1783-93. [PMID: 21087705 DOI: 10.1016/j.jacc.2010.06.045] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 06/14/2010] [Accepted: 06/28/2010] [Indexed: 01/04/2023]
Abstract
The main adverse reactions to coronary stents are in-stent restenosis (ISR) and stent thrombosis. Along with procedural factors, individual susceptibility to these events plays an important role. In particular, inflammatory status, as assessed by C-reactive protein levels, predicts the risk of ISR after bare-metal stent implantation, although it does not predict the risk of stent thrombosis. Conversely, C-reactive protein levels fail to predict the risk of ISR after drug-eluting stent (DES) implantation, although they appear to predict the risk of stent thrombosis. Of note, DES have abated ISR rates occurring in the classical 1-year window, but new concern is emerging regarding late restenosis and thrombosis. The pathogenesis of these late events seems to be related to delayed healing and allergic reactions to polymers, a process in which eosinophils seem to play an important role by enhancing restenosis and thrombosis. The identification of high-risk individuals based on biomarker assessment may be important for the management of patients receiving stent implantation. In this report, we review the evolving role of inflammatory biomarkers in predicting the risk of ISR and stent thrombosis.
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Affiliation(s)
- Giampaolo Niccoli
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
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Niccoli G, Sgueglia GA, Conte M, Cosentino N, Minelli S, Belloni F, Trani C, Sabato V, Burzotta F, Porto I, Leone AM, Schiavino D, Crea F. Eosinophil cationic protein and clinical outcome after bare metal stent implantation. Atherosclerosis 2010; 215:166-9. [PMID: 21183182 DOI: 10.1016/j.atherosclerosis.2010.11.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 11/16/2010] [Accepted: 11/30/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE we assessed the association between baseline eosinophil cationic protein (ECP) levels, a sensitive marker of eosinophil activation, and clinical outcome in patients undergoing bare metal stent (BMS) implantation. METHODS basal ECP levels were measured in 110 patients (69±11 years, 88 men) undergoing BMS implantation. Major adverse cardiac events (MACEs), defined as cardiac death, non-fatal myocardial infarction, or clinically-driven target lesion revascularization, were registered at 24-month follow-up. RESULTS eighteen (16.4%) patients had MACEs and showed higher ECP levels compared with those without MACEs [20.1 (9.8-47.3) vs. 9.5 (5.0-27.2) g/L, p=0.02]. At follow-up, ECP level>11 g/L was the only significant predictor of MACEs (HR 3.5, 95% CI 1.1-10.4, p=0.03). CONCLUSION basal ECP levels are associated with MACEs after BMS implantation, suggesting that an allergic-mediated inflammation against the metal could explain some adverse reactions occurring after coronary stenting.
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Affiliation(s)
- Giampaolo Niccoli
- Institute of Cardiology, Department of Internal Medicine and Allergology, Catholic University of the Sacred Heart, Rome, Italy.
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Niccoli G, Ferrante G, Cosentino N, Conte M, Belloni F, Marino M, Bacà M, Montone RA, Sabato V, Schiavino D, Patriarca G, Crea F. Eosinophil cationic protein: A new biomarker of coronary atherosclerosis. Atherosclerosis 2010; 211:606-11. [DOI: 10.1016/j.atherosclerosis.2010.02.038] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 02/15/2010] [Accepted: 02/24/2010] [Indexed: 01/03/2023]
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Montone RA, Ferrante G, Bacà M, Niccoli G. Predictive value of C-reactive protein after drug-eluting stent implantation. Future Cardiol 2010; 6:167-79. [DOI: 10.2217/fca.09.159] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
During the last few decades, with the evolution of techniques and materials and the increasing experience of operators, percutaneous coronary interventions (PCI) have become an equally efficient alternative to coronary artery bypass grafts for the treatment of most coronary stenoses. Bare-metal stent implantation represented a major step forward, compared with plain old balloon angioplasty (POBA), by improving the immediate angiographic success. However, the incidence of in-stent restenosis (ISR) remained unacceptably high. Development of the drug-eluting stent (DES) significantly improved the outcome of PCI by dramatically abating the rate of ISR and reducing the incidence of target lesion revascularization. However, ISR has not been eliminated and the persistence of metal vessel scaffolding also raises concern regarding the occurrence of late or very late stent thrombosis. POBA and stent implantation have been shown to induce a local and systemic inflammatory response, whose magnitude is associated with worse clinical outcome, and they increase the risk of ISR. C-reactive protein, a marker of systemic inflammation, has been demonstrated to predict clinical and angiographic outcome after POBA or bare-metal stent implantation. However, conflicting data regarding the prognostic value of C-reactive protein following DES implantation are available. In this paper, we review the literature regarding the clinical and pathophysiological association between inflammation and prognosis after DES implantation and suggest some possible therapeutic approaches to reduce inflammatory burden with the aim to improve clinical and angiographic outcome after PCI.
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Affiliation(s)
| | - Giuseppe Ferrante
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Bacà
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giampaolo Niccoli
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
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