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Gijsberts CM, Ellenbroek GH, Ten Berg MJ, Huisman A, van Solinge WW, Asselbergs FW, den Ruijter HM, Pasterkamp G, de Kleijn DP, Hoefer IE. Routinely analyzed leukocyte characteristics improve prediction of mortality after coronary angiography. Eur J Prev Cardiol 2015; 23:1211-20. [PMID: 26643521 DOI: 10.1177/2047487315621832] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 11/20/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Inflammation and leukocyte infiltration are hallmarks of atherosclerosis. Clinically routine hematology analyzers mostly perform an entire differential blood count by default, irrespective of the requested parameter. We hypothesize that these normally unreported leukocyte characteristics associate with coronary artery disease (CAD) severity and can improve prediction of mortality in coronary angiography patients. METHODS We studied coronary angiography patients suspected of CAD (n = 1015) from the Utrecht Coronary Biobank cohort. Leukocyte characteristics were routinely assessed in blood drawn directly prior to angiography using an automated hematology analyzer and extracted from the Utrecht patient oriented database (UPOD) database. Patients were followed up for a median duration of 805 days, during which 65 patients died. We evaluated the association of leukocyte characteristics with synergy between PCI with taxus and cardiac surgery (SYNTAX) score as a measure of CAD severity, all-cause and cardiovascular mortality and major adverse cardiovascular events (MACEs). In order to determine the improvement of risk prediction, we calculated continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI). RESULTS Monocyte percentage showed strong independent predictive value for all-cause mortality (hazard ratio (HR) 1.44 (1.19-1.74), p < 0.001), and the monocyte-to-lymphocyte ratio performed best for cardiovascular mortality (HR 1.42 (1.11-1.81), p = 0.005). The cNRIs and IDIs of leukocyte characteristics for all-cause mortality confirmed the improvement in mortality risk prediction. No significantly predictive leukocyte characteristics were found for MACEs. CONCLUSION Readily available yet unreported leukocyte characteristics from routine hematology analyzers significantly improved prediction of mortality in coronary angiography patients on top of clinical characteristics.
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Affiliation(s)
- Crystel M Gijsberts
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands ICIN-Netherlands Heart Institute, the Netherlands
| | | | - Maarten J Ten Berg
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Albert Huisman
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter W van Solinge
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Hester M den Ruijter
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerard Pasterkamp
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dominique Pv de Kleijn
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands ICIN-Netherlands Heart Institute, the Netherlands Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Cardiovascular Research Institute (CVRI), National University Heart Centre (NUHCS), National University Health System, Singapore
| | - Imo E Hoefer
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
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Schirmer SH, Millenaar DN, Werner C, Schuh L, Degen A, Bettink SI, Lipp P, van Rooijen N, Meyer T, Böhm M, Laufs U. Exercise promotes collateral artery growth mediated by monocytic nitric oxide. Arterioscler Thromb Vasc Biol 2015; 35:1862-71. [PMID: 26088573 DOI: 10.1161/atvbaha.115.305806] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 06/04/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Collateral artery growth (arteriogenesis) is an important adaptive response to hampered arterial perfusion. It is unknown whether preventive physical exercise before limb ischemia can improve arteriogenesis and modulate mononuclear cell function. This study aimed at investigating the effects of endurance exercise before arterial occlusion on MNC function and collateral artery growth. APPROACH AND RESULTS After 3 weeks of voluntary treadmill exercise, ligation of the right femoral artery was performed in mice. Hindlimb perfusion immediately after surgery did not differ from sedentary mice. However, previous exercise improved perfusion restoration ≤7 days after femoral artery ligation, also when exercise was stopped at ligation. This was accompanied by an accumulation of peri-collateral macrophages and increased expression of endothelial nitric oxide synthase and inducible nitric oxide synthase (iNOS) in hindlimb collateral and in MNC of blood and spleen. Systemic monocyte and macrophage depletion by liposomal clodronate but not splenectomy attenuated exercise-induced perfusion restoration, collateral artery growth, peri-collateral macrophage accumulation, and upregulation of iNOS. iNOS-deficient mice did not show exercise-induced perfusion restoration. Transplantation of bone marrow-derived MNC from iNOS-deficient mice into wild-type animals inhibited exercise-induced collateral artery growth. In contrast to sedentary controls, thrice weekly aerobic exercise training for 6 months in humans increased peripheral blood MNC iNOS expression. CONCLUSIONS Circulating mononuclear cell-derived inducible nitric oxide is an important mediator of exercise-induced collateral artery growth.
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Affiliation(s)
- Stephan H Schirmer
- From the Klinik für Innere Medizin III (S.H.S., D.N.M., C.W., L.S., A.D., S.I.B., M.B., U.L.) and Institut für Molekulare Zellbiologie (P.L.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Department of Molecular Cell Biology, Faculty of Medicine, Vrije Universiteit, VUMC, Amsterdam, The Netherlands (N.R.); and Institut für Sport- und Präventivmedizin, Universität des Saarlandes, Saarbrücken, Germany (T.M.).
| | - Dominic N Millenaar
- From the Klinik für Innere Medizin III (S.H.S., D.N.M., C.W., L.S., A.D., S.I.B., M.B., U.L.) and Institut für Molekulare Zellbiologie (P.L.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Department of Molecular Cell Biology, Faculty of Medicine, Vrije Universiteit, VUMC, Amsterdam, The Netherlands (N.R.); and Institut für Sport- und Präventivmedizin, Universität des Saarlandes, Saarbrücken, Germany (T.M.)
| | - Christian Werner
- From the Klinik für Innere Medizin III (S.H.S., D.N.M., C.W., L.S., A.D., S.I.B., M.B., U.L.) and Institut für Molekulare Zellbiologie (P.L.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Department of Molecular Cell Biology, Faculty of Medicine, Vrije Universiteit, VUMC, Amsterdam, The Netherlands (N.R.); and Institut für Sport- und Präventivmedizin, Universität des Saarlandes, Saarbrücken, Germany (T.M.)
| | - Lisa Schuh
- From the Klinik für Innere Medizin III (S.H.S., D.N.M., C.W., L.S., A.D., S.I.B., M.B., U.L.) and Institut für Molekulare Zellbiologie (P.L.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Department of Molecular Cell Biology, Faculty of Medicine, Vrije Universiteit, VUMC, Amsterdam, The Netherlands (N.R.); and Institut für Sport- und Präventivmedizin, Universität des Saarlandes, Saarbrücken, Germany (T.M.)
| | - Achim Degen
- From the Klinik für Innere Medizin III (S.H.S., D.N.M., C.W., L.S., A.D., S.I.B., M.B., U.L.) and Institut für Molekulare Zellbiologie (P.L.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Department of Molecular Cell Biology, Faculty of Medicine, Vrije Universiteit, VUMC, Amsterdam, The Netherlands (N.R.); and Institut für Sport- und Präventivmedizin, Universität des Saarlandes, Saarbrücken, Germany (T.M.)
| | - Stephanie I Bettink
- From the Klinik für Innere Medizin III (S.H.S., D.N.M., C.W., L.S., A.D., S.I.B., M.B., U.L.) and Institut für Molekulare Zellbiologie (P.L.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Department of Molecular Cell Biology, Faculty of Medicine, Vrije Universiteit, VUMC, Amsterdam, The Netherlands (N.R.); and Institut für Sport- und Präventivmedizin, Universität des Saarlandes, Saarbrücken, Germany (T.M.)
| | - Peter Lipp
- From the Klinik für Innere Medizin III (S.H.S., D.N.M., C.W., L.S., A.D., S.I.B., M.B., U.L.) and Institut für Molekulare Zellbiologie (P.L.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Department of Molecular Cell Biology, Faculty of Medicine, Vrije Universiteit, VUMC, Amsterdam, The Netherlands (N.R.); and Institut für Sport- und Präventivmedizin, Universität des Saarlandes, Saarbrücken, Germany (T.M.)
| | - Nico van Rooijen
- From the Klinik für Innere Medizin III (S.H.S., D.N.M., C.W., L.S., A.D., S.I.B., M.B., U.L.) and Institut für Molekulare Zellbiologie (P.L.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Department of Molecular Cell Biology, Faculty of Medicine, Vrije Universiteit, VUMC, Amsterdam, The Netherlands (N.R.); and Institut für Sport- und Präventivmedizin, Universität des Saarlandes, Saarbrücken, Germany (T.M.)
| | - Tim Meyer
- From the Klinik für Innere Medizin III (S.H.S., D.N.M., C.W., L.S., A.D., S.I.B., M.B., U.L.) and Institut für Molekulare Zellbiologie (P.L.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Department of Molecular Cell Biology, Faculty of Medicine, Vrije Universiteit, VUMC, Amsterdam, The Netherlands (N.R.); and Institut für Sport- und Präventivmedizin, Universität des Saarlandes, Saarbrücken, Germany (T.M.)
| | - Michael Böhm
- From the Klinik für Innere Medizin III (S.H.S., D.N.M., C.W., L.S., A.D., S.I.B., M.B., U.L.) and Institut für Molekulare Zellbiologie (P.L.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Department of Molecular Cell Biology, Faculty of Medicine, Vrije Universiteit, VUMC, Amsterdam, The Netherlands (N.R.); and Institut für Sport- und Präventivmedizin, Universität des Saarlandes, Saarbrücken, Germany (T.M.)
| | - Ulrich Laufs
- From the Klinik für Innere Medizin III (S.H.S., D.N.M., C.W., L.S., A.D., S.I.B., M.B., U.L.) and Institut für Molekulare Zellbiologie (P.L.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Department of Molecular Cell Biology, Faculty of Medicine, Vrije Universiteit, VUMC, Amsterdam, The Netherlands (N.R.); and Institut für Sport- und Präventivmedizin, Universität des Saarlandes, Saarbrücken, Germany (T.M.)
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van den Borne P, Haverslag RT, Brandt MM, Cheng C, Duckers HJ, Quax PHA, Hoefer IE, Pasterkamp G, de Kleijn DPV. Absence of chemokine (C-x-C motif) ligand 10 diminishes perfusion recovery after local arterial occlusion in mice. Arterioscler Thromb Vasc Biol 2014; 34:594-602. [PMID: 24407030 DOI: 10.1161/atvbaha.113.303050] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In arteriogenesis, pre-existing anastomoses undergo enlargement to restore blood flow in ischemic tissues. Chemokine (C-X-C motif) ligand 10 (CXCL10) is secreted after Toll-like receptor activation. Toll-like receptors are involved in arteriogenesis; however, the role of CXCL10 is still unclear. In this study, we investigated the role for CXCL10 in a murine hindlimb ischemia model. APPROACH AND RESULTS Unilateral femoral artery ligation was performed in wild-type (WT) and CXCL10(-/-) knockout (KO) mice and perfusion recovery was measured using laser-Doppler perfusion analysis. Perfusion recovery was significantly lower in KO mice compared with WT at days 4 and 7 after surgery (KO versus WT: 28±5% versus 81±13% at day 4; P=0.003 and 57±12% versus 107±8% at day 7; P=0.003). Vessel measurements of α-smooth muscle actin-positive vessels revealed increasing numbers in time after surgery, which was significantly higher in WT when compared with that in KO. Furthermore, α-smooth muscle actin-positive vessels were significantly larger in WT when compared with those in KO at day 7 (wall thickness, P<0.001; lumen area, P=0.003). Local inflammation was assessed in hindlimb muscles, but this did not differ between WT and KO. Chimerization experiments analyzing perfusion recovery and histology revealed an equal contribution for bone marrow-derived and circulating CXCL10. Migration assays showed a stimulating role for both intrinsic and extrinsic CXCL10 in vascular smooth muscle cell migration. CONCLUSIONS CXCL10 plays a causal role in arteriogenesis. Bone marrow-derived CXCL10 and tissue-derived CXCL10 play a critical role in accelerating perfusion recovery after arterial occlusion in mice probably by promoting vascular smooth muscle cell recruitment and maturation of pre-existing anastomoses.
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Affiliation(s)
- Pleunie van den Borne
- From the Laboratory of Experimental Cardiology (P.v.d.B., R.T.H., I.E.H., G.P., D.P.V.d.K.), Department of Nephrology and Hypertension (C.C.), and Department of Cardiology (H.J.D.), University Medical Center Utrecht, Utrecht, The Netherlands; Molecular Cardiology Laboratory, Experimental Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (M.M.B., C.C.); Department of Surgery (P.H.A.Q.) and Einthoven Laboratory of Experimental Vascular Medicine (P.H.A.Q.), Leiden University Medical Center, Leiden, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (I.E.H., G.P., D.P.V.d.K.); and Cardiovascular Research Institute and Surgery, National University Hospital, Singapore, Singapore (D.P.V.d.K.)
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