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Trakarnvanich T, Sirivongrangson P, Trongtrakul K, Srisawat N. The effect of citrate in cardiovascular system and clot circuit in critically ill patients requiring continuous renal replacement therapy. J Artif Organs 2023; 26:53-64. [PMID: 35412099 PMCID: PMC9968675 DOI: 10.1007/s10047-022-01329-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/23/2022] [Indexed: 11/25/2022]
Abstract
We aimed to evaluate the impact of citrate on hemodynamic responses and secondary outcomes, including the filter life span, metabolic complications, and levels of inflammatory cytokines, in critically ill patients who required CRRT compared with those who underwent the heparin-free method. This prospective, multicenter, open-label randomized trial compared regional citrate anticoagulation (RCA) with a heparin-free protocol in severe acute kidney injury (AKI) patients who received continuous venovenous hemodiafiltration (CVVHDF) in the postdilution mode. We measured hemodynamic changes using the FloTrac Sensor/EV1000™ Clinical Platform at certain time points after starting CRRT (0, 6, 12, 24, 48, and 72 h.). The levels of inflammatory cytokines (IL-1β, IL-6, IL-8, IL-10 and TNF-ɑ) were measured on days 1 and 3. Forty-one patients were recruited and randomized into the heparin (n = 20) and citrate groups (n = 21). The cardiac performances were not significantly different between the 2 groups at any time point. The inflammatory cytokines declined similarly in both treatment arms. The maximum filter survival time was insignificantly longer in the RCA group than in the heparin-free group (44.64 ± 26.56 h. vs p = 0.693 in citrate and heparin free group). No serious side effects were observed for either treatment arm, even in the group of liver dysfunction patients. RCA did not affect hemodynamic changes during CRRT. Inflammatory cytokines decreased similarly in both treatment arms.The filter life span was longer in the citrate group. RCA is a valid alternative to traditional anticoagulation and results in stable hemodynamic parameters.
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Affiliation(s)
- Thananda Trakarnvanich
- Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit, Bangkok, 10300, Thailand.
| | | | - Konlawij Trongtrakul
- Faculty of Medicine, Pulmonary, Critical Care, and Allergy Division, Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nattachai Srisawat
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Critical Care Nephrology Research Unit, Chulalongkorn University, Bangkok, Thailand
- Academy of Science, Royal Society of Thailand, Bangkok, Thailand
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2
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Song C, Yuan S, Cui K, Cai Z, Zhang R, He J, Qiao Z, Bian X, Wu S, Wang H, Fu R, Wang C, Liu Q, Yin D, Jia L, Dou K. Prognostic value of N-terminal Pro–B-Type natriuretic peptide in patients with intermediate coronary lesions. Front Cardiovasc Med 2022; 9:903757. [PMID: 35966554 PMCID: PMC9370998 DOI: 10.3389/fcvm.2022.903757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background The optimal treatment strategy for patients with coronary intermediate lesions, defined as diameter stenosis of 50–70%, remains a great challenge for cardiologists. Identification of potential biomarkers predictive of major adverse cardiovascular events (MACEs) risk may assist in risk stratification and clinical decision. Methods A total of 1,187 patients with intermediate coronary lesions and available N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were enrolled in the current study. A baseline NT-proBNP level was obtained. The primary endpoint was defined as MACEs, the composite endpoint of all-cause death and non-fatal myocardial infarction. A multivariate Cox regression model was used to explore the association between NT-proBNP level and MACE risk. Results The mean age of the study cohort was 59.2 years. A total of 68 patients experienced MACE during a median follow-up of 6.1 years. Restricted cubic spline analysis delineated a linear relationship between the baseline NT-proBNP level and MACE risk. Both univariate and multivariate analyses demonstrated that an increased NT-proBNP level was associated with an increased risk of MACE [adjusted hazard ratio (HR) per doubling: 1.412, 95% confidence interval (CI): 1.022–1.952, p = 0.0365]. This association remains consistent in clinical meaningful subgroups according to age, sex, body mass index (BMI), and diabetes. Conclusion An increased NT-proBNP level is associated with an increased risk of MACE in patients with intermediate coronary lesions and may serve as the potential biomarker for risk stratification and treatment decision guidance.
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Affiliation(s)
- Chenxi Song
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Sheng Yuan
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Kongyong Cui
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Zhongxing Cai
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Rui Zhang
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Jining He
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Zheng Qiao
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Xiaohui Bian
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Shaoyu Wu
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Haoyu Wang
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Rui Fu
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Chunyue Wang
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Qianqian Liu
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Dong Yin
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Lei Jia
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- *Correspondence: Lei Jia,
| | - Kefei Dou
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- *Correspondence: Lei Jia,
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Different Contribution of Monocyte- and Platelet-Derived Microvesicles to Endothelial Behavior. Int J Mol Sci 2022; 23:ijms23094811. [PMID: 35563201 PMCID: PMC9105732 DOI: 10.3390/ijms23094811] [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] [Received: 04/06/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 11/17/2022] Open
Abstract
Several contributions of circulating microvesicles (MVs) to the endothelial dysfunction have been reported in the past; a head-to-head comparison of platelet- and monocyte–derived MVs has however never been performed. To this aim, we assessed the involvement of these MVs in vessel damage related processes, i.e., oxidative stress, inflammation, and leukocyte-endothelial adhesion. Platelets and monocytes isolated from healthy subjects (HS, n = 15) were stimulated with TRAP-6 and LPS to release MVs that were added to human vascular endothelial cell (hECV) culture to evaluate superoxide anion production, inflammatory markers (IL-6, TNFα, NF-κB mRNA expression), and hECV adhesiveness. The effects of the MVs-induced from HS were compared to those induced by MVs spontaneously released from cells of patients with ST-segment elevation myocardial infarction (STEMI, n = 7). MVs released by HS-activated cells triggered a threefold increase in oxidative burst in a concentration-dependent manner. Only MVs released from monocytes doubled IL-6, TNFα, and NF-κB mRNA expression and monocyte-endothelial adhesion. Interestingly, the effects of the MVs isolated from STEMI-monocytes were not superimposable to previous ones except for adhesion to hECV. Conversely, MVs released from STEMI-platelets sustained both redox state and inflammatory phenotype. These data provide evidence that MVs released from activated and/or pathologic platelets and monocytes differently affect endothelial behavior, highlighting platelet-MVs as causative factors of impaired endothelial function in the acute phase of STEMI.
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Makarewicz-Wujec M, Henzel J, Kępka C, Kruk M, Wardziak Ł, Trochimiuk P, Parzonko A, Dzielińska Z, Demkow M, Kozłowska-Wojciechowska M. Usefulness of MCP-1 Chemokine in the Monitoring of Patients with Coronary Artery Disease Subjected to Intensive Dietary Intervention: A Pilot Study. Nutrients 2021; 13:nu13093047. [PMID: 34578925 PMCID: PMC8467171 DOI: 10.3390/nu13093047] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/21/2021] [Accepted: 08/27/2021] [Indexed: 12/11/2022] Open
Abstract
Monocyte chemotactic protein-1 (MCP-1) plays an important role in the entire atherosclerotic process, from atherogenesis to destabilisation of the atherosclerotic plaque. The purpose of this study is to evaluate the effect of the dietary approaches to stop hypertension (DASH) diet in patients with coronary artery disease on the MCP-1 plasma concentration and to evaluate the potential usefulness of this chemokine as a marker of change in the volume and composition of coronary plaque. Material and method. As part of the dietary intervention to stop coronary atherosclerosis in computed tomography (DISCO-CT) study, patients were randomised to an intervention group (n = 40) in which the DASH diet was introduced, and to a control group (n = 39) with no dietary intervention. In the DASH group, dietary counselling was provided at all follow-up visits within 12 months of the follow-up period. MCP-1 plasma concentration was determined using enzyme-linked immunosorbent assay (ELISA). Coronary plaque analysis was performed using a semi-automated plaque analysis software system (QAngioCT, Medis, The Netherlands). Results. In the DASH group, MCP-1 plasma concentration significantly decreased by 34.1 pg/mL (p = 0.01), while in the control group, the change in MPC-1 was not significant. Significant inverse correlations were revealed for the change in MCP-1 plasma concentration and change in the consumption of vitamin C and dietary fibre both in the DASH (r = −0.519, p = 0.0005; r = −0.353, p = 0.025, respectively) and in the control group (r = −0.488 p = 0.001; r = −0.502, p = 0.001, respectively). In patients with the highest decrease in percent atheroma volume (PAV), a significant positive correlation was observed between the change in MCP-1 plasma concentration and changes in PAV (r = 0.428, p = 0.033) and calcified plaque component (r = 0.468, p = 0.018), while the change in noncalcified plaque component correlated inversely with change in MCP1 (r = −0.459, p = 0.021). Conclusion. Dietary intervention based on the DASH diet model reduces the MCP-1plasma concentration, mostly due to an increased intake of plant-derived, fibre-rich foods and antioxidants. The change in MCP-1 plasma concentration seems to reflect changes in the atheroma volume and proportions between the calcified and non-calcified plaque elements.
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Affiliation(s)
- Magdalena Makarewicz-Wujec
- Department of Clinical Pharmacy and Pharmaceutical Care, Medical University of Warsaw, 02-091 Warsaw, Poland;
- Correspondence: (M.M.-W.); (J.H.); Tel.: +48-225-720-985 (M.M.-W.); +48-223-434-342 (J.H.)
| | - Jan Henzel
- Department of Coronary and Structural Heart Diseases, Cardinal Stefan Wyszynski Institute of Cardiology, 04-628 Warsaw, Poland; (C.K.); (M.K.); (Ł.W.); (P.T.); (Z.D.); (M.D.)
- Correspondence: (M.M.-W.); (J.H.); Tel.: +48-225-720-985 (M.M.-W.); +48-223-434-342 (J.H.)
| | - Cezary Kępka
- Department of Coronary and Structural Heart Diseases, Cardinal Stefan Wyszynski Institute of Cardiology, 04-628 Warsaw, Poland; (C.K.); (M.K.); (Ł.W.); (P.T.); (Z.D.); (M.D.)
| | - Mariusz Kruk
- Department of Coronary and Structural Heart Diseases, Cardinal Stefan Wyszynski Institute of Cardiology, 04-628 Warsaw, Poland; (C.K.); (M.K.); (Ł.W.); (P.T.); (Z.D.); (M.D.)
| | - Łukasz Wardziak
- Department of Coronary and Structural Heart Diseases, Cardinal Stefan Wyszynski Institute of Cardiology, 04-628 Warsaw, Poland; (C.K.); (M.K.); (Ł.W.); (P.T.); (Z.D.); (M.D.)
| | - Piotr Trochimiuk
- Department of Coronary and Structural Heart Diseases, Cardinal Stefan Wyszynski Institute of Cardiology, 04-628 Warsaw, Poland; (C.K.); (M.K.); (Ł.W.); (P.T.); (Z.D.); (M.D.)
| | - Andrzej Parzonko
- Department of Pharmacognosy and Molecular Basis of Phytotherapy, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Zofia Dzielińska
- Department of Coronary and Structural Heart Diseases, Cardinal Stefan Wyszynski Institute of Cardiology, 04-628 Warsaw, Poland; (C.K.); (M.K.); (Ł.W.); (P.T.); (Z.D.); (M.D.)
| | - Marcin Demkow
- Department of Coronary and Structural Heart Diseases, Cardinal Stefan Wyszynski Institute of Cardiology, 04-628 Warsaw, Poland; (C.K.); (M.K.); (Ł.W.); (P.T.); (Z.D.); (M.D.)
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5
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Reynen S, Schlossbauer M, Hubauer U, Hupf J, Mohr A, Orso E, Zimmermann M, Luchner A, Maier LS, Wallner S, Jungbauer CG. Urinary N-terminal pro-brain natriuretic peptide: prognostic value in patients with acute chest pain. ESC Heart Fail 2021; 8:2293-2305. [PMID: 33822463 PMCID: PMC8120380 DOI: 10.1002/ehf2.13332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/02/2021] [Accepted: 03/12/2021] [Indexed: 11/10/2022] Open
Abstract
AIMS The objective of this study was to investigate the prognostic value of urinary N-terminal pro-brain natriuretic peptide (NT-proBNP) compared with plasma NT-proBNP in patients presenting with acute chest pain in the emergency department. METHODS AND RESULTS We measured simultaneously plasma and urinary NT-proBNP at admission in 301 patients with acute chest pain. In our cohort, 174 patients suffered from acute coronary syndrome (ACS). A follow-up (median of 55 months) was performed regarding the endpoints all-cause mortality and major adverse cardiac events (mortality, congestive heart failure, ACS with the necessity of a coronary intervention, and stroke). Fifty-four patients died during follow-up; 98 suffered from the combined endpoint. A significant and positive correlation of urinary and plasma NT-proBNP was found (r = 0.87, P < 0.05). Patients with troponin positive ACS had significantly elevated levels of plasma and urinary NT-proBNP compared with those with unstable angina pectoris or chest wall syndrome (each P < 0.05). The highest levels of both biomarkers were found in patients with congestive heart failure (each P < 0.05). According to Kaplan-Meier analysis, plasma and urinary NT-proBNP were significant predictors for mortality and the combined endpoint in the whole study cohort and in the subgroup of patients with ACS (each P < 0.05). Regarding Cox regression analysis, plasma and urinary NT-proBNP were independent predictors for mortality and the combined endpoint (each P < 0.05). CONCLUSIONS Urinary NT-proBNP seems to provide a significant predictive value regarding the endpoints all-cause mortality and major adverse cardiac events in patients with acute chest pain and those with ACS.
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Affiliation(s)
- Stefanie Reynen
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany
| | - Michael Schlossbauer
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany.,Department of Anesthesiology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Ute Hubauer
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany
| | - Julian Hupf
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - Arno Mohr
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany.,Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany
| | - Evelyn Orso
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Markus Zimmermann
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - Andreas Luchner
- Department of Cardiology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany
| | - Stefan Wallner
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Carsten G Jungbauer
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany
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6
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Bauer A, Korten I, Juchem G, Kiesewetter I, Kilger E, Heyn J. EuroScore and IL-6 predict the course in ICU after cardiac surgery. Eur J Med Res 2021; 26:29. [PMID: 33771227 PMCID: PMC7995398 DOI: 10.1186/s40001-021-00501-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite modern advances in intensive care medicine and surgical techniques, mortality rates in cardiac surgical patients are still about 3%. Considerable efforts were made to predict morbidity and mortality after cardiac surgery. In this study, we analysed the predictive properties of EuroScore and IL-6 for mortality in ICU, prolonged postoperative mechanical ventilation, and prolonged stay in ICU. METHODS We enrolled 2972 patients undergoing cardiac surgery. The patients either underwent aortic valve surgery (AV), mitral valve surgery (MV), coronary artery bypass grafting (CABG), and combined operations of aortic valve and coronary artery bypass grafting (AV + CABG) or of mitral and tricuspid valve (MV + TV). Different laboratory and clinical parameters were analysed. RESULTS EuroScore as well as IL-6 were associated with increased mortality after cardiac surgery. Furthermore, a higher EuroScore and elevated levels of IL-6 were predictors for prolonged mechanical ventilation and a longer stay in ICU. Especially, highly significant elevated IL-6 levels and an increased EuroScore showed a strong association. Statistics suggested superiority when both parameters were combined in a single model. CONCLUSION Our results suggest that EuroScore and IL-6 are helpful in predicting the course in ICU after cardiac surgery, and therefore, the use of intensive care resources. Especially, the combination of highly elevated levels of IL-6 and EuroScore may prove to be excellent predictors for an unfortunate postoperative course in ICU.
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Affiliation(s)
- Andreas Bauer
- Department of Anaesthesiology, University of Munich (LMU), Wolkerweg 16, 81375, Munich, Germany.,Department of Anesthesiology, Klinikum Rosenheim, Pettenkoferstraße 10, 83022, Rosenheim, Germany
| | - Insa Korten
- Division of Respiraotry Medicine, Department of Pediatrics, Inselspital and University of Bern, 3010 Bern, Switzerland
| | - Gerd Juchem
- Department of Cardiac Surgery, University of Munich (LMU), Wolkerweg 16, 81375, Munich, Germany
| | - Isabel Kiesewetter
- Department of Anaesthesiology, University of Munich (LMU), Wolkerweg 16, 81375, Munich, Germany
| | - Erich Kilger
- Department of Anaesthesiology, University of Munich (LMU), Wolkerweg 16, 81375, Munich, Germany
| | - Jens Heyn
- Department of Anaesthesiology, University of Munich (LMU), Wolkerweg 16, 81375, Munich, Germany. .,Department of Anaesthesiology, University of Munich (LMU), Marchioninistrasse 15, 81377, Munich, Germany.
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7
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Samstag Y, Bogert NV, Wabnitz GH, Din S, Therre M, Leuschner F, Katus HA, Konstandin MH. Reactive Oxidative Species-Modulated Ca 2+ Release Regulates β 2 Integrin Activation on CD4 + CD28 null T Cells of Acute Coronary Syndrome Patients. THE JOURNAL OF IMMUNOLOGY 2020; 205:2276-2286. [PMID: 32938726 DOI: 10.4049/jimmunol.2000327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 08/17/2020] [Indexed: 01/06/2023]
Abstract
The number and activity of T cell subsets in the atherosclerotic plaques are critical for the prognosis of patients with acute coronary syndrome. β2 Integrin activation is pivotal for T cell recruitment and correlates with future cardiac events. Despite this knowledge, differential regulation of adhesiveness in T cell subsets has not been explored yet. In this study, we show that in human T cells, SDF-1α-mediated β2 integrin activation is driven by a, so far, not-described reactive oxidative species (ROS)-regulated calcium influx. Furthermore, we show that CD4+CD28null T cells represent a highly reactive subset showing 25-fold stronger β2 integrin activation upon SDF-1α stimulation compared with CD28+ T cells. Interestingly, ROS-dependent Ca release was much more prevalent in the pathogenetically pivotal CD28null subset compared with the CD28+ T cells, whereas the established mediators of the classical pathways for β2 integrin activation (PKC, PI3K, and PLC) were similarly activated in both T cell subsets. Thus, interference with the calcium flux attenuates spontaneous adhesion of CD28null T cells from acute coronary syndrome patients, and calcium ionophores abolished the observed differences in the adhesion properties between CD28+ and CD28null T cells. Likewise, the adhesion of these T cell subsets was indistinguishable in the presence of exogenous ROS/H2O2 Together, these data provide a molecular explanation of the role of ROS in pathogenesis of plaque destabilization.
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Affiliation(s)
- Yvonne Samstag
- Institute of Immunology, Section Molecular Immunology, Ruprecht-Karls-University, D-69120 Heidelberg, Germany
| | - Nicolai V Bogert
- Department of Cardiology, Heidelberg University Hospital, Ruprecht-Karls-University, D-69120 Heidelberg, Germany; and.,German Centre for Cardiovascular Research Partner Site Heidelberg/Mannheim, Germany, Heidelberg University Hospital, D-69120 Heidelberg, Germany
| | - Guido H Wabnitz
- Institute of Immunology, Section Molecular Immunology, Ruprecht-Karls-University, D-69120 Heidelberg, Germany
| | - Shabana Din
- Department of Cardiology, Heidelberg University Hospital, Ruprecht-Karls-University, D-69120 Heidelberg, Germany; and.,German Centre for Cardiovascular Research Partner Site Heidelberg/Mannheim, Germany, Heidelberg University Hospital, D-69120 Heidelberg, Germany
| | - Markus Therre
- Department of Cardiology, Heidelberg University Hospital, Ruprecht-Karls-University, D-69120 Heidelberg, Germany; and.,German Centre for Cardiovascular Research Partner Site Heidelberg/Mannheim, Germany, Heidelberg University Hospital, D-69120 Heidelberg, Germany
| | - Florian Leuschner
- Department of Cardiology, Heidelberg University Hospital, Ruprecht-Karls-University, D-69120 Heidelberg, Germany; and.,German Centre for Cardiovascular Research Partner Site Heidelberg/Mannheim, Germany, Heidelberg University Hospital, D-69120 Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Ruprecht-Karls-University, D-69120 Heidelberg, Germany; and.,German Centre for Cardiovascular Research Partner Site Heidelberg/Mannheim, Germany, Heidelberg University Hospital, D-69120 Heidelberg, Germany
| | - Mathias H Konstandin
- Department of Cardiology, Heidelberg University Hospital, Ruprecht-Karls-University, D-69120 Heidelberg, Germany; and .,German Centre for Cardiovascular Research Partner Site Heidelberg/Mannheim, Germany, Heidelberg University Hospital, D-69120 Heidelberg, Germany
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8
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Lyngbakken MN, Myhre PL, Røsjø H, Omland T. Novel biomarkers of cardiovascular disease: Applications in clinical practice. Crit Rev Clin Lab Sci 2018; 56:33-60. [DOI: 10.1080/10408363.2018.1525335] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Magnus Nakrem Lyngbakken
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Peder Langeland Myhre
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
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9
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Leow EH, Chan YH, Ng YH, Lim JKB, Nakao M, Lee JH. Prevention of Acute Kidney Injury in Children Undergoing Cardiac Surgery: A Narrative Review. World J Pediatr Congenit Heart Surg 2018; 9:79-90. [PMID: 29310552 DOI: 10.1177/2150135117743211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Children undergoing cardiac surgery are at risk of developing acute kidney injury (AKI). Preventing cardiac surgery-associated AKI (CS-AKI) is important as it is associated with increased early- and long-term mortality and morbidity. Targeting modifiable risk factors (eg, avoiding poor renal perfusion, nephrotoxic drugs, and fluid overload) reduces the risk of CS-AKI. There is currently no strong evidence for the routine use of pharmacological approaches (eg, aminophylline, dexmedetomidine, fenoldopam, and steroids) to prevent CS-AKI. There is robust evidence to support the role of early peritoneal dialysis as a nonpharmacologic approach to prevent CS-AKI.
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Affiliation(s)
- Esther Huimin Leow
- 1 Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yoke Hwee Chan
- 2 Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore.,3 Duke-NUS School of Medicine, Singapore, Singapore
| | - Yong Hong Ng
- 1 Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Joel Kian Boon Lim
- 1 Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Masakazu Nakao
- 4 Department of Paediatric Cardiothoracic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jan Hau Lee
- 2 Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore.,3 Duke-NUS School of Medicine, Singapore, Singapore
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10
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Moledina DG, Isguven S, McArthur E, Thiessen-Philbrook H, Garg AX, Shlipak M, Whitlock R, Kavsak PA, Coca SG, Parikh CR. Plasma Monocyte Chemotactic Protein-1 Is Associated With Acute Kidney Injury and Death After Cardiac Operations. Ann Thorac Surg 2017; 104:613-620. [PMID: 28223055 DOI: 10.1016/j.athoracsur.2016.11.036] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/13/2016] [Accepted: 11/07/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Monocyte chemotactic protein-1 (MCP-1; chemokine C-C ligand-2 [CCL-2]) is upregulated in ischemia-reperfusion injury and is a promising biomarker of inflammation in cardiac operations. METHODS We measured preoperative and postoperative plasma MCP-1 levels in adults undergoing cardiac operations to evaluate the association of perioperative MCP-1 levels with acute kidney injury (AKI) and death in Translational Research Investigating Biomarker Endpoints in AKI (TRIBE-AKI), a prospective, multicenter, observational cohort. RESULTS Of the 972 participants in the study, AKI developed in 329 (34%), and severe AKI developed in 45 (5%). During a median follow-up of 2.9 years (interquartile range, 2.2 to 3.5 years), 119 participants (12%) died. MCP-1 levels were significantly higher in those who developed AKI and died than in those without AKI and death. Participants with a preoperative MCP-1 level in the highest tertile (>196 pg/mL) had an increased AKI risk than those in the lowest tertile (<147 pg/mL; odds ratio [OR], 1.43l; 95% confidence interval [CI], 1.00 to 2.05). The association appeared similar but was not significant for the severe AKI outcome (OR, 1.48; 95% CI, 0.62 to 3.54). Compared with participants with preoperative MCP-1 level in the lowest tertile, those in the highest tertile had higher adjusted risk of death (hazard ratio, 1.82; 95% CI, 1.40 to 2.38). Similarly, participants in the highest tertile had a higher adjusted risk of death (hazard ratio, 1.95; 95% CI, 1.09-3.49) than those with a postoperative MCP-1 level in the lowest tertile. CONCLUSIONS Higher plasma MCP-1 is associated with increased AKI and risk of death after cardiac operations. MCP-1 could be used as a biomarker to identify high-risk patients for potential AKI prevention strategies in the setting of cardiac operations.
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Affiliation(s)
- Dennis G Moledina
- Program of Applied Translational Research, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Selin Isguven
- Program of Applied Translational Research, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences Western, London, Ontario, Canada
| | - Heather Thiessen-Philbrook
- Program of Applied Translational Research, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, and Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Michael Shlipak
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, California
| | - Richard Whitlock
- Division of Cardiac Surgery, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Steven G Coca
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Chirag R Parikh
- Program of Applied Translational Research, Department of Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Internal Medicine, Veterans Affairs Medical Center, West Haven, Connecticut.
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11
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Pudil R, Tichý M, Andrýs C, Řeháček V, Bláha V, Vojáček J, Palička V. Plasma Interleukin-6 Level is Associated with NT-proBNP Level and Predicts Short- and Long Term Mortality in Patients with Acute Heart Failure. ACTA MEDICA (HRADEC KRÁLOVÉ) 2016. [DOI: 10.14712/18059694.2016.81] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: Interleukin 6 plays an important role in chronic heart failure (HF), but little is known about its involvement in acute decompensated heart failure (ADHF). The aim of our study is to evaluate the prognostic role of interleukin 6 (IL-6) in the patients with ADHF. Methods: Plasma levels of interleukin IL-6, N-terminal pro brain natriuretic peptide levels, and clinical covariates were measured in 92 patients with ADHF. Survival was followed up to 12 months, and prognostic factors were evaluated. Results: Elevated plasma IL-6 levels were increased in nonsurvivors and were associated with 1-year mortality (p<0.01). Plasma IL-6 levels were associated with plasma NT-proBNP levels. In multivariate analysis, increased plasma IL-6 and NT-proBNP levels remained strong independent predictors of 1-year mortality. Conclusions: Plasma IL-6 levels provide important prognostic information in the patients with ADHF. Measurement combining plasma IL-6 and NT-proBNP should serve as a powerful prognostic tool of multimarker strategy in patients with acute decompensated heart failure.
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12
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Huffman JC, Beale EE, Celano CM, Beach SR, Belcher AM, Moore SV, Suarez L, Motiwala SR, Gandhi PU, Gaggin HK, Januzzi JL. Effects of Optimism and Gratitude on Physical Activity, Biomarkers, and Readmissions After an Acute Coronary Syndrome: The Gratitude Research in Acute Coronary Events Study. Circ Cardiovasc Qual Outcomes 2016; 9:55-63. [PMID: 26646818 PMCID: PMC4720551 DOI: 10.1161/circoutcomes.115.002184] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/29/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND Positive psychological constructs, such as optimism, are associated with beneficial health outcomes. However, no study has separately examined the effects of multiple positive psychological constructs on behavioral, biological, and clinical outcomes after an acute coronary syndrome (ACS). Accordingly, we aimed to investigate associations of baseline optimism and gratitude with subsequent physical activity, prognostic biomarkers, and cardiac rehospitalizations in post-ACS patients. METHODS AND RESULTS Participants were enrolled during admission for ACS and underwent assessments at baseline (2 weeks post-ACS) and follow-up (6 months later). Associations between baseline positive psychological constructs and subsequent physical activity/biomarkers were analyzed using multivariable linear regression. Associations between baseline positive constructs and 6-month rehospitalizations were assessed via multivariable Cox regression. Overall, 164 participants enrolled and completed the baseline 2-week assessments. Baseline optimism was significantly associated with greater physical activity at 6 months (n=153; β=102.5; 95% confidence interval, 13.6-191.5; P=0.024), controlling for baseline activity and sociodemographic, medical, and negative psychological covariates. Baseline optimism was also associated with lower rates of cardiac readmissions at 6 months (n=164), controlling for age, sex, and medical comorbidity (hazard ratio, 0.92; 95% confidence interval, [0.86-0.98]; P=0.006). There were no significant relationships between optimism and biomarkers. Gratitude was minimally associated with post-ACS outcomes. CONCLUSIONS Post-ACS optimism, but not gratitude, was prospectively and independently associated with superior physical activity and fewer cardiac readmissions. Whether interventions that target optimism can successfully increase optimism or improve cardiovascular outcomes in post-ACS patients is not yet known, but can be tested in future studies. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01709669.
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Affiliation(s)
- Jeff C Huffman
- From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.).
| | - Eleanor E Beale
- From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.)
| | - Christopher M Celano
- From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.)
| | - Scott R Beach
- From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.)
| | - Arianna M Belcher
- From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.)
| | - Shannon V Moore
- From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.)
| | - Laura Suarez
- From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.)
| | - Shweta R Motiwala
- From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.)
| | - Parul U Gandhi
- From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.)
| | - Hanna K Gaggin
- From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.)
| | - James L Januzzi
- From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.)
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13
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Greenberg JH, Whitlock R, Zhang WR, Thiessen-Philbrook HR, Zappitelli M, Devarajan P, Eikelboom J, Kavsak PA, Devereaux PJ, Shortt C, Garg AX, Parikh CR. Interleukin-6 and interleukin-10 as acute kidney injury biomarkers in pediatric cardiac surgery. Pediatr Nephrol 2015; 30:1519-27. [PMID: 25877915 PMCID: PMC4537680 DOI: 10.1007/s00467-015-3088-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 02/06/2015] [Accepted: 03/05/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Children undergoing cardiac surgery may exhibit a pronounced inflammatory response to cardiopulmonary bypass (CPB). Inflammation is recognized as an important pathophysiologic process leading to acute kidney injury (AKI). The aim of this study was to evaluate the association of the inflammatory cytokines interleukin (IL)-6 and IL-10 with AKI and other adverse outcomes in children after CPB surgery. METHODS This is a sub-study of the Translational Research Investigating Biomarker Endpoints in AKI (TRIBE-AKI) cohort, including 106 children ranging in age from 1 month to 18 years undergoing CPB. Plasma IL-6 and IL-10 concentrations were measured preoperatively and postoperatively [day 1 (within 6 h after surgery) and day 3]. RESULTS Stage 2/3 AKI, defined by at least a doubling of the baseline serum creatinine concentration or dialysis, was diagnosed in 24 (23%) patients. The preoperative IL-6 concentration was significantly higher in patients with stage 2/3 AKI [median 2.6 pg/mL, interquartile range (IQR) 2.6 0.6-4.9 pg/mL] than in those without stage 2/3 AKI (median 0.6 pg/mL, IQR 0.6-2.2 pg/mL) (p = 0.03). After adjustment for clinical and demographic variables, the highest preoperative IL-6 tertile was associated with a sixfold increased risk for stage 2/3 AKI compared with the lowest tertile (adjusted odds ratio 6.41, 95 % confidence interval 1.16-35.35). IL-6 and IL-10 levels increased significantly after surgery, peaking postoperatively on day 1. First postoperative IL-6 and IL-10 measurements did not significantly differ between patients with stage 2/3 AKI and those without stage 2/3 AKI. The elevated IL-6 level on day 3 was associated with longer hospital stay (p = 0.0001). CONCLUSIONS Preoperative plasma IL-6 concentration is associated with the development of stage 2/3 AKI and may be prognostic of resource utilization.
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Affiliation(s)
- Jason H. Greenberg
- Department of Pediatrics, Section of Nephrology, Yale University School of Medicine, New Haven, CT,Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT
| | - Richard Whitlock
- Division of Cardiac Surgery, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - William R. Zhang
- Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT
| | | | - Michael Zappitelli
- Department of Pediatrics, Division of Pediatric Nephrology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Prasad Devarajan
- Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - John Eikelboom
- Division of Cardiac Surgery, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Peter A. Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - PJ Devereaux
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Colleen Shortt
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Amit X. Garg
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - Chirag R. Parikh
- Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT,Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT and VA Medical Center, West Haven, CT
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14
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Huffman JC, Beale EE, Beach SR, Celano CM, Belcher AM, Moore SV, Suarez L, Gandhi PU, Motiwala SR, Gaggin H, Januzzi JL. Design and baseline data from the Gratitude Research in Acute Coronary Events (GRACE) study. Contemp Clin Trials 2015; 44:11-19. [PMID: 26166171 DOI: 10.1016/j.cct.2015.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/02/2015] [Accepted: 07/03/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Positive psychological constructs, especially optimism, have been linked with superior cardiovascular health. However, there has been minimal study of positive constructs in patients with acute coronary syndrome (ACS), despite the prevalence and importance of this condition. Furthermore, few studies have examined multiple positive psychological constructs and multiple cardiac-related outcomes within the same cohort to determine specifically which positive construct may affect a particular cardiac outcome. MATERIALS AND METHODS The Gratitude Research in Acute Coronary Events (GRACE) study examines the association between optimism/gratitude 2weeks post-ACS and subsequent clinical outcomes. The primary outcome measure is physical activity at 6months, measured via accelerometer, and key secondary outcome measures include levels of prognostic biomarkers and rates of nonelective cardiac rehospitalization at 6months. These relationships will be analyzed using multivariable linear regression, controlling for sociodemographic, medical, and negative psychological factors; associations between baseline positive constructs and subsequent rehospitalizations will be assessed via Cox regression. RESULTS Overall, 164 participants enrolled and completed the baseline 2-week assessment; the cohort had a mean age of 61.5+/?10.5years and was 84% men; this was the first ACS for 58% of participants. CONCLUSION The GRACE study will determine whether optimism and gratitude are prospectively and independently associated with physical activity and other critical outcomes in the 6months following an ACS. If these constructs are associated with superior outcomes, this may highlight the importance of these constructs as independent prognostic factors post-ACS.
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Affiliation(s)
- Jeff C Huffman
- Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.
| | - Eleanor E Beale
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Scott R Beach
- Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Christopher M Celano
- Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Arianna M Belcher
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
| | - Shannon V Moore
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Laura Suarez
- Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Parul U Gandhi
- Harvard Medical School, Boston, MA, United States; Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
| | - Shweta R Motiwala
- Harvard Medical School, Boston, MA, United States; Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Hanna Gaggin
- Harvard Medical School, Boston, MA, United States; Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
| | - James L Januzzi
- Harvard Medical School, Boston, MA, United States; Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
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15
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Zhang WR, Garg AX, Coca SG, Devereaux PJ, Eikelboom J, Kavsak P, McArthur E, Thiessen-Philbrook H, Shortt C, Shlipak M, Whitlock R, Parikh CR. Plasma IL-6 and IL-10 Concentrations Predict AKI and Long-Term Mortality in Adults after Cardiac Surgery. J Am Soc Nephrol 2015; 26:3123-32. [PMID: 25855775 DOI: 10.1681/asn.2014080764] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 02/10/2014] [Indexed: 12/13/2022] Open
Abstract
Inflammation has an integral role in the pathophysiology of AKI. We investigated the associations of two biomarkers of inflammation, plasma IL-6 and IL-10, with AKI and mortality in adults undergoing cardiac surgery. Patients were enrolled at six academic centers (n = 960). AKI was defined as a ≥ 50% or ≥ 0.3-mg/dl increase in serum creatinine from baseline. Pre- and postoperative IL-6 and IL-10 concentrations were categorized into tertiles and evaluated for associations with outcomes of in-hospital AKI or postdischarge all-cause mortality at a median of 3 years after surgery. Preoperative concentrations of IL-6 and IL-10 were not significantly associated with AKI or mortality. Elevated first postoperative IL-6 concentration was significantly associated with higher risk of AKI, and the risk increased in a dose-dependent manner (second tertile adjusted odds ratio [OR], 1.61 [95% confidence interval (95% CI), 1.10 to 2.36]; third tertile adjusted OR, 2.13 [95% CI, 1.45 to 3.13]). First postoperative IL-6 concentration was not associated with risk of mortality; however, the second tertile of peak IL-6 concentration was significantly associated with lower risk of mortality (adjusted hazard ratio, 0.75 [95% CI, 0.57 to 0.99]). Elevated first postoperative IL-10 concentration was significantly associated with higher risk of AKI (adjusted OR, 1.57 [95% CI, 1.04 to 2.38]) and lower risk of mortality (adjusted HR, 0.72 [95% CI, 0.56 to 0.93]). There was a significant interaction between the concentration of neutrophil gelatinase-associated lipocalin, an established AKI biomarker, and the association of IL-10 concentration with mortality (P = 0.01). These findings suggest plasma IL-6 and IL-10 may serve as biomarkers for perioperative outcomes.
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Affiliation(s)
- William R Zhang
- Program of Applied Translational Research, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Steven G Coca
- Program of Applied Translational Research, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Section of Nephrology, Veterans Affairs CT Healthcare System, West Haven, Connecticut
| | | | - John Eikelboom
- Division of Cardiac Surgery, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Peter Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; and
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Colleen Shortt
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; and
| | - Michael Shlipak
- Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center, University of California, San Francisco
| | - Richard Whitlock
- Division of Cardiac Surgery, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Chirag R Parikh
- Program of Applied Translational Research, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Section of Nephrology, Veterans Affairs CT Healthcare System, West Haven, Connecticut;
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16
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Ding D, Su D, Li X, Li Z, Wang Y, Qiu J, Lin P, Zhang Y, Guo P, Xia M, Li D, Yang Y, Hu G, Ling W. Serum levels of monocyte chemoattractant protein-1 and all-cause and cardiovascular mortality among patients with coronary artery disease. PLoS One 2015; 10:e0120633. [PMID: 25786118 PMCID: PMC4365005 DOI: 10.1371/journal.pone.0120633] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 01/27/2015] [Indexed: 11/28/2022] Open
Abstract
Background Monocyte chemoattractant protein-1 (MCP-1) is an important chemokine at multiple phases of atherosclerosis in animals, but human studies are few and inconsistent. The aim of this study is to investigate the association of serum MCP-1with all-cause and cardiovascular disease (CVD) mortality among coronary artery disease (CAD) patients and determine whether this biomarker can add secondary prognostic value to standard risk predictors. Methods MCP-1 was measured at baseline in 1411 CAD patients who were 40–85 years of age. Cox proportional hazards regression models were used to estimate the association of MCP-1 levels with death risk. Results During a median follow-up of 3.3 years, 117 deaths were recorded, 88 of which were due to CVD. The multivariable-adjusted hazard ratios across tertiles of MCP-1 were 1.51 (95% confidence intervals [CI] 0.89–2.58), 1.00, and 2.11 (95% CI 1.31–3.40) for all-cause mortality, and 1.50 (95% CI 0.80–2.81), 1.00, and 2.21 (95% CI 1.27–3.87) for CVD mortality. The addition of serum MCP-1 to the fully adjusted model increased the C-index by 0.009 (p<0.0001) for all-cause mortality and 0.008 (p<0.0001) for CVD mortality and significantly improved the predictive ability by 12.1% (P = 0.006) on all-cause mortality and 12.6% (P = 0.003) on CVD mortality using the net reclassification improvement method. Conclusions Both lower and higher MCP-1 levels are associated with an increased risk of all-cause and CVD mortality among CAD patients. More research is needed to confirm its clinical relevance.
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Affiliation(s)
- Ding Ding
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Dongfang Su
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xinrui Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhongxia Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yujie Wang
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Jian Qiu
- Department of Cardiology, General Hospital of Guangzhou Military Command of People’s Liberation Army, Guangdong, China
| | - Puqing Lin
- Department of Cardiology, General Hospital of Guangzhou Military Command of People’s Liberation Army, Guangdong, China
| | - Yuan Zhang
- Department of Cardiology, General Hospital of Guangzhou Military Command of People’s Liberation Army, Guangdong, China
| | - Pi Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Min Xia
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Dan Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
- * E-mail: (DL); (GH)
| | - Yan Yang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Gang Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
- * E-mail: (DL); (GH)
| | - Wenhua Ling
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
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Seropian IM, Sonnino C, Van Tassell BW, Biasucci LM, Abbate A. Inflammatory markers in ST-elevation acute myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:382-95. [PMID: 25681486 DOI: 10.1177/2048872615568965] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 01/02/2015] [Indexed: 01/05/2023]
Abstract
After acute myocardial infarction, ventricular remodeling is characterized by changes at the molecular, structural, geometrical and functional level that determine progression to heart failure. Inflammation plays a key role in wound healing and scar formation, affecting ventricular remodeling. Several, rather different, components of the inflammatory response were studied as biomarkers in ST-elevation acute myocardial infarction. Widely available and inexpensive tests, such as leukocyte count at admission, as well as more sophisticated immunoassays provide powerful predictors of adverse outcome in patients with ST-elevation acute myocardial infarction. We review the value of inflammatory markers in ST-elevation acute myocardial infarction and their association with ventricular remodeling, heart failure and sudden death. In conclusion, the use of these biomarkers may identify subjects at greater risk of adverse events and perhaps provide an insight into the mechanisms of disease progression.
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Affiliation(s)
- Ignacio M Seropian
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | - Chiara Sonnino
- VCU Pauley Heart Center, Virginia Commonwealth University, USA Victoria Johnson Research Laboratory, Virginia Commonwealth University, USA Department of Cardiovascular Medicine, Catholic University, Italy
| | - Benjamin W Van Tassell
- VCU Pauley Heart Center, Virginia Commonwealth University, USA Victoria Johnson Research Laboratory, Virginia Commonwealth University, USA School of Pharmacy, Virginia Commonwealth University, USA
| | - Luigi M Biasucci
- Department of Cardiovascular Medicine, Catholic University, Italy
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, USA Victoria Johnson Research Laboratory, Virginia Commonwealth University, USA
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18
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Hung AM, Booker C, Ellis CD, Siew ED, Graves AJ, Shintani A, Abumrad NN, Himmelfarb J, Ikizler TA. Omega-3 fatty acids inhibit the up-regulation of endothelial chemokines in maintenance hemodialysis patients. Nephrol Dial Transplant 2014; 30:266-74. [PMID: 25204316 DOI: 10.1093/ndt/gfu283] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chronic systemic inflammation is common in patients with chronic kidney disease on dialysis (CKD5D) and has been considered a key mediator of the increased cardiovascular risk in this patient population. In this study, we tested the hypothesis that supplementation of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) will attenuate the systemic inflammatory process in CKD5D patients. METHODS The design was a randomized, double-blinded, placebo controlled pilot trial (NCT00655525). Thirty-eight patients were randomly assigned in a 1 : 1 fashion to receive 2.9 g of eicosapentaenoic acid (C20:5, n-3) plus docosahexaenoic acid (C22:6, n-3) versus placebo for 12 weeks. The primary outcome was change in pro-inflammatory chemokines measured by lipopolysaccharide (LPS)-stimulated peripheral blood mononuclear cells (PBMCs). Secondary outcomes were changes in systemic inflammatory markers. Analysis of covariance was used to compare percent change from baseline to 12 weeks. RESULTS Thirty-one patients completed 12 weeks and three patients completed 6 weeks of the study. Median age was 52 (interquartile range 45, 60) years, 74% were African-American and 79% were male. Supplementation of ω-3 PUFAs effectively decreased the LPS-induced PBMC expression of RANTES (Regulated upon Activation, Normal T cell Expressed and Secreted) and MCP-1 (Monocyte Chemotactic Protein-1; unadjusted P = 0.04 and 0.06; adjusted for demographics P = 0.02 and 0.05, respectively). There was no significant effect of the intervention on serum inflammatory markers (C-reactive protein, interleukin-6 and procalcitonin). CONCLUSIONS The results of this pilot study suggest that supplementation of ω-3 PUFAs is beneficial in decreasing the levels of endothelial chemokines, RANTES and MCP-1. Studies of larger sample size and longer duration are required to further evaluate effects of ω-3 PUFAs on systemic markers of inflammation, other metabolic parameters and clinical outcomes, particularly cardiovascular outcomes in CKD5D patients.
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Affiliation(s)
- Adriana M Hung
- CSR&D, Veterans Administration Tennessee Valley Healthcare System, Nashville, TN, USA Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cindy Booker
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Charles D Ellis
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edward D Siew
- CSR&D, Veterans Administration Tennessee Valley Healthcare System, Nashville, TN, USA Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy J Graves
- Division of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Ayumi Shintani
- Division of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Naji N Abumrad
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | | | - Talat Alp Ikizler
- CSR&D, Veterans Administration Tennessee Valley Healthcare System, Nashville, TN, USA Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
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19
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Lippi G, Cervellin G. Risk assessment of post-infarction heart failure. Systematic review on the role of emerging biomarkers. Crit Rev Clin Lab Sci 2014; 51:13-29. [PMID: 24410541 DOI: 10.3109/10408363.2013.863267] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The prognostic significance of cardiospecific troponins and natriuretic peptides in patients with myocardial ischemia is well established, and their measurement is now endorsed by the most important guidelines and recommendations for diagnosis and management of heart failure (HF). Additional biomarkers have also been investigated to support clinical judgment and diagnostic imaging in the stratification of risk of cardiac dysfunction in patients with myocardial infarction (MI). We have performed a systematic analysis of the current scientific literature regarding the most important biomarkers of HF, selecting all prospective studies with adequate sample size (i.e. >100 patients) that have assessed, during the early phase of myocardial ischemia, the prognostic value of emergent biomarkers for new-onset HF or deterioration of cardiac function in patients with MI. This analysis has provided some good evidence suggesting that, in most cases, the use of diagnostic biomarkers of cardiac dysfunction does not translate into efficient risk prediction of HF. However, some notable exceptions were found, including biomarkers of cardiac fibrosis (especially galectin-3), growth differentiation factor-15 (GDF-15), osteoprotegerin, C-reactive protein (CRP), and red blood cell distribution width (RDW). Nevertheless, future studies with well-defined characteristics including the use of larger sample sizes, standardized end points, and replication populations, along with benchmark analyses against other consolidated biomarkers (i.e. cardiospecific troponins and natriuretic peptides), should be planned. Such evaluations will help to establish whether an integrated approach including biomarkers of different pathogenetic pathways - for example, apoptosis, stress of cardiomyocytes, cardiac fibrosis, inflammation, and extra-cardiac involvement - may be cost effective for identifying patients at increased risk of developing HF, and who, therefore, may benefit from a tailored therapeutic strategy.
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Affiliation(s)
- Giuseppe Lippi
- Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma , Parma , Italy and
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20
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Todd J, Simpson P, Estis J, Torres V, Wub AH. Reference range and short- and long-term biological variation of interleukin (IL)-6, IL-17A and tissue necrosis factor-alpha using high sensitivity assays. Cytokine 2013; 64:660-5. [DOI: 10.1016/j.cyto.2013.09.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 09/09/2013] [Accepted: 09/23/2013] [Indexed: 11/28/2022]
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21
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López-Cuenca Á, Manzano-Fernández S, Lip GY, Casas T, Sánchez-Martínez M, Mateo-Martínez A, Pérez-Berbel P, Martínez J, Hernández-Romero D, Romero Aniorte AI, Valdés M, Marín F. Interleucina 6 y proteína C reactiva ultrasensible para la predicción de la evolución clínica en síndromes coronarios agudos sin elevación del segmento ST. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.07.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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22
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López-Cuenca Á, Manzano-Fernández S, Lip GYH, Casas T, Sánchez-Martínez M, Mateo-Martínez A, Pérez-Berbel P, Martínez J, Hernández-Romero D, Romero Aniorte AI, Valdés M, Marín F. Interleukin-6 and high-sensitivity C-reactive protein for the prediction of outcomes in non-ST-segment elevation acute coronary syndromes. ACTA ACUST UNITED AC 2012; 66:185-92. [PMID: 24775452 DOI: 10.1016/j.rec.2012.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 07/30/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES High baseline levels of interleukin-6 and C-reactive protein confer an increased risk of mortality in non-ST-segment elevation acute coronary syndrome. The aim of the study was to determine whether serial measurements of interleukin-6 and high-sensitivity C-reactive protein provide additional information to baseline measurements for risk stratification of non-ST-segment elevation acute coronary syndrome. METHODS Two hundred and sixteen consecutive patients with non-ST-segment elevation acute coronary syndrome were prospectively included. Blood samples were obtained within 24 h of hospital admission and at 30 days of follow-up. The endpoint was a composite of all-cause death, nonfatal myocardial infarction, or acute decompensated heart failure. RESULTS Both interleukin-6 and high-sensitivity C-reactive protein levels decreased from day 1 to day 30, regardless of adverse events (both P<.001). Interleukin-6 levels at 2 time points (interleukin-6 day 1, per pg/mL; hazard ratio=1.006, 95% confidence interval, 1.002-1.010; P=.002 and interleukin-6 day 30, per pg/mL, hazard ratio=1.047, 95% confidence interval, 1.021-1.075, P<.001) were independent predictors of adverse events, whereas high-sensitivity C-reactive protein day 1 and high-sensitivity C-reactive protein day 30 levels were not. Patients with interleukin-6 day 1≤8.24 pg/mL and interleukin-6 day 30≤4.45 pg/mL had the lowest event rates (4.7%), whereas those with both above the median values had the highest event rates (35%). After addition of interleukin-6 day 30 to the multivariate model, C-index increased from 0.71 (95% confidence interval, 0.63-0.78) to 0.80 (95% confidence interval, 0.72-0.86), P=.042, and net reclassification improvement was 0.39 (95% confidence interval, 0.14-0.64; P=.002). CONCLUSIONS In this population, both interleukin-6 and high-sensitivity C-reactive protein concentrations decreased after the acute phase. Serial samples of interleukin-6 concentrations improved the prognostic risk stratification of these patients.
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Affiliation(s)
- Ángel López-Cuenca
- Departamento de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Sergio Manzano-Fernández
- Departamento de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Universidad de Murcia, Murcia, Spain.
| | - Gregory Y H Lip
- Haemostasis, Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, United Kingdom
| | - Teresa Casas
- Departamento de Bioquímica, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Alicia Mateo-Martínez
- Departamento de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Patricio Pérez-Berbel
- Departamento de Cardiología, Hospital General Universitario de Alicante, Alicante, Spain
| | - Javier Martínez
- Departamento de Cardiología, Hospital General Universitario de Alicante, Alicante, Spain
| | - Diana Hernández-Romero
- Departamento de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Ana I Romero Aniorte
- Departamento de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Mariano Valdés
- Departamento de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Universidad de Murcia, Murcia, Spain
| | - Francisco Marín
- Departamento de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Universidad de Murcia, Murcia, Spain
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Dhesy-Thind S, Kumar V, Snider-McNair A, Shortt C, Mukherjee SD, Ellis P, Pond GR, Kavsak PA. Cardiac and inflammation biomarker profile after initiation of adjuvant trastuzumab therapy. Clin Chem 2012; 59:327-9. [PMID: 22997283 DOI: 10.1373/clinchem.2012.192419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Krishnan E, Pandya BJ, Lingala B, Hariri A, Dabbous O. Hyperuricemia and untreated gout are poor prognostic markers among those with a recent acute myocardial infarction. Arthritis Res Ther 2012; 14:R10. [PMID: 22251426 PMCID: PMC3392798 DOI: 10.1186/ar3684] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 11/29/2011] [Accepted: 01/17/2012] [Indexed: 02/07/2023] Open
Abstract
Introduction Patients with a history of myocardial infarction (MI) are often at risk for complications, including subsequent MI and death. Use of prognostic markers may aid in preventing these poor outcomes. Hyperuricemia is associated with increased risk for coronary heart disease (CHD) and/or mortality; however, it is unknown if serum urate (sUA) levels predict outcomes in patients with previous MI. The purpose of this study was to assess hyperuricemia as a biomarker of CHD outcomes in such patients. Methods These were post hoc analyses of datasets from the Aspirin Myocardial Infarction Study, a 1:1 randomized, double-blind clinical trial, conducted from 1975 to 1979, that examined mortality rates following daily aspirin administration over three years in individuals with documented MI. The primary outcome measures were all-cause death, CHD mortality, coronary incidence, and stroke by quartile of baseline sUA. A sub-analysis of all outcome measures in the presence or absence of gouty arthritis was also performed. Results Of 4,524 enrolled participants, data on 4,352 were analyzed here. All outcomes were greatest for patients in the fourth sUA quartile. In multivariate regression models, the hazard ratios (HR) for patients in the highest quartile were 1.88 for all-cause mortality (95% confidence interval (CI), 1.45 to 2.46), 1.99 for CHD mortality (95% CI, 1.49 to 2.66), and 1.36 for coronary incidence (95% CI, 1.08 to 1.70). Participants with untreated gout had an adjusted hazard ratio ranging from 1.5 to 2.0 (all P < 0.01) for these outcomes. Participants with gout who were receiving treatment did not exhibit this additional risk. Conclusions sUA and untreated gout may be independent prognostic markers for poor all-cause and CHD mortality in patients with recent acute MI.
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Affiliation(s)
- Eswar Krishnan
- Department of Medicine, Stanford University School of Medicine, 1000 Welch Rd, Suite 203, Palo Alto, CA 94304, USA.
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25
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Antonelli A, Ferri C, Ferrari S, Di Domenicantonio A, Mancusi C, Marchi S, De Bortoli N, Metelli M, Bruschi F, Fallahi P. Hepatitis C is Associated with High Levels of Circulating N-Terminal Pro-Brain Natriuretic Peptide and Interleukin-6. EUR J INFLAMM 2012. [DOI: 10.1177/1721727x1201000117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To our knowledge, no study has evaluated N-terminal pro-brain natriuretic peptide (NTproBNP) together with interleukin-6 (IL-6) and interferon (IFN)-gamma serum levels in a large series of patients with hepatitis C virus (HCV) as possible markers of cardiac dysfunction. NTproBNP and IL-6 serum levels were valued in 55 HCV-patients, and in 55 sex- and age-matched controls. HCV-patients showed significantly higher mean NTproBNP and IL-6 levels than controls ( P = 0.001); no significant difference was observed for IFN-gamma. By defining high NTproBNP level as a value higher than 300 pg/mL (that is used to rule out heart failure in patients under 75 years of age), 12% (6/49) of HCV-patients and 0 of controls had NTproBNP (χ2; P = 0.012). In conclusion, this study demonstrates high levels of circulating NTproBNP and IL-6 in HCV-patients. The increase of NTproBNP may indicate the presence of a subclinical cardiac dysfunction. Further prospective studies quantifying symptoms and correlating these with echocardiography parameters are needed to confirm this association.
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Affiliation(s)
- A. Antonelli
- Department of Internal Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - C. Ferri
- Department of Internal Medicine, Rheumatology Unit, University of Modena & Reggio E. School of Medicine, Modena, Italy
| | - S.M. Ferrari
- Department of Internal Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - A. Di Domenicantonio
- Department of Internal Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - C. Mancusi
- Department of Internal Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - S. Marchi
- Department of Internal Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - N. De Bortoli
- Department of Internal Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - M.R. Metelli
- Department of Clinical Biochemistry and Molecular Biology, University of Pisa, Pisa, Italy
| | - F. Bruschi
- Department of Experimental Pathology and B.M.I.E., University of Pisa School of Medicine, Pisa, Italy
| | - P. Fallahi
- Department of Internal Medicine, University of Pisa School of Medicine, Pisa, Italy
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Kavsak PA, Hill SA, Bhanich Supapol W, Devereaux PJ, Worster A. Biomarkers for Predicting Serious Cardiac Outcomes at 72 Hours in Patients Presenting Early after Chest Pain Onset with Symptoms of Acute Coronary Syndromes. Clin Chem 2012; 58:298-302. [DOI: 10.1373/clinchem.2011.172064] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Most outcome studies of patients presenting early to the emergency department with potential acute coronary syndromes have focused on either the index diagnosis of myocardial infarction (MI) or a composite end point at a later time frame (30 days or 1 year). We investigated the performance of 9 biomarkers for an early serious outcome.
METHODS
Patients (n = 186) who presented to the emergency department within 6 h of chest pain onset had their presentation serum sample measured for the following analytes: creatine kinase, creatine kinase isoenzyme MB, enhanced AccuTnI troponin I (Beckman Coulter), high-sensitivity cardiac troponin T (hs-cTnT), ischemia-modified albumin, interleukin-6, investigation use only hs-cTnI (Beckman Coulter), N-terminal pro–B-type natriuretic peptide, and cardiac troponin I (Abbott AxSym). We followed patients until 72 h after presentation and determined whether they experienced the following serious cardiac outcomes: MI, heart failure, serious arrhythmia, refractory ischemic cardiac pain, or death. ROC curves were analyzed to determine the area under the ROC curve (AUC) and optimal cutoffs for the biomarkers.
RESULTS
The AUCs for the hs-cTnI assay (0.86; 95% CI, 0.76–0.96), the AccuTnI assay (0.86; 95% CI, 0.78–0.95), and the hs-cTnT assay (0.82; 95% CI, 0.71–0.94) assays were significantly higher than those for the other 6 assays (AUC values ≤0.71 for the rest of the biomarkers, P < 0.05). The ROC curve–derived optimal cutoffs were ≥19 ng/L (diagnostic sensitivity, 80%; specificity, 88%), ≥0.018 μg/L (diagnostic sensitivity, 75%; specificity, 86%), and ≥32 ng/L (diagnostic sensitivity, 68%; specificity, 92%) for the hs-cTnI, AccuTnI, and hs-cTnT assays, respectively.
CONCLUSIONS
The optimal cutoffs for predicting serious cardiac outcomes in this low-risk population are different from the published 99th percentiles. Larger studies are required to verify these findings.
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Affiliation(s)
| | | | | | | | - Andrew Worster
- Medicine, McMaster University, Hamilton, Ontario, Canada
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Pratap P, Gupta S, Berlowtiz M. Routine Invasive Versus Conservative Management Strategies in Acute Coronary Syndrome: Time for a “Hybrid” Approach. J Cardiovasc Transl Res 2011; 5:30-40. [DOI: 10.1007/s12265-011-9333-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 11/09/2011] [Indexed: 11/29/2022]
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Bünger S, Haug U, Kelly FM, Klempt-Giessing K, Cartwright A, Posorski N, Dibbelt L, Fitzgerald SP, Bruch HP, Roblick UJ, von Eggeling F, Brenner H, Habermann JK. Toward standardized high-throughput serum diagnostics: multiplex-protein array identifies IL-8 and VEGF as serum markers for colon cancer. ACTA ACUST UNITED AC 2011; 16:1018-26. [PMID: 21807963 DOI: 10.1177/1087057111414894] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Development and progression of colon cancer may be related to cytokines. Cytokines with diagnostic value have been identified individually but have not been implemented into clinical praxis. Using a multiplex protein array, the authors explore a panel of cytokines simultaneously and compared its performance to carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9). Serum concentrations of 12 cytokines were simultaneously determined by multiplex biochip technology in 50 colon cancer patients and 50 healthy controls. Serum levels of interleukin-8 (IL-8) and CEA were significantly higher in cancer patients than in healthy controls. Areas under the receiver operating characteristic curves (AUCs) were largest for IL-8, followed by CEA, vascular endothelial growth factor (VEGF), and CA 19-9. Analyses regarding marker combinations showed an advantage over single marker performance for CEA, VEGF, and CA 19-9 but not for IL-8. Multiplex biochip array technology represents a practical tool in cytokine and cancer research when simultaneous determination of different biomarkers is of interest. The results suggest that the assessment of IL-8, CEA, VEGF, and possibly CA 19-9 serum levels could be useful for colon cancer screening with the potential of also detecting early stage tumors. Further validation studies using these and additional markers on a multiplex array format are encouraged.
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Affiliation(s)
- Stefanie Bünger
- Laboratory for Surgical Research, Department of Surgery, University of Lübeck, Germany
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29
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Hwang SJ, Park KW, Kwon DA, Kang HJ, Koo BK, Chae IH, Gwon HC, Park SJ, Seung KB, Ahn T, Yoon JH, Jang YS, Jeong MH, Tahk SJ, Kim HS. High plasma interleukin-6 is associated with drug-eluting stent thrombosis: possible role of inflammatory cytokines in the development of stent thrombosis from the Korea Stent Thrombosis Registry. Circ J 2011; 75:1350-7. [PMID: 21498913 DOI: 10.1253/circj.cj-10-0488] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Inflammation might contribute to the development of stent thrombosis (ST). The association between inflammatory cytokine concentrations and drug-eluting ST were evaluated. METHODS AND RESULTS Among the 123 ST patients enrolled in the multicenter Korea Stent Thrombosis registry, plasma samples were available in 41 patients. The patients' clinical characteristics and plasma concentrations of monocyte chemoattractant protein-1, tumor necrosis factor-alpha, and interleukin (IL)-6 were compared with 81 matched controls. Although the concentrations of 3 cytokines were higher in the ST group, they did not have significant differences. When divided into quartiles, the proportion of patients with the highest quartile of IL-6 was higher in the ST group than in the control group (44% vs. 16%, P = 0.001), and the highest IL-6 quartile was an independent predictor of ST for both early (adjusted hazard ratio [HR] 6.96; 95% confidence interval [CI] 1.75-27.66) and late ST (adjusted HR 4.71; 95%CI 1.06-20.92). In addition, the highest IL-6 quartile was an independent predictor of ST in those on clopidogrel (adjusted HR 7.70; 95%CI 1.97-30.13) but not in those who were off clopidogrel. CONCLUSIONS Highest IL-6 quartile was associated with ST, especially in clopidogrel users regardless of the time of ST, suggesting the involvement of inflammatory cytokines in ST.
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Affiliation(s)
- Seok-Jae Hwang
- Cardiovascular Center, Seoul National University Main Hospital, Seoul 110-744, Korea
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Ramasamy I. Biochemical markers in acute coronary syndrome. Clin Chim Acta 2011; 412:1279-96. [PMID: 21501603 DOI: 10.1016/j.cca.2011.04.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Accepted: 04/03/2011] [Indexed: 11/12/2022]
Abstract
Owing to their higher risk for cardiac death or ischemic complications, patients with acute coronary syndrome (ACS) must be identified from other causes of chest pain. Patients with acute coronary syndrome are divided into categories based on their electrocardiogram; those with new ST-segment elevation and those who present with ST-segment depression. The subgroups of patients with ST-segment elevation are candidates for immediate reperfusion, while fibrinolysis appears harmful for those with non-ST elevation myocardial infarction. There is increasing evidence to encourage appropriate risk stratification before deciding on a management strategy (invasive or conservative) for each patient. The TIMI, GRACE or PURSUIT risk models are recommended as useful for decisions regarding therapeutic options. Cardiac biomarkers are useful additions to these clinical tools to correctly risk stratify ACS patients. Cardiac troponin is the biomarker of choice to detect myocardial necrosis and is central to the universal definition of myocardial infarction. The introduction of troponin assays with a lower limit of detection will allow for earlier diagnosis of patients who present with chest pain. Analytical and clinical validations of these new assays are currently in progress. The question is whether the lower detection limit of the troponin assays will be able to indicate myocardial ischemia in the absence of myocardial necrosis. Previous to the development of ultrasensitive cardiac troponin assays free fatty acids unbound to albumin and ischemia modified albumin were proposed as biochemical markers of ischemia. Advances in our knowledge of the pathogenesis of acute coronary thrombosis have stimulated the development of new biomarkers. Markers of left ventricular performance (N-terminal pro-brain natriuretic peptide) and inflammation (e.g. C-reactive protein) are generally recognized as risk indicators. Studies suggest that using a number of biomarkers clinicians can risk stratify patients over a broad range of short and long term cardiac events. Nevertheless, it is still under debate as to which biomarker combination is best preferred for risk prediction. This review will focus on recent practice guidelines for the management of patients with ACS as well as current advances in cardiac biomarkers, their integration into clinical care and their diagnostic, prognostic and therapeutic utility.
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Affiliation(s)
- I Ramasamy
- Worcester Royal Hospital, Worcester WR51DD, United Kingdom.
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Phan K, Sohn KY, Hill SA, Worster A, You J, Oremus M, Devereaux PJ, Jaffe AS, Kavsak PA. Multiplex protein assay performance/evaluation and the requirement for precision and correlation to clinical assays. Clin Chem Lab Med 2011; 49:1915-8. [DOI: 10.1515/cclm.2011.683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ueeda M, Doumei T, Takaya Y, Ohnishi N, Takaishi A, Hirohata S, Miyoshi T, Shinohata R, Usui S, Kusachi S. Association of serum levels of arachidonic acid and eicosapentaenoic acid with prevalence of major adverse cardiac events after acute myocardial infarction. Heart Vessels 2010; 26:145-52. [PMID: 20963593 DOI: 10.1007/s00380-010-0038-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 03/11/2010] [Indexed: 01/23/2023]
Abstract
We studied the association of serum levels of arachidonic acid (AA) and eicosapentaenoic acid (EPA) with the prevalence of major adverse cardiac events (MACE) after acute myocardial infarction (AMI). We measured serum AA and EPA on admission in 146 consecutive AMI patients. The primary clinical endpoint was occurrence of MACE, defined as cardiac death, occurrence of heart failure, reinfarction, recurrent angina pectoris, and requirement of coronary intervention. Common logarithmic transformed serum levels of AA (logAA) and EPA (logEPA) were used in the analyses. The optimum cutoff point of each fatty acid used to distribute patients into two groups for Kaplan-Meier analysis was determined by receiver operating characteristic curves analysis. MACE occurred in 40 patients (27.4%). Kaplan-Meier analysis disclosed that the group with a logAA above the cutoff point [145.3 μg/mL (logAA 2.162)] showed a higher prevalence of MACE than those with a logAA below the cutoff point (P < 0.01). Conversely, the prevalence of MACE was significantly higher in the group with a logEPA below the cutoff point [52.3 μg/mL (logEPA 1.719)] compared to the group with a logEPA above it (P < 0.01). Similar to logAA, logAA/logEPA showed significant differences in the MACE-free curve between the two groups (cutoff 1.301, P < 0.001). Cox proportional hazards regression analysis suggested that logAA, logEPA, and logAA/logEPA were independently associated with the prevalence of MACE. Although the present study included a limited number of patients with single-time point measurement, the results suggested an association of logAA, logEPA, and logAA/logEPA with the prevalence of MACE after AMI. The present study warrants further studies involving a large number of patients to confirm that the serum levels of these fatty acids and their ratios are predictors of MACE after AMI.
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Affiliation(s)
- Masayuki Ueeda
- Department of Cardiovascular Medicine, Mitoyo General Hospital, Kagawa, 769-1695, Japan
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Zeng Q, Sun XN, Ma LH, Chen L, Wang Y, Chen C, Ye ZY, Wu ZH, Li YZ, Xu Y. Biomarkers for the Prediction of Major Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome. Anat Rec (Hoboken) 2010; 293:1512-8. [DOI: 10.1002/ar.21198] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Jensen J, Ma LP, Fu MLX, Svaninger D, Lundberg PA, Hammarsten O. Inflammation increases NT-proBNP and the NT-proBNP/BNP ratio. Clin Res Cardiol 2010; 99:445-52. [DOI: 10.1007/s00392-010-0140-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 02/25/2010] [Indexed: 12/11/2022]
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Antonelli A, Ferri C, Ferrari SM, Ghiri E, Galetta F, Franzoni F, Santoro G, Fallahi P. High circulating levels of N-terminal pro-brain natriuretic peptide and interleukin 6 in patients with mixed cryoglobulinemia. J Med Virol 2010; 82:297-303. [PMID: 20029800 DOI: 10.1002/jmv.21636] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Many patients with mixed cryoglobulinemia and chronic HCV infection experience symptoms, such as dyspnea, which sometimes do not seem to indicate the involvement of the liver but rather the symptoms of heart failure. To our knowledge, there has been no other study evaluating the serum levels of N-terminal pro-brain natriuretic peptide (NTproBNP) and Interleukin 6 (IL-6) in such patients. Serum NTproBNP and IL-6 were assayed in 54 patients with mixed cryoglobulinemia and chronic HCV infection, and in 54 sex- and age-matched controls. Cryoglobulinemic-patients showed significantly higher mean NTproBNP and IL-6 levels than the controls (P = 0.005). By defining a high NTproBNP level as a value higher than 125 pg/ml (the single cut-off point for patients under 75 years of age), 30% of patients with mixed cryoglobulinemia and chronic HCV infection and 7% of controls had high NTproBNP (chi-square; P < 0.003). With a cut-off point of 300 pg/ml (used to rule out heart failure in patients under 75 years of age), 5/49 patients with mixed cryoglobulinemia and chronic HCV infection and 0/54 controls had high NTproBNP (chi-square; P < 0.04). With a cut-off point of 900 pg/ml (used for including heart failure in patients aged between 50 and 75, such as the patients in this study) 3/51 of patients with mixed cryoglobulinemia and chronic HCV infection and 0/54 controls had high NTproBNP (chi-square; P = 0.07). The study revealed high levels of circulating NTproBNP and IL-6 in patients with mixed cryoglobulinemia and chronic HCV infection. The increase in NTproBNP could indicate the presence of a subclinical cardiac dysfunction.
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Affiliation(s)
- Alessandro Antonelli
- Department of Internal Medicine, University of Pisa School of Medicine, Pisa, Italy.
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Gruson D, Bodovitz S. Rapid emergence of multimarker strategies in laboratory medicine. Biomarkers 2010; 15:289-96. [DOI: 10.3109/13547500903560065] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Correia LCL, Andrade BB, Borges VM, Clarêncio J, Bittencourt AP, Freitas R, Souza AC, Almeida MC, Leal J, Esteves JP, Barral-Netto M. Prognostic value of cytokines and chemokines in addition to the GRACE Score in non-ST-elevation acute coronary syndromes. Clin Chim Acta 2010; 411:540-5. [PMID: 20083097 DOI: 10.1016/j.cca.2010.01.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 12/21/2009] [Accepted: 01/07/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND Increased cytokine and chemokine levels are associated with cardiovascular events in patients with non-ST-elevation acute coronary syndromes (ACS), but the incremental prognostic value of these inflammatory markers is not known. We determined if cytokine and chemokine assessment adds prognostic information to the GRACE Score in patients with ACS. METHODS Five cytokines (interleukin (IL)-1beta, IL-6, IL-10, IL-12p70, and tumor necrosis factor (TNF)-alpha soluble receptor I), five chemokines (IL-8, CCL5, CXCL9, CCL2, and CXCL10) and C-reactive protein (CRP) were measured at admission of 87 patients admitted with ACS. RESULTS During hospitalization, the incidence of cardiovascular events was 13% (7 deaths, 1 nonfatal acute myocardial infarction, and 3 refractory unstable angina). Individuals who developed events had significantly greater levels of CRP, IL-1beta, IL-12, TNF-alpha, IL-8, CXCL9 and CCL2, compared with those free of events. Thus, these markers were used to build an Inflammatory Score, by the input of one point for each of these variables above the 75th percentile. After adjustment for the GRACE Score, the Inflammatory Score independently predicted events (OR=1.80; 95% CI=1.12-1.88). Incorporation of the Inflammatory Score into the GRACE Score promoted a C-statistics improvement from 0.77 (95% CI=0.58-0.96) to 0.85 (95% CI=0.71-1.0). Net reclassification improvement obtained with GRACE-Inflammatory Score was 13% (P=0.007), indicating a significant reclassification. When only CRP was incorporated into GRACE, the increase on C-statistics was not relevant (from 0.77 to 0.80). CONCLUSION Cytokines and chemokines measured at admission add prognostic information to the GRACE Score in patients admitted with ACS.
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Peripheral blood monocyte subset assessment in non-ST-segment elevation myocardial infarction is required. J Am Coll Cardiol 2010; 55:169; author reply 169-71. [PMID: 20117390 DOI: 10.1016/j.jacc.2009.07.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 07/21/2009] [Indexed: 10/20/2022]
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Kavsak PA, Newman AM, Ko DT, Macrae AR, Jaffe AS. The use of a cytokine panel to define the long-term risk stratification of heart failure/death in patients presenting with chest pain to the emergency department. Clin Biochem 2009; 43:505-7. [PMID: 19913003 DOI: 10.1016/j.clinbiochem.2009.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 10/22/2009] [Accepted: 11/01/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine if a cytokine panel could be informative regarding subsequent heart failure(HF)/death. DESIGN AND METHODS In 216 subjects presenting with chest pain to an emergency department in 1996, EDTA plasma (-70 degrees C) was thawed for IL-6, MCP-1, IL-10, VEGF, EGF measurement. RESULTS Subjects with any three cytokines elevated were at higher risk for HF/death compared to those with < or = two cytokines elevated. DISCUSSION A cytokine panel might be useful for risk stratification for HF/death.
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Affiliation(s)
- Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
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Zieliński T, Browarek A, Zembala M, Sadowski J, Zakliczyński M, Przybylowski P, Roguski K, Kosakowska AB, Korewicki J. Risk stratification of patients with severe heart failure awaiting heart transplantation-prospective national registry POLKARD HF. Transplant Proc 2009; 41:3161-5. [PMID: 19857702 DOI: 10.1016/j.transproceed.2009.09.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
UNLABELLED Most methods used in the risk assessment of heart transplant candidates do not include new biomarkers. AIMS The aim of the study was to examine the value of NTproBNP and hsCRP and their combined use together with HFSS score in the risk assessment of patients with heart failure enlisted for heart transplantation. METHODS Data of 658 patients enlisted for heart transplantation in all active transplantation centers were stored in a prospective registry. The composite end point-death or urgent transplantation was recorded during the follow-up. RESULTS Death or urgent transplantation was recorded in 161 (24%) of pts. 102 (15%) patients died and 59 (9%) were transplanted urgently. Kaplan-Meier curves for risk of death or urgent transplantation where highly significant when pts were stratified by the quartiles of NT proBNP (P < .000001) or quartiles according to the hsCRP level on admission (P < .002). In the multivariate Cox proportional hazard model, the significance was observed for NTproBNP (P < .01) and HFSS (P < .02), and borderline significance for hsCRP (P = .057). When ROC analyses of the area under the curve (AUC) values were considered, AUC area was for HFSS - 0.645, for NTproBNP - 0.653 and for hsCRP - 0.566. When all those variables were included together in the model, the AUC value rose to 0.6943. Based on those results a weighted risk model with all three parameters was proposed. CONCLUSION HFSS, NTproBNP and hsCRP levels are independent stratification variables of survival or need for urgent heart transplantation. Their predictive value is moderately increased when they are analyzed together.
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Affiliation(s)
- T Zieliński
- Department of Heart Failure and Transplantation, Institute of Cardiology-04-628 Warszawa, ul. Alpejska 42, Warsaw, Poland.
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Di Stefano R, Di Bello V, Barsotti MC, Grigoratos C, Armani C, Dell'Omodarme M, Carpi A, Balbarini A. Inflammatory markers and cardiac function in acute coronary syndrome: difference in ST-segment elevation myocardial infarction (STEMI) and in non-STEMI models. Biomed Pharmacother 2009; 63:773-80. [PMID: 19906505 DOI: 10.1016/j.biopha.2009.06.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Accepted: 06/07/2009] [Indexed: 11/28/2022] Open
Abstract
PURPOSE No studies have been addressed to the differences in inflammation kinetics between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). PATIENTS AND METHODS Forty consecutive patients with acute coronary syndrome (ACS) (n=23 STEMI, age=61.7+/-10.3 years; n=17 NSTEMI, age=65.6+/-11.3 years) were enrolled within 12h after symptoms. All patients received therapy according to the current Guidelines. Blood samples were collected at admission (t0), on days 7 (t1) and 30 (t2) to evaluate CD40 ligand (CD40L), transforming growth factor (TGF)-beta, interleukin (IL)-6, tumor necrosis factor (TNF)-alpha and its receptors TNFRI and TNFRII, high sensitivity C-reactive protein (hs-CRP), serum amyloid A (SAA) and white blood cells (WBC). Echocardiographic parameters were also evaluated. RESULTS STEMI patients, at admission, had significantly higher median values of hs-CRP (p<0.001), WBC (p<0.01), ferritin (p<0.0005) and IL-6 (p<0.05) than NSTEMI. On the contrary, NSTEMI patients had lower median levels of every inflammatory marker except for CD40L (p<0.05) that was significantly higher. Moreover, three out of four deceased patients presented levels of CD40L higher than the median. At admission, STEMI showed a reduced ejection fraction (EF, p<0.01) and increased wall motion score index (WMSI, p<0.001) and end-diastolic volume (EDV, p<0.05) vs NSTEMI. An inverse correlation between admission values of inflammatory markers (SAA and WBC) and cardiac function was observed (p<0.05). Moreover, the necrosis marker troponin I was positively correlated with both WMSI (p<0.05) and hs-CRP (p<0.05). Regarding the inflammation kinetics, a difference was observed in the two groups only for WBC (p<0.05) and SAA (p<0.05). SAA showed higher values in STEMI at t0 and t1. In both groups, TGF-beta had an increase at t1 and t2 with respect to admission, while IL-6 had a decreasing trend. The total incidence of major adverse clinical events (MACE) was 22.5% at t2, with a mortality rate of 10%. CONCLUSION These observations suggest a differential inflammatory pattern in STEMI and NSTEMI patients. The absence of significant correlations between inflammatory indexes and myocardial infarction in NSTEMI supports the hypothesis that a different pattern of inflammation occurs in these patients. CD40L may have an important role as a marker for risk stratification in patients with ACS.
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Affiliation(s)
- Rossella Di Stefano
- Cardiovascular Research Laboratory, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
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Kavsak PA, Henderson M, Moretto P, Hirte H, Evans K, Wong D, Korz W, Hotte SJ. Biochip arrays for the discovery of a biomarker surrogate in a phase I/II study assessing a novel anti-metastasis agent. Clin Biochem 2009; 42:1162-5. [DOI: 10.1016/j.clinbiochem.2009.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 04/08/2009] [Accepted: 04/11/2009] [Indexed: 11/28/2022]
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45
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Konstandin MH, Aksoy H, Wabnitz GH, Volz C, Erbel C, Kirchgessner H, Giannitsis E, Katus HA, Samstag Y, Dengler TJ. Beta2-integrin activation on T cell subsets is an independent prognostic factor in unstable angina pectoris. Basic Res Cardiol 2009; 104:341-51. [DOI: 10.1007/s00395-008-0770-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 11/03/2008] [Indexed: 01/26/2023]
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Kavsak PA, Lee A, Hirte H, Young E, Gauldie J. Cytokine elevations in acute coronary syndrome and ovarian cancer: A mechanism for the up-regulation of the acute phase proteins in these different disease etiologies. Clin Biochem 2008; 41:607-10. [DOI: 10.1016/j.clinbiochem.2008.01.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Revised: 01/17/2008] [Accepted: 01/18/2008] [Indexed: 10/22/2022]
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Kavsak PA, Newman AM, Ko DT, Palomaki GE, Lustig V, MacRae AR, Jaffe AS. Is a pattern of increasing biomarker concentrations important for long-term risk stratification in acute coronary syndrome patients presenting early after the onset of symptoms? Clin Chem 2008; 54:747-51. [PMID: 18375487 PMCID: PMC3569503 DOI: 10.1373/clinchem.2007.094664] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Guidelines for treatment of acute coronary syndrome (ACS) recommend observing a rise or fall in cardiac troponin (cTn) concentrations for assessing acute injury. It is unknown whether a rising pattern presages a more adverse long-term prognosis than elevations that do not change. The present study assessed whether a rising pattern of cardiac biomarkers was more prognostic than simple elevations. METHODS We measured N-terminal pro-brain natriuretic peptide (NT-proBNP) (Roche), cTnT (Roche) and cTnI (Beckman Coulter) in 212 ACS patients. These biomarkers were measured in coincident EDTA and heparin plasma samples available from at least 2 different time points, an early first specimen obtained a median of 2 hours after onset of symptoms, interquartile range (IQR) 2-4 hours, and a later second specimen obtained at 9 hours, IQR 9-9 hours. The cTn concentration in the second specimen was used to classify myocardial necrosis (cTnI >0.04 ug/L; cTnT >0.01 ug/L). Outcomes [death, myocardial infarction (MI), heart failure (HF)] were obtained >8 years after the initial presentation. For patients with myocardial necrosis and a cTn concentration ratio (second/first measured concentrations) > or =1.00, the concentration ratios and the absolute concentrations in the second specimen were used to assess prognosis after 4 years. RESULTS In myocardial necrosis, the relative change (cTn2/cTn1) was greater for cTnI than for cTnT (P <0.01), whereas the relative change in NT-proBNP was the same regardless of which troponin was used to classify necrosis (P = 0.71). The concentration ratio for cTnI, cTnT, and NT-proBNP was not useful for risk stratification (i.e., death/MI/HF; P > or =0.15). CONCLUSIONS A rise in cardiac troponin or NT-proBNP concentration in ACS patients presenting early after onset of pain is not helpful for long-term prognosis.
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Affiliation(s)
- Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
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Kavsak PA, Ko DT, Newman AM, Lustig V, Palomaki GE, MacRae AR, Jaffe AS. Vascular versus myocardial dysfunction in acute coronary syndrome: are the adhesion molecules as powerful as NT-proBNP for long-term risk stratification? Clin Biochem 2007; 41:436-9. [PMID: 18194671 DOI: 10.1016/j.clinbiochem.2007.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Revised: 12/12/2007] [Accepted: 12/15/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine if elevations of adhesion molecules in acute coronary syndrome (ACS) are useful for risk stratification. DESIGN AND METHODS A cell adhesion array (Randox Ltd.) and NT-proBNP were measured in 216 ACS patients. RESULTS Kaplan-Meier and Cox models indicate early elevations of NT-proBNP but not the adhesion molecules are predictive of future death/myocardial infarction. DISCUSSION Elevations of adhesion molecules early after pain onset in ACS are not useful for long-term risk stratification.
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Affiliation(s)
- Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
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