1
|
Siegel PM, Schmich J, Barinov G, Bojti I, Vedecnik C, Simanjuntak NR, Bode C, Moser M, Peter K, Diehl P. Cardiomyocyte microvesicles: proinflammatory mediators after myocardial ischemia? J Thromb Thrombolysis 2021; 50:533-542. [PMID: 32537679 PMCID: PMC8443479 DOI: 10.1007/s11239-020-02156-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Myocardial infarction is a frequent complication of cardiovascular disease leading to high morbidity and mortality worldwide. Elevated C-reactive protein (CRP) levels after myocardial infarction are associated with heart failure and poor prognosis. Cardiomyocyte microvesicles (CMV) are released during hypoxic conditions and can act as mediators of intercellular communication. MicroRNA (miRNA) are short non-coding RNA which can alter cellular mRNA-translation. Microvesicles (MV) have been shown to contain distinct patterns of miRNA from their parent cells which can affect protein expression in target cells. We hypothesized that miRNA containing CMV mediate hepatic CRP expression after cardiomyocyte hypoxia. H9c2-cells were cultured and murine cardiomyocytes were isolated from whole murine hearts. H9c2- and murine cardiomyocytes were exposed to hypoxic conditions using a hypoxia chamber. Microvesicles were isolated by differential centrifugation and analysed by flow cytometry. Next-generation-sequencing was performed to determine the miRNA-expression profile in H9c2 CMV compared to their parent cells. Microvesicles were incubated with a co-culture model of the liver consisting of THP-1 macrophages and HepG2 cells. IL-6 and CRP expression in the co-culture was assessed by qPCR and ELISA. CMV contain a distinct pattern of miRNA compared to their parent cells including many inflammation-related miRNA. CMV induced IL-6 expression in THP-1 macrophages alone and CRP expression in the hepatic co-culture model. MV from hypoxic cardiomyocytes can mediate CRP expression in a hepatic co-culture model. Further studies will have to show whether these effects are reproducible in-vivo.
Collapse
Affiliation(s)
- Patrick Malcolm Siegel
- Cardiology and Angiology I, Heart Center Freiburg University, Medical Faculty, University of Freiburg, 79106, Freiburg im Breisgau, Germany. .,Baker Heart & Diabetes Institute, Atherothrombosis & Vascular Biology Laboratory, Melbourne, Australia.
| | - Judith Schmich
- Cardiology and Angiology I, Heart Center Freiburg University, Medical Faculty, University of Freiburg, 79106, Freiburg im Breisgau, Germany.,Baker Heart & Diabetes Institute, Atherothrombosis & Vascular Biology Laboratory, Melbourne, Australia
| | - Georg Barinov
- Cardiology and Angiology I, Heart Center Freiburg University, Medical Faculty, University of Freiburg, 79106, Freiburg im Breisgau, Germany
| | - István Bojti
- Cardiology and Angiology I, Heart Center Freiburg University, Medical Faculty, University of Freiburg, 79106, Freiburg im Breisgau, Germany
| | - Christopher Vedecnik
- Cardiology and Angiology I, Heart Center Freiburg University, Medical Faculty, University of Freiburg, 79106, Freiburg im Breisgau, Germany
| | - Novita Riani Simanjuntak
- Cardiology and Angiology I, Heart Center Freiburg University, Medical Faculty, University of Freiburg, 79106, Freiburg im Breisgau, Germany
| | - Christoph Bode
- Cardiology and Angiology I, Heart Center Freiburg University, Medical Faculty, University of Freiburg, 79106, Freiburg im Breisgau, Germany
| | - Martin Moser
- Cardiology and Angiology I, Heart Center Freiburg University, Medical Faculty, University of Freiburg, 79106, Freiburg im Breisgau, Germany
| | - Karlheinz Peter
- Baker Heart & Diabetes Institute, Atherothrombosis & Vascular Biology Laboratory, Melbourne, Australia.,Faculty for Medicine & Nursing, Monash University, Melbourne, Australia
| | - Philipp Diehl
- Cardiology and Angiology I, Heart Center Freiburg University, Medical Faculty, University of Freiburg, 79106, Freiburg im Breisgau, Germany.,Baker Heart & Diabetes Institute, Atherothrombosis & Vascular Biology Laboratory, Melbourne, Australia.,Faculty for Medicine & Nursing, Monash University, Melbourne, Australia
| |
Collapse
|
2
|
Lawler PR, Bhatt DL, Godoy LC, Lüscher TF, Bonow RO, Verma S, Ridker PM. Targeting cardiovascular inflammation: next steps in clinical translation. Eur Heart J 2021; 42:113-131. [PMID: 32176778 DOI: 10.1093/eurheartj/ehaa099] [Citation(s) in RCA: 208] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/30/2019] [Accepted: 02/03/2020] [Indexed: 12/31/2022] Open
Abstract
Systemic vascular inflammation plays multiple maladaptive roles which contribute to the progression and destabilization of atherosclerotic cardiovascular disease (ASCVD). These roles include: (i) driving atheroprogression in the clinically stable phase of disease; (ii) inciting atheroma destabilization and precipitating acute coronary syndromes (ACS); and (iii) responding to cardiomyocyte necrosis in myocardial infarction (MI). Despite an evolving understanding of these biologic processes, successful clinical translation into effective therapies has proven challenging. Realizing the promise of targeting inflammation in the prevention and treatment of ASCVD will likely require more individualized approaches, as the degree of inflammation differs among cardiovascular patients. A large body of evidence has accumulated supporting the use of high-sensitivity C-reactive protein (hsCRP) as a clinical measure of inflammation. Appreciating the mechanistic diversity of ACS triggers and the kinetics of hsCRP in MI may resolve purported inconsistencies from prior observational studies. Future clinical trial designs incorporating hsCRP may hold promise to enable individualized approaches. The aim of this Clinical Review is to summarize the current understanding of how inflammation contributes to ASCVD progression, destabilization, and adverse clinical outcomes. We offer forward-looking perspective on what next steps may enable successful clinical translation into effective therapeutic approaches-enabling targeting the right patients with the right therapy at the right time-on the road to more individualized ASCVD care.
Collapse
Affiliation(s)
- Patrick R Lawler
- Peter Munk Cardiac Centre, University Health Network, 190 Elizabeth Street, Toronto, ON M5G 2C4, Canada.,Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada.,University of Toronto, 27 King's College Cir, Toronto, ON M5S 1K1, Canada
| | - Deepak L Bhatt
- Brigham and Women's Hospital, Division of Cardiovascular Medicine, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Lucas C Godoy
- Peter Munk Cardiac Centre, University Health Network, 190 Elizabeth Street, Toronto, ON M5G 2C4, Canada.,Instituto do Coracao (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, 44, Doutor Enéas Carvalho de Aguiar Avenue, São Paulo, SP 05403-900, Brazil
| | - Thomas F Lüscher
- Royal Brompton & Harefield Hospital, Imperial College, 77 Wimpole Street, London W1G 9RU, UK
| | - Robert O Bonow
- Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 251 E Huron, Chicago, IL 60611, USA
| | - Subodh Verma
- University of Toronto, 27 King's College Cir, Toronto, ON M5S 1K1, Canada.,Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON M5B 1W8, Canada
| | - Paul M Ridker
- Brigham and Women's Hospital, Division of Cardiovascular Medicine, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.,Brigham and Women's Hospital, Center for Cardiovascular Disease Prevention, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA
| |
Collapse
|
3
|
Elevated high-sensitivity C-reactive protein concentrations may be associated with increased postdischarge mortality in patients with myocardial injury after noncardiac surgery: A retrospective observational study. Eur J Anaesthesiol 2021; 38:S33-S40. [PMID: 33399373 DOI: 10.1097/eja.0000000000001409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Myocardial injury after noncardiac surgery (MINS) is one of the most common cardiovascular complications associated with mortality and morbidity during the first 2 years after surgery. However, the relevant variables associated with mortality after discharge in patients with MINS have not been fully investigated. OBJECTIVES This study aimed to evaluate the association between persistent inflammation detected by high-sensitivity C-reactive protein (hsCRP) at discharge and postdischarge mortality after MINS. DESIGN Retrospective observational analysis of acquired data from Samsung Medical Center Troponin in Noncardiac Operation (SMC-TINCO) registry. SETTING A tertiary hospital from January 2010 to June 2019. PATIENTS Patients who were discharged alive after a diagnosis of MINS. MAIN OUTCOME MEASURES The primary endpoint was postdischarge 1-year mortality, and 30-day mortality and the mortality from 30 days to 1 year was also compared. RESULTS Data from a total of 4545 adult patients were divided into two groups according to hsCRP concentration at discharge. There were 757 (16.7%) patients in the normal hsCRP group and 3788 (83.3%) patients in the elevated hsCRP group. After inverse probability weighting, 1-year mortality was significantly higher in the elevated group than the normal group (hazard ratio 1.93, 95% CI 1.45 to 2.57, P < 0.001). Thirty-day mortality and the mortality from 30 days to 1 year were also increased in the elevated group. CONCLUSION In patients with MINS, an elevated hsCRP concentration at discharge appeared to be associated with increased mortality. Further research is needed to determine whether controlling inflammation can be helpful in reducing mortality.
Collapse
|
4
|
Cardiovascular Risk Factors from Another Point of View. JOURNAL OF INTERDISCIPLINARY MEDICINE 2021. [DOI: 10.2478/jim-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Cardiovascular diseases remain the main cause of death in western societies. This contributes to the appearance of new diagnostic and treatment methods addressed to reduce the burden of cardiovascular diseases. In the last decades new imaging methods have emerged; furthermore, routine biomarkers were found to be useful in cardiovascular risk stratification. Data reviewed in this article emphasize the multifactorial etiology of cardiovascular disease. The authors describe the role of inflammation in the precipitation and progression of atherosclerosis and atrial fibrillation. Affordable and well-known inflammatory markers can be used alone or in combination with new imaging methods for a better cardiovascular risk stratification. Coronary computed tomographic angiography findings and inflammatory markers are capable to identify patients with high risk of major adverse cardiovascular events or atrial fibrillation. Furthermore, they also have an important role in the choice of treatment strategy and follow-up.
Collapse
|
5
|
Acet H, Güzel T, Aslan B, Isik MA, Ertas F, Catalkaya S. Predictive Value of C-Reactive Protein to Albumin Ratio in ST-Segment Elevation Myocardial Infarction Patients Treated With Primary Percutaneous Coronary Intervention. Angiology 2020; 72:244-251. [PMID: 33371718 DOI: 10.1177/0003319720963697] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The present study aimed to examine the association of C-reactive protein to albumin ratio (CAR) with short-term major adverse cardiac events (MACEs) in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). We included 539 STEMI patient treated with pPCI in this study. Patients were divided into 2 groups according to MACE development. Patients with MACE had higher CAR than those without (1.18 [0.29-1.99] vs 0.21 [0.09-0.49], P < .001). Multivariate analysis showed that The Global Record for Acute Coronary Events score, Percutaneous Coronary Intervention with TAXus and cardiac surgery (SYNTAX) score, glucose and CAR (odds ratio:1.326, 95% CI: 1.212-1452, P < .001) were independent predictors of MACE. The CAR may be proven useful for risk stratification in STEMI patients undergoing pPCI.
Collapse
Affiliation(s)
- Halit Acet
- Department of Cardiology, Faculty of Medicine, 37507Dicle University, Diyarbakir, Turkey
| | - Tuncay Güzel
- Department of Cardiology, Akhisar State Hospital, Manisa, Turkey
| | - Bayram Aslan
- Department of Cardiology, Ergani State Hospital, Diyarbakir, Turkey
| | - Mehmet Ali Isik
- Department of Cardiology, 37507Mardin State Hospital, Mardin, Turkey
| | - Faruk Ertas
- Department of Cardiology, Faculty of Medicine, 37507Dicle University, Diyarbakir, Turkey
| | - Sibel Catalkaya
- Department of Cardiology, Edremit State Hospital, Edremit, Turkey
| |
Collapse
|
6
|
McFadyen JD, Zeller J, Potempa LA, Pietersz GA, Eisenhardt SU, Peter K. C-Reactive Protein and Its Structural Isoforms: An Evolutionary Conserved Marker and Central Player in Inflammatory Diseases and Beyond. Subcell Biochem 2020; 94:499-520. [PMID: 32189313 DOI: 10.1007/978-3-030-41769-7_20] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
C-reactive protein (CRP) is an evolutionary highly conserved member of the pentraxin superfamily of proteins. CRP is widely used as a marker of inflammation, infection and for risk stratification of cardiovascular events. However, there is now a large body of evidence, that continues to evolve, detailing that CRP directly mediates inflammatory reactions and the innate immune response in the context of localised tissue injury. These data support the concept that the pentameric conformation of CRP dissociates into pro-inflammatory CRP isoforms termed pCRP* and monomeric CRP. These pro-inflammatory CRP isoforms undergo conformational changes that facilitate complement binding and immune cell activation and therefore demonstrate the ability to trigger complement activation, activate platelets, monocytes and endothelial cells. The dissociation of pCRP occurs on the surface of necrotic, apoptotic, and ischaemic cells, regular β-sheet structures such as β-amyloid, the membranes of activated cells (e.g., platelets, monocytes, and endothelial cells), and/or the surface of microparticles, the latter by binding to phosphocholine. Therefore, the deposition and localisation of these pro-inflammatory isoforms of CRP have been demonstrated to amplify inflammation and tissue damage in a broad range of clinical conditions including ischaemia/reperfusion injury, Alzheimer's disease, age-related macular degeneration and immune thrombocytopaenia. Given the potentially broad relevance of CRP to disease pathology, the development of inhibitors of CRP remains an area of active investigation, which may pave the way for novel therapeutics for a diverse range of inflammatory diseases.
Collapse
Affiliation(s)
- James D McFadyen
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- Department of Medicine, Monash University, Melbourne, VIC, Australia.
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, VIC, Australia.
- Australian Centre for Blood Diseases, Monash University, Melbourne, VIC, Australia.
| | - Johannes Zeller
- Department of Plastic and Hand Surgery, Medical Faculty of the University of Freiburg, University of Freiburg Medical Centre, Freiburg, Germany
| | | | - Geoffrey A Pietersz
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Immunology, Monash University, Melbourne, VIC, Australia
- Burnet Institute, Melbourne, VIC, Australia
| | - Steffen U Eisenhardt
- Department of Plastic and Hand Surgery, Medical Faculty of the University of Freiburg, University of Freiburg Medical Centre, Freiburg, Germany
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- Department of Medicine, Monash University, Melbourne, VIC, Australia.
- Department of Immunology, Monash University, Melbourne, VIC, Australia.
- Heart Centre, The Alfred Hospital, Melbourne, VIC, Australia.
| |
Collapse
|
7
|
Kobayashi Y, Tanno K, Ueno A, Fukamizu S, Murata H, Watanabe N, Sasaki T, Yamamoto T, Takayama M, Nagao K. In-Hospital Electrical Storm in Acute Myocardial Infarction - Clinical Background and Mechanism of the Electrical Instability. Circ J 2018; 83:91-100. [PMID: 30429432 DOI: 10.1253/circj.cj-18-0785] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2024]
Abstract
BACKGROUND Recurrent ventricular tachycardia (VT) and fibrillation (VF), the so-called "electrical storm" (ES) occurs at various stages of acute myocardial infarction (AMI), but its incidence, background, and short-term prognosis remain unclear. METHODS AND RESULTS A retrospective observational study was performed using the registry database of the Tokyo CCU Network. The individual data of 6,003 patients with AMI during 2011-2012 was corrected. ES was defined as more than 3 episodes of sustained VT/VF during a 24-h period as first documented after hospitalization. ES occurred in 55 patients after admission (0.9%). The ES(+) group had more severe heart failure (Killip class >III), more extensive MI (peak-CK), greater inflammatory reaction (CRP), history of diabetes, and more frequent application of hemodialysis as compared with the ES(-) group (n=5,865). When the ES patients were divided into Early-ES (n=37: ES occurred ≤48 h after the onset of MI) and Late-ES (n=15 >48 h after onset of MI) groups, logistic regression analysis revealed that Early-ES was associated with severity of MI, whereas Late-ES was related to systemic disorders, including inflammation, renal dysfunction, or diabetes. Late-ES was an independent predictor of in-hospital death. CONCLUSIONS In-hospital ES was a rare clinical manifestation of AMI. The features and background of the ES varied as time elapsed after admission for MI.
Collapse
Affiliation(s)
- Yoshinori Kobayashi
- Tokyo CCU Network Scientific Committee
- Cardiology Division, Tokai University Hachioji-Hospital
| | | | - Akira Ueno
- Tokyo CCU Network Scientific Committee
- Cardiology Division, Tokai University Hachioji-Hospital
| | | | | | | | | | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee
| |
Collapse
|
8
|
Xu M, Yan L, Xu J, Yang X, Jiang T. Predictors and prognosis for incident in-hospital heart failure in patients with preserved ejection fraction after first acute myocardial infarction: An observational study. Medicine (Baltimore) 2018; 97:e11093. [PMID: 29901624 PMCID: PMC6024188 DOI: 10.1097/md.0000000000011093] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/22/2018] [Indexed: 12/14/2022] Open
Abstract
Patients with acute myocardial infarction (AMI) complicated by heart failure with preserved ejection fraction (HFpEF) are likely to have more adverse cardiovascular events and higher mortality. The purpose of this study was to examine the predictors and outcomes in AMI patients complicated by HFpEF.We examined the demographics, clinical data, and clinical outcomes in 405 consecutive subjects who firstly presented with AMI after undergoing emergency percutaneous coronary intervention from January 2013 to June 2016.Three hundred twenty patients and eighty-five patients were classified into the nonheart failure (non-HF) group and HFpEF group, respectively. Patients with HFpEF had higher prevalence of prior hypertension, had higher levels of biomarkers, and had a larger left atrial diameter with a nondilated left ventricle were more likely to develop multivessel disease-vessels and had infarction-related artery located in left anterior descending artery than patients without HF. Moreover, patients with HFpEF had a higher probability of developing the in-hospital incident cardiovascular complications and death than non-HF patients.Two routine biomarkers, levels of hypersensitive C-reactive protein and N-terminal-pro brain natriuretic peptide, and number of diseased-vessels were independent predictors for in-hospital HFpEF incidence in AMI patients with preserved LVEF. AMI patients with HFpEF had a higher probability of in-hospital cardiovascular outcomes and mortality.
Collapse
Affiliation(s)
- Mingzhu Xu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou
| | - Lihua Yan
- Department of Thoracic and Cardiovascular Surgery, Nantong First People's hospital, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jialiang Xu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou
| | - Xiangjun Yang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou
| | - Tingbo Jiang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou
| |
Collapse
|
9
|
Hodžić E, Hasković E, Duraković M, Fočak M. Troponin and C-reactive Protein in Risk Stratification after Myocardial Infarction. ACTA FACULTATIS MEDICAE NAISSENSIS 2017. [DOI: 10.1515/afmnai-2017-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Summary
The aim of this study was to investigate the prognostic significance of troponin I, C-reactive protein and risk factors for the occurrence of complications after myocardial infarction.
Troponin I and C-reactive protein values were analyzed in 38% of patients with complications (postinfarction angina, ventricular fibrillation, heart failure and fatal outcome) and in 62% of patients without complications. Values wererecorded on admission and between the eighth and tenth day of hospitalization.
It was found that a larger number of risk factors (p = 0.00), diabetes mellitus (p = 0.02) and smoking (p = 0.01) were significantly associated with the complications. It was shown that hypertension increases the risk of developing heart failure after acute myocardial infarction (p = 0.02). It resulted with statistically non-significant difference in the observed values of troponin I between the group of patients with complications and the group without them (p = 0.22, p = 0.327). There was a statistically significant difference in the observed values of C-reactive protein in the two groups of patients (p = 0.00, p = 0.01).
It can be concluded that the values of troponin I had no prognostic significance in risk stratification, while the values of C-reactive protein, individual risk factors and a large numberof risk factors hadsignificance in risk stratification after myocardial infarction.
Collapse
|
10
|
Ding DC, Shyu WC, Lin SZ, Li H. The Role of Endothelial Progenitor Cells in Ischemic Cerebral and Heart Diseases. Cell Transplant 2017; 16:273-84. [PMID: 17503738 DOI: 10.3727/000000007783464777] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Ischemic heart and cerebral diseases are complex clinical syndromes. Endothelial dysfunction caused by dysfunctional endothelial progenitor cells (EPCs) is thought to play a major role in pathophysiology of both types of disease. Healthy EPCs may be able to replace the dysfunctional endothelium through endogenous repair mechanisms. EPC levels are changed in patients with ischemic cerebrovascular and cardiovascular disease and EPCs may play a role in the pathophysiology of these diseases. EPCs are also a marker for preventive and therapeutic interventions. Homing of EPCs to ischemic sites is a mechanism of ischemic tissue repair, and molecules such as stromal-derived factor-1 and integrin may play a role in EPC homing in ischemic disease. Potentiation of the function and numbers of EPCs as well as combining EPCs with other pharmaceutical agents may improve the condition of ischemia patients. However, the precise role of EPCs in ischemic heart and cerebral disease and their therapeutic potential still remain to be explored. Here, we discuss the identification, mobilization, and clinical implications of EPCs in ischemic diseases.
Collapse
Affiliation(s)
- Dah-Ching Ding
- Graduate Institute of Medical Science, School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | | | | | | |
Collapse
|
11
|
Schulz S, Lüdike H, Lierath M, Schlitt A, Werdan K, Hofmann B, Gläser C, Schaller HG, Reichert S. C-reactive protein levels and genetic variants of CRP as prognostic markers for combined cardiovascular endpoint (cardiovascular death, death from stroke, myocardial infarction, and stroke/TIA). Cytokine 2016; 88:71-76. [PMID: 27580453 DOI: 10.1016/j.cyto.2016.08.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/16/2016] [Accepted: 08/22/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND The aim of this analysis was to evaluate the importance of C-reactive protein levels and genetic variants of CRP as prognostic markers for further cardiovascular (CV) events (3-year follow-up) in a cohort of in-patients with cardiovascular disease (CVD) patients. METHODS AND RESULTS Patients with angiographic proven CVD (n=939) were prospectively included. The three-year CV outcome of the patients was evaluated considering the predefined, combined endpoint (CV death, death from stroke, myocardial infarction, and stroke/TIA). Polymorphisms rs1800947, rs1417938, rs1130864, rs3093077 were analysed. In Kaplan-Meier survival curve and Cox regression increased CRP levels of ⩾5mg/l (log-rank test: p=0.001, Cox regression: hazard ratio=1.77, 95% CI: 1.2-2.7) and the GG genotype of rs1800947 (log-rank test: p=0.01, Cox regression: hazard ratio=1.99, 95% CI: 1.1-3.6) were associated with the incidence of the combined endpoint. CONCLUSIONS Both a CRP level ⩾5mg/l and SNP rs1800947 of the CRP gene were independent risk factors for further adverse CV events among patients with CVD within three years follow-up.
Collapse
Affiliation(s)
- Susanne Schulz
- Department of Operative Dentistry and Periodontology, Martin-Luther University Halle-Wittenberg, Germany.
| | - Henriette Lüdike
- Department of Operative Dentistry and Periodontology, Martin-Luther University Halle-Wittenberg, Germany
| | - Madlen Lierath
- Department of Operative Dentistry and Periodontology, Martin-Luther University Halle-Wittenberg, Germany
| | - Axel Schlitt
- Department of Medicine III, Heart Centre of the University Clinics Halle (Saale), Martin-Luther University Halle-Wittenberg, Germany; Department of Cardiology, Paracelsus-Harz-Clinic Bad Suderode, Germany
| | - Karl Werdan
- Department of Medicine III, Heart Centre of the University Clinics Halle (Saale), Martin-Luther University Halle-Wittenberg, Germany
| | - Britt Hofmann
- Department of Cardiothoracic Surgery, Heart Centre of the University Clinics Halle (Saale), Martin-Luther University Halle-Wittenberg, Germany
| | - Christiane Gläser
- Institute of Human Genetics and Medical Biology, Martin-Luther University Halle-Wittenberg, Germany
| | - Hans-Günter Schaller
- Department of Operative Dentistry and Periodontology, Martin-Luther University Halle-Wittenberg, Germany
| | - Stefan Reichert
- Department of Operative Dentistry and Periodontology, Martin-Luther University Halle-Wittenberg, Germany
| |
Collapse
|
12
|
Li X, Kramer MC, Damman P, van der Wal AC, Grundeken MJ, van Straalen JP, Koch KT, Henriques JP, Baan J, Vis MM, Piek JJ, Fischer JC, Tijssen JGP, de Winter RJ. Older coronary thrombus is an independent predictor of 1-year mortality in acute myocardial infarction. Eur J Clin Invest 2016; 46:501-10. [PMID: 26988709 DOI: 10.1111/eci.12619] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 03/09/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND We have previously shown that older thrombus is associated with a twofold higher long-term mortality in ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (pPCI). We evaluated whether the addition of the presence of older thrombus to a multimarker model would result in increased predictive power for 1-year mortality in STEMI patients. METHODS The study population (n = 1442) consists of STEMI patients treated with thrombus aspiration during pPCI. Patients were included if aspirated thrombus material could histopathologically be classified according to thrombus age (n = 870) and laboratory measurements of biomarkers (cardiac troponin T, glucose, N-terminal pro-brain natriuretic peptide, estimated glomerular filtration rate and C-reactive protein) were available. The additional prognostic value of the presence of older thrombus beyond multiple biomarkers and established clinical risk factors was evaluated using multivariate Cox regression models. RESULTS Serum biomarker concentrations were similar between patients with fresh and older thrombus. Sixty patients (7%) died within 1 year. The presence of older thrombus remained strongly associated with mortality at 1 year after multivariable adjustment for multiple biomarkers and established clinical risk factors. Addition of older thrombus to either a model including clinical risk factors and biomarkers or a model including solely biomarkers resulted in significant increases in the discriminative value, evidenced by net reclassification improvement and integrated discriminative improvement. CONCLUSIONS The presence of older thrombus provides independent complementary information to a multimarker model including established clinical risk factors and multiple biomarkers for predicting 1-year mortality in STEMI patients treated with pPCI and thrombus aspiration.
Collapse
Affiliation(s)
- Xiaofei Li
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Miranda C Kramer
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter Damman
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Allard C van der Wal
- Department of Medical Sciences, Clinical Chemistry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Maik J Grundeken
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan P van Straalen
- Departments of Medical Sciences, Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Karel T Koch
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jose P Henriques
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan Baan
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marije M Vis
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan J Piek
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Johan C Fischer
- Departments of Medical Sciences, Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan G P Tijssen
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Robbert J de Winter
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
13
|
Acute coronary syndrome-associated depression: the salience of a sickness response analogy? Brain Behav Immun 2015; 49:18-24. [PMID: 25746589 DOI: 10.1016/j.bbi.2015.02.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/09/2015] [Accepted: 02/23/2015] [Indexed: 12/12/2022] Open
Abstract
Depression emerging in conjunction with acute coronary syndrome (ACS) is thought to constitute a distinct high-risk phenotype with inflammatory determinants. This review critically examines the notion put forward in the literature that ACS-associated depression constitutes a meaningful subtype that is qualitatively different from depressive syndromes observed in psychiatric patients; and evaluates the salience of an analogy to the acute sickness response to infection or injury as an explanatory model. Specific features differentiating ACS-associated depression from other phenotypes are discussed, including differences in depression symptom profiles, timing of the depressive episode in relation to ACS, severity of the cardiac event, and associated immune activation. While an acute sickness response analogy offers a plausible conceptual framework, concrete evidence is lacking for inflammatory activity as the triggering mechanism. It is likely that ACS-associated depression encompasses several causative scenarios.
Collapse
|
14
|
Sim DS, Ahn Y, Kim YH, Seon HJ, Park KH, Yoon HJ, Yoon NS, Kim KH, Hong YJ, Park HW, Kim JH, Jeong MH, Cho JG, Park JC. The Relationship among N-Terminal Pro-B-Type Natriuretic Peptide, High-Sensitivity C-Reactive Protein and Infarct Size in Patients with Acute ST-Elevation Myocardial Infarction. Korean Circ J 2015; 45:285-93. [PMID: 26240582 PMCID: PMC4521106 DOI: 10.4070/kcj.2015.45.4.285] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 01/16/2015] [Accepted: 04/14/2015] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives We sought to investigate the relationship between levels of high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the infarct size and left ventricular (LV) volume after acute myocardial infarction (MI). Subjects and Methods Eighty-six patients with acute ST-elevation MI underwent delayed enhancement multidetector computed tomography immediately after they underwent percutaneous coronary intervention to determine the infarct size. LV function and remodeling were assessed by echocardiography. Hs-CRP and NT-proBNP were measured at admission, 24 hours and two months later. Results Both hs-CRP and NT-proBNP at 24 hours showed a positive correlation with infarct size and a negative correlation with LV ejection fraction at the baseline and two months later. NT-proBNP at two months correlated with infarct size, LV ejection fraction, and LV end diastolic and systolic volume indices at two months. In patients with high NT-proBNP levels at 24 hours and two months, infarct size was larger and LV ejection fraction was lower. NT-proBNP was higher in patients who developed LV remodeling at two months: 929 pg/mL vs. 134 pg/mL, p=0.002. In contrast, hs-CRP at two months showed no relationship to infarct size, LV function, or LV volumes at two months. Conclusion Elevated hs-CRP level 24 hours after the onset of acute MI is associated with infarct size and LV dysfunction, whereas elevated levels of NT-proBNP 24 hours and two months after the onset of acute MI are both correlated with infarct size, LV dysfunction, and LV remodeling.
Collapse
Affiliation(s)
- Doo Sun Sim
- Department of Cardiology, Cardiovascular Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Cardiovascular Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Ju Seon
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Keun Ho Park
- Department of Cardiology, Cardiovascular Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Hyun Ju Yoon
- Department of Cardiology, Cardiovascular Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Nam Sik Yoon
- Department of Cardiology, Cardiovascular Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Kye Hun Kim
- Department of Cardiology, Cardiovascular Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiology, Cardiovascular Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Hyung Wook Park
- Department of Cardiology, Cardiovascular Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Cardiovascular Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiology, Cardiovascular Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Jong Chun Park
- Department of Cardiology, Cardiovascular Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| |
Collapse
|
15
|
Quinaglia e Silva JC, Coelho-Filho OR, Andrade JM, Quinaglia T, Modolo RGP, Almeida BO, van der Geest RJ, Jerosch-Herold M, Coelho OR, Sposito AC. Peri-infarct zone characterized by cardiac magnetic resonance imaging is directly associated with the inflammatory activity during acute phase myocardial infarction. Inflammation 2015; 37:678-85. [PMID: 24282109 DOI: 10.1007/s10753-013-9784-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Enhanced systemic inflammatory activity (SIA) during myocardial infarction (MI) and the extent of the peri-infarct zone characterized by cardiac magnetic resonance imaging (CMRi) are both associated with increased risk of life-threatening arrhythmias and sudden cardiac death. The present study investigated the existence of association between these two phenomena in 98 patients (55 ± 10 years) with ST segment elevation MI. Plasma levels of C-reactive protein (CRP), interleukin-2 (IL-2), and tumor necrosis factor (TNF) were measured on admission (D1) and on the fifth day post-MI (D5). CMRi was performed 2 weeks after MI to quantify peri-infarct zone (PIZ). Between D1 and D5, the increase in CRP (6.0 vs. 5.6 times; p = 0.02), IL-2 (3.6 vs. 3.4 times; p = 0.04) and tumor necrosis factor type α (TNF-α; 4.6 vs. 3.9 times; p = 0.001) were higher in patients with PIZ above the median than in the counterparts. PIZ was correlated with CRP-D5 (r = 0.69), delta-CRP (r = 0.7), IL-2-D5 (r = 0.5), delta-IL-2 (r = 0.6), TNF-α (r = 0.5), delta-TNF-α (r = 0.4; p = 0.0001). Enhanced activation of SIA during the acute phase of MI is directly related with generation of PIZ.
Collapse
|
16
|
Baumann S, Huseynov A, Koepp J, Jabbour C, Behnes M, Becher T, Renker M, Lang S, Borggrefe M, Lehmann R, Akin I. Comparison of Serum Uric Acid, Bilirubin, and C-Reactive Protein as Prognostic Biomarkers of In-Hospital MACE Between Women and Men With ST-Segment Elevation Myocardial Infarction. Angiology 2015; 67:272-80. [PMID: 26032849 DOI: 10.1177/0003319715589246] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Levels of C-reactive protein (CRP), uric acid (UA), and total bilirubin (TB) are associated with coronary artery disease and major adverse cardiac events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI). We retrospectively included 1167 patients with STEMI who underwent percutaneous coronary intervention and routine blood sampling. The study cohort consisted of 803 patients (73.1% male, mean age 62.5 ± 13.4 years). In men, the levels of CRP, TB, and UA were significantly higher in the MACE than in the non-MACE group (P < .05). The receiver-operating characteristic (ROC) analysis shows that CRP (area under the curve [AUC]: 0.59; 95% confidence interval [CI]: 0.53-0.66; P = .014) and TB (AUC: 0.58; 95% CI: 0.51-0.65; P = .019) are significantly associated with MACE but not UA (AUC: 0.61; 95% CI: 0.42-0.76; P = .083). Logistic regression revealed CRP (odds ratio [OR] 1.01; 95% CI: 1.00-1.01; P = .006) and TB (OR 2.03; 95% CI: 1.12-3.40; P = .007) as an independent predictor for MACE. In women, none of the biomarkers was associated with MACE by ROC analysis or logistic regression analysis. This study demonstrated that high CRP and TB serum levels have a prognostic association with in-hospital MACE in male patients with STEMI.
Collapse
Affiliation(s)
- Stefan Baumann
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Aydin Huseynov
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Johanna Koepp
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Claude Jabbour
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Tobias Becher
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Matthias Renker
- Department of Internal Medicine I, Cardiology and Angiology, Giessen University, Giessen, Germany
| | - Siegfried Lang
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Ralf Lehmann
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| |
Collapse
|
17
|
Biomarkers in Cardiology - Part 2: In Coronary Heart Disease, Valve Disease and Special Situations. Arq Bras Cardiol 2015; 104:337-46. [PMID: 26083777 PMCID: PMC4495448 DOI: 10.5935/abc.20150061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/01/2015] [Indexed: 01/25/2023] Open
Abstract
Cardiovascular diseases are the main causes of mortality and morbidity in Brazil.
Their primary and secondary preventions are a priority for the health system and
require multiple approaches for increased effectiveness. Biomarkers are tools used to
identify with greater accuracy high-risk individuals, establish a faster diagnosis,
guide treatment, and determine prognosis. This review aims to highlight the
importance of biomarkers in clinical cardiology practice and raise relevant points
regarding their application and perspectives for the next few years. This document
was divided into two parts. This second part addresses the application of biomarkers
in coronary heart disease, valvular diseases, cardio-oncology, pulmonary embolism,
and cardiorenal syndrome.
Collapse
|
18
|
Ribeiro DRP, Ramos AM, Vieira PL, Menti E, Bordin OL, Souza PALD, Quadros ASD, Portal VL. High-sensitivity C-reactive protein as a predictor of cardiovascular events after ST-elevation myocardial infarction. Arq Bras Cardiol 2015; 103:69-75. [PMID: 25120085 PMCID: PMC4126763 DOI: 10.5935/abc.20140086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/31/2014] [Indexed: 12/22/2022] Open
Abstract
Background The association between high-sensitivity C-reactive protein and recurrent major
adverse cardiovascular events (MACE) in patients with ST-elevation myocardial
infarction who undergo primary percutaneous coronary intervention remains
controversial. Objective To investigate the potential association between high-sensitivity C-reactive
protein and an increased risk of MACE such as death, heart failure, reinfarction,
and new revascularization in patients with ST-elevation myocardial infarction
treated with primary percutaneous coronary intervention. Methods This prospective cohort study included 300 individuals aged >18 years who were
diagnosed with ST-elevation myocardial infarction and underwent primary
percutaneous coronary intervention at a tertiary health center. An instrument
evaluating clinical variables and the Thrombolysis in Myocardial Infarction (TIMI)
and Global Registry of Acute Coronary Events (GRACE) risk scores was used.
High-sensitivity C-reactive protein was determined by nephelometry. The patients
were followed-up during hospitalization and up to 30 days after infarction for the
occurrence of MACE. Student's t, Mann-Whitney, chi-square, and logistic regression
tests were used for statistical analyses. P values of ≤0.05 were considered
statistically significant. Results The mean age was 59.76 years, and 69.3% of patients were male. No statistically
significant association was observed between high-sensitivity C-reactive protein
and recurrent MACE (p = 0.11). However, high-sensitivity C-reactive protein was
independently associated with 30-day mortality when adjusted for TIMI [odds ratio
(OR), 1.27; 95% confidence interval (CI), 1.07-1.51; p = 0.005] and GRACE (OR,
1.26; 95% CI, 1.06-1.49; p = 0.007) risk scores. Conclusion Although high-sensitivity C-reactive protein was not predictive of combined major
cardiovascular events within 30 days after ST-elevation myocardial infarction in
patients who underwent primary angioplasty and stent implantation, it was an
independent predictor of 30-day mortality.
Collapse
Affiliation(s)
| | | | - Pedro Lima Vieira
- Instituto de Cardiologia, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
| | - Eduardo Menti
- Instituto de Cardiologia, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
| | - Odemir Luiz Bordin
- Instituto de Cardiologia, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
| | | | | | - Vera Lúcia Portal
- Instituto de Cardiologia, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
| |
Collapse
|
19
|
Tanigaki K, Sundgren N, Khera A, Vongpatanasin W, Mineo C, Shaul PW. Fcγ receptors and ligands and cardiovascular disease. Circ Res 2015; 116:368-84. [PMID: 25593280 DOI: 10.1161/circresaha.116.302795] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Fcγ receptors (FcγRs) classically modulate intracellular signaling on binding of the Fc region of IgG in immune response cells. How FcγR and their ligands affect cardiovascular health and disease has been interrogated recently in both preclinical and clinical studies. The stimulation of activating FcγR in endothelial cells, vascular smooth muscle cells, and monocytes/macrophages causes a variety of cellular responses that may contribute to vascular disease pathogenesis. Stimulation of the lone inhibitory FγcR, FcγRIIB, also has adverse consequences in endothelial cells, antagonizing NO production and reparative mechanisms. In preclinical disease models, activating FcγRs promote atherosclerosis, whereas FcγRIIB is protective, and activating FcγRs also enhance thrombotic and nonthrombotic vascular occlusion. The FcγR ligand C-reactive protein (CRP) has undergone intense study. Although in rodents CRP does not affect atherosclerosis, it causes hypertension and insulin resistance and worsens myocardial infarction. Massive data have accumulated indicating an association between increases in circulating CRP and coronary heart disease in humans. However, Mendelian randomization studies reveal that CRP is not likely a disease mediator. CRP genetics and hypertension warrant further investigation. To date, studies of genetic variants of activating FcγRs are insufficient to implicate the receptors in coronary heart disease pathogenesis in humans. However, a link between FcγRIIB and human hypertension may be emerging. Further knowledge of the vascular biology of FcγR and their ligands will potentially enhance our understanding of cardiovascular disorders, particularly in patients whose greater predisposition for disease is not explained by traditional risk factors, such as individuals with autoimmune disorders.
Collapse
Affiliation(s)
- Keiji Tanigaki
- From the Department of Pediatrics, Center for Pulmonary and Vascular Biology (K.T., N.S., C.M., P.W.S.), and Division of Cardiology, Department of Internal Medicine (A.K., W.V.), University of Texas Southwestern Medical Center, Dallas
| | - Nathan Sundgren
- From the Department of Pediatrics, Center for Pulmonary and Vascular Biology (K.T., N.S., C.M., P.W.S.), and Division of Cardiology, Department of Internal Medicine (A.K., W.V.), University of Texas Southwestern Medical Center, Dallas
| | - Amit Khera
- From the Department of Pediatrics, Center for Pulmonary and Vascular Biology (K.T., N.S., C.M., P.W.S.), and Division of Cardiology, Department of Internal Medicine (A.K., W.V.), University of Texas Southwestern Medical Center, Dallas
| | - Wanpen Vongpatanasin
- From the Department of Pediatrics, Center for Pulmonary and Vascular Biology (K.T., N.S., C.M., P.W.S.), and Division of Cardiology, Department of Internal Medicine (A.K., W.V.), University of Texas Southwestern Medical Center, Dallas
| | - Chieko Mineo
- From the Department of Pediatrics, Center for Pulmonary and Vascular Biology (K.T., N.S., C.M., P.W.S.), and Division of Cardiology, Department of Internal Medicine (A.K., W.V.), University of Texas Southwestern Medical Center, Dallas
| | - Philip W Shaul
- From the Department of Pediatrics, Center for Pulmonary and Vascular Biology (K.T., N.S., C.M., P.W.S.), and Division of Cardiology, Department of Internal Medicine (A.K., W.V.), University of Texas Southwestern Medical Center, Dallas.
| |
Collapse
|
20
|
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: 70] [Impact Index Per Article: 7.0] [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.
Collapse
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
| |
Collapse
|
21
|
Kim KH, Kim W, Hwang SH, Kang WY, Cho SC, Kim W, Jeong MH. The CHA2DS2VASc score can be used to stratify the prognosis of acute myocardial infarction patients irrespective of presence of atrial fibrillation. J Cardiol 2015; 65:121-7. [DOI: 10.1016/j.jjcc.2014.04.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/06/2014] [Accepted: 04/21/2014] [Indexed: 12/22/2022]
|
22
|
High sensitive C-reactive protein and the risk of acute kidney injury among ST elevation myocardial infarction patients undergoing primary percutaneous intervention. Clin Exp Nephrol 2014; 19:838-43. [PMID: 25492251 DOI: 10.1007/s10157-014-1071-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/04/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Elevated periprocedural high sensitive C-reactive protein (hs-CRP) was shown to be associated with an increased risk for acute kidney injury (AKI) in non-myocardial infarction (MI) patients undergoing percutaneous coronary intervention (PCI), however, no information to date is present regarding its predicting role for AKI in MI patients. We evaluated whether admission serum hs-CRP levels may predict risk of AKI among ST elevation MI (STEMI) patients undergoing primary PCI. METHODS Five hundred and sixty-two patients that were admitted with STEMI and treated with primary PCI were included in the study. Serum hs-CRP levels were determined from blood samples taken prior to PCI. Patients' medical records were reviewed for occurrence of AKI, in-hospital complications and 30 days mortality. RESULTS Mean age was 62 ± 16 and 455 (80 %) were males. Patients were divided into two groups, according to their admission hs-CRP values: group 1: hs-CRP ≤9 mg/l (n = 394) and group 2: hs-CRP >9 mg/l (n = 168). Patients with hs-CRP >9 mg/l had significantly higher rate of AKI following PCI (17 vs. 6 %; p < 0.001), more in-hospital complications and higher30 -day mortality rate (11 vs. 1 %; p = 0.02). In a multivariable logistic regression model admission hs-CRP level >9 mg/l was an independent predictor for AKI (OR 2.7, 95 % CI: 1.39-5.29; p = 0.001) and a strong trend for 30 day mortality (OR 4.27, 95 % CI: 0.875-21.10; p = 0.07). CONCLUSION Admission serum hs-CRP level >9 mg/l is an independent predictor for AKI following primary PCI in STEMI patients.
Collapse
|
23
|
Turker Y, Ekinozu I, Turker Y, Akkaya M. High levels of high-sensitivity C-reactive protein and uric acid can predict disease severity in patients with mitral regurgitation. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
24
|
High levels of high-sensitivity C-reactive protein and uric acid can predict disease severity in patients with mitral regurgitation. Rev Port Cardiol 2014; 33:699-706. [DOI: 10.1016/j.repc.2014.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 02/10/2014] [Accepted: 03/31/2014] [Indexed: 11/21/2022] Open
|
25
|
Doi M, Nosaka K, Miyoshi T, Iwamoto M, Kajiya M, Okawa K, Nakayama R, Takagi W, Takeda K, Hirohata S, Ito H. Early eicosapentaenoic acid treatment after percutaneous coronary intervention reduces acute inflammatory responses and ventricular arrhythmias in patients with acute myocardial infarction: A randomized, controlled study. Int J Cardiol 2014; 176:577-82. [DOI: 10.1016/j.ijcard.2014.08.055] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 08/07/2014] [Accepted: 08/09/2014] [Indexed: 01/18/2023]
|
26
|
Sheriff A, Schindler R, Vogt B, Abdel-Aty H, Unger JK, Bock C, Gebauer F, Slagman A, Jerichow T, Mans D, Yapici G, Janelt G, Schröder M, Kunze R, Möckel M. Selective apheresis of C-reactive protein: a new therapeutic option in myocardial infarction? J Clin Apher 2014; 30:15-21. [PMID: 25044559 DOI: 10.1002/jca.21344] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/17/2014] [Accepted: 06/20/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is substantial evidence that C-reactive protein (CRP) mediates secondary damage of the myocardium after acute myocardial infarction (AMI). The aim of this animal trial in pigs was to specifically deplete CRP from porcine plasma after AMI and to study possible beneficial effects of the reduced CRP concentration on the infarcted area. METHODS Ten pigs received balloon catheter-induced myocardial infarction. CRP was depleted from five animals utilizing a new specific CRP-adsorber, five animals served as controls. The area of infarction was analyzed by cardiovascular magnetic resonance imaging on day 1 and day 14 after AMI. Porcine CRP levels were determined by ELISA. RESULTS CRP-apheresis resulted in a mean reduction of the CRP levels up to 48.3%. The area of infarction was significantly reduced by 30 ± 6% (P = 0.003) within 14 days in the treatment group, whereas it increased by 19 ± 11% (P = 0.260) in the controls. Fourteen days after infarction, the infarcted area revealed compact, transmural scars in the controls, whereas animals receiving CRP-apheresis showed spotted scar morphology. In the interventional group, a significantly higher left ventricular ejection fraction (LVEF) was observed after 14 days as compared to the controls (57.6 ± 2.4% vs. 46.4 ± 2.7%; P = 0.007). CONCLUSIONS In a pig model for AMI, we observed that selective CRP-apheresis significantly reduces CRP levels and the volume of the infarction zone after AMI. Additionally, it changes the morphology of the scars and preserves cardiac output (LVEF).
Collapse
Affiliation(s)
- Ahmed Sheriff
- Department of Nephrology and Internal Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Shacham Y, Topilsky Y, Leshem-Rubinow E, Arbel Y, Ben Assa E, Keren G, Roth A, Steinvil A. Association between C-reactive protein level and echocardiography assessed left ventricular function in first ST-segment elevation myocardial infarction patients who underwent primary coronary intervention. J Cardiol 2014; 63:402-8. [DOI: 10.1016/j.jjcc.2013.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/16/2013] [Accepted: 10/25/2013] [Indexed: 10/26/2022]
|
28
|
Youn JC, Yu HT, Jeon JW, Lee HS, Jang Y, Park YW, Park YB, Shin EC, Ha JW. Soluble CD93 levels in patients with acute myocardial infarction and its implication on clinical outcome. PLoS One 2014; 9:e96538. [PMID: 24801400 PMCID: PMC4011875 DOI: 10.1371/journal.pone.0096538] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/09/2014] [Indexed: 11/19/2022] Open
Abstract
Background Inflammation plays a key role in the pathogenesis of acute myocardial infarction (MI). However, it is unclear whether marker of immune activation will provide prognostic information in these patients. We hypothesized that circulating levels of soluble CD93 (sCD93), a soluble form of transmembrane glycoprotein CD93, is increased in acute MI patients and its level would be associated with clinical outcomes in patients with acute MI. Methods We measured circulating levels of sCD93 in 120 patients with acute MI (63±13 yrs, M∶F = 85∶35) and in 120 age, sex-matched control subjects. In patients with acute MI, clinical characteristics, echocardiographic and laboratory findings were assessed at the time of initial enrollment. The primary outcome was defined as all-cause and cardiovascular death. Results Circulating sCD93 levels were significantly higher in patients with acute MI than in control subjects (552.1±293.7 vs. 429.8±114.2 ng/mL, p<0.0001). Upon in vitro inflammatory stimulation, increased CD93 shedding was demonstrated in acute MI patients but not in control subjects. During follow up period (median 208 days, 3-1058 days), the primary outcome occurred in 18 (15%) patients (9 cardiovascular deaths). Circulating levels of sCD93 were associated with all cause (p<0.0001) and cardiovascular (p<0.0001) mortality in patients with acute MI. Multivariate Cox regression analysis revealed that initial sCD93 level was found to be an independent predictor of all cause (p = 0.002) and cardiovascular mortality (p = 0.033) when controlled for age and left ventricular ejection fraction. Conclusions Circulating levels of sCD93 are elevated in patients with acute MI and their levels were associated with adverse clinical outcomes.
Collapse
Affiliation(s)
- Jong-Chan Youn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Laboratory of Immunology and Infectious Diseases, Graduate School of Medical Science and Engineering, KAIST, Daejeon, Republic of Korea
| | - Hee Tae Yu
- Laboratory of Immunology and Infectious Diseases, Graduate School of Medical Science and Engineering, KAIST, Daejeon, Republic of Korea
| | - Jae-Won Jeon
- Therapeutic Antibody Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
| | - Hye Sun Lee
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Yonsei Cardiovascular Genome Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Woo Park
- Therapeutic Antibody Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eui-Cheol Shin
- Laboratory of Immunology and Infectious Diseases, Graduate School of Medical Science and Engineering, KAIST, Daejeon, Republic of Korea
- * E-mail: (E-CS); (J-WH)
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail: (E-CS); (J-WH)
| |
Collapse
|
29
|
C-reactive protein and coronary heart disease: all said--is not it? Mediators Inflamm 2014; 2014:757123. [PMID: 24808639 PMCID: PMC3997990 DOI: 10.1155/2014/757123] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/05/2014] [Indexed: 01/04/2023] Open
Abstract
C-reactive protein (CRP) and coronary heart disease (CHD) have been the subject of intensive investigations over the last decades. Epidemiological studies have shown an association between moderately elevated CRP levels and incident CHD whereas genetic studies have shown that polymorphisms associated with elevated CRP levels do not increase the risk of ischemic vascular disease, suggesting that CRP might be a bystander rather than a causal factor in the progress of atherosclerosis. Beside all those epidemiological and genetic studies, the experimental investigations also try to reveal the role of CRP in the progress of atherosclerosis. This review will highlight the complex results of genomic, epidemiological, and experimental studies on CRP and will show why further studies investigating the relationship between CRP and atherosclerosis might be needed.
Collapse
|
30
|
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: 2.9] [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.
Collapse
Affiliation(s)
- Giuseppe Lippi
- Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma , Parma , Italy and
| | | |
Collapse
|
31
|
Fiechter M, Ghadri JR, Jaguszewski M, Siddique A, Vogt S, Haller RB, Halioua R, Handzic A, Kaufmann PA, Corti R, Lüscher TF, Templin C. Impact of inflammation on adverse cardiovascular events in patients with acute coronary syndromes. J Cardiovasc Med (Hagerstown) 2013; 14:807-14. [PMID: 23572059 DOI: 10.2459/jcm.0b013e3283609350] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIMS Inflammation is a key factor in the long-term outcome of acute coronary syndromes (ACS). The aim of the present study was to evaluate inflammatory markers in patients with ACS as predictors for major adverse cardiovascular events (MACE) and hard events. METHODS This study included 1548 patients with ACS. C-reactive protein (CRP), white blood count (WBC), and their subtypes were analyzed during hospitalization. Receiver operator characteristic (ROC) and Kaplan-Meier survival curves were used to assess the predictive value and hard events (nonfatal myocardial infarction and cardiac death) and MACE (hard events, hospitalization for cardiac causes, late revascularization and stroke) were obtained during 30 days. RESULTS ROC analysis of CRP and WBC to predict adverse events revealed cut-offs of 47.5 ng/l and 16.6 × 10/μl for MACE and 93.5 ng/l and 16.6 × 10/μl for hard events. The cumulative adverse event rates were significantly higher in patients with increased CRP (≥47.5 ng/l; 17 versus 4%, P < 0.001) and WBC (≥16.6 × 10/μl; 21 versus 5%, P < 0.001) for MACE and with elevated CRP (≥93.5 ng/l; 16 versus 2%, P < 0.001) and WBC (≥16.6 × 10/μl; 18 versus 2%, P < 0.001) for hard events, demonstrating highest event rates with elevation of both inflammatory markers: (28 versus 5%, P < 0.001) for MACE and (26 versus 2%, P < 0.001) for hard events. Analysis of CRP and WBC further revealed a substantial negative correlation with left ventricular function (P < 0.001). Moreover, markers of myocardial damage were significantly elevated in patients with abnormal CRP or WBC (P < 0.001). CONCLUSION Inflammatory markers such as CRP and WBC alone and, particularly, in combination are strong and independent predictors of outcome in patients with ACS.
Collapse
Affiliation(s)
- Michael Fiechter
- aDepartment of Cardiology, Cardiovascular Center bDepartment of Radiology, Cardiac Imaging, University Hospital Zurich cZurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland *Authors Michael Fiechter and Jelena R. Ghadri contributed equally to the writing of this work
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Sim DS, Ahn Y. Novel inflammatory biomarkers in acute coronary syndrome. Korean J Intern Med 2013; 28:156-8. [PMID: 23526870 PMCID: PMC3604603 DOI: 10.3904/kjim.2013.28.2.156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 02/22/2013] [Indexed: 11/27/2022] Open
Affiliation(s)
- Doo Sun Sim
- Division of Cardiovascular Medicine, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Youngkeun Ahn
- Division of Cardiovascular Medicine, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| |
Collapse
|
33
|
Zamani P, Schwartz GG, Olsson AG, Rifai N, Bao W, Libby P, Ganz P, Kinlay S. Inflammatory biomarkers, death, and recurrent nonfatal coronary events after an acute coronary syndrome in the MIRACL study. J Am Heart Assoc 2013; 2:e003103. [PMID: 23525424 PMCID: PMC3603244 DOI: 10.1161/jaha.112.003103] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background In acute coronary syndromes, C‐reactive protein (CRP) strongly relates to subsequent death, but surprisingly not to recurrent myocardial infarction. Other biomarkers may reflect different processes related to these outcomes. We assessed 8 inflammatory and vascular biomarkers and the risk of death and recurrent nonfatal cardiovascular events in the 16 weeks after an acute coronary syndrome. Methods and Results We measured blood concentrations of CRP, serum amyloid A (SAA), interleukin‐6 (IL‐6), soluble intercellular adhesion molecule (ICAM), soluble vascular cell adhesion molecule (VCAM), E‐selectin, P‐selectin, and tissue plasminogen activator antigen (tPA) 24 to 96 hours after presentation with acute coronary syndrome in 2925 subjects participating in a multicenter study. Biomarkers were related to the risk of death, and recurrent nonfatal acute coronary syndromes (myocardial infarction or unstable angina) over 16 weeks using Cox proportional hazard models. On univariate analyses, baseline CRP (P=0.006), SAA (P=0.012), and IL‐6 (P<0.001) were related to death, but not to recurrent nonfatal acute coronary syndromes. VCAM and tPA related to the risk of death (P<0.001, P=0.021, respectively) and to nonfatal acute coronary syndromes (P=0.021, P=0.049, respectively). Adjusting for significant covariates reduced the strength of the associations; however, CRP and SAA continued to relate to death. Conclusions In acute coronary syndromes, the CRP inflammatory axis relates to the risk of death and may reflect myocardial injury. VCAM and tPA may have greater specificity for processes reflecting inflammation and thrombosis in the epicardial arteries, which determine recurrent coronary events.
Collapse
Affiliation(s)
- Payman Zamani
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Hong YJ, Jeong MH, Ahn Y, Kim SW, Bae JH, Hur SH, Ahn TH, Rha SW, Kim KS, Chae IH, Kim JH, Yun KH, Oh SK. Effect of pitavastatin treatment on changes of plaque volume and composition according to the reduction of high-sensitivity C-reactive protein levels. J Cardiol 2012; 60:277-82. [DOI: 10.1016/j.jjcc.2012.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 03/15/2012] [Accepted: 04/11/2012] [Indexed: 11/30/2022]
|
35
|
Circulating microparticles generate and transport monomeric C-reactive protein in patients with myocardial infarction. Cardiovasc Res 2012; 96:64-72. [DOI: 10.1093/cvr/cvs237] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
|
36
|
van Loon JE, de Maat MPM, Deckers JW, van Domburg RT, Leebeek FWG. Prognostic markers in young patients with premature coronary heart disease. Atherosclerosis 2012; 224:213-7. [PMID: 22818563 DOI: 10.1016/j.atherosclerosis.2012.06.067] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 06/27/2012] [Accepted: 06/28/2012] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the survival and prognostic implications of cardiovascular, inflammatory and prothrombotic risk factors in young patients with premature coronary heart disease (CHD). METHODS Follow-up data were obtained from 353 young patients with a first cardiac event (men ≤45 years and women ≤55 years). Baseline characteristics on traditional risk factors were collected at the time of the first event, and plasma levels of C-reactive protein (CRP), von Willebrand Factor (VWF), and fibrinogen were measured one to three months after the first event to exclude an acute phase response. We performed age and sex adjusted Cox regression analyses to assess the relationship between these factors and recurrent events with three different endpoints: all cause mortality, recurrent cardiac event (myocardial infarction or revascularisation procedure), and any recurrent event (cardiac event, cerebrovascular event or all cause mortality). RESULTS During a total follow-up time of 1483 person years (mean 4.2 years), 11 patients died (3%), 42 patients had a recurrent cardiac event (12%), and 53 patients had any recurrent event (15%). CRP was associated with an increased risk of any recurrent event (HR 1.28[95% CI = 1.02-1.59] per unit increase in lnCRP). Also, both CRP (5.00[1.04-24.04]) and fibrinogen (5.04[1.05-24.23]) were associated with all cause mortality when levels were above the 50th percentile. CONCLUSIONS Fifteen percent of young patients with a first cardiac event have a recurrent event or die within a median follow-up of 4.2 years. In these young patients we have shown that, independently of cardiovascular risk factors, high CRP levels contribute to the risk of recurrent events, including all cause mortality, and high fibrinogen levels are associated with all cause mortality.
Collapse
Affiliation(s)
- Janine E van Loon
- Department of Haematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | | | | |
Collapse
|
37
|
Mayr A, Klug G, Schocke M, Trieb T, Mair J, Pedarnig K, Pachinger O, Jaschke W, Metzler B. Late microvascular obstruction after acute myocardial infarction: Relation with cardiac and inflammatory markers. Int J Cardiol 2012; 157:391-6. [DOI: 10.1016/j.ijcard.2010.12.090] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 11/30/2010] [Accepted: 12/23/2010] [Indexed: 10/18/2022]
|
38
|
Kalogeropoulos AP, Georgiopoulou VV, Butler J. From Risk Factors to Structural Heart Disease: The Role of Inflammation. Heart Fail Clin 2012; 8:113-23. [DOI: 10.1016/j.hfc.2011.08.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
39
|
Poole L, Dickens C, Steptoe A. The puzzle of depression and acute coronary syndrome: reviewing the role of acute inflammation. J Psychosom Res 2011; 71:61-8. [PMID: 21767684 PMCID: PMC3143279 DOI: 10.1016/j.jpsychores.2010.12.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 11/12/2010] [Accepted: 12/14/2010] [Indexed: 12/27/2022]
Abstract
The relationship between depression and coronary heart disease is well-established, but causal mechanisms are poorly understood. The aim of this review is to stimulate different ways of viewing the relationship between depression and adverse outcomes following acute coronary syndrome (ACS) and coronary artery bypass graft (CABG) surgery patients. We present an argument for depression in ACS and CABG patients being a qualitatively distinct form from that observed in psychiatric populations. This is based on three features: (1) depression developing after cardiac events has been linked in many studies to poorer outcomes than recurrent depression; (2) somatic symptoms of depression following cardiac events are particularly cardiotoxic; (3) depression following an ACS does not respond well to antidepressant treatments. We propose that inflammation is a common causal process responsible in part both for the development of depressive symptoms and for adverse cardiac outcomes, and we draw parallels with inflammation-induced sickness behaviour. Clinical implications of our observations are discussed along with suggestions for further work to advance the field.
Collapse
Affiliation(s)
- Lydia Poole
- Department of Epidemiology and Public Health, University College London, London, UK.
| | | | | |
Collapse
|
40
|
Nagesh CM, Roy A. Role of biomarkers in risk stratification of acute coronary syndrome. Indian J Med Res 2011; 132:627-33. [PMID: 21150016 PMCID: PMC3028962 DOI: 10.4103/0971-5916.73419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Diagnosis of acute coronary syndrome (ACS) encompasses a wide spectrum of myocardial ischaemia varying from assuredly benign to potentially fatal. Cardiac biomarkers have had a major impact on the management of this disease and are now the cornerstone in its diagnosis and prognosis. In this review we discuss both the established and the newer emerging biomarkers in ACS and their role in highlighting not only myocardial necrosis but also different facets of the pathophysiology of ACS. The future of cardiac biomarker testing may be in multimarker testing to better characterize each patient of ACS and thus tailor both short-term and long-term therapy accordingly. This novel concept, however, needs to be tested in clinical trials for its incremental value and cost-effectiveness.
Collapse
Affiliation(s)
- C M Nagesh
- Department of Cardiology, Cardio-Thoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | | |
Collapse
|
41
|
Admission C-reactive protein and short- as well as long-term mortality in diabetic versus non-diabetic patients with incident myocardial infarction. Clin Res Cardiol 2010; 99:817-23. [PMID: 20596713 DOI: 10.1007/s00392-010-0193-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 06/17/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND To investigate the association between admission C-reactive protein (CRP) levels and 28-day case fatality as well as long-term mortality after an incident acute myocardial infarction (AMI) in non-diabetic and diabetic patients. METHODS The study was based on 461 diabetic and 1,124 non-diabetic persons consecutively hospitalized with a first-ever MI between January 1998 and December 2003 recruited from a population-based MI registry. The study population was stratified into two groups of admission CRP concentrations (cut-off point median </≥0.5 mg/dl). RESULTS The patients were followed up until 31st December 2005 (median follow-up time of 4.0 years). After multivariable adjustment the odds ratio (OR) (95% confidence interval) for 28-day case fatality among those with high admission CRP values in comparison to persons with low CRP values were 2.55 (1.52-4.28) for the overall population, 2.53 (1.29-4.96) for non-diabetic patients, and 2.75 (1.18-6.37) for diabetic patients. Admission CRP concentration was also associated with long-term mortality. After multivariable adjustment persons with high admission CRP values had a relative risk of 1.90 (95% CI 1.36-2.65) for all-cause mortality compared with those who had CRP values below the median; the corresponding HR in non-diabetic persons was 2.15 (95% CI 1.38-3.35) and in diabetic persons it was 1.38 (95% CI 0.83-2.30). CONCLUSIONS Admission CRP is a strong risk marker of bad short-term prognosis after an incident AMI. However, in contrast to non-diabetic patients in diabetic patients, admission CRP is not independently associated with long-term prognosis.
Collapse
|
42
|
Verouden NJ, Haeck JD, Kuijt WJ, van Geloven N, Koch KT, Henriques JP, Baan J, Vis MM, van Straalen JP, Fischer J, Piek JJ, Tijssen JG, de Winter RJ. Comparison of the usefulness of N-terminal pro-brain natriuretic peptide to other serum biomarkers as an early predictor of ST-segment recovery after primary percutaneous coronary intervention. Am J Cardiol 2010; 105:1047-52. [PMID: 20381651 DOI: 10.1016/j.amjcard.2009.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 12/01/2009] [Accepted: 12/01/2009] [Indexed: 10/19/2022]
Abstract
Data on the ability of serum biomarkers to predict microvascular obstruction by ST-segment recovery after primary percutaneous coronary intervention (PCI) is largely absent. Therefore, we determined the association between 5 serum biomarkers, obtained before emergency coronary angiography, and immediate ST-segment recovery in patients who had undergone primary PCI for ST-segment elevation myocardial infarction. We measured N-terminal pro-brain natriuretic peptide (NT-pro-BNP), cardiac troponin T, creatinine kinase-MB fraction, high-sensitivity C-reactive protein, and serum creatinine from blood samples obtained through the arterial sheath at the start of primary PCI. Serial 12-lead electrocardiograms were recorded in the catheterization laboratory before arterial puncture and at the end of the PCI. ST-segment recovery was defined as incomplete if <50%. Of 662 included patients with ST-segment elevation myocardial infarction, 338 (51%) had incomplete ST-segment recovery. An elevated NT-pro-BNP level (> or = 608 ng/L) was the strongest predictor of incomplete ST-segment recovery (adjusted odds ratio 2.6, 95% confidence interval 1.6 to 4.1; p <0.001) compared to other serum biomarkers and clinical predictors. An elevated NT-pro-BNP level was more strongly predictive in patients without a history of coronary artery disease or hypertension (adjusted odds ratio 4.7, 95% confidence interval 2.4 to 9.2; p <0.001). NT-pro-BNP was the best contributor to both net reclassification (0.43; p <0.001) and integrated discrimination improvement (0.04; p <0.001) when added to a multivariate model with clinical predictors of incomplete ST-segment recovery. In conclusion, NT-pro-BNP was the strongest independent predictor of ST-segment recovery at the end of primary PCI for ST-segment elevation myocardial infarction compared to the other serum biomarkers reflecting myocardial cell damage, renal function, and inflammation.
Collapse
|
43
|
Arruda-Olson AM, Enriquez-Sarano M, Bursi F, Weston SA, Jaffe AS, Killian JM, Roger VL. Left ventricular function and C-reactive protein levels in acute myocardial infarction. Am J Cardiol 2010; 105:917-21. [PMID: 20346306 PMCID: PMC2847591 DOI: 10.1016/j.amjcard.2009.11.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 11/13/2009] [Accepted: 11/13/2009] [Indexed: 11/17/2022]
Abstract
To examine left ventricular (LV) function in patients after acute myocardial infarction (AMI) and assess its relation to C-reactive protein (CRP) as a measure of the early inflammatory response. We measured the CRP levels early after AMI and correlated them with the early structural and functional cardiac alterations. From November 2002 to December 2007, we prospectively enrolled community subjects who had experienced an AMI, as defined by standardized criteria, measured the CRP level, and obtained an echocardiogram. The study consisted of 514 patients (mean age 67 +/- 15 years, 59% men). CRP was measured early after symptom onset (median 6.1 hours; twenty-fifth to seventy-fifth percentile 2.2 to 11.1). The median CRP level was 4.8 mg/L (twenty-fifth to seventy-fifth percentile 1.8 to 24). The echocardiograms were obtained at a median of 1 day after AMI. The wall motion score index, LV ejection fraction, and LV diameter were similar across the CRP tertiles (all p >0.05). Greater CRP levels were associated with the presence of moderate or severe diastolic dysfunction (p = 0.002) and moderate or severe mitral regurgitation (p <0.001). The association with moderate or severe mitral regurgitation was independent of the clinical characteristics and ST-segment elevation status. In conclusion, at the initial phase of AMI, CRP elevation was associated with the presence and severity of mitral regurgitation and diastolic dysfunction. This suggests that inflammation is related to the ventricular remodeling processes, independently of LV systolic function.
Collapse
Affiliation(s)
- Adelaide M. Arruda-Olson
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, 55905
- Department of Health Science Research, Mayo Clinic College of Medicine, Rochester, MN, 55905
| | | | | | - Susan A. Weston
- Department of Health Science Research, Mayo Clinic College of Medicine, Rochester, MN, 55905
| | - Allan S. Jaffe
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, 55905
| | - Jill M. Killian
- Department of Health Science Research, Mayo Clinic College of Medicine, Rochester, MN, 55905
| | - Véronique L. Roger
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, 55905
- Department of Health Science Research, Mayo Clinic College of Medicine, Rochester, MN, 55905
| |
Collapse
|
44
|
Aronson D. Inflammatory markers: linking unstable plaques to coronary event, an interventional perspective. ACTA ACUST UNITED AC 2009; 6:110-8. [PMID: 16146903 DOI: 10.1080/14628840410030522] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Abundant data links inflammatory mechanisms to atheromatous plaque destabilization leading to plaque rupture and coronary events. The discovery of inflammatory cells and inflammatory mediators within atherosclerotic plaques prone to rupture led to a series of studies demonstrating an association between various markers of inflammation and future coronary events. Inflammatory markers have also been used in patients undergoing coronary angioplasty in an attempt to predict restenosis and risk for post-procedural coronary events. This review article provides an overview on the potential use of inflammatory markers in the context of coronary interventions.
Collapse
Affiliation(s)
- Doron Aronson
- Department of Cardiology, Rambam Medical Center, Haifa, Israel.
| |
Collapse
|
45
|
Blumenfeld Z, Boulman N, Leiba R, Siegler E, Shachar S, Linn R, Levy Y. High C‐reactive protein levels are associated with oral hormonal menopausal therapy but not with intrauterine levonorgestrel and transdermal estradiol. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 67:257-63. [PMID: 17454839 DOI: 10.1080/00365510601113241] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Oral hormone replacement therapy (HRT) has been linked to increased cardiovascular (CVD) morbidity. HRT causes a sustained increase in C-reactive protein (CRP), an excellent marker of subclinical inflammation and CVD. The aim of the study was to support our hypothesis that CRP, which is synthesized in the liver, is not increased in association with transdermal/intrauterine HRT. MATERIAL AND METHODS A case-control study was performed in which CRP measurements in women receiving levonorgestrel intrauterine system combined with transdermal estradiol (LNG/TDE, n=27) were followed for 9 months or longer. CRP concentrations in these women were compared with those of either oral HRT users (n=20) or controls (n=19). RESULTS No significant differences were found in CRP concentrations between the LGN/TDE and control groups (1.8+/-1.2 and 1.8+/-1.8 mg/L, respectively). However, CRP was significantly increased in the oral HRT group (5.5+/-2.9 mg/L, p<0.001). CONCLUSIONS CRP is significantly increased by oral HRT but not by the LNG/TDE combination after 9 months of treatment. This trend may explain the preponderance of some menopausal women on HRT being at increased risk for the development of CVD. Therefore, the use of LNG/TDE is acceptable for relief of severe climacteric symptoms possibly not imposing an increased CVD risk documented upon oral HRT.
Collapse
Affiliation(s)
- Z Blumenfeld
- Reproductive Endocrinology, Rambam Medical Center Technion-Israel Institute of Technology, Haifa, Israel.
| | | | | | | | | | | | | |
Collapse
|
46
|
Beygui F, Montalescot G, Vicaut E, Rouanet S, Van Belle E, Baulac C, Degrandsart A, Dallongeville J. Aldosterone and long-term outcome after myocardial infarction: A substudy of the french nationwide Observatoire sur la Prise en charge hospitalière, l'Evolution à un an et les caRactéristiques de patients présentant un infArctus du myocarde avec ou sans onde Q (OPERA) study. Am Heart J 2009; 157:680-7. [PMID: 19332195 DOI: 10.1016/j.ahj.2008.12.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Accepted: 12/15/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND High plasma aldosterone levels at presentation are correlated to poor outcome after ST elevation acute myocardial infarction (AMI). Whether there is a relationship between aldosterone levels and outcome in a broader spectrum of patients admitted for AMI defined by the new definition based on troponin levels remains unknown. METHODS Plasma aldosterone, C-reactive protein, and brain natriuretic peptide (BNP) were measured in 471 patients, 24 and 72 hours after admission for AMI defined by the new definition. The primary outcome was the composite of death, resuscitated cardiac arrest, recurrent/extended myocardial infarction, recurrent ischemia, heart failure, and stroke. RESULTS The highest aldosterone levels quartile at 24 hours was significantly associated with the occurrence of the primary outcome (P < .0001), death (P < .05), heart failure (P < .05), ventricular (P < .0001) and supraventricular arrhythmias (P < .05), and acute renal failure (P < .01) during the in-hospital period, and higher rates of mortality (P < .05) at 1-year follow-up. Independent correlates of the primary outcome at 1 year were age > or =73 (odds ratio [OR] 2.22 [1.38-3.57]), heart failure (OR 6.46 [1.99-20.98]), 24-hour aldosterone > or =103.6 pg.mL(-1) (OR 1.72 [1.07-2.77]), and BNP > or =389 pg.mL(-1) (OR 2.35 [1.44-3.84]) concentrations. The model applied to the 72-hour variables, identified the same correlates. CONCLUSIONS Using the new definition of AMI, based on troponin levels, regardless of ST-segment elevation and management strategies, high aldosterone concentration is associated with major adverse in-hospital events and is an independent correlate of clinical outcome at 1 year. These findings warrant trials assessing the benefit of early aldosterone blockade in such patients.
Collapse
|
47
|
Araújo JP, Lourenço P, Azevedo A, Friões F, Rocha-Gonçalves F, Ferreira A, Bettencourt P. Prognostic value of high-sensitivity C-reactive protein in heart failure: a systematic review. J Card Fail 2008; 15:256-66. [PMID: 19327628 DOI: 10.1016/j.cardfail.2008.10.030] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 09/26/2008] [Accepted: 10/24/2008] [Indexed: 01/30/2023]
Abstract
BACKGROUND Several studies have suggested that high-sensitivity C-reactive protein (hsCRP) is a strong independent predictor of acute myocardial infarction and cardiovascular death. In the specific heart failure (HF) context, a low-grade inflammatory state can contribute to HF progression. AIMS To perform a systematic review on the current knowledge about low-grade inflammation, as assessed by hsCRP, in the prediction of HF in general and in high-risk populations as well as its prognostic value in established HF. METHODS We used a computerized literature search in the Medline database using the following key words: C-Reactive Protein, Heart Failure, Cardiomyopathy, Cardiac Failure, Prognosis, and Death. Articles were selected if they had measurements of hsCRP in different patient samples and reference to outcomes in terms of morbidity and mortality. RESULTS hsCRP is associated with incident HF in general and high-risk populations and provides prognostic information in HF patients. In almost all studies, the association of hsCRP with clinical events was independent of other baseline variables known to influence morbidity and mortality. Very different cutoffs have been proposed in each context across studies. CONCLUSIONS The prognostic power of hsCRP, whether we consider incident HF or adverse outcomes in established HF, is consistent in different patient populations.
Collapse
Affiliation(s)
- José Paulo Araújo
- Heart Failure Clinic, Serviço de Medicina Interna, Hospital S. João, Unidade I&D Cardiovascular do Porto, Porto, Portugal
| | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
Modestly elevated baseline concentrations of C-reactive protein (CRP), the classical acute phase protein, are associated with the long-term risk of coronary heart disease in general populations, whilst the major acute phase response of CRP following myocardial infarction is associated with death and cardiac complications. The pathogenic and clinical significance of these associations is controversial. Here we critically review the evidence and describe large-scale epidemiological studies, novel experiments and possible specific therapies which will rigorously inform the debate. We distinguish between the potential pathogenicity of high acute phase circulating CRP concentrations in individuals with substantial tissue damage and modest but persistent increases in baseline values in generally healthy subjects.
Collapse
Affiliation(s)
- J P Casas
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University College London, London, UK
| | | | | | | | | |
Collapse
|
49
|
Clinical utility of C-reactive protein measured at admission, hospital discharge, and 1 month later to predict outcome in patients with acute coronary disease. The RISCA (recurrence and inflammation in the acute coronary syndromes) study. J Am Coll Cardiol 2008; 51:2339-46. [PMID: 18549920 DOI: 10.1016/j.jacc.2008.03.019] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 03/03/2008] [Accepted: 03/04/2008] [Indexed: 01/29/2023]
Abstract
OBJECTIVES This study was designed to prospectively determine, in patients with an acute coronary syndrome, whether the inflammatory marker, C-reactive protein (CRP), measured at hospital admission, discharge, and 1 month later has incremental value to predict outcomes at 1 year. BACKGROUND The clinical utility of CRP measurements in patients with acute coronary syndromes remains uncertain. Limitations of previous studies have been retrospective design and incomplete adjustment for readily available clinical prognosticators. METHODS The CRP marker was measured at admission, hospital discharge, and 1 month later in consecutive patients hospitalized for acute coronary syndromes in 8 tertiary and secondary hospitals. The primary outcome was a composite of death, nonfatal myocardial infarction (MI), and unstable angina (UA) with electrocardiogram (ECG) changes at 1 year. RESULTS A total of 1,210 patients, age 62 +/- 12 years, 64% with acute myocardial infarction (MI) and 36% with unstable angina (UA), were recruited. At 1 year, the primary outcome occurred in 142 patients (11.7%) and included 58 deaths (4.8%), 79 nonfatal MIs (6.5%), and 26 UA episodes with ECG changes (2.1%). The unadjusted odds ratios (ORs) (95% confidence intervals) of CRP values at admission, hospital discharge, and 1 month later for the occurrence of the primary outcome were 1.20 (1.06 to 1.36), 0.98 (0.85 to 1.14), and 1.23 (1.00 to 1.50), respectively. After multivariate adjustment, ORs were 1.04 (0.91 to 1.20), 0.90 (0.77 to 1.06), and 1.12 (0.93 to 1.34), respectively. The individual components of the primary outcome were also not independently associated with any of the 3 CRP measurements. CONCLUSIONS The modest predictive ability of CRP following admission for an acute coronary syndrome disappeared after adjusting for common clinical variables. This large prospective study does not support the incremental value of measuring CRP in this clinical setting.
Collapse
|
50
|
Liyan C, Jie Z, Yonghua W, Xiaozhou H. Assay of ischemia-modified albumin and C-reactive protein for early diagnosis of acute coronary syndromes. J Clin Lab Anal 2008; 22:45-9. [PMID: 18200582 DOI: 10.1002/jcla.20223] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Diagnosis of cardiac ischemia in patients coming to emergency departments (ED) with symptoms of acute chest pain is often difficult. Many markers are sensitive and specific for the detection of myocardial necrosis but may not rise during reversible myocardial ischemia. Ischemia-modified albumin (IMA) has recently been shown to be a sensitive and early biochemical marker of ischemia. The variation laws were observed by measuring IMA and C-reactive protein (CRP) of 113 patients in ED within 12 hr after onset of chest pain. In the observation, blood was taken for IMA and CRP. Patients underwent standardized triage, diagnostic procedures, and treatment. Results of IMA and CRP were correlated with final diagnoses of nonischemic chest pain (NICP) and acute coronary syndrome (ACS). There were obvious distinction of IMA and CRP levels between the NICP and ACS groups. Receiver operator characteristic (ROC) curve analysis was used to determine the optimal cutoff of this assay for identifying individuals with ACS patients from NICP. The area under the curves of IMA is 0.948. The sensitivity and specificity of albumin cobalt binding (ACB) at a cutoff value of 70.0 units/mL were 94.4% and 82.6%, respectively. The area under the curves of CRP is 0.746. Sensitivity and specificity of CRP at a cutoff value of 3.16 mg/L were 70.0% and 73.9%, respectively. Negative predictive value (NPV) of IMA and CRP for ischemia origin was 79.2% and 38.6%, respectively. IMA may make an early diagnosis of acute coronary ischemia, and will improve the early diagnostic sensitivity and specificity of ACS.
Collapse
Affiliation(s)
- Cui Liyan
- Department of Laboratory Medicine, Third Hospital, Peking University, Beijing, China
| | | | | | | |
Collapse
|