Circulating Chromogranin B Is Associated With Left Ventricular Functional Recovery After Successful Recanalization of Chronic Total Occlusion

Predictors of Coronary Collateral Circulation in Patients with Acute ST-segment Elevation Myocardial Infarction: A Nomogram-based Approach

Background

Coronary collateral circulation (CCC) is a crucial protective mechanism in acute myocardial infarction. This study aimed to identify early predictors of CCC in patients with acute ST-segment elevation myocardial infarction (STEMI) and develop a nomogram for predicting its presence.

Methods

We conducted a retrospective study of STEMI patients admitted to the Beijing Friendship Hospital from January 2015 to December 2023. Patients with CCC, as confirmed by coronary angiography, were matched 1:3 with those without CCC based on the date of admission. We compared baseline characteristics, laboratory parameters, coronary features, and in-hospital outcomes between the two groups. Variable selection was performed using least absolute shrinkage and selection operator (LASSO) regression analysis, followed by univariable and multivariable logistic regression analyses to identify independent predictors of CCC. A nomogram was constructed based on significant predictors and was validated through receiver operating characteristic (ROC) curve analysis, calibration curves, and decision curve analysis.

Results

A total of 668 patients with STEMI were included in the study (501 without CCC and 167 with CCC). Patients with CCC had a higher prevalence of right coronary artery (RCA) closure and multi-vessel disease, as well as elevated inflammatory markers and altered coagulation parameters. Multivariable logistic regression analysis identified a history of coronary heart disease (CHD), osmolality, levels of fibrinogen, and left anterior descending (LAD) artery closure, left circumflex (LCX) artery closure, and RCA closures, as well as the Gensini score, were independent predictors of CCC. The nomogram incorporating these predictors demonstrated good discrimination and calibration, indicating an accurate prediction of the presence of CCC.

Conclusions

History of CHD, osmolality, levels of fibrinogen, LAD, LCX, and RCA closures, as well as the Gensini score, are independent predictors of CCC in patients with STEMI. The developed nomogram offers a clinically useful tool for identifying patients likely to have CCC, potentially aiding in personalized treatment strategies.

Chromogranin B Protects Human Umbilical Endothelial Cells against Oxidative Stress

Chromogranin B (CgB) is involved in the control of the cardiovascular system through the regulation of catecholamine release. Whether CgB can exert direct actions on the endothelium has not yet been clarified. Here, we aimed to investigate the effects of CgB on cell viability, mitochondrial membrane potential, reactive oxygen species (ROS), glutathione (GSH), nitric oxide (NO) release, and the cytosolic calcium concentration ([Ca2+]c) in human vascular endothelial cells (HUVECs) cultured under both physiological and peroxidative conditions. In HUVECs, experiments were conducted to establish the proper concentration and timing of CgB stimulation. Thereafter, specific assays were used to evaluate the response of HUVECs cultured in physiologic or oxidative stress conditions to CgB in the presence or absence of β-adrenergic receptor agonists and antagonists and intracellular pathways blockers. Analysis of cell viability, mitochondrial membrane potential, and NO release revealed that CgB was able to cause increased effects in HUVECs cultured in physiological conditions. Additionally, the same analyses performed in HUVECs cultured with H2O2, showed protective effects exerted by CgB, which was also able to counteract ROS release and maintain GSH levels. Furthermore, CgB played a dual role on the [Ca2+]c depending on the physiological or peroxidative cell culturing conditions. In conclusion, our data provide new information about the direct role of CgB in the physiological regulation of endothelial function and highlight its potential as a protective agent against peroxidative conditions, such as those found in cardiovascular diseases.

Circulating secretoneurin level reflects angiographic coronary collateralization in stable angina patients with chronic total occlusion

OBJECTIVE

To investigate the association between circulating secretoneurin (SN) and angiographic coronary collateralization in stable angina patients with chronic coronary total occlusion (CTO).

METHODS

SN concentrations in serum were measured in 641 stable angina patients with CTO by radioimmunoassay. The status of coronary collaterals from the contra-lateral vessel was visually estimated using the Rentrop grading system, and was categorized into poor (grade 0 or 1) or good (grade 2 or 3) collateralization.

RESULTS

Serum SN levels were significantly higher in patients with good coronary collaterals compared to those with poor collaterals (175.23 ± 52.09 pmol/L vs. 143.29 ± 42.01 pmol/L, P < 0.001). Serum SN increased stepwise across Rentrop score 0 to 3 (P < 0.001), and increasing SN tertiles were associated with higher proportion of good coronary collateralization (OR, 1.907; 95% CI, 1.558 ~ 2.335, P < 0.001). After adjustment for confounding variables, serum SN (per tertile) remained an independent factor for predicting good coronary collaterals (OR, 1.870; 95% CI, 1.515 ~ 2.309; P < 0.001). Moreover, the diagnostic value of serum SN (per tertile) was consistent after stratifying patients based on gender, age, body mass index, hypertension, diabetes, history of smoking, severity of coronary artery disease and kidney function (OR: 1.511 ~ 2.680, P interaction ≥ 0.327).

CONCLUSION

Elevated circulating SN reflects good angiographic coronary collaterals in stable angina patients with CTO. The findings may provide insight into decision-making for these patients.

Diabetic dyslipidemia impairs coronary collateral formation: An update

Coronary collateralization is substantially impaired in patients with type 2 diabetes and occlusive coronary artery disease, which leads to aggravated myocardial ischemia and a more dismal prognosis. In a diabetic setting, altered serum lipid profiles and profound glycoxidative modification of lipoprotein particles induce endothelial dysfunction, blunt endothelial progenitor cell response, and severely hamper growth and maturation of collateral vessels. The impact of dyslipidemia and lipid-lowering treatments on coronary collateral formation has become a topic of heightened interest. In this review, we summarized the association of triglyceride-based integrative indexes, hypercholesterolemia, increased Lp(a) with its glycoxidative modification, as well as quantity and quality abnormalities of high-density lipoprotein with impaired collateral formation. We also analyzed the influence of innovative lipid-modifying strategies on coronary collateral development. Therefore, clinical management of diabetic dyslipidemia should take into account of its effect on coronary collateralization in patients with occlusive coronary artery disease.