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Chakrala T, Prakash R, Valdes C, Pepine CJ, Keeley EC. Circulating Biomarkers in Coronary Microvascular Dysfunction. J Am Heart Assoc 2023:e029341. [PMID: 37301749 DOI: 10.1161/jaha.122.029341] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Coronary microvascular dysfunction is an underdiagnosed pathologic process that is associated with adverse clinical outcomes. Biomarkers, molecules measurable in the blood, could inform the clinician by aiding in the diagnosis and management of coronary microvascular dysfunction. We present an updated review of circulating biomarkers in coronary microvascular dysfunction representing key pathologic processes, including inflammation, endothelial dysfunction, oxidative stress, coagulation, and other mechanisms.
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Affiliation(s)
- Teja Chakrala
- Department of Medicine University of Florida Gainesville FL USA
| | - Roshni Prakash
- Department of Medicine University of Florida Gainesville FL USA
| | - Carlos Valdes
- Department of Medicine University of Florida Gainesville FL USA
| | - Carl J Pepine
- Department of Medicine University of Florida Gainesville FL USA
- Division of Cardiovascular Medicine University of Florida Gainesville FL USA
| | - Ellen C Keeley
- Department of Medicine University of Florida Gainesville FL USA
- Division of Cardiovascular Medicine University of Florida Gainesville FL USA
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Sucato V, Corrado E, Manno G, Amata F, Testa G, Novo G, Galassi AR. Biomarkers of Coronary Microvascular Dysfunction in Patients With Microvascular Angina: A Narrative Review. Angiology 2021; 73:395-406. [PMID: 34338554 DOI: 10.1177/00033197211034267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The current gold standard for diagnosis of coronary microvascular dysfunction (CMD) in the absence of myocardial diseases, whose clinical manifestation is microvascular angina (MVA), is reactivity testing using adenosine or acetylcholine during coronary angiography. This invasive test can be difficult to perform, expensive, and harmful. The identification of easily obtainable blood biomarkers which reflect the pathophysiology of CMD, characterized by high reliability, precision, accuracy, and accessibility may reduce risks and costs related to invasive procedures and even facilitate the screening and diagnosis of CMD. In this review, we summarized the results of several studies that have investigated the possible relationships between blood biomarkers involved with CMD and MVA. More specifically, we have divided the analyzed biomarkers into 3 different groups, according to the main mechanisms underlying CMD: biomarkers of "endothelial dysfunction," "vascular inflammation," and "oxidative stress." Finally, in the last section of the review, we consider mixed mechanisms and biomarkers which are not included in the 3 major categories mentioned above, but could be involved in the pathogenesis of CMD.
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Affiliation(s)
- Vincenzo Sucato
- Unit of Cardiology, University Hospital Paolo Giaccone, University of Palermo, Palermo, Italy.,Department of Excellence of Sciences for Health Promotion and Maternal-Child Care, Internal Medicine and Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Egle Corrado
- Unit of Cardiology, University Hospital Paolo Giaccone, University of Palermo, Palermo, Italy.,Department of Excellence of Sciences for Health Promotion and Maternal-Child Care, Internal Medicine and Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Girolamo Manno
- Unit of Cardiology, University Hospital Paolo Giaccone, University of Palermo, Palermo, Italy.,Department of Excellence of Sciences for Health Promotion and Maternal-Child Care, Internal Medicine and Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Francesco Amata
- Department of Excellence of Sciences for Health Promotion and Maternal-Child Care, Internal Medicine and Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Gabriella Testa
- Unit of Cardiology, University Hospital Paolo Giaccone, University of Palermo, Palermo, Italy.,Department of Excellence of Sciences for Health Promotion and Maternal-Child Care, Internal Medicine and Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Giuseppina Novo
- Unit of Cardiology, University Hospital Paolo Giaccone, University of Palermo, Palermo, Italy.,Department of Excellence of Sciences for Health Promotion and Maternal-Child Care, Internal Medicine and Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Alfredo R Galassi
- Department of Excellence of Sciences for Health Promotion and Maternal-Child Care, Internal Medicine and Specialties (ProMISE), University of Palermo, Palermo, Italy
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Mahfouz RA, Goda M, Galal I, Ghareb MS. Association of morning blood pressure surge with carotid intima-media thickness and cardiac dysfunction in patients with cardiac syndrome-X. Blood Press 2018; 27:297-303. [DOI: 10.1080/08037051.2018.1476056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Ragab A. Mahfouz
- Cardiology Department, Zagazig University Hospital, Zagazig, Egypt
| | - Mohammad Goda
- Cardiology Department, Zagazig University Hospital, Zagazig, Egypt
| | - Islam Galal
- Cardiology Department, Zagazig University Hospital, Zagazig, Egypt
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Efe SC, Demirci K, Ozturk S, Gurbuz AS, Poci N, Kilicgedik A, Guler A, Yilmaz MF, İzgi IA, Kirma C. Serum endocan levels in patients with cardiac syndrome X. Herz 2017; 43:359-363. [PMID: 28589439 DOI: 10.1007/s00059-017-4580-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/30/2017] [Accepted: 05/10/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Endocan is a recently introduced marker of endothelial dysfunction and is also associated with inflammation and atherosclerosis. To date, the relationship between cardiac syndrome X (CSX) and endocan has not been studied. The objective of this study was to compare the serum endocan levels of patients with CSX with those of control subjects. PATIENTS AND METHODS In this study, 50 patients were included in the CSX group and 28 patients in the control group. Patients with pathological conditions that could potentially influence endothelial functions were excluded. Endocan serum concentrations were measured using an enzyme-linked immunosorbent assay. RESULTS The mean endocan level of the CSX group was significantly higher than that of the control group (3051.3 ± 1900.5 ng/l vs. 2088.1 ± 522.2 ng/l; p = 0.002). There was no difference between the two groups in terms of age, gender, hypertension, diabetes mellitus, dyslipidemia, and smoking status. In receiver operating characteristic (ROC) curve analysis, endocan levels greater than 2072 ng/l had a 72% sensitivity and 54% specificity (p = 0.002) for accurately predicting a diagnosis of CSX. CONCLUSION The results of this study suggest that patients with CSX have higher endocan levels. Therefore, endocan may be valuable in helping uncover the underlying pathogenesis of CSX.
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Affiliation(s)
- S C Efe
- Department of Cardiology, Agrı State Hospital, Fırat mahallesi, 00004, Agrı, Turkey.
| | - K Demirci
- Department of Cardiology, Goztepe Research and Education Hospital, Istanbul, Turkey
| | - S Ozturk
- Department of Cardiology, Haseki Training and Education Hospital, Istanbul, Turkey
| | - A S Gurbuz
- Department of Cardiology, Eskisehir State Hospital, Eskisehir, Turkey
| | - N Poci
- Department of Cardiology, Herz-Zentrum Bodensee Konstanz, Konstanz, Germany
| | - A Kilicgedik
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - A Guler
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - M F Yilmaz
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - I A İzgi
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - C Kirma
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
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The usefulness of plateletcrit to predict cardiac syndrome X in patients with normal coronary angiogram. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:197-201. [PMID: 26677359 PMCID: PMC4631733 DOI: 10.5114/pwki.2015.54013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 02/27/2014] [Accepted: 03/10/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction Cardiac syndrome X (CSX) is a clinical entity defined as the triad of typical angina pectoris on exercise, electrocardiographic or metabolic findings of ischemia and normal epicardial coronary arteries. Platelets, whose amount in the blood is indicated with plateletcrit (PCT), play an important role in inflammatory and thrombotic processes and the physiopathology of cardiovascular events. Aim To investigate the association between cardiac syndrome X and PCT and platelet count. Material and methods A total of 113 patients with normal coronary angiogram were included in the study. Fifty patients with typical chest pain and evidence of myocardial ischemia in non-invasive tests formed the CSX patient group. The control group consisted of 63 age- and gender-matched patients with normal coronary arteries but without angina. Results The mean PCT value of the CSX group was significantly higher than that of the control group (0.22 ±0.06 vs. 0.19 ±0.04; respectively, p=0.03). Higher PCT was found to be associated with the presence of CSX in patients with normal coronary arteries by multivariate logistic regression analysis. Conclusions We suggest that high PCT may predict the presence of cardiac syndrome X in patients with normal coronary arteries. The value of PCT appears additive to conventional expensive methods commonly used in CSX prediction.
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Bastrup-Birk S, Munthe-Fog L, Skjoedt MO, Ma YJ, Nielsen H, Køber L, Nielsen OW, Iversen K, Garred P. Pentraxin-3 level at admission is a strong predictor of short-term mortality in a community-based hospital setting. J Intern Med 2015; 277:562-72. [PMID: 25143177 DOI: 10.1111/joim.12294] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The pattern recognition molecule pentraxin-3 (PTX3) is a novel potential marker of prognosis, as elevated levels are associated with both disease severity and mortality in patients with a wide range of conditions. However, the usefulness of PTX3 as a prognostic biomarker in a general hospital setting is unknown. PATIENTS AND METHODS The study cohort consisted of 1326 unselected, consecutive patients (age >40 years) admitted to a community hospital in Copenhagen, Denmark. Patients were followed until death or for a median of 11.5 years after admission. The main outcome measure was all-cause mortality. Serum samples collected from patients at admission and from 192 healthy control subjects were quantified for PTX3 level by enzyme-linked immunosorbent assay. RESULTS PTX3 was elevated in patients (median 3.7 ng mL(-1) , range 0.5-209.8) compared with healthy nonhospitalized subjects (median 3.5 ng mL(-1) , range 0.0-8.3; P = 0.0003). Elevated PTX3 levels, defined as above the 95th percentile of the concentration in healthy subjects, were associated with increased overall mortality during the study (P < 0.0001). This increase in mortality was greatest in the short term, with an unadjusted hazard ratio (HR) of 6.4 [95% confidence interval (CI) 3.8-11.0] at 28 days after admission, compared to 1.7 (95% CI 1.4-2.0) at the end of follow-up. These results were still significant after adjustment for age, gender and glomerular filtration rate: adjusted HR of 5.0 (95% CI 2.9-8.8) and 1.4 (95% CI 1.2-1.8), respectively. CONCLUSION These results suggest that PTX3 could be a widely applicable marker of short-term mortality in hospitalized patients and may be useful in the initial risk stratification.
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Affiliation(s)
- S Bastrup-Birk
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark
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