1
|
González-Lorenzo Ó, Franco Pelaez JA, Kallmeyer A, Nieto L, Esteban L, Pello A, Aceña Á, Aldamiz G, Tuñón J. Non-coronary atherosclerosis: a marker of poor prognosis in patients undergoing coronary artery bypass surgery. Front Cardiovasc Med 2024; 11:1305162. [PMID: 38464841 PMCID: PMC10921089 DOI: 10.3389/fcvm.2024.1305162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/02/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction The presence of non-coronary atherosclerosis (NCA) in patients with coronary artery disease is associated with a poor prognosis. We have studied whether NCA is also a predictor of poorer outcomes in patients undergoing coronary artery bypass grafting (CABG). Materials and methods This is an observational study involving 567 consecutive patients who underwent CABG. Variables and prognosis were analysed based on the presence or absence of NCA, defined as previous stroke, transient ischaemic attack (TIA), or peripheral artery disease (PAD) [lower extremity artery disease (LEAD), carotid disease, previous lower limb vascular surgery, or abdominal aortic aneurysm (AAA)]. The primary outcome was a combination of TIA/stroke, acute myocardial infarction, new revascularization procedure, or death. The secondary outcome added the need for LEAD revascularization or AAA surgery. Results One-hundred thirty-eight patients (24%) had NCA. Among them, traditional cardiovascular risk factors and older age were more frequently present. At multivariate analysis, NCA [hazard ratio (HR) = 1.84, 95% confidence interval (CI) 1.27-2.69], age (HR = 1.35, 95% CI 1.09-1.67, p = 0.004), and diabetes mellitus (HR = 1.50, 95% CI 1.05-2.15, p = 0.025), were positively associated with the development of the primary outcome, while estimated glomerular filtration rate (HR = 0.86, 95% CI 0.80-0.93, p = 0.001) and use of left internal mammary artery (HR = 0.36, 95% CI 0.15-0.82, p = 0.035), were inversely associated with this outcome. NCA was also an independent predictor of the secondary outcome. Mortality was also higher in NCA patients (27.5% vs. 9%, p < 0.001). Conclusions Among patients undergoing CABG, the presence of NCA doubled the risk of developing cardiovascular events, and it was associated with higher mortality.
Collapse
Affiliation(s)
| | | | - Andrea Kallmeyer
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Luis Nieto
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Laura Esteban
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Ana Pello
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Faculty of Medicine, Autónoma University, Madrid, Spain
| | - Gonzalo Aldamiz
- Department of Cardiac Surgery, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - José Tuñón
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Faculty of Medicine, Autónoma University, Madrid, Spain
- Laboratory Department of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- CIBERCV, ISCIII, Madrid, Spain
| |
Collapse
|
2
|
Kallmeyer A, Pello A, Cánovas E, Aceña Á, González‐Casaus ML, Tarín N, Cristóbal C, Gutiérrez‐Landaluce C, Huelmos A, Rodríguez‐Valer A, González‐Lorenzo Ó, Alonso J, López‐Bescós L, Egido J, Mahillo I, Lorenzo Ó, Tuñón J. Fibroblast growth factor 23 independently predicts adverse outcomes after an acute coronary syndrome. ESC Heart Fail 2024; 11:240-250. [PMID: 37950429 PMCID: PMC10804179 DOI: 10.1002/ehf2.14568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/10/2023] [Accepted: 10/08/2023] [Indexed: 11/12/2023] Open
Abstract
AIMS Abnormalities of mineral metabolism (MM) have been related to cardiovascular disorders. There are no reports on the prognostic role of MM after an acute coronary syndrome (ACS). We aim to assess the prognostic role of MM after an ACS. METHODS AND RESULTS Plasma levels of components of MM [fibroblast growth factor 23 (FGF23), calcidiol, parathormone, klotho, and phosphate], high-sensitivity C-reactive protein, and N-terminal-pro-brain natriuretic peptide were measured in 1190 patients at discharge from an ACS. The primary outcome was a combination of acute ischaemic events, heart failure (HF) and death. Secondary outcomes were the separate components of the primary outcome. Age was 61.7 ± 12.2 years, and 77.1% were men. Median follow-up was 5.44 (3.03-7.46) years. Two hundred and ninety-four patients developed the primary outcome. At multivariable analysis FGF23 (hazard ratio, HR 1.18 [1.08-1.29], P < 0.001), calcidiol (HR 0.86 [0.74-1.00], P = 0.046), previous coronary or cerebrovascular disease, and hypertension were independent predictors of the primary outcome. The predictive power of FGF23 was homogeneous across different subgroups of population. FGF23 (HR 1.45 [1.28-1.65], P < 0.001) and parathormone (HR 1.06 1.01-1.12]; P = 0.032) resulted as independent predictors of HF. FGF23 (HR 1.21 [1.07-1.37], P = 0.002) and calcidiol (HR 0.72 [0.54-0.97), P = 0.028) were independent predictors of death. No biomarker predicted acute ischaemic events. FGF23 predicted independently the primary outcome in patients with estimated glomerular filtration rate > 60 mL/min/1.73 m2 . CONCLUSIONS FGF23 and other components of MM are independent predictors of HF and death after an ACS. This effect is homogeneous across different subgroups of population, and it is not limited to patients with chronic kidney disease.
Collapse
Affiliation(s)
- Andrea Kallmeyer
- Department of CardiologyIIS‐Fundación Jiménez DíazMadridSpain
- Faculty of MedicineAutónoma UniversityMadridSpain
| | - Ana Pello
- Department of CardiologyIIS‐Fundación Jiménez DíazMadridSpain
- Faculty of MedicineAutónoma UniversityMadridSpain
| | - Ester Cánovas
- Department of CardiologyIIS‐Fundación Jiménez DíazMadridSpain
| | - Álvaro Aceña
- Department of CardiologyIIS‐Fundación Jiménez DíazMadridSpain
- Faculty of MedicineAutónoma UniversityMadridSpain
| | | | - Nieves Tarín
- Department of CardiologyHospital Universitario de MóstolesMadridSpain
- Faculty of MedicineRey Juan Carlos UniversityMadridSpain
| | - Carmen Cristóbal
- Faculty of MedicineRey Juan Carlos UniversityMadridSpain
- Department of CardiologyHospital Universitario de FuenlabradaMadridSpain
| | | | - Ana Huelmos
- Department of CardiologyHospital Universitario Fundación AlcorcónMadridSpain
| | | | - Óscar González‐Lorenzo
- Department of CardiologyIIS‐Fundación Jiménez DíazMadridSpain
- Faculty of MedicineAutónoma UniversityMadridSpain
| | | | | | - Jesús Egido
- CIBERDEMMadridSpain
- Department of NephrologyIIS‐Fundación Jiménez DíazMadridSpain
- Laboratory of Vascular PathologyIIS‐Fundación Jiménez DíazMadridSpain
| | - Ignacio Mahillo
- Laboratory of EpidemiologyIIS‐Fundación Jiménez DíazMadridSpain
| | - Óscar Lorenzo
- Faculty of MedicineAutónoma UniversityMadridSpain
- CIBERDEMMadridSpain
- Laboratory of Vascular PathologyIIS‐Fundación Jiménez DíazMadridSpain
| | - José Tuñón
- Department of CardiologyIIS‐Fundación Jiménez DíazMadridSpain
- Faculty of MedicineAutónoma UniversityMadridSpain
- Laboratory of Vascular PathologyIIS‐Fundación Jiménez DíazMadridSpain
- CIBERCV, ISCIIIMadridSpain
| |
Collapse
|
3
|
Tuñón J, Pello A, Aceña Á, Ramos-Cillán S, Martínez-Milla J, González-Lorenzo Ó, Fuentes-Antras J, Tarín N, Cristóbal C, Blanco-Colio LM, Martín-Ventura JL, Huelmos A, Gutiérrez-Landaluce C, López-Castillo M, Alonso J, Bescós LL, Egido J, Mahíllo-Fernández I, Lorenzo Ó. N-Terminal Pro-Brain Natriuretic Peptide Plasma Levels Are Associated with Intermediate-Term Follow-Up Cancer in Coronary Patients. J Clin Med 2021; 10:jcm10184042. [PMID: 34575153 PMCID: PMC8466930 DOI: 10.3390/jcm10184042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 11/21/2022] Open
Abstract
N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels are increased in patients with cancer. In this paper, we test whether NT-proBNP may identify patients who are going to receive a future cancer diagnosis (CD) in the intermediate-term follow-up. We studied 962 patients with stable coronary artery disease and free of cancer and heart failure at baseline. This sample represents a re-analysis of a previous work expanding the sample size and the follow-up. NT-proBNP, galectin-3, monocyte chemoattractant protein-1, high-sensitivity C-reactive protein, high-sensitivity cardiac troponin I (hsTnI), and calcidiol (vitamin D) plasma levels were assessed. The primary outcome was new CD. After 5.40 (2.81–6.94) years of follow-up, 59 patients received a CD. NT-proBNP [HR 1.036 CI (1.015–1.056) per increase in 100 pg/mL; p = 0.001], previous atrial fibrillation (HR 3.140 CI (1.196–8.243); p = 0.020), and absence of previous heart failure (HR 0.067 CI (0.006–0.802); p = 0.033) were independent predictors of receiving a CD in the first three years of follow-up. None of the variables analyzed predicted a CD beyond this time. The number of patients developing heart failure during follow-up was 0 (0.0%) in patients receiving CD in the first three years of follow-up, 2 (6.9%) in those receiving a CD diagnosis beyond this time, and 40 (4.4%) in patients not developing cancer (p = 0.216). These numbers suggest that future heart failure was not a confounding factor. In patients with coronary artery disease, NT-proBNP was an independent predictor of CD in the first three years of follow-up but not later, suggesting that it could be detecting subclinical undiagnosed cancers.
Collapse
Affiliation(s)
- José Tuñón
- Department of Cardiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (A.P.); (Á.A.); (J.M.-M.); (Ó.G.-L.); (M.L.-C.)
- Department of Medicine, School of Medicine, Autónoma University, 28040 Madrid, Spain; (S.R.-C.); (J.L.M.-V.); (J.E.); (Ó.L.)
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain;
- CIBERCV, 28040 Madrid, Spain
- Correspondence:
| | - Ana Pello
- Department of Cardiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (A.P.); (Á.A.); (J.M.-M.); (Ó.G.-L.); (M.L.-C.)
- Department of Medicine, School of Medicine, Autónoma University, 28040 Madrid, Spain; (S.R.-C.); (J.L.M.-V.); (J.E.); (Ó.L.)
| | - Álvaro Aceña
- Department of Cardiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (A.P.); (Á.A.); (J.M.-M.); (Ó.G.-L.); (M.L.-C.)
- Department of Medicine, School of Medicine, Autónoma University, 28040 Madrid, Spain; (S.R.-C.); (J.L.M.-V.); (J.E.); (Ó.L.)
| | - Sergio Ramos-Cillán
- Department of Medicine, School of Medicine, Autónoma University, 28040 Madrid, Spain; (S.R.-C.); (J.L.M.-V.); (J.E.); (Ó.L.)
| | - Juan Martínez-Milla
- Department of Cardiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (A.P.); (Á.A.); (J.M.-M.); (Ó.G.-L.); (M.L.-C.)
- Department of Medicine, School of Medicine, Autónoma University, 28040 Madrid, Spain; (S.R.-C.); (J.L.M.-V.); (J.E.); (Ó.L.)
| | - Óscar González-Lorenzo
- Department of Cardiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (A.P.); (Á.A.); (J.M.-M.); (Ó.G.-L.); (M.L.-C.)
- Department of Medicine, School of Medicine, Autónoma University, 28040 Madrid, Spain; (S.R.-C.); (J.L.M.-V.); (J.E.); (Ó.L.)
| | - Jesús Fuentes-Antras
- Department of Oncology, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain;
| | - Nieves Tarín
- Department of Cardiology, Hospital Universitario de Móstoles, 28040 Madrid, Spain;
| | - Carmen Cristóbal
- Department of Cardiology, Hospital de Fuenlabrada, 28040 Madrid, Spain; (C.C.); (C.G.-L.)
- Department of Medicine, School of Medicine, Rey Juan Carlos University, Alcorcón, 28040 Madrid, Spain; (J.A.); (L.L.B.)
| | - Luis M. Blanco-Colio
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain;
- CIBERCV, 28040 Madrid, Spain
| | - José Luis Martín-Ventura
- Department of Medicine, School of Medicine, Autónoma University, 28040 Madrid, Spain; (S.R.-C.); (J.L.M.-V.); (J.E.); (Ó.L.)
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain;
- CIBERCV, 28040 Madrid, Spain
| | - Ana Huelmos
- Department of Cardiology, Hospital Universitario Fundación Alcorcón, 28040 Madrid, Spain;
| | | | - Marta López-Castillo
- Department of Cardiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (A.P.); (Á.A.); (J.M.-M.); (Ó.G.-L.); (M.L.-C.)
- Department of Medicine, School of Medicine, Autónoma University, 28040 Madrid, Spain; (S.R.-C.); (J.L.M.-V.); (J.E.); (Ó.L.)
| | - Joaquín Alonso
- Department of Medicine, School of Medicine, Rey Juan Carlos University, Alcorcón, 28040 Madrid, Spain; (J.A.); (L.L.B.)
- Department of Cardiology, Hospital de Getafe, 28040 Madrid, Spain
| | - Lorenzo López Bescós
- Department of Medicine, School of Medicine, Rey Juan Carlos University, Alcorcón, 28040 Madrid, Spain; (J.A.); (L.L.B.)
| | - Jesús Egido
- Department of Medicine, School of Medicine, Autónoma University, 28040 Madrid, Spain; (S.R.-C.); (J.L.M.-V.); (J.E.); (Ó.L.)
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain;
- CIBERDEM, 28040 Madrid, Spain
| | | | - Óscar Lorenzo
- Department of Medicine, School of Medicine, Autónoma University, 28040 Madrid, Spain; (S.R.-C.); (J.L.M.-V.); (J.E.); (Ó.L.)
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain;
- CIBERDEM, 28040 Madrid, Spain
| |
Collapse
|
4
|
Gutiérrez-Landaluce C, Aceña Á, Pello A, Martínez-Milla J, González-Lorenzo Ó, Tarín N, Cristóbal C, Blanco-Colio LM, Martín-Ventura JL, Huelmos A, López-Castillo M, Alonso J, López Bescós L, Alonso-Pulpón L, González-Parra E, Egido J, Mahíllo-Fernández I, Lorenzo Ó, González-Casaus ML, Tuñón J. Parathormone levels add prognostic ability to N-terminal pro-brain natriuretic peptide in stable coronary patients. ESC Heart Fail 2021; 8:2713-2722. [PMID: 33932116 PMCID: PMC8318437 DOI: 10.1002/ehf2.13331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/20/2021] [Accepted: 03/19/2021] [Indexed: 12/15/2022] Open
Abstract
Aims There are controversial data on the ability of the components of mineral metabolism (vitamin D, phosphate, parathormone [PTH], fibroblast growth factor‐23 [FGF23], and klotho) to predict cardiovascular events. In addition, it is unknown whether they add any prognostic value to other well‐known biomarkers. Methods and results In 969 stable coronary patients, we determined plasma levels of all the aforementioned components of mineral metabolism with a complete set of clinical and biochemical variables, including N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), high‐sensitivity troponin I (hs‐TnI), and high‐sensitivity C‐reactive protein. Secondary outcomes were ischaemic events (any acute coronary syndrome, stroke, or transient ischaemic attack) and heart failure or death. The primary outcome was a composite of the secondary outcomes. Median follow‐up was 5.39 years. Age was 60 (52–72) years. Median glomerular filtration rate was 80.4 (65.3–93.1) mL/min/1.73 m2. One‐hundred and eighty‐five patients developed the primary outcome. FGF23, PTH, hs‐TnI, and NT‐proBNP were directly related with the primary outcome on univariate Cox analysis, while Klotho and calcidiol were inversely related. On multivariate analysis, only PTH (HR 1.058 [CI 1.021–1.097]; P = 0.002) and NT‐proBNP (HR 1.020 [CI 1.012–1.028]; P < 0.001) were independent predictors of the primary outcome but also for the secondary outcome of heart failure or death (HR 1.066 [CI 1.016–1.119]; P = 0.009 and HR 1.024 [CI 1.014–1.034]; P < 0.001, respectively). PTH was the only biomarker that predicted ischaemic events (HR 1.052 [1.010–1.096]; P = 0.016). Patients were divided in two subgroups according to FGF23 plasma levels. PTH retained its prognostic value only in patients with FGF23 levels above the median (>85.5 RU/mL) (P < 0.001) but not in patients with low FGF23 levels (P = 0.551). There was a significant interaction between FGF23 and PTH (P = 0.002). However, there was no significant interaction between PTH and both klotho and calcidiol levels. Conclusions Parathormone is an independent predictor of cardiovascular events in coronary patients, adding complimentary prognostic information to NT‐proBNP plasma levels. This predictive value is restricted to patients with high FGF23 plasma levels. This should be considered in the design of future studies in this field.
Collapse
Affiliation(s)
| | - Álvaro Aceña
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Avda. Reyes Católicos 2, Madrid, 28040, Spain.,Autónoma University, Madrid, Spain
| | - Ana Pello
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Avda. Reyes Católicos 2, Madrid, 28040, Spain.,Autónoma University, Madrid, Spain
| | - Juan Martínez-Milla
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Avda. Reyes Católicos 2, Madrid, 28040, Spain.,Autónoma University, Madrid, Spain
| | - Óscar González-Lorenzo
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Avda. Reyes Católicos 2, Madrid, 28040, Spain.,Autónoma University, Madrid, Spain
| | - Nieves Tarín
- Department of Cardiology, Hospital Universitario de Móstoles, Madrid, Spain
| | - Carmen Cristóbal
- Department of Cardiology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,Rey Juan Carlos University, Madrid, Spain
| | - Luis M Blanco-Colio
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.,CIBERCV, Madrid, Spain
| | - José Luis Martín-Ventura
- Autónoma University, Madrid, Spain.,Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.,CIBERCV, Madrid, Spain
| | - Ana Huelmos
- Department of Cardiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Marta López-Castillo
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Avda. Reyes Católicos 2, Madrid, 28040, Spain
| | - Joaquín Alonso
- Rey Juan Carlos University, Madrid, Spain.,Department of Cardiology, Hospital de Getafe, Madrid, Spain
| | | | - Luis Alonso-Pulpón
- Autónoma University, Madrid, Spain.,Department of Cardiology, Hospital Puerta de Hierro, Madrid, Spain
| | - Emilio González-Parra
- Autónoma University, Madrid, Spain.,Department of Nephrology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Jesús Egido
- Autónoma University, Madrid, Spain.,Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.,Department of Nephrology, IIS-Fundación Jiménez Díaz, Madrid, Spain.,CIBERDEM, Madrid, Spain
| | | | - Óscar Lorenzo
- Autónoma University, Madrid, Spain.,Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.,CIBERDEM, Madrid, Spain
| | | | - José Tuñón
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Avda. Reyes Católicos 2, Madrid, 28040, Spain.,Autónoma University, Madrid, Spain.,Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.,CIBERCV, Madrid, Spain
| |
Collapse
|
5
|
Gutierrez C, Acena A, Pello A, Martinez-Milla J, Gonzalez-Lorenzo O, Tarin N, Cristobal C, Huelmos A, Lopez-Castillo M, Alonso J, Gonzalez-Parra E, Egido J, Mahillo-Fernandez I, Lorenzo O, Tunon J. High parathormone levels are associated with adverse cardiovascular events in coronary patients with high fibroblast growth factor-23. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Disturbances of the components of the mineral metabolism (MM) (vitamin D, phosphate, parathormone [PTH], fibroblast growth factor-23 [FGF23] and klotho) have been linked to cardiovascular disease. However, the available data are controversial, probably because most studies deal with individual rather than with the whole MM components.
Purpose
To the study the relationship between MM components and cardiovascular events, after controlling for other well-known markers (N-Terminal pro-brain natriuretic peptide [NT-proBNP], high-sensitivity troponin I [hs-TnI], and high-sensitivity c-reactive protein [hs-CRP]), and relevant clinical variables in stable coronary artery disease (CAD) patients.
Methods
We analyzed the aforementioned markers in 964 CAD patients and followed them subsequently. The primary outcome (PO) was the composite of ischemic events (acute coronary syndrome, stroke or transient ischemic attack), heart failure and death. Secondary outcomes were any ischemic event and the composite of heart failure and death.
Results
Median follow-up was 5.39 years (2.81 - 6.92). Age was 60 (52–72) years and 76.2% patients were male. Median glomerular filtration rate was 80.4 (65.3–93.1) ml/min/1.73 m2. 185 patients developed the PO.
At the univariate analysis PTH, FGF23, NT-proBNP and hs-TnI were directly associated with the PO, while calcidiol and Klotho were inversely related, and phosphate did not reach statistical significance. However, only PTH (HR 1.058 [CI 1.021–1.097]; p=0.002) and NT-proBNP (HR 1.020 [CI 1.012–1.028]; p<0.001) were independent predictors of the PO at multivariate Cox regression analysis. Both PTH and NT-proBNP were also independent predictors of HF or death (HR 1.066 [1.016 - 1.119]; p=0.009 and HR 1.024 [1.014 - 1.034]; p<0.001 respectively), while only PTH predicted ischemic events (HR 1.052 [1.010–1.096]; p=0.016).
After dividing patients in two subgroups according to whether they had FGF23 plasma levels above the median (85.5 RU/ml) or not, PTH remained as a predictor of the PO only in the subgroup with FGF23 >85.5 RU/ml (p<0.001), but not in patients with FGF23 ≤85.5 RU/ml (p=0.551). There was a significant interaction between FGF23 and PTH plasma levels (p=0.002).
Conclusion
PTH predicts cardiovascular events in CAD patients with elevated FGF23 levels even after taking into account all the other components of MM and controlling for NT-ProBNP, hs-CPR and TnI. There is an interaction between PTH and FGF23 levels, and they should be assessed together when exploring their potential predictive power.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Fondo de Investigaciones Sanitarias
Collapse
Affiliation(s)
| | - A Acena
- Fundacion Jimenez Diaz University Hospital, Cardiology, Madrid, Spain
| | - A Pello
- Fundacion Jimenez Diaz University Hospital, Cardiology, Madrid, Spain
| | - J Martinez-Milla
- Fundacion Jimenez Diaz University Hospital, Cardiology, Madrid, Spain
| | | | - N Tarin
- University Hospital Mostoles, Cardiology, Mostoles, Spain
| | | | - A Huelmos
- Fundacion Hospital Alcorcon, Cardiology, Alcorcon, Spain
| | - M Lopez-Castillo
- Fundacion Jimenez Diaz University Hospital, Cardiology, Madrid, Spain
| | - J Alonso
- University Hospital of Getafe, Cardiology, Getafe, Spain
| | - E Gonzalez-Parra
- Fundacion Jimenez Diaz University Hospital, Nephrology, Madrid, Spain
| | - J Egido
- Fundacion Jimenez Diaz University Hospital, Nephrology, Madrid, Spain
| | | | - O Lorenzo
- Autonomous University of Madrid, Madrid, Spain
| | - J Tunon
- Fundacion Jimenez Diaz University Hospital, Cardiology, Madrid, Spain
| |
Collapse
|
6
|
Lorenzo-Almorós A, Pello A, Aceña Á, Martínez-Milla J, González-Lorenzo Ó, Tarín N, Cristóbal C, Blanco-Colio LM, Martín-Ventura JL, Huelmos A, Gutiérrez-Landaluce C, López-Castillo M, Kallmeyer A, Cánovas E, Alonso J, López Bescós L, Egido J, Lorenzo Ó, Tuñón J. Galectin-3 Is Associated with Cardiovascular Events in Post-Acute Coronary Syndrome Patients with Type-2 Diabetes. J Clin Med 2020; 9:jcm9041105. [PMID: 32294902 PMCID: PMC7230213 DOI: 10.3390/jcm9041105] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction: Type-2 diabetes mellitus (T2DM) is associated with early and severe atherosclerosis. However, few biomarkers can predict cardiovascular events in this population. Methods: We followed 964 patients with coronary artery disease (CAD), assessing plasma levels of galectin-3, monocyte chemoattractant protein-1 (MCP-1), and N-terminal fragment of brain natriuretic peptide (NT-proBNP) at baseline. The secondary outcomes were acute ischemia and heart failure or death. The primary outcome was the combination of the secondary outcomes. Results. Two hundred thirty-two patients had T2DM. Patients with T2DM showed higher MCP-1 (144 (113–195) vs. 133 (105–173) pg/mL, p = 0.006) and galectin-3 (8.3 (6.5–10.5) vs. 7.8 (5.9–9.8) ng/mL, p = 0.049) levels as compared to patients without diabetes. Median follow-up was 5.39 years (2.81–6.92). Galectin-3 levels were associated with increased risk of the primary outcome in T2DM patients (Hazard ratio (HR) 1.57 (1.07–2.30); p = 0.022), along with a history of cerebrovascular events. Treatment with clopidogrel was associated with lower risk. In contrast, NT-proBNP and MCP-1, but not galectin-3, were related to increased risk of the event in nondiabetic patients (HR 1.21 (1.04–1.42); p = 0.017 and HR 1.23 (1.05–1.44); p = 0.012, respectively), along with male sex and age. Galectin-3 was also the only biomarker associated with the development of acute ischemic events and heart failure or death in T2DM patients, while, in nondiabetics, MCP-1 and NT-proBNP, respectively, were related to these events. Conclusion: In CAD patients, galectin-3 plasma levels are associated with cardiovascular events in patients with T2DM, and MCP-1 and NT-proBNP in those without T2DM.
Collapse
Affiliation(s)
- Ana Lorenzo-Almorós
- Department of Internal Medicine, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain;
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (L.M.B.-C.); (J.L.M.-V.); (J.E.); (Ó.L.)
| | - Ana Pello
- Department of Cardiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (A.P.); (Á.A.); (J.M.-M.); (Ó.G.-L.); (M.L.-C.); (A.K.); (E.C.)
- Department of Medicine, School of Medicine, Universidad Autónoma, 28029 Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (A.P.); (Á.A.); (J.M.-M.); (Ó.G.-L.); (M.L.-C.); (A.K.); (E.C.)
- Department of Medicine, School of Medicine, Universidad Autónoma, 28029 Madrid, Spain
| | - Juan Martínez-Milla
- Department of Cardiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (A.P.); (Á.A.); (J.M.-M.); (Ó.G.-L.); (M.L.-C.); (A.K.); (E.C.)
| | - Óscar González-Lorenzo
- Department of Cardiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (A.P.); (Á.A.); (J.M.-M.); (Ó.G.-L.); (M.L.-C.); (A.K.); (E.C.)
| | - Nieves Tarín
- Department of Cardiology, Hospital Universitario de Móstoles, 28935 Madrid, Spain;
| | - Carmen Cristóbal
- Department of Cardiology, Hospital de Fuenlabrada, 28942 Madrid, Spain; (C.C.); (C.G.-L.)
- Department of Medicine, Rey Juan Carlos University, Alcorcón, 28943 Madrid, Spain; (J.A.); (L.L.B.)
| | - Luis M Blanco-Colio
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (L.M.B.-C.); (J.L.M.-V.); (J.E.); (Ó.L.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28040 Madrid, Spain
| | - José Luis Martín-Ventura
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (L.M.B.-C.); (J.L.M.-V.); (J.E.); (Ó.L.)
- Department of Medicine, School of Medicine, Universidad Autónoma, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28040 Madrid, Spain
| | - Ana Huelmos
- Department of Cardiology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain;
| | | | - Marta López-Castillo
- Department of Cardiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (A.P.); (Á.A.); (J.M.-M.); (Ó.G.-L.); (M.L.-C.); (A.K.); (E.C.)
- Department of Medicine, School of Medicine, Universidad Autónoma, 28029 Madrid, Spain
| | - Andrea Kallmeyer
- Department of Cardiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (A.P.); (Á.A.); (J.M.-M.); (Ó.G.-L.); (M.L.-C.); (A.K.); (E.C.)
| | - Ester Cánovas
- Department of Cardiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (A.P.); (Á.A.); (J.M.-M.); (Ó.G.-L.); (M.L.-C.); (A.K.); (E.C.)
| | - Joaquín Alonso
- Department of Medicine, Rey Juan Carlos University, Alcorcón, 28943 Madrid, Spain; (J.A.); (L.L.B.)
- Department of Cardiology, Hospital de Getafe, 28905 Madrid, Spain
| | - Lorenzo López Bescós
- Department of Medicine, Rey Juan Carlos University, Alcorcón, 28943 Madrid, Spain; (J.A.); (L.L.B.)
| | - Jesús Egido
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (L.M.B.-C.); (J.L.M.-V.); (J.E.); (Ó.L.)
- Department of Medicine, School of Medicine, Universidad Autónoma, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red de diabetes y enfermedades metabólicas asociadas (CIBERDEM), 28040 Madrid, Spain
| | - Óscar Lorenzo
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (L.M.B.-C.); (J.L.M.-V.); (J.E.); (Ó.L.)
- Department of Medicine, School of Medicine, Universidad Autónoma, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red de diabetes y enfermedades metabólicas asociadas (CIBERDEM), 28040 Madrid, Spain
| | - Jose Tuñón
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (L.M.B.-C.); (J.L.M.-V.); (J.E.); (Ó.L.)
- Department of Cardiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (A.P.); (Á.A.); (J.M.-M.); (Ó.G.-L.); (M.L.-C.); (A.K.); (E.C.)
- Department of Medicine, School of Medicine, Universidad Autónoma, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28040 Madrid, Spain
- Correspondence:
| |
Collapse
|
7
|
Aceña Á, Martín-Mariscal ML, Tarín N, Cristóbal C, Huelmos A, Pello A, Carda R, Alonso J, Lorenzo Ó, Mahíllo-Fernández I, Tuñón J. Comparison of 3 Predictive Clinical Risk Scores in 603 Patients with Stable Coronary Artery Disease. Tex Heart Inst J 2017; 44:239-244. [PMID: 28878576 DOI: 10.14503/thij-15-5643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
No clinical risk score is universally accepted for coronary artery disease. In 603 patients (mean age, 61.2 ± 12.3 yr) with stable coronary artery disease, we investigated the predictive power of clinical risk scores derived from the Framingham, the Long-term Intervention with Pravastatin in Ischemic Disease (LIPID), and the Vienna and Ludwigshafen Coronary Artery Disease (VILCAD) studies. Secondary outcomes were the recurrence of an acute thrombotic event (coronary events, strokes, or transient ischemic attacks), or heart failure or death. The primary outcome was the combination of secondary outcomes. During follow-up (duration, 2.08 ± 0.97 yr), 42 patients had an acute thrombotic event; 22, heart failure or death; and 60, the primary outcome. The Framingham score predicted acute thrombotic events: hazard ratio (HR)=1.05; 95% confidence interval (CI), 1.01-1.08; P=0.03; net reclassification index (NRI, calculated to evaluate improvement in prediction gained by adding different risk scores to models constructed with variables excluded from the calculation of that score)=9.7% (95% CI, 9.6-9.8). The LIPID (HR=1.13; 95% CI, 1.04-1.22; P=0.005) and VILCAD scores (HR=1.99; 95% CI, 1.48-2.67; P <0.001) predicted heart failure or death with NRIs of 5.8% (95% CI, 5.7-5.9) and 18.6% (95% CI, 18.3-18.9), respectively. The primary outcome was predicted by the LIPID (HR=1.1; 95% CI, 1.03-1.17; P=0.005) and VILCAD scores (HR=1.39; 95% CI, 1.13-1.70; P=0.003). The NRIs (95% CIs) were 3.4% (3.3-3.5) and 19.4% (19.3-19.6), respectively. We conclude that the accuracy of these risk scores varies in accordance with the outcome studied.
Collapse
|
8
|
Tuñón J, Higueras J, Tarín N, Cristóbal C, Lorenzo Ó, Blanco-Colio L, Martín-Ventura JL, Huelmos A, Alonso J, Aceña Á, Pello A, Carda R, Asensio D, Mahíllo-Fernández I, López Bescós L, Egido J, Farré J. N-Terminal Pro-Brain Natriuretic Peptide Is Associated with a Future Diagnosis of Cancer in Patients with Coronary Artery Disease. PLoS One 2015; 10:e0126741. [PMID: 26046344 PMCID: PMC4457823 DOI: 10.1371/journal.pone.0126741] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 04/07/2015] [Indexed: 11/18/2022] Open
Abstract
Objective Several papers have reported elevated plasma levels of natriuretic peptides in patients with a previous diagnosis of cancer. We have explored whether N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels predict a future diagnosis of cancer in patients with coronary artery disease (CAD). Methods We studied 699 patients with CAD free of cancer. At baseline, NT-proBNP, galectin-3, monocyte chemoattractant protein-1, soluble tumor necrosis factor-like weak inducer of apoptosis, high-sensitivity C-reactive protein, and high-sensitivity cardiac troponin I plasma levels were assessed. The primary outcome was new cancer diagnosis. The secondary outcome was cancer diagnosis, heart failure requiring hospitalization, or death. Results After 2.15±0.98 years of follow-up, 24 patients developed cancer. They were older (68.5 [61.5, 75.8] vs 60.0 [52.0, 72.0] years; p=0.011), had higher NT-proBNP (302.0 [134.8, 919.8] vs 165.5 [87.4, 407.5] pg/ml; p=0.040) and high-sensitivity C-reactive protein (3.27 [1.33, 5.94] vs 1.92 [0.83, 4.00] mg/L; p=0.030), and lower triglyceride (92.5 [70.5, 132.8] vs 112.0 [82.0, 157.0] mg/dl; p=0.044) plasma levels than those without cancer. NT-proBNP (Hazard Ratio [HR]=1.030; 95% Confidence Interval [CI]=1.008-1.053; p=0.007) and triglyceride levels (HR=0.987; 95%CI=0.975-0.998; p=0.024) were independent predictors of a new cancer diagnosis (multivariate Cox regression analysis). When patients in whom the suspicion of cancer appeared in the first one-hundred days after blood extraction were excluded, NT-proBNP was the only predictor of cancer (HR=1.061; 95%CI=1.034-1.088; p<0.001). NT-proBNP was an independent predictor of cancer, heart failure, or death (HR=1.038; 95%CI=1.023-1.052; p<0.001) along with age, and use of insulin and acenocumarol. Conclusions NT-proBNP is an independent predictor of malignancies in patients with CAD. New studies in large populations are needed to confirm these findings.
Collapse
Affiliation(s)
- José Tuñón
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- * E-mail:
| | - Javier Higueras
- Department of Cardiology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Nieves Tarín
- Department of Cardiology, Hospital Universitario de Móstoles, Madrid, Spain
| | - Carmen Cristóbal
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
- Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Óscar Lorenzo
- Autónoma University, Madrid, Spain
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Luis Blanco-Colio
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - José Luis Martín-Ventura
- Autónoma University, Madrid, Spain
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Ana Huelmos
- Department of Cardiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Joaquín Alonso
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
- Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Ana Pello
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Rocío Carda
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Dolores Asensio
- Department of Biochemistry, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Jesús Egido
- Autónoma University, Madrid, Spain
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- CIBERDEM, Madrid, Spain
| | - Jerónimo Farré
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
| |
Collapse
|
9
|
Carda R, Aceña Á, Pello A, Cristóbal C, Tarín N, Huelmos A, Alonso J, Asensio D, Lorenzo Ó, Martín-Ventura JL, Blanco-Colio L, Farré J, López Bescós L, Egido J, Tuñón J. The Prognostic Value of High-Sensitive Troponin I in Stable Coronary Artery Disease Depends on Age and Other Clinical Variables. Cardiology 2015; 132:1-8. [DOI: 10.1159/000381259] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 02/25/2015] [Indexed: 11/19/2022]
Abstract
Objectives: To study the prognostic value of high-sensitive troponin (hs-cTn) I in stable coronary artery disease. Methods: In total, we studied 705 patients. Secondary outcomes were the incidence of: (1) acute ischemic events and (2) heart failure or death. The primary outcome was the composite of them. Results: Patients with hs-cTnI >0 ng/ml (62.1%) were older, had a lower estimated glomerular filtration rate, more frequent a history of hypertension, atrial fibrillation, ejection fraction <40%, and therapy with angiotensin-converting enzyme inhibitors, diuretics and acenocumarol. The follow-up period was 2.2 ± 0.99 years. Fifty-three patients suffered an acute ischemic event, 33 died or suffered heart failure and 78 developed the primary outcome. By univariate Cox's regression analysis, hs-cTnI >0 was associated with a higher risk of developing the primary outcome [relative risk = 2.360 (1.359-4.099); p = 0.001] and heart failure or death [relative risk = 5.932 (1.806-19.482); p < 0.001], but not with acute ischemic events. Statistical significance was lost after controlling for age. By logistic regression analysis, age [relative risk = 1.026 (1.009-1.044); p = 0.003], ejection fraction <40% [relative risk = 4.099 (2.043-8.224); p < 0.001], use of anticoagulants [relative risk = 2.785 (1.049-7.395); p = 0.040] and therapy with angiotensin-converting enzyme inhibitors [relative risk = 1.471 (1.064-2.034); p = 0.020], and estimated glomerular filtration rate [relative risk = 0.988 (0.977-0.999); p = 0.027] were associated with hs-cTnI >0. Conclusions: In stable coronary disease, hs-cTnI is associated with the incidence of heart failure or death, but this relationship depends on other variables.
Collapse
|
10
|
Higueras J, Martín-Ventura JL, Blanco-Colio L, Cristóbal C, Tarín N, Huelmos A, Alonso J, Pello A, Aceña Á, Carda R, Lorenzo Ó, Mahíllo-Fernández I, Asensio D, Almeida P, Rodríguez-Artalejo F, Farré J, López Bescós L, Egido J, Tuñón J. [Impact of plasma pro-B-type natriuretic peptide amino-terminal and galectin-3 levels on the predictive capacity of the LIPID Clinical Risk Scale in stable coronary disease]. Clin Investig Arterioscler 2014; 27:57-63. [PMID: 25127747 DOI: 10.1016/j.arteri.2014.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 06/23/2014] [Indexed: 11/18/2022]
Abstract
INTRODUCTION At present, there is no tool validated by scientific societies for risk stratification of patients with stable coronary artery disease (SCAD). It has been shown that plasma levels of monocyte chemoattractant protein-1 (MCP-1), galectin-3 and pro-B-type natriuretic peptide amino-terminal (NT-proBNP) have prognostic value in this population. OBJECTIVE To analyze the prognostic value of a clinical risk scale published in Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) study and determining its predictive capacity when combined with plasma levels of MCP-1, galectin-3 and NT-proBNP in patients with SCAD. METHODS AND RESULTS A total of 706 patients with SCAD and a history of acute coronary syndrome (ACS) were analyzed over a follow up period of 2.2 ± 0.99 years. The primary endpoint was the occurrence of an ischemic event (any SCA, stroke or transient ischemic attack), heart failure, or death. A clinical risk scale derived from the LIPID study significantly predicted the development of the primary endpoint, with an area under the ROC curve (Receiver Operating Characteristic) of 0.642 (0.579 to 0.705); P<0.001. A composite score was developed by adding the scores of the LIPID and scale decile levels of MCP -1, galectin -3 and NT-proBNP. The predictive value improved with an area under the curve of 0.744 (0.684 to 0.805); P<0.001 (P=0.022 for comparison). A score greater than 21.5 had a sensitivity of 74% and a specificity of 61% for the development of the primary endpoint (P<0.001, log -rank test). CONCLUSION Plasma levels of MCP-1, galectin -3 and NT-proBNP improve the ability of the LIPID clinical scale to predict the prognosis of patients with SCAD.
Collapse
Affiliation(s)
- Javier Higueras
- Servicio de Cardiología, Hospital Clínico Universitario San Carlos, Madrid, España; Universidad Complutense, Madrid, España
| | - José Luis Martín-Ventura
- Universidad Autónoma, Madrid, España; Laboratorio de Patología Vascular, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Luis Blanco-Colio
- Laboratorio de Patología Vascular, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Carmen Cristóbal
- Servicio de Cardiología, Hospital de Fuenlabrada, Fuenlabrada, Madrid, España; Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - Nieves Tarín
- Servicio de Cardiología, Hospital Universitario de Móstoles, Móstoles, Madrid, España
| | - Ana Huelmos
- Servicio de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Joaquín Alonso
- Servicio de Cardiología, Hospital de Fuenlabrada, Fuenlabrada, Madrid, España; Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - Ana Pello
- Servicio de Cardiología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Álvaro Aceña
- Servicio de Cardiología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Rocío Carda
- Servicio de Cardiología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Óscar Lorenzo
- Universidad Autónoma, Madrid, España; Laboratorio de Patología Vascular, IIS-Fundación Jiménez Díaz, Madrid, España
| | | | - Dolores Asensio
- Laboratorio de bioquímica de la Fundación Jiménez Díaz, Madrid, España
| | - Pedro Almeida
- Servicio de Cardiología, IIS-Fundación Jiménez Díaz, Madrid, España
| | | | - Jerónimo Farré
- Universidad Autónoma, Madrid, España; Servicio de Cardiología, IIS-Fundación Jiménez Díaz, Madrid, España
| | | | - Jesús Egido
- Universidad Autónoma, Madrid, España; Laboratorio de Patología Vascular, IIS-Fundación Jiménez Díaz, Madrid, España; CIBERDEM, Madrid, España
| | - José Tuñón
- Universidad Autónoma, Madrid, España; Laboratorio de Patología Vascular, IIS-Fundación Jiménez Díaz, Madrid, España; Servicio de Cardiología, IIS-Fundación Jiménez Díaz, Madrid, España.
| |
Collapse
|
11
|
Martínez-Sellés M, Datino T, Pello A. Dipyridamole echocardiography test in patients with normal or near normal coronary arteries. Eur Heart J 2005; 27:499; author reply 499-500. [PMID: 16361322 DOI: 10.1093/eurheartj/ehi689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|