Abstract
ObjectivesFollistatin-like 1 (FSTL1) is a glycoprotein secreted by skeletal muscle cells and cardiac myocytes. Previous studies showed that serum FSTL1 concentrations were increased in acute coronary syndrome and chronic heart failure. The aim of this study was to assess the associations among plasma FSTL1 concentration, clinical parameters, and whether FSTL1 concentration could predict cardiovascular events in patients with elective percutaneous coronary intervention (PCI).Methods and resultsA consecutive series of 410 patients who underwent elective PCI with drug-eluting stents (DES) were enrolled between August 2004 and December 2006 at Juntendo University hospital. We measured plasma FSTL1 levels prior to elective PCI and assessed the association among FSTL1 levels, clinical parameters, and occurrence of major adverse cardiac or cerebrovascular events (MACCE) defined as cardiac death, nonfatal myocardial infarction, unstable angina, stroke, and hospitalization for heart failure. FSTL1 concentration was positively correlated with high-sensitivity C-reactive protein (hsCRP), serum creatinine, and N-terminal pro b-type natriuretic peptide (all P < 0.01). After excluding patients with creatinine clearance < 60 mL/min and hsCRP ≥ 0.2 mg/dL, the remaining 214 were followed for a median of 5.1 years. Twenty (9.3%) patients experienced MACCE. Receiver operating characteristics curve analysis estimated an FSTL1 cutoff of 41.1 ng/mL to predict MACCE occurrence. Kaplan–Meier analysis found a higher MACCE rate in patients with high (≥ 41.1 ng/mL) than with low (< 41.1 ng/mL) FSTL1 (P < 0.01). Multivariate Cox hazard analysis found that high FSTL1 was an independent predictor of MACCE (hazard ratio 4.54, 95% confidence interval: 1.45–20.07, P < 0.01).ConclusionHigh plasma FSTL1 may be a predictor of cardiovascular events in patients who underwent elective PCI with DES, especially with preserved renal function and low hsCRP.
Highlights
Follistatin-like 1 (FSTL1) is a glycoprotein, known as transforming growth factor (TGF)β1–stimulated clone 36 (TSC-36) [1, 2], synthesized and secreted by skeletal muscle cells and cardiomyocytes
Hayakawa et al demonstrated that plasma FSTL1 levels were correlated with hsCRP and reactive oxidative metabolites (ROMs) in healthy Japanese male subjects [9], and their results indicate that FSTL1 may be a biomarker for inflammatory and oxidative stress responses
Plasma FSTL1 was significantly higher in patients with than in those without major adverse cardiac or cerebrovascular events (MACCE) (80.8 ± 70.1 vs. 66.9 ± 61.2 NT-proBNP (pg/mL) Follistatin-like 1 (ng/mL), P = 0.019)
Summary
Follistatin-like 1 (FSTL1) is a glycoprotein, known as transforming growth factor (TGF)β1–stimulated clone 36 (TSC-36) [1, 2], synthesized and secreted by skeletal muscle cells and cardiomyocytes. Previous clinical studies showed that serum FSTL1 concentrations were increased in patients with acute coronary syndrome (ACS) [7] and chronic systolic heart failure (HF) [8]. El-Armouche et al found that elevated serum FSTL1 in patients with HF was associated with left ventricular hypertrophy (LVH) [8]. These results suggested that FSTL1 may be a useful marker for evaluation of cardiovascular disease. The aim of this study is to clarify the association of FSTL1 concentration and clinical parameters, and the occurrence of major adverse cardiac or cerebrovascular events (MACCE) in patients with elective percutaneous coronary intervention (PCI)
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