Severe Coronary Artery Disease Groups Research Articles

Triglyceride-glucose Index as a Valuable Marker to Predict Severity of Coronary Artery Disease: A Retrospective Cohort Study.

The diagnostic standard of coronary artery disease (CAD) is coronary angiography (CAG). Since CAG is an invasive procedure underscores the need for identifying non-invasive, effective, and innovative biomarkers. Our study aimed to retrospectively analyze hematological markers for predicting the severity of CAD. Case data were collected from 195 CAD patients admitted to the hospital for CAG. According to Gensini score, patients were divided into mild, moderate, and severe CAD groups. Blood indexes and predictive efficacy of the triglyceride-glucose (TyG) index were retrospectively analyzed. Among 195 CAD patients, 81 had mild CAD, 60 had moderate CAD, and 54 had severe CAD. Sex, fast blood glucose (FBG), TyG index, and high-sensitivity C-reactive protein (hs-CRP) significantly differed among the three groups. The TyG index demonstrated higher values in patients with moderate (9.07[8.62-9.44]) and severe (8.98[8.46-9.45]) CAD compared to those with mild CAD (8.75[8.49-9.14]). The AUC of the TyG index was 0.615 (95% confidence interval (CI): 0.536-0.694, P =.004), with a cut-off value of 8.997, specificity of 0.704, and sensitivity of 0.535. Logistics analysis showed the risk of moderate and severe CAD with an odds ratio (OR) value of 2.595 (95% CI: 1.199-5.619, adjusted P = .016) following regrouping by the TyG index optimal cut-off value of 8.997. The TyG index combined with FBG and hs-CRP had an elevated AUC value, significantly higher than other combinations (P = .011 and 0.02, respectively). The severity of CAD is positively correlated with an increased TyG index value. A combination of TyG, FBG, and hs-CRP has demonstrated improved diagnostic efficiency, suggesting its potential as a novel indicator for predicting and diagnosing CAD progression.

Cytokine profile in patients with obstructive coronary artery disease

Background. Studies of the role of cytokines in the pathogenesis of coronary artery disease (CAD) are quite relevant. Significant cytokine imbalance is mostly observed in patients with acute coronary syndrome. However, there are limited reports of serum cytokine levels in patients with chronic stable CAD. The problem of relationship between cytokines to the severity of coronary atherosclerosis is still urgent.Aim: To investigate the relationship between serum levels of cytokines and the severity of CAD.Material and Methods. Serum levels of IL-2, IL-4, IL-6, IL-10, TNF-a was analyzed in 24 healthy control patients and 70 patients with stable CAD who underwent coronary angiography. Coronary atherosclerosis was assessed with Gensini scoring system. Depending on the median of GS (38.0), the patients were divided into moderate CAD group (GS = 8–37) and severe CAD group (GS ≥ 38). The data were analyzed using Statistical Package for the Social Sciences (SPSS) software 26.0.Results. Patients with obstructive CAD presented higher TNF-α levels and lower IL-4. Patients with severe CAD increased IL-6 and reduced IL-2 levels. Logistic regression analysis showed that the IL-6 was independently related to the presence of obstructive CAD (OR = 3.836; 95% CI= 1.8–8.177). ROC analysis of the IL-6 logistic regression model showed that a cut-off of 5.19 pg/mL had 75.0 % sensitivity and 70.0 % specificity to predict severe atherosclerosis.Conclusion. Pro-inflammatory TNF-α and IL-6 cytokines increased, while regulatory IL-2 and anti-inflammatory IL-4 decreased in patients with stable CAD. Cytokine imbalance contributes to CAD progression. Elevated IL-6 levels and the pro-inflammatory potential of the blood increases in case of severe coronary atherosclerosis. It has been shown that with an increase in IL-6 levels, the odds of detecting severe CAD increases 3.5-folds.

Serum Cytokines Predict the Severity of Coronary Artery Disease Without Acute Myocardial Infarction.

IntroductionVarious cytokines were involved in the process of atherosclerosis, and their serum levels were correlated with coronary artery disease (CAD) to varying degrees. However, there were limited reports about the correlation between serum cytokines and the severity of coronary atherosclerotic lesion in patients with non-acute myocardial infarction (AMI). The purpose of this study was to investigate the relationship between serum cytokines and the severity of CAD, and identify the predictors of severe CAD in patients suspected to have CAD but AMI had been ruled out.MethodsA total of 502 patients who had suspected CAD and underwent coronary angiography were enrolled. The serum levels of IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-17, TNF-α, IFN-α,and IFN-γ were determined by multiplexed particle-based flow cytometric assays technology. And the severity of CAD was evaluated by Gensini score (GS).ResultsThe serum levels of IL-4, IL-12p70, IL-17, and IFN-α were significantly lower in the severe CAD group (GS≥30) than those in the non-severe CAD group (GS < 30). And IL-12p70 and IL-17 were negatively correlated with the severity of CAD. Multivariate logistic regression analyses demonstrated that two serum cytokines (IL-12p70 and IL-17), one clinical protective factor (HDL-C), and two clinical risk factors (gender and diabetes) were the independent predictors of severe CAD. ROC curve analysis showed that multivariate mode combined these predictors had a good performance in predicting severe CAD.ConclusionThe combination of serum cytokines (IL-12p70 and IL-17) and clinical risk factors (HDL-C, gender, and diabetes) may help identify patients with more severe coronary artery lesions from those with suspected CAD but not AMI, and may contribute to guiding the risk stratification for patients with chest discomfort in health care facilities without sufficient medical resources (especially cardiac catheterization resources).

A Novel Electrocardiographic Score Predicts the Severity of Coronary Artery Disease and Clinical Outcomes in Patients with Non-ST Segment Elevation Myocardial Infarction.

There are many electrocardiographic (ECG) changes in non-ST segment elevation myocardial infarction (NSTEMI). However, the diagnostic power is limited in determining the severity of coronary artery disease (CAD) and clinical outcomes. This study investigated the role of a risk-based ECG score in predicting the severity of CAD and clinical outcomes in NSTEMI patients. One hundred and fifty-two patients were enrolled in the study. Severe CAD was defined as; intermediate (> 22) or high SYNTAX score (> 32), three-vessel disease, and left main coronary artery lesions. A risk-based ECG score was calculated, and the patients were categorized. All patients were followed up, and mortality and repeat revascularizations were evaluated. The severe CAD group had a significantly higher risk-based ECG score than the non-severe CAD group (p = 0.013). The patients with a high risk-based ECG score had more severe CAD (p = 0.013), higher SYNTAX score (p < 0.001), more three-vessel disease (p = 0.003), coronary artery calcification (p = 0.02), and one-year mortality (p = 0.006) than those with medium or low ECG scores. Multivariate logistic regression analysis showed that a 1-point increase in the risk-based ECG score was associated with a 1.573-fold [95% confidence interval (CI): 1.111-2.227, p = 0.011] increase probability of severe CAD. Kaplan-Meier analysis demonstrated that the high-risk group had a significantly higher one-year mortality rate than the low-risk and moderate-risk groups (hazard ratio: 2.383, 95% CI: 1.395-4.072, p = 0.001). This study demonstrated that higher ECG scores were associated with a higher risk of severe CAD and worse clinical outcomes in NSTEMI patients.

Relationship between frontal QRS-T duration and the severity of coronary artery disease in who were non-diabetic and had stable angina pectoris.

There is a known relationship between frontal-QRS-T (F-QRS-T) angle and coronary artery disease (CAD). This study examined the relationship between F-QRS-T angle changes and CAD severity in patients with stable CAD. A total of 202 patients were included in the study after the implementation of exclusion criteria among 894 patients, who were admitted to the outpatient clinic with stable angina pectoris between September 2018 and September 2019. The F-QRS-T angle calculated on the 12-lead electrocardiograms (ECGs) of the patients (taken in the outpatient clinic), and the CAD severity calculated using the Gensini score in patients undergoing coronary angiography were compared. Of the patients included in the study, 38.6% were female and 61.4% were male. The mean age was calculated as 60.16±11.27 years, and 52% of the patients had hypertension. There was no difference between the groups in terms of demographic and clinical values. In a comparison of CAD severity and F-QRS-T angles, the F-QRS-T angle was seen to be statistically significantly higher in the severe CAD group [91°° (102/79)] compared to the group with mild CAD [53°° (64/38)]. In the multivariate logistic regression analysis, there was a significant association between the F-QRS-T angle (odds ratio=1.09, 95% confidence interval=1.06-1.11, p<0.001) and CAD severity. It seems that CAD severity in patients who were non-diabetic and had stable angina pectoris is associated with the F-QRS-T angle.

Chronic elevation of cardiac troponin I predicts the extent of coronary disease in hemodialysis patients presenting with acute enzyme elevation

IntroductionElevation of cardiac troponin I (cTn-I) is associated with coronary artery disease (CAD) in asymptomatic patients with end-stage renal disease (ESRD) receiving hemodialysis. We aim to investigate the diagnostic value of chronically elevated cTn-I in ESRD patients presenting with an acute rise in serum cTn-I levels. MethodsWe performed a retrospective analysis of 364 patients. Using coronary angiography, we correlated baseline elevation of cTn-I with the severity of CAD when hemodialysis patients present with acute symptomatic elevation in serum cTn-I. ResultsIn hemodialysis patients presenting with a rise in serum cTn-I above baseline levels, 59% had severe CAD, and 17% had no angiographic evidence of CAD. Hemodialysis patients with severe CAD had significantly higher baseline cTn-I levels compared to patients with non-severe CAD or normal coronaries (p < 0.0001). Baseline elevation of cTn-I in the severe CAD group was correlated with the degree of CAD occlusion (r2 0.56, p < 0.0001), fitting a positive linear model. Furthermore, baseline cTn-I differentiates between patients with and without severe CAD with a test accuracy of 0.72 (95% CI, 0.69–0.75, p < 0.001). At a value of ≥0.2 ng/mL (cutoff for myocardial necrosis), the specificity of baseline cTn-I for underlying severe CAD was 0.95. ConclusionsElevated baseline cTn-I has good accuracy for anticipating more advanced angiographic CAD when hemodialysis patients present with a symptomatic rise in serum cTn-I above baseline levels. Baseline elevation of cTn-I can be used for cardiac disease risk management in hemodialysis patients presenting with symptoms suggestive of CAD.

Analysis of the Correlation between the Level of Serum Inflammatory Factors and the Degree and Diagnosis of Coronary Artery Disease

To observe the changes of neutrophil gelatinase associated apolipoprotein (neutrophil gelatinase associated lipocalin), lipoprotein associated phospholipase A2 and inflammatory cytokine hypersensitive C-reactive protein in patients with coronary heart disease and to explore the correlation between serum lipoproteinassociated phospholipase A2, neutrophil gelatinase associated lipocalin, hypersensitive C-reactive protein and the degree of coronary artery disease in patients with coronary heart disease. 200 inpatients in cardiovascular department of our hospital were divided into coronary heart disease group (n=153) and control group (n=47) according to coronary angiography. The serum levels of lipoprotein-associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein were measured. According to the Gensini score, the patients in the CHD group were divided into mild, moderate, severe and extremely severe groups. The changes of serum lipoprotein associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein was analyzed. At the same time, the relationship between the levels of serum lipoprotein associated phospholipase A2, neutrophil gelatinase associated lipocalin, hypersensitive C-reactive protein and the degree of coronary artery disease was discussed from the three aspects of coronary artery stenosis and Gensini score and the value of combined detection in the diagnosis of coronary heart disease. The serum levels of lipoprotein associated phospholipase A2 lipoprotein associated phospholipase A2 , neutrophil gelatinase-associated lipocalin, hypersensitive C-reactive protein and Gensini score in the coronary heart disease group were significantly higher than those in the control group (p<0.01). The serum levels of lipoprotein-associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein in extremely severe coronary artery disease group were significantly higher than those in moderate to severe disease group, mild disease group and control group (p<0.05) and those in severe disease group were significantly higher than those in mild and moderate disease group and control group (p<0.05). The area under the curve of combined detection of lipoprotein-associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein in the diagnosis of coronary heart disease reached 0.859. The serum levels of lipoprotein associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein are significantly increased in patients with coronary heart disease and are closely related to the severity of coronary artery disease, which can be used to evaluate the severity of coronary artery disease. The diagnostic rate of combined detection of serum lipoprotein associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein for coronary heart disease can reach 0.859, which can provide important clinical guidance value.

The correlation between plasma human neutrophil peptide 1-3 levels and severity of coronary artery disease.

IntroductionInflammation plays a key role in atherosclerosis, and discovering new biomarkers of inflammation is becoming important in order to uncover the pathogenesis of atherosclerotic coronary artery disease (CAD). Recent studies have focused on polymorphonuclear neutrophils. It has been suggested that human neutrophil peptide 1-3 (HNP1-3) is proatherogenic. In this study, we aimed to investigate the associations between plasma HNP1-3 levels and the severity of atherosclerosis via a generally accepted scoring system.Material and methodsThis cross-sectional, observational study included 107 consecutive patients suffering from stable angina pectoris and undergoing coronary angiography (CAG). Patients were divided into two groups according to the Gensini scoring (GS) system evaluating disease severity. Group 1 was composed of mild CAD patients with GS < 20 and group 2 consisted of severe CAD patients with GS ≥ 20. Plasma HNP1-3 levels were assessed by the ELISA method.ResultsThe mean HNP1-3 levels were found to be lower in group 1 than group 2 (134.7 ng/ml vs. 147.5 ng/ml). HNP1-3 levels were significantly higher in the severe CAD group than the mild CAD group according to GS (p < 0.001). The results of multivariate logistic regression analysis revealed that only age > 62 years and HNP1-3 > 134 ng/ml were independent predictors of the severity of CAD after adjusting for gender, smoking, hypertension, hyperlipidemia, diabetes, family history of CAD and white blood cell count. In predicting the severity of CAD, the sensitivity and specificity of HNP1-3 were 83.9% (p < 0.001) and 58.8% (p < 0.001), respectively.ConclusionsThis study revealed that the plasma levels of HNP1-3 were significantly higher in severe CAD than mild CAD.

Relationship between osteopenic syndrome and severity of coronary artery disease detected with coronary angiography and Gensini score in men.

BackgroundMany studies have shown that evidence supporting the relationship between low bone mineral density (BMD) and coronary artery disease (CAD) has been increasing. There is a significant increase of myocardial infarction in men with low BMD.PurposeWe aimed to detect the relationship between BMD and CAD in patients whose CAD was detected with coronary angiography, and its severity and prevalence was detected with Gensini score.MethodsA total of 55 patients were selected who were found to have single or multiple infarctions through using coronary angiography in the cardiology clinic. The CAD severity was evaluated by calculating the Gensini score. These patients were divided into two groups: mild CAD and severe CAD groups. Femur bone mineral density (FBMD) was measured with dual energy X-ray absorptiometry. T score values were determined to be normal if the values were >−1.0 (n=22, 40%), and osteopenia–osteoporosis (osteopenic syndrome) if the T score values were ≤−1 (n=33, 60%).ResultsThe FBMD of severe CAD according to the Gensini risk score was found to be significantly lower. FBMD values in patients decreased as their Gensini scores increased.ConclusionThere was a significant relationship between CAD and osteopenic syndrome. FBMD level in men with severe CAD is significantly low when compared with patients who have mild CAD.

Association of Platelet to Lymphocyte Ratio With Inflammation and Severity of Coronary Atherosclerosis in Patients With Stable Coronary Artery Disease.

The platelet to lymphocyte ratio (PLR) has recently emerged as a potential inflammatory biomarker. Hence, we assessed the relationship between PLR and the extent/severity of coronary artery disease (CAD) using the Gensini score in association with the inflammatory marker C-reactive protein (CRP) in patients with stable CAD. Angiographic data of 1646 patients were analyzed in this cross-sectional study. Patients were categorized according to Gensini scores as no CAD (control), mild, and severe CAD groups. The PLR in the control group was significantly lower than those of mild and severe CAD groups. In multivariate logistic regression analysis, PLR was found to be an independent predictor of the presence of severe CAD (odds ratio: 1.043 [1.036-1.049], P < .001). Furthermore, there was a significant correlation between PLR and the severity of CAD (r = .370, P < .001) and CRP levels (r = .312, P < .001). In conclusion, PLR was independently and positively associated with the severity of coronary atherosclerosis. These results suggest that PLR is an easily available and cheap inflammatory indicator that can be used in predicting the severity of CAD.

Association of serum total bilirubin level with severity of coronary atherosclerosis is linked to systemic inflammation

ObjectiveAlthough cardiovascular protective action of bilirubin has been attributed to its antioxidant effect, there was scarce data regarding the anti-inflammatory properties. Herein, we aimed to assess the relationship between serum total bilirubin level and severity of coronary artery disease (CAD) in association with the direct inflammatory marker such as C-reactive protein (CRP), the other indirect markers included in inflammation process such as neutrophil to lymphocyte ratio (NLR) and red cell distribution width (RDW) in patients with stable CAD. MethodsAngiographic data of 1501 patients were analyzed in this retrospective cross-sectional study. Patients were categorized according to Gensini scores as control, mild CAD and severe CAD groups. The association of clinical and laboratory parameters with the severity of CAD were determined by multivariable linear regression analysis. ResultsTotal bilirubin level in the control group was significantly higher than those of the other groups. After multivariable linear regression analysis total bilirubin [β = −3.131 (−4.481, −1.782), p < 0.001] was significantly associated with the severity of CAD. Futhermore, there was a moderate and significant inverse correlation between serum total bilirubin level and the severity of CAD (r = −0.173, p < 0.001), CRP (r = −0.112, p < 0.001), NLR (r = −0.070, p = 0.026) and RDW (r = −0.074, p = 0.027). ConclusionSerum total bilirubin level was independently and inversely associated with the severity of coronary atherosclerosis in patients with stable CAD. In addition, total bilirubin level was inversely correlated with CRP, NLR and RDW. These results suggest that besides its already known effect on the oxidative stress, higher serum total bilirubin level may exhibit an anti-inflammatory effect in the coronary atherosclerotic process.

The association between fasting serum insulin, apo-lipoproteins level, and severity of coronary artery involvement in non-diabetic patients.

Background:In the previous studies, fasting insulin and apo-lipoproteins are considered as one of the risk-factor of coronary artery disease (CAD) but did not have the same results.In this study, we attempted to define the association of high fasting insulin and apo-lipoproteins of serum in non-diabetic patients who were afflicted with coronary arteries disease with severity of coronary arteries involvement.Materials and Methods:This study was conducted between September 2011 and February 2012 on three groups, each one consisting of 100 members while using angiographic scores of Gensini with three equal groups with low, medium, and high stenosis of coronary arteries.The evaluation of non-diabetic patients afflicted with CADs, included the fasting glucose level less than 126 mg/dl or non-consumption of blood glucose reduction drugs or negativity history of diabetes.Results:In this study, there were 300 non-diabetic patients afflicted with CAD in three groups of low, medium, and high extremity. Due to attained results, the patients afflicted with high CAD had a higher level of insulin (18.3 ± 0.8) in relation with low and medium groups (P < 0.001). As it was observed, the level of serum apo-lipoproteins of A1 (APO-A1) in low group of CAD (175 ± 36.4) is meaningfully higher than its quantity in high-CAD group (158 ± 42.4, P < 0.001). Furthermore, the quantity of serum apo-lipoproteins of B (APO-B) in mild CAD group (139 ± 30.4) is meaningfully less than severe CAD group (155.21 ± 29.7, P < 0.001).Conclusion:Our findings show that insulin, APO-A1, APO-B, and total cholesterol measurement is a good case for defining the severity of coronary artery involvement, while high-density lipoprotein, low-density lipoprotein, and triglyceride are not important risk-factors.

Reduced Paraoxonase 1 Activity as a Marker for Severe Coronary Artery Disease

Paraoxonase-1 (PON1), a high-density-lipoprotein- (HDL-) associated enzyme, has the potential to protect against atherogenesis. We examine the relationships between plasma PON1 activity and the progression of atherosclerosis as well as coronary artery disease (CAD). Fasting blood samples were collected from female apolipoprotein E-deficient (apoE−/−) mice and 149 patients undergoing coronary angiography for the biochemical parameters measurement. The severity of CAD was defined using angiographic Gensini score (GSS). Compared to 3-month-old apoE−/− mice, aged mice had significantly lower PON1 activity, which is negatively correlated with the size of atherosclerotic lesion and plasma interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) levels. In study patients, PON1 activity was correlated with age, sex, and HDL-cholesterol, apolipoprotein AI, and high-sensitivity C-reactive protein (hs-CRP) levels and was significantly lower in CAD group than that in non-CAD control group. Interestingly, PON1 activity in severe CAD group (GSS > 40) was further significantly reduced compared to those in mild and moderate subgroups (GSS ≤ 40) (P < 0.01). There is a significant correlation between PON1 activity and the severity of CAD as assessed by GSS (r = −0.393, P < 0.001). PON1 activity may be a potential biomarker for the severity of CAD.

UGT1A1 Promoter Genotype is not Strongly Associated With Severity of Coronary Artery Disease

Atherosclerosis is a leading cause of morbidity and mortality. Oxidative stress is thought to play a role in its pathogenesis. Bilirubin is an endogenous antioxidant that is mildly elevated in people with Gilbert syndrome. Homozygosity for a A(TA)7TAA variant of the UDP-glucuronosyltransferase 1 family, polypeptide A1 (UGT1A1) promoter is necessary for expression of the Gilbert phenotype. We studied the relationship between coronary artery disease (CAD) and the Gilbert genotype. Decedents who underwent autopsy were categorized into none/mild, moderate, and severe CAD groups based on autopsy findings. Known CAD risk factors were evaluated for each decedent in the severe CAD group (n=35), and for an age, race, and sex-matched control group with none/mild CAD (n=45). Formalin-fixed paraffin-embedded (FFPE) tissue was tested for UGT1A1 promoter variants by polymerase chain reaction and capillary electrophoresis. To our knowledge, this is the first study to successfully apply UGT1A1 promoter genotyping to formalin-fixed paraffin-embedded tissue, which may facilitate more thorough examination of clinicopathologic correlations. The frequency of the Gilbert genotype was compared between the none/mild cohort and the severe cohort. UGT1A1 promoter genotype data were obtained for 76/80 cases. The overall frequency of the Gilbert genotype compared well with previously reported frequencies at 16%, with a frequency of 16% in the none/mild CAD group and 15% in the severe CAD group. These findings suggest that UGT1A1 promoter genotype is not a major factor contributing to risk of CAD.

Decreased ratio of high-molecular-weight to total adiponectin is associated with angiographic coronary atherosclerosis severity but not restenosis

Backgrounds Adiponectin is thought to protect against atherosclerosis and its expression is decreased in metabolic syndrome and diabetes mellitus. Adiponectin has a high-molecular-weight (HMW) multimer structure in the blood. We determined whether circulating HMW adiponectin, total adiponectin, or their ratio predicts baseline angiographic coronary artery disease (CAD) severity and restenosis after percutaneous coronary intervention (PCI). Methods Patients with stable angina pectoris who underwent PCI for a de novo lesion and had angiographic follow-up at our hospital were retrospectively enrolled. The study patients were grouped as moderate ( N = 68) or severe ( N = 63) coronary atherosclerosis by the baseline median Gensini severity score (moderate < 22, severe ≥ 22). Results Univariate analysis showed that subjects in the severe CAD group had a lower HMW/total adiponectin ratio (0.32 ± 0.19 vs. 0.37 ± 0.16, p = 0.024) while the absolute value of HMW adiponectin (2.17 ± 2.05 vs. 2.27 ± 2.07 µg/ml, p = 0.389) and total adiponectin (5.97 ± 3.12 vs. 5.76 ± 2.91 µg/ml, p = 0.807) were similar between the severe and moderate CAD groups. In a multivariate binary logistic regression model, a higher serum HMW/total adiponectin ratio (odds ratio 0.058, p = 0.018) was negatively, while hypercholesterolemia (OR 2.475, p = 0.029) was positively associated with coronary atherosclerosis disease severity. In terms of restenosis after PCI (mean follow-up at 12 ± 13 months), HMW adiponectin, total adiponectin and their ratio were similar between restenotic ( N = 91) and non-restenotic groups ( N = 40). Conclusions A decreased ratio of circulating HMW adiponectin to total adiponectin is associated with angiographic disease severity but not restenosis in CAD patients undergoing PCI.

Angiopoietin-1, Angiopoietin-2 and Tie-2 in the Coronary Circulation of Patients With and Without Coronary Collateral Vessels

The role of the angiopoietin (Ang)/Tie-2 system in coronary collateral growth is not well understood, so the purpose of this study was to investigate and elucidate the relationship of this system to coronary collateral formation in patients with coronary artery disease (CAD). Fifty-nine patients with CAD were recruited. Blood samples from the left ventricle (LV) and coronary sinus (CS) were obtained during cardiac catheterization, and serum concentrations of Ang-1, Ang-2, and Tie-2 were measured by enzyme-linked immunosorbent assay. Patients were then classified as mild CAD (n=30), defined as </=90% stenosis of the coronary arterial luminal diameter, or severe CAD (n=29), which was total (or near total) coronary occlusion requiring coronary collateral growth. Ang-1, Ang-2, and Tie-2 in the LV and CS sera were not significantly different between groups. In the severe CAD group, spillover of Tie-2 (CS-LV value) from the coronary circulation was found in comparison with the mild CAD group (3.43+/-2.22 vs -3.29+/-1.54 ng/ml, p=0.01), whereas the CS-LV values of Ang-1 and Ang-2 did not differ between groups. Tie-2 production was markedly increased in patients with well-developed collaterals. A positive and significant correlation was found between coronary Ang-2 and Tie-2 levels (r=0.44, p<0.001). Tie-2 is probably produced in the coronary circulation and may induce the development or maintenance of coronary collaterals in CAD patients. Furthermore, the role of Ang-2 in the formation of coronary collaterals may be more important than that of Ang-1.