Suspicion Of Angina Research Articles

Abstract 18987: Warning Symptoms Precede Sudden Cardiac Death in Majority of Men

Introduction: Despite significant enhancements in resuscitation methodology, survival after sudden cardiac arrest (SCA) remains low. Improved knowledge of warning signs and symptoms may assist the process of early intervention for SCA. Hypothesis: We hypothesize that a sub-group of men who suffer SCA have warning symptoms prior to SCA. Methods: In a large, ongoing, prospective, population-based study in a Northwestern US metro region (population approx. 1 million; 2002-2012), we systematically evaluated the frequency, characteristics and temporal trends of all symptomatology in the 4 weeks prior to SCA among middle aged male cases (35-65 years). We performed a detailed and comprehensive assessment of the accounts of family members/relatives, witnesses, emergency medicine personnel, as well as medical records during this time period. Results: Of the 825 SCA cases, 258 (31%) did not have sufficient information to ascertain the presence of symptoms. Of the 567 cases with appropriate assessment [mean age 52±12 yr, initial shockable rhythm 59%, presence of witness 40%, bystander CPR 27%, presence of coronary artery disease (CAD) 84%], 300 (53%) patients presented with symptoms. These were principally chest pain in 167 patients (56%), dyspnea in 38 (13%), and dizziness/syncope/palpitations in 11 (4%). Episodes of chest pain were categorized as typical angina in 111 (67%) and suspicion of angina in 56 (33%). In an additional 29 cases (10%), typical flu symptoms were noted during the 4 weeks period. Overall, most symptoms (79%) occurred more than 1 hr before the SCD event (up to 4 weeks), whereas symptoms immediately preceding (<1 hour) were less frequent (21%). Symptoms were especially frequent with associated CAD compared to non CAD-related SCA (56% vs. 32%, P=0.0005). Among patients with previously known CAD 55% had symptoms before SCA. Conclusions: In this community-based study, a higher than expected proportion of middle-aged men had warning symptoms prior to SCA. These findings may be explained by longer duration of evaluation, and have implications for SCA surveillance and prevention.

C-Type Natriuretic Peptide as a Surrogate Marker in Variant Angina Pectoris

Background and ObjectivesThe purpose of this study was to assess the value of C-type natriuretic peptide (CNP) as a surrogate marker for detection of coronary artery spasm in variant angina pectoris (VAP).Subjects and MethodsSixty-six patients (mean age: 51±11 years, M : F=40 : 26) who underwent coronary angiography on suspicion of angina and who were diagnosed with VAP by the acetylcholine-induced spasm provocation test (SPT) were enrolled and divided into a SPT (-) group (n=23) and a SPT (+) group (n=43). Concentrations of CNP and other markers were determined by immunoassay in both groups.ResultsPlasma CNP and creatine kinase myoglobin band (CK-MB) concentrations were significantly increased in the SPT (+) group relative to the SPT (-) group (CNP, 5.268±1.800 pg/mL vs. 3.342±1.150 pg/mL, p=0.002; CK-MB, 2.54±1.03 ng/dL vs. 1.86±0.96 ng/dL, p=0.019, respectively) while plasma high sensitivity C-reactive protein (hs-CRP) and N-terminal pro-brain natriuretic peptide (NT pro-BNP) concentrations were not significantly different between the SPT (-) group and SPT (+) group (hs-CRP, 2.76±4.99 mg/L vs. 3.13±4.88 mg/L, p=0.789; NT pro-BNP, 49±47 pg/mL vs. 57±63 pg/mL, p=0.818, respectively). Plasma CNP concentration was independently associated with the VAP via SPT {odds ratio: 2.014 (95% confidence interval: 1.016-3.992), p=0.045}. A CNP cut-off value of 4.096 pg/mL was found to have a sensitivity of 68.2% and a specificity of 40.0% for predicting the probability of VAP via SPT.ConclusionIncreased plasma CNP concentration in patients with VAP may have an impact on the regulation of endothelial function in accordance with the progression of atherosclerosis. Further analysis is warranted to develop clinical applications of this finding.

Association of the manganese superoxide dismutase polymorphism with vasospastic angina pectoris

Vasospastic angina (VSA) is closely related to endothelial dysfunction caused by oxidative damage. Manganese superoxide dismutase (MnSOD) is an antioxidant enzyme that functions in mitochondria. There are two genetic variants of MnSOD arising from a substitution of an alanine for a valine in the signal peptide. We previously reported that the valine allele of MnSOD decreases the mitochondrial MnSOD (mtMnSOD) activity. Here, we investigated the association of the MnSOD polymorphism (Ala16Val) with VSA. Blood samples were collected from 618 healthy subjects who did not have any symptoms or other evidence suggesting angina pectoris, and 228 patients who underwent coronary angiography on suspicion of angina, and were diagnosed to have VSA by acetylcholine test. MnSOD genotype of each subject was determined by real-time polymerase chain reaction. The valine allele frequency was higher in the VSA patients (0.890) than in the healthy subjects (0.839) [odds ratio (OR)=1.55, p=0.0085]. In healthy subjects the MnSOD genotype distribution was as follows: alanine/alanine 1.9%, alanine/valine 28.3%, and valine/valine 69.8%, and in VSA patients the prevalence was: alanine/alanine 1.3%, alanine/valine 19.3%, and valine/valine 79.4%. Thus, the valine allele was closely associated with VSA (p=0.019). Multivariate logistic regression analysis showed valine/valine homozygosity to be an independent risk factor for VSA (OR=2.02, 95% CI 1.43, 2.85; p=0.0012). The valine variant of MnSOD signal peptide increases the risk of VSA.