Value For Future Cardiovascular Events Research Articles

The role of echocardiographic parameters in the prevention and monitoring of cardiac toxicity on antitumor treatments.

The paper presents a summary of the literature that includes the results of the research on the echocardiographic parameters for the early detection and monitoring of the cardiac toxicity of the antitumor treatment. While the left ventricular ejection fraction is currently the most widely used index to quantify cardiac function in cardio-oncology, there are a number of indices under investigation to prove their prognostic value in the occurrence of adverse cardiac events during cancer therapy. Such indices derived from the Doppler method, speckle tracking parameters, strain rate as well as parameters derived from three-dimensional echocardiography, which can provide additional sensitivity and substantial prognostic value for future cardiovascular events.

Abstract 13441: Transcriptomic Analysis of Endothelial Colony Forming Cells From the BioHEART-CT Study to Unravel New Biomarkers for Coronary Artery Disease

Coronary artery disease (CAD) remains the leading cause of death worldwide. There are unmet needs for the diagnosis and treatment for patients with CAD, especially those without modifiable risk factors who are suspected to be at low risk for CAD. Endothelial function has predictive value for future cardiovascular events. We previously showed that endothelial colony forming cells (ECFCs) derived from the BioHEART-CT (The BioHEART Study: Assessing Patients with Suspected Cardiovascular Disease for New Biomarkers and Risk Factors) cohort can be used as a viable tool to evaluate endothelial function in patients as these cells retain the memory of their host. Here, we aimed to characterize the transcriptomic profiles of ECFCs in non-CAD and CAD patients. Based upon our previous findings on the positive correlation between mitochondrial superoxide level and the severity of CAD, we hypothesize that the transcriptomic and functional analyses of the mitochondrial pathways are dysregulated in the ECFCs in CAD patients. RNA-sequencing was performed in ECFCs cultured from the peripheral blood of 44 patients from the BioHEART-CT cohort who had computed tomography coronary angiograms scored for coronary artery calcium (CAC) and Gensini to measure CAD severity. The cohort included 45.5% women and 54.5% men with an average age of 61.6 years. Non-CAD group was determined by a Gensini score of zero, whereas CAD group was determined by a Gensini score of greater than 5. These CAD patients had median CAC score of 266.8, with significant presence of calcified and soft plaques in their coronary arteries. Transcriptomic analysis of ECFCs showed that a total of 37 genes were upregulated and 77 genes were downregulated in the CAD patients. To investigate the functional relevance of the pathways altered in the CAD cohort, dysregulation of genes was analyzed using gene set enrichment analysis. We found that the metabolic processes, those associated with mitochondrial biogenesis, were significantly altered in the ECFCs. Our approach of using RNA-sequencing to determine the gene characteristics of CAD patients and their functional relevance to disease has the potential to unravel previously un-identified genes or biomarkers that are distinct to CAD patients.

Exercise-Induced Cardiac Troponin Elevations: From Underlying Mechanisms to Clinical Relevance.

Serological assessment of cardiac troponins (cTn) is the gold standard to assess myocardial injury in clinical practice. A greater magnitude of acutely or chronically elevated cTn concentrations is associated with lower event-free survival in patients and the general population. Exercise training is known to improve cardiovascular function and promote longevity, but exercise can produce an acute rise in cTn concentrations, which may exceed the upper reference limit in a substantial number of individuals. Whether exercise-induced cTn elevations are attributable to a physiological or pathological response and if they are clinically relevant has been debated for decades. Thus far, exercise-induced cTn elevations have been viewed as the only benign form of cTn elevations. However, recent studies report intriguing findings that shed new light on the underlying mechanisms and clinical relevance of exercise-induced cTn elevations. We will review the biochemical characteristics of cTn assays, key factors determining the magnitude of postexercise cTn concentrations, the release kinetics, underlying mechanisms causing and contributing to exercise-induced cTn release, and the clinical relevance of exercise-induced cTn elevations. We will also explain the association with cardiac function, correlates with (subclinical) cardiovascular diseases and exercise-induced cTn elevations predictive value for future cardiovascular events. Last, we will provide recommendations for interpretation of these findings and provide direction for future research in this field.

Risk for cardiovascular events following ‘microsize’ versus usual myocardial infarctions

BackgroundMicrosize myocardial infarction (MI) is a recently described phenomenon that meets rigorous criteria for MI with very low peak troponin elevations. We aim to compare the risk for cardiovascular events...

Time-dependent prognostic effect of high sensitivity C-reactive protein with statin therapy in acute myocardial infarction

BackgroundElevated high sensitivity C-reactive protein (hs-CRP) in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) has prognostic value for future cardiovascular events. This study aimed to ascertain a valid prognostic time-period for predicting cardiovascular outcome based on baseline hs-CRP in AMI patients undergoing successful PCI on statin therapy. MethodsOverall, 4410 AMI patients were enrolled from the Korea Acute Myocardial Infarction-National Institutes of Health (KAMIR-NIH) registry. Participants were divided into groups according to cut-off values of baseline hs-CRP (1.0, 3.0, and 10.0mg/L) and statin therapy intensity. The primary outcome was 36-month major adverse cardiovascular events (MACE), a composite of all-cause mortality, any myocardial infarction, and repeat revascularization. The secondary outcome was MACE developed 0–6, 6–12, and 12–36 months after AMI. ResultsThe overall incidence of 36-month MACE was significantly higher as baseline hs-CRP increased (by groups: 8.8% vs. 8.6% vs. 10.7% vs. 15.4%, log-rank p<0.001). The prognostic effect of baseline hs-CRP was mostly confined to the first 6 months after AMI (0–6 months MACE by groups: 1.6% vs. 2.3% vs. 4.3% vs. 6.1%, log-rank p<0.001) and attenuated in high-intensity statin users. Six months after AMI, this prognostic effect of baseline hs-CRP was remarkably reduced (6–12 month MACE by groups: 2.4% vs. 2.1% vs. 2.8% vs. 4.0%, log-rank p=0.111, 12–36 month MACE by groups: 4.7% vs. 4.1% vs. 4.0% vs. 6.2%, log-rank p=0.218); however, high-intensity statin treatment showed a consistent improvement in outcome. The observed time-dependent prognostic effects remained consistent following multivariate analysis. ConclusionsThe prognostic impact of elevated hs-CRP at baseline was most evident during the first 6 months after AMI; however, the use of high-intensity statin persistently improved the clinical outcome even after the resolution of inflammatory reactions.

Determinants of coronary flow reserve in non-diabetic patients with chest pain without myocardial perfusion defects.

BackgroundMicrovascular dysfunction could be responsible for chest pain in patients without myocardial perfusion defects. We evaluated microvascular function using ultrasound-assessed coronary flow reserve (CFR) in patients with chest pain and normal myocardial perfusion scintigram. Secondly, we investigated association between cardiovascular parameters and decreased CFR in a sex specific manner.MethodsA total of 202 (128 women) non-diabetic patients with chest pain and suspected myocardial ischemia, but without myocardial perfusion defects on myocardial perfusion scintigram, were enrolled and underwent CFR examination and blood sampling. All patients were followed-up for cardiovascular events. We used a supervised principal component analysis including 66 variables such as clinical parameters, ongoing medication, coronary artery disease history, lipids, metabolic parameters, inflammatory and other cardiovascular parameters.ResultsDuring a median follow-up time of 5.4 years, 25 cardiovascular events occurred; (men;18, women;7). Average CFR of the study cohort was 2.7±1.2 and 14% showed impaired CFR<2.0. In an adjusted Cox regression analysis, CFR<2.0 independently predicted event-free survival (HR:2.5, p = 0.033). In the supervised principal component analysis high insulin resistance assessed by Homeostatic model assessment for insulin resistance was the strongest biochemical marker associated with decreased CFR. Interestingly, upon sex specific multivariable linear regression analysis, the association was only significant in men (β = -0.132, p = 0.041) while systolic blood pressure remained an independent predictor in women (β = -0.009, p = 0.011).ConclusionsIn non-diabetic patients with chest pain without myocardial perfusion defects, low CFR has prognostic value for future cardiovascular events. Insulin resistance appears to be a marker for decreased CFR in men. Indeed, in the context of contribution of traditional risk factors in this patient population, the value of systolic blood pressure seems to be important in the women.

PP.09.08] SMOKING ACCELERATES ALBUMIN EXCRETION IN HYPERTENSIVE PATIENTS WITH METABOLIC SYNDROME

Objective: Microalbuminuria is a marker of kidney organ damage and has independent prognostic value for future cardiovascular events. Metabolic syndrome (MS) is prognostic of cardiovascular disease, either as a distinct entity or through its clustering cardiometabolic abnormalities. Whether smoking may accelerate microalbuminuria in patients with MS, is not well clarified. Design and method: We studied 524 patients with never-treated arterial hypertension and metabolic syndrome, defined by the ATP III criteria. Smoking status was assessed by recording the current habit of smoking. Albumin excretion was evaluated in all patients after 24 h urine collection, using immunonephelometry, and albumin to creatinine ratio (ACR) was calculated. High-sensitivity C-reactive protein (hsCRP) was measured as an inflammatory biomarker. All participants were free from overt cardiovascular disease. Results: Smokers (n = 274) were younger compared to non-smokers (mean age: 51 vs 56 years old, p < 0.001), had increased levels of hsCRP (1.9 ± 1.2 vs 1.7 ± 1.1 mg/L, p < 0.01) but, marginally, lower mean arterial pressure (MAP) levels compared to non-smokers (111.3 ± 11.8 vs 113.2 ± 12.8 mmHg, p = 0.06). No difference in glucose, total cholesterol and triglycerides was observed between the two groups (p = NS). Albumin excretion was significantly higher in smokers compared to non-smokers (mean ACR: 40.4 vs 32.9 mg/g, p = 0.04). In linear regression analysis, ACR was independently associated with smoking (b = 0.10, p = 0.01) after adjustment for age, gender, BMI, plasma glucose, MAP and hsCRP. Conclusions: Smoking accelerates microalbuminuria in hypertensive patients with MS, independently of other classic or novel risk factors. Given the prognostic significance of microalbuminuria, it might be suggested that smoking may further enhance the cardiovascular risk associated with MS through the adverse effect on albumin excretion. Whether quitting smoking may result in regression of microalbumiuria, thus with a more favorable cardiovascular risk profile, is a question that warrants further investigation. Until then, microalbuminuria should be assesed in all smokers with MS and arterial hypertension in order to improve risk stratification and guide therapy.

MR imaging of iliofemoral peripheral vascular calcifications using proton density-weighted, in-phase three-dimensional stack-of-stars gradient echo.

The presence of vascular calcifications helps to determine percutaneous access for interventional vascular procedures and has prognostic value for future cardiovascular events. Unlike CT, standard MRI techniques are insensitive to vascular calcifications. In this prospective study, we tested a proton density-weighted, in-phase (PDIP) three-dimensional (3D) stack-of-stars gradient-echo pulse sequence with approximately 1 mm3 isotropic spatial resolution at 1.5 Tesla (T) and 3T to detect iliofemoral peripheral vascular calcifications and correlated MR-determined lesion volumes with CT angiography (CTA). The study was approved by the Institutional Review Board. The prototype PDIP stack-of-stars pulse sequence was applied in 12 patients with iliofemoral peripheral vascular calcifications who had undergone CTA. Vascular calcifications were well visualized in all subjects, excluding segments near prostheses or stents. The location, size, and shape of the calcifications were similar to CTA. Quantitative analysis showed excellent correlation (r2 = 0.84; P < 0.0001) between MR- and CT-based measures of calcification volume. In one subject in whom three pulse sequences were compared, PDIP stack-of-stars outperformed cartesian 3D gradient-echo and point-wise encoding time reduction with radial acquisition (PETRA). In this pilot study, a PDIP 3D stack-of-stars gradient-echo pulse sequence with high spatial resolution provided excellent image quality and accurately depicted the location and volume of iliofemoral vascular calcifications. Magn Reson Med 77:2146-2152, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Microvascular dysfunction in schizophrenia: a case-control study.

Background:Schizophrenia is a mental illness associated with cardiovascular disease at a younger age than in the general population. Endothelial dysfunction has predictive value for future cardiovascular events; however, the impact of a diagnosis of schizophrenia on this marker is unknown.Aims:We tested the hypothesis that subjects with schizophrenia have impaired endothelial function.Methods:A total of 102 subjects (34.5±7.5 years) participated in this study. This sample consisted of 51 subjects with a diagnosis of schizophrenia and 51 healthy subjects, who were matched for age (P=0.442), sex (P>0.999), and smoking status (P=0.842). Peripheral artery microvascular and conduit vessel endothelial function was measured using hyperemic velocity time integral (VTI), pulse arterial tonometry (PAT), and flow-mediated dilation (FMD).Results:Significantly lower values of VTI were noted in subjects with schizophrenia (104.9±33.0 vs. 129.1±33.8 cm, P<0.001), whereas FMD (P=0.933) and PAT (P=0.862) did not differ between the two groups. A multivariable-linear-regression analysis, built on data from univariate and partial correlations, showed that only schizophrenia, sex, lipid-lowering medications, antihypertensive medications, and low-density lipoprotein (LDL)-cholesterol were predictive of attenuated VTI, whereas age, ethnicity, family history of cardiovascular disease, smoking status, systolic blood pressure, waist circumference, HDL-cholesterol, triglycerides, C-reactive protein, and homeostatic model assessment-insulin resistance (HOMA-IR), antidiabetic medications, antidepressant medications, mood stabilizers, benzodiazepines, and anticholinergic medications did not predict VTI in this model (adjusted R 2=0.248).Conclusions:Our findings suggest that a diagnosis of schizophrenia is associated with impaired microvascular function as indicated by lower values of VTI, irrespective of many other clinical characteristics. It might be an early indicator of cardiovascular risk in schizophrenia, and might help to identify high-risk individuals.

Endothelial dysfunction and coronary artery disease: assessment, prognosis, and treatment.

Progress in the modification of conventional coronary risk factors and lifestyle behavior has reduced the incidence of atherosclerotic coronary artery disease; nonetheless, it continues to be the leading cause of mortality in the world. This might be attributed to the defective risk stratifying and prevention strategy for coronary artery disease. In the current clinical setting, atherosclerotic coronary artery disease risk is estimated on the basis of identifying and quantifying only traditional risk factors; it does not take into consideration nontraditional risk factors. In addition, most of the prevailing therapies for atherosclerosis are targeted toward traditional risk factors rather than atherosclerosis itself. It is desirable to develop a method that can directly assess the activity of atherogenesis at every moment. Endothelial function is an integrated index of all atherogenic and atheroprotective factors present in an individual including nontraditional factors and heretofore unknown factors, and it is reported to have additional predictive value for future cardiovascular events to traditional risk factors. Moreover, endothelial function has a pivotal role in all phases of atherosclerosis, from initiation to atherothrombotic complication, and is reversible at every phase, indicating that endothelial function-guided therapies might be effective and feasible in cardiovascular practice. Thus, the introduction of endothelial function testing into clinical practice might enable us to innovate individualized cardiovascular medicine. In this review, we summarize the current knowledge on the contribution of endothelial dysfunction to atherogenesis and review the methods that assess endothelial function. Finally, we focus on the effects of major antiatherosclerotic disease therapies on endothelial function and argue the possibility of noninvasive assessment of endothelial function aiming at individualized cardiovascular medicine.

Evaluation of Endothelial Function by Flow Mediated Dilation: Methodological Issues and Clinical Importance

Endothelium plays a primary role in the control of vascular function and structure by protective properties of nitric oxide, which have stimulated the development of methods to assess of endothelial function. Flow-mediated dilation is the most widely used method to test endothelial function since it is non-invasive, and measures by ultrasounds the response to increased shear stress, commonly in the brachial artery. This review focuses on available evidence on FMD, which has been tested for the association with risk factors, target organ damage and the predictive value for future cardiovascular events. FMD has been studied widely in clinical research as it enables serial evaluation, also testing the effect of lifestyle and pharmacological interventions on endothelial function at an early preclinical stage, when the disease process is most likely to be reversible. Despite these advantages, endothelial tests, including FMD, are not yet recommended by guidelines for cardiovascular prevention, for the absence of clear additional prognostic value and particularly the poorly standardized non-invasive methodology. However, recent multicenter studies suggest that accurate methodology ensures reproducible FMD measurements, which can be used in future clinical research to test whether interventions ameliorating FMD function are associated to better cardiovascular prognosis.

Is Toll-like receptor responsiveness a marker and predictor of coronary artery disease?

Is Toll-like receptor responsiveness a marker and predictor of coronary artery disease?

Increased cytokine response after toll-like receptor stimulation in patients with stable coronary artery disease

ObjectiveAtherosclerosis is associated with increased levels of plasma cytokines and expression of Toll-like receptors (TLRs). Yet, little is known about the potential use of TLR ligand induced cytokine release as a biomarker of coronary artery disease (CAD). In this study, we investigated whether TLR ligand induced cytokine release is associated with atherosclerotic disease severity and its predictive value for future cardiovascular events. MethodsBlood samples were obtained from 260 patients with stable angina and 15 healthy controls. Cytokine levels of TNFα, IL-8 and IL-6 were measured after 2 h of whole blood stimulation with 10 ng/ml lipopolysaccharide (LPS, TLR4 ligand) and P3C 500 ng/ml (TLR2 ligand). In a subgroup, dose–response curves were created using additional LPS concentrations. ResultsLPS induced whole blood release of TNFα and IL-6, but not IL-8, was significantly higher in patients compared to healthy controls. Among CAD patients, TLR responses did hardly differ when associated with the presence of traditional risk factors and atherosclerotic disease severity (number of diseased vessels and coronary stenosis degree). Patients with secondary events during follow-up showed a trend towards an increased TLR response. Furthermore, positive associations were found between CRP levels and TLR-induced TNFα (CRP<2: 2055 pg/ml; CRP>2: 2364 pg/ml) and IL-6 production (CRP<2: 1742 pg/ml; CRP>2: 2250 pg/ml). ConclusionIn conclusion, TLR-induced whole blood cytokine release in patients with stable angina indicates the presence of coronary atherosclerosis but does not reflect its severity.

Soluble ST2 levels are not associated with secondary cardiovascular events and vulnerable plaque phenotype in patients with carotid artery stenosis

ObjectiveSoluble ST2 (sST2), a novel biomarker predictive for heart disease, has recently been shown associated with the progression of atherosclerotic disease in a mouse model. The present study was designed to assess sST2 plasma levels in patients scheduled for carotid endarterectomy and relate it with the occurrence of adverse cardiovascular events during follow-up. In addition, sST2 levels were associated to patient clinical data and atherosclerotic plaque characteristics. Methods and resultsPlasma sST2 levels were measured in 391 patients who underwent carotid endarterectomy and were subsequently followed for 3 years. Primary composite endpoint was the occurrence of an adverse cardiovascular event.At baseline, no differences were observed in sST2 levels between asymptomatic (n = 75) and symptomatic (n = 316) patients (85 [49–122] versus 90 [58–137] pg/ml, p = 0.263). Soluble ST2 plasma levels did not differ between patients who experienced a secondary manifestation of cardiovascular disease and patients who remained free of symptoms (90 [60–129] versus 88 [46–140] pg/ml, p = 0.519). There was no association between sST2 levels and any of the following plaque characteristics: size of a lipid core, degree of calcification, number of macrophages or smooth muscle cells, amount of collagen and number of microvessels. ConclusionsSoluble ST2 plasma levels have no predictive value for future cardiovascular events in patients with significant carotid artery stenosis. In addition, we did not observe an association between plasma sST2 levels and the histopathological features of a rupture prone plaque. This study does not provide supportive evidence that sST2 reflects a progressive state of advanced atherosclerotic disease.

Novel Risk Factors Related to Stable Angina

Stable angina (SA) pectoris is a common and disabling disorder in patients with coronary artery disease (CAD), with increasing epidemiology and is associated with myocardial infarction and increased mortality. However, within the population of SA patients, an individual's prognosis can vary considerably. Except from conventional risk factors a variety of biomarkers have been evaluated for their prognostic significance in the settings of SA. Novel biomarkers associated with inflammatory status, such as C reactive protein and tumor necrosis factor alpha, with myocardial performance, such as B-type natriuretic peptide, with extracellular matrix remodeling, with vascular calcification such as osteoprotogerin and osteopontin, with myocardial ischemia, such as ischemia modified albumin have been associated with the progression of CAD and with the prognosis of SA patients. Despite the multiplicity of novel biomarkers there is lack of a clinical useful, highly specific for CAD biomarker with the ability to guide treatment decisions. In the context of this evidence in this review article we summarize the so far acquired knowledge of the most promising biomarkers and we discuss the major clinical correlations of novel risk factors with SA physical history, their predictive value for future cardiovascular events and their use in the treatment monitoring of this population.

Hemostasis Parameters Disturbances in Healthy Individuals with Prehypertension

Prehypertension (PH) seems to be related to increased cardiovascular risk in healthy normotensive subjects, while essential hypertension is associated with hemostasis balance disturbances. The aim of our study was to examine the impact of PH on hemostasis parameters in healthy individuals with PH and to compare the findings with those of healthy normotensives with normal blood pressure (NBP) levels. This study was performed in 204 (96 M, 108 F) subjects who attended our hypertension clinic. Seventy-eight (36 M, 42 F) subjects with PH, mean age 52 ± 5 years, and body mass index (BMI) 23 ± 1.5 kg/m2 made up group A, and 126 (60 M, 66 F) subjects with NBP, mean age 53 ± 6 years, and BMI 23.2 ± 1.4 kg/m2 without any history of cardiovascular disease or diabetes mellitus made up group B. Systolic blood pressure and diastolic blood pressure were measured in three sequential visits, which were performed by the same trained nurse. Serum lipid levels, fibrinogen (F), thrombomodulin (TM), and plasminogen activator inhibitor-1 antigen, and tissue plasminogen activator antigen were determined in the whole population. Plasminogen activator inhibitor-1 antigen and tissue plasminogen activator antigen levels were significantly higher in the PH group as compared with normotensives, while in PH subjects, significantly higher plasma levels of F and TM were found compared with normotensive group. The two groups were matched for age, sex, BMI, and serum lipid levels. Our findings indicate that PH is associated with hemostasis disturbances predisposing to hypercoagulability and impaired fibrinolysis. This observation may be of prognostic value for future cardiovascular events in this group and needs further investigation.

Biomarkers Determining Cardiovascular Risk in Patients with Kidney Disease

Cardiovascular disease (CVD) remains the leading cause of premature death in patients with chronic kidney disease (CKD). Recent evidence suggests that the interaction of "classic" and "non-classic" cardiovascular risk factors is an important contributor in excessive and accelerated CVD in patients with CKD. Indeed, the imposing cardiovascular morbidity and mortality of CKD patients corresponds to a significant extent in endothelial dysfunction, inflammation, oxidative stress, vascular calcification and volume overload. In addition, the kidney's function decline is independently associated with CVD in patients with chronic kidney disease. Currently, there is a growing interest in the role of new biomarkers that are closely correlated with CVD in CKD population. In current review, we summarize the so far acquired knowledge of the most promising biomarkers and we discuss the major clinical correlations of novel risk factors and new biomarkers of CVD in CKD patients, their predictive value for future cardiovascular events and their use in the treatment monitoring of this population.

B-Type Natriuretic Peptide for Diagnosis and Therapy

Brain natriuretic peptide (BNP) plays an important role in cardiovascular homeostasis. Plasma BNP increases markedly in left ventricular dysfunction from several causes, and its levels in heart failure (HF) correlate with symptoms severity. BNP has recently emerged as a potentially important clinical marker for the diagnosis of HF in patients with unexplained dyspnea. Other clinical applications of BNP, such as screening for asymptomatic ventricular dysfunction, establishing the prognosis or guiding the titration of drug therapy, are under investigation and have not yet been sufficiently validated for widespread clinical use. Laboratory-based and point-of-care analyses are available for BNP and N-terminal proBNP as fully-automated immunoassays. Several patented inventions and reagents for the diagnosis of various heart pathologies provide helpful information, particularly in conjunction with other clinical tests. They also have prognostic value for future cardiovascular events. Patents owned by Scios Inc. recommended recombinant BNP for managing acute decompensated HF. However, this treatment apparently has safety problems and no proven clinical advantage over existing treatments in terms of improved survival and prevention of subsequent hospitalizations.

Usefulness of combined high-sensitive C-reactive protein and N-terminal-probrain natriuretic peptide for predicting cardiovascular events in patients with suspected coronary artery disease

We examined whether the combined use of high-sensitive C-reactive protein (hsCRP) and N-terminal-probrain natriuretic peptide (NT-proBNP) could increase the predictive value for future cardiovascular events. hsCRP and NT-proBNP both have been shown to be strong predictors of cardiovascular events in patients with coronary artery disease. Few data are, however, available to assess whether combined use of these two distinct biomarkers improves the risk stratification in predicting cardiovascular events. A total of 205 participants with suspected coronary artery disease referred for coronary angiography were enrolled in the study. Plasma levels of hsCRP and NT-proBNP were measured before coronary angiography. Cox regression analyses were conducted for the 205 participants, with cardiovascular events being defined as nonfatal myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, and ischemic stroke. All patients were divided into four groups by using median values of hsCRP (1.1 mg/l) and NT-proBNP (472.6 fmol/ml): group 1, low hsCRP/low NT-proBNP (n=60); group 2, high hsCRP/low NT-proBNP (n=42); group 3, low hsCRP/high NT-proBNP (n=42); and group 4, high hsCRP/high NT-proBNP (n=61). During a median follow-up of 4 years, there were 84 cardiovascular events (41%): 11 events (18%) in group 1, 13 events (31%) in group 2, 20 events (48%) in group 3, and 40 events (66%) in group 4 (P<0.001). Patients with cardiovascular event had significantly attenuated flow-mediated vasodilation (3.6+/-3.4 vs. 5.3+/-3.5%, P=0.001) and increased plasma levels of NT-proBNP (627+/-330 vs. 458+/-196 fmol/ml, P<0.001). Simple linear regression analysis on all studied participants demonstrated significant associations between levels of hsCRP and NT-proBNP (hsCRP vs. NT-proBNP: r=0.354, P<0.001). Cox regression hazards model showed that combined use of NT-proBNP and hsCRP significantly increased predictive value for future cardiovascular events [hazard ratio (HR) 4.922, 95% confidence interval (CI), 2.519-9.617; P<0.0001 for high hsCRP/high NT-proBNP vs. low hsCRP/low NT-proBNP]. These findings demonstrated that a simple combination of distinct biomarkers of hsCRP and NT-proBNP might provide additional information for predicting cardiovascular events.

Nichtinvasive Untersuchung der Herzkranzgefäße mittels Mehrzeilen-Spiral-CT

Multi-detector computed tomography (MDCT) techniques have been improved rapidly during the last decade. Beside a high spatial and temporal resolution, newest scanner generations provide a fast volume coverage which allows imaging of the heart and the visualization of the coronary arteries in less than 10 seconds. However, despite numerous studies concerning the detection of coronary artery calcifications, the clinical role of CT for the evaluation of the coronary arteries has to be defined. Current statements of the American College of Cardiology and the American Heart Association discuss the possible clinical use of MDCT for the evaluation of coronary artery disease. Besides the detection of coronary artery calcifications as a sub-clinical marker for the presence of coronary artery atherosclerosis with a strong predictive value for future cardiovascular events, contrast-enhanced CT coronary angiography has demonstrated its ability to reliably exclude significant coronary artery stenoses in patients with a low to intermediate pre-test likelihood. This article will provide a brief summary of clinical data and possible indications of MDCT for the evaluation of the coronary arteries.