Detection of anti-hsp70 immunoglobulin G antibodies indicates better outcome in coronary artery bypass grafting patients suffering from severe preoperative angina.
BACKGROUND
Recent findings indicate that molecular chaperones actively participate in myocardial cytoprotection. Moreover, ischemic tolerance can be induced in humans by brief ischemic events. Therefore, we investigated patients with severe angina attacks before coronary artery bypass grafting. We focused on appearance of anti-hsp70 antibodies as an immunologic response to heat shock protein induction by ischemia followed up by hemodynamic measurements perioperatively. We correlated these clinical findings with the presence of antibodies against hsp70 and the antioxidative capacity of patients' sera.


METHODS
Thirty-five consecutive patients with coronary artery disease scheduled for coronary artery bypass grafting were included. Seventeen patients had severe angina, and 18 patients suffered from chronic stable angina preoperatively. In the patients' sera, antibodies against hsp70 were detected by enzyme-linked immunosorbent assay, and antioxidative capacity was detected using the chromogen assay. Cardiac output and pulmonary capillary wedge pressure were measured using a thermodilution catheter. We also evaluated C-reactive protein and creatine kinase MB isoenzyme, and performed a conventional leukocyte count.


RESULTS
The sera of the 17 patients with severe angina attacks before surgery contained antibodies against hsp70 and a low antioxidative capacity. The interval between a severe angina attack and anti-hsp70 antibody titer are inversely correlated. These patients had better cardiac output and lower pulmonary capillary wedge pressure values after surgery.


CONCLUSIONS
Severe angina before cardiac surgery coincided with an improved outcome as measured by hemodynamic variables as compared with chronic stable angina. This finding correlated significantly with a low antioxidative capacity and the presence of antibodies against hsp70. These pathophysiologic mechanisms might therefore play a role in myocardial protection.
Vogt
Sebastian
S
Department of Cardiovascular Surgery, Philipps-University Hospital, Marburg, Germany. vogts@med.uni-marburg.de
Portig
Irene
I
Kusch
Björn
B
Pankuweit
Sabine
S
Sirat
Abdul Sami
AS
Troitzsch
Dirk
D
Maisch
Bernhard
B
Moosdorf
Rainer
R
D000368:Aged; D000789:Angina, Unstable / Q000145:classification / Q000276:immunology* / Q000503:physiopathology / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002302:Cardiac Output; D002908:Chronic Disease; D001026:Coronary Artery Bypass / Q000379:methods*; D003402:Creatine Kinase / Q000378:metabolism; D052279:Creatine Kinase, MB Form; D005260:Female; D018840:HSP70 Heat-Shock Proteins / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007527:Isoenzymes / Q000378:metabolism; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D016896:Treatment Outcome
D015415:Biomarkers; D018840:HSP70 Heat-Shock Proteins; D007074:Immunoglobulin G; D007527:Isoenzymes; D002097:C-Reactive Protein; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form