Novel atherogenesis markers for identification of patients with a multivessel coronary artery disease.
BACKGROUND
Patients with advanced coronary artery disease (CAD) have an unfovourable prognosis. Therefore, early identification of this high-risk group is important.


OBJECTIVE
To asses the utility of clinical, electrographic and echocardiographic parameters, supported by novel atherogenesis markers, to identify patients with triple vessel coronary artery disease (CAD).


METHODS
The study group comprised 37 patients (29 males, mean age 64+/-8 years) suffering from multivessel CAD and a control group of 16 patients (8 males, mean age 60+/-10 years), in whom - despite typical stenocardial symptoms, positive exercise stress test and segmental contractility disturbances - coronary angiography did not reveal any haemodynamically significant CAD. Apart from coronary angiography, each patient had additionally an entire test panel performed assessing both the disease severity and the presence of other systemic dysfunction. Mean Gensini score in the study group was 91.9+/-43.8, including proximal Gensini score 52.6+/-45.6 and distal one 39.4+/-29.7.


RESULTS
Patients with triple vessel disease had a long history of angina (mean 84 months), of whom 30 (81%) experienced at least Q-wave myocardial infarction (MI). ECG changes typical for ischaemia were observed more often than in the control group. Also in patients with triple vessel disease echocardiography showed more escalated segmental contractility disorders, and left ventricular ejection fraction in this group was significantly lower than in the control group (44 vs. 55%, p <0.001). There were significant differences between CAD patients and control groups with respect to serum levels of: adiponectin (10.5+/-4.2 vs. 17.6+/-3 microg/ml, p=0.001), resistin (13.7+/-6.1 vs. 7.2+/-2.4 ng/ml, p=0.007), TNF-alpha (4.2+/-2.9 vs. 2.1+/-1.1 pg/ml, p=0.02) and IL-8 (18.4+/-4.1 vs. 12.2+/-4.1 pg/ml, p=0.008). Significant differences were also noted in lipid profile (total cholesterol: 201+/-47.1 vs. 183+/-18 mg/dl, NS; HDL cholesterol: 45+/-8.5 vs. 54+/-11 mg/dl, p=0.005; LDL cholesterol: 126.1+/-46.9 vs. 102+/-29 mg/dl, p=0.004), NT-proBNP [516 (174-1426) vs. 187 (39-573) pg/ml, p=0.02] and fasting blood glucose levels (97+/-14 vs. 94+/-11 mg/dl, p=0.03). Significantly lower serum adiponectin levels were observed in men and tobacco smokers.


CONCLUSIONS
Medical history, supported by interpretation of selected, routine imaging studies and novel biochemical markers, such as adiponectin, resistin, TNF-alpha, IL-8 or NT-proBNP, seem to be the key factors when assessing the risk of presence of advanced coronary artery atherosclerosis.
Krecki
Radosław
R
2nd Chair and Department of Cardiology, Medical University, Lotz, Poland. rkrecki@gazeta.pl
Drozdz
Jarosław
J
Szcześniak
Piotr
P
Orszulak-Michalak
Daria
D
Krzemińska-Pakuła
Maria
M
D052242:Adiponectin / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D052243:Resistin / Q000097:blood; D012907:Smoking / Q000097:blood / Q000453:epidemiology; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D052242:Adiponectin; D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D016209:Interleukin-8; D010446:Peptide Fragments; D052243:Resistin; D014409:Tumor Necrosis Factor-alpha; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain