title: Neopterin levels and left ventricular dysfunction in patients with chronic stable angina pectoris.
abstract: BACKGROUND
  Left ventricular ejection fraction (LVEF) is the strongest predictor of survival in patients with chronic stable angina (CSA). Inflammation plays a key role in the pathogenesis of atherosclerosis and an enhanced inflammatory status has a negative impact on patient outcome. It is not known whether a relationship exists between inflammation and LV function in patients with CSA. We therefore sought to investigate whether C reactive protein (CRP) and neopterin correlate with LV dysfunction in patients with CSA.
  
  
  METHODS
  We assessed 181 patients with CSA who underwent diagnostic coronary angiography in our institution. High-sensitivity CRP and neopterin serum concentrations were measured immediately before angiography.
  
  
  RESULTS
  Baseline neopterin levels - but not CRP - showed a significant inverse correlation with LVEF (r=-0.222; p=0.003 and r=-0.097; p=0.194, respectively). After adjustment for relevant confounders which included, among others, the extent and severity of coronary disease, neopterin was found to be independently associated with LVEF (B -2.36, CI 95% -4.560 to -0.176, p=0.034). Moreover, high neopterin levels were an independent predictor of LV dysfunction (LVEF <45%) (OR, 8.52, CI 95% 1.10-65.64; p=0.040). Receiver operating characteristic analysis for neopterin showed an area under the curve of 0.736 (CI 95% 0.59-0.87, p<0.009) for prediction of LV dysfunction.
  
  
  CONCLUSIONS
  Increased serum neopterin concentrations inversely correlate with LVEF values and high neopterin levels are a predictor of LV dysfunction in patients with CSA, irrespective of the extent and severity of coronary artery disease. Neopterin may thus be clinically useful for patient risk stratification.
authors: Cardiovascular Biology Research Centre, Division of Cardiac and Vascular Sciences, St George's, University of London, London, UK.
authors: Rodrigo
authors: R
authors: Estévez-Loureiro
authors: Alejandro
authors: A
authors: Recio-Mayoral
authors: Juan A
authors: JA
authors: Sieira-Rodríguez-Moret
authors: Ernesto
authors: E
authors: Trallero-Araguás
authors: Juan Carlos
authors: JC
authors: Kaski
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002908:Chronic Disease; D017023:Coronary Angiography; D019992:Databases as Topic; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019798:Neopterin / Q000097:blood*; D016017:Odds Ratio; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D015854:Up-Regulation; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D019798:Neopterin; D002097:C-Reactive Protein