[The relation between exercise-induced myocardial ischemia and high-sensitive C-reactive protein and neopterin levels].
OBJECTIVE
High sensitivity C-reactive protein (hsCRP) and neopterin are associated with atherosclerosis. We aimed to evaluate the association between hsCRP and neopterin, and myocardial ischemia during exercise stress test (EST) in patients with stable angina pectoris (SAP) and to assess the predictive value of these mediators in obstructive coronary artery disease.


METHODS
Forty-five patients with SAP were included in this prospective observational study. EST- positive group included 23 patients (15 males, mean age 54 ± 10 years) and EST-negative group-22 patients (14 males, mean age 52 ± 9 years). In each patient, blood samples were obtained 1 hour before and 30 minutes after EST. In EST-positive group, coronary angiography was performed to determine the presence and severity of coronary artery lesions as assessed by Gensini score. Statistical analysis was performed using Chi-square, unpaired t, Mann-Whitney U and Wilcoxon rank tests. Logistic regression analysis was used to establish the predictive value of tests.


RESULTS
Before EST, hsCRP and neopterin levels were similar between the two groups, however, hsCRP levels were higher in EST-positive group after EST (p=0.03). There was no significant difference between the two groups with respect to neopterin levels after EST (p=0.4). In EST-positive group, EST resulted in significant increases in both hsCRP and neopterin levels (from 3.8 ± 2.8 mg/L to 4.3 ± 3.1 mg/L, p=0.001; from 8.7 ± 4.0 nmol/L to 13.1 ± 10.0 nmol/L, p=0.001, respectively). In EST-negative group only neopterin levels significantly increased after EST (from 6.9 ± 1.8 nmol/L to 9.0 ± 3.9 nmol/L, p=0.001). No relation was observed between the obstructive coronary lesions and the levels of hsCRP or neopterin at any point.


CONCLUSIONS
In SAP patients, independent with the existence of obstructive coronary lesion, elevated levels of hsCRP after EST might be an indicator of immune activation caused by myocardial ischemia.
Başar
Nurcan
N
Türkiye Yüksek İhtisas Hastanesi, Kardiyoloji Bölümü, Ankara, Türkiye. nurcanbasar@gmail.com
Saatçi Yaşar
Ayşe
A
Erden
Gönül
G
Cağlı
Kumral
K
Sen
Nihat
N
Metin
Fatma
F
Biçer Yeşilay
Asuman
A
Malçok Gürel
Ozgür
O
Ozcan
Fırat
F
Yıldırımkaya
Metin
M
Gölbaşı
Zehra
Z
Erbay
Ali Rıza
AR
D000328:Adult; D000787:Angina Pectoris / Q000097:blood / Q000378:metabolism; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000378:metabolism; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000378:metabolism*; D019798:Neopterin / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013312:Stress, Physiological
D015415:Biomarkers; D019798:Neopterin; D002097:C-Reactive Protein