title: Diagnostic value of soluble adhesion molecule kinetics in patients with suspected myocardial ischemia undergoing dobutamine stress echocardiography.
abstract: BACKGROUND
  Previous studies have shown an exercise-induced increase in circulating adhesion molecules (sICAM-1 and sVCAM-1) in patients with coronary artery disease (CAD). The aim of this study was to evaluate the diagnostic role of changes in serum adhesion molecules in the setting of a dobutamine stress echocardiogram (DSE).
  
  
  METHODS
  Thirty patients (18 men and 12 women aged 63.3 ± 10.67 years) with suspected myocardial ischemia underwent a DSE in our department's laboratory of echocardiography in order to identify inducible ischemia. Dobutamine was infused in incremental doses from 5 μg/kg/min up to 40 μg/kg/min. Blood samples were drawn at baseline as well as at peak stress and circulating adhesion molecules sVCAM-1 and sICAM-1 levels were measured by ELISA. Patients with a positive DSE underwent coronary arteriography within 2 weeks of the DSE study.
  
  
  RESULTS
  Sixteen patients had a positive DSE for inducible ischemia while 14 had a negative test. Among the patients with positive DSE, 12 had angiographically significant CAD as well as statistically significantly higher levels of sICAM-1 than DSE negative patients (n=14), both at baseline (302.57 ± 43.37 vs. 267.47 ± 28.03 ng/mL, p=0.028) and at peak stress (322.07 ± 49.64 vs. 260.43 ± 36.45 ng/mL, p=0.001). A significant increase from baseline to peak stress was also noted in this group (from 302.57 ± 43.37 to 322.07 ± 49.64 ng/mL, p=0.043). There were no statistically significant differences in the levels of sVCAM-1 between groups at baseline and there was no change from baseline to peak stress.
  
  
  CONCLUSIONS
  Plasma levels of sICAM-1 were found to be elevated in subjects with a positive DSE and angiographically significant CAD compared to patients with a negative DSE, both before and after inducible ischemia. In contrast, no changes were noted regarding sVCAM-1 levels.
authors.affiliation: Department of Cardiology and Laboratory of Echocardiography, "G. Gennimatas" General Hospital, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Perpinia
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsounis
authors.forename: Apostolos
authors.initials: A
authors.lastname: Karavidas
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Papoutsidakis
authors.forename: Georgios
authors.initials: G
authors.lastname: Lazaros
authors.forename: Achilleas
authors.initials: A
authors.lastname: Zaharoulis
authors.forename: Sofia
authors.initials: S
authors.lastname: Arapi
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Matzaraki
authors.forename: Theodora
authors.initials: T
authors.lastname: Dimitroula
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsitsinakis
authors.forename: Vlassios
authors.initials: V
authors.lastname: Pyrgakis
mesh_terms: D002316:Cardiotonic Agents; D015815:Cell Adhesion Molecules / Q000097:blood*; D017023:Coronary Angiography; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000379:methods*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D011379:Prognosis; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood
chemical_list: D002316:Cardiotonic Agents; D015815:Cell Adhesion Molecules; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1; D004280:Dobutamine