title: Low Homoarginine Levels in the Prognosis of Patients With Acute Chest Pain.
abstract: BACKGROUND
  The endogenous amino acid homoarginine predicts mortality in cerebro- and cardiovascular disease. The objective was to explore whether homoarginine is associated with atrial fibrillation (AF) and outcome in patients with acute chest pain.
  
  
  RESULTS
  One thousand six hundred forty-nine patients with acute chest pain were consecutively enrolled in this study, of whom 589 were diagnosed acute coronary syndrome (ACS). On admission, plasma concentrations of homoarginine as well as brain natriuretic peptide (BNP), and high-sensitivity assayed troponin I (hsTnI) were determined along with electrocardiography (ECG) variables. During a median follow-up of 183 days, 60 major adverse cardiovascular events (MACEs; 3.8%), including all-cause death, myocardial infarction, or stroke, were registered in the overall study population and 43 MACEs (7.5%) in the ACS subgroup. Adjusted multivariable Cox regression analyses revealed that an increase of 1 SD of plasma log-transformed homoarginine (0.37) was associated with a hazard reduction of 26% (hazard ratio [HR], 0.74; 95% CI, 0.57-0.96) for incident MACE and likewise of 35% (HR, 0.65; 95% CI, 0.49-0.88) in ACS patients. In Kaplan-Meier survival curves, homoarginine was predictive for patients with high-sensitivity assayed troponin I (hsTnI) above 27 ng/L (P<0.05). Last, homoarginine was inversely associated with QTc duration (P<0.001) and prevalent AF (OR, 0.83; 95% CI, 0.71-0.95).
  
  
  CONCLUSIONS
  Low plasma homoarginine was identified as a risk marker for incident MACEs in patients with acute chest pain, in particular, in those with elevated hsTnI. Impaired homoarginine was associated with prevalent AF. Further studies are needed to investigate the link to AF and evaluate homoarginine as a therapeutic option for these patients.
authors.affiliation: Department of Cardiovascular Medicine, University of Oxford, United Kingdom German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany dorothee.atzler@well.ox.ac.uk dorothee.atzler@gmail.com.
authors.forename: Dorothee
authors.initials: D
authors.lastname: Atzler
authors.affiliation: German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Baum
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Francisco
authors.initials: F
authors.lastname: Ojeda
authors.affiliation: Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany German Center for Cardiovascular Research (DZHK), Partner Site Rhein/Main, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Keller
authors.affiliation: German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany Department of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Cordts
authors.affiliation: German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Renate B
authors.initials: RB
authors.lastname: Schnabel
authors.affiliation: Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Chi-un
authors.initials: CU
authors.lastname: Choe
authors.affiliation: German Center for Cardiovascular Research (DZHK), Partner Site Rhein/Main, Germany Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Lackner
authors.affiliation: German Center for Cardiovascular Research (DZHK), Partner Site Rhein/Main, Germany Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.affiliation: German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany Department of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Rainer H
authors.initials: RH
authors.lastname: Böger
authors.affiliation: German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany Department of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Edzard
authors.initials: E
authors.lastname: Schwedhelm
authors.affiliation: German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Zeller
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis; D059787:Acute Pain / Q000097:blood / Q000175:diagnosis; D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006709:Homoarginine / Q000097:blood*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011379:Prognosis; D016016:Proportional Hazards Models; D020521:Stroke / Q000097:blood / Q000175:diagnosis
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D006709:Homoarginine
keywords: acute coronary syndrome; atrial fibrillation; homoarginine; l‐arginine:glycine amidinotransferase