ABSTRACT
BACKGROUND: Patients with coronary artery disease (CAD) and left ventricular systolic dysfunction (LVSD) are often asymptomatic. Angiogenesis is implicated in the physiology of vascular repair and cardiac remodelling, and is one of many pathophysiological processes implicated in heart failure. We hypothesized that plasma indices associated with angiogenesis [angiogenin, vascular endothelial growth factor (VEGF), and angiopoietin (Ang)-1 and Ang-2] would be abnormal in CAD patients with LVSD, being correlated with EF and wall motion abnormalities (wall motion score) independently of underlying CAD (coronary atheroma score). We also evaluated the specificity of angiogenic 'biomarkers' in their detection of LVSD [ejection fraction (EF) <40%] amongst CAD patients. METHODS: Using a cross sectional approach, we measured angiogenin, VEGF, Ang-1 and Ang-2 by ELISA in 194 CAD patients (aged 34-81 years) undergoing elective coronary angiography. RESULTS: Levels of angiogenin were inversely related with EF (r = -0.17, P = 0.02) and positively with coronary atheroma scores (r = 0.15, P = 0.04, but not independently of EF). Other angiogenic markers were unrelated to objective measures of LVSD but VEGF (P = 0.008) and Ang-2 (P = 0.015) were lower amongst those patients with heart failure. Angiogenin levels were related to wall motion scores (r = 0.16, P = 0.024). CONCLUSION: Heart failure has a modest impact on biomarkers of angiogenesis, in patients with CAD. Further research is warranted into the diagnostic and prognostic utility of biomarkers of angiogenesis, in this common cardiac condition.
Subject(s)
Coronary Artery Disease/blood , Neovascularization, Pathologic/blood , Ribonuclease, Pancreatic/blood , Ventricular Dysfunction, Left/blood , Adult , Aged , Aged, 80 and over , Analysis of Variance , Angiopoietin-1/blood , Angiopoietin-2/blood , Biomarkers/blood , Coronary Angiography , Coronary Artery Disease/diagnosis , Cross-Sectional Studies , Enzyme-Linked Immunosorbent Assay , Female , Heart Failure/blood , Humans , Male , Middle Aged , Neovascularization, Pathologic/diagnosis , Stroke Volume , Vascular Endothelial Growth Factor A/blood , Ventricular Dysfunction, Left/diagnosisABSTRACT
BACKGROUND: Abnormal adipocyte function is implicated in both the pathophysiology of coronary heart disease (CHD) and cardiac function, where adiponectin provides a putative link. However, the utility of adiponectin as a discriminator of CHD severity is unclear and may be confounded by cardiac function. We hypothesized that plasma adiponectin would relate to indices of coronary artery disease severity (coronary atheroma scores, CAS), ejection fraction (EF) and regional wall motion abnormalities (RWMA) therein. METHOD: We measured adiponectin using a cross-sectional approach, we measured plasma adiponectin enzyme-linked immunosorbent assay in 204 consecutive patients (aged 34-81 years) undergoing elective coronary angiography. RESULTS: Levels of adiponectin decreased in an ordinal fashion across tertiles of increasing CAS (P = 0.047), but were nonsignificantly correlated to absolute values of CAS (P = 0.06). Adiponectin levels were unrelated to left ventricular dysfunction related measures of RWMA or EF. On multivariate analysis, (including factors relating to CHD risk, history and medication) adiponectin levels were independently inversely associated with triglycerides (P = 0.001), CAS tertiles (P = 0.01) and positively with age (P < 0.001). CONCLUSION: Levels of adiponectin decreased with coronary artery disease severity, without impact from systolic dysfunction, but levels may be moderated through established CHD risk factors such as smoking and triglycerides. Further work is warranted as to the clinical prognostic utility of this marker amongst CHD patients.
