Association between serum cystatin C, monocytes and other inflammatory markers.

BACKGROUND: Cystatin C is a marker of renal function that appears to be associated with inflammation. The aim of the present study was to investigate whether there is any relationship between cystatin C, total and differential leukocyte count and other inflammatory markers. METHODS: Cystatin C, creatinine, high sensitivity C-reactive protein (hs-CRP), haptoglobin, ferritin, serum albumin, glucose, total cholesterol, HDL and triglycerides together with total and differential leukocyte count were determined in 490 adults (46 ± 16 years, 40% men) who underwent a typical health examination. Glomerular filtration rate was estimated by the simplified Modification of Diet in Renal Disease formula. Anthropometric and lifestyle characteristics were also recorded. RESULTS: After adjustment for demographic risk factors, comorbid health conditions and renal function, a positive and independent relationship of serum cystatin C levels with peripheral monocyte blood count (regression coefficient ± SE: 12 ± 3.38, P < 0.001) and white blood count (0.616 ± 0.278, P= 0.027) was evident. In this multiple linear regression analysis, other inflammatory markers (i.e. hs-CRP, haptoglobin, ferritin, albumin) did not seem to affect cystatin C blood levels. CONCLUSION: The results of this study demonstrated that monocytes, which play an important role in chronic inflammation and atherosclerosis, were independently related with cystatin C concentrations. This finding may provide a plausible link for the usefulness of cystatin C in predicting increased cardiovascular risk.

Echocardiographic detection of the extent of coronary artery disease in the elderly using dobutamine and adenosine infusion.

BACKGROUND: The high prevalence of asymptomatic multivessel disease in the elderly and the fact that most of them can not carry out an exercise stress testing renders the application of other stress modalities necessary. The aim of this study is to compare the diagnostic value of dobutamine and adenosine stress echocardiography and their accuracy in determining the extent of coronary artery disease in elderly people. METHODS: Dobutamine and adenosine stress echocardiography were performed in 128 consecutive patients > or = 70 years-of-age with known or suspected coronary artery disease. All patients underwent coronary angiography within 2 weeks of the stress tests. RESULTS: The presence of any echocardiographic abnormality on dobutamine (odds ratio 30.8) and adenosine (odds ratio 18.1) test, the need for cessation of dobutamine test and the ST depression during dobutamine infusion, were independent predictors of significant coronary artery disease. Both tests proved more sensitive for detecting multivessel disease (89% for dobutamine, 74% for adenosine test), than one-vessel disease (74 and 39%, respectively). This difference was statistically significant only for the adenosine echocardiography test (P = 0.008). In patients with localized resting wall motion abnormalities, the accuracy of dobutamine test to predict a remotely diseased vessel (70%), was statistically superior to the accuracy of adenosine test (57%, P = 0.008). Patients with multivessel disease showed delayed resolution of test-induced wall motion abnormalities, during the recovery period after both tests, compared with those who suffered from one-vessel disease. CONCLUSIONS: Dobutamine echocardiography was more sensitive and accurate than adenosine echocardiography in detecting and determining the extent and the severity of coronary artery disease in the elderly. A positive adenosine echocardiography result reflected the presence of advanced coronary artery disease. The two tests, combined with clinical data, could classify the elderly into low- and high-risk subgroups for ischemic heart disease.

Stress echocardiography in elderly patients with coronary artery disease: applicability, safety and prognostic value of dobutamine and adenosine echocardiography in elderly patients.

OBJECTIVES: Our aim was to determine the applicability, safety and prognostic value of adenosine and dobutamine stress echocardiography in patients > or = 70 years old. BACKGROUND: These tests are sometimes mandatory because of difficulties and inaccuracies in interpreting traditional electrocardiographic stress tests. Furthermore, if these tests could be used to avoid coronary arteriography and cardiac catheterization, they would become essential in the care of the elderly, whose numbers are increasing. METHODS: We performed coronary arteriography and dobutamine and adenosine stress echocardiographic tests in 120 patients (72 men) > or = 70 years old who entered the hospital because of chest pain and had known or suspected coronary artery disease. The stress tests were performed on separate days, within 2 weeks of coronary arteriography. Both the arteriograms and the echocardiograms were analyzed by two experts who had no knowledge of the patients' other data or the other interpreter's report. Tests were judged to have positive or negative results, and the patients were followed up for the development of cardiac events. Univariate and multivariate analyses and other statistical modalities were applied for comparisons. RESULTS: Documented coronary artery disease was found in 89 patients. During the 14 +/- 7 of follow-up, cardiac events developed in 50 patients, including 3 (7.9%) of 38 patients with negative dobutamine and 12 (20.7%) of 58 patients with negative adenosine test results. Demonstration of any abnormality on stress echocardiography was an independent factor for cardiac events, both for dobutamine (relative risk 7.3) and for adenosine (relative risk 3.0). Both cessation of dobutamine or adenosine tests and diagnosis of disease in two or more coronary vessels were also independent predictors. ST segment depression > or = 1mm was related to future events only with the dobutamine test. CONCLUSIONS: These echocardiographic stress tests proved safe and well tolerated. They successfully stratified this cohort of elderly patients with coronary artery disease to low or high risk subgroups for subsequent cardiac events.

Dobutamine-induced transmural myocardial ischemia in a patient with mild coronary lesions.

A 70-year-old man was admitted for evaluation of retrosternal pain at rest. During infusion of dobutamine (25 micrograms/kg/min) the patient developed angina, ST-segment elevation in the inferior leads, and echocardiographic hypokinesia in the inferior-basal myocardial wall. Coronary angiography revealed insignificant (20-30%) stenosis of the right coronary artery and a normal remaining tree. This case suggests that dobutamine may induce transmural myocardial ischemia in patients with mild coronary lesions, probably by producing occlusive coronary spasm on a substrate of arterial endothelial dysfunction.