The role of selected adipokines and ghrelin in the prognosis after myocardial infarction in a 12-month follow-up in the presence of metabolic syndrome.

INTRODUCTION: The aim of this study was to evaluate the predictive value of selected adipokines in the improvement in the ejection fraction and in the development of adverse cardiac remodeling during 12 months of follow-up among patients with an ST-segment elevation acute myocardial infarction (STEMI) in the presence of metabolic syndrome (MeS). MATERIAL AND METHODS: The study population consisted of 69 patients (49 male; mean age: 59 ±10 years) with a first STEMI that was treated with a primary percutaneous coronary intervention (pPCI). In this group, 36 patients (18 male; mean age: 60 ±15 years) had MeS according to the definition of the International Diabetes Federation. The baseline clinical evaluation included a clinical examination and evaluation of the blood levels of C-reactive protein, ghrelin, resistin, and fasting glucose. Within 72 h after the STEMI, an echocardiographic examination was performed. A complete clinical evaluation was repeated after 12 months. Adverse cardiac remodeling was defined as an increase in the left ventricular end-diastolic volume of ≥ 8%. An improvement of the ejection fraction (EF) was defined as an increase of more than 5% in the EF. RESULTS: A concentration of ghrelin ≤ 160.46 pg/ml (AUC = 0.71, p = 0.032) had a good predictive value for the occurrence of adverse left ventricular remodeling but only in the patients without MeS. Among the patients with MeS, a concentration of resistin ≤ 5196 pg/ml (AUC = 0.073, p = 0.024) had a good predictive value for the occurrence of left ventricular remodeling. A concentration of leptin > 52.18 pg/ml (AUC = 0.81, p < 0.0001) and resistin > 4419.27 ng/ml (AUC = 0.67, p = 0.049) had a good predictive value for improvement of the LVEF in the patients without MeS. CONCLUSIONS: The selected adipokines had a good predictive value for the development of adverse cardiac remodeling and for improvement of the ejection fraction among patients after a STEMI in the presence of metabolic syndrome.

In-hospital daily insulin dose predicts long-term adverse outcome in patients with diabetes with ST-elevation myocardial infarction treated with successful primary percutaneous angioplasty.

INTRODUCTION: Early initiation of reperfusion therapy including primary percutaneous coronary revascularization (PPCI) has been recognized as a crucial factor determining clinical outcomes in the acute phase of myocardial infarction. In unstable patients with type 2 diabetes mellitus (T2D) the clear benefit from PPCI was proven. We aim to evaluate the prognostic value of factors describing glycometabolic state on admission in patients with T2D undergoing PPCI in acute ST-elevation myocardial infarction (STEMI). MATERIAL AND METHODS: Prospective analysis of clinical and laboratory variables (mean daily short acting exogenous insulin dose (DID), admission blood glucose, glycated hemoglobin (HbA1c), microalbuminuria) was performed in 112 consecutive patients with T2D with STEMI who underwent PPCI. Women comprised 58% of the group. RESULTS: Insulin dosing was targeted to obtain a mean daily glucose level < 7.8 mmol/l. During 12-month follow-up 33 (29.5%) major adverse cardiac events (major adverse cardiac events (MACE) consisting of death, reinfarction, and repeated target vessel revascularization) were reported. Microalbuminuria was present in 68 (60.5%) patients. The mean HbA1c level was 7.9%. In the multivariate logistic regression model only DID > 44 IU remained an independent risk factor for MACE (p = 0.02, OR = 5.2). CONCLUSIONS: In patients with diabetes with STEMI treated with PPCI, simple measurement of DID during hospitalization can add valuable prognostic information about the future risk of MACE.

Characteristics, management and five-year outcomes of patients with high risk, stable multivessel coronary heart disease.

BACKGROUND: Multivessel coronary artery disease (MCAD) is a common manifestation of advanced coronary atherosclerosis. AIM: To determine the clinical characteristics and long term follow up prognostic factors in patients with high risk, stable MCAD from a single institution. METHODS: We included in the final analysis 270 patients with stable MCAD. Patients were followed for the occurrence of death, stroke and myocardial infarction (MI). We defined a cumulative major adverse cardiac and cerebrovascular event (MACCE) asa composite of death, stroke, MI and urgent revascularisation. Median follow up was 5 years (4-5.5 years). 176 (65%) patients were treated surgically (coronary artery bypass grafting, CABG), 19 (7%) patients were treated percutaneously, while 75 (28%) patients were treated medically; this meant that 94 (35%) patients were treated non-surgically. RESULTS: Predictors of MACCE in the study group of patients revealed by univariate logistic regression analysis were: diabetes mellitus (p = 0.04), kidney failure (p = 0.05), total cholesterol (p = 0.05), LDL-cholesterol (p = 0.02), chest pain symptoms in CCS III class (p = 0.05), heart rate (p = 0,02), NT-proBNP (p = 0.01), left ventricular diastolic (p = 0.003) and systolic diameter (p = 0.003), left ventricular ejection fraction (p = 0.001), Gensini score (p = 0.05) and CABG treatment strategy (p = 0.001). In Cox logistic regression analysis, non CABG treatment strategy (b = 0.06), heart rate (b = 0.02), and LDL cholesterol level (b = 0.006) were independent predictors of MACCE (p = 0.01). CONCLUSIONS: Our study showed that patients with advanced MCAD who are qualified for complete surgical revascularisation benefitted more with regard to several primary end points at five-year follow-up than those who were not qualified for surgery and who were treated with medical therapy supplemented in selected cases with incomplete percutaneous revascularisation.

Transthoracic measurement of left coronary artery flow reserve improves the diagnostic value of routine dipyridamole-atropine stress echocardiogram.

INTRODUCTION: We hypothesized that coronary flow reserve (CFR) in the left anterior descending artery (LAD) can be effectively measured during an accelerated dipyridamole-atropine stress echocardiography (DASE) protocol to improve the diagnostic performance of the test. MATERIAL AND METHODS: In 64 patients with suspected or known coronary artery disease scheduled for coronary angiography DASE with concomitant CFR measurement in LAD was performed. RESULTS: Coronary flow reserve measurement and calculation were feasible in 83% of patients. The positive predictive value of undetectable LAD flow was 81% for severe LAD disease. Measured values of CFR were in the range 1.3-4.1 (mean: 2.2 ±0.7). Significantly lower CFR was found in patients with LAD disease (1.97 ±0.62 vs. 2.55 ±0.57, p = 0.0015). The optimal cutoff for detecting ≥ 50% stenosis was CFR ≤ 2.1 (ROC AUC 0.776), corresponding with 68% sensitivity and 84% specificity. In patients with negative DASE results 67% of patients with LAD disease had abnormal CFR, whereas in patients with a positive DASE result 92% of patients with normal LAD had normal CFR. The DASE diagnostic accuracy for the detection of coronary artery disease (CAD) increased from 75% to 85% when CFR measurement was added to wall motion abnormality (WMA) analysis. No test with both abnormalities was false positive for the detection of coronary disease. CONCLUSIONS: Incorporation of CFR measurement into WMA-based stress echocardiography is feasible even in an accelerated DASE protocol and can be translated into an approximate gain of 10% in overall test accuracy.

Severe obesity impairs systolic and diastolic heart function - the significance of pulsed tissue Doppler, strain, and strain rate parameters.

BACKGROUND: We assessed the impact of morbid obesity on systolic and diastolic heart function in severely obese, but otherwise healthy subjects and age-matched controls. METHODS: Overall, 27 obese patients: 19 female (F) and 8 male (M) mean age 37 ± 9, mean body mass index (BMI) 46 ± 6 and 27 control subjects: mean age 36 ± 10, mean BMI 23 ± 3 were examined by transthoracic echocardiography, including tissue Doppler echocardiographic (TDE) assessment and speckle tracking echocardiography to measure left ventricular longitudinal, circumferential, and radial strain (S) and strain rate (SR) during systolic and early diastolic phase. RESULTS: Obese patients presented with enlargement of both ventricles and the left atrium, and thicker left ventricular wall. Although left ventricular ejection fraction (EF) as well as amplitude of tricuspid annulus plane systolic excursion (TAPSE) was similar, the amplitude of mitral annulus plane systolic excursion (MAPSE) and ventricular systolic and early diastolic velocities measured by TDE were significantly lower for both ventricles in the obese group. (RV S' 13 ± 3 cm/sec vs. 15 ± 2 cm/sec, P = 0.0057; LV S' lat 8.5 ± 1.6 cm/sec vs. 12.1 ± 2.8, P < 0.0001, E' lat: 12.4 ± 2.9 vs. 16.4 ± 3.5 cm/sec for left ventricular and E' 12 ± 3 cm/sec vs. 18 ± 4 for right ventricular velocities, P < 0.0001). Among the deformation parameters, systolic and diastolic circumferential and systolic radial strain and SR were decreased in the obese subjects, whereas longitudinal strain did not differ significantly. CONCLUSIONS: TDE parameters documented reduced systolic and diastolic function of both ventricles in obese patients. 2-dimensional speckle tracking analysis revealed that circumferential and radial but not longitudinal strain and SR were impaired in the obese group.

Influence of crossover on mortality in a randomized study of revascularization in patients with systolic heart failure and coronary artery disease.

BACKGROUND: To assess the influence of therapy crossovers on treatment comparisons and mortality at 5 years in patients with ischemic heart disease and heart failure randomly assigned to medical therapy alone (MED) or to MED and coronary artery bypass graft (CABG) surgery in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. METHODS AND RESULTS: The influence of early crossover (within the first year after randomization) on 5-year mortality was assessed using time-dependent multivariable Cox models. CABG was performed in 65/602 patients (10.8%) assigned to MED, and 55/610 patients (9.0%) assigned to CABG received MED only. Common reasons for crossover from MED to CABG were progressive symptoms or acute decompensation. MED-assigned patients who underwent CABG had lower 5-year mortality than those who received MED only (25% vs 42%; hazard ratio, 0.50; 95% confidence interval, 0.30-0.85; P=0.008).The main reason for crossover from CABG to MED was patient/family decision. Five patients did not undergo their assigned CABG within a year but died before receiving surgery without status change. They were deemed crossover to MED. The CABG-to-MED crossover population had higher 5-year mortality compared with those treated with CABG per-protocol (59% vs 33%; hazard ratio, 2.01; 95% confidence interval, 1.36-2.96; P<0.001). CABG was associated with lower mortality compared with MED in per-protocol and several time-dependent analyses (all P<0.05). CONCLUSIONS: CABG reduced mortality in both the per-protocol and crossover STICH patient populations. Crossover from assigned therapy, therefore, diminished the impact of CABG on survival in STICH when analyzed by intention to treat. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00023595.

Real-time 3D echocardiography and tissue Doppler echocardiography in the assessment of right ventricle systolic function in patients with right ventricular myocardial infarction.

AIMS: Knowledge of right ventricular (RV) function may be crucial in diagnosis and proper management of patients with suspected acute myocardial infarction (MI). Standard echocardiography has several drawbacks, tissue Doppler echocardiography (TDE) and real-time three-dimensional echocardiography (RT3DE) could be used for evaluation of the RV performance. The purpose of this study was to assess RV function in patients with inferior wall acute MI with both TDE and RT3DE. METHODS AND RESULTS: Study group consisted of 85 patients in the acute phase of MI complicated with right ventricular myocardial infarction (RVMI) admitted for primary coronary intervention (PCI). Control group was formed from 85 patients with isolated inferior wall infarction matched to RVMI group. Before PCI all of the patients underwent echocardiographic examination with the assessment of RV function by TDE and RT3DE. TDE derived peak systolic velocity ', peak early diastolic velocity of RV free wall differed significantly between groups. Three-dimensional reconstruction and calculation of the right ventricular ejection fraction (RVEF) showed that in RVMI patients RVEF values were lower than in the controls (41.7 ± 6.03 vs. 52.7 ± 2.3%, respectively). RVEF < 51% allowed diagnosis of RVMI with sensitivity 91% and specificity 80%. CONCLUSION: Three-dimensional echocardiography is a useful method in the estimation of RVEF, however does not perform better than TDE in diagnosis of RVMI. Threshold of RVEF < 51% may be used for diagnosing of RVMI with adequate sensitivity and specificity.

Presence of coronary collaterals in ST-elevation myocardial infarction patients does not affect long-term outcome.

INTRODUCTION: The significance of coronary collateral circulation in the prognosis of patients after myocardial infarction remains disputable. OBJECTIVES: The aim of the study was to evaluate the effect of coronary collateral circulation, assessed by the Rentrop score, on long-term prognosis in patients treated with primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). PATIENTS AND METHODS: Coronary collateral flow was assessed by angiography in 330 patients with myocardial infarction using the Rentrop score. Patients were followed up for the mean period of 26 ±12 months with the clinical endpoints of cardiac death, nonfatal reinfarction, and repeat percutaneous or surgical revascularization. RESULTS:  Collateral circulation was graded Rentrop 0 in 39%, Rentrop 1 in 36%, Rentrop 2 in 18%, and Rentrop 3 in 7% of the patients. The mortality rate was 8.7%. Reinfarction occurred in 4.7% of the subjects, and repeat coronary revascularization was performed in 10.9% of the patients. These endpoints were not correlated with the degree of collateral circulation. A significant inverse association was observed between the Rentrop score and the infarct-related artery antegrade flow (P <0.001). CONCLUSIONS: The degree of collateral circulation assessed by the Rentrop score during primary PCI is not a useful long-term prognostic factor in the population with STEMI in the current therapeutic approach. This may result from the negative correlation between the Rentrop score and the degree of blood flow in the infarct-related artery. Thus, collateral circulation in a patient with STEMI should not discourage intensive cardiovascular risk factor control in secondary prevention of coronary artery disease.

Predictors of successful acetylsalicylic acid resistance suppression after percutaneous coronary revascularisation.

BACKGROUND AND AIM: There is no established management of resistance to acetylsalicylic acid (ASA) in patients with coronary artery disease (CAD). We hypothesised that simply doubling the usual daily dose of ASA could be effective in overcoming ASA resistance. METHODS: Our study comprised 40 subjects with CAD (male 67.5%, mean age 60.5 ± 8.8 years, mean body mass index 26.9 ± 2.7 kg/m² and median aspirin reaction unit [ARU] value obtained with a Verify Now Aspirin Test 612 [573-634]) with resistance to 75 mg/daily ASA defined as ARU ≥ 550. According to the overcoming of resistance or lack there of in a repeated test after four weeks of 150 mg daily ASA treatment, we defined two subsets: subjects who regained ASA sensitivity, and those who did not. RESULTS: Successful overcoming of ASA resistance was observed in 62.5% of patients. Multivariate analysis regression confirmed that two variables independently determined successful ASA resistance suppression: male gender (OR 6.88; 95% CI 1.29-36.75; p = 0.024), and ARU for 75 mg daily (OR 0.97 per unit at 75 mg; 95% CI 0.94-0.99; p = 0.039). ROC analysis indicated that the threshold value at which ARU at 75 mg ASA treatment was predictive of successful ASA resistance overcoming was ≤ 608 ARU. Using a simple point score (one point for male gender and one for initial ARU ≤ 608), we found that ASA resistance was overcome in 8%, 36% and 56% of patients, when zero, any single, or two predictors were present. CONCLUSIONS: ASA resistance overcoming by dose doubling can be achieved more often in males and in subjects with lower ARU value at ASA 75 mg.

Prognostic value of platelet indices after acute myocardial infarction treated with primary percutaneous coronary intervention.

BACKGROUND: Mean platelet volume (MPV) is a strong predictor of impaired angiographic reperfusion and 6-month mortality in ST-elevation myocardial infarction (MI) treated with primary percutaneous coronary intervention (PCI). No data is available for other platelet volume indices: platelet distribution width (PDW) and platelet large cell ratio (P-LCR). The aim was to assess the impact of 3 platelet volume indices on long-term prognosis in patients treated with primary PCI in acute MI. METHODS: This prospective study enrolled 538 patients who underwent primary PCI in acute MI. Admission blood samples were measured for MPV, PDW, and P-LCR. The patients were followed-up a mean period of 26 ± 11 months with regard to cardiac death, non-fatal reinfarction, re-PCI or coronary artery bypass grafting. RESULTS: Kaplan-Meier survival analysis showed a significantly higher 26-month mortalityrate in patients with high MPV (≥ 11.7 fL) than in those with low MPV (< 11.7 fL) (14.6% vs. 5.5%, p = 0.0008). Similar findings were related to high P-LCR (≥ 38.1%) vs. low P-LCR (< 38.1%) - mortality 13.8% vs. 5.8%, p = 0.0025. Higher PDW values (≥ 16 fL) correlated with higher mortality rate as compared to PDW < 16 fL (17.4% vs. 6.3%, p = 0.0012). PDW was found to be an independent prognostic factor for cardiac mortality and composite endpoint. CONCLUSIONS: Mean platelet volume, platelet distribution width and platelet large cell ratio measured on admission are strong, independent prognostic factors in PCI-treated acute MI.

The new oral adenosine A1 receptor agonist capadenoson in male patients with stable angina.

BACKGROUND: Anti-ischaemic effect of A1 adenosine receptor agonists was shown in animal and preclinical studies. The present proof-of-concept study aimed at evaluation of the efficacy and safety of a new adenosine A1 receptor agonist capadenoson in patients with stable angina. METHODS: This was a randomized, double-blind, placebo-controlled, single dose-escalating, multicenter trial comparing the effect of capadenoson at 1, 2.5, 5, 10, and 20 mg versus placebo. For each dose step patients were randomized to receive single doses of either capadenoson or matching placebo in a 5:1 ratio. The primary efficacy variable was the absolute difference in heart rate (HR) at maximum comparable level of workload between baseline and post dose exercise tolerance test at maximum concentration of capadenoson. Capadenoson effect on total exercise time and time to 1-mm ST-segment depression were also measured. RESULTS: Sixty-two male patients with stable angina were enrolled in the study. There was a consistent trend for HR reduction at comparable maximum work load in active treatment groups, with significant differences against placebo for 10 and 20 mg (HR reduction by 12.2 and 6.8 beats per min, p = 0.0002 and p = 0.032, respectively). A statistically significant trend (p = 0.0003) for a reduction in HR with increasing doses of capadenoson was shown. Increases in total exercise time and time to 1-mm ST-segment depression were also observed. CONCLUSIONS: In patients with stable angina capadenoson lowers exercise HR at comparable maximum workload, which is associated with improved total exercise time and prolongation of time to ischaemia.

Melatonin - a somniferous option which does not aggravate sleep-disordered breathing in cardiac risk patients: a Holter ECG based study.

BACKGROUND AND AIM: We hypothesised that melatonin may represent a safe somniferous drug for cardiac patients, and assessed the effects of administering 5 mg of melatonin daily before bedtime for 30 days in patients with coronary artery disease (CAD) regarding changes in the nocturnal breathing pattern. METHODS: Sixty patients with CAD (aged 48-80 years) were randomised to melatonin/placebo treatment in a 2:1 ratio. A Holter ECG-based method (Lifescreen Apnea software) which has been validated as a screening tool for sleep-disordered breathing was used to estimate the apnoea/hypopnoea index (AHI). A 24-h Holter ECG was used to detect nocturnal breathing abnormalities at the beginning and at the end of the observation. The values of estimated AHI (eAHI) ≤ 15 were classified as optimal (Opt) and those 〉 15 - as pathological (Pat). A change of the breathing pattern was classified on the basis of the transition between the initial and final eAHI status (Opt→Opt; Opt→Pat; Pat→Pat, Pat→Opt). The mean initial and final value of eAHI and the percent of Opt and Pat values of eAHI in the initial and final assessment were compared between the melatonin and the placebo groups. RESULTS: The breathing pattern was not affected by melatonin - the mean initial value of the eAHI in the melatonin group was 18.2 ± 9.4, and in the placebo group 19.6 ± 12.3 (p = 0.64), whereas at the end of the observation in the melatonin group it increased by 1.2 ± 11.3, and in the placebo group - by 1.0 ± 9.0 (p = 0.44). CONCLUSIONS: Hypnagogic treatment with melatonin did not worsen the eAHI in patients with CAD.

The prevalence and the prognostic value of microvolt T-wave alternans in patients with hypertrophic cardiomyopathy.

BACKGROUND: Nonsustained ventricular tachycardia (nVT) may have ominous implications for patients with hypertrophic cardiomyopathy (HCM). The microvolt T-wave alternans (TWA) has been proposed as a noninvasive tool-identifying patients at risk of sudden cardiac death and ventricular tachycardia/fibrillation (VT/VF). The aim of the study was to determine the significance of TWA in predicting nVT episodes and compare how other electrocardiographic parameters can predict the occurrence of nVT. METHODS: The study group consisted of 88 patients with HCM. TWA was assessed during exercise test using the CH2000 system. All patients underwent Holter monitoring (HM) within 2-4 weeks before TWA test (preexercise HM1) and immediately after (postexercise HM2). During HM, we analyzed: arrhythmias, QT intervals, the presence of late ventricular potentials (LP), heart rate variability, heart rate turbulence. RESULTS: Depending on TWA results, the patients were divided into two groups: TWA+; 46 patients (52.3%) with positive/indeterminate results, and TWA-; 42 patients (47.7%) with negative results. The nVT episodes were more frequent among TWA(+) both in HM1 and HM2. The presence of TWA increases the risk of postexercise nVT over twenty times (OR = 21.03). Moreover, in HM1, QTc and LP, and in HM2, again QTc and N-terminal precursor of brain natriuretic peptide proved to be significant predictors of nVT. The addition of TWA to the models did not improve the arrhythmia risk assessment. CONCLUSIONS: Repolarization abnormality plays an important role in generating nVT in patients with HCM, but TWA does not specifically predict the risk of arrhythmic end point.

Direct comparison of the diagnostic value of point-of-care tests detecting heart-type fatty acid binding protein or glycogen phosphorylase isoenzyme BB in patients with acute coronary syndromes with persistent ST-segment elevation.

BACKGROUND: Myocardial infarction (MI) with its complications is one of the most serious challenges in contemporary cardiology. Among biochemical markers of myocardial necrosis, heart-type specific fatty acid binding protein (h-FABP) showed excellent sensitivity and specificity for the early diagnosis of an acute MI. The h-FABP is released rapidly (after 30 min) from the cardiomiocyte to the circulation in response to myocardial injury and may be useful for rapid confirmation or exclusion of MI. In recent years, glycogen phosphorylase BB (GP-BB) also emerged as a promising early specific marker of myocardial necrosis. Rapid, qualitative "point of care" tests (POCT) detecting h-FABP (Cardio Detect med) and GP-BB (Diacordon) have recently become available. AIM: To evaluate and compare qualitative POCTs detecting h-FABP and GP-BB in patients with an acute coronary syndrome (ACS). METHODS: We studied 52 patients with a strong suspicion of ACS with persistent ST-segment elevation and chest pain lasting less than 6 hours. The ultimate diagnosis of ST-segment elevation MI (STEMI) was confirmed in case of a second (6 h after admission) positive quantitative result of a cardiac troponin T (cTnT) test. On admission, POCTs to detect both h-FABP and GP-BB were performed. The study population was divided into two groups, with chest pain lasting 〈 3 h (n = 20) or 4-6 h (n = 32). All patients underwent coronary angiography and angioplasty if indicated. The sensitivity of the analysed biomarkers of myocardial necrosis was calculated. RESULTS: The sensitivity of h-FABP (84%) was superior in comparison to the other biomarkers, GP-BB and cTnT, which had sensitivity of 64% and 50%, respectively. Comparison of typical parameters of the diagnostic value of a test (sensitivity, predictive values and accuracy) in both time periods demonstrated that h-FABP was superior to GP-BB. In particular, sensitivity and accuracy of h-FABP was excellent in the group of patients with chest pain lasting 〈 3 h, with sensitivity of 79% for h-FABP and only 47% for GP-BB. Sensitivity and accuracy of cTnT were significantly lower (32% and 35%, respectively). CONCLUSIONS: The h-FABP seems to be an excellent early biomarker of cardiac necrosis in the group of patients with chest pain lasting 〈 3 h. The GP-BB can be also used as a biomarker of myocardic necrosis, but its sensitivity in the early phase of MI is limited.

The effects of intracoronary delivery of mononuclear bone marrow cells in patients with myocardial infarction: a two year follow-up results.

BACKGROUND: Transplantation of bone marrow stem cells (BMSC) is a new method of prevention of left ventricular (LV) remodelling in post-infarction patients. Studies published to date point to LV systolic and diastolic function improvement following this therapy however only a few studies assessed the long-term effects of BMSC. AIM: To assess the 2 year prognosis in patients with anterior myocardial infarction (MI) treated with BMSC transplantation in the acute phase. METHODS: The study group consisted of 60 patients with first anterior ST-segment elevation MI (STEMI), treated with primary percutaneous angioplasty, with baseline LV ejection fraction (LVEF) 〈 40%, who were randomly assigned to undergo BMSC transplantation on day 7 of the STEMI (40 patients, BMSC group) or to receive standard treatment (20 patients, control group). In all the patients echocardiography was performed at baseline and after 1, 3, 6, 12 and 24 months. The composite end-point (death, MI, admission for heart failure or repeat revascularisation) was assessed after 2 years of follow-up. RESULTS: Absolute increase of LVEF compared to baseline values was higher in the BMSC group than in the control group. The LVEF increase in BMSC group at 1 month was 7.1% (95% CI 3.1-11.1%), at 6 months - 9.3% (95% CI 5.3-13.3%), at 12 months - 11.0% (95% CI 6.2-13.3%) and at 24 months - 10% (95% CI 7.2-12.1%). In the control group, LVEF increase was 3.7% (95% CI 2.3-9.7%) at 1 month, 4.7% (95% CI 1.2-10.6%) at 6 months, 4.8% (95% CI 1.5-11.0%) at 12 months and 4.7% (95% CI 1.4-10.7%) at 24 months. The composite end-point occurred significantly more frequently in the control group (55%) than in the BMSC group (23%): OR 2.72; 95% CI 1.06-7.02, p = 0.015. CONCLUSIONS: Treatment with mononuclear bone marrow cells on day 7 of the first anterior MI in patients with significant baseline systolic dysfunction improves 2-year outcome.

Elevated resistin opposed to adiponectin or angiogenin plasma levels as a strong, independent predictive factor for the occurrence of major adverse cardiac and cerebrovascular events in patients with stable multivessel coronary artery disease over 1-year follow-up.

BACKGROUND: Adipokines such as adiponectin and resistin, as well as angiogenin, may be associated with inflammation and atherosclerosis. The relationship between their levels and prognosis in high risk patients is, however, still unclear. The aim of this study was to evaluate the prognostic value of these adipokines in patients with stable multivessel coronary artery disease (MCAD). MATERIAL/METHODS: The study group comprised 107 MCAD patients (74% males, mean age 63 ± 8 years). Adiponectin, resistin and angiogenin plasma levels were measured at admission and after 1-year follow-up. Primary end point (major adverse cardiac and cerebrovascular events--MACCE) was defined as cardiac death, nonfatal myocardial infarction, stroke, and hospitalization for angina or heart failure over a 1-year period. RESULTS: After 1-year follow-up, 9 (8%) patients died, all from cardiovascular causes. Primary end point was experienced by 32% of patients. Surgical treatment (CABG) was received by 51% of patients, while 49% were treated medically alone. Total cholesterol concentration levels ≥ 173 mg/dl were associated with a 7-fold increase (OR 7.3; 95% CI, 1.6-33.0); LDL ≥ 93.5 mg/dl with a 16-fold increase (OR 16.3; 95% CI, 2.8-93.8), and resistin ≥ 17.265 ng/ml with a 13-fold increase in MACCE risk (OR 13.5; 95% CI, 2.3-80.3). In multivariate analysis, a medical treatment strategy (p = 0.001), a higher CCS class (p = 0.004), resistin levels (p = 0.003) and a higher Gensini score (p = 0.03) were independent predictors of MACCE. CONCLUSIONS: In stable patients with MCAD, elevated plasma resistin (as opposed to adiponectin or angiogenin) is a strong, independent predictive factor for the occurrence of MACCE over 1-year follow-up.

Relationship of serum angiogenin, adiponectin and resistin levels with biochemical risk factors and the angiographic severity of three-vessel coronary disease.

BACKGROUND: Patients with advanced coronary artery disease (CAD) have an unfavorable prognosis. Therefore, early identification of this high-risk group is important. The aim of this study was to assess the usefulness of clinical, electrocardiographic and echocardiographic parameters supported by novel atherogenesis and angiogenesis markers in identifying patients with stable, three-vessel coronary artery disease. METHODS: The study group comprised 107 patients suffering from three-vessel CAD and a control group of 15 patients presenting with typical angina, a positive exercise stress test and abnormal segmental contractility, but no hemodynamically significant coronary stenosis in their angiograms. In each patient, we characterized a biochemistry test panel including novel markers: angiogenin, resistin, adiponectin, IL-8 and a TNF-a. The angiographic severity of CAD was expressed as a Gensini score. RESULTS: There were significant differences between three-vessel CAD patients and control groups with respect to the serum levels of: hsCRP (2.8 vs 1.4 mg/L, p = 0.01), HDL-cholesterol (45 vs 54 mg/dL, p = 0.04), LDL-cholesterol (102 vs 95 mg/dL, p = 0.04), NT-proBNP (392 vs 151 pg/mL, p = 0.008) and a marker of angiogenetic activity, angiogenin (414 vs 275 ng/mL, p = 0.02), However, no significant differences were found between three-vessel CAD and the control group with respect to the serum level of adiponectin (8.08 vs 7.82 µg/mL), resistin (17.5 vs 21 ng/mL), IL-8 (20.7 vs 26.8 pg/mL) and TNF-a (4.1 vs 4.3 pg/mL). Angiogenin tended to be higher in patients with higher Gensini scores (p = 0.06) but no influence of ejection fraction was noted. CONCLUSIONS: Angiogenin is a novel marker of three-vessel coronary disease showing a relationship with the angiographic severity of the disease.

Influence of treatment strategy on serum adiponectin, resistin and angiogenin concentrations in patients with stable multivessel coronary artery disease after one-year follow-up.

BACKGROUND: Adiponectin and resistin, as well as the novel angiogenetic factor angiogenin, may be associated with inflammation and atherosclerosis. However, the available data are limited regarding adipocytokines and angiogenesis factors long-term serum concentration changes in patients with coronary artery disease (CAD). AIM: To evaluate the treatment strategy-dependent changes in serum concentrations of adiponectin, resistin and angiogenin in patients with stable multivessel CAD (MCAD) and their association with cardiovascular events. METHODS: The study group comprised 107 MCAD patients (80 males, mean age 63±8 years); 55 (51%) patients were treated surgically (coronary artery bypass grafting-CABG), while the other 52 (49%) were treated medically. Adiponectin, resistin and angiogenin plasma levels were measured on admission and after one-year follow-up. Major adverse cardiac events (MACE) were defined as cardiac death, non-fatal myocardial infarction, stroke or hospitalisation for angina or heart failure over the 12 month period. RESULTS: During one-year follow-up, nine (8%) patients died, all from cardiovascular causes, and 34 (32%) patients experienced MACE. The CABG group revealed significant decrease in angiogenin (p<0.0001) and adiponectin (p=0.03) serum levels. In the medically treated group, we noted a significant reduction in the adiponectin serum concentration (p=0.003), with no change in resistin and angiogenin serum levels. CONCLUSIONS: In stable patients with MCAD, the choice of treatment strategy (optimal medical therapy or surgery) influences cytokines profile and modifies serum concentration of angiogenin and adiponectin during 12 months of follow-up. Assessing the dynamic concentration changes of these novel biomarkers may be useful for clinical practice.