Admission values of all natriuretic peptides can be used to predict cardiac death and all-cause mortality. A preliminary comparison suggests that discharge values of NT-proBNP have the greatest diagnostic yield for predicting these end points. Further studies should explore the synergistic prognostic potential of all natriuretic peptides.

This study investigates the cellular localization and regulation of endothelin-1 (ET-1) and angiotensin II (Ang II) receptors and the effects of ET-1 and Ang II on [Ca2+]i in cardiac hypertrophy due to volume overload in the rat. Radioligand binding assays and [Ca2+]i measurements by fura 2 methodology were performed on isolated ventricular cardiomyocytes and fibroblasts from the heart of rats with a 4-week aortocaval shunt. In the hypertrophied myocardium, ET-1 and Ang II concentrations were unchanged in ventricles. Ventricular ET-1 receptors had a cell-specific distribution: > 90% of ET receptors in cardiomyocytes are of the ETA subtype, whereas fibroblasts had a nearly equal proportion of the ETA and ETB subtypes. ET-1 receptor densities, affinities, and ET-1-induced [Ca2+]i were not significantly different from control in both ventricular cell types from hypertrophied myocardium. Ang II specific binding was very low on isolated ventricular cardiomyocytes, suggesting few receptors in control conditions. However, [Ca2+]i responses induced by Ang II at concentrations > 10(-8) mol/L were detectable and were significantly higher in hypertrophied cardiomyocytes. Ang II receptor density (exclusively AT1) on fibroblasts was significantly reduced (42,970 +/- 3330 versus 73,870 +/- 7940 sites per cell for control cells, P < .01), but AT1 receptor affinity was unchanged after volume overload. The maximum increase in [Ca2+]i evoked by 10(-6) to 10(-4) mol/L Ang II was significantly lower in fibroblasts from overloaded hearts. In conclusion, ET-1 receptor proportion is cell specific, with cardiomyocytes possessing predominantly the ETA subtype and fibroblasts possessing both ETA and ETB receptors. Plasma and cardiac ET-1 concentrations and ET-1 receptor regulation on both ventricular cell types are not altered in cardiac volume overload, suggesting that cardiac ET-1 may not play a significant role in this model. Cardiac hypertrophy induced a significant downregulation of AT1 receptors on fibroblasts, whereas total binding and [Ca2+]i sensitivity to Ang II were significantly enhanced in hypertrophied cardiomyocytes. This suggests that cardiac Ang II may be involved in the pathophysiology of the cardiac hypertrophy of volume overload.

Objective-Previous proteomics experiments have demonstrated that several proteins are differentially expressed in vulnerable human carotid plaques compared with stable plaques. This study aims to investigate the prognostic value of 13 such circulating biomarkers in patients with coronary artery disease. Approach and Results-Between 2008 and 2011, 768 patients who underwent coronary angiography for acute coronary syndrome or stable angina pectoris were included in a prospective biomarker study. Plasma concentrations of 13 biomarkers were measured in 88 patients who experienced a major adverse cardiovascular event (MACE) within 1 year and 176 control patients without MACE who were matched on age, sex, and number of diseased coronary vessels. MACE comprised all-cause mortality, acute coronary syndrome, unplanned coronary revascularization, and stroke. After adjustment for established cardiovascular risk factors, osteoglycin (OGN; odds ratio per SD increase in ln-transformed OGN, 1.53; 95% confidence interval, 1.11-2.11; P=0.010) and neutrophil gelatinase-associated lipocalin/matrix metalloproteinase 9 (NGAL/MMP9; odds ratio per SD increase in ln-transformed NGAL/MMP9, 1.37; 95% confidence interval, 1.01-1.85; P=0.042) complex were independently associated with MACE during follow-up. These associations were independent of C-reactive protein levels. Cheng et al OGN and NGAL/MMP9 Predict Cardiovascular Outcome 1079human carotid plaques when compared with stable fibrotic plaques. 8 The majority of these proteins, including aciculin, oncogene DJ1 (DJ1), microfibril-associated glycoprotein 4, osteoglycin (OGN), procollagen C proteinase enhancer 1, phosphatidylethanol-amine-binding protein 1, and peroxiredoxin 2, have not yet been investigated as prognostic biomarkers in CAD patients. In addition, evidence exists that neutrophil gelatinase-associated lipocalin (NGAL) and its NGAL/matrix metalloproteinase 9 (NGAL/MMP9) complex display increased expression in (unstable) atherosclerotic plaques.9,10 These proteins have also not yet been investigated as prognostic biomarkers in CAD patients.We have performed a prospective, nested case-control study in a cohort of 768 patients undergoing coronary angiography to investigate whether plasma levels of the above-described novel protein biomarkers are associated with adverse cardiovascular events. We have also evaluated whether these biomarkers improve discrimination and risk reclassification. Materials and MethodsMaterials and Methods are available in the online-only Supplement. Results Baseline CharacteristicsMean age of the patients was 64.9 (SD, 10.6) years, 77% were men, and 52% had acute coronary syndrome (Table 1). Percutaneous coronary intervention was performed in 82% of the patients. The group of patients who experienced major adverse cardiovascular event (MACE) during follow-up displayed a higher prevalence of diabetes mellitus (27.3% versus 14.9%; P=0.016) and a tendency toward a higher prevalence of renal insufficiency (11.4% versus 4.6%; P=0.053) compared with the gro...