C-reactive protein, clinical presentation, and ischemic activity in patients with chest pain and normal coronary angiograms

Cosı́n-Sales, Juan; Pizzi, Carmine; Brown, Sue; Kaski, Juan Carlos

doi:10.1016/s0735-1097(03)00243-2

Cited by 141 publications

(92 citation statements)

References 21 publications

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“…Veleska et al could not find any relationship between serum hs-CRP levels and exercise testing results in a study that included 200 patients with positive exercise tests 8. On the other hand, Cosin-Sales et al reported a correlation between serum hs-CRP levels and ST-segment depression during exercise testing with Holter monitoring, and the frequency of angina episodes in patients with typical chest pain and normal coronary angiograms 6. Therefore, the relationship between hs-CRP and reversible myocardial ischaemia was not as clear as in unstable coronary artery disease and needs to be clarified in large-scale studies.…”

Section: Discussionmentioning

confidence: 98%

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Serum high-sensitivity C-reactive protein, amyloid-associated protein and N-terminal proBNP levels do not predict reversible myocardial ischaemia

Başkurt¹,

Aktürk²,

Keskin³

et al. 2011

CardioVascular Journal of Africa

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AimThe aim of this study was to detect any relationship between serum high-sensitivity C-reactive protein (hs-CRP), serum amyloid-associated protein (SAA) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and reversible myocardial ischaemia during cardiovascular exercise tests and to determine whether these biomarkers could predict transient myocardial ischaemia.MethodsNinety-six patients (36 women, 60 men, mean age 57 ± 8.5 years) were included in the study. Venous blood samples were taken from patients before and 15 minutes after exercise testing. SAA and hs-CRP were analysed using immunonephelometric assays (Dade-Behring, BN II, Marburg, Germany). NT-proBNP (pg/ml) was determined using the immulite 1 000 chemiluminescence immunoassay system (Siemens Medical Solution Diagnostics, Deerfiled, USA). Forty-eight patients (18 women, 30 men) with positive exercise tests were allocated to the exercise-positive group and 48 (18 women, 30 men) with negative exercise tests were put in the exercise-negative group. Coronary angiography was performed on all patients in the exercise-positive group.ResultsThere was no difference between the levels of hs-CRP, SAA and NT-pro-BNP before and after exercise testing in both of the exercise groups.ConclusionSerum levels of hs-CRP, SAA and NT-proBNP could not predict the occurrence of reversible myocardial ischaemia during exercise. Large-scale clinical studies are needed to clarify the status of hs-CRP, SAA and NT-proBNP with exercise.

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Section: Discussionmentioning

confidence: 98%

“…However, its role in predicting transient myocardial ischaemia in stable coronary heart disease is not clear. While some studies found a strong relationship between serum hs-CRP levels and reversible myocardial ischaemia in exercise electrocardiographic testing,6 others did not find such a relationship 7,8…”

Section: Discussionmentioning

confidence: 98%

Serum high-sensitivity C-reactive protein, amyloid-associated protein and N-terminal proBNP levels do not predict reversible myocardial ischaemia

Başkurt¹,

Aktürk²,

Keskin³

et al. 2011

CardioVascular Journal of Africa

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“…Anjiyografik olarak normal koronerleri ve reversibl miyokardiyal kanlanma defekti olan bireylerde iskemi sırasında endoteliyal disfonksiyon ve transmiyokardiyal laktat üretimi izlenmiştir (27). İskemi sırasında hsCRP düzeylerinin arttığı görülmüştür (13). İskemiyi takip eden reperfüzyon sonrasında kısa bir sürede (yaklaşık 15 dakika) serbest oksijen radikallerinin oluşumu, kompleman sistem aktivasyonu, koroner endoteline nötrofil tutunması ve IL-6 ve IL-1 gibi akut proinflamatuvar sitokinlerin aktive olduğu deneysel çalışmalarda gösterilmiştir (28 arasında pozitif korelasyon olduğunu göstermişlerdir.…”

Section: Discussionunclassified

The relation between exercise- induced myocardial ischemia and high-sensitive C-reactive protein and neopterin levels

Başar¹,

Yaşar²,

Erden³

et al. 2010

Anadolu Kardiyol Derg

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ÖZETAmaç: Yüksek duyarlılıklı C-reaktif protein (hsCRP) ve neopterin, ateroskleroz gelişimi ile ilişkilidir. Bu çalışmada kararlı anjina pektorisli (KAP) hastalarda, egzersiz stres testi (EST) esnasında oluşan miyokart iskemisi ile hsCRP ve neopterin seviyeleri arasındaki ilişki ve EST ile hsCRP ve neopterin düzeylerinde meydana gelen değişimin tıkayıcı koroner lezyon varlığını öngörmedeki yeri araştırılmıştır. Yöntemler: Çalışmamız prospektif, gözlemsel olarak dizayn edildi. Çalışmaya KAP ile takip edilen 45 hasta alındı. Egzersiz stres testi pozitif grupta 23 (15 erkek, yaş ortalaması 54±10 yıl), EST-negatif grupta 22 hasta (14 erkek, yaş ortalaması 52±9 yıl) mevcuttu. Her hastadan EST'den 1 saat önce ve 30 dakika sonra alınan kan örneklerinde hsCRP ve neopterin düzeyleri belirlendi. Egzersiz stres testi pozitif olan hastalara koroner anjiyografi yapılarak tıkayıcı koroner lezyon varlığı ve Gensini skoru ile yaygınlığı değerlendirildi. Bulgular: Egzersiz stres testi öncesi hsCRP ve neopterin düzeyleri iki grup arasında benzer iken EST sonrası hsCRP düzeyleri, EST-pozitif grupta daha yüksek izlendi (p=0.03); neopterin düzeyleri açısından EST sonrasında iki grup arasında fark saptanmadı (p=0.4). Egzersiz stres testi, ESTpozitif olan grupta hem hsCRP, hem de neopterin düzeylerinde anlamlı artışa neden olurken (sırasıyla, 3.8±2.8 mg/L'den 4.3±3.1 mg/L'ye, p=0.001; 8.7±4.0 nmol/L'den 13.1±10.0 nmol/L'ye, p=0.001), egzersiz stres testi negatif olan grupta sadece neopterin düzeylerinde anlamlı artış izlendi (6.9±1.8 nmol/L'den 9.0±3.9 nmol/L'ye, p=0.001). Tıkayıcı koroner lezyon varlığı ve yaygınlığı ile herhangi bir noktada bakılan hsCRP ve neopterin düzeyleri arasında ise anlamlı ilişki izlenmedi. İstatistiksel analiz Ki-kare, eşleştirilmemiş t, Mann-Whitney U ve Wilcoxon rank testleri ile yapıldı. Testlerin öngördürücü değerini belirlemede lojistik regresyon analizi kullanıldı. Sonuç: Kararlı anjina pektorisli hastalarda tıkacı lezyonun varlığından bağımsız olarak pozitif egzersiz testi sonrasında oluşan hsCRP artışı, miyokardiyal iskemi sırasında oluşan immün aktivasyonun bir göstergesi olabilir. (Anadolu Kardiyol Derg 2010 Aralık 1; 10(6): 502-7) Anahtar kelimeler: Egzersiz stres test, kararlı anjina pektoris, hsC-reaktif protein, neopterin, tıkayıcı koroner lezyon, testlerin prediktif değeri ABSTRACT Objective: High sensitivity C-reactive protein (hsCRP) and neopterin are associated with atherosclerosis. We aimed to evaluate the association between hsCRP and neopterin, and myocardial ischemia during exercise stress test (EST) in patients with stable angina pectoris (SAP) and to assess the predictive value of these mediators in obstructive coronary artery disease. Methods: Forty-five patients with SAP were included in this prospective observational study. EST-positive group included 23 patients (15 males, mean age 54±10 years) and EST-negative group-22 patients (14 males, mean age 52±9 years). In each patient, blood samples were obtained 1 hour before and 30 minutes after EST. In EST-positive group, coronary ang...

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“…4,12,14) More recently, chronic inflammation was found to be associated with cardiac syndrome X. 15,16) The evidence for this was the elevated inflammatory markers associated with the disease activity and the effect of statin, a lipid-lowering as well as anti-inflammatory drug, which has significantly modified the disease process in cardiac syndrome X. [17][18][19] CRP is the prototypic acute phase reactant and marker of inflammation.…”

Section: Discussionmentioning

confidence: 99%

Microvascular Angina. The Possible Role of Inflammation, Uric Acid, and Endothelial Dysfunction

et al. 2009

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SummaryMicrovascular angina is a condition characterized by angina-like chest pain and normal coronary angiography. Endothelial dysfunction and systemic inflammation with elevated serum high-sensitive C-reactive protein (hsCRP) levels play a role in its pathogenesis. This study aimed to explore the possible relation between CRP, brachial flowmediated dilatation (FMD), and microvascular angina.We included 21 patients with attacks of chest pain diagnosed as microvascular angina (study group) and 10 normal asymptomatic subjects (control group). Patients and controls were thoroughly examined clinically and by echocardiography, electrocardiography, and brachial FMD (using external brachial ultrasonography). Serum hsCRP and uric acid levels were assessed in all subjects. A significantly higher mean hsCRP level was found in the study group compared to controls (11.5 ± 3.8 versus 3.34 ± 1.5 mg/L; P < 0.001). FMD of the brachial artery showed significant impairment in patients with microvascular angina compared to controls (0.16 ± 0.06 versus 0.76 ± 0.09 mm; P < 0.001). There were significantly higher total cholesterol (196.1 ± 44.4 versus 159.8 ± 14.5 mg/dL; P = 0.018) and triglyceride levels (185.0 ± 103.2 versus 113.0 ± 17.6 mg/dL; P = 0.038) in the patients compared to controls; but there was a statistically insignificant difference in mean serum uric acid levels between these two groups. There were no significant correlations between the brachial FMD and any of the clinical variables studied (apart from ankle/brachial index).Microvascular angina may have an inflammatory element (reflected as a higher serum hsCRP level), together with a contribution by endothelial dysfunction (reflected as impaired brachial artery FMD); while serum uric acid is possibly not associated with microvascular angina. (Int Heart J 2009; 50: 407-419)

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C-reactive protein, clinical presentation, and ischemic activity in patients with chest pain and normal coronary angiograms

Abstract: The hs-CRP correlates with symptoms and ECG markers of myocardial ischemia in CPNCA patients. Whether hs-CRP is related to the pathogenesis of angina in these patients deserves further investigation.

Cited by 141 publications

References 21 publications

Serum high-sensitivity C-reactive protein, amyloid-associated protein and N-terminal proBNP levels do not predict reversible myocardial ischaemia

Serum high-sensitivity C-reactive protein, amyloid-associated protein and N-terminal proBNP levels do not predict reversible myocardial ischaemia

The relation between exercise- induced myocardial ischemia and high-sensitive C-reactive protein and neopterin levels

Microvascular Angina. The Possible Role of Inflammation, Uric Acid, and Endothelial Dysfunction

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