High-sensitivity cardiac troponin T in patients with intermittent claudication and its relation with cardiovascular events and all-cause mortality – The CAVASIC Study

Pohlhammer, Johannes; Kronenberg, Florian; Rantner, Barbara; Stadler, Marietta; Peric, Slobodan; Hammerer-Lercher, Angelika; Klein-Weigel, Peter; Fraedrich, Gustav; Kollerits, Barbara

doi:10.1016/j.atherosclerosis.2014.10.097

Cited by 16 publications

(11 citation statements)

References 36 publications

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“…The 47 included studies were sorted per biomarker; several studies appeared in different groups as they investigated multiple biomarkers. The following biomarkers were studied: 13 studies investigated high-sensitivity CRP (hs-CRP), 11 , 14 – 26 2 reported on GDF-15 (growth differentiation factor 15), 14 , 27 2 on MPO (myeloperoxidase), 24 , 28 6 on the neutrophil-lymphocyte ratio (NLR), 29 – 34 2 assessed SAA (serum amyloid A), 22 , 35 6 reported on fibrinogen, 19 , 35 – 39 another 7 assessed d -dimer, 22 , 25 , 38 , 40 – 43 7 investigated NT-proBNP, 11 , 15 , 17 , 44 – 47 5 hs-cTnT, 10 , 44 , 45 , 48 , 49 4 asymmetrical dimethylarginine (ADMA), 50 – 53 4 assessed adiponectin, 54 – 57 and 3 homocysteine. 18 , 22 , 58 Investigated outcomes were heterogenous across studies but mainly included all-cause mortality, cardiovascular mortality, cardiovascular events, major adverse cardiovascular events (MACE), major adverse limb events, coronary events, amputation-free survival, amputation, reintervention for lower extremity PAD, and graft patency.…”

Section: Resultsmentioning

confidence: 99%

“…Short-term prediction of cardiovascular events was found to be more successful compared with long-term prediction (>4 years). 9 The third group of biomarkers are cardiac markers including NT-proBNP (N-terminal pro-B-type natriuretic peptide) 10 , 11 and high-sensitivity cTnT (cardiac troponin T; hs-cTnT), 10 but these biomarkers have not been reviewed systematically in lower extremity PAD thus far. Apart from these 3 major groups of plasma biomarkers, there are >30 proteins that were found to be associated with cardiovascular risk and increased mortality.…”

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confidence: 99%

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Plasma Biomarkers to Predict Cardiovascular Outcome in Patients With Peripheral Artery Disease

Kremers

Wübbeke

Mees

et al. 2020

ATVB

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Objective: Patients with lower extremity peripheral artery disease (PAD) are at increased risk of major adverse cardiovascular events. Numerous plasma biomarkers have been investigated in lower extremity PAD, but none are used for clinical risk assessments. We aimed to provide a comprehensive overview of biomarker testing in PAD as a first step to improve risk stratification. Approach and Results: A systematic literature review in MEDLINE/PubMed, Cochrane, and Embase was performed, identifying all studies investigating plasma biomarkers in association with cardiovascular events and mortality in lower extremity PAD. Forty-seven studies comprising 21 473 PAD patients met our criteria and were included. Effect estimates were provided by the studies based on a minimum follow-up of 1 year. Meta-analyses were performed by pooling studies per biomarker for each end point. Patients with increased high-sensitivity CRP (C-reactive protein) levels had a relative risk of 1.86 (1.48–2.33) for major adverse cardiovascular events and a relative risk of 3.49 (2.35–5.19) for mortality. Increased fibrinogen and d -dimer levels were associated with an increased relative risk of mortality of 2.08 (1.46–2.97) and 2.22 (1.24–3.98), respectively. Additionally, patients with increased NT-proBNP (N-terminal pro-B-type natriuretic peptide) and high-sensitivity cTnT (cardiac troponin T) levels were at an even higher risk of mortality with relative risks of 4.50 (2.98–6.81) and 3.33 (2.70–4.10), respectively. Conclusions: This systematic review identifies promising biomarkers representing different pathophysiological processes implicated in lower extremity PAD, including high-sensitivity CRP, neutrophil-lymphocyte ratio, fibrinogen, d -dimer, NT-proBNP, and high-sensitivity cTnT. Clinical implementation should be preceded by a management study to test the utility of a combination of these markers for individual risk stratification. Ultimately, this may contribute to tailored treatment and increased effectiveness of current treatment strategies in PAD.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Plasma Biomarkers to Predict Cardiovascular Outcome in Patients With Peripheral Artery Disease

Kremers

Wübbeke

Mees

et al. 2020

ATVB

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“…From the 214 patients with symptomatic PAD still alive at the follow-up investigation1112, interviews based on a standardized questionnaire were performed at the respective medical center (n = 181) or by telephone survey where a visit in the outpatient ward was not possible (n = 3). These examinations were done by one specially trained medical doctor and one study nurse at each participating center.…”

Section: Methodsmentioning

confidence: 99%

The fate of patients with intermittent claudication in the 21st century revisited – results from the CAVASIC Study

Rantner

Kollerits

Pohlhammer

et al. 2017

Sci Rep

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Patients with intermittent claudication carry a high risk for cardiovascular complications. The TransAtlantic Inter-Society Consensus (TASC) Group estimated a five-year overall mortality of 30% for these patients, the majority dying from cardiovascular causes. We investigated whether this evaluation is still applicable in nowadays patients. We therefore prospectively followed 255 male patients with intermittent claudication from the CAVASIC Study during 7 years for overall mortality, vascular morbidity and mortality and local PAD outcomes. Overall mortality reached 16.1% (n = 41). Most patients died from cancer (n = 20). Half of patients (n = 22; 8.6%) died within the first five years. Incident cardiovascular events were observed among 70 patients (27.5%), 54 (21.2%) during the first five years. Vascular mortality was low with 5.1% (n = 13) for the entire and 3.1% for the first five years of follow-up. Prevalent coronary artery disease did not increase the risk to die from all or vascular causes. PAD symptoms remained stable or improved in the majority of patients (67%). In summary, compared to TASC, the proportion of cardiovascular events did not markedly decrease over the last two decades. Vascular mortality, however, was low among our population. This indicates that nowadays patients more often survive cardiovascular events and a major number dies from cancer.

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“…During the last decade, the falling prevalence of smoking and the larger coverage of cardiovascular medication among individuals with cardiovascular disease might well have impacted the incidence of PAD (Alhadad et al 2013). Troponin levels have been shown to be related to both PAD (Pohlhammer et al 2014), and clinical outcome in PAD patients (Clemens et al 2019). Unfortunately, however, no measurements of this marker had been performed in the MDCS subjects.…”

Section: Discussionmentioning

confidence: 99%

Copeptin, B-type natriuretic peptide and cystatin C are associated with incident symptomatic PAD

et al. 2019

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Purpose: The aim of this study is to evaluate plasma biomarkers as predictors for peripheral arterial disease (PAD). Materials and methods: Prospective longitudinal cohort study of middle-aged individuals from the cardiovascular cohort of the Malm€ o Diet and Cancer study (MDCS) (n ¼ 5550; 1991-94). Cystatin C, copeptin, N-terminal pro-B-type natriuretic peptide (N-BNP), midregional proatrial natriuretic peptide (MR-proANP), mid-regional proadrenomedullin (MR-proADM), and conventional risk factors were measured at baseline. The diagnosis of symptomatic PAD was validated in 97% of the cases. Results: Cumulative incidence of PAD during median follow up of 23.4 years was 4.4% (men 5.9%, women 3.3%). Adjusted for age, sex, smoking, body mass index, hypertension, diabetes mellitus and total cholesterol, copeptin (hazard ratio [HR] 1.46; 95% confidence interval [CI] 1.19-1.80), N-BNP (HR 1.28; 95% CI 1.11-1.48), and cystatin C (HR 1.19; 95% CI 1.10-1.29) were independently associated with incident PAD. Subjects with the three biomarkers copeptin, N-BNP, and cystatin C in the highest quartiles, ran a high risk of incident PAD (HR 3.29; 95% CI 1.76-6.17) compared to those with no biomarker in the highest quartile. Conclusion: Copeptin, N-BNP, and cystatin C were associated with incident symptomatic PAD, implying that these biomarkers are sensitive indicators of early subclinical PAD. CLINICAL SIGNIFICANCE First prospective longitudinal cohort study evaluating Cystatin C, copeptin, N-terminal pro-B-type natriuretic peptide (N-BNP), midregional proatrial natriuretic peptide (MR-proANP), and mid-regional proadrenomedullin (MR-proADM) as predictors for peripheral arterial disease (PAD). Copeptin, N-BNP, and Cystatin C where independently associated with incident symptomatic PAD after adjustment for conventional risk factors. Copeptin, N-BNP, and Cystatin C seem to be sensitive indicators of early subclinical PAD.

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High-sensitivity cardiac troponin T in patients with intermittent claudication and its relation with cardiovascular events and all-cause mortality – The CAVASIC Study

Cited by 16 publications

References 36 publications

Plasma Biomarkers to Predict Cardiovascular Outcome in Patients With Peripheral Artery Disease

Plasma Biomarkers to Predict Cardiovascular Outcome in Patients With Peripheral Artery Disease

The fate of patients with intermittent claudication in the 21st century revisited – results from the CAVASIC Study

Copeptin, B-type natriuretic peptide and cystatin C are associated with incident symptomatic PAD

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