Lack of Association of Soluble CD40 Ligand with the Presence of Acute Myocardial Infarction or Ischemic Stroke in the Emergency Department

Abstract Background: Soluble CD40 ligand (sCD40L) has been proposed as a new risk marker for cardiovascular diseases; however, its possible role as a diagnostic marker in the emergency department (ED) has not yet been investigated. Methods: We investigated sCD40L for the diagnosis of acute myocardial infarction or ischemic stroke in 1089 consecutive patients (525 males, 564 females; age, 17–98 years; median, 56 years) in an ED treating mainly adults with medical or neurologic emergencies. We used a research assay from Roche Diagnostics to measure sCD40L in heparinized plasma prepared from routinely drawn blood samples. Results: Intraassay and interassay CVs in our laboratory ranged from 1.6%–4.2% and from 4.4%–4.9%, respectively. A multiple linear regression analysis revealed sCD40L concentration to be significantly associated with C-reactive protein concentration (P = 0.012) and platelet count (P < 0.001). In addition, a subgroup analysis revealed a significant association between smoking and sCD40L concentration (P = 0.006). All other tested variables, including discharge diagnosis, age, sex, and other laboratory variables, showed no significant associations. Conclusions: In adults presenting to the ED, sCD40L is not useful as a diagnostic marker for acute cardiac, cerebrovascular ischemic, or thromboembolic events.

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Detecting plaque rupture? Soluble CD40 ligand for early diagnosis of acute myocardial infarction in the emergency department

Emergency Medicine Journal ◽

10.1136/emj.2010.103150.16 ◽

2010 ◽

Vol 27 (Suppl 1) ◽

pp. A6.2-A6

Author(s):

Richard Body

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Department ◽

Early Diagnosis ◽

Adverse Events ◽

Troponin T ◽

Cd40 Ligand ◽

Soluble Cd40 Ligand ◽

Calcium Blockers ◽

Significant Difference

BackgroundIn recent years there has been growing interest in the identification of novel biomarkers that may enable early exclusion of acute coronary syndromes (ACS) in the Emergency Department (ED). Soluble CD40 ligand (sCD40L) has been identified as a potential marker of coronary plaque destabilisation and platelet activation. We aimed to investigate the value of sCD40L measured at the time of ED presentation for enabling early diagnosis and exclusion of ACS.MethodsWe recruited patients presenting to the ED with suspected cardiac chest pain within the previous 24 h. We measured sCD40L in plasma samples taken at the point of ED presentation. All patients had troponin T measured at least 12 h after symptom onset and were followed up for 6 months for adverse events (death, acute myocardial infarction (AMI) or the need for urgent revascularisation).Results706 patients were recruited to the study. sCD40L levels were significantly lower in smokers, in patients with hyperlipidaemia or prior coronary revascularisation and in patients taking statins, r angiotensin-converting enzyme or calcium blockers. There was no significant difference in sCD40L levels between patients with (median 33.8ng/ml, IQR 18.0–80.5) and without (36.3 ng/ml, IQR 14.2–94.3) AMI (p=0.92) or between patients who did (34.0 ng/ml, 14.2–94.3) and who did not (34.9, 18.2–80.4) develop adverse events (p=0.82). The area under the Receiver Operating Characteristic curve was 0.50 (95% CI 0.45 to 0.56) for AMI and 0.49 (0.44–0.55) for adverse events. There was no trend towards increasing incidence of either outcome with ascending quintiles of sCD40L.ConclusionssCD40L is unhelpful in the ED diagnosis of ACS. Future work in this area should focus on other biomarkers.

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Soluble CD40 ligand and interleukin-6 in the coronary circulation after acute myocardial infarction

International Journal of Cardiology ◽

10.1016/j.ijcard.2005.09.051 ◽

2006 ◽

Vol 112 (1) ◽

pp. 52-58 ◽

Cited By ~ 22

Author(s):

Yoshitaka Ohashi ◽

Seinosuke Kawashima ◽

Takao Mori ◽

Mitsuyasu Terashima ◽

Shinobu Ichikawa ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Interleukin 6 ◽

Coronary Circulation ◽

Cd40 Ligand ◽

Soluble Cd40 Ligand

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Plasma concentrations of soluble CD40 ligand in smokers with acute myocardial infarction: a pilot study

Heart and Vessels ◽

10.1007/s00380-010-0036-x ◽

2010 ◽

Vol 26 (2) ◽

pp. 131-137 ◽

Cited By ~ 8

Author(s):

Mehmet Kayrak ◽

Ahmet Bacaksiz ◽

Mehmet S. Ulgen ◽

Mehmet Akif Vatankulu ◽

Kadriye Zengin ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Pilot Study ◽

Plasma Concentrations ◽

Cd40 Ligand ◽

Soluble Cd40 Ligand

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0338: C-reactive protein and mean platelet volume/platelet count ratio as predictors of ischemic stroke after acute myocardial infarction

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(15)71535-1 ◽

2015 ◽

Vol 7 (1) ◽

pp. 16-17

Author(s):

Olivier Hachet ◽

Charles Guenancia ◽

Yannick Béjot ◽

Thibault Leclercq ◽

Karim Stamboul ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Platelet Count ◽

Ischemic Stroke ◽

Mean Platelet Volume ◽

C Reactive Protein ◽

Platelet Volume ◽

Reactive Protein ◽

Count Ratio

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Abstract 17519: Exercise Capacity Increase, Obesity, and Statin Therapy Are the Key Factor for Decrease C-Reactive Protein through Exercise Training after Acute Myocardial Infarction

Circulation ◽

10.1161/circ.130.suppl_2.17519 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Takahito Doi ◽

Reon Kumasaka ◽

Tetsuo Arakawa ◽

Michio Nakanishi ◽

Teruo Noguchi ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Exercise Training ◽

Statin Therapy ◽

Exercise Capacity ◽

Linear Regression Analysis ◽

Hdl Cholesterol ◽

C Reactive Protein ◽

Reactive Protein ◽

Statin Use

Backgrounds: Cardiac rehabilitation with exercise training (CR/ET) has been reported to be associated with reduction in C-reactive protein (CRP) levels in patients with coronary artery disease. However, determinants of reduction in CRP through CR/ET after acute myocardial infarction (AMI) are not fully understood. Methods: We studied 490 consecutive AMI patients (age 63±11 years, male 83%) who participated in our CR/ET program and underwent measurements for serum CRP and peak oxygen uptake (PVO2) by symptom-limited cardiopulmonary exercise test at the beginning and the end of the 3-month CR program. Patients with abnormally high CRP (>= 20mg/L at baseline, >=10mg/L at 3 months) or on hemodialysis were excluded. Results: After the 3-month CR/ET, body mass index (BMI, 23.3 to 23.1, P<0.001) and CRP (4.7mg/L to 1.1mg/L, P<0.001) significantly decreased, and normalized PVO2 increased (77.4% to 84.9% P<0.001). The magnitude of changes in CRP (ΔCRP) were greater in patients with statin therapy than in patients without statin therapy (-2.9 +/- 0.4mg/L vs -3.9,+/- 0.3mg/L p<0.05). There were significant positive correlation between ΔCRP and HDL-cholesterol (r=0.14), and inverse correlations between ΔCRP and BMI (r=-0.09) and changes in %PVO2 (%ΔPVO2, r=-0.16). Multiple linear regression analysis (incorporating age, sex, baseline ejection fraction, BMI, Brain natriuretic peptide, Hemoglobin A1c, HDL-cholesterol, LDL-cholesterol, statin use, and %ΔPVO2) demonstrated that higher BMI, greater increase in PVO2, higher HDL-cholesterol, and statin use were the independent determinants (all p<0.05) of greater decrease in CRP. Diabetes and smoking status were not the independent determinants of CRP decrease. Conclusion: A greater increase in exercise capacity, in combination with obesity and statin use, significantly associated with a greater reduction in CRP in patients after AMI participating in CR/ET.

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Changes of soluble CD40 ligand in the progression of acute myocardial infarction associate to endothelial nitric oxide synthase polymorphisms and vascular endothelial growth factor but not to platelet CD62P expression

Translational Research ◽

10.1016/j.trsl.2015.07.006 ◽

2015 ◽

Vol 166 (6) ◽

pp. 650-659 ◽

Cited By ~ 11

Author(s):

Patrícia Napoleão ◽

Maria do Céu Monteiro ◽

Luís B.P. Cabral ◽

Maria Begoña Criado ◽

Catarina Ramos ◽

...

Keyword(s):

Nitric Oxide ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Endothelial Nitric Oxide Synthase ◽

Cd40 Ligand ◽

Vascular Endothelial ◽

Soluble Cd40 Ligand ◽

Oxide Synthase ◽

Endothelial Growth Factor ◽

Endothelial Nitric Oxide

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Differentiation between myopericarditis and acute myocardial infarction on presentation in the emergency department using the admission C-reactive protein to troponin ratio

PLoS ONE ◽

10.1371/journal.pone.0248365 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0248365

Author(s):

Simcha R. Meisel ◽

Hamuda Nashed ◽

Randa Natour ◽

Rami Abu Fanne ◽

Majdi Saada ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Department ◽

Roc Analysis ◽

Area Under The Curve ◽

C Reactive Protein ◽

Reactive Protein ◽

St Elevation ◽

Operator Curve ◽

Median Admission

Background The treatment of myopericarditis is different than that of acute myocardial infarction (AMI). However, since their clinical presentation is frequently similar it may be difficult to distinguish between these entities despite a disparate underlying pathogenesis. Myopericarditis is primarily an inflammatory disease associated with high C-reactive protein (CRP) and relatively low elevated troponin concentrations, while AMI is characterized by the opposite. We hypothesized that evaluation of the CRP/troponin ratio on presentation to the emergency department could improve the differentiation between these two related clinical entities whose therapy is different. Such differentiation should facilitate triage to appropriate and expeditious therapy. Methods We evaluated the CRP/troponin ratio on presentation among patients consecutively included in a large single center registry that included 1898 consecutive patients comprising 1025 ST-elevation myocardial infarction (STEMI) patients, 518 Non-STEMI (NSTEMI) patients, and 355 patients diagnosed on discharge as myopericarditis. CRP and troponin were sampled on admission in all patients and their ratio was assessed against discharge diagnosis. ROC analysis of the CRP/troponin ratios evaluated the diagnostic accuracy of myopericarditis against all AMI, STEMI, and NSTEMI patients. Results Median admission CRP/troponin ratios were 84, 65, and 436 mg×ml/liter×ng in STEMI, NSTEMI and myopericarditis groups, respectively (p<0.001) demonstrating good differentiating capability. The Receiver-operator-curve of admission CRP/troponin ratio for diagnosis of myopericarditis against all AMI, STEMI, and NSTEMI patients yielded an area-under-the curve of 0.74, 0.73, and 0.765, respectively. CRP/troponin ratio>500 resulted in specificity exceeding 85%, and for a ratio>1000, specificity>92%. Conclusion The CRP/troponin ratio can serve as an effective tool to differentiate between myopericarditis and AMI. In the appropriate clinical context, the CRP/troponin ratio may preclude further evaluation.

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