scholarly journals Cardiac Troponin T Measured by a High-Sensitivity Assay Predicts Recurrent Cardiovascular Events in Stable Coronary Heart Disease Patients with 8-Year Follow-up

2012 ◽  
Vol 58 (8) ◽  
pp. 1215-1224 ◽  
Author(s):  
Wolfgang Koenig ◽  
Lutz P Breitling ◽  
Harry Hahmann ◽  
Bernd Wüsten ◽  
Hermann Brenner ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cystatin C ◽  
Troponin T ◽  
Plasma Concentrations ◽  
High Sensitivity ◽  
Net Reclassification Improvement ◽  
Stable Coronary Heart Disease ◽  
Chd Risk Factors

Abstract BACKGROUND The clinical relevance of slightly increased circulating troponin concentrations in patients with stable coronary heart disease (CHD) several weeks after an acute event or CABG has not been fully evaluated. METHODS Baseline plasma concentrations of troponin T were measured with a high-sensitivity assay (hs-cTnT) (Roche Elecsys) in a cohort of 1050 CHD patients from 30 to 70 years of age. The prognostic value of hs-cTnT on a combined cardiovascular disease (CVD) end point after adjustment for covariates was determined with Cox proportional hazards modeling. RESULTS The median hs-cTnT concentration was 10.9 ng/L (interquartile range, 5.1–18.9 ng/L). Increased hs-cTnT concentrations were associated with an older age, history of hypertension and diabetes, more advanced coronary artery disease, and other CHD risk factors. Furthermore, hs-cTnT concentration was strongly correlated with N-terminal pro–B-type natriuretic peptide (NT-proBNP) and cystatin C (ρ = 0.61, and ρ = 0.32, respectively; both P values <0.0001). During a median follow-up of 8.1 years, 150 patients (14.3%) experienced a secondary CVD event. In a multivariate model, hs-cTnT was associated with a hazard ratio (HR) for secondary events of 2.83 (95% CI, 1.68–4.79) when the extreme quartiles were compared. Further adjustment for cystatin C, NT-proBNP, and C-reactive protein attenuated this association only slightly (HR, 2.27; 95% CI, 1.31–3.95); P for trend < 0.002). ROC curve analysis of a clinical model that added hs-cTnT to a baseline model showed nonsignificant improvement in the area under the curve (0.69 vs 0.67), whereas the net reclassification improvement was 17.2% (P = 0.029). CONCLUSIONS Slightly increased hs-cTnT concentrations in stable CHD patients are associated with several cardiovascular disorders and predict long-term CVD events.

scholarly journals Growth Differentiation Factor 15 Predicts All-Cause Morbidity and Mortality in Stable Coronary Heart Disease

2017 ◽  
Vol 63 (1) ◽  
pp. 325-333 ◽  
Author(s):  
Emil Hagström ◽  
Claes Held ◽  
Ralph A H Stewart ◽  
Philip E Aylward ◽  
Andrzej Budaj ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Troponin T ◽  
High Sensitivity ◽  
Prognostic Biomarkers ◽  
Morbidity And Mortality ◽  
Growth Differentiation Factor 15 ◽  
End Point ◽  
Differentiation Factor ◽  
Stable Coronary Heart Disease

Abstract BACKGROUND Higher growth differentiation factor 15 (GDF-15) concentrations are associated with cardiovascular (CV) and non-CV morbidity and mortality. However, information on associations between GDF-15 and the risk of specific CV and non-CV events in stable coronary heart disease (CHD) patients is limited. METHODS In 14 577 patients with stable CHD participating in the Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy Trial (STABILITY), GDF-15 and other prognostic biomarkers (N-terminal pro–B-type natriuretic peptide, high-sensitivity troponin T, cystatin C, and high-sensitivity C-reactive protein) were measured. In adjusted Cox regression models, the associations between GDF-15 and the composite CV end point [CV death, myocardial infarction (MI), and stroke], as well as other CV and non-CV events, were assessed. RESULTS The median concentration (interquartile range) of GDF-15 at baseline was 1253 (915–1827) ng/L. The hazard ratio for the composite end point for the highest compared to the lowest quartile of GDF-15 was 1.8 (95% CI, 1.5–2.2); for CV death, 2.63 (1.9–3.6); for sudden death, 3.06 (1.9–4.8); for heart failure (HF) death, 4.3 (1.3–14); for cancer death, 2.5 (1.3–4.7); for hospitalization for HF, 5.8 (3.2–10); for MI 1.4 (95% CI, 1.1–1.9); and for stroke, 1.8 (95% CI, 1.1–2.8). After adjustment for other prognostic biomarkers, GDF-15 remained significantly associated with all outcomes except for MI. CONCLUSIONS In stable CHD, GDF-15 was independently associated with CV, non-CV, and cancer mortality, as well as with MI and stroke. When also adjusting for other prognostic biomarkers, the associations to all fatal and nonfatal events were maintained except for MI. Information on GDF-15, therefore, might be helpful when assessing the risk of adverse outcomes in patients with stable CHD. ClinicalTrials.gov Identifier: NCT00799903

scholarly journals Effects of Xuefu Zhuyu Granules on Patients with Stable Coronary Heart Disease: A Double-Blind, Randomized, and Placebo-Controlled Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Yuzhen Li ◽  
Tianqi Tao ◽  
Dandan Song ◽  
Tao He ◽  
Xiuhua Liu
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Blood Perfusion ◽  
Controlled Study ◽  
Canadian Cardiovascular Society ◽  
Stable Coronary Heart Disease ◽  
Grading Scale ◽  
Cutaneous Blood

Despite advances in the drug treatment strategy for stable coronary heart disease (CHD), the mortality of CHD continues to rise. New or adjuvant treatments would be desirable for CHD. Xuefu Zhuyu granules are derived from the formula of traditional Chinese medicine. To determine whether Xuefu Zhuyu granules might have adjuvant effects on stable CHD, we conducted a controlled clinical trial. Patients with stable CHD were enrolled and randomly assigned to receive Xuefu Zhuyu granules or placebo for 12 weeks in addition to their standard medications for the treatment of CHD. The primary endpoints comprise the Canadian Cardiovascular Society Angina Grading Scale (CCS class), echocardiographic measures, Seattle Angina Questionnaire (SAQ), and coronary artery CT. The secondary endpoints included the parameters of nailfold capillary measurement and cutaneous blood perfusion (CBP). After 12 weeks of follow-up, there was a great improvement of the Canadian Cardiovascular Society Angina Grading Scale (CCS class) in the Xuefu Zhuyu group compared with the placebo group ( p < 0.01 ). Also, a decrease was found in the percentage of patients with CCS class II in the Xuefu Zhuyu group between follow-up at 12 weeks and baseline ( p < 0.01 ). We observed a significant increase in SAQ scores of physical limitation ( p < 0.01 ) and treatment satisfaction ( p < 0.05 ) in patients receiving Xuefu Zhuyu treatment at 12 weeks in comparison with those at baseline, but not in placebo treatment ( p > 0.05 ). Amelioration in coronary artery stenosis in the Xuefu Zhuyu group was noted ( p < 0.05 ). Xuefu Zhuyu granule treatment led to great improvements in cutaneous blood perfusion at follow-up of 12 weeks compared with placebo ( p < 0.05 ). These findings suggest that on a background of standard medications, Xuefu Zhuyu granules have the ability to further improve the prognosis of patients with stable CHD.

Abstract 4496: Percutaneous Coronary Intervention in Stable Coronary Heart Disease: Value of Nt-Probnp for Stratification of Long-Term Risk

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Pedro Carmo ◽  
Carlos Aguiar ◽  
Jorge Ferreira ◽  
Luis Raposo ◽  
Pedro Goncalves ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Coronary Intervention ◽  
Inter Quartile Range ◽  
Quartile Range ◽  
Stable Coronary Heart Disease ◽  
Percutaneous Coronary

Purpose: N-terminal fragment of the B type-natriuretic peptide (NT-proBNP) is an established tool for assessing acute dyspnoea and stratifying risk in heart failure, acute coronary syndromes (ACS), and stable coronary heart disease (SCHD). The aim of this study was to determine the value of NT-proBNP in predicting long-term risk of patients (Pts) submitted to elective percutaneous coronary intervention (PCI) in the setting of SCHD. Methods: We prospectively studied 291 Pts (age 64.3±9.6 years, 64 female) with SCHD submitted to successful elective PCI, and determined NT-proBNP immediately before PCI. Pts were divided into 2 groups according to NT-proBNP level: group T3 formed by Pts with NT-proBNP level in the highest tertile and group T1+T2 formed by all remaining Pts. The study endpoint was time to the first occurrence of death (D) or non-fatal myocardial infarction (MI) during the mean follow-up of 568 ± 322 days. Multivariable analyses were performed to adjust the prognostic value of NT-proBNP for the effects of factors known to influence NT-proBNP (age, gender, renal function, body mass index) and of other potential predictors of outcome (cardiovascular risk factors, prior cardiovascular events, left ventricular ejection fraction, and PCI characteristics). Results: NT-proBNP ranged from 5 pg/ml to 104 pg/ml in the 1st tertile (T1), 105 pg/ml to 358 pg/ml in the 2nd tertile (T2), and 364 pg/ml to 33.991 pg/ml in the 3rd tertile (T3). During follow-up, 8 Pts died and 11 suffered a non-fatal MI. NT-proBNP was significantly higher in Pts who experienced an adverse outcome (440 pg/ml [inter-quartile range, 104 –1712] vs 174 pg/ml [inter-quartile range, 78 – 460) in Pts with uneventful follow-up; P= 0.007). An NT-proBNP level ≥364 pg/ml was associated with a higher endpoint rate (13.4% vs 3.1% in group T1+T2) and independently predicted outcome: adjusted hazard ratio 3.11, 95% CI, 1.15– 8.37, P=0.025. The sensitivity, specificity, predictive positive value, and negative predictive value for the criterion NT-proBNP ≥364 pg/ml were 68.4%, 69.1%, 13.4%, and 96.9%, respectively. Conclusion: In the setting of SCHD, the level of NT-proBNP is a powerful prognostic marker even after successful PCI.

Abstract P370: Obesity and Incident Coronary Heart Disease in the Million Women Study: A Prospective, Population-based Cohort Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Dexter Canoy ◽  
Benjamin J Cairns ◽  
Angela Balkwill ◽  
Jayne Green ◽  
Lucy Wright ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cumulative Risk ◽  
Excess Weight ◽  
Adjusted Relative Risk ◽  
Chd Risk ◽  
Wide Range ◽  
Chd Risk Factors ◽  
The Impact

Background: Higher body-mass index (BMI) has been associated with increased risk for coronary heart disease (CHD) mortality but its association with incident CHD is less investigated, and data for women are limited. Methods: We examined the prospective relation between BMI and incident CHD (first CHD hospitalization or death) in 1.2 million women aged ≥50 years without prior CHD, who were recruited through a national breast screening programme in 1996 to 2001 and followed for an average of 9 years (48,842 events with 10.7 million person-years of follow-up). Absolute and relative risks (using Cox regression) associated with higher BMI were estimated. Results: After excluding the first 4 years of follow-up, there were 32,465 events (5.9 million person-years) including 3,345 CHD deaths. The adjusted relative risk per 5 kg/m 2 BMI difference was 1.24 [95% confidence interval (CI) 1.22 to 1.25]. CHD risk increased linearly across a wide range of BMI, with no apparent excess risk in the lower end of BMI distribution. The relation persisted after excluding current smokers or limiting cases to myocardial infarction only. For women in this cohort, the 20-year cumulative risk of CHD from age 55 to 74 years (95% CI) ranged from 9% (8 to10) to 18% (16 to 20) for women with BMI of 20 to 22.5 kg/m 2 and ≥35 kg/m 2 , respectively. Never smokers with BMI ≥35 kg/m 2 had comparable cumulative risk to current smokers with BMI of 20 to 22.5 kg/m 2 . Conclusion: In this large cohort of women, the impact of excess weight on CHD morbidity and mortality is substantial. Measures to prevent and control excess weight and other CHD risk factors are needed to help reduce CHD burden in women.

scholarly journals Comparison of Cystatin C and Creatinine as Predictors of Cardiovascular Events in a Community-Based Elderly Population

2010 ◽  
Vol 56 (5) ◽  
pp. 799-804 ◽  
Author(s):  
John Beilby ◽  
Mark L Divitini ◽  
Matthew W Knuiman ◽  
Enrico Rossi ◽  
Joseph Hung
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Renal Function ◽  
Heart Disease ◽  
Creatinine Clearance ◽  
Cystatin C ◽  
Cardiovascular Events ◽  
Community Based ◽  
Hazard Ratios

Abstract Background: Reduced renal function is an established risk factor for cardiovascular events. We compared 3 measures of renal function—serum cystatin C, serum creatinine, and calculated creatinine clearance—as predictors of subsequent cardiovascular events in a community-based population of elderly individuals. Methods: Comprehensive cardiovascular risk factor data were available for 1410 surviving participants of previous Busselton health surveys who were ≥60 years old. Hazard ratios for risk of incident coronary heart disease and cardiovascular disease over 10 years of follow-up were derived for each baseline measure of renal function by use of Cox regression. Results: All measures of renal function were significantly related to risks of morbidity and mortality from coronary heart disease and cardiovascular disease. There were 453 incident cardiovascular disease events; and the age- and sex-adjusted hazard ratios (95% CIs) were 1.34 (1.23–1.46), 1.32 (1.20–1.45), and 1.22 (1.06–1.41) per 1-SD deterioration in cystatin C, creatinine, and creatinine clearance, respectively. All 3 measures gave approximately the same age-adjusted relative risk estimates. After further adjustment for established cardiovascular risk factors, the relative risk estimates were all reduced but remained statistically significant (P &lt; 0.05). Cystatin C was not a significant predictor for cardiovascular disease after adjustment for creatinine clearance. Conclusions: In relation to predicting risk for coronary heart disease or cardiovascular disease over a 10-year follow-up in a community-based population of elderly subjects, there was no evidence that cystatin C was a better risk predictor than creatinine or creatinine clearance.

scholarly journals Elevated circulating high-sensitivity cardiac troponin t and cardiac remodeling in obesity

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiaojiao Huang ◽  
Ming Liu ◽  
Enyong Su ◽  
Peng Yu ◽  
Hong Jiang ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Myocardial Injury ◽  
Troponin T ◽  
High Sensitivity ◽  
Coronary Intervention ◽  
Continuous Variables ◽  
Chi Square ◽  
Chi Square Test ◽  
The Impact

Abstract Background It is well established that body mass index (BMI) and troponins are independently associated. However, whether the obesity could cause myocardial injury independent of coronary heart disease (CHD) remains unclear. This study focuses on the relationship between BMI and troponins, and whether this relationship is being attenuated when CHD is accounted for. Methods In populations without acute ischemic events, 383 patients with coronary artery stenosis less than 75% were included, that is, people who have not yet reached the indications for coronary intervention, and of them 70 patients being obese according to BMI ≥ 28 kg/m2. Continuous variables were represented as mean ± SD or median(inter quartile range[IQR]). Chi-square test was adopted for categorical data. Correlations between variables were evaluated by Spearman analysis, multiple regression or logistic regression. Results The circulating hs-cTnT level was higher in the obese group [8(6,11) ng/L vs. 6(4,9) ng/L; p < 0.001). In subgroup analysis based on the presence or absence of coronary heart disease(CHD), the adjusted β(95%CI) for circulating hs-cTnT exhibited a proportional relationship with BMI when the non-obesity were defined as the reference[β; 2.22(95%CI, 0.73 to 3.71) in non-CHD, 5.58(95%CI, 0.70 to 10.46) in CHD, p < 0.05]. Additionally, the degree of coronary stenosis has shown a positive correlation with circulating hs-cTnT (rho = 0.1162; p < 0.05). Conclusion When CHD is taken into account, obesity is independently associated to the elevation of circulating hs-cTnT, a biomarker of myocardial injury, potentially indicating the impact of obesity on non-ischemic subclinical myocardial injury.

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