Vascular endothelial growth factor-A promoter polymorphisms, circulating VEGF-A and survival in acute coronary syndromes

Background Development of a competent collateral circulation in established coronary artery disease is cardio-protective. The vascular endothelial growth factor (VEGF) system plays a key role in this process. We investigated the prognostic performance of circulating VEGF-A and three genetic variants in the VEGFA gene in a clinical coronary cohort. Methods and results The Coronary Disease Cohort Study (CDCS) recruited 2,140 patients, with a diagnosis of acute coronary syndrome (ACS), after admission to Christchurch or Auckland City Hospitals between July 2002 and January 2009. We present data for 1927 patients from the cohort genotyped for three SNPs in the VEGF-A gene, rs699947 (C-2578A), rs2010963 (C405G) and rs3025039 (C936T). Plasma VEGF-A concentrations were assayed in a subgroup (n = 550) of CDCS patients (geometric mean 36.6 [34.7–38.5] pg/ml). VEGF-A levels correlated with patient heart rate at baseline (p = 0.034). None of rs699947, rs3025039, nor rs2010963 genotypes were significantly associated with VEGF-A levels, but rs3025039 genotype was positively associated with collateral vessels perfusion according to the Rentrop classification (p = 0.01) and baseline natriuretic peptide levels (p<0.05). Survival in the CDCS cohort was independently associated with baseline VEGF-A levels and (in males) with rs699947 genotype. Conclusions This study is strongly suggestive that VEGF-A levels have value as a prognostic biomarker in coronary heart disease patients and SNPs in VEGF-A deserve further investigation as prognostic markers and indicators of angiogenic potential influencing the formation of collateral circulation.

Stress perfusion CMR – a report of an initial Romanian experience

Objectives – To provide preliminary data on practice of stress perfusion cardiovascular magnetic resonance (CMR) in a single center in Romania. Methods – We retrospectively reviewed the clinical files and CMR reports of patients who underwent stress perfusion CMR in our institution between January 2018 and December 2020. Results – A total of 1036 patients underwent CMR examinations during this period in our institution. Of these, 120 patients had stress perfusion CMR. The most common indication was the assessment of myocardial ischaemia in patients with established coronary artery disease (CAD) (77 patients, 64.16%), with either a history of myocardial infarction or previous coronary revascularization, or with intermediate lesions on invasive coronary angiography (ICA). The other indications consisted in detection of ischaemia in patients with suspected CAD (36 patients, 30%), characterization of the substrate of ventricular arrhythmia (5 patients, 4.16%) and assessment of the etiology of dilated cardiomyopathy (DCM) (4 patients, 3.33%). All patients had vasodilator stress with adenosine and an adequate stress response was obtained in 113 patients (94.16%). There were 21 patients (18.58%) with an abnormal stress test and patients with intermediate lesions on ICA had the highest prevalence of positive reports (24.32%). Sixty-three patients had myocardial fibrosis (52.5%): 49 patients (40.83%) had subendocardial (ischaemic) scars, while 14 patients (11.66%) had non-ischaemic scars. There were no serious adverse events related to the procedure. Conclusions – This is the first report in Romania on the use of stress perfusion CMR in clinical practice. We report our experience on stress efficiency, acquisition protocol, artifacts, prevalence of positive tests and safety. Most stress CMRs were requested in patients with established CAD.