Management and outcomes of patients with unstable angina with undetectable, normal, or intermediate hsTnT levels

Giannitsis, Evangelos; Biener, Moritz; Hund, Hauke; Mueller‐Hennessen, Matthias; Vafaie, Mehrshad; Gandowitz, Jochen; Löhr, Julia; Katus, Hugo A.; Stoyanov, Kiril M

doi:10.1007/s00392-019-01529-4

Cited by 22 publications

(23 citation statements)

References 48 publications

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“…Chapman et al asserted that the combination of hs-cTnI with clinical risk scores demonstrated some Notes: vWF --von Willebrand factor, Se --sensitivity, Sp --specificity, AUC -area under the curve, LR+ -positive likelihood ratio, PP --posterior probability, CI --confidence interval. benefits to rule in and rule out MI [21], while Giannitsis et al proclaimed the need for additional risk stratification including other risk indicators [23]. Thus, estimated cardiovascular risk is believed to be more important for accurate clinical management of UA patients [22,23].…”

Section: Discussionmentioning

confidence: 99%

Blood Plasma Serotonin and von Willebrand Factor as Biomarkers of Unstable Angina Progression Toward Myocardial Infarction

et al. 2021

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Aim: To investigate the serotonin and von Willebrand factor (vWF) concentrations among unstable angina (UA) patients without and with progression toward myocardial infarction (outcome) and to assess the utility of both as prognostic markers of UA complications. Materials and methods: In observational cohort study, we recruited 103 patients with ischemic heart disease (the median age 65.0 (59.0-69.0) years, 45 females (43.7%)). After full set of investigations including high sensitive Troponin I test and 28-day follow-up period, we defined three groups: Group 1 - stable angina patients (n=22) as control, Group 2 - UA patients without outcome (n=71), Group 3 - UA patients with outcome (n=10). We analyzed the blood plasma serotonin content by the ion-exchange chromatography with measurement of serotonin on fluorescence spectrophotometer. VWF concentration was determined by ELISA. We compared the concentrations of observed parameters among the groups with the Kruskal-Wallis test (with post-hoc Mann-Whitney test with Bonferroni-Holm correction). We assessed binary logistic models, receiver operating characteristic curves, calculated sensitivity (Se), specificity (Sp), and positive likelihood ratio (LR+) for each indicator. Results: We registered elevation in serotonin concentration and decline in vWF concentration in Group 3 in comparison with Group 2 (22.670 (20.687-24.927) μg/ml vs 11.980 (8.120-15.000) μg/ml, p< 0.001, and 0.117 (0.109-0.120) rel.units/ml vs 0.134 (0.127-0.143) rel.units/ml, p < 0.001) and Group 1 (12.340 (10.052-13.619) μg/ml, p < 0.001, and 0.137 (0.127-0.156) rel.units/ml, p < 0.001), respectively. No significant differences in serotonin and vWF concentrations between Group 1 and Group 2 were detected (p=0.81 and p=0.36, respectively). The probability of outcome increased significantly (by 60.7% and 59.7%, LR+ 19.0 [6.0, 60.0] and 18.0 [3.9, 80.0]) if serotonin concentration was above 21.575 μg/ml (Se=80.0%, Sp=95.8%, AUC=0.975) and vWF concentration was below 0.114 rel.units/ml (Se=50.0%, Sp=97.2%, AUC=0.973), respectively. Conclusions: Serotonin and vWF as biomarkers are demonstrated promising results for rule-in the patients with risk of short-term UA progression toward myocardial infarction.

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Section: Discussionmentioning

confidence: 99%

Blood Plasma Serotonin and von Willebrand Factor as Biomarkers of Unstable Angina Progression Toward Myocardial Infarction

et al. 2021

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“…UA, ST-segment elevation myocardial infarction (STEMI) and non-STsegment elevation myocardial infarction (NSTEMI) have been collectively described acute coronary syndromes (ACS) [3]. However, although UA has clinical evidence of myocardial ischemia, the key characteristic is without significant myocardial injury [4][5][6]. Previous studies have shown that the pathogenesis of unstable angina is mainly related to platelet activation and aggregation and the inflammatory response-induced decline in the stability of atherosclerotic plaque [7,8].…”

Section: Introductionmentioning

confidence: 99%

Investigating the multi-target pharmacological mechanism of danhong injection acting on unstable angina by combined network pharmacology and molecular docking

Guo

Zhou

et al. 2020

BMC Complement Med Ther

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Background: Danhong injection (DHI), which is one of the most well-known Traditional Chinese Medicine (TCM) injections, widely used to treat unstable angina (UA). However, its underlying pharmacological mechanisms need to be further clarified. Methods: In the present study, network pharmacology was adopted. Firstly, the relative compounds were obtained by a wide-scaled literatures-mining and potential targets of these compounds by target fishing were collected. Then, we built the UA target database by DisGeNET, DigSee, TTD, OMIM. Based on data, protein-protein interaction (PPI) analysis, GO and KEGG pathway enrichment analysis were performed and screen the hub targets by topology. Furthermore, evaluation of the binding potential of key targets and compounds through molecular docking. Results: The results showed that 12 ingredients of DHI and 27 putative known therapeutic targets were picked out. By systematic analysis, identified 4 hub targets (TNF, TLR4, NFKB1 and SERPINE1) mainly involved in the complex treating effects associated with coagulation and hemostasis, cell membrane region, platelet alpha granule, NFkappa B signaling pathway and TNF signaling pathway. Conclusion: The results of this study preliminarily explained the potential targets and signaling pathways of DHI in the treatment of UA, which may help to laid a good foundation for experimental research and further clinical application.

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“…Moreover, the non-existence of myocardial injury in UA patients even suggests differences in pathophysiology [10]. Several studies showed higher rates of future MI and coronary revascularisation in UA patients compared with non UA/non ACS patients [10][11][12]. These findings emphasise the need for additional risk stratification to identify patients with low hsTn levels but true UA, since they have a non-neglectable risk of future adverse cardiovascular events [7].…”

Section: Introductionmentioning

confidence: 99%

Extracellular Vesicle cystatin c is associated with unstable angina in troponin negative patients with acute chest pain

et al. 2020

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Background Despite the use of high-sensitive cardiac troponin there remains a group of high-sensitive cardiac troponin negative patients with unstable angina with a non-neglectable risk for future adverse cardiovascular events, emphasising the need for additional risk stratification. Plasma extracellular vesicles are small bilayer membrane vesicles known for their potential role as biomarker source. Their role in unstable angina remains unexplored. We investigate if extracellular vesicle proteins are associated with unstable angina in patients with chest pain and low high-sensitive cardiac troponin. Methods The MINERVA study included patients presenting with acute chest pain but no acute coronary syndrome. We performed an exploratory retrospective case-control analysis among 269 patients. Cases were defined as patients with low high-sensitive cardiac troponin and proven ischemia. Patients without ischemia were selected as controls. Blood samples were fractionated to analyse the EV proteins in three plasma-subfractions: TEX, HDL and LDL. Protein levels were quantified using electrochemiluminescence immunoassay. Results Lower levels of (adjusted) EV cystatin c in the TEX subfraction were associated with having unstable angina (OR 0.93 95% CI 0.88-0.99).

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Management and outcomes of patients with unstable angina with undetectable, normal, or intermediate hsTnT levels

Cited by 22 publications

References 48 publications

Blood Plasma Serotonin and von Willebrand Factor as Biomarkers of Unstable Angina Progression Toward Myocardial Infarction

Blood Plasma Serotonin and von Willebrand Factor as Biomarkers of Unstable Angina Progression Toward Myocardial Infarction

Investigating the multi-target pharmacological mechanism of danhong injection acting on unstable angina by combined network pharmacology and molecular docking

Extracellular Vesicle cystatin c is associated with unstable angina in troponin negative patients with acute chest pain

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