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P1-15 THE VALUE OF HUMAN HEART-TYPE CYTOPLASMIC FATTY ACID BINDING PROTEIN (H-FABP) AS A MARKER FOR THE EARLY DIAGNOSIS OF ACUTE CORONARY SYNDROME
Abstract of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13–16 December, 2007 but SOD (0.88) could distinguish the metabolic syndrome more accurately than CRP (0.63) as denoted by the comparison of areas under the receiver operating characteristic curves. Conclusions: higher plasma SOD activity is associated with carotid atherosclerosis. Additional studies are necessary to determine whether plasma SOD activity can serve as a new marker for metabolic syndrome.
P1-13 REACH REGISTRY – AN INTERNATIONAL LARGE SCALE REGISTRY ON ATHEROTHROMBOSIS – TAIWAN 1-YEAR RESULTS
Chiau-Suong Liau, Tain-Junn Cheng, Yuan-Kai Hsieh, Wen-Ter Lai, Huei-Ming Lo, Shan-Jin Ryu, Mao-Lin Song, Wen-Long Tsao, Ping-Keung Yip. On behalf of Taiwan REACH Registry investigators. *National Taiwan University Hospital, Taipei, Taiwan The Reduction of Atherothrombosis for Continued Health (REACH) Registry is an international, prospective, observational registry which is intended to evaluate the long-term risk of atherothrombotic events in a diverse population of patients (pts) at risk of atherothrombosis (pts with multiple risk factors or with symptomatic cardiovascular [CV] diseases, including coronary artery disease [CAD], cerebrovascular disease [CVD], and peripheral artery disease [PAD]). A total of 67,888 pts were enrolled by 5,473 physicians from 44 countries worldwide. 1081 pts were enrolled from Taiwan. Among the Taiwanese pts, 1,062 were analyzed for baseline profiles and 1,024 for 1-yr follow-up data. At baseline, 91.3% of the Taiwanese pts were with symptomatic CV diseases while 8.7% were with ≥3 risk factors but without apparent CV diseases. The baseline clinical characteristics were: mean age 66 yrs; male 69%; diabetic 44%; hypertensive 75%; hypercholesterolemic 48%; current smokers 18%; former smokers 26%; average BMI 26 kg/m2 ; the waist circumference 92 cm for males and 90 cm for females. At baseline, 85% pts were receiving antiplatelet therapy and 45% receiving statins. At 1-yr follow-up, these parameters were not markedly changed except for reduction in statin therapy from 45% to 36%. The 1-yr follow-up data are presented in the Table. The incidence of CV events was higher in the symptomatic group than in the risk factor-only group. During the 1-yr follow-up, 8 patients died, all from the symptomatic group. The occurrence of stroke was much more frequent than that of CAD. The symptomatic pts had much higher incidence of all major CV events (CV death/MI/stroke) than pts with risk factors only. But to include hospitalization for atherothrombotic events, the incidence of all CV events was not much different between the 2 groups of pts. In comparing with the global cases, most of the CV events were much lower for Taiwanese pts. It is concluded that in pts with high risk for atherothrombotic diseases, the occurrence of CV events at 1-yr follow-up was high. In comparing with global cases, the occurrence of CV events was much lower for Taiwanese pts. It is recommended that, for the high risk pts, intensive interventions are mandatory for the prevention of future atherothrombotic events.
CV death:
T G Non-fatal MI: T G Non-fatal stroke: T G All major CV events*: T G All CV events#: T G
Total (1,024)
Multiple RF only (87)
Total symptomatic (924)
CAD (520)
CVD (467)
PAD (29)
0.72 1.65 0.35 1.14 2.16 1.66 3.24 4.24 8.33 12.81
0.00 0.75 0.00 0.76 1.33 0.80 1.34 2.15 7.40 5.31
0.78 1.84 0.39 1.22 2.24 1.86 3.42 4.69 8.42 14.41
1.08 1.93 0.70 1.44 1.64 1.38 3.49 4.52 10.18 15.20
0.39 2.05 0.60 0.99 3.17 3.70 4.15 6.47 7.56 14.53
0.00 2.51 0.00 1.29 0.00 1.92 0.00 5.35 6.93 21.14
Note: T = Taiwanese; G = Global, *CV death/MI/stroke, #CV death/MI/stroke/hospitalization.
65
P1-14 HDL-ASSOCIATED PLATELET-ACTIVATING FACTOR ACETYLHYDROLASE AS A PREDICTIVE FACTOR OF CORONARY ARTERY CALCIFICATION
Ryoko Mitsutake, Shin-ichiro Miura, Bo Zhang, Keijiro Saku. Fukuoka University Hospital, Department Of Cardiology,Japan Background: Platelet-activating factor acetylhydrolase (PAF-AH) activity is associated with coronary artery disease (CAD) evaluated by invasive coronary angiography. Coronary artery calcification (CAC) score determined by multidetector row computed tomography (MDCT) predicts CAD events in several reports. However, There has been a paucity of research of predicting coronary artery calcification in the cross sectional study, and the association between CAC score determined by MDCT and PAF-AH are not well known. Methods and Results: Subjects included 195 consecutive patients who underwent coronary angiography using MDCT because of suspected CAD. CAC score by MDCT, PAF-AH, free cholesterol (FC), remnant-like lipoprotein particlecholesterol (RLP-C), apolipoprotein (apo)-C, apo-B, apo-C3, apo-E, highlysensitive C-reactive protein (hsCRP) were determined. The subjects were divided into three groups according to the CAC score: low (0-12), intermediate (13-445), and high (445-). The groups of the CAC score was significantly associated with age, sex, hypertension, high-density lipoprotein (HDL), angiotensin II receptor blocker (ARB), calcium channel blocker (CCB), arteriosclerosis obliterans, and PWV. HDL-associated PAF-AH level in the high CAC score group was significantly lower than the low CAC score group (p<0.03). Conclusions: The decrease in the HDL-associated PAF-AH level was associated with an increase in the extent of the coronary artery calcification in patients with suspected CAD. Therefore, in addition to conventional risk factors, measurement of HDL-associated PAF-AH level before performing MDCT angiography is useful for predicting coronary artery calcification.
P1-15 THE VALUE OF HUMAN HEART-TYPE CYTOPLASMIC FATTY ACID BINDING PROTEIN (H-FABP) AS A MARKER FOR THE EARLY DIAGNOSIS OF ACUTE CORONARY SYNDROME
Maureen Valentin, Marcellus Francis Ramirez, Orlando Bugarin, Allan Malvar, Milagros Yamamoto, Eduardo Vicente Caguioa. Department of Medicine, Section of Cardiology, University of Santo Tomas, Manila, Philippines Background: The heart-type fatty acid-binding protein (H-FABP) is an emerging marker for the early diagnosis and stratification of acute coronary syndrome (ACS). Objective: To evaluate the usefulness of H-FABP compared to Troponin I in the early diagnosis of acute non-ST-elevation myocardial infarction (NSTEMI). Methods: The study included 35 consecutive adult patients who presented with clinical features of ACS. Patients with ST elevation on electrocardiogram (ECG) and a history of muscle injury were excluded. ECG and blood samples were taken for Troponin I and H-FABP. The quantitative Troponin I assay was timed at least 4 hours after the onset of symptoms while qualitative H-FABP was extracted immediately on presentation. The results of the H-FABP were compared with Troponin I as a gold standard for AMI using a cut off value of 0.5 ng/ml. Results: The mean age of the study population was 57.34 + 13.69 years; 19 patients (54.3%) were males. Majority had normal renal function. Among the 35 patients, 11 were positive for H-FABP while 24 were negative. The minimum time from onset of symptoms to H-FABP testing was 1 hour. The group with positive H-FABP had significantly higher Troponin I levels compared to the negative H-FABP group (2.193 + 2.763 vs 0.024 + 0.018 ng/ml, p=0.01). Using a Troponin I value of 0.5 ng/ml as a diagnostic cut off for AMI, H-FABP had 100% sensitivity and 85.7% specificity for the diagnosis of NSTEMI, with a positive predictive value of 64% and negative predictive value of 100%. Receiver operating characteristic curve analysis showed a value of 0.929 (95% confidence interval 0.788 to 0.987, p value of 0.0001). Conclusion: The qualitative whole blood rapid H-FABP test is a useful and accurate test in the early evaluation of patients with suspected AMI. It offers the advantage of earlier release and detection compared to the standard Troponin I.
P1-13 REACH REGISTRY – AN INTERNATIONAL LARGE SCALE REGISTRY ON ATHEROTHROMBOSIS – TAIWAN 1-YEAR RESULTS
Chiau-Suong Liau, Tain-Junn Cheng, Yuan-Kai Hsieh, Wen-Ter Lai, Huei-Ming Lo, Shan-Jin Ryu, Mao-Lin Song, Wen-Long Tsao, Ping-Keung Yip. On behalf of Taiwan REACH Registry investigators. *National Taiwan University Hospital, Taipei, Taiwan The Reduction of Atherothrombosis for Continued Health (REACH) Registry is an international, prospective, observational registry which is intended to evaluate the long-term risk of atherothrombotic events in a diverse population of patients (pts) at risk of atherothrombosis (pts with multiple risk factors or with symptomatic cardiovascular [CV] diseases, including coronary artery disease [CAD], cerebrovascular disease [CVD], and peripheral artery disease [PAD]). A total of 67,888 pts were enrolled by 5,473 physicians from 44 countries worldwide. 1081 pts were enrolled from Taiwan. Among the Taiwanese pts, 1,062 were analyzed for baseline profiles and 1,024 for 1-yr follow-up data. At baseline, 91.3% of the Taiwanese pts were with symptomatic CV diseases while 8.7% were with ≥3 risk factors but without apparent CV diseases. The baseline clinical characteristics were: mean age 66 yrs; male 69%; diabetic 44%; hypertensive 75%; hypercholesterolemic 48%; current smokers 18%; former smokers 26%; average BMI 26 kg/m2 ; the waist circumference 92 cm for males and 90 cm for females. At baseline, 85% pts were receiving antiplatelet therapy and 45% receiving statins. At 1-yr follow-up, these parameters were not markedly changed except for reduction in statin therapy from 45% to 36%. The 1-yr follow-up data are presented in the Table. The incidence of CV events was higher in the symptomatic group than in the risk factor-only group. During the 1-yr follow-up, 8 patients died, all from the symptomatic group. The occurrence of stroke was much more frequent than that of CAD. The symptomatic pts had much higher incidence of all major CV events (CV death/MI/stroke) than pts with risk factors only. But to include hospitalization for atherothrombotic events, the incidence of all CV events was not much different between the 2 groups of pts. In comparing with the global cases, most of the CV events were much lower for Taiwanese pts. It is concluded that in pts with high risk for atherothrombotic diseases, the occurrence of CV events at 1-yr follow-up was high. In comparing with global cases, the occurrence of CV events was much lower for Taiwanese pts. It is recommended that, for the high risk pts, intensive interventions are mandatory for the prevention of future atherothrombotic events.
CV death:
T G Non-fatal MI: T G Non-fatal stroke: T G All major CV events*: T G All CV events#: T G
Total (1,024)
Multiple RF only (87)
Total symptomatic (924)
CAD (520)
CVD (467)
PAD (29)
0.72 1.65 0.35 1.14 2.16 1.66 3.24 4.24 8.33 12.81
0.00 0.75 0.00 0.76 1.33 0.80 1.34 2.15 7.40 5.31
0.78 1.84 0.39 1.22 2.24 1.86 3.42 4.69 8.42 14.41
1.08 1.93 0.70 1.44 1.64 1.38 3.49 4.52 10.18 15.20
0.39 2.05 0.60 0.99 3.17 3.70 4.15 6.47 7.56 14.53
0.00 2.51 0.00 1.29 0.00 1.92 0.00 5.35 6.93 21.14
Note: T = Taiwanese; G = Global, *CV death/MI/stroke, #CV death/MI/stroke/hospitalization.
65
P1-14 HDL-ASSOCIATED PLATELET-ACTIVATING FACTOR ACETYLHYDROLASE AS A PREDICTIVE FACTOR OF CORONARY ARTERY CALCIFICATION
Ryoko Mitsutake, Shin-ichiro Miura, Bo Zhang, Keijiro Saku. Fukuoka University Hospital, Department Of Cardiology,Japan Background: Platelet-activating factor acetylhydrolase (PAF-AH) activity is associated with coronary artery disease (CAD) evaluated by invasive coronary angiography. Coronary artery calcification (CAC) score determined by multidetector row computed tomography (MDCT) predicts CAD events in several reports. However, There has been a paucity of research of predicting coronary artery calcification in the cross sectional study, and the association between CAC score determined by MDCT and PAF-AH are not well known. Methods and Results: Subjects included 195 consecutive patients who underwent coronary angiography using MDCT because of suspected CAD. CAC score by MDCT, PAF-AH, free cholesterol (FC), remnant-like lipoprotein particlecholesterol (RLP-C), apolipoprotein (apo)-C, apo-B, apo-C3, apo-E, highlysensitive C-reactive protein (hsCRP) were determined. The subjects were divided into three groups according to the CAC score: low (0-12), intermediate (13-445), and high (445-). The groups of the CAC score was significantly associated with age, sex, hypertension, high-density lipoprotein (HDL), angiotensin II receptor blocker (ARB), calcium channel blocker (CCB), arteriosclerosis obliterans, and PWV. HDL-associated PAF-AH level in the high CAC score group was significantly lower than the low CAC score group (p<0.03). Conclusions: The decrease in the HDL-associated PAF-AH level was associated with an increase in the extent of the coronary artery calcification in patients with suspected CAD. Therefore, in addition to conventional risk factors, measurement of HDL-associated PAF-AH level before performing MDCT angiography is useful for predicting coronary artery calcification.
P1-15 THE VALUE OF HUMAN HEART-TYPE CYTOPLASMIC FATTY ACID BINDING PROTEIN (H-FABP) AS A MARKER FOR THE EARLY DIAGNOSIS OF ACUTE CORONARY SYNDROME
Maureen Valentin, Marcellus Francis Ramirez, Orlando Bugarin, Allan Malvar, Milagros Yamamoto, Eduardo Vicente Caguioa. Department of Medicine, Section of Cardiology, University of Santo Tomas, Manila, Philippines Background: The heart-type fatty acid-binding protein (H-FABP) is an emerging marker for the early diagnosis and stratification of acute coronary syndrome (ACS). Objective: To evaluate the usefulness of H-FABP compared to Troponin I in the early diagnosis of acute non-ST-elevation myocardial infarction (NSTEMI). Methods: The study included 35 consecutive adult patients who presented with clinical features of ACS. Patients with ST elevation on electrocardiogram (ECG) and a history of muscle injury were excluded. ECG and blood samples were taken for Troponin I and H-FABP. The quantitative Troponin I assay was timed at least 4 hours after the onset of symptoms while qualitative H-FABP was extracted immediately on presentation. The results of the H-FABP were compared with Troponin I as a gold standard for AMI using a cut off value of 0.5 ng/ml. Results: The mean age of the study population was 57.34 + 13.69 years; 19 patients (54.3%) were males. Majority had normal renal function. Among the 35 patients, 11 were positive for H-FABP while 24 were negative. The minimum time from onset of symptoms to H-FABP testing was 1 hour. The group with positive H-FABP had significantly higher Troponin I levels compared to the negative H-FABP group (2.193 + 2.763 vs 0.024 + 0.018 ng/ml, p=0.01). Using a Troponin I value of 0.5 ng/ml as a diagnostic cut off for AMI, H-FABP had 100% sensitivity and 85.7% specificity for the diagnosis of NSTEMI, with a positive predictive value of 64% and negative predictive value of 100%. Receiver operating characteristic curve analysis showed a value of 0.929 (95% confidence interval 0.788 to 0.987, p value of 0.0001). Conclusion: The qualitative whole blood rapid H-FABP test is a useful and accurate test in the early evaluation of patients with suspected AMI. It offers the advantage of earlier release and detection compared to the standard Troponin I.