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540 PREDICTIVE VALUE OF INFLAMMATORY MARKERS ON CARDIOVASCULAR EVENTS IN PATIENTS WITH CHRONIC HEART FAILURE
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Atherosclerosis Supplements 12, no. 1 (2011) 13–184
after further dividing CAD group using tHcy below 15 mM as reference, Trx activity was significantly decreased in CAD group, and was inversely associated with tHcy levels (r = −0.199, P < 0.05) that was, however, weakly positively associated with TrxR activity. Neither lipids nor glucose significantly affected Trx/TrxR activity. Association of CAD severity with low Trx plus high tHcy was strong (r = −0.458, P < 0.001), but with high tHcy alone was rather weak (r = 0.125, P = 0.225). Conclusion: In CAD patients, homocysteine-induced Trx falling appears to be involved in the disease severity. 536 THE EFFECT OF ROSUVASTATIN TREATMENT ON D-DIMER LEVELS IN OBESE PATIENTS WITH PRIMARY DYSLIPIDEMIA D.I. Agapakis1 , C. Savopoulos2 , K. Tziomalos2 , E.V. Massa2 , N. Katsiki2 , E. Satsoglou1 , A.I. Hatzitolios2 . 1 Internal Medicine, General Hospital of Goumenissa, Goumenissa, 2 First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hospital AHEPA, Thessalon´ıki, Greece Introduction: Risk of thromboembolic complications is increased in obese subjects. Current literature suggests that statin therapy decreases the risk of venous thrombosis and reduces plasma D-dimer (D-d) levels, a marker of hypercoagulable state. Aim: To evaluate the effect of rosuvastatin on D-d levels in patients with uncontrolled primary dyslipidemia and elevated body mass index (BMI). Material and Methods: 37 patients with uncontrolled primary dyslipidemia under hypolipidemic diet treatment, included in the study. The control group was 23 normolipidemic healthy subjects with similar characteristics (age, sex, BMI) with the study group. Dyslipidemic patients were treated with 10 mg/day rosuvastatin for 9 weeks. Lipids parameters and D-d levels (Triage D-Dimer test kit) were measured at baseline for both groups and after rosuvastatin treatment in dyslipidemic group. Results: At baseline, both groups had no significant differences in D-d levels (493±175 ng/ml vs 457±237 ng/ml, p > 0.05). In addition to lipid parameters, the D-d levels significantly decreased after rosuvastatin treatment from 493±175 ng/ml to 367±137 ng/ml, p < 0.001 Conclusions: These data support that beyond the hypolipidemic effect rosuvastatin also possesses significant anti-coagulation properties and could play a role in reducing thromboembolic complications in primary hyperlipidemic obese patients. 537 THE LINK BETWEEN CARDIAC AUTONOMIC FUNCTION AND MARKERS OF OXIDATIVE STRESS IN CORONAY ARTERY DISEASE (CAD) S. Radovanovic, L. Stojanovic, M. Zdravkovic, M. Krotin, B. Milovanovic. University Hospital Bezanijska Kosa, Belgrade, Serbia Background: The objective was to examine cardiovascular autonomic (cANS) function and its potential relationships with markers of oxidative stress in coronary artery disease (CAD) patients Methods: A total of 120 CAD patients mean age, 59±7 years (74 men and 46 women) were included in the stady. All of them had cANS function assessed via heart rate variability (HRV) methods during resting conditions. Standard time-domain and frequency-domain measures [high-frequency normalized units (HFnu; measure of parasympathetic nervous system activity) and low frequency:high-frequency ratio (LF:HF; overall sympathovagal balance)] of HRV were calculated. Plasma malondialdehyde (MDA), protein thiol (P-SH) and reactive carbonyl groups (RCD), together with glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) activities were determined spectrophotometrically and/or by ELISA methods and correlated with timedomein parameters of HRV (mean RR interval, SDNN, SDANN, rMSSD and pNN50%) as well as with frequency-domain measures (ULF, VLF, LF, LF/HF) Results: Significantly corelation was found between SDNN and GSH-Px (r = 0.221, p = 0.039) as well as between pNN50LF and MDA (r = 0.215, p = 0.045). By analyzing the corelation of frequency-domain measures with oxidative demage of proteins (P-SH) were observed following correlation: P-SH and ULF (r = −0.234, p = 0.034); P-SH and VLF (r = −0.219, p = 0.046); P-SH and LF/HF (r = −0.247, p = 0.025). LF was significantly related to GPx (r = 0.212, p = 0.054). Conclusion: We can conclude that cardiovascular autonomic (cANS) dysfunction assessed via heart rate variability was significantly related to increased oxidative stress in chronic heart failure.
Poster presentations
538 ISCHEMIA MODIFIED ALBUMIN (IMA) IN POSTMENOPAUSAL WOMEN WITH OR WITHOUT CORONARY ARTERY DISEASE (CAD) IN RELATION TO BMI AND OGTT K. Kazanis1 , M. Dalamaga1 , E. Kassi1 , G. Merantzi2 , I. Vagionas2 , G. Jullien2 , A. Dionyssiou-Asteriou1 . 1 Clinical Biochemistry, University of Athens, Medical School, 2 Laboratory of Biochemistry, Evangelismos General Hospital, Athens, Greece Background: IMA is a new biomarker of oxidative processes. Its measurement by the cobalt albumin binding assay is reported as an assessment of atherosclerotic burden. In postmenopausal women with or without CAD, we assessed IMA and determined its correlation with BMI, hsCRP and hyperglycaemia. Methods: 120 postmenopausal women, aged 43−80 years, were divided into three groups: Group A (n = 30) with BMI > 26−32 (15 with normal OGTT and 15 with impaired OGTT), Group B (n = 60) with BMI > 21−25 and Group C (n = 30) with BMI > 23−29 and documented CAD. Glucose, insulin, IMA, albumin and hsCRP were measured in an automated analyzer (Roche). The ratio IMA/albumin, HOMA and QUICKI were calculated. Results: IMA and IMA/albumin were significantly elevated in Group A compared to Group B (p < 0.001) but similar to those of Group C (p=1, p = 0.33 respectively). In Group A, there wasn’t any difference between subjects with normal and impaired OGTT. In Group A and B, serum hsCRP was similar but lower in comparison to Group C (p < 0.001). Glucose, insulin and HOMA were elevated in Group A compared to Group B while QUICKI was lower (p < 0.001). In Group A, IMA was positively correlated with BMI (p = 0.03), hsCRP (p < 0.001), insulin and HOMA and negatively with QUICKI (p < 0.01). Regression analysis revealed that obesity was the strongest predictor of IMA. Conclusions: Serum IMA in overweight women without CAD was similar to those with CAD. Whether IMA measurement provides an early assessment of atherosclerotic burden before clinical evidence of CAD needs further investigation. 539 DISORDERS OF PURINE METABOLISM ENZYMES IN ATHEROSCLEROSIS S. Kundalic1 , B. Kundalic2 , T. Ristic1 , D. Stankovic-Ferlez1 . 1 Centre of Medical Biochemistry, Clinical Centre Nis, 2 Faculty of Medicine, University of Nis, Nis, Serbia Since purine metabolism is important for endothelial cells’ normal function, purine catabolism enzymes have an especial place in damaged endothelium of atherosclerotic blood vessels in hyperlipidemias. The activities of 5’-nucleotidase (5’-NT), adenosine deaminase (ADA) and xanthine oxidase (XO) were investigated in atherosclerotic patients. This study obtained 55 patients with atherosclerosis whose results were compared to 46 healthy individuals. According to the values of lipid parameters: cholesterol, triglycerides, HDL-cholesterol (HDL-c) and LDL-cholesterol, the patients were allocated into hyperlipoproteinemic types by Fredrickson, while type subgroups were formed based on the values of hypercholesterolemia and hypertriglyceridemia. The most frequent types of hyperlipoproteinemias were IIa, IIb and type IV. Activity of 5’-NT was significantly increased in serum of patients with atherosclerosis (p < 0.001) and showed significant positive correlation with atherogenic lipid parameters (p < 0.001) and negative correlation with HDL-c (p < 0.05). Total ADA activity in atherosclerotic patients were statistically significantly higher than those in healthy donors (p < 0.001). There was statistically significant positive correlation between ADA activity and atherogenic lipid parameters. Significant negative correlation was found between ADA activity and protective HDL-c (p < 0.001). Activity of XO showed significant increase in serum of atherosclerotic patients (p < 0.001) compared to control group. There is also a significant positive correlation between XO and atherogenic lipids and significant negative correlation between XO and HDL-c. The obtained results suggest a possibility of purine metabolism enzymes estimation, using them as markers of endothelial damage in atherosclerosis, but also a potential of therapeutic correction in practice. 540 PREDICTIVE VALUE OF INFLAMMATORY MARKERS ON CARDIOVASCULAR EVENTS IN PATIENTS WITH CHRONIC HEART FAILURE S. Radovanovic1 , L. Stojanovic1 , M. Krotin1 , A. Djokovic1 , A. Savic-Radojevic2 , S.V. Dragan3 , T. Simic2 . 1 University Hospital Bezanijska Kosa, 2 Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, 3 Clinica of Cardiology, Clinical Center of Serbia, Belgrade, Serbia Background: With respect to clinical practice, recent prospective data indicate that markers of inflammation play a critical role in the progression of atherosclerosis and can be used to predict the future occurrence of cardiovascular events. However, it is unknown whether markers of inflamation in ishemic chronic heart failure (CHF) are truly independently associated with impaired outcome or progression of the disease.
79th EAS Congress
Atherosclerosis Supplements 12, no. 1 (2011) 13–184
Methods and Results: We assessed the follow-up of 120 consecutive patients with CHF in which markers of inflamation [high sensitive-C reactive protein (hs-CRP), vascular cell adhesion molecule-1 (VCAM-1) and intracellular cell adhesion molecule-1 (ICAM-1)] were determined. The primary endpoint was defined by cardiac death, hospitalization due to worsening of heart failure. Cox regression analysis was used to determine whether hs-CRP, VCAM and ICAM were associated with these heart failure-related events. During a median follow-up of 18.4 months 9 patients were hospitalized due to worsening of heart failure, 7 for new episodes of non-stable angina pectoris, 11 patients died for cardiac reasons. Cox regression analysis demonstrated that hs-CRP (OR = 1.06, CI: 1.02–1.11; p < 0.02) was independent predictive factor for cardiac death. ROC curve was drawn to evaluate the reliability of hs-CRP as marker of mortality (AUC = 0.68, CI: 0.51–0.85, p < 0.02). The best balanced threshold was 3.3 mg/l with 63.6% sensitivity and 63.3% specificity. VCAM-1 was significantly correlated with repeted hospitalization (r = 0.185, p < 0.04) and total number of cardiovascular events (r = 0.22, p < 0.02). Conclusion: Level of hs-CRP is independently associated with mortality and morbidity. The ability of treatments to reduce CRP levels may be important for slowing the progression of atherosclerosis and by that improve the prognosis of CHF. 541 A COMPARISON BETWEEN INSULIN RESISTANCE SCORES PARAMETERS IN IDENTIFYING METABOLIC SYNDROME (MS) PATIENTS A. Cozma1 , A.V. Sitar-Taut2 , D. Pop3 , D.T. Zdrenghea3 . 1 4 th Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, 2 Babes Bolyai University, 3 Cardiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania Background: MS is associated with increased cardiovascular risk, being a common cause of the development of atherosclerotic vascular disease. Also, MS is considered as a state of insulin resistance. Purpose: To evaluate the capacity of different insulin resistance scores to identify patients with MS, comparing with standard criteria of MS diagnosis. Methods: 84 patients (63 women), mean age 56.89±11.05, 65.5% presenting MS. As risk factors have been assessed the body weight, smoking status, diabetes, hypertension and dyslipidaemia (total cholesterol >200 mg/dl or serum triglycerides >150 mg/dl). As insulin resistance scores were calculated: Homeostatic model assessment (HOMA) = insulin(mU/mL)·glycemia(mg/dl)/405; Quantitative insulin sensitivity check index (QUICKI) = 1/[log10 (insulin(mU/mL))+log10 (glycemia(mg/dl))]; McCauley Score for measuring the Insulin Sensitivity Index = exp[3.29 − 0.25ln(Insulin) − 0.22ln(BMI) − 0.28ln(Triglycerides)]. Cut off values, optimum sensitivity, specificity and area under the receiver operating characteristic (ROC) curve were evaluated. Classification of the MS was based on the IDF guidelines. Results: patients with MS presented greater insulin resistance (estimated through HOMA index 1.59 vs. 1.04, p = 0.0001, and McCauley Score 2.37±0.43 vs. 1.89±0.36, p = 0.0001) and lower insulin sensitivity (0.35±0.026 vs. 0.37±0.026, p = 0.0001). Determined areas under the ROC curve were as follows: 0.769 for HOMA, 0.769 for QUICKI index, 0.818 for McCauley Score. Diagnostic cut off levels with optimum sensitivity and specificity were found to be for HOMA 1.07 (sensitivity 87.27%, specificity 62.07%), for McCauley Score 2.14 (sensitivity 81.82%, specificity 75.86%), QUICKI index 0.37 (sensitivity 87.27%, specificity 62.07%). Conclusion: Although, in practice is commonly used HOMA (probably due to an easily use), McCauley Score seems to have a better specificity in identifying patients with MS. Acknowledgment: ID_2246/2009 542 ASSOCIATION OF SCLEROSTIN SERUM LEVELS WITH THE SEVERITY OF AORTIC VALVE CALCIFICATION R. Koos1 , A.H. Mahnken2 , N. Marx1 , V. Brandenburg1 . 1 Department of Cardiology, 2 Department of Diagnostic Radiology, University Hospital RWTH Aachen, Aachen, Germany Introduction: Sclerostin is a key negative regulator of bone formation. Recently, sclerostin was identified in human aortas at the protein level. We hypothesized that sclerostin may also play a potential role in the pathogenesis of aortic valve calcification (AVC). Therfore, we aimed to investigate the relationsship between serum sclerostin levels in patients with different degrees of AVC assessed by dual-source computed tomography (DSCT) compared to a healthy control group. Methods: A prospective cross-sectional study in 115 patients (mean age 71±7 years) with echocardiographically proven aortic valve disease was performed. In all patients serum sclerostin levels were measured by ELISA (Tecomedical, Bunde, ¨ Germany) and compared to values obtained from a healthy control population (n = 57, mean age 48±20 years). For quantification of AVC all patients of the study cohort underwent non contrast-enhanced DSCT (Definition, Siemens, Germany).
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Results: Patients with AVC showed significantly higher serum sclerostin levels as compared to healthy controls (0.94±0.45 vs. 0.58±0.26 ng/mL, p < 0.001). A significant correlation between serum sclerostin levels and Agatston AVC scores assessed by DSCT was observed (r = 0.62, p < 0.001) in the study cohort. Patients with high sclerostin levels above the median (median = 0.83ng/mL; n = 57) showed significantly higher Agatston AVC scores (2095±1447) compared to patients with low sclerostin levels (n = 58; 601±545, p < 0.001). Conclusion: Patients with AVC showed increased serum levels of sclerostin compared to a healthy reference population. In addition, the severity of AVC may be linked to increased sclerostin serum levels. Thus, the present study suggests a potential role for sclerostin in the pathogenesis of AVC. 543 PLASMA VISFATIN CONCENTRATION IS A MARKER OF AN ATHEROGENIC METABOLIC PROFILE T. Filippatos1 , V. Tsimihodimos1 , C.S. Derdemezis1 , I.F. Gazi1 , V. Saougos1 , A.D. Tselepis2 , M.S. Elisaf1 . 1 Department of Internal Medicine, Medical School, 2 Laboratory of Biochemistry, Department of Chemistry, University of Ioannina, Ioannina, Greece Background and Aims: Human visfatin is associated with atherosclerosisrelated diseases. We assessed in non-diabetic individuals the association of plasma visfatin levels with cardiovascular disease (CVD) risk. Methods and Results: When study population (n = 179, age 49±11 years) was divided according to visfatin tertiles, the 10-year CVD Framingham risk scores were significantly increased in the top visfatin tertile. Furthermore, body mass index, waist circumference and blood pressure were significantly higher in the top visfatin tertile compared with the lower tertiles. Total cholesterol, nonhigh density lipoprotein cholesterol (nonHDL-C) and triglyceride levels were significantly greater in subjects with high visfatin levels compared with subjects with lower values. Plasma levels of the atherogenic small dense low density lipoprotein (LDL) subclasses were significantly increased in the top visfatin tertile compared with the lower tertiles, resulting in a significantly decreased mean LDL particle diameter. Plasma levels of large high density lipoprotein (HDL) subclasses, as well as their percentage over the HDL cholesterol (HDL-C), were significantly lower in the top visfatin tertile compared with the other tertiles. The percentage of small HDL subclasses over the HDL-C concentration was significantly higher in the top visfatin tertiles compared with the lower tertiles. High sensitivity C-reactive protein concentration was significantly increased in the top visfatin tertile compared with the lower tertiles. Conclusions: Our results support a role for visfatin in the detection of subjects with many metabolic abnormalities. 544 CHARACTERISTICS AND PREDICTIVE BIOMARKERS OF IN-STENT RESTENOSIS WITHIN DRUG-ELUTING STENTS S.-H. Kim1 , H.L. Lee2 , J.B. Seo1 , W.Y. Chung1 , J.H. Zo1 , H.S. Ahn1 , M.A. Kim1 . 1 Internal Medicine, Cardiology, Seoul National University Boramae Hospital, 2 Seoul North Geriatric Hospital, Seoul, Republic of Korea Introduction: In-stent restenosis (ISR) was created by the percutaneous coronary intervention (PCI) with stent and it was almost entirely a result of neointimal smooth muscle cell hyperplasia. In many studies, longer lesion length and stent length, smaller vessel size and so on appear to increase the risk of restenosis. Drug-eluting stents (DES) became the dominant strategy for treatment of ISR. Very little information is available to predict the ISR after DES implantation. Objective: The purpose of this study was to find appropriate predictive index of ISR with general characteristics of ISR of DES. Methods: 261 patients who underwent mandatory follow-up coronary angiography on 9 months after stent insertion from April 2008 to March 2010 were included. Clinical profiles and laboratory data were analyzed for investigation. Results: ISR occurred in 38 (14.6%) of 261 patients. 6 patients were treated by coronary artery bypass surgery (CABG), 16 patients were treated by DES and 16 patients were treated by medical therapy. Baseline lipid profile, drug treatment and traditional risk factors including hypertension, age and so on were not significantly different between ISR and non-ISR group. But CRP, uric acid level were significantly higher in ISR group. Non-HDL cholesterol, CD40 level showed the insignificant higher tendency in ISR group. After adjustment. uric acid level was associated with ISR after PCI with DES. Conclusions: Uric acid level was independently associated with ISR in this study. Additional experience and longer follow up is needed for the prediction and treatment of ISR of DES.
Atherosclerosis Supplements 12, no. 1 (2011) 13–184
after further dividing CAD group using tHcy below 15 mM as reference, Trx activity was significantly decreased in CAD group, and was inversely associated with tHcy levels (r = −0.199, P < 0.05) that was, however, weakly positively associated with TrxR activity. Neither lipids nor glucose significantly affected Trx/TrxR activity. Association of CAD severity with low Trx plus high tHcy was strong (r = −0.458, P < 0.001), but with high tHcy alone was rather weak (r = 0.125, P = 0.225). Conclusion: In CAD patients, homocysteine-induced Trx falling appears to be involved in the disease severity. 536 THE EFFECT OF ROSUVASTATIN TREATMENT ON D-DIMER LEVELS IN OBESE PATIENTS WITH PRIMARY DYSLIPIDEMIA D.I. Agapakis1 , C. Savopoulos2 , K. Tziomalos2 , E.V. Massa2 , N. Katsiki2 , E. Satsoglou1 , A.I. Hatzitolios2 . 1 Internal Medicine, General Hospital of Goumenissa, Goumenissa, 2 First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hospital AHEPA, Thessalon´ıki, Greece Introduction: Risk of thromboembolic complications is increased in obese subjects. Current literature suggests that statin therapy decreases the risk of venous thrombosis and reduces plasma D-dimer (D-d) levels, a marker of hypercoagulable state. Aim: To evaluate the effect of rosuvastatin on D-d levels in patients with uncontrolled primary dyslipidemia and elevated body mass index (BMI). Material and Methods: 37 patients with uncontrolled primary dyslipidemia under hypolipidemic diet treatment, included in the study. The control group was 23 normolipidemic healthy subjects with similar characteristics (age, sex, BMI) with the study group. Dyslipidemic patients were treated with 10 mg/day rosuvastatin for 9 weeks. Lipids parameters and D-d levels (Triage D-Dimer test kit) were measured at baseline for both groups and after rosuvastatin treatment in dyslipidemic group. Results: At baseline, both groups had no significant differences in D-d levels (493±175 ng/ml vs 457±237 ng/ml, p > 0.05). In addition to lipid parameters, the D-d levels significantly decreased after rosuvastatin treatment from 493±175 ng/ml to 367±137 ng/ml, p < 0.001 Conclusions: These data support that beyond the hypolipidemic effect rosuvastatin also possesses significant anti-coagulation properties and could play a role in reducing thromboembolic complications in primary hyperlipidemic obese patients. 537 THE LINK BETWEEN CARDIAC AUTONOMIC FUNCTION AND MARKERS OF OXIDATIVE STRESS IN CORONAY ARTERY DISEASE (CAD) S. Radovanovic, L. Stojanovic, M. Zdravkovic, M. Krotin, B. Milovanovic. University Hospital Bezanijska Kosa, Belgrade, Serbia Background: The objective was to examine cardiovascular autonomic (cANS) function and its potential relationships with markers of oxidative stress in coronary artery disease (CAD) patients Methods: A total of 120 CAD patients mean age, 59±7 years (74 men and 46 women) were included in the stady. All of them had cANS function assessed via heart rate variability (HRV) methods during resting conditions. Standard time-domain and frequency-domain measures [high-frequency normalized units (HFnu; measure of parasympathetic nervous system activity) and low frequency:high-frequency ratio (LF:HF; overall sympathovagal balance)] of HRV were calculated. Plasma malondialdehyde (MDA), protein thiol (P-SH) and reactive carbonyl groups (RCD), together with glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) activities were determined spectrophotometrically and/or by ELISA methods and correlated with timedomein parameters of HRV (mean RR interval, SDNN, SDANN, rMSSD and pNN50%) as well as with frequency-domain measures (ULF, VLF, LF, LF/HF) Results: Significantly corelation was found between SDNN and GSH-Px (r = 0.221, p = 0.039) as well as between pNN50LF and MDA (r = 0.215, p = 0.045). By analyzing the corelation of frequency-domain measures with oxidative demage of proteins (P-SH) were observed following correlation: P-SH and ULF (r = −0.234, p = 0.034); P-SH and VLF (r = −0.219, p = 0.046); P-SH and LF/HF (r = −0.247, p = 0.025). LF was significantly related to GPx (r = 0.212, p = 0.054). Conclusion: We can conclude that cardiovascular autonomic (cANS) dysfunction assessed via heart rate variability was significantly related to increased oxidative stress in chronic heart failure.
Poster presentations
538 ISCHEMIA MODIFIED ALBUMIN (IMA) IN POSTMENOPAUSAL WOMEN WITH OR WITHOUT CORONARY ARTERY DISEASE (CAD) IN RELATION TO BMI AND OGTT K. Kazanis1 , M. Dalamaga1 , E. Kassi1 , G. Merantzi2 , I. Vagionas2 , G. Jullien2 , A. Dionyssiou-Asteriou1 . 1 Clinical Biochemistry, University of Athens, Medical School, 2 Laboratory of Biochemistry, Evangelismos General Hospital, Athens, Greece Background: IMA is a new biomarker of oxidative processes. Its measurement by the cobalt albumin binding assay is reported as an assessment of atherosclerotic burden. In postmenopausal women with or without CAD, we assessed IMA and determined its correlation with BMI, hsCRP and hyperglycaemia. Methods: 120 postmenopausal women, aged 43−80 years, were divided into three groups: Group A (n = 30) with BMI > 26−32 (15 with normal OGTT and 15 with impaired OGTT), Group B (n = 60) with BMI > 21−25 and Group C (n = 30) with BMI > 23−29 and documented CAD. Glucose, insulin, IMA, albumin and hsCRP were measured in an automated analyzer (Roche). The ratio IMA/albumin, HOMA and QUICKI were calculated. Results: IMA and IMA/albumin were significantly elevated in Group A compared to Group B (p < 0.001) but similar to those of Group C (p=1, p = 0.33 respectively). In Group A, there wasn’t any difference between subjects with normal and impaired OGTT. In Group A and B, serum hsCRP was similar but lower in comparison to Group C (p < 0.001). Glucose, insulin and HOMA were elevated in Group A compared to Group B while QUICKI was lower (p < 0.001). In Group A, IMA was positively correlated with BMI (p = 0.03), hsCRP (p < 0.001), insulin and HOMA and negatively with QUICKI (p < 0.01). Regression analysis revealed that obesity was the strongest predictor of IMA. Conclusions: Serum IMA in overweight women without CAD was similar to those with CAD. Whether IMA measurement provides an early assessment of atherosclerotic burden before clinical evidence of CAD needs further investigation. 539 DISORDERS OF PURINE METABOLISM ENZYMES IN ATHEROSCLEROSIS S. Kundalic1 , B. Kundalic2 , T. Ristic1 , D. Stankovic-Ferlez1 . 1 Centre of Medical Biochemistry, Clinical Centre Nis, 2 Faculty of Medicine, University of Nis, Nis, Serbia Since purine metabolism is important for endothelial cells’ normal function, purine catabolism enzymes have an especial place in damaged endothelium of atherosclerotic blood vessels in hyperlipidemias. The activities of 5’-nucleotidase (5’-NT), adenosine deaminase (ADA) and xanthine oxidase (XO) were investigated in atherosclerotic patients. This study obtained 55 patients with atherosclerosis whose results were compared to 46 healthy individuals. According to the values of lipid parameters: cholesterol, triglycerides, HDL-cholesterol (HDL-c) and LDL-cholesterol, the patients were allocated into hyperlipoproteinemic types by Fredrickson, while type subgroups were formed based on the values of hypercholesterolemia and hypertriglyceridemia. The most frequent types of hyperlipoproteinemias were IIa, IIb and type IV. Activity of 5’-NT was significantly increased in serum of patients with atherosclerosis (p < 0.001) and showed significant positive correlation with atherogenic lipid parameters (p < 0.001) and negative correlation with HDL-c (p < 0.05). Total ADA activity in atherosclerotic patients were statistically significantly higher than those in healthy donors (p < 0.001). There was statistically significant positive correlation between ADA activity and atherogenic lipid parameters. Significant negative correlation was found between ADA activity and protective HDL-c (p < 0.001). Activity of XO showed significant increase in serum of atherosclerotic patients (p < 0.001) compared to control group. There is also a significant positive correlation between XO and atherogenic lipids and significant negative correlation between XO and HDL-c. The obtained results suggest a possibility of purine metabolism enzymes estimation, using them as markers of endothelial damage in atherosclerosis, but also a potential of therapeutic correction in practice. 540 PREDICTIVE VALUE OF INFLAMMATORY MARKERS ON CARDIOVASCULAR EVENTS IN PATIENTS WITH CHRONIC HEART FAILURE S. Radovanovic1 , L. Stojanovic1 , M. Krotin1 , A. Djokovic1 , A. Savic-Radojevic2 , S.V. Dragan3 , T. Simic2 . 1 University Hospital Bezanijska Kosa, 2 Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, 3 Clinica of Cardiology, Clinical Center of Serbia, Belgrade, Serbia Background: With respect to clinical practice, recent prospective data indicate that markers of inflammation play a critical role in the progression of atherosclerosis and can be used to predict the future occurrence of cardiovascular events. However, it is unknown whether markers of inflamation in ishemic chronic heart failure (CHF) are truly independently associated with impaired outcome or progression of the disease.
79th EAS Congress
Atherosclerosis Supplements 12, no. 1 (2011) 13–184
Methods and Results: We assessed the follow-up of 120 consecutive patients with CHF in which markers of inflamation [high sensitive-C reactive protein (hs-CRP), vascular cell adhesion molecule-1 (VCAM-1) and intracellular cell adhesion molecule-1 (ICAM-1)] were determined. The primary endpoint was defined by cardiac death, hospitalization due to worsening of heart failure. Cox regression analysis was used to determine whether hs-CRP, VCAM and ICAM were associated with these heart failure-related events. During a median follow-up of 18.4 months 9 patients were hospitalized due to worsening of heart failure, 7 for new episodes of non-stable angina pectoris, 11 patients died for cardiac reasons. Cox regression analysis demonstrated that hs-CRP (OR = 1.06, CI: 1.02–1.11; p < 0.02) was independent predictive factor for cardiac death. ROC curve was drawn to evaluate the reliability of hs-CRP as marker of mortality (AUC = 0.68, CI: 0.51–0.85, p < 0.02). The best balanced threshold was 3.3 mg/l with 63.6% sensitivity and 63.3% specificity. VCAM-1 was significantly correlated with repeted hospitalization (r = 0.185, p < 0.04) and total number of cardiovascular events (r = 0.22, p < 0.02). Conclusion: Level of hs-CRP is independently associated with mortality and morbidity. The ability of treatments to reduce CRP levels may be important for slowing the progression of atherosclerosis and by that improve the prognosis of CHF. 541 A COMPARISON BETWEEN INSULIN RESISTANCE SCORES PARAMETERS IN IDENTIFYING METABOLIC SYNDROME (MS) PATIENTS A. Cozma1 , A.V. Sitar-Taut2 , D. Pop3 , D.T. Zdrenghea3 . 1 4 th Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, 2 Babes Bolyai University, 3 Cardiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania Background: MS is associated with increased cardiovascular risk, being a common cause of the development of atherosclerotic vascular disease. Also, MS is considered as a state of insulin resistance. Purpose: To evaluate the capacity of different insulin resistance scores to identify patients with MS, comparing with standard criteria of MS diagnosis. Methods: 84 patients (63 women), mean age 56.89±11.05, 65.5% presenting MS. As risk factors have been assessed the body weight, smoking status, diabetes, hypertension and dyslipidaemia (total cholesterol >200 mg/dl or serum triglycerides >150 mg/dl). As insulin resistance scores were calculated: Homeostatic model assessment (HOMA) = insulin(mU/mL)·glycemia(mg/dl)/405; Quantitative insulin sensitivity check index (QUICKI) = 1/[log10 (insulin(mU/mL))+log10 (glycemia(mg/dl))]; McCauley Score for measuring the Insulin Sensitivity Index = exp[3.29 − 0.25ln(Insulin) − 0.22ln(BMI) − 0.28ln(Triglycerides)]. Cut off values, optimum sensitivity, specificity and area under the receiver operating characteristic (ROC) curve were evaluated. Classification of the MS was based on the IDF guidelines. Results: patients with MS presented greater insulin resistance (estimated through HOMA index 1.59 vs. 1.04, p = 0.0001, and McCauley Score 2.37±0.43 vs. 1.89±0.36, p = 0.0001) and lower insulin sensitivity (0.35±0.026 vs. 0.37±0.026, p = 0.0001). Determined areas under the ROC curve were as follows: 0.769 for HOMA, 0.769 for QUICKI index, 0.818 for McCauley Score. Diagnostic cut off levels with optimum sensitivity and specificity were found to be for HOMA 1.07 (sensitivity 87.27%, specificity 62.07%), for McCauley Score 2.14 (sensitivity 81.82%, specificity 75.86%), QUICKI index 0.37 (sensitivity 87.27%, specificity 62.07%). Conclusion: Although, in practice is commonly used HOMA (probably due to an easily use), McCauley Score seems to have a better specificity in identifying patients with MS. Acknowledgment: ID_2246/2009 542 ASSOCIATION OF SCLEROSTIN SERUM LEVELS WITH THE SEVERITY OF AORTIC VALVE CALCIFICATION R. Koos1 , A.H. Mahnken2 , N. Marx1 , V. Brandenburg1 . 1 Department of Cardiology, 2 Department of Diagnostic Radiology, University Hospital RWTH Aachen, Aachen, Germany Introduction: Sclerostin is a key negative regulator of bone formation. Recently, sclerostin was identified in human aortas at the protein level. We hypothesized that sclerostin may also play a potential role in the pathogenesis of aortic valve calcification (AVC). Therfore, we aimed to investigate the relationsship between serum sclerostin levels in patients with different degrees of AVC assessed by dual-source computed tomography (DSCT) compared to a healthy control group. Methods: A prospective cross-sectional study in 115 patients (mean age 71±7 years) with echocardiographically proven aortic valve disease was performed. In all patients serum sclerostin levels were measured by ELISA (Tecomedical, Bunde, ¨ Germany) and compared to values obtained from a healthy control population (n = 57, mean age 48±20 years). For quantification of AVC all patients of the study cohort underwent non contrast-enhanced DSCT (Definition, Siemens, Germany).
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Results: Patients with AVC showed significantly higher serum sclerostin levels as compared to healthy controls (0.94±0.45 vs. 0.58±0.26 ng/mL, p < 0.001). A significant correlation between serum sclerostin levels and Agatston AVC scores assessed by DSCT was observed (r = 0.62, p < 0.001) in the study cohort. Patients with high sclerostin levels above the median (median = 0.83ng/mL; n = 57) showed significantly higher Agatston AVC scores (2095±1447) compared to patients with low sclerostin levels (n = 58; 601±545, p < 0.001). Conclusion: Patients with AVC showed increased serum levels of sclerostin compared to a healthy reference population. In addition, the severity of AVC may be linked to increased sclerostin serum levels. Thus, the present study suggests a potential role for sclerostin in the pathogenesis of AVC. 543 PLASMA VISFATIN CONCENTRATION IS A MARKER OF AN ATHEROGENIC METABOLIC PROFILE T. Filippatos1 , V. Tsimihodimos1 , C.S. Derdemezis1 , I.F. Gazi1 , V. Saougos1 , A.D. Tselepis2 , M.S. Elisaf1 . 1 Department of Internal Medicine, Medical School, 2 Laboratory of Biochemistry, Department of Chemistry, University of Ioannina, Ioannina, Greece Background and Aims: Human visfatin is associated with atherosclerosisrelated diseases. We assessed in non-diabetic individuals the association of plasma visfatin levels with cardiovascular disease (CVD) risk. Methods and Results: When study population (n = 179, age 49±11 years) was divided according to visfatin tertiles, the 10-year CVD Framingham risk scores were significantly increased in the top visfatin tertile. Furthermore, body mass index, waist circumference and blood pressure were significantly higher in the top visfatin tertile compared with the lower tertiles. Total cholesterol, nonhigh density lipoprotein cholesterol (nonHDL-C) and triglyceride levels were significantly greater in subjects with high visfatin levels compared with subjects with lower values. Plasma levels of the atherogenic small dense low density lipoprotein (LDL) subclasses were significantly increased in the top visfatin tertile compared with the lower tertiles, resulting in a significantly decreased mean LDL particle diameter. Plasma levels of large high density lipoprotein (HDL) subclasses, as well as their percentage over the HDL cholesterol (HDL-C), were significantly lower in the top visfatin tertile compared with the other tertiles. The percentage of small HDL subclasses over the HDL-C concentration was significantly higher in the top visfatin tertiles compared with the lower tertiles. High sensitivity C-reactive protein concentration was significantly increased in the top visfatin tertile compared with the lower tertiles. Conclusions: Our results support a role for visfatin in the detection of subjects with many metabolic abnormalities. 544 CHARACTERISTICS AND PREDICTIVE BIOMARKERS OF IN-STENT RESTENOSIS WITHIN DRUG-ELUTING STENTS S.-H. Kim1 , H.L. Lee2 , J.B. Seo1 , W.Y. Chung1 , J.H. Zo1 , H.S. Ahn1 , M.A. Kim1 . 1 Internal Medicine, Cardiology, Seoul National University Boramae Hospital, 2 Seoul North Geriatric Hospital, Seoul, Republic of Korea Introduction: In-stent restenosis (ISR) was created by the percutaneous coronary intervention (PCI) with stent and it was almost entirely a result of neointimal smooth muscle cell hyperplasia. In many studies, longer lesion length and stent length, smaller vessel size and so on appear to increase the risk of restenosis. Drug-eluting stents (DES) became the dominant strategy for treatment of ISR. Very little information is available to predict the ISR after DES implantation. Objective: The purpose of this study was to find appropriate predictive index of ISR with general characteristics of ISR of DES. Methods: 261 patients who underwent mandatory follow-up coronary angiography on 9 months after stent insertion from April 2008 to March 2010 were included. Clinical profiles and laboratory data were analyzed for investigation. Results: ISR occurred in 38 (14.6%) of 261 patients. 6 patients were treated by coronary artery bypass surgery (CABG), 16 patients were treated by DES and 16 patients were treated by medical therapy. Baseline lipid profile, drug treatment and traditional risk factors including hypertension, age and so on were not significantly different between ISR and non-ISR group. But CRP, uric acid level were significantly higher in ISR group. Non-HDL cholesterol, CD40 level showed the insignificant higher tendency in ISR group. After adjustment. uric acid level was associated with ISR after PCI with DES. Conclusions: Uric acid level was independently associated with ISR in this study. Additional experience and longer follow up is needed for the prediction and treatment of ISR of DES.