- Email: [email protected]
Positive Predictive Value of Exercise Electrocardiography in Patients Referred from a Brisbane Emergency Department with Chest Pain
tion of LVT. Our experimental findings would be useful for pathological or imaging research on human MI patients. doi:10.1016/j.hlc.2010.06.740 74 Platelet CD147 Expression is Upregulated Within the Cardiac Circulation in Humans A. Yong 1,∗ , G. Pennings 2 , D. Brieger 1 , M. Ng 3 , H. Lowe 1 , L. Kritharides 1 1 Department
of Cardiology, Concord Hospital, Sydney, Aus-
tralia 2 ANZAC
Research Institute, University of Sydney, Sydney, Australia 3 Royal Prince Alfred Hospital, Sydney, Australia Background: Matrix metalloproteinases (MMP) are implicated in atherosclerosis progression, lesion destabilisation and plaque rupture. CD147, also known as extracellular MMP inducer, is known to be present on leukocytes and platelets in vitro. We recently demonstrated CD147 expression on circulating platelets and leukocytes in humans, especially in those with coronary disease. We now test the hypothesis that platelet CD147 is upregulated within the cardiac circulation in patients with coronary disease. Methods: N = 30 patients undergoing elective coronary intervention underwent blood sampling prior to intervention. To assess difference between peripheral and cardiac circulation, blood from the femoral vein (FV) and coronary sinus (CS) was compared in 14 patients. To investigate transcardiac upregulation, blood obtained from the proximal coronary artery (PA) and CS was compared in 15 patients. To investigate trans-coronary upregulation, blood from PA and coronary artery distal to the target lesion (DA) was compared 17 patients. Blood samples were analysed for platelet and leukocyte CD147 expression by flow cytometry. Results: Platelet CD147 was higher in CS compared to FV (mean fluorescence intensity: 2.6 ± 0.74 vs. 2.2 ± 0.46, p = 0.01), higher in CS compared to PA (3.1 ± 0.81 vs. 2.8 ± 0.63, p < 0.01) and higher in DA compared to PA (3.7 ± 0.6 vs. 2.5 ± 0.6, p = 0.01). There was a non-significant trend towards higher levels in the CS compared to DA (3.5 ± 0.78 vs. 3.3 ± 0.90, p = 0.07). Granulocyte and monocyte CD147 levels obtained from the various sites were not different. Conclusions: These data show, for the first time, evidence of platelet CD147 upregulation within the cardiac circulation in man. This has implications for local intracardiac MMP regulation. doi:10.1016/j.hlc.2010.06.741
Abstracts
S33
75 Positive Predictive Value of Exercise Electrocardiography in Patients Referred from a Brisbane Emergency Department with Chest Pain A. Camuglia ∗ , J. Gibson, C. Hammett, A. Brown, L. Cullen, W. Parsonage Royal Brisbane and Women’s Hospital, Herston, Queensland 4029, Australia Introduction: Diagnosis and risk stratification of patients presenting with chest pain to the emergency department remains challenging. The aim of this study is to assess the discriminative power of a positive exercise ECG stress test (EST) in emergency patients deemed intermediate risk with negative ischaemic biomarkers. Methods: We retrospectively analysed data of 2483 patient’s consecutive ESTs referred from the Department of Emergency Medicine at the Royal Brisbane and Women’s Hospital, (a tertiary referral and teaching hospital in Queensland, Australia) performed between 2005 and 2009. The primary outcome measure was the positive predictive value (PPV) of EST for epicardial coronary artery disease (CAD) with luminal narrowing of 50% or more. We also assessed the PPV for revascularisation (a composite of PCI or referral for bypass surgery). Results: We identified 146 patients with a positive EST (5.88% of the cohort, 60.3% men and 39.7% women) with an average age of 57.7 years (SEM: ±0.95). Overall, the PPV of EST for the primary outcome was 23.3% (95% CI: 17.2–30.8) and 19.9% (95% CI: 14.2–27.1) for revascularisation. For men (average age 57.6 years, SEM: ±1.28), the PPV of EST for the primary outcome was 30.7% (95% CI: 22.0–41.0). The PPV for revascularisation was 27.3% (95% CI: 19.1–37.4). For women (average age 57 years, SEM: ±1.34), the PPV for the primary outcome was 12.1% (95% CI: 6.0–22.9). The PPV for revascularisation was 8.6% (95% CI: 3.7–18.6). Conclusion: The PPV of EST may be of clinical relevance in men but the discriminatory ability of a positive test is less robust in females consistent with previous findings by other investigators. doi:10.1016/j.hlc.2010.06.742 76 Presence of Recent Chest Pain in Patients with NonObstructive Coronary Artery Disease R. Tavella ∗ , C. Wong, S. Cherian, J. Beltrame The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, Australia Introduction: Many patients with non-obstructive CAD (NoCAD) on angiography report on-going chest pain. Despite this, there is little data evaluating the persistence of chest pain and its effect on health status in patients with NoCAD. Methods: Health status of outpatients with NoCAD 2–5 years following index angiography was evaluated by the
ABSTRACTS
Heart, Lung and Circulation 2010;19S:S1–S268
of Cardiology, Concord Hospital, Sydney, Aus-
tralia 2 ANZAC
Research Institute, University of Sydney, Sydney, Australia 3 Royal Prince Alfred Hospital, Sydney, Australia Background: Matrix metalloproteinases (MMP) are implicated in atherosclerosis progression, lesion destabilisation and plaque rupture. CD147, also known as extracellular MMP inducer, is known to be present on leukocytes and platelets in vitro. We recently demonstrated CD147 expression on circulating platelets and leukocytes in humans, especially in those with coronary disease. We now test the hypothesis that platelet CD147 is upregulated within the cardiac circulation in patients with coronary disease. Methods: N = 30 patients undergoing elective coronary intervention underwent blood sampling prior to intervention. To assess difference between peripheral and cardiac circulation, blood from the femoral vein (FV) and coronary sinus (CS) was compared in 14 patients. To investigate transcardiac upregulation, blood obtained from the proximal coronary artery (PA) and CS was compared in 15 patients. To investigate trans-coronary upregulation, blood from PA and coronary artery distal to the target lesion (DA) was compared 17 patients. Blood samples were analysed for platelet and leukocyte CD147 expression by flow cytometry. Results: Platelet CD147 was higher in CS compared to FV (mean fluorescence intensity: 2.6 ± 0.74 vs. 2.2 ± 0.46, p = 0.01), higher in CS compared to PA (3.1 ± 0.81 vs. 2.8 ± 0.63, p < 0.01) and higher in DA compared to PA (3.7 ± 0.6 vs. 2.5 ± 0.6, p = 0.01). There was a non-significant trend towards higher levels in the CS compared to DA (3.5 ± 0.78 vs. 3.3 ± 0.90, p = 0.07). Granulocyte and monocyte CD147 levels obtained from the various sites were not different. Conclusions: These data show, for the first time, evidence of platelet CD147 upregulation within the cardiac circulation in man. This has implications for local intracardiac MMP regulation. doi:10.1016/j.hlc.2010.06.741
Abstracts
S33
75 Positive Predictive Value of Exercise Electrocardiography in Patients Referred from a Brisbane Emergency Department with Chest Pain A. Camuglia ∗ , J. Gibson, C. Hammett, A. Brown, L. Cullen, W. Parsonage Royal Brisbane and Women’s Hospital, Herston, Queensland 4029, Australia Introduction: Diagnosis and risk stratification of patients presenting with chest pain to the emergency department remains challenging. The aim of this study is to assess the discriminative power of a positive exercise ECG stress test (EST) in emergency patients deemed intermediate risk with negative ischaemic biomarkers. Methods: We retrospectively analysed data of 2483 patient’s consecutive ESTs referred from the Department of Emergency Medicine at the Royal Brisbane and Women’s Hospital, (a tertiary referral and teaching hospital in Queensland, Australia) performed between 2005 and 2009. The primary outcome measure was the positive predictive value (PPV) of EST for epicardial coronary artery disease (CAD) with luminal narrowing of 50% or more. We also assessed the PPV for revascularisation (a composite of PCI or referral for bypass surgery). Results: We identified 146 patients with a positive EST (5.88% of the cohort, 60.3% men and 39.7% women) with an average age of 57.7 years (SEM: ±0.95). Overall, the PPV of EST for the primary outcome was 23.3% (95% CI: 17.2–30.8) and 19.9% (95% CI: 14.2–27.1) for revascularisation. For men (average age 57.6 years, SEM: ±1.28), the PPV of EST for the primary outcome was 30.7% (95% CI: 22.0–41.0). The PPV for revascularisation was 27.3% (95% CI: 19.1–37.4). For women (average age 57 years, SEM: ±1.34), the PPV for the primary outcome was 12.1% (95% CI: 6.0–22.9). The PPV for revascularisation was 8.6% (95% CI: 3.7–18.6). Conclusion: The PPV of EST may be of clinical relevance in men but the discriminatory ability of a positive test is less robust in females consistent with previous findings by other investigators. doi:10.1016/j.hlc.2010.06.742 76 Presence of Recent Chest Pain in Patients with NonObstructive Coronary Artery Disease R. Tavella ∗ , C. Wong, S. Cherian, J. Beltrame The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, Australia Introduction: Many patients with non-obstructive CAD (NoCAD) on angiography report on-going chest pain. Despite this, there is little data evaluating the persistence of chest pain and its effect on health status in patients with NoCAD. Methods: Health status of outpatients with NoCAD 2–5 years following index angiography was evaluated by the
ABSTRACTS
Heart, Lung and Circulation 2010;19S:S1–S268