Effect of Revascularization on Exercise-Induced Changes in Cardiac and Prothrombotic Biomarkers in Patients with Coronary Artery Disease

We examined whether resting levels and exercise-induced changes during exercise ECG stress test (EST) of cardiac Troponin T (cTnT), NT-proBNP and prothrombotic markers were affected by revascularization in patients with coronary artery disease (CAD). EST1 was performed before coronary angiography and revascularization, and patients (n  =  20) with confirmed CAD, performed another EST (EST2) 9 weeks later. Blood samples were drawn at rest and within five min after termination of ESTs. cTnT and NT-proBNP increased during exercise at both ESTs (p &lt; 0.001, all). Resting cTnT levels at EST2 versus EST1 were significantly higher (p  =  0.02) whereas NT-proBNP did not differ. At both visits, increased D-dimer (p  =  0.008 and &lt;0.001), pro-thrombin fragment 1  +  2 (p  =  0.009 and 0.001) and tissue factor pathway inhibitor (TFPI) (p &lt; 0.001 and 0.001) during exercise were demonstrated. Resting levels of endogenous thrombin potential (ETP) and TFPI were reduced at EST2 versus EST1 (p &lt; 0.01). Revascularization did not affect exercise-induced release of cardiac and prothrombotic biomarkers and did not reduce resting levels of cTnT or NT-proBNP, suggesting revascularization per se not to prevent secretion of biomarkers. The lower resting levels of ETP and TFPI after revascularization may however, be indicative of reduced thrombin generation and endothelial activation. Clinicaltrials.gov, CADENCE, NCT01495091 https://clinicaltrials.gov/ct2/show/NCT01495091?term = 01495091&amp;draw = 2&amp;rank = 1 . </jats:p

Effect of revascularization on exercise-induced changes in cardiac and pro-thrombotic biomarkers in patients with coronary artery disease

Abstract Introduction Exercise-induced increase in cardiac and pro-thrombotic biomarkers have previously been shown in patients with coronary artery disease (CAD) before revascularization, which may be due to myocardial ischemia. Purpose We aimed to examine whether resting levels and exercise-induced changes of high sensitive cardiac Troponin T (cTnT), NT-proBNP, pro-thrombin fragment (F) 1+2, D-dimer, tissue factor pathway inhibitor (TFPI) and endogenous thrombin potential (ETP) were affected by revascularization in patients with CAD. We hypothesized that resting and exercise-induced levels of the biomarkers would be reduced after revascularization. Methods Patients presenting with symptoms of CAD were included. A maximal exercise ECG stress test (EST) (EST1) was performed, and venous blood samples were drawn at rest and within five min after termination. All patients underwent coronary angiography. Patients (n=20) with confirmed CAD, fully revascularized with percutaneous coronary intervention (PCI) and without symptoms of angina, were invited to perform a second EST (EST2), at the same workload (median 145W), at a median of 66 days after revascularization. Mean exercise duration at both time points were 11:30 min:sec. Of the total population 15 patients were treated with PCI on stenosis located on LAD and 5 patients with stenosis on RCA. Results Significant increase in cTnT and NT-proBNP from resting to post exercise levels at EST1 was found as expected (p&amp;lt;0.001, both). Also at EST2, increased levels were observed (p&amp;lt;0.01, both), however, not significantly different from the changes at EST1. Resting levels of cTnT at EST2 compared to EST1 were significantly higher (median 8.1 vs 7.1 ng/L, p=0.02). At both visits significant increase in D-dimer (p=0.008 and &amp;lt;0.001), F1+2 (p=0.009 and 0.001) and TFPI (p&amp;lt;0.001 and 0.001) during exercise were demonstrated, with no difference in these changes. There were no significant changes in ETP during exercise at any visit, but resting levels were reduced at EST2 vs EST1 (p&amp;lt;0.01). Also resting levels of TFPI were reduced at EST2 (p&amp;lt;0.01). Conclusion After revascularization there was still significant increase in exercise-induced release of cardiac and pro-thrombotic biomarkers, thus revascularization does not affect the ability to release these biomarkers. Also, the higher resting levels of cTnT after revascularization indicate that revascularization per se does not affect secretion of cardiac biomarkers, probably due to the disease state. The lower resting levels of ETP and TFPI after revascularization may, however, be indicative of reduced thrombin generation potential and endothelial activation. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Stein Erik Hagens Foundation for Clinical Heart Research, Oslo, Norway </jats:sec

One year of omega 3 polyunsaturated fatty acid supplementation does not reduce circulating prothrombotic microvesicles in elderly subjects after suffering a myocardial infarction

Altres ajuts: Stein Erik Hagens Foundation of Clinical Heart Research, Oslo, Norway.Background & aims: Circulating microvesicles (cMV) are both effectors and biomarkers of cardiovascular disease (CVD), and the effects of omega 3 polyunsaturated fatty acids (n3 PUFA) in MV shedding are not yet well known. Therefore, we aimed to investigate the effects of long-term n3 PUFA supplementation on cMV release from cells of the vascular compartment in elderly subjects at very high risk of CVD. Methods: We included 156 elderly patients 2-8 weeks after suffering an acute myocardial infarction from the OMEMI cohort. Subjects were randomly allocated to receive 930 mg EPA + 660 mg DHA (n3 PUFA intervention) or corn oil (56% linoleic acid, 32% oleic acid, 10% palmitic acid) used as placebo daily for two years. At inclusion and after one-year follow-up, prothrombotic [annexin V (AV)] cMV derived from blood and vascular cells were phenotyped by flow cytometry. Results: No differences were observed in the levels of cMV between the randomized groups at inclusion in the study. After one-year follow-up, total AV, platelet-derived CD61/AV, and endothelial-derived CD31/AV and CD31/CD42b/AV cMV increased significantly in both groups. In the n3 PUFA supplemented group, platelet-derived CD62P/AV, CD42b/AV and CD31/CD42b/AV; leukocyte-derived CD62L/AV, CD45/AV, and CD11b/AV, as well as endothelial derived CD146/AV, CD62E/AV, and CD309/AV cMV also increased significantly. No significant differences were however, observed in the changes of cMV levels between groups. Conclusion: In elderly Norwegians who have suffered a recent acute myocardial infarction and treated as per guidelines, long-term supplementation with 1.8 g/day n3 PUFA does not modulate prothrombotic MV release from blood and vascular cells. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01841944

sj-docx-1-cat-10.1177_10760296221094029 - Supplemental material for Effect of Revascularization on Exercise-Induced Changes in Cardiac and Prothrombotic Biomarkers in Patients with Coronary Artery Disease

Supplemental material, sj-docx-1-cat-10.1177_10760296221094029 for Effect of Revascularization on Exercise-Induced Changes in Cardiac and Prothrombotic Biomarkers in Patients with Coronary Artery Disease by C. H. Hansen, J. Cwikiel, V. Bratseth, H. Arnesen, A. Flaa and I. Seljeflot in Clinical and Applied Thrombosis/Hemostasis</p