Predictive value of C-reactive protein and troponin T in patients with unstable angina: a comparative analysis

AbstractOBJECTIVESWe evaluated C-reactive protein (CRP) and troponin T (TnT) for predicting six-month cardiac risk in patients with unstable angina.BACKGROUNDTroponin T is predictive of cardiac risk in patients with unstable angina. The clinical implications of elevated CRP in such patients remains controversial.METHODSBaseline TnT and CRP values were determined in 447 patients with unstable angina enrolled in the placebo group of the Chimeric c7E3 AntiPlatelet Therapy in Unstable angina REfractory to standard treatment trial (CAPTURE) trial. All patients underwent a coronary intervention and were followed for a six month period in which 13 deaths and 47 myocardial infarctions were documented (MIs).RESULTSTroponin T was >0.1 μg/liter in 30% and CRP was >10 mg/L in 41% of the patients. For the initial 72-h period (including coronary intervention), TnT (17.4% vs. 4.2%; p < 0.001) but not CRP (10.3% vs. 8%; p = 0.41) was predictive of mortality and MI. The TnT-positive patients displayed more frequent recurrent instability before the planned intervention (44.8% vs. 16.9%; p < 0.001), but in the CRP-positive patients, no such increase was observed (25.9% vs. 24.8%; p = 0.92). In contrast, for the six month follow-up period, CRP was predictive of cardiac risk (mortality, MI) (18.9% vs. 9.5%; p = 0.003). Using multivariate analysis, both CRP and TnT emerged as independent predictors of mortality and MI at six- month follow-up. Furthermore, the incidence of coronary restenosis during six-month follow-up was not related to TnT status (3% vs. 4.5%; p = 0.49); however, it was significantly related to CRP status (7% vs. 2.3%; p = 0.03).CONCLUSIONSTroponin T, but not CRP, was predictive of cardiac risk during the initial 72-h period, whereas CRP was an independent predictor of both cardiac risk and repeated coronary revascularization (coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty) during six month follow-up

Radio astronomy

The following subject areas are covered: (1) scientific opportunities (millimeter and sub-millimeter wavelength astronomy; meter to hectometer astronomy; the Sun, stars, pulsars, interstellar masers, and extrasolar planets; the planets, asteroids, and comets; radio galaxies, quasars, and cosmology; and challenges for radio astronomy in the 1990's); (2) recommendations for new facilities (the millimeter arrays, medium scale instruments, and small-scale projects); (3) continuing activities and maintenance, upgrading of telescopes and instrumentation; (4) long range programs and technology development; and (5) social, political, and organizational considerations

Pregnancy-associated plasma protein-A levels in patients with acute coronary syndromes Comparison with markers of systemic inflammation, platelet activation, and myocardial necrosis

ObjectivesThe goal of this study was to determine the predictive value of pregnancy-associated plasma protein-A (PAPP-A) in patients with acute coronary syndromes (ACS).BackgroundPregnancy-associated plasma protein-A is a zinc-binding matrix metalloproteinase abundantly expressed in eroded and ruptured plaques and may serve as a marker of plaque destabilization.MethodsIn 547 patients with angiographically validated ACS and in a heterogeneous emergency room population of 644 patients with acute chest pain, respectively, PAPP-A as well as markers of myocardial necrosis (troponin T [TnT]), ischemia (vascular endothelial growth factor [VEGF]), inflammation (high-sensitivity C-reactive protein [hsCRP]), anti-inflammatory activity (interleukin [IL]-10), and platelet activation (soluble CD40 ligand [sCD40L]) were determined. Patients were followed for the occurrence of death or myocardial infarction.ResultsIn patients with ACS, elevated PAPP-A levels (>12.6 mIU/l) indicated an increased risk (odds ratio 2.44 [95% confidence interval (CI) 1.43 to 4.15]; p = 0.001). When the analysis was restricted to TnT-negative patients, PAPP-A still identified a subgroup of high-risk patients (odds ratio [OR] 2.72 [95% confidence interval (CI) 1.25 to 5.89]; p = 0.009). In a multivariable model, PAPP-A (OR 2.01; p = 0.015), sCD40L (OR 2.37; p = 0.003), IL-10 (OR 0.43; p = 0.003), and VEGF (OR 2.19; p = 0.018) were independent predictors. Prospective validation in patients with chest pain confirmed that PAPP-A levels reliably identify high-risk patients (adjusted OR 2.32 [95% CI 1.32 to 4.26]; p = 0.008). Patients negative for all three markers (TnT, sCD40L, and PAPP-A) were at very low cardiac risk (30 days: 3.0% event rate; no death).ConclusionsThe PAPP-A level as a marker of plaque instability is a strong independent predictor of cardiovascular events in patients with ACS. Simultaneous determination of biomarkers with distinct pathophysiological profiles appears to remarkably improve risk stratification in patients with ACS

Discovery of Radio Outbursts in the Active Nucleus of M81

The low-luminosity active galactic nucleus of M81 has been monitored at centimeter wavelengths since early 1993 as a by-product of radio programs to study the radio emission from Supernova 1993J. The extensive data sets reveal that the nucleus experienced several radio outbursts during the monitoring period. At 2 and 3.6 cm, the main outburst occurred roughly in the beginning of 1993 September and lasted for approximately three months; at longer wavelengths, the maximum flux density decreases, and the onset of the burst is delayed. These characteristics qualitatively resemble the standard model for adiabatically expanding radio sources, although certain discrepancies between the observations and the theoretical predictions suggest that the model is too simplistic. In addition to the large-amplitude, prolonged variations, we also detected milder changes in the flux density at 3.6 cm and possibly at 6 cm on short (less than 1 day) timescales. We discuss a possible association between the radio activity and an optical flare observed during the period that the nucleus was monitored at radio wavelengths.Comment: To appear in The Astronomical Journal. Latex, 18 pages including embedded figures and table

Distribution and height of methane bubble plumes on the Cascadia Margin characterized by acoustic imaging

Submersible investigations of the Cascadia accretionary complex have identified localized venting of methane gas bubbles in association with gas hydrate occurrence. Acoustic profiles of these bubble plumes in the water column in the vicinity of Hydrate Ridge offshore Oregon provide new constraints on the spatial distribution of these gas vents and the fate of the gas in the water column. The gas vent sites remained active over the span of two years, but varied dramatically on time scales of a few hours. All plumes emanated from local topographic highs near the summit of ridge structures. The acoustic images of the bubble plumes in the water column disappear at water depths between 500 to 460 m, independent of the seafloor depth. This coincides with the predicted depth of the gas hydrate stability boundary of 510 to 490 m, suggesting that the presence of a hydrate skin on the bubble surface prevents them from rapid dissolution. The upper limit of the acoustic bubble plumes at 460 m suggests that dissolution of the residual bubbles is relatively rapid above the hydrate stability zone

The Microarcsecond Sky and Cosmic Turbulence

Radio waves are imprinted with propagation effects from ionized media through which they pass. Owing to electron density fluctuations, compact sources (pulsars, masers, and compact extragalactic sources) can display a wide variety of scattering effects. These scattering effects, particularly interstellar scintillation, can be exploited to provide *superresolution*, with achievable angular resolutions (<~ 1 microarcsecond) far in excess of what can be obtained by very long baseline interferometry on terrestrial baselines. Scattering effects also provide a powerful sub-AU probe of the microphysics of the interstellar medium, potentially to spatial scales smaller than 100 km, as well as a tracer of the Galactic distribution of energy input into the interstellar medium through a variety of integrated measures. Coupled with future gamma-ray observations, SKA observations also may provide a means of detecting fainter compact gamma-ray sources. Though it is not yet clear that propagation effects due to the intergalactic medium are significant, the SKA will either detect or place stringent constraints on intergalactic scattering.Comment: 20 pages, 8 figures in 8 PostScript files, to appear in "Science with the Square Kilometer Array," eds. C. Carilli and S. Rawlings, New Astronomy Reviews (Elsevier: Amsterdam

cGMP-Dependent Protein Kinase I Is Crucial for Angiogenesis and Postnatal Vasculogenesis

Background Endothelium-derived nitric oxide plays an important role for the bone marrow microenvironment. Since several important effects of nitric oxide are mediated by cGMP-dependent pathways, we investigated the role of the cGMP downstream effector cGMP-dependent protein kinase I (cGKI) on postnatal neovascularization. Methodology/Principal Findings In a disc neovascularization model, cGKI -/- mice showed an impaired neovascularization as compared to their wild-type (WT) littermates. Infusion of WT, but not cGKI -/- bone marrow progenitors rescued the impaired ingrowth of new vessels in cGKI-deficient mice. Bone marrow progenitors from cGKI -/- mice showed reduced proliferation and survival rates. In addition, we used cGKI alpha leucine zipper mutant (LZM) mice as model for cGKI deficiency. LZM mice harbor a mutation in the cGKI alpha leucine zipper that prevents interaction with downstream signaling molecules. Consistently, LZM mice exhibited reduced numbers of vasculogenic progenitors and impaired neovascularization following hindlimb ischemia compared to WT mice. Conclusions/Significance Our findings demonstrate that the cGMP-cGKI pathway is critical for postnatal neovascularization and establish a new role for cGKI in vasculogenesis, which is mediated by bone marrow-derived progenitors

ICMSF Methods Studies. XV. Comparison of Four Media and Methods for Enumerating Staphylococcus aureus in Powdered Milk.

Four media were examined for their usefulness in enumerating Staphylococcus aureus inoculated (a) into milk that was then dried or (b) directly into dried milk powder. In all, seven strains of S. aureus were inoculated individually into each preparation and were enumerated after two periods of storage (18 to 19 d and 60 to 61 d). Fourteen laboratories from twelve countries participated in the comparison which found that direct plating on agar medium in 14-cm petri dishes may be as useful as enrichment followed by streaking. Plating on Baird-Parker medium or on Hauschild pork plasma fibrinogen medium and a MPN method using Giolitti and Cantoni's broth with Tween 80 were equally sensitive for enumerating S. aureus in dried milk powder. The use of Hauschild medium may eliminate the need for supplementary tests to confirm colonies as S. aureus , but in some cases was found to fail in some laboratories. Giolitti and Cantoni's broth without Tween 80 generally was less useful than the three other media for enumerating S. aureus . S. aureus inoculated into milk that was then dried survived longer than when inoculated into dried milk

Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels

Background: In patients with refractory unstable angina, the platelet glycoprotein IIb/IIIa-receptor antibody abciximab reduces the incidence of cardiac events before and during coronary angioplasty. We investigated whether serum troponin T levels identify patients most likely to benefit from therapy with this drug. Methods: Among 1265 patients with unstable angina who were enrolled in the c7E3 Fab Antiplatelet Therapy in Unstable Refractory Angina (CAPTURE) trial, serum samples drawn at the time of randomization to abciximab or placebo were available from 890 patients; we used these samples for the determination of troponin T and creatine kinase MB levels. Patients with postinfarction angina were not included. Results: Serum troponin T levels at the time of study entry were elevated (above 0.1 ng per milliliter) in 275 patients (30.9 percent). Among patients receiving placebo, the risk of death or nonfatal myocardial infarction was related to troponin T levels. The six-month cumulative event rate was 23.9 percent among patients with elevated troponin T levels, as compared with 7.5 percent among patients without elevated troponin T levels (P<0.001). Among patients treated with abciximab, the respective six-month event rates were 9.5 percent for patients with elevated troponin T levels and 9.4 percent for those without elevated levels. As compared with placebo, the relative risk of death or nonfatal myocardial infarction associated with treatment with abciximab in patients with elevated troponin T levels was 0.32 (95 percent confidence interval, 0.14 to 0.62; P=0.002). The lower event rates in patients receiving abciximab were attributable to a reduction in the rate of myocardial infarction (odds ratio, 0.23; 95 percent confidence interval, 0.12 to 0.49; P<0.001). In patients without elevated troponin T levels, there was no benefit of treatment with respect to the relative risk of death or myocardial infarction at six months (odds ratio, 1.26; 95 percent confidence interval, 0.74 to 2.31; P=0.47). Conclusions: The serum troponin T level, which is considered to be a surrogate marker for thrombus formation, identifies a high-risk subgroup of patients with refractory unstable angina suitable for coronary angioplasty who will particularly benefit from antiplatelet treatment with abciximab