Abstract
To test whether circulating and intracoronary biomarkers and coronary plaque strain have additive values to Global Registry of Acute Coronary Events (GRACE) score for predicting long-term cardiovascular events in ACS patients. One hundred ACS patients were enrolled and the GRACE score and plasma levels and intracoronary gradients of a number of biomarkers were measured. Coronary plaque burden and morphology in non-critical stenotic plaques were determined by intravascular ultrasound (IVUS) technique, and the maximal shear strain (SSmax) and maximal area strain (ASmax) were determined by intravascular ultrasound elastography (IVUSE) technique. Patients were followed for cardiovascular events and the predictive values of clinical characteristics, plasma biomarkers and plaque parameters were compared with GRACE score, and the incremental values of these measurements to the GRACE score were assessed. GRACE score, plasma biomarkers and plaque strain were independent predictors of cardiovascular events. Combination of GRACE score, plasma biomarkers and plaque strains significantly improved the predictive value of the GRACE score alone with the receiver-operating characteristic area increased from 0.457 to 0.667 (P=0.014). The combination of circulating and intracoronary biomarkers, plaque strain and GRACE score provides a better predictive tool than GRACE score alone in patients with ACS.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Anderson, J.L., Adams, C.D., Antman, E.M., Bridges, C.R., Califf, R.M., Casey, D.E. Jr., Chavey, W.E. 2nd, Fesmire, F.M., Hochman, J.S., Levin, T.N., et al. (2007). ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol 50, e1–157.
Antoniades, C., Bakogiannis, C., Tousoulis, D., Antonopoulos, A.S., and Stefanadis, C. (2009). The CD40/CD40 ligand system: linking inflammation with atherothrombosis. J Am College Cardiol 54, 669–677.
Brugaletta, S., Garcia-Garcia, H.M., Serruys, P.W., Maehara, A., Farooq, V., Mintz, G.S., de Bruyne, B., Marso, S.P., Verheye, S., Dudek, D., et al. (2012). Relationship between palpography and virtual histology in patients with acute coronary syndromes. JACC Cardiovasc Imaging 5, S19–S27.
Di, M., Wang, L., Li, M., Zhang, Y., Liu, X., Zeng, R., Wang, H., Chen, Y., Chen, W., Zhang, Y., et al. (2017). Dickkopf1 destabilizes atherosclerotic plaques and promotes plaque formation by inducing apoptosis of endothelial cells through activation of ER stress. Cell Death Dis 8, e2917.
Eagle, K.A., Lim, M.J., Dabbous, O.H., Pieper, K.S., Goldberg, R.J., Van de Werf, F., Goodman, S.G., Granger, C.B., Steg, P.G., Gore, J.M., et al. (2004). A validated prediction model for all forms of acute coronary syndrome. JAMA 291, 2727–2733.
Granger, C.B., Goldberg, R.J., Dabbous, O., Pieper, K.S., Eagle, K.A., Cannon, C.P., Van De Werf, F., Avezum, A., Goodman, S.G., Flather, M.D., et al. (2003). Predictors of hospital mortality in the Global Registry of Acute Coronary Events. Arch Intern Med 163, 2345–2353.
Hu, F., Zhong, Q., Gong, J., Qin, Y., Cui, L., and Yuan, H. (2016). Plasma surfactant protein D is associated with atherosclerosis of the carotid artery in patients on maintenance hemodialysis. Clin Lab 62, 97–104.
Hu, X.B., Zhang, P.F., Su, H.J., Yi, X., Chen, L., Rong, Y.Y., Zhang, K., Li, X., Wang, L., Sun, C.L., et al. (2012). Intravascular ultrasound area strain imaging used to characterize tissue components and assess vulnerability of atherosclerotic plaques in a rabbit model. Ultrasound Med Biol 37, 1579–1587.
Li, H., Huang, S., Wang, S., Zhao, J., Su, L., Zhao, B., Zhang, Y., Zhang, S., and Miao, J. (2013). Targeting annexin A7 by a small molecule suppressed the activity of phosphatidylcholine-specific phospholipase C in vascular endothelial cells and inhibited atherosclerosis in apolipoprotein E−/− mice. Cell Death Dis 4, e806.
Li, Z., Wang, L., Hu, X., Zhang, P., Chen, Y., Liu, X., Xu, M., Su, H., and Zhang, M. (2017). Intravascular ultrasound elastography analysis of the elastic mechanical properties of atherosclerotic plaque. Int J Cardiovasc Imag 33, 1663–1671.
Li, Z., Wang, L., Hu, X., Zhang, P., Chen, Y., Liu, X., Xu, M., Zhang, Y., and Zhang, M. (2016). Effect of rosuvastatin on atherosclerotic plaque stability: An intravascular ultrasound elastography study. Atherosclerosis 248, 27–35.
Lind, L., Simon, T., Johansson, L., Kotti, S., Hansen, T., Machecourt, J., Ninio, E., Tedgui, A., Danchin, N., Ahlström, H., et al. (2012). Circulating levels of secretory- and lipoprotein-associated phospholi- pase A2 activities: relation to atherosclerotic plaques and future all-cause mortality. Eur Heart J 33, 2946–2954.
Oörni, K., and Kovanen, P.T. (2009). Lipoprotein modification by secretory phospholipase A2 enzymes contributes to the initiation and progression of atherosclerosis. Curr Opin Lipidol 20, 421–427.
Peters, R.J.G., Kok, W.E.M., Havenith, M.G., Rijsterborgh, H., van der Wal, A.C., and Visser, C.A. (1994). Histopathologic validation of intracoronary ultrasound imaging. J Am Soc Echocard 7, 230–241.
Ridker, P.M. (2007). C-reactive protein and the prediction of cardiovascular events among those at intermediate risk: Moving an inflammatory hypothesis toward consensus. J Am Coll Cardiol 49, 2129–2138.
Roffi, M., Patrono, C., Collet, J.P., Mueller, C., Valgimigli, M., Andreotti, F., Bax, J.J., Borger, M.A., Brotons, C., Chew, D.P., et al. (2016). 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 37, 267–315.
Sorensen, G.L., Madsen, J., Kejling, K., Tornoe, I., Nielsen, O., Townsend, P., Poulain, F., Nielsen, C.H., Reid, K.B.M., Hawgood, S., et al. (2006). Surfactant protein D is proatherogenic in mice. Am J Physiol Heart Circ Physiol 290, H2286–H2294.
Stone, G.W., Maehara, A., Lansky, A.J., de Bruyne, B., Cristea, E., Mintz, G.S., Mehran, R., McPherson, J., Farhat, N., Marso, S.P., et al. (2011). A prospective natural-history study of coronary atherosclerosis. N Engl J Med 364, 226–235.
Virmani, R., Burke, A.P., Farb, A., and Kolodgie, F.D. (2006). Pathology of the vulnerable plaque. J Am Coll Cardiol 47, C13–C18.
Virmani, R., Kolodgie, F.D., Burke, A.P., Farb, A., and Schwartz, S.M. (2000). Lessons from sudden coronary death. Arterioscler Thromb Vasc Biol 20, 1262–1275.
Wang, L., Hu, X.B., Zhang, W., Wu, L.D., Liu, Y.S., Hu, B., Bi, C.L., Chen, Y.F., Liu, X.X., Ge, C., et al. (2013). Dickkopf-1 as a novel predictor is associated with risk stratification by GRACE risk scores for predictive value in patients with acute coronary syndrome: a retrospective research. PLoS ONE 8, e54731.
Wang, Y., Li, L., Tan, H.W., Yu, G.S., Ma, Z.Y., Zhao, Y.X., and Zhang, Y. (2007). Transcoronary concentration gradient of sCD40L and hsCRP in patients with coronary heart disease. Clin Cardiol 30, 86–91.
Zhang, C., Zhang, M.X., Shen, Y.H., Burks, J.K., Zhang, Y., Wang, J., LeMaire, S.A., Yoshimura, K., Aoki, H., Coselli, J.S., et al. (2007). TNF-α suppresses prolyl-4-hydroxylase α1 expression via the ASK1-JNK-NonO pathway. ATVB 27, 1760–1767.
Zhang, L., Liu, Y., Zhang, P.F., Zhao, Y.X., Ji, X.P., Lu, X.T., Chen, W.Q., Liu, C.X., Zhang, C., and Zhang, Y. (2010b). Peak radial and circumferential strain measured by velocity vector imaging is a novel index for detecting vulnerable plaques in a rabbit model of atherosclerosis. Atherosclerosis 211, 146–152.
Zhang, L., Zhao, J., Su, L., Huang, B., Wang, L., Su, H., Zhang, Y., Zhang, S.L., and Miao, J.Y. (2010a). D609 inhibits progression of preexisting atheroma and promotes lesion stability in apolipoprotein e−/− mice: a role of phosphatidylcholine-specific phospholipase in atherosclerosis. ATVB 30, 411–418.
Zhang, P.F., Su, H.J., Yao, G.H., Wu, W., Zhang, M., Liu, C.X., Jiang, H., Ding, S.F., Zhang, C., Zhao, Y.X., et al. (2009). Plaque volume compression ratio, a novel biomechanical index, is independently associated with ischemic cerebrovascular events. J Hypertension 27, 348–356.
Acknowledgements
This work was supported by the Program of Introducing Talents of Discipline to Universities (B07035), the State Key Program of National Natural Science of China (81530014), and the grants of the National Natural Science Foundation of China (81425004, 81770442, 81570324), and the Taishan Scholars Program of Shandong Province, China (Zhang Cheng).
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
The author(s) declare that they have no conflict of interest. This study was conformed with the Helsinki Declaration of 1975 (as revised in 2008) concerning human and animal rights.
Rights and permissions
About this article
Cite this article
Xu, M., Hu, X., Wang, L. et al. Plasma biomarkers and plaque strain predict long-term cardiovascular events in patients with acute coronary syndrome. Sci. China Life Sci. 63, 269–278 (2020). https://doi.org/10.1007/s11427-019-9557-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11427-019-9557-7