Impact of soluble fms-like tyrosine kinase-1 and placental growth factor serum levels for risk stratification and early diagnosis in patients with suspected acute myocardial infarction
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Impact of soluble fms-like tyrosine kinase-1 and placental growth factor serum levels for risk stratification and early diagnosis in patients with suspected acute myocardial infarction. / Hochholzer, Willibald; Reichlin, Tobias; Stelzig, Claudia; Hochholzer, Kirsten; Meissner, Julia; Breidthardt, Tobias; Reiter, Miriam; Duehsler, Bettina; Freidank, Heike; Winkler, Katrin; Twerenbold, Raphael; Mueller, Christian.
in: EUR HEART J, Jahrgang 32, Nr. 3, 02.2011, S. 326-35.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Impact of soluble fms-like tyrosine kinase-1 and placental growth factor serum levels for risk stratification and early diagnosis in patients with suspected acute myocardial infarction
AU - Hochholzer, Willibald
AU - Reichlin, Tobias
AU - Stelzig, Claudia
AU - Hochholzer, Kirsten
AU - Meissner, Julia
AU - Breidthardt, Tobias
AU - Reiter, Miriam
AU - Duehsler, Bettina
AU - Freidank, Heike
AU - Winkler, Katrin
AU - Twerenbold, Raphael
AU - Mueller, Christian
PY - 2011/2
Y1 - 2011/2
N2 - AIMS: Angiogenic factors play an important role in the development of atherosclerosis and show pronounced changes during acute myocardial infarction (AMI). We analysed the impact of placental growth factor (PlGF) and its endogen opponent, soluble fms-like tyrosine kinase-1 (sFlt-1), on clinical outcome and the early diagnosis of AMI.METHODS AND RESULTS: This multicentre study enrolled patients presenting with symptoms suggestive of AMI. The final diagnosis was adjudicated by two independent physicians. Levels of sFlt-1 and PlGF were compared with results of a standard troponin T and a novel high-sensitive troponin (hsTnT) assay. Of the 763 patients enrolled, 132 were diagnosed with AMI. Multivariable Cox regression analysis demonstrated sFlt-1 >84 ng/L [hazard ratios (HR) 2.6, 95% confidence intervals (CI) 1.2-5.4, P=0.01] and PlGF >20 ng/L (HR 3.6, 95% CI 1.3-10.4, P=0.02) as predictors for mortality during 1-year follow-up, independent from information provided by troponin T and N-terminal pro-B-type natriuretic peptide (NT-proBNP). However, only sFlt-1 persisted as independent predictor for mortality when analysed together with hsTnT and NT-proBNP, and after adjusting for significant clinical parameters. For the diagnosis of AMI, the combination of troponin T and sFlt-1 improved the performance of troponin T alone and led to a negative predictive value of 98.3% already at time of presentation. However, sFlt-1 and PlGF added only limited diagnostic information when used together with hsTnT.CONCLUSION: Only sFlt-1 but not PlGF provides overall independent prognostic information in patients presenting with symptoms suggestive of AMI. After the introduction of hsTnT in clinical routine, sFlt-1 and PlGF can only add limited diagnostic information for the detection or exclusion of AMI.CLINICAL TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov, NCT00470587.
AB - AIMS: Angiogenic factors play an important role in the development of atherosclerosis and show pronounced changes during acute myocardial infarction (AMI). We analysed the impact of placental growth factor (PlGF) and its endogen opponent, soluble fms-like tyrosine kinase-1 (sFlt-1), on clinical outcome and the early diagnosis of AMI.METHODS AND RESULTS: This multicentre study enrolled patients presenting with symptoms suggestive of AMI. The final diagnosis was adjudicated by two independent physicians. Levels of sFlt-1 and PlGF were compared with results of a standard troponin T and a novel high-sensitive troponin (hsTnT) assay. Of the 763 patients enrolled, 132 were diagnosed with AMI. Multivariable Cox regression analysis demonstrated sFlt-1 >84 ng/L [hazard ratios (HR) 2.6, 95% confidence intervals (CI) 1.2-5.4, P=0.01] and PlGF >20 ng/L (HR 3.6, 95% CI 1.3-10.4, P=0.02) as predictors for mortality during 1-year follow-up, independent from information provided by troponin T and N-terminal pro-B-type natriuretic peptide (NT-proBNP). However, only sFlt-1 persisted as independent predictor for mortality when analysed together with hsTnT and NT-proBNP, and after adjusting for significant clinical parameters. For the diagnosis of AMI, the combination of troponin T and sFlt-1 improved the performance of troponin T alone and led to a negative predictive value of 98.3% already at time of presentation. However, sFlt-1 and PlGF added only limited diagnostic information when used together with hsTnT.CONCLUSION: Only sFlt-1 but not PlGF provides overall independent prognostic information in patients presenting with symptoms suggestive of AMI. After the introduction of hsTnT in clinical routine, sFlt-1 and PlGF can only add limited diagnostic information for the detection or exclusion of AMI.CLINICAL TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov, NCT00470587.
KW - Adult
KW - Aged
KW - Biomarkers/metabolism
KW - Early Diagnosis
KW - Humans
KW - Middle Aged
KW - Myocardial Infarction/diagnosis
KW - Placenta Growth Factor
KW - Pregnancy Proteins/metabolism
KW - Prospective Studies
KW - ROC Curve
KW - Risk Assessment
KW - Risk Factors
KW - Vascular Endothelial Growth Factor Receptor-1/metabolism
KW - Young Adult
U2 - 10.1093/eurheartj/ehq429
DO - 10.1093/eurheartj/ehq429
M3 - SCORING: Journal article
C2 - 21138939
VL - 32
SP - 326
EP - 335
JO - EUR HEART J
JF - EUR HEART J
SN - 0195-668X
IS - 3
ER -
