TY - JOUR
T1 - Clinical differences between total PAPP-A and measurements specific for the products of free PAPP-A activity in patients with stable cardiovascular disease
AU - Schulz, Olaf
AU - Postnikov, Alexander B.
AU - Smolyanova, Tatiana I.
AU - Katrukha, Alexey G.
AU - Schimke, Ingolf
AU - Jaffe, Allan S.
PY - 2014/2
Y1 - 2014/2
N2 - Objectives: We have previously reported that increases in total pregnancy-associated plasma protein-A (PAPP-A) which are thought to be indicative of vulnerable plaques and thus poor outcomes predict outcomes in patients with stable coronary artery disease. We hypothesized that the determination of CT- and NT-fragments of insulin-like growth factor binding protein 4 (CT- and NT-IGFBP4) which should be indicative of free PAPP-A would result in better performance. Methods: In 229 stable cardiovascular patients with indication for heart catheterization after performance of a stress test and an echocardiogram, CT- and NT-IGFBP4 were measured. Their values were investigated in relation to clinical characteristics, findings of noninvasive investigations, laboratory data and coronary angiography as well as to outcomes after a follow-up of 1094. ±. 307. days. Results: CT-IGFBP4 values were independently predicted by patients with B-type (p. =. 0.0069) or complex coronary lesions (p. =. 0.0445). B-type and vulnerable coronary lesions were independently predicted by levels of CT-IGFBP4. ≥. a cutoff of 31.55. ng/mL derived from ROC analysis (p. =. 0.0090 and 0.0480). NT-IGFBP4 was not predictive of coronary characteristics. Both IGFBP4 fragments were strongly dependent on age and renal function and were not predictive of outcomes. Conclusion: Despite the relation of CT-IGFBP4 to a more severe coronary artery disease, CT- and NT-IGFBP4, in contrast to our report based on total PAPP-A, failed to predict any long-term outcomes in patients with stable cardiovascular disease. Further knowledge about the interaction of the PAPP-A-insulin-like growth factor system is needed to explain values of IGFBP4 fragments in these patients.
AB - Objectives: We have previously reported that increases in total pregnancy-associated plasma protein-A (PAPP-A) which are thought to be indicative of vulnerable plaques and thus poor outcomes predict outcomes in patients with stable coronary artery disease. We hypothesized that the determination of CT- and NT-fragments of insulin-like growth factor binding protein 4 (CT- and NT-IGFBP4) which should be indicative of free PAPP-A would result in better performance. Methods: In 229 stable cardiovascular patients with indication for heart catheterization after performance of a stress test and an echocardiogram, CT- and NT-IGFBP4 were measured. Their values were investigated in relation to clinical characteristics, findings of noninvasive investigations, laboratory data and coronary angiography as well as to outcomes after a follow-up of 1094. ±. 307. days. Results: CT-IGFBP4 values were independently predicted by patients with B-type (p. =. 0.0069) or complex coronary lesions (p. =. 0.0445). B-type and vulnerable coronary lesions were independently predicted by levels of CT-IGFBP4. ≥. a cutoff of 31.55. ng/mL derived from ROC analysis (p. =. 0.0090 and 0.0480). NT-IGFBP4 was not predictive of coronary characteristics. Both IGFBP4 fragments were strongly dependent on age and renal function and were not predictive of outcomes. Conclusion: Despite the relation of CT-IGFBP4 to a more severe coronary artery disease, CT- and NT-IGFBP4, in contrast to our report based on total PAPP-A, failed to predict any long-term outcomes in patients with stable cardiovascular disease. Further knowledge about the interaction of the PAPP-A-insulin-like growth factor system is needed to explain values of IGFBP4 fragments in these patients.
KW - IGF fragments
KW - PAPP-A
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U2 - 10.1016/j.clinbiochem.2013.10.027
DO - 10.1016/j.clinbiochem.2013.10.027
M3 - Article
C2 - 24201068
AN - SCOPUS:84893766007
SN - 0009-9120
VL - 47
SP - 177
EP - 183
JO - Clinical Biochemistry
JF - Clinical Biochemistry
IS - 3
ER -