Advertisement

Assessment of systemic inflammation and infective pathogen burden in patients with cardiac syndrome X

      Abstract

      Inflammation plays a key role in coronary artery disease (CAD), but whether it is involved in the pathogenesis of syndrome X (SX) is not known. Thus, we assessed the presence of systemic inflammation in patients with SX and its possible relation to infections from Helicobacter pylori, Chlamydia pneumoniae, cytomegalovirus, and Epstein-Barr virus. We studied 55 patients with SX (57 ± 8 years old; 27 women), 49 with stable angina and obstructive CAD (56 ± 8 years old; 24 women), and 60 healthy controls (57 ± 11 years old; 24 women). Plasma levels of high-sensitivity C-reactive protein and interleukin-1 receptor antagonist were measured in all patients. Infection from Helicobacter pylori, Chlamydia pneumoniae, cytomegalovirus, and Epstein-Barr virus was assessed in 43 patients with SX, 40 patients with CAD, and in 39 controls. Patients with SX had lower serum levels of C-reactive protein than did patients with CAD (4.06 ± 6.8 vs 5.99 ± 7.8 mg/L, p = 0.013) but higher levels of C-reactive protein than did controls (1.75 ± 1.98 mg/L; p = 0.008). Plasma levels of interleukin-1 receptor antagonist were higher in patients with CAD (570 ± 738 pg/ml) and patients with SX (494 ± 677 pg/ml) than in controls (254 ± 174, pg/ml; p = 0.0003 vs CAD and p = 0.013 vs SX) but did not differ significantly between patients with CAD or SX (p = 0.20). There were no differences across groups in the prevalence of infection from Helicobacter pylori, Chlamydia pneumoniae, cytomegalovirus, and Epstein-Barr virus and in the prevalence of 1, 2, 3, and 4 infections (p = 0.99). Among patients with SX, no correlation was found between markers of inflammation and indexes of disease activity (angina episodes, exercise test results). Our data show evidence of increased low-grade systemic inflammation in patients with cardiac SX, which was unrelated to an increased infectious pathogen burden.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Opherk D
        • Zebe H
        • Weihe E
        • Mall G
        • Durr C
        • Gravert B
        • Mehmel H.C
        • Schwarz F
        • Kubler W
        Reduced coronary dilator capacity and ultrastructural changes of the myocardium in patients with angina pectoris but normal coronary arteriograms.
        Circulation. 1981; 63: 817-825
        • Cannon R.O
        • Epstein S.E
        “Microvascular angina” as a cause of chest pain with angiographically normal coronary arteries.
        Am J Cardiol. 1988; 61: 1338-1343
        • Egashira K
        • Inou T
        • Hirooka Y
        • Yamada A
        • Urabe Y
        • Takeshita A
        Evidence of impaired endothelium-dependent coronary vasodilation in patients with angina pectoris and normal coronary angiograms.
        N Engl J Med. 1993; 328: 1659-1664
        • Chauhan A
        • Mullins P.A
        • Taylor M
        • Petch M.C
        • Schofield P.M
        Both endothelium-dependent and endothelium-independent function is impaired in patients with angina pectoris and normal coronary angiograms.
        Eur Heart J. 1997; 18: 60-68
        • Bottcher M
        • Botker H.E
        • Sonne H
        • Nielsen T.T
        • Czernin J
        Endothelium-dependent and -independent perfusion reserve and the effect of l-arginine on myocardial perfusion in patients with syndrome X.
        Circulation. 1999; 99: 1795-1801
        • Bellamy M.F
        • Goodfellow J
        • Tweddel A.C
        • Dunstan F.D
        • Lewis M.J
        • Henderson A.H
        Syndrome X and endothelial dysfunction.
        Cardiovasc Res. 1998; 40: 410-417
        • Quyyumi A.A
        • Cannon III, R.O
        • Panza J.A
        • Diodati J.G
        • Epstein S.E
        Endothelial dysfunction in patients with chest pain and normal coronary arteries.
        Circulation. 1992; 86: 1864-1871
        • Kaski J.C
        • Elliott P.M
        • Salomone O
        • Dickinson K
        • Gordon D
        • Hann C
        • Holt D.W
        Concentration of circulating plasma endothelin in patients with angina and normal coronary angiograms.
        Br Heart J. 1995; 74: 620-625
        • Lanza G.A
        • Lüscher T.F
        • Pasceri V
        • Shaw S
        • Buffon A
        • Montenero A.S
        • Crea F
        • Maseri A
        Effects of atrial pacing on arterial and coronary sinus endothelin-1 levels in syndrome X.
        Am J Cardiol. 1999; 84: 1187-1191
        • Cox I.D
        • Botker H.E
        • Bagger J.P
        • Sonne H.S
        • Kristensen B.O
        • Kaski J.C
        Elevated endothelin concentrations are associated with reduced coronary vasomotor responses in patients with chest pain and normal coronary arteriograms.
        J Am Coll Cardiol. 1999; 34: 455-460
        • Tousoulis D
        • Davies G.J
        • Asimakopoulos G
        • Homaei H
        • Zouridakis E
        • Ahmed N
        • Kaski J.C
        Vascular cell adhesion molecule-1 and intercellular adhesion molecule-1 serum level in patients with chest pain and normal coronary arteries (syndrome X).
        Clin Cardiol. 2001; 24: 301-304
        • Colin-Sales J
        • Pizzi C
        • Brown S
        • Kaski J.C
        C-reactive protein, clinical presentation and ischemic activity in patients with chest pain and normal coronary angiograms.
        J Am Coll Cardiol. 2003; 41: 1468-1474
        • Patel P
        • Mendall M.A
        • Carrington D
        • Strachan D.P
        • Leatham E
        • Molineaux N
        • Levy J
        • Blakeston C
        • Seymour C.A
        • Camm A.J
        • Northfield T.C
        Association of Helicobacter pylori and Chlamydia pneumoniae infections with coronary heart disease and cardiovascular risk factors.
        BMJ. 1995; 311: 711-714
        • Whincup P.H
        • Mendall M.A
        • Perry I.J
        • Strachan D.P
        • Walker M
        Prospective relations between Helicobacter pylori infection, coronary heart disease, and stroke in middle aged men.
        Heart. 1996; 75: 568-572
        • Pasceri V
        • Cammarota G
        • Patti G
        • Cuoco L
        • Gasbarrini A
        • Grillo R.L
        • Fedeli G
        • Gasbarrini G
        • Maseri A
        Association of virulent Helicobacter pylori strains with ischemic heart disease.
        Circulation. 1998; 97: 1675-1679
        • Davidson M
        • Kuo C.C
        • Middaugh J.P
        • Campbell L.A
        • Wang S.P
        • Newman III, W.P
        • Finley J.C
        • Grayston J.T
        Confirmed previous infection with Chlamydia pneumoniae (TWAR) and its presence in early coronary atherosclerosis.
        Circulation. 1998; 98: 628-633
        • Saikku P
        • Leinonen M
        • Mattila K
        • Ekman M.R
        • Nieminen M.S
        • Makela P.H
        • Huttunen J.K
        • Valtonen V
        Serological evidence of an association of a novel Chlamydia, TWAR, with chronic coronary heart disease and acute myocardial infarction.
        Lancet. 1988; 2: 983-986
        • Zhou Y.F
        • Leon M.B
        • Waclawiw M.A
        • Popma J.J
        • Yu Z.X
        • Finkel T
        • Epstein S.E
        Association between prior cytomegalovirus infection and the risk of restenosis after coronary atherectomy.
        N Engl J Med. 1996; 335: 624-630
        • Nieto F.J
        • Adam E
        • Sorlie P
        • Farzadegan H
        • Melnick J.L
        • Comstock G.W
        • Szklo M
        Cohort study of cytomegalovirus infection as a risk factor for carotid intimal-medial thickening, a measure of subclinical atherosclerosis.
        Circulation. 1996; 94: 922-927
        • Ismail A
        • Khosravi H
        • Olson H
        The role of infection in atherosclerosis and coronary artery disease.
        Heart Dis. 1999; 1: 233-240
        • Shi Y
        • Tokunaga O
        Herpesvirus (HSV-1, EBV and CMV) infections in atherosclerotic compared with non-atherosclerotic aortic tissue.
        Pathol Int. 2002; 52: 31-39
        • Goddard A.F
        • Logan R.P
        Urea breath tests for detecting Helicobacter pylori.
        Aliment Pharmacol Ther. 1997; 11: 641-649
        • Libby P
        • Ridker P.M
        • Maseri A
        Inflammation and atherosclerosis.
        Circulation. 2002; 105: 1135-1143
        • Arroyo-Espliguero R
        • Mollichelli N
        • Avanzas P
        • Emmanouil Z
        • Newey V.R
        • Nassiri D.K
        • Kaski J.C
        Chronic inflammation and increased arterial stiffeness in patients with cardiac syndrome X.
        Eur Heart J. 2003; 24: 2006-2011
        • Fichtlscherer S
        • Rosenberger G
        • Walter D.H
        • Breuer S
        • Dimeler S
        • Zeiher A.M
        Elevated C-reactive protein levels and impaired endothelial vasoreactivity in patients with coronary artery disease.
        Circulation. 2000; 102: 1000-1006