, Volume 40, Issue 3, pp 495–501 | Cite as

Predictive value of plasma asymmetric dimethylarginine, homocysteine, and high-sensitive CRP levels in occult coronary artery disease

A multidetector-row computed tomography study
  • E. Gürel
  • K. Tigen
  • T. Karaahmet
  • Ç. Geçmen
  • B. Mutlu
  • Y. Başaran
e-Herz: Original article



Multidetector-row computed tomography (MDCT) is an attractive noninvasive imaging modality for detecting coronary atherosclerotic plaques, which may be underestimated by conventional angiography. The aim of our study was to determine the predictive value of plasma asymmetric dimethylarginine (ADMA), homocysteine, and high-sensitivity C-reactive protein (hsCRP) levels for occult coronary artery disease (CAD).

Patients and methods

Thirty-five patients with angiographically normal coronary arteries (NCA) were consecutively included in our study. They underwent MDCT including indications and were divided into an NCA group (18 subjects, 8 male, 46 ± 8  years) and an occult CAD group (17 subjects, 11 male, 48 ± 9 years), with respect to the presence of coronary plaque. Plasma ADMA, homocysteine, and hsCRP levels were measured in blood samples.


Plasma ADMA and homocysteine levels of the occult CAD group were significantly higher than those of the NCA group. A nonsignificant trend was observed for higher serum hsCRP levels in the occult CAD group. Receiver operating characteristics analysis revealed that an ADMA level of > 0.71 μmol/l could predict patients with occult CAD (sensitivity, 76 %; specificity, 67 %). The discriminative power of ADMA in distinguishing the occult CAD group from the NCA group was high (area under the curve, 0.80; CI, 0.66–0.95, p = 0.002), while it was not sufficiently high for homocysteine and hsCRP (p > 0.05).


Plasma ADMA is a useful parameter for predicting subclinical atherosclerosis, whereas homocysteine and hsCRP are not, and it may be complementary to the conventional cardiovascular risk factors for the selection of individuals at high risk for CAD before undertaking MDCT procedures in clinical practice.


Coronary artery disease  Computed tomography Atherosclerosis Asymmetric dimethylarginine Risk factors 

Prädiktiver Wert der Plasmawerte für asymmetrisches Dimethylarginin, Homozystein und hochsensitives CRP bei maskierter koronarer Herzkrankheit

Eine Multidetektor-Computertomographie-Studie



Die Multidetektor-Computertomographie (MDCT) ist ein interessantes nichtinvasives bildgebendes Verfahren für die Erkennung koronarer atherosklerotischer Plaques, die bei der herkömmlichen Angiographie unterschätzt werden können. Ziel der vorliegenden Studie war es, den prädiktiven Wert von asymmetrischem Dimethylarginin (ADMA), Homozystein und hochsensitivem C-reaktivem Protein (hsCRP) im Plasma bei maskierter koronarer Herzkrankheit (KHK) zu untersuchen.


In die Studie wurden nacheinander 35 Patienten mit angiographisch normalen Koronararterien (NCA) aufgenommen. Bei ihnen erfolgte bei entsprechender Indikation eine MDCT; sie wurden dann in eine NCA-Gruppe (18 Teilnehmer, 8 Männer, 46 ± 8 Jahre) und eine Gruppe mit maskierter KHK (17 Teilnehmer, 11 Männer, 48 ± 9 Jahre) unterteilt – je nach Vorliegen koronarer Plaques. In Blutproben wurden Plasma-ADMA-, -Homozystein- und -hsCRP-Werte gemessen.


Die Plasmawerte für ADMA und Homozystein waren in der Gruppe mit maskierter KHK signifikant höher als in der Gruppe mit NCA. Eine nichtsignifikante Tendenz zu höheren Serum-hsCRP-Werten wurde bei der Gruppe mit maskierter KHK festgestellt. Anhand der Receiver-operating-characteristics-Analyse zeigte sich, dass ein ADMA-Wert > 0,71 μmol/l die Erkennung von Patienten mit maskierter KHK ermöglichte (Sensitivität: 76 %; Spezifität: 67 %). Die diskriminative Power von ADMA zur Unterscheidung der Gruppe mit maskierter KHK von der NCA-Gruppe war hoch [Fläche unter der Kurve (AUC): 0,80; KI: 0,66–0,95; p = 0,002], nicht ausreichend hoch war sie jedoch für Homozystein und hsCRP (p > 0,05).


Der Plasma-ADMA-Wert ist ein hilfreicher Parameter zur Erkennung einer subklinischen Atherosklerose, während dies für Homozystein und hsCRP nicht gilt, und kann im klinischen Alltag ergänzend zu den herkömmlichen kardiovaskulären Risikofaktoren zur Selektion von Hochrisikopersonen für eine KHK vor einer MDCT-Untersuchung eingesetzt werden.


Koronare Herzkrankheit Computertomographie Atherosklerose Asymmetrischem Dimethylarginin Risikofaktoren 


Compliance with ethical guidelines

Conflict of interest. E. Gürel, K. Tigen, T. Karaahmet, Ç. Geçmen, B. Mutlu, and Y. Başaran state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.


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Copyright information

© Urban & Vogel 2013

Authors and Affiliations

  • E. Gürel
    • 1
  • K. Tigen
    • 2
  • T. Karaahmet
    • 3
  • Ç. Geçmen
    • 4
  • B. Mutlu
    • 2
  • Y. Başaran
    • 2
  1. 1.Department of CardiologyOrdu State HospitalOrduTurkey
  2. 2.Department of CardiologyMarmara University HospitalIstanbulTurkey
  3. 3.Department of CardiologyAcibadem University HospitalIstanbulTurkey
  4. 4.Department of CardiologyKartal Koşuyolu Heart and Research HospitalIstanbulTurkey

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