Advertisement

Heart and Vessels

, Volume 34, Issue 3, pp 410–418 | Cite as

Interrelationship in the prognostic efficacy of regional coronary flow reserve, fractional flow reserve, high-sensitivity cardiac troponin-I and NT-proBNP in patients with stable coronary artery disease

  • Rikuta Hamaya
  • Taishi Yonetsu
  • Yoshihisa Kanaji
  • Eisuke Usui
  • Masahiro Hoshino
  • Masahiro Hada
  • Yoshinori Kanno
  • Tadashi Murai
  • Tetsumin Lee
  • Tsunekazu KakutaEmail author
Original Article
First Online:

Abstract

This study aimed to investigate the combined efficacy in prediction of major adverse cardiac events (MACE) by coronary regional physiological indices including coronary flow reserve (CFR) or fractional flow reserve (FFR) and high-sensitivity cardiac troponin-I (hs-cTnI) or N-terminal pro brain natriuretic peptide (NT-proBNP). Impaired CFR, decreased FFR, elevated cardiac troponin, and NT-proBNP are all associated with increased MACE, while these interaction or collinearity remains uncertain. The study included 429 patients with stable coronary artery disease (CAD) evaluated hs-cTnI and NT-proBNP levels before regional physiological measurement during coronary angiography. Patients were followed up for MACE including all-cause death, myocardial infarction, hospital admission for heart failure and target vessel remote revascularization. Median hs-cTnI and NT-proBNP values were 4 ng/L and 85 ng/L, respectively. Regional CFR was significantly albeit weakly correlated with hs-cTnI and NT-proBNP, while fractional flow reserve (FFR) was only linked to hs-cTnI. The addition of hs-cTnI and NT-proBNP on clinical backgrounds and angiographic score significantly improved predictive accuracy for MACE incidence, and further consideration of FFR and CFR could refine the model. The combined stratification using hs-cTnI, NT-proBNP, FFR and CFR could efficiently stratify patient risk for MACE. In patients with stable CAD, integrated assessment of cardiac biomarkers and physiological indices could be useful for predicting future cardiovascular events.

Keywords

High-sensitivity cardiac troponin-I N-terminal pro brain natriuretic peptide Coronary flow reserve Fractional flow reserve 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgements

We thank the physicians, nurses, other catheter laboratory staffs, and patients involved in this study.

Funding

No funding was used to support this study.

Compliance with ethical standards

Conflict of interest

All the authors have nothing to declare.

References

  1. 1.
    Taqueti VR, Hachamovitch R, Murthy VL, Naya M, Foster CR, Hainer J, Dorbala S, Blankstein R, Di Carli MF (2015) Global coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity and modifies the effect of early revascularization. Circulation 131:19–27CrossRefGoogle Scholar
  2. 2.
    van de Hoef TP, van Lavieren MA, Damman P, Delewi R, Piek MA, Chamuleau SA, Voskuil M, Henriques JP, Koch KT, de Winter RJ, Spaan JA, Siebes M, Tijssen JG, Meuwissen M, Piek JJ (2014) Physiological basis and long-term clinical outcome of discordance between fractional flow reserve and coronary flow velocity reserve in coronary stenoses of intermediate severity. Circ Cardiovasc Interv 7:301–311CrossRefGoogle Scholar
  3. 3.
    Ndrepepa G, Braun S, Schulz S, Fusaro M, Keta D, Pache J, Seyfarth M, Mehilli J, Schomig A, Kastrati A (2011) Sensitive troponin and N-terminal probrain natriuretic peptide in stable angina. Eur J Clin Invest 41:1054–1062CrossRefGoogle Scholar
  4. 4.
    Roos A, Bandstein N, Lundback M, Hammarsten O, Ljung R, Holzmann MJ (2017) Stable high-sensitivity cardiac troponin T levels and outcomes in patients with chest pain. J Am Coll Cardiol 70:2226–2236CrossRefGoogle Scholar
  5. 5.
    Kragelund C, Gronning B, Kober L, Hildebrandt P, Steffensen R (2005) N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med 352:666–675CrossRefGoogle Scholar
  6. 6.
    Taqueti VR, Everett BM, Murthy VL, Gaber M, Foster CR, Hainer J, Blankstein R, Dorbala S, Di Carli MF (2015) Interaction of impaired coronary flow reserve and cardiomyocyte injury on adverse cardiovascular outcomes in patients without overt coronary artery disease. Circulation 131:528–535CrossRefGoogle Scholar
  7. 7.
    Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, Garg S, Huber K, James S, Knuuti J, Lopez-Sendon J, Marco J, Menicanti L, Ostojic M, Piepoli MF, Pirlet C, Pomar JL, Reifart N, Ribichini FL, Schalij MJ, Sergeant P, Serruys PW, Silber S, Sousa Uva M, Taggart D (2010) Guidelines on myocardial revascularization. Eur Heart J 31:2501–2555CrossRefGoogle Scholar
  8. 8.
    Klinkenberg LJ, van Dijk JW, Tan FE, van Loon LJ, van Dieijen-Visser MP, Meex SJ (2014) Circulating cardiac troponin T exhibits a diurnal rhythm. J Am Coll Cardiol 63:1788–1795CrossRefGoogle Scholar
  9. 9.
    Aw TC, Phua SK, Tan SP (2013) Measurement of cardiac troponin I in serum with a new high-sensitivity assay in a large multi-ethnic Asian cohort and the impact of gender. Clin Chim Acta 422:26–28CrossRefGoogle Scholar
  10. 10.
    Pijls NH, De Bruyne B, Smith L, Aarnoudse W, Barbato E, Bartunek J, Bech GJ, Van De Vosse F (2002) Coronary thermodilution to assess flow reserve: validation in humans. Circulation 105:2482–2486CrossRefGoogle Scholar
  11. 11.
    Petersen JW, Pepine CJ (2015) Microvascular coronary dysfunction and ischemic heart disease: where are we in 2014? Trends Cardiovasc Med 25:98–103CrossRefGoogle Scholar
  12. 12.
    Ndrepepa G, Braun S, Mehilli J, Birkmeier KA, Byrne RA, Ott I, Hosl K, Schulz S, Fusaro M, Pache J, Hausleiter J, Laugwitz KL, Massberg S, Seyfarth M, Schomig A, Kastrati A (2011) Prognostic value of sensitive troponin T in patients with stable and unstable angina and undetectable conventional troponin. Am Heart J 161:68–75CrossRefGoogle Scholar
  13. 13.
    Everett BM, Brooks MM, Vlachos HE, Chaitman BR, Frye RL, Bhatt DL (2015) Troponin and cardiac events in stable ischemic heart disease and diabetes. N Engl J Med 373:610–620CrossRefGoogle Scholar
  14. 14.
    deFilippi CR, de Lemos JA, Christenson RH, Gottdiener JS, Kop WJ, Zhan M, Seliger SL (2010) Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults. JAMA 304:2494–2502CrossRefGoogle Scholar
  15. 15.
    Pauriah M, Khan F, Lim TK, Elder DH, Godfrey V, Kennedy G, Belch JJ, Booth NA, Struthers AD, Lang CC (2012) B-type natriuretic peptide is an independent predictor of endothelial function in man. Clin Sci (Lond) 123:307–312CrossRefGoogle Scholar
  16. 16.
    Rubattu S, Sciarretta S, Valenti V, Stanzione R, Volpe M (2008) Natriuretic peptides: an update on bioactivity, potential therapeutic use, and implication in cardiovascular diseases. Am J Hypertens 21:733–741CrossRefGoogle Scholar
  17. 17.
    Barbato E, Aarnoudse W, Aengevaeren WR, Werner G, Klauss V, Bojara W, Herzfeld I, Oldroyd KG, Pijls NH, De Bruyne B (2004) Validation of coronary flow reserve measurements by thermodilution in clinical practice. Eur Heart J 25:219–223CrossRefGoogle Scholar
  18. 18.
    Blankenberg S, Zeller T, Saarela O, Havulinna AS, Kee F, Tunstall-Pedoe H, Kuulasmaa K, Yarnell J, Schnabel RB, Wild PS, Munzel TF, Lackner KJ, Tiret L, Evans A, Salomaa V (2010) Contribution of 30 biomarkers to 10-year cardiovascular risk estimation in 2 population cohorts: the MONICA, risk, genetics, archiving, and monograph (MORGAM) biomarker project. Circulation 121:2388–2397CrossRefGoogle Scholar
  19. 19.
    Caselli C, Prontera C, Liga R, De Graaf MA, Gaemperli O, Lorenzoni V, Ragusa R, Marinelli M, Del Ry S, Rovai D, Giannessi D, Aguade-Bruix S, Clemente A, Bax JJ, Lombardi M, Sicari R, Zamorano J, Scholte AJ, Kaufmann PA, Knuuti J, Underwood SR, Clerico A, Neglia D (2016) Effect of coronary atherosclerosis and myocardial ischemia on plasma levels of high-sensitivity troponin T and NT-proBNP in patients with stable angina. Arterioscler Thromb Vasc Biol 36:757–764CrossRefGoogle Scholar
  20. 20.
    Guethlin M, Kasel AM, Coppenrath K, Ziegler S, Delius W, Schwaiger M (1999) Delayed response of myocardial flow reserve to lipid-lowering therapy with fluvastatin. Circulation 99:475–481CrossRefGoogle Scholar
  21. 21.
    Fujii K, Kawasaki D, Oka K, Akahori H, Iwasaku T, Fukunaga M, Eguchi A, Sawada H, Masutani M, Lee-Kawabata M, Tsujino T, Ohyanagi M, Masuyama T (2011) The impact of pravastatin pre-treatment on periprocedural microcirculatory damage in patients undergoing percutaneous coronary intervention. JACC Cardiovasc Interv 4:513–520CrossRefGoogle Scholar
  22. 22.
    Ford I, Shah AS, Zhang R, McAllister DA, Strachan FE, Caslake M, Newby DE, Packard CJ, Mills NL (2016) High-sensitivity cardiac troponin, statin therapy, and risk of coronary heart disease. J Am Coll Cardiol 68:2719–2728CrossRefGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Rikuta Hamaya
    • 1
  • Taishi Yonetsu
    • 1
  • Yoshihisa Kanaji
    • 1
  • Eisuke Usui
    • 1
  • Masahiro Hoshino
    • 1
  • Masahiro Hada
    • 1
  • Yoshinori Kanno
    • 1
  • Tadashi Murai
    • 1
  • Tetsumin Lee
    • 1
  • Tsunekazu Kakuta
    • 1
    Email author
  1. 1.Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiura cityJapan

Personalised recommendations

Cite article

Buy options