The relation of autonomic biomarkers to the patient's outcome with acute coronary syndrome
DOI:
https://doi.org/10.22317/jcms.v9i1.1264Keywords:
Autonomic biomarkers, Chromogranin A, Plasma and RBC Cholinesterase activity, Acute coronary syndromeAbstract
Objectives: This study aimed to evaluate the neurohormonal activity in patients with acute coronary syndrome and their relation to clinical outcomes by measuring plasma chromogranin A and plasma and RBC cholinesterase activity.
Methods: In this case-control study, cardiac and neurohormonal parameters were compared between fifty-one patients with acute coronary syndrome admitted to the cardiac center in Azadi teaching Hospital in Duhok-Iraq, and thirty comparable gender and age-healthy subjects.
Results: A significant increase in sympathetic activity was reported in patients with the acute coronary syndrome, reflected by the rise in the plasma chromogranin A compared to the control group (994.47 vs. 1203.95 ng/L, respectively, P<0.05). Meanwhile, cardiac troponin was significantly elevated in those patients compared to healthy subjects (0.17 vs. 4.82 ng/ml, respectively). However, the parasympathetic biomarkers (plasma and RBC cholinesterase activity) did not differ substantially between patients and healthy controls (0.83 vs. 0.92, P > 0.05 and 1.36 vs. 1.37, P>0.05, respectively). Serum troponin I was more valid than chromogranin A in differentiating acute coronary syndrome from healthy subjects. The area under the curve for troponin I was (0.989) compared to ( 0.724) for chromogranin A. Furthermore, plasma chromogranin A but not plasma and RBC cholinesterase activity was significantly increased in fatal cases compared to nonfatal patients (1166.68 vs. 3435.64 ng/L).
Conclusion: Plasma chromogranin A was less effective than troponin I in detecting acute coronary cases; however, it can be helpful as a prognostic marker in those patients. Parasympathetic biomarkers were not appreciable in diagnosing and detecting risky patients.
References
Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe 2014: epidemiological update. European heart journal. 2014;35(42):2950-9.
Jiang W, Chen C, Huo J, Lu D, Jiang Z, Geng J, et al. Comparison between renal denervation and metoprolol on the susceptibility of ventricular arrhythmias in rats with myocardial infarction. Scientific reports. 2018;8(1):10206.
Bueno HJEC. Epidemiology of acute coronary syndromes. ESC CardioMed. 2018.
Pagidipati NJ, Peterson ED. Acute coronary syndromes in women and men. Nature reviews Cardiology. 2016;13(8):471-80.
Garg P, Morris P, Fazlanie AL, Vijayan S, Dancso B, Dastidar AG, et al. Cardiac biomarkers of acute coronary syndrome: from history to high-sensitivity cardiac troponin. Internal and emergency medicine. 2017;12(2):147-55.
Katus H, Ziegler A, Ekinci O, Giannitsis E, Stough WG, Achenbach S, et al. Early diagnosis of acute coronary syndrome. European heart journal. 2017;38(41):3049-55.
Yilmaz AS, Çinier G, Kahraman F, Çetin M, Çirakoglu ÖFJJoARiM. The PR Interval Predicted Major Adverse Cardiovascular Events in Patients with Acute Coronary Syndrome Who Underwent Percutaneous Coronary Intervention: 3 Years Follow-up Results/Primer Perkütan Koroner Girisim Uygulanan Akut Koroner Sendrom Hastalarinda PR Mesafesi Majör Istenmeyen Olaylari Öngörmüstür: 3 Yillik Takip Sonuçlari. Journal of Academic Research in Medicine. 2021;11(3):241-9.
Ardell JL, Rajendran PS, Nier HA, KenKnight BH, Armour JA. Central-peripheral neural network interactions evoked by vagus nerve stimulation: functional consequences on control of cardiac function. American journal of physiology Heart and circulatory physiology. 2015;309(10):H1740-52.
Aço JRLC. Role of the autonomic nervous system in the genesis of cardiac arrhythmias: pathophysiology and therapy implications. 2021.
Fukuda K, Kanazawa H, Aizawa Y, Ardell JL, Shivkumar K. Cardiac innervation and sudden cardiac death. Circulation research. 2015;116(12):2005-19.
Franciosi S, Perry FKG, Roston TM, Armstrong KR, Claydon VE, Sanatani S. The role of the autonomic nervous system in arrhythmias and sudden cardiac death. Autonomic neuroscience : basic & clinical. 2017;205:1-11.
Mosqueda-Garcia R. Evaluation of autonomic failure. Disorders of the autonomic nervous system. London: CRC Press; 2019. p. 25-60.
Goetze JP, Alehagen U, Flyvbjerg A, Rehfeld JF. Making sense of chromogranin A in heart disease. The lancet Diabetes & endocrinology. 2013;1(1):7-8.
Bauer MB, Currie KP. Adrenal Medulla Hormones. In: Litwack G, editor. Hormonal Signaling in Biology and Medicine. United States: Elsevier; 2020. p. 635-53.
Di Comite G, Morganti A. Chromogranin A: a novel factor acting at the cross road between the neuroendocrine and the cardiovascular systems. Journal of hypertension. 2011;29(3):409-14.
Cooper TM, McKinley PS, Seeman TE, Choo TH, Lee S, Sloan RP. Heart rate variability predicts levels of inflammatory markers: Evidence for the vagal anti-inflammatory pathway. Brain, behavior, and immunity. 2015;49:94-100.
Ackland GL, Minto G, Clark M, Whittle J, Stephens RCM, Owen T, et al. Autonomic regulation of systemic inflammation in humans: A multi-center, blinded observational cohort study. Brain, behavior, and immunity. 2018;67:47-53.
Shenhar-Tsarfaty S, Brzezinski RY, Waiskopf N, Finkelstein A, Halkin A, Berliner S, et al. Blood acetylcholinesterase activity is associated with increased 10 year all-cause mortality following coronary angiography. Atherosclerosis. 2020;313:144-9.
Mushtaq G, Greig NH, Khan JA, Kamal MA. Status of acetylcholinesterase and butyrylcholinesterase in Alzheimer's disease and type 2 diabetes mellitus. CNS & neurological disorders drug targets. 2014;13(8):1432-9.
Arbel Y, Shenhar-Tsarfaty S, Waiskopf N, Finkelstein A, Halkin A, Revivo M, et al. Decline in serum cholinesterase activities predicts 2-year major adverse cardiac events. Molecular medicine (Cambridge, Mass). 2014;20(1):38-45.
Calderon-Margalit R, Adler B, Abramson JH, Gofin J, Kark JD. Butyrylcholinesterase activity, cardiovascular risk factors, and mortality in middle-aged and elderly men and women in Jerusalem. Clinical chemistry. 2006;52(5):845-52.
Goliasch G, Haschemi A, Marculescu R, Endler G, Maurer G, Wagner O, et al. Butyrylcholinesterase activity predicts long-term survival in patients with coronary artery disease. Clinical chemistry. 2012;58(6):1055-8.
Shen MJ, Zipes DP. Role of the autonomic nervous system in modulating cardiac arrhythmias. Circulation research. 2014;114(6):1004-21.
De Ferrari GM, Vanoli E, Stramba-Badiale M, Hull SS, Jr., Foreman RD, Schwartz PJ. Vagal reflexes and survival during acute myocardial ischemia in conscious dogs with healed myocardial infarction. The American journal of physiology. 1991;261(1 Pt 2):H63-9.
Heusch G. Vagal Cardioprotection in Reperfused Acute Myocardial Infarction. JACC Cardiovascular interventions. 2017;10(15):1521-2.
Mohammad FK, Faris GA, al-Kassim NA. A modified electrometric method for measurement of erythrocyte acetylcholinesterase activity in sheep. Veterinary and human toxicology. 1997;39(6):337-9.
Mohammad FK, Alias AS, Ahmed OA. Electrometric measurement of plasma, erythrocyte, and whole blood cholinesterase activities in healthy human volunteers. Journal of medical toxicology : official journal of the American College of Medical Toxicology. 2007;3(1):25-30.
Ricci B, Cenko E, Vasiljevic Z, Stankovic G, Kedev S, Kalpak O, et al. Acute Coronary Syndrome: The Risk to Young Women. Journal of the American Heart Association. 2017;6(12).
Mohammad AM, Rashad HH, Habeeb QS, Rashad BH, Saeed SY. Demographic, clinical and angiographic profile of coronary artery disease in kurdistan region of Iraq. American journal of cardiovascular disease. 2021;11(1):39-45.
Huffman MD, Mohanan PP, Devarajan R, Baldridge AS, Kondal D, Zhao L, et al. Effect of a Quality Improvement Intervention on Clinical Outcomes in Patients in India With Acute Myocardial Infarction: The ACS QUIK Randomized Clinical Trial. Jama. 2018;319(6):567-78.
Nowbar AN, Gitto M, Howard JP, Francis DP, Al-Lamee R. Mortality From Ischemic Heart Disease. Circulation Cardiovascular quality and outcomes. 2019;12(6):e005375.
Bhatt DL, Lopes RD, Harrington RA. Diagnosis and Treatment of Acute Coronary Syndromes: A Review. Jama. 2022;327(7):662-75.
Alkhouli M, Alqahtani F, Jneid H, Al Hajji M, Boubas W, Lerman A. Age-Stratified Sex-Related Differences in the Incidence, Management, and Outcomes of Acute Myocardial Infarction. Mayo Clinic proceedings. 2021;96(2):332-41.
Ralapanawa U, Kumarasiri PVR, Jayawickreme KP, Kumarihamy P, Wijeratne Y, Ekanayake M, et al. Epidemiology and risk factors of patients with types of acute coronary syndrome presenting to a tertiary care hospital in Sri Lanka. BMC cardiovascular disorders. 2019;19(1):1-9.
Wahrenberg A, Kuja-Halkola R, Magnusson PKE, Häbel H, Warnqvist A, Hambraeus K, et al. Cardiovascular Family History Increases the Risk of Disease Recurrence After a First Myocardial Infarction. Journal of the American Heart Association. 2021;10(23):e022264.
Cheema FM, Cheema HM, Akram Z. Identification of risk factors of acute coronary syndrome in young patients between 18-40 years of age at a teaching hospital. Pakistan journal of medical sciences. 2020;36(4):821-4.
Wibring K, Herlitz J, Christensson L, Lingman M, Bång A. Prehospital factors associated with an acute life-threatening condition in non-traumatic chest pain patients - A systematic review. International journal of cardiology. 2016;219:373-9.
Sedighi SM, Nguyen M, Khalil A, Fülöp T. The impact of cardiac troponin in elderly patients in the absence of acute coronary syndrome: A systematic review. International journal of cardiology Heart & vasculature. 2020;31:100629.
Eggers KM, Lindahl B. Prognostic Biomarkers in Acute Coronary Syndromes: Risk Stratification Beyond Cardiac Troponins. Current cardiology reports. 2017;19(4):29.
Dang H, Li J, Liu C, Xu F. Chromogranin A provides additional prognostic information in children with severe hand, foot, and mouth disease: A prospective observational study. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2020;93:367-74.
Dev NB, Gayen JR, O'Connor DT, Mahata SK. Chromogranin a and the autonomic system: decomposition of heart rate variability and rescue by its catestatin fragment. Endocrinology. 2010;151(6):2760-8.
Capellino S, Lowin T, Angele P, Falk W, Grifka J, Straub RH. Increased chromogranin A levels indicate sympathetic hyperactivity in patients with rheumatoid arthritis and systemic lupus erythematosus. The Journal of rheumatology. 2008;35(1):91-9.
Jansson AM, Røsjø H, Omland T, Karlsson T, Hartford M, Flyvbjerg A, et al. Prognostic value of circulating chromogranin A levels in acute coronary syndromes. European heart journal. 2009;30(1):25-32.
Corti A, Marcucci F, Bachetti T. Circulating chromogranin A and its fragments as diagnostic and prognostic disease markers. Pflugers Archiv : European journal of physiology. 2018;470(1):199-210.
Goetze JP, Alehagen U, Flyvbjerg A, Rehfeld JF. Chromogranin A as a biomarker in cardiovascular disease. Biomarkers in medicine. 2014;8(1):133-40.
Angelone T, Mazza R, Cerra MC. Chromogranin-A: a multifaceted cardiovascular role in health and disease. Current medicinal chemistry. 2012;19(24):4042-50.
Mahata SK, Corti A. Chromogranin A and its fragments in cardiovascular, immunometabolic, and cancer regulation. Annals of the New York Academy of Sciences. 2019;1455(1):34-58.
Ji L, Pei ZQ, Ma DF, Zhang J, Su JS, Gao XD, et al. [Prognostic value of circulating catestatin levels for in-hospital heart failure in patients with acute myocardial infarction]. Zhonghua xin xue guan bing za zhi. 2012;40(11):914-9.
Jeske W, Glinicki P. Prognostic value of circulating chromogranin A levels in acute coronary syndrome. European heart journal. 2010;31(1):128; author reply -9.
ABDULLAH QH, SHAIKHO SK, ALI IHJDMJ. ROLE OF CHROMOGRANIN A IN THE ASSESSMENT OF SYMPATHETIC ACTIVITY IN ACUTE MYOCARDIAL INFARCTION. Duhok Medical Journal. 2011;5(2).
Tota B, Angelone T, Cerra MC. The surging role of Chromogranin A in cardiovascular homeostasis. Frontiers in chemistry. 2014;2:64.
Herlitz J, Thuresson M, Svensson L, Lindqvist J, Lindahl B, Zedigh C, et al. Factors of importance for patients' decision time in acute coronary syndrome. International journal of cardiology. 2010;141(3):236-42.
Pieroni M, Corti A, Tota B, Curnis F, Angelone T, Colombo B, et al. Myocardial production of chromogranin A in human heart: a new regulatory peptide of cardiac function. European heart journal. 2007;28(9):1117-27.
Gallo MP, Levi R, Ramella R, Brero A, Boero O, Tota B, et al. Endothelium-derived nitric oxide mediates the antiadrenergic effect of human vasostatin-1 in rat ventricular myocardium. American journal of physiology Heart and circulatory physiology. 2007;292(6):H2906-12.
Hsu CH, Reyes LF, Orihuela CJ, Buitrago R, Anzueto A, Soni NJ, et al. Chromogranin A levels and mortality in patients with severe sepsis. Biomarkers : biochemical indicators of exposure, response, and susceptibility to chemicals. 2015;20(3):171-6.
D'Amico M A, Ghinassi B, Izzicupo P, Manzoli L, Di Baldassarre A. Biological function and clinical relevance of chromogranin A and derived peptides. Endocrine connections. 2014;3(2):R45-54.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Journal of Contemporary Medical Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
