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Abstract: Background: The presence of effort induced angina, positive exercise stress test responses and angiographically normal coronary arteries defines cardiac syndrome X (CSX). Its pathogenesis, although mostly attributed to endothelial dysfunction and coronary microcirculation abnormalities, is incompletely understood. The soluble CD40 ligand (sCD40L) has multiple autocrine, paracrine and endocrine actions that may lead to endothelial dysfunction and atherothrombosis. We sought to investigate the relationship among sCD40L levels and ischemic burden in patients with CSX and whether sCD40L levels are increased in patients with CSX compared to control subjects. Methods: We assessed 30 prospectively enrolled patients with CSX and 28 apparently healthy subjects matched for coronary risk factors. All CSX patients and control subjects underwent myocardial perfusion scintigraphy. The summed difference score is taken to be an index of ischemic burden. This was classified as mildly, moderately and severely abnormal. White blood cells, sCD40L and C-reactive protein (CRP) concentrations were measured at peak exercise. Results: At peak exercise, sCD40L levels were significantly greater in CSX patients than in the control group (P =0.008). Similarly, white blood cell count and CRP levels were higher in patients with CSX than in normal controls (P =0.02). After multivariable adjustment, sCD40L (P =0.03) was the only independent predictor of severe ischemic burden in CSX patients. Conclusions: The present study showed for the first time that sCD40L is associated with ischemic burden in patients with CSX. The potential role of this inflammatory molecule in the pathogenesis of CSX deserves investigation in future studies. [ABSTRACT FROM AUTHOR]

Abstract: Background: Left ventricle remodeling (LVR) is a relatively common and unfavourable event occurring after acute myocardial infarction. A link exists between inflammation and LVR. Neopterin, a marker of inflammation and macrophage activation, is a predictor of left ventricular dysfunction in patients with coronary artery disease. We therefore sought to assess whether both neopterin and brain natriuretic peptide (BNP), a marker of LV dysfunction and patient outcome, correlate with LVR in patients with ST-segment elevation myocardial infarction (STEMI). Methods: We prospectively assessed 108 STEMI patients (age 64±11 years; 85% male) undergoing primary percutaneous coronary intervention (PCI) who were assessed echocardiographycally assessment was performed at 96±10h after the onset of symptoms and 12month after STEMI. LVR was defined as >20% increase in LV end-diastolic volume at 12months of follow-up compared to baseline. Neopterin and BNP serum concentrations were measured immediately before primary PCI. Results: At 1 year, 21 patients (19%) showed LVR and 87 (81%) had no LVR. Patients with LVR had higher levels of neopterin at study entry (7.45±1.04 vs 5.19±1.39nmol/L; p <0.001). After adjustment for relevant confounders, neopterin levels were found to be an independent predictor of LVR (OR ranging from [3.10, CI 95% 1.928–4.990, p <0.001] to [3.32, CI 95% 1.999–5.532, p <0.001]). ROC analysis showed an area under the curve of 0.901 for neopterin (CI 95% 0.84–0.96, p <0.0001) compared to 0.579 for BNP (CI 95% 0.409–0.748) regarding LVR. Conclusions: In STEMI patients undergoing primary PCI, high neopterin levels – but not BNP – predict LVR at 1-year follow-up. [ABSTRACT FROM AUTHOR]