Interrelationship of interleukin 6, C-reactive protein and Chlamydia pneumoniae IgG antibodies in patients with acute coronary syndromes

Background/Aim. Inflammation due to infection could be associated with the development of acute coronary syndromes, clinical manifestations of ongoing atherosclerosis in vessel walls. Our aim was determine whether interleukin 6, C-reactive protein and Chlamydia pneumoniae IgG antibodies are connected with the development of acute coronary syndromes, to evaluate their interrelationship and to examine whether they are predictive of new events and mortality. Methods. This prospective study included 211 subjects, of whom 111 were patients with acute coronary syndromes (60% male, mean age 59.42 years) and 100 were healthy controls (58% male, mean age 59.03 yuears). Blood samples were taken for analysis on admission, before the application of the therapy. Interleukin 6, high sensitivity C-reactive protein and Chlamydia pneumoniae IgG antibodies were measured, in a follow-up period of 30 days. Results. Levels of interleukin 6 (p < 0.001) and C-reactive protein (p < 0.001) were significantly higher among the patients with acute coronary syndromes than among controls. Chronic infection caused by Chlamydia pneumoniae was present in 72% of patients and in 22% of healthy controls (p < 0.001). There was a correlation between interleukin 6 and C-reactive protein, C-reactive protein and Chlamydia pneumoniae but not between Chlamydia pneumoniae and interleukin 6. Higher levels of interleukin 6 and C-reactive protein were seen with increasing body mass index, smoking exposure, presence of hypertension and diabetes, and decreasing ejection fraction. The patients with ST-segment elevation had higher examined markers than the patients without ST-segment elevation. Interleukin 6 and C-reactive protein were independently related to the clinical outcome. Conclusion. Interleukin 6, C-reactive protein and Chlamydia pneumoniae infection are connected with the development of acute coronary syndromes and may reflect a clinical outcome of the disease

Chronic Exposure to Oral Pathogens and Autoimmune Reactivity in Acute Coronary Atherothrombosis

Background. It has been hypothesized that various infective agents may activate immune reactions as part of the atherosclerotic process. We aimed to investigate the interrelationship between chronic exposure to oral pathogens and immune-inflammatory response in patients with acute coronary atherothrombosis. Patients and Methods. The study included 200 participants from Serbia: 100 patients with acute myocardial infarction (MI), and 100 age- and sex-matched controls. Antibodies to oral anaerobes and aerobes were determined as well as autoantibodies to endothelial cells, beta-2 glycoprotein I, platelet glycoprotein IIb/IIIa and anticardiolipin. Interleukin-6 (IL-6) and C-reactive protein (CRP) were measured. Results. The mean serum antibodies to oral anaerobes tended to be higher among subjects with MI (0.876 ± 0.303 versus 0.685 ± 0.172 OD, P<0.001). Similarly, antibody levels against oral aerobes in patients were significantly different from controls. Antibodies against endothelial cell, beta-2 glycoprotein I, platelet glycoprotein IIb/IIIa, anticardiolipin along with CRP and IL-6 were highly elevated in patients. The levels of antibodies to oral bacteria showed linear correlation with tissue antibodies, CRP and IL-6. Conclusion. Antibody response to chronic oral bacterial infections and host immune response against them may be responsible for the elevation of tissue antibodies and biomarkers of inflammation which are involved in acute coronary thrombosis development

Diagnosis and treatment of cardiac amyloidosis: a position statement of the ESC Working Group on Myocardial and Pericardial Diseases

Cardiac amyloidosis is a serious and progressive infiltrative disease that is caused by the deposition of amyloid fibrils at the cardiac level. It can be due to rare genetic variants in the hereditary forms or as a consequence of acquired conditions. Thanks to advances in imaging techniques and the possibility of achieving a non-invasive diagnosis, we now know that cardiac amyloidosis is a more frequent disease than traditionally considered. In this position paper the Working Group on Myocardial and Pericardial Disease proposes an invasive and non-invasive definition of cardiac amyloidosis, addresses clinical scenarios and situations to suspect the condition and proposes a diagnostic algorithm to aid diagnosis. Furthermore, we also review how to monitor and treat cardiac amyloidosis, in an attempt to bridge the gap between the latest advances in the field and clinical practice

Diagnosis and treatment of cardiac amyloidosis. A position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases

Cardiac amyloidosis is a serious and progressive infiltrative disease that is caused by the deposition of amyloid fibrils at the cardiac level. It can be due to rare genetic variants in the hereditary forms or as a consequence of acquired conditions. Thanks to advances in imaging techniques and the possibility of achieving a non-invasive diagnosis, we now know that cardiac amyloidosis is a more frequent disease than traditionally considered. In this position paper the Working Group on Myocardial and Pericardial Disease proposes an invasive and non-invasive definition of cardiac amyloidosis, addresses clinical scenarios and situations to suspect the condition and proposes a diagnostic algorithm to aid diagnosis. Furthermore, we also review how to monitor and treat cardiac amyloidosis, in an attempt to bridge the gap between the latest advances in the field and clinical practice

Pre-excitation pattern associated with accessory pathway related tachycardia: Case report

Introduction. Pre-excitation is based on an accessory conduction pathway between the atrium and ventricle. The term Wolff- Parkinson-White (WPW) syndrome is used for patients with the pre-excitation/WPW pattern associated with AP-related tachycardia. Case Outline. We present a 52-year-old man with severe palpitation, fatigue, lightheadedness and difficulty breathing. The initial ECG showed tachyarrhythmia with heart rate between 240 and 300/min. He was treated with antiarrhythmics (Digitalis, Verapamil, Lidocaine) with no response. Then, the patient was treated with electrical cardioversion and was referred to our Clinic for further evaluation with the diagnosis: ?Ventricular tachycardia?. During in-hospital stay, the previously undiagnosed WPW pattern had been seen. Additional diagnostic tests confirmed permanent pre-excitacion pattern (ECG Holter recording, exercises test). The patient was referred to an electrophysiologist for further evaluation. Mapping techniques provided an accurate assessment of the position of the accessory pathway which was left lateral. The elimination of the accessory pathway by radiofrequent catheter ablation is highly effective in termination and elimination of tacchyarrhythmias. Conclusion. Symptomatic, life-threatening arrhythmia, first considered as ventricular tachycardia, reflected atrial fibrillation with ventricular pre-excitation over an accessory pathway in a patient with previously undiagnosed WPW syndrome.</jats:p

Interrelationship of interleukin 6, C-reactive protein and Chlamydia pneumoniae IgG antibodies in patients with acute coronary syndromes

Background/Aim. Inflammation due to infection could be associated with the development of acute coronary syndromes, clinical manifestations of ongoing atherosclerosis in vessel walls. Our aim was determine whether interleukin 6, C-reactive protein and Chlamydia pneumoniae IgG antibodies are connected with the development of acute coronary syndromes, to evaluate their interrelationship and to examine whether they are predictive of new events and mortality. Methods. This prospective study included 211 subjects, of whom 111 were patients with acute coronary syndromes (60% male, mean age 59.42 years) and 100 were healthy controls (58% male, mean age 59.03 yuears). Blood samples were taken for analysis on admission, before the application of the therapy. Interleukin 6, high sensitivity C-reactive protein and Chlamydia pneumoniae IgG antibodies were measured, in a follow-up period of 30 days. Results. Levels of interleukin 6 (p &lt; 0.001) and C-reactive protein (p &lt; 0.001) were significantly higher among the patients with acute coronary syndromes than among controls. Chronic infection caused by Chlamydia pneumoniae was present in 72% of patients and in 22% of healthy controls (p &lt; 0.001). There was a correlation between interleukin 6 and C-reactive protein, C-reactive protein and Chlamydia pneumoniae but not between Chlamydia pneumoniae and interleukin 6. Higher levels of interleukin 6 and C-reactive protein were seen with increasing body mass index, smoking exposure, presence of hypertension and diabetes, and decreasing ejection fraction. The patients with ST-segment elevation had higher examined markers than the patients without ST-segment elevation. Interleukin 6 and C-reactive protein were independently related to the clinical outcome. Conclusion. Interleukin 6, C-reactive protein and Chlamydia pneumoniae infection are connected with the development of acute coronary syndromes and may reflect a clinical outcome of the disease.</jats:p

Abstract 367: Antibodies Against Oxidized LDL, ß2 Glycoprotein I and Chlamydia pneumoniae Heat Shock Protein 70 in Acute Coronary Atherothrombosis Development

Background and aims: Atherothrombosis is the major determinant of acute cardiovascular events, such as myocardial infarction. Inflammatory processes have been linked to all phases of atherogenesis. Data suggest that atherosclerosis also constitutes an autoimmune disease. We aimed to investigate the presence of anti oxidized LDL (ox-LDL) antibodies (IgG) and anti beta 2 glycoprotein I antibodies in acute coronary atherothrombosis development. Methods: The study included 206 participants of whom 106 were patients with acute coronary syndromes (ACS), (61.2 ± 3.21 years of age, 62% males) and 100 were age and sex matched controls with no known coronary artery disease. Patients with previous infection were excluded from the study. Blood was sampled, frozen and sent on dry ice to Immunosciences Lab. Inc (USA) for analyses. All traditional risk factors were noted. Anti ox-LDL antibodies (IgG), anti beta 2 glycoprotein I (IgG) antibodies were determined as well as anti Chlamydia pneumoniae heat shock protein (HSP) 70 (IgG) antibodies. Interleukin 6 and C- reactive protein were measured. Results: Our data showed significant prevalence of examined antibodies in patients with ACS: 30% of patients had anti Ox-LDL antibodies (IgG) detectable, 25% had anti beta glycoprotein I antibodies compared to 8% of controls. The total of 31% patients versus 13% of controls had anti Chlamydia pneumoniae HSP 70 (IgG) antibodies detectable, RR 2.36, (1.32-4.28 95% CI for RR, p=0.003) The levels of circulating antibodies were significantly higher in patients (p&lt;0.001). Markers of inflammation differed significantly between the groups. Our data indicated linear correlation between examined antibodies and markers of inflammation. In conclusion, the results of our study suggest that antibodies (IgG) against Ox- LDL, beta 2 glycoprotein I and Chlamydia pneumonia HSP 70 can be detected in patients with acute coronary atherothrombosis. The clinical relevance for circulating autoantibodies in cardiovascular outcomes is still debated. We believe that further research will help to assess if those autoantibodies could improve current cardiovascular risk stratification approaches and therapeutic algorithm, both in primary and secondary prevention.</jats:p