Korean Circulation Journal

  • 제43권3호
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  • Pages.168-173
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  • 2013
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  • 1738-5520(pISSN)
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  • 1738-5555(eISSN)
대한심장학회 (The Korean Society of Cardiology)
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C-Type Natriuretic Peptide as a Surrogate Marker in Variant Angina Pectoris

  • Lee, Dong-Hyeon (Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Youn, Ho-Joong (Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Choi, Yun-Seok (Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Lee, Jong-Min (Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Park, Chul-Soo (Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Jung, Hae-Ok (Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Jeon, Hui-Kyung (Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Lee, Man-Young (Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine)
  • 발행 : 2013.03.30
⟨ 이전 논문 다음 논문 ⟩

초록

Background and Objectives: The purpose of this study was to assess the value of C-type natriuretic peptide (CNP) as a surrogate marker for detection of coronary artery spasm in variant angina pectoris (VAP). Subjects and Methods: Sixty-six patients (mean age: $51{\pm}11$ years, M : F=40 : 26) who underwent coronary angiography on suspicion of angina and who were diagnosed with VAP by the acetylcholine-induced spasm provocation test (SPT) were enrolled and divided into a SPT (-) group (n=23) and a SPT (+) group (n=43). Concentrations of CNP and other markers were determined by immunoassay in both groups. Results: Plasma CNP and creatine kinase myoglobin band (CK-MB) concentrations were significantly increased in the SPT (+) group relative to the SPT (-) group (CNP, $5.268{\pm}1.800pg/mL$ vs. $3.342{\pm}1.150pg/mL$, p=0.002; CK-MB, $2.54{\pm}1.03ng/dL$ vs. $1.86{\pm}0.96ng/dL$, p=0.019, respectively) while plasma high sensitivity C-reactive protein (hs-CRP) and N-terminal pro-brain natriuretic peptide (NT pro-BNP) concentrations were not significantly different between the SPT (-) group and SPT (+) group (hs-CRP, $2.76{\pm}4.99mg/L$ vs. $3.13{\pm}4.88mg/L$, p=0.789; NT pro-BNP, $49{\pm}47pg/mL$ vs. $57{\pm}63pg/mL$, p=0.818, respectively). Plasma CNP concentration was independently associated with the VAP via SPT {odds ratio: 2.014 (95% confidence interval: 1.016-3.992), p=0.045}. A CNP cut-off value of 4.096 pg/mL was found to have a sensitivity of 68.2% and a specificity of 40.0% for predicting the probability of VAP via SPT. Conclusion: Increased plasma CNP concentration in patients with VAP may have an impact on the regulation of endothelial function in accordance with the progression of atherosclerosis. Further analysis is warranted to develop clinical applications of this finding.

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참고문헌

  1. Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med 1959; 27:375-88. https://doi.org/10.1016/0002-9343(59)90003-8
  2. Mayer S, Hillis LD. Prinzmetal's variant angina. Clin Cardiol 1998;21:243-6. https://doi.org/10.1002/clc.4960210403
  3. Hillis LD, Braunwald E. Coronary-artery spasm. N Engl J Med 1978;299:695-702. https://doi.org/10.1056/NEJM197809282991305
  4. Marx JL. Coronary artery spasms and heart disease. Science 1980;208:1127-30. https://doi.org/10.1126/science.6246580
  5. Braunwald E. Coronary artery spasm. Mechanisms and clinical relevance. JAMA 1981;246:1957-9. https://doi.org/10.1001/jama.1981.03320170067037
  6. Yandle TG. Biochemistry of natriuretic peptides. J Intern Med 1994;235:561-76. https://doi.org/10.1111/j.1365-2796.1994.tb01263.x
  7. Komatsu Y, Nakao K, Itoh H, Suga S, Ogawa Y, Imura H. Vascular natriuretic peptide. Lancet 1992;340:622. https://doi.org/10.1016/0140-6736(92)92167-E
  8. Suzuki T, Yamazaki T, Yazaki Y. The role of the natriuretic peptides in the cardiovascular system. Cardiovasc Res 2001;51:489-94. https://doi.org/10.1016/S0008-6363(01)00238-3
  9. Baim DS, Grossman W. Grossman's Cardiac Catheterization, Angiography, and Intervention. 6th ed. Philadelphia: Lippincott Williams & Wilkins;2000. p.247-51.
  10. Okumura K, Yasue H, Horio Y, et al. Multivessel coronary spasm in patients with variant angina: a study with intracoronary injection of acetylcholine. Circulation 1988;77:535-42. https://doi.org/10.1161/01.CIR.77.3.535
  11. Sudoh T, Minamino N, Kangawa K, Matsuo H. C-type natriuretic peptide (CNP): a new member of natriuretic peptide family identified in porcine brain. Biochem Biophys Res Commun 1990;168:863-70. https://doi.org/10.1016/0006-291X(90)92401-K
  12. Ogawa Y, Nakao K, Nakagawa O, et al. Human C-type natriuretic peptide. Characterization of the gene and peptide. Hypertension 1992;19(6 Pt 2):809-13. https://doi.org/10.1161/01.HYP.19.6.809
  13. Kalra PR, Clague JR, Bolger AP, et al. Myocardial production of C-type natriuretic peptide in chronic heart failure. Circulation 2003;107:571-3. https://doi.org/10.1161/01.CIR.0000047280.15244.EB
  14. Del Ry S, Maltinti M, Cabiati M, Emdin M, Giannessi D, Morales MA. Ctype natriuretic peptide and its relation to non-invasive indices of left ventricular function in patients with chronic heart failure. Peptides 2008;29:79-82. https://doi.org/10.1016/j.peptides.2007.10.022
  15. Komatsu Y, Itoh H, Suga S, et al. Regulation of endothelial production of C-type natriuretic peptide in coculture with vascular smooth muscle cells. Role of the vascular natriuretic peptide system in vascular growth inhibition. Circ Res 1996;78:606-14. https://doi.org/10.1161/01.RES.78.4.606
  16. Chun TH, Itoh H, Ogawa Y, et al. Shear stress augments expression of C-type natriuretic peptide and adrenomedullin. Hypertension 1997;29: 1296-302. https://doi.org/10.1161/01.HYP.29.6.1296
  17. Kelsall CJ, Chester AH, Sarathchandra P, Singer DR. Expression and localization of C-type natriuretic peptide in human vascular smooth muscle cells. Vascul Pharmacol 2006;45:368-73. https://doi.org/10.1016/j.vph.2006.06.011
  18. Vlachopoulos C, Ioakeimidis N, Terentes-Printzios D, et al. Amino-terminal pro-C-type natriuretic peptide is associated with arterial stiffness, endothelial function and early atherosclerosis. Atherosclerosis 2010;211:649-55. https://doi.org/10.1016/j.atherosclerosis.2010.03.020
  19. Naruko T, Itoh A, Haze K, et al. C-Type natriuretic peptide and natriuretic peptide receptors are expressed by smooth muscle cells in the neointima after percutaneous coronary intervention. Atherosclerosis 2005;181:241-50. https://doi.org/10.1016/j.atherosclerosis.2005.01.023
  20. Costa MA, Elesgaray R, Caniffi C, Fellet A, Arranz C. Role of cardiovascular nitric oxide system in C-type natriuretic peptide effects. Biochem Biophys Res Commun 2007;359:180-6. https://doi.org/10.1016/j.bbrc.2007.05.095
  21. Palmer SC, Prickett TC, Espiner EA, Yandle TG, Richards AM. Regional release and clearance of C-type natriuretic peptides in the human circulation and relation to cardiac function. Hypertension 2009;54:612-8. https://doi.org/10.1161/HYPERTENSIONAHA.109.135608
  22. Hwang HJ, Chung WB, Park JH, et al. Estimation of coronary flow velocity reserve using transthoracic Doppler echocardiography and cold pressor test might be useful for detecting of patients with variant angina. Echocardiography 2010;27:435-41. https://doi.org/10.1111/j.1540-8175.2009.01038.x
  23. Park CS, Youn HJ, Ihm SH, et al. Relation between peripheral vascular endothelial function and coronary flow reserve in patients with chest pain and normal coronary angiogram. Korean Circ J 2004;34:485-91. https://doi.org/10.4070/kcj.2004.34.5.485
  24. Park CS, Youn HJ, Kim JH, et al. Relation between peripheral vascular endothelial function and coronary flow reserve in patients with chest pain and normal coronary angiogram. Int J Cardiol 2006;113:118-20. https://doi.org/10.1016/j.ijcard.2005.08.018
  25. Egashira K, Inou T, Hirooka Y, Yamada A, Urabe Y, Takeshita A. Evidence of impaired endothelium-dependent coronary vasodilatation in patients with angina pectoris and normal coronary angiograms. N Engl J Med 1993;328:1659-64. https://doi.org/10.1056/NEJM199306103282302
  26. Camici PG, Crea F. Coronary microvascular dysfunction. N Engl J Med 2007;356:830-40. https://doi.org/10.1056/NEJMra061889
  27. Libby P, Ridker PM, Hansson GK. Progress and challenges in translating the biology of atherosclerosis. Nature 2011;473:317-25. https://doi.org/10.1038/nature10146
  28. Kuo JY, Yeh HI, Chang SH, et al. C-type natriuretic peptide in individuals with normal left ventricular systolic function. Scand Cardiovasc J 2007;41:155-9. https://doi.org/10.1080/14017430701302482
  29. Lupattelli G, Marchesi S, Siepi D, et al. Natriuretic peptides levels are related to HDL-cholesterol with no influence on endothelium dependent vasodilatation. Vasa 2006;35:215-20. https://doi.org/10.1024/0301-1526.35.4.215