Bedside-Friendly Prediction for Presence of Post-Myocardial lnfarction Systolic Dysfunction Using Multimarker Panel: Integrating Salivary Diagnostics into Clinical Practice.
10.4070/kcj.2013.43.4.246
- Author:
Ahmadreza ASSAREH
1
;
Habib HAYBAR
;
Hojjat YOOSEFI
;
Mohammadreza BOZORGMANESH
Author Information
1. Cardiovascular Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran. takamoolsk@yahoo.com
- Publication Type:Original Article
- Keywords:
Interleukins;
Transforming growth factor-beta;
Tumor necrosis factor-alpha;
Saliva;
Left ventricular dysfunction
- MeSH:
Biomarkers;
Cytokines;
Humans;
Interleukin-2;
Interleukin-6;
Interleukins;
Logistic Models;
Myocardial Infarction;
Plasma;
Risk Factors;
Saliva;
Transforming Growth Factor beta;
Troponin;
Tumor Necrosis Factor-alpha;
Ventricular Dysfunction, Left
- From:Korean Circulation Journal
2013;43(4):246-254
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND AND OBJECTIVES: We investigated if a combination of plasma or salivary interleukin-2 (IL-2), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), transforming growth factor-beta (TGF-beta), and troponin can improve estimation of the pretest probability of the left ventricular systolic dysfunction (LVSD). SUBJECTS AND METHODS: Eighty patients with newly-diagnosed myocardial infarction (MI) were echocardiographically examined for LVSD (ejection fraction < or =40%). Measurements included traditional MI risk factors, plasma and salivary concentrations of troponin, IL-2, IL-6, TNF-alpha, and TGF-beta. With the LVSD as the outcome variable, we developed logistic regression models, starting with a basic model incorporating traditional risk factors and consecutively adding salivary and plasma biomarkers. Models were compared using several criteria, including (but not limited to) C statistic (discrimination) and net reclassification improvement index (NRI). RESULTS: Apart from troponin, plasma, and salivary values of the biomarkers were correlated: spearman's rho was 0.19 (p=0.088) for troponin, 0.36 (p=0.001) for IL-2, 0.74 (p<0.001) for IL-6, 0.61 (p<0.001) for TNF-alpha, and 0.65 (p<0.001) for TGF-beta. The predictive performances of the basic model for estimating the pretest probability of the presence of LVSD considerably improved when cytokines were added (salivary added: C-statistic from 0.77 to 0.82 and NRI 77%; plasma added: C-statistic to 0.80 and NRI 134%). CONCLUSION: Multiple biomarkers added diagnostic value to the standard risk factors for predicting the presence of post-MI LVSD.
