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KMID : 0368120130430030246
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Korean Circulation Journal
2013 Volume.43 No. 3 p.246 ~ p.254
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Bedside-Friendly Prediction for Presence of Post-Myocardial lnfarction Systolic Dysfunction Using Multimarker Panel: Integrating Salivary Diagnostics into Clinical Practice
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Assareh Ahmadreza
Haybar Habib
Yoosefi Hojjat
Bozorgmanesh Mohammadreza
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Abstract
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Background/Objectives: We investigated if a combination of plasma or salivary interleukin-2 (IL-2), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), transforming growth factor-beta (TGF-β), 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 ≤40%). Measurements included traditional MI risk factors, plasma and salivary concentrations of troponin, IL-2, IL-6, TNF-α, and TGF-β. 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 ρ 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-α, and 0.65 (p<0.001) for TGF-β. 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.
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KEYWORD
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Interleukins, Transforming growth factor-beta, Tumor necrosis factor-alpha, Saliva, Left ventricular dysfunction
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