Procalcitonin and Infective Endocarditis
Procalcitonin, known as a marker of bacterial infection in the heart muscle, is also useful in determining the presence of infective endocarditis, said Swiss researchers in a report in this week’s issue of the journal Circulation (Circulation. 2004;109:1707–1710OpenUrl).
Saying that ineffective resources are currently used in the diagnosis of infective endocarditis, Christian Mueller, MD, and his colleagues of the University Hospital in Basel, Switzerland, noted that the changing profile of infective endocarditis makes it difficult to diagnose.
“Our data suggest that the use of procalcitonin values may help to improve the resource utilization of diagnostic imaging. In conclusion, procalcitonin may be a valuable additional diagnostic marker in patients with suspected IE [infective endocarditis],” the authors wrote.
The researchers prospectively evaluated 67 consecutive patients who were admitted to the hospital with the suspicion of infective endocarditis or whose probable diagnosis became evident during hospitalization. Infective endocarditis was confirmed in 21 of the patients.
Levels of procalcitonin were significantly higher in the patients who had infective endocarditis than in those for whom other diagnoses were eventually confirmed. The infective endocarditis patients had average procalcitonin levels of 6.56 ng/mL, whereas those with other heart problems had procalcitonin levels of, on average, 0.44 ng/mL. Using multiple logistic regression, the researchers determined that procalcitonin was the only significant independent predictor of infective endocarditis when patients were admitted to the hospital.
Abciximab ACEs Coronary Stenting
Abciximab improved 1-year survival and reduced reinfarction in patients undergoing routine artery stenting after myocardial infarction, said an international group of researchers for the ACE (Abciximab and Carbostent Evaluation) trial in a report in this week’s issue of Circulation (Circulation. 2004;109:1704–1706OpenUrl).
The study, which compared abciximab (as an adjunct treatment to routine coronary stenting after myocardial infarction) with placebo, was led by David Antoniucci, MD, of Careggi Hospital in Florence, Italy. Included were 400 consecutive patients with ST-segment–elevation acute myocardial infarction who were randomly assigned to either the treatment group or the placebo group.
At 1 year, survival was 95% in the abciximab group and 88% in the control group. Reinfarction rate was 1% in the abciximab group and 6% in the placebo group, whereas there was no significant difference in the need for target-vessel revascularization. The researchers concluded: “The improved myocardial salvage in the early phase may translate into improved survival in the long-term follow-up.”
Drug Increases HDL
The drug torcetrapib increased levels of high-density lipoprotein (HDL) cholesterol and decreased levels of low-density lipoprotein (LDL) cholesterol in subjects who had low HDL levels at baseline, said New England researchers in the April 8, 2004, issue of The New England Journal of Medicine (N Engl J Med. 2004;350:1505–1515OpenUrlCrossRefPubMed).
The researchers, led by Margaret E. Brousseau, PhD, of New England Medical Center and Tufts School of Medicine, hypothesized that the drug, an inhibitor of cholesteryl ester transfer protein (CETP), would raise HDL levels. They hoped that by raising the levels of the protein, they could inhibit the development of coronary heart disease in the patients.
A total of 19 subjects with low levels of HDL cholesterol (<40 mg per deciliter) entered the study. All subjects received placebo for 4 weeks and then 120 mg of torcetrapib daily for another 4 weeks. Nine of the subjects received 20 mg of atorvastatin each day. Six subjects who did not receive the statin participated in a third phase of the trial, in which they received 120 mg of torcetrapib twice daily.
The treatment with torcetrapib once daily at a dose of 120 mg increased levels of HDL cholesterol in the plasma by 61% in the group that received atorvastatin and 46% in the group that did not receive the statin. The doubled dose of 120 mg twice daily increased HDL cholesterol levels by 106%. LDL levels dropped 17% in the group that received torcetrapib and atorvastatin. The mean particles sizes of HDL and LDL increased in the various groups. There were no serious adverse events, and no one withdrew from the trial. Twenty “mild” and 8 “moderate” adverse events were reported. In the group receiving the doubled dose, 3 reported headache, dyspepsia, amnesia, or abnormal thinking.
The researchers noted that the study was designed to examine the effects of torcetrapib in this group of patients. Yet, they cautioned, “The relation of CETP activity to the risk of coronary heart disease remains controversial. It is not clear whether CETP-deficient persons are protected from coronary heart disease; they may even be at increased risk. In the Honolulu Heart Program, a subgroup of persons heterozygous for a functional CETP mutation who had HDL cholesterol levels in the range of 40 to 60 mg per deciliter (1.0 to 1.6 mmol per liter) appeared to be at increased risk for coronary heart disease. However, a recent analysis of seven-year prospective data from this study did not reveal a significant relation between heterozygosity for CETP mutations and coronary heart disease or stroke. . . . Ultimately, the question of whether CETP inhibition is effective in reducing atherosclerotic cardiovascular disease in humans will be resolved only by trials based on hard clinical end points.”