Volume 14, Issue 1 (2022)
Iran J War Public Health 2022, 14(1): 25-35 |
Back to browse issues page
Article Type:
Subject:
History
Received: 2022/01/5 | Accepted: 2022/02/23 | Published: 2022/03/5
Received: 2022/01/5 | Accepted: 2022/02/23 | Published: 2022/03/5
Rights and permissions
1- Department of Internal Medicine No. 4, Bogomolets National Medical University, 01601, Kyiv, Ukraine
2- Department of Biochemistry, Taras Shevchenko National University of Kyiv, 01601, Kyiv, Ukraine
2- Department of Biochemistry, Taras Shevchenko National University of Kyiv, 01601, Kyiv, Ukraine
Abstract (1118 Views)
Aims: The study aimed to assess the diagnostic accuracy of some fibrinolytic parameters in the differential diagnosis between patients with unstable angina and musculoskeletal disorders.
Materials & Methods: This cross-sectional study included 119 patients with chest pain, and the provisional diagnosis “UA” was conducted in in 2021 in Bogomolets National Medical University. After a full set of diagnostic procedures, the authors formed four groups: patients with ischemic and non-cardiogenic chest pain without coronary artery disease history (1 & 2) or coronary artery disease history (3 & 4). Blood plasma tissue plasminogen activator and plasminogen activator inhibitor type 1 concentrations, tissue plasminogen activator/plasminogen activator inhibitor type 1, and plasminogen activator inhibitor type 1/tissue plasminogen activator ratios were analyzed.
Findings: Binary logistic models were assessed, receiver operating characteristic curves, calculated sensitivity, specificity, and positive likelihood ratio of each indicator. No diagnostic utility of tissue plasminogen activator concentration alone was revealed (p=0.68). Plasminogen activator inhibitor type 1 concentration and plasminogen activator inhibitor type 1/tissue plasminogen activator ratio demonstrated a moderate increase (by 28% and 26%) in the probability of UA (positive likelihood ratio= 4.66 (2.57, 8.45) and 3.87 (2.29, 6.55), sensitivity 87.3% and 88.7%, specificity 81.2% and 77.1% at cut-off point 0.343rel.units/ml and 1.775, respectively), while tissue plasminogen activator/plasminogen activator inhibitor type 1 raised the probability of MSD by 41% (positive likelihood ratio= 6.47 (3.29, 13.00), sensitivity 72.9%, specificity 88.7% at cut-off point 0.584).
Conclusion: PAI-1 concentration alone and tissue plasminogen activator /PAI-1 ratio but not tissue plasminogen activator alone have demonstrated promising results for differential diagnostic between ischemic and non-cardiogenic chest pain.
Materials & Methods: This cross-sectional study included 119 patients with chest pain, and the provisional diagnosis “UA” was conducted in in 2021 in Bogomolets National Medical University. After a full set of diagnostic procedures, the authors formed four groups: patients with ischemic and non-cardiogenic chest pain without coronary artery disease history (1 & 2) or coronary artery disease history (3 & 4). Blood plasma tissue plasminogen activator and plasminogen activator inhibitor type 1 concentrations, tissue plasminogen activator/plasminogen activator inhibitor type 1, and plasminogen activator inhibitor type 1/tissue plasminogen activator ratios were analyzed.
Findings: Binary logistic models were assessed, receiver operating characteristic curves, calculated sensitivity, specificity, and positive likelihood ratio of each indicator. No diagnostic utility of tissue plasminogen activator concentration alone was revealed (p=0.68). Plasminogen activator inhibitor type 1 concentration and plasminogen activator inhibitor type 1/tissue plasminogen activator ratio demonstrated a moderate increase (by 28% and 26%) in the probability of UA (positive likelihood ratio= 4.66 (2.57, 8.45) and 3.87 (2.29, 6.55), sensitivity 87.3% and 88.7%, specificity 81.2% and 77.1% at cut-off point 0.343rel.units/ml and 1.775, respectively), while tissue plasminogen activator/plasminogen activator inhibitor type 1 raised the probability of MSD by 41% (positive likelihood ratio= 6.47 (3.29, 13.00), sensitivity 72.9%, specificity 88.7% at cut-off point 0.584).
Conclusion: PAI-1 concentration alone and tissue plasminogen activator /PAI-1 ratio but not tissue plasminogen activator alone have demonstrated promising results for differential diagnostic between ischemic and non-cardiogenic chest pain.
Keywords:
References
1. Hurst JW, Morris DC. Chest pain. Armonk: Futura Pub; 2001. [Link]
2. National Hospital Ambulatory Medical Care Survey. 2017 emergency department summary tables. Hyattsville: National Hospital Ambulatory Medical Care Survey; 2017 [cited 2021 Aug 13]. Available from: https://www.cdc.gov/nchs/data/nhamcs/web_tables/2017_ed_web_tables-508.pdf. [Link]
3. Johnson K, Ghassemzadeh S. Chest pain. Treasure Island, FL: StatPearls Publishing LLC; 2020. [Link]
4. Charpentier S, Beaune S, Joly LM, Khoury A, Duchateau F-X, Briot R, Renaud B, Ageron F-X. Management of chest pain in the French emergency healthcare system: the prospective observational EPIDOULTHO study. Eur J Emerg Med. 2018;25(6):404-10. [Link] [DOI:10.1097/MEJ.0000000000000481]
5. World Health Organization. The top 10 causes of death. Geneva: World Health Organization; 2018 [cited 2021 August 13]. Available from: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. [Link]
6. Mourad G, Alwin J, Strömberg A, Jaarsma T. Societal costs of non-cardiac chest pain compared with ischemic heart disease--a longitudinal study. BMC Health Serv Res. 2013;13:403. [Link] [DOI:10.1186/1472-6963-13-403]
7. Morgan DJ, Dhruva SS, Coon ER, Wright SM, Korenstein D. 2017 update on medical overuse: A systematic review. JAMA Intern Med. 2018;178(1):110-5. [Link] [DOI:10.1001/jamainternmed.2017.4361]
8. Fruergaard P, Launbjerg J, Hesse B, Jørgensen F, Petri A, Eiken P, et al. The diagnoses of patients admitted with acute chest pain but without myocardial infarction. Eur Heart J. 1996;17(7):1028-34. [Link] [DOI:10.1093/oxfordjournals.eurheartj.a014998]
9. Chapin JC, Hajjar KA. Fibrinolysis and the control of blood coagulation. Blood Rev. 2015;29(1):17-24. [Link] [DOI:10.1016/j.blre.2014.09.003]
10. Asada Y, Sato Y, Hatakeyama K. Pathophysiology of atherothrombosis: Mechanisms of thrombus formation on disrupted atherosclerotic plaques. Pathol Int. 2020;70(6):309-22. [Link] [DOI:10.1111/pin.12921]
11. Fadi S, Krychun I. Some markers of systemic inflammatory response and endothelial dysfunction in patients with neurologic manifestations of lumbar osteochondrosis. Technolo Transf Innovative Solut Med. 2017;35-7. [Link] [DOI:10.21303/2585-663.2017.00461]
12. Pérez-García S, Carrión M, Gutiérrez-Cañas I. Profile of matrix-remodeling proteinases in osteoarthritis: Impact of fibronectin. Cells. 2019;9(1):40. [Link] [DOI:10.3390/cells9010040]
13. Yang X, Chang Y, Wei W. Endothelial dysfunction and inflammation: Immunity in rheumatoid arthritis. Mediators of Inflamm. 2016;2016:6813016. [Link] [DOI:10.1155/2016/6813016]
14. Lin H, Xu L, Yu S. Therapeutics targeting the fibrinolytic system. Exp Mol Med. 2020;52:367-79. [Link] [DOI:10.1038/s12276-020-0397-x]
15. Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289-367. [Link] [DOI:10.1093/eurheartj/ehaa575]
16. Sharma H, Tiwari A. Respiratory T-Wave inversion in a patient with chest pain. Clin Med Insights Case Rep. 2017;10:1179547617723309. [Link] [DOI:10.1177/1179547617723309]
17. Mitchell C, Rahko PS, Blauwet LA. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: Recommendations from the American society of echocardiography. J Amer Soc Echocardiogr. 2019;32(1):1-64. [Link] [DOI:10.1016/j.echo.2018.06.004]
18. Shreffler J, Huecker MR. Diagnostic testing accuracy: Sensitivity, specificity, predictive values and likelihood ratios. Treasure Island (FL): StatPearls Publishing LLC; 2020. [Link]
19. Song C, Burgess S, Eicher JD, O'Donnell CJ, Johnson AD. Causal effect of plasminogen activator inhibitor type 1 on coronary heart disease. J Amer Heart Assoc. 2017;6(6):e004918. [Link]
20. Labrique AB, Pan WK. Diagnostic tests: understanding results, assessing utility, and predicting performance. Amer J Ophthalmol. 2010;149(6):878-81. [Link] [DOI:10.1016/j.ajo.2010.01.001]
21. Gago LA, Saed G, Elhammady E, Diamond MP. Effect of oxidized regenerated cellulose (Interceed®) on the expression of tissue plasminogen activator and plasminogen activator inhibitor-1 in human peritoneal fibroblasts and mesothelial cells. Fertil Steril. 2006;86(Suppl 4):1223-7. [Link] [DOI:10.1016/j.fertnstert.2006.04.021]
22. Catarino C, Rebelo I, Belo L, Rocha S, Castro EB, Patricio B, et al. Relathionship between maternal and cord blood hemostatic disturbances in preeclamptic pregnancies. Thromb Res. 2008;123(2):219-24. [Link] [DOI:10.1016/j.thromres.2008.02.007]
23. Longstaff C. Measuring fibrinolysis: From research to routine diagnostic assays. J Thromb Haemostasis 2018;16(4):652-62. [Link] [DOI:10.1111/jth.13957]
24. Sugimoto MA, Ribeiro ALC, Costa BRC, Vago JP, Lima KM, Carneiro FS, et al. Plasmin and plasminogen induce macrophage reprogramming and regulate key steps of inflammation resolution via annexin A1. Blood. 2017;129(21):2896-907. [Link] [DOI:10.1182/blood-2016-09-742825]
25. Deryugina EI, Quigley JP. Cell surface remodeling by plasmin: a new function for an old enzyme. J Biomed Biotech. 2012;2012:564259. [Link] [DOI:10.1155/2012/564259]
26. Cao Y, Xue L. Angiostatin. Semin Thromb Hemostasis 2004;30(1):83-93. [Link] [DOI:10.1055/s-2004-822973]
27. Ulfhammer E, Larsson P, Karlsson L. TNF-alpha mediated suppression of tissue type plasminogen activator expression in vascular endothelial cells is NF-kappaB- and p38 MAPK-dependent. J Thromb Haemostasis 2006;4(8):1781-9. [Link] [DOI:10.1111/j.1538-7836.2006.02035.x]
28. Zhang W, Xu J, Fang H, Tang L, Chen W, Sun Q, et al. Endothelial cells promote triple-negative breast cancer cell metastasis via PAI-1 and CCL5 signaling. FASEB J. 2018;32(1):276-88. [Link] [DOI:10.1096/fj.201700237RR]
29. Medcalf RL. Fibrinolysis: from blood to the brain. J Thromb Haemostasis 2017;15(11):2089-98. [Link] [DOI:10.1111/jth.13849]
30. Kendir C, van den Akker M, Vos R, Metsemakers J. Cardiovascular disease patients have increased risk for comorbidity: A cross-sectional study in the Netherlands. Eur J Gen Pract. 2018;24(1):45-50. [Link] [DOI:10.1080/13814788.2017.1398318]
31. Rahman MM, Kopec JA, Cibere J, Goldsmith CH, Anis AH. The relationship between osteoarthritis and cardiovascular disease in a population health survey: A cross-sectional study. BMJ Open. 2013;3:e002624. [Link] [DOI:10.1136/bmjopen-2013-002624]
32. O'Rourke J, Jiang X, Hao Z, Cone RE, Hand AR. Distribution of sympathetic tissue plasminogen activator (tPA) to a distant microvasculature. J Neurosci Res. 2005;79(6):727-33. [Link] [DOI:10.1002/jnr.20366]
33. Mann CJ, Perdiguero E, Kharraz Y, Aguilar S, Pessina P, Serrano AL, et al. Aberrant repair and fibrosis development in skeletal muscle. Skelet Muscle 2011;1(1):21. [Link] [DOI:10.1186/2044-5040-1-21]
34. Yamanaka H, Obata K, Fukuoka T, Dai Y, Kobayashi K, Tokunaga A, et al. Tissue plasminogen activator in primary afferents induces dorsal horn excitability and pain response after peripheral nerve injury. Eur J Neurosci. 2004;19(1):93-102. [Link] [DOI:10.1046/j.1460-9568.2003.03080.x]
35. Oikonomou E, Siasos G, Tsigkou V, Bletsa E, Panoilia ME, Niovi Oikonomou I, et al. Coronary artery disease and endothelial dysfunction: novel diagnostic and therapeutic approaches. Curr Med Chem. 2020;27(7):1052‐80. [Link] [DOI:10.2174/0929867326666190830103219]
36. Katsiari CG, Bogdanos DP, Sakkas LI. Inflammation and cardiovascular disease. World J Transl Med. 2019;8(1):1-8. [Link] [DOI:10.5528/wjtm.v8.i1.1]
37. Brogren H, Wallmark K, Deinum J, Karlsson L, Jern S. Platelets retain high levels of active plasminogen activator inhibitor 1. PLoS One. 2011;6(11):e26762. [Link] [DOI:10.1371/journal.pone.0026762]
38. Habib SS, Abdel Gader AG, Kurdi MI, Suriya MO, Al Aseri Z. Tissue plasminogen activator and plasminogen activator inhibitor-1 levels in patients with acute myocardial infarction and unstable angina. J Pak Med Assoc. 2012;62(7):681-5. [Link]
39. Popa LE, Petresc B, Cătană C, Moldovanu CG, Sorina Feier D, Lebovici A, et al. Association between cardiovascular risk factors and coronary artery disease assessed using CAD-RADS classification: a cross-sectional study in Romanian population. BMJ Open. 2020;10(1):e031799. [Link] [DOI:10.1136/bmjopen-2019-031799]
40. Godo S, Shimokawa H. Endothelial functions. Arterioscler Thromb Vasc Biol. 2017;37(9):e108‐14. [Link] [DOI:10.1161/ATVBAHA.117.309813]