Soluble CD40 ligand predicts ischemic stroke and myocardial infarction in patients with nonvalvular atrial fibrillation

被引:73
作者
Ferro, Domenico
Loffredo, Lorenzo
Polimeni, Licia
Fimognari, Filippo
Villari, Paolo
Pignatelli, Pasquale
Fuster, Valentin
Violi, Francesco
机构
[1] Div Med Interna H, I-00161 Rome, Italy
[2] Univ Roma La Sapienza, Dept Expt Med, Rome, Italy
[3] Leopoldo Delfino Hosp, Div Internal Med, ASL Roma G Colleferro, Rome, Italy
[4] Mt Sinai Hosp, Mt Sinai Sch Med, Cardiovasc Inst, New York, NY 10029 USA
关键词
atrial fibrillation; sCD40L; atherosclerosis;
D O I
10.1161/ATVBAHA.107.152777
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective - Atrial fibrillation (AF) is associated with a high incidence of vascular disease that may be related to a prothrombotic and inflammatory state. Soluble CD40 ligand (sCD40L), which stems essentially from platelet activation, possesses inflammatory and prothrombotic properties. The aim of the study was to assess whether sCD40L is a predictor of stroke or myocardial infarction (MI) in patients with nonvalvular AF. Methods and Results - Plasma levels of sCD40L were measured in 231 patients (177 [77%] had permanent or persistent AF, and 54 [23%] had paroxysmal AF). Patients were followed for a mean period of 27.8 +/- 8.8 months, and cardiovascular events such as fatal and nonfatal stroke and MI were recorded. AF population was divided in 2 groups according to sCD40L level above or below the median (4.76 ng/mL). The 2 patients' groups had similar distribution of cardiovascular risk factors, age, gender, medications, or serum C-reactive protein levels. During the follow-up period, vascular events occurred in 6 (2 nonfatal MI and 4 nonfatal ischemic strokes) of 116 patients with low levels of sCD40L (5.1%) and in 29 (11 fatal and 3 nonfatal MI; 3 fatal and 12 nonfatal ischemic strokes) of 115 patients with high levels (25.2%) (log-rank test: P < 0.001). Using the COX proportional Hazards model, patients with sCD40L above the median were 4.63 times more likely to experience a vascular event (95% C.I.: 1.92 to 11.20). Conclusions - This study shows that enhanced soluble CD40L level is a predictor of vascular events in patients with nonvalvular AF, thus suggesting that enhanced platelet activation may play a role in its clinical progression.
引用
收藏
页码:2763 / 2768
页数:6
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