MPO as a Marker for Oxidative Stress

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Fig. 9. Multimarker approach. The results of the combined use ofPlGF and sCD40L for risk stratification of patients with acute chest pain and troponin T levels <0.01 pg/L with respect to death or nonfatal AMI during 30 d of follow-up (n = 531) are shown.

Fig. 10. Neutrophil activation is indicated by the change in the MPO index in blood from the aorta and great cardiac vein. In patients with unstable angina, but not in patients with stable angina, a decrease in MPO content was observed in blood from the great cardiac vein, not only when the neutrophils traversed the coronary vascular bed perfused by the culprit stenosis and thus subjected to recurrent ischemia (unstable angina with a left coronary lesion), but also when there was no coronary stenosis or any plausible cause of ischemia in the vascular bed draining into the great cardiac vein (unstable angina with a right coronary lesion).

Fig. 10. Neutrophil activation is indicated by the change in the MPO index in blood from the aorta and great cardiac vein. In patients with unstable angina, but not in patients with stable angina, a decrease in MPO content was observed in blood from the great cardiac vein, not only when the neutrophils traversed the coronary vascular bed perfused by the culprit stenosis and thus subjected to recurrent ischemia (unstable angina with a left coronary lesion), but also when there was no coronary stenosis or any plausible cause of ischemia in the vascular bed draining into the great cardiac vein (unstable angina with a right coronary lesion).

(NO), thereby reducing NO bioavailability and impairing its vasodilatory and antiinflammatory functions (53,54). Two recent studies have also revealed that MPO is strongly associated with adverse outcome in patients with ACS (55,56). Particularly in individuals with low troponin levels, MPO identified patients at increased risk for early cardiovascular events that occur within days after the onset of symptoms (Fig. 11) (55). This suggests

MPO medium

MPO low CRP low

Fig. 11. Predictive value of MPO for incidence of death and nonfatal MI in relation to CRP serum levels. Diagnostic threshold levels were 222 and 350 ^g/L for MPO and 5 and 15 mg/L for CRP (n = 547). MI indicates nonfatal MI.

MPO medium

MPO low CRP low

Fig. 11. Predictive value of MPO for incidence of death and nonfatal MI in relation to CRP serum levels. Diagnostic threshold levels were 222 and 350 ^g/L for MPO and 5 and 15 mg/L for CRP (n = 547). MI indicates nonfatal MI.

that MPO unmasks states of acute inflammation in the coronary circulation indicative of increased neutrophil activation, which ultimately precedes myocardial injury. Although future prospective studies are warranted to confirm these results, the current findings support the rationale to further evaluate MPO for risk stratification in patients with ACS and encourage the development of pharmacological strategies to modulate the catalytic activity of this enzyme.

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