The implication of calcium score and pentraxin-3 in non-invasive identification of significant coronary artery stenosis in chronic stable angina pectoris


Objective: Coronary Artery Disease (CAD) would continue to concern medical society in the foreseeable future. Determining the extent of coronary luminal stenosis is a key factor in management of CAD. Methods presently used are costly and pose certain dangers, ranging from nephrotoxicity to death. Long Pentraxin or Pentraxin-3 (PTX3) has been used to predict survival or atherosclerotic process, but not to identify coronary stenosis. Calcium Score has been used to this end with some success. Methods: Individuals with chronic stable angina, without evidence of Myocardial Infarction (MI), who were categorized as intermediate-risk after completing a treadmill exercise test, according to Duke Protocol, underwent cardiac catheterization. In addition, blood samples were drawn for coronary sinus PTX3, and also PTX3, uric acid, high-sensitivity C-reactive protein (hs-CRP), cholesterol, glucose and High-Density Lipo-protein (HDL) in peripheral circulation. Calcium Scores were calculated using Agatston Score and non-contrast multi-slice CT scan. Participants were divided according to the number of stenotic coronary arteries (patent, one-, two-and three-vessel disease). Results: We found that PTX3 levels in coronary sinus and femoral vein correlated with each other, after log-transforming the values. Also we found that PTX3 levels and Calcium Scores differed among individuals with triple-vessel involvement and individuals without significant stenosis in any of coronary arteries. No significant differences were observed, regarding hs-CRP levels. Conclusion: PTX3 levels in periphery correlate with those in coronary arteries, and this variable can be measured with a less invasive procedure. In addition to Calcium Score, PTX3 levels are different in our four groups. The combined contribution of PTX3 and calcium score may help us identify individuals with significant coronary artery stenosis without needing to perform cardiac catheterization in a select group of patients.

Share and Cite:

Haybar, H. , Davoodi, M. , Shahlaee, A. , Eslami Shahr Babaki, A. , Fazelinezhad, Z. , Azarian, M. and Salemzadeh, M. (2013) The implication of calcium score and pentraxin-3 in non-invasive identification of significant coronary artery stenosis in chronic stable angina pectoris. World Journal of Cardiovascular Diseases, 3, 433-441. doi: 10.4236/wjcd.2013.37068.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Murray, C. and Lopez, A. (1997) Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. The Lancet, 349, 1436-1442.
[2] Fuster, V., Badimon, L., Badimon, J.J. and Chesebro, J.H. (1992) The pathogenesis of coronary artery disease and the acute coronary syndrome. New England Journal of Medicine, 326, 242-250.
[3] Fuster, V. and Lewis, A. (1995) Conner memorial lecture. Mechanisms leading to myocardial infarction: Insights from studies of vascular biology. Circulation, 90, 2126-2146.
[4] Gibbons, R.J., Chatterjee, K., Daley, J., Douglas, J.S., Fihn, S.D, Gardin, J.M., et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: Executive summary and recommendations: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee on management of patients with chronic stable angina). Circulation, 99, 2829-2848.
[5] Braunwald, E. (1997) Unstable angina: Diagnosis and management-clinical practice guideline. DIANE Publishing, Darby.
[6] Hessel, S.J., Adams, D.F. and Abrams, H.L. (1981) Complications of angiography. Radiology, 138, 273-281.
[7] Kwok, J.M.F., Miller, T.D., Christian, T.F., Hodge, D.O. and Gibbons, R.J. (1999) Prognostic value of a treadmill exercise score in symptomatic patients with non-specific ST-T abnormalities on resting ECG. Journal of American Medical Association, 282, 1047-1053.
[8] Lodh, M., Goswami, B., Parida, A., Patra, S. and Saxena, A. (2012) Assessment of serum leptin, pregnancy-associated plasma protein A and CRP levels as indicators of plaque vulnerability in patients with acute coronary syndrome. Cardiovascular Journal of Africa, 23, 330-335.
[9] Polonsky, T.S., McClelland, R.L., Jorgensen, N.W., Bild, D.E., Burke, G.L., Guerci, A.D., et al. (2010) Coronary artery calcium score and risk classification for coronary heart disease prediction. Journal of American Medical Association, 303, 1610-1616.
[10] Wexler, L., Brundage, B., Crouse, J., Detrano, R., Fuster, V., Maddahi, J., et al. (1996) Coronary artery calcification: Pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association. Circulation, 94, 1175-1192.
[11] Vidula, H., Tian, L., Liu, K., Criqui, M.H., Ferrucci, L., Pearce, W.H., et al. (2008) Biomarkers of inflammation and thrombosis as predictors of near-term mortality in patients with peripheral arterial disease: A cohort study. Annals of Internal Medicine, 148, 85-93.
[12] Anderson, J.L., Carlquist, J.F., Muhlestein, J.B., Horne, B.D. and Elmer, S.P. (1998) Evaluation of C-reactive protein, an inflammatory marker, and infectious serology as risk factors for coronary artery disease and myocardial infarction. Journal of the American College of Cardiology, 32, 35-41.
[13] Cho, D.Y., Kim, K.N., Kim, K.M., Lee, D.J. and Kim, B.T. (2012) Combination of high-sensitivity C-reactive protein and homocysteine may predict an increased risk of coronary artery disease in Korean population. Chinese Medical Journal, 125, 569-573.
[14] Savchenko, A.S., Imamura, M., Ohashi, R., Jiang, S., Kawasaki, T., Hasegawa, G., et al. (2008) Expression of Pentraxin 3 (PTX3) in human atherosclerotic lesions. The Journal of Pathology, 215, 48-55.
[15] Klouche, M., Peri, G., Knabbe, C., Eckstein, H.H., Schmid, F.X., Schmitz, G., et al. (2004) Modified atherogenic lipoproteins induce expression of Pentraxin-3 by human vascular smooth muscle cells. Atherosclerosis, 175, 221-228.
[16] Mantovani, A., Garlanda, C., Bottazzi, B., Peri, G., Doni, A. and Martinez de la Torre, Y., et al. (2006) The long Pentraxin PTX3 in vascular pathology. Vascular Pharmacology, 45, 326-330.
[17] Latini, R., Maggioni, A.P., Peri, G., Gonzini, L., Lucci, D., Mocarelli, P., et al. (2004) Prognostic significance of the long Pentraxin PTX3 in acute myocardial infarction. Circulation, 110, 2349-2354.
[18] Karakas, M.F., Buyukkaya, E., Kurt, M., Motor, S., Akcay, A.B., Buyukkasa, S., et al. (2013) Serum pentraxin 3 levels are associated with the complexity and severity of coronary artery disease in patients with stable angina pectoris. Journal of Investigative Medicine, 61, 278-285.
[19] Jenny, N.S., Arnold, A.M., Kuller, L.H., Tracy, R.P. and Psaty, B.M. (2009) Associations of Pentraxin 3 with cardiovascular disease and all-cause death. Arteriosclerosis, Thrombosis, and Vascular Biology, 29, 594-599.
[20] Hou Z.H., Lu, B., Gao, Y., Jiang, S.L., Wang, Y., Li, W., et al. (2012) Prognostic Value of coronary CT angiography and calcium score for major adverse cardiac events in outpatients. Journal of American College of Cardiology Cardiovascular Imaging, 5, 990-999.
[21] Greenland, P., Bonow, R.O., Brundage, B.H., Budoff, M.J., Eisenberg, M.J., Grundy, S.M., et al. (2007) ACCF/ AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain. Journal of the American College of Cardiology, 49, 378-402.
[22] Agatston, A.S., Janowitz, W.R., Hildner, F.J., Zusmer, N.R., Viamonte Jr., M. and Detrano, R. (1990) Quantification of coronary artery calcium using ultrafast computed tomography. Journal of the American College of Cardiology, 15, 827-832.
[23] Perkins, N.J. and Schisterman, E.F. (2006) The inconsistency of “optimal” cut-points using two ROC based criteria. American Journal of Epidemiology, 163, 670-675.
[24] Zweig, M.H. and Campbell, G. (1993) Receiver-operating characteristic (ROC) plots: A fundamental evaluation tool in clinical medicine. Clinical Chemistry, 39, 561-577.
[25] Rumberger, J.A., Brundage, B.H., Rader, D.J. and Kondos, G. (1999) Electron beam computed tomographic coronary calcium scanning: A review and guidelines for use in asymptomatic persons. Mayo Clinic Proceedings, 74, 243-252.
[26] Tamon, R., Kou, Y., Yoshida, Y., Ogawa, Y. and Imaki, M. (2011) Study on the evaluation of serum hsCRP as predictor of the coronary artery disease by using Framingham Risk Score (FRS). Journal of Analytical BioScience, 34, 324-330.
[27] Soeki, T., Niki, T., Kusunose, K., Bando, S., Hirata, Y., Tomita, N., et al. (2011) Elevated concentrations of Pentraxin 3 are associated with coronary plaque vulnerability. Journal of Cardiology, 58, 151-157.
[28] Norata, G.D., Marchesi, P., Pulakazhi Venu, K.V., Pasqualini, F., Anselmo, A., Moalli, F., et al. (2009) Deficiency of the long Pentraxin PTX3 promotes vascular inflammation and atherosclerosis. Circulation, 120, 699-708.
[29] Leali, D., Inforzato, A., Ronca, R., Bianchi, R., Belleri, M., Coltrini, D., et al. (2012) Long pentraxin 3/tumor necrosis factor-stimulated gene-6 interaction: A biological rheostat for fibroblast growth factor 2-mediated angiogenesis. Arteriosclerosis, Thrombosis, and Vascular Biology, 32, 696-703.
[30] Norata, G.D., Garlanda, C. and Catapano, A.L. (2010) The long Pentraxin PTX3: A modulator of the immunoinflammatory response in atherosclerosis and cardiovascular diseases. Trends in Cardiovascular Medicine, 20, 35-40.
[31] Norata, G.D., Marchesi, P., Pirillo, A., Uboldi, P., Chiesa, G., Maina, V., et al. (2008) Long pentraxin 3, a key component of innate immunity, is modulated by high-density lipoproteins in endothelial cells. Arteriosclerosis, Thrombosis, and Vascular Biology, 28, 925-931.
[32] Haybar, H., Assareh, A., Ghotbi, Y., Torabizadeh, M. and Bozorgmanesh, M. (2013) Incremental diagnostic value of circulating pentraxin in patients with intermediate risk of coronary artery disease. Heart, 99, 640-648.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.