BACKGROUND:There is an intimate relationship between activation of the sympathetic nervous system and myocardial ischemia. This study examined whether plasma levels of dopamine, a precursor of norepinephrine, may provide prognostic information in coronary artery disease (CAD). METHODS AND RESULTS:Plasma levels of free dopamine were measured by high-performance liquid chromatography in 210 consecutive patients with stable CAD. The patients were prospectively followed up for a period of < or =36 months until occurrence of a clinical coronary event. Coronary events occurred in 37 patients during follow-up. In Kaplan-Meier survival analysis, higher dopamine levels (> or =30 pg/ml) resulted in a higher event probability (p<0.01). Multivariate Cox hazards analysis showed that higher dopamine levels were a significant and independent risk factor for future coronary events (hazard ratio 3.3, 95% confidence interval 1.3-8.1, p<0.01). Furthermore, patients with higher dopamine levels had lower left ventricular (LV) ejection fraction and higher levels of brain natriuretic peptide, C-reactive protein, and fibrinogen than those with lower dopamine levels. CONCLUSIONS:Plasma levels of free dopamine are increased in association with a decrease in LV function and an increase in inflammatory risk markers. Higher free dopamine levels are an independent risk factor for future coronary events in CAD patients.

Background: There is extensive evidence that low serum levels of high-density lipoprotein (HDL) cholesterol and apolipoprotein A-I (apoA-I) predict a worse prognosis in patients with ischemic heart disease. This study examined whether apoA-I levels may also provide prognostic information in patients with nonischemic heart failure.Methods and Results: A prospective follow-up study was performed in 117 consecutive patients with nonischemic heart failure for a period of <= 36 months until the first occurrence of l of the following clinical events: all-cause death, cardiac death, and hospitalization with worsening heart failure. Serum levels of apoA-I were measured by immunoturbidimetry. A clinical event occurred during follow-up in 28 (24%) patients. A multivariate Cox proportional hazards analysis showed that lower apoA-I levels (<103 mg/dL: determined by a receiver-operating characteristic analysis) were significantly associated with an adverse outcome that was independent of creatinine clearance, HDL cholesterol levels, and brain natriuretic peptide levels. ApoA-I was inversely correlated with levels of C-reactive protein and fibrinogen, known inflammatory predictors of poor prognosis in heart failure.Conclusions: Low levels of apoA-I are independently associated with an adverse prognosis in patients with nonischemic heart failure. ApoA-I may play a beneficial role in nonischemic heart failure partly through an anti-inflammatory action.

Although endothelial dysfunction is a predictor of cardiovascular events, it remains unclear whether reversibility of endothelial dysfunction in response to risk-factor reduction provides prognosti...

Two patients with amiodarone-induced pulmonary toxicity (APT) showed abnormally increased serum SP-D concentrations, although their KL-6 level was within the normal range. In a 59-year-old man with ischemic heart disease, APT progressed rapidly and required steroid pulse therapy. During the clinical course, SP-D was as high as 375 ng/ml, although the KL-6 level was only 289 U/ml. In a 58-year-old man treated for dilated cardiomyopathy, SP-D increased to 289 ng/ml, while KL-6 remained at less than 500 U/ml. These cases indicate that SP-D is a useful and early diagnostic marker for APT even when KL-6 is not elevated.