Serum basic fibroblast growth factor levels in patients with ischemic heart disease
Introduction
Basic fibroblast growth factor (bFGF) is a 18-kDa molecule with widespread tissue distribution, stored primarily in the endothelial basement membrane [1]. Being a potent mitogen of cells of mesenchymal origin, it promotes proliferation of endothelial and smooth muscle cells [1].
Angiogenesis is the key to coronary collateral development in response to myocardial ischemia [2]. Exogenously-administered bFGF has been shown to induce myocardial angiogenesis in different experimental models of myocardial ischemia/infarction 3, 4, 5, 6, 7, thus increasing coronary collateral flow 3, 5, 6, 7. Angiogenesis is also a fundamental process in tumor growth and metastasis [8]. Using an immunoassay for bFGF [9], increased serum and urine levels of bFGF have been reported in patients with different malignancies 10, 11, 12, supposedly due to bFGF production by tumor cells [13]. As a common process to tumor metastasis and myocardial ischemia, one could postulate that angiogenesis in response to myocardial ischemia would result in elevated systemic levels of bFGF.
Atherogenesis is a complex process entailing smooth muscle proliferation and angiogenesis within the vessel wall [14]. Several workers have previously shown that bFGF might be an important participant in atherogenesis 15, 16, 17, 18, 19. As atherosclerosis is a systemic process with widespread involvement, serum bFGF might be elevated in patients with ischemic heart disease and coronary artery atherosclerosis.
The purpose of the present study was to examine whether serum levels of bFGF are detectable in patients with ischemic heart disease, and to evaluate a possible correlation between serum bFGF levels and extent of coronary artery disease and coronary collateral circulation.
Section snippets
Study population
The study protocol was approved by our institutional review board. All patients gave informed consent after the purpose of the study was explained to them.
The study population consisted of 33 patients undergoing elective coronary angiography due to presence of typical anginal pain and 12 patients recovering from uncomplicated acute myocardial infarction (7.2±1.9 days post-infarction). Patients were not required to undergo noninvasive evaluation for ischemia prior to coronary angiography; the
Results
The demographic and clinical characteristics of the three subgroups comprising the study population are presented in Table 1. Patients with angina and minimal coronary artery disease tended to be younger, but there was no difference between the three subgroups in gender or risk factors. There were subtle differences in drug therapy between the subgroups. Among patients in subgroups II and III, patients in subgroup II had a significantly higher history of previous myocardial infarction, but no
Main findings
We found that serum levels of bFGF are elevated in patients with ischemic heart disease. Elevated serum bFGF levels are found more commonly in patients with minimal coronary artery disease, and are not indicative of status of coronary collateral circulation. Among patients recovering from myocardial infarction, in which bFGF is expected to participate not only in formation of collateral circulation, but also in wound repair and healing [4], bFGF is detectable in only a minority of patients.
Possible explanations
As
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