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[Detection of circulating endothelial cells: a new diagnostic test of angina at rest]
Insights
Detecting circulating endothelial cells offers a new biological test for spontaneous angina, aiding retrospective diagnosis. This method shows promise for identifying plaque instability, a common trigger for angina attacks.
Area of Science:
- Cardiology
- Vascular Biology
- Biomarker Discovery
Background:
- Spontaneous angina diagnosis relies on electrocardiographic changes, lacking simple retrospective biological tests.
- Angina attacks are often linked to atheromatous plaque instability and endothelial cell release into the bloodstream.
Purpose of the Study:
- To evaluate the utility of detecting circulating endothelial cells (CECs) as a biological marker for spontaneous angina.
- To assess the specificity and sensitivity of CEC detection for diagnosing spontaneous angina retrospectively.
Main Methods:
- An immuno-magnetic method was employed to detect CECs in three patient groups admitted within 24 hours.
- Group I: Acute myocardial infarction (n=11).
- Group II: Spontaneous angina with ST depression and coronary stenosis (n=23).
- Group III: Chest pain with normal angiography and negative spasm test (n=6).
Main Results:
- CECs were detected in 100% of acute myocardial infarction patients.
- 78% of spontaneous angina patients (Group II) showed detectable CECs.
- Only 18% of patients with non-cardiac chest pain (Group III) had detectable CECs.
- The test demonstrated 83% specificity and 95% positive predictive value for spontaneous angina.
- Sensitivity and negative predictive value were 78% and 50%, respectively.
Conclusions:
- Detection of circulating endothelial cells presents a simple, reliable test for the retrospective diagnosis of spontaneous angina.
- The test shows high specificity and positive predictive value, though moderate sensitivity and negative predictive value suggest alternative diagnostic mechanisms in some cases.
- Further research may explore other causes for CEC release in spontaneous angina beyond atheromatous plaque fissuration.
Abstract:
The diagnosis of spontaneous angina depends on the recording of per-critical electrocardiographic changes. There is no simple biological test to make its retrospective diagnosis. The attack is usually triggered by instability of an atheromatous plaque which fissures and liberates endothelial cells in the blod stream. The detection of these cells cold therefore be a biological sign of this condition. The technique of detection of circulating endothelial cells by immuno-magnetic method was used in 3 groups of patients admitted to hospital within 24 hours: group I comprised 11 patients with acute myocardial infarction, group II comprised 23 patients who had suffered from spontaneous angina with ST segment depression during the attack and significant coronary arterial stenosis, group III comprised 6 patients with chest pain for which coronary angiography is normal and provocative test of spasm is negative. Circulating endothelial cells were detected in all patients of group I (100%), in 18 of the 23 patients of group II (78%) and only in one of group III (18%). These results confer on this biological test for spontaneous angina a specificity and predictive positive value of 83 and 95% and a sensitivity and negative predictive value of 78 and 50%. Therefore the detection of circulating endothelial cells could be used as a simple and reliable test for retrospective diagnosis of spontaneous angina. The mediocre sensitivity and negative predictive value may be explained by a mechanism other than fissuration of atheromatous plaque in some cases of spontaneous angina.