Association between high-sensitivity troponin T, left ventricular hypertrophy, and myocardial performance index

Left ventricle mass index in paediatric intensive care unit acquired hypertension

BACKGROUND

Hypertension acquired in paediatric critical patients is a recognised challenge, with variable reported frequency. Pain, agitation, and/or medications such as beta stimulants and corticosteroids are well-known risk factors. Sympathomimetics in septic patients can cause high blood pressure, especially with unobserved haemodynamic monitors. Beyond haemodynamic factors, several endocrinal-metabolic factors - including catecholamines, insulin, renin, angiotensin, the aldosterone system, and sodium consumption - may contribute to the left ventricular growth. It is well known that the sympathetic tone has a trophic effect on the heart muscle.

METHOD

A prospective cohort study was conducted during the year 2021. The children were divided into two groups: those who were critically ill with paediatric intensive care unit-acquired hypertension (n = 59) and those without paediatric intensive care unit-acquired hypertension (n = 62). We used the American Academy of Pediatrics' 2017 definition of hypertension to diagnose paediatric intensive care unit-acquired hypertension. Measurement of cardiac output and systemic vascular resistance was performed by cardiometry. Left ventricular myocardial performance and left ventricular mass index were measured by bedside echocardiography at the onset of hypertension diagnosis.

RESULTS

Critically ill children with acquired hypertension had a higher cardiac index (p = 0.0001), systemic vascular resistance index (<0.0001), myocardial performance (0.037), and left ventricular mass index (0.009). The longer duration of stay observed in the hypertension group had no observable effect on mortality (<0.0001).

CONCLUSION

Both myocardial performance and left ventricle mass index increased in critically ill children with paediatric intensive care unit-acquired hypertension.

Joint effect of highly-sensitive cardiac troponin T and ankle-brachial index on incident cardiovascular events: The MESA and CHS

Background

Elevated highly-sensitive cardiac troponin-T (hs-cTnT≥14 ng/L) and low ankle-brachial index (ABI<0.9) are risk factors for atherosclerotic cardiovascular diseases (ASCVD) but their joint effect on the risk of ASCVD events is unknown.

Methods

We used data from the two population-based cohort studies, the Multi-Ethnic study of Atherosclerosis (MESA) and Cardiovascular Heart Study (CHS) among 10,897 participants free of CVD events at baseline (mean age 66.3 years, 44.7% males). Incident ASCVD was defined as CHD (fatal/non-fatal MI or revascularization), transient ischemic attack, or stroke,. Hazard ratio (HR) and 95% CI was calculated from a Cox regression model. Interaction on the additive scale was assessed using relative excess risk due to interaction (RERI) and interaction on the multiplicative scale was assessed by Likelihood ratio (LR) test.

Results

At baseline (2000-2002 for MESA and 1989-1990 for CHS), 10.2% of participants had elevated hs-cTnT and 7.5% had low ABI. During a median follow-up of 13.6 years (interquartile range, 7.5-14.7 years), there were 2590 incident ASCVD and 1542 incident CHD events. The hazard of CHD and ASCVD was higher in participants with both elevated hs-cTnT and low ABI [HR(95% CI): CHD: 2.04 (1.45, 2.88), ASCVD: 2.05 (1.58, 2.66)] than those with only elevated hs-cTnT [CHD: 1.65 (1.37, 1.99), ASCVD: 1.67 (1.44, 1.99)] or only low ABI [CHD: 1.87 (1.52, 2.31), ASCVD: 1.67 (1.42, 1.97)]. Antagonistic multiplicative interaction was observed for CHD (LR test p-value=0.042) but not for ASCVD (LR test p-value =0.08). No significant additive interaction was detected for CHD and ASCVD (RERI p-value ≥0.23).

Conclusion

The observed joint effect of elevated cTnT and low ABI on ASCVD risk was smaller (i.e., antagonistic interaction) than that expected by the combined independent effects of each risk factor.

Echocardiographic predictors of presence of cardiac amyloidosis in aortic stenosis

AIMS

Aortic stenosis (AS) and cardiac amyloidosis (CA) frequently coexist but the diagnosis of CA in AS patients remains a diagnostic challenge. We aim to evaluate the echocardiographic parameters that may aid in the detection of the presence of CA in AS patients.

METHOD AND RESULTS

We performed a systematic literature search of electronic databases for peer-reviewed articles from inception until 10 January 2022. Of the 1449 patients included, 160 patients had both AS-CA whereas the remaining 1289 patients had AS-only. The result of our meta-analyses showed that interventricular septal thickness [standardized mean difference (SMD): 0.74, 95% CI: 0.36-1.12, P = 0.0001), relative wall thickness (SMD: 0.74, 95% CI: 0.17-1.30, P < 0.0001), posterior wall thickness (SMD: 0.74, 95% CI 0.51 to 0.97, P = 0.0011), LV mass index (SMD: 1.62, 95% CI: 0.63-2.62, P = 0.0014), E/A ratio (SMD: 4.18, 95% CI: 1.91-6.46, P = 0.0003), and LA dimension (SMD: 0.73, 95% CI: 0.43-1.02, P < 0.0001)] were found to be significantly higher in patients with AS-CA as compared with AS-only patients. In contrast, myocardial contraction fraction (SMD: -2.88, 95% CI: -5.70 to -0.06, P = 0.045), average mitral annular S' (SMD: -1.14, 95% CI: -1.86 to -0.43, P = 0.0017), tricuspid annular plane systolic excursion (SMD: -0.36, 95% CI: -0.62 to -0.09, P = 0.0081), and tricuspid annular S' (SMD: -0.77, 95% CI: -1.13 to -0.42, P < 0.0001) were found to be significantly lower in AS-CA patients.

CONCLUSION

Parameters based on echocardiography showed great promise in detecting CA in patients with AS. Further studies should explore the optimal cut-offs for these echocardiographic variables for better diagnostic accuracy.

Effect of Dynamic Hyperinflation on Cardiac Response to Exercise of Patients With Chronic Obstructive Pulmonary Disease

INTRODUCTION

Although the major limitation to exercise performance in patients with COPD is dynamic hyperinflation (DH), little is known about its relation with cardiac response to exercise. Our objectives were to compare the exercise response of stroke volume (SV) and cardiac output (CO) between COPD patients with or without DH and control subjects, and to assess the main determinants.

METHODS

Fifty-seven stable COPD patients without cardiac comorbidity and 25 healthy subjects were recruited. Clinical evaluation, baseline function tests, computed tomography and echocardiography were conducted in all subjects. Patients performed consecutive incremental exercise tests with measurement of operating lung volumes and non-invasive measurement of SV, CO and oxygen uptake (VO₂) by an inert gas rebreathing method. Biomarkers of systemic inflammation and oxidative stress, tissue damage/repair, cardiac involvement and airway inflammation were measured.

RESULTS

COPD patients showed a lower SV/VO₂ slope than control subjects, while CO response was compensated by a higher heart rate increase. COPD patients with DH experienced a reduction of SV/VO₂ and CO/VO₂ compared to those without DH. In COPD patients, the end-expiratory lung volume (EELV) increase was related to SV/VO₂ and CO/VO₂ slopes, and it was the only independent predictor of cardiac response to exercise. However, in the regression models without EELV, plasma IL-1β and high-sensitivity cardiac troponin T were also retained as independent predictors of SV/VO₂ slope.

CONCLUSION

Dynamic hyperinflation decreases the cardiac response to exercise of COPD patients. This effect is related to systemic inflammation and myocardial stress but not with left ventricle diastolic dysfunction.

Morning blood pressure surge is associated with the severity of stable coronary artery disease in hypertensive patients

Background: We aimed to investigate the association between morning surge (MS) of blood pressure (BP) and SYNTAX score (SS) which gives information regarding the complexity and extent of coronary artery disease (CAD) in hypertensive patients. Methods: We included 187 hypertensive patients (134 males, 53 females; mean age: 62.5 ± 10.9 years) who underwent elective coronary angiography. Patients with the acute coronary syndrome and a history of coronary intervention were excluded from the study. The MBPS was calculated as the difference between the average BP during the 2 hours after awakening (four BP readings) and the lowest nighttime BP. The severity of coronary lesions was evaluated based on the SS assessed by coronary angiography. Patients were classified into two groups according to SS: low SS (SS ≤ 22) and intermediate-to-high SS (>22).Results: Patients in the intermediate-to-high SS group were found to be older, have higher uric acid levels, average daytime systolic BP (SBP), nighttime SBP, morning SBP, MS of BP and have higher rates of diabetes (DM) and female gender. There was no significant difference in terms of hypertensive treatment. In multivariate analysis, MS of BP (OR: 2.151, p: 0.005) and DM (OR: 0.014, p: 0.015) were independent parameters for predicting intermediate-to-high SS. The cutoff value of MS of BP obtained by ROC curve analysis was 18,5 mmHg for prediction of intermediate-high SS (sensitivity: 76.5%, specificity: 71.2%). The area under the curve was 0.762 (p < .001).Conclusion: MS of BP significantly correlates with the severity of coronary stenosis in hypertensive patients, suggesting that it could be a potential predictive marker of CAD.

Elevated Cardiac Troponin Levels in Geriatric Patients Without ACS: Role of Comorbidities

Background

Elevated levels of cardiac troponin T as measured by a high-sensitivity test (hscTnT) are common in geriatric patients with a large spectrum of comorbidities but without acute coronary syndrome (ACS). However, the relative contribution of individual comorbidities has never been clearly addressed. This study aimed to determine the relationship between hscTnT elevation as a response variable and individual comorbidities, and to estimate the impact of individual comorbidities on hscTnT elevation in geriatric patients free of ACS.

Methods

A nonexperimental, retrospective, matched, longitudinal cohort study was designed to evaluate the files of 7062 geriatric patients (aged ≥ 65 years) without ACS. The hscTnT levels of the patients have already been measured in all evaluated medical records. The dataset was split into 2 groups (0 and 1) based on the individual comorbidity (0 and 1) and hscTnT levels (≤ 14 ng/L = 0 and > 14 ng/L = 1).

Results

Our results show that although age was positively and significantly correlated with hscTnT (r = 0.17, P < 0.0001), the likelihood of experiencing elevated hscTnT levels in older individuals after having excluded ACS was related to the presence of comorbidities independently of their number (P < 0.0001). The regression coefficients (β) associated with renal insufficiency (0.71), cardiomyopathy (0.63), chronic obstructive pulmonary disease (0.30), diabetes (0.25), and anemia (0.22) indicated that there exists a significant association between these comorbidities and the elevated hscTnT levels (P < 0.001). The receiver operating characteristic curve for predictive modeling was estimated at 71% (P < 0.0001).

Conclusions

Elevated hscTnT levels were mostly associated with renal insufficiency, cardiac myopathies, chronic obstructive pulmonary disease, diabetes, and anemia in geriatric patients without ACS. Developing guidelines to accurately evaluate hscTnT elevation in geriatric patients with comorbidities, without ACS, is clinically essential.

Beta 1 adrenoceptor blockade promotes angiogenesis in hypertrophied myocardium of transverse aortic constricted mice

Left ventricular hypertrophy (LVH) is an adaptive structural remodelling consequent to uncontrolled blood pressure. Impaired angiogenesis plays a vital role in transiting LVH into cardiac failure. Catecholamines modulate myocardial function through beta adrenoceptors, and their blockers (β-AR) reduce cardiovascular morbidity and mortality by decelerating the LVH progression. Nonetheless, the effect of β-AR blockers on myocardial vascular bed remains largely obscure. Hence, this study is focussed on analysing the possible outcomes of β-AR blockers on myocardial vascular remodelling using a surgically induced LVH mice model. Transverse aortic constricted mice and sham-operated mice were administered with metoprolol at a dose of 30 mg/kg/d for 60 days and myocardial vascular endothelial growth factor (VEGF) alpha levels, GSH/GSSG ratio, myocardial protein carbonyl content, hypertrophy index and global myocardial function, trans-aortic fluid dynamics and expression pattern of angiopoietin-1 and VEGF alpha were assessed. These findings were further confirmed by histochemical analysis for myocardial capillary density, perivascular fibrosis ratio and intimal thickening. Sub- chronic β-AR blockade reduced the oxidative stress, hypertrophic index, intimal thickening and perivascular fibrosis ratio. A marked increase in myocardial VEGF, angiopoietin 1, global myocardial function and myocardial capillary density was also observed. There was a reduction in the LVH and upregulation of myocardial angiogenesis concluding that β-AR blockers prevent adverse vascular remodelling which might underlie its concealed mechanism of action.

Effect of Dynamic Hyperinflation on Cardiac Response to Exercise of Patients With Chronic Obstructive Pulmonary Disease

INTRODUCTION

Although the major limitation to exercise performance in patients with COPD is dynamic hyperinflation (DH), little is known about its relation with cardiac response to exercise. Our objectives were to compare the exercise response of stroke volume (SV) and cardiac output (CO) between COPD patients with or without DH and control subjects, and to assess the main determinants.

METHODS

Fifty-seven stable COPD patients without cardiac comorbidity and 25 healthy subjects were recruited. Clinical evaluation, baseline function tests, computed tomography and echocardiography were conducted in all subjects. Patients performed consecutive incremental exercise tests with measurement of operating lung volumes and non-invasive measurement of SV, CO and oxygen uptake (VO₂) by an inert gas rebreathing method. Biomarkers of systemic inflammation and oxidative stress, tissue damage/repair, cardiac involvement and airway inflammation were measured.

RESULTS

COPD patients showed a lower SV/VO₂ slope than control subjects, while CO response was compensated by a higher heart rate increase. COPD patients with DH experienced a reduction of SV/VO₂ and CO/VO₂ compared to those without DH. In COPD patients, the end-expiratory lung volume (EELV) increase was related to SV/VO₂ and CO/VO₂ slopes, and it was the only independent predictor of cardiac response to exercise. However, in the regression models without EELV, plasma IL-1β and high-sensitivity cardiac troponin T were also retained as independent predictors of SV/VO₂ slope.

CONCLUSION

Dynamic hyperinflation decreases the cardiac response to exercise of COPD patients. This effect is related to systemic inflammation and myocardial stress but not with left ventricle diastolic dysfunction.

Clinical importance of high- sensitivity troponin T in patients without coronary artery disease

Cardiac troponin is the preferred biomarker for the diagnosis of the acute coronary syndrome (ACS), but many other diseases can be identified with elevated troponin levels in the absence of ACS. The recent development of a high-sensitive cardiac troponin T (hs-cTnT) assay permits the detection of very low levels of cTnT. The use of hs-cTnT assay has emerged as a tool for identifying high-risk individuals for primary preventive treatment and can detect subclinical injury in asymptomatic patients. Hs-cTnT analyses are generally related to ischemia in the literature. Thus, we made an evaluation of hs-cTnT analysis in non-coronary patients, which may contribute to the literature.

The association of high-sensitivity cardiac troponin I and T with echocardiographic stages of heart failure with preserved ejection fraction

Background

This study evaluates the associations between high-sensitivity troponin I and T (hs-TnI/hs-TnT) and the stages of heart failure with preserved ejection fraction (HFpEF)/diastolic dysfunction.

Methods

Blood samples for biomarker measurements (hs-TnI/hs-TnT/NT-proBNP) were collected within 24 h of routine echocardiographic examination. Patients with left ventricular ejection fraction <50%, right ventricular dysfunction and moderate-to-severe valvular heart disease were excluded. Graduation of diastolic dysfunction was determined according to current guidelines.

Results

A total of 70 patients were included. Hs-TnT concentrations increased significantly according to the progression of diastolic dysfunction ( P = 0.024). Hs-TnT was able to discriminate patients with diastolic dysfunction grade III (AUC = 0.737; P = 0.013), while NT-proBNP revealed a greater AUC (AUC 0.798; P = 0.002). Concentrations of hs-TnI increased only numerically according to the increasing stages of diastolic dysfunction ( P = 0.353). In multivariable logistic regression models, hs-TnT concentrations > 28 ng/L were associated with diastolic dysfunction grade III (OR = 4.7, P = 0.024), even after adjusting for NT-proBNP.

Conclusion

Increasing concentrations of hs-TnT may reflect the stages of diastolic dysfunction being assessed by echocardiography, whereas hs-TnI does not show any association with diastolic dysfunction.

Morphologic and Functional Heart Abnormalities Associated to High Modified Tei Index in Hypertensive Patients

INTRODUCTION

LV dysfunction develops early in hypertension, even previously to left ventricular remodeling.

AIMS

To determine the frequency of morphologic and functional heart abnormalities associated to abnormal modified Tei Index in untreated hypertensive (HBP) patients (p) with preserved ejection fraction (pEF).

METHODS

Case-control study. Three groups: (1) HBP without left ventricular hypertrophy (LVH); (2) HBP with LVH; (3) non-HBP controls. Ejection fraction >54 % identified pEF. LVH measured by Devereux method. Systolic and diastolic functions assessed by standard echocardiography and tissue Doppler. 2013 ESH/ESC Hypertension Guidelines normal values were considered. Tei index measured at the lateral and septal LV walls in apical 4-chamber view by tissue Doppler, value >0.40 considered abnormal.

STATISTICAL ANALYSIS

multifactorial ANOVA test adjusted by sex and age, p < 0.05 statistically significant.

RESULTS

The study included 14 controls, 88 HBP p without LVH, and 19 HBP p with LVH. The HBP p sample mean age was 58.7 ± 13.5 years and 52 (44.1 %) were males. Mean Tei Index was 0.35 ± 0.03 in controls; 0.42 ± 0.05 in HBP without LVH; and 0.42 ± 0.06 in HBP with LVH (p < 0.025). Abnormal Tei Index was present in 2p (14.3 %) controls; 64 p (72.7 %) HBP without LVH; and 15 p (78.9 %) HBP with LVH (p < 0.0009). Tissue Doppler's wave was 8.4 ± 0.9 cm/s in controls; 8 ± 1.6 cm/s in HBP without LVH and 7.8 ± 1.1 cm/s in HBP with LVH.

CONCLUSIONS

(1) Left ventricular dysfunction is frequent in HBP p, even without LVH; (2) modified tissue Doppler Tei index is a useful tool for the diagnosis of left ventricular dysfunction.