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Reversed Septal Curvature Is Associated with Elevated Troponin Level in Hypertrophic Cardiomyopathy. DISEASE MARKERS 2020; 2020:8821961. [PMID: 33354249 PMCID: PMC7737433 DOI: 10.1155/2020/8821961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/27/2020] [Accepted: 11/21/2020] [Indexed: 11/17/2022]
Abstract
The aim of study was to compare patients with hypertrophic cardiomyopathy divided according to septal configuration assessed in a 4-chamber apical window. The study group consisted of 56 consecutive patients. Reversed septal curvature (RSC) and non-RSC were diagnosed in 17 (30.4%) and 39 (69.6%) patients, respectively. Both RSC and non-RSC groups were compared in terms of the level of high-sensitivity troponin I (hs-TnI), NT-proBNP (absolute value), NT-proBNP/ULN (value normalized for sex and age), and echocardiographic parameters, including left ventricular outflow tract gradient (LVOTG). A higher level of hs-TnI was observed in RSC patients as compared to the non-RSC group (102 (29.2-214.7) vs. 8.7 (5.3-18) (ng/l), p = 0.001). A trend toward increased NT-proBNP value was reported in RSC patients (1279 (367.3-1186) vs. 551.7 (273-969) (pg/ml), p = 0.056). However, no difference in the NT-proBNP/ULN level between both groups was observed. Provocable LVOTG was higher in RSC as compared to non-RSC patients (51 (9.5-105) vs. 13.6 (7.5-31) (mmHg), p = 0.04). Furthermore, more patients with RSC had prognostically unfavourable increased septal thickness to left LV diameter at the end diastole ratio. Patients with RSC were associated with an increased level of hs-TnI, and the only trend observed in this group was for the higher NT-proBNP levels. RSC seems to be an alerting factor for the risk of ischemic events. Not resting but only provocable LVOTG was higher in RSC as compared to non-RSC patients.
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Arcari L, Luciani M, Cacciotti L, Musumeci MB, Spuntarelli V, Pistella E, Martolini D, Manzo D, Pucci M, Marone C, Melandri S, Ansalone G, Santini C, Martelletti P, Volpe M, De Biase L. Incidence and determinants of high-sensitivity troponin and natriuretic peptides elevation at admission in hospitalized COVID-19 pneumonia patients. Intern Emerg Med 2020; 15:1467-1476. [PMID: 32986136 PMCID: PMC7520380 DOI: 10.1007/s11739-020-02498-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Myocardial involvement in the course of coronavirus disease 2019 (COVID-19) pneumonia has been reported, though not fully characterized yet. The aim of the present study is to undertake a joint evaluation of hs-Troponin and natriuretic peptides (NP) in patients hospitalized for COVID-19 pneumonia. METHODS In this multicenter observational study, we analyzed data from n = 111 patients. Cardiac biomarkers subgroups were identified according to values beyond reference range. RESULTS Increased hs-Troponin and NP were found in 38 and 56% of the cases, respectively. As compared to those with normal cardiac biomarkers, these patients were older, had higher prevalence of cardiovascular diseases (CVD) and had more severe COVID-19 pneumonia by higher CRP and D-dimer and lower PaO2/FIO2. Two-dimensional echocardiography performed in a subset of patients (n = 24) showed significantly reduced left ventricular ejection fraction in patients with elevated NP (p = 0.02), whereas right ventricular systolic function (tricuspid annular plane systolic excursion) was significantly reduced both in patients with high hs-Troponin and NP (p = 0.022 and p = 0.03, respectively). Both hs-Troponin and NP were higher in patients with in-hospital mortality (p = 0.001 and p = 0.002, respectively). On multivariable analysis, independent associations were found of hs-Troponin with age, PaO2/FIO2 and D-dimer (B = 0.419, p = 0.001; B = - 0.212, p = 0.013; and B = 0.179, p = 0.037, respectively) and of NP with age and previous CVD (B = 0.480, p < 0.001; and B = 0.253, p = 0.001, respectively). CONCLUSIONS Myocardial involvement at admission is common in COVID-19 pneumonia. Independent associations of hs-Troponin with markers of disease severity and of NP with underlying CVD might point toward existing different mechanisms leading to their elevation in this setting.
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Affiliation(s)
- Luca Arcari
- Department of Cardiology, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177, Rome, Italy.
- Covid Unit 2, Madre Giuseppina Vannini Hospital, Rome, Italy.
| | - Michelangelo Luciani
- Internal Medicine Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Luca Cacciotti
- Department of Cardiology, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177, Rome, Italy
- Covid Unit 2, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Maria Beatrice Musumeci
- Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Cardiology Unit, Sapienza University of Rome, Rome, Italy
- Heart Failure Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Covid Unit, Sapienza University of Rome, Rome, Italy
| | - Valerio Spuntarelli
- Internal Medicine Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
- Emergency Medicine, Department of Clinical and Molecular Medicine, Covid Unit, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Eleonora Pistella
- Covid Unit 2, Madre Giuseppina Vannini Hospital, Rome, Italy
- Internal Medicine Department, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Dario Martolini
- Covid Unit 2, Madre Giuseppina Vannini Hospital, Rome, Italy
- Internal Medicine Department, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Daniele Manzo
- Department of Cardiology, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177, Rome, Italy
- Covid Unit 2, Madre Giuseppina Vannini Hospital, Rome, Italy
| | | | - Claudio Marone
- Covid Unit 2, Madre Giuseppina Vannini Hospital, Rome, Italy
- Internal Medicine Department, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Serena Melandri
- Covid Unit 2, Madre Giuseppina Vannini Hospital, Rome, Italy
- Internal Medicine Department, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Gerardo Ansalone
- Department of Cardiology, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177, Rome, Italy
| | - Claudio Santini
- Covid Unit 2, Madre Giuseppina Vannini Hospital, Rome, Italy
- Internal Medicine Department, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Paolo Martelletti
- Internal Medicine Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
- Emergency Medicine, Department of Clinical and Molecular Medicine, Covid Unit, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Massimo Volpe
- Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Cardiology Unit, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Luciano De Biase
- Heart Failure Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Covid Unit, Sapienza University of Rome, Rome, Italy
- Heart Failure Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Hypertrophic Cardiomyopathy: The Time-Synchronized Relationship between Ischemia and Left Ventricular Dysfunction Assessed by Highly Sensitive Troponin I and NT-proBNP. DISEASE MARKERS 2019; 2019:6487152. [PMID: 31320942 PMCID: PMC6610740 DOI: 10.1155/2019/6487152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/22/2019] [Accepted: 04/15/2019] [Indexed: 01/06/2023]
Abstract
The aim of this study was to compare NT-proBNP using the absolute values and NT-proBNP/ULN values that were standardized by age and gender between three subgroups: those without ischemia (negative hs-troponin I and no anginal pain (hsTnI-/AP-)), those with painless ischemia (hsTnI+/AP-), and those with painful ischemia (hsTnI+/AP+). Additionally, echocardiographic parameters were compared in these three subgroups. The absolute value of NT-proBNP was significantly higher in the painful ischemia subgroup (hsTnI-/AP- vs. hsTnI+/AP- vs. hsTnI+/AP+: 502 (174-833) vs. 969 (363-1346) vs. 2053 (323-3283) pg/ml; p = 0.018 for the whole-model analysis). The standardized value of NT-proBNP/ULN was gradually increased (hsTnI-/AP- vs. hsTnI+/AP- vs. hsTnI+/AP+: 3.61 + 0.63 vs. 6.90 + 1.31 vs. 9.35 + 1.87; p = 0.001 for the whole-model analysis). In the comparison between subgroups (hsTnI-/AP- vs. hsTnI+/AP- vs. hsTnI+/AP+), two echocardiographic parameters increased significantly. The left ventricular maximum wall thickness (LVMWT) at diastole was 1.99 ± 0.08 cm vs. 2.28 ± 0.13 cm vs. 2.49 ± 0.15 cm (p = 0.004 for the whole-model analysis). The maximal gradient of the provoked left ventricular outflow tract (LVOT) gradient increased significantly in only the painful-ischemia subgroup (11 (7-30) mmHg vs. 12 (9.35-31.5) mmHg vs. 100 (43-120) mmHg). In conclusion, both painless ischemia and painful ischemia are associated with a gradual, significant increase in NT-proBNP/ULN in comparison to the double-negative hsTnI/AP subgroup. In contrast, NT-proBNP is significantly higher in only the subgroup with painful ischemia.
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