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Park M, Hur M, Kim H, Lee CH, Lee JH, Kim HW, Nam M, Lee S. Soluble ST2 as a Useful Biomarker for Predicting Clinical Outcomes in Hospitalized COVID-19 Patients. Diagnostics (Basel) 2023; 13:diagnostics13020259. [PMID: 36673069 PMCID: PMC9857572 DOI: 10.3390/diagnostics13020259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/31/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023] Open
Abstract
Soluble suppression of tumorigenesis-2 (sST2) is an emerging biomarker for sepsis as well as for heart failure. We investigated the prognostic utility of sST2 for predicting clinical outcomes in hospitalized coronavirus disease 2019 (COVID-19) patients. In a total of 52 hospitalized COVID-19 patients, sST2 levels were measured using the ichroma ST2 assay (Boditech Med Inc., Chuncheon-si, Gang-won-do, Republic of Korea). Clinical outcomes included intensive care unit (ICU) admission, ventilator use, extracorporeal membrane oxygenation (ECMO) use, and 30-day mortality. sST2 was analyzed according to clinical outcomes. sST2, sequential organ failure assessment (SOFA) score, critical disease, and 4C mortality score were compared using the receiver operating characteristic (ROC) curve and Kaplan−Meier methods for clinical outcomes. The sST2 level differed significantly according to ICU admission, ventilator use, ECMO use, and 30-day mortality (all p < 0.05). On ROC curve analysis, sST2 predicted ICU admission, ventilator use, ECMO use, and 30-day mortality comparable to SOFA score but significantly better than critical disease. sST2 predicted ICU admission, ventilator use, and ECMO use significantly better than the 4C mortality score. On Kaplan−Meier survival analysis, hazard ratios (95% confidence interval) were 8.4 (2.7−26.8) for sST2, 14.8 (3.0−71.7) for SOFA score, 1.8 (0.5−6.5) for critical disease, and 11.7 (3.4−40.1) for 4C mortality score. This study demonstrated that sST2 could be a useful biomarker to predict ICU admission, ventilator use, ECMO use, and 30-day mortality in hospitalized COVID-19 patients. sST2 may be implemented as a prognostic COVID-19 biomarker in clinical practice.
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Affiliation(s)
- Mikyoung Park
- Department of Laboratory Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
- Correspondence: ; Tel.: +82-2-2030-5581
| | - Hanah Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
| | - Chae Hoon Lee
- Department of Laboratory Medicine, Yeungnam University College of Medicine, Daegu 42415, Republic of Korea
| | - Jong Ho Lee
- Department of Laboratory Medicine, Yeungnam University College of Medicine, Daegu 42415, Republic of Korea
| | - Hyung Woo Kim
- Department of Laboratory Medicine, Yeungnam University College of Medicine, Daegu 42415, Republic of Korea
| | - Minjeong Nam
- Department of Laboratory Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Seungho Lee
- Department of Preventive Medicine, College of Medicine, Dong-A University, Busan 49201, Republic of Korea
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Topf A, Mirna M, Bacher N, Paar V, Motloch LJ, Ohnewein B, Larbig R, Grueninger J, Hoppe UC, Lichtenauer M, Pistulli R. Analysis of Selected Cardiovascular Biomarkers in Takotsubo Cardiomyopathy and the Most Frequent Cardiomyopathies. Front Cardiovasc Med 2021; 8:700169. [PMID: 34805296 PMCID: PMC8597641 DOI: 10.3389/fcvm.2021.700169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 09/27/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction: Among the causes of de novo diagnosed cardiomyopathy, Takotsubo cardiomyopathy (TTC) plays a minor role, with an occurrence of 50,000–100,000 cases per annum in the United States. In clinical practice, a differentiation of a TTC toward an ischemic cardiomyopathy (ICMP) or a dilatative cardiomyopathy (DCMP) appears to be challenging, especially in a subacute setting or in atypical types of TTC. Methods: To investigate this issue, we analyzed serum levels of sST2, GDF-15, suPAR, HFABP, and clinical parameters including echocardiography in 51 patients with TTC, 52 patients with ischemic cardiomyopathy (ICMP) and 65 patients with dilated cardiomyopathy (DCMP). Results: sST-2 seemed to be the most promising biomarker for prediction of a TTC in differential diagnosis to an ICMP (AUC: 0.879, p = < 0.001, Cut off values: 12,140.5 pg/ml) or to a DCMP (AUC: 0.881, p = < 0.001, cut off value: 14521.9 pg/ml). GDF-15 evidenced a slightly lower AUC for prediction of a TTC in differential diagnosis to an ICMP (AUC: 0.626, p = 0.028) and to a DCMP (AUC: 0.653, p = 0.007). A differential diagnostic value was found for H-FABP in the prediction of a DCMP compared to TTC patients (AUC: 0.686, p = < 0.001). In propensity score matching for left ventricular ejection fraction, sex, and cardiovascular risk factors, differences in the plasma levels of sST2 and H-FABP in the matched cohort of TTC vs. DCMP remained statistically significant. In the matched cohort of TTC vs. ICMP, differences in sST2 also remained statistically significant Conclusion: As medical therapy, long term prognosis, interval of follow-ups, rehabilitation program and recommendations differ completely between TTC and ICMP/DCMP, biomarkers for differential diagnosis, or rather for confirmation of diagnosis, are warranted in cases of cardiomyopathies with unsure origin. sST-2, GDF-15 and H-FABP might facilitate the classification.
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Affiliation(s)
- Albert Topf
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Moritz Mirna
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Nina Bacher
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Vera Paar
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Lukas J Motloch
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Ohnewein
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Robert Larbig
- Devision of Cardiology, Hospital Maria Hilf Moenchengladbach, Moenchengladbach, Germany
| | - Janine Grueninger
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Uta C Hoppe
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Rudin Pistulli
- Devision of Cardiology, University Hospital of Muenster, Muenster, Germany
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Rawish E, Stiermaier T, Santoro F, Brunetti ND, Eitel I. Current Knowledge and Future Challenges in Takotsubo Syndrome: Part 1-Pathophysiology and Diagnosis. J Clin Med 2021; 10:jcm10030479. [PMID: 33525539 PMCID: PMC7865728 DOI: 10.3390/jcm10030479] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 02/06/2023] Open
Abstract
First recognized in 1990, takotsubo syndrome (TTS) constitutes an acute cardiac condition that mimics acute myocardial infarction commonly in the absence of obstructive coronary artery disease; it is characterized by temporary left ventricular dysfunction, regularly in a circumferential apical, midventricular, or basal distribution. Considering its acute clinical presentation, coronary angiography with left ventriculography constitutes the gold standard diagnostic tool to exclude or confirm TTS. Frequently, TTS is related to severe emotional or physical stress and a subsequent increased adrenergic stimulation affecting cardiac function. Beyond clinical presentation, epidemiology, and novel diagnostic biomarkers, this review draws attention to potential pathophysiological mechanisms for the observed reversible myocardial dysfunction such as sympathetic overdrive-mediated multi-vessel epicardial spasms, microvascular dysfunction, the direct toxicity of catecholamines, lipotoxicity, and inflammation. Considering the long-term prognosis, further experimental and clinical research is indispensable to elucidate further pathophysiological mechanisms underlying TTS before randomized control trials with evidence-based therapeutic management can be performed.
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Affiliation(s)
- Elias Rawish
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) University Heart Center, 23538 Lübeck, Germany; (E.R.); (T.S.)
- DZHK (German Centre for Cardiovascular Research), 23538 Lübeck, Germany
| | - Thomas Stiermaier
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) University Heart Center, 23538 Lübeck, Germany; (E.R.); (T.S.)
- DZHK (German Centre for Cardiovascular Research), 23538 Lübeck, Germany
| | - Francesco Santoro
- Department of Medical & Surgery Sciences, University of Foggia, 71121 Foggia, Italy
| | - Natale D. Brunetti
- Department of Medical & Surgery Sciences, University of Foggia, 71121 Foggia, Italy
| | - Ingo Eitel
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) University Heart Center, 23538 Lübeck, Germany; (E.R.); (T.S.)
- DZHK (German Centre for Cardiovascular Research), 23538 Lübeck, Germany
- Correspondence: ; Tel.: +49-451-500-44501
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Wu HY, Cheng G, Liang L, Cao YW. Recurrent Takotsubo cardiomyopathy triggered by emotionally stressful events: A case report. World J Clin Cases 2021; 9:677-684. [PMID: 33553408 PMCID: PMC7829724 DOI: 10.12998/wjcc.v9.i3.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/24/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy (TCM) is characterized by reversible left ventricular dysfunction triggered by emotional or physical stress. Only 1%-2% of patients with acute coronary syndrome are diagnosed with TCM. Although obstructive coronary artery disease is frequently considered to be the cause of chest pain, TCM should be considered in some clinical settings. In this case, clinicians did not make a timely and accurate diagnosis for TCM due to a lack of knowledge until the third hospitalization with a left ventriculogram.
CASE SUMMARY A 55-year-old postmenopausal woman had intermittent chest pain following emotionally stressful events three times in the past 3 years. Cardiac troponin levels increased after each instance of symptom onset. A transthoracic echocardiogram showed reversible left ventricular dysfunction. The patient underwent three coronary angiograms without evidence of coronary artery disease. A left ventriculogram was first performed at the third hospitalization and revealed apical akinesia with ballooning of the apical region and consistent hypercontractile basal segments. The diagnosis of TCM was confirmed. The patient was treated with an angiotensin-converting-enzyme inhibitor (perindopril) and a β-blocker (metoprolol). No complications occurred during the patient’s hospitalization. The patient was told to avoid stressful events. During the 9-mo follow-up visit, the patient was asymptomatic with an ejection fraction of 55%.
CONCLUSION Clinicians should be conscious of the possibility of TCM, especially in postmenopausal women presenting with clinical manifestations similar to acute coronary syndrome without coronary occlusion.
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Affiliation(s)
- Hao-Yu Wu
- Department of Cardiology, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
| | - Gong Cheng
- Department of Cardiology, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
| | - Lei Liang
- Department of Cardiology, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
| | - Yi-Wei Cao
- Department of Electrocardiology, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
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Ghali R, Altara R, Louch WE, Cataliotti A, Mallat Z, Kaplan A, Zouein FA, Booz GW. IL-33 (Interleukin 33)/sST2 Axis in Hypertension and Heart Failure. Hypertension 2018; 72:818-828. [DOI: 10.1161/hypertensionaha.118.11157] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Rana Ghali
- From the Department of Pharmacology and Toxicology, American University of Beirut Medicine Center, Lebanon (R.G., A.K., F.A.Z.)
| | - Raffaele Altara
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Norway (R.A., W.E.L., A.C.)
- KG Jebsen Center for Cardiac Research, Oslo, Norway (R.A., W.E.L., A.C.)
- Department of Pathology (R.A.), School of Medicine, University of Mississippi Medical Center, Jackson
| | - William E. Louch
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Norway (R.A., W.E.L., A.C.)
- KG Jebsen Center for Cardiac Research, Oslo, Norway (R.A., W.E.L., A.C.)
| | - Alessandro Cataliotti
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Norway (R.A., W.E.L., A.C.)
- KG Jebsen Center for Cardiac Research, Oslo, Norway (R.A., W.E.L., A.C.)
| | - Ziad Mallat
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, United Kingdom (Z.M.)
- Institut National de la Sante et de la Recherche Medicale (Inserm), Unit 970, Paris Cardiovascular Research Center, France (Z.M.)
| | - Abdullah Kaplan
- From the Department of Pharmacology and Toxicology, American University of Beirut Medicine Center, Lebanon (R.G., A.K., F.A.Z.)
| | - Fouad A. Zouein
- From the Department of Pharmacology and Toxicology, American University of Beirut Medicine Center, Lebanon (R.G., A.K., F.A.Z.)
| | - George W. Booz
- Department of Pharmacology and Toxicology (G.W.B.), School of Medicine, University of Mississippi Medical Center, Jackson
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Yang HS, Hur M, Yi A, Kim H, Kim J. Prognostic Role of High-sensitivity Cardiac Troponin I and Soluble Suppression of Tumorigenicity-2 in Surgical Intensive Care Unit Patients Undergoing Non-cardiac Surgery. Ann Lab Med 2018; 38:204-211. [PMID: 29401554 PMCID: PMC5820064 DOI: 10.3343/alm.2018.38.3.204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/29/2017] [Accepted: 12/26/2017] [Indexed: 12/22/2022] Open
Abstract
Background The prognostic utility of cardiac biomarkers, high-sensitivity cardiac troponin I (hs-cTnI) and soluble suppression of tumorigenicity-2 (sST2), in non-cardiac surgery is not well-defined. We evaluated hs-cTnI and sST2 as predictors of 30-day major adverse cardiac events (MACE) in patients admitted to the surgical intensive care unit (SICU) following major non-cardiac surgery. Methods hs-cTnI and sST2 concentrations were measured in 175 SICU patients immediately following surgery and for three days postoperatively. The results were analyzed in relation to 30-day MACE and were compared with the revised Goldman cardiac risk index (RCRI) score. Results Overall, 30-day MACE was observed in 16 (9.1%) patients. hs-cTnI and sST2 concentrations differed significantly between the two groups with and without 30-day MACE (P<0.05). The maximum concentration of sST2 was an independent predictor of 30-day MACE (odds ratio=1.016, P=0.008). The optimal cut-off values of hs-cTnI and sST2 for predicting 30-day MACE were 53.0 ng/L and 182.5 ng/mL, respectively. A combination of hs-cTnI and sST2 predicted 30-day MACE better than the RCRI score. Moreover, 30-day MACE was observed more frequently with increasing numbers of above-optimal cut-off hs-cTnI and sST2 values (P<0.0001). Reclassification analyses indicated that the addition of biomarkers to RCRI scores improved the prediction of 30-day MACE. Conclusions This study demonstrates the utility of hs-cTnI and sST2 in predicting 30-day MACE following non-cardiac surgery. Cardiac biomarkers would provide enhanced risk stratification in addition to clinical RCRI scores for patients undergoing major non-cardiac surgery.
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Affiliation(s)
- Hyun Suk Yang
- Department of Cardiovascular Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea.
| | - Ahram Yi
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hanah Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jayoun Kim
- Research Coordinating Center, Konkuk University Medical Center, Seoul, Korea
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Oras J, Redfors B, Ricksten SE. Reply to What is the real incidence of Takotsubo syndrome in intensive care units? Acta Anaesthesiol Scand 2017; 61:1372-1373. [PMID: 28952143 DOI: 10.1111/aas.13003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J Oras
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - B Redfors
- Department of Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S-E Ricksten
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Gopalakrishnan P, Zaidi R, Sardar MR. Takotsubo cardiomyopathy: Pathophysiology and role of cardiac biomarkers in differential diagnosis. World J Cardiol 2017; 9:723-730. [PMID: 29081904 PMCID: PMC5633535 DOI: 10.4330/wjc.v9.i9.723] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 05/10/2017] [Accepted: 05/24/2017] [Indexed: 02/06/2023] Open
Abstract
Takotsubo cardiomyopathy (TC) is characterized by reversible ventricular dysfunction, not limited to the distribution of an epicardial coronary artery. A disease primarily afflicting post-menopausal women, it is frequently mistaken for acute anterior wall myocardial infarction. Alternatively called Stress Cardiomyopathy, physical or emotional triggers are identified in only three fourths of TC patients. Long considered a benign condition, recent findings suggest poor short term prognosis similar to acute coronary syndrome (ACS). Despite the widely recognized pathophysiological role of catecholamine excess, its diagnostic role is uncertain. TC is suspected based on typical wall motion abnormalities in ventriculogram or echocardiogram. Several additional electrocardiographic, laboratory and imaging parameters have been studied with the goal of clinical diagnosis of TC. While several clinical clues differentiate it from ACS, a clinical diagnosis is often elusive leading to avoidable cardiac catheterizations. Natriuretic peptides (NPs), a family of peptide hormones released primarily in response to myocardial stretch, play a significant role in pathophysiology, diagnosis as well as treatment of congestive heart failure. TC with its prominent ventricular dysfunction is associated with a significant elevation of NPs. NPs are elevated in ACS as well but the degree of elevation is typically lesser than in TC. Markers of myocardial injury such as troponin are usually elevated to a higher degree in ACS than in TC. This differential elevation of NPs and markers of myocardial injury may play a role in early clinical recognition of TC.
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Affiliation(s)
| | - Ramsha Zaidi
- Division of Cardiology, Department of Medicine, Aultman Hospital, Canton, OH 44710, United States
| | - Muhammad Rizwan Sardar
- Division of Cardiology, Department of Medicine, Aultman Hospital, Canton, OH 44710, United States
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Oras J, Lundgren J, Redfors B, Brandin D, Omerovic E, Seeman-Lodding H, Ricksten SE. Takotsubo syndrome in hemodynamically unstable patients admitted to the intensive care unit - a retrospective study. Acta Anaesthesiol Scand 2017; 61:914-924. [PMID: 28718877 DOI: 10.1111/aas.12940] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/02/2017] [Accepted: 06/21/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Takotsubo syndrome (TS) is an acute cardiac condition that is often triggered by critical illness but that has rarely been studied in the intensive care unit (ICU) setting. The aim of this study was to (i) estimate the incidence of TS in a hemodynamically unstable ICU-population; (ii) identify predictors of TS in this population; (iii) study the impact of TS on prognosis and course of hospitalization. METHODS Medical records from all patients admitted to our general ICU from 2012 to 2015 were analyzed. TS was defined as having transient regional wall motion abnormalities (RWMA) with a typical pattern not attributable to a history of coronary artery disease or acute coronary syndromes. RESULTS Out of 6470 patients admitted to the ICU, echocardiography due to hemodynamic instability was performed in 1051 patients; 467 had LV dysfunction and 59 fulfilled TS criteria. Patients with TS had higher SAPS 3 scores on admission than patients with normal LV function. Septic shock, cardiac arrest, cerebral mass lesion, female sex and low pH were independently associated with TS on admission. Patients with TS needed more ICU resources measured by higher NEMS scores and longer ICU-stay. Crude mortality was higher in TS patients (32%) vs the ICU-population (20%, P = 0.020), but there were no differences in a SAPS 3 adjusted analysis. CONCLUSION TS was not an uncommon cause of LV dysfunction in hemodynamically unstable ICU-patients. Furthermore, TS was associated with a more complex disease. TS is a complication to take in consideration in the critically ill.
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Affiliation(s)
- J. Oras
- The Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - J. Lundgren
- Department of Cardiology; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - B. Redfors
- Department of Cardiology; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - D. Brandin
- The Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - E. Omerovic
- Department of Cardiology; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - H. Seeman-Lodding
- The Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - S.-E. Ricksten
- The Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Fitzgibbons TP, Edwards YJK, Shaw P, Iskandar A, Ahmed M, Bote J, Shah T, Sinha S, Gerszten RE, Keaney JF, Zile MR, Aurigemma GP. Activation of Inflammatory and Pro-Thrombotic Pathways in Acute Stress Cardiomyopathy. Front Cardiovasc Med 2017; 4:49. [PMID: 28824923 PMCID: PMC5541033 DOI: 10.3389/fcvm.2017.00049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/13/2017] [Indexed: 01/27/2023] Open
Abstract
Stress cardiomyopathy (SCM) is a unique cardiac disorder that more often occurs in women. SCM presents in a similar fashion as acute myocardial infarction (AMI), with chest pain, ECG changes, and congestive heart failure. The primary distinguishing feature is the absence of thrombotic coronary occlusion in SCM. How this reduction in cardiac function occurs in the absence of coronary occlusion remains unknown. Therefore, we tested the hypothesis that a targeted proteomic comparison of patients with acute SCM and AMI might identify relevant mechanistic differences. Blood was drawn in normal controls (n = 6), women with AMI (n = 12), or women with acute SCM (n = 15). Two-week follow-up samples were available in AMI (n = 4) and SCM patients (n = 11). Relative concentrations of 1,310 serum proteins were measured in each of the 48 samples using the SOMAscan assay. Women with AMI had greater myocyte necrosis, as reflected by a higher peak troponin I concentration (AMI 32.03 ± 29.46 vs. SCM 2.68 ± 2.6 ng/ml, p < 0.05). AMI and SCM patients had equivalent reductions in left ventricular ejection fraction [LVEF (%) 39 ± 12 vs. 37 ± 12, p = 0.479]. In follow-up, women with SCM had a greater improvement in cardiac function [LVEF (%) 60 ± 7 vs. 45 ± 13, p < 0.001]. No differentially expressed proteins were detected (absolute log2-fold change >1; q < 0.05) between AMI and SCM in the acute or recovery phase. However, when we compared normal controls to patients with AMI, there was differential expression of 35 proteins. When we compared normal controls to patients with SCM, 45 proteins were differentially expressed. In comparison to normal controls, biological processes such as complement, coagulation, and inflammation were activated in both AMI and SCM. There were four proteins that showed a non-significant trend to be increased in acute SCM vs. AMI (netrin-1, follistatin-like 3, kallikrein 7, kynureninase). Despite a lesser degree of myocardial necrosis than AMI, SCM is characterized by a similar activation of inflammatory, complement, and coagulation pathways. These findings may explain reported thromboembolic complications in the short term and elevated risk of mortality in the long term of SCM.
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Affiliation(s)
- Timothy P Fitzgibbons
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Yvonne J K Edwards
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Peter Shaw
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Aline Iskandar
- Division of Cardiovascular Medicine, Maine Medical Center, Portland, ME, United States
| | - Mohamed Ahmed
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Josiah Bote
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Tejen Shah
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Sumita Sinha
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Robert E Gerszten
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - John F Keaney
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Michael R Zile
- Ralph H. Johnson Veterans Administration Medical Center, Medical University of South Carolina, Charleston, SC, United States
| | - Gerard P Aurigemma
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
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11
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Yang HS, Hur M, Kim H, Magrini L, Marino R, Di Somma S. Soluble Suppression of Tumorigenicity 2 and Echocardiography in Sepsis. Ann Lab Med 2017; 36:590-4. [PMID: 27578513 PMCID: PMC5011113 DOI: 10.3343/alm.2016.36.6.590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/22/2016] [Accepted: 06/29/2016] [Indexed: 12/29/2022] Open
Abstract
Soluble suppression of tumorigenicity 2 (sST2) has emerged as a biomarker of cardiac stretch or remodeling, and has demonstrated a role in acutely decompensated heart failure. However, its role in sepsis-induced cardiac dysfunction is still unknown. We explored whether sST2 serum concentration reflects either systolic or diastolic dysfunction as measured by Doppler echocardiography. In a total of 127 patients with sepsis, correlations between sST2 and blood pressure, left ventricular (LV) ejection fraction, LV diastolic filling (ratio of early transmitral flow velocity to early diastolic mitral annulus velocity), and resting pulmonary arterial pressure were evaluated. Correlations between sST2 and other sepsis biomarkers (high-sensitivity C-reactive protein [hs-CRP] and procalcitonin) were also examined. sST2 showed a moderate correlation with mean arterial pressure (r=-0.3499) but no correlation with LV ejection fraction, diastolic filling, or resting pulmonary hypertension. It showed moderate correlations with hs-CRP and procalcitonin (r=0.2608 and r=0.3829, respectively). sST2 might have a role as a biomarker of shock or inflammation, but it cannot reflect echocardiographic findings of LV ejection fraction or diastolic filling in sepsis.
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Affiliation(s)
- Hyun Suk Yang
- Department of Cardiovascular Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Mina Hur
- Department of Cardiovascular Medicine, Konkuk University School of Medicine, Seoul, Korea.
| | - Hanah Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Laura Magrini
- Department of Medical-Surgery Sciences and Translational Medicine, University La Sapienza Rome, Sant'Andrea Hospital, Rome, Italy
| | - Rossella Marino
- Department of Medical-Surgery Sciences and Translational Medicine, University La Sapienza Rome, Sant'Andrea Hospital, Rome, Italy
| | - Salvatore Di Somma
- Department of Medical-Surgery Sciences and Translational Medicine, University La Sapienza Rome, Sant'Andrea Hospital, Rome, Italy.
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12
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Anaphylaxis-triggered takotsubo syndrome: What is its prevalence? Am J Emerg Med 2016; 34:748. [DOI: 10.1016/j.ajem.2016.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 01/18/2016] [Indexed: 11/22/2022] Open
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13
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Madias JE. Hip fracture-triggered Takotsubo syndrome: what is its real prevalence? Intern Emerg Med 2016; 11:285-6. [PMID: 26667257 DOI: 10.1007/s11739-015-1365-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, USA.
- Division of Cardiology, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY, 11373, USA.
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14
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Speckle tracking in patients with atypical Takotsubo syndrome: seek, and ye shall find! Intensive Care Med 2015; 42:303. [PMID: 26590034 DOI: 10.1007/s00134-015-4143-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
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15
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Yang HS, Hur M. Response to letter to the editor "High prevalence of Takotsubo syndrome in patients admitted to the Medical Intensive Care Unit with non-cardiac illnesses" by John E. Madias, MD. Heart Lung 2015; 44:545-6. [PMID: 26277733 DOI: 10.1016/j.hrtlng.2015.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Hyun Suk Yang
- Department of Cardiovascular Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul 143-729, South Korea.
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16
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Madias JE. High prevalence of Takotsubo syndrome in patients admitted to the Medical Intensive Care Unit with mon-cardiac illnesses. Heart Lung 2015; 44:486. [PMID: 26233259 DOI: 10.1016/j.hrtlng.2015.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 06/28/2015] [Indexed: 10/23/2022]
Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, USA.
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