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Marcos-Garcés V, Merenciano-González H, Gavara J, Gabaldón-Pérez A, López-Lereu MP, Monmeneu JV, Nuñez J, Pérez N, Ríos-Navarro C, de Dios E, Chorro FJ, Valente F, Lorenzatti D, Domenech-Ximenos B, Alonso Tello A, Maymí-Ballesteros M, Rello-Sabaté P, Morr CI, Ortiz-Pérez JT, Rodríguez-Palomares JF, Bodí V. MRI Investigation of the Differential Impact of Left Ventricular Ejection Fraction After Myocardial Infarction in Elderly vs. Nonelderly Patients to Predict Readmission for Heart Failure. J Magn Reson Imaging 2023; 58:1507-1518. [PMID: 36748793 DOI: 10.1002/jmri.28632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients with ST-segment elevation myocardial infarction (STEMI), especially elderly individuals, have an increased risk of readmission for acute heart failure (AHF). PURPOSE To study the impact of left ventricular ejection fraction (LVEF) by MRI to predict AHF in elderly (>70 years) and nonelderly patients after STEMI. STUDY TYPE Prospective. POPULATION Multicenter registry of 759 reperfused STEMI patients (23.3% elderly). FIELD STRENGTH/SEQUENCE 1.5-T. Balanced steady-state free precession (cine imaging) and segmented inversion recovery steady-state free precession (late gadolinium enhancement) sequences. ASSESSMENT One-week MRI-derived LVEF (%) was quantified. Sequential MRI data were recorded in 579 patients. Patients were categorized according to their MRI-derived LVEF as preserved (p-LVEF, ≥50%), mildly reduced (mr-LVEF, 41%-49%), or reduced (r-LVEF, ≤40%). Median follow-up was 5 [2.33-7.54] years. STATISTICAL TESTS Univariable (Student's t, Mann-Whitney U, chi-square, and Fisher's exact tests) and multivariable (Cox proportional hazard regression) comparisons and continuous-time multistate Markov model to analyze transitions between LVEF categories and to AHF. Hazard ratios (HR) with 95% confidence intervals (CIs) were computed. P < 0.05 was considered statistically significant. RESULTS Over the follow-up period, 79 (10.4%) patients presented AHF. MRI-LVEF was the most robust predictor in nonelderly (HR 0.94 [0.91-0.98]) and elderly patients (HR 0.94 [0.91-0.97]). Elderly patients had an increased AHF risk across the LVEF spectrum. An excess of risk (compared to p-LVEF) was noted in patients with r-LVEF both in nonelderly (HR 11.25 [5.67-22.32]) and elderly patients (HR 7.55 [3.29-17.34]). However, the mr-LVEF category was associated with increased AHF risk only in elderly patients (HR 3.66 [1.54-8.68]). Less transitions to higher LVEF states (n = 19, 30.2% vs. n = 98, 53%) and more transitions to AHF state (n = 34, 53.9% vs. n = 45, 24.3%) were observed in elderly than nonelderly patients. DATA CONCLUSION MRI-derived p-LVEF confers a favorable prognosis and r-LVEF identifies individuals at the highest risk of AHF in both elderly and nonelderly patients. Nevertheless, an excess of risk was also found in the mr-LVEF category in the elderly group. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Víctor Marcos-Garcés
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- INCLIVA Health Research Institute, Valencia, Spain
| | - Héctor Merenciano-González
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- INCLIVA Health Research Institute, Valencia, Spain
| | - José Gavara
- INCLIVA Health Research Institute, Valencia, Spain
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Ana Gabaldón-Pérez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- INCLIVA Health Research Institute, Valencia, Spain
| | - María P López-Lereu
- Cardiovascular Magnetic Resonance Unit, ASCIRES Biomedical Group, Valencia, Spain
| | - José V Monmeneu
- Cardiovascular Magnetic Resonance Unit, ASCIRES Biomedical Group, Valencia, Spain
| | - Julio Nuñez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- INCLIVA Health Research Institute, Valencia, Spain
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Nerea Pérez
- INCLIVA Health Research Institute, Valencia, Spain
| | | | - Elena de Dios
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
| | - Francisco J Chorro
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- INCLIVA Health Research Institute, Valencia, Spain
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Filipa Valente
- Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain
| | - Daniel Lorenzatti
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Blanca Domenech-Ximenos
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Cardiothoracic Imaging -Diagnostic Imaging Center, Hospital Clínic, Barcelona, Spain
| | - Albert Alonso Tello
- Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain
| | | | - Pau Rello-Sabaté
- Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain
| | - Carlos Igor Morr
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Jose T Ortiz-Pérez
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Jose F Rodríguez-Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
- Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vicente Bodí
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- INCLIVA Health Research Institute, Valencia, Spain
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
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Mavungu Mbuku JM, Mukombola Kasongo A, Goube P, Miltoni L, Nkodila Natuhoyila A, M’Buyamba-Kabangu JR, Longo-Mbenza B, Kianu Phanzu B. Factors associated with complications in ST-elevation myocardial infarction: a single-center experience. BMC Cardiovasc Disord 2023; 23:468. [PMID: 37726694 PMCID: PMC10510166 DOI: 10.1186/s12872-023-03498-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND ST-elevation myocardial infarction (STEMI) is a major public health problem. This study aimed to determine the prevalence and identify the determinants of STEMI-related complications in the Cardiology Intensive Care Unit of the Sud Francilien Hospital Center (SFHC). METHODS We retrospectively analyzed the data of 315 patients with STEMI aged ≥ 18 years. Logistic regression was used to identify factors independently associated with the occurrence of complications. RESULTS Overall, 315 patients aged 61.7 ± 13.4 years, of whom 261 were men, had STEMI during the study period. The hospital frequency of STEMI was 12.7%. Arrhythmias and acute heart failure were the main complications. Age ≥ 75 years (adjusted odds ratio [aOR], 5.18; 95% confidence interval [CI], 3.92-8.75), hypertension (aOR, 3.38; 95% CI, 1.68-5.82), and cigarette smoking (aOR, 3.52; 95% CI, 1.69-7.33) were independent determinants of acute heart failure. Meanwhile, diabetes mellitus (aOR, 1.74; 95% CI, 1.09-3.37), history of atrial fibrillation (aOR, 2.79; 95% CI, 1.66-4.76), history of stroke or transient ischemic attack (aOR, 1.99; 95% CI, 1.31-2.89), and low high-density lipoprotein-cholesterol (HDL-C) levels (aOR, 3.70; 95% CI, 1.08-6.64) were independent determinants of arrhythmias. CONCLUSION STEMI is a frequent condition at SFHC and is often complicated by acute heart failure and arrhythmias. Patients aged ≥ 75 years, those with hypertension or diabetes mellitus, smokers, those with a history of atrial fibrillation or stroke, and those with low HDL-C levels require careful monitoring for the early diagnosis and management of these complications.
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Affiliation(s)
- Jean-Michel Mavungu Mbuku
- Unit of cardiology, University of Kinshasa, 58, Avenue Biangala, Righini, Commune Lemba, Kinshasa, Democratic Republic of Congo
| | | | - Pascale Goube
- Cardiology Intensive Care Unit, Hôpital Sud Francilien, Paris, France
| | - Laetitia Miltoni
- Cardiology Intensive Care Unit, Hôpital Sud Francilien, Paris, France
| | | | - Jean-Réné M’Buyamba-Kabangu
- Unit of cardiology, University of Kinshasa, 58, Avenue Biangala, Righini, Commune Lemba, Kinshasa, Democratic Republic of Congo
| | - Benjamin Longo-Mbenza
- Unit of cardiology, University of Kinshasa, 58, Avenue Biangala, Righini, Commune Lemba, Kinshasa, Democratic Republic of Congo
| | - Bernard Kianu Phanzu
- Unit of cardiology, University of Kinshasa, 58, Avenue Biangala, Righini, Commune Lemba, Kinshasa, Democratic Republic of Congo
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3
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Kilci H, Altınbilek E, Çetinkal G, Sığırcı S, Koçaş BB, Yıldız SS, Kılıçkesmez KO. Relation of a novel fibrosis marker and post-myocardial infarction left ventricular ejection fraction in revascularized patients. Biomark Med 2021; 15:1651-1658. [PMID: 34704823 DOI: 10.2217/bmm-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To investigate the relationship between post-myocardial infarction (MI) left ventricular ejection fraction (LVEF) and fibrosis marker HE-4 in primarily revascularized patients with ST-segment elevation MI (STEMI). Patients & methods: In 94 consecutive STEMI patients (median age 57 [IQR: 50-69] years; 77.7% male), HE-4 values were measured at hospital admission and 4 days after STEMI. Transthoracic echocardiography was performed 4 days after STEMI (median 5 days [interquartile range: 4-6]). Results: HE-4 levels 4 days after STEMI were significantly higher in the low ejection fraction group (30.1 [26.0-46.5] pmol/l vs 48.5 [32.5-85.9] pmol/l, p = 0.004). In the multivariable analysis, HE-4 values (odds ratio: 1.029, 95% CI: 1.012-1.046, p = 0.001), troponin I levels, anterior MI and diabetes mellitus were independent predictors of low LVEF after STEMI. A negative correlation existed between ΔHE-4 levels and LVEF (r: -0.337, p = 0.001). Receiver operating characteristic analysis indicated 34.01 pmol/l HE-4 at 4 days after STEMI identified patients with low LVEF (AUC = 0.707; 95% CI: 0.601-0.813; p = 0.001). Conclusion: In revascularized STEMI patients, high HE-4 levels are associated with decreased LVEF. HE-4 may represent a diagnostic marker and treatment target for patients with heart failure or left ventricular systolic dysfunction after STEMI.
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Affiliation(s)
- Hakan Kilci
- Department of Cardiology, Sisli Hamidiye Etfal Training & Research Hospital, Istanbul, 34371,Turkey
| | - Ertuğrul Altınbilek
- Department of Emergency, Sisli Hamidiye Etfal Training & Research Hospital, Istanbul, 34371, Turkey
| | - Gökhan Çetinkal
- Department of Cardiology, Sisli Hamidiye Etfal Training & Research Hospital, Istanbul, 34371,Turkey
| | - Serhat Sığırcı
- Department of Cardiology, Sisli Hamidiye Etfal Training & Research Hospital, Istanbul, 34371,Turkey
| | - Betül B Koçaş
- Department of Cardiology, Sisli Hamidiye Etfal Training & Research Hospital, Istanbul, 34371,Turkey
| | - Süleyman S Yıldız
- Department of Cardiology, Sisli Hamidiye Etfal Training & Research Hospital, Istanbul, 34371,Turkey
| | - Kadriye Orta Kılıçkesmez
- Department of Cardiology, Sisli Hamidiye Etfal Training & Research Hospital, Istanbul, 34371,Turkey
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Falcão F, Oliveira F, Cantarelli F, Cantarelli R, Brito Júnior P, Lemos H, Silva P, Camboim I, Freire MC, Carvalho O, Sobral Filho DC. Carbohydrate antigen 125 for mortality risk prediction following acute myocardial infarction. Sci Rep 2020; 10:11016. [PMID: 32620821 PMCID: PMC7335179 DOI: 10.1038/s41598-020-67548-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/08/2020] [Indexed: 11/08/2022] Open
Abstract
Carbohydrate antigen 125 (CA125) is a congestion and inflammation biomarker and has been proved to be related to a worse prognosis in heart diseases. However, the precise relationship between elevated CA125 in patients with ST-segment elevation myocardial infarction (STEMI) has not yet been sufficiently studied. We set out to determine the association of CA125 with all-cause mortality at 6 months in STEMI. CA125, N-terminal pro brain natriuretic peptide (NTproBNP) and high sensitive C-reactive protein (hs-CRP) were measured in 245 patients admitted consecutively with STEMI undergoing coronary angioplasty. The mean age in our sample was 63.7 years, 64.9% were males, 28.3% had diabetes and 17.7% presented with acute heart failure (Killip ≥ 2). The median serum level of CA125 was 8.1 U/ml. At 6 months, the rate of all-cause mortality was 18% (44 patients). Receiver operating characteristic curve analysis demonstrated that CA125 presented similar performance to predict mortality as NTproBNP and hs-CRP. Patients with CA125 ≥ 11.48 had a higher rate of mortality (Hazard Ratio = 2.07, 95% confidence interval = 1.13-3.77, p = 0.017) than patients with CA125 < 11.48. This study suggests that elevated CA125 levels might be used to identify patients with STEMI with a higher risk of death at 6 months. CA125 seems to be a similar predictor of mortality compared to NTproBNP and hs-CRP.
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Affiliation(s)
- Felipe Falcão
- Departamento de Medicina Interna, Universidade de Pernambuco (UPE), Garanhuns, PE, Brazil.
- Unidade de Cardiologia Invasiva (UCI) - Hospital Memorial São José, Rede d'Or São Luiz, Recife, PE, Brazil.
| | - Flávio Oliveira
- Unidade de Cardiologia Invasiva (UCI) - Hospital Memorial São José, Rede d'Or São Luiz, Recife, PE, Brazil
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE-UPE), Recife, PE, Brazil
| | - Fabiano Cantarelli
- Unidade de Cardiologia Invasiva (UCI) - Hospital Memorial São José, Rede d'Or São Luiz, Recife, PE, Brazil
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE-UPE), Recife, PE, Brazil
| | - Rodigo Cantarelli
- Unidade de Cardiologia Invasiva (UCI) - Hospital Memorial São José, Rede d'Or São Luiz, Recife, PE, Brazil
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE-UPE), Recife, PE, Brazil
| | - Paulo Brito Júnior
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE-UPE), Recife, PE, Brazil
| | - Hygor Lemos
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE-UPE), Recife, PE, Brazil
| | - Paloma Silva
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE-UPE), Recife, PE, Brazil
| | - Irla Camboim
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE-UPE), Recife, PE, Brazil
| | | | - Osmário Carvalho
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE-UPE), Recife, PE, Brazil
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5
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Falcão FJA, Oliveira FRA, Cantarelli F, Cantarelli R, Brito-Júnior P, Lemos H, Silva P, Camboim I, Freire MC, Carvalho O, Sobral-Filho DC. Carbohydrate antigen 125 predicts pulmonary congestion in patients with ST-segment elevation myocardial infarction. ACTA ACUST UNITED AC 2019; 52:e9124. [PMID: 31826182 PMCID: PMC6903802 DOI: 10.1590/1414-431x20199124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/03/2019] [Indexed: 11/22/2022]
Abstract
Carbohydrate antigen 125 (CA125) has long been used as an ovarian cancer biomarker. However, because it is not specific for ovarian cells, CA125 could also be used to monitor congestion and inflammation in heart disease. Acute heart failure (HF) is used to identify patients with a worse prognosis in ST-segment elevation myocardial infarction (STEMI). We aimed to determine the association of CA125 with acute HF in STEMI and to compare CA125 with N-terminal pro brain natriuretic peptide (NTproBNP) with a cross-sectional study. At admission, patients were examined to define Killip class and then underwent coronary angioplasty. Blood samples, preferably taken in the hemodynamic ward, were centrifuged (1500 g for 15 min at ambient temperature) and stored at −80°C until biomarker assays were performed. Patients were divided into two groups according to the presence or absence of congestion. Patients in Killip class ≥II were in the congestion group and those with Killip <II in the absence of congestion group. We evaluated 231 patients. The mean age was 63.3 years. HF at admission was identified in 17.7% of patients. CA125 and NTproBNP levels were higher in patients with Killip class ≥II than those with Killip class <II (8.03 vs 9.17, P=0.016 and 772.45 vs 1925, P=0.007, respectively). The area under the receiver operator characteristic curve was 0.60 (95%CI 0.53−0.66, P=0.024) for CA125 and 0.63 (95%CI 0.56−0.69, P=0.001) for NTproBNP. There was no statistical difference between the curves (P=0.69). CA125 has similar use to NTproBNP in identifying acute HF in patients presenting with STEMI.
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Affiliation(s)
- F J A Falcão
- Faculdade de Ciência, Educação e Tecnologia, Universidade de Pernambuco, Garanhuns, PE, Brasil.,Centro de Ciências Médicas, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, PE, Brasil.,Unidade de Cardiologia Invasiva, Hospital Memorial São José, Rede D'Or São Luiz, Recife, PE, Brasil.,Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brasil
| | - F R A Oliveira
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil.,Unidade de Cardiologia Invasiva, Hospital Memorial São José, Rede D'Or São Luiz, Recife, PE, Brasil.,Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brasil
| | - F Cantarelli
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil.,Unidade de Cardiologia Invasiva, Hospital Memorial São José, Rede D'Or São Luiz, Recife, PE, Brasil.,Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brasil
| | - R Cantarelli
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil.,Unidade de Cardiologia Invasiva, Hospital Memorial São José, Rede D'Or São Luiz, Recife, PE, Brasil.,Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brasil
| | - P Brito-Júnior
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil
| | - H Lemos
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil
| | - P Silva
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil
| | - I Camboim
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil
| | - M C Freire
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil
| | - O Carvalho
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil
| | - D C Sobral-Filho
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil
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