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Jakubiak GK. Cardiac Troponin Serum Concentration Measurement Is Useful Not Only in the Diagnosis of Acute Cardiovascular Events. J Pers Med 2024; 14:230. [PMID: 38540973 PMCID: PMC10971222 DOI: 10.3390/jpm14030230] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 08/01/2024] Open
Abstract
Cardiac troponin serum concentration is the primary marker used for the diagnosis of acute coronary syndrome. Moreover, the measurement of cardiac troponin concentration is important for risk stratification in patients with pulmonary embolism. The cardiac troponin level is also a general marker of myocardial damage, regardless of etiology. The purpose of this study is to conduct a literature review and present the most important information regarding the current state of knowledge on the cardiac troponin serum concentration in patients with chronic cardiovascular disease (CVD), as well as on the relationships between cardiac troponin serum concentration and features of subclinical cardiovascular dysfunction. According to research conducted to date, patients with CVDs, such as chronic coronary syndrome, chronic lower extremities' ischemia, and cerebrovascular disease, are characterized by higher cardiac troponin concentrations than people without a CVD. Moreover, the literature data indicate that the concentration of cardiac troponin is correlated with markers of subclinical dysfunction of the cardiovascular system, such as the intima-media thickness, pulse wave velocity, ankle-brachial index, coronary artery calcium index (the Agatston score), and flow-mediated dilation. However, further research is needed in various patient subpopulations and in different clinical contexts.
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Affiliation(s)
- Grzegorz K Jakubiak
- Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland
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Papakonstantinou K, Rorris FP, Schizas N, Antonopoulos C, Samiotis I, Patris V, Geroulakos G, Antoniou GA. Echocardiographic Changes in Cardiac Function After Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2023; 90:119-127. [PMID: 36442711 DOI: 10.1016/j.avsg.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/01/2022] [Accepted: 10/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Evidence suggests thoracic stent grafts increase the aortic stiffness postimplantation. Our objective was to examine the effect of thoracic aortic stenting on heart function, as demonstrated with echocardiography. METHODS We considered nonrandomized studies examining echocardiographic parameters (left ventricle ejection fraction (LVEF), left ventricle end-diastolic (LVED) and end-systolic diameter (LVESD), posterior wall thickness (LVPWT), interventricular septal thickness (IVST), mass, and mass index) pre and poststent graft implantation in patients with thoracic aortic diseases (aneurysm, dissection, and blunt injury). MEDLINE and CENTRAL were searched (up to March 2021) for eligible studies. The National Institutes of Health Quality Assessment Tool was used for risk of bias assessment. Echocardiographic data pre and postimplantation were compared using the pooled standardized mean difference (SMD) and 95% confidence interval (CI). RESULTS Four studies were included in the meta-analysis. Three of the studies were judged to be "good" quality and one "fair". Nonsignificant differences pre and postimplantation were found for ejection fraction (SMD = -0.53, 95% CI = -1.8 to 0.728, P = 0.406), IVST (SMD = -0.79, 95%, CI = -3.25 to 1.66, P = 0.52), EDD (SMD = -0.10, 95% CI = -0.48 to 0.28, P = 0.60), ESD (SMD = -0.66, 95% CI = -2.35 to 1.02, P = 0.44), and PWT (SMD = -2.20, 95% CI = -5.89 to 1.47, P = 0.24). A trend toward an increase in mass postimplantation was found (SMD = 0.28, 95%, CI = -0.03 to 0.60, P = 0.08), but there was no significant difference in mass index (SMD = 0, 95%, CI = -0.195 to 0.195, P = 1). CONCLUSIONS Thoracic aortic stenting does not appear to significantly impact cardiac physiology as indicated by echocardiographic parameters.
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Affiliation(s)
| | | | - Nikolaos Schizas
- Department of Cardiovascular and Thoracic Surgery, Evaggelismos General Hospital, Athens, Greece
| | | | - Ilias Samiotis
- Department of Cardiovascular and Thoracic Surgery, Evaggelismos General Hospital, Athens, Greece
| | - Vasileios Patris
- Department of Cardiovascular and Thoracic Surgery, Evaggelismos General Hospital, Athens, Greece
| | - George Geroulakos
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK; Division of Cardiovascular Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK
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Schnaubelt S, Oppenauer J, Bader M, DU N, Eibensteiner F, Kienbacher CL, Baldi E, Mueller M, Perkmann T, Haslacher H, Schreiber W, Niessner A, Schlager O, Domanovits H, Sulzgruber P. Arterial stiffness in acute coronary syndrome as a potential triage tool: a prospective observational study. Minerva Med 2023; 114:1-14. [PMID: 35266659 DOI: 10.23736/s0026-4806.22.07909-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Diagnosis and percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) are time-sensitive. Triage and algorithms identify patients at high-risk. However, additional prediction tools are warranted for prioritized care based on predicted coronary pathologies and PCI complexity. Pulse-wave velocity (PWV) is a non-invasive measurement related to cardiovascular morbidity, and their exact value in ACS evaluation is unclear. METHODS In patients undergoing coronary angiography (CA) and - if warranted - PCI for ACS evaluation at a tertiary university hospital in Vienna, Austria, brachial-ankle (ba)PWV and carotid-femoral (cf)PWV were prospectively measured from January 2020 to January 2021. RESULTS PWV was measured in 58 patients (60.3% male; 65 [61-69] years). Risk prediction scores (GRACE, CRUSADE, TIMI), cardiac enzymes, and fraction of patients with a three-vessel disease were significantly higher in the pathological PWV ranges. Adjusted for age and comorbidities, baPWV independently predicted the LAD being relevantly stenotic (crude OR=1.416 [1.143-1.755], P=0.001; adjusted OR=1.340 [1.039-1.727], P=0.024; cut-off 15.5 m/s in CART-analysis), being the culprit lesion (crude OR=1.320 [1.094-1.594], P=0.004; adjusted OR=1.311 [1.037-1.657], P=0.024; cut-off 15.5 m/s), and being totally occluded (crude OR=1.422 [1.113-1.818], P=0.005; adjusted OR=1.677 [1.189-2.366], P=0.003; cut-off 19.6 m/s). Moreover, CA or PCI complexity were associated with higher PWV. CONCLUSIONS Pathological PWV as a surrogate for arterial stiffness, polyvascular disease and a larger atherosclerotic burden was associated with GRACE, CRUSADE, and TIMI scores, and PCI duration and complexity. BaPWV independently predicted relevant LAD pathologies, and is suggested as a potential novel triage and prioritization tool for suspected NSTE-ACS in emergency departments.
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Affiliation(s)
- Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria -
| | - Julia Oppenauer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Mathias Bader
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Na DU
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Felix Eibensteiner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Calvin L Kienbacher
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Enrico Baldi
- Section of Cardiology, Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Unit of Cardiac Intensive Care, Arrhythmia, Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Markus Mueller
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Schreiber
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Oliver Schlager
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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The relationship between day-to-day variability in home blood pressure measurement and multiple organ function. Hypertens Res 2021; 45:474-482. [PMID: 34934161 DOI: 10.1038/s41440-021-00818-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 12/18/2022]
Abstract
Blood pressure variability (BPV) is associated with the prognosis of cardiovascular diseases. However, it is unclear how BPV is related to various organs. The aim of this study is to investigate the association between BPV and multiple organ functions. A total of three hundred fifteen participants (114 males; mean age: 70 ± 9 years) participated in a community health checkup held in Tarumizu City. Home blood pressure (BP) was measured using a HEM-9700T (OMRON Healthcare, Kyoto, Japan). Day-to-day BPV was evaluated by the coefficient of variation (CV) of home BP measured in the morning for one month. N-terminal pro B-type natriuretic peptide (NT-pro BNP) and high-sensitivity (hs-)troponin T were measured as cardiac biomarkers. Liver stiffness and renal function were evaluated using the Fibrous-4 (Fib4) index and estimated glomerular filtration rate (eGFR), respectively. NT-pro BNP and hs-troponin T were divided by the median value. Fib4 index greater than 2.67 and eGFR less than 60 mL/min/1.73 m2 were defined as high Fib4 index and low eGFR, respectively. In a multivariable logistic regression analysis, the CV of systolic BP was significantly associated with high NT-pro BNP, high Fib 4 index, and low eGFR, but not with high hs-troponin T. In contrast, the CV of diastolic BP was not associated with low eGFR, and the other three biomarkers had the same results as systolic BP. In conclusion, day-to-day BPV of systolic BP is independently associated with NT-pro BNP, eGFR, and Fib4 index, but not with hs-troponin T. In contrast, diastolic BPV was not found to be associated with eGFR.
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Youssef A, Kalaja I, Alkomi U, Abt T, Hoffmann RT, Reeps C, Weiss N, Karl Lackner H, Mahlmann A. Aortic stiffness and related complications after endovascular repair of blunt thoracic aortic injury in young patients. VASA 2020; 49:295-300. [DOI: 10.1024/0301-1526/a000858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Summary: Background: This study aimed to evaluate the changes in aortic stiffness in young patients undergoing thoracic endovascular aortic repair (TEVAR) after blunt thoracic aortic injury (TBAI) and to examine the associated cardiovascular complications during follow-up. Patients and methods: We included survivors of TBAI who underwent stent graft placement between November 2009 and November 2019 and gave their consent to participate. Patients with relevant cardiovascular risk factors, comorbidities with potential impact on arterial stiffness, and prior aortic surgical or endovascular interventions were excluded. Fourteen TEVAR patients prospectively underwent clinical and noninvasive examinations and morphological imaging (mean time of follow-up and duration of implanted stent graft: 5.3 ± 1.8 years; mean age: 35.1 ± 8.7 years) and were compared to 14 healthy controls (matched for sex, age, height, and body mass index) in order to evaluate aortic stiffness. During the follow-up examinations, we assessed the pulse wave velocity (PWV; m/s) and development of arterial hypertension or heart failure, as indicated by N-terminal pro-brain natriuretic peptide (NT-proBNP; pg/mL) levels and performed echocardiography. Results: A significant increase in PWV values was recorded in the TEVAR group (median = 10.1; interquartile range [IQR] = 8.9–11.6) compared to the healthy controls (median = 7.3; IQR = 6.7–8.4), with an increase in the rank mean PWV (+ 3.8; Mann-Whitney U test p < .001). NT-proBNP levels of patients after TEVAR did not vary significantly compared to those of healthy controls (Mann-Whitney U test, p = .154). After TEVAR, five patients developed arterial hypertension during the follow-up, and three of them exhibited diastolic dysfunction. Conclusions: In young patients, TEVAR after TBAI may cause adverse cardiovascular complications due to increased aortic stiffness; therefore, screening for arterial hypertension during follow-up is recommended.
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Affiliation(s)
- Akram Youssef
- Division of Cardiology and Angiology, Department of Internal Medicine I, Hospital Chemnitz, Germany
| | - Igli Kalaja
- University Centre for Vascular Medicine and Division of Angiology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Usama Alkomi
- Division of Cardiology and Angiology, Department of Internal Medicine I, Hospital Chemnitz, Germany
| | - Tobias Abt
- University Centre for Vascular Medicine and Division of Angiology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Ralf-Thorsten Hoffmann
- University Centre for Vascular Medicine and Institute for Diagnostic Radiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Christian Reeps
- University Centre for Vascular Medicine and Department of Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Norbert Weiss
- University Centre for Vascular Medicine and Division of Angiology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Helmut Karl Lackner
- Otto Loewi Research Center (for Vascular Biology, Immunology and Inflammation), Division of Physiology, Medical University of Graz, Austria
| | - Adrian Mahlmann
- University Centre for Vascular Medicine and Division of Angiology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
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Rhee TM, Kim HL, Oh S, Lim WH, Seo JB, Chung WY, Kim SH, Kim MA, Zo JH. Gender difference in the association between brachial-ankle pulse wave velocity and cardiovascular risk scores. Korean J Intern Med 2019; 34. [PMID: 29540053 PMCID: PMC6506726 DOI: 10.3904/kjim.2017.357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND/AIMS Although brachial-ankle pulse wave velocity (baPWV) has been validated as a novel method to predict the cardiovascular risk in general population, the relevance of baPWV to the traditional risk scores has not been clearly revealed. This study investigated the relationship between baPWV and four different cardiovascular risk-predicting scores in men and women. METHODS A total of 539 subjects (58.1 ± 12.2 years, 50.1% men) without cardiovascular disease (CVD) who underwent health examinations including baPWV measurement were retrospectively analyzed. Four cardiovascular risk scores (Framingham risk score [FRS; 1998], Adult Treatment Panel [ATP] III revised FRS [2002], generalized FRS [2008], and American College of Cardiology/American Heart Association [ACC/AHA] CVD risk [2013]) were calculated in each subject. RESULTS In a total population, baPWV was moderately correlated with four cardiovascular risk scores (r = 0.577 for FRS; r = 0.594 for ATP III revised FRS; r = 0.589 for generalized FRS; r = 0.571 for ACC/AHA CVD risk; p < 0.001 for each). These correlations were stronger in women than in men (r = 0.649 vs. 0.451 for FRS; r = 0.719 vs. 0.411 for ATP III revised FRS; r = 0.735 vs. 0.540 for generalized FRS; r = 0.699 vs. 0.552 for ACC/AHA CVD risk; p for gender difference ≤ 0.005 for each). CONCLUSION In middle-aged and elderly Koreans without CVD, baPWV was identified as having a moderately positive correlation with four different risk scores. The correlation was stronger in women than in men, implying the better performance of baPWV in women for predicting cardiovascular risk of healthy population.
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Affiliation(s)
- Tae-Min Rhee
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hack-Lyoung Kim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Woo-Hyun Lim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Bin Seo
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Woo-Young Chung
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hyun Kim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-A Kim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joo-Hee Zo
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Correspondence to Joo-Hee Zo, M.D. Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea Tel: +82-2-870-2114 Fax: +82-2-870-3866 E-mail:
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Central and peripheral pulse wave velocity and subclinical myocardial stress and damage in older adults. PLoS One 2019; 14:e0212892. [PMID: 30811490 PMCID: PMC6392306 DOI: 10.1371/journal.pone.0212892] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/11/2019] [Indexed: 01/05/2023] Open
Abstract
Background Arterial stiffness independently predicts cardiovascular disease. However, few studies have evaluated the associations of central and peripheral pulse wave velocity (PWV) with biomarkers of both myocardial stress (natriuretic peptide [NT-proBNP]) and damage (high-sensitivity cardiac troponin-T [hs-cTnT]) among persons without cardiac disease. Methods We examined 3,348 participants (67–90 years) without prevalent cardiac disease in the Atherosclerosis Risk in Communities (ARIC) Study (2011–13). The cross-sectional associations of PWV quartiles for central arterial segments (carotid-femoral, heart-carotid, heart-femoral) and peripheral artery (femoral-ankle) with NT-proBNP and hs-cTnT were evaluated accounting for potential confounders. Results Most PWV measures demonstrated J- or U-shaped associations with the two cardiac biomarkers. The highest (Q4) vs. second lowest (Q2) quartile of central PWV measures (carotid-femoral, heart-carotid, heart-femoral PWV) were associated with higher levels of NT-proBNP independently of demographic characteristics. The associations were less evident for hs-cTnT. These associations were attenuated after adjusting for traditional cardiovascular risk factors, but the heart-carotid PWV-NT-proBNP relationship remained borderline significant (difference in log-NT-proBNP = 0.08 [-0.01, 0.17] in Q4 vs. Q2, p = 0.07). Peripheral PWV demonstrated inverse associations. Higher values of NT-proBNP were seen in the lowest vs. second lowest quartile of all PWV measures. Conclusions Central stiffness measures showed stronger associations with cardiac biomarkers (particularly NT-proBNP) than peripheral measures among older adults without cardiac disease. Our findings are consistent with the concept of ventricular-vascular coupling and suggest that central rather than peripheral arterial hemodynamics are more closely related to myocardial stress rather than damage.
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Ozkaramanli Gur D, Gur O, Guzel S, Akyuz A, Gurkan S, Alpsoy S, Gulec NS, Koc F. Inflammatory Mediators Across the Spectrum of Ankle-Brachial Index. J Atheroscler Thromb 2018; 26:351-361. [PMID: 30249941 PMCID: PMC6456454 DOI: 10.5551/jat.44891] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: Peripheral artery disease (PAD) is a manifestation of atherosclerosis with poor prognosis. It is generally complicated by vascular calcification, which is located either in the intima as patchy infiltrates; or circumferentially in the media, also known as medial arterial calcification (MAC). Obstructive PAD is reflected by low anklebrachial index (ABI ≤ 0.9), whereas MAC is revealed by high ABI (ABI > 1.4). Considering the increase in cardiovascular mortality at both ends of the ABI spectrum, this study aimed to explore the underlying pathology through cytokines with established prognostic significance; namely pentraxin-3(PTX3), high sensitivity C-reactive protein (hsCRP), copeptin, soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), NT-proBNP, and neopterin. Methods: We categorized 180 patients with previous multivessel coronary artery bypass grafting surgery into three groups based on their ABI measurements; 60 patients with ABI ≤ 0.9, 60 patients with ABI within 0.91 and 1.4 (normal ABI), and 60 patients with ABI > 1.4 constituted the “PAD,” “normal,” “MAC” groups, respectively. The circulating levels of the biochemical markers were determined. Results: In the PAD group, the cytokine levels with predominantly proatherogenic actions such as PTX3, hsCRP, copeptin, and sTREM-1 were increased and these cytokine levels declined as the ABI increased. In the MAC group, the cytokine concentrations with pleiotropic actions such as NT-proBNP and neopterin increased and; NT-proBNP and neopterin concentrations decreased as ABI decreased. The linear regression analysis revealed that neopterin (β = 0.72), PTX3 (β = −0.32), and copeptin (β = −0.48) were independent predictors of ABI. Conclusions: These findings suggest that different inflammatory pathways influence the pathology at the opposing ends of the ABI spectrum. Consequently, we suggest that PTX3, copeptin, and neopterin are promising biomarkers for future research.
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Affiliation(s)
| | - Ozcan Gur
- Department of Cardiovascular Surgery, Namik Kemal University Faculty of Medicine
| | - Savas Guzel
- Department of Biochemistry, Namik Kemal University Faculty of Medicine
| | - Aydin Akyuz
- Department of Cardiology, Namik Kemal University Faculty of Medicine
| | - Selami Gurkan
- Department of Cardiovascular Surgery, Namik Kemal University Faculty of Medicine
| | - Seref Alpsoy
- Department of Cardiology, Namik Kemal University Faculty of Medicine
| | | | - Fatma Koc
- Department of Biochemistry, Namik Kemal University Faculty of Medicine
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Ichise T, Tada H, Sakata K, Kawashiri MA, Yamagishi M, Hayashi K. Impact of Aging on High-sensitivity Cardiac Troponin T in Patients Suspected of Acute Myocardial Infarction. Intern Med 2017; 56:2097-2102. [PMID: 28781317 PMCID: PMC5596267 DOI: 10.2169/internalmedicine.8510-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective High-sensitivity cardiac troponin T (hs-cTnT) is widely used for the diagnosis of acute myocardial infarction (AMI). The current cut-off value of 0.014 ng/mL was determined based on the 99th percentile of a normal reference population; however, little data exist regarding the appropriate cut-off value in the elderly (≥75 years). Accordingly, we aimed to investigate the accuracy of the current cut-off value in an elderly population. Methods We assessed 355 consecutive patients (mean age =66.7±16.1 years, male =210) whose hs-cTnT levels were measured at Kanazawa University Hospital from January 2014 to July 2015. Twenty-six patients were eventually diagnosed with AMI. Hs-cTnT was measured during a visit to the emergency or outpatient department. Receiver operating characteristic (ROC) curves were assessed to determine the appropriate cut-off levels, yielding the maximum sensitivity and specificity while dividing the subjects into two groups according to ages (≥75 or ≤74 years). Results The appropriate overall cut-off value was 0.038, the sensitivity and specificity of which were 85% and 89%, respectively, with an area under the ROC curve (AUC) of 0.945 overall. The conventional cut-off value (99th percentile: 0.014 ng/mL) provided low specificity, particularly in the elderly or those with renal dysfunction. In contrast, a calculated appropriate cut-off provided higher sensitivity with significantly larger c-statistics in the elderly (0.940 vs. 0.629, p<0.001). Conclusion When measuring hs-cTnT, careful assessments are needed in elderly subjects.
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Affiliation(s)
- Taro Ichise
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Japan
| | - Hayato Tada
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Japan
| | - Kenji Sakata
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Japan
| | - Masa-Aki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Japan
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Japan
| | - Kenshi Hayashi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Japan
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Deep Phenotyping of Systemic Arterial Hemodynamics in HFpEF (Part 2): Clinical and Therapeutic Considerations. J Cardiovasc Transl Res 2017; 10:261-274. [PMID: 28401511 DOI: 10.1007/s12265-017-9736-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 01/30/2017] [Indexed: 01/09/2023]
Abstract
Multiple phase III trials over the last few decades have failed to demonstrate a clear benefit of various pharmacologic interventions in heart failure with a preserved left ventricular (LV) ejection fraction (HFpEF). Therefore, a better understanding of its pathophysiology is important. An accompanying review describes key technical and physiologic aspects regarding the deep phenotyping of arterial hemodynamics in HFpEF. This review deals with the potential of this approach to enhance our clinical, translational, and therapeutic approach to HFpEF. Specifically, the role of arterial hemodynamics is discussed in relation to (1) the pathophysiology of left ventricular diastolic dysfunction, remodeling, and fibrosis, (2) impaired oxygen delivery to peripheral skeletal muscle, which affects peripheral oxygen extraction, (3) the frequent presence of comorbidities, such as renal failure and dementia in this population, and (4) the potential to enhance precision medicine approaches. A therapeutic approach to target arterial hemodynamic abnormalities that are prevalent in this population (particularly, with inorganic nitrate/nitrite) is also discussed.
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Moulakakis KG, Kadoglou NP, Antonopoulos CN, Mylonas SN, Kakisis J, Papadakis I, Karakitsos P, Liapis CD. Changes in Arterial Stiffness and N-terminal pro-brain natriuretic peptide Levels after Endovascular Repair of Descending Thoracic Aorta. Ann Vasc Surg 2017; 38:220-226. [DOI: 10.1016/j.avsg.2016.04.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 03/21/2016] [Accepted: 04/10/2016] [Indexed: 11/15/2022]
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