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Dyab R, Zuccarella-Hackl C, Princip M, Sivakumar S, Meister-Langraf RE, Znoj H, Schmid JP, Barth J, Schnyder U, von Känel R, Gidron Y. Role of Heart Rate Variability in the Association between Myocardial Infarction Severity and Post-Myocardial Infarction Distress. Life (Basel) 2023; 13:2266. [PMID: 38137867 PMCID: PMC10744743 DOI: 10.3390/life13122266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE Myocardial infarction (MI) results in mental health consequences, including depression and post-traumatic stress disorder (PTSD). The risk and protective factors of such mental consequences are not fully understood. This study examined the relation between MI severity and future mental health consequences and the moderating role of vagal nerve activity. METHODS In a reanalysis of data from the Myocardial Infarction-Stress Prevention Intervention (MI-SPRINT) study, 154 post-MI patients participated. MI severity was measured by the Killip Scale and by troponin levels. Depression and PTSD symptoms were assessed with valid questionnaires, both at 3 and 12 months. Vagal nerve activity was indexed by the heart rate variability (HRV) parameter of the root-mean square of successive R-R differences (RMSSD). Following multivariate analyses, the association between MI severity and distress was examined in patients with low and high HRV (RMSSD = 30 ms). RESULTS In the full sample, the Killip index predicted post-MI distress only at 3 months, while troponin predicted distress at 3- and 12-months post-MI. However, HRV moderated the effects of the Killip classification; Killip significantly predicted symptoms of depression and PTSD at 3- and 12-months post-MI, but only in patients with low HRV. Such moderation was absent for troponin. CONCLUSION MI severity (Killip classification) predicted post-MI depression and PTSD symptoms, but only in patients with low HRV, suggesting that the vagal nerve is a partial protective (moderating) factor in the relation between Killip score and post-MI distress.
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Affiliation(s)
- Reham Dyab
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, The University of Haifa, Haifa 3498838, Israel
- Lady Davis Carmel Medical Center, Haifa 3436212, Israel
| | - Claudia Zuccarella-Hackl
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (C.Z.-H.); (M.P.); (S.S.); (R.E.M.-L.); (R.v.K.)
| | - Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (C.Z.-H.); (M.P.); (S.S.); (R.E.M.-L.); (R.v.K.)
| | - Sinthujan Sivakumar
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (C.Z.-H.); (M.P.); (S.S.); (R.E.M.-L.); (R.v.K.)
| | - Rebecca E. Meister-Langraf
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (C.Z.-H.); (M.P.); (S.S.); (R.E.M.-L.); (R.v.K.)
- Faculty of Medicine, University of Zürich, 8006 Zurich, Switzerland;
- Clienia Schlössli AG, 8618 Oetwil am See, Switzerland
| | - Hansjörg Znoj
- Department of Clinical Psychology and Psychotherapy, University of Bern, 3012 Bern, Switzerland;
| | - Jean-Paul Schmid
- Department of Internal Medicine and Cardiology, Clinic Gais AG, 9056 Gais, Switzerland;
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zürich, University of Zürich, 8006 Zurich, Switzerland;
| | - Ulrich Schnyder
- Faculty of Medicine, University of Zürich, 8006 Zurich, Switzerland;
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (C.Z.-H.); (M.P.); (S.S.); (R.E.M.-L.); (R.v.K.)
- Faculty of Medicine, University of Zürich, 8006 Zurich, Switzerland;
| | - Yori Gidron
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, The University of Haifa, Haifa 3498838, Israel
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Murphy D, Firoozi S, Herzog CA, Banerjee D. Cardiac Troponin, Kidney Function, Heart Failure and Mortality After Myocardial Infarction in Patients With and Without Kidney Impairment. Am J Cardiol 2023; 204:383-391. [PMID: 37579521 DOI: 10.1016/j.amjcard.2023.07.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/16/2023]
Abstract
Cardiac troponins (cTn) are routinely measured for the diagnosis and prognosis of myocardial infarction (MI). The relation between troponin levels, estimated glomerular filtration rate (eGFR), postinfarction heart failure (HF), and mortality is unclear in patients with kidney impairment. This is a retrospective, cross-sectional study of patients presenting to the Emergency Department at a single tertiary center. Participants presenting with confirmed type I MI from January 1, 2019, to December 31, 2021, were analyzed from the Myocardial Ischemia National Audit Project database. Main outcomes were acute HF, measured using Killip class, and inpatient mortality. Peak cardiac troponin T (cTnT) level was a secondary outcome. Data on 2,815 patients (67±14 years, 28% female) were analyzed. Ordinal logistic regression analysis was used to test for predictors of increasing Killip class. Binary logistic regression was used to test for predictors of inpatient mortality. Analysis of a sub-sample matched for age and diabetes mellitus status showed increased mortality in patients with eGFR <60 ml/min/1.73 m2 (12.2% vs 4.4%, p <0.001). Multivariate predictors of acute HF included log-transformed peak cTnT, eGFR, body mass index (BMI), and diabetes mellitus status. Multivariate predictors of inpatient mortality included log-transformed peak cTnT, eGFR, age, BMI, and Killip class 3/4. On multivariate analysis, eGFR, ST-elevation MI diagnosis, BMI, male gender, diabetes mellitus status, and hypertension were all predictive of peak cTnT after MI. In conclusion, peak cTnT level and eGFR at presentation after MI are independent predictors of acute HF severity and death in patients with and without kidney impairment.
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Affiliation(s)
- Daniel Murphy
- Cardiology Clinical Academic Group, Institute of Medical and Biomedical Education, St George's, University of London, Cranmer Terrace, London, United Kingdom; Department of Renal and Transplant Medicine, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, United Kingdom
| | - Sami Firoozi
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, United Kingdom
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, Minnesota
| | - Debasish Banerjee
- Cardiology Clinical Academic Group, Institute of Medical and Biomedical Education, St George's, University of London, Cranmer Terrace, London, United Kingdom; Department of Renal and Transplant Medicine, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, United Kingdom.
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Bardooli F, Kumar D, Hasan J, Mengal N, Iqbal Bhatti K, Makwana D, Rai K, Maheswari L. Prognostic Significance of Electrocardiography, Echocardiography, and Troponin in Patients Admitted With Non-ST Elevation Myocardial Infarction. Cureus 2023; 15:e37629. [PMID: 37200672 PMCID: PMC10186068 DOI: 10.7759/cureus.37629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Non-ST segment elevation myocardial infarction (NSTEMI) is a clinical condition characterized by typical symptoms of myocardial ischemia along with electrocardiographic changes and a positive value of troponin. After presentation in the emergency department, these patients have their troponin I value and electrocardiography done. Echocardiography (echo) should also be performed on these patients. This study was conducted to determine the prognostic significance of ECG, echo, and troponin. METHODS This observational study was conducted at a tertiary care cardiac hospital on 221 diagnosed patients of NSTEMI. Electrocardiography was performed to see any particular resting ECG findings and the peak values of cardiospecific troponin were analyzed for associations with major adverse events after a six-month period of follow-up. On echo, the left ventricular ejection fraction was divided into two categories: left ventricular ejection fraction (LVEF) <40% and LVEF >40%. RESULTS The most frequent finding on presenting ECG was ST depression in anterior leads (V1-V6) in 27.6%. Median troponin I at presentation was 3.2 ng/dl and the median ejection fraction was 45%. The overall all-cause mortality rate at six months was observed to be 8.6%; re-infarction in 5%, re-hospitalization in 16.3%, and heart failure in 25.3% were observed. However, mortality was higher for patients with baseline ECG findings of A-fib, generalized ST-depression, poor R-wave progression, Wellens sign, and T-wave inversion in inferior; the mortality rate was also relatively higher among patients with poor LVEF (<30%). CONCLUSION ECG and echo were prognostically significant and with the combined incidence of adverse events. However, troponin lacks prognostic significance at six months.
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Affiliation(s)
- Fawaz Bardooli
- Interventional Cardiology, Mohammed Bin Khalifa Bin Salman Al Khalifa Specialist Cardiac Centre, Awali, BHR
| | - Dileep Kumar
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Jehangir Hasan
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Naeem Mengal
- Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | | | - Dayaram Makwana
- Cardiology, Mohammed Bin Khalifa Bin Salman Al Khalifa Specialist Cardiac Centre, Awali, BHR
| | - Kelash Rai
- Internal Medicine, Wayne State University School of Medicine, Rochester Hills, USA
| | - Lalit Maheswari
- Medicine, Global Medical Solutions Hospital Management LLC, Abu Dhabi, ARE
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Cao W, Li Y, Wen Y, Fang S, Zhao B, Zhang X, Zhang Y, Lang X, Yu B, Zhang Y. Higher serum phosphorus and calcium levels provide prognostic value in patients with acute myocardial infarction. Front Cardiovasc Med 2022; 9:929634. [PMID: 36158790 PMCID: PMC9489914 DOI: 10.3389/fcvm.2022.929634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022] Open
Abstract
Background Although traditional cardiovascular risk factors are closely related to the poor prognosis of acute myocardial infarction (AMI) patients, there are few studies on the relationship of serum phosphorus and calcium with prognosis in AMI patients. The relationship of serum phosphorus and calcium with prognostic biomarkers in AMI remains unclear. Methods and results A total of 3,891 AMI patients were enrolled from a prospective cohort study. We investigated the association of serum phosphorus and calcium with prognostic biomarkers. The risk of in-hospital heart failure (HF), post-discharge HF, all-cause mortality and cardiac mortality was estimated across quartiles of serum phosphorus and calcium levels. Serum phosphorus and calcium levels were associated with biomarkers of prognosis. Overall, 969 patients developed in-hospital HF during hospitalization, 549 patients developed post-discharge HF during a median follow-up of 12 months, and 252 patients died, with 170 cardiac deaths since admission. In the fully adjusted model, compared with patients in quartile 2 (Q2), patients with serum phosphorus levels in Q4 were at greater risk of post-discharge HF [sub-distributional hazard ratios (SHR) 1.55; 95% confidence interval (CI), 1.21–1.99], in-hospital HF [odds ratio (OR) 1.84; 95% CI, 1.47–2.31], all-cause mortality (HR 1.59; 95% CI, 1.08–2.32), and cardiac mortality (SHR 1.68; 95% CI, 1.03–2.75). Compared with patients in Q2, patients with corrected calcium levels in Q4 had a higher risk of in-hospital HF (OR 1.62; 95% CI, 1.29–2.04), all-cause mortality (HR 1.99; 95% CI, 1.37–2.88), and cardiac mortality (SHR 1.87; 95% CI, 1.19–2.96; all p-trend < 0.05). Conclusion Serum phosphorus and calcium levels were associated with AMI prognostic biomarkers in AMI. Higher serum phosphorus was independently related to the increased risk of in-hospital HF, postdischarge HF, all-cause mortality and cardiac mortality, and higher serum calcium was independently related to the increased risk of in-hospital HF, all-cause mortality and cardiac mortality after AMI.
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Affiliation(s)
- Wei Cao
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Department of Cardiology, Heilongjiang Provincial Hospital, Harbin, China
| | - Yilan Li
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Yao Wen
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shaohong Fang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Bing Zhao
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Xiaoyuan Zhang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Yanxiu Zhang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Xueyan Lang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Bo Yu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
- Bo Yu
| | - Yao Zhang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
- *Correspondence: Yao Zhang
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5
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Peak Troponin and CMR to Guide Management in Suspected ACS and Nonobstructive Coronary Arteries. JACC: CARDIOVASCULAR IMAGING 2022; 15:1578-1587. [DOI: 10.1016/j.jcmg.2022.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/18/2022] [Accepted: 03/10/2022] [Indexed: 12/25/2022]
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6
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Myocardial ischemia and its complications. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sane PS, Manoj V, Demel R, Vijaykumar S, Mullasari AS. Prognostic significance of Troponin I in patients undergoing primary percutaneous coronary intervention. Indian Heart J 2021; 73:737-739. [PMID: 34861984 PMCID: PMC8642639 DOI: 10.1016/j.ihj.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/25/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
This observational study investigates the prognostic significance of troponin I in patients undergoing primary percutaneous intervention (pPCI). Sequential cardiac biomarker sampling of the enrolled patients (n = 167) was performed on admission and at 6,12,24 and 48 h. Clinical characteristics, major adverse cardiac and cerebrovascular events (MACCE) (death, reinfarction, stroke and new or worsening heart failure) and left ventricular ejection fraction (LVEF) were noted on admission and 30 day follow-up. A 24-h troponin I level >60 ng/ml predicted MACCE (OR 4.06, p = 0.023; adjusted OR 5.09, p = 0.034) and less than 10% improvement in LVEF on follow-up (OR 2.49, p = 0.007). Thus, in patients undergoing pPCI, 24-h cardiac Troponin I is a good non-invasive surrogate to predict MACCE and improvement in LVEF.
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Affiliation(s)
| | - V Manoj
- Resident in Cardiology, Madras Medical Mission, Chennai, India
| | - Rufus Demel
- Resident in Cardiology, Madras Medical Mission, Chennai, India
| | - S Vijaykumar
- Head of Intravascular Imaging Department, Senior Consultant Cardiology, ICVD Madras Medical Mission, Chennai, India
| | - Ajit S Mullasari
- Director Cardiology, ICVD Madras Medical Mission, Chennai, India
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8
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Chronic inflammatory diseases and coronary heart disease: Insights from cardiovascular CT. J Cardiovasc Comput Tomogr 2021; 16:7-18. [PMID: 34226164 DOI: 10.1016/j.jcct.2021.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 01/17/2023]
Abstract
Epidemiological and clinical studies have demonstrated a consistent relationship between increased systemic inflammation and increased risk of cardiovascular events. In chronic inflammatory states, traditional risk factors only partially account for the development of coronary artery disease (CAD) but underestimate total cardiovascular risk likely due to the residual risk of inflammation. Computed coronary tomography angiography (CCTA) may aid in risk stratification by noninvasively capturing early CAD, identifying high risk plaque morphology and quantifying plaque at baseline and in response to treatment. In this review, we focus on reviewing studies on subclinical atherosclerosis by CCTA in individuals with chronic inflammatory conditions including rheumatoid arthritis (RA), systemic lupus erythematous (SLE), human immunodeficiency virus (HIV) infection and psoriasis. We start with a brief review on the role of inflammation in atherosclerosis, highlight the utility of using CCTA to delineate vessel wall and plaque characteristics and discuss combining CCTA with laboratory studies and emerging technologies to complement traditional risk stratification in chronic inflammatory states.
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9
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Manemann SM, St Sauver JL, Liu H, Larson NB, Moon S, Takahashi PY, Olson JE, Rocca WA, Miller VM, Therneau TM, Ngufor CG, Roger VL, Zhao Y, Decker PA, Killian JM, Bielinski SJ. Longitudinal cohorts for harnessing the electronic health record for disease prediction in a US population. BMJ Open 2021; 11:e044353. [PMID: 34103314 PMCID: PMC8190051 DOI: 10.1136/bmjopen-2020-044353] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The depth and breadth of clinical data within electronic health record (EHR) systems paired with innovative machine learning methods can be leveraged to identify novel risk factors for complex diseases. However, analysing the EHR is challenging due to complexity and quality of the data. Therefore, we developed large electronic population-based cohorts with comprehensive harmonised and processed EHR data. PARTICIPANTS All individuals 30 years of age or older who resided in Olmsted County, Minnesota on 1 January 2006 were identified for the discovery cohort. Algorithms to define a variety of patient characteristics were developed and validated, thus building a comprehensive risk profile for each patient. Patients are followed for incident diseases and ageing-related outcomes. Using the same methods, an independent validation cohort was assembled by identifying all individuals 30 years of age or older who resided in the largely rural 26-county area of southern Minnesota and western Wisconsin on 1 January 2013. FINDINGS TO DATE For the discovery cohort, 76 255 individuals (median age 49; 53% women) were identified from which a total of 9 644 221 laboratory results; 9 513 840 diagnosis codes; 10 924 291 procedure codes; 1 277 231 outpatient drug prescriptions; 966 136 heart rate measurements and 1 159 836 blood pressure (BP) measurements were retrieved during the baseline time period. The most prevalent conditions in this cohort were hyperlipidaemia, hypertension and arthritis. For the validation cohort, 333 460 individuals (median age 54; 52% women) were identified and to date, a total of 19 926 750 diagnosis codes, 10 527 444 heart rate measurements and 7 356 344 BP measurements were retrieved during baseline. FUTURE PLANS Using advanced machine learning approaches, these electronic cohorts will be used to identify novel sex-specific risk factors for complex diseases. These approaches will allow us to address several challenges with the use of EHR.
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Affiliation(s)
- Sheila M Manemann
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer L St Sauver
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Hongfang Liu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas B Larson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Sungrim Moon
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul Y Takahashi
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Janet E Olson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter A Rocca
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Women's Health Research Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Virginia M Miller
- Mayo Clinic Women's Health Research Center, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Specialized Center of Research Excellence, Mayo Clinic Rochester, Minnesota, USA, Mayo Clinic, Rochester, Minnesota, USA
| | - Terry M Therneau
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Che G Ngufor
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Veronique L Roger
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Epidemiology and Community Health Branch National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Yiqing Zhao
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul A Decker
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Jill M Killian
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Suzette J Bielinski
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
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Jenča D, Melenovský V, Stehlik J, Staněk V, Kettner J, Kautzner J, Adámková V, Wohlfahrt P. Heart failure after myocardial infarction: incidence and predictors. ESC Heart Fail 2020; 8:222-237. [PMID: 33319509 PMCID: PMC7835562 DOI: 10.1002/ehf2.13144] [Citation(s) in RCA: 244] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/14/2020] [Accepted: 11/15/2020] [Indexed: 12/11/2022] Open
Abstract
Aims The aim of the present paper was to provide an up‐to‐date view on epidemiology and risk factors of heart failure (HF) development after myocardial infarction. Methods and results Based on literature review, several clinical risk factors and biochemical, genetic, and imaging biomarkers were identified to predict the risk of HF development after myocardial infarction. Conclusions Heart failure is still a frequent complication of myocardial infarction. Timely identification of subjects at risk for HF development using a multimodality approach, and early initiation of guideline‐directed HF therapy in these patients, can decrease the HF burden.
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Affiliation(s)
- Dominik Jenča
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vojtěch Melenovský
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Vladimír Staněk
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jiří Kettner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Faculty of Medicine, Dentistry of the Palacký University, Olomouc, Czech Republic
| | - Věra Adámková
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Peter Wohlfahrt
- Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Centre for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University, Videnska 800, Prague 4, 140 59, Czech Republic
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11
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Chang CY, Chien YJ, Lin PC, Chen CS, Wu MY. Nonthyroidal Illness Syndrome and Hypothyroidism in Ischemic Heart Disease Population: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2020; 105:5847674. [PMID: 32459357 DOI: 10.1210/clinem/dgaa310] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/21/2020] [Indexed: 02/05/2023]
Abstract
CONTEXT The association of non-thyroidal illness syndrome (NTIS) and hypothyroidism with the prognosis in ischemic heart disease (IHD) population is inconclusive. OBJECTIVE We aimed to evaluate the influence of NTIS and hypothyroidism on all-cause mortality and major adverse cardiac events (MACE) in IHD population. DATA SOURCES We searched PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library from inception through February 17, 2020. STUDY SELECTION Original articles enrolling IHD patients, comparing all-cause mortality and MACE of NTIS and hypothyroidism with those of euthyroidism, and providing sufficient information for meta-analysis were considered eligible. DATA EXTRACTION Relevant information and numerical data were extracted for methodological assessment and meta-analysis. DATA SYNTHESIS Twenty-three studies were included. The IHD population with NTIS was associated with higher risk of all-cause mortality (hazard ratio [HR] = 2.61; 95% confidence interval [CI] = 1.89-3.59) and MACE (HR = 2.22; 95% CI = 1.71-2.89) than that without. In addition, the IHD population with hypothyroidism was also associated with higher risk of all-cause mortality (HR = 1.47; 95% CI = 1.10-1.97) and MACE (HR = 1.53; 95% CI = 1.19-1.97) than that without. In the subgroup analysis, the acute coronary syndrome (ACS) subpopulation with NTIS was associated with higher risk of all-cause mortality (HR = 3.30; 95% CI = 2.43-4.48) and MACE (HR = 2.19; 95% CI = 1.45-3.30). The ACS subpopulation with hypothyroidism was also associated with higher risk of all-cause mortality (HR = 1.67; 95% CI = 1.17-2.39). CONCLUSIONS The IHD population with concomitant NTIS or hypothyroidism was associated with higher risk of all-cause mortality and MACE. Future research is required to provide evidence of the causal relationship and to elucidate whether normalizing thyroid function parameters can improve prognosis.
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Affiliation(s)
- Chun-Yu Chang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yung-Jiun Chien
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Po-Chen Lin
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chien-Sheng Chen
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
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Suthahar N, Meems LMG, van Veldhuisen DJ, Walter JE, Gansevoort RT, Heymans S, Schroen B, van der Harst P, Kootstra-Ros JE, van Empel V, Mueller C, Bakker SJL, de Boer RA. High-Sensitivity Troponin-T and Cardiovascular Outcomes in the Community: Differences Between Women and Men. Mayo Clin Proc 2020; 95:1158-1168. [PMID: 32498772 DOI: 10.1016/j.mayocp.2020.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate associations of high-sensitivity cardiac troponin-T (cTnT) with cardiovascular disease (CVD), heart failure (HF), and mortality in community-dwelling women and men. PARTICIPANTS AND METHODS A total of 8226 adults from the Prevention of Renal and Vascular End-stage Disease (PREVEND) cohort (1997-1998) were enrolled in a prospective observational study (mean age: 49 years; 50.2% women). Sex-specific associations of cTnT levels with future clinical outcomes were evaluated using adjusted Cox-regression models. RESULTS Measurable cTnT levels (≥3 ng/L) were detected in 1102 women (26.7%) and in 2396 men (58.5%). Baseline cTnT levels were associated with a greater risk of developing CVD in women than men [Hazard ratio (HRwomen), 1.48 per unit increase in log2-cTnT; 95% CI, 1.21 to 1.81 vs HRmen, 1.20; 95% CI, 1.07 to 1.35; Pinteraction<.001]. Similar sex-related differences were observed for HF (Pinteraction= .005) and mortality (Pinteraction= .008). Further, compared with referent category (cTnT <3 ng/L), women with cTnT levels greater than or equal to 6 ng/L had a significantly increased risk for CVD (HR, 2.30; 95% CI, 1.45 to 3.64), HF (HR, 2.86; 95% CI, 1.41 to 5.80), and mortality (HR, 2.65; 95% CI, 1.52 to 4.61), whereas men with cTnT levels greater than or equal to 6 ng/L had a significantly increased risk only for CVD (HR, 1.51; 95% CI, 1.07 to 2.13). CONCLUSION Baseline cTnT levels were associated with future CVD, HF, and mortality in both sexes, and these associations were stronger in women. Future studies are needed to determine the value of cTnT in early diagnosis of CVD, particularly in women.
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Affiliation(s)
- Navin Suthahar
- University of Groningen, University Medical Center Groningen, Department of Cardiology, the Netherlands.
| | - Laura M G Meems
- University of Groningen, University Medical Center Groningen, Department of Cardiology, the Netherlands
| | - Dirk J van Veldhuisen
- University of Groningen, University Medical Center Groningen, Department of Cardiology, the Netherlands
| | - Joan E Walter
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Ron T Gansevoort
- University of Groningen, University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, the Netherlands
| | - Stephane Heymans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, the Netherlands
| | - Blanche Schroen
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, the Netherlands
| | - Pim van der Harst
- University of Groningen, University Medical Center Groningen, Department of Cardiology, the Netherlands
| | - Jenny E Kootstra-Ros
- University of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, the Netherlands
| | - Vanessa van Empel
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, the Netherlands
| | - Christian Mueller
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Stephan J L Bakker
- University of Groningen, University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, the Netherlands
| | - Rudolf A de Boer
- University of Groningen, University Medical Center Groningen, Department of Cardiology, the Netherlands
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Mok Y, Sang Y, Ballew SH, Hoogeveen RC, Ballantyne CM, Rosamond W, Coresh J, Selvin E, Matsushita K. Premorbid levels of high-sensitivity cardiac troponin T and natriuretic peptide and prognosis after incident myocardial infarction. Am Heart J 2019; 216:62-73. [PMID: 31404723 PMCID: PMC6842707 DOI: 10.1016/j.ahj.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/05/2019] [Indexed: 12/22/2022]
Abstract
High-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) at the time of myocardial infarction (MI) are strong predictors of prognosis. However, whether their premorbid (before MI occurrence) levels are associated with prognosis after incident MI is unknown. METHODS In 1,054 participants from the Atherosclerosis Risk in Communities Study with incident MI, we evaluated premorbid levels of hs-cTnT and NT-proBNP measured on median 5.8 (interquartile interval 3.0-11.5 [mean 5.5]) years prior to incident MI and their associations with subsequent composite and individual outcomes of all-cause mortality, cardiovascular mortality, recurrent MI, heart failure, and stroke. RESULTS During a median follow-up of 3.0 years after MI, 801 participants developed the composite outcome. Both hs-cTnT and NT-proBNP were independently associated with the composite outcome after incident MI. Among individual outcomes, all-cause mortality, cardiovascular mortality, and heart failure showed significant associations with both cardiac markers. Overall, NT-proBNP demonstrated a more evident relationship than hs-cTnT. Indeed, the addition of premorbid NT-proBNP alone, but not hs-cTnT alone, to conventional predictors at incident MI significantly improved risk prediction of the composite outcome after incident MI (Δc-statistic 0.013 [95% CI 0.005-0.022] from 0.691 with conventional predictors). CONCLUSIONS Premorbid levels of hs-cTnT and NT-proBNP assessed on average 6 years prior to incident MI were associated with adverse outcomes after incident MI. These results further highlight the importance of cardiac health at an earlier stage of life.
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Affiliation(s)
- Yejin Mok
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yingying Sang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shoshana H Ballew
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ron C Hoogeveen
- Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Christie M Ballantyne
- Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Wayne Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Josef Coresh
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kunihiro Matsushita
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Ge Z, Baber U, Claessen BE, Farhan S, Chandrasekhar J, Li SX, Sartori S, Kini AS, Rao SV, Weiss S, Henry TD, Vogel B, Sorrentino S, Faggioni M, Kapadia S, Muhlestein B, Strauss C, Toma C, DeFranco A, Effron MB, Keller S, Baker BA, Pocock S, Dangas G, Mehran R. The prevalence, predictors and outcomes of guideline-directed medical therapy in patients with acute myocardial infarction undergoing PCI, an analysis from the PROMETHEUS registry. Catheter Cardiovasc Interv 2018; 93:E112-E119. [DOI: 10.1002/ccd.27860] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/12/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Zhen Ge
- Icahn School of Medicine at Mount Sinai; New York New York
- Division of Cardiology, Nanjing First Hospital; Nanjing Medical University; Nanjing China
| | - Usman Baber
- Icahn School of Medicine at Mount Sinai; New York New York
| | | | - Serdar Farhan
- Icahn School of Medicine at Mount Sinai; New York New York
| | | | - Shawn X. Li
- Geisel School of Medicine Dartmouth; Lebanon New Hampshire
| | | | | | - Sunil V. Rao
- The Duke Clinical Research Institute; Durham North Carolina
| | | | | | - Birgit Vogel
- Icahn School of Medicine at Mount Sinai; New York New York
| | | | | | | | | | | | - Catalin Toma
- University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | | | - Mark B. Effron
- Eli Lilly and Company; Indianapolis Indiana
- John Ochsner Heart and Vascular Center; Ochsner Medical Center; New Orleans Louisiana
| | | | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine; London UK
| | - George Dangas
- Icahn School of Medicine at Mount Sinai; New York New York
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai; New York New York
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Gerber Y, Weston SA, Enriquez-Sarano M, Manemann SM, Chamberlain AM, Jiang R, Roger VL. Atherosclerotic Burden and Heart Failure After Myocardial Infarction. JAMA Cardiol 2018; 1:156-62. [PMID: 27437886 DOI: 10.1001/jamacardio.2016.0074] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
IMPORTANCE Whether the extent of coronary artery disease (CAD) is associated with the occurrence of heart failure (HF) after myocardial infarction (MI) is not known. Furthermore, whether this association might differ by HF type according to preserved or reduced ejection fraction (EF) has yet to be determined. OBJECTIVES To evaluate in a community cohort of patients with incident (first-ever) MI the association of angiographic CAD with subsequent HF and to examine the prognostic role of CAD according to HF subtypes: HF with reduced EF and HF with preserved EF. DESIGN, SETTING, AND PARTICIPANTS A population-based cohort study was conducted in 1922 residents of Olmsted County, Minnesota, with incident MI diagnosed between January 1, 1990, and December 31, 2010, and no prior HF; study participants were followed up through March 31, 2013. The extent of angiographic CAD was determined at baseline and categorized according to the number of major epicardial coronary arteries with 50% or more lumen diameter obstruction. MAIN OUTCOMES AND MEASURES The primary end point was time to incident HF. The primary exposure variable was the extent of CAD as expressed by the number of major coronary arteries with significant obstruction (0-, 1-, 2-, or 3-vessel disease) obtained from coronary angiograms performed no more than 1 day after the MI. Heart failure was ascertained by the Framingham criteria and classified by type according to EF (50% cutoff). RESULTS Of the 1922 participants, 1258 (65.4%) were men (mean [SD] age, 64 [13] years). During a mean follow-up period of 6.7 (5.9) years, 588 patients (30.6%) developed HF. With death and recurrent MI modeled as competing risks, the cumulative incidence rates of post-MI HF among patients with 0 or 1, 2, and 3 diseased vessels were 10.7%, 14.6%, and 23.0% at 30 days; and 14.7%, 20.6%, and 29.8% at 5 years, respectively (P < .001 for trend). After adjustment for clinical characteristics in a Cox proportional hazards regression model, the hazard ratios (95% CIs) for HF were 1.25 (0.99-1.59) and 1.75 (1.40-2.20) in patients with 2 and 3 vessels vs 0 or 1 occluded vessel, respectively (P < .001 for trend). The increased risk with a greater number of occluded vessels was independent of the occurrence of a recurrent MI and did not differ appreciably by HF type. CONCLUSIONS AND RELEVANCE The extent of angiographic CAD is an indicator of post-MI HF regardless of HF type and independent of recurrent MI. These data underscore the need to further investigate the processes taking place in the transition from myocardial injury to HF.
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Affiliation(s)
- Yariv Gerber
- Division of Cardiovascular Diseases, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota2Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Susan A Weston
- Division of Cardiovascular Diseases, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Maurice Enriquez-Sarano
- Division of Cardiovascular Diseases, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Sheila M Manemann
- Division of Cardiovascular Diseases, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Alanna M Chamberlain
- Division of Cardiovascular Diseases, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Ruoxiang Jiang
- Division of Cardiovascular Diseases, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Véronique L Roger
- Division of Cardiovascular Diseases, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Lenz M, Krychtiuk KA, Goliasch G, Distelmaier K, Wojta J, Heinz G, Speidl WS. N-terminal pro-brain natriuretic peptide and high-sensitivity troponin T exhibit additive prognostic value for the outcome of critically ill patients. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 9:496-503. [PMID: 29617154 DOI: 10.1177/2048872618768088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Patients treated at medical intensive care units suffer from various pathologies and often present with elevated troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Both markers may reflect different forms of cardiac involvement in critical illness. Therefore, the aim of our study was to examine the synergistic prognostic potential of NT-proBNP and high-sensitivity TnT (hs)TnT in unselected critically ill patients. METHODS We included all consecutive patients admitted to our intensive care unit within one year, excluding those suffering from acute myocardial infarction or undergoing cardiac surgery and measured NT-proBNP and TnT plasma levels on the day of admission and 72 hours thereafter. RESULTS Of the included 148 patients, 52% were male, mean age was of 64.2 ± 16.8 years and 30-day mortality was 33.2%. Non-survivors showed significantly higher NT-proBNP and TnT plasma levels as compared with survivors (p<0.01). An elevation of both markers exhibited an additive effect on mortality, as those with both NT-proBNP and TnT levels above the median had a 30-day mortality rate of 51.0%, while those with both markers below the median had a 16.7% mortality rate (hazard ratio 3.7). These findings were independent of demographic and clinical parameters (p<0.05). CONCLUSIONS Our findings regarding the individual predictive properties of NT-proBNP and TnT are in line with literature. However, we were able to highlight that they exhibit additive prognostic potential which exceeds their individual value. This might be attributed to a difference in underlying pathomechanisms and an assessment of synergistic risk factors.
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Affiliation(s)
- Max Lenz
- Department of Internal Medicine II - Division of Cardiology, Medical University of Vienna, Austria.,Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - Konstantin A Krychtiuk
- Department of Internal Medicine II - Division of Cardiology, Medical University of Vienna, Austria.,Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II - Division of Cardiology, Medical University of Vienna, Austria
| | - Klaus Distelmaier
- Department of Internal Medicine II - Division of Cardiology, Medical University of Vienna, Austria
| | - Johann Wojta
- Department of Internal Medicine II - Division of Cardiology, Medical University of Vienna, Austria.,Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.,Core Facilities, Medical University of Vienna, Austria
| | - Gottfried Heinz
- Department of Internal Medicine II - Division of Cardiology, Medical University of Vienna, Austria
| | - Walter S Speidl
- Department of Internal Medicine II - Division of Cardiology, Medical University of Vienna, Austria
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Robinson S, Follo M, Haenel D, Mauler M, Stallmann D, Tewari M, Duerschmied D, Peter K, Bode C, Ahrens I, Hortmann M. Droplet digital PCR as a novel detection method for quantifying microRNAs in acute myocardial infarction. Int J Cardiol 2018; 257:247-254. [DOI: 10.1016/j.ijcard.2017.10.111] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/22/2017] [Accepted: 10/31/2017] [Indexed: 12/20/2022]
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Prognostic Value of Soluble ST2 After Myocardial Infarction: A Community Perspective. Am J Med 2017; 130:1112.e9-1112.e15. [PMID: 28344136 PMCID: PMC5572469 DOI: 10.1016/j.amjmed.2017.02.034] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Soluble ST2 (sST2) is a marker of cardiac mechanical strain hypothesized to adversely impact short-term prognosis after myocardial infarction. We examined the association of sST2 with longer-term outcomes after myocardial infarction in a geographically defined community. METHODS Olmsted County, Minnesota residents who experienced an incident (first-ever) myocardial infarction between November 1, 2002 and December 31, 2012 were prospectively enrolled; sST2 levels were measured. Patients were followed for heart failure and death. RESULTS We studied 1401 patients with incident myocardial infarction (mean age 67 years; 61% men; 79% non-ST-elevation myocardial infarction). Median sST2 (ng/mL) was 48.7 (25th-75th percentile 32.5-103.3). Soluble ST2 was elevated in 51% of patients. Higher values of sST2 were associated with increased age, female sex, and comorbidities. During 5 years of follow-up, 388 persons died and 360 developed heart failure. After adjustment for age, sex, comorbidities, Killip class, and troponin T, the hazard ratios for death were 1.73 (95% confidence interval [CI], 1.22-2.45) and 3.57 (95% CI, 2.57-4.96) for sST2 tertiles 2 and 3, respectively (Ptrend <.001). For heart failure, the hazard ratios were 1.67 (95% CI, 1.18-2.37) and 2.88 (95% CI, 2.05-4.05), respectively (Ptrend <.001). Results were similar among 30-day survivors. CONCLUSIONS In the community, sST2 elevation is present in half of myocardial infarctions. Higher values of sST2 are associated with a large excess risk of death and heart failure independently of other prognostic indicators. Measurement of sST2 should be considered for risk stratification after myocardial infarction.
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Attia NE. Cardiac biomarkers and ultrasonography as tools in prediction and diagnosis of traumatic pericarditis in Egyptian buffaloes. Vet World 2016; 9:976-982. [PMID: 27733799 PMCID: PMC5057037 DOI: 10.14202/vetworld.2016.976-982] [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: 04/01/2016] [Accepted: 08/08/2016] [Indexed: 12/30/2022] Open
Abstract
AIM This study was designed to evaluate the cardiac biomarkers and ultrasonography in prediction and early diagnosis of traumatic pericarditis (TP) in Egyptian buffaloes. MATERIALS AND METHODS A total number of 47 buffaloes were included in the study and divided into two groups: Healthy (n=10) and diseased groups (n=37). Diseased buffaloes were admitted to the Veterinary Teaching Hospital at Zagazig University, Egypt, with a history of anorexia, sudden, and severe reduction of milk production with no response to a previous medical treatment some animals had edema at the dewlap and congestion of the jugulars. These animals were subjected to clinical examination, evaluation by hemato-biochemical analysis including cardiac biomarkers and sonography. RESULTS The hemato-biochemical analysis revealed leukocytosis with a shift to left and hyperfibrinogenemia (indicating inflammation). Serum cardiac biomarkers including cardiac troponin I (cTnI), cTnT, nitric oxide, creatine kinase myocardial band, and lactic dehydrogenase enzyme were significantly increased in buffaloes with TP compared with control ones. Ultrasonographically, there were hypoechoic materials with echogenic fibrin interspersed in between the pericardial sac. CONCLUSIONS The cardiac biomarkers may be considered a useful index in the early diagnosis of TP. Moreover, ultrasonography is an excellent tool for early prediction and diagnosis of such condition.
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Affiliation(s)
- Noura E Attia
- Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Egypt
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22
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Gerber Y, Weston SA, Enriquez-Sarano M, Berardi C, Chamberlain AM, Manemann SM, Jiang R, Dunlay SM, Roger VL. Mortality Associated With Heart Failure After Myocardial Infarction: A Contemporary Community Perspective. Circ Heart Fail 2015; 9:e002460. [PMID: 26699392 DOI: 10.1161/circheartfailure.115.002460] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 11/06/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contemporary data are lacking on the prognostic importance of heart failure (HF) after myocardial infarction (MI). We evaluated the prognostic impact of HF post MI according to preserved/reduced ejection fraction and the timing of its occurrence. METHODS AND RESULTS All Olmsted County, Minnesota, residents (n=2596) with incident MI diagnosed in 1990 to 2010 and no prior HF were followed through March 2013. Cox models were used to examine (1) the hazard ratios for death associated with HF type and timing and (2) secular trends in survival by HF status. During a mean follow-up of 7.6 years, there were 1116 deaths, 634 in the 902 patients who developed HF (70%) and 482 in the 1694 patients who did not develop HF (28%). After adjustment for age and sex, HF as a time-dependent variable was strongly associated with mortality (hazard ratio =3.31, 95% confidence interval: 2.93-3.75), particularly from cardiovascular causes (hazard ratio =4.20, 95% confidence interval: 3.50-5.03). Further adjustment for MI severity and comorbidity, acute treatment, and recurrent MI moderately attenuated these associations (hazard ratio =2.49 and 2.94 for all-cause and cardiovascular mortality, respectively). Mortality did not differ by ejection fraction, but was higher for delayed- versus early-onset HF (P for heterogeneity =0.002). The age- and sex-adjusted 5-year survival estimates in 2001 to 2010 versus 1990 to 2000 were 82% and 81% among HF-free and 61% and 54% among HF patients, respectively (P for heterogeneity of trends =0.05). CONCLUSIONS HF markedly increases the risk of death after MI. This excess risk is similar regardless of ejection fraction but greater for delayed- versus early-onset HF. Mortality after MI declined over time, primarily as a result of improved HF survival.
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Affiliation(s)
- Yariv Gerber
- From the Department of Health Sciences Research, Division of Epidemiology (Y.G., S.A.W., C.B., A.M.C., S.M.M., R.J., V.L.R.) and Department of Cardiovascular Diseases (M.E.-S., S.M.D., V.L.R.), Mayo Clinic, Rochester, MN; Department of Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY (C.B.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.G.)
| | - Susan A Weston
- From the Department of Health Sciences Research, Division of Epidemiology (Y.G., S.A.W., C.B., A.M.C., S.M.M., R.J., V.L.R.) and Department of Cardiovascular Diseases (M.E.-S., S.M.D., V.L.R.), Mayo Clinic, Rochester, MN; Department of Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY (C.B.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.G.)
| | - Maurice Enriquez-Sarano
- From the Department of Health Sciences Research, Division of Epidemiology (Y.G., S.A.W., C.B., A.M.C., S.M.M., R.J., V.L.R.) and Department of Cardiovascular Diseases (M.E.-S., S.M.D., V.L.R.), Mayo Clinic, Rochester, MN; Department of Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY (C.B.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.G.)
| | - Cecilia Berardi
- From the Department of Health Sciences Research, Division of Epidemiology (Y.G., S.A.W., C.B., A.M.C., S.M.M., R.J., V.L.R.) and Department of Cardiovascular Diseases (M.E.-S., S.M.D., V.L.R.), Mayo Clinic, Rochester, MN; Department of Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY (C.B.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.G.)
| | - Alanna M Chamberlain
- From the Department of Health Sciences Research, Division of Epidemiology (Y.G., S.A.W., C.B., A.M.C., S.M.M., R.J., V.L.R.) and Department of Cardiovascular Diseases (M.E.-S., S.M.D., V.L.R.), Mayo Clinic, Rochester, MN; Department of Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY (C.B.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.G.)
| | - Sheila M Manemann
- From the Department of Health Sciences Research, Division of Epidemiology (Y.G., S.A.W., C.B., A.M.C., S.M.M., R.J., V.L.R.) and Department of Cardiovascular Diseases (M.E.-S., S.M.D., V.L.R.), Mayo Clinic, Rochester, MN; Department of Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY (C.B.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.G.)
| | - Ruoxiang Jiang
- From the Department of Health Sciences Research, Division of Epidemiology (Y.G., S.A.W., C.B., A.M.C., S.M.M., R.J., V.L.R.) and Department of Cardiovascular Diseases (M.E.-S., S.M.D., V.L.R.), Mayo Clinic, Rochester, MN; Department of Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY (C.B.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.G.)
| | - Shannon M Dunlay
- From the Department of Health Sciences Research, Division of Epidemiology (Y.G., S.A.W., C.B., A.M.C., S.M.M., R.J., V.L.R.) and Department of Cardiovascular Diseases (M.E.-S., S.M.D., V.L.R.), Mayo Clinic, Rochester, MN; Department of Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY (C.B.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.G.)
| | - Véronique L Roger
- From the Department of Health Sciences Research, Division of Epidemiology (Y.G., S.A.W., C.B., A.M.C., S.M.M., R.J., V.L.R.) and Department of Cardiovascular Diseases (M.E.-S., S.M.D., V.L.R.), Mayo Clinic, Rochester, MN; Department of Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY (C.B.); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.G.).
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Biomarkers in Cardiology - Part 2: In Coronary Heart Disease, Valve Disease and Special Situations. Arq Bras Cardiol 2015; 104:337-46. [PMID: 26083777 PMCID: PMC4495448 DOI: 10.5935/abc.20150061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/01/2015] [Indexed: 01/25/2023] Open
Abstract
Cardiovascular diseases are the main causes of mortality and morbidity in Brazil.
Their primary and secondary preventions are a priority for the health system and
require multiple approaches for increased effectiveness. Biomarkers are tools used to
identify with greater accuracy high-risk individuals, establish a faster diagnosis,
guide treatment, and determine prognosis. This review aims to highlight the
importance of biomarkers in clinical cardiology practice and raise relevant points
regarding their application and perspectives for the next few years. This document
was divided into two parts. This second part addresses the application of biomarkers
in coronary heart disease, valvular diseases, cardio-oncology, pulmonary embolism,
and cardiorenal syndrome.
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24
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Torre M, Jarolim P. Cardiac troponin assays in the management of heart failure. Clin Chim Acta 2014; 441:92-8. [PMID: 25545229 DOI: 10.1016/j.cca.2014.12.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 01/18/2023]
Abstract
Cardiac troponins I and T are established biomarkers of cardiac injury. Testing for either of these two cardiac troponins has long been an essential component of the diagnosis of acute myocardial infarction. In addition, cardiac troponin concentrations after acute myocardial infarction predict future adverse events including development of ischemic heart failure and chronic elevations of cardiac troponin correlate with heart failure severity. These predictions and correlations are particularly obvious when cardiac troponin concentrations are measured using the new high sensitivity cardiac troponin assays. Thus, a growing body of literature suggests that cardiac troponin testing may have important clinical implications for heart failure patients with reduced or preserved ejection fraction. In this review, we explore the prognostic utility of measuring cardiac troponin concentrations in patients with acute or chronic heart failure and in populations at risk of developing heart failure and the relationship between cardiac troponin levels and disease severity. We also summarize the ongoing debates and research on whether serial monitoring of cardiac troponin levels may become a useful tool for guiding therapeutic interventions in patients with heart failure.
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Affiliation(s)
| | - Petr Jarolim
- Harvard Medical School, Boston, MA, USA; Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
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25
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Gerber Y, Weston SA, Berardi C, McNallan SM, Jiang R, Redfield MM, Roger VL. Contemporary trends in heart failure with reduced and preserved ejection fraction after myocardial infarction: a community study. Am J Epidemiol 2013; 178:1272-80. [PMID: 23997209 DOI: 10.1093/aje/kwt109] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Major changes have recently occurred in the epidemiology of myocardial infarction (MI) that could possibly affect outcomes such as heart failure (HF). Data describing trends in HF after MI are scarce and conflicting and do not distinguish between preserved and reduced ejection fraction (EF). We evaluated temporal trends in HF after MI. All residents of Olmsted County, Minnesota (n = 2,596) who had a first-ever MI diagnosed in 1990-2010 and no prior HF were followed-up through 2012. Framingham Heart Study criteria were used to define HF, which was further classified according to EF. Both early-onset (0-7 days after MI) and late-onset (8 days to 5 years after MI) HF were examined. Changes in patient presentation were noted, including fewer ST-segment-elevation MIs, lower Killip class, and more comorbid conditions. Over the 5-year follow-up period, 715 patients developed HF, 475 of whom developed it during the first week. The age- and sex-adjusted risk declined from 1990-1996 to 2004-2010, with hazard ratios of 0.67 (95% confidence interval (CI): 0.54, 0.85) for early-onset HF and 0.63 (95% CI: 0.45, 0.86) for late-onset HF. Further adjustment for patient and MI characteristics yielded hazard ratios of 0.86 (95% CI: 0.66, 1.11) and 0.63 (95% CI: 0.45, 0.88) for early- and late-onset HF, respectively. Declines in early-onset and late-onset HF were observed for HF with reduced EF (<50%) but not for HF with preserved EF, indicating a change in the case mix of HF after MI that requires new prevention strategies.
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