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Emakhu J, Monplaisir L, Aguwa C, Arslanturk S, Masoud S, Nassereddine H, Hamam MS, Miller JB. Acute coronary syndrome prediction in emergency care: A machine learning approach. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107080. [PMID: 36037605 DOI: 10.1016/j.cmpb.2022.107080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 07/30/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Clinical concern for acute coronary syndrome (ACS) is one of emergency medicine's most common patient encounters. This study aims to develop an ensemble learning-driven framework as a diagnostic support tool to prevent misdiagnosis. METHODS We obtained extensive clinical electronic health data on patient encounters with clinical concerns for ACS from a large urban emergency department (ED) between January 2017 and August 2020. We applied an analytical framework equipped with many well-developed algorithms to improve the data quality by addressing missing values, dimensionality reduction, and data imbalance. We trained ensemble learning algorithms to classify patients with ACS or non-ACS etiologies of their symptoms. We used performance evaluation metrics such as accuracy, sensitivity, precision, F1-score, and the area under the receiver operating characteristic (AUROC) to measure the model's performance. RESULTS The analysis included 31,228 patients, of whom 563 (1.8%) had ACS and 30,665 (98.2%) had alternative diagnoses. Eleven features, including systolic blood pressure, brain natriuretic peptide, chronic heart disease, coronary artery disease, creatinine, glucose, heart attack, heart rate, nephrotic syndrome, red cell distribution width, and troponin level, are reported as significantly contributing risk factors. The proposed framework successfully classifies these cohorts with sensitivity and AUROC as high as 86.3% and 93.3%. Our proposed model's accuracy, precision, specificity, Matthew's correlation coefficient, and F1-score were 85.7%, 86.3%, 93%, 80%, and 86.3%, respectively. CONCLUSION Our proposed framework can identify early patients with ACS through further refinement and validation.
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Affiliation(s)
- Joshua Emakhu
- Department of Industrial and Systems Engineering, Wayne State University, Detroit, MI 48201, USA.
| | - Leslie Monplaisir
- Department of Industrial and Systems Engineering, Wayne State University, Detroit, MI 48201, USA
| | - Celestine Aguwa
- Department of Industrial and Systems Engineering, Wayne State University, Detroit, MI 48201, USA
| | - Suzan Arslanturk
- Department of Computer Science, Wayne State University, Detroit, MI 48202, USA
| | - Sara Masoud
- Department of Industrial and Systems Engineering, Wayne State University, Detroit, MI 48201, USA
| | | | - Mohamed S Hamam
- Emergency Department, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Joseph B Miller
- Emergency Department, Henry Ford Hospital, Detroit, MI 48202, USA
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Al-hadlaq SM, Balto HA, Hassan WM, Marraiki NA, El-Ansary AK. Biomarkers of non-communicable chronic disease: an update on contemporary methods. PeerJ 2022; 10:e12977. [PMID: 35233297 PMCID: PMC8882335 DOI: 10.7717/peerj.12977] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/31/2022] [Indexed: 01/11/2023] Open
Abstract
Chronic diseases constitute a major global burden with significant impact on health systems, economies, and quality of life. Chronic diseases include a broad range of diseases that can be communicable or non-communicable. Chronic diseases are often associated with modifications of normal physiological levels of various analytes that are routinely measured in serum and other body fluids, as well as pathological findings, such as chronic inflammation, oxidative stress, and mitochondrial dysfunction. Identification of at-risk populations, early diagnosis, and prediction of prognosis play a major role in preventing or reducing the burden of chronic diseases. Biomarkers are tools that are used by health professionals to aid in the identification and management of chronic diseases. Biomarkers can be diagnostic, predictive, or prognostic. Several individual or grouped biomarkers have been used successfully in the diagnosis and prediction of certain chronic diseases, however, it is generally accepted that a more sophisticated approach to link and interpret various biomarkers involved in chronic disease is necessary to improve our current procedures. In order to ensure a comprehensive and unbiased coverage of the literature, first a primary frame of the manuscript (title, headings and subheadings) was drafted by the authors working on this paper. Second, based on the components drafted in the preliminary skeleton a comprehensive search of the literature was performed using the PubMed and Google Scholar search engines. Multiple keywords related to the topic were used. Out of screened papers, only 190 papers, which are the most relevant, and recent articles were selected to cover the topic in relation to etiological mechanisms of different chronic diseases, the most recently used biomarkers of chronic diseases and finally the advances in the applications of multivariate biomarkers of chronic diseases as statistical and clinically applied tool for the early diagnosis of chronic diseases was discussed. Recently, multivariate biomarkers analysis approach has been employed with promising prospect. A brief discussion of the multivariate approach for the early diagnosis of the most common chronic diseases was highlighted in this review. The use of diagnostic algorithms might show the way for novel criteria and enhanced diagnostic effectiveness inpatients with one or numerous non-communicable chronic diseases. The search for new relevant biomarkers for the better diagnosis of patients with non-communicable chronic diseases according to the risk of progression, sickness, and fatality is ongoing. It is important to determine whether the newly identified biomarkers are purely associations or real biomarkers of underlying pathophysiological processes. Use of multivariate analysis could be of great importance in this regard.
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Affiliation(s)
- Solaiman M. Al-hadlaq
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Hanan A. Balto
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia,Central Research Laboratory, Female Campus, King Saud University, Riyadh, Saudi Arabia
| | - Wail M. Hassan
- Department of Biomedical Sciences, University of Missouri-Kansas City School of Medicine, Kansas City, KS, United States of America
| | - Najat A. Marraiki
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Afaf K. El-Ansary
- Central Research Laboratory, Female Campus, King Saud University, Riyadh, Saudi Arabia
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3
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Ghantous CM, Kamareddine L, Farhat R, Zouein FA, Mondello S, Kobeissy F, Zeidan A. Advances in Cardiovascular Biomarker Discovery. Biomedicines 2020; 8:biomedicines8120552. [PMID: 33265898 PMCID: PMC7759775 DOI: 10.3390/biomedicines8120552] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases are the leading causes of mortality worldwide. Among them, hypertension and its pathological complications pose a major risk for the development of other cardiovascular diseases, including heart failure and stroke. Identifying novel and early stage biomarkers of hypertension and other cardiovascular diseases is of paramount importance in predicting and preventing the major morbidity and mortality associated with these diseases. Biomarkers of such diseases or predisposition to their development are identified by changes in a specific indicator’s expression between healthy individuals and patients. These include changes in protein and microRNA (miRNA) levels. Protein profiling using mass spectrometry and miRNA screening utilizing microarray and sequencing have facilitated the discovery of proteins and miRNA as biomarker candidates. In this review, we summarized some of the different, promising early stage protein and miRNA biomarker candidates as well as the currently used biomarkers for hypertension and other cardiovascular diseases. Although a number of promising markers have been identified, it is unlikely that a single biomarker will unambiguously aid in the classification of these diseases. A multi-marker panel-strategy appears useful and promising for classifying and refining risk stratification among patients with cardiovascular disease.
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Affiliation(s)
- Crystal M. Ghantous
- Department of Nursing and Health Sciences, Faculty of Nursing and Health Sciences, Notre Dame University-Louaize, Keserwan 72, Lebanon;
| | - Layla Kamareddine
- Biomedical Sciences Department, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar;
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha 2713, Qatar
| | - Rima Farhat
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107, Lebanon;
| | - Fouad A. Zouein
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut 1107, Lebanon;
| | - Stefania Mondello
- Oasi Research Institute-IRCCS, 94018 Troina, Italy;
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, 98125 Messina, Italy
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut 1107, Lebanon;
| | - Asad Zeidan
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha 2713, Qatar
- Department of Basic Medical Science, Faculty of Medicine, QU Health, Qatar University, Doha 2713, Qatar
- Correspondence: ; Tel.: +97-431-309-19
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Ueda Y, Yee JL, Williams A, Roberts JA, Christe KL, Stern JA. Identifying Cardiac Diseases using Cardiac Biomarkers in Rhesus Macaques ( Macaca mulatta). Comp Med 2020; 70:348-357. [PMID: 32778203 DOI: 10.30802/aalas-cm-19-000117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cardiac biomarkers are an important tool for diagnosing cardiac diseases in both human and veterinary patients. Serum concentrations of N-terminal probrain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) have been used to indicate the presence of various cardiac diseases including hypertrophic cardiomyopathy (HCM) in various species including humans. However, these cardiac biomarkers have not been established as a diagnostic tool for detecting cardiac disease in rhesus macaques. In the rhesus macaque colony at the California National Primate Research Center, naturally occurring HCM and various other cardiac diseases have been identified. In this study, commercially available assays were used to measure serum cTnI and NT-proBNP concentrations to evaluate their utility as a diagnostic screening tool for cardiac diseases in rhesus macaques. This study revealed that the serum cTnI concentration was significantly higher in animals with echocardiographically apparent cardiac disease as compared with the animals that had no cardiac structural and functional changes (the control group). However, no significant differences were detected between animals with HCM and non-HCM cardiac disease. Because the area under the receiver operating characteristic curve was 0.81 when the serum cTnI was compared between the control and cardiac disease groups, serum cTnI was considered a moderately accurate test to predict the presence of cardiac disease. The optimal cut-off value of serum cTnI concentration for diagnosis of cardiac disease was 0.0085 ng/mL, with a sensitivity of 0.68 and specificity of 0.94. Significant but weak correlations were noted between the serum cTnI concentration and several echocardiographic parameters. Conversely, no significant differences in NT-proBNP concentrations were detected between animals with and without cardiac diseases. In conclusion, measurement of serum cTnI can be used to aid in diagnosing cardiac diseases in rhesus macaques. However, cTnI measurement does not replace echocardiographic evaluation to diagnose cardiac diseases in rhesus macaques due to the poor sensitivity of the assay and the weak correlation to with more established echocardiographic markers for cardiac disease.
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Affiliation(s)
- Yu Ueda
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis California
| | - JoAnn L Yee
- California National Primate Research Center, University of California-Davis, Davis California
| | - Amber Williams
- California National Primate Research Center, University of California-Davis, Davis California
| | - Jeffrey A Roberts
- California National Primate Research Center, University of California-Davis, Davis California
| | - Kari L Christe
- California National Primate Research Center, University of California-Davis, Davis California
| | - Joshua A Stern
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis California; California National Primate Research Center, University of California-Davis, Davis California;,
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Cao RY, Zheng H, Guo J, Redfearn DP. Prognostic value of plasma biomarkers in patients with acute coronary syndrome: a review of advances in the past decade. Biomark Med 2016; 10:525-35. [PMID: 27089223 DOI: 10.2217/bmm-2015-0029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Acute coronary syndrome (ACS), especially myocardial infarction, commonly known as a heart attack, is a serious life-threatening cardiovascular disease. Despite dramatic therapeutic advances, there have still been more than 20% patients with ACS suffering recurrent adverse cardiovascular events 3 years after disease onset. Therefore, the aim to prevent cardiac death caused by the heart attack remains challenging. Plasma biomarkers, originally developed to complement clinical assessment and electrocardiographic examination for the diagnosis of ACS, have been reported to play important prognostic roles in predicting adverse outcomes. These biomarkers mirror different pathophysiological mechanisms in association with ACS. In this review, we focus on advances of prognostic biomarkers in the past decade for short- and long-term risk assessment and management of patients with ACS.
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Affiliation(s)
- Richard Y Cao
- Department of Cardiology, Shanghai Xuhui Central Hospital/Shanghai Clinical Research Center, Chinese Academy of Sciences, Shanghai, China
| | - Hongchao Zheng
- Department of Cardiology, Shanghai Xuhui Central Hospital/Shanghai Clinical Research Center, Chinese Academy of Sciences, Shanghai, China
| | - Junjun Guo
- Department of Cardiology, Shanghai Xuhui Central Hospital/Shanghai Clinical Research Center, Chinese Academy of Sciences, Shanghai, China
| | - Damian P Redfearn
- Department of Biomedical & Molecular Sciences, Queen's University, Kingston, Ontario, Canada.,Department of Medicine, Kingston General Hospital, Kingston, Ontario, Canada
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Haberland A, Munoz Saravia SG, Wallukat G, Ziebig R, Schimke I. Chronic Chagas disease: from basics to laboratory medicine. Clin Chem Lab Med 2013; 51:271-94. [DOI: 10.1515/cclm-2012-0316] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 08/15/2012] [Indexed: 12/27/2022]
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7
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Parikh NI, Vasan RS. Assessing the clinical utility of biomarkers in medicine. Biomark Med 2012; 1:419-36. [PMID: 20477384 DOI: 10.2217/17520363.1.3.419] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Biomarkers in medicine have gained immense scientific and clinical interest in recent years. Biomarkers are potentially useful in the contexts of primary, secondary and tertiary prevention. Some of the characteristics of an ideal biomarker include that they are safe and easy to measure, are associated with acceptable costs (including those of the follow-up tests), and there is scientific evidence to suggest that biomarker use/modification influences disease outcomes. Additionally, variation in biomarker levels with gender and ethnicity should be elucidated, and the biomarker should have 'good performance characteristics' (i.e., sensitivity, specificity, positive- and negative-predictive values and positive- and negative-likelihood ratios). Risk prediction scores can combine information from several different biomarkers in order to estimate an individual's risk of developing an outcome, such as disease or death. Three commonly employed methods to test if a biomarker will add to traditional risk prediction models are model discrimination, model calibration and risk reclassification. 'Multimarker' strategies serve to integrate information from multiple biomarkers into risk prediction but may be limited by the presence of highly correlated biomarkers, economic costs and selection bias of biomarker candidates in a particular study sample. In the future, integration of biomarkers identified using emerging technologies from the 'omics fields (including genomics, proteomics, metabolomics, lipomics, ribomics and pharmacogenomics) may be useful for the 'personalization' of treatment/disease prevention.
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Affiliation(s)
- Nisha I Parikh
- Framingham Heart Study, 73 Mount Wayte Avenue, Suite 2, Framingham, MA 01702-5803, USA
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Muñoz-Saravia SG, Haberland A, Wallukat G, Schimke I. Chronic Chagas' heart disease: a disease on its way to becoming a worldwide health problem: epidemiology, etiopathology, treatment, pathogenesis and laboratory medicine. Heart Fail Rev 2012; 17:45-64. [PMID: 21165698 DOI: 10.1007/s10741-010-9211-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Chagas' disease, caused by Trypanosoma cruzi infection, is ranked as the most serious parasitic disease in Latin America. Nearly 30% of infected patients develop life-threatening complications, and with a latency of 10-30 years, mostly Chagas' heart disease which is currently the major cause of morbidity and mortality in Latin America, enormously burdening economic resources and dramatically affecting patients' social and labor situations. Because of increasing migration, international tourism and parasite transfer by blood contact, intrauterine transfer and organ transplantation, Chagas' heart disease could potentially become a worldwide problem. To raise awareness of this problem, we reflect on the epidemiology and etiopathology of Chagas' disease, particularly Chagas' heart disease. To counteract Chagas' heart disease, in addition to the general interruption of the infection cycle and chemotherapeutic elimination of the infection agent, early and effective causal or symptomatic therapies would be indispensable. Prerequisites for this are improved knowledge of the pathogenesis and optimized patient management. From economic and logistics viewpoints, this last prerequisite should be performed using laboratory medicine tools. Consequently, we first summarize the mechanisms that have been suggested as driving Chagas' heart disease, mainly those associated with the presence of autoantibodies against G-protein-coupled receptors; secondly, we indicate new treatment strategies involving autoantibody apheresis and in vivo autoantibody neutralization; thirdly, we present laboratory medicine tools such as autoantibody estimation and heart marker measurement, proposed for diagnosis, risk assessment and patient guidance and lastly, we critically reflect upon the increase in inflammation and oxidative stress markers in Chagas' heart disease.
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Affiliation(s)
- Allan S Jaffe
- Cardiovascular Division, Gonda 5, Mayo Clinic and Medical School, 200 First St SW, Rochester, MI 55905, USA.
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10
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Parikh CR, Coca SG, Thiessen-Philbrook H, Shlipak MG, Koyner JL, Wang Z, Edelstein CL, Devarajan P, Patel UD, Zappitelli M, Krawczeski CD, Passik CS, Swaminathan M, Garg AX. Postoperative biomarkers predict acute kidney injury and poor outcomes after adult cardiac surgery. J Am Soc Nephrol 2011; 22:1748-57. [PMID: 21836143 DOI: 10.1681/asn.2010121302] [Citation(s) in RCA: 403] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Acute kidney injury (AKI) is a frequent complication of cardiac surgery and increases morbidity and mortality. The identification of reliable biomarkers that allow earlier diagnosis of AKI in the postoperative period may increase the success of therapeutic interventions. Here, we conducted a prospective, multicenter cohort study involving 1219 adults undergoing cardiac surgery to evaluate whether early postoperative measures of urine IL-18, urine neutrophil gelatinase-associated lipocalin (NGAL), or plasma NGAL could identify which patients would develop AKI and other adverse patient outcomes. Urine IL-18 and urine and plasma NGAL levels peaked within 6 hours after surgery. After multivariable adjustment, the highest quintiles of urine IL-18 and plasma NGAL associated with 6.8-fold and 5-fold higher odds of AKI, respectively, compared with the lowest quintiles. Elevated urine IL-18 and urine and plasma NGAL levels associated with longer length of hospital stay, longer intensive care unit stay, and higher risk for dialysis or death. The clinical prediction model for AKI had an area under the receiver-operating characteristic curve (AUC) of 0.69. Urine IL-18 and plasma NGAL significantly improved the AUC to 0.76 and 0.75, respectively. Urine IL-18 and plasma NGAL significantly improved risk prediction over the clinical models alone as measured by net reclassification improvement (NRI) and integrated discrimination improvement (IDI). In conclusion, urine IL-18, urine NGAL, and plasma NGAL associate with subsequent AKI and poor outcomes among adults undergoing cardiac surgery.
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Affiliation(s)
- Chirag R Parikh
- Section of Nephrology, Yale University and Veterans Administration Medical Center, 950 Campbell Avenue, Mail Code 151B, West Haven, CT 06516, USA.
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Hasegawa K, Fix ML, Wendell L, Schwab K, Ay H, Smith EE, Greenberg SM, Rosand J, Goldstein JN, Brown DFM. Ischemic-appearing electrocardiographic changes predict myocardial injury in patients with intracerebral hemorrhage. Am J Emerg Med 2011; 30:545-52. [PMID: 21450435 DOI: 10.1016/j.ajem.2011.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Revised: 02/04/2011] [Accepted: 02/05/2011] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Myocardial injury is common among patients with intracerebral hemorrhage (ICH). However, it is challenging for emergency physicians to recognize acute myocardial injury in this population, as electrocardiographic (ECG) abnormalities are common in this setting. Our objective is to examine whether ischemic-appearing ECG changes predict subsequent myocardial injury in the context of ICH. METHODS Consecutive patients with primary ICH presenting to a single academic center were prospectively enrolled. Electrocardiograms were retrospectively reviewed by 3 independent readers. Anatomical areas of ischemia were defined as I and aVL; II, III, and aVF; V(1) to V(4); and V(5) and V(6). Medical record review identified myocardial injury, defined as troponin I or T elevation (cutoff 1.5 and 0.1 ng/mL, respectively), within 30 days. RESULTS Between 1998 and 2004, 218 patients presented directly to our emergency department and did not have a do-not-resuscitate/do-not-intubate order; arrival ECGs and troponin levels were available for 206 patients. Ischemic-appearing changes were noted in 41% of patients, and myocardial injury was noted in 12% of patients. Ischemic-appearing changes were more common in patients with subsequent injury (64% vs 37%; P = .02). After multivariable analysis controlling for age and cardiac risk factors, ischemic-appearing ECG changes independently predicted myocardial injury (odds ratio, 3.2; 95% confidence interval, 1.3-8.2). In an exploratory analysis, ischemic-appearing ECG changes in leads I and aVL as well as V(5) and V(6) were more specific for myocardial injury (P = .002 and P = .03, respectively). CONCLUSION In conclusion, although a range of ECG abnormalities can occur after ICH, the finding of ischemic-appearing changes in an anatomical distribution can help predict which patients are having true myocardial injury.
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Affiliation(s)
- Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
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Saravia SGM, Haberland A, Bartel S, Araujo R, Valda G, Reynaga DD, Ramirez ID, Borges AC, Wallukat G, Schimke I. Cardiac troponin T measured with a highly sensitive assay for diagnosis and monitoring of heart injury in chronic Chagas disease. Arch Pathol Lab Med 2011; 135:243-8. [PMID: 21284445 DOI: 10.5858/135.2.243] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Chronic Chagas disease (15 million patients; annual incidence, 40, 000 patients; annual mortality, 12 ,500 patients) is the most serious parasitic disease in Latin America. Between 10 and 30 years after infection, 30% of patients with Chagas disease develop heart injury, which is the main reason for its high mortality. Consequently, frequent cardiac diagnostics are required for patients with Chagas disease. OBJECTIVE To minimize time-intensive and cost-intensive diagnostics, such as electrocardiography, echocardiography, and radiologic imaging, we tested the effect of measuring serum cardiac troponin T (cTnT) with a highly sensitive assay. To indicate the pathophysiologic background for cTnT release in Chagas heart injury, inflammation markers, such as C-reactive protein and interleukin 6, were measured in parallel. DESIGN Serum cTnT was measured in 26 healthy subjects and in 179 patients with chronic Chagas disease who were asymptomatic (indeterminate stage, n = 86), who were suffering from cardiomyopathy with or without megacolon (n = 71), or who were suffering from megacolon exclusively (n = 22). RESULTS Serum cTnT was significantly higher in patients with cardiomyopathy with or without megacolon than in healthy subjects, asymptomatic subjects, and patients with megacolon, and the cTnT value was correlated with the severity of the cardiomyopathy. The lower limit of detection for the highly sensitive assay (3 ng/L) was best at distinguishing patients with, and without, heart injury. C-reactive protein and interleukin 6 were found to parallel cTnT changes in both the different Chagas groups and the cardiomyopathy groups separated by disease severity. CONCLUSIONS Highly sensitive cTnT measurement has the potential to contribute to diagnosis and monitoring of heart injury in patients with chronic Chagas disease. The highly sensitive assay of cTnT release seems to be related to Chagas heart disease-specific inflammation.
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Park JP, Park MK, Yun JW. Proteomic biomarkers for diagnosis in acute myocardial infarction. Biomarkers 2010; 16:1-11. [DOI: 10.3109/1354750x.2010.515688] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dronavalli VB, Banner NR, Bonser RS. Assessment of the Potential Heart Donor. J Am Coll Cardiol 2010; 56:352-61. [DOI: 10.1016/j.jacc.2010.02.055] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 01/19/2010] [Accepted: 02/16/2010] [Indexed: 11/29/2022]
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McLean S, Phillips A, Carruthers K, Fox KAA. Use of the GRACE score by cardiology nurse specialists in the emergency department. ACTA ACUST UNITED AC 2010. [DOI: 10.12968/bjca.2010.5.2.46386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Scott McLean
- The Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA.
| | | | | | - Keith AA Fox
- Cardiovascular Research, University of Edinburgh
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Derer W, Barnathan ES, Safak E, Agarwal P, Heidecke H, Möckel M, Gross M, Oezcelik C, Dietz R, Dechend R. Vitronectin concentrations predict risk in patients undergoing coronary stenting. Circ Cardiovasc Interv 2008; 2:14-9. [PMID: 20031688 DOI: 10.1161/circinterventions.108.795799] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vitronectin is a multifunctional protein with a multiple binding domain that interacts with a variety of plasma and cell proteins. Vitronectin binds multiple ligands, including the soluble vitronectin receptor. Abciximab binds equally well to soluble vitronectin receptor and glycoprotein IIb/IIIa, because both share the beta(3) subunit. We tested whether vitronectin concentrations correlate with adverse outcomes in acute coronary syndrome patients. METHODS AND RESULTS Baseline serum samples (n=233) from a randomized, placebo-controlled trial of abciximab plus stenting (Evaluation of Platelet IIb/IIIa Inhibitor for Stenting EPISTENT) were retrospectively analyzed. We stratified vitronectin concentrations into the 3 lower quartiles (n=178; <49.7 microg/mL) versus the fourth upper quartile (n=55; >or=49.7 microg/mL). The end point was a major adverse cardiovascular event defined as death, myocardial infarction or urgent revascularization at 30 days and 6 months. A higher proportion of patients with baseline vitronectin >or=49.7 microg/mL had major adverse cardiovascular event than patients with baseline vitronectin <49.7 microg/mL at 30 days (18.2% versus 5.6%; P=0.01) and 6 months (20.0% versus 6.2%; P=0.006). When baseline variables not predictive of major adverse cardiovascular event (eg, troponin positive, history of congestive heart failure, diabetes, history of hypertension, smoking status) were excluded from the multivariate model, only baseline vitronectin >or=49.7 microg/mL (at 30 days: OR, 3.23; 95% CI, 1.23, 8.49; at 6 months: OR, 3.36; 95% CI, 1.33, 8.52) and history of myocardial infarction (at 30 days: OR, 5.02; 95% CI, 1.41, 17.9; at 6 months: OR, 3.99; 95% CI, 1.28, 12.43) remained. No interaction occurred between abciximab and vitronectin. CONCLUSIONS Our findings indicate that vitronectin may be an independent predictor of adverse cardiovascular outcomes following acute stenting.
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The protecting effects and mechanisms of Baicalin and Octreotide on heart injury in rats with SAP. Mediators Inflamm 2008; 2007:19469. [PMID: 18274634 PMCID: PMC2220025 DOI: 10.1155/2007/19469] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2007] [Accepted: 10/24/2007] [Indexed: 12/13/2022] Open
Abstract
Purpose. To observe the protecting effects and mechanisms
of Baicalin and Octreotide on heart injury in rats with severe
acute pancreatitis (SAP).
Methods. The SAP rat models were randomly divided into
the model group, Baicalin-treated group, Octreotide treated group,
and sham operation group. The contents of some inflammatory
indexes in blood were determined. The rat mortality, pathological
changes of heart, the changes of NF-κB,
P-Selectin, Bax, Bcl-2, and Caspase-3 protein
expression levels as well as apoptotic index were observed in all
groups, respectively, at 3 hours, 6 hours, and 12 hours after
operation.
Results. The survival rate of model group was less
than treated groups at 12 hours, difference was significant. The
contents of some inflammatory indexes of the treated groups were
lower than those of the model group to various degrees at
different time points. The pathological myocardial changes under
light microscope were milder in treated groups than in model
group. The changes of
NF-κB,
P-Selectin, Bax, Bcl-2, and Caspase-3 protein expression levels in
all groups were different. There was only a case of myocardial
cell apoptosis in an Octreotide-treated group at 6 hours.
Conclusion. Baicalin and Octreotide have protecting
effects on heart injury of rats with SAP.
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18
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Fromm RE. Cardiac troponins in the intensive care unit: common causes of increased levels and interpretation. Crit Care Med 2007; 35:584-8. [PMID: 17205004 DOI: 10.1097/01.ccm.0000254349.10953.be] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Clinical chemistry is an important component of the diagnosis of many conditions, and advances in laboratory science have brought many new diagnostic tools to the intensive care unit clinician, including new biomarkers of cardiac injury like troponin T and I. Interpretation of these clinical laboratory results requires knowledge of the performance of these tests. SETTING AND PATIENTS This article reviews the interpretation and performance of diagnostic markers of myocardial injury in patients with diverse clinical conditions of interest to critical care practitioners. CONCLUSIONS Cardiac troponin I and T, regulatory components of the contractile apparatus, are sensitive indicators of myocardial injury and have become central to the diagnosis of myocardial infarction. The troponins are also released in a number of clinical situations in which thrombotic complications of coronary artery disease and resultant acute myocardial infarction have not occurred. These situations include conditions like pulmonary embolism, sepsis, myocarditis, and acute stroke. Elevated troponins in these conditions are thought to emanate from injured myocardial cells and, in most circumstances, have been associated with adverse outcomes. Practitioners should be mindful of the wide spectrum of diseases that may result in elevated troponin when interpreting these measurements.
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Affiliation(s)
- Robert E Fromm
- Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
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19
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Abstract
The serum markers of myocardial injury are used to help in establishing the diagnosis of myocardial infarction. The older markers like aspartate amino-transferase, creatine kinase, lactate dehydrogenase etc. lost their utility due to lack of specificity and limited sensitivities. Among the currently available markers cardiac troponins are the most widely used due to their improved sensitivity specificity, efficiency and low turn around time. Studies have shown that cardiac troponins should replace CKMB as the diagnostic 'gold standard' for the diagnosis of myocardial injury. The combination of myoglobin with cardiac troponins has further improved the accuracy in the diagnosis of acute coronary syndromes and thereby reducing the hospital stay and patients' money. Among the other new markers of early detection of myocardial damage, heart fatty acid binding protein, glycogen phosphorylase BB and myoglobin/carbonic anhydrase III ratio seem to be the most promising. But the search for the most ideal marker of myocardial injury is still on.
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Affiliation(s)
- P K Nigam
- Dept. of Cardiology, King George's Medical University, 226 003 Lucknow
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20
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Abstract
Oxidative damage to lipids and proteins is an important component of atherosclerotic cardiovascular disease (CVD). Studies of oxidation-related molecules are helping to define atherosclerotic mechanisms, and measurements of circulating levels of specific oxidant compounds may improve cardiovascular risk assessment. The present article reviews accumulating data of selected oxidative biomarkers that support their role in providing diagnostic and/or prognostic information. For example, plasma levels of the enzyme myeloperoxidase, which generates the strong oxidizing agent hypochlorous acid, have been found to be correlated with risk for myocardial infarction and endothelial dysfunction. Elevated levels of lipoprotein-associated phospholipase A(2) are associated with coronary artery disease (CAD) and stroke. Oxidized phospholipids play an important role in atherosclerosis. Recent studies measuring circulating levels of oxidized phospholipids have suggested a strong association with CAD, plaque disruption, and response to 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor ("statin") therapy. Isoprostanes correlate strongly with cardiovascular risk factors, but their role in risk prediction is less well defined. Future studies are expected to clarify the role of oxidative biomarkers in the diagnosis and prognosis of CVD and to determine their value in specific clinical populations.
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Affiliation(s)
- Sotirios Tsimikas
- Interventional Cardiology Program, Section of Vascular Medicine, Division of Cardiovascular Diseases, Department of Medicine, University of California-San Diego, La Jolla, California, USA.
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21
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Affiliation(s)
- Ramachandran S Vasan
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Department of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA, USA.
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22
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HEI ZQ, LIU DZ, LUO CF, LI SR, MA WH, LUO GJ. Perioperative changes of ventricular function and three indicators of myocardial injury during orthotopic liver transplantation. Chin Med J (Engl) 2006. [DOI: 10.1097/00029330-200606010-00010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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23
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Abstract
BACKGROUND The mechanisms explaining morphological electrocardiogram (ECG) changes and increased troponin T (TnT) in acute stroke are unclear. The aims of the present study were to assess the prevalence of ECG and TnT changes in acute ischaemic stroke, to investigate whether ischaemic-like ECG changes correlate to a rise in TnT and to examine whether ECG changes and elevated TnT predict a poor short-time outcome. METHODS From 2000 to 2002 a total of 279 patients suffering from acute ischaemic stroke were included prospectively in the present study. ECG was carried out at admission and on day 1 in all patients. TnT was analysed at admission and on day 1. RESULTS The most frequent ECG changes were: prolonged QTc 36.0%, ST depression 24.5%, atrial fibrillation 19.9% and T wave inversion 17.8%. In logistic regression analyses, ST depression and Q waves were significantly associated with a rise in TnT. TnT was elevated (>0.04 microg L(-1)) in 26 patients (9.6%). In logistic regression analyses, a rise in TnT was significantly associated with a poor short-term outcome (modified Rankin scale >3). CONCLUSION ECG changes are prevalent in acute ischaemic stroke. ST depression and Q waves are related to an increase in TnT, suggesting that these ECG changes may indicate coexisting ischaemic heart disease. A rise in TnT predicts a poor outcome. Patients with acute ischaemic stroke should be offered adequate treatment with secondary prevention and preferably a follow-up with focus on cardiologic as well as neurological aspects.
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Affiliation(s)
- B Fure
- Department of Geriatric Medicine, Ullevaal University Hospital, Oslo, Norway.
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24
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Miller WL, Garratt KN, Burritt MF, Lennon RJ, Reeder GS, Jaffe AS. Baseline troponin level: key to understanding the importance of post-PCI troponin elevations. Eur Heart J 2006; 27:1061-9. [PMID: 16481332 DOI: 10.1093/eurheartj/ehi760] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIMS The adverse prognostic significance of biomarker elevations after percutaneous coronary intervention (PCI) is well established. However, often baseline troponin values are not included in the analysis or sensitive criteria are not employed. Accordingly, we assessed the timing and magnitude of post-PCI troponin T (cTnT) levels and their relationships to outcomes in patients with and without pre-PCI baseline cTnT elevations using a sensitive assay and sensitive cut-off values. METHODS AND RESULTS cTnT was measured at baseline (pre-PCI), 8 and 16 h post-PCI in 2352 patients. A cTnT elevation was defined as > or =0.03 ng/mL. No baseline cTnT elevations were detected in 1619 patients undergoing mostly (97%) non-urgent procedures (cTnT = 0.01 +/- 0.002 ng/mL; mean +/- SD). 733 patients had baseline cTnT elevations. Only the baseline troponin value had prognostic importance. Patients with elevated cTnT baseline levels had a higher overall cumulative 12-month death/MI rate of 11.1% compared with those without elevated baseline levels of 4.7% (P < 0.05). Neither the timing nor the magnitude of the post-procedure cTnT elevations was predictive of long-term death/MI rates when baseline elevations were included in the analysis. Similar findings were observed for baseline creatine kinase-MB (CK-MB) levels. Late increases in cTnT levels (16 h post-PCI) presaged in-hospital events only. CONCLUSION Long-term prognosis is most often related to the baseline pre-PCI troponin value and not the biomarker response to the PCI. These results support a re-evaluation of the use of biomarker data in relation to PCI.
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Affiliation(s)
- Wayne L Miller
- Cardiovascular Division, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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25
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Nusier MK, Ababneh BM. Diagnostic Efficiency of Creatine Kinase (CK), CKMB, Troponin T and Troponin I in Patients with Suspected Acute Myocardial Infarction. ACTA ACUST UNITED AC 2006. [DOI: 10.1248/jhs.52.180] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Mohamad Khalid Nusier
- Department of Biochemistry and Molecular Biology, Jordan University of Science and Technology, School of Medicine
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26
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Zaky J, Caraang C, Yu R, El-Bialy A. Elevated troponins and the Churg-Strauss syndrome: a case report. J Cardiovasc Pharmacol Ther 2005; 10:131-6. [PMID: 15965564 DOI: 10.1177/107424840501000207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In a patient with persistently elevated troponin levels but normal ischemic work-up, a diagnostic dilemma can ensue. This is the case of a 65-year-old woman whose only cardiac risk factor was age. She presented repeatedly with chest pain, elevated troponins, and consistently elevated eosinophil levels until the fourth admission when she presented with multi-organ abnormalities including asthma and vasculitis that led to the diagnosis of Churg-Strauss syndrome (CSS). Initiation of corticosteroids immediately resolved all of her presenting symptoms; troponin and eosinophil levels quickly normalized. Eosinophilia from CSS can lead to multi-organ damage including the heart. Therefore, one must consider CSS in the differential of eosinophilia as early detection and treatment may be critical in decreasing morbidity and mortality.
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Affiliation(s)
- Joseph Zaky
- Department of Medicine, Sylmar, California 91342-1495, USA
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27
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Lim W, Qushmaq I, Cook DJ, Crowther MA, Heels-Ansdell D, Devereaux PJ. Elevated troponin and myocardial infarction in the intensive care unit: a prospective study. Crit Care 2005; 9:R636-44. [PMID: 16280062 PMCID: PMC1414005 DOI: 10.1186/cc3816] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2005] [Revised: 08/23/2005] [Accepted: 09/02/2005] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Elevated troponin levels indicate myocardial injury but may occur in critically ill patients without evidence of myocardial ischemia. An elevated troponin alone cannot establish a diagnosis of myocardial infarction (MI), yet the optimal methods for diagnosing MI in the intensive care unit (ICU) are not established. The study objective was to estimate the frequency of MI using troponin T measurements, 12-lead electrocardiograms (ECGs) and echocardiography, and to examine the association of elevated troponin and MI with ICU and hospital mortality and length of stay. METHOD In this 2-month single centre prospective cohort study, all consecutive patients admitted to our medical-surgical ICU were classified in duplicate by two investigators as having MI or no MI based on troponin, ECGs and echocardiograms obtained during the ICU stay. The diagnosis of MI was based on an adaptation of the joint European Society of Cardiology/American College of Cardiology definition: a typical rise or fall of an elevated troponin measurement, in addition to ischemic symptoms, ischemic ECG changes, a coronary artery intervention, or a new cardiac wall motion abnormality. RESULTS We screened 117 ICU admissions and enrolled 115 predominantly medical patients. Of these, 93 (80.9%) had at least one ECG and one troponin; 44 of these 93 (47.3%) had at least one elevated troponin and 24 (25.8%) had an MI. Patients with MI had significantly higher mortality in the ICU (37.5% versus 17.6%; P = 0.050) and hospital (50.0% versus 22.0%; P = 0.010) than those without MI. After adjusting for Acute Physiology and Chronic Health Evaluation II score and need for inotropes or vasopressors, MI was an independent predictor of hospital mortality (odds ratio 3.22, 95% confidence interval 1.04-9.96). The presence of an elevated troponin (among those patients in whom troponin was measured) was not independently predictive of ICU or hospital mortality. CONCLUSION In this study, 47% of critically ill patients had an elevated troponin but only 26% of these met criteria for MI. An elevated troponin without ischemic ECG changes was not associated with adverse outcomes; however, MI in the ICU setting was an independent predictor of hospital mortality.
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Affiliation(s)
- Wendy Lim
- Research Fellow, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ismael Qushmaq
- Research Fellow, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Professor, Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Mark A Crowther
- Associate Professor, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Diane Heels-Ansdell
- Statistical Analyst, Department Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - PJ Devereaux
- Assistant Professor, Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
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