1
|
Elahimanesh M, Shokri N, Mahdinia E, Mohammadi P, Parvaz N, Najafi M. Differential gene expression patterns in ST-elevation Myocardial Infarction and Non-ST-elevation Myocardial Infarction. Sci Rep 2024; 14:3424. [PMID: 38341440 PMCID: PMC10858964 DOI: 10.1038/s41598-024-54086-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/08/2024] [Indexed: 02/12/2024] Open
Abstract
The ST-elevation Myocardial Infarction (STEMI) and Non-ST-elevation Myocardial Infarction (NSTEMI) might occur because of coronary artery stenosis. The gene biomarkers apply to the clinical diagnosis and therapeutic decisions in Myocardial Infarction. The aim of this study was to introduce, enrich and estimate timely the blood gene profiles based on the high-throughput data for the molecular distinction of STEMI and NSTEMI. The text mining data (50 genes) annotated with DisGeNET data (144 genes) were merged with the GEO gene expression data (5 datasets) using R software. Then, the STEMI and NSTEMI networks were primarily created using the STRING server, and improved using the Cytoscape software. The high-score genes were enriched using the KEGG signaling pathways and Gene Ontology (GO). Furthermore, the genes were categorized to determine the NSTEMI and STEMI gene profiles. The time cut-off points were identified statistically by monitoring the gene profiles up to 30 days after Myocardial Infarction (MI). The gene heatmaps were clearly created for the STEMI (high-fold genes 69, low-fold genes 45) and NSTEMI (high-fold genes 68, low-fold genes 36). The STEMI and NSTEMI networks suggested the high-score gene profiles. Furthermore, the gene enrichment suggested the different biological conditions for STEMI and NSTEMI. The time cut-off points for the NSTEMI (4 genes) and STEMI (13 genes) gene profiles were established up to three days after Myocardial Infarction. The study showed the different pathophysiologic conditions for STEMI and NSTEMI. Furthermore, the high-score gene profiles are suggested to measure up to 3 days after MI to distinguish the STEMI and NSTEMI.
Collapse
Affiliation(s)
- Mohammad Elahimanesh
- Clinical Biochemistry Department, Faculty of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Nafiseh Shokri
- Clinical Biochemistry Department, Faculty of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Elmira Mahdinia
- Clinical Biochemistry Department, Faculty of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Payam Mohammadi
- Clinical Biochemistry Department, Faculty of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Najmeh Parvaz
- Clinical Biochemistry Department, Faculty of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Najafi
- Clinical Biochemistry Department, Faculty of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran.
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
2
|
Griffin BR, Gist KM, Faubel S. Current Status of Novel Biomarkers for the Diagnosis of Acute Kidney Injury: A Historical Perspective. J Intensive Care Med 2019; 35:415-424. [PMID: 30654681 DOI: 10.1177/0885066618824531] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute kidney injury (AKI) is a common and serious medical condition associated with significant increases in morbidity, mortality, and cost of care. Because of the high incidence and poor outcomes associated with AKI, there has been significant interest in the development of new therapies for the prevention and treatment of the disease. A lack of efficacy in drug trials led to the concern that AKI was not being diagnosed early enough for an effective intervention and that a rise in serum creatinine itself is not a sensitive-enough marker. Researchers have been searching for novel biomarkers that can not only assess a decline in kidney function but also demonstrate structural damage to the kidney and at time points earlier than increases in serum creatinine measurements allow. Over the past 10 years, there have been 3300 new publications and hundreds of new biomarkers investigated, yet concern still remains regarding AKI biomarker performance. The AKI biomarkers are yet to be widely utilized in clinical practice, leading some to question whether AKI biomarkers will ever reach their initial promise. However, we believe that biomarkers are an important part of current and future AKI research and clinical management. In this review, we compare the historical contexts of acute myocardial ischemia and AKI biomarker development to illustrate the progress that has been made within AKI biomarker research in a relatively short period of time and also to point out key differences between the disease processes that have been barriers to widespread AKI biomarker adoption. Finally, we discuss potential paths by which biomarkers can lead to appropriate AKI treatment responses that lower morbidity and mortality.
Collapse
Affiliation(s)
- Benjamin R Griffin
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Katja M Gist
- Department of Pediatrics, The Heart Institute, University of Colorado, Aurora, CO, USA
| | - Sarah Faubel
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Renal Section, Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA
| |
Collapse
|
3
|
Veličković VM, Rochau U, Conrads-Frank A, Kee F, Blankenberg S, Siebert U. Systematic assessment of decision-analytic models evaluating diagnostic tests for acute myocardial infarction based on cardiac troponin assays. Expert Rev Pharmacoecon Outcomes Res 2018; 18:619-640. [DOI: 10.1080/14737167.2018.1512857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Vladica M. Veličković
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
- Faculty of Medicine, University of Niš, Nis, Serbia
| | - Ursula Rochau
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
- Area 4 Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Annette Conrads-Frank
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health Research, Queens University Belfast, Belfast, United Kingdom
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Hamburg, Germany
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
- Area 4 Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
- Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
- Program on Cardiovascular Research, Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Jiang H, Li Y, Mo J, Chen X, Li M, Lin P, Hung KKC, Rainer TH, Graham CA. Comparison of outcomes in emergency department patients with suspected cardiac chest pain: two-centre prospective observational study in Southern China. BMC Cardiovasc Disord 2018; 18:95. [PMID: 29769019 PMCID: PMC5956813 DOI: 10.1186/s12872-018-0814-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hong Kong (HK) and Guangzhou (GZ) are cities in China with different healthcare systems. This study aimed to compare 30-day and 6-month mortality and characteristics of patients with suspected cardiac chest pain admitted to two emergency departments (ED) in HK and GZ. METHODS A prospective observational study enrolled patients with suspected cardiac chest pain presenting to EDs in the Prince of Wales Hospital (PWH), HK and the Second Affiliated Hospital of Guangzhou Medical University (AHGZMU),GZ. The primary outcome was 30-day and 6-month mortality. RESULTS In total, 996 patients were recruited, 407 cases from GZ and 589 cases from HK.The 30-day and 6-month mortality of chest patients were 3.7% and 4.7% in GZand 0.3% and 1.9% in HK, respectively. Serum creatinine level (Cr) was an independent factor for 30-day mortality whilst Cr and systolic blood pressure (SBP) were independent factors for 6-month mortality. In Cox regression analysis, unadjusted and adjusted hazard ratios for 30-day and 6-month mortality in GZ were significantly increased. CONCLUSION The 30-day and 6-month mortality of patients with suspected cardiac chest pain in Guangzhou were higher than in Hong Kong due to due to different baseline clinical characteristics of patients and different distributions of diagnoses, which were associated with different healthcare systems. Serum creatinine and SBP were independent factors for 30-day and 6-month mortality.
Collapse
Affiliation(s)
- Huilin Jiang
- Emergency Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yunmei Li
- Emergency Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Junrong Mo
- Emergency Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaohui Chen
- Emergency Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Min Li
- Emergency Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Peiyi Lin
- Emergency Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kevin K C Hung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Main Clinical Block and Trauma Centre, Shatin, N.T, Hong Kong, China
| | - Timothy H Rainer
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Main Clinical Block and Trauma Centre, Shatin, N.T, Hong Kong, China
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Main Clinical Block and Trauma Centre, Shatin, N.T, Hong Kong, China.
| |
Collapse
|
5
|
Wang X, Wang D, Wu J, Yu X, Lv J, Kong J, Zhu G, Su R. Metabolic Characterization of Myocardial Infarction Using GC-MS-Based Tissue Metabolomics. Int Heart J 2017; 58:441-446. [PMID: 28484125 DOI: 10.1536/ihj.16-432] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Understanding the metabolic features of myocardial infarction (MI) is critical to its prevention and treatment. Here, we aimed to characterize the metabolic features of early MI using a tissue metabolomics method based on gas chromatography-mass spectrometry (GC-MS). Thirty-four pairs of infarcted myocardia and their matched non-infarcted myocardia were collected from 34 rats that underwent coronary artery ligation (CAL); their metabolic profiles were compared by GC-MS-based tissue metabolomics to characterize the metabolic features of MI. On the basis of differential metabolites, their diagnostic potential for MI was analyzed, and MI-related metabolic pathways were investigated. Serum samples before and post MI were used to validate the results obtained in myocardia. The metabolic profile of the infarcted myocardia was obviously different from that of the non-infarcted myocardia, as indicated by partial least squares discriminate analysis (PLS-DA) plots. Twenty-two metabolites were identified to be different between the infarcted myocardia and non-infarcted myocardia. These metabolic alterations reflect energy deficit, acidosis, oxidative stress, ionic imbalance, and cardiac injury post MI. Glutamine, glutamate, and lactate were confirmed to jointly confer a favorable potential for diagnosing MI, which can be well validated in serum.
Collapse
Affiliation(s)
- Xingxing Wang
- Department of Forensic Medicine, Shantou University Medical College
- Department of Pathology, Shantou University Medical College 2nd Affiliated Hospital
| | - Dian Wang
- Department of Forensic Medicine, Shantou University Medical College
| | - Jiayan Wu
- Department of Forensic Medicine, Shantou University Medical College
| | - Xiaojun Yu
- Department of Forensic Medicine, Shantou University Medical College
| | - Junyao Lv
- Department of Forensic Medicine, Shantou University Medical College
| | - Jing Kong
- Department of Forensic Medicine, Shantou University Medical College
| | - Guanghui Zhu
- Department of Forensic Medicine, Shantou University Medical College
| | - Ruibing Su
- Department of Forensic Medicine, Shantou University Medical College
| |
Collapse
|
6
|
Kasteleyn MJ, Vos RC, Jansen H, Rutten GEHM. Differences in clinical characteristics between patients with and without type 2 diabetes hospitalized with a first myocardial infarction. J Diabetes Complications 2016; 30:830-3. [PMID: 27134032 DOI: 10.1016/j.jdiacomp.2016.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/07/2016] [Accepted: 03/18/2016] [Indexed: 11/28/2022]
Abstract
AIMS To explore differences in clinical characteristics of patients with and without type 2 diabetes (T2DM) hospitalized with a first myocardial infarction (MI). METHODS In this cross-sectional study we examined differences between patients with and without T2DM hospitalized with a first MI (n=563). Multiple linear regression modeling was used to examine the association between T2DM and age of occurrence of MI. We adjusted for gender, systolic blood pressure (BP), lipids and creatinine level to examine whether these variables explained the association between T2DM and age of occurrence of MI. RESULTS Among 563 patients with a first MI, T2DM patients (n=77) were older than non-diabetic patients (67.8±10.9 vs. 64.4±13.4years, p<0.05), had lower LDL (2.5±0.8 vs. 3.4±1.1mmol/l, p<0.001) and total cholesterol levels (4.4±0.9 vs. 5.4±1.2mmol/l, p<0.001), but higher systolic BP (150.3±29.9 vs. 141.7±27.5mmHg, p<0.05). The association between T2DM and age of occurrence of MI was largely explained by cholesterol levels. CONCLUSIONS T2DM patients were older when hospitalized with a first MI. This difference was largely explained by differences in cholesterol levels. The lower cholesterol levels in T2DM patients compared to non-diabetic patients, and maybe also the older age of occurrence of MI, might reflect the results successful primary prevention and systematic monitoring in T2DM.
Collapse
Affiliation(s)
- Marise J Kasteleyn
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands, P.O. Box 8500, 3508 GA Utrecht.
| | - Rimke C Vos
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands, P.O. Box 8500, 3508 GA Utrecht.
| | - Hanneke Jansen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands, P.O. Box 8500, 3508 GA Utrecht.
| | - Guy E H M Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands, P.O. Box 8500, 3508 GA Utrecht.
| |
Collapse
|
7
|
van Beek MHCT, Oude Voshaar RC, van Deelen FM, van Balkom AJLM, Pop G, Speckens AEM. Inverse correlation between cardiac injury and cardiac anxiety: a potential role for communication. J Cardiovasc Nurs 2015; 29:448-53. [PMID: 23782865 DOI: 10.1097/jcn.0b013e3182982550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE General anxiety in cardiac patients is associated with worsened cardiac course. An acute coronary syndrome (ACS) might evoke specific cardiac anxiety. We explored the characteristics associated with cardiac anxiety in ACS patients. METHODS We assessed cardiac anxiety in 237 patients admitted with ACS using the Cardiac Anxiety Questionnaire and gathered information on sociodemographic, psychological, and cardiac disease characteristics. Univariate, multivariate logistic, and linear regression analyses were used to determine which characteristics were associated with cardiac anxiety. RESULTS Cardiac anxiety was not associated with sociodemographic variables. More severe cardiac injury, as indicated by ST-elevated myocardial infarction and troponin level, was associated with less cardiac anxiety. Psychological variables (depressive symptoms, agoraphobic cognitions, avoidance behavior) were associated with more cardiac anxiety. DISCUSSION Cardiac anxiety in ACS patients is associated with more psychological distress but lower severity of cardiac injury as indicated by ST-elevated myocardial infarction and troponin level. Two explanations seem likely for this latter finding. First, anxious persons might seek help earlier, thus being diagnosed more often with minor cardiac pathology. Second, cardiac anxiety might partly be caused by diagnostic uncertainty. Future research should focus on communication strategies to reassure patients more efficiently.
Collapse
Affiliation(s)
- Maria H C T van Beek
- Maria H.C.T. van Beek, MD Psychiatrist, Radboud University Nijmegen Medical Centre, Department of Psychiatry, Nijmegen, the Netherlands. Richard C. Oude Voshaar, MD, PhD Senior researcher at the Radboud University Nijmegen Medical Centre, Department of Psychiatry, Nijmegen, and Professor, Old Age Psychiatry at University Center of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands. Femke M. van Deelen, MD Medical Doctor, Radboud University Nijmegen Medical Centre, Department of Psychiatry, Nijmegen, the Netherlands. Anton J.L.M. van Balkom, MD, PhD Professor of Psychiatry, Department of Psychiatry and EMGO+ Institute, VU University Medical Centre and GGZinGeest, Amsterdam, the Netherlands. Gheorghe Pop, MD, PhD Cardiologist, Radboud University Nijmegen Medical Centre, Department of Cardiology, Nijmegen, the Netherlands. Anne E.M. Speckens, MD, PhD Professor of Psychiatry, Radboud University Nijmegen Medical Centre, Department of Psychiatry, Nijmegen, the Netherlands
| | | | | | | | | | | |
Collapse
|
8
|
Bagai A, Huang Z, Lokhnygina Y, Harrington RA, Armstrong PW, Strony J, White HD, Leonardi S, Held C, Van de Werf F, Wallentin L, Tricoci P, Mahaffey KW. Magnitude of Troponin Elevation and Long-Term Clinical Outcomes in Acute Coronary Syndrome Patients Treated With and Without Revascularization. Circ Cardiovasc Interv 2015; 8:e002314. [DOI: 10.1161/circinterventions.115.002314] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
In patients with non–ST-segment–elevation acute coronary syndrome (NSTE ACS), elevated troponin levels identify patients at high risk for adverse outcomes; however, it is unknown whether the magnitude of troponin elevation during hospitalization remains predictive of subsequent events in patients undergoing coronary revascularization.
Methods and Results—
We studied 12 635 patients with NSTE ACS in the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) study with at least 1 troponin measurement during index hospitalization. Cox proportional hazards regression was used to examine the relationship between peak troponin level (standardized as the ratio of peak troponin value measured during hospitalization and local laboratory upper reference limit [URL]) and revascularization on all-cause mortality at 2 years. Revascularization (percutaneous coronary intervention or coronary artery bypass graft) was performed during index hospitalization in 8586 patients (68.0%); revascularized patients had higher peak troponin ratios (median, 23 versus 9.5× URL). Among patients that did not undergo revascularization, the mortality rate at 2 years increased in a curvilinear fashion with increasing levels of peak troponin. In contrast, the mortality rate at 2 years remained constant irrespective of peak troponin levels among revascularized patients (
P
for interaction=0.004). This relationship was unchanged after multivariable adjustment.
Conclusions—
There is a differential relationship between the magnitude of troponin elevation and long-term mortality in ACS patients treated with and without revascularization. Although prognostically important in patients treated without revascularization, the prognostic implications of peak troponin level seem to be minimal in revascularized patients.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00527943.
Collapse
Affiliation(s)
- Akshay Bagai
- From the Terrence Donnelly Heart Center, St. Michael’s Hospital, University of Toronto, Ontario, Canada (A.B.); Department of Medicine, Duke Clinical Research Center, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (A.B., Z.H., Y.L., S.L., P.T.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Merck & Co, Whitehouse Station, NJ (J.S.); Department of Medicine, Green Lane
| | - Zhen Huang
- From the Terrence Donnelly Heart Center, St. Michael’s Hospital, University of Toronto, Ontario, Canada (A.B.); Department of Medicine, Duke Clinical Research Center, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (A.B., Z.H., Y.L., S.L., P.T.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Merck & Co, Whitehouse Station, NJ (J.S.); Department of Medicine, Green Lane
| | - Yuliya Lokhnygina
- From the Terrence Donnelly Heart Center, St. Michael’s Hospital, University of Toronto, Ontario, Canada (A.B.); Department of Medicine, Duke Clinical Research Center, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (A.B., Z.H., Y.L., S.L., P.T.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Merck & Co, Whitehouse Station, NJ (J.S.); Department of Medicine, Green Lane
| | - Robert A. Harrington
- From the Terrence Donnelly Heart Center, St. Michael’s Hospital, University of Toronto, Ontario, Canada (A.B.); Department of Medicine, Duke Clinical Research Center, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (A.B., Z.H., Y.L., S.L., P.T.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Merck & Co, Whitehouse Station, NJ (J.S.); Department of Medicine, Green Lane
| | - Paul W. Armstrong
- From the Terrence Donnelly Heart Center, St. Michael’s Hospital, University of Toronto, Ontario, Canada (A.B.); Department of Medicine, Duke Clinical Research Center, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (A.B., Z.H., Y.L., S.L., P.T.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Merck & Co, Whitehouse Station, NJ (J.S.); Department of Medicine, Green Lane
| | - John Strony
- From the Terrence Donnelly Heart Center, St. Michael’s Hospital, University of Toronto, Ontario, Canada (A.B.); Department of Medicine, Duke Clinical Research Center, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (A.B., Z.H., Y.L., S.L., P.T.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Merck & Co, Whitehouse Station, NJ (J.S.); Department of Medicine, Green Lane
| | - Harvey D. White
- From the Terrence Donnelly Heart Center, St. Michael’s Hospital, University of Toronto, Ontario, Canada (A.B.); Department of Medicine, Duke Clinical Research Center, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (A.B., Z.H., Y.L., S.L., P.T.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Merck & Co, Whitehouse Station, NJ (J.S.); Department of Medicine, Green Lane
| | - Sergio Leonardi
- From the Terrence Donnelly Heart Center, St. Michael’s Hospital, University of Toronto, Ontario, Canada (A.B.); Department of Medicine, Duke Clinical Research Center, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (A.B., Z.H., Y.L., S.L., P.T.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Merck & Co, Whitehouse Station, NJ (J.S.); Department of Medicine, Green Lane
| | - Claes Held
- From the Terrence Donnelly Heart Center, St. Michael’s Hospital, University of Toronto, Ontario, Canada (A.B.); Department of Medicine, Duke Clinical Research Center, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (A.B., Z.H., Y.L., S.L., P.T.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Merck & Co, Whitehouse Station, NJ (J.S.); Department of Medicine, Green Lane
| | - Frans Van de Werf
- From the Terrence Donnelly Heart Center, St. Michael’s Hospital, University of Toronto, Ontario, Canada (A.B.); Department of Medicine, Duke Clinical Research Center, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (A.B., Z.H., Y.L., S.L., P.T.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Merck & Co, Whitehouse Station, NJ (J.S.); Department of Medicine, Green Lane
| | - Lars Wallentin
- From the Terrence Donnelly Heart Center, St. Michael’s Hospital, University of Toronto, Ontario, Canada (A.B.); Department of Medicine, Duke Clinical Research Center, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (A.B., Z.H., Y.L., S.L., P.T.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Merck & Co, Whitehouse Station, NJ (J.S.); Department of Medicine, Green Lane
| | - Pierluigi Tricoci
- From the Terrence Donnelly Heart Center, St. Michael’s Hospital, University of Toronto, Ontario, Canada (A.B.); Department of Medicine, Duke Clinical Research Center, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (A.B., Z.H., Y.L., S.L., P.T.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Merck & Co, Whitehouse Station, NJ (J.S.); Department of Medicine, Green Lane
| | - Kenneth W. Mahaffey
- From the Terrence Donnelly Heart Center, St. Michael’s Hospital, University of Toronto, Ontario, Canada (A.B.); Department of Medicine, Duke Clinical Research Center, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (A.B., Z.H., Y.L., S.L., P.T.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Merck & Co, Whitehouse Station, NJ (J.S.); Department of Medicine, Green Lane
| |
Collapse
|
9
|
Zhang J, Liu S, Xu B, Li G, Li G, Huang A, Wu B, Peng L, Song M, Xie Q, Lin W, Xie W, Wen S, Zhang Z, Xu X, Liang S. Study of baicalin on sympathoexcitation induced by myocardial ischemia via P2X3 receptor in superior cervical ganglia. Auton Neurosci 2014; 189:8-15. [PMID: 25554221 DOI: 10.1016/j.autneu.2014.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/05/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
Abstract
After the myocardial ischemia, injured myocardial tissues released large quantity of ATP, which activated P2X3 receptor in superior cervical ganglia and made the SCG postganglionic neurons excited. Excitatory of sympathetic postganglionic efferent neurons increased the blood pressure and heart rates, which aggravated the myocardial ischemic injury. Baicalin has anti-inflammatory and anti-oxidant properties. Our study showed that baicalin reduced the incremental concentration of serum CK-MB, cTn-T, epinephrine and ATP, decreased the up-regulated expression levels of P2X3 mRNA and protein in SCG after MI, and then inhibited the sympathetic excitatory activity triggered by MI injury. These results indicated that baicalin acted on P2X3 receptor was involved in the transmission of sympathetic excitation after the myocardial ischemic injury. Baicalin might decrease sympathetic activity via inhibiting P2X3 receptor in rat SCG to protect the myocardium.
Collapse
Affiliation(s)
- Jun Zhang
- Department of Physiology, Medical School of Nanchang University, Nanchang 330006, PR China
| | - Shuangmei Liu
- Department of Physiology, Medical School of Nanchang University, Nanchang 330006, PR China
| | - Baohua Xu
- Department of Laboratory Animal, Medical School of Nanchang University, Nanchang 330006, PR China
| | - Guodong Li
- Department of Physiology, Medical School of Nanchang University, Nanchang 330006, PR China
| | - Guilin Li
- Department of Physiology, Medical School of Nanchang University, Nanchang 330006, PR China
| | - An Huang
- Jiangxi University of Finance and Economics, Nanchang, Jiangxi 330006, PR China
| | - Bing Wu
- Department of Physiology, Medical School of Nanchang University, Nanchang 330006, PR China
| | - Lichao Peng
- Department of Physiology, Medical School of Nanchang University, Nanchang 330006, PR China
| | - Miaomiao Song
- Department of Physiology, Medical School of Nanchang University, Nanchang 330006, PR China
| | - Qiuyu Xie
- 2012 Grade of Department of Clinical Medicine of Nanchang University, Nanchang 330006, PR China
| | - Weijian Lin
- 2012 Grade of Department of Clinical Medicine of Nanchang University, Nanchang 330006, PR China
| | - Wei Xie
- 2012 Grade of Department of Clinical Medicine of Nanchang University, Nanchang 330006, PR China
| | - Shiyao Wen
- 2012 Grade of Department of Clinical Medicine of Nanchang University, Nanchang 330006, PR China
| | - Zhedong Zhang
- 2012 Grade of Department of Clinical Medicine of Nanchang University, Nanchang 330006, PR China
| | - Xiaoling Xu
- Department of Biomedical Engineering, Information Engineering College of Nanchang University, Nanchang 330006, PR China
| | - Shangdong Liang
- Department of Physiology, Medical School of Nanchang University, Nanchang 330006, PR China; Institute of Life Science of Nanchang University, Nanchang 330006, PR China.
| |
Collapse
|
10
|
de Jager DJ, Vervloet MG, Dekker FW. Noncardiovascular mortality in CKD: an epidemiological perspective. Nat Rev Nephrol 2014; 10:208-14. [DOI: 10.1038/nrneph.2014.8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
11
|
Abstract
Acute chest pain suggestive of ischemic cardiac origin, with a normal or nondiagnostic electrocardiogram and negative initial cardiac markers for myocardial necrosis represent a significant diagnostic dilemma for clinicians. Multiple imaging modalities play a pivotal role in early diagnosis and safe discharge of these patients. In this review, we compare the current imaging modalities available for these patients including their diagnostic accuracy, feasibility, and cost effectiveness. Acute rest myocardial perfusion imaging significantly improves the clinical outcome in these patients and reduces the overall cost when incorporated into the decision making pathway. The choice of imaging modality recommended should be based on local institutional expertise and the overall clinical presentation. The imaging modality with high diagnostic accuracy and negative predictive value will provide for precise risk stratification which is important to clinical decision making, including patients who require admission to the hospital and those who can be safely discharged.
Collapse
Affiliation(s)
- Abhijit Ghatak
- Division of Cardiovascular Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | |
Collapse
|
12
|
Nam SW, Lee IH, Lee GH, Choi YO, Lee EH, Shin JH, Choi BM, Hong YS, Son CS. Myocardial Injury in Newborn Infants with Severe Metabolic Acidosis at the First Day of Life. NEONATAL MEDICINE 2013. [DOI: 10.5385/nm.2013.20.1.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Seong Woo Nam
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - In Hak Lee
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Gui Hee Lee
- Department of Nursing, Korea University Ansan Hospital, Ansan, Korea
| | - Young Ok Choi
- Department of Nursing, Korea University Ansan Hospital, Ansan, Korea
| | - Eun Hee Lee
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Jeong Hee Shin
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Byung Min Choi
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Young Sook Hong
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Chang Sung Son
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| |
Collapse
|
13
|
van Beek MHCT, Voshaar RCO, van Deelen FM, van Balkom AJLM, Pop G, Speckens AEM. The cardiac anxiety questionnaire: cross-validation among cardiac inpatients. Int J Psychiatry Med 2012; 43:349-64. [PMID: 23094467 DOI: 10.2190/pm.43.4.e] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE General anxiety symptoms are common in patients with cardiac disease and considered to have an adverse effect on cardiac prognosis. The role of specific cardiac anxiety, however, is still unknown. The aim of this study is to examine the factor structure, reliability, and validity of the Dutch version of the Cardiac Anxiety Questionnaire (CAQ), which was specifically designed to assess heart focused anxiety. METHODS Two hundred thirty-seven patients admitted for an acute coronary syndrome (ACS) and a control group of 49 patients admitted for an exacerbation of rheumatoid arthritis (RA) completed the CAQ, the Agoraphobic Cognitions Questionnaire, Mobility Inventory, Beck Depression Inventory, Beck Anxiety Inventory, and the State-Trait Anxiety Inventory. RESULTS Although the original three-factor solution (fear, avoidance, and attention) was acceptable (model fit parameters: CFI = 0.89 and TLI = 0.87), our data were best explained by a four-factor model including safety seeking behaviors. Internal consistency and test-retest reliability were good. The CAQ had moderate correlations with the other anxiety and depression questionnaires. Recently admitted ACS patients had significantly higher scores than RA patients, even after controlling for general anxiety and depressive symptoms (p < 0.001). CONCLUSION The CAQ is a reliable and valid instrument to assess cardiac anxiety in patients hospitalized with ACS. These results enable longitudinal studies to examine the relationship of heart-focused anxiety with cardiac prognosis and to evaluate interventions specifically targeted at anxiety in cardiac patients.
Collapse
Affiliation(s)
- M H C T van Beek
- Department of Psychiatry, Radboud University Nijmegen Medical Centre, The Netherlands.
| | | | | | | | | | | |
Collapse
|
14
|
Seydel KB, Fox LL, Glover SJ, Reeves MJ, Pensulo P, Muiruri A, Mpakiza A, Molyneux ME, Taylor TE. Plasma concentrations of parasite histidine-rich protein 2 distinguish between retinopathy-positive and retinopathy-negative cerebral malaria in Malawian children. J Infect Dis 2012; 206:309-18. [PMID: 22634877 DOI: 10.1093/infdis/jis371] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Brain histology and ophthalmoscopy suggest that approximately 25% of children with World Health Organization-defined cerebral malaria (CM) have a nonmalarial cause of death. Misclassification complicates clinical care, confounds studies of association, and may obfuscate successes in malaria control. Retinopathy predicts intracerebral parasite sequestration with >90% sensitivity and specificity, but detecting retinopathy requires well-trained personnel and expensive equipment. METHODS We investigated the utility of plasma concentrations of parasite histidine-rich protein 2 (pHRP2), a Plasmodium-specific protein, as a predictor of intracerebral parasite sequestration at autopsy and of malaria retinopathy on clinical examination in patients with clinically defined CM. RESULTS In 64 autopsy cases, 47 of whom had histological evidence of sequestration, the sensitivity and specificity of a plasma pHRP2 level of >1700 ng/mL were 98% and 94%, respectively, and the area under the receiver operating characteristic (AUROC) curve was 0.98. In a separate, prospectively studied group of 101 children with clinically defined CM, of whom 71 had retinopathy, the same pHRP2 cutoff predicted retinopathy-positivity with a sensitivity of 90% and specificity of 87% (AUROC, 0.90). CONCLUSIONS Elevated plasma pHRP2 concentrations can identify Malawian children with histologically confirmed or retinopathy-positive CM and is a more field-friendly approach to confirming the diagnosis than post mortem sampling or ophthalmoscopy.
Collapse
Affiliation(s)
- Karl B Seydel
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Nayak SB, Pinto Pereira LM, Boodoo S, Kimberlyali A, Baptiste C, Maraj S, Persad N, Khan N, Surendran S, Legall G. Association of troponin T and altered lipid profile in patients admitted with acute myocardial infarction. Arch Physiol Biochem 2010; 116:21-7. [PMID: 19916752 DOI: 10.3109/13813450903397638] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine whether elevated levels of troponin T are associated with altered lipid profile. METHODS Data were collected from 205 patients each of whom presented elevated troponin T levels. RESULTS 195 patients presented with suspected myocardial infarction, 10 patients did not. Of which 68 had medium, 107 high and 20 presented with very high troponin T levels. The proportions were significantly different (p = 0.000215). Regression analysis showed that troponin T level was a useful quadratic predictor of total cholesterol (p = 0.000), triglycerides (p = 0.003), and low density cholesterol (p = 0.000); and a useful linear predictor of TC/HC ratio (p = 0.001). CONCLUSIONS The occurrence of myocardial infarction is associated with elevated troponin T levels; troponin T is positively correlated with total cholesterol, triglycerides, LDL and TC/HC ratio and negatively correlated with HDL. TC/HC ratio was not found to be a useful predictor of the likelihood of MI.
Collapse
Affiliation(s)
- Shivananda B Nayak
- Department of Preclinical Sciences, The University of the West Indies, Trinidad.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Usefulness of 201TlCl/ 123I-BMIPP dual-myocardial SPECT for patients with non-ST segment elevation myocardial infarction. Ann Nucl Med 2008; 22:363-9. [PMID: 18600413 DOI: 10.1007/s12149-007-0126-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Accepted: 12/21/2007] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Earlier studies suggested that elevated cardiac troponin T (cTnT) might be useful for detecting less severe types of myocardial injury (i.e., non-ST segment elevation myocardial infarction). The objective of this study is to elucidate the usefulness of (201)thallous chloride ((201)TlCl) and (123)I-betamethyl-p-iodophenyl-pentadecanoic acid ((123)I-BMIPP) dual-single-photon emission computed tomography (SPECT) imaging for patients with myocardial infarction (MI) without ST segment elevation. METHODS Consecutive 86 patients (56 men and 30 women; mean age 66 +/- 12 years) clinically diagnosed with acute myocardial infarction (AMI) were divided into two groups according to serum creatine kinase MB (CK-MB) and cTnT levels. Group A consisted of 53 patients with increased serum CK-MB and cTnT levels, and Group B, 33 patients with increased serum cTnT without increased serum CK-MB. All patients underwent (201)TlCl and (123)I-BMIPP dual-SPECT about 8 days following the onset. The left ventricular myocardium was divided into 20 segments on each SPECT image, and tracer accumulation in those segments was scored on a five-point scoring system. The total defect scores (TDS) were calculated by summing the scores for all 20 segments, and compared between groups A and B. Group B patients were subdivided into two groups according to the TDS on (123)I-BMIPP images as groups B(S) (severe; TDS > or = 8) and B(M) (mild; TDS < or = 7), and we compared the prognosis over a period of 2 years from the onset between the three groups. RESULTS The TDS of group A derived from (201)TlCl and (123)I-BMIPP images was significantly higher than those of group B (14.5 +/- 10.8 vs. 1.5 +/- 2.4 and 20.8 +/- 13.3 vs. 9.1 +/- 6.2, respectively; P < 0.0001). The sensitivities of (201)TlCl and (123)I-BMIPP images were 94.3% (50/53) and 96.2% (51/53) to detect the culprit coronary lesions in group A (no significant difference). In contrast, the sensitivity of (123)I-BMIPP images (72.7%, 24/33) was higher than that of (201)TlCl images (27.3%, 9/33) in group B (P < 0.05). At 2 years of follow-up, the incidence of hard cardiac events in groups A, B(S), and B(M) was 24.5%, 27.8%, and 6.7%, respectively. The rate of group BS, as well as that of group A, was significantly higher than that of group B(M) (P < 0.05). CONCLUSIONS Of those with a clinical diagnosis of AMI accompanied by increased cTnT, the CK-MB negative patients accounted for 38% (33/86) of all patients as having non-ST segment elevation myocardial infarction such as NTMI. For such patients, (123)I-BMIPP imaging is useful not only for the detection of the culprit lesions but also for the prediction of the prognosis.
Collapse
|
17
|
Nagurney JT, Huang C, Heredia O, Sane S, Lewis SC, Chang Y, Jang IK. The new and old definitions of acute myocardial infarction: a data-based comparison. Am J Emerg Med 2008; 26:523-31. [PMID: 18534279 DOI: 10.1016/j.ajem.2007.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 06/22/2007] [Accepted: 08/02/2007] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To measure the agreement between the newer European Society of Cardiology-American College of Cardiology (ESC-ACC) definition of acute myocardial infarction (AMI) and the traditional definition established by the World Health Organization (WHO). BASIC PROCEDURES All adult ED patients admitted to our institution with at least one abnormally elevated cardiac biomarker were determined to have had an AMI by either or both definitions. The degree of agreement and the frequency of the reasons for disagreement between these 2 definitions were measured. MAIN FINDINGS A final study population consisted of 339 patients; 196 (58%) had an AMI by one or both definitions. Among them, 126 (64%; 95% confidence interval [CI], 57-71) were discordant for these 2 definitions: 104 (53%; 95% CI, 46-60) met only the ESC-ACC, whereas 22 (11%; 95% CI, 6-16) met only the WHO definition. Among those who met only the ESC-ACC definition, 37 (36%; 95% CI, 27-45) met none of the 3 traditional WHO criteria. PRINCIPAL CONCLUSIONS More patients are discordant than concordant for the 2 standard definitions of AMI. Among them, a large majority meet only the new ESC-ACC definition.
Collapse
Affiliation(s)
- John Tobias Nagurney
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
| | | | | | | | | | | | | |
Collapse
|
18
|
Szymankiewicz M, Matuszczak-Wleklak M, Vidyasagar D, Gadzinowski J. Retrospective diagnosis of hypoxic myocardial injury in premature newborns. J Perinat Med 2006; 34:220-5. [PMID: 16602843 DOI: 10.1515/jpm.2006.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Perinatal asphyxia has a high impact on neonatal mortality, morbidity, and neurological outcome. The hypoxic effects on brain, kidney and gastrointestinal system are well recognized in newborns. While it is known that hypoxia also effects cardiac function, there are few studies of quantitative myocardial injury in premature infants who suffered hypoxia. AIM To investigate usefulness of cardiac troponin (cTnT) and creatinine kinase MB (CK-MB) in the diagnosis of myocardial injury due to birth hypoxia and to correlate these markers with cardiac functions as measured by echocardiogram. METHODS We studied 43 preterm infants: 21 with birth asphyxia and 22 controls. Echocardiographic studies and quantitative determination of cTnT and CK-MB in blood serum was performed between the 12(th) and the 24(th) h of life. RESULTS cTnT and CK-MB levels were higher in asphyxiated infants compared to controls (0.287 +/- 0.190 vs. 0.112 +/- 0.099 ng/mL, P < 0.001) and (18.35 +/-14.81 vs. 11.09 +/- 5.17 ng/L, P < 0.05). Among controls, we observed an elevated value of cTnT in those with respiratory distress syndrome (RDS). We found a decrease in fractional shortening (P < 0.05) and an increase in tricuspid insufficiency (P < 0.01) in asphyxiated newborns. CONCLUSIONS cTnT and CK-MB levels are strong indicators of myocardial injury due to perinatal hypoxia. The cTnT level was most strongly related to RDS.
Collapse
|
19
|
Ray KK, Sheridan PJ, Bolton J, Clayton TC, Veitch A, Manivarmane R, Al Rifai A, Payne G, Baig W. Management and outcomes of acute coronary syndrome with minimal myocardial necrosis: analysis of a large prospective registry from a non-interventional centre. Int J Clin Pract 2006; 60:383-90. [PMID: 16620349 DOI: 10.1111/j.1368-5031.2006.00816.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to assess the clinical risk of minimal myonecrosis below the cut-off for acute myocardial infarction (MI) in comparison with other grades of acute coronary syndrome (ACS). One-thousand four hundred and sixty seven consecutive patients with ACS admitted between May 2001 and April 2002 were studied in a non-interventional centre. Patients were divided into unstable angina (UA) (cTnT < 0.01 microg/l), non-ST elevation ACS with minimal myonecrosis (0.01 <or= cTnT < 0.1 microg/l), non-ST elevation MI (NSTEMI) (cTnT >or= 0.1 microg/L) and ST elevation myocardial infarction (STEMI). UA (n = 638) was associated with the fewest events at 6 months (2% cardiac death or MI). Patients with any myonecrosis (n = 829) had worse outcomes (6-month cardiac death or MI 18.3-23.3%). Compared with ACS patients with minimal myonecrosis, UA patients were at significantly lower risk (OR 0.21, 95% CI 0.12-0.45, p < 0.001), NSTEMI patients were at similar risk (OR 1.45, 95% CI 0.89-2.35, p = 0.13), and STEMI patients were at higher risk (OR 2.12 95% CI 1.26-3.85, p = 0.008) in adjusted analyses. Nearly 85% of cardiac deaths occurred within 6 months. The risk of adverse events was higher among patients managed by non-cardiologists (OR 1.66, 95% CI 1-2.75, p = 0.049). Patients with non-ST elevation ACS and minimal myonecrosis are a high-risk group more comparable with NSTEMI and clearly distinguishable from patients with UA.
Collapse
Affiliation(s)
- K K Ray
- Cardiology Department, Doncaster Royal Infirmary, Doncaster, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
Each year in the United States, over 8 million patients present to the emergency department(ED) with complaints of chest discomfort or other symptoms consistent with possible acute coronary syndrome (ACS). While over half of these patients are typically admitted for further diagnostic evaluation, fewer than 20% are diagnosed with ACS. With hospital beds and inpatient resources scarce, these admissions can be avoided by evaluating low- to moderate-risk patients in chest pain units. This large, undifferentiated patient population represents a potential high-risk group for emergency physicians requiring a systematic approach and specific ED resources. This evaluation is required to appropriately determine if a patient is safe to be discharged home with outpatient follow-up versus requiring admission to the hospital for monitoring and further testing.
Collapse
Affiliation(s)
- Andra L Blomkalns
- Department of Emergency Medicine, University of Cincinnati College of Medicine, OH 45267-0769, USA.
| | | |
Collapse
|
21
|
Ohtani T, Ueda Y, Shimizu M, Mizote I, Hirayama A, Hori M, Kodama K. Association between cardiac troponin T elevation and angioscopic morphology of culprit lesion in patients with non-ST-segment elevation acute coronary syndrome. Am Heart J 2005; 150:227-33. [PMID: 16086923 DOI: 10.1016/j.ahj.2004.09.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Accepted: 09/14/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND It is well known that cardiac troponin T (TnT) elevation on admission indicates a high-risk subgroup among patients with non-ST-segment elevation acute coronary syndrome (NSEACS). Although the mechanism of TnT elevation is speculated to be the microthromboembolism from unstable plaques, it has not been clarified. The aim of this study is to clarify the association between the serum TnT elevation and the angioscopically evaluated morphology of culprit lesion in the patients with NSEACS. METHODS Among 113 patients with NSEACS who had significant coronary stenosis, 62 patients with successful angioscopic examination were prospectively and consecutively enrolled from October 2001 to August 2002. Patients were divided into 2 groups according to the serum TnT level measured before percutaneous coronary intervention: TnT-positive or TnT-negative group. Thrombus and plaque color at culprit lesion were evaluated by angioscopy and were compared between the groups. Plaque color was determined as yellow or white, and thrombus as none, small, or large. Three different definitions for TnT-positive (> or =0.1, > or =0.03, and > or =0.01 ng/mL) were used and the sensitivity and specificity for detecting thrombus was compared. RESULTS Prevalence of thrombus, large thrombus, and yellow plaque were all higher in TnT-positive than in TnT-negative group for 3 different cutoff values of TnT. Angiographic slow-flow occurred more frequently after percutaneous coronary intervention in TnT-positive than in TnT-negative group for 3 different cutoff values of TnT. Sensitivity/specificity of detecting large thrombus were 33%/100%, 44%/91%, and 56%/83% when TnT-positive was defined as TnT > or = 0.1, > or =0.03, and > or =0.01 ng/mL, respectively. CONCLUSIONS Serum TnT level was significantly associated with the prevalence of thrombus and yellow plaque at the culprit lesions of NSEACS. Troponin T, when positive was defined as > or =0.01 ng/mL, still have a high specificity for detecting intracoronary thrombus.
Collapse
Affiliation(s)
- Tomohito Ohtani
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | | | | | | | | | | | | |
Collapse
|
22
|
Matunović R, Stojanović A, Damjanović M. [Natriuretic peptides in clinical practice]. VOJNOSANIT PREGL 2005; 62:147-53. [PMID: 15787168 DOI: 10.2298/vsp0502147m] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
23
|
Blomkalns AL, Gibler WB. Development of the chest pain center: rationale, implementation, efficacy, and cost-effectiveness. Prog Cardiovasc Dis 2004; 46:393-403. [PMID: 15179628 DOI: 10.1016/j.pcad.2003.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Andra L Blomkalns
- University of Cincinnati College of Medicine, Department of Emergency Medicine, Ohio 45267-0769, USA.
| | | |
Collapse
|
24
|
Kontos MC, Shah R, Fritz LM, Anderson FP, Tatum JL, Ornato JP, Jesse RL. Implication of different cardiac troponin I levels for clinical outcomes and prognosis of acute chest pain patients. J Am Coll Cardiol 2004; 43:958-65. [PMID: 15028350 DOI: 10.1016/j.jacc.2003.10.036] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2003] [Revised: 09/30/2003] [Accepted: 10/06/2003] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We compared outcomes in patients with non-ST-segment elevation acute coronary syndromes (ACS) according to the degree of cardiac troponin I (cTnI) elevation. BACKGROUND Controlled trials of high-risk patients have found that troponin elevations identify an even higher risk subset. It is unclear whether outcomes are similar among a lower risk, heterogeneous patient group. Also, few studies have reported outcomes other than myocardial infarction (MI) or death, based on the peak troponin value. METHODS Consecutively, admitted patients without ST-segment elevation on the initial electrocardiogram underwent serial marker sampling using creatine kinase (CK), CK-MB fraction, and cTnI. Patients were grouped according to peak cTnI: negative = no detectable cTnI; low = peak greater than the lower limit of detectability but less than the optimal diagnostic value; intermediate = peak greater than or equal to the optimal diagnostic value but less than the manufacturer's suggested upper reference limit (URL); and high = peak greater than or equal to the URL. Thirty-day outcomes included cardiac death, MI based on CK-MB, revascularization, significant disease, and a reversible defect on stress testing. Six-month mortality was also determined. Negative evaluations for ischemia included nonsignificant disease, no reversible stress defect, and negative rest perfusion imaging. RESULTS Of the 4,123 patients admitted, 893 (22%) had detectable cTnI values. Cardiac events and positive test results at 30 days and 6-month mortality increased significantly with increasing cTnI values. Negative evaluations for ischemia were significantly and inversely related to peak cTnI values. Although adverse events were significantly more common in patients with a low cTnI value than in those with negative cTnI, negative evaluations for ischemia were frequent. CONCLUSIONS Increased cTnI values are associated with worse outcomes. Although low cTnI values are associated with adverse events, they do not have the same implication as higher cTnI values, and nonischemic evaluations are frequent.
Collapse
Affiliation(s)
- Michael C Kontos
- Department of Internal Medicine, Cardiology Division, Medical College of Virginia, Virginia Commonwealth University, 12th and Marshall Streets, Richmond, VA 23298-0051, USA.
| | | | | | | | | | | | | |
Collapse
|
25
|
van der Voort D, Pelsers MMAL, Korf J, Hermens WT, Glatz JFC. Development of a displacement immunoassay for human heart-type fatty acid-binding protein in plasma: the basic conditions. Biosens Bioelectron 2003; 19:465-71. [PMID: 14623471 DOI: 10.1016/s0956-5663(03)00205-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To risk-stratify patients with chest pain who are admitted to emergency rooms and for whom initial evaluation is not conclusive, the use of cardiac markers has become a standard procedure. A recently introduced early plasma marker for acute myocardial infarction (AMI) is the 14.5-kDa cytoplasmic heart-type fatty acid-binding protein (FABP). To fully exploit its early release from injured myocardium, a rapid method for repeated measurements or continuous monitoring of FABP in plasma is desirable. Such an on-line method could be an immunosensor based on displacement. The aim of the present study was to further investigate the principles underlying the displacement assay of FABP, both in buffer and in plasma. Batches of sepharose-bound FABP were loaded with an antibody-horseradish peroxidase (HRP) conjugate (anti-FABP). Continuous measurement of FABP was mimicked by repeated addition of FABP containing solutions followed by several washing steps. In the presence of free FABP the antibody-HRP complex dissociated and was subsequently quantified. Significant displacement in the presence of free FABP was observed in both buffer and human plasma. Anti-FABP could be intermittently displaced in the same batch, for at least 9 h, and the displacement was concentration-dependent. These results show the feasibility of a sensor based on the displacement principle to be used for the diagnosis of AMI in emergency medicine.
Collapse
Affiliation(s)
- D van der Voort
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | | | | | | | | |
Collapse
|
26
|
Bholasingh R, Cornel JH, Kamp O, van Straalen JP, Sanders GT, Dijksman L, Tijssen JGP, de Winter RJ. The prognostic value of markers of inflammation in patients with troponin T-negative chest pain before discharge from the emergency department. Am J Med 2003; 115:521-8. [PMID: 14599630 DOI: 10.1016/j.amjmed.2003.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the prognostic value of markers of inflammation for rule-out purposes in patients admitted to the emergency department with troponin T-negative chest pain. METHODS Patients presenting to the emergency department within 6 hours of symptom onset and who had a normal or nondiagnostic electrocardiogram were eligible. The standard rule-out protocol, which included serial creatine kinase and creatine kinase-MB measurements, was applied, and markers of inflammation (C-reactive protein, erythrocyte sedimentation rate, and total white blood cell count and differential count) were measured. The study group comprised patients with negative serial troponin T results (<0.06 microg/L) who were discharged home after unstable coronary artery disease was ruled out. Endpoints during the 6-month follow-up were cardiac death, myocardial infarction, or rehospitalization for unstable angina. RESULTS A total of 382 troponin T-negative patients were discharged, of whom 2 died, 2 had a myocardial infarction, and 7 were rehospitalized for unstable angina. A positive C-reactive protein test result (>0.3 mg/dL) was associated with future clinical events (hazard risk [HR] = 4.5; 95% confidence interval [CI]: 1.2 to 17.0; P = 0.03), as was a positive test (>13 mm/h) for erythrocyte sedimentation rate (HR = 5.6; 95% CI: 1.5 to 22.2; P = 0.01). Patients with positive results for both tests were at highest risk of clinical events (9.3%) compared with patients with other combinations of test results (1.1% to 2.1%; HR = 7.5; 95% CI: 2.2 to 25.5; P = 0.001). CONCLUSION The combination of C-reactive protein and erythrocyte sedimentation rate had prognostic value in patients with troponin T-negative chest pain and a normal or nondiagnostic electrocardiogram in whom unstable coronary artery disease was ruled out.
Collapse
Affiliation(s)
- Radha Bholasingh
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Kontos MC, Fritz LM, Anderson FP, Tatum JL, Ornato JP, Jesse RL. Impact of the troponin standard on the prevalence of acute myocardial infarction. Am Heart J 2003; 146:446-52. [PMID: 12947361 DOI: 10.1016/s0002-8703(03)00245-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recent recommendations are that troponin should replace creatine kinase (CK)-MB as the diagnostic standard for myocardial infarction (MI). The impact of this change has not been well described. Our objective was to determine the impact of a troponin standard on the prevalence of acute non-ST-elevation MI. METHODS The current study was a retrospective analysis of consecutive patients without ST-segment elevation admitted for exclusion of myocardial ischemia to an inner city urban tertiary care center. All patients underwent serial marker sampling (CK, CK-MB, and cardiac troponin I [cTnI]). Patients with ST elevation consistent with acute MI (n = 130) or who did not have an 8 hour cTnI (n = 124) were excluded. The impact of 3 different cTnI diagnostic values were examined in 2181 patients: the lower limit of detectability (LLD); an optimal diagnostic value (OPT), chosen using receiver operator characteristic curve analysis; and the manufacturer's suggested upper reference level (URL), when compared to a gold standard CK-MB MI definition. In addition, MI prevalence was assessed using different CK-MB MI definitions and evaluated in patients with ischemic changes only. RESULTS The prevalence CK-MB MI was 7.8%. Using the various cTnI diagnostic values, the incidence of MI increased the prevalence by 28% to 195%. Using the optimal diagnostic value for cTnI, patients with cTnI elevations not meeting CK-MB MI criteria had an intermediate 30-day mortality (5.4%) compared to those with CK-MB MI (7.1%). Grouping the cTnI positive, CK-MB MI negative patients with the CK-MB MI patients rather than the non-CK-MB MI patients reduced mortality for both the MI (to 5.9%) and non-MI groups (from 1.9% to 1.6%). CONCLUSIONS Changing to a troponin standard will have a substantial impact on the number of patients diagnosed with MI. The revised definition for MI will have important clinical and health care implications.
Collapse
Affiliation(s)
- Michael C Kontos
- Department of Internal Medicine, Cardiology Division, Medical College of Virginia, Virginia Commonwealth University, Richmond, Va 23298-0051, USA.
| | | | | | | | | | | |
Collapse
|
28
|
Bholasingh R, Cornel JH, Kamp O, van Straalen JP, Sanders GT, Tijssen JGP, Umans VAWM, Visser CA, de Winter RJ. Prognostic value of predischarge dobutamine stress echocardiography in chest pain patients with a negative cardiac troponin T. J Am Coll Cardiol 2003; 41:596-602. [PMID: 12598071 DOI: 10.1016/s0735-1097(02)02897-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We prospectively studied the prognostic value of predischarge dobutamine stress echocardiography (DSE) in low-risk chest pain patients with a normal or nondiagnostic electrocardiogram (ECG) and a negative serial troponin T. BACKGROUND Noninvasive stress testing is recommended before discharge or within 72 h in patients with low-risk chest pain. The prognostic value of immediate DSE has not been studied in a blinded, prospective fashion. METHODS Patients presenting at the emergency room within 6 h of symptom onset and a normal or nondiagnostic ECG were eligible. Dobutamine stress echocardiography was performed after unstable coronary artery disease was ruled out by a standard rule-out protocol and a negative serial troponin T; the occurrence of any new wall motion abnormality was considered positive. Results were kept blinded. End points were cardiac death, myocardial infarction, rehospitalization for unstable angina or revascularization. RESULTS In total, 377 patients were included. There were 2 deaths, 2 myocardial infarctions, 8 rehospitalization for unstable angina, and 10 revascularizations at six-month follow-up. The end points occurred in 8/26 (30.8%) patients with a positive versus 14/351 (4.0%) patients with a negative DSE (odds ratio, 10.7; 95% confidence interval, 4.0 to 28.8; p < 0.0001). By multivariate analysis, DSE remained a predictor of end points (p < 0.0001). CONCLUSIONS A predischarge DSE had important, independent prognostic value in low-risk, troponin negative, chest pain patients.
Collapse
Affiliation(s)
- Radha Bholasingh
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Zarich SW, Qamar AU, Werdmann MJ, Lizak LS, McPherson CA, Bernstein LH. Value of a single troponin T at the time of presentation as compared to serial CK-MB determinations in patients with suspected myocardial ischemia. Clin Chim Acta 2002; 326:185-92. [PMID: 12417111 DOI: 10.1016/s0009-8981(02)00303-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prior studies with cardiac markers have focused predominantly on subjects presenting to the emergency department with chest pain or unstable angina, and have relied on serial markers for the diagnosis of acute myocardial infarction. We evaluated the diagnostic utility of a single cardiac troponin T (cTnT) determination at the time of presentation as compared to serial creatine kinase (CK) MB determinations in a broad spectrum of patients with suspected myocardial ischemia. METHODS A total of 267 consecutive patients presenting to the emergency department with suspected myocardial ischemia had a single, blinded cTnT determination drawn at the time of presentation to the emergency department in addition to routine serial electrocardiographic and CK-MB determinations. RESULTS The specificity (93.7% vs. 87.1%; p<0.05) and positive predictive value (80.0% vs. 69.4%; p<0.05) of a single cTnT determination were superior to that of serial CK-MB determinations without compromising sensitivity. Forty-six percent of patients with confirmed myocardial infarction and an abnormal cTnT at presentation had a normal initial CK-MB determination. Conversely, 20% of patients without acute coronary syndromes had an abnormal CK-MB determination in the setting of a normal cTnT. The initial cTnT was abnormal in all patients with confirmed myocardial infarction and a symptom duration of at least 3.5 h. CONCLUSIONS In a heterogeneous population of patients with suspected myocardial ischemia, the initial cTnT determination drawn at the time of presentation is a powerful diagnostic tool that, when used in context with symptom duration, allows for more rapid and accurate triage of patients than serial CK-MB determinations.
Collapse
Affiliation(s)
- Stuart W Zarich
- Department of Medicine, Division of Cardiology, Bridgeport Hospital, Yale University School of Medicine, New Haven, CT, USA.
| | | | | | | | | | | |
Collapse
|
30
|
Abstract
The role of biochemical markers in the diagnosis of acute coronary syndromes has increased considerably in the past decade. The World Health Organization previously defined acute myocardial infarction as a combination of at least 2 of 3 components: symptoms consistent with acute myocardial infarction, electrocardiogram changes diagnostic of acute myocardial infarction, and an enzyme pattern with classic rise and fall. Measurement of creatine kinase and its MB fraction by various assays was the gold standard for the diagnosis. Troponins are more specific and sensitive markers for myocardial injury, and their increasing utilization has resulted in a broadening of the definition of acute myocardial infarction to incorporate high-risk acute coronary syndromes. Previously, traditional enzyme evaluation left patients with small amounts of cellular death undiagnosed; these patients were categorized as having unstable angina or, worse, noncardiac chest pain. Newer markers now identify these patients as a subgroup at high risk for cardiac death or cardiac events. Newer therapeutic interventions and a more invasive strategy have been shown to improve outcomes in this high-risk subgroup. Increased specificity has also reduced the number of patients who undergo extensive, expensive, and invasive evaluations for noncardiac syndromes due to false elevations of traditional markers. This article comprehensively reviews the evolution of biochemical markers for the diagnosis of acute myocardial infarction, addressing their promise for improving delivery of care and outcomes and their technical and diagnostic pitfalls.
Collapse
Affiliation(s)
- Beth R Malasky
- Clinical Assistant Professor of Medicine Robert S. and Irene P. Flinn Professor of Medicine and Chair, Department of Medicine University of Arizona Health Sciences Center, Tucson, Arizona 85724-5037, USA
| | | |
Collapse
|
31
|
Bock JL. Test strategies for the detection of myocardial damage. Clin Lab Med 2002; 22:357-75. [PMID: 12134465 DOI: 10.1016/s0272-2712(01)00006-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In the space of half a century, cardiac marker testing has advanced incrementally from enzymes present in nearly all tissues to proteins having remarkable specificity for myocardium. Markers with other desirable properties, such as earlier release, have also been introduced and others may be anticipated, although a single perfect marker is not on the horizon. Optimum application of these new markers still requires improved robustness and harmonization of commercial assays, and continuing insights in the pathophysiology of acute coronary syndromes. As these advances occur, future testing will likely focus more on therapeutic decisions than on arbitrary diagnostic classifications.
Collapse
Affiliation(s)
- Jay L Bock
- Department of Pathology, University Hospital and Medical Center, Stony Brook University, Stony Brook, NY 11794-7300, USA.
| |
Collapse
|
32
|
Bodí VV, Sanchis J, Llácer A, Graells ML, Llorca L, Chorro FJ, Insa LD, Navarro A, Plancha E, Cortés FJ, Ponce De León JC, Valls A. [Is troponin I useful for predicting in-hospital risk for unstable angina patients in a community hospital? Results of a prospective study]. Rev Esp Cardiol 2002; 55:100-6. [PMID: 11852020 DOI: 10.1016/s0300-8932(02)76568-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Before including troponin I detection in the daily practice of our hospital we performed a prospective study to determine its real usefulness and to establish the best cut-off point. METHODS We studied 82 consecutive patients admitted with unstable angina to a community hospital. Troponin I was determined (> 10 h after chest pain). Patients were referred to a tertiary hospital for catheterization/revascularization if clinical events developed. RESULTS Twenty-five patients (31%) suffered events during admission: recurrent angina in 23 cases (28%); heart failure in 5 (6%); exitus in 3 (4%); myocardial infarction in 1 (1%). The cut-off point for troponin I that best predicted events was 0.1 ng/ml. Patients with troponin I > 0.1 (34 patients, 42%) experienced more events [47 vs. 19%; OR = 3.8 (1.4-10.4); p = 0.01] and had higher rates of recurrent angina (42 vs. 19%), heart failure (12 vs. 2%) and exitus (9 vs 0%). Patients with ECG changes and troponin I > 0.1 showed a significantly higher percentage of events (63%) than those with ECG changes alone (23%) or troponin I > 0.1 alone (15%) or those without ECG changes and troponin I < 0.1 (17%) (p < 0.0001). CONCLUSIONS Troponin I elevation is useful for predicting in-hospital risk for unstable angina patients admitted to a community hospital. A low cut-off value (0.1 ng/ml) predicts events. The association of ECG changes and high troponin I identifies a population at very high risk; however, the absence of both variables in patients with a diagnosis of unstable angina does not preclude the development of events.
Collapse
Affiliation(s)
- Vicente V Bodí
- Servicio de Cardiología. Hospital Clínico y Universitario. Valencia. Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Kontos MC, Ornato JP, Schmidt KL, Tatum JL, Jesse RL. Incidence of high-risk acute coronary syndromes and eligibility for glycoprotein IIb/IIIa inhibitors among patients admitted for possible myocardial ischemia. Am Heart J 2002; 143:70-5. [PMID: 11773914 DOI: 10.1067/mhj.2002.119614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Recent studies have demonstrated that glycoprotein (GP) IIb/IIIa inhibitors can reduce cardiac events in patients with acute coronary syndromes (ACS). However, little is known about how many patients are actually eligible for treatment. Our purpose was to determine how many patients admitted for possible myocardial infarction (MI) meet GP IIb/IIIa inhibitor treatment criteria. METHODS Patients admitted for possible MI who underwent a standard protocol that included serial sampling of total creatine kinase (CK), CK-MB, and troponin I (TnI) were retrospectively assigned to different treatment algorithms on the basis of criteria from GP IIb/IIIa inhibitor trials: an electrocardiogram (ECG) consistent with acute MI or ischemia, and myocardial marker elevations. Elevated CK-MB was considered diagnostic of MI. High-risk ACS was defined as ischemic ECG changes or troponin elevations without CK-MB elevations. RESULTS A total of 2179 patients were admitted for MI exclusion. MI was identified in 304 patients (14.0%) (123 ST-elevation, 49 ischemic ECG, 132 nonischemic ECG). Another 273 patients (12.5%) without CK-MB criteria for MI met high-risk ACS criteria (172 ischemic ECG, 120 TnI elevations). Ischemic ECGs or elevated myocardial markers identified 454 (21%) patients as eligible for treatment. Inclusion of patients with ST elevation increased eligibility to 26.5%. Of the 454 non-ST-elevation ACS patients, 340 (74%) were identified early by the ECG or the initial markers. CONCLUSIONS A large proportion of patients admitted for possible MI met criteria for treatment with GP IIb/IIIa inhibitors. The non-ST-elevation ACS group was >3 times larger than the ST-elevation MI group. These findings have important implications for treatment of patients with ACS.
Collapse
Affiliation(s)
- Michael C Kontos
- Medical College of Virginia Hospitals of Virginia Commonwealth University, Richmond, Va, USA.
| | | | | | | | | |
Collapse
|
34
|
Jones PG, McClelland A, McNeil A, Gamble G. Agreement between troponin T levels from plain and heparinized tubes. Emerg Med Australas 2001; 13:451-5. [PMID: 11903430 DOI: 10.1046/j.1035-6851.2001.00260.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To determine whether there was a clinically significant effect on troponin T measurement when the sample was collected in a heparinized (plasma) blood collection tube compared with a serum tube. METHODS Prospective cohort study using a convenience sample of 198 patients with undifferentiated illness presenting to an Emergency Department who required troponin T measurement. Samples were collected in both plain (serum) tubes and plasma tubes for comparison. All samples were measured using an Elecsys 2010 Immunoassay system (Roche-Boehringer Mannheim, Germany). RESULTS There were 35 troponin T measurements > or = 0.03 microg/L (the limit of reproducibility of the test). The negative predictive value for troponin T performed in heparinized tubes compared with plain tubes was 100% (95% confidence interval 96.4-100) at the > or = 0.03 microg/L level and 100% (95% confidence interval 97-100%) at the > or = 0.1 microg/L level. At a cut-off point for risk stratification in acute coronary syndromes (> or = 0.1 microg/L), there was 100% concordance between the two measurements for each sample. CONCLUSION The use of plasma (heparinized) tubes for the collection of troponin T samples is unlikely to produce clinically significant false-negative results compared with collection of troponin T samples in serum (plain) tubes.
Collapse
Affiliation(s)
- P G Jones
- Departments of Emergency Medicine and Clinical Chemistry, Auckland Hospital, Auckland, New Zealand
| | | | | | | |
Collapse
|
35
|
Chance JJ, Segal JB, Wallerson G, Kasper E, Hruban RH, Kickler TS, Chan DW. Cardiac troponin T and C-reactive protein as markers of acute cardiac allograft rejection. Clin Chim Acta 2001; 312:31-9. [PMID: 11580907 DOI: 10.1016/s0009-8981(01)00590-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Due to myocyte damage and an associated inflammatory response, it is possible that cardiac troponin T and C-reactive protein (CRP) concentrations may correlate with the histologic grade of rejection in endomyocardial biopsy samples obtained from patients who have received a heart transplant. In this study, 704 blood samples were obtained from 145 different heart transplant recipients just prior to endomyocardial biopsy. Plasma specimens were assayed for troponin T and CRP concentration and the results compared with the assigned International Society of Heart and Lung Transplantation (ISHLT) histologic grade. Rejection was defined as an ISHLT grade of 3A or higher. The negative predictive values were near 80% in all cases, and a statistically significant increase in median troponin T concentration was observed across ISHLT grades. After the first month posttransplantation, the specificity of the troponin T test (cutoff 0.1 ng/ml) was 95% and increased to 98% when false positives seen in renal disease patients were excluded. Both tests demonstrated poor sensitivity and positive predictive value for rejection. Neither CRP nor troponin T had sufficient sensitivity to serve as an alternative to endomyocardial biopsy in the diagnosis of acute cardiac allograft rejection. However, the troponin T test had a high specificity, especially when patients with renal insufficiency were excluded, and could serve as an adjunct test in this setting. When combined with a normal serum creatinine, a troponin T > or =0.1 ng/ml prior to endomyocardial biopsy correlated with graft rejection in almost all cases, making biopsy unnecessary.
Collapse
Affiliation(s)
- J J Chance
- Department of Pathology, Johns Hopkins Hospital, 600 N. Wolfe Street/Meyer B-125, Baltimore, MD 21287-7065, USA
| | | | | | | | | | | | | |
Collapse
|
36
|
Heidenreich PA, Alloggiamento T, Melsop K, McDonald KM, Go AS, Hlatky MA. The prognostic value of troponin in patients with non-ST elevation acute coronary syndromes: a meta-analysis. J Am Coll Cardiol 2001; 38:478-85. [PMID: 11499741 DOI: 10.1016/s0735-1097(01)01388-2] [Citation(s) in RCA: 255] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study was designed to compare the prognostic value of an abnormal troponin level derived from studies of patients with non-ST elevation acute coronary syndromes (ACS). BACKGROUND Risk stratification for patients with suspected ACS is important for determining need for hospitalization and intensity of treatment. METHODS We identified clinical trials and cohort studies of consecutive patients with suspected ACS without ST-elevation from 1966 through 1999. We excluded studies limited to patients with acute myocardial infarction and studies not reporting mortality or troponin results. RESULTS Seven clinical trials and 19 cohort studies reported data for 5,360 patients with a troponin T test and 6,603 with a troponin I test. Patients with positive troponin (I or T) had significantly higher mortality than those with a negative test (5.2% vs. 1.6%, odds ratio [OR] 3.1). Cohort studies demonstrated a greater difference in mortality between patients with a positive versus negative troponin I (8.4% vs. 0.7%, OR 8.5) than clinical trials (4.8% if positive, 2.1% if negative, OR 2.6, p = 0.01). Prognostic value of a positive troponin T was also slightly greater for cohort studies (11.6% mortality if positive, 1.7% if negative, OR 5.1) than for clinical trials (3.8% if positive, 1.3% if negative, OR 3.0, p = 0.2) CONCLUSIONS In patients with non-ST elevation ACS, the short-term odds of death are increased three- to eightfold for patients with an abnormal troponin test. Data from clinical trials suggest a lower prognostic value for troponin than do data from cohort studies.
Collapse
Affiliation(s)
- P A Heidenreich
- Veterans Affairs Palo Alto Health Care System, California 94304, USA.
| | | | | | | | | | | |
Collapse
|
37
|
Bholasingh R, de Winter RJ, Fischer JC, Koster RW, Peters RJ, Sanders GT. Safe discharge from the cardiac emergency room with a rapid rule-out myocardial infarction protocol using serial CK-MB(mass). Heart 2001; 85:143-8. [PMID: 11156661 PMCID: PMC1729613 DOI: 10.1136/heart.85.2.143] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To determine whether a new protocol, using a rapid and sensitive CK-MB(mass) assay and serial sampling, can rule out myocardial infarction in patients with chest pain and decrease their length of stay in the cardiac emergency room without increasing risk. DESIGN The combined incidence of cardiac death and acute myocardial infarction at 30 days, six months, and 24 months of follow up were compared between patients discharged home from the cardiac emergency room after ruling out myocardial infarction with a CK-MB(activity) assay in 1994 and those discharged home after a rapid CK-MB(mass) assay in 1996. SETTING Cardiac emergency room of a large university hospital. PATIENTS In 1994 and 1996, 230 and 423 chest pain patients, respectively, were discharged home from the cardiac emergency room with a normal CK-MB and an uneventful observation period. RESULTS The median length of stay in the cardiac emergency room was significantly reduced, from 16.0 hours in 1994 to 9.0 hours in 1996 (p < 0.0001). Mean event rates in patients from the 1994 and 1996 cohorts, respectively, were 0.9% (95% confidence interval (CI) -0.3% to 2.1%) v 0.7% (95% CI -0.1% to 1. 5%) at 30 days, 3.0% (95% CI 0.8% to 5.2%) v 2.8% (95% CI 1.2% to 4. 4%) at six months, and 7.0% (95% CI 3.7% to 10.3%) v 5.7% (95% CI 3. 5% to 7.9%) at 24 months. Kaplan-Meier survival analysis showed no difference in mean event-free survival at 30 days, six months, and 24 months of follow up. CONCLUSIONS Using a rule-out myocardial infarction protocol with a rapid and sensitive CK-MB(mass) assay and serial sampling, the length of stay of patients with chest pain in the cardiac emergency room can be reduced without compromising safety.
Collapse
Affiliation(s)
- R Bholasingh
- Department of Cardiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
| | | | | | | | | | | |
Collapse
|
38
|
|
39
|
Kontos MC, Anderson FP, Alimard R, Ornato JP, Tatum JL, Jesse RL. Ability of troponin I to predict cardiac events in patients admitted from the emergency department. J Am Coll Cardiol 2000; 36:1818-23. [PMID: 11092650 DOI: 10.1016/s0735-1097(00)00943-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We sought to determine the predictive ability of troponin I (TnI) in a heterogeneous group of patients with chest pain admitted from the emergency department (ED) for exclusion of myocardial infarction (MI). BACKGROUND Previous studies in high-risk patients demonstrated that troponin elevations are associated with increased cardiac events. Little information is available on its predictive ability in more heterogeneous, lower risk patients. METHODS Consecutive patients admitted from the ED for possible MI underwent serial myocardial marker sampling of TnI and creatine kinase, CK-MB over an 8-h period. Patients with ST segment elevation were excluded. End points included MI, death, significant complications (e.g., cardiac or respiratory arrest, intra-aortic balloon pump, pulmonary artery catheter or pacemaker placement, revascularization or inotropic infusion) and significant disease. RESULTS Events occurred in 513 (27%) of the 1,929 patients evaluated: MI in 175 (9.1%) and death in 34 (1.8%); an additional 248 patients (13%) without MI had complications, and 323 (17%) without MI had significant disease. Sensitivity of TnI for MI was high (96%). Patients without MI who were TnI-positive were more likely to have complications (43% vs. 12%) or significant disease (41% vs. 17%) as compared with those who were TnI-negative; however, the sensitivity of TnI for these two end points was low (14% and 21%, respectively). Predictive values were unchanged after excluding patients with ischemic electrocardiograms. CONCLUSIONS Troponin I had a high sensitivity for MI when used as part of a rapid rule-in protocol; however, the sensitivity for other end points was low. Use of TnI alone failed to identify the majority of patients who had either significant disease or complications.
Collapse
Affiliation(s)
- M C Kontos
- Department of Internal Medicine, Medical College of Virginia, Hospitals of Virginia, Commonwealth University, Richmond, USA.
| | | | | | | | | | | |
Collapse
|
40
|
Polanczyk CA, Kuntz KM, Sacks DB, Johnson PA, Lee TH. Emergency department triage strategies for acute chest pain using creatine kinase-MB and troponin I assays: a cost-effectiveness analysis. Ann Intern Med 1999; 131:909-18. [PMID: 10610641 DOI: 10.7326/0003-4819-131-12-199912210-00002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Evaluation of acute chest pain is highly variable. OBJECTIVE To evaluate the cost-effectiveness of strategies using cardiac markers and noninvasive tests for myocardial ischemia. DESIGN Cost-effectiveness analysis. DATA SOURCES Prospective data from 1066 patients with chest pain and from the published literature. TARGET POPULATION Patients admitted with acute chest pain. TIME HORIZON Lifetime. PERSPECTIVE Societal. INTERVENTIONS Creatine kinase (CK)-MB mass assay alone; CK-MB mass assay followed by cardiac troponin I assay if the CK-MB value is normal; CK-MB mass assay followed by troponin I assay if the CK-MB value is normal and electrocardiography shows ischemic changes; both CK-MB mass and troponin I assays; and troponin I assay alone. These strategies were evaluated alone or in combination with early exercise testing. OUTCOME MEASURES Lifetime cost, life expectancy (in years), and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS For patients 55 to 64 years of age, measurement of CK-MB mass followed by exercise testing in appropriate patients was the most competitive strategy ($43000 per year of life saved). Measurement of CK-MB mass followed by troponin I measurement had an incremental cost-effectiveness ratio of $47400 per year of life saved for patients 65 to 74 years of age; it was also the most cost-effective strategy when early exercise testing could not be performed, CK-MB values were normal, and ischemic changes were seen on electrocardiography. RESULTS OF SENSITIVITY ANALYSIS Results were influenced by age, probability of myocardial infarction, and medical costs. CONCLUSIONS Measurement of CK-MB mass plus early exercise testing is a cost-effective initial strategy for younger patients and those with a low to moderate probability of myocardial infarction. Troponin I measurement can be a cost-effective second test in higher-risk subsets of patients if the CK-MB level is normal and early exercise testing is not an option.
Collapse
Affiliation(s)
- C A Polanczyk
- Brigham and Women's Hospital, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts, USA
| | | | | | | | | |
Collapse
|
41
|
Phillips M. Cardiac troponin T in the early detection for myocardial ischemia. Crit Care 1999. [DOI: 10.1186/ccf-1999-1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
42
|
|