1
|
Armbruster RR, Kumar D, Benyard B, Jacobs P, Khandavilli A, Liu F, Nanga RPR, McCormack S, Cappola AR, Wilson N, Reddy R. Personalized and muscle-specific OXPHOS measurement with integrated CrCEST MRI and proton MR spectroscopy. Nat Commun 2024; 15:5387. [PMID: 38918361 PMCID: PMC11199598 DOI: 10.1038/s41467-024-49253-6] [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: 12/29/2023] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
Creatine chemical exchange saturation transfer (CrCEST) MRI is an emerging high resolution and noninvasive method for measuring muscle specific oxidative phosphorylation (OXPHOS). However, CrCEST measurements are sensitive to changes in muscle pH, which might confound the measurement and interpretation of creatine recovery time (τCr). Even with the same prescribed exercise stimulus, the extent of acidification and hence its impact on τCr is expected to vary between individuals. To address this issue, a method to measure pH pre- and post-exercise and its impact on CrCEST MRI with high temporal resolution is needed. In this work, we integrate carnosine 1H- magnetic resonance spectroscopy (MRS) and 3D CrCEST to establish "mild" and "moderate/intense" exercise stimuli. We then test the dependence of CrCEST recovery time on pH using different exercise stimuli. This comprehensive metabolic imaging protocol will enable personalized, muscle specific OXPHOS measurements in both healthy aging and myriad other disease states impacting muscle mitochondria.
Collapse
Affiliation(s)
- Ryan R Armbruster
- Department of Radiology, Center for Advanced Metabolic Imaging in Precision Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Dushyant Kumar
- Department of Radiology, Center for Advanced Metabolic Imaging in Precision Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Blake Benyard
- Department of Radiology, Center for Advanced Metabolic Imaging in Precision Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Paul Jacobs
- Department of Radiology, Center for Advanced Metabolic Imaging in Precision Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Aditi Khandavilli
- Department of Biology, Department of Nutrition and Science, Cornell University, Ithaca, NY, 14850, USA
| | - Fang Liu
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ravi Prakash Reddy Nanga
- Department of Radiology, Center for Advanced Metabolic Imaging in Precision Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Shana McCormack
- Neuroendocrine Center, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Anne R Cappola
- Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Neil Wilson
- Department of Radiology, Center for Advanced Metabolic Imaging in Precision Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ravinder Reddy
- Department of Radiology, Center for Advanced Metabolic Imaging in Precision Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| |
Collapse
|
2
|
Labonia MCI, Estapé Senti M, van der Kraak PH, Brans MAD, Dokter I, Streef TJ, Smits AM, Deshantri AK, de Jager SCA, Schiffelers RM, Sluijter JPG, Vader P. Cardiac delivery of modified mRNA using lipid nanoparticles: Cellular targets and biodistribution after intramyocardial administration. J Control Release 2024; 369:734-745. [PMID: 38604385 DOI: 10.1016/j.jconrel.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
Despite research efforts being made towards preserving (or even regenerating) heart tissue after an ischemic event, there is a lack of resources in current clinical treatment modalities for patients with acute myocardial infarction that specifically address cardiac tissue impairment. Modified messenger RNA (modRNA) presents compelling properties that could allow new therapeutic strategies to tackle the underlying molecular pathways that ultimately lead to development of chronic heart failure. However, clinical application of modRNA for the heart is challenged by the lack of effective and safe delivery systems. Lipid nanoparticles (LNPs) represent a well characterized class of RNA delivery systems, which were recently approved for clinical usage in mRNA-based COVID-19 vaccines. In this study, we evaluated the potential of LNPs for cardiac delivery of modRNA. We tested how variations in C12-200 modRNA-LNP composition affect transfection levels and biodistribution after intramyocardial administration in both healthy and myocardial-infarcted mice, and determined the targeted cardiac cell types. Our data revealed that LNP-mediated modRNA delivery outperforms the current state of the art (modRNA in citrate buffer) upon intramyocardial administration in mice, with only minor differences among the formulations tested. Furthermore, we determined both in vitro and in vivo that the cardiac cells targeted by modRNA-LNPs include fibroblasts, endothelial cells and epicardial cells, suggesting that these cell types could represent targets for therapeutic interference with these LNP formulations. These outcomes may serve as a starting point for LNP development specifically for therapeutic mRNA cardiac delivery applications.
Collapse
Affiliation(s)
- M C I Labonia
- Department of Cardiology, Laboratory of Experimental Cardiology, UMC, Utrecht, the Netherlands
| | - M Estapé Senti
- Laboratory of CDL Research, UMC, Utrecht, the Netherlands
| | - P H van der Kraak
- Department of Cardiology, Laboratory of Experimental Cardiology, UMC, Utrecht, the Netherlands
| | - M A D Brans
- Department of Cardiology, Laboratory of Experimental Cardiology, UMC, Utrecht, the Netherlands
| | - I Dokter
- Department of Cardiology, Laboratory of Experimental Cardiology, UMC, Utrecht, the Netherlands
| | - T J Streef
- Department of Cell and Chemical Biology, Leiden University Medical Center, the Netherlands
| | - A M Smits
- Department of Cell and Chemical Biology, Leiden University Medical Center, the Netherlands
| | - A K Deshantri
- Department of Cardiology, Laboratory of Experimental Cardiology, UMC, Utrecht, the Netherlands
| | - S C A de Jager
- Department of Cardiology, Laboratory of Experimental Cardiology, UMC, Utrecht, the Netherlands
| | | | - J P G Sluijter
- Department of Cardiology, Laboratory of Experimental Cardiology, UMC, Utrecht, the Netherlands; UMC Utrecht Regenerative Medicine Center, Circulatory Health Research Center, University Medical Center Utrecht, Utrecht University, Utrecht 3508GA, the Netherlands
| | - P Vader
- Department of Cardiology, Laboratory of Experimental Cardiology, UMC, Utrecht, the Netherlands; Laboratory of CDL Research, UMC, Utrecht, the Netherlands.
| |
Collapse
|
3
|
Tahlawi ME, Ismail SM, Eldamanhory A, Khorshed A, Salem SM. In emergency hypertension, could biomarkers change the guidelines? BMC Cardiovasc Disord 2024; 24:152. [PMID: 38481132 PMCID: PMC10935803 DOI: 10.1186/s12872-024-03785-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Hypertension may cause target organ damage (TOD). Target blood pressure (BP) management may not be appropriate in some conditions. AIM We aim to assess the impact of targeted BP management in severe hypertension on renal TOD. PATIENTS & METHODS This is a prospective cohort study involving patients admitted due to severe hypertension (BP > 180/120) associated with any symptoms. The study involved patients referred to the ICU in our tertiary center during the period between August 2017 and February 2018. All patients underwent target BP treatment according to recent guidelines. Hs-Troponin T (hs-TNT) and serum creatinine (s.creat) were measured in all patients on admission and 24 h later. Patients were divided into Group A (with initial normal hs-TNT) and Group B (with initial high hs-TNT). The main outcome was in-hospital renal-related morbidity (including renal failure). RESULTS Four hundred seventy consecutive patients with hypertensive crises were involved in the study. Group B had a significantly higher incidence of in-hospital mortality (4 patients) and renal TOD (acute renal dysfunction) than Group A (P value = 0.001 and 0.000 respectively). There was a significant difference between initial s.creat on admission and follow-up s.creat values in Group B with significant elevation of their s.creat on the following 24 h (P = 0.002), while this difference is insignificant in Group A (P = 0.34). There was a significant positive correlation between hs-TNT and the follow-up s.creat (P = 0.004). CONCLUSION In severe HTN, hs-TNT may be elevated due to marked afterload. Patients with severe HTN and high hs-TNT have higher s.creat values, which are associated with an increased risk of renal failure and in-hospital mortality if their BP decreases acutely to the guideline-target BP. Using biomarkers during the management of emergency HTN should be considered before following clinical guidelines. However, our findings do underscore the potential utility of hs-TNT as an indicator for risk stratification in patients with severe or emergency HTN.
Collapse
Affiliation(s)
| | - Scopus Mohamed Ismail
- Zagazig University Hospitals, Zagazig, Egypt
- University of Central Florida College of Medicine, Graduate Medical Education, Florida, USA
| | | | | | - Salem M Salem
- Zagazig University Hospitals, Zagazig, Egypt
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
4
|
Elias M, Tateosian VS, Richman DC. What's New in Preoperative Cardiac Testing. Anesthesiol Clin 2024; 42:9-25. [PMID: 38278596 DOI: 10.1016/j.anclin.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
More than 300 million surgeries are performed annually worldwide. Patients are progressively aging and often have multiple comorbidities that put them at increased cardiovascular risk in the perioperative period. The United States published latest guidelines regarding preoperative cardiac evaluation and risk stratification for patients undergoing non-cardiac surgery in 2014. There are multiple risk stratification tools available that can help guide management. Furthermore, newer laboratory tests, such as preoperative NT-proBNP and high-sensitivity troponin assays, may aid in preventing and diagnosing perioperative myocardial injury.
Collapse
Affiliation(s)
- Murad Elias
- Department of Anesthesiology, Renaissance School of Medicine at Stony Brook University, Health Sciences Center, Level 4, 101 Nicolls Road, Stony Brook, NY 11794-8480, USA.
| | - Vahé S Tateosian
- Department of Anesthesiology, Renaissance School of Medicine at Stony Brook University, Health Sciences Center, Level 4, 101 Nicolls Road, Stony Brook, NY 11794-8480, USA
| | - Deborah C Richman
- Department of Anesthesiology, Renaissance School of Medicine at Stony Brook University, Health Sciences Center, Level 4, 101 Nicolls Road, Stony Brook, NY 11794-8480, USA
| |
Collapse
|
5
|
Sagris M, Antonopoulos AS, Angelopoulos A, Papanikolaou P, Simantiris S, Vamvakaris C, Koumpoura A, Farmaki M, Antoniades C, Tsioufis C, Tousoulis D. High-sensitivity Troponin (hs-Tn) for Cardiovascular Risk Prognostication: A Systematic Review and Meta-analysis. Curr Med Chem 2024; 31:1941-1953. [PMID: 36924099 DOI: 10.2174/0929867330666230315152045] [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: 08/02/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Chronic low-grade inflammation is involved in coronary atherosclerosis progression whereas recent research efforts suggest that preventative methods should be tailored to the "residual inflammatory risk". As such, modalities for the early identification of the risk have to be investigated. METHODS We performed a systematic review and meta-analysis according to the PRISMA guidelines. Any study that presented the prognostic value of high sensitivity troponin (hs-cTn) of vascular inflammation in stable patients without known cardiac heart disease was considered to be potentially eligible. The Medline (PubMed) database was searched up to April 22, 2021. The main endpoint was the difference in c-index (Δ[c-index]) with the use of hs-cTn for major adverse cardiovascular events (MACEs), cardiovascular and all-cause mortality. We calculated I2 to test heterogeneity. RESULTS In total, 44 studies and 112,288 stable patients without known coronary heart disease were included in this meta-analysis. The mean follow-up duration of the whole cohort was 6.8 ± 1.1 years. 77,004 (68.5%) of the patients presented at low cardiovascular risk while 35,284 (31.5%) in high. The overall pooled estimate of Δ[c-index] for MACE was 1.4% (95%CI: 0.7-2.1, I2=0%) and for cardiovascular death 1.3% (95%CI: 0.3-2.3, I2=0%). Finally, the overall pooled estimate of Δ[c-index] for all-cause mortality was 3% (95%CI: 1.9-3.9, I2=86%), while high heterogeneity was observed between the studies. CONCLUSION The predictive usefulness of changes in hs-cTn measures in stable individuals with either high or low cardiovascular risk, demonstrates that assessing vascular inflammation in addition to clinical risk factors enhances risk prediction for cardiovascular events and allcause mortality. Further prospective studies are necessary to confirm these findings and assist clinical decision-making regarding the most optimal prevention strategy.
Collapse
Affiliation(s)
- Marios Sagris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexios S Antonopoulos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Andreas Angelopoulos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Papanikolaou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Simantiris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos Vamvakaris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alkmini Koumpoura
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Farmaki
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Constantinos Tsioufis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
6
|
Abreu MAD, de Castro PASV, Moreira FRC, de Oliveira Ferreira H, Simões E Silva AC. Potential Role of Novel Cardiovascular Biomarkers in Pediatric Patients with Chronic Kidney Disease. Mini Rev Med Chem 2024; 24:491-506. [PMID: 37231748 DOI: 10.2174/1389557523666230523114331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/15/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Cardiovascular Disease is the leading cause of death in adult and pediatric patients with Chronic Kidney Disease (CKD) and its pathogenesis involves the interaction of multiple pathways. As Inflammatory mechanisms play a critical role in the vascular disease of CKD pediatric patients, there are several biomarkers related to inflammation strongly associated with this comorbidity. OBJECTIVE This review provides available evidence on the link between several biomarkers and the pathophysiology of heart disease in patients with CKD. METHODS The data were obtained independently by the authors, who carried out a comprehensive and non-systematic search in PubMed, Cochrane, Scopus, and SciELO databases. The search terms were "Chronic Kidney Disease", "Cardiovascular Disease", "Pediatrics", "Pathophysiology", "Mineral and Bone Disorder (MBD)", "Renin Angiotensin System (RAS)", "Biomarkers", "BNP", "NTproBNP", "CK-MB", "CXCL6", "CXCL16", "Endocan-1 (ESM-1)", "FABP3", "FABP4", h-FABP", "Oncostatin- M (OSM)", "Placental Growth Factor (PlGF)" and "Troponin I". RESULTS The pathogenesis of CKD-mediated cardiovascular disease is linked to inflammatory biomarkers, which play a critical role in the initiation, maintenance, and progression of cardiovascular disease. There are several biomarkers associated with cardiovascular disease in pediatric patients, including BNP, NTproBNP, CK-MB, CXCL6, CXCL16, Endocan-1 (ESM-1), FABP3, FABP4, Oncostatin- M (OSM), Placental Growth Factor (PlGF), and Troponin I. CONCLUSION The pathogenesis of CKD-mediated cardiovascular disease is not completely understood, but it is linked to inflammatory biomarkers. Further studies are required to elucidate the pathophysiological and potential role of these novel biomarkers.
Collapse
Affiliation(s)
- Maria Augusta Duarte Abreu
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Pedro Alves Soares Vaz de Castro
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Fernanda Rocha Chaves Moreira
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Henrique de Oliveira Ferreira
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Ana Cristina Simões E Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Department of Pediatric Unit of Pediatric Nephrology, Faculty of Medicine UFMG, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
7
|
Delalić Đ, Brežni T, Prkačin I. Diagnostic value and utility of commonly used biomarkers of cardiac and renal function in cardiorenal syndromes: a narrative review. Biochem Med (Zagreb) 2023; 33:030502. [PMID: 37545695 PMCID: PMC10373058 DOI: 10.11613/bm.2023.030502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/15/2023] [Indexed: 08/08/2023] Open
Abstract
Cardiorenal syndrome (CRS), first defined in 2004 as a consequence of the interactions between the kidneys and other circulatory departments leading to acute heart failure, has since been recognized as a complex clinical entity that is hard to define, diagnose and classify. The framework for the classification of CRS according to pathophysiologic background was laid out in 2008, dividing CRS into five distinct phenotypes. However, determining the timing of individual organ injuries and making a diagnosis of either renal or cardiac failure remains an elusive task. In clinical practice, the diagnosis and phenotyping of CRS is mostly based on using laboratory biomarkers in order to directly or indirectly estimate the degree of end-organ functional decline. Therefore, a well-educated clinician should be aware of the effects that the reduction of renal and cardiac function has on the diagnostic and predictive value and properties of the most commonly used biomarkers (e.g. troponins, N-terminal pro-brain natriuretic peptide, serum creatinine etc). They should also be acquainted, on a basic level, with emerging biomarkers that are specific to either the degree of glomerular integrity (cystatin C) or tubular injury (neutrophil gelatinase-associated lipocalin). This narrative review aims to provide a scoping overview of the different roles that biomarkers play in both the diagnosis of CRS and the prognosis of the disease in patients who have been diagnosed with it, along with highlighting the most important pitfalls in their interpretation in the context of impaired renal and/or cardiac function.
Collapse
Affiliation(s)
- Điđi Delalić
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Tanja Brežni
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Ingrid Prkačin
- University of Zagreb School of Medicine, Zagreb, Croatia
- Emergency Internal Medicine Clinic, Clinical Hospital Merkur, Zagreb, Croatia
| |
Collapse
|
8
|
Abstract
Cardiovascular disease (CVD) is prevalent in patients with chronic kidney disease (CKD) and it is responsible for approximately half of all CKD-related deaths. CVDs are the primary cause of death in hemodialysis patients due to major adverse cardiovascular events. Therefore, better approaches for differentiating chronic hemodialysis patients at higher cardiovascular risk will help physicians improve clinical outcomes. Hence, there is an urgent need to discover feasible and reliable cardiac biomarkers to improve diagnostic accuracy, reflect myocardial injury, and identify high-risk patients. Numerous biomarkers that have significant prognostic value with respect to adverse CVD outcomes in the setting of mild to severe CKD have been identified. Therefore, a better understanding of the positive clinical impact of cardiac biomarkers on CVD patient outcomes is an important step toward prevention and improving treatment in the future. In this review, we address the relationship between cardiovascular biomarkers and CKD treatment strategies to elucidate the underlying importance of these biomarkers to patient outcomes.
Collapse
Affiliation(s)
- Ying-Ju Chen
- Division of Laboratory Medicine, Asia University Hospital, Asia University, Taichung, Taiwan
| | - Chih-Chieh Chen
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Tze-Kiong Er
- Division of Laboratory Medicine, Asia University Hospital, Asia University, Taichung, Taiwan; Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan.
| |
Collapse
|
9
|
O'Lone E, Apple FS, Burton JO, Caskey FJ, Craig JC, de Filippi CR, Forfang D, Hicks KA, Jha V, Mahaffey KW, Mark PB, Rossignol P, Scholes-Robertson N, Jaure A, Viecelli AK, Wang AY, Wheeler DC, White D, Winkelmayer WC, Herzog CA. Defining Myocardial Infarction in trials of people receiving hemodialysis: consensus report from the SONG-HD MI Expert Working group. Kidney Int 2023; 103:1028-1037. [PMID: 37023851 DOI: 10.1016/j.kint.2023.02.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/22/2023] [Accepted: 02/15/2023] [Indexed: 04/08/2023]
Abstract
Cardiovascular disease is the leading cause of death in patients receiving hemodialysis. Currently there is no standardized definition of myocardial infarction (MI) for patients receiving hemodialysis. Through an international consensus process MI was established as the core CVD measure for this population in clinical trials. The Standardised Outcomes in Nephrology Group - Hemodialysis (SONG-HD) initiative convened a multidisciplinary, international working group to address the definition of MI in this population.Based on current evidence, the working group recommends using the 4th Universal Definition of MI with specific caveats with regard to the interpretation of "ischemic symptoms" and performing a baseline 12-lead electrocardiogram to facilitate interpretation of acute changes on subsequent tracings. The working group does not recommend obtaining baseline cardiac troponin values, though does recommend obtaining serial cardiac biomarkers in settings where ischemia is suspected. Application of an evidence-based uniform definition should increase the reliability and accuracy of trial results.
Collapse
Affiliation(s)
- E O'Lone
- The University of Sydney, Camperdown, Sydney, Australia.
| | - F S Apple
- Departments of Laboratory Medicine and Pathology, Hennepin Healthcare/Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota
| | - J O Burton
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital Leicester, Leicester, UK
| | - F J Caskey
- Population Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - J C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - C R de Filippi
- Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - D Forfang
- The National Forum of ESRD Networks, Kidney Patient Advisory Council (KPAC) WI USA
| | - K A Hicks
- Division of Cardiology and Nephrology, Office of Cardiology, Hematology, Endocrinology, and Nephrology, Center for Drug Evaluation and Research (CDER), United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - V Jha
- George Institute of Global Health, UNSW, New Delhi, India; School of Public Health, Imperial College, London, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - K W Mahaffey
- The Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - P B Mark
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - P Rossignol
- Université de Lorraine, Centre d'Investigation Clinique Plurithématique 1433 -INSERM- CHRU de Nancy, Inserm U1116 & FCRIN INI-CRCT (Cardiovascular and RenalClinical Trialists), Vandoeuvre-les-Nancy, France; Medical specialties and nephrology -hemodialysis departments, Princess Grace Hospital, and Monaco Private Hemodialysis Centre, Monaco, Monaco
| | - N Scholes-Robertson
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - A Jaure
- The University of Sydney, Camperdown, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - A K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - A Y Wang
- Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - D C Wheeler
- University College London, London, United Kingdom
| | - D White
- American Association of Kidney Patients, Tampa, Florida
| | - W C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - C A Herzog
- Chronic Disease Research Group, Hennepin Healthcare Research Institute,Minneapolis, Minnesota; Division of Cardiology, Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
10
|
Wang CK, Yen CC, Chen SY, Lo HY, Ng CJ, Chaou CH. Prognostic value of cardiac troponin in dialysis patients with paroxysmal supraventricular tachycardia. Medicine (Baltimore) 2022; 101:e30513. [PMID: 36086794 PMCID: PMC10980411 DOI: 10.1097/md.0000000000030513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/05/2022] [Indexed: 10/14/2022] Open
Abstract
A rise in cardiac troponin I (cTnI) is common in supraventricular tachycardia (SVT). While troponin elevation in SVT is thought to be a predictor of future adverse events in patients with prior coronary artery disease, the prognostic significance of cTnI in end-stage kidney disease (ESKD) patients with SVT are not known. We aimed to examine the prognostic significance of cTnI in ESKD patients presenting with SVT in the emergency department. This was a retrospective, multiple-center observational study utilizing regularly collected electronic medical records. We screened electronic medical records of all dialysis patients presenting to the emergency departments in 5 hospitals over 12 years with SVT. These patients were divided into whether cTnI was tested, and were further stratified into the cTnI-positive and cTnI-negative groups. The primary outcome of the study was the 3-year risk of major adverse cardiovascular events (MACE). Sixty-two patients were qualified for inclusion. Fifty-seven patients (91.9%) were tested for cTnI, and 5 patients were not. Patients with the cTnI test were older (P = .03) and had a longer length of hospital stay (P < .001). Forty-seven patients (82.5%) had a positive result, and 10 (17.5%) had a negative result. A history of hypertension (P = .013) and decreased left ventricular ejection fraction (P = .048) were the independent predictors of cTnI elevation. After a mean follow-up period of 20.6 ± 14.7 months, there were no differences in 3-year MACE between patients with or without elevated cTnI levels in Kaplan-Meier analysis (P = .34). A history of coronary artery disease was the only independent predictor of 3-year MACE (P = .017). Through the subgroup analysis, a history of coronary artery disease (HR 2.73; CI 1.01-7.41; P = .049) remained an independent risk factor for 3-year MACE in patients with elevated cTnI levels. A large proportion (82.5%) of troponin elevation was observed in ESKD patients with SVT, but it had a poor correlation with MACE.
Collapse
Affiliation(s)
- Chih-Kai Wang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chieh-Ching Yen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Chang Gung Medical Education Research Center, Taoyuan, Taiwan
| | - Hsiang-Yun Lo
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Chang Gung Medical Education Research Center, Taoyuan, Taiwan
| |
Collapse
|
11
|
Pan Q, Liu Y, Ma W, Kan R, Zhu H, Li D. Cardioprotective Effects and Possible Mechanisms of Luteolin for Myocardial Ischemia-Reperfusion Injury: A Systematic Review and Meta-Analysis of Preclinical Evidence. Front Cardiovasc Med 2022; 9:685998. [PMID: 35548432 PMCID: PMC9081501 DOI: 10.3389/fcvm.2022.685998] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAt present, effective clinical therapies for myocardial ischemia-reperfusion injury (MIRI) are lacking. We investigated if luteolin conferred cardioprotective effects against MIRI and elucidated the potential underlying mechanisms.MethodFour databases were searched for preclinical studies of luteolin for the treatment of MIRI. The primary outcomes were myocardial infarct size (IS) and intracardiac hemodynamics. The second outcomes were representative indicators of apoptosis, oxidative stress, and inflammatory. The Stata and RevMan software packages were utilized for data analysis.ResultsLuteolin administration was confirmed to reduce IS and ameliorate hemodynamics as compared to the control groups (p < 0.01). IS had decreased by 2.50%, 2.14%, 2.54% in three subgroups. Amelioration of hemodynamics was apparent in two different myocardial infarct models (model of left anterior descending branch ligation and model of global heart ischemia), as left ventricular systolic pressure improved by 21.62 and 35.40 mmHg respectively, left ventricular end-diastolic pressure decreased by 7.79 and 4.73 mmHg respectively, maximum rate of left ventricular pressure rise increased by 737.48 and 750.47 mmHg/s respectively, and maximum rate of left ventricular pressure decrease increased by 605.66 and 790.64 mmHg/s respectively. Apoptosis of cardiomyocytes also significantly decreased, as indicated by thelevels of MDA, an oxidative stress product, and expression of the inflammatory factor TNF-α (p < 0.001).ConclusionPooling of the data demonstrated that luteolin exerts cardioprotective effects against MIRI through different signaling pathways. As possible mechanisms, luteolin exerts anti-apoptosis, anti-oxidation, and anti-inflammation effects against MIRI.
Collapse
Affiliation(s)
- Qinyuan Pan
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, China
| | - Yang Liu
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, China
| | - Wenrui Ma
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, China
| | - Rongsheng Kan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Hong Zhu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Hong Zhu
| | - Dongye Li
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, China
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- *Correspondence: Dongye Li
| |
Collapse
|
12
|
He Y, Lu X, Liang Z, Chen T, Chen C, Zhang Y, Lei W. Noninvasively ventilated and easily operated mouse model of myocardial infarction. Anat Rec (Hoboken) 2022; 305:3192-3198. [PMID: 35098691 DOI: 10.1002/ar.24877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/22/2021] [Accepted: 10/02/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Yuan He
- Guangdong Provincial Engineering Technology Research Center for Molecular Diagnosis and Innovative Drugs Translation of Cardiopulmonary Vascular Diseases, University Joint Laboratory of Guangdong Province and Macao Region on Molecular Targets and Intervention of Cardiovascular Diseases Affiliated Hospital of Guangdong Medical University Zhanjiang Guangdong China
- Laboratory of Cardiovascular Diseases Affiliated Hospital of Guangdong Medical University Zhanjiang Guangdong China
| | - Xinlin Lu
- Cardiovascular Medicine Center Affiliated Hospital of Guangdong Medical University Zhanjiang Guangdong China
| | - Zheng Liang
- Cardiovascular Medicine Center Affiliated Hospital of Guangdong Medical University Zhanjiang Guangdong China
| | - Tao Chen
- Cardiovascular Medicine Center Affiliated Hospital of Guangdong Medical University Zhanjiang Guangdong China
| | - Can Chen
- Laboratory of Cardiovascular Diseases Affiliated Hospital of Guangdong Medical University Zhanjiang Guangdong China
- Cardiovascular Medicine Center Affiliated Hospital of Guangdong Medical University Zhanjiang Guangdong China
| | - Yuanqi Zhang
- Department of Vascular, Thyroid and Breast Surgery Affiliated Hospital of Guangdong Medical University Zhanjiang Guangdong China
| | - Wei Lei
- Guangdong Provincial Engineering Technology Research Center for Molecular Diagnosis and Innovative Drugs Translation of Cardiopulmonary Vascular Diseases, University Joint Laboratory of Guangdong Province and Macao Region on Molecular Targets and Intervention of Cardiovascular Diseases Affiliated Hospital of Guangdong Medical University Zhanjiang Guangdong China
- Laboratory of Cardiovascular Diseases Affiliated Hospital of Guangdong Medical University Zhanjiang Guangdong China
- Department of Precision Laboratory Affiliated Hospital of Guangdong Medical University Zhanjiang Guangdong China
| |
Collapse
|
13
|
Chauin A. The Main Causes and Mechanisms of Increase in Cardiac Troponin Concentrations Other Than Acute Myocardial Infarction (Part 1): Physical Exertion, Inflammatory Heart Disease, Pulmonary Embolism, Renal Failure, Sepsis. Vasc Health Risk Manag 2021; 17:601-617. [PMID: 34584417 PMCID: PMC8464585 DOI: 10.2147/vhrm.s327661] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022] Open
Abstract
The causes and mechanisms of increased cardiac troponin T and I (cTnT and cTnI) concentrations are numerous and are not limited to acute myocardial infarction (AMI) (ischemic necrosis of cardiac myocytes). Any type of reversible or irreversible cardiomyocyte injury can result in elevated serum cTnT and cTnI levels. Researchers and practitioners involved in the diagnosis and treatment of cardiovascular disease, including AMI, should know the key causes and mechanisms of elevated serum cTnT and cTnI levels. This will allow to reduce or completely avoid diagnostic errors and help to choose the most correct tactics for further patient management. The purpose of this article is to discuss the main causes and mechanisms of increase in cardiac troponins concentrations in frequently occurring physiological (physical exertion, psycho-emotional stress) and pathological conditions (inflammatory heart disease, pulmonary embolism, chronic renal failure and sepsis (systemic inflammatory response)) not related to myocardial infarction.
Collapse
Affiliation(s)
- Aleksey Chauin
- Department of Cardiology and Cardiovascular Surgery, Samara State Medical University, Samara, 443099, Russia.,Department of Histology and Embryology, Samara State Medical University, Samara, 443099, Russia
| |
Collapse
|
14
|
Chaulin AM. Elevation Mechanisms and Diagnostic Consideration of Cardiac Troponins under Conditions Not Associated with Myocardial Infarction. Part 1. Life (Basel) 2021; 11:life11090914. [PMID: 34575063 PMCID: PMC8471393 DOI: 10.3390/life11090914] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 12/31/2022] Open
Abstract
Although cardiac troponins are considered the most specific biomarkers for the diagnosis of acute myocardial infarction (AMI), their diagnostic consideration goes far beyond the detection of this dangerous disease. The mechanisms of cardiac troponin elevation are extremely numerous and not limited to ischemic necrosis of cardiac myocytes. Practitioners should be well aware of the underlying pathological and physiological conditions that can lead to elevated serum levels of cardiac troponins to avoid differential diagnostic errors, which will be greatly increased if clinicians rely on laboratory data alone. This article presents a classification of the main causes of an elevation in cardiac troponins and discusses in detail the mechanisms of such elevation and the diagnostic consideration of cardiac troponins in some conditions not associated with AMI, such as physical exertion, inflammatory heart diseases (myocarditis and endocarditis), pulmonary embolism (PE), renal failure, and systemic inflammation (sepsis).
Collapse
Affiliation(s)
- Aleksey M. Chaulin
- Department of Cardiology and Cardiovascular Surgery, Samara State Medical University, 443099 Samara, Russia; ; Tel.: +7-(927)-770-25-87
- Department of Histology and Embryology, Samara State Medical University, 443099 Samara, Russia
| |
Collapse
|
15
|
Zhao L, Feng Y, Xu ZJ, Zhang NY, Zhang WP, Zuo G, Khalil MM, Sun LH. Selenium mitigated aflatoxin B1-induced cardiotoxicity with potential regulation of 4 selenoproteins and ferroptosis signaling in chicks. Food Chem Toxicol 2021; 154:112320. [PMID: 34116104 DOI: 10.1016/j.fct.2021.112320] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/30/2021] [Accepted: 05/31/2021] [Indexed: 01/18/2023]
Abstract
The aim of the present study was to explore the underlying mechanism of selenium (Se)-mediated detoxification of aflatoxin B1 (AFB1)-induced cardiotoxicity in chicks. A Se-deficient, corn-soybean meal-basal diet (36 μg Se/kg, BD) and three test diets (BD+1.0 mg AFB1/kg, 0.3 mg Se/kg, or 1.0 mg AFB1/kg+0.3 mg Se/kg) were used in a 3-wk 2 × 2 factorial design trial (n = 30 chicks/group). Dietary AFB1 led to induced (P < 0.05) serum creatine kinase and creatine kinase MB isoenzyme activities and heart histopathologic lesions. However, Se deficiency aggravated most of these alterations induced by AFB1. Moreover, mRNA levels of two ferroptosis activators (solute carrier family 11 Member 2 and transferrin) were upregulated (P < 0.05) in the AFB1-treated groups. Additionally, Se deficiency reduced (P < 0.05) glutathione peroxidase (GPX) 3 and thioredoxin reductase 3 mRNA and GPX activity but increased (P < 0.05) selenoprotein M and selenophosphate synthetase 2 mRNA in the heart in AFB1-administered groups. The in vitro study showed that Se alleviated (P < 0.05) AFB1-reduced cell viability and induced (P < 0.05) ROS and ferroptosis in H9C2 cardiac cells. It also downregulated (P < 0.05) two ferroptosis activators (long-chain acyl-CoA synthetase 4 and solute carrier family 11 Member 2) in the AFB1-treated groups in the H9C2 cells. In conclusion, this study illustrated that Se alleviates AFB1-induced cardiotoxicity and cardiomyocyte damage potentially related to the regulation of redox status, 4 selenoproteins, and ferroptosis-related signaling.
Collapse
Affiliation(s)
- Ling Zhao
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Huazhong Agricultural University, Wuhan, Hubei, 430070, China
| | - Yue Feng
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Huazhong Agricultural University, Wuhan, Hubei, 430070, China
| | - Zi-Jian Xu
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Huazhong Agricultural University, Wuhan, Hubei, 430070, China
| | - Ni-Ya Zhang
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Huazhong Agricultural University, Wuhan, Hubei, 430070, China
| | - Wan-Po Zhang
- Department of Veterinary Pathology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Gang Zuo
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Hunan Agricultural University, Changsha, Hunan, 410128, China
| | - Mahmoud Mohamed Khalil
- Animal Production Department, Faculty of Agriculture, Benha University, 13736, Egypt; Monogastric Research Centre, School of Agriculture and Environment, Massey University, Palmerston North, 4442, New Zealand
| | - Lv-Hui Sun
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Huazhong Agricultural University, Wuhan, Hubei, 430070, China.
| |
Collapse
|
16
|
Diagnostic Application of Postmortem Cardiac Troponin I Pericardial Fluid/Serum Ratio in Sudden Cardiac Death. Diagnostics (Basel) 2021; 11:diagnostics11040614. [PMID: 33808170 PMCID: PMC8067238 DOI: 10.3390/diagnostics11040614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 01/29/2023] Open
Abstract
In approximately 5% of unexpected deaths, establishing a conclusive diagnosis exclusively on the basis of anatomo-pathological findings in a classic autopsy is difficult. Postmortem biomarkers have been actively investigated as complementary indicators to help to reach valid conclusions about the circumstances of death. Several studies propose either the pericardial fluid or peripheral veins as a location for troponin determination, but the optimum sampling site is still a matter of debate. Our objective was to evaluate the association between the ratio of troponin values in the pericardial fluid and serum (determined postmortem) and the diagnosis of acute myocardial infarction (AMI) in the context of sudden cardiac death. We included 175 forensic cases. Two groups were established: AMI deaths (48; 27.4%) and the control group (127; 72.6%). The cardiac Troponin I (cTnI) values in the pericardial fluid and the troponin ratio were found to be associated with the cause of death. Univariate regression analyses showed that both age and the cTnI ratio were significantly associated with the diagnosis of AMI death. In a multivariate analysis, adjusting for confounding factors, the age and cTnI ratio were independent predictors of death from myocardial infarction. We performed a receiver operating characteristic (ROC) curve for the cTnI ratio for AMI death and selected a cut-off point. Our biomarker was found to be a valuable and highly effective tool for use in the forensic field as a complementary method to facilitate diagnosis in nonconclusive autopsies.
Collapse
|
17
|
Benes J, Kotrc M, Jarolim P, Hoskova L, Hegarova M, Dorazilova Z, Podzimkova M, Binova J, Lukasova M, Malek I, Franekova J, Jabor A, Kautzner J, Melenovsky V. The effect of three major co-morbidities on quality of life and outcome of patients with heart failure with reduced ejection fraction. ESC Heart Fail 2021; 8:1417-1426. [PMID: 33512782 PMCID: PMC8006738 DOI: 10.1002/ehf2.13227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/28/2020] [Accepted: 01/13/2021] [Indexed: 12/18/2022] Open
Abstract
Aims Diabetes mellitus, chronic obstructive pulmonary disease, and chronic kidney disease are prevalent in patients with heart failure with reduced ejection fraction (HFrEF). We have analysed the impact of co‐morbidities on quality of life (QoL) and outcome. Methods and results A total of 397 patients (58.8 ± 11.0 years, 73.6% with New York Heart Association functional class ≥3) with stable advanced HFrEF were followed for a median of 1106 (inter‐quartile range 379–2606) days, and 68% of patients (270 patients) experienced an adverse outcome (death, urgent heart transplantation, and implantation of mechanical circulatory support). Chronic obstructive pulmonary disease was present in 16.4%, diabetes mellitus in 44.3%, and chronic kidney disease in 34.5% of patients; 33.5% of patients had none, 40.0% had one, 21.9% had two, and 3.8% of patient had three co‐morbidities. Patients with more co‐morbidities reported similar QoL (assessed by Minnesota Living with Heart Failure Questionnaire, 45.46 ± 22.21/49.07 ± 21.69/47.52 ± 23.54/46.77 ± 23.60 in patients with zero to three co‐morbidities, P for trend = 0.51). Multivariable regression analysis revealed that furosemide daily dose, systolic blood pressure, New York Heart Association functional class, and body mass index, but not the number of co‐morbidities, were significantly (P < 0.05) associated with QoL. Increasing co‐morbidity burden was associated with worse survival (P < 0.0001), lower degree of angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker treatment (P = 0.001), and increasing levels of BNP (mean of 685, 912, 1053, and 985 ng/L for patients with zero to three co‐morbidities, P for trend = 0.008) and cardiac troponin (sm‐cTnI, P for trend = 0.0496), which remained significant (P < 0.05) after the adjustment for left ventricular ejection fraction, left ventricular end‐diastolic diameter, right ventricular dysfunction grade, body mass index, and estimated glomerular filtration rate. Conclusions In stable advanced HFrEF patients, co‐morbidities are not associated with impaired QoL, but negatively affect the prognosis both directly and indirectly through lower level of HF pharmacotherapy and increased myocardial stress and injury.
Collapse
Affiliation(s)
- Jan Benes
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic.,Department of Internal Medicine, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Martin Kotrc
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Petr Jarolim
- 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lenka Hoskova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Marketa Hegarova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Zora Dorazilova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Mariana Podzimkova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Jana Binova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Marianna Lukasova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Ivan Malek
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Janka Franekova
- Department of Laboratory Methods, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic.,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Antonin Jabor
- Department of Laboratory Methods, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic.,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Vojtech Melenovsky
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| |
Collapse
|
18
|
Cormican DS, Sonny A, Crowley J, Sheu R, Sun T, Gibson CM, Núñez-Gil IJ, Ramakrishna H. Acute Myocardial Infarction Complicated by Cardiogenic Shock: Analysis of the Position Statement From the European Society of Cardiology Acute Cardiovascular Care Association, With Perioperative Implications. J Cardiothorac Vasc Anesth 2020; 35:3098-3104. [PMID: 33234469 DOI: 10.1053/j.jvca.2020.10.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 12/28/2022]
Abstract
Effective management of cardiogenic shock (CS) is hampered by a lack of evidence-based information. This is a high-mortality condition, without clear, evidence-based guidelines for perioperative management, specifically-a lack of target endpoints for treatment (e.g.: mean arterial pressure or oxygenation), utility of regional care systems or the benefits of palliative care. The Acute Cardiovascular Care Association (ACCA) of the European Society of Cardiology (ESC) recently published a position statement that aimed to offer contemporary guidance on the diagnosis and treatment of acute myocardial infarction (AMI) complicated by CS. Herein, we review this complex clinical topic and review the ACCA statement on AMI associated with CS, with a focus on relevance to perioperative management.
Collapse
Affiliation(s)
- Daniel S Cormican
- Department of Anesthesiology, Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, Allegheny Health Network, Pittsburgh, PA
| | - Abraham Sonny
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Jerome Crowley
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Richard Sheu
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA
| | - Terri Sun
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA
| | | | - Iván J Núñez-Gil
- Interventional Cardiology. Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
19
|
Geyer M, Wild J, Münzel T, Gori T, Wenzel P. State of the Art-High-Sensitivity Troponins in Acute Coronary Syndromes. Cardiol Clin 2020; 38:471-479. [PMID: 33036710 DOI: 10.1016/j.ccl.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In cases of suspected acute coronary syndrome (ACS), rapid and accurate diagnosis is essential to establish effective evidence-based medical treatment. Patients' history, clinical examination, 12-lead electrocardiogram, and cardiac biomarkers are cornerstones in initial management. Since high-sensitivity cardiac troponins were established, they have markedly expedited and revolutionized rule-in and rule-out pathways of patients with ACS and changed our everyday clinical practice. Thus, they have become an indispensable tool in daily routine in emergency units. This review focuses on historical and contemporary standards in laboratory biomarkers of myocardial injury and discusses their implication in the context of the updated universal definition of myocardial infarction.
Collapse
Affiliation(s)
- Martin Geyer
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.
| | - Johannes Wild
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Tommaso Gori
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Philip Wenzel
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| |
Collapse
|
20
|
Buffa V, Di Renzi P. CMR in the diagnosis of ischemic heart disease. Radiol Med 2020; 125:1114-1123. [PMID: 32936388 DOI: 10.1007/s11547-020-01278-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022]
Abstract
Cardiovascular magnetic resonance has always been more often used in the last 10 years in evaluation of heart disease. Role in diagnosis of ischemia and in evaluation of myocardial infarction is well established by many scientific papers and included in current guidelines. High accuracy in evaluation of stress-induced ischemia, tissue characterization and functional parameters are the pillars the make the method widely used. In this paper are described role and techniques in diagnosis of ischemia, myocardial infarction and its sequelae.
Collapse
Affiliation(s)
- Vitaliano Buffa
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
| | - Paolo Di Renzi
- Department of Radiology, Ospedale San Giovanni Calibita FBF, Rome, Italy
| |
Collapse
|
21
|
Evaluation of Serum Serotonin as a Biomarker for Myocardial Infarction and Ischemia/Reperfusion Injury. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10186379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Activated platelets release serotonin during acute myocardial infarction (AMI), aggravating myocardial damage and ischemia/reperfusion (I/R) injury. However, serum serotonin and its potential role as a biomarker for myocardial infarction and I/R injury have not been studied so far. Methods: In this investigator-initiated pilot study, we examined 38 patients with ST-segment myocardial infarction (STEMI). We determined serum serotonin levels prior to percutaneous coronary intervention and 8, 16, and 24 h afterwards. We studied whether serum serotonin was associated with I/R injury assessed by ECG analysis and by analysis of TIMI myocardial perfusion grade (TMP) and myocardial blush grade (MGB). Serum serotonin levels were compared to an age-matched control group consisting of patients admitted to the emergency department for any other reason than STEMI. Results: Serum serotonin levels were not elevated in the myocardial infarction group compared to the control cohort and they did not show any timeline kinetics after STEMI. They were not associated with the severity of coronary artery disease, the outcome of coronary angiography, the extent of I/R injury, or the degree of heart failure. Conclusions: Serum serotonin is not suitable as a biomarker after myocardial infarction and in the assessment of I/R injury.
Collapse
|
22
|
Kumar D, Nanga RPR, Thakuri D, Wilson N, Cember A, Martin ML, Zhu D, Shinohara RT, Qin Q, Hariharan H, Reddy R. Recovery kinetics of creatine in mild plantar flexion exercise using 3D creatine CEST imaging at 7 Tesla. Magn Reson Med 2020; 85:802-817. [PMID: 32820572 DOI: 10.1002/mrm.28463] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 07/08/2020] [Accepted: 07/14/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE Two-dimensional creatine CEST (2D-CrCEST), with a slice thickness of 10-20 mm and temporal resolution (τRes ) of about 30 seconds, has previously been shown to capture the creatine-recovery kinetics in healthy controls and in patients with abnormal creatine-kinase kinetics following the mild plantar flexion exercise. Since the distribution of disease burden may vary across the muscle length for many musculoskeletal disorders, there is a need to increase coverage in the slice-encoding direction. Here, we demonstrate the feasibility of 3D-CrCEST with τRes of about 30 seconds, and propose an improved voxel-wise B 1 + -calibration approach for CrCEST. METHODS The current 7T study with enrollment of 5 volunteers involved collecting the baseline CrCEST imaging for the first 2 minutes, followed by 2 minutes of plantar flexion exercise and then 8 minutes of postexercise CrCEST imaging, to detect the temporal evolution of creatine concentration following exercise. RESULTS Very good repeatability of 3D-CrCEST findings for activated muscle groups on an intraday and interday basis was established, with coefficient of variance of creatine recovery constants (τCr ) being 7%-15.7%, 7.5%, and 5.8% for lateral gastrocnemius, medial gastrocnemius, and peroneus longus, respectively. We also established a good intraday and interday scan repeatability for 3D-CrCEST and also showed good correspondence between τCr measurements using 2D-CrCEST and 3D-CrCEST acquisitions. CONCLUSION In this study, we demonstrated for the first time the feasibility and the repeatability of the 3D-CrCEST method in calf muscle with improved B 1 + correction to measure creatine-recovery kinetics within a large 3D volume of calf muscle.
Collapse
Affiliation(s)
- Dushyant Kumar
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Deepa Thakuri
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neil Wilson
- Siemens Medical Solutions USA Inc., Malvern, Pennsylvania, USA
| | - Abigail Cember
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melissa Lynne Martin
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Dan Zhu
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Qin Qin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Hari Hariharan
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ravinder Reddy
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
23
|
Cole EM, Docherty AB. Troponin in critical care patients and outcomes. Br J Hosp Med (Lond) 2020; 81:1-8. [PMID: 32468943 DOI: 10.12968/hmed.2020.0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Myocardial infarction is common in the critically unwell population with pre-existing cardiovascular disease and is associated with a greater overall mortality. This article explores guidelines for diagnosing myocardial infarction, and research into the use of troponin as both a diagnostic and prognostic tool. Currently, the majority of patients in the intensive care unit with acute myocardial infarction go unrecognised. The underlying cause is predominantly oxygen supply-demand imbalance, therefore identifying those at risk is important as there is the potential to modify elements of their care and reduce their overall mortality.
Collapse
Affiliation(s)
| | - Annemarie B Docherty
- Department of Anaesthesia and Critical Care, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
24
|
Interpreting troponin in renal disease: A narrative review for emergency clinicians. Am J Emerg Med 2020; 38:990-997. [DOI: 10.1016/j.ajem.2019.11.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/16/2019] [Accepted: 11/26/2019] [Indexed: 01/11/2023] Open
|
25
|
Galvani M. Integration of the Universal Definition of Myocardial Infarction into administrative data. J Cardiovasc Med (Hagerstown) 2020; 21:40-41. [DOI: 10.2459/jcm.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
26
|
Vinnakota S, Scott CG, Rodeheffer RJ, Chen HH. Estimated Glomerular Filtration Rate, Activation of Cardiac Biomarkers and Long-Term Cardiovascular Outcomes: A Population-Based Cohort. Mayo Clin Proc 2019; 94:2189-2198. [PMID: 31668448 PMCID: PMC6959123 DOI: 10.1016/j.mayocp.2019.03.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 02/28/2019] [Accepted: 03/18/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To classify subjects in a general population per their renal function and characterize the cardiac biomarker levels, left ventricular function and cardiovascular outcomes over a 10.2 year follow-up period (interquartile range, 5.1-11.4 years). METHODS This was a retrospective review of a population-based random sample of residents aged ≥45 years. Data were collected between January 1, 1997, and December 31, 2000. One thousand nine hundred eighty-one individuals were classified based on estimated glomerular filtration rate (eGFR) into group I (>90 mL/min/1.73 m2), group II (60 to 89 mL/min/1.73 m2) and group III (<60 mL/min/1.73 m2; chronic kidney disease [CKD]). Age/sex-adjusted baseline characteristics, tertiles of N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT) and their interactions with eGFR were examined. Outcomes measured included incident myocardial infarction (MI), congestive heart failure, stroke, and all-cause mortality. RESULTS Eight hundred nineteen patients were classified as group I, 1036 as group II, and 126 of 1981 (6.4%) as group III or CKD. Subjects in group III were older and had a higher incidence of hypertension, diabetes, and MI at baseline. Over a 10.2-year follow-up period, CKD was associated with an increased risk of MI (hazard ratio, 1.95; 95% CI, 1.2-3.14; P=.006) and composite cardiovascular outcomes including MI, congestive heart failure, stroke, and all-cause mortality (hazard ratio, 1.38; 95% CI, 1.05-1.83 ;P=.02). Subjects with NT-proBNP or hs-TnT in the third tertile were at greater risk of cardiovascular events without significant interactions between eGFR and levels of NT-proBNP and hs-TnT. CONCLUSION Subjects with CKD had significantly elevated cardiac biomarkers and were at an increased risk of MI and adverse cardiovascular events. This warrants future studies to investigate whether these cardiac biomarkers could identify high-risk CKD patients for aggressive management of cardiovascular risk factors.
Collapse
Affiliation(s)
| | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - Horng H Chen
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| |
Collapse
|
27
|
Bansal N, Zelnick L, Go A, Anderson A, Christenson R, Deo R, Defilippi C, Lash J, He J, Ky B, Seliger S, Soliman E, Shlipak M. Cardiac Biomarkers and Risk of Incident Heart Failure in Chronic Kidney Disease: The CRIC (Chronic Renal Insufficiency Cohort) Study. J Am Heart Assoc 2019; 8:e012336. [PMID: 31645163 PMCID: PMC6898812 DOI: 10.1161/jaha.119.012336] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Cardiac biomarkers may signal mechanistic pathways involved in heart failure (HF), a leading complication in chronic kidney disease. We tested the associations of NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), high‐sensitivity troponin T (hsTnT), galectin‐3, growth differentiation factor‐15 (GDF‐15), and soluble ST2 (sST2) with incident HF in chronic kidney disease. Methods and Results We examined adults with chronic kidney disease enrolled in a prospective, multicenter study. All biomarkers were measured at baseline. The primary outcome was incident HF. Secondary outcomes included HF with preserved ejection fraction (EF≥50%) and reduced ejection fraction (EF<50%). Cox models were used to test the association of each cardiac biomarker with HF, adjusting for demographics, kidney function, cardiovascular risk factors, and medication use. Among 3314 participants, all biomarkers, with the exception of galectin‐3, were significantly associated with increased risk of incident HF (hazard ratio per SD higher concentration of log‐transformed biomarker): NT‐proBNP (hazard ratio, 2.07; 95% CI, 1.79–2.39); hsTnT (hazard ratio, 1.38; 95% CI, 1.21–1.56); GDF‐15 (hazard ratio, 1.44; 95% CI, 1.26–1.66) and sST2 (hazard ratio, 1.19; 95% CI, 1.05–1.35). Higher NT‐proBNP, hsTnT, and GDF‐15 were also associated with a greater risk of HF with reduced EF; while higher NT‐proBNP GDF‐15 and sST2 were associated with HF with preserved EF. Galectin‐3 was not associated with either HF with reduced EF or HF with preserved EF. Conclusions In chronic kidney disease, elevations of NT‐proBNP, hsTnT, GDF‐15, sST2 were associated with incident HF. There was a borderline association of galectin‐3 with incident HF. NT‐proBNP and hsTnT were more strongly associated with HF with reduced EF, while the associations of the newer biomarkers GDF‐15 and sST2 were stronger for HF with preserved EF.
Collapse
Affiliation(s)
| | | | - Alan Go
- Division of Research Kaiser Permanente Northern California Oakland CA
| | | | | | - Rajat Deo
- University of Pennsylvania Philadelphia PA
| | | | | | - Jiang He
- Tulane University New Orleans LA
| | - Bonnie Ky
- University of Pennsylvania Philadelphia PA
| | | | | | | | | | | |
Collapse
|
28
|
Abstract
Procalcitonin is a biomarker that is generally elevated in bacterial infections. This review describes a conceptual framework for biomarkers using lessons from the history of troponin, applies this framework to procalcitonin with a review of observational studies and randomized trials in and out of the intensive care unit, and concludes with clinical recommendations and thoughts on how to test a test.
Collapse
|
29
|
Dhir S, Dhir A. Cardiovascular Risk Assessment for Noncardiac Surgery: Are We Ready for Biomarkers? J Cardiothorac Vasc Anesth 2019; 34:1914-1924. [PMID: 31866221 DOI: 10.1053/j.jvca.2019.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/07/2019] [Accepted: 10/04/2019] [Indexed: 02/07/2023]
Abstract
Biomarkers aided perioperative cardiac assessment is a relatively new concept. Cardiac biomarkers with historical significance (aspartate transaminase, dehydrogenase, creatinine kinase and myoglobin) have paved the way for traditional biomarkers (cardiac troponin, C-reactive protein, lipoprotein). Contemporary biomarkers like natriuretic peptides (BNP and ProBNP) are validated risk markers in both acute and chronic cardiac diseases and are showing remarkable promise in predicting serious cardiovascular complications after non-cardiac surgery. This review is intended to provide a critical overview of traditional and contemporary biomarkers for perioperative cardiovascular assessment and management. This review also discusses the potential utility of newer biomarkers like galectin-3, sST-2, GDF-15, TNF-alpha, MiRNAs and many others that can predict inflammation, cardiac remodeling, injury and endogenous stress and need further investigations to establish their clinical utility. Though promising, biomarker led perioperative care is still in infancy and it has not been determined that it can improve clinical outcomes.
Collapse
Affiliation(s)
- Shalini Dhir
- Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada.
| | - Achal Dhir
- Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada
| |
Collapse
|
30
|
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD. Fourth Universal Definition of Myocardial Infarction (2018). Circulation 2019; 138:e618-e651. [PMID: 30571511 DOI: 10.1161/cir.0000000000000617] [Citation(s) in RCA: 1721] [Impact Index Per Article: 344.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
31
|
Is It Time to Recalibrate Cardiac Prediction Tools to Accommodate Chronic Kidney Disease? Can J Cardiol 2019; 35:1082-1084. [PMID: 31472806 DOI: 10.1016/j.cjca.2019.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 06/30/2019] [Indexed: 10/26/2022] Open
|
32
|
Bañón R, Hernández-Romero D, Navarro E, Pérez-Cárceles MD, Noguera-Velasco JA, Osuna E. Combined determination of B-type natriuretic peptide and high-sensitivity troponin I in the postmortem diagnosis of cardiac disease. Forensic Sci Med Pathol 2019; 15:528-535. [PMID: 31471870 DOI: 10.1007/s12024-019-00150-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
Cardiac disease is the most common cause of sudden death in Western countries. It is known that high-sensitivity troponin I (hs-cTnI), widely used for detection of myocardial injury, is a sensitive biochemical marker. B-type natriuretic peptide (BNP) is a reliable tool for diagnosing heart failure, and for establishing prognosis or disease severity. We aimed to evaluate the diagnostic efficacy of the postmortem determination of BNP in serum alone or in addition to other biomarkers, such as hs-cTnI and MB isoenzyme of creatine kinase (CK-MB), to ascertain whether its determination improves the post-mortem diagnosis of heart failure-associated causes of death. This study involved 133 cadavers with a mean age of 58.2 (± 17.6) years and a mean postmortem interval of 12.8 (±6.6) h. Cases were assigned into two diagnostic groups, according to the cause of death: cardiac deaths (N = 62) and control (N = 71). In the cardiac group, two categories were established according to morphological features of the heart: 'ischemic deaths' (N = 39), and 'congestive heart' (n = 23). Both hs-cTnI and BNP were useful in diagnosing cardiac deaths, whereas CK-MB did not have any diagnostic relevance. hs-cTnI is higher in cases which acute ischemia as the principal pathology, while the presence of high BNP values is significantly related with chronic cardiac situations with significant ventricular overload. Our findings show that postmortem determination of hs-cTnI and BNP provides valuable information; hs-cTnI is useful for diagnosis of cardiac deaths, mainly with ischemic implications, and BNP gave better results for the diagnosis of congestive heart failure.
Collapse
Affiliation(s)
| | - Diana Hernández-Romero
- Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB-Arrixaca), Regional Campus of International Excellence ''Campus Mare Nostrum", University of Murcia, Murcia, Spain.
| | | | - María Dolores Pérez-Cárceles
- Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB-Arrixaca), Regional Campus of International Excellence ''Campus Mare Nostrum", University of Murcia, Murcia, Spain
| | | | - Eduardo Osuna
- Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB-Arrixaca), Regional Campus of International Excellence ''Campus Mare Nostrum", University of Murcia, Murcia, Spain
| |
Collapse
|
33
|
Huang J, Ruse RB, Walcott GP, Litovsky S, Bohanan SJ, Gong DW, Kroll MW. Ascending Defibrillation Waveform Significantly Reduces Myocardial Morphological Damage and Injury Current. JACC Clin Electrophysiol 2019; 5:854-862. [PMID: 31320015 DOI: 10.1016/j.jacep.2019.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/19/2019] [Accepted: 04/17/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study tested the hypothesis that a biphasic defibrillation waveform with an ascending first phase (ASC) causes less myocardial damage by pathology and injury current than a standard biphasic truncated exponential (BTE) waveform in a swine model. BACKGROUND Although lifesaving, defibrillation shocks have significant iatrogenic effects that reduce their benefit for patient survival. METHODS An ASC waveform with an 8-ms linear ramp followed by an additional positive 0.5-ms decaying portion with amplitudes of 20 J (ASC 20J) and 25 J (ASC 25J) was used. The control was a 25-J BTE conventional waveform (BTE 25J) RESULTS: The ASC 20J and ASC 25J shocks were both successful in 6 of 6 pigs, but the BTE 25J was successful in only 6 of 14 pigs (p < 0.05). Post-shock ST-segment elevation (injury current) in the right ventricular electrode was significantly greater with BTE 25J than with ASC 20J and ASC 25J. With a blinded pathology reading, hemorrhage, inflammation, thrombi, and necrosis 24 h post-shock were significantly greater with BTE 25J than with ASC 20J and ASC 25J. Troponin levels were also markedly lower at 3, 4, 5, and 6 h post-shock. CONCLUSIONS Defibrillation shocks cause electrophysiological, histological, and biochemical signs of myocardial damage and necrosis. These signs of damage are markedly less for an ASC waveform than for a conventional BTE waveform.
Collapse
Affiliation(s)
- Jian Huang
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Gregory P Walcott
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Silvio Litovsky
- Department of Medicine, Department of Pathology, University of Alabama at Birmingham, Alabama
| | | | - Da-Wei Gong
- School of Medicine, University of Maryland, Baltimore, Maryland
| | - Mark W Kroll
- Department of Biomedical Engineering, University of Minnesota Crystal Bay, Minnesota; Department of Biomedical Engineering, California Polytechnical University, San Luis Obispo, California.
| |
Collapse
|
34
|
Narayanan MA, Garcia S. Role of High-sensitivity Cardiac Troponin in Acute Coronary Syndrome. US CARDIOLOGY REVIEW 2019. [DOI: 10.15420/usc.2018.16.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chest pain is one of the most common reasons for an emergency room (ER) visit in the US, with almost 6 million ER visits annually. High-sensitivity cardiac troponin (hscTn) assays have the ability to rapidly rule in or rule out acute coronary syndrome with improved sensitivity, and they are increasingly being used. Though hscTn assays have been approved for use in European, Australian, and Canadian guidelines since 2010, the FDA only approved their use in 2017. There is no consensus on how to compare the results from various hscTn assays. A literature review was performed to analyze the advantages and limitations of using hscTn as a standard biomarker to evaluate patients with suspected ACS in the emergency setting.
Collapse
Affiliation(s)
- Mahesh Anantha Narayanan
- Division of Cardiovascular Disease, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Santiago Garcia
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN
| |
Collapse
|
35
|
Szczykowska J, Hryszko T, Naumnik B. Cardiac troponins in chronic kidney disease patients with special emphasis on their importance in acute coronary syndrome. Adv Med Sci 2019; 64:131-136. [PMID: 30641274 DOI: 10.1016/j.advms.2018.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 06/04/2018] [Accepted: 08/31/2018] [Indexed: 11/27/2022]
Abstract
Troponin measurement is one of crucial assessments facilitating diagnosis of acute coronary syndrome. Patients with chronic kidney disease are decimated by cardiovascular disease. Unfortunately, elevated concentration of serum troponin is commonly faced in clinical practice creating a challenge to rule out acute cardiac ischaemia in this vulnerable population. This review presents current knowlegde on analytical differences in troponin T and I measurements, their prognostic significance and their application in diagnosing acute coronary syndrome in chronic kidney disease patients. It also points out poorly known aspects and suggests directions for future research.
Collapse
Affiliation(s)
- Joanna Szczykowska
- 1st Department of Nephrology and Transplantation with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland.
| | - Tomasz Hryszko
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | - Beata Naumnik
- 1st Department of Nephrology and Transplantation with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| |
Collapse
|
36
|
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol 2018; 72:2231-2264. [PMID: 30153967 DOI: 10.1016/j.jacc.2018.08.1038] [Citation(s) in RCA: 2091] [Impact Index Per Article: 348.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
37
|
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Mickley H, Crea F, Van de Werf F, Bucciarelli-Ducci C, Katus HA, Pinto FJ, Antman EM, Hamm CW, De Caterina R, Januzzi JL, Apple FS, Alonso Garcia MA, Underwood SR, Canty JM, Lyon AR, Devereaux PJ, Zamorano JL, Lindahl B, Weintraub WS, Newby LK, Virmani R, Vranckx P, Cutlip D, Gibbons RJ, Smith SC, Atar D, Luepker RV, Robertson RM, Bonow RO, Steg PG, O’Gara PT, Fox KAA, Hasdai D, Aboyans V, Achenbach S, Agewall S, Alexander T, Avezum A, Barbato E, Bassand JP, Bates E, Bittl JA, Breithardt G, Bueno H, Bugiardini R, Cohen MG, Dangas G, de Lemos JA, Delgado V, Filippatos G, Fry E, Granger CB, Halvorsen S, Hlatky MA, Ibanez B, James S, Kastrati A, Leclercq C, Mahaffey KW, Mehta L, Müller C, Patrono C, Piepoli MF, Piñeiro D, Roffi M, Rubboli A, Sharma S, Simpson IA, Tendera M, Valgimigli M, van der Wal AC, Windecker S, Chettibi M, Hayrapetyan H, Roithinger FX, Aliyev F, Sujayeva V, Claeys MJ, Smajić E, Kala P, Iversen KK, El Hefny E, Marandi T, Porela P, Antov S, Gilard M, Blankenberg S, Davlouros P, Gudnason T, Alcalai R, Colivicchi F, Elezi S, Baitova G, Zakke I, Gustiene O, Beissel J, Dingli P, Grosu A, Damman P, Juliebø V, Legutko J, Morais J, Tatu-Chitoiu G, Yakovlev A, Zavatta M, Nedeljkovic M, Radsel P, Sionis A, Jemberg T, Müller C, Abid L, Abaci A, Parkhomenko A, Corbett S. Fourth universal definition of myocardial infarction (2018). Eur Heart J 2018; 40:237-269. [DOI: 10.1093/eurheartj/ehy462] [Citation(s) in RCA: 1047] [Impact Index Per Article: 174.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
38
|
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD. Fourth Universal Definition of Myocardial Infarction (2018). Glob Heart 2018; 13:305-338. [PMID: 30154043 DOI: 10.1016/j.gheart.2018.08.004] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
39
|
Affiliation(s)
- W A Parsonage
- Royal Brisbane & Women's Hospital, Brisbane, Qld, Australia
| | - L Ruane
- Royal Brisbane & Women's Hospital, Brisbane, Qld, Australia
| |
Collapse
|
40
|
Sandesara PB, O'Neal WT, Tahhan AS, Hayek SS, Lee SK, Khambhati J, Topel ML, Hammadah M, Alkhoder A, Ko YA, Gafeer MM, Beshiri A, Murtagh G, Kim JH, Wilson P, Shaw L, Epstein SE, Sperling LS, Quyyumi AA. Comparison of the Association Between High-Sensitivity Troponin I and Adverse Cardiovascular Outcomes in Patients With Versus Without Chronic Kidney Disease. Am J Cardiol 2018; 121:1461-1466. [PMID: 29628129 DOI: 10.1016/j.amjcard.2018.02.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/07/2018] [Accepted: 02/16/2018] [Indexed: 10/17/2022]
Abstract
It is unknown whether the association of high-sensitivity troponin I (hs-TnI) with adverse cardiovascular outcomes varies by the presence of chronic kidney disease (CKD). We examined the association of hs-TnI with adverse cardiovascular outcomes in those with and without CKD in 4,107 (mean age, 64 years; 63% men; 20% black) patients from the Emory Cardiovascular Biobank who underwent coronary angiography. CKD (n = 1,073) was defined as estimated glomerular filtration rate <60 ml/min/1.73 m2 or urine albumin/creatinine ratio >30 mg/g at baseline. Cox regression was used to compute hazard ratios (HR) for the association between hs-TnI levels (per doubling of hs-TnI: log2[hs-TnI] + 1) and death, cardiovascular death, and major adverse cardiac events (MACE), separately. Hs-TnI was a stronger predictor of death (CKD: HR 1.23, 95% confidence interval [CI] 1.15 to 1.31; no CKD: HR 1.11, 95% CI 1.05 to 1.17, p-interaction = 0.023), cardiovascular death (CKD: HR 1.24, 95% CI 1.14 to 1.34; no CKD: HR 1.15, 95% CI 1.07 to 1.22, p-interaction = 0.12), and MACE (CKD: HR 1.18, 95% CI 1.11 to 1.25; no CKD: HR 1.11, 95% CI 1.06 to 1.16, p-interaction = 0.095) in CKD compared with non-CKD. The association between hs-TnI and death in patients with CKD was stronger for patients without obstructive coronary artery disease (no obstructive coronary artery disease: HR 1.60, 95% CI 1.27 to 2.01; obstructive coronary artery disease: HR 1.19, 95% CI 1.11 to 1.27, p-interaction = 0.041). In conclusion, hs-TnI is a stronger predictor of adverse cardiovascular events in patients who have CKD than those without, even in the absence of obstructive coronary artery disease. Hs-TnI may identify CKD patients who are high risk for adverse cardiovascular outcomes in whom aggressive risk factor modification strategies are warranted.
Collapse
|
41
|
Chen M, Gerson H, Eintracht S, Nessim SJ, MacNamara E. Effect of Hemodialysis on Levels of High-Sensitivity Cardiac Troponin T. Am J Cardiol 2017; 120:2061-2064. [PMID: 29033047 DOI: 10.1016/j.amjcard.2017.08.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/25/2017] [Accepted: 08/08/2017] [Indexed: 10/18/2022]
Abstract
Cardiac troponin (cTn) is essential for the diagnosis of an acute coronary syndrome (ACS). However, in end-stage renal disease (ESRD) baseline cTn levels are often elevated, and it is unknown whether the hemodialysis (HD) procedure affects cTn levels. This leaves clinicians unsure of how to interpret cTn in HD patients with cardiac ischemia. We therefore sought to determine if plasma levels of high-sensitivity cardiac troponin T (hs-cTnT) vary during or after HD treatment. We prospectively enrolled 10 chronic HD patients who were admitted to our institution. All participants were receiving thrice weekly HD before admission and were medically stable. Those admitted for ACS or to critical care units were excluded. Baseline hs-cTnT was measured immediately before HD. For the subsequent 6 hours, hs-cTnT was measured every 2 hours and every 3 hours thereafter for a total collection period of 24 hours. A significant decline in mean hs-cTnT was noted with HD. During HD (2 hours after HD initiation), hs-cTnT decreased by 10.7% (confidence interval 5% to 17%). Immediately after HD (4 hours after HD initiation), a decline of 12% (confidence interval 5% to 19%) was observed. Thereafter hs-cTnT began to rise. Hs-cTnT levels returned to baseline by 11 hours after HD completion and remained stable for the reminder of the study. In conclusion, HD induces a short-lived negative bias in hs-cTnT. When measured for investigation of ACS, hs-cTnT concentration should be interpreted with respect to time of dialysis and specimen collection.
Collapse
|
42
|
Árnadóttir Á, Falk Klein C, Iversen K. Head-to-head comparison of cardiac troponin T and troponin I in patients without acute coronary syndrome: a systematic review. Biomarkers 2017; 22:701-708. [DOI: 10.1080/1354750x.2017.1335779] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | | | - Kasper Iversen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark
| |
Collapse
|
43
|
Garg P, Morris P, Fazlanie AL, Vijayan S, Dancso B, Dastidar AG, Plein S, Mueller C, Haaf P. Cardiac biomarkers of acute coronary syndrome: from history to high-sensitivity cardiac troponin. Intern Emerg Med 2017; 12:147-155. [PMID: 28188579 PMCID: PMC5329082 DOI: 10.1007/s11739-017-1612-1] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 01/18/2017] [Indexed: 12/21/2022]
Abstract
The role of cardiac troponins as diagnostic biomarkers of myocardial injury in the context of acute coronary syndrome (ACS) is well established. Since the initial 1st-generation assays, 5th-generation high-sensitivity cardiac troponin (hs-cTn) assays have been developed, and are now widely used. However, its clinical adoption preceded guidelines and even best practice evidence. This review summarizes the history of cardiac biomarkers with particular emphasis on hs-cTn. We aim to provide insights into using hs-cTn as a quantitative marker of cardiomyocyte injury to help in the differential diagnosis of coronary versus non-coronary cardiac diseases. We also review the recent evidence and guidelines of using hs-cTn in suspected ACS.
Collapse
Affiliation(s)
- Pankaj Garg
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - Paul Morris
- Cardiology and Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, S5 7AU, UK
- Department of Cardiovascular Science, University of Sheffield, Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Asma Lina Fazlanie
- Cardiology and Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, S5 7AU, UK
| | - Sethumadhavan Vijayan
- Cardiology and Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, S5 7AU, UK
| | - Balazs Dancso
- Cardiology and Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, S5 7AU, UK
| | | | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Philip Haaf
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK.
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
| |
Collapse
|
44
|
von Jeinsen B, Keller T. Strategies to overcome misdiagnosis of type 1 myocardial infarction using high sensitive cardiac troponin assays. Diagnosis (Berl) 2016. [DOI: 10.1515/dx-2016-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
High sensitive cardiac troponin assays have become the gold standard in the diagnosis of an acute type 1 myocardial infarction (MI) in the absence of ST-segment elevation. Several acute or chronic conditions that impact cardiac troponin levels in the absence of a MI might lead to a misdiagnosis of MI. For example, patients with impaired renal function as well as elderly patients often present with chronically increased cardiac troponin levels. Therefore, the diagnosis of MI type 1 based on the 99th percentile upper limit of normal threshold is more difficult in these patients. Different diagnostic approaches might help to overcome this limitation of reduced MI specificity of sensitive troponin assays. First, serial troponin measurement helps to differentiate chronic from acute troponin elevations. Second, specific diagnostic cut-offs, optimized for a particular patient group, like elderly patients, are able to regain specificity. Such an individualized use and interpretation of sensitive cardiac troponin measurements improves diagnostic accuracy and reduces the amount of misdiagnosed MI type 1.
Collapse
Affiliation(s)
- Beatrice von Jeinsen
- Department of Internal Medicine III, Division of Cardiology, Goethe University Frankfurt, Frankfurt, Germany
- German Centre for Cardiovascular Research (DZHK), Partnersite RheinMain, Frankfurt, Germany
| | - Till Keller
- Department of Internal Medicine III, Division of Cardiology, Goethe University Frankfurt, Frankfurt, Germany
- German Centre for Cardiovascular Research (DZHK), Partnersite RheinMain, Frankfurt, Germany
| |
Collapse
|
45
|
Landesberg G, Jaffe AS. 'Paradox' of troponin elevations after non-cardiac surgery. Br J Anaesth 2015; 114:863-5. [PMID: 25819027 DOI: 10.1093/bja/aev068] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- G Landesberg
- Department of Anesthesiology and Critical Care Medicine, Hadassah - Hebrew University Medical Center, Jerusalem 91120, Israel
| | - A S Jaffe
- Cardiovascular Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
46
|
Rahman A, Broadley SA. Review article: elevated troponin: diagnostic gold or fool's gold? Emerg Med Australas 2015; 26:125-30. [PMID: 24708000 DOI: 10.1111/1742-6723.12203] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2014] [Indexed: 11/30/2022]
Abstract
Troponin is a highly sensitive biomarker of myocardial injury and has been used extensively in everyday clinical practice in the community as well as in hospitals for the diagnosis of acute myocardial infarction (AMI) and for risk stratification of patients with acute coronary symptoms. Dynamic elevations in biomarkers (troponin) are considered fundamental to the diagnosis of AMI. Unfortunately, many clinical conditions can cause troponin elevation in the absence of myocardial ischaemia, and elevated levels sometimes pose a diagnostic dilemma. In some cases, inappropriate diagnosis of 'AMI' based primarily on a raised troponin can have a deleterious impact on an individual, including on driving, insurance and other medicolegal matters. An incorrect diagnosis of myocardial infarction can also lead to the oversight of serious life-threatening alternative causes of troponin elevation (e.g. pulmonary embolism). This article discusses the role of troponin in our everyday clinical practice in the ED.
Collapse
Affiliation(s)
- Atifur Rahman
- School of Medicine, Gold Coast Campus, Griffith University, Gold Coast, Queensland, Australia; Department of Cardiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | | |
Collapse
|
47
|
Bansal N, Hyre Anderson A, Yang W, Christenson RH, deFilippi CR, Deo R, Dries DL, Go AS, He J, Kusek JW, Lash JP, Raj D, Rosas S, Wolf M, Zhang X, Shlipak MG, Feldman HI. High-sensitivity troponin T and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and risk of incident heart failure in patients with CKD: the Chronic Renal Insufficiency Cohort (CRIC) Study. J Am Soc Nephrol 2014; 26:946-56. [PMID: 25278510 DOI: 10.1681/asn.2014010108] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
High-sensitivity troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) strongly predict heart failure (HF) in the general population. However, the interpretation of levels of these biomarkers as predictors of HF is uncertain among patients with CKD. Here, we investigated whether hsTnT and NT-proBNP are associated with incident HF among patients with CKD. In a prospective cohort analysis, we studied 3483 people with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study recruited from June of 2003 to August of 2008 who were free of HF at baseline. We used Cox regression to examine the association of baseline levels of hsTnT and NT-proBNP with incident HF after adjustment for demographic factors, traditional cardiovascular risk factors, markers of kidney disease, pertinent medication use, and mineral metabolism markers. At baseline, hsTnT levels ranged from ≤5.0 to 738.7 pg/ml, and NT-proBNP levels ranged from ≤5 to 35,000 pg/ml. Compared with those who had undetectable hsTnT, participants in the highest quartile (>26.5 pg/ml) had a significantly higher rate of HF (hazard ratio, 4.77; 95% confidence interval, 2.49 to 9.14). Similarly, compared with those in the lowest NT-proBNP quintile (<47.6 pg/ml), participants in the highest quintile (>433.0 pg/ml) experienced a substantially higher rate of HF (hazard ratio, 9.57; 95% confidence interval, 4.40 to 20.83) [corrected]. In conclusion, hsTnT and NT-proBNP were strongly associated with incident HF among a diverse cohort of individuals with mild to severe CKD. Elevations in these biomarkers may indicate subclinical changes in volume and myocardial stress that subsequently contribute to clinical HF.
Collapse
Affiliation(s)
| | | | - Wei Yang
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Rajat Deo
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Alan S Go
- Kaiser Permanente Northern California, Oakland, California
| | - Jiang He
- Tulane University, New Orleans, Louisiana
| | - John W Kusek
- National Institutes of Health, Bethesda, Maryland
| | | | - Dominic Raj
- The George Washington University, Washington, DC
| | - Sylvia Rosas
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Myles Wolf
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois; and
| | | | | | | |
Collapse
|
48
|
Independent value of cardiac troponin T and left ventricular global longitudinal strain in predicting all-cause mortality among stable hemodialysis patients with preserved left ventricular ejection fraction. BIOMED RESEARCH INTERNATIONAL 2014; 2014:217290. [PMID: 24895553 PMCID: PMC4033336 DOI: 10.1155/2014/217290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/05/2014] [Indexed: 01/23/2023]
Abstract
Using a speckle-tracking echocardiography (STE), we recently demonstrated that a left ventricular (LV) global longitudinal strain (GLS) ≥ -15% and the serum cardiac troponin T (cTnT) concentration are associated with mortality in stable hemodialysis patients with preserved LV ejection fraction (LVEF). In this study, we explored the relationship between cTnT and echocardiographic parameters and evaluated whether the prognostic value provided by cTnT is independent of a GLS ≥ -15% and vice versa. Eighty-eight stable hemodialysis patients with preserved LVEF were followed for 31 months. STE studies and measurements of cTnT were performed at baseline. CTnT concentration had a modest correlation with GLS (rs = 0.44; P < 0.001) but had a weak or nonsignificant correlation with other echocardiographic parameters. Adjusting for clinical parameters, hazard ratios for each increase of 0.01 ng/mL in cTnT, and a GLS ≥ -15% on mortality were 1.13 (P = 0.009) and 3.09 (P = 0.03) without significant interaction between cTnT and GLS ≥ -15%. In addition, an increased cTnT concentration, a GLS ≥ -15%, or their combination showed significant additional predictive value for mortality when included in models consisting of clinical parameters. Therefore, both cTnT and a GLS ≥ -15% are independent predictors of mortality and are useful for risk stratification.
Collapse
|
49
|
Farshid A, Pathak R, Shadbolt B, Arnolda L, Talaulikar G. Diastolic function is a strong predictor of mortality in patients with chronic kidney disease. BMC Nephrol 2013; 14:280. [PMID: 24359445 PMCID: PMC3878021 DOI: 10.1186/1471-2369-14-280] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 12/17/2013] [Indexed: 11/12/2022] Open
Abstract
Background Cardiovascular disease is a major cause of death in patients with stage 4–5 Chronic Kidney disease (CKD, eGFR < 30). There are only limited data on the risk factors predicting these complications in CKD patients. Our aim was to determine the role of clinical and echocardiographic parameters in predicting mortality and cardiovascular complications in CKD patients. Methods We conducted a prospective observational cohort study of 153 CKD patients between 2007 and 2009. All patients underwent echocardiography at baseline and were followed for a mean of 2.6 years using regular clinic visits and review of files and hospital presentations to record the incidence of cardiovascular events and death. Results Of 153 patients enrolled, 57 (37%) were on dialysis and 45 (78%) of these patients were on haemodialysis. An enlarged LV was present in 32% of patients and in 22% the LVEF was below 55%. LV mass index was increased in 75% of patients. Some degree of diastolic dysfunction was present in 85% of patients and 35% had grade 2 or higher diastolic dysfunction. During follow up 41 patients (27%) died, 15 (39%) from cardiovascular causes. Mortality was 24.0% in the non-dialysis patients versus 31.6% in patients on dialysis (p=ns). On multivariate analysis age >75 years, previous history of MI, diastolic dysfunction and detectable serum troponin T were significant independent predictor of mortality (P < 0.01). Conclusion Patients with stage 4–5 CKD had a mortality rate of 27% over a mean follow up of 2.6 years. Age >75 years, history of MI, diastolic dysfunction and troponin T were independent predictors of mortality.
Collapse
Affiliation(s)
- Ahmad Farshid
- Cardiology Unit, The Canberra Hospital, PO Box 11, Woden, ACT 2605, Australia.
| | | | | | | | | |
Collapse
|
50
|
Brandão J, Wong C, Kurotaki T, Johnson J, Mitchell M, Roy A, Pucheu-Haston C, Del Piero F, Tully T. Chronic dermatitis caused by Lactobacillus jensenii infection in a blue and gold macaw (Ara ararauna). J Am Vet Med Assoc 2013; 243:1030-4. [PMID: 24050571 DOI: 10.2460/javma.243.7.1030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
CASE DESCRIPTION A 5-year-old sexually intact female blue and gold macaw (Ara ararauna) was evaluated because of a swelling on the right side of the face and irritated area on the ventral aspect of the keel. CLINICAL FINDINGS Clinical findings were consistent with dermatitis (right facial lesion) and a coalescing subdermal granuloma (ventral keel lesion). Hematologic analysis revealed monocytosis and mild anemia. Histologic evaluation of the ventral keel lesion revealed evidence of chronic heterophilic dermatitis with multinucleated giant cells and bacterial rods and cocci. An unspeciated gram-positive rod-shaped bacterium was isolated via aerobic bacterial culture. Results of bacterial biochemical tests suggested the organism was a type of Actinomyces. A 16S rRNA gene sequence analysis was performed; results indicated the organism was Lactobacillus jensenii. TREATMENT AND OUTCOME Extensive surgical debridement of the branching granuloma, which extended throughout the length of the keel, followed by long-term treatment with ciprofloxacin and clindamycin provided full resolution of clinical signs. No recrudescence of clinical signs was evident for up to 18 months after the initial evaluation. CLINICAL RELEVANCE To the authors' knowledge, this is the first report of Lactobacillus-associated dermatitis or subdermal granuloma in the scientific literature and the second report of L jensenii in avian species. Use of 16S rRNA gene sequence analysis was instrumental in the identification of this fastidious organism, indicating the method's usefulness as a diagnostic tool.
Collapse
Affiliation(s)
- João Brandão
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803
| | | | | | | | | | | | | | | | | |
Collapse
|