1
|
Patel B, Omeh J, Tackling G, Gupta R, Sahadeo T, Villcant V, Dussie T, Atnas M, Hai O, Zeltser R, Makaryus AN. The Clinical Association between Carbon Monoxide Poisoning and Myocardial Injury as Measured by Elevated Troponin I Levels. J Clin Med 2023; 12:5529. [PMID: 37685595 PMCID: PMC10488441 DOI: 10.3390/jcm12175529] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Carbon monoxide (CO) poisoning accounts for over 50,000 estimated emergency room visits and approximately 1200 deaths per year in the US. Despite the high prevalence, there is a paucity of data looking at the association between laboratory biomarkers and clinical outcomes. Our study investigates the association between myocardial injury as assessed by increased troponin levels and its effect on in-hospital outcomes in CO poisoning. A total of 900 sequential charts of patients presenting with CO poisoning between 1 January 2012, and 31 August 2019, at our tertiary center with regional hyperbaric chamber and burn unit, were reviewed. Of the 900, a total of 488 patients had elevated carboxyhemoglobin levels. Of these 488 patients, 119 (24.4%) also had blood troponin levels measured. Patients were stratified based on the presence or absence of myocardial injury as evidenced by highly sensitive serum troponin I (TnI) level > 0.5 ng/mL to determine if a correlation exists relating to myocardial injury and risk of major adverse events. Mean age was 51.2 years, 58.8% were males, 35.3% were non-White, and 10.1% were intentional CO poisonings. Comorbidities included hypertension: 37%, diabetes: 21%, smoking: 21%, hyperlipidemia: 17.6%, coronary artery disease: 11.8%, asthma: 5.9%, heart failure: 5%, atrial fibrillation: 4.2%, and chronic obstructive pulmonary disease: 4.2%. Myocardial injury occurred in 22 patients (18.5%) and was associated with increased likelihood of requiring intensive care admission (54.5% vs. 20.6%, p = 0.002) and intubation (40.9% vs. 14.4%, p = 0.008). TnI elevation was associated with higher in-hospital mortality (p = 0.008, OR 21.3) compared to patients without TnI elevation. Older age was independently associated with increased in-hospital mortality (p = 0.03, OR 1.08). When controlling for age, in-hospital mortality remained statistically significant (p = 0.01, OR 21.37). No significant difference was found with respect to age, comorbidities, gender, race, ethnicity, or hospital length of stay in patients with and without myocardial injury. Myocardial injury induced by CO exposure occurs frequently and adversely affects clinical outcomes. Further research is needed to help guide physicians in the management of CO poisoning and associated myocardial injury to improve patient outcomes.
Collapse
Affiliation(s)
- Bhakti Patel
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Jideofor Omeh
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Gary Tackling
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Rohun Gupta
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Tiffany Sahadeo
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Viliane Villcant
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Tashina Dussie
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Mirette Atnas
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Ofek Hai
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Roman Zeltser
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Amgad N. Makaryus
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| |
Collapse
|
2
|
Assessment of left ventricle myocardial deformation in a hemorrhagic shock swine model by two-dimensional speckle tracking echocardiography. J Trauma Acute Care Surg 2022; 93:838-845. [PMID: 35393381 DOI: 10.1097/ta.0000000000003644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Trauma-induced secondary cardiac injury has been associated with significant adverse cardiovascular events. Speckle tracking echocardiography is a novel technology that allows an accurate and reproducible cardiac structure and function assessment. We evaluated the left ventricle (LV) myocardial deformation by speckle tracking echocardiography in a hemorrhagic shock (HS) swine model. METHODS Seven healthy male Landrace pigs were included in this study. Severe HS was reached through three sequentially blood withdraws of 20% of estimated blood volume, and it was maintained for 60 minutes. Volume resuscitation was performed using all precollected blood volume. A 1.8- to 4.2-MHz phased-array transducer was used to acquire the two-dimensional echocardiography images. Strain measurements were obtained semiautomatically by wall motion tracking software. Results are presented as medians and interquartile ranges and compared using Wilcoxon rank-sum test. A p value of <0.05 was considered statistically significant. RESULTS The median weight was 32 (26.1-33) kg, and the median total blood volume withdrawn was 1,100 (1,080-1,190) mL. During the severe HS period, the median arterial systemic pressure was 39 (36-46) mm Hg, and the cardiac index was 1.7 (1.6-2.0) L/min/m 2 . There was statistically significant absolute decrease in the global longitudinal strain 2 hours postresuscitation comparing with the basal measurements (-9.6% [-10.7 to -8.0%] vs. -7.9% [-8.1 to -7.4%], p = 0.03). There were no statistically significant differences between the basal and 2 hours postresuscitation assessments in the invasive/noninvasive hemodynamic, other two-dimensional echocardiogram (LV ejection fraction, 49.2% [44-54.3%] vs. 53.2% [51.5-55%]; p = 0.09), and circumferential strain (-10.6% [-14.4 to -9.0%] vs. -8.5% [-8.6 to -5.2%], p = 0.06) parameters. CONCLUSION In this experimental swine model of controlled HS, LV global longitudinal strain analysis accurately characterizes the timing and magnitude of subclinical cardiac dysfunction associated with trauma-induced secondary cardiac injury.
Collapse
|
3
|
Kumar M, Patil S, Godoy LDC, Kuo CL, Swede H, Kuchel GA, Chen K. Demand Ischemia as a Predictor of Mortality in Older Patients With Delirium. Front Cardiovasc Med 2022; 9:917252. [PMID: 35734279 PMCID: PMC9207259 DOI: 10.3389/fcvm.2022.917252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe impact of demand ischemia on clinical outcomes in patients with delirium remains largely unexplored. This study aims to evaluate the effects of demand ischemia in older patients with delirium on in-hospital mortality and length of stay (LOS) using the largest US inpatient care database, National Inpatient Sample (NIS).MethodsWe obtained data from the year 2010 to 2014 National Inpatient Sample (NIS). We used the International Classification of Diseases-Ninth Edition-Clinical Modification (ICD-9-CM) diagnosis codes to identify all the records with a primary or secondary diagnosis of delirium with or without demand ischemia and other clinical characteristics. We then compared in-hospital mortality and length of stay (LOS) in patients with and without demand ischemia.ResultsWe analyzed 232,137 records. Patients with demand ischemia had higher overall in-hospital mortality than those without demand ischemia (28 vs. 12%, p < 0.001). After adjusting for clinical comorbidities and complications, demand ischemia was no longer associated with increased in-hospital mortality (OR: 1.14; 95% CI: 0.96–1.35; p = 0.141). However, further analysis with the exclusion of critically ill patients with non-cardiogenic shock or mechanical ventilation showed a significant association of demand ischemia with increased in-hospital mortality (adjusted OR: 1.39; 95% CI: 1.13–1.71; p = 0.002). Among non-critically ill survivors, patients with demand ischemia had a longer median LOS [4, (3–7) days] than those without demand ischemia [4, (2–6) days] (p < 0.001). However, the difference was not statistically significant after adjustment for covariates.Conclusion/RelevanceDemand ischemia did not affect mortality in critically sick patients. In non-critically ill patients, however, demand ischemia was significantly associated with increased in-hospital mortality, likely due to the severity of the underlying acute illness. Measures aimed at mitigating risk factors that contribute to delirium and/or demand ischemia need to be explored.
Collapse
Affiliation(s)
- Manish Kumar
- Department of Medicine, Pat and Jim Calhoun Cardiology Center, University of Connecticut, Farmington, CT, United States
| | - Shivaraj Patil
- Department of Internal Medicine, University of Connecticut, Farmington, CT, United States
| | - Lucas Da Cunha Godoy
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT, United States
| | - Chia-Ling Kuo
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT, United States
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, United States
- UConn Center of Aging, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Helen Swede
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, United States
| | - George A. Kuchel
- UConn Center of Aging, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Kai Chen
- Department of Medicine, Pat and Jim Calhoun Cardiology Center, University of Connecticut, Farmington, CT, United States
- *Correspondence: Kai Chen
| |
Collapse
|
4
|
Canei DH, Pereira ME, de Freitas MN, Trevisan YPA, Zorzo C, Bortolini J, Mendonça AJ, Sousa VRF, Ferreira de Almeida ADBP. Biochemical, electrolytic, and cardiovascular evaluations in cats with urethral obstruction. Vet World 2021; 14:2002-2008. [PMID: 34566314 PMCID: PMC8448651 DOI: 10.14202/vetworld.2021.2002-2008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background and Aim: Urethral obstruction (UO) is a common condition in feline medicine. Severe acid-base and electrolyte disorders promote relevant electrocardiographic changes in these animals. Cardiac biomarkers such as cardiac troponin I have been shown to be useful in identifying cats with myocardial disease, but it has not been investigated whether UO leads to myocardial damages. This study aimed to evaluate biochemical changes, electrocardiographic findings, troponin I measurements, and electrolyte disturbances for 7 days in cats with UO. Materials and Methods: This follow-up prospective study included 33 cats diagnosed with UO for 7 days. For all cats, clinical examination, serum biochemistry, electrolyte analyses, blood pressure, and electrocardiography were performed. Cardiac troponin I was measured in the serum in 16 cats at 3 different times. Results: The mean age of the feline population was 1.83±1.58 years (mean±standard deviation). Creatinine, urea, blood urea nitrogen, glucose, phosphorus, base excess, bicarbonate, and serum potassium decreased significantly (p≤0.05), while ionic calcium and blood pH increased significantly (p≤0.05) at different times. Electrocardiographic abnormalities were observed in 21/33 (63.63%) of the felines on admission day. The electrocardiographic abnormalities were no longer observed on the subsequent days. Only one feline showed changes in troponin I cardiac concentrations. Conclusion: This study suggests the sum and severity of electrolyte abnormalities aggravate the clinical and cardiovascular status of these patients. However, cTnI, blood pressure, and heart rate within the reference range do not exclude the presence of major cardiovascular and metabolic abnormalities. The hyperglycemia in felines with UO appears to be associated with decreased renal clearance, which may reflect the severity of hyperkalemia and azotemia. The metabolic and cardiovascular changes of these felines are minimized by the establishment of appropriate intensive care; however, cardiac and blood gas monitoring is essential to assess the severity of the disease.
Collapse
Affiliation(s)
- Darlan Henrique Canei
- Program of Postgraduate in Veterinary Sciences, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - Mato Grosso, Brazil
| | - Mariana Elisa Pereira
- Program of Postgraduate in Veterinary Sciences, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - Mato Grosso, Brazil
| | - Maria Natália de Freitas
- Scientific Initiation Volunteer (CNPq), Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - Mato Grosso, Brazil
| | - Yolanda Paim Arruda Trevisan
- Program of Postgraduate in Veterinary Sciences, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - Mato Grosso, Brazil
| | - Carolina Zorzo
- Program of Postgraduate in Veterinary Sciences, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - Mato Grosso, Brazil
| | - Juliano Bortolini
- Department of Statistics, Federal University of Mato Grosso, Cuiabá - MT, Brazil
| | - Adriane Jorge Mendonça
- Veterinary Hospital, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - Mato Grosso, Brazil
| | - Valéria Régia Franco Sousa
- Veterinary Hospital, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - Mato Grosso, Brazil
| | | |
Collapse
|
5
|
Calvo-Fernández A, Izquierdo A, Subirana I, Farré N, Vila J, Durán X, García-Guimaraes M, Valdivielso S, Cabero P, Soler C, García-Ribas C, Rodríguez C, Llagostera M, Mojón D, Vicente M, Solé-González E, Sánchez-Carpintero A, Tevar C, Marrugat J, Vaquerizo B. Markers of myocardial injury in the prediction of short-term COVID-19 prognosis. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:576-583. [PMID: 33153955 PMCID: PMC7522647 DOI: 10.1016/j.rec.2020.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/14/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES COVID-19 is currently causing high mortality and morbidity worldwide. Information on cardiac injury is scarce. We aimed to evaluate cardiovascular damage in patients with COVID-19 and determine the correlation of high-sensitivity cardiac-specific troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) with the severity of COVID-19. METHODS We included 872 consecutive patients with confirmed COVID-19 from February to April 2020. We tested 651 patients for high-sensitivity troponin T (hs-TnT) and 506 for NT-proBNP on admission. Cardiac injury was defined as hs-TnT> 14ng/L, the upper 99th percentile. Levels of NT-proBNP> 300 pg/mL were considered related to some extent of cardiac injury. The primary composite endpoint was 30-day mortality or mechanical ventilation (MV). RESULTS Cardiac injury by hs-TnT was observed in 34.6% of our COVID-19 patients. Mortality or MV were higher in cardiac injury than noncardiac injury patients (39.1% vs 9.1%). Hs-TnT and NT-proBNP levels were independent predictors of death or MV (HR, 2.18; 95%CI, 1.23-3.83 and 1.87 (95%CI, 1.05-3.36), respectively) and of mortality alone (HR, 2.91; 95%CI, 1.211-7.04 and 5.47; 95%CI, 2.10-14.26, respectively). NT-ProBNP significantly improved the troponin model discrimination of mortality or MV (C-index 0.83 to 0.84), and of mortality alone (C-index 0.85 to 0.87). CONCLUSIONS Myocardial injury measured at admission was a common finding in patients with COVID-19. It reliably predicted the occurrence of mortality and need of MV, the most severe complications of the disease. NT-proBNP improved the prognostic accuracy of hs-TnT.
Collapse
Affiliation(s)
- Alicia Calvo-Fernández
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Andrea Izquierdo
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Isaac Subirana
- Centro de Investigaciones Biomédicas en Red Epidemiología y Salud Pública (CIBERESP), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Epidemiología y Genética Cardiovascular, Grupo REGICOR, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, Spain
| | - Nuria Farré
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Joan Vila
- Epidemiología y Genética Cardiovascular, Grupo REGICOR, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Xavier Durán
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, Spain
| | - Marcos García-Guimaraes
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | | | - Paula Cabero
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Cristina Soler
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | | | | | | | - Diana Mojón
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Miren Vicente
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | | | - Andrea Sánchez-Carpintero
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, Spain
| | - Cristina Tevar
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Jaume Marrugat
- Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Investigaciones Biomédicas en Red Epidemiología y Salud Pública (CIBERESP), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Epidemiología y Genética Cardiovascular, Grupo REGICOR, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, Spain
| | - Beatriz Vaquerizo
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain.
| |
Collapse
|
6
|
Calvo-Fernández A, Izquierdo A, Subirana I, Farré N, Vila J, Durán X, García-Guimaraes M, Valdivielso S, Cabero P, Soler C, García-Ribas C, Rodríguez C, Llagostera M, Mojón D, Vicente M, Solé-González E, Sánchez-Carpintero A, Tevar C, Marrugat J, Vaquerizo B. [Markers of myocardial injury in the prediction of short-term COVID-19 prognosis]. Rev Esp Cardiol 2021; 74:576-583. [PMID: 33262553 PMCID: PMC7691144 DOI: 10.1016/j.recesp.2020.09.017] [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: 06/29/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES COVID-19 is currently causing high mortality and morbidity worldwide. Information on cardiac injury is scarce. We aimed to evaluate cardiovascular damage in patients with COVID-19 and determine the correlation of high-sensitivity cardiac-specific troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) with the severity of COVID-19. METHODS We included 872 consecutive patients with confirmed COVID-19 from February to April 2020. We tested 651 patients for high-sensitivity troponin T (hs-TnT) and 506 for NT-proBNP on admission. Cardiac injury was defined as hs-TnT > 14 ng/L, the upper 99th percentile. Levels of NT-proBNP > 300 pg/mL were considered related to some extent of cardiac injury. The primary composite endpoint was 30-day mortality or mechanical ventilation (MV). RESULTS Cardiac injury by hs-TnT was observed in 34.6% of our COVID-19 patients. Mortality or MV were higher in cardiac injury than noncardiac injury patients (39.1% vs 9.1%). Hs-TnT and NT-proBNP levels were independent predictors of death or MV (HR, 2.18; 95%CI, 1.23-3.83 and 1.87 (95%CI, 1.05-3.36), respectively) and of mortality alone (HR, 2.91; 95%CI, 1.211-7.04 and 5.47; 95%CI, 2.10-14.26, respectively). NT-ProBNP significantly improved the troponin model discrimination of mortality or MV (C-index 0.83 to 0.84), and of mortality alone (C-index 0.85 to 0.87). CONCLUSIONS Myocardial injury measured at admission was a common finding in patients with COVID-19. It reliably predicted the occurrence of mortality and need of MV, the most severe complications of the disease. NT-proBNP improved the prognostic accuracy of hs-TnT.
Collapse
Affiliation(s)
- Alicia Calvo-Fernández
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
- Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España
| | - Andrea Izquierdo
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
- Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España
| | - Isaac Subirana
- Centro de Investigaciones Biomédicas en Red Epidemiología y Salud Pública (CIBERESP), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
- Epidemiología y Genética Cardiovascular, Grupo REGICOR, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, España
| | - Nuria Farré
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
- Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, España
- Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - Joan Vila
- Epidemiología y Genética Cardiovascular, Grupo REGICOR, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - Xavier Durán
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, España
| | - Marcos García-Guimaraes
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
- Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | | | - Paula Cabero
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, España
- Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - Cristina Soler
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, España
- Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | | | - Clara Rodríguez
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
| | - Marc Llagostera
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
| | - Diana Mojón
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
| | - Miren Vicente
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
| | | | - Andrea Sánchez-Carpintero
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, España
| | - Cristina Tevar
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
| | - Jaume Marrugat
- Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España
- Centro de Investigaciones Biomédicas en Red Epidemiología y Salud Pública (CIBERESP), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
- Epidemiología y Genética Cardiovascular, Grupo REGICOR, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, España
| | - Beatriz Vaquerizo
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
- Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, España
- Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| |
Collapse
|
7
|
Chuang A(MY, Nguyen MT, Khan E, Jones D, Horsfall M, Lehman S, Smilowitz NR, Lambrakis K, Than M, Vaile J, Sinhal A, French JK, Chew DP. Troponin elevation pattern and subsequent cardiac and non-cardiac outcomes: Implementing the Fourth Universal Definition of Myocardial Infarction and high-sensitivity troponin at a population level. PLoS One 2021; 16:e0248289. [PMID: 33711079 PMCID: PMC7954292 DOI: 10.1371/journal.pone.0248289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/23/2021] [Indexed: 01/19/2023] Open
Abstract
Background The Fourth Universal Definition of Myocardial Infarction (MI) differentiates MI from myocardial injury. We characterised the temporal course of cardiac and non-cardiac outcomes associated with MI, acute and chronic myocardial injury. Methods We included all patients presenting to public emergency departments in South Australia between June 2011–Sept 2019. Episodes of care (EOCs) were classified into 5 groups based on high-sensitivity troponin-T (hs-cTnT) and diagnostic codes: 1) Acute MI [rise/fall in hs-cTnT and primary diagnosis of acute coronary syndrome], 2) Acute myocardial injury with coronary artery disease (CAD) [rise/fall in hs-cTnT and diagnosis of CAD], 3) Acute myocardial injury without CAD [rise/fall in hs-cTnT without diagnosis of CAD], 4) Chronic myocardial injury [elevated hs-cTnT without rise/fall], and 5) No myocardial injury. Multivariable flexible parametric models were used to characterize the temporal hazard of death, MI, heart failure (HF), and ventricular arrhythmia. Results 372,310 EOCs (218,878 individuals) were included: acute MI (19,052 [5.12%]), acute myocardial injury with CAD (6,928 [1.86%]), acute myocardial injury without CAD (32,231 [8.66%]), chronic myocardial injury (55,056 [14.79%]), and no myocardial injury (259,043 [69.58%]). We observed an early hazard of MI and HF after acute MI and acute myocardial injury with CAD. In contrast, subsequent MI risk was lower and more constant in patients with acute injury without CAD or chronic injury. All patterns of myocardial injury were associated with significantly higher risk of all-cause mortality and ventricular arrhythmia. Conclusions Different patterns of myocardial injury were associated with divergent profiles of subsequent cardiac and non-cardiac risk. The therapeutic approach and modifiability of such excess risks require further research.
Collapse
Affiliation(s)
- Anthony (Ming-yu) Chuang
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
- * E-mail:
| | - Mau T. Nguyen
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Ehsan Khan
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Dylan Jones
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Matthew Horsfall
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
| | - Sam Lehman
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Nathaniel R. Smilowitz
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York City, New York, United States of America
| | - Kristina Lambrakis
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Martin Than
- Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand
| | - Julian Vaile
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Ajay Sinhal
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - John K. French
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
- Western Sydney University, Sydney, Australia
| | - Derek P. Chew
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| |
Collapse
|
8
|
Park SH, Kim T, Cha WC, Yoon H, Hwang SY, Shin TG, Sim MS, Jo I, Lee S, Park H, Choi J. Cardiac troponin I predicts clinical outcome of patients with cancer at emergency department. Clin Cardiol 2020; 43:1585-1591. [PMID: 33085130 PMCID: PMC7724208 DOI: 10.1002/clc.23486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/01/2020] [Accepted: 10/12/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The prognostic ability of cardiac troponin I (TnI) has been demonstrated in general populations and among cardiovascular disease patients, but it has not been evaluated in cancer patients. HYPOTHESIS This study assumes to have the prognostic ability of cardiac troponin in cancer patients visiting the emergency department. METHODS Cancer patients visiting the emergency department were enrolled in this retrospective cohort study. Patients with previously known coronary artery disease or clinically indicated coronary angiography were not included. The maximal value from Siemens ADVIA Centaur troponin I Ultra assay within 24 hours was assessed. The primary endpoint was 180-day all-cause death, including cardiovascular and noncardiovascular death. RESULTS A total of 9135 cancer patients (mean age: 63 years, male gender: 60%) were enrolled. Lowest (0.006 ng/mL), assay-specific <99th % (0.007-0.039 ng/mL), below median ≥ 99th % (0.040-0.129 ng/mL), and above median ≥ 99th % (≥0.130 ng/mL) TnI were found in 4487 (49.1%), 3158 (34.6%), 852 (9.3%), and 638 (7.0%) patients, respectively. There was 3192 (34.9%) all-cause deaths including 137 (1.5%) cardiovascular and 3047 (33.4%) noncardiovascular deaths in the 180-day follow-up period. The risks of all-cause, cardiovascular, and noncardiovascular death increased across higher TnI strata (hazard ratio [HR] = 1.3-2.9; 2.1-9.3; 1.3-1.8; P < .001, all). These findings were consistent within clinical subgroups including solid and hematologic cancers. CONCLUSIONS Cancer patients visiting the emergency department with elevated troponin I were at increased risk of 180-day death. Cancer patients with elevated TnI may need additional evaluation or careful follow-up even without cardiovascular disease diagnosis.
Collapse
Affiliation(s)
- Soo Hyun Park
- Department of Medicine, Graduate SchoolKyung Hee UniversitySeoulSouth Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Won Cul Cha
- Department of Emergency Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - IkJoon Jo
- Department of Emergency Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Seung‐Hwa Lee
- Department of MedicineSamsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Hyung‐Doo Park
- Department of Laboratory Medicine and GeneticsSamsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Jin‐Ho Choi
- Department of Emergency Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| |
Collapse
|
9
|
Ribeiro ACS, da Conceição ÂI, Soares GSL, Correia FR, de Oliveira-Filho JP, Soares PC, de Mendonça CL, Afonso JAB. Hemogasometry, cardiac biomarkers and blood metabolites in goats with experimentally induced acute ruminal lactic acidosis. Small Rumin Res 2020. [DOI: 10.1016/j.smallrumres.2020.106187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
10
|
Petros S, Weidhase L. [Laboratory testing in intensive care medicine]. Med Klin Intensivmed Notfmed 2020; 115:539-544. [PMID: 32880671 DOI: 10.1007/s00063-020-00730-y] [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: 07/19/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
Despite the tremendous technological developments in medicine, careful history-taking and clinical examination remain the cornerstones of diagnostics. Numerous laboratory tests are ordered in intensive care and emergency medicine. The rate of overutilization of these tests during initial patient admission is almost 50%. Patient history may be frequently insufficient for conducting targeted laboratory testing, and concern about not overlooking a pathology also contributes to laboratory test overutilization. On the other hand, laboratory test profiles are frequently defined a priori to simplify the management process. However, these profiles are commonly based on symptoms rather than on a suspected diagnosis. Several laboratory variables are outside the normal range in critically ill patients. However, normal ranges are defined on the basis of data from healthy subjects, and these do not allow for a clear distinction between stress adaptation and clinically relevant changes that require correction. Pathophysiological changes due to the acute injury in critically ill patients and the reaction of the organism to the injury or even to the treatment itself can lead to changes in laboratory values. Untargeted laboratory tests contribute to iatrogenic anemia and increased costs. The results of such tests are either hardly noticed or, in the worst case, lead to further unnecessary diagnostic steps and unjustified therapeutic measures. Point-of-care laboratory tests, including blood gas analysis, blood count, serum electrolytes, and lactate, to assess the patient's homeostatic state and laboratory data for the relevant critical care scores are uniformly required. Beyond that, every laboratory test should be chosen wisely based on a concrete clinical question.
Collapse
Affiliation(s)
- S Petros
- Interdisziplinäre Internistische Intensivmedizin, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland. .,Medizinische Klinik 1, Bereich Hämostaseologie, Universitätsklinikum Leipzig, Leipzig, Deutschland.
| | - L Weidhase
- Interdisziplinäre Internistische Intensivmedizin, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| |
Collapse
|
11
|
Cecconi M, Piovani D, Brunetta E, Aghemo A, Greco M, Ciccarelli M, Angelini C, Voza A, Omodei P, Vespa E, Pugliese N, Parigi TL, Folci M, Danese S, Bonovas S. Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy. J Clin Med 2020; 9:jcm9051548. [PMID: 32443899 PMCID: PMC7290833 DOI: 10.3390/jcm9051548] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 01/08/2023] Open
Abstract
We described features of hospitalized Covid-19 patients and identified predictors of clinical deterioration. We included patients consecutively admitted at Humanitas Research Hospital (Rozzano, Milan, Italy); retrospectively extracted demographic; clinical; laboratory and imaging findings at admission; used survival methods to identify factors associated with clinical deterioration (defined as intensive care unit (ICU) transfer or death), and developed a prognostic index. Overall; we analyzed 239 patients (29.3% females) with a mean age of 63.9 (standard deviation [SD]; 14.0) years. Clinical deterioration occurred in 70 patients (29.3%), including 41 (17.2%) ICU transfers and 36 (15.1%) deaths. The most common symptoms and signs at admission were cough (77.8%) and elevated respiratory rate (34.1%), while 66.5% of patients had at least one coexisting medical condition. Imaging frequently revealed ground-glass opacity (68.9%) and consolidation (23.8%). Age; increased respiratory rate; abnormal blood gas parameters and imaging findings; coexisting coronary heart disease; leukocytosis; lymphocytopenia; and several laboratory parameters (elevated procalcitonin; interleukin-6; serum ferritin; C-reactive protein; aspartate aminotransferase; lactate dehydrogenase; creatinine; fibrinogen; troponin-I; and D-dimer) were significant predictors of clinical deterioration. We suggested a prognostic index to assist risk-stratification (C-statistic; 0.845; 95% CI; 0.802–0.887). These results could aid early identification and management of patients at risk, who should therefore receive additional monitoring and aggressive supportive care.
Collapse
Affiliation(s)
- Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
- Correspondence: ; Tel.: +39-34-0366-5193
| | - Enrico Brunetta
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Massimiliano Greco
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Michele Ciccarelli
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Claudio Angelini
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Paolo Omodei
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Edoardo Vespa
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Nicola Pugliese
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Tommaso Lorenzo Parigi
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Marco Folci
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| |
Collapse
|
12
|
Vafaie M, Stoyanov KM, Giannitsis E. [Diagnosis of myocardial infarction in critically ill, ventilated patients]. Med Klin Intensivmed Notfmed 2019; 114:290-296. [PMID: 30923853 DOI: 10.1007/s00063-019-0572-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/20/2019] [Accepted: 03/04/2019] [Indexed: 11/25/2022]
Abstract
Elevated cardiac troponin values are frequently observed in critically ill patients. These are often not due to myocardial infarction (MI) but caused by various other etiologies of myocardial injury. Understanding the etiology of any troponin elevation is of enormous importance for management and therapy. According to the fourth version of the Universal Definition of MI, myocardial injury is present if at least one troponin value is above the 99th percentile upper reference limit and considered acute, when a rise and/or fall occurs. Patients with acute MI are a subgroup of patients with acute myocardial injury, who present in an ischemic clinical context. Variables defining the clinical criteria of MI include symptoms of ischemia, presumably new electrocardiographic (ECG) changes or imaging evidence of new loss of viable myocardium or regional wall motion abnormalities, or detection of an intracoronary thrombus. In critically ill or mechanically ventilated patients, the diagnosis of MI is challenging due to limitations in history taking, co-existence of comorbidities, overlapping symptoms and equivocal or unspecific ECG changes. This article presents the diagnostic criteria of the Universal MI definition, discusses subtypes of MI and focuses on various differential diagnoses. Furthermore, implications of diagnosis of MI in critically ill patients, especially regarding the use of ECG and troponin assays, are discussed.
Collapse
Affiliation(s)
- M Vafaie
- Medizinische Klinik III, Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
| | - K M Stoyanov
- Medizinische Klinik III, Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
| | - E Giannitsis
- Medizinische Klinik III, Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
| |
Collapse
|