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Ali F, Arshad K, Szpunar S, Daher E. Elevated Troponins and Diagnosis of Non-ST-Elevation Myocardial Infarction in the Emergency Department. Cureus 2024; 16:e59910. [PMID: 38854192 PMCID: PMC11161129 DOI: 10.7759/cureus.59910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
Background In the emergency department (ED), the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) is primarily based on the presence or absence of elevated cardiac troponin levels, ECG changes, and clinical presentation. However, limited data exist regarding the incidence, clinical characteristics, and predictive value of different cardiac diagnostic tests and outcomes in patients with non-acute coronary syndrome (ACS)-related troponin elevation. Our study aimed to determine the percentage of patients with elevated troponin levels who had true ACS and identify various risk factors associated with true ACS in these patients. Methodology This was a single-center retrospective study. We performed a chart review of patients who presented to the ED from January 1, 2016, to December 31, 2017, and were admitted to the hospital with an elevated cardiac troponin I level in the first 12 hours after ED presentation with a diagnosis of NSTEMI. True ACS was defined as (a) patients with typical symptoms of ischemia and ECG ischemic changes and (b) patients with atypical symptoms of myocardial ischemia or without symptoms of ischemia and new segmental wall motion abnormalities on echocardiogram or evidence of culprit lesion on angiography. A logistic regression model was used to determine the association between risk factors and true ACS. Results A total of 204 patients were included in this study. The mean age of the study group was 67.4 ± 14.5 years; 53.4% (n = 109) were male, and 57.4% (n = 117) were Caucasian. In our study, 51% of patients were found to have true ACS, and the remaining 49% had a non-ACS-related elevation in troponins. Most patients without ACS had alternate explanations for elevated troponin levels. The presence of chest pain (odds ratio (OR) = 3.7, 95% confidence interval (CI) = 1.8-7.7, p = 0.001), tobacco smoking (OR = 4, 95% CI = 1.06-3.8, p = 0.032), and wall motion abnormalities on echocardiogram (OR = 3.8, 95% CI = 1.8-6.5, p = 001) were associated with increased risk of true ACS in patients with elevated troponins. Conclusions Cardiac troponin levels can be elevated in hospitalized patients with various medical conditions, in the absence of ACS. The diagnosis of ACS should not be solely based on elevated troponin levels, as it can lead to expensive workup and utilization of hospital resources.
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Affiliation(s)
- Farman Ali
- Medicine, Ascension St. John Hospital and Medical Center, Detroit, USA
| | - Khurram Arshad
- Internal Medicine, Corewell Health East Dearborn, Dearborn, USA
| | - Susan Szpunar
- Biomedical Investigations and Research, Ascension St. John Hospital and Medical Center, Detroit, USA
| | - Edouard Daher
- Cardiology, Ascension St. John Hospital and Medical Center, Detroit, USA
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Maayah M, Grubman S, Allen S, Ye Z, Park DY, Vemmou E, Gokhan I, Sun WW, Possick S, Kwan JM, Gandhi PU, Hu JR. Clinical Interpretation of Serum Troponin in the Era of High-Sensitivity Testing. Diagnostics (Basel) 2024; 14:503. [PMID: 38472975 DOI: 10.3390/diagnostics14050503] [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: 01/01/2024] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 03/14/2024] Open
Abstract
Cardiac troponin (Tn) plays a central role in the evaluation of patients with angina presenting with acute coronary syndrome. The advent of high-sensitivity assays has improved the analytic sensitivity and precision of serum Tn measurement, but this advancement has come at the cost of poorer specificity. The role of clinical judgment is of heightened importance because, more so than ever, the interpretation of serum Tn elevation hinges on the careful integration of findings from electrocardiographic, echocardiographic, physical exam, interview, and other imaging and laboratory data to formulate a weighted differential diagnosis. A thorough understanding of the epidemiology, mechanisms, and prognostic implications of Tn elevations in each cardiac and non-cardiac etiology allows the clinician to better distinguish between presentations of myocardial ischemia and myocardial injury-an important discernment to make, as the treatment of acute coronary syndrome is vastly different from the workup and management of myocardial injury and should be directed at the underlying cause.
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Affiliation(s)
- Marah Maayah
- Yale School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Scott Grubman
- Yale School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Stephanie Allen
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Zachary Ye
- Department of Internal Medicine, Temple University Medical Center, Philadelphia, PA 19140, USA
| | - Dae Yong Park
- Department of Internal Medicine, Cook County Hospital, Chicago, IL 60612, USA
| | - Evangelia Vemmou
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Ilhan Gokhan
- Yale School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Wendy W Sun
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Stephen Possick
- Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Jennifer M Kwan
- Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Parul U Gandhi
- Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, CT 06520, USA
- Department of Cardiology, Veterans Affairs Connecticut Health Care System, West Haven, CT 06516, USA
| | - Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, CT 06520, USA
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Chand DH, Sun R, Diab KA, Kenny D, Tukov FF. Review of cardiac safety in onasemnogene abeparvovec gene replacement therapy: translation from preclinical to clinical findings. Gene Ther 2023; 30:685-697. [PMID: 37095320 PMCID: PMC10125853 DOI: 10.1038/s41434-023-00401-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Abstract
Human gene replacement therapies such as onasemnogene abeparvovec (OA) use recombinant adeno-associated virus (rAAV) vectors to treat monogenic disorders. The heart and liver are known target organs of toxicity in animals; with cardiac and hepatic monitoring recommended in humans after OA dosing. This manuscript provides a comprehensive description of cardiac data from preclinical studies and clinical sources including clinical trials, managed access programs and the post-marketing setting following intravenous OA administration through 23 May 2022. Single dose mouse GLP-Toxicology studies revealed dose-dependent cardiac findings including thrombi, myocardial inflammation and degeneration/regeneration, which were associated with early mortality (4-7 weeks) in the high dose groups. No such findings were documented in non-human primates (NHP) after 6 weeks or 6 months post-dose. No electrocardiogram or echocardiogram abnormalities were noted in NHP or humans. After OA dosing, some patients developed isolated elevations in troponin without associated signs/symptoms; the reported cardiac adverse events in patients were considered of secondary etiology (e.g. respiratory dysfunction or sepsis leading to cardiac events). Clinical data indicate cardiac toxicity observed in mice does not translate to humans. Cardiac abnormalities have been associated with SMA. Healthcare professionals should use medical judgment when evaluating the etiology and assessment of cardiac events post OA dosing so as to consider all possibilities and manage the patient accordingly.
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Affiliation(s)
- Deepa H Chand
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
- Department of Pediatrics, University of Illinois College of Medicine and Children's Hospital of Illinois, Peoria, IL, USA.
| | - Rui Sun
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Karim A Diab
- Division of Cardiology, Department of Pediatrics, Inova Children's Hospital, Fairfax, VA, USA
| | - Damien Kenny
- Department of Paediatric Cardiology, CHI at Crumlin, Dublin, Ireland
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Kulkarni SM, Roongta R, Sankar S. Clinical profile of patients and sensitivity of troponin I in patients with and without acute coronary syndrome: An observational study. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:305-309. [PMID: 38759980 DOI: 10.25259/nmji_801_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Background Various clinical conditions can cause troponin elevation in the absence of myocardial ischaemia. Elevated troponin represents the likely occurrence of myocardial necrosis and does not itself provide any indication of the aetiology. Identifying the cause for troponin elevation and its sensitivity and specificity in predicting acute coronary syndrome (ACS) and cardiac mortality is an important step in determining the optimal management for these patients. Methods We retrospectively collected data of inpatients who had troponin I (TnI) testing as part of their clinical assessment, either in the emergency department, medical wards, coronary care unit (CCU) or intensive care unit (ICU) with their final diagnosis. TnI was used as the index test of sensitivity to diagnose ACS and either echocardiography or coronary angiogram in those available as the reference gold standard. They were classified into two groups of normal and elevated TnI, and further divided into those with ACS and no ACS. Data on clinical parameters and aetiology of elevated TnI in patients without ACS were analysed. Results Of the 254 patients studied, 114 patients (45%) had normal TnI and 140 (55%) had elevated TnI. Seventy-eight patients had ACS, 66 (84.6%) of whom had elevated TnI and 12 (15.38%) had normal TnI. Seventy-four (52.85%) of 140 patients with elevated TnI had alternate causes of TnI elevation; the most common being sepsis, acute kidney injury (AKI) and heart failure without ACS. All-cause mortality was significantly higher in patients with elevated TnI with or without ACS. There was no cardiac mortality among patients with ACS with normal TnI. Sensitivity and specificity of TnI for predicting ACS was 84.6% (95% CI 74.7%-91.8%) and 58% (95% CI 50.3%-65.3%), respectively. Conclusion A variety of conditions apart from myocardial infarction can lead to elevated TnI. Hence, caution should be exercised while diagnosing a patient with ACS based on TnI value in the absence of other supporting evidence given its low specificity. Elevated TnI portends a worse prognosis regardless of the aetiology and has a role in predicting all-cause and cardiac mortality.
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Affiliation(s)
- Shruthi M Kulkarni
- Department of General Medicine, St John's Medical College Hospital, Koramangala, Bengaluru 560034, Karnataka, India
| | - Rashmi Roongta
- Department of General Medicine, St John's Medical College Hospital, Koramangala, Bengaluru 560034, Karnataka, India
| | - Seena Sankar
- Department of General Medicine, St John's Medical College Hospital, Koramangala, Bengaluru 560034, Karnataka, India
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Liu P, Wang S, Li K, Yang Y, Man Y, Du F, Wang L, Tian J, Su G. Exosomal microRNA‑4516, microRNA‑203 and SFRP1 are potential biomarkers of acute myocardial infarction. Mol Med Rep 2023; 27:124. [PMID: 37203392 PMCID: PMC10206682 DOI: 10.3892/mmr.2023.13010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/20/2023] [Indexed: 05/20/2023] Open
Abstract
Acute myocardial infarction (AMI) is a serious disease which threatens public health. Exosomes (exos) contain certain genetic information and are important communication vehicles between cells. In the present study, different exosomal microRNAs (miRs), which exhibit a notable association between expression levels in plasma and AMI were assessed to support the development of new diagnostic and clinical assessment markers of patients with AMI. In total, 93 individuals, including 31 healthy controls and 62 patients with AMI, were recruited for the present study. Data on age, blood pressure, glucose levels, lipid levels and coronary angiography images were collected from the enrolled individuals, and plasma samples were collected. Plasma exos were extracted and verified using ultracentrifugation, transmission electron microscopy (TEM), nanoparticle tracking analysis (NTA) and western blotting (WB). Exo‑miR‑4516 and exo‑miR‑203 in plasma exos were identified by exosomal miRNA sequencing analysis, reverse transcription‑quantitative PCR was performed to detect the levels of exo‑miR‑4516 and exo‑miR‑203 in plasma exos, and ELISA was performed to detect the levels of secretory frizzled‑related protein 1 (SFRP1) in samples. The correlation analysis between exo‑miR‑4516, exo‑miR‑203 and SFRP1 in plasma exos and AMI was presented as receiver operating characteristic curves (ROCs) of the SYNTAX score, cardiac troponin I (cTnI), low‑density lipoprotein (LDL) and each indicator separately. Kyoto Encyclopedia of Genes and Genomes enrichment analysis was performed to predict relevant enrichment pathways. Exos were successfully isolated from plasma by ultracentrifugation, which was confirmed by TEM, NTA and WB. Exo‑miR‑4516, exo‑miR‑203 and SFRP1 levels in plasma were significantly higher in the AMI group compared with the healthy control group. ROCs demonstrated that exo‑miR‑4516, exo‑miR‑203 and SFRP1 levels had a high diagnostic efficiency in predicting AMI. Exo‑miR‑4516 was positively correlated with SYNTAX score, and plasma SFRP1 was positively correlated with plasma cTnI and LDL. In conclusion, the data demonstrated that exo‑miR‑4516, exo‑miR‑203 and SFRP1 levels could be used in combination to diagnose and assess the severity of AMI. The present study was retrospectively registered (TRN, NCT02123004).
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Affiliation(s)
- Peng Liu
- Department of Cardiovascular Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan, Shandong 250000, P.R. China
| | - Shuya Wang
- Department of Cardiovascular Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan, Shandong 250000, P.R. China
| | - Kaiyuan Li
- Dalian Medical University, Dalian, Liaoning 116000, P.R. China
| | - Yang Yang
- Department of Cardiovascular Medicine, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
| | - Yilong Man
- Department of Cardiovascular Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan, Shandong 250000, P.R. China
| | - Fengli Du
- Department of Cardiovascular Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan, Shandong 250000, P.R. China
- Department of Cardiovascular Medicine, Shandong Provincial Public Health Centre, Jinan, Shandong 250000, P.R. China
| | - Lei Wang
- Department of Cardiovascular Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan, Shandong 250000, P.R. China
| | - Jing Tian
- Department of Cardiovascular Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan, Shandong 250000, P.R. China
| | - Guohai Su
- Department of Cardiovascular Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan, Shandong 250000, P.R. China
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Cardiac MRI in patients with COVID-19 infection. Eur Radiol 2022; 33:3867-3877. [PMID: 36512043 PMCID: PMC9745285 DOI: 10.1007/s00330-022-09325-x] [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: 05/09/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
Objective COVID-19 infection is a systemic disease with various cardiovascular symptoms and complications. Cardiac MRI with late gadolinium enhancement is the modality of choice for the assessment of myocardial involvement. T1 and T2 mapping can increase diagnostic accuracy and improve further management. Our study aimed to evaluate the different aspects of myocardial damage in cases of COVID-19 infection using cardiac MRI. Methods This descriptive retrospective study included 86 cases, with a history of COVID-19 infection confirmed by positive RT-PCR, who met the inclusion criteria. Patients had progressive chest pain or dyspnoea with a suspected underlying cardiac cause, either by an abnormal electrocardiogram or elevated troponin levels. Cardiac MRI was performed with late contrast-enhanced (LGE) imaging, followed by T1 and T2 mapping. Results Twenty-four patients have elevated hsTnT with a median hsTnT value of 133 ng/L (IQR: 102 to 159 ng/L); normal value < 14 ng/L. Other sixty-two patients showed elevated hsTnI with a median hsTnI value of 1637 ng/L (IQR: 1340 to 2540 ng/L); normal value < 40 ng/L. CMR showed 52 patients with acute myocarditis, 23 with Takotsubo cardiomyopathy, and 11 with myocardial infarction. Invasive coronary angiography was performed only in selected patients. Conclusion Different COVID-19-related cardiac injuries may cause similar clinical symptoms. Cardiac MRI is the modality of choice to differentiate between the different types of myocardial injury such as Takotsubo cardiomyopathy and infection-related cardiomyopathy or even acute coronary syndrome secondary to vasculitis or oxygen-demand mismatch. Key Points • It is essential to detect early COVID-related cardiac injury using different cardiac biomarkers and cardiac imaging, as it has a significant impact on patient management and outcome. • Cardiac MRI is the modality of choice to differentiate between the different aspects of COVID-related myocardial injury.
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Troponin I New Biomarker in Traumatic Brain Injury. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03648-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Mortality in traumatic brain injury (TBI) is thought to be pathology in the heart-brain axis but its effect on the prognosis of traumatic brain injury remains unclear. Our study aimed to investigate the relationship between cardiac troponin I (cTnI) level and prognosis in TBI patients. Between January 2017 and May 2021, 480 patients diagnosed with TBI, who applied to the emergency department, were retrospectively included in this multicentric study. The databases of the hospitals were examined comprehensively and the demographic, clinical, laboratory, radiological, and therapeutic data and results of the patients were obtained. The severity of trauma and clinical status was evaluated with AIS, Injury Severity Score (ISS), ASA physical status, and Glasgow Coma Scale (GCS). The severity of the trauma was evaluated with the ISS. The modified Rankin Scale (mRS) and the Glasgow Outcome Scale (GOS) at discharge were used to evaluate in-hospital clinical outcomes. cTnI levels were classified into three categories: normal (< 0.05 ng/ml), mildly elevated (0.05–0.99 ng/ml), and severely elevated (≥ 1 ng/ml). The mean age of the patients was 41.7 and 75.4% of them were men. It was observed that mortality among patients over 65 years (13.9%) increased. High cTnI was detected in 284 (59.1%) patients. Although it was not statistically significant regarding the elevation of cTnI in patients under 65 years of age (P = 0.62), the difference was significant for cTnI in patients over 65 years of age (P < 0.001). The relationship between cTnI elevation was found to be statistically significant (P < 0.001) as the severity of the trauma increased and when severe additional traumas (thoracic, abdominal, or pelvic) occurred. A high cTnI level is associated with poor prognosis in TBI patients. cTnI measurement is a useful tool for early risk stratification and accelerated care; however, further prospective studies are needed.
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Payne RM. Cardiovascular Research in Friedreich Ataxia: Unmet Needs and Opportunities. JACC Basic Transl Sci 2022; 7:1267-1283. [PMID: 36644283 PMCID: PMC9831864 DOI: 10.1016/j.jacbts.2022.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 01/18/2023]
Abstract
Friedreich Ataxia (FRDA) is an autosomal recessive disease in which a mitochondrial protein, frataxin, is severely decreased in its expression. In addition to progressive ataxia, patients with FRDA often develop a cardiomyopathy that can be hypertrophic. This cardiomyopathy is unlike the sarcomeric hypertrophic cardiomyopathies in that the hypertrophy is associated with massive mitochondrial proliferation within the cardiomyocyte rather than contractile protein overexpression. This is associated with atrial arrhythmias, apoptosis, and fibrosis over time, and patients often develop heart failure leading to premature death. The differences between this mitochondrial cardiomyopathy and the more common contractile protein hypertrophic cardiomyopathies can be a source of misunderstanding in the management of these patients. Although imaging studies have revealed much about the structure and function of the heart in this disease, we still lack an understanding of many important clinical and fundamental molecular events that determine outcome of the heart in FRDA. This review will describe the current basic and clinical understanding of the FRDA heart, and most importantly, identify major gaps in our knowledge that represent new directions and opportunities for research.
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Affiliation(s)
- R. Mark Payne
- Address for correspondence: Dr R. Mark Payne, Division of Pediatric Cardiology, Wells Center for Pediatric Research, Indiana University School of Medicine, 1044 West Walnut, R4 302b, Indianapolis, Indiana 46202, USA.
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Roman S, Sran M, Makaryus AN. A Case of Elevated Troponin I Level After Packed Red Blood Cell Transfusion With Normal Coronary Angiography. Cureus 2022; 14:e26193. [PMID: 35891818 PMCID: PMC9306223 DOI: 10.7759/cureus.26193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/05/2022] Open
Abstract
Other than acute coronary syndrome (ACS), many clinical conditions are associated with increased cardiac troponin I (cTnI) levels. Conditions such as pulmonary embolism, acute heart failure, myocarditis, sepsis, and renal failure are commonly reported as underlying causes. Analytical interference with the cTnI assay can also lead to falsely elevated troponin I levels. That can happen due to multiple causes such as fibrin clots, heterophile antibodies, microparticles contained in the sample, rheumatoid factor, interference by bilirubin, hemolysis, and elevated alkaline phosphatase activity. Herein, we present the case of a 66-year-old female who presented with pleuritic chest pain and had a cTnI of 35.5 ng/mL post-transfusion of three units of packed red blood cells. The patient had a complete ischemic workup for ACS, including coronary angiography, which was negative for coronary artery disease.
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The prognostic value of cardiac troponin T in different age groups of traumatic brain injury patients. Acta Neurol Belg 2022; 122:709-719. [PMID: 34528158 DOI: 10.1007/s13760-021-01796-x] [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: 08/02/2021] [Accepted: 09/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The cardiac dysfunction has been confirmed as a common non-neurological complication and associated with increased mortality in traumatic brain injury (TBI) patients. As a biological marker of cardiac injury, the cardiac troponin T (TnT) has been verified correlated with the outcome of some non-traumatic brain injury patients. However, the prognostic value of TnT in TBI patients has not been clearly illustrated. We designed this study to explore the association between TnT and the outcome of TBI patients in different age subgroups. METHODS Patients diagnosed with TBI in a prospective critical care database were eligible for this study. Univariate logistic regression analysis was firstly performed to explore the relationship between included variables and mortality. Then, the real effect of TnT on the outcome of different age subgroups was analyzed by multivariate logistic regression analysis adjusting the confounding effects of other significant risk factors. Finally, we draw receiver operating characteristic (ROC) curves to evaluate the prognostic value of TnT in different age groups of TBI patients. RESULTS 520 patients were included in this study with a mortality rate of 20.2%. There were 112 (21.5%) non-elderly patients (age < 65) and 408 (78.5%) elderly patients (age ≥ 65). Non-survivors had a higher percentage of previous acute myocardial infarction (p = 0.019) and pupil no-reaction (p = 0.028; p = 0.011) than survivors. Survivors had higher GCS (p < 0.001) and lower TnT than non-survivors (p < 0.001). TnT was significantly associated with mortality in non-elderly patients (p = 0.031) but not in overall patients (p = 0.143) and elderly patients (p = 0.456) in multivariate logistic regression analysis. The AUC (area under the ROC curve) value of TnT in overall, non-elderly and elderly patients was 0.644, 0.693 and 0.632, respectively. Combining TnT with GCS increased the sensitivity of predicting the poor outcome in both non-elderly and elderly TBI patients. CONCLUSION The prognostic value of TnT differed between elderly and non-elderly TBI patients. Level of TnT was associated with mortality of non-elderly TBI patients but not elderly patients. Combining the TnT with GCS could increase the sensitivity of prognosis evaluation.
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Tsuruda T, Sato Y, Tomita M, Tanaka H, Hatakeyama K, Otsu M, Kawano A, Nagatomo K, Yoshikawa N, Ikeda R, Asada Y, Kaikita K. Aberrant Expression of Cardiac Troponin-T in Lung Cancer Tissues in Association With Pathological Severity. Front Cardiovasc Med 2022; 9:833649. [PMID: 35479276 PMCID: PMC9037982 DOI: 10.3389/fcvm.2022.833649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Cardiac troponin-T (TNNT2) is exclusively present in cardiac muscle. Measurement of TNNT2 is used for diagnosing acute coronary syndrome. However, its expression may not be limited in myocardium. This study aimed at evaluating the expression of TNNT2 in neoplastic tissues. Methods and Results We used paraffin-embedded blocks of 68 patients with lung cancer (age, 68 ± 11 years old; early-stage, 33; advance-stage, 35) at Miyazaki University Hospital, Japan between January 1, 2017, and March 31, 2019. We stained the slide sections with primary monoclonal antibody against TNNT2 protein, and assessed the frequency of positive staining, and its association with pathological severity. In addition, we examined whether TNNT2 gene is detected in lung cancer tissues of four patients using reverse transcription-polymerase chain reaction. Immunoreactivity for TNNT2 protein was present in the cytoplasm and nucleus of lung cancer cells. The frequency was 37% (25 of 68) in all patients and was irrespective of histologic type (six of 13, squamous cell carcinoma; 18 of 50, adenocarcinoma; 0 of 4, neuroendocrine cell carcinoma; 1 of 1, large cell carcinoma). The prevalence increased with pathological staging [9% (3 of 33) at early-stage (Stage 0–I); 63% (22 of 35) at advance-stage (Stage II–IV and recurrence)]. In addition, frequency of positive staining for TNNT2 increased with pleural (χ2 = 5.877, P = 0.015) and vascular (χ2 = 2.449, P = 0.118) invasions but decreased with lymphatic invasion (χ2 = 3.288, P = 0.070) in specimens performed surgical resection. Furthermore, TNNT2 mRNA was detected in the resected squamous cell carcinoma and adenocarcinoma tissues. Conclusions Our data suggest the aberrant expression of TNNT2 in lung cancer and its prevalence increases with pathological severity.
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Affiliation(s)
- Toshihiro Tsuruda
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
- *Correspondence: Toshihiro Tsuruda
| | - Yuichiro Sato
- Department of Diagnostic Pathology, Faculty of Medicine, Miyazaki University Hospital, Miyazaki, Japan
| | - Masaki Tomita
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroyuki Tanaka
- Department of Pathology, Section of Oncopathology and Regenerative Biology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kinta Hatakeyama
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Misa Otsu
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Aya Kawano
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Keiko Nagatomo
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Naoki Yoshikawa
- Department of Pharmacy, Faculty of Medicine, Miyazaki University Hospital, Miyazaki, Japan
| | - Ryuji Ikeda
- Department of Pharmacy, Faculty of Medicine, Miyazaki University Hospital, Miyazaki, Japan
| | - Yujiro Asada
- Department of Pathology, Faculty of Medicine, Miyazaki University Hospital, Miyazaki, Japan
| | - Koichi Kaikita
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Rapid and low-cost, and disposable electrical sensor using an extended gate field-effect transistor for cardiac troponin I detection. Biomed Eng Lett 2022; 12:197-203. [PMID: 35529342 PMCID: PMC9046487 DOI: 10.1007/s13534-022-00219-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022] Open
Abstract
Field effect transistor (FET) biosensor is based on metal oxide field effect transistor that is gated by changes in the surface charges induced the reaction of biomolecules. In most cases of FET biosensor, FET biosensor is not being reused after the reaction; therefore, it is an important concept of investigate the biosensor with simplicity, cheap and reusability. However, the conventional cardiac troponin I (cTnI) sensing technique is inadequate owing to its low sensitivity and high operational time and cost. In this study, we developed a rapid and low-cost, and disposable electrical sensor using an extended gate field-effect transistor (EGFET) to detect cTnI, as a key biomarker for myocardiac infarction. We first investigated pH sensing characteristics according to the pH level, which provided a logarithmically linear sensitivity in the pH sensing buffer solution of approximately 57.9 mV/pH. Subsequently, we prepared a cTnI sample and monitored the reaction between cTnI and cTnI antibodies through the changes in the drain current and transfer curves. Our results showed that the EGFET biosensor could successfully detect the cTnI levels as well as the pH with low-cost and rapid detection.
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13
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Cachia R, Taieb J, Bun SS, Dabry T, Trevisan L, Jouve B. [False positive troponinemia in patient with pneumothorax : a case report]. Ann Cardiol Angeiol (Paris) 2021; 71:176-180. [PMID: 34955165 DOI: 10.1016/j.ancard.2021.09.005] [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: 08/05/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Abstract
A 20-year-old patient is admitted to the emergency room for chest pain occurring in the context of recurrent left complete pneumothorax. Ultrasensitive troponinemia is elevated to 20 times normal. Myocardial distress is attributed to pneumothorax following the negativity of cardiological examinations (EKG, TTE, cardiac MRI). The pneumothorax is drained with a favorable evolution. This is the first reported case of pneumothorax associated with a significant elevation of troponin without ECG change, TakoTsubo syndrome, or myocardial inflammation. Several mechanisms are considered: rotation of the myocardium around its axis, increase in pulmonary vascular resistance with overload of right ventricular pressure, disturbance of coronary blood flow on significant mediastinal compression with decrease in systolo-diastolic myocardial perfusion.
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Affiliation(s)
| | | | | | | | | | - Bernard Jouve
- Chef de service du service de Cardiologie, CH d'Aix en Provence.
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14
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Wong YK, Tse HF. Circulating Biomarkers for Cardiovascular Disease Risk Prediction in Patients With Cardiovascular Disease. Front Cardiovasc Med 2021; 8:713191. [PMID: 34660715 PMCID: PMC8517145 DOI: 10.3389/fcvm.2021.713191] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/08/2021] [Indexed: 12/23/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death globally. Risk assessment is crucial for identifying at-risk individuals who require immediate attention as well as to guide the intensity of medical therapy to reduce subsequent risk of CVD. In the past decade, many risk prediction models have been proposed to estimate the risk of developing CVD. However, in patients with a history of CVD, the current models that based on traditional risk factors provide limited power in predicting recurrent cardiovascular events. Several biomarkers from different pathophysiological pathways have been identified to predict cardiovascular events, and the incorporation of biomarkers into risk assessment may contribute to enhance risk stratification in secondary prevention. This review focuses on biomarkers related to cardiovascular and metabolic diseases, including B-type natriuretic peptide, high-sensitivity cardiac troponin I, adiponectin, adipocyte fatty acid-binding protein, heart-type fatty acid-binding protein, lipocalin-2, fibroblast growth factor 19 and 21, retinol-binding protein 4, plasminogen activator inhibitor-1, 25-hydroxyvitamin D, and proprotein convertase subtilisin/kexin type 9, and discusses the potential utility of these biomarkers in cardiovascular risk prediction among patients with CVD. Many of these biomarkers have shown promise in improving risk prediction of CVD. Further research is needed to assess the validity of biomarker and whether the strategy for incorporating biomarker into clinical practice may help to optimize decision-making and therapeutic management.
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Affiliation(s)
- Yuen-Kwun Wong
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hung-Fat Tse
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.,Department of Medicine, Shenzhen Hong Kong University Hospital, Shenzhen, China.,Hong Kong-Guangdong Joint Laboratory on Stem Cell and Regenerative Medicine, The University of Hong Kong, Hong Kong, China.,Shenzhen Institutes of Research and Innovation, The University of Hong Kong, Hong Kong, China
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15
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Sisti N, Valente S, Mandoli GE, Santoro C, Sciaccaluga C, Franchi F, Cameli P, Mondillo S, Cameli M. COVID-19 in patients with heart failure: the new and the old epidemic. Postgrad Med J 2020; 97:175-179. [PMID: 32732260 DOI: 10.1136/postgradmedj-2020-138080] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has spread in nearly 200 countries in less than 4 months since its first identification; accordingly, the coronavirus disease 2019 (COVID 2019) has affirmed itself as a clinical challenge. The prevalence of pre-existing cardiovascular diseases in patients with COVID19 is high and this dreadful combination dictates poor prognosis along with the higher risk of intensive care mortality. In the setting of chronic heart failure, SARS-CoV-2 can be responsible for myocardial injury and acute decompensation through various mechanisms. Given the clinical and epidemiological complexity of COVID-19, patiens with heart failure may require particular care since the viral infection has been identified, considering an adequate re-evaluation of medical therapy and a careful monitoring during ventilation.
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Affiliation(s)
- Nicolò Sisti
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Italy
| | - Carlotta Sciaccaluga
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Federico Franchi
- Department of Medicine, Surgery and Neuroscience, Anesthesia and Intensive Care Unit, University of Siena, Siena, Italy
| | - Paolo Cameli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplantation, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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16
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Bender M, Stein M, Schoof B, Kolodziej MA, Uhl E, Schöller K. Troponin I as an early biomarker of cardiopulmonary parameters during the first 24 h of intensive care unit treatment in isolated traumatic brain injury patients. Injury 2020; 51:1189-1195. [PMID: 31926612 DOI: 10.1016/j.injury.2020.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/14/2019] [Accepted: 01/03/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Cardiopulmonary (CP) complications are well-known phenomena after an isolated traumatic brain injury (iTBI) and they may be associated with an elevated serum troponin I (TnI) value. However, the influence of an elevated TnI level on CP parameters within the first 24 h after an iTBI is still unknown. The current study was conducted to assess the associations between the initial TnI value on admission and CP parameters during the first 24 h of intensive care unit (ICU) treatment in iTBI patients. PATIENTS AND METHODS A total of 288 patients with iTBIs, who were admitted to our emergency department between January 2010 and November 2016 were retrospectively analyzed. Blood samples were taken on admission to determine TnI value. Each patient's demographic data, treatment regime, computed tomography results, and intra-hospital outcomes were evaluated, as well as several CP parameters, within the first 24 h of ICU treatment. The entire study population was stratified into patients with an initial TnI elevation (TnI positive) and without an initial TnI elevation (TnI negative). RESULTS Increased TnI values on admission were found in 59 (20.5%) patients. There were significant correlations between an initially elevated TnI value and a lower Glasgow Coma Scale score (p = 0.003), higher head Abbreviated Injury Scale score (p<0.0001), and higher Acute Physiology and Chronic Health Evaluation II score (p = 0.005) on admission, as well as a lower Glasgow Outcome Scale score (p = 0.0002) and higher modified Rankin Scale score (p = 0.0001) at discharge. In addition, a significantly higher norepinephrine application rate (NAR) (p<0.0001) and inspiratory oxygen fraction (FiO2) (p = 0.028) were needed in the TnI positive group. CONCLUSION Patients with elevated TnI values on admission require more circulation support (NAR and FiO2) within the first 24 h of ICU treatment after an iTBI. Therefore, the TnI may be a useful biomarker to improve ICU treatment of these patients.
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Affiliation(s)
- Michael Bender
- Department of Neurosurgery, Justus-Liebig-University Giessen, Klinikstrasse 33, Giessen 35392, Germany.
| | - Marco Stein
- Department of Neurosurgery, Justus-Liebig-University Giessen, Klinikstrasse 33, Giessen 35392, Germany
| | - Bennet Schoof
- Department of Trauma, Orthopedic and Reconstructive Surgery, Sana Klinikum Düsseldorf, Düsseldorf 40625, Germany
| | - Malgorzata Anna Kolodziej
- Department of Neurosurgery, Justus-Liebig-University Giessen, Klinikstrasse 33, Giessen 35392, Germany
| | - Eberhard Uhl
- Department of Neurosurgery, Justus-Liebig-University Giessen, Klinikstrasse 33, Giessen 35392, Germany
| | - Karsten Schöller
- Department of Neurosurgery, Justus-Liebig-University Giessen, Klinikstrasse 33, Giessen 35392, Germany
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17
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Long B, Long DA, Tannenbaum L, Koyfman A. An emergency medicine approach to troponin elevation due to causes other than occlusion myocardial infarction. Am J Emerg Med 2020; 38:998-1006. [DOI: 10.1016/j.ajem.2019.12.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/18/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
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18
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Montazer SH, Jahanian F, Khatir IG, Bozorgi F, Assadi T, Pashaei SM, Sazgar M, Mousavi SJ, Yekta AS. Prognostic Value of Cardiac Troponin I and T on Admission in Mortality of Multiple Trauma Patients Admitted to the Emergency Department: a Prospective Follow-up Study. Med Arch 2019; 73:11-14. [PMID: 31097852 PMCID: PMC6445627 DOI: 10.5455/medarh.2019.73.11-14] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: The relationship between increased levels of cardiac troponins and morbidity and mortality of traumatic patients is not still well recognized. Aim: The aim of this study was to investigate the prognostic value of cardiac troponin I and T on admission in mortality of multiple trauma patients admitted to the emergency department. Methods: In this prospective follow-up study, the cardiac troponin I and T levels were measured in patients with multiple trauma referring to the emergency department (ED) between March 2014 and February 2015 at Imam Khomeini Hospital, Sari, Iran. Patients were followed prospectively until discharge from hospital or death. Results: The levels of cardiac troponins I and T in patients with multiple trauma were significantly associated with their mortality, especially at the level of 0.5 and 1.2 μg/dl (p<0.05). Multivariate regression analysis showed association of level of cardiac troponin I and T with patients’ mortality, after controlling for patients’ age, vital signs and GCS on admission. The sensitivity and specificity of troponin I at levels greater than 0.4 μg/dl in predict mortality in this study were as 65.5% and 55.3%, while the values for troponin T were 65.1% and 54.9%, respectively. Conclusion: Elevated cardiac troponin I and T levels provide excellent prognostic information regarding mortality in patients with multiple-trauma, independent of age, hemodynamic variables and GCS score.
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Affiliation(s)
- Seyed Hossein Montazer
- Department of Emergency Medicine, Orthopedic Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Jahanian
- Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Iraj Goli Khatir
- Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Farzad Bozorgi
- Department of Emergency Medicine, Gut and Liver Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Touraj Assadi
- Department of Emergency Medicine, Diabetes Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyedeh Masoumeh Pashaei
- Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Sazgar
- Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Jaber Mousavi
- Department of Community Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Setayesh Yekta
- Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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19
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DeFilippis AP, Chapman AR, Mills NL, de Lemos JA, Arbab-Zadeh A, Newby LK, Morrow DA. Assessment and Treatment of Patients With Type 2 Myocardial Infarction and Acute Nonischemic Myocardial Injury. Circulation 2019; 140:1661-1678. [PMID: 31416350 PMCID: PMC6855329 DOI: 10.1161/circulationaha.119.040631] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Although coronary thrombus overlying a disrupted atherosclerotic plaque has long been considered the hallmark and the primary therapeutic target for acute myocardial infarction (MI), multiple other mechanisms are now known to cause or contribute to MI. It is further recognized that an MI is just one of many types of acute myocardial injury. The Fourth Universal Definition of Myocardial Infarction provides a taxonomy for acute myocardial injury, including 5 subtypes of MI and nonischemic myocardial injury. The diagnosis of MI is reserved for patients with myocardial ischemia as the cause of myocardial injury, whether attributable to acute atherothrombosis (type 1 MI) or supply/demand mismatch without acute atherothrombosis (type 2 MI). Myocardial injury in the absence of ischemia is categorized as acute or chronic nonischemic myocardial injury. However, optimal evaluation and treatment strategies for these etiologically distinct diagnoses have yet to be defined. Herein, we review the epidemiology, risk factor associations, and diagnostic tools that may assist in differentiating between nonischemic myocardial injury, type 1 MI, and type 2 MI. We identify limitations, review new research, and propose a framework for the diagnostic and therapeutic approach for patients who have suspected MI or other causes of myocardial injury.
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Affiliation(s)
- Andrew P DeFilippis
- Division of Cardiovascular Medicine, Department of Medicine, University of Louisville School of Medicine, KY (A.P.D.).,Johns Hopkins University, Baltimore, MD (A.P.D., A.A.-Z.)
| | - Andrew R Chapman
- BHF/University Centre for Cardiovascular Science (A.R.C., N.L.M.), University of Edinburgh, UK
| | - Nicholas L Mills
- BHF/University Centre for Cardiovascular Science (A.R.C., N.L.M.), University of Edinburgh, UK.,Usher Institute of Population Health Sciences and Informatics (N.L.M.), University of Edinburgh, UK
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.)
| | | | - L Kristin Newby
- Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.K.N.)
| | - David A Morrow
- Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.K.N.)
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20
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Motz BM, Baimas-George M, Barnes TE, Ragunanthan BV, Symanski JD, Christmas AB, Sing RF, Ross SW. Mitigating clinical waste in the trauma intensive care unit: Limited clinical utility of cardiac troponin testing for trauma patients with atrial fibrillation. Am J Surg 2019; 219:1050-1056. [PMID: 31371023 DOI: 10.1016/j.amjsurg.2019.07.033] [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: 04/08/2019] [Revised: 07/03/2019] [Accepted: 07/22/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The clinical significance of obtaining cardiac troponin (cTn) levels among trauma patients with new onset arrhythmias is unknown. We aimed to assess whether cTn levels actually influence clinical decision making or represent an inappropriate use of resources. METHODS Trauma patients admitted from 2013 to 2014 diagnosed with atrial fibrillation (AF) were retrospectively reviewed using the institutional trauma database. Demographics, cTn levels, and myocardial infarction (MI) diagnosis data were recorded. Standard univariate tests were used to compare data between patients with and without cTn. RESULTS There were 258 patients included of which 126 patients had cTn levels obtained (48.8%, TEST group). The remaining 132 patients (51.2%) were untested (noTEST group). Among TEST patients, use of echocardiography nearly doubled and cardiology consultations increased (all p < 0.05). No TEST patients suffered MI or PE. CONCLUSIONS Obtaining cTn values in trauma patients with new-onset AF resulted in increased resource utilization without clinical utility.
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Affiliation(s)
- Benjamin M Motz
- Division of Acute Care Surgery, Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd., MEB Suite 601, Charlotte, NC, 28203, USA
| | - Maria Baimas-George
- Division of Acute Care Surgery, Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd., MEB Suite 601, Charlotte, NC, 28203, USA
| | - T Ellis Barnes
- Division of Acute Care Surgery, Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd., MEB Suite 601, Charlotte, NC, 28203, USA
| | - Branavan V Ragunanthan
- Division of Acute Care Surgery, Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd., MEB Suite 601, Charlotte, NC, 28203, USA
| | - John D Symanski
- Sanger Heart & Vascular Institute, Department of Cardiology, Carolinas Medical Center, 1001 Blythe Blvd., Suite 300, Charlotte, NC, USA
| | - A Britton Christmas
- Division of Acute Care Surgery, Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd., MEB Suite 601, Charlotte, NC, 28203, USA
| | - Ronald F Sing
- Division of Acute Care Surgery, Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd., MEB Suite 601, Charlotte, NC, 28203, USA
| | - Samuel W Ross
- Division of Acute Care Surgery, Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd., MEB Suite 601, Charlotte, NC, 28203, USA.
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21
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Stokes EA, Doble B, Pufulete M, Reeves BC, Bucciarelli-Ducci C, Dorman S, Greenwood JP, Anderson RA, Wordsworth S. Cardiovascular magnetic resonance in emergency patients with multivessel disease or unobstructed coronary arteries: a cost-effectiveness analysis in the UK. BMJ Open 2019; 9:e025700. [PMID: 31300495 PMCID: PMC6629389 DOI: 10.1136/bmjopen-2018-025700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To identify the key drivers of cost-effectiveness for cardiovascular magnetic resonance (CMR) when patients activate the primary percutaneous coronary intervention (PPCI) pathway. DESIGN Economic decision models for two patient subgroups populated from secondary sources, each with a 1 year time horizon from the perspective of the National Health Service (NHS) and personal social services in the UK. SETTING Usual care (with or without CMR) in the NHS. PARTICIPANTS Patients who activated the PPCI pathway, and for Model 1: underwent an emergency coronary angiogram and PPCI, and were found to have multivessel coronary artery disease. For Model 2: underwent an emergency coronary angiogram and were found to have unobstructed coronary arteries. INTERVENTIONS Model 1 (multivessel disease) compared two different ischaemia testing methods, CMR or fractional flow reserve (FFR), versus stress echocardiography. Model 2 (unobstructed arteries) compared CMR with standard echocardiography versus standard echocardiography alone. MAIN OUTCOME MEASURES Key drivers of cost-effectiveness for CMR, incremental costs and quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios. RESULTS In both models, the incremental costs and QALYs between CMR (or FFR, Model 1) versus no CMR (stress echocardiography, Model 1 and standard echocardiography, Model 2) were small (CMR: -£64 (95% CI -£232 to £187)/FFR: £360 (95% CI -£116 to £844) and CMR/FFR: 0.0012 QALYs (95% CI -0.0076 to 0.0093)) and (£98 (95% CI -£199 to £488) and 0.0005 QALYs (95% CI -0.0050 to 0.0077)), respectively. The diagnostic accuracy of the tests was the key driver of cost-effectiveness for both patient groups. CONCLUSIONS If CMR were introduced for all subgroups of patients who activate the PPCI pathway, it is likely that diagnostic accuracy would be a key determinant of its cost-effectiveness. Further research is needed to definitively answer whether revascularisation guided by CMR or FFR leads to different clinical outcomes in acute coronary syndrome patients with multivessel disease.
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Affiliation(s)
- Elizabeth A Stokes
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Brett Doble
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria Pufulete
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Barnaby C Reeves
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Chiara Bucciarelli-Ducci
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Stephen Dorman
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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22
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Harris JM, Brierley RC, Pufulete M, Bucciarelli-Ducci C, Stokes EA, Greenwood JP, Dorman SH, Anderson RA, Rogers CA, Wordsworth S, Berry S, Reeves BC. A national registry to assess the value of cardiovascular magnetic resonance imaging after primary percutaneous coronary intervention pathway activation: a feasibility cohort study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Cardiovascular magnetic resonance (CMR) is increasingly used in patients who activate the primary percutaneous coronary intervention (PPCI) pathway to assess heart function. It is uncertain whether having CMR influences patient management or the risk of major adverse cardiovascular events in these patients.
Objective
To determine whether or not it is feasible to set up a national registry, linking routinely collected data from hospital information systems (HISs), to investigate the role of CMR in patients who activate the PPCI pathway.
Design
A feasibility prospective cohort study.
Setting
Four 24/7 PPCI hospitals in England and Wales (two with and two without a dedicated CMR facility).
Participants
Patients who activated the PPCI pathway and underwent an emergency coronary angiogram.
Interventions
CMR either performed or not performed within 10 weeks of the index event.
Main outcome measures
A. Feasibility parameters – (1) patient consent implemented at all hospitals, (2) data extracted from more than one HIS and successfully linked for > 90% of consented patients at all four hospitals, (3) HIS data successfully linked with Hospital Episode Statistics (HES) and Patient Episode Database Wales (PEDW) for > 90% of consented patients at all four hospitals and (4) CMR requested and carried out for ≥ 10% of patients activating the PPCI pathway in CMR hospitals. B. Key drivers of cost-effectiveness for CMR (identified from simple cost-effectiveness models) in patients with (1) multivessel disease and (2) unobstructed coronary arteries. C. A change in clinical management arising from having CMR (defined using formal consensus and identified using HES follow-up data in the 12 months after the index event).
Results
A. (1) Consent was implemented (for all hospitals, consent rates were 59–74%) and 1670 participants were recruited. (2) Data submission was variable – clinical data available for ≥ 82% of patients across all hospitals, biochemistry and echocardiography (ECHO) data available for ≥ 98%, 34% and 87% of patients in three hospitals and medications data available for 97% of patients in one hospital. (3) HIS data were linked with hospital episode data for 99% of all consented patients. (4) At the two CMR hospitals, 14% and 20% of patients received CMR. B. In both (1) multivessel disease and (2) unobstructed coronary arteries, the difference in quality-adjusted life-years (QALYs) between CMR and no CMR [‘current’ comparator, stress ECHO and standard ECHO, respectively] was very small [0.0012, 95% confidence interval (CI) –0.0076 to 0.0093 and 0.0005, 95% CI –0.0050 to 0.0077, respectively]. The diagnostic accuracy of the ischaemia tests was the key driver of cost-effectiveness in sensitivity analyses for both patient subgroups. C. There was consensus that CMR leads to clinically important changes in management in five patient subgroups. Some changes in management were successfully identified in hospital episode data (e.g. new diagnoses/procedures, frequency of outpatient episodes related to cardiac events), others were not (e.g. changes in medications, new diagnostic tests).
Conclusions
A national registry is not currently feasible. Patients were consented successfully but conventional consent could not be implemented nationally. Linking HIS and hospital episode data was feasible but HIS data were not uniformly available. It is feasible to identify some, but not all, changes in management in the five patient subgroups using hospital episode data. The delay in obtaining hospital episode data influenced the relevance of some of our study objectives.
Future work
To test the feasibility of conducting the study using national data sets (e.g. HES, British Cardiovascular Intervention Society audit database, Diagnostic Imaging Dataset, Clinical Practice Research Datalink).
Funding
The National Institute for Health Research (NIHR) Health Services and Delivery Research programme. This study was designed and delivered in collaboration with the Clinical Trials and Evaluation Unit, a UK Clinical Research Collaboration-registered clinical trials unit that, as part of the Bristol Trials Centre, is in receipt of NIHR clinical trials unit support funding.
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Affiliation(s)
- Jessica M Harris
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Rachel C Brierley
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Maria Pufulete
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Chiara Bucciarelli-Ducci
- National Institute for Health Research (NIHR) Bristol Cardiovascular Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Elizabeth A Stokes
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Stephen H Dorman
- National Institute for Health Research (NIHR) Bristol Cardiovascular Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Chris A Rogers
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sunita Berry
- NHS England, South West Clinical Networks and Senate, Bristol, UK
| | - Barnaby C Reeves
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
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Heizmann CW. S100 proteins: Diagnostic and prognostic biomarkers in laboratory medicine. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2019; 1866:1197-1206. [DOI: 10.1016/j.bbamcr.2018.10.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/12/2018] [Indexed: 01/04/2023]
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Habbab KM, D'Aiuto F, Habbab MA, Porter SR. Molecular markers relevant to myocardial injury following dental extraction in patients with or without coronary artery disease. BDJ Open 2019; 5:9. [PMID: 31240112 PMCID: PMC6586777 DOI: 10.1038/s41405-019-0018-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/07/2019] [Accepted: 05/12/2019] [Indexed: 12/20/2022] Open
Abstract
Objectives The aim of this study was to characterize biological changes following dental extractions in patients with and without coronary artery disease (CAD). Materials and methods Forty-five patients (36 males and 9 females) referred for dental extraction underwent treatment and provided blood samples before, immediately after, and 24 h after the procedure. A broad array of biomarkers was employed to assess myocardial injury (highly sensitive troponin T, hs-TnT), bacterial burden (LPS endotoxin activity), and systemic inflammation (CRP, fibrinogen, IFN-γ, IL-1β, IL-6, IL-8, IL-10, IL-12, and TNF-α). Results Dental extraction in patients with and without CAD was associated with rises in hs-TnT (p = 0.013), hs-CRP (p < 0.001), fibrinogen (p = 0.005), endotoxin activity (p < 0.001), IFN-γ (p < 0.001), IL-6 (p < 0.001), IL-8 (p = 0.011), and IL-12 (p < 0.001) at 24 h compared with immediately post procedure. Changes in systemic inflammation and endotoxin activity were more evident in those with hs-TnT rise. Conclusions Simple dental extractions may cause mild increase in hs-TnT, indicating minor myocardial injury in both patients with and without CAD. Acute systemic inflammation and endotoxemia could represent a possible link between invasive dental treatment and increased risk of acute cardiovascular events. These findings indicate that invasive dental treatment (as simple as a single dental extraction) may impact negatively on clinical outcomes in dental patients, especially those with CAD.
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Affiliation(s)
- K M Habbab
- 1UCL Eastman Dental Institute, London, England UK.,2Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - F D'Aiuto
- 1UCL Eastman Dental Institute, London, England UK
| | - M A Habbab
- 2Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - S R Porter
- 1UCL Eastman Dental Institute, London, England UK
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Heizmann CW. Ca 2+-Binding Proteins of the EF-Hand Superfamily: Diagnostic and Prognostic Biomarkers and Novel Therapeutic Targets. Methods Mol Biol 2019; 1929:157-186. [PMID: 30710273 DOI: 10.1007/978-1-4939-9030-6_11] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A multitude of Ca2+-sensor proteins containing the specific Ca2+-binding motif (helix-loop-helix, called EF-hand) are of major clinical relevance in a many human diseases. Measurements of troponin, the first intracellular Ca-sensor protein to be discovered, is nowadays the "gold standard" in the diagnosis of patients with acute coronary syndrome (ACS). Mutations have been identified in calmodulin and linked to inherited ventricular tachycardia and in patients affected by severe cardiac arrhythmias. Parvalbumin, when introduced into the diseased heart by gene therapy to increase contraction and relaxation speed, is considered to be a novel therapeutic strategy to combat heart failure. S100 proteins, the largest subgroup with the EF-hand protein family, are closely associated with cardiovascular diseases, various types of cancer, inflammation, and autoimmune pathologies. The intention of this review is to summarize the clinical importance of this protein family and their use as biomarkers and potential drug targets, which could help to improve the diagnosis of human diseases and identification of more selective therapeutic interventions.
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Affiliation(s)
- Claus W Heizmann
- Department of Pediatrics, Division of Clinical Chemistry and Biochemistry, University of Zürich, Zürich, Switzerland.
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Kim DH, Lee SH, Kim SC, Kim T, Kang C, Jeong JH, Park YJ, Lim D, Lee SB. The ratio of N-terminal pro-B-type natriuretic peptide to troponin I for differentiating acute coronary syndrome. Am J Emerg Med 2019; 37:1013-1019. [DOI: 10.1016/j.ajem.2018.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/03/2018] [Accepted: 08/11/2018] [Indexed: 10/28/2022] Open
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Gupta S, Tomar DS. Septic Shock and Troponin I: Are They in a Relationship? Indian J Crit Care Med 2019; 23:294. [PMID: 31406427 PMCID: PMC6686589 DOI: 10.5005/jp-journals-10071-23201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Gupta S, Tomar DS. Septic Shock and Troponin I: Are They in a Relationship? Indian J Crit Care Med 2019;23(7):294.
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Affiliation(s)
- Sachin Gupta
- Department of Critical Care, Narayana Superspeciality Hospital, Gurugram, Haryana, India
| | - Deeksha Singh Tomar
- Department of Critical Care, Narayana Superspeciality Hospital, Gurugram, Haryana, India
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Su J, Gao C, Wang R, Xiao C, Yang M. Genes associated with inflammation and the cell cycle may serve as biomarkers for the diagnosis and prognosis of acute myocardial infarction in a Chinese population. Mol Med Rep 2018; 18:1311-1322. [PMID: 29845217 PMCID: PMC6072145 DOI: 10.3892/mmr.2018.9077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/03/2018] [Indexed: 12/22/2022] Open
Abstract
The present study aimed to identify biomarkers for the clinical diagnosis of acute myocardial infarction (AMI) in a Chinese population using microarray data collected from the Gene Expression Omnibus database under accession number GSE97320. This included the peripheral blood samples of three patients with AMI and three controls. Differentially expressed genes (DEGs) were identified using the limma package and protein-protein interaction networks were constructed using data from the Search Tool for the Retrieval of Interacting Genes database, followed by module analysis to screen for hub genes. Functional enrichment analyses were performed using the Database for Annotation, Visualization and Integrated Discovery. The identified genes were verified by overlapping with the target genes of microRNAs (miRs) known to be associated with AMI, as well as the DEGs identified in other AMI datasets, including GSE24519, GSE34198 and GSE48060. As a result, 752 DEGs (449 upregulated and 303 downregulated) were identified in the GSE97320 dataset. The upregulated DEGs were predicted to participate in inflammatory pathways, including the toll-like receptor (TLR) signaling pathway, including ras-related C3 botulinum toxin substrate 1 (RAC1), TLR4, C-C motif chemokine receptor (CCR)1; cytokine-cytokine receptor interaction, including signal transducer and activator of transcription (STAT)3; chemokine signaling pathway, including CCR10; pathways associated with cancer, including colony stimulating factor 3 receptor (CSF3R); and leukocyte transendothelial migration, including matrix metallopeptidase 9 (MMP9). The downregulated DEGs were associated with the cell cycle, including alstrom syndrome protein 1 (ALMS1). These conclusions were made following functional analysis of the genes in the three identified modules. MMP9, TLR4, STAT3, CCR1 and ALMS1 were regulated by miR-21-5p, whereas RAC1 was regulated by miR-30c-5p. A comparison among the four datasets confirmed the roles of CSF3R and CCR10. HtrA serine peptidase 1 (HTRA1) was the only gene associated with both mortality and recurrence. In conclusion, inflammation-associated genes, including STAT3, CCR1, RAC1, MMP9, CCR10, CSF3R and HTRA1, as well as cell cycle-associated genes such as ALMS1, may be biomarkers for the diagnosis and prognosis of AMI in Chinese people.
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Affiliation(s)
- Jiang Su
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing 100039, P.R. China
| | - Changqing Gao
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing 100039, P.R. China
| | - Rong Wang
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing 100039, P.R. China
| | - Cangsong Xiao
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing 100039, P.R. China
| | - Ming Yang
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing 100039, P.R. China
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Elnegouly M, Umgelter K, Safi W, Hapfelmeier A, Schmid RM, Umgelter A. Elevated cardiac troponin T in cirrhotic patients with emergency care admissions: Associations with mortality. J Gastroenterol Hepatol 2018; 33:518-523. [PMID: 28730699 DOI: 10.1111/jgh.13902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/03/2017] [Accepted: 07/13/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Mortality of cirrhotic patients after emergency care admission is high, and prognostic factors can help in prioritizing patients. The aim of our study was to assess the association between levels of cardiac troponin T (cTnT) and 1-year mortality in patients with liver cirrhosis without known cardiac disease, who were admitted to the emergency department (ED). METHODS All patients with cirrhosis presented to the ED from October 2009 until August 2015 who had an initial cTnT value measured with the first lab panel were retrospectively analyzed with a follow-up of 365 days. RESULTS Of a total of 237 cirrhotic ED patients, cTnT measurements were available for 87 (63% men, mean age 58.9 ± 11.0 years, and median Model for End-stage Liver Disease score was 15 [25th-75th percentile: 10-19]). Chronic Liver Failure Consortium acute-on-chronic liver failure (CLIF-C-ACLF) score was 33. Forty-three patients (49%) had cTnT values above the normal range (14 ng/L), of which 19 (22%) had values over 30 ng/L. Two patients were lost to follow-up. In multivariable analysis, both CLIF-C-ACLF (hazard ratio 1.072 per point increase; 95% confidence interval 1.029-1.117; P < 0.001) and cTnT (hazard ratio 1.014 per ng/L increase; 95% confidence interval 1.004-1.024; P = 0.008) emerged as independently associated with mortality. CONCLUSIONS A large proportion of cirrhotic patients in the ED have elevated levels of cTnT even if there is no evidence of cardiac disease. Elevated cTnT is associated with increased mortality during 1 year after correcting for Model for End-stage Liver Disease and CLIF-C-ACLF scores.
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Affiliation(s)
- Mayada Elnegouly
- 2nd Medical Department, Technical University of Munich, Munich, Germany.,Department of Infectious Diseases and Endemic Hepatology and Gastroenterology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
| | - Katrin Umgelter
- Department of Anaesthesiology, Technical University of Munich, Munich, Germany
| | - Wajima Safi
- Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen-Nuremberg, Germany
| | - Alexander Hapfelmeier
- Institute for Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Roland M Schmid
- 2nd Medical Department, Technical University of Munich, Munich, Germany
| | - Andreas Umgelter
- 2nd Medical Department, Technical University of Munich, Munich, Germany
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Vieira Marques F, Montenegro Sá F, Lapa T, Simões I. Postoperative myocardial infarction in an orthognatic jaw surgery. ACTA ACUST UNITED AC 2017. [PMID: 28625607 DOI: 10.1016/j.redar.2017.02.012] [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: 11/25/2022]
Abstract
Cardiovascular complications, in particular perioperative myocardial infarctions, are central contributors to morbidity and mortality after non-cardiac surgery. We present a case of a 41-year-old male, smoker and dyslipidemic, who underwent bimaxillary orthognathic jaw surgery with the development of an acute coronary syndrome in the immediate postoperative period. We managed to early diagnose the myocardial infarction and promptly performed a percutaneous transluminal coronary angioplasty, resulting in a positive outcome.
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Affiliation(s)
- F Vieira Marques
- Departamento de Anestesiología, Centro Hospitalar é Universitário de Coimbra, Coimbra, Portugal.
| | - F Montenegro Sá
- Departamento de Cardiología, Hospital de Santo André, Leiria, Portugal
| | - T Lapa
- Departamento de Anestesiología, Centro Hospitalar é Universitário de Coimbra, Coimbra, Portugal; Facultad de Ciencias de la Salud, Universidad da Beira Interior, Covilhã, Portugal
| | - I Simões
- Departamento de Anestesiología, Centro Hospitalar é Universitário de Coimbra, Coimbra, Portugal
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[Diagnosis of ischemia and revascularization in patients with ventricular tachyarrhythmia]. Herzschrittmacherther Elektrophysiol 2017; 28:157-161. [PMID: 28597214 DOI: 10.1007/s00399-017-0515-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
Sustained ventricular tachyarrhythmia usually occurs on the basis of structural heart disease, particularly coronary heart disease (CAD). Although monomorphic ventricular tachycardia (VT) appears mainly in patients with CAD, it is typically not triggered by acute ischemia, in contrast to polymorphic VT or ventricular fibrillation (VF). To judge if VT is caused by acute ischemia is even more difficult in context with an elevated highly sensitive troponin T which is generally elevated in sustained VT because tachycardia in chronic stable coronary artery sclerosis causes a mismatch between increased oxygen demand and limited oxygen supply. Therefore, acute coronary angiography and revascularization may frequently not be necessary in monomorphic VT, will usually not improve rhythm stabilization, and may lead to misinterpretation of monomorphic VT being caused by a coronary stenosis. This can lead to withholding antiarrhythmic therapy after revascularization since it is assumed that the cause of VT has been treated. On the other hand, acute coronary angiography and revascularization are useful in polymorphic VT/VF, ECG signs of ischemia, or typical chest pain before occurrence of VT/VF. Coronary angiography should also be performed in patients with VT with newly diagnosed reduced left ventricular function and before catheter ablation.
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33
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Wilson G, Barkley K, Slicker K, Kowal R, Pope B, Michel J. Overuse of Troponin? A Comprehensive Evaluation of Testing in a Large Hospital System. J Hosp Med 2017; 12:329-331. [PMID: 28459901 DOI: 10.12788/jhm.2732] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Troponin assays are integral to the diagnosis of acute myocardial infarction (AMI), but there is concern that testing is over utilized and may not conform to published guidelines. We reviewed all testing performed at 14 hospitals over 12 months and associated troponin values with the primary and secondary diagnoses for each visit. Troponin was determined to be negative, indeterminate or elevated based on reference ranges. The majority of troponin measurements were single, not serial (64%). The rate of AMI was low, with only 3.5% of tested patients having a primary or secondary diagnosis of AMI. Sensitivity, specificity and negative predictive value were excellent, exceeding 90%. However, positive predictive value was low, suggesting testing of populations with diseases known to be associated with elevated troponin levels in the absence of AMI. The majority (79%) of elevated troponin values were associated with primary diagnoses other than AMI. Only 28% of elevated troponins were associated with a primary or secondary diagnosis of AMI. These data suggest possible overuse of troponin testing in our healthcare system. Journal of Hospital Medicine 2017;12:329-331.
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Affiliation(s)
- Gibbs Wilson
- Department of Internal Medicine, Scott and White Memorial Hospital, Temple, TX
| | - Kyler Barkley
- Department of Cardiology, Scott and White Memorial Hospital, Temple, TX
| | - Kipp Slicker
- Department of Cardiology, Scott and White Memorial Hospital, Temple, TX
| | | | | | - Jeffrey Michel
- Department of Cardiology, Scott and White Memorial Hospital, Temple, TX
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Etaher A, Chew D, Redfern J, Briffa T, Ellis C, Hammett C, Lefkovits J, Elliott J, Cullen L, Brieger D, French JK. Suspected ACS Patients Presenting With Myocardial Damage or a Type 2 Myocardial Infarction Have a Similar Late Mortality to Patients With a Type 1 Myocardial Infarction: A Report From the Australian and New Zealand 2012 SNAPSHOT ACS Study. Heart Lung Circ 2017; 26:1051-1058. [PMID: 28139353 DOI: 10.1016/j.hlc.2016.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/29/2016] [Accepted: 11/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cardiac troponin (T and I) are considered the standard markers for detection of myocardial damage and the diagnosis of acute coronary syndrome (ACS) among patients who present to an emergency department with chest pain. However, these markers can be released in other situations and may be associated with short- and long-term clinical outcomes. In this study, we examine late mortality rates among patients presenting with a suspected ACS due to an unstable coronary plaque and those patients having a non-ACS. METHODS 4388 patients were hospitalised with suspected ACS, between 14 and 27 May 2012 in the Australia and New Zealand SNAPSHOT ACS study. Those patients were categorised in five diagnostic groups: 1) ST elevation MI (n=419); 2) non-ST elevation MI (n=1012); 3) unstable angina (n=925); 4) non-ACS diagnoses (n=837); and 5) chest pain considered unlikely ischaemic (not otherwise specified, n=1195). RESULT The respective mortality rates at 18 months in these groups were 16.2%, 16.3%, 6.8%, 12.8%, and 4.8%; Pearson χ2=110 p<0.001. Among non-ACS diagnoses patients (group 4) those with the highest mortality rates (cardiac (14.4%), respiratory (18.2%), sepsis (15.4%) and neoplastic (67%) diagnoses) had the highest rates of elevated troponin levels (48%, 31%, 38% and 67% respectively). By contrast, those with the lowest mortality rates (musculoskeletal (2.9%), gastrointestinal disorders (3.9%) and non-specific chest pain (7.4%)) had the lowest rate of elevated troponin levels (9%, 18% and 15.8% respectively). However, after adjusting for baseline clinical and demographic characteristics, the mortality rate at 18 months for patients with elevated troponin was similar for ACS or non-ACS diagnoses (Hazard Ratio, 95% C.I.0.98-1.07, p=0.333). CONCLUSIONS Among patients in the 2012 SNAPSHOT ACS study, non-ACS diagnoses characterised by high rates of elevated troponin levels had high mortality rates similar to those diagnosed with ACS. Therapies known to be effective in ACS patients, including early invasive management, should be examined in these non-ACS patients with troponin elevations within adequately powered randomised trials.
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Affiliation(s)
- Aisha Etaher
- Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, the University of New South Wales, Sydney, NSW, Australia
| | - Derek Chew
- Flinders University of South Australia, Adelaide, SA, Australia
| | - Julie Redfern
- The George Institute, University of Sydney, Sydney, NSW, Australia
| | - Tom Briffa
- University of Western Australia, Perth, WA, Australia
| | | | | | | | - John Elliott
- Christchurch Hospital, Christchurch, New Zealand
| | | | | | - John K French
- Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, the University of New South Wales, Sydney, NSW, Australia.
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Motazedian P, Le May MR, Glover C, Hibbert B. A Woman in Her 80s With Anterior ST-Elevation Myocardial Infarction and Shock. Chest 2017; 151:e5-e8. [PMID: 28065257 DOI: 10.1016/j.chest.2016.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/15/2016] [Accepted: 05/05/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Pouya Motazedian
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Michel R Le May
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Christopher Glover
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
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Liyanage T, Sangha A, Sardar R. Achieving biosensing at attomolar concentrations of cardiac troponin T in human biofluids by developing a label-free nanoplasmonic analytical assay. Analyst 2017; 142:2442-2450. [DOI: 10.1039/c7an00430c] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A nanoplasmonic-based highly reproducible and ultrasensitive analytical sensor was fabricated to quantify cardiac troponin T at attomolar concentration with high selectivity.
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Affiliation(s)
- Thakshila Liyanage
- Department of Chemistry and Chemical Biology
- Indiana University-Purdue University Indianapolis
- Indianapolis
- USA
| | - Andeep Sangha
- Department of Chemistry and Chemical Biology
- Indiana University-Purdue University Indianapolis
- Indianapolis
- USA
| | - Rajesh Sardar
- Department of Chemistry and Chemical Biology
- Indiana University-Purdue University Indianapolis
- Indianapolis
- USA
- Integrated Nanosystems Development Institute
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Abstract
Chronic kidney disease is prevalent among adults in the United States. To aid in diagnosis and treatment, the Kidney Disease: Improving Global Outcomes 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease provides an evidence-based approach. This article reviews the major recommendations of this guideline.
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Affiliation(s)
- Cynthia Ann Smith
- Cynthia Ann Smith is a nephrology and family NP at Renal Consultants, PLLC, South Charleston, W.Va
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Yilmaz H, Yilmaz G, Kostakoğlu U, Yaman H, Örem A, Köksal İ. The prognostic significance of serum troponin T levels in Crimean-Congo hemorrhagic fever patients. J Med Virol 2016; 89:408-412. [PMID: 26693839 DOI: 10.1002/jmv.24454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2015] [Indexed: 11/05/2022]
Abstract
Crimean-Congo Hemorrhagic Fever (CCHF) is a disease transmitted by the Crimean-Congo hemorrhagic fever virus (CCHFV), characterized by severe fever and hemorrhage and with a reported fatality level of 3-30%. Cerebral hemorrhage, gastrointestinal hemorrhage, severe anemia, shock, myocardial infarction, pulmonary edema, and pleural effusion may be seen as causes of death. Cardiac troponin T (cTn-T) is a biochemical marker with high sensitivity and specificity in myocardial injury. The purpose of this study was to determine the prognostic significance of serum troponin T levels in CCHF patients. Patients hospitalized with a diagnosis of CCHF and whose serum cTn-T was investigated were examined retrospectively. Patients were divided into two groups on the basis of presence or absence of hemorrhage. Data were subjected to statistical analysis. One hundred thirty-five CCHF patients and 72 control subjects were included. Hemorrhage was present in 48 (35.6%) patients. Mean serum cTn-T level was 17.3 ± 28.0 ng/L in the patients with hemorrhage, 9.98 ± 5.97 ng/L in the non-hemorrhage patients (P = 0.001) and 6.6P = 2.6 ng/L in the control samples (P < 0.001). At a cTn-T level cut-off point of 9 ng/L, area under the ROC curve was 0.797 (95%CI: 0.730-0.854), sensitivity 83.0%, specificity 87.5%, PPD 95.7%, and NPV 60.3%. At logistic regression analysis, a rise in cTn-T level above 14 ng/L increased the probability of hemorrhage in CCHF patients approximately threefold. An increased troponin T level may be a prognostic risk factor for hemorrhage in CCHF patients. This marker should therefore be borne in mind in determining treatment strategy in these patients. J. Med. Virol. 89:408-412, 2017. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Hülya Yilmaz
- Department of Medical Biochemistry, Karadeniz Technical University, Faculty of Medicine and Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Gürdal Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - Uğur Kostakoğlu
- Department of Infectious Diseases and Clinical Microbiology, Recep Tayyip Erdoğan University, Faculty of Medicine, Rize, Turkey
| | - Hüseyin Yaman
- Department of Medical Biochemistry, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Asım Örem
- Department of Medical Biochemistry, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - İftihar Köksal
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
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Fagbuyi DB, Venkataraman S, Ralphe JC, Zuckerbraun NS, Pitetti RD, Lin Y, Jeong K, Saladino RA, Manole MD. Diastolic Hypotension, Troponin Elevation, and Electrocardiographic Changes Associated With the Management of Moderate to Severe Asthma in Children. Acad Emerg Med 2016; 23:816-22. [PMID: 27129445 DOI: 10.1111/acem.12997] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/12/2016] [Accepted: 04/06/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective was to determine the occurrence of, and the factors associated with, diastolic hypotension and troponin elevation or electrocardiogram (ECG) ST-segment changes in a convenience sample of children with moderate to severe asthma receiving continuous albuterol nebulization. METHODS This was a prospective, descriptive study in a pediatric emergency department and an intensive care unit of a tertiary academic center. Fifty children with moderate to severe asthma (clinical asthma score > 8) who received 10 to 15 mg/hour continuous albuterol for >2 hours between June 5, 2007, and February 4, 2008, were approached. Hourly diastolic blood pressures were recorded. Cardiac troponin I (cTnI) and ECG tracings were obtained following the first 2 hours of albuterol and then subsequently every 12 hours while receiving continuous albuterol. Main outcome measures were: 1) incidence of diastolic hypotension, 2) incidence of troponin elevation, and 3) incidence of ECG ST-depression. RESULTS Fifty patients were enrolled. Thirty-three (66%) patients developed diastolic hypotension during the first 6 hours of continuous albuterol. Diastolic blood pressure declined from baseline at 1-6 hours (p < 0.01 vs. baseline). Twelve patients (24%) had elevated cTnI, 15 patients (30%) had ST-segment change, four patients (8%) had both, and 23 patients (46%, 95% confidence interval [CI] = 32 to 60) had either a cTnI elevation or an ECG ST-segment change. Troponin elevation and diastolic hypotension were not associated (RR = 1.2, 95% CI = 0.6 to 2.3). CONCLUSIONS In a subset of children with moderate to severe asthma, diastolic hypotension, troponin elevation, and ECG ST-segment change occur during administration of continuous albuterol. Future studies are necessary to determine the clinical significance of these findings.
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Affiliation(s)
- Daniel B. Fagbuyi
- Department of Pediatrics; Division of Emergency Medicine; Children's National Medical Center; The George Washington University School of Medicine; Washington DC
| | - Shekhar Venkataraman
- Department of Critical Care Medicine; Children's Hospital of Pittsburgh; Pittsburgh PA
| | - J. Carter Ralphe
- Division of Pediatric Cardiology; University of Wisconsin School of Medicine and Public Health; Madison WI
| | - Noel S. Zuckerbraun
- Department of Pediatrics; Division of Pediatric Emergency Medicine; Children's Hospital of Pittsburgh; Pittsburgh PA
| | - Raymond D. Pitetti
- Department of Pediatrics; Division of Pediatric Emergency Medicine; Children's Hospital of Pittsburgh; Pittsburgh PA
| | - Yan Lin
- Institute for Clinical Research Education; University of Pittsburgh Graduate School of Public Health; Pittsburgh PA
| | - Kwonho Jeong
- Department of Biostatistics; University of Pittsburgh Graduate School of Public Health; Pittsburgh PA
| | - Richard A. Saladino
- Department of Pediatrics; Division of Pediatric Emergency Medicine; Children's Hospital of Pittsburgh; Pittsburgh PA
| | - Mioara D. Manole
- Department of Pediatrics; Division of Pediatric Emergency Medicine; Children's Hospital of Pittsburgh; Pittsburgh PA
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Mehta MD, Marwah SA, Ghosh S, Shah HN, Trivedi AP, Haridas N. A synergistic role of ischemia modified albumin and high-sensitivity troponin T in the early diagnosis of acute coronary syndrome. J Family Med Prim Care 2016; 4:570-5. [PMID: 26985418 PMCID: PMC4776611 DOI: 10.4103/2249-4863.174295] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim: The aim was to evaluate the role of high sensitivity troponin T and ischemia modified albumin (IMA) and in the early diagnosis of acute coronary syndrome (ACS). Materials and Methods: This was a cross-sectional study that comprised of 120 individuals of which 75 were cases and 45 healthy controls. On the basis of clinical history and 12-lead electrocardiogram, initial diagnosis of ACS was made in the cases. High sensitive cardiac troponin T (hs-cTnT) and IMA were measured in all the individuals. Results: Levels of IMA were significantly higher in patients of ACS as compared to those in control group (means: 101.83 [95% confidence interval (CI): 91.96–111.70] vs. 41.11 [95% CI: 38.55–43.67]). By taking the cut-off as >65.23 U/mL for IMA, which was obtained from receiver operating characteristic (ROC) curve, the sensitivity was 91.3%, specificity was 81.1%, positive predictive value (PPV) was 74.4%, and negative predictive value (NPV) was 93.9%. Positive likelihood ratio was 4.83 while negative likelihood ratio was 0.11, whereas the corresponding values in case of hs-cTnT were 95.6% (95% CI: 85.2–99.5), 61.3% (95% CI: 49.5–72.6), 59.7%, 95.8%, 2.47 and 0.07 by taking cut-off as >14 pg/mL. The area under the ROC curves (AUC) of IMA and hs-cTnT at 0–6 h were 0.932 (95% CI: 0.87–0.97, P < 0.001) and 0.797 (95% CI: 0.71–0.86, P < 0.001), respectively. The logistic model combining the two markers yielded sensitivity, specificity, PPV, and NPV of 95.7%, 81.1%, 88.6%, and 92.5% respectively. Conclusion: hs-cTnT and IMA may be useful tools for risk stratification of ACS and can be used together with better accuracy in the early diagnosis of ACS.
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Affiliation(s)
- Mihir D Mehta
- Department of Biochemistry, Pramukhswami Medical College, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
| | - Simbita A Marwah
- Department of Biochemistry, Pramukhswami Medical College, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
| | - S Ghosh
- Department of Biochemistry, Pramukhswami Medical College, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
| | - Hitesh N Shah
- Department of Biochemistry, Pramukhswami Medical College, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
| | - Amit P Trivedi
- Department of Biochemistry, Pramukhswami Medical College, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
| | - N Haridas
- Department of Biochemistry, Pramukhswami Medical College, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
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Koycheva RY, Cholakov V, Andreev J, Penev M, Iliev R, Nancheva K, Tsoneva V. Cardiac Biomarkers and Left Ventricular Hypertrophy in Asymptomatic Hemodialysis Patients. Open Access Maced J Med Sci 2015; 4:59-64. [PMID: 27275331 PMCID: PMC4884254 DOI: 10.3889/oamjms.2016.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 10/27/2015] [Accepted: 12/02/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND: Cardiac biomarkers are often elevated in dialysis patients showing the presence of left ventricular dysfunction. The aim of the study is to establish the plasma levels of high-sensitivity cardiac troponin T (hs TnT), precursor of B-natriuretic peptide (NT-proBNP) and high sensitivity C-reactive protein (hs CRP) and their relation to the presence of left ventricular hypertrophy (LVH) in patients undergoing hemodialysis without signs of acute coronary syndrome or heart failure. MATERIAL AND METHODS: We studied 48 patients - 26 men and 22 women. Pre and postdialysis levels of hs cTnT, NT-proBNP and hs CRP were measured at week interim procedure. Patients were divided in two groups according to the presence of echocardiographic evidence of LVH - gr A - 40 patients (with LVH), and gr B - 8 patients (without LVH). RESULTS: In the whole group of patients was found elevated predialysis levels of all three biomarkers with significant increase (p < 0.05) after dialysis with low-flux dialyzers. Predialysis values of NT-proBNP show moderate positive correlation with hs cTnT (r = 0.47) and weaker with hs CRP (r = 0.163). Such dependence is observed in postdialysis values of these biomarkers. There is a strong positive correlation between the pre and postdialysis levels: for hs cTnT (r = 0.966), for NT-proBNP (r = 0.918) and for hs CRP (r = 0.859). It was found a significant difference in the mean values of hs cTnT in gr. A and gr. B (0.07 ± 0.01 versus 0.03 ± 0.01 ng/mL, p < 0.05) and NT-proBNP (15,605.8 ± 2,072.5 versus 2,745.5 ± 533.55 pg/mL, p < 0.05). Not find a significant difference in hs CRP in both groups. CONCLUSIONS: The results indicate the relationship of the studied cardiac biomarkers with LVH in asymptomatic patients undergoing hemodialysis treatment.
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Affiliation(s)
- Reneta Yovcheva Koycheva
- Department of Nephrology, University Hospital "Prof. Dr. Stoyan Kirkovich", Stara Zagora, Bulgaria
| | - Vasil Cholakov
- Department of Nephrology, University Hospital "Prof. Dr. Stoyan Kirkovich", Stara Zagora, Bulgaria
| | - Jivko Andreev
- Department of Nephrology, University Hospital "Prof. Dr. Stoyan Kirkovich", Stara Zagora, Bulgaria
| | - Margarit Penev
- Department of Nephrology, University Hospital "Prof. Dr. Stoyan Kirkovich", Stara Zagora, Bulgaria
| | - Rosen Iliev
- Department of Nephrology, University Hospital "Prof. Dr. Stoyan Kirkovich", Stara Zagora, Bulgaria
| | - Krasimira Nancheva
- Department of Nephrology, University Hospital "Prof. Dr. Stoyan Kirkovich", Stara Zagora, Bulgaria
| | - Vanya Tsoneva
- Department of Nephrology, University Hospital "Prof. Dr. Stoyan Kirkovich", Stara Zagora, Bulgaria
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Greenberg RN, Hurley Y, Dinh DV, Mraz S, Vera JG, von Bredow D, von Krempelhuber A, Roesch S, Virgin G, Arndtz-Wiedemann N, Meyer TP, Schmidt D, Nichols R, Young P, Chaplin P. A Multicenter, Open-Label, Controlled Phase II Study to Evaluate Safety and Immunogenicity of MVA Smallpox Vaccine (IMVAMUNE) in 18-40 Year Old Subjects with Diagnosed Atopic Dermatitis. PLoS One 2015; 10:e0138348. [PMID: 26439129 PMCID: PMC4595076 DOI: 10.1371/journal.pone.0138348] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/26/2015] [Indexed: 01/19/2023] Open
Abstract
Background Replicating smallpox vaccines can cause severe complications in individuals with atopic dermatitis (AD). Prior studies evaluating Modified Vaccinia Ankara virus (MVA), a non-replicating vaccine in humans, showed a favorable safety and immunogenicity profile in healthy volunteers. Objective This Phase II study compared the safety and immunogenicity of MVA enrolling groups of 350 subjects with AD (SCORAD ≤ 30) and 282 healthy subjects. Methods Subjects were vaccinated twice with MVA, each dose given subcutaneously 4 weeks apart. Adverse events, cardiac parameters, and the development of vaccinia virus humoral immune responses were monitored. Results The overall safety of the vaccine was similar in both groups. Adverse events affecting skin were experienced significantly more often in subjects with AD, but the majority of these events were mild to moderate in intensity. Seroconversion rates and geometric mean titers for total and neutralizing vaccinia-specific antibodies in the AD group were non-inferior compared to the healthy subjects. Limitations The size of the study population limited the detection of serious adverse events occurring at a frequency less than 1%. Conclusion MVA has a favorable safety profile and the ability to elicit vaccinia-specific immune responses in subjects with AD. Trial Registration ClinicalTrials.gov NCT00316602
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Affiliation(s)
- Richard N Greenberg
- University of Kentucky School of Medicine, Lexington, KY, United States of America
- * E-mail:
| | - Yadira Hurley
- Saint Louis University, Department of Dermatology, Saint Louis, MO, United States of America
| | - Dinh V. Dinh
- Rx Clinical Research, Inc., Garden Grove, CA, United States of America
| | - Serena Mraz
- Vallejo Dermatology Office, Vallejo, CA, United States of America
| | - Javier Gomez Vera
- Hospital Regional Lic. Adolfo Lopez Mateos, ISSSTE, Mexico City, Mexico
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Lazzarino AI, Hamer M, Gaze D, Collinson P, Rumley A, Lowe G, Steptoe A. The association between fibrinogen reactivity to mental stress and high-sensitivity cardiac troponin T in healthy adults. Psychoneuroendocrinology 2015; 59:37-48. [PMID: 26010862 PMCID: PMC4512259 DOI: 10.1016/j.psyneuen.2015.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/06/2015] [Accepted: 05/06/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Plasma fibrinogen is considered as a positive mediator between mental stress and cardiovascular disease because it is an acute-phase protein released in response to mental stress and a coagulation factor. However those three factors have never been studied together within a single integrated framework, using cardiac troponin T as a marker of cardiovascular risk. METHODS 491 disease-free men and women aged 53-76 were tested for fibrinogen levels before, immediately after, and following recovery from standardized mental stress tasks. We measured plasma cardiac troponin T using a high-sensitivity assay (HS-CTnT) and coronary calcification using electron-beam dual-source computed tomography. RESULTS The average fibrinogen concentration increased by 5.1% (s.d.=7.3) in response to stress and then tended to return to baseline values. People with higher baseline fibrinogen values had smaller increases (blunted responses) following the stress task (P=0.001), and people with higher stress responses showed better recovery (P<0.001). In unadjusted analyses, higher baseline fibrinogen was associated with higher chances of having detectable HS-CTnT (P=0.072) but, conversely, higher fibrinogen response was associated with lower chances of having detectable HS-CTnT (P=0.007). The adjustment for clinical, inflammatory, and haemostatic factors, as well as for coronary calcification eliminated the effect of baseline fibrinogen, whereas the negative association between fibrinogen response and HS-CTnT remained robust: the odds of detectable HS-CTnT halved for each 10% increase in fibrinogen concentration due to stress (OR=0.49, P=0.007, 95% CI=0.30-0.82). CONCLUSIONS Greater fibrinogen responses to mental stress are associated with lower likelihood of detectable high-sensitivity troponin T plasma concentration. A more dynamic fibrinogen response appears to be advantageous for cardiovascular health.
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Affiliation(s)
- Antonio Ivan Lazzarino
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
| | - Mark Hamer
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom
| | - David Gaze
- Chemical Pathology, Clinical Blood Sciences, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London SW17 0QT, United Kingdom
| | - Paul Collinson
- Chemical Pathology, Clinical Blood Sciences, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London SW17 0QT, United Kingdom
| | - Ann Rumley
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, United Kingdom
| | - Gordon Lowe
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, United Kingdom
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom
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Arshed S, Luo HX, Zafar S, Regeti K, Malik N, Alam M, Yousif A. Elevated Troponin I in the Absence of Coronary Artery Disease: A Case Report With Review of Literature. J Clin Med Res 2015; 7:820-4. [PMID: 26346942 PMCID: PMC4554225 DOI: 10.14740/jocmr2280w] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 11/24/2022] Open
Abstract
Cardiac troponins are the most sensitive and specific markers of myocardial injury. In fact, the Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction (MI) states that troponins are the preferred cardiac marker for detecting myocardial injury. For the aforementioned reasons, troponin levels are routinely ordered for patients presenting to the emergency department with chest pain, dyspnea, syncope, or any other possible presentations of MI. While troponin levels do reflect the extent of myocardial damage, they do not necessarily indicate myocardial ischemia in a subset of patients. Elevated troponin levels can be due to a wide array of mechanisms in the absence of myocardial ischemia and injury. Thus, relying solely on troponin levels, in the presence of a normal electrocardiogram (ECG), to diagnose myocardial ischemia can lead to unnecessary and expensive invasive testing. It is therefore important for the clinician to keep in mind the varying causes of troponin elevations in order to provide the highest value care to the patient. We present a case and review of literature regarding patients who present with elevated troponin levels in the absence of any coronary artery disease.
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Affiliation(s)
- Sabrina Arshed
- Raritan Bay Medical Center, Internal Medicine Residency Program, 530 New Brunswick Avenue, Perth Amboy, NJ 08861, USA
| | - Hong Xiu Luo
- Raritan Bay Medical Center, Internal Medicine Residency Program, 530 New Brunswick Avenue, Perth Amboy, NJ 08861, USA
| | - Shoaib Zafar
- Raritan Bay Medical Center, Internal Medicine Residency Program, 530 New Brunswick Avenue, Perth Amboy, NJ 08861, USA
| | - Kalyani Regeti
- Raritan Bay Medical Center, Internal Medicine Residency Program, 530 New Brunswick Avenue, Perth Amboy, NJ 08861, USA
| | - Nilma Malik
- Raritan Bay Medical Center, Internal Medicine Residency Program, 530 New Brunswick Avenue, Perth Amboy, NJ 08861, USA
| | - Mahmood Alam
- Raritan Bay Medical Center, Internal Medicine Residency Program, 530 New Brunswick Avenue, Perth Amboy, NJ 08861, USA
| | - Abdalla Yousif
- Raritan Bay Medical Center, Internal Medicine Residency Program, 530 New Brunswick Avenue, Perth Amboy, NJ 08861, USA
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Davis MB, Shafton A, Desai A, Childers D, Bach DS. Reliable exclusion of acute coronary syndrome among hospitalized patients with elevated troponin. Clin Cardiol 2015; 37:395-401. [PMID: 25180409 DOI: 10.1002/clc.22263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Elevated cardiac troponin I (cTnI) occurs in acute coronary syndrome (ACS) as well as various scenarios not associated with ACS. HYPOTHESIS Simple clinical criteria can reliably exclude ACS among hospitalized patients with elevated cTnI. METHODS Records for patients hospitalized from January to April 2011 with elevated cTnI (>0.29 ng/dL) and an available echocardiogram were retrospectively reviewed. Patients with ST-segment elevation myocardial infarction were excluded. Based on available clinical data, patients were classified as having ACS or elevation of cTnI unrelated to ACS (non-ACS). Median follow-up was 365 days. RESULTS Of 265 records meeting inclusion criteria, 82 (31%) had ACS and 183 (69%) had non-ACS. In multivariable analysis, odds ratios for non-ACS were 7.6 (95% confidence interval [CI]: 3.8-15.3) for peak cTnI <2 ng/dL, 6.3 (95% CI: 3.1-13.0) for absent wall-motion abnormality, and 4.4 (95% CI: 2.2-8.6) for no prior coronary artery disease history. The area under the receiver operating curve for amodel using these 3 variables was 0.86, with a 98% negative predictive value for excluding ACS. Patients who met these 3 criteria had no ACS-related deaths over 1-year follow-up. CONCLUSIONS Hospitalized patients with peak Tn level<2 ng/dL, no prior history of coronary artery disease, and no new echocardiographic wall-motion abnormality appear to have a very low likelihood of ACS. Prospective validation of these results is needed to determine whether additional diagnostic testing could be safely avoided in hospitalized patients meeting these simple clinical criteria.
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Affiliation(s)
- Melinda B Davis
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
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Emrich T, Emrich K, Abegunewardene N, Oberholzer K, Dueber C, Muenzel T, Kreitner KF. Cardiac MR enables diagnosis in 90% of patients with acute chest pain, elevated biomarkers and unobstructed coronary arteries. Br J Radiol 2015; 88:20150025. [PMID: 25782462 DOI: 10.1259/bjr.20150025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To assess the diagnostic value of cardiac MRI (CMR) in patients with acute chest pain, elevated cardiac enzymes and a negative coronary angiogram. METHODS This study included a total of 125 patients treated in the chest pain unit during a 39-month period. Each included patient underwent MRI within a median of 3 days after cardiac catheterization. The MRI protocol comprised cine, oedema-sensitive and late gadolinium-enhancement imaging. The standard of reference was a consensus diagnosis based on clinical follow-up and the synopsis of all clinical, laboratory and imaging data. RESULTS MRI revealed a multitude of diagnoses, including ischaemic cardiomyopathy (CM), dilated CM, myocarditis, Takotsubo CM, hypertensive heart disease, hypertrophic CM, cardiac amyloidosis and non-compaction CM. MRI-based diagnoses were the same as the final reference diagnoses in 113/125 patients (90%), with the two diagnoses differing in only 12/125 patients. In two patients, no final diagnosis could be established. CONCLUSION CMR performed early after the onset of symptoms revealed a broad spectrum of diseases. CMR delivered a correct final diagnosis in 90% of patients with acute chest pain, elevated cardiac enzymes and a negative coronary angiogram. ADVANCES IN KNOWLEDGE Diagnosing patients with acute coronary syndrome but unobstructed coronary arteries remains a challenge for cardiologists. CMR performed early after catheterization reveals a broad spectrum of diseases with only a simple and quick examination protocol, and there is a high concordance between MRI-based diagnoses and final reference diagnoses.
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Affiliation(s)
- T Emrich
- 1 Department of Diagnostic and Interventional Radiology, Universitätsmedizin, Johannes Gutenberg University of Mainz, Mainz, Germany
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Cardiac Troponin I after Carotid Endarterectomy in Different Cardiac Risk Patients. J Stroke Cerebrovasc Dis 2015; 24:711-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.11.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 11/16/2014] [Accepted: 11/22/2014] [Indexed: 11/18/2022] Open
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Outcomes of pediatric patients undergoing cardiac catheterization while on extracorporeal membrane oxygenation. Pediatr Cardiol 2015; 36:625-32. [PMID: 25381624 DOI: 10.1007/s00246-014-1057-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Abstract
The aim of the study is to explore the indications for cardiac catheterization while on extracorporeal membrane oxygenation (ECMO) and the various catheter interventions performed as well as assess the safety profile and determine the short- and intermediate-term survival. ECMO is a lifesaving intervention for pediatric patients with respiratory and/or cardiovascular failure. There is limited recent literature discussing the survival and outcomes of patients undergoing cardiac catheterization while on ECMO. A retrospective review of consecutive patients undergoing catheterization while on ECMO from 2004 to 2013 was performed. Thirty-six patients who underwent 40 cardiac catheterizations were identified. Indications for catheterization included hemodynamic/anatomic assessment of postoperative (16) and non-operative patients (7), planned catheter interventions (CI) (12), and cardiomyopathy assessment (5). CI were performed during 18 (45 %) catheterizations, including stenting of vessels/surgical shunts (9), balloon atrial septostomy (4), device closure of septal defects/vessels (3), thrombolysis of vessels (2), endomyocardial biopsy (2), and temporary pacer wire placement (1). Unexpected diagnostic information was found in 21 (52 %), and 13 patients were referred for surgical intervention. Successful decannulation was achieved in 86 % of patients. Survival to discharge was 72 % and intermediate survival was 69 % (median = 29 months). Survival was 88 % (15/17) among patients who underwent CI. There were six procedural complications (15 %); five vascular and one non-vascular. There were no complications related to patient transport. Cardiac catheterization and interventions while on ECMO are safe, with a survival to discharge of 72 %. Diagnostic information obtained from catheterization leads to management decisions which may impact survival.
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