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Dugbartey GJ, Wonje QL, Alornyo KK, Robertson L, Adams I, Boima V, Mensah SD. Combination Therapy of Alpha-Lipoic Acid, Gliclazide and Ramipril Protects Against Development of Diabetic Cardiomyopathy via Inhibition of TGF-β/Smad Pathway. Front Pharmacol 2022; 13:850542. [PMID: 35401218 PMCID: PMC8988231 DOI: 10.3389/fphar.2022.850542] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/21/2022] [Indexed: 12/17/2022] Open
Abstract
Background: Diabetic cardiomyopathy (DCM) is a major long-term complication of diabetes mellitus, accounting for over 20% of annual mortality rate of diabetic patients globally. Although several existing anti-diabetic drugs have improved glycemic status in diabetic patients, prevalence of DCM is still high. This study investigates cardiac effect of alpha-lipoic acid (ALA) supplementation of anti-diabetic therapy in experimental DCM. Methods: Following 12 h of overnight fasting, 44 male Sprague Dawley rats were randomly assigned to two groups of healthy control (n = 7) and diabetic (n = 37) groups, and fasting blood glucose was measured. Type 2 diabetes mellitus (T2DM) was induced in diabetic group by intraperitoneal (i.p.) administration of nicotinamide (110 mg/kg) and streptozotocin (55 mg/kg). After confirmation of T2DM on day 3, diabetic rats received monotherapies with ALA (60 mg/kg; n = 7), gliclazide (15 mg/kg; n = 7), ramipril (10 mg/kg; n = 7) or combination of the three drugs (n = 7) for 6 weeks while untreated diabetic rats received distilled water and were used as diabetic control (n = 9). Rats were then sacrificed, and blood, pancreas and heart tissues were harvested for analyses using standard methods. Results: T2DM induction caused pancreatic islet destruction, hyperglycemia, weight loss, high relative heart weight, and development of DCM, which was characterized by myocardial degeneration and vacuolation, cardiac fibrosis, elevated cardiac damage markers (plasma and cardiac creatine kinase-myocardial band, brain natriuretic peptide and cardiac troponin I). Triple combination therapy of ALA, gliclazide and ramipril preserved islet structure, maintained body weight and blood glucose level, and prevented DCM development compared to diabetic control (p < 0.001). In addition, the combination therapy markedly reduced plasma levels of inflammatory markers (IL-1β, IL-6 and TNF-α), plasma and cardiac tissue malondialdehyde, triglycerides and total cholesterol while significantly increasing cardiac glutathione and superoxide dismutase activity and high-density lipoprotein-cholesterol compared to diabetic control (p < 0.001). Mechanistically, induction of T2DM upregulated cardiac expression of TGF-β1, phosphorylated Smad2 and Smad3 proteins, which were downregulated following triple combination therapy (p < 0.001). Conclusion: Triple combination therapy of ALA, gliclazide and ramipril prevented DCM development by inhibiting TGF-β1/Smad pathway. Our findings can be extrapolated to the human heart, which would provide effective additional pharmacological therapy against DCM in T2DM patients.
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Affiliation(s)
- George J Dugbartey
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Quinsker L Wonje
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Karl K Alornyo
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Louis Robertson
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ismaila Adams
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Vincent Boima
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Samuel D Mensah
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Accra, Ghana
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Souza LM, Mendonça CL, Assis RN, Oliveira Filho EF, Soares GSL, Souto RJC, Soares PC, Afonso JAB. Changes in cardiac biomarkers in goats naturally affected by pregnancy toxemia. Res Vet Sci 2020; 130:73-78. [PMID: 32146378 DOI: 10.1016/j.rvsc.2020.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 01/25/2023]
Abstract
Pregnancy toxemia (PT) is considered one of the most common metabolic diseases with high impact on the production of small ruminants. The objective of this study was investigate possible myocardial damage in goats affected with PT by the determination of serum myocardial biomarkers CK-MB and cTnI. A total of 44 goats affected with PT, and 10 apparently healthy goats (control group or CG) were used in the study. In goats with PT, the serum concentrations of cTnI (0.43 ng/mL) were significantly higher than that in CG goats (0.06 ng/mL). Although CK-MB showed no significant difference, it was approximately three times higher in animals with PT. The serum concentrations of insulin were significantly lower in PT goats (5.03 ppmol/L) compared to CG goats (10.66 pmol/L). The serum concentrations of cortisol in PT goats (155.41 nmol/L) were significantly higher than that in CG goats (36.58 nmol/L). Results of this study indicate that a clinically significant myocardial damage might occur in goats affected with PT leading to significant elevations in values of cTnI and CK-MB. Therefore, these parameters could be used as a potential prognostic indicator in goats affected with this important disease.
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Affiliation(s)
- L M Souza
- Federal Rural University of Pernambuco (UAG/UFRPE), Postgraduate Program in Sanitation and Reproduction of Ruminants, Av. Bom Pastor, s/n, CP 152-Boa Vista, 55292-278 Garanhuns, Pernambuco, Brazil.
| | - C L Mendonça
- Cattle Clinic, Campus Garanhuns/UFRPE, Av. Bom Pastor, s/n, CP 152-Boa Vista, 55292-278 Garanhuns, Pernambuco, Brazil
| | - R N Assis
- Federal Rural University of Pernambuco (UAG/UFRPE), Postgraduate Program in Sanitation and Reproduction of Ruminants, Av. Bom Pastor, s/n, CP 152-Boa Vista, 55292-278 Garanhuns, Pernambuco, Brazil
| | - E F Oliveira Filho
- Federal Rural University of Pernambuco, Postgraduate Program in Veterinary Medicine, Campus Recife/UFRPE, Av. Manuel de Medeiros, s/n-Dois Irmãos, 52171-900 Recife, Pernambuco, Brazil
| | - G S L Soares
- Federal Rural University of Pernambuco, Postgraduate Program in Veterinary Medicine, Campus Recife/UFRPE, Av. Manuel de Medeiros, s/n-Dois Irmãos, 52171-900 Recife, Pernambuco, Brazil
| | - R J C Souto
- Cattle Clinic, Campus Garanhuns/UFRPE, Av. Bom Pastor, s/n, CP 152-Boa Vista, 55292-278 Garanhuns, Pernambuco, Brazil
| | - P C Soares
- Department of Veterinary Medicine, Campus Recife/UFRPE, Av. Manuel de Medeiros, s/n-Dois Irmãos, 52171-900 Recife, Pernambuco, Brazil
| | - J A B Afonso
- Cattle Clinic, Campus Garanhuns/UFRPE, Av. Bom Pastor, s/n, CP 152-Boa Vista, 55292-278 Garanhuns, Pernambuco, Brazil
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El Razaky O, El Amrousy D, Elrifaey S, Elgendy M, Ibrahim W. Three-dimensional speckle tracking echocardiography: Is it the magic wand in the diagnosis of subclinical myocardial dysfunction in children with type 1 diabetes mellitus? Echocardiography 2018; 35:1657-1663. [PMID: 29981180 DOI: 10.1111/echo.14095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To revaluate the role of three-dimensional speckle tracking echocardiography (3D-STE) in the evaluation of subclinical myocardial dysfunction in asymptomatic children with type 1 diabetes mellitus (DM). PATIENTS AND METHODS Fifty asymptomatic children with type 1 DM were included as a patient group. Fifty healthy children of matched age, sex, and weight served as a control group. Laboratory investigations in the form of complete blood count (CBC), liver function test, renal function test, complete blood lipid profile, glycosylated hemoglobin (HbA1c), fasting and 2 hours postprandial (PP) glucose levels, and cardiac troponin I (cTnT I) were drawn. Complete echocardiographic evaluation of the left ventricular (LV) function was performed in the form of conventional echo, 2D strain, tissue Doppler imaging (TDI), and 3D- STE. RESULTS cTnT I levels were significantly higher in the patient group than the control group, and this increase was significantly correlated with Hb A1c. Conventional echocardiography showed normal systolic and diastolic function of the LV. Diastolic (by TDI) as well as systolic functions of LV (by 4D LV quantification tool) were found to be significantly lower in patient group than control group. 3D-STE examination showed that there was a significant decrease in all component of strain in patient group than control group and that decrease correlated well with 4D LV EF but did not correlate with the duration of DM. There was a significant negative correlation between longitudinal strain and the control of DM. CONCLUSION 3D-STE is a good tool for prediction of early cardiac dysfunction in asymptomatic children with type 1 DM.
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Affiliation(s)
- Osama El Razaky
- Pediatric Department, Tanta University Hospital, Tanta, Egypt
| | - Doaa El Amrousy
- Pediatric Department, Tanta University Hospital, Tanta, Egypt
| | | | - Marwa Elgendy
- Pediatric Department, Tanta University Hospital, Tanta, Egypt
| | - Wesam Ibrahim
- Clinical Pathology Department, Tanta University Hospital, Tanta, Egypt
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Sharma E, Dahal S, Sharma P, Ghimire DK, Dahal S. A Case of Pseudoinfarction Pattern in Diabetic Ketoacidosis: A Diagnostic and Therapeutic Dilemma. Cardiol Res 2018; 9:250-252. [PMID: 30116454 PMCID: PMC6089466 DOI: 10.14740/cr747w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/23/2018] [Indexed: 11/21/2022] Open
Abstract
Diabetic ketoacidosis (DKA) is regularly associated with hyperkalemia that results in well-described changes on the electrocardiogram (EKG). However, ST-segment elevations on EKG mimicking acute myocardial infarction have rarely been described in the setting of DKA. Here we present a case of a 43-year-old male with DKA who had pseudoinfarction pattern of ST-segment elevation on EKG that resolved with treatment of DKA and discuss the diagnostic and therapeutic dilemma around the condition.
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Affiliation(s)
- Eliza Sharma
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Suyash Dahal
- Department of Medicine, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - Pratibha Sharma
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Dipesh Kc Ghimire
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Sumit Dahal
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
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Agiostratidou G, Anhalt H, Ball D, Blonde L, Gourgari E, Harriman KN, Kowalski AJ, Madden P, McAuliffe-Fogarty AH, McElwee-Malloy M, Peters A, Raman S, Reifschneider K, Rubin K, Weinzimer SA. Standardizing Clinically Meaningful Outcome Measures Beyond HbA 1c for Type 1 Diabetes: A Consensus Report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange. Diabetes Care 2017; 40:1622-1630. [PMID: 29162582 PMCID: PMC5864122 DOI: 10.2337/dc17-1624] [Citation(s) in RCA: 258] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify and define clinically meaningful type 1 diabetes outcomes beyond hemoglobin A1c (HbA1c) based upon a review of the evidence, consensus from clinical experts, and input from researchers, people with type 1 diabetes, and industry. Priority outcomes include hypoglycemia, hyperglycemia, time in range, diabetic ketoacidosis (DKA), and patient-reported outcomes (PROs). While priority outcomes for type 1 and type 2 diabetes may overlap, type 1 diabetes was the focus of this work. RESEARCH AND METHODS A Steering Committee-comprising representatives from the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange-was the decision-making body for the Type 1 Diabetes Outcomes Program. Their work was informed by input from researchers, industry, and people with diabetes through Advisory Committees representing each stakeholder group. Stakeholder surveys were used to identify priority outcomes. The outcomes prioritized in the surveys were hypoglycemia, hyperglycemia, time in range, DKA, and PROs. To develop consensus on the definitions of these outcomes, the Steering Committee relied on published evidence, their clinical expertise, and feedback from the Advisory Committees. RESULTS The Steering Committee developed definitions for hypoglycemia, hyperglycemia, time in range, and DKA in type 1 diabetes. The definitions reflect their assessment of the outcome's short- and long-term clinical impact on people with type 1 diabetes. Knowledge gaps to be addressed by future research were identified. The Steering Committee discussed PROs and concluded that further type 1 diabetes-specific development is needed. CONCLUSIONS The Steering Committee recommends use of the defined clinically meaningful outcomes beyond HbA1c in the research, development, and evaluation of type 1 diabetes therapies.
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Affiliation(s)
| | | | | | - Lawrence Blonde
- American Association of Clinical Endocrinologists, Jacksonville, FL
| | | | | | | | - Paul Madden
- American Diabetes Association, Arlington, VA
| | | | | | | | - Sripriya Raman
- American Association of Clinical Endocrinologists, Jacksonville, FL
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Yılmaz FH, Arı Yuca S, Vatansev H, Cimbek EA, Şen Y, Yılmaz İ, Akyürek F, Arslan D, Çimen D, Yorulmaz A. Heart-Type Fatty Acid Binding Protein Level as a Tool in Identification of Early Cardiac Effects of Diabetic Ketoacidosis. J Clin Res Pediatr Endocrinol 2017; 9:118-123. [PMID: 28077344 PMCID: PMC5463283 DOI: 10.4274/jcrpe.3961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE This study aimed to measure the serum levels of heart-type fatty acid binding protein (H-FABP) in patients presenting with diabetic ketoacidosis (DKA) and diabetic ketosis (DK) and to determine its role in identifying early-period cardiac ischemia. METHODS This prospective study included 35 patients diagnosed with DKA, 20 patients diagnosed with DK, and 20 control subjects. H-FABP, creatine kinase-MB (CK-MB), and troponin I levels were investigated at presentation in patients with DKA and DK and in the control group. H-FABP values were measured again after acidosis correction in the DKA patients. RESULTS No statistically significant differences were found with respect to troponin I and CK-MB within the groups. The H-FABP values of DKA patients at presentation were found to be significantly higher than those of DK patients and the control group (p=0.015). The H-FABP value of the DKA group was also found to be significantly higher than the value at hour 36 after acidosis correction (p=0.0001). CONCLUSION We would like to propose H-FABP as a potential marker for indicating myocardial ischemia.
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Affiliation(s)
- Fatma Hilal Yılmaz
- Selçuk University Faculty of Medicine, Department of Child Health and Diseases, Konya, Turkey, Phone: 0090332 224 39 88 E-mail:
| | - Sevil Arı Yuca
- Selçuk University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Hüsamettin Vatansev
- Selçuk University Faculty of Medicine, Department of Biochemistry, Konya, Turkey
| | - Emine Ayça Cimbek
- Selçuk University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Yaşar Şen
- Selçuk University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - İsa Yılmaz
- Selçuk University Faculty of Medicine, Department of Child Health and Diseases, Konya, Turkey
| | - Fikret Akyürek
- Selçuk University Faculty of Medicine, Department of Biochemistry, Konya, Turkey
| | - Derya Arslan
- Konya Training and Research Hospital, Clinic of Pediatric Cardiology, Konya, Turkey
| | - Derya Çimen
- Selçuk University Faculty of Medicine, Department of Pediatric Cardiology, Konya, Turkey
| | - Alaaddin Yorulmaz
- Beyhekim State Hospital, Clinic of Child Health and Diseases, Konya, Turkey
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Arora R, Chiwane S, Hartwig E, Kannikeswaran N. A child with altered sensorium, hyperglycemia, and elevated troponins. J Emerg Med 2013; 46:184-90. [PMID: 23880446 DOI: 10.1016/j.jemermed.2013.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 01/23/2013] [Accepted: 05/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are potentially life-threatening complications of diabetes mellitus. Although DKA and HHS share similar features, they are distinct clinical entities requiring different treatment measures. OBJECTIVE This case illustrates that the clinical distinction between these two entities can be difficult at times, especially in children who can present with an overlapping picture. CASE REPORT We report an interesting case of a 12-year-old whose initial presentation of diabetes was a mixed picture of hyperosmolar DKA and HHS coma complicated by myocardial strain and acute renal insufficiency. The myocardial strain resolved completely with resolution of the metabolic abnormalities. CONCLUSIONS Emergency physicians should be cognizant of varied presentations of hyperglycemic emergencies in children to initiate appropriate management for better outcomes.
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Affiliation(s)
- Rajan Arora
- Carman and Ann Adam Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
| | - Saurabh Chiwane
- Carman and Ann Adam Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
| | - Earl Hartwig
- Carman and Ann Adam Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
| | - Nirupama Kannikeswaran
- Carman and Ann Adam Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
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Eubanks A, Raza F, Alkhouli M, Glenn AN, Homko C, Kashem A, Bove A. Clinical significance of troponin elevations in acute decompensated diabetes without clinical acute coronary syndrome. Cardiovasc Diabetol 2012; 11:154. [PMID: 23270513 PMCID: PMC3549932 DOI: 10.1186/1475-2840-11-154] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 12/19/2012] [Indexed: 11/17/2022] Open
Abstract
Background Elevation of cardiac troponin has been documented in multiple settings without acute coronary syndrome. However, its impact on long-term cardiac outcomes in the context of acute decompensated diabetes remains to be explored. Methods We performed a retrospective analysis of 872 patients admitted to Temple University Hospital from 2004–2009 with DKA or HHS. Patients were included if they had cardiac troponin I (cTnI) measured within 24 hours of hospital admission, had no evidence of acute coronary syndrome and had a follow up period of at least 18 months. Of the 264 patients who met the criteria, we reviewed the baseline patient characteristics, admission labs, EKGs and major adverse cardiovascular events during the follow up period. Patients were categorized into two groups with normal and elevated levels of cardiac enzymes. The composite end point of the study was the occurrence of a major cardiovascular event (MACE) during the follow up period and was compared between the two groups. Results Of 264 patients, 24 patients were found to have elevated cTnI. Compared to patients with normal cardiac enzymes, there was a significant increase in incidence of MACE in patients with elevated cTnI. In a regression analysis, which included prior history of CAD, HTN and ESRD, the only variable that independently predicted MACE was an elevation in cTnI (p = 0.044). Patients with elevated CK-MB had increased lengths of hospitalization compared to the other group (p < 0.001). Conclusions Elevated cardiac troponin I in patients admitted with decompensated diabetes and without evidence of acute coronary syndrome, strongly correlate with a later major cardiovascular event. Thus, elevated troponin I during metabolic abnormalities identify a group of patients at an increased risk for poor long-term outcomes. Whether these patients may benefit from early detection, risk stratification and preventive interventions remains to be investigated.
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Affiliation(s)
- Anthony Eubanks
- Cardiology Section, Temple University School of Medicine, PA, USA
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ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: a report of the American College of Cardiology Foundation task force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2012; 60:2427-63. [PMID: 23154053 DOI: 10.1016/j.jacc.2012.08.969] [Citation(s) in RCA: 263] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Porciello F, Rishniw M, Herndon WE, Birettoni F, Antognoni MT, Simpson KW. Cardiac troponin I is elevated in dogs and cats with azotaemia renal failure and in dogs with non-cardiac systemic disease. Aust Vet J 2008; 86:390-4. [DOI: 10.1111/j.1751-0813.2008.00345.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Al-Mallah M, Zuberi O, Arida M, Kim HE. Positive troponin in diabetic ketoacidosis without evident acute coronary syndrome predicts adverse cardiac events. Clin Cardiol 2008; 31:67-71. [PMID: 18257021 DOI: 10.1002/clc.20167] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elevated troponin I has been associated with increased mortality in critically ill patients without acute coronary syndrome (ACS). However, the prognostic significance of troponin elevation in patients with diabetic ketoacidosis (DKA) without evident ACS has not been studied. METHODS Retrospective study of all patients admitted to a U.S. tertiary center between 01/98 and 12/00 with DKA and had troponin I level measured. Patients with evidence of ACS or who met the American College of Cardiology/European Society of Cardiology (ACC/ESC) definition for myocardial infarction were excluded. Baseline characteristics, cardiac evaluation and 2 year major adverse coronary event (MACE) rate were compared between patients with positive and negative troponin. RESULTS Ninety-six patients fulfilled the inclusion criteria of this study, 26 had positive troponin. There were no differences in baseline characteristics between the two groups. After a 2 year follow-up, there was significantly increased mortality in patients with elevated troponin (50.0% versus 27.1%, hazard-ratio (HR) 2.3, 95% confidence interval (CI) 1.2-4.8, p = 0.02). Patients with elevated troponin also had significantly increased MACE rate at 2 years (50.0% versus 28.6%, HR 2.6, 95% CI 1.3-5.3, p = 0.007) driven primarily by mortality. Using Cox Proportional Hazard Analysis, elevated troponin was a predictor of increased MACE after adjusting for confounding variables. (Adjusted HR 2.3, 95% CI 1.1-4.6, p = 0.02) CONCLUSIONS Elevated troponin I in diabetic patients admitted with DKA identifies a group at very high risk for future cardiac events and mortality. Whether cardiac risk stratification of these patients will improve long term outcome remains to be studied.
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Affiliation(s)
- Mouaz Al-Mallah
- Heart and Vascular Institute, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
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