1
|
Gottlieb M, Moyer E, Bernard K. Epidemiology of heart failure presentations to United States emergency departments from 2016 to 2023. Am J Emerg Med 2024; 86:70-73. [PMID: 39366035 DOI: 10.1016/j.ajem.2024.09.059] [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: 08/16/2024] [Revised: 09/20/2024] [Accepted: 09/22/2024] [Indexed: 10/06/2024] Open
Abstract
INTRODUCTION Heart failure (HF) is a common condition prompting presentation to the Emergency Department (ED) and is associated with significant morbidity and mortality. However, there is limited recent large-scale, robust data available on the admission rates, evaluation, and treatment of HF in the ED setting. METHODS This was a cross-sectional study of ED presentations for HF from 1/1/2016 to 12/31/2023 using the Epic Cosmos database. All ED visits with ICD-10 codes corresponding to acute HF were included. We excluded congenital heart disease and isolated right-sided HF. Outcomes included percentage of total ED visits, admission rates, troponin, B-type natriuretic peptide (BNP), chest radiography, and diuretic and nitroglycerin medication administration. Subgroup analyses of medications were performed by medication and route of administration (transdermal, sublingual/oral, and intravenous). RESULTS Out of 190,694,752 ED encounters, 2,626,011 (1.4 %) visits were due to acute HF. Of these, 1,897,369 (72.3 %) were admitted to the hospital. The majority of patients had a troponin (90.3 %), BNP (91.1 %), and chest radiograph (89.5 %) ordered. 82.5 % received intravenous diuresis, while 46.2 % received oral diuresis. The most common diuretic was furosemide (78.4 % intravenous, 32.5 % oral), followed by bumetanide (9.5 % intravenous, 7.1 % oral), and torsemide (0 % intravenous, 8.1 % oral). Nitroglycerin was given in 26.0 %, with the most common route being sublingual/oral (16.6 %), followed by transdermal (9.2 %) and intravenous (3.5 %). CONCLUSION HF represents a common reason for ED presentation, with the majority of patients being admitted. All patients received diuresis in the ED, with the majority receiving intravenous diuresis with furosemide. Approximately one-quarter received nitroglycerin with the sublingual/oral route being most common. These findings can help inform health policy initiatives, including admission decisions and evidence-based medication administration.
Collapse
Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Eric Moyer
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Kyle Bernard
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
2
|
Horiuchi Y, Maisel AS, van Veldhuisen DJ, Mueller C, Hogan C, Kontos MC, Cannon CM, Müller GA, Taub P, Vilke GM, Duff S, McDonald K, Mahon N, Nuñez J, Briguori C, Passino C, Murray PT, Wettersten N. Significance of an Early Repeat Troponin Measurement Upon Presentation to the Hospital for Acute Heart Failure. J Am Heart Assoc 2024; 13:e034850. [PMID: 39248254 DOI: 10.1161/jaha.124.034850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 08/08/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Higher cardiac troponin is associated with worse outcomes in patients with acute heart failure. The significance of repeat measurements over hours remains unclear. We assessed whether a repeat measurement and the Δ between measurements of high-sensitivity cardiac troponin I (hs-cTnI) were associated with outcomes in hypervolemic patients with acute heart failure without acute coronary syndrome. METHODS AND RESULTS We analyzed 582 individuals from AKINESIS (Acute Kidney Injury Neutrophil Gelatinase-Associated Lipocalin Evaluation of Symptomatic Heart Failure Study) with hs-cTnI measured ≤12 hours from admission and repeated ≤6 hours thereafter. Associations between hs-cTnI levels and their Δ with short-term (death, intensive care unit admission, receipt of inotropes, or positive pressure ventilation during hospitalization) and long-term (death or heart failure readmission within 1 year) outcomes were assessed. The average age was 69±13 years, 62% were men, 65% were White, 46% had coronary artery disease, and 22% had chest pain. Median hs-cTnI levels were 27 (interquartile range [IQR], 13-62) ng/L initially and 28 (IQR, 14-68) ng/L subsequently, with a Δ of 0 [IQR, -2 to 4] ng/L over 3.4±1 hours. Only the second measurement was associated with short-term outcomes (odds ratio, 1.14 per 2-fold higher [95% CI, 1.02-1.28]). Both individual measurements and the Δ were associated with long-term outcomes (hazard ratios, 1.09, 1.12, and 1.16 for first, second, and Δ, respectively). Associated risk for the first and second measurements were not constant over the year but highest early after being measured and decreased over 1 year. CONCLUSIONS Repeat measurements of hs-cTnI over hours can identify individuals with acute heart failure without acute coronary syndrome at risk for short- and long-term outcomes.
Collapse
Affiliation(s)
- Yu Horiuchi
- Division of Cardiology Mitsui Memorial Hospital Tokyo Japan
| | - Alan S Maisel
- Division of Cardiovascular Medicine University of California, San Diego La Jolla CA
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen University of Groningen Groningen the Netherlands
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel University of Basel Basel Switzerland
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical Center Virginia Commonwealth University Richmond VA
| | - Michael C Kontos
- Division of Cardiology, VCU Medical Center Virginia Commonwealth University Richmond VA
| | - Chad M Cannon
- Department of Emergency Medicine University of Kansas Medical Center Kansas City KS
| | - Gerhard A Müller
- Division of Nephrology and Rheumatology, UMG, University of Göttingen Göttingen Germany
| | - Pam Taub
- Division of Cardiovascular Medicine University of California, San Diego La Jolla CA
| | - Gary M Vilke
- Department of Emergency Medicine University of California, San Diego La Jolla CA
| | - Stephen Duff
- School of Medicine University College Dublin Dublin Ireland
| | - Kenneth McDonald
- Department of Cardiology, Mater Misericordiae University Hospital University College Dublin Dublin Ireland
- Department of Cardiology St. Vincent's University Hospital Dublin Ireland
| | - Niall Mahon
- Department of Cardiology, Mater Misericordiae University Hospital University College Dublin Dublin Ireland
| | - Julio Nuñez
- Department of Cardiology, Hospital Clínico Universitario Valencia, INCLIVA University of Valencia Valencia Spain
- CIBER in Cardiovascular Diseases Madrid Spain
| | - Carlo Briguori
- Department of Cardiology, Interventional Cardiology Mediterranea Cardiocentro Naples Italy
| | - Claudio Passino
- Department of Cardiology and Cardiovascular Medicine Fondazione Gabriele Monasterio Pisa Italy
| | | | - Nicholas Wettersten
- Division of Cardiovascular Medicine University of California, San Diego La Jolla CA
- Division of Cardiovascular Medicine San Diego Veterans Affairs Medical Center San Diego CA
| |
Collapse
|
3
|
Abraham MK, Madanan AS, Varghese S, Shkhair AI, Indongo G, Rajeevan G, S VN, George S. MnO 2 nanosheet quenched thulium doped photon-up conversion luminescent immunoprobe for the 'turn-on' detection of cardiac troponin T. Talanta 2024; 275:126096. [PMID: 38631263 DOI: 10.1016/j.talanta.2024.126096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/19/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024]
Abstract
A "turn-on" photon up conversion nano couple based on NaYF4: Yb, Tm UCNPs quenched with MnO2 nanosheet was developed for the rapid and selective detection of cTnT. Herein, MnO2 nanosheet hold on the surface of Antibody cTnT (Ab-cTnT) conjugated blue emitting up conversion nanoprobe (λem at 475 nm), which leads to quenching of fluorescence due to energy transfer from photon up conversion nanoparticles to MnO2 nanosheets. On introducing cTnT antigen to the system, the energy transfer process is hindered due to strong antigen -antibody interface on the surface. This in turn, influences the nano-couples positions and effectively separates up conversion nanoprobe from MnO2 nanosheets surface resulting in restriction to energy transfer process enabling fluorescence recovery. The developed probe shows a linear response towards cTnT in the range of 0.16-2.77 ng/mL with a Limit of Detection (LoD) of 0.025 ng/mL. The practical feasibility of the nanoprobe is performed with possible coexisting biomolecules. Biological study in human blood serum samples exhibited sufficient recovery percentage in the range of 92-103 % is obtained.
Collapse
Affiliation(s)
- Merin K Abraham
- Department of Chemistry, School of Physical and Mathematical Science, Research Centre, University of Kerala, Kariavattom Campus, Thiruvananthapuram, 695581, Kerala, India
| | - Anju S Madanan
- Department of Chemistry, School of Physical and Mathematical Science, Research Centre, University of Kerala, Kariavattom Campus, Thiruvananthapuram, 695581, Kerala, India
| | - Susan Varghese
- Department of Chemistry, School of Physical and Mathematical Science, Research Centre, University of Kerala, Kariavattom Campus, Thiruvananthapuram, 695581, Kerala, India
| | - Ali Ibrahim Shkhair
- Department of Chemistry, School of Physical and Mathematical Science, Research Centre, University of Kerala, Kariavattom Campus, Thiruvananthapuram, 695581, Kerala, India
| | - Geneva Indongo
- Department of Chemistry, School of Physical and Mathematical Science, Research Centre, University of Kerala, Kariavattom Campus, Thiruvananthapuram, 695581, Kerala, India
| | - Greeshma Rajeevan
- Department of Chemistry, School of Physical and Mathematical Science, Research Centre, University of Kerala, Kariavattom Campus, Thiruvananthapuram, 695581, Kerala, India
| | - Vijila N S
- Department of Chemistry, School of Physical and Mathematical Science, Research Centre, University of Kerala, Kariavattom Campus, Thiruvananthapuram, 695581, Kerala, India
| | - Sony George
- Department of Chemistry, School of Physical and Mathematical Science, Research Centre, University of Kerala, Kariavattom Campus, Thiruvananthapuram, 695581, Kerala, India.
| |
Collapse
|
4
|
Li H, Wan L, Liu M, Ma E, Huang L, Yang Y, Li Q, Fang Y, Li J, Han B, Zhang C, Sun L, Hou X, Li H, Sun M, Qian S, Duan X, Zhao R, Yang X, Chen Y, Wu S, Zhang X, Zhang Y, Cheng G, Chen G, Gao Q, Xu J, Hou L, Wei C, Zhong H. SARS-CoV-2 spike-induced syncytia are senescent and contribute to exacerbated heart failure. PLoS Pathog 2024; 20:e1012291. [PMID: 39102426 PMCID: PMC11326701 DOI: 10.1371/journal.ppat.1012291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 08/15/2024] [Accepted: 05/27/2024] [Indexed: 08/07/2024] Open
Abstract
SARS-CoV-2 spike protein (SARS-2-S) induced cell-cell fusion in uninfected cells may occur in long COVID-19 syndrome, as circulating SARS-2-S or extracellular vesicles containing SARS-2-S (S-EVs) were found to be prevalent in post-acute sequelae of COVID-19 (PASC) for up to 12 months after diagnosis. Although isolated recombinant SARS-2-S protein has been shown to increase the SASP in senescent ACE2-expressing cells, the direct linkage of SARS-2-S syncytia with senescence in the absence of virus infection and the degree to which SARS-2-S syncytia affect pathology in the setting of cardiac dysfunction are unknown. Here, we found that the senescent outcome of SARS-2-S induced syncytia exacerbated heart failure progression. We first demonstrated that syncytium formation in cells expressing SARS-2-S delivered by DNA plasmid or LNP-mRNA exhibits a senescence-like phenotype. Extracellular vesicles containing SARS-2-S (S-EVs) also confer a potent ability to form senescent syncytia without de novo synthesis of SARS-2-S. However, it is important to note that currently approved COVID-19 mRNA vaccines do not induce syncytium formation or cellular senescence. Mechanistically, SARS-2-S syncytia provoke the formation of functional MAVS aggregates, which regulate the senescence fate of SARS-2-S syncytia by TNFα. We further demonstrate that senescent SARS-2-S syncytia exhibit shrinked morphology, leading to the activation of WNK1 and impaired cardiac metabolism. In pre-existing heart failure mice, the WNK1 inhibitor WNK463, anti-syncytial drug niclosamide, and senolytic dasatinib protect the heart from exacerbated heart failure triggered by SARS-2-S. Our findings thus suggest a potential mechanism for COVID-19-mediated cardiac pathology and recommend the application of WNK1 inhibitor for therapy especially in individuals with post-acute sequelae of COVID-19.
Collapse
Affiliation(s)
- Huilong Li
- Beijing Institute of Biotechnology, Beijing, China
- College of Basic Medical Sciences, School of Medicine, Zhejiang University, Hangzhou, China
| | - Luming Wan
- Beijing Institute of Biotechnology, Beijing, China
| | - Muyi Liu
- Beijing Institute of Biotechnology, Beijing, China
| | - Enhao Ma
- Tsinghua-Peking Center for Life Sciences, School of Medicine, Tsinghua University, Beijing, China
| | - Linfei Huang
- Beijing Institute of Biotechnology, Beijing, China
| | - Yilong Yang
- Beijing Institute of Biotechnology, Beijing, China
| | - Qihong Li
- The Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yi Fang
- The Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jingfei Li
- Beijing Institute of Biotechnology, Beijing, China
| | - Bingqing Han
- Beijing Institute of Biotechnology, Beijing, China
| | - Chang Zhang
- Beijing Institute of Biotechnology, Beijing, China
| | - Lijuan Sun
- Beijing Yaogen Biotechnology Co.Ltd, Beijing, China
| | - Xufeng Hou
- Beijing Yaogen Biotechnology Co.Ltd, Beijing, China
| | - Haiyang Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mingyu Sun
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Sichong Qian
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xuejing Duan
- Department of Pathology, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Ruzhou Zhao
- Beijing Institute of Biotechnology, Beijing, China
| | - Xiaopan Yang
- Beijing Institute of Biotechnology, Beijing, China
| | - Yi Chen
- Beijing Institute of Biotechnology, Beijing, China
| | - Shipo Wu
- Beijing Institute of Biotechnology, Beijing, China
| | - Xuhui Zhang
- Beijing Yaogen Biotechnology Co.Ltd, Beijing, China
| | | | - Gong Cheng
- Tsinghua-Peking Center for Life Sciences, School of Medicine, Tsinghua University, Beijing, China
| | - Gengye Chen
- People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Qi Gao
- Beijing Yaogen Biotechnology Co.Ltd, Beijing, China
| | - Junjie Xu
- Beijing Institute of Biotechnology, Beijing, China
| | - Lihua Hou
- Beijing Institute of Biotechnology, Beijing, China
- College of Basic Medical Sciences, School of Medicine, Zhejiang University, Hangzhou, China
| | - Congwen Wei
- Beijing Institute of Biotechnology, Beijing, China
| | - Hui Zhong
- Beijing Institute of Biotechnology, Beijing, China
| |
Collapse
|
5
|
Dang HNN, Viet Luong T, Cao MTT, Bui VT, Tran TT, Nguyen HM. Assessing red blood cell distribution width in Vietnamese heart failure patients: A cross-sectional study. PLoS One 2024; 19:e0301319. [PMID: 39042640 PMCID: PMC11265657 DOI: 10.1371/journal.pone.0301319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/07/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Heart failure (HF) is becoming a growing public health concern. Diagnostic tests for determining the severity of HF often come with high costs and require specialized expertise, which makes it difficult to assess HF severity, especially in low-income countries or at primary healthcare facilities. Recently, red blood cell distribution width (RDW) has emerged as a promising, easily accessible marker associated with HF severity. The study aimed to assess changes in RDW levels in HF patients and the diagnostic value of RDW in detecting acute heart failure (AHF) among HF patients. METHODS We conducted a cross-sectional examination involving 351 participants divided into HF and non-HF cohorts. HF was defined and categorized according to the diagnostic and treatment guidelines for AHF and chronic heart failure (CHF) set forth by the European Society of Cardiology (2021). Univariate and multivariate analysis of factors associated with AHF was performed. RESULTS The study revealed that HF patients displayed higher median RDW levels (14.90% [13.70-17.00]) compared to non-HF individuals (13.00% [12.23-13.78]). RDW was notably elevated in HF patients with left ventricular ejection fraction < 50% compared to those with left ventricular ejection fraction ≥ 50%. ROC curve analysis of RDW for AHF detection identified a cutoff value of 13.85%, with a sensitivity of 86.05% and specificity of 47.18%, statistically significant at p < 0.001. RDW > 13.85% was identified as an independent risk factor for AHF in patients with HF, with odds ratios of 2.644 (95% CI, 1.190-5.875; p = 0.017). CONCLUSION The study revealed significant RDW variations in patients with CHF and AHF compared to the control group. These findings suggest that RDW could be a biomarker for detecting HF severity.
Collapse
Affiliation(s)
- Hai Nguyen Ngoc Dang
- The Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
- Cardiovascular Center, Hue Central Hospital, Hue, Vietnam
| | - Thang Viet Luong
- University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Mai Thi Thu Cao
- University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Vinh Trung Bui
- University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thanh Thien Tran
- University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Hung Minh Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| |
Collapse
|
6
|
Abubakar M, Irfan U, Abdelkhalek A, Javed I, Khokhar MI, Shakil F, Raza S, Salim SS, Altaf MM, Habib R, Ahmed S, Ahmed F. Comprehensive Quality Analysis of Conventional and Novel Biomarkers in Diagnosing and Predicting Prognosis of Coronary Artery Disease, Acute Coronary Syndrome, and Heart Failure, a Comprehensive Literature Review. J Cardiovasc Transl Res 2024:10.1007/s12265-024-10540-8. [PMID: 38995611 DOI: 10.1007/s12265-024-10540-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 06/25/2024] [Indexed: 07/13/2024]
Abstract
Coronary artery disease (CAD), acute coronary syndrome (ACS), and heart failure (HF) are major global health issues with high morbidity and mortality rates. Biomarkers like cardiac troponins (cTn) and natriuretic peptides (NPs) are crucial tools in cardiology, but numerous new biomarkers have emerged, proving increasingly valuable in CAD/ACS. These biomarkers are classified based on their mechanisms, such as fibrosis, metabolism, inflammation, and congestion. The integration of established and emerging biomarkers into clinical practice is an ongoing process, and recognizing their strengths and limitations is crucial for their accurate interpretation, incorporation into clinical settings, and improved management of CVD patients. We explored established biomarkers like cTn, NPs, and CRP, alongside newer biomarkers such as Apo-A1, IL-17E, IgA, Gal-3, sST2, GDF-15, MPO, H-FABP, Lp-PLA2, and ncRNAs; provided evidence of their utility in CAD/ACS diagnosis and prognosis; and empowered clinicians to confidently integrate these biomarkers into clinical practice based on solid evidence.
Collapse
Affiliation(s)
- Muhammad Abubakar
- Department of Internal Medicine, Ameer-Ud-Din Medical College, 6 Birdwood Road, Jinnah Town, Lahore, 54000, Punjab, Pakistan.
| | - Umema Irfan
- Department of Internal Medicine, Deccan College of Medical Sciences, Hyderabad, India
| | - Ahmad Abdelkhalek
- Department of Internal Medicine, Zhejiang University, Zhejiang, China
| | - Izzah Javed
- Department of Internal Medicine, Ameer-Ud-Din Medical College, 6 Birdwood Road, Jinnah Town, Lahore, 54000, Punjab, Pakistan
| | | | - Fraz Shakil
- Department of Emergency Medicine, Mayo Hospital, Lahore, Pakistan
| | - Saud Raza
- Department of Anesthesia, Social Security Teaching Hospital, Lahore, Punjab, Pakistan
| | - Siffat Saima Salim
- Department of Surgery, Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh
| | - Muhammad Mahran Altaf
- Department of Internal Medicine, Ameer-Ud-Din Medical College, 6 Birdwood Road, Jinnah Town, Lahore, 54000, Punjab, Pakistan
| | - Rizwan Habib
- Department of Internal Medicine and Emergency, Indus Hospital, Lahore, Pakistan
| | - Simra Ahmed
- Department of Internal Medicine, Ziauddin Medical College, Karachi, Pakistan
| | - Farea Ahmed
- Department of Internal Medicine, Ziauddin Medical College, Karachi, Pakistan
| |
Collapse
|
7
|
Olopade EO, Morakinyo AE, Alao JO, Oyedepo TA. Effects of n-hexane fraction of Piper guineense seed extract on N ω-nitro-L-arginine methyl ester hydrochloride-induced hypertension in rats. Cell Biochem Funct 2024; 42:e4095. [PMID: 39004810 DOI: 10.1002/cbf.4095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/14/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024]
Abstract
This study aimed to investigate the effects of the n-hexane fraction of the ethanolic seed extract of PG (NFESEPG) on hypertension induced by Nω-nitro-L-arginine methyl ester (L-NAME) in rats. Specifically, the study examined the impact of NFESEPG on blood pressure, oxidative stress markers, NO concentration, angiotensin-converting enzyme (ACE) and arginase activities, and cardiac biomarkers in hypertensive rats. The study involved collecting, identifying, and processing the PG plant to obtain the ethanolic seed extract. The extract was then partitioned with solvents to isolate the n-hexane fraction. Hypertension was induced in rats by oral administration of L-NAME for 10 days, while concurrent treatment with NFESEPG at two doses (200 and 400 mg/kg/day) was administered orally. Blood pressure was measured using a noninvasive tail-cuff method, and various biochemical parameters were assessed. Treatment with both doses of NFESEPG significantly reduced systolic and diastolic blood pressure in L-NAME-induced hypertensive rats. Additionally, NFESEPG administration increased NO concentration and decreased ACE and arginase activities, malondialdehyde (MDA) levels, and cardiac biomarkers in hypertensive rats. The findings indicate that NFESEPG effectively lowered blood pressure in hypertensive rats induced by L-NAME, potentially through mechanisms involving the modulation of oxidative stress, NO bioavailability, and cardiac biomarkers. These results suggest the therapeutic potential of NFESEPG in managing hypertension and related cardiovascular complications.
Collapse
Affiliation(s)
| | | | - Jude Oluwapelumi Alao
- School of Public Health and Interdisciplinary Studies, Auckland University of Technology, Auckland, New Zealand
| | | |
Collapse
|
8
|
Venishetty N, Jose J, Purudappa PPA, Mounasamy V, Sambandam S. Factors that influence the mortality of patients following hip hemiarthroplasty. ARTHROPLASTY 2024; 6:36. [PMID: 38844977 PMCID: PMC11157840 DOI: 10.1186/s42836-024-00247-1] [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: 09/27/2023] [Accepted: 03/07/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION Hip hemiarthroplasty (HHA) is one of the most common types of orthopedic surgery. With the prevalence and utilization of the surgery increasing year after year, this procedure is found to be associated with severe postoperative complications and eventually mortality. Thus, it is crucial to understand the factors that increase the risk of mortality following HHA. METHODS Using the Nationwide Inpatient Sample (NIS) database, patients undergoing HHA from 2016 to 2019 were identified. This sample was stratified into a mortality group and a control group. The data regarding patients' demographics, co-morbidities, and associated complications were compared between the groups. RESULTS Of the 84,067 patients who underwent the HHA procedures, 1,327 (1.6%) patients died. Additionally, the mortality group had a higher percentage of patients who were non-electively admitted (P < 0.001) and diabetic patients with complications (P < 0.001), but lower incidences of tobacco-related disorders (P < 0.001). Significant differences were also seen in age (P < 0.001), length of stay (P < 0.001), and total charges (P < 0.001) between the two groups. Preoperatively, those aged > 70 years (OR: 2.11, 95% CI [1.74, 2.56], P < 0.001) had diabetes without complications (OR: 0.32, 95% CI [0.23, 0.44], P < 0.001), tobacco-related disorders (OR: 0.24, 95% CI [0.17, 0.34], P < 0.001) and increased rates of mortality after HHA. Postoperatively, conditions, such as pulmonary embolisms (OR: 6.62, 95% CI [5.07, 8.65], P < 0.001), acute renal failure (OR: 4.58 95% CI [4.09, 5.13], P < 0.001), pneumonia (95% CI [2.72, 3.83], P < 0.001), and myocardial infarctions (OR: 2.65, 95% CI [1.80, 3.92], P < 0.001) increased likelihood of death after undergoing HHA. Patients who were electively admitted (OR: 0.46 95% CI [0.35, 0.61], P < 0.001) had preoperative obesity (OR: 0.67, 95% CI [0.44, 0.84], P = 0.002), and a periprosthetic dislocation (OR: 0.51, 95% CI [0.31, 0.83], P = 0.007) and were found to have a decreased risk of mortality following THA. CONCLUSIONS Analysis of pre- and postoperative complications relating to HHA revealed that several comorbidities and postoperative complications increased the odds of mortality. Old age, pulmonary embolisms, acute renal failure, pneumonia, and myocardial infraction enhanced the odds of post-HHA mortality.
Collapse
Affiliation(s)
- Nikit Venishetty
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, 79905, USA.
| | | | | | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Dallas VAMC, Dallas, TX, 75390, USA
| | - Senthil Sambandam
- Department of Orthopedics, University of Texas Southwestern, Dallas VAMC, Dallas, TX, 75390, USA.
| |
Collapse
|
9
|
Koirala S, Danley K, Kerolos M, Chu J, Yucebay E, Purim-Shem-Tov Y, Volgman AS, Attanasio S. Effect of transitioning from conventional cardiac troponin to high-sensitivity cardiac troponin on resource utilization- a single center experience. Am J Emerg Med 2024; 80:174-177. [PMID: 38613986 DOI: 10.1016/j.ajem.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/09/2024] [Accepted: 04/06/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Compared to conventional cardiac troponin (cTn), the high-sensitivity cardiac troponin (hs-cTn) assay is associated with improved detection of myocardial infarction (MI). METHODS We performed a descriptive retrospective analysis of resource utilization at Rush University Medical Center over the transition period (July 1, 2021) from a cTn to a hs-cTn assay. Inclusion criteria included emergency department (ED) encounters between January 1 to December 31, 2021, with chief complaints of "chest pain" or "dyspnea" with associated troponin orders. The primary endpoint was the percentage of ED discharges. Secondary endpoints included the number of cardiac studies ordered. Univariable comparisons of these endpoints were performed using Student's t-test for continuous variables and Chi-square tests for binary/categorical variables. RESULTS A total of 5113 encounters were analyzed. Hs-cTn was associated with an overall increase in ED patient discharges with negative troponin tests (44.1% vs. 29.9%, P < 0.01). In terms of cardiac testing per encounter, hs-cTn was associated with significant increases in the number of troponin tests (1.9 vs. 1.6, P < 0.01), electrocardiograms (3.0 vs. 2.9, P = 0.01), and echocardiograms (0.5 vs. 0.4, P < 0.01). There was a significant decrease in the utilization of stress testing (0.21 vs. 0.26, P < 0.01). There was a significant increase in total coronary angiography use during the hs-cTn period compared to cTn (227/2471 (9.2%) vs. 195/2642 (7.4%), P = 0.02). CONCLUSION Transitioning from cTn to hs-cTn was associated with significantly increased ED discharges and an increase in troponin tests, ECG, echocardiograms, and coronary angiograms. There was a decrease in the number of stress tests.
Collapse
Affiliation(s)
- Sushant Koirala
- Department of Internal Medicine, Rush University Medical Center, 600 S. Paulina St., Chicago, IL 60612, USA.
| | - Kelsey Danley
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Mina Kerolos
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Jian Chu
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Elif Yucebay
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
| | | | - Annabelle Santos Volgman
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Steve Attanasio
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
| |
Collapse
|
10
|
Montecillo J, Pirker T, Pemberton C, Chew-Harris J. suPAR in cardiovascular disease. Adv Clin Chem 2024; 121:89-131. [PMID: 38797545 DOI: 10.1016/bs.acc.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Soluble urokinase plasminogen activator receptor (suPAR), the soluble counterpart of urokinase plasminogen activator receptor, is found in the circulation at various levels. suPAR and its parent molecule, cell surface uPAR, exhibit similar structure and extracellular functional roles facilitating fibrinolysis, cellular adhesion, and migration. Studies have assessed the correlation between suPAR in cardiovascular disease (CVD). It is postulated that suPAR may serve as an indicator of inflammatory activation and burden during CVD progression. Increased suPAR independently predicts poorer outcomes in acute coronary syndromes, in heart failure, as well as in coronary artery disease and atherosclerosis. To guide translation into clinical utization, suPAR has been assessed in numerous CVD settings for improved risk discrimination independently or in association with established traditional risk factors. Whilst the involvement of suPAR has been explored in other diseases such as kidney diseases and cancer, there is only emerging evidence of suPAR's mechanistic involvement in cardiovascular disease. In this review, we provide a background into suPAR and its potential role as a biomarker in CVD.
Collapse
Affiliation(s)
- Jaya Montecillo
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Thomas Pirker
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | | | - Janice Chew-Harris
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
| |
Collapse
|
11
|
Gulia A, Srivastava M, Kumar P. Elevated troponin levels as a predictor of mortality in patients with acute stroke: a systematic review and meta-analysis. Front Neurol 2024; 15:1351925. [PMID: 38590721 PMCID: PMC10999611 DOI: 10.3389/fneur.2024.1351925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
Background and Aim The prognostic potential of cardiac troponin (cTn) in acute stroke patients has been a subject of ongoing debate. Our objective was to provide a comprehensive evidence for predicting mortality in acute stroke patients by using the elevated troponin levels. Methods We conducted an extensive literature search, including PubMed, EMbase, and Trip Databases, covering studies published up to September 30, 2023. We computed risk ratios (RR) with 95% confidence intervals (CIs), performed sensitivity analysis, and conducted trial sequential analysis (TSA). Results In total, 53 studies were analyzed, with 37 focusing on acute ischemic stroke (AIS), 11 on subarachnoid hemorrhage (SAH), and 7 on Intracerebral hemorrhage (ICH). Elevated cTn levels were significantly showed a higher predictive risk for In-hospital mortality in both AIS (RR=3.80, 95% CI; 2.82 to 5.12) as well as SAH (RR=2.23, 95% CI; 1.64 to 3.02). However, no significant predictive risk between elevated cTn levels and in-hospital mortality for ICH patients (RR=1.13, 95% CI: 0.46 to 2.79). A similar pattern was observed for elevated cTn levels, indicating an increased risk of last follow-up mortality for AIS (RR=2.41, 95% CI: 1.98 to 2.93) and SAH (RR=3.08, 95% CI: 2.25 to 4.21). Conclusion Elevated troponin levels can serve as a promising predictive marker for both in-hospital and last follow-up mortality in AIS and SAH patients but not in ICH patients. Further prospective studies are needed to validate our findings along with exploring the preventive management of mortality in acute stroke settings.
Collapse
Affiliation(s)
| | | | - Pradeep Kumar
- Clinical Research Unit, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
12
|
Cao J, Wei Z, Nie Y, Chen HZ. Therapeutic potential of alternative splicing in cardiovascular diseases. EBioMedicine 2024; 101:104995. [PMID: 38350330 PMCID: PMC10874720 DOI: 10.1016/j.ebiom.2024.104995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/15/2024] Open
Abstract
RNA splicing is an important RNA processing step required by multiexon protein-coding mRNAs and some noncoding RNAs. Precise RNA splicing is required for maintaining gene and cell function; however, mis-spliced RNA transcripts can lead to loss- or gain-of-function effects in human diseases. Mis-spliced RNAs induced by gene mutations or the dysregulation of splicing regulators may result in frameshifts, nonsense-mediated decay (NMD), or inclusion/exclusion of exons. Genetic animal models have characterised multiple splicing factors required for cardiac development or function. Moreover, sarcomeric and ion channel genes, which are closely associated with cardiovascular function and disease, are hotspots for AS. Here, we summarise splicing factors and their targets that are associated with cardiovascular diseases, introduce some therapies potentially related to pathological AS targets, and raise outstanding questions and future directions in this field.
Collapse
Affiliation(s)
- Jun Cao
- College of Chemistry and Life Science, Beijing University of Technology, Beijing, 100124, PR China; University of Texas Medical Branch at Galveston, TX, 77555, USA
| | - Ziyu Wei
- Department of Biochemistry & Molecular Biology, State Key Laboratory of Common Mechanism Research for Major Diseases, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China
| | - Yu Nie
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
| | - Hou-Zao Chen
- Department of Biochemistry & Molecular Biology, State Key Laboratory of Common Mechanism Research for Major Diseases, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China; Medical Epigenetics Research Center, Chinese Academy of Medical Sciences, Beijing, China.
| |
Collapse
|
13
|
Kayani M, Fatima N, Yarra PC, Almansouri NE, K D, Balasubramanian A, Parvathaneni N, Mowo-Wale AG, Valdez JA, Nazir Z. Novel Biomarkers in Early Detection of Heart Failure: A Narrative Review. Cureus 2024; 16:e53445. [PMID: 38435138 PMCID: PMC10909379 DOI: 10.7759/cureus.53445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/05/2024] Open
Abstract
Heart failure (HF) represents a significant global health challenge, characterized by a variety of symptoms resulting from cardiac dysfunction. This dysfunction often leads to systemic and pulmonary congestion. The pathophysiology of HF is complex, involving stimulation of the sympathetic nervous system, which is insufficiently balanced by the release of natriuretic peptide. This imbalance leads to progressive hypertrophy and dilatation of the heart's chambers, impairing its pumping efficiency and increasing the risk of arrhythmias and conduction disorders. The prevalence of HF is exceptionally high in industrialized nations and is expected to increase owing to an aging population and advancements in diagnostic methods. This study emphasizes the critical role of early diagnosis in reducing morbidity and mortality associated with HF, focusing specifically on the evolving importance of biomarkers in managing this condition. Biomarkers have played a key role in transforming the diagnosis and treatment of HF. Traditional biomarkers such as b-type natriuretic peptide and N-terminal pro-b-type natriuretic peptide have been widely adopted for their cost-effectiveness and ease of access. However, the rise of novel biomarkers such as growth differentiation factor 15 and adrenomedullin has shown promising results, offering superior sensitivity and specificity. These new biomarkers enhance diagnostic accuracy, risk stratification, and prognostic evaluation in HF patients. Despite these advancements, challenges remain, such as limited availability, high costs, and the need for further validation in diverse patient populations. Through a comprehensive literature review across databases such as PubMed, Google Scholar, and the Cochrane Library, this study compiles and analyzes data from 18 relevant studies, offering a detailed understanding of the current state of HF biomarkers. The study examines both traditional and emerging biomarkers such as galectin-3 and soluble suppression of tumorigenicity 2 in HF, exploring their clinical roles and impact on patient outcomes.
Collapse
Affiliation(s)
- Maryam Kayani
- Cardiology, Shifa Tameer-e-Millat University Shifa College of Medicine, Islamabad, PAK
| | - Neha Fatima
- Internal Medicine, Lisie Hospital, Kochi, IND
| | | | - Naiela E Almansouri
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, University of Tripoli, Tripoli, LBY
| | - Deepshikha K
- Cardiology, Pondicherry Institute of Medical Sciences, Pondicherry, IND
| | | | | | | | - Josue A Valdez
- General Practice, Universidad Autónoma de Durango, Los Mochis, MEX
| | - Zahra Nazir
- Internal Medicine, Combined Military Hospital, Quetta, PAK
| |
Collapse
|
14
|
Zhang X, Wan Y, Karunathilaka N, Chan W, Kostner K, Hartel G, Coats AJS, Atherton JJ, Punyadeera C. Prognostic utility of serum NT-proBNP (fragments 1-76aa and 13-71aa) and galectin-3 in predicting death and re-hospitalisation due to cardiovascular events in patients with heart failure. Heart Vessels 2024; 39:86-94. [PMID: 37537380 PMCID: PMC10764512 DOI: 10.1007/s00380-023-02296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
Patients with heart failure (HF) are at a higher risk of rehospitalisation. In this study, we investigated the prognostic utility of galectin-3 (Gal-3) and NT-proBNP fragments (1-76aa and 13-71aa) as biomarkers to predict outcomes for patients with HF. We collected blood samples from patients with HF (n = 101). Gal-3 and NT-proBNP fragments (1-76aa and 13-71aa) concentrations were measured by immunoassay. Survival analysis and Cox proportional regression models were used to determine the prognostic utility of Gal-3 and NT-proBNP fragments. In patients with increased baseline levels of NT-proBNP1-76 the time to primary endpoint (cardiovascular death or re-hospitalisation) was significantly shorter (p = 0.0058), but not in patient with increased baseline levels of Gal-3 or NTproBNP13-71. Patients with increased levels of NT-proBNP13-71aa at 1 month showed reduced time to the primary endpoint (p = 0.0123). Our findings demonstrated that Gal-3 and NT-proBNP can be used as prognostic biomarkers to stratify patients with HF.
Collapse
Affiliation(s)
- Xi Zhang
- Saliva and Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, 46, Don Young Rd, Nathan, QLD, 4111, Australia
- Menzies Health Institute Queensland (MHIQ), Griffith University, Gold Coast, QLD, Australia
| | - Yunxia Wan
- Saliva and Liquid Biopsy Translational Laboratory, The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nuwan Karunathilaka
- Saliva and Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, 46, Don Young Rd, Nathan, QLD, 4111, Australia
- Menzies Health Institute Queensland (MHIQ), Griffith University, Gold Coast, QLD, Australia
| | - Wandy Chan
- The Prince Charles Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Karam Kostner
- Department of Cardiology, Mater Adult Hospital, Brisbane, QLD, Australia
| | - Gunter Hartel
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Andrew J S Coats
- Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- University of Warwick, Coventry, UK
- Monash University, Clayton, Australia
| | - John J Atherton
- Cardiology Department, Faculty of Medicine, Royal Brisbane and Women's Hospital and University of Queensland, Brisbane, QLD, Australia
| | - Chamindie Punyadeera
- Saliva and Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, 46, Don Young Rd, Nathan, QLD, 4111, Australia.
- Saliva and Liquid Biopsy Translational Laboratory, The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.
- Translational Research Institute, Woolloongabba, Australia.
- Menzies Health Institute Queensland (MHIQ), Griffith University, Gold Coast, QLD, Australia.
| |
Collapse
|
15
|
Tiwari D, Aw TC. Optimizing the Clinical Use of High-Sensitivity Troponin Assays: A Review. Diagnostics (Basel) 2023; 14:87. [PMID: 38201396 PMCID: PMC10795745 DOI: 10.3390/diagnostics14010087] [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: 10/26/2023] [Revised: 12/14/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Ischemic heart diseases (IHDs) remain a global health concern. Many IHD cases go undiagnosed due to challenges in the initial diagnostic process, particularly in cases of acute myocardial infarction (AMI). High-sensitivity cardiac troponin (hs-cTn) assays have revolutionized myocardial injury assessment, but variations in diagnostic cut-off values and population differences have raised challenges. This review addresses essential laboratory and clinical considerations for hs-cTn assays. Laboratory guidelines discuss the importance of establishing standardized 99th-percentile upper reference limits (URLs) considering factors such as age, sex, health status, and analytical precision. The reference population should exclude individuals with comorbidities like diabetes and renal disease, and rigorous selection is crucial. Some clinical guidelines emphasize the significance of sex-specific URL limits while others do not. They highlight the use of serial troponin assays for AMI diagnosis. In addition, timely reporting of accurate hs-cTn results is essential for effective clinical use. This review aims to provide a clearer understanding among laboratory professionals and clinicians on how to optimize the use of hs-cTn assays in clinical settings in order to ensure accurate AMI diagnosis and thus improve patient care and outcomes.
Collapse
Affiliation(s)
- Dipti Tiwari
- Independent Researcher, Singapore 069046, Singapore;
| | - Tar Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore 529889, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore 119228, Singapore
- Pathology Academic Clinical Program, Duke-NUS Graduate School of Medicine, Singapore 169857, Singapore
| |
Collapse
|
16
|
Light MP, Kreitinger KY, Lee E, DeYoung PN, Lakhani A, Siegel B, Daniels LB, Malhotra A, Owens RL. The impact of sleep disordered breathing on cardiac troponin in acutely decompensated heart failure. Sleep Breath 2023; 27:553-560. [PMID: 35641808 PMCID: PMC9708937 DOI: 10.1007/s11325-022-02646-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/05/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Sleep disordered breathing in decompensated heart failure has physiological consequences (e.g., intermittent hypoxemia) that may predispose to subclinical myocardial injury, yet a temporal relationship between sleep apnea and troponin elevation has not been established. METHODS We assessed the feasibility of performing respiratory polygraphy and measuring overnight high-sensitivity cardiac troponin T change in adults admitted to the hospital with acutely decompensated heart failure. Repeat sleep apnea tests (SATs) were performed to determine response to optimal medical heart failure therapy. Multivariable logistic regression was used to identify associations between absolute overnight troponin change and sleep apnea characteristics. RESULTS Among the 19 subjects with acutely decompensated heart failure, 92% of SATs demonstrated sleep disordered breathing (apnea-hypopnea index [AHI] > 5 events/h). For those with repeat SATs, AHI increased in 67% despite medical management of heart failure. Overnight troponin increase was associated with moderate to severe sleep apnea (vs. no to mild sleep apnea, odds ratio (OR = 18.4 [1.51-224.18]), central apnea index (OR = 1.11 [1.01-1.22]), and predominantly central sleep apnea (vs. obstructive, OR = 22.9 [1.29-406.32]). CONCLUSIONS Sleep apnea severity and a central apnea pattern may be associated with myocardial injury. Respiratory polygraphy with serial biomarker assessment is feasible in this population, and combining this approach with interventions (e.g., positive airway pressure) may help establish if a link exists between sleep apnea and subclinical myocardial injury.
Collapse
Affiliation(s)
- Matthew P Light
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), 9300 Campus Point Drive #7381, La Jolla, CA, 92037, USA.
| | - Kimberly Y Kreitinger
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), 9300 Campus Point Drive #7381, La Jolla, CA, 92037, USA
| | - Euyhyun Lee
- Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla, CA, USA
| | - Pamela N DeYoung
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), 9300 Campus Point Drive #7381, La Jolla, CA, 92037, USA
| | - Avni Lakhani
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), 9300 Campus Point Drive #7381, La Jolla, CA, 92037, USA
| | - Brent Siegel
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), 9300 Campus Point Drive #7381, La Jolla, CA, 92037, USA
| | - Lori B Daniels
- Division of Cardiology, Department of Medicine, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), 9300 Campus Point Drive #7381, La Jolla, CA, 92037, USA
| | - Robert L Owens
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), 9300 Campus Point Drive #7381, La Jolla, CA, 92037, USA
| |
Collapse
|
17
|
Berezin AE, Berezin AA. Biomarkers in Heart Failure: From Research to Clinical Practice. Ann Lab Med 2023; 43:225-236. [PMID: 36544334 DOI: 10.3343/alm.2023.43.3.225] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/19/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
The aim of this narrative review is to summarize contemporary evidence on the use of circulating cardiac biomarkers of heart failure (HF) and to identify a promising biomarker model for clinical use in personalized point-of-care HF management. We discuss the reported biomarkers of HF classified into clusters, including myocardial stretch and biomechanical stress; cardiac myocyte injury; systemic, adipocyte tissue, and microvascular inflammation; cardiac fibrosis and matrix remodeling; neurohumoral activation and oxidative stress; impaired endothelial function and integrity; and renal and skeletal muscle dysfunction. We focus on the benefits and drawbacks of biomarker-guided assistance in daily clinical management of patients with HF. In addition, we provide clear information on the role of alternative biomarkers and future directions with the aim of improving the predictive ability and reproducibility of multiple biomarker models and advancing genomic, transcriptomic, proteomic, and metabolomic evaluations.
Collapse
Affiliation(s)
- Alexander E Berezin
- Internal Medicine Department, Zaporozhye Medical Academy of Postgraduate Education, Zaporozhye, Ukraine
| | - Alexander A Berezin
- Internal Medicine Department, Zaporozhye Medical Academy of Postgraduate Education, Zaporozhye, Ukraine
| |
Collapse
|
18
|
Bon-Mathier AC, Déglise T, Rignault-Clerc S, Bielmann C, Mazzolai L, Rosenblatt-Velin N. Brain Natriuretic Peptide Protects Cardiomyocytes from Apoptosis and Stimulates Their Cell Cycle Re-Entry in Mouse Infarcted Hearts. Cells 2022; 12:cells12010007. [PMID: 36611800 PMCID: PMC9818267 DOI: 10.3390/cells12010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Brain Natriuretic Peptide (BNP) supplementation after infarction increases heart function and decreases heart remodeling. BNP receptors, NPR-A and NPR-B are expressed on adult cardiomyocytes (CMs). We investigated whether a part of the BNP cardioprotective effect in infarcted and unmanipulated hearts is due to modulation of the CM fate. For this purpose, infarcted adult male mice were intraperitoneally injected every two days during 2 weeks with BNP or saline. Mice were sacrificed 1 and 14 days after surgery. BNP or saline was also injected intraperitoneally every two days into neonatal pups (3 days after birth) for 10 days and in unmanipulated 8-week-old male mice for 2 weeks. At sacrifice, CMs were isolated, counted, measured, and characterized by qRT-PCR. The proportion of mononucleated CMs was determined. Immunostainings aimed to detect CM re-entry in the cell cycle were performed on the different hearts. Finally, the signaling pathway activated by BNP treatment was identified in in vitro BNP-treated adult CMs and in CMs isolated from BNP-treated hearts. An increased number of CMs was detected in the hypoxic area of infarcted hearts, and in unmanipulated neonatal and adult hearts after BNP treatment. Accordingly, Troponin T plasma concentration was significantly reduced 1 and 3 days after infarction in BNP-treated mice, demonstrating less CM death. Furthermore, higher number of small, dedifferentiated and mononucleated CMs were identified in adult BNP-treated hearts when compared to saline-treated hearts. BNP-treated CMs express higher levels of mRNAs coding for hif1 alpha and for the different cyclins than CMs isolated from saline-treated hearts. Higher percentages of CMs undergoing DNA synthesis, expressing Ki67, phospho histone3 and Aurora B were detected in all BNP-treated hearts, demonstrating that CMs re-enter into the cell cycle. BNP effect on adult CMs in vivo is mediated by NPR-A binding and activation of the ERK MAP kinase pathway. Interestingly, an increased number of CMs was also detected in adult infarcted hearts treated with LCZ696, an inhibitor of the natriuretic peptide degradation. Altogether, our results identified BNP and all therapies aimed to increase BNP's bioavailability as new cardioprotective targets as BNP treatment leads to an increased number of CMs in neonatal, adult unmanipulated and infarcted hearts.
Collapse
|
19
|
Chetran A, Costache AD, Ciongradi CI, Duca ST, Mitu O, Sorodoc V, Cianga CM, Tuchilus C, Mitu I, Mitea RD, Badescu MC, Afrasanie I, Huzum B, Moisa SM, Prepeliuc CS, Roca M, Costache II. ECG and Biomarker Profile in Patients with Acute Heart Failure: A Pilot Study. Diagnostics (Basel) 2022; 12:diagnostics12123037. [PMID: 36553044 PMCID: PMC9776598 DOI: 10.3390/diagnostics12123037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Biomarkers, electrocardiogram (ECG) and Holter ECG are basic, accessible and feasible cardiac investigations. The combination of their results may lead to a more complex predictive model that may improve the clinical approach in acute heart failure (AHF). The main objective was to investigate which ECG parameters are correlated with the usual cardiac biomarkers (prohormone N-terminal proBNP, high-sensitive cardiac troponin I) in patients with acute heart failure, in a population from Romania. The relationship between certain ECG parameters and cardiac biomarkers may support future research on their combined prognostic value. Methods: In this prospective case-control study were included 49 patients with acute heart failure and 31 participants in the control group. For all patients we measured levels of prohormone N-terminal proBNP (NT-proBNP), high-sensitive cardiac troponin I (hs-cTnI) and MB isoenzyme of creatine phosphokinase (CK-MB) and evaluated the 12-lead ECG and 24 h Holter monitoring. Complete clinical and paraclinical evaluation was performed. Results: NT-proBNP level was significantly higher in patients with AHF (p < 0.001). In patients with AHF, NT-proBNP correlated with cQTi (p = 0.027), pathological Q wave (p = 0.029), complex premature ventricular contractions (PVCs) (p = 0.034) and ventricular tachycardia (p = 0.048). Hs-cTnI and CK-MB were correlated with ST-segment modification (p = 0.038; p = 0.018) and hs-cTnI alone with complex PVCs (p = 0.031). Conclusions: The statistical relationships found between cardiac biomarkers and ECG patterns support the added value of ECG in the diagnosis of AHF. We emphasize the importance of proper ECG analysis of more subtle parameters that can easily be missed. As a non-invasive technique, ECG can be used in the outpatient setting as a warning signal, announcing the acute decompensation of HF. In addition, the information provided by the ECG complements the biomarker results, supporting the diagnosis of AHF in cases of dyspnea of uncertain etiology. Further studies are needed to confirm long-term prognosis in a multi-marker approach.
Collapse
Affiliation(s)
- Adriana Chetran
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
- Cardiology Clinic, Clinical Emergency Hospital “Sfantul Spiridon”, 700111 Iasi, Romania
| | - Alexandru Dan Costache
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Carmen Iulia Ciongradi
- 2nd Department of Surgery—Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Pediatric and Orthopaedic Surgery Clinic, “Sfânta Maria” Emergency Children Hospital, 700309 Iași, Romania
| | - Stefania Teodora Duca
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
- Cardiology Clinic, Clinical Emergency Hospital “Sfantul Spiridon”, 700111 Iasi, Romania
- Correspondence: ; Tel.: +40-751-533-554
| | - Ovidiu Mitu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
- Cardiology Clinic, Clinical Emergency Hospital “Sfantul Spiridon”, 700111 Iasi, Romania
| | - Victorita Sorodoc
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
- II Internal Medicine Clinic, Clinical Emergency Hospital “Sfantul Spiridon”, 700111 Iasi, Romania
| | - Corina Maria Cianga
- Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
- Immunology Laboratory, Clinical Emergency Hospital “Sfantul Spiridon”, 700111 Iasi, Romania
| | - Cristina Tuchilus
- Department of Microbiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- Microbiology Laboratory, Clinical Emergency Hospital “Sfantul Spiridon”, 700111 Iasi, Romania
| | - Ivona Mitu
- Department of Morpho-Functional Sciences II, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
| | - Raluca Daria Mitea
- Department of Cardiology, Faculty of Medicine, University of Medicine and Pharmacy “Lucian Blaga, 550169 Sibiu, Romania
- Cardiology Clinic, Clinical Emergency Hospital Sibiu, 550245 Sibiu, Romania
| | - Minerva Codruta Badescu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
- III Internal Medicine Clinic, Clinical Emergency Hospital “Sfantul Spiridon”, 700111 Iasi, Romania
| | - Irina Afrasanie
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
- Cardiology Clinic, Clinical Emergency Hospital “Sfantul Spiridon”, 700111 Iasi, Romania
| | - Bogdan Huzum
- Department of Physiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Stefana Maria Moisa
- Department of Pediatrics, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristian Sorin Prepeliuc
- “Saint Parascheva”, Infectious Diseases Clinical Universitary Hospital Iasi, 700116 Iasi, Romania
| | - Mihai Roca
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Irina Iuliana Costache
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
- Cardiology Clinic, Clinical Emergency Hospital “Sfantul Spiridon”, 700111 Iasi, Romania
| |
Collapse
|
20
|
Ahmed SH, Pervez N, Rehan ST, Shaikh TG, Waseem S. Postoperative cardiac troponin I as an indicator of surgical outcomes: A systematic review. J Card Surg 2022; 37:5351-5361. [PMID: 36403270 DOI: 10.1111/jocs.17197] [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: 09/09/2022] [Accepted: 10/27/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Cardiac surgeries are generally associated with high morbidity and mortality. To prevent any adverse outcomes, it is crucial to identify patients at risk of developing postoperative complications and initiate relevant therapeutic interventions. Several biomarkers are used to determine postoperative myocardial injury but they either lack sensitivity and specificity or are elevated for a short time. In this systematic review, we evaluate postoperative troponin I as a predictor of postoperative myocardial infarction, mortality, and hospital and Intensive Care Unit stay. METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A thorough literature search was conducted over PubMed, clinicaltrials. gov, and the Cochrane library from inception till May 24, 2022 using relevant keywords, and only articles that met the pre-defined criteria were recruited. RESULTS Following a comprehensive literature search, a total of 359 articles were obtained. Following a rigid screening and full-length review, only 13 studies met our inclusion criteria and were included. The recruited studies evaluated data from a total of 12,483 individuals and assessed troponin I as a predictor of at least one outcome. CONCLUSION Troponin I has the potential to be used as a stand-alone predictor of surgical outcomes following coronary artery bypass grafting and valvular surgeries. However, supplementing it with other markers and scores offers the best chance at timely diagnosing any complications.
Collapse
Affiliation(s)
| | - Neha Pervez
- Dow University of Health Sciences, Karachi, Pakistan
| | | | | | | |
Collapse
|
21
|
Miftode RS, Constantinescu D, Cianga CM, Petris AO, Costache II, Mitu O, Miftode IL, Mitu I, Timpau AS, Duca ST, Costache AD, Cianga P, Serban IL. A Rising Star of the Multimarker Panel: Growth Differentiation Factor-15 Levels Are an Independent Predictor of Mortality in Acute Heart Failure Patients Admitted to an Emergency Clinical Hospital from Eastern Europe. Life (Basel) 2022; 12:life12121948. [PMID: 36556311 PMCID: PMC9784402 DOI: 10.3390/life12121948] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
Abstract
(1) Background: Acute heart failure (HF) represents one of the most common yet extremely severe presentations in emergency services worldwide, requiring prompt diagnosis, followed by an adequate therapeutic approach, and a thorough risk stratification. Natriuretic peptides (NPs) are currently the most widely implemented biomarkers in acute HF, but due to their lack of specificity, they are mainly used as ruling-out criteria. Growth differentiation factor-15 (GDF-15) is a novel molecule expressing different pathophysiological pathways in HF, such as fibrosis, remodeling, and oxidative stress. It is also considered a very promising predictor of mortality and poor outcome. In this study, we aimed to investigate the GDF-15’s expression and particularities in patients with acute HF, focusing mainly on its role as a prognosis biomarker, either per se or as part of a multimarker panel. (2) Methods: This unicentric prospective study included a total of 173 subjects, divided into 2 subgroups: 120 patients presented in emergency with acute HF, while 53 were ambulatory-evaluated controls with chronic HF. At admission, all patients were evaluated according to standard clinical echocardiography and laboratory panel, including the assessment of GDF-15. (3) Results: The levels of GDF-15 were significantly higher in patients with acute HF, compared to controls [596 (305−904) vs. 216 (139−305) ng/L, p < 0.01]. GDF-15 also exhibited an adequate diagnostic performance in acute HF, expressed as an area under the curve (AUC) of 0.883 [confidence interval (CI) 95%: 0.828−0.938], similar to that of NT-proBNP (AUC: 0.976, CI 95%: 0.952−1.000), or troponin (AUC: 0.839, CI 95%: 0.733−0.944). High concentrations of GDF-15 were significantly correlated with mortality risk. In a multivariate regression model, GDF-15 was the most important predictor of a poor outcome, superior to NT-proBNP or troponin. (4) Conclusions: GDF-15 proved to be a reliable tool in the multimarker assessment of patients with acute HF. Compared to the gold standard NT-proBNP, GDF-15 presented a similar diagnostic performance, doubled by a significantly superior prognostic value, making it worth being included in a standardized multimarker panel.
Collapse
Affiliation(s)
- Radu-Stefan Miftode
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
| | - Daniela Constantinescu
- Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
| | - Corina-Maria Cianga
- Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
| | - Antoniu-Octavian Petris
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
| | - Irina-Iuliana Costache
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
- Correspondence: (I.-I.C.); (P.C.)
| | - Ovidiu Mitu
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
| | - Ionela-Larisa Miftode
- Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
| | - Ivona Mitu
- Department of Morpho-Functional Sciences II, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
| | - Amalia-Stefana Timpau
- Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
| | - Stefania-Teodora Duca
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
| | - Alexandru-Dan Costache
- Department of Cardiovascular Rehabilitation, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
| | - Petru Cianga
- Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
- Correspondence: (I.-I.C.); (P.C.)
| | - Ionela-Lacramioara Serban
- Department of Morpho-Functional Sciences II, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
| |
Collapse
|
22
|
Gürgöze MT, van Vark LC, Baart SJ, Kardys I, Akkerhuis KM, Manintveld OC, Postmus D, Hillege HL, Lesman-Leegte I, Asselbergs FW, Brunner-la-Rocca HP, van den Bos EJ, Orsel JG, de Ridder SP, Pinto YM, Boersma E. Multimarker Analysis of Serially Measured GDF-15, NT-proBNP, ST2, GAL-3, cTnI, Creatinine, and Prognosis in Acute Heart Failure. Circ Heart Fail 2022; 16:e009526. [PMID: 36408685 PMCID: PMC9833118 DOI: 10.1161/circheartfailure.122.009526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Studies on serially measured GDF-15 (growth differentiation factor 15) in acute heart failure (HF) are limited. Moreover, several pathophysiological pathways contribute to HF. Therefore, we aimed to explore the (additional) prognostic value of serially measured GDF-15 using a multi-marker approach to more accurately predict HF risk. METHODS TRIUMPH (Translational Initiative on Unique and Novel Strategies for Management of Patients With Heart Failure) is a prospective cohort of 496 patients with acute HF who were enrolled in 14 hospitals in the Netherlands between 2009 and 2014. Blood sampling was scheduled at 7 moments during 1-year follow-up. GDF-15, NT-proBNP (N-terminal pro-B-type natriuretic peptide), ST2 (suppression of tumorigenicity 2), galectin-3, troponin I, and creatinine were measured in a central laboratory. We associated repeated measurements of these biomarkers with the composite primary end point of all-cause mortality and HF rehospitalization, using multivariable joint modeling. RESULTS Median age was 74 years, and 37% were women. Median baseline GDF-15 was 4632 pg/mL. The primary end point was reached in 188 (40%) patients. The average estimated GDF-15 level increased weeks before the primary end point was reached. The hazard ratio per 1 SD difference in log-GDF-15 was 2.14 (95% CI, 1.78-2.57) unadjusted, 1.96 (1.49-2.53) after adjustment for clinical confounders and 1.44 (1.05-1.91) when jointly modeled with all biomarkers. The adjusted HRs for NT-proBNP were 2.38 (1.78-3.33) and 1.52 (1.15-2.08), respectively. The multimarker model combining GDF-15, NT-proBNP, and troponin I provided a favorable risk discrimination (area under the curve=0.785). CONCLUSIONS Sequentially measured GDF-15 independently and dynamically predicts risk of adverse outcomes during 1-year follow-up after index admission for acute HF. NT-proBNP remains a robust predictor among potential candidates. Multiple biomarkers should be considered for stratification in clinical practice. REGISTRATION URL: https://www.trialregister.nl/trial/1783; Unique Identifier: NTR1893. (The trial can be found temporarily at https://trialsearch.who.int/Trial2.aspx?TrialID=NTR1893.).
Collapse
Affiliation(s)
- Muhammed T. Gürgöze
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
| | - Laura C. van Vark
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
| | - Sara J. Baart
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, the Netherlands (S.J.B.)
| | - Isabella Kardys
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
| | - K. Martijn Akkerhuis
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
| | - Olivier C. Manintveld
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
| | - Douwe Postmus
- Department of Epidemiology (D.P., H.L.H.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Hans L. Hillege
- Department of Epidemiology (D.P., H.L.H.), University Medical Center Groningen, University of Groningen, the Netherlands,Department of Cardiology (H.L.H.), University Medical Center Groningen, University of Groningen, the Netherlands,University Medical Center Groningen, University of Groningen, the Netherlands (H.L.H.)
| | - Ivonne Lesman-Leegte
- Department of General Practice and Elderly Care Medicine (I.L.-L.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Folkert W. Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, the Netherlands (F.W.A.).,Institute of Cardiovascular Science, Faculty of Population Health Sciences (F.W.A.), University College London, United Kingdom.,Health Data Research UK and Institute of Health Informatics (F.W.A.), University College London, United Kingdom
| | | | - Ewout J. van den Bos
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (E.J.v.d.B.)
| | - Joke G. Orsel
- Philips Healthcare, Eindhoven, the Netherlands (J.G.O.)
| | - Stijn P.J. de Ridder
- Department of Cardiology, St. Anna Hospital, Geldrop, the Netherlands (S.P.J.d.R.)
| | - Yigal M. Pinto
- Department of Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands (Y.M.P.)
| | - Eric Boersma
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
| |
Collapse
|
23
|
Talle MA, Ngarande E, Doubell AF, Herbst PG. Cardiac Complications of Hypertensive Emergency: Classification, Diagnosis and Management Challenges. J Cardiovasc Dev Dis 2022; 9:276. [PMID: 36005440 PMCID: PMC9409837 DOI: 10.3390/jcdd9080276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Abstract
While mortality in patients with hypertensive emergency has significantly improved over the past decades, the incidence and complications associated with acute hypertension-mediated organ damage have not followed a similar trend. Hypertensive emergency is characterized by an abrupt surge in blood pressure, mostly occurring in people with pre-existing hypertension to result in acute hypertension-mediated organ damage. Acute hypertension-mediated organ damage commonly affects the cardiovascular system, and present as acute heart failure, myocardial infarction, and less commonly, acute aortic syndrome. Elevated cardiac troponin with or without myocardial infarction is one of the major determinants of outcome in hypertensive emergency. Despite being an established entity distinct from myocardial infarction, myocardial injury has not been systematically studied in hypertensive emergency. The current guidelines on the evaluation and management of hypertensive emergencies limit the cardiac troponin assay to patients presenting with features of myocardial ischemia and acute coronary syndrome, resulting in underdiagnosis, especially of atypical myocardial infarction. In this narrative review, we aimed to give an overview of the epidemiology and pathophysiology of hypertensive emergencies, highlight challenges in the evaluation, classification, and treatment of hypertensive emergency, and propose an algorithm for the evaluation and classification of cardiac acute hypertension-mediated organ damage.
Collapse
Affiliation(s)
- Mohammed A. Talle
- Department of Medicine, Division of Cardiology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town 7505, South Africa
- Department of Medicine, Faculty of Clinical Sciences, College of Medical Sciences, University of Maiduguri and University of Maiduguri Teaching Hospital, Maiduguri 600004, Nigeria
| | - Ellen Ngarande
- Department of Medicine, Division of Cardiology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town 7505, South Africa
| | - Anton F. Doubell
- Department of Medicine, Division of Cardiology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town 7505, South Africa
| | - Philip G. Herbst
- Department of Medicine, Division of Cardiology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town 7505, South Africa
| |
Collapse
|
24
|
Prognosis is worse with elevated cardiac troponin in nonacute coronary syndrome compared with acute coronary syndrome. Coron Artery Dis 2022; 33:376-384. [PMID: 35880560 DOI: 10.1097/mca.0000000000001135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac troponin (cTn) can be elevated in many patients presenting to the emergency department (ED) with chest pain but without a diagnosis of acute coronary syndrome (ACS). We compared the prognostic significance of cTn in these different populations. METHODS We retrospectively analyzed the CHOPIN study, which enrolled patients who presented to the ED with chest pain. Patients were grouped as ACS, non-ACS cardiovascular disease, noncardiac chest pain and chest pain not otherwise specified (NOS). We examined the prognostic ability of cTnI for the clinical endpoints of mortality and major adverse cardiovascular event (MACE; a composite of acute myocardial infarction, unstable angina, revascularization, reinfarction, and congestive heart failure and stroke) at 180-day follow-up. RESULTS Among 1982 patients analyzed, 14% had ACS, 21% had non-ACS cardiovascular disease, 31% had a noncardiac diagnosis and 34% had chest pain NOS. cTnI elevation above the 99th percentile was observed in 52, 18, 6 and 7% in these groups, respectively. cTnI elevation was associated with mortality and MACE, and their relationships were more prominent in noncardiac diagnosis and chest pain NOS than in ACS and non-ACS cardiovascular diagnoses for mortality, and in non-ACS patients than in ACS patients for MACE (hazard ratio for doubling of cTnI 1.85, 2.05, 8.26 and 4.14, respectively; P for interaction 0.011 for mortality; 1.04, 1.23, 1.54 and 1.42, respectively; P for interaction <0.001 for MACE). CONCLUSION In patients presenting to the ED with chest pain, cTnI elevation was associated with a worse prognosis in non-ACS patients than in ACS patients.
Collapse
|
25
|
Lee N, Cho JY, Kim KH, Kim HY, Cho HJ, Lee HY, Jeon ES, Kim JJ, Cho MC, Chae SC, Baek SH, Kang SM, Choi DJ, Yoo BS, Oh BH. Impact of Cardiac Troponin Elevation on Mortality of Patients with Acute Heart Failure: Insights from the Korea Acute Heart Failure (KorAHF) Registry. J Clin Med 2022; 11:jcm11102800. [PMID: 35628925 PMCID: PMC9145996 DOI: 10.3390/jcm11102800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 12/10/2022] Open
Abstract
We aimed to conduct the largest study evaluating the impact of cardiac troponin (TnI) status on mid- and long-term mortality in patients admitted for acute heart failure (AHF) as compared between patients with ischemic (IHF) vs. non-ischemic heart failure (non-IHF). Among 5625 patients from the Korea Acute Heart Failure (KorAHF) registry, 4396 eligible patients with TnI measurement were analyzed. The patients were included on admission with the diagnosis of AHF, and TnI level was measured on the day of admission. A TnI value of <0.05 ng/mL was considered normal. The patients were divided into four groups according to the etiology of heart failure and the status of TnI: non-IHF with normal TnI (n = 1009) vs. non-IHF with elevated TnI (n = 1665) vs. IHF with normal TnI (n = 258) vs. IHF with elevated TnI (n = 1464). The primary outcome was death from all causes according to the etiology (non-IHF vs. IHF) and TnI elevation during the entire follow-up period of 784 days (IQR 446−1116). Elevation of TnI was observed in 71.2% of all patients with AHF. Patients with IHF had higher all-cause mortality compared to those with non-IHF. Elevated TnI was associated with higher 90-day and post-90-day mortality in the non-IHF group. IHF as compared to non-IHF and elevation of TnI were independent predictors of mortality also in the adjustment analysis. In the IHF group, however, elevated TnI had a higher mortality with only 90-day follow-up (18.6% vs. 25.9%, log-rank p < 0.001), not in the post-90-day follow-up (31.1% vs. 32.5%, log-rank p = 0.799). In conclusion, elevated TnI in patients with heart failure is associated with increased all-cause mortality regardless of the etiology of HF. Elevation of TnI was associated to a higher post-90 day mortality in patients with non-IHF but not in patients with IHF.
Collapse
Affiliation(s)
- Nuri Lee
- Department of Cardiovascular Medicine, Chonnam National University Hwasun Hospital, Hwasun 58128, Korea;
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju 61469, Korea;
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju 61469, Korea;
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju 61469, Korea;
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju 61469, Korea;
- Correspondence: ; Tel.: +82-62-220-6266; Fax: +82-62-223-3105
| | - Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju 61469, Korea;
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (H.-J.C.); (H.-Y.L.); (B.-H.O.)
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (H.-J.C.); (H.-Y.L.); (B.-H.O.)
| | - Eun-Seok Jeon
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul 16419, Korea;
| | - Jae-Joong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Myeong-Chan Cho
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju 28644, Korea;
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu 37224, Korea;
| | - Sang Hong Baek
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Seok-Min Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
| | - Byung-Su Yoo
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
| | - Byung-Hee Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (H.-J.C.); (H.-Y.L.); (B.-H.O.)
| | | |
Collapse
|
26
|
Ilieșiu AM, Hodorogea AS, Balahura AM, Bădilă E. Non-Invasive Assessment of Congestion by Cardiovascular and Pulmonary Ultrasound and Biomarkers in Heart Failure. Diagnostics (Basel) 2022; 12:962. [PMID: 35454010 PMCID: PMC9024731 DOI: 10.3390/diagnostics12040962] [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: 03/16/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Worsening chronic heart failure (HF) is responsible for recurrent hospitalization and increased mortality risk after discharge, irrespective to the ejection fraction. Symptoms and signs of pulmonary and systemic congestion are the most common cause for hospitalization of acute decompensated HF, as a consequence of increased cardiac filling pressures. The elevated cardiac filling pressures, also called hemodynamic congestion, may precede the occurrence of clinical congestion by days or weeks. Since HF patients often have comorbidities, dyspnoea, the main symptom of HF, may be also caused by respiratory or other illnesses. Recent studies underline the importance of the diagnosis and treatment of hemodynamic congestion before HF symptoms worsen, reducing hospitalization and improving prognosis. In this paper we review the role of integrated evaluation of biomarkers and imaging technics, i.e., echocardiography and pulmonary ultrasound, for the diagnosis, prognosis and treatment of congestion in HF patients.
Collapse
Affiliation(s)
- Adriana Mihaela Ilieșiu
- Cardiology and Internal Medicine Department, Theodor Burghele Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Andreea Simona Hodorogea
- Cardiology and Internal Medicine Department, Theodor Burghele Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Ana-Maria Balahura
- Internal Medicine Department, Bucharest Clinical Emergency Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.B.); (E.B.)
| | - Elisabeta Bădilă
- Internal Medicine Department, Bucharest Clinical Emergency Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.B.); (E.B.)
| |
Collapse
|
27
|
Fermann GJ, Schrock JW, Levy PD, Pang P, Butler J, Chang AM, Char D, Diercks D, Han JH, Hiestand B, Hogan C, Jenkins CA, Kampe C, Khan Y, Kumar VA, Lee S, Lindenfeld J, Liu D, Miller KF, Peacock WF, Reilly CM, Robichaux C, Rothman RL, Self WH, Singer AJ, Sterling SA, Storrow AB, Stubblefield WB, Walsh C, Wilburn J, Collins SP. Troponin is unrelated to outcomes in heart failure patients discharged from the emergency department. J Am Coll Emerg Physicians Open 2022; 3:e12695. [PMID: 35434709 PMCID: PMC8994616 DOI: 10.1002/emp2.12695] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022] Open
Abstract
Background Prior data has demonstrated increased mortality in hospitalized patients with acute heart failure (AHF) and troponin elevation. No data has specifically examined the prognostic significance of troponin elevation in patients with AHF discharged after emergency department (ED) management. Objective Evaluate the relationship between troponin elevation and outcomes in patients with AHF who are treated and released from the ED. Methods This was a secondary analysis of the Get with the Guidelines to Reduce Disparities in AHF Patients Discharged from the ED (GUIDED-HF) trial, a randomized, controlled trial of ED patients with AHF who were discharged. Patients with elevated conventional troponin not due to acute coronary syndrome (ACS) were included. Our primary outcome was a composite endpoint: time to 30-day cardiovascular death and/or heart failure-related events. Results Of the 491 subjects included in the GUIDED-HF trial, 418 had troponin measured during the ED evaluation and 66 (16%) had troponin values above the 99th percentile. Median age was 63 years (interquartile range, 54-70), 62% (n = 261) were male, 63% (n = 265) were Black, and 16% (n = 67) experienced our primary outcome. There were no differences in our primary outcome between those with and without troponin elevation (12/66, 18.1% vs 55/352, 15.6%; P = 0.60). This effect was maintained regardless of assignment to usual care or the intervention arm. In multivariable regression analysis, there was no association between our primary outcome and elevated troponin (hazard ratio, 1.00; 95% confidence interval, 0.49-2.01, P = 0.994). Conclusion If confirmed in a larger cohort, these findings may facilitate safe ED discharge for a group of patients with AHF without ACS when an elevated troponin is the primary reason for admission.
Collapse
Affiliation(s)
- Gregory J. Fermann
- Department of Emergency MedicineUniversity of CincinnatiCincinnatiOhioUSA
| | - Jon W. Schrock
- Department of Emergency MedicineMetro HealthClevelandOhioUSA
| | - Phillip D. Levy
- Department of Emergency MedicineWayne State UniversityDetroitMichiganUSA
| | - Peter Pang
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Javed Butler
- Division of Cardiovascular MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Anna Marie Chang
- Department of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Douglas Char
- Division of Emergency MedicineWashington UniversitySt. LouisMissouriUSA
| | - Deborah Diercks
- Department of Emergency MedicineUniversity of Texas‐SouthwesternDallasTexasUSA
| | - Jin H. Han
- Department of Emergency MedicineMetro HealthClevelandOhioUSA
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- Department of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Brian Hiestand
- Department of Emergency MedicineWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | - Chris Hogan
- Department of Emergency MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Cathy A. Jenkins
- Department of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Christy Kampe
- Department of BiostatisticsVanderbilt UniversityNashvilleTennesseeUSA
| | - Yosef Khan
- American Heart Association/American Stroke AssociationDallasTexasUSA
| | - Vijaya A. Kumar
- Department of Emergency MedicineWayne State UniversityDetroitMichiganUSA
| | - Sangil Lee
- Department of Emergency MedicineUniversity of IowaIowa CityIowaUSA
| | - JoAnn Lindenfeld
- Division of Cardiovascular DiseaseVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Dandan Liu
- Department of BiostatisticsVanderbilt UniversityNashvilleTennesseeUSA
| | - Karen F. Miller
- Department of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - W. Frank Peacock
- Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | | | - Chad Robichaux
- Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Russell L. Rothman
- Department of Internal MedicinePediatrics & Health PolicyVanderbilt UniversityNashvilleTennesseeUSA
| | - Wesley H. Self
- Department of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Adam J. Singer
- Department of Emergency MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Sarah A. Sterling
- Department of Emergency MedicineUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Alan B. Storrow
- Department of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | | | - Cheryl Walsh
- Geriatric ResearchEducationand Clinical CenterTennessee Valley Healthcare SystemNashvilleTennesseeUSA
| | - John Wilburn
- Department of Emergency MedicineWayne State UniversityDetroitMichiganUSA
| | - Sean P. Collins
- Department of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| |
Collapse
|
28
|
Paana T, Jaakkola S, Biancari F, Nuotio I, Vasankari T, Kiviniemi TO, Airaksinen KEJ. Minor troponin T elevation and mortality in patients with atrial fibrillation presenting to the emergency department. Eur J Clin Invest 2021; 51:e13590. [PMID: 34002383 DOI: 10.1111/eci.13590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/25/2021] [Accepted: 05/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are limited data on the association of minor troponin elevation in unselected patients with atrial fibrillation (AF) presenting to the emergency department (ED) with adverse events. In this study, we sought to assess the early and mid-term mortality of these patients. METHODS In this observational study, 2911 patients with AF were admitted to the ED. They were divided into 3 groups based on peak high-sensitivity troponin (TnT) levels: normal (<15 ng/L), 15-50 ng/L and 51-100 ng/L. The primary outcomes of this study were all-cause mortality at 30 days and 1 year. RESULTS All-cause mortality was 6.7% (n = 196) at 30 days and 22.2% (n = 646) at 1 year. Mortality rate increased along with increasing levels of TnT irrespective of baseline covariates, primary discharge diagnosis and type of AF. A significant association between TnT levels and all-cause mortality was observed. The adjusted hazard ratio (HR) at 30 days was 6.02 (95% CI 2.62-13.83) for TnT 15-50 ng/L and 11.28 (95% CI 4.87-26.12) for TnT 51-100 ng/L (P<.001 for both) compared to TnT <15 ng/L. At 1 year, the adjusted HRs were 3.08 (95% CI 2.15-4.40) and 5.07 (95% CI 3.49-7.35), respectively (P < .001). When patients with TnT <15 ng/L were divided into two groups at the median value, TnT elevation of 10 to 14 ng/L was also associated with increased 1-year mortality (HR 2.51; 95% CI 1.09-5.74; P = .03). CONCLUSIONS Among patients with AF admitted to the ED, increased TnT levels were associated with increased early and mid-term all-cause mortality irrespective of baseline covariates and type of AF.
Collapse
Affiliation(s)
- Tuomas Paana
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Samuli Jaakkola
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Fausto Biancari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland
| | - Ilpo Nuotio
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Department of Acute Internal Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuomas O Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
29
|
Mostafa AM, Barton SJ, Wren SP, Barker J. Review on molecularly imprinted polymers with a focus on their application to the analysis of protein biomarkers. Trends Analyt Chem 2021. [DOI: 10.1016/j.trac.2021.116431] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
30
|
Wang S, Dong Y, Wang J, Leng L, Song X, Huang W. The protective effect of ulinastatin combined with Xuebijing on myocardial injuries in patients with severe pneumonia. Am J Transl Res 2021; 13:11745-11751. [PMID: 34786102 PMCID: PMC8581934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the protective effect of ulinastatin combined with Xuebijing on myocardial injuries in patients with severe pneumonia. METHODS The clinical data of 86 patients with severe pneumonia treated in our hospital were analyzed retrospectively. According to the treatment method each patient was administered, they were divided into a control group (43 cases, routine treatment + Xuebijing) and an observation group (43 cases, routine treatment + Xuebijing + ulinastatin). All the patients were treated for 2 weeks. The clinical efficacy, the inflammatory factor levels (TNF-α, C-reactive protein (CRP), and procalcitonin (PCT)), the myocardial index levels (creatine kinase-myocardial band (CK-MB), lactic dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (α-HBDE), N-terminal pro-brain natriuretic peptide (NT-proBNP), and cardiac troponin I (cTn I)), the blood gas index levels (arterial partial pressure of oxygen (PaO2), oxygen saturation (SaO2), and oxygenation index (OI)), the coagulation functions (prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen (FIB)) and the acute physiology and chronic health evaluation (APACHE-II) scores were compared between the two groups. RESULTS After the treatment, the total effective rate in the observation group was higher than it was in the control group (P<0.05). After the treatment, the serum TNF-α, CRP, PCT, CK-MB, LDH, α-HBDE, NT-proBNP, and cTnI levels and the APACHE-II scores were decreased in the two groups, and they were even lower in the observation group (all P<0.05). The PaO2, SaO2, and OI levels were increased in the two groups, and they were higher in the observation group (all P<0.05). Compared with before the treatment, the patients' PT and APTT levels in both groups were prolonged after the treatment, and the observation group was longer than the control group. The plasma FIB levels were decreased in both groups, and they were lower in the observation group than in the control group (P<0.05). CONCLUSION Ulinastatin combined with Xuebijing can significantly alleviate pulmonary inflammation, improve the blood gas, and protect the damaged myocardia in patients with severe pneumonia.
Collapse
Affiliation(s)
- Sha Wang
- Department of Emergency, The Fourth Hospital of Shijiazhuang, Shijiazhuang Obstetrics and Gynecology HospitalShijiazhuang, Hebei Province, China
| | - Yiming Dong
- Department of Respiratory Intensive Care Unit II, Weifang People’s HospitalWeifang, Shandong Province, China
| | - Jingfeng Wang
- Department of Pharmacy, Yantai Affiliated Hospital of Binzhou Medical UniversityYantai, Shandong Province, China
| | - Lihong Leng
- Department of Anesthesiology, YanTai Penglai Traditional Chinese Medicine HospitalYantai, Shandong Province, China
| | - Xianfang Song
- Department of Obstetrics, The Fourth Hospital of Shijiazhuang, Shijiazhuang Obstetrics and Gynecology HospitalShijiazhuang, Hebei Province, China
| | - Wanyang Huang
- Department of Critical Care Medicine, Beibei Traditional Chinese Medical HospitalChongqing, China
| |
Collapse
|
31
|
Ma H, Cassedy A, O'Kennedy R. The role of antibody-based troponin detection in cardiovascular disease: A critical assessment. J Immunol Methods 2021; 497:113108. [PMID: 34329690 PMCID: PMC8412434 DOI: 10.1016/j.jim.2021.113108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/13/2021] [Accepted: 07/24/2021] [Indexed: 01/19/2023]
Abstract
Cardiovascular disease has remained the world's biggest killer for 30 years. To aid in the diagnosis and prognosis of patients suffering cardiovascular-related disease accurate detection methods are essential. For over 20 years, the cardiac-specific troponins, I (cTnI) and T (cTnT), have acted as sensitive and specific biomarkers to assist in the diagnosis of various types of heart diseases. Various cardiovascular complications were commonly detected in patients with COVID-19, where cTn elevation is detectable, which suggested potential great prognostic value of cTn in COVID-19-infected patients. Detection of these biomarkers circulating in the bloodstream is generally facilitated by immunoassays employing cTnI- and/or cTnT-specific antibodies. While several anti-troponin assays are commercially available, there are still obstacles to overcome to achieve optimal troponin detection. Such obstacles include the proteolytic degradation of N and C terminals on cTnI, epitope occlusion of troponin binding-sites by the cTnI/cTnT complex, cross reactivity of antibodies with skeletal troponins or assay interference caused by human anti-species antibodies. Therefore, further research into multi-antibody based platforms, multi-epitope targeting and rigorous validation of immunoassays is required to ensure accurate measurements. Moreover, with combination and modification of various latest technical (e.g. microfluidics), antibody-based troponin detection systems can be more specific, sensitive and rapid which could be incorporated into portable biosensor systems to be used at point-of care.
Collapse
Affiliation(s)
- Hui Ma
- School of Biotechnology, Dublin City University, Dublin 9 D09 V2O9, Ireland
| | - Arabelle Cassedy
- School of Biotechnology, Dublin City University, Dublin 9 D09 V2O9, Ireland
| | - Richard O'Kennedy
- School of Biotechnology, Dublin City University, Dublin 9 D09 V2O9, Ireland; Qatar Foundation and Hamad Bin Khalifa University, Research Complex, Education City, Doha, Qatar.
| |
Collapse
|
32
|
Lichtenauer M, Jirak P, Paar V, Sipos B, Kopp K, Berezin AE. Heart Failure and Diabetes Mellitus: Biomarkers in Risk Stratification and Prognostication. APPLIED SCIENCES 2021; 11:4397. [DOI: 10.3390/app11104397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
Heart failure (HF) and type 2 diabetes mellitus (T2DM) have a synergistic effect on cardiovascular (CV) morbidity and mortality in patients with established CV disease (CVD). The aim of this review is to summarize the knowledge regarding the discriminative abilities of conventional and novel biomarkers in T2DM patients with established HF or at higher risk of developing HF. While conventional biomarkers, such as natriuretic peptides and high-sensitivity troponins demonstrate high predictive ability in HF with reduced ejection fraction (HFrEF), this is not the case for HF with preserved ejection fraction (HFpEF). HFpEF is a heterogeneous disease with a high variability of CVD and conventional risk factors including T2DM, hypertension, renal disease, older age, and female sex; therefore, the extrapolation of predictive abilities of traditional biomarkers on this population is constrained. New biomarker-based approaches are disputed to be sufficient for improving risk stratification and the prediction of poor clinical outcomes in patients with HFpEF. Novel biomarkers of biomechanical stress, fibrosis, inflammation, oxidative stress, and collagen turn-over have shown potential benefits in determining prognosis in T2DM patients with HF regardless of natriuretic peptides, but their role in point-to-care and in routine practice requires elucidation in large clinical trials.
Collapse
|
33
|
Han JH, Hwang SO, Cha KC, Roh YI, Kim SJ, Kim HS, Jung WJ. High-Sensitivity Troponin I Assay for Differential Diagnosis of New-Onset Myocardial Infarction in Patients with Acute Decompensated Heart Failure. Yonsei Med J 2021; 62:129-136. [PMID: 33527792 PMCID: PMC7859689 DOI: 10.3349/ymj.2021.62.2.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/04/2020] [Accepted: 11/30/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Acute decompensated heart failure (ADHF) caused by ischemic heart disease is associated with higher mortality and requires immediate diagnosis. Recently, novel methods to diagnose non-ST elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin have been applied. We compared the clinical utility of high-sensitivity troponin I (hS-TnI), delta troponin I, and other traditional methods to diagnose NSTEMI in patients with ADHF. MATERIALS AND METHODS This retrospective cross-sectional study was conducted to analyze patients with ADHF who underwent hS-TnI evaluation of 0-2-h protocol in our emergency department. Patients were grouped according to a diagnosis of NSTEMI. RESULTS A total of 524 ADHF [ADHF with NSTEMI, n=109 (20.8%)] patients were enrolled in this analysis. The mean values of hS-TnI (ng/mL) in the ADHF with and without NSTEMI groups were 2.44±5.60 and 0.25±0.91, respectively. Multivariable analysis revealed that regional wall-motion abnormality, T-wave inversion/hyperacute T wave, and initial and delta hS-TnI were predictive factors for NSTEMI. Laboratory values related to cardiac biomarkers, including hS-TnI [odds ratio (OR) (95% confidence interval, CI): 2.18], and the delta hS-TnI [OR (95% CI): 1.55] were significant predictors of NSTEMI. Moreover, receiver operating characteristic analysis showed that the areas under receiver operating characteristic curves for electrocardiographic abnormalities, initial hS-TnI, and delta hS-TnI were 0.794, 0.802, and 0.773, respectively. CONCLUSION For diagnosis of suspected NSTEMI in patients with ADHF, initial hS-TnI assay has similar predictive value as ischemic changes on electrocardiogram and superior predictive value than delta hS-TnI calculated by the 0-2-h protocol.
Collapse
Affiliation(s)
- Joo Hong Han
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kyoung Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Il Roh
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sun Ju Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hye Sim Kim
- Center of Biomedical Data Science, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Woo Jin Jung
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
| |
Collapse
|
34
|
Haliga RE, Sorodoc V, Lionte C, Petris OR, Bologa C, Coman AE, Vata LG, Puha G, Dumitrescu G, Sirbu O, Stoica A, Ceasovschih A, Constantin M, Nicoleta Catana A, Jaba E, Sorodoc L. Acute Clinical Syndromes and Suspicion of SARS-CoV-2 Infection: The Experience of a Single Romanian Center in the Early Pandemic Period. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:121. [PMID: 33572732 PMCID: PMC7911742 DOI: 10.3390/medicina57020121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 12/29/2022]
Abstract
Background and Objectives: During the coronavirus disease 2019 (COVID-19) pandemic, patients with chronic diseases suffering exacerbations have required acute medical care. The purpose of our study was to determine useful criteria for the differentiation of patients with acute clinical syndromes and suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Materials and Methods: This was an observational retrospective study, conducted in an internal medicine clinic from April to May 2020. We collected clinical, biological, and computed tomography (CT) data on patients with exacerbations of chronic diseases and clinical suspicion of SARS-CoV-2 infection. Patients with an already-positive real-time reverse-transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2 on presentation at the emergency department were excluded from our study. Results: Of 253 suspected cases, 20 were laboratory-confirmed as having SARS-CoV-2 infection by RT-PCR, whereas COVID-19 diagnosis was ruled out in the remaining 233. Venous thromboembolism (VTE) correlated significantly with COVID-19 diagnosis in suspected patients, while laboratory markers were not significantly different between the two groups. Of the suspected patients, significantly higher percentages of dry cough, fever, myalgias, sore throat, loss of smell and appetite, and ground-glass opacities (GGOs) on CT were found in SARS-CoV-2-positive individuals. Conclusions: The study demonstrated that, until receiving the result of an RT-PCR test for SARS-CoV-2 (usually 12-24 h), association with VTE as a comorbidity, fever, dry cough, and myalgia as clinical features, and GGO on CT are the main markers for the identification of COVID-19 patients among those suspected with acute clinical syndromes. Our results also provide evidence for doctors not to rely solely on biological markers in the case of suspected SARS-CoV-2 infection in patients with exacerbations of chronic diseases. These data are useful for faster decision-making with regard to suspected COVID-19 patients before receiving RT-PCR test results, thus avoiding keeping patients in crowded emergency departments.
Collapse
Affiliation(s)
- Raluca Ecaterina Haliga
- Department of Internal Medicine, “St. Spiridon” Emergency Clinical Hospital, 700111 Iași, Romania; (V.S.); (C.L.); (O.R.P.); (C.B.); (A.E.C.); (L.G.V.); (G.P.); (G.D.); (O.S.); (A.S.); (A.C.); (M.C.); (L.S.)
- Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Victorita Sorodoc
- Department of Internal Medicine, “St. Spiridon” Emergency Clinical Hospital, 700111 Iași, Romania; (V.S.); (C.L.); (O.R.P.); (C.B.); (A.E.C.); (L.G.V.); (G.P.); (G.D.); (O.S.); (A.S.); (A.C.); (M.C.); (L.S.)
- Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Catalina Lionte
- Department of Internal Medicine, “St. Spiridon” Emergency Clinical Hospital, 700111 Iași, Romania; (V.S.); (C.L.); (O.R.P.); (C.B.); (A.E.C.); (L.G.V.); (G.P.); (G.D.); (O.S.); (A.S.); (A.C.); (M.C.); (L.S.)
- Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ovidiu Rusalim Petris
- Department of Internal Medicine, “St. Spiridon” Emergency Clinical Hospital, 700111 Iași, Romania; (V.S.); (C.L.); (O.R.P.); (C.B.); (A.E.C.); (L.G.V.); (G.P.); (G.D.); (O.S.); (A.S.); (A.C.); (M.C.); (L.S.)
- Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Cristina Bologa
- Department of Internal Medicine, “St. Spiridon” Emergency Clinical Hospital, 700111 Iași, Romania; (V.S.); (C.L.); (O.R.P.); (C.B.); (A.E.C.); (L.G.V.); (G.P.); (G.D.); (O.S.); (A.S.); (A.C.); (M.C.); (L.S.)
- Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Adorata Elena Coman
- Department of Internal Medicine, “St. Spiridon” Emergency Clinical Hospital, 700111 Iași, Romania; (V.S.); (C.L.); (O.R.P.); (C.B.); (A.E.C.); (L.G.V.); (G.P.); (G.D.); (O.S.); (A.S.); (A.C.); (M.C.); (L.S.)
- Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Luminita Gina Vata
- Department of Internal Medicine, “St. Spiridon” Emergency Clinical Hospital, 700111 Iași, Romania; (V.S.); (C.L.); (O.R.P.); (C.B.); (A.E.C.); (L.G.V.); (G.P.); (G.D.); (O.S.); (A.S.); (A.C.); (M.C.); (L.S.)
- Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Gabriela Puha
- Department of Internal Medicine, “St. Spiridon” Emergency Clinical Hospital, 700111 Iași, Romania; (V.S.); (C.L.); (O.R.P.); (C.B.); (A.E.C.); (L.G.V.); (G.P.); (G.D.); (O.S.); (A.S.); (A.C.); (M.C.); (L.S.)
- Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Gabriela Dumitrescu
- Department of Internal Medicine, “St. Spiridon” Emergency Clinical Hospital, 700111 Iași, Romania; (V.S.); (C.L.); (O.R.P.); (C.B.); (A.E.C.); (L.G.V.); (G.P.); (G.D.); (O.S.); (A.S.); (A.C.); (M.C.); (L.S.)
- Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Oana Sirbu
- Department of Internal Medicine, “St. Spiridon” Emergency Clinical Hospital, 700111 Iași, Romania; (V.S.); (C.L.); (O.R.P.); (C.B.); (A.E.C.); (L.G.V.); (G.P.); (G.D.); (O.S.); (A.S.); (A.C.); (M.C.); (L.S.)
- Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Alexandra Stoica
- Department of Internal Medicine, “St. Spiridon” Emergency Clinical Hospital, 700111 Iași, Romania; (V.S.); (C.L.); (O.R.P.); (C.B.); (A.E.C.); (L.G.V.); (G.P.); (G.D.); (O.S.); (A.S.); (A.C.); (M.C.); (L.S.)
- Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Alexandr Ceasovschih
- Department of Internal Medicine, “St. Spiridon” Emergency Clinical Hospital, 700111 Iași, Romania; (V.S.); (C.L.); (O.R.P.); (C.B.); (A.E.C.); (L.G.V.); (G.P.); (G.D.); (O.S.); (A.S.); (A.C.); (M.C.); (L.S.)
- Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Mihai Constantin
- Department of Internal Medicine, “St. Spiridon” Emergency Clinical Hospital, 700111 Iași, Romania; (V.S.); (C.L.); (O.R.P.); (C.B.); (A.E.C.); (L.G.V.); (G.P.); (G.D.); (O.S.); (A.S.); (A.C.); (M.C.); (L.S.)
- Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Andreea Nicoleta Catana
- Department of Infectious Diseases, “St. Spiridon” Emergency Clinical Hospital, 700111 Iași, Romania;
| | - Elisabeta Jaba
- Statistics Department, FEEA, “Al. I. Cuza” University, 700506 Iasi, Romania;
| | - Laurentiu Sorodoc
- Department of Internal Medicine, “St. Spiridon” Emergency Clinical Hospital, 700111 Iași, Romania; (V.S.); (C.L.); (O.R.P.); (C.B.); (A.E.C.); (L.G.V.); (G.P.); (G.D.); (O.S.); (A.S.); (A.C.); (M.C.); (L.S.)
- Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| |
Collapse
|
35
|
Biomarkers in Acute Heart Failure: Diagnosis, Prognosis, and Treatment. INTERNATIONAL JOURNAL OF HEART FAILURE 2021; 3:81-105. [PMID: 36262882 PMCID: PMC9536694 DOI: 10.36628/ijhf.2020.0036] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/28/2020] [Accepted: 01/11/2021] [Indexed: 01/16/2023]
Abstract
Heart failure is a global health problem. An episode of acute heart failure (AHF) is a period of substantial morbidity and mortality with few advances in the management of an episode that have improved outcomes. The measurement of multiple biomarkers has become an integral adjunctive tool for the management of AHF. Many biomarkers are now well established in their ability to assist with diagnosis and prognostication of an AHF patient. There are also emerging biomarkers that are showing significant promise in the areas of diagnosis and prognosis. For improving the management of AHF, both established and novel biomarkers may assist in guiding medical therapy and subsequently improving outcomes. Thus, it is important to understand the different abilities and limitations of established and emerging biomarkers in AHF so that they may be correctly interpreted and integrated into clinical practice for AHF. This knowledge may improve the care of AHF patients. This review will summarize the evidence of both established and novel biomarkers for diagnosis, prognosis and management in AHF so that the treating clinician may become more comfortable incorporating these biomarkers into clinical practice in an evidence-based manner.
Collapse
|
36
|
Dimitropoulos S, Mystakidi VC, Oikonomou E, Siasos G, Tsigkou V, Athanasiou D, Gouliopoulos N, Bletsa E, Kalampogias A, Charalambous G, Tsioufis C, Vavuranakis M, Tousoulis D. Association of Soluble Suppression of Tumorigenesis-2 (ST2) with Endothelial Function in Patients with Ischemic Heart Failure. Int J Mol Sci 2020; 21:ijms21249385. [PMID: 33317161 PMCID: PMC7764062 DOI: 10.3390/ijms21249385] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/29/2020] [Accepted: 12/06/2020] [Indexed: 02/07/2023] Open
Abstract
Soluble suppression of tumorigenesis-2 (sST2) has been introduced as a marker associated with heart failure (HF) pathophysiology and status. Endothelial dysfunction is a component underlying HF pathophysiology. Therefore, we examined the association of arterial wall properties with sST2 levels in patients with HF of ischemic etiology. We enrolled 143 patients with stable HF of ischemic etiology and reduced left ventricular ejection fraction (LVEF) and 77 control subjects. Flow-mediated dilation (FMD) was used to evaluate endothelial function and pulse wave velocity (PWV) to assess arterial stiffness. Although there was no significant difference in baseline demographic characteristics, levels of sST2 were increased in HF compared to the control (15.8 (11.0, 21.8) ng/mL vs. 12.5 (10.4, 16.3) ng/mL; p < 0.001). In the HF group, there was a positive correlation of sST2 levels with age (rho = 0.22; p = 0.007) while there was no association of LVEF with sST2 (rho = −0.119; p = 0.17) nor with PWV (rho = 0.1; p = 0.23). Interestingly, sST2 was increased in NYHA III [20.0 (12.3, 25.7) ng/mL] compared to patients with NYHA II (15.0 (10.4, 18.2) ng/mL; p = 0.003) and inversely associated with FMD (rho = −0.44; p < 0.001) even after adjustment for possible confounders. In patients with chronic HF of ischemic etiology, sST2 levels are increased and are associated with functional capacity. There is an inverse association between FMD and sST2 levels, highlighting the interplay between the dysfunctional endothelium and HF pathophysiologic mechanisms.
Collapse
Affiliation(s)
- Stathis Dimitropoulos
- First Department of Cardiology, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (S.D.); (V.C.M.); (G.S.); (V.T.); (D.A.); (N.G.); (E.B.); (A.K.); (G.C.); (C.T.); (D.T.)
| | - Vasiliki Chara Mystakidi
- First Department of Cardiology, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (S.D.); (V.C.M.); (G.S.); (V.T.); (D.A.); (N.G.); (E.B.); (A.K.); (G.C.); (C.T.); (D.T.)
| | - Evangelos Oikonomou
- First Department of Cardiology, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (S.D.); (V.C.M.); (G.S.); (V.T.); (D.A.); (N.G.); (E.B.); (A.K.); (G.C.); (C.T.); (D.T.)
- Third Department of Cardiology, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece;
- Correspondence: , Tel.: +30-210-7763488
| | - Gerasimos Siasos
- First Department of Cardiology, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (S.D.); (V.C.M.); (G.S.); (V.T.); (D.A.); (N.G.); (E.B.); (A.K.); (G.C.); (C.T.); (D.T.)
- Third Department of Cardiology, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Vasiliki Tsigkou
- First Department of Cardiology, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (S.D.); (V.C.M.); (G.S.); (V.T.); (D.A.); (N.G.); (E.B.); (A.K.); (G.C.); (C.T.); (D.T.)
| | - Dimitris Athanasiou
- First Department of Cardiology, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (S.D.); (V.C.M.); (G.S.); (V.T.); (D.A.); (N.G.); (E.B.); (A.K.); (G.C.); (C.T.); (D.T.)
| | - Nikolaos Gouliopoulos
- First Department of Cardiology, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (S.D.); (V.C.M.); (G.S.); (V.T.); (D.A.); (N.G.); (E.B.); (A.K.); (G.C.); (C.T.); (D.T.)
| | - Evanthia Bletsa
- First Department of Cardiology, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (S.D.); (V.C.M.); (G.S.); (V.T.); (D.A.); (N.G.); (E.B.); (A.K.); (G.C.); (C.T.); (D.T.)
| | - Aimilios Kalampogias
- First Department of Cardiology, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (S.D.); (V.C.M.); (G.S.); (V.T.); (D.A.); (N.G.); (E.B.); (A.K.); (G.C.); (C.T.); (D.T.)
| | - Georgios Charalambous
- First Department of Cardiology, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (S.D.); (V.C.M.); (G.S.); (V.T.); (D.A.); (N.G.); (E.B.); (A.K.); (G.C.); (C.T.); (D.T.)
| | - Costas Tsioufis
- First Department of Cardiology, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (S.D.); (V.C.M.); (G.S.); (V.T.); (D.A.); (N.G.); (E.B.); (A.K.); (G.C.); (C.T.); (D.T.)
| | - Manolis Vavuranakis
- Third Department of Cardiology, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Dimitris Tousoulis
- First Department of Cardiology, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (S.D.); (V.C.M.); (G.S.); (V.T.); (D.A.); (N.G.); (E.B.); (A.K.); (G.C.); (C.T.); (D.T.)
| |
Collapse
|
37
|
Redón P, Shahzad A, Iqbal T, Wijns W. Benefits of Home-Based Solutions for Diagnosis and Treatment of Acute Coronary Syndromes on Health Care Costs: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5006. [PMID: 32899338 PMCID: PMC7506920 DOI: 10.3390/s20175006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/29/2020] [Accepted: 09/01/2020] [Indexed: 01/06/2023]
Abstract
Diagnosing and treating acute coronary syndromes consumes a significant fraction of the healthcare budget worldwide. The pressure on resources is expected to increase with the continuing rise of cardiovascular disease, other chronic diseases and extended life expectancy, while expenditure is constrained. The objective of this review is to assess if home-based solutions for measuring chemical cardiac biomarkers can mitigate or reduce the continued rise in the costs of ACS treatment. A systematic review was performed considering published literature in several relevant public databases (i.e., PUBMED, Cochrane, Embase and Scopus) focusing on current biomarker practices in high-risk patients, their cost-effectiveness and the clinical evidence and feasibility of implementation. Out of 26,000 references screened, 86 met the inclusion criteria after independent full-text review. Current clinical evidence highlights that home-based solutions implemented in primary and secondary prevention reduce health care costs by earlier diagnosis, improved patient outcomes and quality of life, as well as by avoidance of unnecessary use of resources. Economical evidence suggests their potential to reduce health care costs if the incremental cost-effectiveness ratio or the willingness-to-pay does not surpass £20,000/QALY or €50,000 limit per 20,000 patients, respectively. The cost-effectiveness of these solutions increases when applied to high-risk patients.
Collapse
Affiliation(s)
- Pau Redón
- CÚRAM Center for Research in Medical Devices, H91 W2TY Galway, Ireland;
- Smart Sensor Lab, School of Medicine, National University of Ireland, Galway (NUIG), H91 TK33 Galway, Ireland; (A.S.); (T.I.)
| | - Atif Shahzad
- Smart Sensor Lab, School of Medicine, National University of Ireland, Galway (NUIG), H91 TK33 Galway, Ireland; (A.S.); (T.I.)
| | - Talha Iqbal
- Smart Sensor Lab, School of Medicine, National University of Ireland, Galway (NUIG), H91 TK33 Galway, Ireland; (A.S.); (T.I.)
| | - William Wijns
- CÚRAM Center for Research in Medical Devices, H91 W2TY Galway, Ireland;
- Smart Sensor Lab, School of Medicine, National University of Ireland, Galway (NUIG), H91 TK33 Galway, Ireland; (A.S.); (T.I.)
- Saolta University Healthcare Group, University Hospital Galway, Newcastle Road, H91 YR71 Galway, Ireland
| |
Collapse
|
38
|
Prognostic Value of Lactate Dehydrogenase for Mid-Term Mortality in Acute Decompensated Heart Failure: A Comparison to Established Biomarkers and Brain Natriuretic Peptide. Heart Lung Circ 2020; 29:1318-1327. [DOI: 10.1016/j.hlc.2019.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 10/08/2019] [Accepted: 11/10/2019] [Indexed: 11/23/2022]
|
39
|
Furosemide and spironolactone doses and hyponatremia in patients with heart failure. BMC Pharmacol Toxicol 2020; 21:57. [PMID: 32746925 PMCID: PMC7397681 DOI: 10.1186/s40360-020-00431-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/16/2020] [Indexed: 01/13/2023] Open
Abstract
Background Hyponatremia, a marker of disease severity and prognosis, has been associated with various clinical factors and drug use, especially diuretics. Methods This observational prospective cohort study enrolled patients hospitalized at the University Hospital Center Split because of heart failure (HF). We investigated the association of clinical variables and cardiovascular drugs, including furosemide, hydrochlorothiazide, spironolactone, and their doses, with the presence of hyponatremia at admission. Results Of the 565 included patients, 32.4% were hyponatremic, 62.6% were males, and the mean age was 73.1 ± 10.6 years. In the univariate analysis, hyponatremic patients were more often current smokers (p = 0.01), alcohol consumers (p = 0.01), receiving spironolactone (p = 0.004) or combination of furosemide and spironolactone (p = 0.003). Patients who received 50 and 100 mg of spironolactone, compared to those receiving 25 mg (p < 0.0001), as well as patients who received 250 to 500 mg of furosemide compared to ≤240 mg (p = 0.001), were significantly more often hyponatremic. In the multivariate analysis, when diuretic doses were accounted for, furosemide doses of 250 to 500 mg (p = 0.009), spironolactone doses of 50 to 100 mg (p = 0.0003), increasing age (p = 0.03), diabetes mellitus (p = 0.02) and alcohol consumption (p = 0.04) were independently associated with hyponatremia. Conclusion High doses of furosemide and spironolactone, or concomitant use of these diuretics, seem to be an important cause of hyponatremia in HF patients, particularly in combination with advanced age, diabetes and alcohol consumption. Diuretic dose reduction may help avoid hyponatremia and improve clinical status and prognosis in such patients.
Collapse
|
40
|
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.
Collapse
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
| |
Collapse
|
41
|
Bachar-Wikstrom E, Curman P, Ahanian T, Leong IUS, Larsson H, Cederlöf M, Wikstrom JD. Darier disease is associated with heart failure: a cross-sectional case-control and population based study. Sci Rep 2020; 10:6886. [PMID: 32327688 PMCID: PMC7181854 DOI: 10.1038/s41598-020-63832-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/03/2020] [Indexed: 01/16/2023] Open
Abstract
Human data supporting a role for endoplasmic reticulum (ER) stress and calcium dyshomeostasis in heart disease is scarce. Darier disease (DD) is a hereditary skin disease caused by mutations in the ATP2A2 gene encoding the sarcoendoplasmic-reticulum Ca2+ ATPase isoform 2 (SERCA2), which causes calcium dyshomeostasis and ER stress. We hypothesized that DD patients would have an increased risk for common heart disease. We performed a cross-sectional case-control clinical study on 25 DD patients and 25 matched controls; and a population-based cohort study on 935 subjects with DD and matched comparison subjects. Main outcomes and measures were N-terminal pro-brain natriuretic peptide, ECG and heart diagnosis (myocardial infarction, heart failure and arrythmia). DD subjects showed normal clinical heart phenotype including heart failure markers and ECG. The risk for heart failure was 1.59 (1,16-2,19) times elevated in DD subjects, while no major differences were found in myocardial infarcation or arrhythmias. Risk for heart failure when corrected for cardivascular risk factors or alcohol misuse was 1.53 (1.11-2.11) and 1.58 (1,15-2,18) respectively. Notably, heart failure occurred several years earlier in DD patients as compared to controls. We conclude that DD patients show a disease specific increased risk of heart failure which should be taken into account in patient management. The observation also strenghtens the clinical evidence on the important role of SERCA2 in heart failure pathophysiology.
Collapse
Affiliation(s)
- Etty Bachar-Wikstrom
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Philip Curman
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
- Dermato-Venereology Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Tara Ahanian
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
- Dermato-Venereology Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Ivone U S Leong
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Martin Cederlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Norra Stationsgatan 69, Stockholm, Sweden
| | - Jakob D Wikstrom
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.
- Dermato-Venereology Clinic, Karolinska University Hospital, Stockholm, Sweden.
| |
Collapse
|
42
|
Suthahar N, Meems LMG, Ho JE, de Boer RA. Sex-related differences in contemporary biomarkers for heart failure: a review. Eur J Heart Fail 2020; 22:775-788. [PMID: 32220046 PMCID: PMC7319414 DOI: 10.1002/ejhf.1771] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 12/28/2022] Open
Abstract
The use of circulating biomarkers for heart failure (HF) is engrained in contemporary cardiovascular practice and provides objective information about various pathophysiological pathways associated with HF syndrome. However, biomarker profiles differ considerably among women and men. For instance, in the general population, markers of cardiac stretch (natriuretic peptides) and fibrosis (galectin‐3) are higher in women, whereas markers of cardiac injury (cardiac troponins) and inflammation (sST2) are higher in men. Such differences may reflect sex‐specific pathogenic processes associated with HF risk, but may also arise as a result of differences in sex hormone profiles and fat distribution. From a clinical perspective, sex‐related differences in biomarker levels may affect the objectivity of biomarkers in HF management because what is considered to be ‘normal’ in one sex may not be so in the other. The objectives of this review are, therefore: (i) to examine the sex‐specific dynamics of clinically relevant HF biomarkers in the general population, as well as in HF patients; (ii) to discuss the overlap between sex‐related and obesity‐related effects, and (iii) to identify knowledge gaps to stimulate research on sex‐related differences in
HF.
Collapse
Affiliation(s)
- Navin Suthahar
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | - Laura M G Meems
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | - Jennifer E Ho
- Division of Cardiology, Department of Medicine, and Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rudolf A de Boer
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| |
Collapse
|
43
|
Norepinephrine as new functional monomer for molecular imprinting: An applicative study for the optical sensing of cardiac biomarkers. Biosens Bioelectron 2020; 157:112161. [PMID: 32250934 DOI: 10.1016/j.bios.2020.112161] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 11/23/2022]
Abstract
The continuous research for alternatives to antibody-based detection drove, in the last decades, the development of numerous strategies. Molecularly imprinted polymers (MIPs) emerged thanks to the low-cost and long-term stability features, where the choice of natural functional monomer(s) represents the key step for efficient imprinting of biomolecules. The chemical structure of dopamine (DA), one of the most used natural functional monomers, provided the inspiration for this work. We wondered why norepinephrine (NE) that differs from dopamine only for an additional hydroxyl group was not investigated at all in biosensing applications. In fact, there is only one paper exploiting polynorepinephrine (PNE) in molecular recognition applications, taking advantage of molecular imprinting, but not for biosensing purposes. In contrast, hundreds of papers describe polydopamine-based sensors. Therefore, we firstly investigated how the additional hydroxyl group of NE could affect the properties of the resulting polymer, and how these properties could be exploited for biosensing applications. The results highlighted the reduced non-specific adsorption of proteins onto PNE with respect to dopamine polymer. Furthermore, as a case study, we successfully developed a PNE-based imprinted biosensor for the early detection of Troponin I, a crucial biomarker for heart failure, by coupling the MIP biosensor with surface plasmon resonance (SPR) detection. The results indicate the feasible use of imprinted PNE as synthetic receptor for biomolecules, opening new perspectives for this biopolymer, so far not considered, and encouraging further investigations on its potential application in biosensing.
Collapse
|
44
|
Šimić S, Svaguša T, Prkačin I, Bulum T. Relationship between hemoglobin A1c and serum troponin in patients with diabetes and cardiovascular events. J Diabetes Metab Disord 2019; 18:693-704. [PMID: 31890693 PMCID: PMC6915172 DOI: 10.1007/s40200-019-00460-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/24/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Diabetes mellitus is a group of metabolic disorders associated with high risk for cardiovascular disease. Although troponins are primarily clinically used for the diagnosis of acute coronary syndrome, they are also used in risk assessment in patients with acute coronary syndrome as well as in a number of other conditions. The aim of this review was to investigate the relationship between hemoglobin A1c and serum troponin in patients with diabetes and cardiovascular events. METHODS Hemoglobin A1c has been chosen as the best clinical indicator of glucose control and risk of micro and macrovascular complications. We investigated cardiac troponins as a group of markers of muscle injury which includes troponin T, troponin I and troponin C. Troponin T and I are specific for myocardial injury, compared to C which is specific for skeletal muscle. RESULTS In this review, we showed that there was a causal relation between hemoglobin A1c levels and serum troponin concentrations. Hemoglobin A1c has shown to be a positive predictive factor of incidence, mortality and morbidity of conditions such as acute coronary syndrome, arrhythmias, stroke, pulmonary embolism and other conditions that causes troponin elevation by its release in circulation. CONCLUSIONS Chronic hyperglycemia decreases glomerular filtration and consequently decreases troponin elimination and also by affecting the heart microcirculation it leads to microvascular damage and consequently to ischemia which contribute to troponin concentration elevation. Furthermore, correlation between hemoglobin A1c and troponin concentration manifests in their prognostic value for mortality.
Collapse
Affiliation(s)
- Stjepan Šimić
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Tomo Svaguša
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia
| | - Ingrid Prkačin
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia
| | - Tomislav Bulum
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
| |
Collapse
|
45
|
Jaakkola S, Paana T, Nuotio I, Kiviniemi TO, Pouru JP, Porela P, Biancari F, Airaksinen KEJ. Etiology of Minor Troponin Elevations in Patients with Atrial Fibrillation at Emergency Department-Tropo-AF Study. J Clin Med 2019; 8:E1963. [PMID: 31739414 PMCID: PMC6912339 DOI: 10.3390/jcm8111963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/31/2019] [Accepted: 11/10/2019] [Indexed: 12/20/2022] Open
Abstract
Patients with atrial fibrillation (AF) presenting to the emergency department (ED) often have elevated cardiac troponin T (TnT) levels without evidence of type 1 myocardial infarction. We sought to explore the causes and significance of minor TnT elevations in patients with AF at the ED. All patients with AF admitted to the ED of Turku University Hospital between 1 March, 2013 and 11 April, 2016, and at least two TnT measurements, were screened. Overall, 2911 patients with a maximum TnT of 100 ng/L during hospitalization were analyzed. TnT was between 15 and 100 ng/L in 2116 patients. The most common primary discharge diagnoses in this group were AF (18.1%), infection (18.3%), ischemic stroke/transient ischemic attack (10.7%), and heart failure (5.0%). Acute coronary syndrome (ACS) was equally uncommon both in patients with normal TnT and elevated TnT (4.4% vs. 4.5%). Age ≥75 years, low estimated glomerular filtration rate (eGFR), high C-reactive protein (CRP), and hemoglobin <10.0 g/dL, were the most important predictors of elevated TnT. Importantly, TnT elevation was a very frequent (>93%) finding in elderly (≥75 years) AF patients with either low eGFR or high CRP. In conclusion, minor TnT elevations carry limited diagnostic value in elderly AF patients with comorbidities.
Collapse
Affiliation(s)
- Samuli Jaakkola
- Heart Center, Turku University Hospital and University of Turku, 20521 Turku, Finland; (S.J.); (T.P.); (I.N.); (T.O.K.); (J.-P.P.); (P.P.); (F.B.)
| | - Tuomas Paana
- Heart Center, Turku University Hospital and University of Turku, 20521 Turku, Finland; (S.J.); (T.P.); (I.N.); (T.O.K.); (J.-P.P.); (P.P.); (F.B.)
| | - Ilpo Nuotio
- Heart Center, Turku University Hospital and University of Turku, 20521 Turku, Finland; (S.J.); (T.P.); (I.N.); (T.O.K.); (J.-P.P.); (P.P.); (F.B.)
- Department of Acute Internal Medicine, Turku University Hospital and University of Turku, 20521 Turku, Finland
| | - Tuomas O. Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, 20521 Turku, Finland; (S.J.); (T.P.); (I.N.); (T.O.K.); (J.-P.P.); (P.P.); (F.B.)
- Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jussi-Pekka Pouru
- Heart Center, Turku University Hospital and University of Turku, 20521 Turku, Finland; (S.J.); (T.P.); (I.N.); (T.O.K.); (J.-P.P.); (P.P.); (F.B.)
| | - Pekka Porela
- Heart Center, Turku University Hospital and University of Turku, 20521 Turku, Finland; (S.J.); (T.P.); (I.N.); (T.O.K.); (J.-P.P.); (P.P.); (F.B.)
| | - Fausto Biancari
- Heart Center, Turku University Hospital and University of Turku, 20521 Turku, Finland; (S.J.); (T.P.); (I.N.); (T.O.K.); (J.-P.P.); (P.P.); (F.B.)
- Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, 90014 Oulu, Finland
| | - K. E. Juhani Airaksinen
- Heart Center, Turku University Hospital and University of Turku, 20521 Turku, Finland; (S.J.); (T.P.); (I.N.); (T.O.K.); (J.-P.P.); (P.P.); (F.B.)
| |
Collapse
|
46
|
Marsault E, Llorens-Cortes C, Iturrioz X, Chun HJ, Lesur O, Oudit GY, Auger-Messier M. The apelinergic system: a perspective on challenges and opportunities in cardiovascular and metabolic disorders. Ann N Y Acad Sci 2019; 1455:12-33. [PMID: 31236974 PMCID: PMC6834863 DOI: 10.1111/nyas.14123] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/11/2019] [Accepted: 05/02/2019] [Indexed: 12/11/2022]
Abstract
The apelinergic pathway has been generating increasing interest in the past few years for its potential as a therapeutic target in several conditions associated with the cardiovascular and metabolic systems. Indeed, preclinical and, more recently, clinical evidence both point to this G protein-coupled receptor as a target of interest in the treatment of not only cardiovascular disorders such as heart failure, pulmonary arterial hypertension, atherosclerosis, or septic shock, but also of additional conditions such as water retention/hyponatremic disorders, type 2 diabetes, and preeclampsia. While it is a peculiar system with its two classes of endogenous ligand, the apelins and Elabela, its intricacies are a matter of continuing investigation to finely pinpoint its potential and how it enables crosstalk between the vasculature and organ systems of interest. In this perspective article, we first review the current knowledge on the role of the apelinergic pathway in the above systems, as well as the associated therapeutic indications and existing pharmacological tools. We also offer a perspective on the challenges and potential ahead to advance the apelinergic system as a target for therapeutic intervention in several key areas.
Collapse
Affiliation(s)
- Eric Marsault
- Department of Pharmacology and Physiology, Institut de Pharmacologie de Sherbrooke, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Catherine Llorens-Cortes
- Collège de France, Center for Interdisciplinary Research in Biology, INSERM U1050, CNRS UMR7241, Paris, France
| | - Xavier Iturrioz
- Collège de France, Center for Interdisciplinary Research in Biology, INSERM U1050, CNRS UMR7241, Paris, France
| | - Hyung J. Chun
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Departments of Internal Medicine and Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Olivier Lesur
- Department of Pharmacology and Physiology, Institut de Pharmacologie de Sherbrooke, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Department of Medicine – Division of Intensive Care Units, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Gavin Y. Oudit
- Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Mannix Auger-Messier
- Department of Pharmacology and Physiology, Institut de Pharmacologie de Sherbrooke, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Department of Medicine – Division of Cardiology, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
| |
Collapse
|
47
|
|
48
|
Lai YJ, Hanneman SK, Casarez RL, Wang J, McCullough LD. Blood biomarkers for physical recovery in ischemic stroke: a systematic review. Am J Transl Res 2019; 11:4603-4613. [PMID: 31497186 PMCID: PMC6731415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/11/2019] [Indexed: 06/10/2023]
Abstract
Stroke is a common cause of physical disability. Biomarkers have been used to predict prognosis in ischemic stroke, but studies linking biomarkers to physical recovery from ischemic stroke have not been systematically evaluated since 2011. The purpose of this paper is to report the findings of a systematic review of the intervening literature to identify potential predictive biomarkers for recovery of physical function following ischemic stroke. The PubMed, Embase, and CINAHL databases were searched for studies reported between January 1, 2011, and September 18, 2018. Search criteria were adult ischemic stroke patients, blood sample collection within 24 ± 6 hrs of stroke onset, and outcome measures, including physical function. Identified from 18 studies and representing four biological classifications, 34 biomarkers were significantly associated with physical recovery after ischemic stroke: (1) immune response (15, 44%); (2) lipids/metabolism (4, 12%); (3) neuronal function (4, 12%); and (4) blood vessel/circulation (11, 32%). Of the predictive biomarkers associated with 1-month recovery, 60% (6 of 10) was classified into blood vessel/circulation; 54% (14 of 26) of the biomarkers associated with 3-6 month physical recovery involved the immune response. Blood biomarkers might provide useful information to improve the prediction of physical outcome after ischemic stroke. The data suggest that biomarkers from four biological classifications may predict physical recovery in patients after ischemic stroke.
Collapse
Affiliation(s)
- Yun-Ju Lai
- Cizik School of Nursing, University of Texas Health Science Center at HoustonHouston, TX 77030, USA
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at HoustonHouston, TX 77030, USA
| | - Sandra K Hanneman
- Cizik School of Nursing, University of Texas Health Science Center at HoustonHouston, TX 77030, USA
| | - Rebecca L Casarez
- Cizik School of Nursing, University of Texas Health Science Center at HoustonHouston, TX 77030, USA
| | - Jing Wang
- School of Nursing, University of Texas Health Science Center at San AntonioSan Antonio, TX 78229, USA
| | - Louise D McCullough
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at HoustonHouston, TX 77030, USA
| |
Collapse
|
49
|
Tomin T, Schittmayer M, Honeder S, Heininger C, Birner-Gruenberger R. Irreversible oxidative post-translational modifications in heart disease. Expert Rev Proteomics 2019; 16:681-693. [PMID: 31361162 PMCID: PMC6816499 DOI: 10.1080/14789450.2019.1645602] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Development of specific biomarkers aiding early diagnosis of heart failure is an ongoing challenge. Biomarkers commonly used in clinical routine usually act as readouts of an already existing acute condition rather than disease initiation. Functional decline of cardiac muscle is greatly aggravated by increased oxidative stress and damage of proteins. Oxidative post-translational modifications occur already at early stages of tissue damage and are thus regarded as potential up-coming disease markers. Areas covered: Clinical practice regarding commonly used biomarkers for heart disease is briefly summarized. The types of oxidative post-translational modification in cardiac pathologies are discussed with a special focus on available quantitative techniques and characteristics of individual modifications with regard to their stability and analytical accessibility. As irreversible oxidative modifications trigger protein degradation pathways or cause protein aggregation, both influencing biomarker abundance, a chapter is dedicated to their regulation in the heart.
Collapse
Affiliation(s)
- Tamara Tomin
- Institute of Pathology, Diagnostic and Research Center for Molecular Biomedicine, Medical University of Graz , Graz , Austria.,Omics Center Graz, BioTechMed-Graz , Graz , Austria.,Institute of Chemical Technologies and Analytics, Vienna University of Technology , Vienna , Austria
| | - Matthias Schittmayer
- Institute of Pathology, Diagnostic and Research Center for Molecular Biomedicine, Medical University of Graz , Graz , Austria.,Omics Center Graz, BioTechMed-Graz , Graz , Austria.,Institute of Chemical Technologies and Analytics, Vienna University of Technology , Vienna , Austria
| | - Sophie Honeder
- Institute of Pathology, Diagnostic and Research Center for Molecular Biomedicine, Medical University of Graz , Graz , Austria.,Omics Center Graz, BioTechMed-Graz , Graz , Austria
| | - Christoph Heininger
- Institute of Pathology, Diagnostic and Research Center for Molecular Biomedicine, Medical University of Graz , Graz , Austria.,Omics Center Graz, BioTechMed-Graz , Graz , Austria
| | - Ruth Birner-Gruenberger
- Institute of Pathology, Diagnostic and Research Center for Molecular Biomedicine, Medical University of Graz , Graz , Austria.,Omics Center Graz, BioTechMed-Graz , Graz , Austria.,Institute of Chemical Technologies and Analytics, Vienna University of Technology , Vienna , Austria
| |
Collapse
|
50
|
Catestatin in Acutely Decompensated Heart Failure Patients: Insights from the CATSTAT-HF Study. J Clin Med 2019; 8:jcm8081132. [PMID: 31366074 PMCID: PMC6722699 DOI: 10.3390/jcm8081132] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 12/16/2022] Open
Abstract
The role of catestatin (CST) in acutely decompensated heart failure (ADHF) and myocardial infarction (MI) is poorly elucidated. Due to the implicated role of CST in the regulation of neurohumoral activity, the goals of the study were to determine CST serum levels among ninety consecutively enrolled ADHF patients, with respect to the MI history and left ventricular ejection fraction (LVEF) and to examine its association with clinical, echocardiographic, and laboratory parameters. CST levels were higher among ADHF patients with MI history, compared to those without (8.94 ± 6.39 vs. 4.90 ± 2.74 ng/mL, p = 0.001). CST serum levels did not differ among patients with reduced, midrange, and preserved LVEF (7.74 ± 5.64 vs. 5.75 ± 4.19 vs. 5.35 ± 2.77 ng/mL, p = 0.143, respectively). In the multivariable linear regression analysis, CST independently correlated with the NYHA class (β = 0.491, p < 0.001), waist-to-hip ratio (WHR) (β = −0.237, p = 0.026), HbA1c (β = −0.235, p = 0.027), LDL (β = −0.231, p = 0.029), non-HDL cholesterol (β = −0.237, p = 0.026), hs-cTnI (β = −0.221, p = 0.030), and the admission and resting heart rate (β = −0.201, p = 0.036 and β = −0.242, p = 0.030), and was in positive association with most echocardiographic parameters. In conclusion, CST levels were increased in ADHF patients with MI and were overall associated with a favorable cardiometabolic profile but at the same time reflected advanced symptomatic burden (CATSTAT-HF ClinicalTrials.gov number, NCT03389386).
Collapse
|