Cost-effectiveness of cardiac biomarkers as screening test in acute chest pain

Investigation of hs-TnI and sST-2 as Potential Predictors of Long-Term Cardiovascular Risk in Patients with Survived Hospitalization for COVID-19 Pneumonia

Introduction: COVID-19 survivors reveal an increased long-term risk for cardiovascular disease. Biomarkers like troponins and sST-2 improve stratification of cardiovascular risk. Nevertheless, their prognostic value for identifying long-term cardiovascular risk after having survived COVID-19 has yet to be evaluated. Methods: In this single-center study, admission serum biomarkers of sST-2 and hs-TnI in a single cohort of 251 hospitalized COVID-19 survivors were evaluated. Concentrations were correlated with major cardiovascular events (MACE) defined as cardiovascular death and/or need for cardiovascular hospitalization during follow-up after hospital discharge [FU: 415 days (403; 422)]. Results: MACE was a frequent finding during FU with an incidence of 8.4% (cardiovascular death: 2.8% and/or need for cardiovascular hospitalization: 7.2%). Both biomarkers were reliable indicators of MACE (hs-TnI: sensitivity = 66.7% & specificity = 65.7%; sST-2: sensitivity = 33.3% & specificity = 97.4%). This was confirmed in a multivariate proportional-hazards analysis: besides age (HR = 1.047, 95% CI = 1.012−1.084, p = 0.009), hs-TnI (HR = 4.940, 95% CI = 1.904−12.816, p = 0.001) and sST-2 (HR = 10.901, 95% CI = 4.509−29.271, p < 0.001) were strong predictors of MACE. The predictive value of the model was further improved by combining both biomarkers with the factor age (concordance index hs-TnI + sST2 + age = 0.812). Conclusion: During long-term FU, hospitalized COVID-19 survivors, hs-TnI and sST-2 at admission, were strong predictors of MACE, indicating both proteins to be involved in post-acute sequelae of COVID-19.

Biomarker panel for early screening of trastuzumab -induced cardiotoxicity among breast cancer patients in west virginia

Cardiotoxicity is a well-known pathophysiological consequence in breast cancer patients receiving trastuzumab. Trastuzumab related cardiotoxicity typically results in an overall decline in cardiac function, primarily characterized by reduction in left ventricular ejection fraction (LVEF) and development of symptoms associated with heart failure. Current strategies for the monitoring of cardiac function, during trastuzumab therapy, includes serial echocardiography, which is cost ineffective as well as offers limited specificity, while offering limited potential in monitoring early onset of cardiotoxicity. However, biomarkers have been shown to be aberrant prior to any detectable functional or clinical deficit in cardiac function. Hence, this study aims to develop a panel of novel biomarkers and circulating miRNAs for the early screening of trastuzumab induced cardiotoxicity. Patients with clinical diagnosis of invasive ductal carcinoma were enrolled in the study, with blood specimen collected and echocardiography performed prior to trastuzumab therapy initiation at baseline, 3- and 6-months post trastuzumab therapy. Following 6-months of trastuzumab therapy, about 18% of the subjects developed cardiotoxicity, as defined by reduction in LVEF. Our results showed significant upregulation of biomarkers and circulating miRNAs, specific to cardiac injury and remodeling, at 3- and 6-months post trastuzumab therapy. These biomarkers and circulating miRNAs significantly correlated with the cardiac injury specific markers, troponin I and T. The findings in the present study demonstrates the translational applicability of the proposed biomarker panel in early preclinical diagnosis of trastuzumab induced cardiotoxicity, further allowing management of cardiac function decline and improved health outcomes for breast cancer patients.

Identification of Novel Molecular Network Expression in Acute Myocardial Infarction

Background:

In the current study, we aimed to analyze the hypothesis that human myocardial-specific extracellular RNAs expression could be used for acute myocardial injury(AMI) diagnosis.

Methodology:

We used bioinformatics’ analysis to identify RNAs linked to ubiquitin system and specific to AMI, named, (lncRNA-RP11-175K6.1), (LOC101927740), microRNA-106b-5p (miR-106b-5p) and Anaphase, promoting complex 11 (ANapc11mRNA). We measured the serum expression of the chosen RNAs in 69 individuals with acute coronary syndromes, 31 individuals with angina pectoris without MI and non-cardiac chest pain and 31 healthy control individuals by real-time reverse-transcription PCR.

Results:

Our study revealed a significant decrease in both lncRNA-RP11-175K6.1 and ANapc11mRNA expression of in the sera samples of AMI patients compared to that of the two control groups alongside with significant upregulation of miR-106b-5p.

Conclusion:

Of note, the investigated serum RNAs decrease the false discovery rate of AMI to 3.2%.

The Veracity of Troponin Test Requests for Patients Presenting to the Emergency Department with Chest Pain; a Clinical Audit

Introduction

Troponin test is one of the methods for diagnosing acute coronary syndrome, but the overuse and misuse of this test has increased the costs imposed on the health system and the patients.

Objective

The present study was conducted to investigate the veracity of troponin test requests for patients presenting to an emergency department with chest pain and examine the effectiveness of training emergency medicine assistants in reducing unnecessary and inappropriate requests in emergency departments.

Methods

This clinical audit was conducted in the emergency department of Imam Hossein Hospital, Tehran, Iran, in 2014. Sampling was carried out using the census method and all the cases presenting to the emergency department for whom a troponin test was requested by the emergency medical assistants were included in the research. First, the veracity of the current troponin test requests was assessed; then, training was given to the personnel, and the veracity of the troponin test requests was once again verified after the training was completed. The rate of veracious troponin requests for the patients was measured based on two factors, including the interval between the patients' admission and the troponin test request, and the interval between the onset of pain and the troponin test request. The veracity of the troponin test request was compared before and after training using the Phi test and Cramer's V test in IBM SPSS-21.

Results

This study examined a total of 500 patients (250 before training and 250 after), who had a mean age of 57.65±18.15 years, including 51.6% men. Significant differences were observed between the mean time of the patients' admission and the overall and post-training troponin test results (P=0.000), and also between the mean time of the onset of pain and the overall and post-training troponin test results (P=0.000). The number of positive troponin test results did not differ significantly between the patients in either of the two stages (P=0.39).

Conclusion

Unnecessary troponin test requests reduced significantly after this clinical audit in the examined emergency department.

Freedom from atrial fibrillation after cox maze III ablation during follow-up

Background:

Nearly 60% of patients undergoing mitral valve (MV) operations are affected by atrial fibrillation (AF). Cox Maze III ablation is one of the effective ways for restoring sinus rhythm for patients undergoing open heart surgery. The aim of present study was to evaluate efficacy of Maze III ablation procedure for restoring sinus rhythm among patients who had underwent open heart surgery.

Materials and Methods:

During present descriptive-analytic prospective study 114 patients with chronic AF had undergone open heart surgery for their valvular or coronary artery diseases in Educational-Medical centres of Tabriz University of Medical Sciences (Tabriz, Iran) 2006-2012, were included in the study. For all patients Maze III ablation was done. Patients were evaluated by 12 lead electrocardiography (ECG) and 24 hours ambulatory ECG monitoring after 3-6 years (mean 4.8) of follow-up.

Result:

Patients' rhythm before Cox Maze III surgery was chronic AF in all patients. All patients were discharged from operating room with sinus rhythm. During intensive care unit (ICU) hospitalization, rhythm of 34 patients changed to AF and 80 patients had sinus rhythm. Sixteen patients had undergone electrical cardioversion for restoring sinus rhythm which was successful in 12 patients. Ninety-two patients had sinus rhythm when discharged from the hospital. After termination of follow-up, freedom from atrial fibrillation was 51%. Patients with AF during follow-up on surface ECG didn't have episodes of sinus rhythm in their ambulatory monitoring. One patient implanted cardiac pacemaker due to persistent sinus bradycardia.

Conclusion:

Based on the results of this study, Cox Maze III ablation procedure is an effective and safe way for restoring sinus rhythm among patients who are candidate for open heart surgery, while no significant complication was seen among patients.

Medical treatment of allergy in children with recurrent or chronic sinusitis

Background:

Diagnosis and treatment of chronic and recurrent sinusitis in children is of potential importance and many factors can havean influence on it. This study assessed the chronic and recurrent sinusitis and affecting factors, as well as the role of allergy in its course and treatment in children.

Materials and Methods:

A total of 106 children with the diagnosis of chronic or recurrent sinusitis, referred to specialty clinics of otolaryngology and allergy of Tabriz Children Educational-Medical centres since 2010 to 2012, were enrolled. The history and physicalexamination findings were recorded for all patients and allergy Prick test was done for all. Response to treatment was evaluated during the follow-up visits.

Results:

The mean age of studied patients was 6.5 ± 2.9 years. Of all the patients, 54 (50.9%) were male and 52 (49.1%) were female. Skin Prick test was positive in 69.8%. Response to treatment was seen in 86.8% of the patients while 7.5% did not have any favourable outcome. Anti-allergic treatment caused better outcomes in patients with positive Skin Prick test than those with negative results.

Conclusion:

The prevalence of allergic disease in children with chronic or recurrent sinusitis is considerable and anti-allergic treatments can result infavourable therapeutic outcomes in children with sinusitis, especially with positive skin prick test results.

Effects of high versus low-dose atorvastatin on high sensitive C-reactive protein in acute coronary syndrome

BACKGROUND

Cardiovascular disease is the leading cause of mortality. The previous findings which suggest the reduction in C-reactive protein (CRP) levels by statin encouraged us to conduct the present study in which we tested the effects of atorvastatin, on levels of hs-CRP in a prospective randomised clinical trial study on patients with acute coronary syndrome.

MATERIALS AND METHODS

Present prospective randomised clinical trial study conducted on 180 patients who had developed coronary artery disease and presented in emergency departments of Educational-Medical centers of Tabriz University of Medical Sciences. The patients were divided randomly into two groups and then two therapeutic protocols were given to them. One group medicated by high-dose atorvastatin (40 mg) and the other group received low-dose atorvastatin (20 mg). All variables were collected by questionnaires and were analyzed.

RESULTS

There were 180 patients consisted of 34 females and 56 males in low-dose atorvastatin group (L-DA group), and 30 females and 60 males in high-dose atorvastatin group (H-DA group) (P = 0.533). In this study atorvastatin in high doses decreased hs-CRP levels about 40% and in low doses it only caused decrease of 13.3%, and significant correlation was observed between two groups (Paired Sample T-test) (P = 0.001). Also atorvastatin in high doses decreased LDL levels about 23% and in low doses it only decreased 10%, and significant correlation was observed between two groups (Paired Sample T-test) (P = 0.001). Atorvastatin in high doses decreased HDL levels about 9% and in low doses it only decreased 6%, and again significant correlation was observed between two groups (P = 0.009).

CONCLUSION

The present study confirms the novel observation that atorvastatin therapy results in a significant reduction in hs-CRP levels.