1
|
Strunz CMC, Hueb W, Rezende PC, Vendramini SPDA, de Assis ACR, Roggerio A, Tairova MS, Silva MF, Oliveira SA, Kisser GDCA, Kalil Filho R. High-Sensitivity Troponin I and Cardiovascular Events in Stable Coronary Artery Disease: Insights from a Longitudinal Outpatient Study. Int J Mol Sci 2023; 24:17286. [PMID: 38139114 PMCID: PMC10743542 DOI: 10.3390/ijms242417286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Numerous studies have been published suggesting that troponin levels are related to adverse outcomes in chronic cardiac and non-cardiac conditions. Our study investigated whether troponin levels gathered from unselected blood samples taken during outpatient care are associated with adverse outcomes in a population with stable coronary artery disease. In a cohort of 949 patients with stable coronary artery disease, an average age of 67.5 ± 9.5 years, 69.5% male, 52.1% diabetics, 51.6% with previous myocardial infarction, and 57.9% with triple-vessel disease, 21.7% of patients encountered new events during an average period of monitoring of 2.07 ± 0.81 years. Troponin I/99th percentile categorized into tertiles emerged as an independent predictor of death and combined events risk (hazard ratio: 2.02 (1.13-3.60), p = 0.017; 2.30 (1.37-3.88, p = 0.002, respectively). A troponin ratio > 0.24 was able to identify 53.3% of patients at risk of death and heart failure hospitalization. In patients with stable coronary artery disease who are adherent to treatment, troponin levels are independently associated with death and heart failure hospitalization in a medium-term follow-up.
Collapse
Affiliation(s)
- Celia Maria Cassaro Strunz
- Clinical Laboratory, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (S.P.d.A.V.); (A.R.); (S.A.O.); (G.d.C.A.K.)
| | - Whady Hueb
- Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (W.H.); (P.C.R.); (A.C.R.d.A.); (M.S.T.); (M.F.S.); (R.K.F.)
| | - Paulo Cury Rezende
- Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (W.H.); (P.C.R.); (A.C.R.d.A.); (M.S.T.); (M.F.S.); (R.K.F.)
| | - Sabrina Pacheco do Amaral Vendramini
- Clinical Laboratory, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (S.P.d.A.V.); (A.R.); (S.A.O.); (G.d.C.A.K.)
| | - Arthur Cicupira Rodrigues de Assis
- Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (W.H.); (P.C.R.); (A.C.R.d.A.); (M.S.T.); (M.F.S.); (R.K.F.)
| | - Alessandra Roggerio
- Clinical Laboratory, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (S.P.d.A.V.); (A.R.); (S.A.O.); (G.d.C.A.K.)
| | - Maria Stanislavovna Tairova
- Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (W.H.); (P.C.R.); (A.C.R.d.A.); (M.S.T.); (M.F.S.); (R.K.F.)
| | - Marcela Francisca Silva
- Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (W.H.); (P.C.R.); (A.C.R.d.A.); (M.S.T.); (M.F.S.); (R.K.F.)
| | - Senili Avila Oliveira
- Clinical Laboratory, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (S.P.d.A.V.); (A.R.); (S.A.O.); (G.d.C.A.K.)
| | - Gyovanna de Cassia Agreste Kisser
- Clinical Laboratory, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (S.P.d.A.V.); (A.R.); (S.A.O.); (G.d.C.A.K.)
| | - Roberto Kalil Filho
- Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (W.H.); (P.C.R.); (A.C.R.d.A.); (M.S.T.); (M.F.S.); (R.K.F.)
| |
Collapse
|
2
|
Araujo SDS, Brigo IR, Angerami LFMC, de Brito PHF, Filho RBR, Terra TMS, Teixeira TB, de Assis ACR, Soares PR, Scudeler TL. Fulminant Lymphocytic Myocarditis Successfully Managed with Intra-Aortic Balloon Pump and Extracorporeal Membrane Oxygenation: A Case Report. Am J Case Rep 2023; 24:e941422. [PMID: 37908061 PMCID: PMC10626596 DOI: 10.12659/ajcr.941422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/20/2023] [Accepted: 09/07/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Lymphocytic myocarditis (LM) is a rare inflammatory disease of the heart. The clinical presentation of LM varies from mild flu-like symptoms to fulminant myocarditis with cardiogenic shock. Fulminant myocarditis has a poor prognosis and the usual treatment is inotropes with or without ventricular assist devices such as intra-aortic balloon pump (IABP) and venoarterial extracorporeal membrane oxygenation (V-A ECMO). We report the case of fulminant LM with severe cardiogenic shock that was successfully treated with concomitant use of IABP and V-A ECMO. CASE REPORT A 32-year-old woman with no medical history presented to the Emergency Department (ED) with chest pain with irradiation to the left upper limb, worse when supine. The electrocardiogram (ECG) on admission showed sinus rhythm with nonspecific ST-T repolarization abnormalities, and laboratory results showed elevated ultrasensitive troponin and C-reactive protein. Transthoracic echocardiography (TTE) showed left ventricular ejection fraction (LVEF) of 25% and diffuse hypokinesis. On the next day, she developed cardiogenic shock requiring vasoactive drugs, IABP, and V-A ECMO. Pulse therapy with methylprednisolone was started. Endomyocardial biopsy (EMB) revealed acute LM, and intravenous human immunoglobulin was administered. The patient evolved with progressive clinical improvement, being discharged 56 days after admission, with an improvement in the LVEF to 55%. CONCLUSIONS Fulminant LM is a rare and potentially fatal condition that requires immediate intervention. The combination of IABP and V-A ECMO among patients with LM-cardiogenic shock may provide survival benefits.
Collapse
|
3
|
Bailuni Neto JJ, Siqueira BDL, Machado FC, Boros GAB, Akamine MAV, Cordeiro de Paula LJ, Rodrigues de Assis AC, Soares PR, Scudeler TL. BRASH Syndrome: A Case Report. Am J Case Rep 2022; 23:e934600. [PMID: 35058422 PMCID: PMC8793789 DOI: 10.12659/ajcr.934600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patient: Male, 76-year-old
Final Diagnosis: Cardiogenic shock
Symptoms: Lethargy
Medication:—
Clinical Procedure: N/A
Specialty: Cardiology
Collapse
Affiliation(s)
- José João Bailuni Neto
- Department of Emergency, Heart Institute (InCor), University of São Paulo Faculty of Medicine Clinics Hospital, São Paulo, SP, Brazil
| | - Bernardo de Lima Siqueira
- Department of Emergency, Heart Institute (InCor), University of São Paulo Faculty of Medicine Clinics Hospital, São Paulo, SP, Brazil
| | - Fernando Chiodini Machado
- Department of Emergency, Heart Institute (InCor), University of São Paulo Faculty of Medicine Clinics Hospital, São Paulo, SP, Brazil
| | - Gustavo André Boeing Boros
- Department of Emergency, Heart Institute (InCor), University of São Paulo Faculty of Medicine Clinics Hospital, São Paulo, SP, Brazil
| | - Marco Alexander Valverde Akamine
- Department of Emergency, Heart Institute (InCor), University of São Paulo Faculty of Medicine Clinics Hospital, São Paulo, SP, Brazil
| | - Leonardo Jorge Cordeiro de Paula
- Department of Emergency, Heart Institute (InCor), University of São Paulo Faculty of Medicine Clinics Hospital, São Paulo, SP, Brazil
| | | | - Paulo Rogério Soares
- Department of Emergency, Heart Institute (InCor), University of São Paulo Faculty of Medicine Clinics Hospital, São Paulo, SP, Brazil
| | - Thiago Luis Scudeler
- Department of Emergency, Heart Institute (InCor), University of São Paulo Faculty of Medicine Clinics Hospital, São Paulo, SP, Brazil
| |
Collapse
|