Pubblicazioni recenti - cardiac troponin
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Risk factors and outcomes associated with systolic dysfunction following traumatic brain injury.
Medicine (Baltimore)2024 Jul;103(30):e38891. doi: 10.1097/MD.0000000000038891.
Li Jungen, Miao Yuzhu, Zhang Guoxing, Xu Xiaowen, Guo Yanxia, Zhou Bingyuan, Jiang Tingbo, Lu Shiqi,
Abstract
Systolic dysfunction has been observed following isolated moderate-severe traumatic brain injury (Ims-TBI). However, early risk factors for the development of systolic dysfunction after Ims-TBI and their impact on the prognosis of patients with Ims-TBI have not been thoroughly investigated. A prospective observational study among patients aged 16 to 65 years without cardiac comorbidities who sustained Ims-TBI (Glasgow Coma Scale [GCS] score ?12) was conducted. Systolic dysfunction was defined as left ventricular ejection fraction
Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.
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Association of Abnormal Cardiac Biomarkers and Cardiovascular Complications, with Mortality in Patients with SARS-CoV-2 Infection in Latin America.
J Cardiovasc Dev Dis2024 Jun;11(7):. doi: 205.
Gómez-Mesa Juan Esteban, Escalante Manuela, Muñoz-Ordoñez Juan Andrés, Azcárate-Rodriguez Valeria, Peláez-Martínez Juan David, Arteaga-Tobar Andrea Alejandra, León-Giraldo Hoover, Valencia-Orozco Andrea, Perna Eduardo Roque, Romero Alexander, Mendoza Iván, Wyss Fernando, Barisani José Luis, Speranza Mario, Alarco Walter, Herrera Cesar, Lugo-Peña Julián, Cárdenas-Aldaz Liliana Patricia, Rossel Victor, Sierra Daniel, ,
Abstract
BACKGROUND:
The COVID-19 pandemic has highlighted a correlation between cardiac complications and elevated cardiac biomarkers, which are linked to poorer clinical outcomes.
OBJECTIVE:
This study aims to determine the clinical impact of cardiac biomarkers in COVID-19 patients in Latin America.
SUBJECTS AND METHODS:
The CARDIO COVID 19-20 Registry is a multicenter observational study across 44 hospitals in Latin America and the Caribbean. It included hospitalized COVID-19 patients ( = 476) who underwent troponin, natriuretic peptide, and D-dimer tests. Patients were grouped based on the number of positive biomarkers.
RESULTS:
Among the 476 patients tested, 139 had one positive biomarker (Group C), 190 had two (Group B), 118 had three (Group A), and 29 had none (Group D). A directly proportional relationship was observed between the number of positive biomarkers and the incidence of decompensated heart failure. Similarly, there was a proportional relationship between the number of positive biomarkers and increased mortality. In Group B, patients with elevated troponin and natriuretic peptide and those with elevated troponin and D-dimer had 1.4 and 1.5 times higher mortality, respectively, than those with elevated natriuretic peptide and D-dimer.
CONCLUSIONS:
In Latin American COVID-19 patients, a higher number of positive cardiac biomarkers is associated with increased cardiovascular complications and mortality. These findings suggest that cardiac biomarkers should be utilized to guide acute-phase treatment strategies.
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Evaluation of Transducer Elements Based on Different Material Configurations for Aptamer-Based Electrochemical Biosensors.
Biosensors (Basel)2024 Jul;14(7):. doi: 341.
Lopez Carrasco Ivan, Cuniberti Gianaurelio, Opitz Jörg, Beshchasna Natalia,
Abstract
The selection of an appropriate transducer is a key element in biosensor development. Currently, a wide variety of substrates and working electrode materials utilizing different fabrication techniques are used in the field of biosensors. In the frame of this study, the following three specific material configurations with gold-finish layers were investigated regarding their efficacy to be used as electrochemical (EC) biosensors: (I) a silicone-based sensor substrate with a layer configuration of 50 nm SiO/50 nm SiN/100 nm Au/30-50 nm WTi/140 nm SiO/bulk Si); (II) polyethylene naphthalate (PEN) with a gold inkjet-printed layer; and (III) polyethylene terephthalate (PET) with a screen-printed gold layer. Electrodes were characterized using electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV) to evaluate their performance as electrochemical transducers in an aptamer-based biosensor for the detection of cardiac troponin I using the redox molecule hexacyanoferrade/hexacyaniferrade (K3[Fe (CN)6]/K4[Fe (CN)6]. Baseline signals were obtained from clean electrodes after a specific cleaning procedure and after functionalization with the thiolate cardiac troponin I aptamers "Tro4" and "Tro6". With the goal of improving the PEN-based and PET-based performance, sintered PEN-based samples and PET-based samples with a carbon or silver layer under the gold were studied. The effect of a high number of immobilized aptamers will be tested in further work using the PEN-based sample. In this study, the charge-transfer resistance (Rct), anodic peak height (I), cathodic peak height (I) and peak separation (?E) were determined. The PEN-based electrodes demonstrated better biosensor properties such as lower initial Rct values, a greater change in Rct after the immobilization of the Tro4 aptamer on its surface, higher I and I values and lower ?E, which correlated with a higher number of immobilized aptamers compared with the other two types of samples functionalized using the same procedure.
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The effects of berberine and curcumin on cardiac, lipid profile and fibrosis markers in cyclophosphamide-induced cardiac damage: The role of the TRPM2 channel.
J Biochem Mol Toxicol2024 Aug;38(8):e23783. doi: 10.1002/jbt.23783.
Huyut Zübeyir, Yildizhan Kenan, Alt?nda? Fikret,
Abstract
Cyclophosphamide (CYP) is widely used to treat various types of cancer. In addition to the therapeutic properties of this drug, unfortunately, its side effects are still not fully understood. This study investigated the protective effect of curcumin (CURC) and berberine (BER) on CYP-induced cardiac damage. Thirty-six male rats were equally divided into the control, dimethyl sulfoxide (DMSO), CYP, CYP?+?CURC, CYP?+?BER and CYP?+?BER?+?CURC groups. Troponin-I, Creatine kinase-myocardial band (CK-MB), total cholesterol, triglyceride levels in serum samples, and reactive oxygen species (ROS), poly(ADP-ribose) polymerase-1 (PARP-1), and transient receptor potential melastatin 2 (TRPM2) channel levels in heart tissue were measured using an enzyme-linked immunoassay (ELISA) kit. In addition, histopathological examination and immunohistochemical investigation of the TRPM2 channel, fibroblast specific protein-1 (FSP1), transforming growth factor-beta- 1 (TGF-?1) and ?-smooth muscle actin (?-SMA) expressions were determined in heart tissue. The CYP group's troponin-I, total cholesterol, triglyceride, CK-MB, ROS, PARP-1 and TRPM2 channel levels were higher than in the other groups in the ELISA measurements (p?0.05). In contrast, these parameters in the group treated with CURC and BER together with CYP were lower than in the CYP group (p?0.05). Additionally, CUR and BER reduced CYP-induced pathological damage, TRPM2, FSP1, TGF-?1 and ?-SMA expressions. The data showed that CYP administration can cause cardiac damage by increasing the TRPM2 channel, TGF-?1, FSP1 and ?-SMA expression levels. Therefore, we concluded that CURC and BER administration following CYP application may be used as therapeutic agents to prevent CYP-induced cardiac damage.
© 2024 Wiley Periodicals LLC.
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How accurate are NT-proBNP, ANP, and cTnI levels in diagnosing dogs with myxomatous mitral valve disease?
Open Vet J2024 Jun;14(6):1426-1441. doi: 10.5455/OVJ.2024.v14.i6.10.
Chanmongkolpanit Kittara, Riengvirodkij Nattapon, Channgam Phuttipan, Kaenchan Pemika, Buayam Wasana, Janhirun Yada, Phonarknguen Rassameepen, Tansakul Mookmanee, Sakcamduang Walasinee,
Abstract
BACKGROUND:
Myxomatous mitral valve disease (MMVD) is prevalent in dogs. Specialized diagnostics (radiography and echocardiography) may be unavailable in some veterinary settings. Cardiac biomarkers offer potential alternatives.
AIM:
This study evaluated the diagnostic value of -terminal fragments of pro-brain natriuretic peptides (NT-proBNPs), atrial natriuretic peptides (ANPs), and cardiac troponin I (cTnI) levels in dogs with MMVD.
METHODS:
69 dogs with MMVD (asymptomatic and symptomatic) and 19 healthy controls were assessed. Biomarker levels were measured using commercial kit rapid tests.
RESULTS:
Our results showed that the median NT-proBNP level in the symptomatic group was higher than those in the asymptomatic ( 505.65 pmol/l [sensitivity, 76.8%; specificity, 89.5%; and area under the curve (AUC), 0.862]. The suggested cutoff value of the NT-proBNP level to differentiate symptomatic MMVD from asymptomatic MMVD was >787.65 pmol/l (sensitivity, 78.38%; specificity, 72.55%; and AUC, 0.792).
CONCLUSION:
NT-proBNP and cTnI may serve as point-of-care tests for dyspneic dogs, aiding MMVD assessment where specialized diagnostics are limited.
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Acute Myocardial Infarction in the Setting of Pulmonary Hypertension due to a Patent Foramen Ovale and Paradoxical Embolism.
Case Rep Pulmonol2024 ;2024():6725308. doi: 10.1155/2024/6725308.
Franke Madeline, Safdar Zeenat,
Abstract
A 67-year-old woman with pulmonary hypertension (PH) presented with a 1-day history of worsening shortness of breath and pleuritic chest pain and was found to have a troponin T level of 3755?ng/L (ref. range 0-19?ng/L). An initial diagnostic workup in the emergency department (ED) led to an urgent left heart catheterization which revealed a 90% occlusive right coronary artery blood clot, even though a recent heart catheterization less than a month prior was completely unremarkable. Further workup led to the discovery of a patent foramen ovale (PFO) and an aneurysmal interatrial septum, suggesting the presence of a paradoxical embolism. While typically asymptomatic, a PFO is an important clinical entity that can lead to irreversible cardiac damage. Suspicion should be high for this finding in the case of an acute myocardial infarction (MI) with no clear cause, especially in a patient with elevated right heart pressures.
Copyright © 2024 Madeline Franke and Zeenat Safdar.
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Reversine enhances the conversion of dedifferentiated fat cells into mature cardiomyocytes.
F1000Res2022 ;11():851. doi: 10.12688/f1000research.122788.3.
Dharmadjati Budi Baktijasa, Sargowo Djanggan, Aulanni'am , Pikir Budi Susetyo, Oktaviono Yudi Her, Sativa Oryza, Arjani Kandita, Nugraha Ricardo Adrian,
Abstract
BACKGROUND:
There is an essential need for cardiomyocyte regeneration among patients with heart failure. Transplantation of dedifferentiated fat (DFAT) cells may lead to an improvement of cardiomyocyte regeneration among heart failure patients. We believe that DFAT cells are promising candidate cell sources for cardiac regeneration. However, the pathway underlying how DFAT cells of the adipose lineage differentiate into mature cardiomyocytes isn't fully understood.
METHODS:
We conducted an experimental laboratory study on isolated DFAT cells from adipose tissue of healthy adults. Then, we treated cells with different concentrations of reversine (10, 20 and 40 nM), and performed RNA extraction and cDNA synthesis. Next, we used a ceiling culture method based on the buoyancy properties of mature lipid-filled adipocytes. Stemness expression (Octamer-binding transcription factor 4 [Oct4], brachyury, Fetal liver kinase 1 [Flk-1]) was quantified by reverse transcription-quantitative (RT-q)PCR, while cardiomyocyte expression (Transcription factor GATA-4 [GATA4] and cardiac troponin T [cTnT]) was quantified by immunocytochemistry.
RESULTS:
ANOVA with Tukey's post-hoc found that 10 nM reversine increased greater Flk-1 expression compared to the control group (MD: 5.037 + 0.998;
CONCLUSIONS:
Reversine could increase the expression of Flk-1, but it was unable to stimulate the expression of Oct4 and brachyury related to cell stemness. An optimal concentration of 10 nM reversine may have the greatest effect on enhancing the differentiation of DFAT cells into mature cardiomyocytes, as indicated by higher cTnT expression between cells.
Copyright: © 2024 Dharmadjati BB et al.
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Electroacupuncture alleviates myocardial ischemia-reperfusion injury by inhibiting hypothalamic paraventricular nucleus neurons projecting to the rostral ventrolateral medulla.
Eur J Neurosci2024 Jul;():. doi: 10.1111/ejn.16480.
Shu Qi, Zhou Jie, Zhang Bin, Zhang Fan, Zhou Xiang, Wu Yan, Chang Huimin, Hu Ling, Cai Ronglin, Yu Qing,
Abstract
Accumulating evidence suggests that electroacupuncture (EA) has obvious therapeutic effects and unique advantages in alleviating myocardial ischemia-reperfusion injury (MIRI), while the underlying neuromolecular mechanisms of EA intervention for MIRI have not been fully elucidated. The aim of the study is to investigate the role of the neural pathway of hypothalamic paraventricular nucleus (PVN) neurons projecting to the rostral ventrolateral medulla (RVLM) in the alleviation of MIRI rats by EA preconditioning. MIRI models were established by ligating the left anterior descending coronary artery for 30?min followed by reperfusion for 2 h. Electrocardiogram recording, chemogenetics, enzyme-linked immunosorbent assay, multichannel physiology recording and haematoxylin-eosin and immunofluorescence staining methods were conducted to demonstrate that the firing frequencies of neurons in the PVN and the expression of c-Fos decreased by EA pretreatment. Meanwhile, EA preconditioning significantly reduced the levels of creatine kinase isoenzymes (CK-MB), cardiac troponin I (cTnI) and lactic dehydrogenase (LDH). Virus tracing showed a projection connection between PVN and RVLM. The inhibition of the PVN-RVLM neural pathway could replicate the protective effect of EA pretreatment on MIRI rats. However, the activation of the pathway weakened the effect of EA preconditioning. EA pretreatment alleviated MIRI by regulating PVN neurons projecting to RVLM. This work provides novel evidence of EA pretreatment for alleviating MIRI.
© 2024 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.
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Pulmonary vasodilation during cardiopulmonary resuscitation - a randomized, controlled porcine study.
Resuscitation2024 Jul;():110329. doi: 10.1016/j.resuscitation.2024.110329.
Nørholt Casper, Johannsen Cecilie M, Baltsen Cecilie D, Lund Margrete H, Kjærsgaard Lykke, M A Solberg Sara, Hørsdal Oskar K, Vammen Lauge, Dam Lyhne Mads, Andersen Lars W, Granfeldt Asger,
Abstract
BACKGROUND:
During resuscitation pulmonary artery pressure (PAP) increases. This reduces left ventricular filling, leading to decreased blood flow. Inhaled nitric oxide (iNO) produces selective pulmonary vasodilation. We hypothesized that iNO would lower PAP during resuscitation resulting in increased survival.
METHODS:
30 pigs (40kg) were subjected to cardiac arrest for 9.5 minutes after myocardial ischemia induced by coronary artery occlusion of the left anterior descending artery and ventricular fibrillation. During resuscitation, the pigs were randomized to 40 ppm iNO or placebo. The primary outcome was return of spontaneous circulation (ROSC). Pigs achieving ROSC underwent 4-hours intensive care.
RESULTS:
The ROSC rate was 9/14 (64%) in the control group and 11/16 (69%) in the iNO group (OR 1.2 95%CI [0.3;5.6], p>0.99). There was no difference in diastolic aorta pressure/PAP ratio (mean difference -0.99?[95% CI: -2.33-0.36],?p=0.14). Mean pulmonary artery pressure was lower in the iNO group 60 and 120 minutes after ROSC (mean difference: -12.18 mmHg [95%CI: -16.94; -7.43] p
CONCLUSION:
Application of iNO did not improve the rate of ROSC or hemodynamic function but increased myocardial injury.
Copyright © 2024. Published by Elsevier B.V.
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Myocardial Injury in Patients with Hip Fracture: A HIP ATTACK Randomized Trial Substudy.
J Bone Joint Surg Am2024 Jul;():. doi: 10.2106/JBJS.23.01459.
Borges Flavia K, Guerra-Farfan Ernesto, Bhandari Mohit, Patel Ameen, Slobogean Gerard, Feibel Robert J, Sancheti Parag K, Tiboni Maria E, Balaguer-Castro Mariano, Tandon Vikas, Tomas-Hernandez Jordi, Sigamani Alben, Sigamani Alen, Szczeklik Wojciech, McMahon Stephen J, ?l?czka Pawel, Ramokgopa Mmampapatla T, Adinaryanan S, Umer Masood, Jenkinson Richard J, Lawendy Abdel, Popova Ekaterine, Nur Aamer Nabi, Wang Chew Yin, Vizcaychipi Marcela, Biccard Bruce M, Ofori Sandra, Spence Jessica, Duceppe Emmanuelle, Marcucci Maura, Harvey Valerie, Balasubramanian Kumar, Vincent Jessica, Tonelli Ana Claudia, Devereaux P J, ,
Abstract
BACKGROUND:
Myocardial injury after a hip fracture is common and has a poor prognosis. Patients with a hip fracture and myocardial injury may benefit from accelerated surgery to remove the physiological stress associated with the hip fracture. This study aimed to determine if accelerated surgery is superior to standard care in terms of the 90-day risk of death in patients with a hip fracture who presented with an elevated cardiac biomarker/enzyme measurement at hospital arrival.
METHODS:
The HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) trial was a randomized controlled trial designed to determine whether accelerated surgery for hip fracture was superior to standard care in reducing death or major complications. This substudy is a post-hoc analysis of 1392 patients (from the original study of 2970 patients) who had a cardiac biomarker/enzyme measurement (>99.9% had a troponin measurement and thus "troponin" is the term used throughout the paper) at hospital arrival. The primary outcome was all-cause mortality. The secondary composite outcome included all-cause mortality and non-fatal myocardial infarction, stroke, and congestive heart failure 90 days after randomization.
RESULTS:
Three hundred and twenty-two (23%) of the 1392 patients had troponin elevation at hospital arrival. Among the patients with troponin elevation, the median time from hip fracture diagnosis to surgery was 6 hours (interquartile range [IQR] = 5 to 13) in the accelerated surgery group and 29 hours (IQR = 19 to 52) in the standard care group. Patients with troponin elevation had a lower risk of mortality with accelerated surgery compared with standard care (17 [10%] of 163 versus 36 [23%] of 159; hazard ratio [HR] = 0.43 [95% confidence interval (CI) = 0.24 to 0.77]) and a lower risk of the secondary composite outcome (23 [14%] of 163 versus 47 [30%] of 159; HR = 0.43 [95% CI = 0.26 to 0.72]).
CONCLUSIONS:
One in 5 patients with a hip fracture presented with myocardial injury. Accelerated surgery resulted in a lower mortality risk than standard care for these patients; however, these findings need to be confirmed.
LEVEL OF EVIDENCE:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.
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Effect of the combined use of ivabradine and metoprolol in patients with acute myocardial infarction early after percutaneous coronary intervention: A randomized controlled study.
Heliyon2024 Jul;10(13):e33779. doi: e33779.
He Ruiqing, Li Lingyan, Han Chao, An Wen, Liu Zongjun, Gao Junqing,
Abstract
OBJECTIVE:
To investigate the effect and safety of the combined use of ivabradine and metoprolol in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).
METHODS:
Eighty patients with AMI were randomly divided into the ivabradine group and the control group. The ivabradine group was treated with ivabradine combined with metoprolol after PCI, while the control group was treated with metoprolol only. Both groups were treated continuously for 1 year. Echocardiography-derived parameters, heart rate, cardiopulmonary exercise testing (CPET) data, major adverse cardiac events (MACE) and myocardial markers were analyzed. The primary endpoint was the left ventricular ejection fraction (LVEF). The safety outcomes were blood pressure, liver and kidney function.
RESULTS:
The LVEF was significantly higher in the ivabradine group than in the control group at 1 week, 3 months and 1 year after PCI. The heart rate of the ivabradine group was significantly lower than that of the control group at 1 week and 1month after PCI. The VO2max, metabolic equivalents, anaerobic threshold heart rate, peak heart rate, and heart rate recovery at 8 min of the ivabradine group were significantly higher than those of the control group at 1 year after PCI. Kaplan-Meier analysis demonstrated the one-year total incidence of MACE in the ivabradine group was significantly lower than that in the control group. The B-type natriuretic peptide of the ivabradine group was significantly lower than that of the control group on Day 2 and Day 3 after PCI. The high-sensitivity cardiac troponin I level of the ivabradine group was significantly lower than that of the control group on Day 5 after PCI.
CONCLUSION:
Early use of ivabradine in patients with AMI after PCI can achieve effective heart rate control, reduce myocardial injury, improve cardiac function and exercise tolerance, and may reduce the incidence of major adverse cardiac events. (Clinical research registration number: ChiCTR2000032731).
© 2024 Published by Elsevier Ltd.
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Mortality After Procedural or Spontaneous Myocardial Infarction.
J Am Coll Cardiol2024 Jul;84(5):467-477. doi: 10.1016/j.jacc.2024.04.061.
Spirito Alessandro, Sartori Samantha, Koshy Anoop N, Feng Yihan, Vogel Birgit, Baber Usman, Sweeny Joseph, Khera Sahil, Kini Annapoorna S, Windecker Stephan, Dangas George, Sharma Samin K, Mehran Roxana,
Abstract
BACKGROUND:
It remains unclear whether procedural myocardial infarction (pMI) and spontaneous myocardial infarction (spMI) have a similar impact on prognosis.
OBJECTIVES:
The aim of this study was to assess mortality after pMI and spMI.
METHODS:
Patients with chronic coronary syndrome (CCS) and baseline troponin ?1× the upper reference level (URL) or with acute spMI who underwent percutaneous coronary intervention (PCI) were included. PMI was defined as post-PCI troponin increase >1× URL in patients with CCS. SpMI comprised any acute coronary syndrome with elevated troponin. The 1-year risk of all-cause death was assessed after pMI and spMI across 3 strata of troponin elevation (>1-5×, >5-35×, and >35× URL), with CCS patients having post-PCI troponin ?1× URL as a reference group. Conventional troponin I was measured using the Architect methodology (Abbott).
RESULTS:
Among 10,707 patients undergoing PCI from 2012 to 2020, 8,515 patients presented with CCS and 2,192 with spMI. Among CCS patients, 913 (10.7%) had pMI. Troponin peaks >1-5×, >5-35×, and >35× URL were observed in 53%, 41%, and 6% of patients with pMI, and in 24%, 38%, and 37% of patients with spMI, respectively. Mortality at 1 year was higher after pMI (7.7%; adjusted HR: 4.40; 95% CI: 1.59-12.2), and spMI (8.5%; adjusted HR: 7.57; 95% CI: 5.44-10.5) with troponin peak >35× URL compared with no-MI (1.4%). Mortality was also increased after spMI with troponin peak >1-5× or >5-35× URL.
CONCLUSIONS:
Mortality at 1 year was significantly increased after pMI and spMI with troponin peak >35× URL, whereas for troponin levels ?35× only spMI had a relevant impact on mortality.
Copyright © 2024. Published by Elsevier Inc.
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Comparability of Beckman Coulter Cardiac Troponin I Assays.
Ann Clin Lab Sci2024 May;54(3):408-412.
Stanek Caroline G, Lima Jose, Cao Liyun,
Abstract
OBJECTIVE:
Cardiac troponin I (cTnI) is one of the most sensitive and specific biomarkers of myocardial injury. The rise and/or fall of cardiac troponins above the 99th percentile of the upper reference limit (URL) is required in the assessment of acute myocardial infarction.
METHODS:
We analyzed the variation between the Beckman Coulter contemporary cTnI AccuTnI+3 assay and high sensitivity cTnI (hs-cTnI) assay tested on DXI 800 using 424 patient specimens with troponin levels ranging from 0-16754 ng/L. We also analyzed the concordance of the same assay hs-cTnI on different Beckman Coulter instruments Access 2 and DXI 800 using 115 patient specimens with troponin levels ranging from 2-100466 ng/L.
RESULTS:
The between-method comparison of AccuTnI+3 and hs-cTnI on DXI 800 showed a good correlation with the slope of 1.003, correlation coefficient (CC) of 0.9590, and bias of -40.65 (-5.16%). However, comparison of AccuTnI+3 and hs-cTnI in 103 patients with troponin less than 20 ng/L, the 99th percentile of the URL for male, showed the slope of 1.325, CC of 0.7462, and bias of 1.91 (21.53%). The within-method comparison of hs-cTnI on Access 2 and DXI 800 showed the slope was 1.130 with CC of 0.9915, and bias of 840.4 (10.6%). Further examination of the results revealed that hs-cTnI levels were more comparable at levels less than 200 ng/L, with a slope of 1.069, CC of 0.9951, and bias of 2.3 (6.2%).
CONCLUSION:
These data indicate that contemporary cTnI AccuTnI+3 results above the 99th percentile URL are comparable with hs-cTnI results if both are tested on DXI 800, and hs-cTnI results tested on Access 2 and DXI 800 are comparable at levels less than 200 ng/L. Therefore, to use the Beckman Coulter cTnI assay properly, we suggest the laboratory report cardiac troponins with the assay and instrument names to reduce confusion during results comparison.
© 2024 by the Association of Clinical Scientists, Inc.
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Neurofilament Light Chain and Risk of Stroke in Patients With Atrial Fibrillation.
Circulation2024 Jul;():. doi: 10.1161/CIRCULATIONAHA.124.069440.
Aulin Julia, Sjölin Karl, Lindbäck Johan, Benz Alexander P, Eikelboom John W, Hijazi Ziad, Kultima Kim, Oldgren Jonas, Wallentin Lars, Burman Joachim, ,
Abstract
BACKGROUND:
Biomarkers reflecting brain injury are not routinely used in risk assessment of stroke in atrial fibrillation (AF). Neurofilament light chain (NFL) is a novel biomarker released into blood after cerebral insults. We investigated the association between plasma concentrations of NFL, other biomarkers, and risk of stroke and death in patients with AF not receiving oral anticoagulation.
METHODS:
For this observational study, baseline plasma samples were available from 3077 patients with AF randomized to aspirin in ACTIVE A (Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events; 2003 to 2008) and AVERROES (Apixaban Versus Acetylsalicylic Acid [ASA] to Prevent Stroke in Atrial Fibrillation Patients Who Have Failed or Are Unsuitable for Vitamin K Antagonist Treatment; 2007 to 2009). Median follow-up was 1.5 years. NFL was analyzed with a Single Molecule Array (Simoa). Associations with outcomes (total stroke or systemic embolism, ischemic stroke, cardiovascular death, and all-cause death) were explored with Cox regression models.
RESULTS:
In the combined cohort, the median NFL level was 16.9 ng/L (interquartile range, 11.1-26.5 ng/L), the median age was 71 years, 58% were men, and 13% had a history of previous stroke. NFL was associated with older age, higher creatinine, lower body mass index, previous stroke, female sex, and diabetes but not cardiac rhythm. Higher NFL was associated with a higher risk of stroke or systemic embolism (n=206) independently of clinical characteristics (hazard ratio, 1.27 [95% CI, 1.10-1.46] per doubling of NFL) and other biomarkers (hazard ratio, 1.18 [95% CI, 1.01-1.37]) and including in patients without previous stroke (hazard ratio, 1.23 [95% CI, 1.02-1.48]). NFL was also independently associated with cardiovascular (n=219) and all-cause (n=311) death. The C index for stroke using only NFL was 0.642, on par with the currently used clinical risk scores. Addition of information on NFL improved discrimination in a model also including clinical information, NT-proBNP (N-terminal pro-B-type natriuretic peptide), and high-sensitivity cardiac troponin T, yielding a C index of 0.727.
CONCLUSIONS:
NFL reflects overt and covert episodes of cerebral ischemia and improves risk assessment of stroke and death in patients with AF without oral anticoagulation, including in patients without previous stroke. The combination of NFL with information on age, history of stroke, and other biomarkers should be explored as a future avenue for stroke risk assessments in patients with AF.
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Post-cardiac arrest temporal evolution of left ventricular function in a rat model: speckle-tracking echocardiography and cardiac circulating biomarkers.
Eur Heart J Imaging Methods Pract2024 Jan;2(1):qyae006. doi: qyae006.
De Giorgio Daria, Olivari Davide, Fumagalli Francesca, Novelli Deborah, Cerrato Marianna, Motta Francesca, Ristagno Giuseppe, Latini Roberto, Staszewsky Lidia,
Abstract
AIMS:
There is little information from experimental studies regarding the evolution of post-resuscitation cardiac arrest [post-return of spontaneous circulation (post-ROSC)] myocardial dysfunction during mid-term follow-up. For this purpose, we assessed left ventricular (LV) function and circulating cardiac biomarkers at different time points in a rat model of cardiac arrest (CA).
METHODS AND RESULTS:
Rats were divided into two groups: control and post-ROSC rats. Eight minutes of untreated ventricular fibrillation were followed by 8?min of cardiopulmonary resuscitation. Conventional and speckle-tracking echocardiographic (STE) parameters and cardiac circulating biomarkers concentrations were assessed, at 3, 4, 72, and 96?h post-ROSC. At 3 and 4?h post-ROSC, LV systolic function was severely impaired, and high-sensitivity cardiac troponin T and N-terminal pro-atrial natriuretic peptide (NT-proANP) plasma concentrations were significantly increased, compared with control rats (
CONCLUSION:
s' velocity, GLS, and GLSR indicated that LV systolic function was still impaired 96?h post-ROSC. These findings agree with NT-proANP concentrations, which continue to be high. Normalization of LVEF supports the use of STE for its greater sensitivity for monitoring post-CA cardiac function. Further investigations are needed to provide evidence of the post-ROSC LV diastolic function pattern.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Right heart echocardiography findings in hypoxic pneumonia patients during the COVID-19 pandemic in a South African population.
Eur Heart J Imaging Methods Pract2023 Sep;1(2):qyad030. doi: qyad030.
van Blydenstein S A, Omar S, Jacobson B, Menezes C N, Meel R,
Abstract
AIMS:
The right ventricle is affected by Coronavirus disease 19 (COVID-19) via multiple mechanisms, which can result in right ventricular dysfunction (RVD). This study aimed to provide an assessment of right heart function using conventional echocardiography and advanced strain imaging, in patients with hypoxic pneumonia during the COVID-19 pandemic.
METHODS AND RESULTS:
This study was an observational, prospective, single-centre study, including adults with hypoxic pneumonia, in two groups: COVID-19 pneumonia; and non-COVID-19 pneumonia. Bedside echocardiography was performed according to a pre-specified protocol and all right heart measurements were done as per standard guidelines. Right ventricular free wall strain (RVFWS) was measured using Philips® QLAB 11.0 speckle tracking software. Descriptive and comparative statistics were used to analyse data. Spearman Rank Order Correlations were used to determine the correlation between right ventricular (RV) parameters and clinical parameters. Univariate and multivariate logistic regression analyses were performed to characterize the predictors of in-hospital mortality. We enrolled 48 patients with COVID-19 pneumonia and 24 with non-COVID-19 pneumonia. COVID-19 patients were significantly older with a higher frequency of hypertension and diabetes and a trend towards a lower severity of illness score. Mean RVFWS yielded the highest estimates for the prevalence of RVD (81%), with no difference between the two pneumonia groups. Median Tricuspid Annular Plane Systolic Excursion (TAPSE) and right ventricular systolic excursion velocity (RVS') were not significantly different between COVID-19 (TAPSE 17.2 and RVS' 12), and non-COVID-19 pneumonia (TAPSE 17.8 and RVS' 12.1) with values of 0.29 and 0.86, respectively. Non-COVID-19 pneumonia patients with moderate to severe hypoxaemia (PF 30?mmHg respiratory rate = 3.25 (CI 1.35-7.82) on admission. Troponin levels discriminated between COVID-19 survivors (6?ng/L) and non-survivors (13?ng/L), = 0.04. The mortality rate for COVID-19 was high (27%) compared to non-COVID-19 pneumonia (12%).
CONCLUSION:
Patients with COVID-19 pneumonia had a similar admission prevalence of RVD when compared to patients with non-COVID-19 pneumonia. Despite preserved traditional parameters of RV systolic function, RVFWS was diminished in both groups, and we propose that RVFWS serves as an important marker of the subclinical disease of RV.
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Evaluation of microcirculatory protection in percutaneous revascularisation: A stent implantation technique and device comparison.
Catheter Cardiovasc Interv2024 Jul;():. doi: 10.1002/ccd.31155.
Aetesam-Ur-Rahman Muhammad, Zhao Tian X, Paques Kitty, Oliveira Joana, Chiu Yi-Da, Duckworth Melissa, Khialani Bharat, Kyranis Stephen, Bennett Martin R, West Nick E J, Hoole Stephen P,
Abstract
BACKGROUND:
Coronary microvascular dysfunction (CMD) after percutaneous coronary intervention (PCI) is prognostically important and may also be a cause of persistent angina. The stent balloon inflation technique or material properties may influence the degree of CMD post-PCI.
METHODS:
Thirty-six patients with stable angina attending for elective PCI were randomized to either slow drug eluting stent (DES) implantation technique (DES slow group): +2?atm. every 5?s., maintained for a further 30?s or a standard stent implantation technique (DES std group): rapid inflation and deflation. PressureWire X with thermodilution at rest and hyperemia and optical coherence tomography (OCT) were performed pre- and post-PCI. Combined primary endpoints were changes in index of microvascular resistance (delta IMR) and coronary flow reserve (delta CFR) following PCI. The secondary endpoints included differences in cardiac troponin I (delta cTnI) at 6?h post-PCI, Seattle angina questionnaire (SAQ) at 1, 3, 6, and 12 months and OCT measures of stent results immediately post-PCI and at 3 months.
RESULTS:
Both groups were well matched, with similar baseline characteristics and OCT-defined plaque characteristics. Delta IMR was significantly better in the DES slow PCI arm with a median difference of -4.14 (95% CI -10.49, -0.39, p?=?0.04). Delta CFR was also numerically higher with a median difference of 0.47 (95% CI -0.52, 1.31, p?=?0.46). This did not translate to improved delta median cTnI (1.5 (34.8) vs. 0 (27.5) ng/L, p?=?0.75) or median SAQ score at 3 months, (85 (20) vs. 95 (17.5), p?=?0.47).
CONCLUSION:
Slow stent implantation is associated with less CMD after elective PCI in patients with stable angina.
© 2024 The Author(s). Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.
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Aortic Aneurysm Mimicking Inferior ST-Elevation Myocardial Infarction: A Case Report.
J Investig Med High Impact Case Rep2024 ;12():23247096241264634. doi: 23247096241264634.
Alhatemi Ahmed Qasim Mohammed, Aziz Ezzat Mohammed Hussain, Al-Yaseen Amjed Hussein Alwan, Hashim Hashim Talib, Abduljabbar Zaid Haitham, Sultan Salwan Qahtan, Abdulhussain Tiba Khalid, Abdulhussain Rand,
Abstract
Here, we report a rare case of a 22-year-old female presenting with recurrent chest pain mimicking inferior ST-elevation myocardial infarction (STEMI) but ultimately attributed to an aortic aneurysm. Despite facing initial challenges in diagnosis, such as normal troponin levels and temporary electrocardiogram (ECG) changes, advanced imaging showed a large mass in the chest pressing on the right coronary artery. Prompt multidisciplinary intervention, including surgical resection of the aneurysm, led to successful management and improved outcomes. This case highlights the importance of considering unusual etiologies in atypical presentations of myocardial infarction, necessitating comprehensive evaluation and collaboration among various specialties for optimal patient care.
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The Role and Implications of COVID-19 in Incident and Prevalent Heart Failure.
Curr Heart Fail Rep2024 Jul;():. doi: 10.1007/s11897-024-00677-7.
Rico-Mesa Juan Simon, Haloot Justin, Anupama B K, Atluri Suman, Liu Jing, Khalid Umair,
Abstract
PURPOSE OF REVIEW:
This review examines the pathophysiological interactions between COVID-19 and heart failure, highlighting the exacerbation of heart failure in COVID-19 patients. It focuses on the complex mechanisms driving worse outcomes in these patients.
RECENT FINDINGS:
Patients with pre-existing heart failure experience more severe symptoms and higher mortality rates due to mechanisms such as cytokine storms, myocardial infarction, myocarditis, microvascular dysfunction, thrombosis, and stress cardiomyopathy. Elevated biomarkers like troponin and natriuretic peptides correlate with severe disease. Long-term cardiovascular risks for COVID-19 survivors include increased incidence of heart failure, non-ischemic cardiomyopathy, cardiac arrest, and cardiogenic shock. COVID-19 significantly impacts patients with pre-existing heart failure, leading to severe symptoms and higher mortality. Elevated cardiac biomarkers are indicators of severe disease. Acute and long-term cardiovascular complications are common, calling for ongoing research into targeted therapies and improved management strategies to better prevent, diagnose, and treat heart failure in the context of COVID-19.
© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.
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Evaluation of cell survival in different 3D-printed geometric shapes of human iPSC-derived engineered heart tissue.
Artif Organs2024 Jul;():. doi: 10.1111/aor.14833.
Yildirim Yalin, Degener Louisa, Reuter Lukas, Petersen Johannes, Gabel Lilian, Sommer Annika, Pahrmann Christiane, Reichenspurner Hermann, Pecha Simon,
Abstract
OBJECTIVES:
Engineered Heart Tissue (EHT) is a promising tool to repair heart muscle defects and can additionally be used for drug testing. Due to the absence of an in vitro vascularization, EHT geometry crucially impacts nutrient and oxygen supply by diffusion capacity. We analyzed cardiomyocyte survival in different EHT geometries.
METHODS:
Different geometries with varying surface-area-to-volume-ratios were calculated (structure A (Ring) AS/V?=?58.47?mm/440??L, structure B (Infinity) 25.86?mm/440??L). EHTs were generated from hiPSC-derived cardiomyocytes (4?×?10) and a fibrin/thrombin hydrogel. Cell viability was evaluated by RT-PCR, cytometric studies, and Bioluminescence imaging.
RESULTS:
Using 3D-printed casting molds, spontaneously beating EHTs can be generated in various geometric forms. At day 7, the RT-PCR analyses showed a significantly higher Troponin-T value in ring EHTs, compared to infinity EHTs. In cytometric studies, we evaluated 15% more Troponin-T positive cells in ring (73%?±?12%), compared to infinity EHTs (58%?±?11%, p?=?0.04). BLI visualized significantly higher cell survival in ring EHTs (ROI?=?A: 1.14?×?10 p/s and B: 8.47?×?10 p/s, p?0.001) compared to infinity EHTs during longitudinal cultivation process.
CONCLUSION:
Use of 3D-printing allows the creation of EHTs in all desired geometric shapes. The geometry with an optimized surface-area-to-volume-ratio (ring EHT) demonstrated a significantly higher cell survival measured by RT-PCR, Bioluminescence imaging, and cytometric studies using FACS analysis.
© 2024 The Author(s). Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.
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