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1.
Int Heart J ; 64(1): 114-119, 2023 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-36682767

RESUMO

The 12-lead electrocardiogram (ECG) remains a key tool to diagnose ST elevation myocardial infarction (STEMI). However, a variety of other conditions aside from obstructive coronary disease, including hyperkalemia, myocarditis, pericarditis, and Takotsubo and Brugada syndrome, may also cause ST segment elevation, with an incidence rate of 3%-15% and mean age of 45 ± 14 years. A combination of a detailed past medical history, thorough physical examination, and additional imaging tests may allow physicians to make the correct diagnosis.In this report, we present a case of a 39-year-old woman with metaplastic breast cancer in the process of combined oncological treatment admitted to the emergency department because of general body weakness, chest pain, and accompanying hypotonia with an initial diagnosis of acute coronary syndrome.The ECG at presentation showed ST segment elevation, but owing to the observed neoplastic cachexia and frailty, she was medically managed and the diagnostics were extended to include transthoracic echocardiogram and computed tomography scan. The patient was found to have an external mass that infiltrated into the thoracic wall, pericardium, right ventricle, interventricular septum, and coronary arteries.In cancer patients with chest pain and ST segment elevation, STEMI should not be the only diagnosis taken into account. In our report, using a combination of available cardiac imaging methods, we were able to evaluate the stage of the lesion and coronary involvement.


Assuntos
Neoplasias da Mama , Doença da Artéria Coronariana , Infarto do Miocárdio , Infarto do Miocárdio com Supradesnível do Segmento ST , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Eletrocardiografia/métodos , Arritmias Cardíacas , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Neoplasias da Mama/complicações , Neoplasias da Mama/diagnóstico
2.
Int J Mol Sci ; 23(11)2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35683019

RESUMO

Proteomic analyses based on mass spectrometry provide a powerful tool for the simultaneous identification of proteins and their signatures. Disorders detection at the molecular level delivers an immense impact for a better understanding of the pathogenesis and etiology of various diseases. Acute coronary syndrome (ACS) refers to a group of heart diseases generally associated with rupture of an atherosclerotic plaque and partial or complete thrombotic obstruction of the blood flow in the infarct-related coronary artery. The essential role in the pathogenesis of ACS is related to the abnormal, pathological activation of blood platelets. The multifactorial and complex character of ACS indicates the need to explain the molecular mechanisms responsible for thrombosis. In our study, we performed screening and comparative analysis of platelet proteome from ACS patients and healthy donors. Two-dimensional fluorescence difference gel electrophoresis and nanoscale liquid chromatography coupled to tandem mass spectrometry showed altered expressions of six proteins (i.e., vinculin, transgelin-2, fibrinogen ß and γ chains, apolipoprotein a1, and tubulin ß), with the overlapping increased expression at the mRNA level for transgelin-2. Dysregulation in protein expression identified in our study may be associated with an increased risk of thrombotic events, correlated with a higher aggregability of blood platelets and induced shape change, thus explaining the phenomenon of the hyperreactivity of blood platelets in ACS.


Assuntos
Síndrome Coronariana Aguda , Trombose , Síndrome Coronariana Aguda/metabolismo , Plaquetas/metabolismo , Humanos , Proteínas dos Microfilamentos , Proteínas Musculares , Proteoma/metabolismo , Proteômica/métodos , Espectrometria de Massas em Tandem , Trombose/metabolismo , Transcriptoma
3.
Int J Mol Sci ; 23(9)2022 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-35563407

RESUMO

The pathophysiology of atherosclerosis and acute coronary syndrome (ACS) is related to interactions between immune cells, endothelium, and blood platelets. An increasing number of reports confirm the link between excessive immune activation and cellular cross-talk with ACS incidence. Our genetic and proteomic analysis was performed on strictly selected atherosclerotic patients with non-fatal ACS without typical risk factors and healthy donors. Results showed changes in the gene expression levels of the various inflammatory factors derived from the peripheral blood cells that drive the over-activation of the immune system. The enhanced activation of the immune system may lead to the overexpression of the pro-inflammatory mediators, which causes self-perpetuating machinery of processes associated with thrombosis. In our preliminary study, we confirmed an altered expression of genes associated with the inflammation and overall interaction of the vascular microenvironment. Furthermore, 5 of 92 analyzed genes, CCL2, CCR2, CSF2, GZMB, and ICOS, were expressed only in patients with ACS. In conclusion, the augmented expression of the pro-inflammatory genes from the peripheral blood cells may be a crucial genetic factor leading to the occurrence of acute inflammation and thus be significant in ACS pathogenesis.


Assuntos
Síndrome Coronariana Aguda , Aterosclerose , Aterosclerose/metabolismo , Plaquetas/metabolismo , Humanos , Inflamação/metabolismo , Proteômica , Transcriptoma
4.
Curr Ther Res Clin Exp ; 93: 100599, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874376

RESUMO

BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) is a common cause of hospital-acquired AKI and a serious complication of percutaneous coronary intervention. OBJECTIVE: The aim of the present study was to assess whether remote ischemic preconditioning (RIPC) reduces the incidence of CI-AKI. METHODS: We conducted a prospective, randomized, sham-controlled clinical study. The study included 101 patients admitted to the Intensive Cardiac Therapy Clinic of Medical University of Lodz for elective percutaneous coronary intervention. The participants were randomly assigned in a 1:1 ratio to either a control group (n = 51) or an RIPC group (n = 50). In the latter, RIPC was achieved before percutaneous coronary intervention by 4 cycles of 5-minute inflation of a cuff on the left upper arm to 200 mm Hg followed by 5-minute deflation. In the control group, a deflated cuff was placed on the left arm for 40 minutes. Serum creatinine concentration was measured to check for the presence of CI-AKI within 48 to 72 hours of percutaneous coronary intervention. Serum neutrophil gelatinase-associated lipocalin level was also measured within 3 hours. RESULTS: CI-AKI occurred in 2 patients from the RIPC group (4%) and 3 patients from the control group (5.9%), but the difference was not significant (P = 0.98). The patients who developed CI-AKI also demonstrated increased serum neutrophil gelatinase-associated lipocalin concentrations (the area under the receiver operator characteristic curve = 0.97; 95% CI, 0.938-1.00; P < 0.00) and the optimal cutoff point value was 118.9 ng/mL. CONCLUSIONS: The use of RIPC before elective percutaneous coronary intervention was not found to prevent CI-AKI. ClinicalTrials.gov identifier: NCT03761368. (Curr Ther Res Clin Exp. 2020; 81:XXX-XXX).

5.
Aust Crit Care ; 32(4): 293-298, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30213588

RESUMO

BACKGROUND: The development of cardiogenic shock remains the most important factor affecting the prognosis of patients with acute coronary syndrome. Despite significant advances in treatment, achieved in the last two decades, the mortality rate is still very high. The development of knowledge about the pathophysiology of cardiogenic shock, necessitates a thorough and comprehensive assessment of its progress at all stages of medical care. OBJECTIVES: The aim of the study was to assess the prehospital clinical presentation in patients with acute coronary syndrome complicated by cardiogenic shock. METHODS: The population of our study consisted of 40 patients with acute coronary syndrome complicated by cardiogenic shock who were transported to the Intensive Cardiac Therapy Clinic by ambulances directly from place of the event in order to implement primary coronary intervention. The control group was selected among age, gender and infarct location-matched patients with acute coronary syndrome uncomplicated by shock. The clinical presentation in investigated patients was assessed on the basis of the data contained in the medical records of Emergency Medical Services teams. RESULTS: In univariate logistic regression analysis eight prehospital clinical symptoms proved to be statistically significant predictors of the development of cardiogenic shock: fainting and/or impaired consciousness, pale skin, cold skin, clammy skin, dyspnea, pulmonary congestion, peripheral cyanosis and hyperglycemia >11,1 mmol/l. In the multivariate model significant predictors of cardiogenic shock development were: pale skin and hyperglycemia >11.1 mmol/l. A risk prediction model was constructed. It proved to differentiate patients from study and control group highly significantly (p < 0.001). CONCLUSIONS: Patients with acute coronary syndrome who develop cardiogenic shock, present a different clinical symptoms at the moment of the first medical contact. The proposed 4S Scale can be used for quick assessment of risk in patients with acute coronary syndrome before the development of a fully-blown cardiogenic shock with severe, long-lasting hypotonia.


Assuntos
Síndrome Coronariana Aguda/complicações , Serviços Médicos de Emergência , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/etiologia , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Polônia , Prognóstico , Fatores de Risco , Choque Cardiogênico/fisiopatologia
6.
Biomarkers ; 22(3-4): 296-303, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27788594

RESUMO

CONTEXT: Cardiogenic shock (CS) still remains one of the main causes of death in acute myocardial infarction (AMI). OBJECTIVE: The aim of this study was to evaluate the prognostic value of midregional (MR)-proadrenomedullin in AMI complicated by CS. METHODS: Forty-seven consecutive patients were included in our prospective observational study. All patients underwent coronarography and successful percutaneous coronary intervention (PCI). Plasma levels of MR-proADM were measured by a immunofluorescence method. The primary endpoint of the study, defined as cardiovascular death, occurred in 17 patients (36%). RESULTS AND CONCLUSION: Elevated plasma level of MR-proADM, determined 24 h after diagnosis of CS could be a predictor of in-hospital mortality in patients with AMI complicated by CS.


Assuntos
Síndrome Coronariana Aguda/complicações , Adrenomedulina/sangue , Precursores de Proteínas/sangue , Choque Cardiogênico/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Mortalidade Hospitalar , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Prognóstico , Estudos Prospectivos
7.
BMC Cardiovasc Disord ; 16: 76, 2016 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-27130218

RESUMO

BACKGROUND: Stress- induced cardiomyopathy is acute, reversible left ventricle mainly apical dysfunction in patients with normal coronary angiography. Rarely it regards basal segments, therefore defined as "inverted stress- induced cardiomyopathy". While classic form mostly affects postmenopausal women, inverted variant occurs essentially in younger females, always triggered by stress. It can also develop after medical procedures and surgery. Herein we report such unique case of 36- year old woman after cesarean delivery. CASE PRESENTATION: A 36- year- old white woman at 40 week of gestation was admitted to hospital for elective repeated cesarean delivery. During caesarean delivery under spinal anaesthesia a previously healthy woman became hypotensive, requiring ephedrine to maintain her blood pressure. Three hours after delivery the patient presented acute heart failure and pulmonary oedema. Due to low blood pressure she demanded the administration of inotropic agents. Owing to respiratory failure and gradual deterioration of consciousness, mechanical ventilation was applied. Results of additional tests finally excluded pulmonary thromboembolism and acute coronary syndrome. The transthoracic echocardiography revealed severe left ventricular systolic dysfunction, ejection fraction 30 % with hypokinesis of the mid and basal segments of posterior, anterior and lateral wall with preserved contractility of the apical segments. The diagnosis of inverted stress- induced cardiomyopathy was set upon the overall clinical data. Both echocardiography and magnetic resonance imaging performed on the fifth day showed complete recovery of myocardial function. The patient was discharged after 15 days in good overall condition. At 12- month follow- up she remained asymptomatic with no echocardiographic abnormalities. CONCLUSIONS: Inverted stress- induced cardiomyopathy may occur in postpartum period, especially in combination with spinal anesthesia and adrenergic stimulants administration. The clinical awareness and multimodality imaging of possible diagnosis and further management of this unexpected variant of acute heart failure after caesarean delivery is required.


Assuntos
Cesárea/efeitos adversos , Insuficiência Cardíaca/etiologia , Cardiomiopatia de Takotsubo/etiologia , Doença Aguda , Adulto , Eletrocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Imageamento por Ressonância Magnética , Valor Preditivo dos Testes , Gravidez , Fatores de Risco , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/fisiopatologia , Cardiomiopatia de Takotsubo/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Ann Noninvasive Electrocardiol ; 19(5): 471-6, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24597906

RESUMO

BACKGROUND: The aim of this study was to ascertain whether individual atrioventricular delay (AVD) optimization using impedance cardiography (ICG) offers beneficial hemodynamic effects as well as improved exercise tolerance and quality of life in patients with requiring constant right ventricular pacing. METHODS: There were 37 patients with advanced AV block included in the study. Several examinations were performed at the beginning. Next, the optimization of AVD by ICG was done. The next step of the study patients have been randomized into optimal AVD group (AVDopt) or factory setting group (AVDfab). After 3 months, the follow-up all data were collected again and crossover was performed. After another 3 months, during the final follow-up all these measures were repeated. RESULTS: In 87.5% patients, AVDopt were different than factory value. Cardiac output (CO), cardiac index (CI), and stroke volume (SV) were significantly (P < 0.001) higher in AVDopt group than in AVDfab group (CO: 6.0 ± 1.4 L/minute vs. 5.3 ± 1.2 L/minute; SV: 85.8 ± 25.7 mL vs.76.9 ± 22.5 mL; CI: 3.2 ± 0.7 L/minute/m(2) vs. 2.7 ± 0.6 L/minute/m(2) ). There was a statistical significant (P < 0.05) reduction of proBNP and NYHA class in patients with AVDopt compared to AVDfab (proBNP: 196.4 ± 144.7pg/mL vs. 269.4 ± 235.8 pg/mL; NYHA class: 1.7 ± 0.5 vs. 2.3 ± 0.6). Six-minute walking test was significantly (P < 0.05) higher in AVDopt group (409 ± 90 m) than in AVDfab group (362 ± 93 m). There were no statistically significant differences in echocardiographic parameters between AVDopt and AVDfab settings. CONCLUSION: Our study results suggest that AVD optimization in patients with DDD pacemaker with ICG improves hemodynamic when compared to the default factory settings. Furthermore, optimally programmed AVD reduces BNP and improves exercise tolerance and functional class.


Assuntos
Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial/métodos , Hemodinâmica/fisiologia , Marca-Passo Artificial , Qualidade de Vida , Biomarcadores/sangue , Estudos Cross-Over , Ecocardiografia , Eletrocardiografia , Feminino , Testes de Função Cardíaca , Humanos , Masculino , Fatores de Risco
9.
Acta Cardiol ; 69(5): 532-40, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25638841

RESUMO

OBJECTIVE: Experimental and clinical studies have proven the neuroprotective effects of hypothermia in unconscious patients with spontaneous circulation after out-of-hospital cardiac arrest. Based on this evidence, recommendations have been made to incorporate mild therapeutic hypothermia into practice. ECG changes are well documented in people with incidental hypothermia but there are only few studies on ECG abnormalities in patients undergoing mild therapeutic hypothermia after cardiac arrest due to ST-elevation myocardial infarction. METHODS: Ten patients with ST-elevation myocardial infarction (STEMI) complicated by cardiac arrest and receiving mild therapeutic hypothermia (MTH) after return of spontaneous circulation and ten comparable patients but not receiving mild therapeutic hypothermia as a control group were incorporated into our prospective study. We analysed electrocardiographic (ECG) changes during hypothermia and its influence on ECG evolution in patients after STEMI. RESULTS: MTH was mainly associated with decrease of heart rate (P = 0.014) and QTc interval prolongation (P = 0.005). In 60% of patients the Osborn wave was registered. The presence of a new Q wave or new negative T wave in ECGs registered on the 3rd day of STEMI was comparable in the two groups. CONCLUSIONS: Although hypothermia is associated with typical ECG findings like Osborn wave, the electrocardiographic evolution of STEMI in patients receiving MTH is comparable with that in patients without it.


Assuntos
Hipotermia Induzida , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Parada Cardíaca Extra-Hospitalar/etiologia , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Resultado do Tratamento
10.
Biomarkers ; 18(8): 655-9, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24102091

RESUMO

CONTEXT: Galectin-3, as a biomarker of inflammation and fibrosis, has been reported to be associated with coronary artery disease. OBJECTIVE: The study aimed to assess the relationship between galectin-3 levels and the occurrence of reinfarction early after myocardial infarction (MI). METHODS: The study included 145 consecutive patients with first MI treated invasively. Serum galectin-3 was measured using VIDAS (bioMérieux, Marcy-l'Etoile, France). RESULTS: The independent predictors of reinfarction in our group were as follows: female gender, elevated hs-C-reactive protein and galectin-3 levels (measured both at discharge). CONCLUSIONS: Galectin-3 might be an additional useful biomarker in prediction for reinfarction early after first MI.


Assuntos
Biomarcadores/metabolismo , Galectina 3/metabolismo , Infarto do Miocárdio/patologia , Idoso , Proteínas Sanguíneas , Feminino , Galectinas , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/metabolismo , Infarto do Miocárdio/cirurgia , Recidiva
11.
Ginekol Pol ; 84(6): 471-5, 2013 Jun.
Artigo em Polonês | MEDLINE | ID: mdl-24032267

RESUMO

Hypercoagulable state during pregnancy and puerperium is associated with an increased risk of venous thromboembolic disease. Pulmonary embolism (PE) is the leading cause of maternal death in the developed world. Clinical assessment of PE may be difficult due to nonspecific signs and symptoms, especially in pregnant women. Diagnostic procedures using ionizing radiation may be harmful for the fetus while aggressive anticoagulation may expose the mother to bleeding complications The aim of this paper was to present a case of a 27-year-old pregnant woman with high-risk PE.


Assuntos
Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamento farmacológico , Adulto , Anticoagulantes/uso terapêutico , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Cuidado Pós-Natal/métodos , Gravidez , Cuidado Pré-Natal/métodos
12.
J Clin Med ; 12(8)2023 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-37109114

RESUMO

BACKGROUND: The aim of present study was to assess left ventricular myocardial deformation detected by 2D STE in patients with suspected acute myocarditis (AM) early on admission in whom later cardiac magnetic resonance (CMR) evaluation was performed. METHODS: A total of 47 patients with suspected AM based on clinical practice were prospectively enrolled. Coronary angiography was performed on all patients to rule out significant coronary artery disease. CMR confirmed myocardial inflammation, oedema, and regional necrosis meeting the Lake Louise criteria in 25 patients (53%, oedema (+) subgroup). In the remaining patients, only LGE was confirmed in the sub-epicardial or intramuscular localization (22 patients, 47%, oedema (-) subgroup). Early on admission, echocardiography with measurements of global and segmental longitudinal strains (GLS), circumferential strains (GCS) at the endocardial (endocardial GCS) and epicardial (epicardial GCS) layers, transmural GCS, and radial strains (RS) were performed. RESULTS: Mild reduction of GLS, GRS, and transmural GCS values were found in patients with oedema (+) subgroup. The epicardial GCS turned out to be the diagnostic factor for oedema with a cut-off point of 13,0% (AUC 0.747, p = 0.0005). Twenty-two patients (all but three) with an acute phase of myocarditis and epicardial GCS -13.0% or less had oedema confirmed by CMR. CONCLUSIONS: 2D STE can help to set the diagnosis of AM in patients with acute chest pain with a normal coronary angiogram. The epicardial GCS can serve as a diagnostic factor for oedema in patients with early stage of AM. In patients presenting with signs of AM (oedema in CMR), the epicardial GCS is modified in comparison with a subgroup without oedema; therefore, this parameter could be used to improve the performance of ultrasound.

13.
Biomedicines ; 11(6)2023 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-37371618

RESUMO

Two-dimensional speckle-tracking echocardiography (2DSTE) detects myocardial dysfunction despite a preserved left ventricular ejection fraction. Fibroblast growth factor 23 (FGF23) has become a promising biomarker of cardiovascular risk. This study aimed to determine whether FGF23 may be used as a marker of myocardial damage among patients with diabetes mellitus type 2 (T2DM) and no previous history of myocardial infarction. The study enrolled 71 patients with a median age of 70 years. Laboratory data were analyzed retrospectively. Serum FGF23 levels were determined using a sandwich enzyme-linked immunosorbent assay. All patients underwent conventional echocardiography and 2DSTE. Baseline characteristics indicated that the median time elapsed since diagnosis with T2DM was 19 years. All subjects were divided into two groups according to left ventricular diastolic function. Individuals with confirmed left ventricular diastolic dysfunction had significantly lower levels of estimated glomerular filtration rate and higher values of hemoglobin A1c. Global circumferential strain (GCS) was reduced in the majority of patients. Only an epicardial GCS correlated significantly with the FGF23 concentration in all patients. The study indicates that a cardiac strain is a reliable tool for a subtle myocardial damage assessment. It is possible that FGF23 may become an early diagnostic marker of myocardial damage in patients with T2DM.

14.
Rev Diabet Stud ; 18(2): 68-75, 2022 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-35831937

RESUMO

1,5-anhydroglucitol (1,5-AG) is a biomarker of acute hyperglycemia in diabetology and also in cardiodiabetology. It is used to monitor fluctuating glucose levels. 1,5-AG is a monosaccharide that is biochemically similar to D-glucose and originates from the nutrition. The presence of 1,5-AG in blood and tissue is nearly constant due to reabsorption in the renal proximal tubule. In acute hyperglycemia, renal reabsorption is inhibited by glucose and 1,5- AG is excreted in the urine, while its serum level decreases rapidly. 1,5-AG reflects glucose excursions over 1-3 days to 2 weeks. In this regard, low levels of serum 1,5-AG can be a clinical marker of short- term glycemic derangements such as postprandial hyperglycemia, which is an important risk factor for the pathogenesis of coronary artery disease (CAD) as low levels of 1,5-AG reflect severe plaque calcification in CAD and correlate with high-density lipoprotein cholesterol (HDL-C) levels. For these reasons, 1,5-AG may also be a marker for atherosclerosis; in fact an even better marker than HbA1c or fructosamine which are normally used. 1,5-AG may also be a predictor of cardiovascular disease, left ventricular dysfunction after acute coronary syndrome (ACS), and mortality after ACS. This articles reviews the current knowledge on 1,5-AG related to its use as predictor for cardiovascular events.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Hiperglicemia , Biomarcadores , Glicemia , Doença da Artéria Coronariana/diagnóstico , Desoxiglucose , Hemoglobinas Glicadas , Humanos , Hiperglicemia/diagnóstico
15.
Metabolites ; 12(6)2022 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-35736431

RESUMO

Numerous clinical studies have indicated that elevated FGF23 (fibroblast growth factor 23) levels may be associated with cardiovascular (CV) mortality, especially in patients with chronic kidney disease. The purpose of this study was to examine the hypothesis that FGF23 may be a potent CV risk factor among patients with long-standing type 2 diabetes mellitus (T2DM). Research was performed utilizing patients with T2DM and regular outpatient follow-up care. Baseline characteristics determined by laboratory tests were recorded. Serum FGF23 levels were detected using a sandwich enzyme-linked immunosorbent assay. All patients underwent echocardiograms and 12-lead electrocardiograms. Data records of 102 patients (males: 57%) with a median age of 69 years (interquartile range (IQR) 66.0-74.0) were analyzed. Baseline characteristics indicated that one-third (33%) of patients suffered from ischemic heart disease (IHD), and the median time elapsed since diagnosis with T2DM was 19 years (IQR 14.0-25.0). The hemoglobin A1c, estimated glomerular filtration rate, and FGF23 values were, respectively, as follows: 6.85% (IQR 6.5-7.7), 80 mL/min/1.73 m2 (IQR 70.0-94.0), and 253.0 pg/mL (IQR 218.0-531.0). The study revealed that FGF23 was elevated in all patients, regardless of IHD status. Thus, the role of FGF23 as a CV risk factor should not be overestimated among patients with T2DM and good glycemic control.

16.
J Clin Med ; 11(4)2022 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-35207189

RESUMO

Myocarditis may mimic myocardial infarction (MI) due to a similar clinical presentation, including chest pain, electrocardiography changes, and laboratory findings. The purpose of the study was to investigate the diagnostic value of clinical, laboratory, and electrocardiography characteristics of patients with acute coronary syndrome - like myocarditis and MI. We analysed 90 patients (≤45 years old) with an initial diagnosis of ST-segment elevation myocardial infarction; 40 patients (44.4%), through the use of cardiac magnetic resonance, were confirmed to have myocarditis, and 50 patients (55.6%) were diagnosed with MI. Patients with myocarditis were younger and had fewer cardiovascular risk factors than those with MI. The cutoff value distinguishing between myocarditis and MI was defined as the age of 36 years. The history of recent infections (82.5% vs. 6%) and C-reactive protein (CRP) levels on admission (Me 45.9 vs. 3.4) was more associated with myocarditis. Further, the QTc interval was inversely correlated with the echocardiographic ejection fraction in both groups but was significantly longer in patients with MI. Non-invasive diagnostics based on clinical features and laboratory findings are basic but still essential tools for differentiation between MI and myocarditis. The three-factor model including the criteria of age, abnormal CRP, and history of recent infections might become a valuable clinical indication.

17.
PLoS One ; 17(8): e0271483, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35939417

RESUMO

PURPOSE: Comparing myocarditis with an acute coronary syndrome (ACS)-like presentation and acute myocardial infarction (AMI) poses an important clinical challenge. The purpose of the study was to investigate the diagnostic value of the clinical, laboratory and especially echocardiographic characteristics including speckle tracking echocardiography (STE) of patients with ACS-like myocarditis and AMI. METHODS: We conducted a retrospective analysis comparing 69 symptomatic patients (≤ 45 years old), hospitalized at the Department of Interventional Cardiology (Medical University of Lodz, Poland) between April 2014 and June 2021 with an initial diagnosis of ST-segment elevation myocardial infarction. RESULTS: 37 patients with the cardiac magnetic resonance-confirmed acute myocarditis and 32 patients diagnosed with AMI based on the clinical presentation, electrocardiogram and the presence of a culprit lesion on the coronary angiography were analysed including echocardiography parameters. On STE analysis an average global longitudinal (GLS), radial and circumferential strain including three-layers observation were significantly lower (absolute value) in patients with AMI versus acute myocarditis (p<0.05). There was no significant difference in Endo/Epi ratio (p = 0.144) between the groups. An average GLS < (-17.5) represented the optimal cut-off value for the myocarditis diagnosis. CONCLUSION: In patients with AMI a significant reduction of global and three-layers strains compared to patients with myocarditis was detected. Furthermore, our analysis also confirmed the discriminative pattern of myocardial injury between the groups.


Assuntos
Síndrome Coronariana Aguda , Infarto do Miocárdio , Miocardite , Síndrome Coronariana Aguda/diagnóstico por imagem , Ecocardiografia , Eletrocardiografia , Humanos , Pessoa de Meia-Idade , Miocardite/diagnóstico por imagem , Estudos Retrospectivos , Adulto Jovem
18.
Biology (Basel) ; 11(5)2022 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-35625372

RESUMO

The pathological conditions caused by blood platelet activation constitute a fundamental core in the pathogenesis of Acute Coronary Syndrome (ACS). The hyperactivity of platelets in ACS is well-documented, but there is still little research into the molecular basis of phenotypic changes in platelet functionality. To expand the knowledge of this phenomenon, we analyzed the disturbances in the expression of several key platelet receptors and the aspect of regulating potential abnormalities. Platelet surface receptors are responsible for maintaining the hemostatic balance, platelet interaction with immune cells, and support of the coagulation cascade leading to occlusion of the vessel lumen. Due to their prominent role, platelet receptors constitute a major target in pharmacological treatment. Our work aimed to identify the molecular alteration of platelet surface receptors, which showed augmented mRNA expression of P2Y12, GP1BB, ITGA2B, and ITGB3 and increased protein concentrations of P2Y12 and GP IIb/IIIa in ACS. The upregulation of the P2Y12 level was also confirmed by confocal and cytometric visualization. Furthermore, we evaluated the expression of two microRNAs: miR-223-3p and miR-126-3p, which were suggested to regulate platelet P2Y12 expression. Results of our study present new insight into the molecular background of ACS.

19.
Dis Markers ; 2021: 8821292, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34055103

RESUMO

FGF23 is a hormone secreted mainly by osteocytes and osteoblasts in bone. Its pivotal role concerns the maintenance of mineral ion homeostasis. It has been confirmed that phosphate and vitamin D metabolisms are related to the effect of FGF23 and its excess or deficiency leads to various hereditary diseases. Multiple studies have shown that FGF23 level increases in the very early stages of chronic kidney disease (CKD), and its concentration may also be highly associated with cardiac complications. The present review is limited to some of the most important aspects of calcium and phosphate metabolism. It discusses the role of FGF23, which is considered an early and sensitive marker for CKD-related bone disease but also as a novel and potent cardiovascular risk factor. Furthermore, this review gives particular attention to the reliability of FGF23 measurement and various confounding factors that may impact on the clinical utility of FGF23. Finally, this review elaborates on the clinical usefulness of FGF23 and evaluates whether FGF23 may be considered a therapeutic target.


Assuntos
Doenças Cardiovasculares/metabolismo , Fator de Crescimento de Fibroblastos 23/metabolismo , Insuficiência Renal Crônica/metabolismo , Biomarcadores/metabolismo , Cálcio/metabolismo , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Humanos , Fosfatos/metabolismo , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/etiologia
20.
Biomolecules ; 11(12)2021 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-34944477

RESUMO

Atrial natriuretic peptide (ANP) is secreted in response to the stretching of the atrial wall. Atrial ischemia most likely impairs the ability of atrial myocytes to produce ANP. Atrial infarction (AI) is rarely diagnosed but not infrequently associated with myocardial infarction (MI). The aim of the study was to assess the association between AI and the prognostic value of N-terminal proANP (NT-proANP) in patients with MI treated with primary percutaneous coronary intervention (PCI). We evaluated data of 100 consecutive patients. Plasma levels of NT-proANP were measured by the ELISA method. ECG recordings were interpreted to diagnose AI according to Liu's criteria. All patients were followed-up prospectively for 12 months for the manifestation of major adverse cardiovascular events (MACE), defined as unplanned coronary revascularization, stroke, reinfarction or all-cause death. AI was diagnosed in 36 patients. 14% of patients developed MACE. AI did not affect the incidence of MACE or any of its components, nor the patients' prognosis. NT-proANP revealed to be a strong predictor of death but was not associated with other adverse events. Conclusions: AI in patients with MI treated with primary PCI is not connected with their prognosis nor affects the usefulness of NT-proANP in predicting death during the 12-month follow-up.


Assuntos
Fator Natriurético Atrial/metabolismo , Biomarcadores/metabolismo , Átrios do Coração/fisiopatologia , Intervenção Coronária Percutânea/métodos , Precursores de Proteínas/metabolismo , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Idoso , Eletrocardiografia , Feminino , Átrios do Coração/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/metabolismo
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