Unexpectedly elevated cardiac troponin I level in the patient without acute coronary syndrome.

BACKGROUND: Since cTnI assay is leading test in diagnostic of myocardial infarctions, and it is used for risk assessment in patients with ACS as well as unstable angina pectoris, it is very important to measure its concentration accurately and precisely. METHODS: Here we report a case in which there was a significant difference in the cTnI concentrations measured by three different methods, which was detected in one patient's sera during preoperative evaluation for cardiac surgery. RESULTS: Due to variations in the results for the cTnI concentrations (0.62; 0.13; 0.89 microg/L), the question was raised about the possibility of an interference known to occur in especially rare situations. A 76-year-old male was operated, temporal elevation and subsequent decrease in the concentrations of cTnI were monitored. CONCLUSIONS: It was observed that results obtain with different assays are not comparable.

Survival of patients treated with online hemodiafiltration compared to conventional hemodialysis.

Accumulating data from observational studies showed that online hemodiafiltration (OLHDF) might improve survival in chronic hemodialysis (HD) patients. According to this data, the aim of our study was to investigate whether there was a difference in survival of patients treated with OLHDF compared to standard, conventional HD. We included 85 prevalent patients with end-stage renal disease (ESRD) treated with HD as a method of renal replacement therapy (RRT) for more than three months. Patients were previously treated with HD and divided into two groups: in 42 patients new treatment with OLHDF was introduced, and 43 patients were treated with HD. Both groups were followed over a period of 36 months. The study showed significantly better survival of patients treated with OLHDF, compared to the survival of patients treated with HD in the whole study population, as well as in the subgroups of diabetics, of patients who were on RRT with HD for more than five years and of the patients who were older than 65 years. In the nondiabetics, patients who were on RRT for less than five years and in the patients who were younger than 65 years, survival results in the OLHDF group were not significantly better compared to those in the HD group. As in our study, there are accumulating data from observational studies that HDF may improve survival in chronic HD patients, but new, prospective randomized trials are needed to support evidence about this hypothesis.

Bioactive Compounds and Antioxidant Activity of Red and White Wines Produced from Autochthonous Croatian Varieties: Effect of Moderate Consumption on Human Health.

Moderate wine consumption is often associated with healthy lifestyle habits. The role of wine as a healthy drink is mainly due to its bioactive compounds, which differ according to various viticultural and enological factors. The aim of the present study was to observe the differences in bioactive compounds of white and red autochthonous Croatian wines, differing in terms of the grape variety and production technology. Our further aim was to explore the effect of their moderate consumption (200 mL per day) over the course of six weeks on some aspects of health in sixty-six healthy individuals. Participants were divided into eight groups depending on the wines consumed, while one group formed a non-consuming control group. Medical examination and laboratory tests were performed before the start and at the end of the consumption period. Systolic and diastolic blood pressure, total cholesterol, and LDL concentrations decreased. Additionally, an increase in HDL concentrations, and serotonin and dopamine levels, was observed. ALT, ALP, and GGT levels did not significantly increase in consumer groups, although alcohol concentration was relatively high in all the wines. Such results support the beneficial effects of wine-derived bioactive compounds on some health aspects resulting from moderate white and red wine consumption.

A simple prognostic model for assessing in-hospital mortality risk in patients with acutely decompensated heart failure.

Background An assessing of the in-hospital mortality risk for an emergency hospitalized patient with acutely decompensated heart failure (ADHF) is challenging task. Simple formula can help. Methods On the base of six indicators identified in derivation group, simple formula for assessing the risk for in-hospital mortality of ADHF patients was derived and later tested in validation group. Results The retrospective analysis of a derivation group (533 survivors, 121 deceased) identified six risk indicators: age, heart rate (HR), systolic blood pressure (SBP) and serum concentrations of urea, sodium (Na) and uric acid (UA). The final formula was created ([age/10]2 × HR/SBP)+(Urea-Na/10)+UA/100 and formula result of 53 was established as cut-off result. In the derivation group, at the cut-off point of 53, area under the ROC curve (AUC) was 0.741 (95% CI 0.701-0.776); with sensitivity 54% and specificity 83%. The discriminative capacity of the formula was significantly higher than each of its components. In the validation group of 591 patients (527 survived, 64 died) AUC was also 0.741 (95% CI 0.706-0.774), sensitivity was 66% and specificity 76%. Positive predictive value (PPV) of the developed formula was modest (34%), but negative predictive value (NPV) was 95%. N-terminal pro-B type natriuretic peptide and troponin I were determined, but not included into formula. Conclusions The developed formula enables simple, rapid and inexpensive risk assessment, but its disadvantage is a low PPV. However, a high NPV permits the identification of patients with a low risk of in-hospital mortality, which could lead to a more rational patient treatment.

Prognostic factors for in-hospital mortality of patients hospitalized for acutely decompensated heart failure.

Objectives Despite improved treatment during last 20 years, prognosis for patients hospitalized for acutely decompensated heart failure (ADHF) is poor and mortality rates reported for these patients are high. Laboratory results can assist clinicians in evaluation and triaging of patients on hospital admission, and are important for the medical decision-making and prognosis assessments. Recently, new guidelines for the diagnosis and treatment of acute and chronic HF patients were published introducing a new group of patients with mid-range left ventricular ejection fraction (LVEF). Methods In order to explore the prognostic value for the in-hospital mortality of ADHF patients we analyzed laboratory test results for 165 emergency hospitalized patients regarding the survival and LVEF. Results In-hospital mortality was 16%. Patients who died were older than survivals (p = 0.003). There were no differences in LVEF between survivals and non-survivals. Patients who survived had significantly lower N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), uric acid, urea, creatinine, and red blood cell distribution width (RDW) than patients who died (p < 0.001). All these tests had a good discrimination power between survivals and non-survivals (p < 0.001), but their incremental addition to NT-proBNP didn't improve its overall prognostic value. There was only a very weak correlation between NT-proBNP concentrations and LVEF. Groups with different LVEF status showed significant difference in number of erythrocytes, RDW and hemoglobin concentrations. Conclusions NT-proBNP had the best discriminatory power between survivals and non-survivals. Some routine laboratory test results, like RDW, uric acid, urea, and creatinine, have potentially significant value.

Comparison of survival between diabetic and non-diabetic patients on maintenance hemodialysis: a single-centre experience.

We analyzed survival rates of 144 prevalent patients on maintenance hemodialysis from 1998 to 2003 at the Department of Nephrology and Dialysis, Rijeka University Hospital, Rijeka, Croatia, and evaluated risk factors predicting their survival. Included were only end-stage renal disease (ESRD) patients on maintenance hemodialysis treatment dialysed more than 6 months before entering the study and who were clinically stable. The patients were randomised in two groups according to the presence or absence of diabetic nephropathy as the cause of ESRD and followed-up. The patient's death as outcome measure was recorded. The survival rates were estimated by the Kaplan-Meier method. The major causes of death were cardiovascular disease in 40 (60.6%) patients. An acute myocardial infarction in 15 (22.7%) patients was the major single cause of death. We found a significantly lower survival of diabetic patients than non-diabetic patients (P=0.0013). The most important predictors of death among diabetic patients on maintenance hemodialysis were hyperglycaemia (P<0.001), ischemic heart disease (P=0.004), hypercholesterolemia (P=0.013), and low delivered dialysis dose (P=0.013). The survival of diabetic patients undergoing hemodialysis was much worse than survival of non-diabetic patients. The cardiovascular disease remained the major cause of death in both groups. Early detection of pre-existing cardiovascular risk factors and diseases, and treatment of infections leading to sepsis, are of great importance, as they may influence the survival rates. Intensive management of diabetic patients is essential.

Serum zinc concentrations in the maintenance hemodialysis patients.

Zinc is necessary for growth and cells' division. Its deficiency may seriously affect antioxidant defense system and is usually related to renal failure, gastrointestinal diseases and alcoholism. It is very important to know zinc status in dialyzed patients and to prevent hypo- or hyperzincemia. Serum samples from 89 patients with chronic terminal renal failure on regular hemodialysis were withdrawn for the estimation of zinc concentrations immediately before and after dialysis. Serum zinc concentrations showed to be highly dependent on hemodialysis. In 57 (64%) patients, serum zinc concentrations decreased, sometimes from very high to normal values. In remaining 32 (36%) patients serum zinc concentrations tended to increase, but remained within normal range. Zinc supplementation may be recommended only in the patients with proven zinc deficiency, but for all chronic renal failure patients it is questionable.

Soluble intracellular adhesion molecule-1 and omentin-1 as potential biomarkers of subclinical atherosclerosis in hemodialysis patients.

PURPOSE: Atherosclerotic cardiovascular complications represent significant cause of mortality in hemodialysis (HD) patients. The aims of this study were to: (a) investigate association of sICAM-1, sVCAM-1, omentin-1 and other non-traditional risk factors with subclinical atherosclerosis; (b) examine the diagnostic value of these specific markers in the early detection of subclinical atherosclerosis; and (c) examine their role as predictors of mortality in group of patients with subclinical atherosclerosis on regular HD. MATERIALS AND METHODS: Starting from November 2011, a cohort of 210 HD patients participated in this 3-year follow-up study. The subjects were divided into three groups according to the presence of atherosclerosis. Atherosclerotic disease was assessed by measuring carotid intima-media thickness (IMT). Samplings were withdrawn at baseline and thereafter every 12 months until the end of follow-up. RESULTS: IMT showed weak correlation with sICAM-1 (r = 0.39, P = 0.001), sVCAM-1 (r = 0.27, P = 0.015) and omentin-1 (r = -0.25, P = 0.020), and also omentin-1 showed good correlation with parameters of systolic and diastolic function (r = 0.52, P = 0.001 and r = 0.51, P = 0.001). Multivariate analysis showed that sICAM-1 and sVCAM-1 concentrations were a strong independent correlate of IMT (P = 0.031 and P = 0.010, respectively). The Cox proportional analysis showed that sICAM-1 and omentin-1 concentrations were strong predictors of cardiovascular death (HR 1.85, CI 1.18-2.32, P = 0.021 and HR 4.14, CI 1.38-12.1, P = 0.004, respectively) and that serial measurements of these markers predict IMT progression (HR 1.98, 95 % CI 1.21-2.38, P < 0.002 and HR 2.91, 95 % CI 1.57-4.72, P < 0.001, respectively). CONCLUSIONS: Our study demonstrated that sICAM-1 and omentin-1 levels are strong predictors of cardiovascular death in HD patients with subclinical atherosclerosis.

Serum omentin-1 levels as a possible risk factor of mortality in patients with diabetes on haemodialysis.

AIM: The main cause of mortality in haemodialysis (HD) patients is cardiovascular disease. Serum omentin-1 level was found to be associated with cardio-metabolic disorders. The aim of this study was to examine the role of omentin-1 as a predictor of mortality in a group of diabetes positive HD patients. METHODS: A total of 120 prevalent HD patients were included in the study from December 2012 to May 2014. Patients were divided into two groups according to the presence or absence of diabetes. Venous blood samples were taken at months 0 and 18 following an overnight fast (prior to a midweek HD session). Serum omentin-1 level was assessed by enzyme-linked immunosorbent assay. RESULTS: A total of 84 HD patients were analysed at the end of an 18-month follow-up. Omentin-1 levels of HD patients with diabetes were found to be lower than of HD patients without diabetes (9.1±5.8 ng/mL vs. 11.4±4.1 ng/mL, respectively; P=0.015) at the end of follow-up. Omentin-1 levels of survived patients with diabetes were found to be higher than of nonsurvived patients with diabetes (16.5±10.1 ng/mL vs. 12.9±5.3 ng/mL, respectively; P=0.045). During follow-up, 36 patients (30%) died, of whom 25 had diabetes (34%). CONCLUSIONS: Serum omentin-1 levels were significantly lower in HD patients with diabetes. A decrease in omentin-1 levels could be an independent mortality risk factor in this patient group. Further investigation in a greater number of patients is needed.

[pp65 antigenemia in evaluation of cytomegalovirus infection after kidney transplantation]. / pp65 antigenemija u pracenju citomegalovirusne infekcije nakon transplantacije bubrega.

INTRODUCTION: Cytomegalovirus (CMV) infection is the most common infectious complication after organ transplantation. Serology is useful only for detecting previous CMV infection. Dissatisfied with serologic follow-up after kidney transplantation, three years ago we introduced detection of CMV antigenemia by an immunocytochemical method using a monoclonal antibody specific for the pp65 CMV matrix protein. This test allows for quantification of positive leukocytes. The purpose of this paper is to present our three-year experience. PATIENTS AND METHODS: From May 1999 till May 2002 CMV antigenemia was examined in 76 patients: 55 patients submitted to kidney transplantation during the study period, and 21 patients previously. Antigenemia became positive at 25.68 +/- 15.51 days after transplantation. These 76 patients were divided into three groups according to the number of positive cells per 200,000 leukocytes: < 5 (group I), 6-20 (group II) and > 20 (group III). The groups consisted of 23, 20 and 11 patients, respectively. The percentage of patients treated by ganciclovir was 4.34%, 15% and 100%, respectively. In group I only one patient received ganciclovir because of geographic indication, in group II three patients because of septicemia, thrombopenia and leukopenia and previous miliary tuberculosis. RESULTS: One patient from group III with steroid diabetes died from pneumonia with abscess formation three days from admission. In another two patients, interstitial pneumonia and abscess of the arm developed. Five patients had an acute rejection episode each and were treated by high doses of methylprednisolone. Five patients had elevated temperature, transaminases were elevated in five patients, and neutropenia with or without thrombopenia was found in six patients. One patient had recurrent CMV disease and lymphocele. Two patients had preemptive treatment by ganciclovir based on positive CMV antigenemia. DISCUSSION: Various centers differ according to the approach to treatment of CMV infection, ranging from prophylaxis to deferred treatment for CMV disease. Determination of pp65 CMV antigenemia allowed us a safe follow-up of patients after kidney transplantation. Compared with previous serologic follow-up antigenemia is a considerable progress. We did not use CMV prophylaxis because it is more expensive and can cause resistance to ganciclovir. A promising novel drug valganciclovir will allow for good prophylaxis owing to its better absorption from the gut. Based on our three-year experience, optimal cut-off for antigenemia has been set at 20 positive cells per 200,000 leukocytes. The existence of symptoms or changes in the level of leukocytes, platelets or transaminases goes in favor of treatment decision. CONCLUSION: Cytomegalovirus pp65 antigenemia is a reliable tool in the follow-up of patients after kidney transplantation. Patients with primary CMV infection, those with rejection episode and threshold of 20 positive cells require preemptive treatment with ganciclovir. The measurement of pp65 CMV antigenemia has clinical, analytical and cost-effective advantages. Intensive monitoring for CMV infection allows for quick and specific detection of active CMV infection. This approach avoids resistance to ganciclovir. The method is simple and specific without expensive equipment. Avoidance of unnecessary prophylaxis adds to its cost-effectiveness.

[Recent findings regarding physiological characteristics and effects of renal dopamine]. / Novije spoznaje o fizioloskim svojstvima i ucincima bubreznog dopamina.

During the past decade, it has become evident that dopamine acts not only as a classical neurotransmitter in the central and peripheral nervous system but also as an autocrine, paracrine and/or endocrine substance in peripheral, non-neuronal tissues. This work is aimed to review some of the recent aspects related to the physiological features and effects of renal origin dopamine. Renal dopamine is synthesized in the proximal tubule epithelial cells. Newly formed dopamine leaves the cellular compartment by crossing the apical cell border and the basolateral membrane side. Dopamine exerts its intrarenal action via specific cell surface receptors, differentially expressed along the nephron and other structural components of renal tissue. These receptors have been classified into five types. D1 and D5 receptors are linked to stimulation, while D2, D3 and D4 receptors are linked to inhibition of adenylyl cyclase. Renal dopamine affects electrolyte and fluid balance by regulation of renal excretion of electrolytes and water through actions on renal hemodynamics and tubular, epithelial transport. The importance of intrarenally produced dopamine as a natriuretic hormone is reflected by its capacity to inhibit the majority of sodium transporters (Na+K+ATPase, Na+/H+-exchanger) in the entire nephron. Numerous clinical and animal, experimental observations suggest that dopamine coordinates the effects of antinatriuretic and natriuretic factors and indicate that the intact renal dopamine system is of major importance for maintenence of sodium homeostasis and systemic blood pressure. Sodium retention leads to an increase in renal dopamine tonus. This function is, due to deficient renal dopamine production and/or a D1 receptor G-protein coupling defect, lost in human essential hypertension and in some animal models of genetic hypertension. A better knowledge of molecular bases of these changes may contribute to the development of specific diagnostic and therapeutic approaches in essential as well as secondary forms of hypertension.

Predicting carotid restenosis by comparison of plaque MCP-1 mRNA expression and serum levels.

As cardiovascular pathology grows in numbers, research into the discovery of new chemokine biomarkers should not be neglected, as they seem to be paramount in atherosclerosis prevention and its early detection. Chemokines attract and activate leukocytes and are well recognized in the environment of inflammatory response. MCP-1 is a valuable chemokine whose potential to become a new crucial atherosclerosis marker is surely worth investigating. Since quantities of MCP-1 found in lesions are as low as immeasurable, we propose the use of an immunohistochemical method for the quantification of MCP-1 levels in atherosclerotic lesions. Additionally, serum levels of MCP-1 can be measured by commercially available immunoassays. Proposed MCP-1 concentration increase may explain the acceleration in lesion's atherosclerosis progression as chemokine activation occurs once they bind to specific ligands. If proven, this hypothesis would indicate the need for further studies in order to objectively link the increased MCP-1 expression with carotid restenosis.

Diagnostic accuracy of heart fatty acid binding protein (H-FABP) and glycogen phosphorylase isoenzyme BB (GPBB) in diagnosis of acute myocardial infarction in patients with acute coronary syndrome.

INTRODUCTION: This study aimed to assess whether heart fatty acid-binding protein (H-FABP) and glycogen phosphorylase isoenzyme BB (GPBB) could be used for the accurate diagnosis of acute myocardial infarction (AMI) in acute coronary syndrome (ACS) patients. MATERIALS AND METHODS: The study included 108 ACS patients admitted to a coronary unit within 3 h after chest pain onset. AMI was distinguished from unstable angina (UA) using a classical cardiac troponin I (cTnI) assay. H-FABP and GPBB were measured by ELISA on admission (0 h) and at 3, 6, 12, and 24 h after admission; their accuracy to diagnose AMI was assessed using statistical methods. RESULTS: From 92 patients with ACS; 71 had AMI. H-FABP and GPBB had higher peak value after 3 h from admission than cTnI (P = 0.001). Both markers normalized at 24 h. The area under the receiver operating characteristic curves was significantly greater for both markers in AMI patients than in UA patients at all time points tested, including admission (P < 0.001). At admission, the H-FABP (37%) and GPBB (40%) sensitivities were relatively low. They increased at 3 and 6 h after admission for both markers and decreased again after 24 h. It was 40% for H-FABP and approximately 2-times lower for GPBB (P < 0.01). In AMI patients, both biomarkers had similar specificities, positive- and negative-predictive values, positive and negative likelihood ratios, and risk ratios for AIM. CONCLUSION: H-FABP and GPBB can contribute to early AMI diagnosis and can distinguish AMI from UA.

C-reactive protein is a strong predictor of mortality in hemodialysis patients.

BACKGROUND: To establish the baseline cutoff value of C-reactive protein (CRP) that would predict increased overall and cardiovascular mortality in patients with end-stage renal disease (ESRD). METHODS: A cohort of 270 prevalent hemodialysis patients treated at Rijeka University Hospital was eligible for the study. Monthly CRP measurements were performed for three consecutive months. Only the patients with CRP values varying <20% were included (n=256). During the follow-up, 24 patients were transplanted and therefore excluded from the analysis. The CRP cutoff point of 6.2 mg/L was established by Receiver Operating Characteristic curve. The patients were divided into four groups according to their CRP values. Group 1 included 80 (34.5%) patients with CRP <3.0 mg/L, group 2 included 23 (9.9%) patients with CRP 3.0-6.1 mg/L, group 3 consisted of 18 (7.7%) patients with CRP 6.2-10.0 mg/L, and group 4 included 111 (47.9%) patients with CRP >10.0 mg/L. The survival was evaluated by Kaplan-Meier curve. RESULTS: During the two-year follow-up, 59 patients died. The major cause of death was cardiovascular disease (64%). Significantly higher overall and cardiovascular mortality was observed in group 3 when compared with groups 1 and 2 (chi2=11.97; P < 0.001) and in group 4 when compared with groups 1 and 2 (chi2=14.40; P<0.001). Compared with survivors, non-survivors had a higher median CRP value (19.0 [1.5-99.7] mg/L vs. 2.3 [0.1-49.1] mg/L, respectively; P<0.001). CONCLUSION: Serum concentration of CRP above 6.2 mg/L is a strong predictor of overall and cardiovascular mortality in patients with ESRD.