Relationship between serum soluble suppression of tumorigenicity (ST) 2 and global longitudinal strain in early onset preeclampsia.

BACKGROUND: Preeclampsia is one of the leading causes of death in childbearing women worldwide. Hemodynamic changes in preeclampsia can trigger cardiac remodeling as indicated by increase of soluble-ST2 (sST2). Global longitudinal strain were able to detect systolic dysfunction better than the ejection fraction. This study aims to evaluate the correlation between serum levels of sST2 towards GLS in patients with early-onset preeclampsia. METHODS: This is a cross-sectional observational study with correlation analysis. Subjects were patients with severe preeclampsia with gestational age before 34 weeks at Dr. Hasan Sadikin Central General Hospital Bandung and Bandung Kiwari Regional General Hospital from June to August 2022. Examination of sST2 was carried out through blood samples using the ELISA method. sST2 was measured using Presage ST2 Assay reagent. GLS examination was carried out using speckle tracking technique with EchoPAC. Correlation analysis was conducted using the Pearson test if normally distributed, otherwise Spearman's correlation was conducted. Correlation analysis was followed by linear regression. RESULTS: A total of 30 patients met the inclusion criteria. The mean age was 30.83 ± 7.09, with 17 (56.7%) multiparous patients. The median sST2 was 145.75 ng/mL, and the median GLS was - 17.4%. Spearman correlation analysis showed that there was a significant positive correlation with moderate strength between sST2 and GLS (r = 0.583; p < 0.002). Linear regression showed that every 1 ng/ml increase in sST2 would give an increase in GLS of 0.014%. CONCLUSION: There is a significant correlation between sST2 and GLS in patients with early onset severe preeclampsia.

The pivotal role of compelling high-risk electrocardiographic markers in prediction of ventricular arrhythmic risk in arrhythmogenic right ventricular cardiomyopathy: A systematic review and meta-analysis.

INTRODUCTION: Several investigations have shown that existing risk stratification processes remain insufficient for stratifying sudden cardiac death risk in arrhythmogenic right ventricular cardiomyopathy (ARVC). Multiple auxiliary parameters are investigated to offer a more precise prognostic model. Our aim was to assess the association between several ECG markers (epsilon waves, prolonged terminal activation duration (TAD) of QRS, fragmented QRS (fQRS), late potentials on signal-averaged electrocardiogram (SA-ECG), T-wave inversion (TWI) in right precordial leads, and extension of TWI in inferior leads) with the risk of developing poor outcomes in ARVC. METHODS: A systematic literature search from several databases was conducted until September 9th, 2023. Studies were eligible if it investigated the relationship between the ECG markers with the risk of developing ventricular arrhythmic events. RESULTS: This meta-analysis encompassed 25 studies with a total of 3767 participants. Our study disclosed that epsilon waves, prolonged TAD of QRS, fQRS, late potentials on SA-ECG, TWI in right precordial leads, and extension of TWI in inferior leads were associated with the incremental risk of ventricular arrhythmias, implantable cardioverter-defibrillator shock, and sudden cardiac death, with the risk ratios ranging from 1.46 to 2.11. In addition, diagnostic test accuracy meta-analysis stipulated that the extension of TWI in inferior leads had the uppermost overall area under curve (AUC) value amidst other ECG markers apropos of our outcomes of interest. CONCLUSION: A multivariable risk assessment strategy based on the previously stated ECG markers potentially enhances the current risk stratification models in ARVC patients, especially extension of TWI in inferior leads.

The soluble suppression of tumorigenicity 2 as a biomarker of early cardiac remodeling in bradycardia patients receiving permanent pacemaker therapy.

Aim: This study aims to evaluate: the difference of soluble suppression of tumorigenicity 2 (sST2) level, a biomarker for cardiac remodeling and echocardiography parameters value prior to and 1 month after implantation; and the association between pacemaker parameters and pacemaker mode along with delta sST2 levels. Materials & methods: This prospective cohort study enrolled all symptomatic bradycardia patients aged >18 years with preserved ejection fraction who underwent permanent pacemaker (PPM) implantation. Results: A total of 49 patients were included in this study. The sST2 level (ng/ml) were significantly different between prior and 1 month following PPM implantation (23.4 ± 28.4 vs 39.9 ± 63.7; p = 0.001). Conclusion: The early cardiac remodeling has occurred within 1 month after PPM implantation as indicated by increasing delta sST2 level.

It is widely known that pacing induced cardiomyopathy, which results from the utilization of a permanent pacemaker (PPM) within a long-term duration, will increase the risk of mortality and morbidity. Hence, early detection of the cardiac remodeling process is warranted in order to prevent this course. In this study, the soluble suppression of tumorigenicity 2 level (ng/ml), known as an indicator of cardiac remodeling, was significantly higher in 1 month following PPM implantation compared with the baseline (23.4 ± 28.4 vs 39.9 ± 63.7; p = 0.001). Thus, it denotes that early cardiac remodeling might occur earlier than expected, within 1 month following PPM implantation.

Left Volume Atrial Index and P-wave Dispersion as Predictors of Postoperative Atrial Fibrillation After Coronary Artery Bypass Graft: A Retrospective Cohort Study.

Preoperative left atrial remodeling as Postoperative atrial fibrillation (POAF) predisposing factors could be measured by left atrial volume index (LAVI) and P-wave dispersion. This study aimed to assess P-wave dispersion and LAVI as preoperative predictors of POAF among patients who underwent Coronary Artery Bypass Graft (CABG). An analytical retrospective cohort study was performed on patients who underwent CABG. The P-wave dispersion and POAF were evaluated based on documented ECG results. LAVI size was collected from echocardiographic reports. Hazard ratios of P-wave dispersion and LAVI for POAF were analyzed using Cox proportional hazard model. A total of 42 subjects (57 ± 1 years) were included in this study. POAF occurred in 28.6% of patients at a median of 2 days after CABG. P-wave dispersion was significantly longer in patients in whom AF was developed (53.03 ± 3.82 ms vs 44.01 ± 1.98ms, p:0.028), while LAVI difference was not significant. The Cox proportional hazard model showed a significant association between P-wave dispersion and risk of POAF (HR 1.05, CI95%, 1.001-1.103; P = 0.048). There was no association between LAVI and risk of POAF (HR 1.003, CI 95%, 0.965-1.044; P = 0.864). P-wave dispersion is a predictor of POAF in patients who underwent CABG. Risk stratification using P-wave dispersion enables clinicians to identify high-risk patients before CABG surgery.

How Electronic Cigarette Affects the Vascular System.

The popularity of the electronic cigarette has soared in the last decades. However, the health effect of smoking electronic cigarettes on the vascular system is unclear. This systematic review examines the electronic cigarettes' effect on the vascular system from recent evidence. A systematic search was conducted in MEDLINE (PubMed) database from January 2016 to August 2021 for studies assessing the vascular effect of chronic use of electronic cigarettes on human and animal. The Cochrane Risk of Bias 2, NIH Quality Assessment for Cross-Sectional Study, and SYRCLE's Risk of Bias were used to assess the risk of bias in interventional, observational, and animal study, respectively. A narrative synthesis of evidence is provided to describe results. From 101 retrieved studies related to electronic cigarettes effect on the vascular system, a total of 16 studies are included in this review. The overall results indicated that electronic cigarette use is associated with adverse events in the vascular, including the incident of elevated oxidative stress, endothelial dysfunction, inflammation, arterial stiffness, and the development of atherosclerotic lesion. Further studies should broaden perspectives and reveal more about the mechanism of how electronic cigarettes impact on vascular system.

Case Series: Extracorporeal Shockwave Myocardial Revascularization Therapy Improves Ischemic Response, Functional Capacity, and Quality of Life in Indicated CABG-Stable Angina Pectoris Patients.

INTRODUCTION: Extracorporeal shockwave myocardial revascularization (ESMR) is included in the guidelines only for patients with refractory angina pectoris having no option for invasive revascularization. We intend to report a case series with ESMR therapy is indicated patients with coronary artery bypass grafting-stable angina pectoris (CABG-SAP) who refuse the surgery, irrespective of angina symptoms. METHODS: We review medical records of patients with SAP admitted to ESMR therapy in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia from January 2018 to December 2019. Recorded variables at baseline and after therapy extracted, namely, (1) ischemic response, double product, and (2) functional capacity measured as metabolic equivalent (MET) using treadmill test; (3) six-minute walking test distance achieved; and (4) quality of life using SF-36 Questionnaire. RESULTS: A total of four indicated patients with CABG-SAP from 50 to 75 years old were included in this study. At baseline, one patient is CCS class I and two patients are CCS class II with SDS ranging from 3 to 17. Ischemic response improved in all the patients. The double product improved in patient 1 9,600-14,872 mm Hg × bpm, patient 2 9,460-10,640 mm Hg × bpm, and patient 4 17,220-20,480 mm Hg × bpm. The functional capacity improved in Patient 1 8.07-8.91 METs, patient 2 1.91-4.01 METs, patient 3 3.45-6.39 METs, and patient 4 3.9-4.43 METs. The 6-min walking distance improved in patient 1 540-570 m and patient 2 345-405 m. The CCS class, bodily pain, and general health domain scores improved in all patients. CONCLUSION: ESMR therapy might be beneficial for indicated patients with CABG-SAP to improve ischemic response, functional capacity, and physical component of quality of life.

Differences in maternal soluble ST2 levels in the third trimester of normal pregnancy versus preeclampsia.

BACKGROUND: Preeclampsia is associated with intense inflammatory response in pregnancy, and soluble ST2 (sST2) is pathologically increased in this condition. No data exist regarding maternal sST2 levels in normal pregnancy versus preeclampsia in areas of southeast Asia with an ethnic Malay predominance. MATERIALS AND METHODS: Patients were sorted into normal pregnancy or preeclampsia. Patients with a history of allergic, inflammatory, or malignant disease were excluded. One sample was taken per patient; all samples were taken during the third trimester of pregnancy. Thirty samples from each group were enrolled in the study, totaling 60 samples. Soluble ST2 levels in maternal plasma were measured using the Presage® ST2 Assay according to manufacturer instructions, and data was analyzed using SPSS 23. RESULTS: Patients in the preeclampsia group were significantly older than those in the normal pregnancy group (p = 0.01). Most patients with preeclampsia presented as early-onset (n = 23). Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly higher (p < 0.001) in the preeclampsia group. Mean sST2 level in the preeclampsia group (85.89 ng/ml) was significantly higher than the normal pregnancy group mean (38.3 ng/ml) during the third trimester (p < 0.001). This study also found a correlation between sST2 and preeclampsia (p < 0.001, r = 0.480), SBP (p < 0.001, r = 0.407), and DBP (p = 0.007, r = 0.342), while preeclampsia was found to be the best explanatory variable of sST2 levels (r = 0.468, p < 0.001). sST2 level> 63.66 ng/ml has sensitivity 50% and specificity 93.3%, with AUC of 0.78 [95% CI 0.66 - 0.90], p < 0.001. The sST2 > 63.66 ng/ml has an OR of 14.0 [95% CI 2.82 - 69.6], p < 0.001 for preeclampsia. The dose-response relationship between sST2 level and preeclampsia was linear. CONCLUSION: Soluble ST2 levels were increased in both normal pregnancy and preeclampsia but were significantly higher in patients with preeclampsia. Preeclampsia was also found to be the best explanatory variable for the increase of sST2 levels in ethnic Malay predominance.

A case of endocarditis and spondylodiscitis associated with Mycobacterium tuberculosis.

Tuberculosis (TB) is a global health problem, in which the majority of cases occur in population-dense developing countries. Despite advances in various diagnostic TB modalities, extrapulmonary TB remains a challenge due to complexities related to its diagnostic approach. Hereby, we present a rare case of endocarditis and spondylodiscitis associated with Mycobacterium tuberculosis (MTB). This case report highlighted the challenges faced in diagnosing blood culture-negative infective endocarditis (BCNIE). We also emphasized the importance of considering MTB as etiology of BCNIE, particularly in endemic TB areas.

Cardiotoxicity by Anthracycline Regimen Chemotherapy Prolonged T Peak to T End Interval.

BACKGROUND: Myocardial necrosis may occur due to anthracycline (doxorubicin/adriamycin) chemotherapy usage. Furthermore, myocardial necrosis can affect the heterogeneity of heart conduction system and lead to repolarization abnormalities. The aim of this study was to investigate the effect of cardiotoxicity caused by anthracycline to repolarization abnormalities measured by T peak to T end (TpTe) interval. METHODS: This was a single center prospective cohort study with linear regression from October 2018 to May 2019. The subjects of the study were breast cancer patients after completing administration of chemotherapy with fluorouracil, adriamycin and cyclophosphamide (FAC) regimen (containing anthracycline) for 6 months. Myocardial necrosis was assessed by high sensitive (hs)-troponin I, and the heterogeneity of repolarization was measured by TpTe interval. RESULTS: This study involved 25 breast cancer patients after chemotherapy in the 6-month FAC regimen. The mean age is 46 ± 7 years, and the cumulative dose of anthracycline is 591 ± 52 mg/m2. The mean level of hs-troponin I is 90.5 ± 44.7 ng/L and the TpTe interval is 108.2 ± 10 ms. The results of linear regression analysis showed a positive correlation between hs-troponin I and TpTe interval (r: 0.421, P: 0.036) after controlling for one confounding variable (cumulative dose of anthracycline). CONCLUSIONS: Cardiotoxicity caused by accumulative dose of anthracycline may lead to myocardial necrosis which was shown by elevated hs-troponin I levels. This process may lead to heterogeneity conduction system that affect the repolarization phase of cardiac cycle which was shown by increased TpTe interval.