RESUMEN
OBJECTIVES: We explored any possible difference in the percentage of CD4 + CD28null T cells between patients with ST-segment-elevation myocardial infarction (STEMI) and those with non-ST-segment-elevation acute coronary syndrome. DESIGN: We enrolled 55 consecutive patients admitted with acute coronary syndrome, and 16 healthy control subjects. CD4 + CD28null T cell percentage was assayed by flow cytometry from blood samples withdrawn at the time of enrollment. RESULTS: Mean age was 55.2 ± 10.8 years (69.1% males). Mean CD4 + CD28null T cell percentage was 5.9 ± 3.8% in the study cohort versus 0.8 ± 0.7% in controls (p < 0.001). Mean CD4 + CD28null T cell percentage was higher in patients presenting with non-ST-segment-elevation acute coronary syndrome versus those presenting with STEMI: 7.3 ± 4.1% versus 4.6 ± 3.1%, respectively (p = 0.008). Multivariable regression analysis identified the category of acute coronary syndrome as the only variable independently associated with CD4 + CD28null T cell percentage (p = 0.007). CONCLUSIONS: In patients presenting with acute coronary syndrome, the CD4 + CD28null T cell percentage was higher in patients with non-ST-segment-elevation acute coronary syndrome versus those with STEMI. The category of acute coronary syndrome was the only variable independently associated with the CD4 + CD28null T cell percentage in multivariable regression analysis.
Asunto(s)
Síndrome Coronario Agudo/inmunología , Antígenos CD28/análisis , Linfocitos T CD4-Positivos/inmunología , Infarto del Miocardio/inmunología , Síndrome Coronario Agudo/diagnóstico , Adulto , Anciano , Biomarcadores/análisis , Recuento de Linfocito CD4 , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Estudios Transversales , Femenino , Citometría de Flujo , Humanos , Inmunofenotipificación , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Infarto del Miocardio/diagnóstico , Fenotipo , Estudios Prospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: The assessment of patients with mitral stenosis before percutaneous balloon mitral valvuloplasty (PBMV) is crucial to predict outcome after the procedure. We tried to explore the prognostic power of a novel echocardiographic score to predict immediate postprocedural outcome in comparison to the standard score. METHODS: We enrolled 50 consecutive patients with moderate to severe mitral stenosis admitted to undergo PBMV. For all patients, we assessed both the standard Massachusetts General Hospital (MGH) score and a novel score based on calcification (especially commissural) and subvalvular involvement. Patients underwent PBMV with the double balloon technique. Thereafter, patients were classified into two groups: group 1 (poor outcome) defined as no procedural success and/or increase of MR by more than 1 grade and group 2 (optimal outcome) defined as procedural success with increase of MR by 1 grade or less. RESULTS: The total MGH score did not differ significantly between the two groups. However, among the individual parameters of the score, both calcification and subvalvular affection were significantly higher in group 1 versus group 2 (2.8 +/- 0.4 versus 1.7 +/- 0.8, and 2.4 +/- 0.5 versus 1.6 +/- 0.4, respectively, P < 0.01 for both). The total novel score and its two individual parameters (calcification and subvalvular involvement) were all significantly higher in group 1 versus group 2 (6 +/- 1.5 versus 2.9 +/- 1.9, 4.9 +/- 1.2 versus 2.4 +/- 1.5, 1.5 +/- 1.6 versus 0.5 +/- 0.9, respectively, P < 0.01 for all). Multivariate analysis demonstrated the novel score to be the only independent predictor of poor outcome. CONCLUSION: The novel score is more reliable and correlates with outcome better than the standard score.