Prognostic performance of troponin in COVID-19: A diagnostic meta-analysis and meta-regression.

BACKGROUND: Cardiac injury is frequently encountered in patients with coronavirus disease 2019 (COVID-19) and is associated with increased risk of mortality. Elevated troponin may signify myocardial damage and is predictive of mortality. This study aimed to assess the prognostic value of troponin above the 99th percentile upper reference limit (URL) for mortality, and factors affecting the relationship. METHODS: A comprehensive literature search of PubMed (MEDLINE), Scopus and Embase was undertaken, from inception of the databases until 16 December 2020. The key exposure was elevated serum troponin, defined as troponin (of any type) above the 99th percentile URL. The outcome was mortality due to any cause. RESULTS: In total, 12,262 patients from 13 studies were included in this systematic review and meta-analysis. The mortality rate was 23% (20-26%). Elevated troponin was observed in 31% (23-38%) of patients. Elevated troponin was associated with increased mortality [odds ratio (OR) 4.75, 95% confidence interval (CI) 4.07-5.53; P < 0.001; I2 = 19.9%]. Meta-regression showed that the association did not vary with age (P = 0.218), male gender (P = 0.707), hypertension (P = 0.182), diabetes (P = 0.906) or coronary artery disease (P = 0864). The association between elevated troponin and mortality had sensitivity of 0.55 (0.44-0.66), specificity of 0.80 (0.71-0.86), positive likelihood ratio of 2.7 (2.2-3.3), negative likelihood ratio of 0.56 (0.49-0.65), diagnosis odds ratio of 5 (4-5) and area under the curve of 0.73 (0.69-0.77). The probability of mortality was 45% in patients with elevated troponin and 14% in patients with non-elevated troponin. CONCLUSION: Elevated troponin was associated with mortality in patients with COVID-19 with 55% sensitivity and 80% specificity.

Left and right ventricular longitudinal strains are associated with poor outcome in COVID-19: a systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis aimed to assess whether ventricular longitudinal strain can be used as a prognostication tool in patients with coronavirus disease 2019 (COVID-19). METHODS: Systematic literature searches of PubMed, Embase, and EuropePMC databases were performed on 16 November 2020. Left ventricular global longitudinal strain (LV-GLS) refers to LV contraction measurement using the speckle tracking-based method refers to the mean of strain values of the RV free wall (three segments) measured using echocardiography. The main outcome was poor outcome, defined as a composite of mortality and severe COVID-19. RESULTS: Seven studies comprising of 612 patients were included in meta-analysis. Six studies have mortality as their outcome, and 1 study has severity as their outcome. Patients with poor outcome have lower LV-GLS (SMD 1.15 (0.57, 1.72), p < 0.001; I2 70.4%). Each 1% decrease in LV-GLS was associated with 1.4x increased risk of poor outcome (OR 1.37 (1.12, 1.67), p = 0.002; I2 48.8%). Patients with poor outcome have lower RV-LS (SMD 1.18 (0.91, 1.45), p < 0.001; I2 0%). Each 1% decrease in RV-LS was associated with 1.3x increased risk of poor outcome (OR 1.25 (1.15, 1.35), p < 0.001; I2 11.8%). Subgroup analysis showed that for every 1% decrease in LV-GLS and RV-LS is increased mortality with OR of 1.30 (1.12, 1.50) and OR of 1.24 (1.14, 1.35), respectively. CONCLUSION: This study shows that lower LV-GLS and RV-LS measurements were associated with poor outcome in patients with COVID-19. TRIAL REGISTRATION: PROSPERO CRD42020221144.

A novel de novo mutation in Lamin A/C gene in Emery Dreifuss Muscular Dystrophy patient with atrial paralysis.

We present a 26 year old female Indonesian patient with full spectrum Emery Dreifuss Muscular Dystrophy (EDMD) characterized with contracture of elbows, heel cord and pelvic muscle wasting and weakness and atrial paralysis, as rare cardiac findings in EDMD . A novel de novo pathogenic heterozygous missense mutation (NM_170707.3: c.122G>T, p.Arg41Leu) in exon 1 was detected. Preventing atrial paralytic patients from systemic embolism is important. Early diagnosis, intervention, targeted management and counseling are necessary for a better health and life quality of individuals with EDMD.

Endothelial dysfunction in the young adult: a retrospective cohort study on the effect of low birth weight.

AIM: to investigate the effect of low birth weight (LBW) on endothelial function, and to determine the role of plasma adiponectin in endothelial dysfunction by conducting flow mediated brachial artery (FMBA) test or vasodilation response (VR) and by measuring plasma asymmetrical dimethylarginine (ADMA) of young adults born with LBW. METHODS: in a retrospective cohort study, subjects were randomly selected from the growth study cohort of Tanjungsari Sumedang district West Java. They consisted of 67 LBW and 67 NBW (Normal Birth Weight) young adults. Dependent variables were plasma adiponectin, plasma ADMA, and VR. The correlation between plasma adiponectin and ADMA level was examined using Pearson's correlation. RESULTS: the relative risk for LBW to have low brachialis artery vasodilation response was 2.94, (95% CI:1.91-4.53), and to have low of plasma adiponectin concentration 1.53, (95% CI: 1.07-2.18). There was a statistically significant difference for all variables studied (FMBA, plasma ADMA, and plasma Adiponectin concentrations), while simultaneous confidence interval measurements indicated that the value of FMBA and the concentration of plasma adiponectin were significantly lower, respectively p<0.001, 95% CI: -4.409-(-2.114), and p=0.015, 95% CI: -1.083-(-0.082) in LBW compared to NBW subjects. The correlation between plasma adiponectin concentration and plasma ADMA concentration in LBW subjects was not significant. CONCLUSION: there is an effect of LBW on endothelial function. LBW compared to NBW subjects have lower VR and plasma adiponectin concentration. There may be a small role of plasma adiponectin in endothelial dysfunction of young adults with LBW.

Comparison of pro B-natriuretic peptide in hypertensive patients with and without diastolic dysfunction.

AIM: to evaluate whether pro BNP can be used for detection of diastolic dysfunction. METHODS: thirty nine hypertensive patients with normal systolic function, consecutively referred for echocardiography examination between October and December 2004 were recruited in the study. Diastolic dysfunction was diagnosed when echocardiographic mitral flow pattern demonstrated impaired relaxation, pseudonormalization or restrictive like patterns. NT-pro BNP levels were assessed using electro chemiluminescence Immunoassay (ECLIA) method. Unpaired t test was used to analyze the results. RESULTS: twelve out of thirty nine subjects had normal diastolic function. All base line characteristics, except for uric acid, were equally distributed between normal and abnormal diastolic function group. NT-pro BNP levels were nearly significantly higher in the diastolic dysfunction group (P=0.053). CONCLUSION: NT-pro BNP levels trends to be higher in hypertensive subjects with diastolic dysfunction.