The role of Tei index added to the GRACE risk score for prediction of in-hospital MACE after acute myocardial infarction.

Introduction: The Global Registry of Acute Coronary Events (GRACE) risk score is widely recommended for risk assessment in patients with acute myocardial infarction (AMI). Variable degrees of impairment in left ventricular (LV) systolic and diastolic function might be found after AMI. Tei index is an echocardiography parameter that represents both systolic and diastolic LV performance. Previous studies demonstrate Tei index as an independent predictor of Major Adverse Cardiovascular Events (MACE) after AMI. This study investigates whether the addition of Tei index could improve the GRACE risk score performance to predict inhospital MACE after AMI. Methods: A prospective cohort study was conducted on 75 patients who presented with AMI. Total GRACE score was calculated on patient admission and echocardiography was conducted within 72 hours of hospitalization for measurement of MPI. All patients were observed for the incidence of MACE during hospitalization. The incremental predictive value of the GRACE risk score alone and combined with Tei index was assessed by the change in area under the curve (AUC) by DeLong's method, likelihood ratio test (LRT), and continuous net reclassification improvement (cNRI). Results: The addition of Tei index to the GRACE risk score significantly improves the predictive value of the GRACE risk score (increase in AUC from 0.753 for the GRACE risk score to 0.801 for the GRACE score combine with Tei index, p=0.354; LRT=4.65, p=0.030; cNRI=0.515, p=0.046). Conclusions: Adjustment of Tei index to GRACE risk score might improve risk prediction of in-hospital MACE after AMI.

Usefulness of Reticulocyte Hemoglobin Equivalent in Management of Regular Hemodialysis Patients with Iron Deficiency Anemia.

INTRODUCTION: Reticulocyte hemoglobin equivalent (RET-He) is a new parameter for evaluating iron status. This study aims to assess diagnostic value and investigate RET-He as early predictor of response to intravenous iron supplementation. METHODS: Seventy-two regular hemodialysis patients at Adam Malik Hospital were studied from April to May 2011. RET-He was compared with conventional iron parameters for identification of iron deficiency. Fifteen patients with iron deficiency anemia were selected to receive 100 mg iron sucrose intravenous during every dialysis session (2x/weeks) for 4 weeks. RESULTS: Receiver operating characteristic (ROC) curve for RET-He revealed the value of area under the curve was 0.818 (p < 0.0001). Using cutoff level 31.65 pg, RET-He showed 81.5% sensitivity and 61.6% specificity. Serum ferritin (r = 0.499, p < 0.0001) and transferrin saturation/ TSAT (r = 0.592, p < 0.0001) were correlated to RET-He. Significant improvement in hemoglobin, hematocrit and RET-He were found after intervention (p = 0.023, p = 0.049 and p = 0.019, respectively). CONCLUSION: RET-He is a useful marker of iron deficiency and early predictor of response to intravenous iron supplementation in regular hemodialysis patients.