B-type natriuretic peptide levels normalise in preterm infants without a patent ductus arteriosus by the fifth postnatal day.

AIM: Few published reports have established B-type natriuretic peptide (BNP) levels in preterm infants without a patent ductus arteriosus (PDA). This study addressed that gap in our knowledge by establishing a reference range for BNP levels during the first two weeks of life in preterm infants without a PDA. METHODS: We enrolled 36 preterm infants between 24 and 32 weeks of gestation in this prospective, noninterventional study. Infants with a PDA, congenital heart disease, possible or confirmed sepsis and, or, meningitis, or perinatal depression requiring chest compressions were excluded. BNP levels were measured on postnatal days one, five, 10 and 15, with an echocardiogram on day five. Statistical analyses were performed using the ANOVA and Mann-Whitney U-tests. RESULTS: BNP levels were significantly higher on day one than on days five, 10 and 15, and there was no statistical difference between days five, 10 and 15. The levels were not statistically different between infants of less than and greater than 29 weeks of gestation. CONCLUSION: BNP levels were significantly elevated on postnatal day one in preterm infants without a PDA, but then decreased by day five and continued to stay low after that. Gestational age did not have an effect on BNP levels.

Oxidized-LDL/beta(2)-glycoprotein I complexes are associated with disease severity and increased risk for adverse outcomes in patients with acute coronary syndromes.

Oxidized low-density lipoprotein (oxLDL)/beta(2)-glycoprotein I (beta2GPI) complexes have been implicated in atherogenesis. oxLDL/beta2GPI complexes were measured in 339 patients with suspected acute coronary syndromes. Approximately 68% had angiographically documented coronary artery disease (CAD) and significantly higher mean + or - SD levels of oxLDL/beta2GPI (3.75 + or - 6.31 U/mL) than patients with normal coronary arteries (2.21 + or - 3.03 U/mL; P = .0026). Patients with severe CAD had significantly higher mean + or - SD levels of oxLDL/beta2GPI (8.71 + or - 12.87 U/mL) compared with the overall mean of 3.25 U/mL (P < .05) and a significantly higher rate (28.9%) of adverse events than the overall rate of 11.2% (P < .05). Patients with adverse events had higher mean + or - SD levels of oxLDL/beta2GPI (4.05 + or - 5.38 U/mL) than patients without adverse events (3.15 + or - 5.53; P = .029). The relative risk for adverse events in higher oxLDL/beta2GPI quartiles was 3.1 (95% confidence interval, 1.0-9.1; P = .06) for quartile 3 and 3.5 (95% confidence interval, 1.2-10.4; P = .02) for quartile 4. Our results support the concept that oxLDL/beta2GPI complexes are associated with severity of CAD and a 3.5-fold increased risk for adverse outcomes.

Newer antiphospholipid antibodies predict adverse outcomes in patients with acute coronary syndrome.

Antiphospholipid antibodies (aPLs) have been implicated in atherogenesis. We studied 344 patients with acute coronary syndromes; approximately 40% were aPL+ in 1 or more tests and 60% aPL-. In 215 patients, coronary artery disease (CAD) was angiographically documented, with 43.7% positive for aPL vs 34.9% of patients without CAD positive for aPLs. Anti-beta(2)-glycoprotein I (beta2GPI; 54%) and anti-oxidized low-density lipoprotein (oxLDL)/beta2GPI (48%) were most frequent, accounting for 87% of all aPL+ CAD cases. aPLs correlated with severity of CAD (P = .012). Adverse events occurred in 16.7% of patients with CAD, more frequently in patients who were aPL+ (P = .0006; relative risk, 2.9; 95% confidence interval, 1.5-5.6). Patients who were aPL+ with severe CAD had more adverse events than patients who were aPL- with severe CAD (P = .005) and aPL+ patients undergoing revascularization procedures (P = .001). Vascular events occurred in 21.7% of aPL+ patients compared with 7.1% of aPL- patients (P = .005). Anti-beta2GPI and anti-oxLDL/beta2GPI were associated with CAD severity and adverse outcomes.

Acute myocardial infarction as the presenting symptom of systemic lupus erythematosus.

We report a case of acute myocardial infarction due to non-antiphospholipid-related coronary artery thrombosis as the presenting manifestation of systemic lupus erythematosus in a young patient. We present the acute workup and the results of successful transcatheter coronary intervention. The causes of acute myocardial infarction and coronary artery thrombosis in pediatric patients are reviewed.

Antiphospholipid antibodies in patients with coronary artery disease: new cardiac risk factors?

Antiphospholipid antibodies (aPL) have been implicated in the pathogenesis of coronary artery disease (CAD). We evaluated the presence of aPL in patients with chest pain/acute coronary syndromes (ACS) to determine if aPL were associated with the presence and severity of CAD, adverse outcomes, and other coronary risk factors. Patients with chest pain/ACS were evaluated for aPL prior to diagnostic and therapeutic investigations. Coronary angiograms were graded according to the severity of disease. Risk factors, including family histories, were assessed and patients were followed for adverse outcomes. To date, 232 patients (116 M, 116 F, mean age 63 years) with a mean follow-up of 9 months were studied. Thirty-seven percent (86/232) were positive for one or more aPL. More women, 49/86 (57%), were aPL positive versus men, 37/86 (43%). The presence of aPL appeared associated with both presence and severity of CAD (P = 0.176 women; P = 0.163 men). In patients undergoing procedures (angioplasty, stent, bypass), aPL was significantly associated with both an increase in adverse cardiac outcomes (P = 0.045) and extracardiac thrombotic events (P = 0.033). Anti-beta2 glycoprotein-1 (abeta2GP1) was the most frequent aPL, occurring in 68.5% of aPL-positive patients with CAD. Anticardiolipin antibody (aCL) occurred in only 7.4%. IgM isotypes were the most frequent for all categories of aPL (range 55-90%). Family history of antiphospholipid syndrome (APS)-related events was more significant in aPL-positive than aPL-negative individuals (P = 0.027).

Late-onset Mycobacterium abscessus sepsis in a very low birthweight premature infant: diagnostic and therapeutic challenges.

Late-onset sepsis (after 3 days of life) is a frequent a complication found in very low birth weight (VLBW, 1000 to 1500 g) premature infants. We report the second case of late-onset sepsis caused by an uncommon pathogen, Mycobacterium abscessus.