[Troponin T in acute myocardial infarction. Diagnosis and prognosis in patients admitted for suspected acute myocardial infarction]. / Troponin T ved akut myokardieinfarkt. Diagnostik og prognostik hos patienter indlagt til observation for akut myokardieinfarkt.

Cardiac troponin T (TnT) is a new serological marker for use as a diagnostic tool for myocardial damage. A blinded prospective multicentre study representing 298 patients who on admission were suspected of acute myocardial infarction (AMI) to the coronary care units of six Scandinavian hospitals was undertaken to assess the diagnostic performance and prognostic efficacy of a new cardiospecific TnT immunoassay. We used a discriminator value of TnT of 0.20 micrograms/l. One hundred and fifty-five patients (52%) had definite AMI, based on WHO criteria (all had peak S-TnT values > or = 0.20 micrograms/l); 127 patients (43%) had ischaemic heart disease (IHD) without AMI; and 16 patients (5%) had non-IHD (all had peak S-TnT values < 0.20 micrograms/l). The 127 IHD-patients without definite AMI could be subdivided into a group of 44 patients with S-TnT peak values > or = 0.20 micrograms/l, and a group of 83 patients with TnT below this level. A follow-up study was able to define the clinical significance of these findings. The cumulative six months probability of suffering cardiac death or AMI was significantly higher in the subgroup with increased TnT values (14% (6/44)) as compared to the other subgroup (4% (3/83)) (Log-rank test, p = 0.025). The probability of cardiac events was 15% for the patients with definite AMI. We conclude that increased troponin T in serum can detect a subgroup of IHD-patients in whom AMI has been ruled out, but who still have a prognosis as serious as that of patients with definite AMI.

Diagnostic performance and prognostic value of serum troponin T in suspected acute myocardial infarction.

Cardiac troponin T (TnT) is a new serological marker for use as a diagnostic tool for myocardial damage. A blinded prospective multicentre study representing 298 patients suspected of having acute myocardial infarction (AMI), and admitted to the coronary care units of six Scandinavian Hospitals was undertaken to assess the diagnostic performance and prognostic efficacy of a new cardiospecific TnT immunoassay. We used a discriminator TnT value of 0.20 microgram l-1. One hundred and fifty five patients (52%) had definite AMI, based on WHO criteria (all had peak S-TnT values of > or = 0.20 micrograms l-1); 127 patients (43%) had ischaemic heart disease (IHD) without AMI; and 16 patients (5%) had non-IHD (all had peak S-TnT values of < 0.20 microgram l-1). The 127 IHD-patients without definite AMI could be subdivided into a group of 44 patients with S-TnT peak values of > or = 0.20 microgram l-1, and a group of 83 patients with TnT below this level. An equal identification of these patients among the centres was seen (mean +/- SD 35 +/- 13%; range 20-55%). A follow-up study was able to define the clinical significance of these findings. The cumulative 6 months probability of suffering cardiac death or AMI was significantly higher in the subgroup with increased TnT values (14% (6/44)) as compared to the other subgroup (4% (3/83)) (Log-rank test, p = 0.025). The probability of cardiac events was 15% for the patients with definite AMI.(ABSTRACT TRUNCATED AT 250 WORDS)

Biochemical markers for myocardial infarction used in combination with clinical decision limits. Influence of S-myoglobin on the predictive values.

To predict the development of an acute myocardial infarction (AMI) in a patient with chest pain or other symptoms compatible with myocardial infarction is a difficult clinical problem. In this study of 927 consecutive patients with a suspected AMI symptoms selected by the Multicenter Chest Pain Study Group were tested. An equation was constructed based on five of the most significant variables found. In a subgroup of 305 patients the additional value of S-Myoglobin was tested and found to be valuable for the decision of further handling of the patient with suspected AMI.

Hyperhomocysteinaemia in stroke: prevalence, cause, and relationships to type of stroke and stroke risk factors.

Moderate hyperhomocysteinaemia is a frequent finding in atherothrombotic cerebrovascular disease. This study confirms and extends this observation. Hyperhomocysteinaemia was present in 57 of 142 survivors with stroke (40%) and in four of 66 controls (6%). Plasma homocysteine concentrations were increased not only in carotid artery disease or lucunar stroke but also in haemorrhagic or embolic strokes. Homocysteine values were unrelated to the presence of hypertension, smoking, or hypercholesterolaemia, or to the concentrations of blood glucose, glycosylated haemoglobin, and plasma fibrinogen. Multiple regression analysis of the patient data showed that about 40% of the variation in plasma homocysteine concentrations could be predicted by the values for the homocysteine metabolism cofactors, blood folate and plasma pyridoxal 5-phosphate and by renal function as reflected in the values for serum creatinine. In patients, urine excretion of homocysteine per unit creatinine was significantly increased and strongly correlated both to the plasma homocysteine concentration and to the values for blood folate, plasma pyridoxal 5-phosphate, and serum vitamin B12. We conclude that moderate hyperhomocysteinaemia is frequently present in cases of stroke, is independent of other stroke risk factors or the type of stroke, and is partly related to renal function and the concentrations of homocysteine metabolism cofactors.

Plasma homocysteine before and after methionine loading with regard to age, gender, and menopausal status.

Homocysteine is a probably atherogenic amino acid, the fasting and post-methionine load serum concentrations of which have been reported to be much lower in premenopausal women than in men and postmenopausal women. This difference has been proposed to explain the reduced proneness of premenopausal women to vascular disease. We measured both free and total plasma homocysteine concentrations both fasting and post-methionine load, in 169 healthy subjects. Twelve subjects (7%) had distinctly abnormal plasma homocysteine values. Among the remaining 157 subjects, neither fasting nor post-load values of free or total homocysteine were lower in premenopausal women (n = 46) than in men of similar age (n = 41) or postmenopausal women (n = 37). Fasting but not post-load values were lower in postmenopausal women than in men of similar age (n = 33), and lower among the women as a whole (n = 83) than among the men (n = 74). In men, fasting values increased with age, and paralleled age-related decreases in the concentrations of homocysteine metabolism cofactors (serum vitamin B12, blood folate, and plasma pyridoxal 5-phosphate). Both in men and in women, fasting total plasma homocysteine values were significantly and negatively correlated to serum vitamin B12 and blood folate concentrations. Whether the small differences in plasma homocysteine values between the present men and women may be a contributory factor vis-à-vis their different proneness to vascular disease has yet to be settled.

Eighty-year-old men without cardiovascular disease in the community of Malmö. Part II. Smoking characteristics and ultrasound findings, with special reference to glutathione transferase and pyridoxal-5-phosphate.

A total of 1280 80-year-old men in the community of Malmö were questioned about smoking habits and the occurrence of cardiovascular disease (CVD). After a careful medical and duplex ultrasound examination, four groups were selected for further studies: (1) no CVD, non-smokers: (2) no CVD, smokers: (3) CVD, smokers: (4) CVD, non-smokers. In total 122 individuals participated. The average tobacco consumption by smokers was 13 g d-1 for 59 years. In the CVD group 45% of subjects had atherosclerotic symptoms at more than one site. Smoking was found to be correlated with lower extremity atherosclerosis, cholesterol and LDL cholesterol were correlated with carotid artery lesions and pathological ankle/arm index, and blood pressure was correlated with lower extremity lesions. In contrast with middle-aged populations, individuals with an increasing degree of lesions in the lower extremities had a larger percentage of high glutathione transferase activity than subjects without CVD. Smokers had significantly lower pyridoxal-5-phosphate levels than non-smokers. It is concluded that some heavy smokers might reach an advanced age in good health. Smoking was also operative as a risk indicator for lower extremity atherosclerosis in 80-year-old individuals.

Impaired homocysteine metabolism in early-onset cerebral and peripheral occlusive arterial disease. Effects of pyridoxine and folic acid treatment.

Severe homocysteinemia due to genetic defects either of pyridoxal 5-phosphate (PLP)-dependent cystathionine beta-synthase (CBS) or of enzymes in vitamin B12 and folate metabolism is associated with very early-onset vascular disease. Therefore, we studied homocysteine metabolism in 72 patients presenting before the age of 55 years with occlusive arterial disease of cerebral, carotid, or aorto-iliac vessels. Twenty patients (28%) had basal homocysteinemia; and 26 patients (36%) had abnormal increases of plasma homocysteine after peroral methionine loading, which exceeded the highest value for 46 comparable controls and was within the range for 20 obligate heterozygotes for homocystinuria due to CBS deficiency. Basal plasma homocysteine content was strongly and negatively correlated to vitamin B12 and folate concentrations. Plasma PLP was depressed in most patients but there was no correlation between PLP and homocysteine values. In 20 patients, treatment with pyridoxine hydrochloride (240 mg/day) and folic acid (10 mg/day) reduced fasting homocysteine after 4 weeks by a mean of 53%, and methionine response by a mean of 39%. These data show that a substantial proportion of patients with early-onset vascular disease have impaired homocysteine metabolism, which may contribute to vascular disease, and that the impaired metabolism can be improved easily and without side effects.

Use of biochemical tests for myocardial infarction in the county of Västernorrland, a clinical chemistry routine for the diagnosis of myocardial infarction.

A study of 116 patients admitted on the suspicion of myocardial infarction is presented. Twenty three of the patients were found to have infarction. For the diagnosis of infarct the most reliable biochemical analyses at present appear to be serum creatine kinase (S-CK, E.C.2.7.3.2.) with its isoenzyme S-CKMB and serum lactate dehydrogenase (S-LD, E.C.1.1.1.27.) with its isoenzyme S-LD-1. If an organization with blood samples at fixed intervals after the appearance of symptoms could be arranged, this would be most recommendable. In many hospitals this is, however, difficult and the blood samples have to be drawn at specified hours. In the four hospitals in the county of Västernorrland, Sweden, this latter procedure has been introduced. Blood is drawn at the arrival of the patient, at 8 am and 8 pm the first day, and at 8 am the next two days of the stay in hospital. In the first two samples S-CK and S-LD are determined, in the third S-CK, in the fourth S-CK and S-LD and in the fifth S-CK. If the values are elevated, S-CKMB and S-LD-1 are determined. S-Myoglobin has been found valuable in the early exclusion of the diagnosis of infarction.

Plasma pyridoxal phosphate levels in newborn infants, their mothers and in the mothers' breast milk.

Plasma pyridoxal phosphate (PLP) was determined in 10 newborn infants (two pairs of twins), their 8 mothers, and in addition in the mothers' breast milk. Mothers who did not take extra vitamin B-6 during pregnancy had lower levels of PLP both in plasma and in their milk. The infants' PLP decreased during the first two weeks of life when receiving only their mothers' milk. None of the mothers nor the infants showed any clinical signs of vitamin B-6 deficiency.

A simplified method for determination of pyridoxal phosphate in biological samples.

A new method for the determination of pyridoxal phosphate in plasma and in cerebrospinal fluid is described. It is based on the generally accepted apotyrosine decarboxylase method, but, in stead of following the decarboxylation rate using 14C- och 3H-labelled tyrosine, a high performance liquid chromatography (HPLC) method for separation of tyrosine and tyramine is used. This procedure is recommended as it is less time consuming and avoids utilizing radioactive material.

Parathyroid hormone and calcitonin in diabetes mellitus.

Forty patients with diabetes mellitus and a reference group of forty-five healthy controls have been studied. Significantly increased serum concentrations of parathyroid hormone and calcitonin were found in the diabetics as well as increased levels of alkaline phosphatase activity and phosphate independent of the duration of the diabetic state. No difference was found in serum calcium levels when compared with the healthy controls. Since these results cannot be explained by diabetes nephropathy an altered balance between parathyroid hormone and calcitonin in diabetes mellitus is postulated.

Studies on the efficacy and adrenal effects of Diprolene ointment 0.05 percent and Dermovate ointment 0.05 percent in patients with psoriasis or other resistant dermatoses.

The efficacy of Diprolene ointment 0.05 percent (betamethasone dipropionate in a glycol formulation) and Dermovate ointment 0.05 percent (clobetasone propionate) and their effects on adrenal function were evaluated in two double-blind, parallel group studies. A fixed dose of 7 gm of ointment a day was applied topically for fourteen days (Study 1) or twenty-one days (Study 2) to the skin of patients with psoriasis or other resistant dermatoses. To evaluate the adrenal effect of the treatments, plasma cortisol levels were determined for twenty of the sixty-one patients in Study 1 and for all of the twenty patients in Study 2. Efficacy and adverse experience data were evaluated for all patients. At the initial visit and at weekly follow-up visits, the selected lesions were graded for the severity of the signs and symptoms of disease. Most of the patients in these studies experienced a complete clearing of all the signs and symptoms of their disease by the end of the treatment with either Diprolene or Dermovate. The two treatments were equally effective. No adverse experiences were seen in the Diprolene group, but one patient with psoriasis in the Dermovate group had an exacerbation of the disease and the treatment was discontinued. In Study 1, reduction in plasma cortisol levels during treatment was observed in both groups, but to a distinctly lesser degree in the Diprolene than in the Dermovate group; levels below the normal range (184 to 767 nmol/l) were observed in one patient in the Diprolene group and in four patients in the Dermovate group.(ABSTRACT TRUNCATED AT 250 WORDS)

Pyridoxal phosphate, tryptophan, and tyrosine in blood and cerebrospinal fluid in elderly patients.

In a material of 74 elderly patients with cerebral symptoms, most of them on account of atherosclerosis, deficiency of pyridoxal phosphate is uncommon: only ten had extremely low plasma levels. Nine of the patients had rather high levels of serum tryptophan. This might depend upon poor metabolization when pyridoxal phosphate is available in insufficient supply. In addition mean values are given for tryptophan, tyrosin and serotonin in this group of patients.

Plasma pyridoxal phosphate in women taking oral contraceptives since at least five years.

PIP: This study was aimed at assessing the need for vitamin B6 in users of oral contraceptives (OCs). There is concern that OC use may alter the function of pyridoxal phosphate (Pal-P) as a co-enzyme in the niacintryptophan pathway. Plasma-Pl was determined in 290 healthy OC users, 275 of whom had been taking OCs for more than 5 years. The normal range is 20-60 nmol/1. Of the 275 longterm OC users, 25 (9%) had Pal-P values below 10 nmol/1 and 117 (43%) had values below 20 nmol/1; 9 had levels above 60 nmol/1. There was no correlation between Pal-P levels and oral glucose tolerance test results. In addition, Pal-P values were determined at onset of OC use, after 3 months, and again after 6 months in the 15 subjects who were not longterm users. 3 of these women showed decreasing values to below normal limits. These results suggest that a minority of women do develop low levels of Pal-P as a result of longterm OC use. Thus, it is recommended that longterm users be advised to increase their comsumption of pyridoxin-rich foods or take vitamin B6 supplements.^ieng

Pyridoxal phosphate concentration in blood in newborn infants and their mothers compared with the amount of extra pyridoxol taken during pregnancy and breast feeding.

The concentrations of pyridoxal phosphate have been estimated in cord blood and capillary blood samples taken at 3 hours, 2 days, 4 days, 7 days and 6 weeks of age, from eleven full-term infants. Pyridoxal phosphate concentrations were also determined in venous blood samples taken from the mothers at delivery. A highly significant correlation between pyridoxal phosphate in cord whole blood and venous whole blood taken from the mothers at delivery was found. Infants whose mothers had taken extra pyridoxol during pregnancy had a higher concentration of pyridoxal phosphate at 3 hours of age compared with infants whose mothers had not taken extra pyridoxol. During the first week of life the concentrations of pyridoxal phosphate in capillary blood decreases strikingly. At 6 weeks of age the concentration of pyridoxal phosphate is in the same range as that of normal adults. Findings are also discussed which indicates that: 1) Vitamin B6 is transported in breast milk; 2) The giving of supplemental pyridoxol during pregnancy in ordinary doses (2-6 mg/day) does not have an antilactogenic effect. No correlation between the erythrocyte aspartate aminotransferase activation with pyridoxal phosphate in vitro and pyridoxal phosphate concentration in plasma was found during the first 6 weeks of life.