Fibroblast Growth Factor 23: Potential Marker of Invisible Heart Damage in Diabetic Population.

Two-dimensional speckle-tracking echocardiography (2DSTE) detects myocardial dysfunction despite a preserved left ventricular ejection fraction. Fibroblast growth factor 23 (FGF23) has become a promising biomarker of cardiovascular risk. This study aimed to determine whether FGF23 may be used as a marker of myocardial damage among patients with diabetes mellitus type 2 (T2DM) and no previous history of myocardial infarction. The study enrolled 71 patients with a median age of 70 years. Laboratory data were analyzed retrospectively. Serum FGF23 levels were determined using a sandwich enzyme-linked immunosorbent assay. All patients underwent conventional echocardiography and 2DSTE. Baseline characteristics indicated that the median time elapsed since diagnosis with T2DM was 19 years. All subjects were divided into two groups according to left ventricular diastolic function. Individuals with confirmed left ventricular diastolic dysfunction had significantly lower levels of estimated glomerular filtration rate and higher values of hemoglobin A1c. Global circumferential strain (GCS) was reduced in the majority of patients. Only an epicardial GCS correlated significantly with the FGF23 concentration in all patients. The study indicates that a cardiac strain is a reliable tool for a subtle myocardial damage assessment. It is possible that FGF23 may become an early diagnostic marker of myocardial damage in patients with T2DM.

2D Strain Analysis in Myocarditis-Can We Be Any Closer to Diagnose the Acute Phase of the Disease?

BACKGROUND: The aim of present study was to assess left ventricular myocardial deformation detected by 2D STE in patients with suspected acute myocarditis (AM) early on admission in whom later cardiac magnetic resonance (CMR) evaluation was performed. METHODS: A total of 47 patients with suspected AM based on clinical practice were prospectively enrolled. Coronary angiography was performed on all patients to rule out significant coronary artery disease. CMR confirmed myocardial inflammation, oedema, and regional necrosis meeting the Lake Louise criteria in 25 patients (53%, oedema (+) subgroup). In the remaining patients, only LGE was confirmed in the sub-epicardial or intramuscular localization (22 patients, 47%, oedema (-) subgroup). Early on admission, echocardiography with measurements of global and segmental longitudinal strains (GLS), circumferential strains (GCS) at the endocardial (endocardial GCS) and epicardial (epicardial GCS) layers, transmural GCS, and radial strains (RS) were performed. RESULTS: Mild reduction of GLS, GRS, and transmural GCS values were found in patients with oedema (+) subgroup. The epicardial GCS turned out to be the diagnostic factor for oedema with a cut-off point of 13,0% (AUC 0.747, p = 0.0005). Twenty-two patients (all but three) with an acute phase of myocarditis and epicardial GCS -13.0% or less had oedema confirmed by CMR. CONCLUSIONS: 2D STE can help to set the diagnosis of AM in patients with acute chest pain with a normal coronary angiogram. The epicardial GCS can serve as a diagnostic factor for oedema in patients with early stage of AM. In patients presenting with signs of AM (oedema in CMR), the epicardial GCS is modified in comparison with a subgroup without oedema; therefore, this parameter could be used to improve the performance of ultrasound.

Acute coronary syndrome versus acute myocarditis in young adults-value of speckle tracking echocardiography.

PURPOSE: Comparing myocarditis with an acute coronary syndrome (ACS)-like presentation and acute myocardial infarction (AMI) poses an important clinical challenge. The purpose of the study was to investigate the diagnostic value of the clinical, laboratory and especially echocardiographic characteristics including speckle tracking echocardiography (STE) of patients with ACS-like myocarditis and AMI. METHODS: We conducted a retrospective analysis comparing 69 symptomatic patients (≤ 45 years old), hospitalized at the Department of Interventional Cardiology (Medical University of Lodz, Poland) between April 2014 and June 2021 with an initial diagnosis of ST-segment elevation myocardial infarction. RESULTS: 37 patients with the cardiac magnetic resonance-confirmed acute myocarditis and 32 patients diagnosed with AMI based on the clinical presentation, electrocardiogram and the presence of a culprit lesion on the coronary angiography were analysed including echocardiography parameters. On STE analysis an average global longitudinal (GLS), radial and circumferential strain including three-layers observation were significantly lower (absolute value) in patients with AMI versus acute myocarditis (p<0.05). There was no significant difference in Endo/Epi ratio (p = 0.144) between the groups. An average GLS < (-17.5) represented the optimal cut-off value for the myocarditis diagnosis. CONCLUSION: In patients with AMI a significant reduction of global and three-layers strains compared to patients with myocarditis was detected. Furthermore, our analysis also confirmed the discriminative pattern of myocardial injury between the groups.

Fibroblast Growth Factor 23 and Cardiovascular Risk in Diabetes Patients-Cardiologists Be Aware.

Numerous clinical studies have indicated that elevated FGF23 (fibroblast growth factor 23) levels may be associated with cardiovascular (CV) mortality, especially in patients with chronic kidney disease. The purpose of this study was to examine the hypothesis that FGF23 may be a potent CV risk factor among patients with long-standing type 2 diabetes mellitus (T2DM). Research was performed utilizing patients with T2DM and regular outpatient follow-up care. Baseline characteristics determined by laboratory tests were recorded. Serum FGF23 levels were detected using a sandwich enzyme-linked immunosorbent assay. All patients underwent echocardiograms and 12-lead electrocardiograms. Data records of 102 patients (males: 57%) with a median age of 69 years (interquartile range (IQR) 66.0-74.0) were analyzed. Baseline characteristics indicated that one-third (33%) of patients suffered from ischemic heart disease (IHD), and the median time elapsed since diagnosis with T2DM was 19 years (IQR 14.0-25.0). The hemoglobin A1c, estimated glomerular filtration rate, and FGF23 values were, respectively, as follows: 6.85% (IQR 6.5-7.7), 80 mL/min/1.73 m2 (IQR 70.0-94.0), and 253.0 pg/mL (IQR 218.0-531.0). The study revealed that FGF23 was elevated in all patients, regardless of IHD status. Thus, the role of FGF23 as a CV risk factor should not be overestimated among patients with T2DM and good glycemic control.

Symptomatic Young Adults with ST-Segment Elevation-Acute Coronary Syndrome or Myocarditis: The Three-Factor Diagnostic Model.

Myocarditis may mimic myocardial infarction (MI) due to a similar clinical presentation, including chest pain, electrocardiography changes, and laboratory findings. The purpose of the study was to investigate the diagnostic value of clinical, laboratory, and electrocardiography characteristics of patients with acute coronary syndrome - like myocarditis and MI. We analysed 90 patients (≤45 years old) with an initial diagnosis of ST-segment elevation myocardial infarction; 40 patients (44.4%), through the use of cardiac magnetic resonance, were confirmed to have myocarditis, and 50 patients (55.6%) were diagnosed with MI. Patients with myocarditis were younger and had fewer cardiovascular risk factors than those with MI. The cutoff value distinguishing between myocarditis and MI was defined as the age of 36 years. The history of recent infections (82.5% vs. 6%) and C-reactive protein (CRP) levels on admission (Me 45.9 vs. 3.4) was more associated with myocarditis. Further, the QTc interval was inversely correlated with the echocardiographic ejection fraction in both groups but was significantly longer in patients with MI. Non-invasive diagnostics based on clinical features and laboratory findings are basic but still essential tools for differentiation between MI and myocarditis. The three-factor model including the criteria of age, abnormal CRP, and history of recent infections might become a valuable clinical indication.

FGF23: A Review of Its Role in Mineral Metabolism and Renal and Cardiovascular Disease.

FGF23 is a hormone secreted mainly by osteocytes and osteoblasts in bone. Its pivotal role concerns the maintenance of mineral ion homeostasis. It has been confirmed that phosphate and vitamin D metabolisms are related to the effect of FGF23 and its excess or deficiency leads to various hereditary diseases. Multiple studies have shown that FGF23 level increases in the very early stages of chronic kidney disease (CKD), and its concentration may also be highly associated with cardiac complications. The present review is limited to some of the most important aspects of calcium and phosphate metabolism. It discusses the role of FGF23, which is considered an early and sensitive marker for CKD-related bone disease but also as a novel and potent cardiovascular risk factor. Furthermore, this review gives particular attention to the reliability of FGF23 measurement and various confounding factors that may impact on the clinical utility of FGF23. Finally, this review elaborates on the clinical usefulness of FGF23 and evaluates whether FGF23 may be considered a therapeutic target.

Shock index and TIMI risk index as valuable prognostic tools in patients with acute coronary syndrome complicated by cardiogenic shock.

BACKGROUND: The aim of the study was to evaluate the usefulness of the shock index (SI) and the TIMI risk index (TRI Thrombolysis in Myocardial Infarction Risk Index) one hour after successful primary percutaneous coronary intervention (pPCI) for predicting in-hospital mortality in patients with acute coronary syndrome complicated by cardiogenic shock (CS). METHODS: Forty-seven consecutive patients with acute myocardial infarction (AMI) complicated by CS were included in this prospective observational study. All patients underwent pPCI and obtained TIMI Grade Flow 3. SI and TRI were calculated one hour after pPCI. RESULTS: The primary endpoint-death from cardiovascular causes-occurred in 17 patients (36%). All calculated parameters were significantly higher in fatal CS than in the non-fatal CS group. A multivariate logistic regression model found only TRI to be an independent, significant predictor of death in the study group, with a proposed cut-off point of 66, with sensitivity 76.5% and specificity 83.3% (AUC 0.811, p = 0.00001). CONCLUSIONS: The simple parameters of clinical assessment-SI and TRI-calculated one hour after a successful pPCI of infarct related artery are important predictors of death in AMI complicated by cardiogenic shock.

The prognostic value of MR-proadrenomedullin in patients with acute coronary syndrome complicated by cardiogenic shock.

CONTEXT: Cardiogenic shock (CS) still remains one of the main causes of death in acute myocardial infarction (AMI). OBJECTIVE: The aim of this study was to evaluate the prognostic value of midregional (MR)-proadrenomedullin in AMI complicated by CS. METHODS: Forty-seven consecutive patients were included in our prospective observational study. All patients underwent coronarography and successful percutaneous coronary intervention (PCI). Plasma levels of MR-proADM were measured by a immunofluorescence method. The primary endpoint of the study, defined as cardiovascular death, occurred in 17 patients (36%). RESULTS AND CONCLUSION: Elevated plasma level of MR-proADM, determined 24 h after diagnosis of CS could be a predictor of in-hospital mortality in patients with AMI complicated by CS.

Admission hyperglycemia in patients with acute coronary syndrome complicated by cardiogenic shock.

BACKGROUND: Many reports shoed that for patients with acute coronary syndrome (ACS) increased admission blood glucose (ABG) level is associated with adverse outcomes. Although scientific reports on this issue are still inconsistent, many recent studies confirm that hyperglycemia is also an unfavorable prognostic factor in patients with ACS complicated by cardiogenic shock (CS). The aim of this study is to determine if hyperglycemia on admission can be a predictor of in-hospital death in patients with ACS complicated by CS. METHODS: The study population consisted of 40 patients with ACS complicated by CS admitted to the Intensive Cardiac Therapy Clinic from January 2010 to May 2013 and treated with primary percutaneous coronary intervention. A control group was selected among patients with uncomplicated ACS. RESULTS: Patients with CS had significantly higher levels of ABG (15.4 ± 6.26 vs. 7.97 ± ± 2.28 mmol/L, p < 0.01) in comparison with the control group. There was no statistically significant correlation between the level of glucose on admission and in-hospital mortality. Average ABG in patients who survived and in those who died were respectively 15.42 ± 5.61 vs. 15.40 ± 6.87 mmol/L, p > 0.05. Comparison in groups depending on ABG level and calculations with use of receiver-operating characteristics curves showed no relationship between the level of ABG and patients' deaths. CONCLUSIONS: Hyperglycemia on admission is a clinical feature of patients with ACS who develop CS, however its prognostic value requires further studies.

Mean platelet volume and its prognostic value in acute coronary syndrome complicated by cardiogenic shock.

BACKGROUND: Elevated mean platelet volume (MPV) has been recently discussed as a predictor of death in patients with acute coronary syndrome (ACS), but the cut-off point of MPV in relation to poor prognosis has not been estimated so far. The aim of this study was to evaluate MPV and its prognostic value in ACS complicated by cardiogenic shock (CS). Such an analysis in patients with the most serious and fatal complication of ACS has not been performed inpreviously published research. METHODS: Fifty three patients with ACS complicated by CS (age 68.9 ± 11.4, 49% women, 92% STEMI, 55% fatal CS) and 53 age- and gender-matched patients with uncomplicated ACS as a control group (age 69.1 ± 10.6, 49% women, 92% STEMI, 0% fatal) were included in our prospective study from 2010 to 2012. All the patients underwent successful primary percutaneous coronary intervention. MPV was determined on admission (MPV1) and in consecutive two days of hospitalization (MPV2, MPV3). The blood sample was analyzed immediately after collection in EDTA tubes using an automatic blood counter. RESULTS: MPV1 was similar in both groups (8.91 ± 1.11 fl vs. 8.57 ± 0.74 fl, NS). Furthermore, there were no statistically significant differences in MPV value in fatal and nonfatal CS(8.90 ± 1.18 fl vs. 8.93 ± 1.05 fl, NS). CONCLUSIONS: The above results suggest that MPV cannot be considered a predictor of poor in-hospital outcome in patients with ACS complicated by cardiogenic shock.

[Complete atrio-ventricular block as a first symptom of borreliosis: antibiotic treatment instead of pacemaker implantation]. / Calkowity blok przedsionkowo-komorowy jako pierwszy objaw boreliozy: antybiotykoterapia zamiast wszczepienia rozrusznika serca.

We present a 46-year-old male patient with complete atrio-ventricular block. A inflammatory etiology was suspected and finally lyme carditis was diagnosed. The conduction abnormalities disappeared with antibiotic treatment and a pacemaker implantation was not needed. Further follow-up of two years was uneventful.