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1.
J Clin Med ; 9(11)2020 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-33126723

RESUMO

This study aimed to assess the time course of circulating neutrophil and lymphocyte counts and their ratio (NLR) in ST-segment elevation myocardial infarction (STEMI) and coronavirus disease (COVID)-19 and explore their associations with clinical events and structural damage. Circulating neutrophil, lymphocyte and NLR were sequentially measured in 659 patients admitted for STEMI and in 103 COVID-19 patients. The dynamics detected in STEMI (within a few hours) were replicated in COVID-19 (within a few days). In both entities patients with events and with severe structural damage displayed higher neutrophil and lower lymphocyte counts. In both scenarios, higher maximum neutrophil and lower minimum lymphocyte counts were associated with more events and more severe organ damage. NLR was higher in STEMI and COVID-19 patients with the worst clinical and structural outcomes. A canonical deregulation of the immune response occurs in STEMI and COVID-19 patients. Boosted circulating innate (neutrophilia) and depressed circulating adaptive immunity (lymphopenia) is associated with more events and severe organ damage. A greater understanding of these critical illnesses is pivotal to explore novel alternative therapies.

2.
J Med Virol ; 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32706420

RESUMO

Knowledge of the precise timing of SARS-CoV-2 infection may be of clinical and epidemiological relevance. The presence of low-avidity IgGs has conventionally been considered an indicator of recent infection. Here, we carried out qualitative assessment of SARS-CoV-2-specific antibody avidity using an urea (6M) dissociation test performed on a lateral flow immunochromatographic IgG/IgM device. We included a total of 76 serum specimens collected from 57 COVID-19 patients, of which 39 tested positive for both IgG and IgM and 37 only for IgG. Sera losing IgG reactivity after urea treatment (n = 28) were drawn significantly earlier (P = .04) after onset of symptoms than those which preserved it (n = 48). This assay may be helpful to estimate the time of acquisition of infection in patients with mild to severe COVID-19.

3.
Eur Heart J Acute Cardiovasc Care ; 9(6): 567-575, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32067483

RESUMO

BACKGROUND: Undetectable high-sensitivity cardiac troponin (hs-cTn) in a single determination upon admission may rule out acute coronary syndrome. We investigated undetectable hs-cTnT (

4.
Am J Med ; 133(3): 370-380.e4, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31422111

RESUMO

BACKGROUND: The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation. METHODS: This multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into 2 groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-guided group (n = 79) and in clinical evaluation in the usual-care group (n = 81). Changes in estimated glomerular filtration rate (eGFR) at 72 and 24 hours were the co-primary endpoints, respectively. RESULTS: The mean age was 78 ± 8 years, the median amino-terminal pro-brain natriuretic peptide was 7765 pg/mL, and the mean eGFR was 33.7 ± 11.3 mL/min/1.73m2. Over 72 hours, the CA125-guided group received higher furosemide equivalent dose compared to usual care (P = 0.011), which translated into higher urine volume (P = 0.042). Moreover, patients in the active arm with CA125 >35 U/mL received the highest furosemide equivalent dose (P <0.001) and had higher diuresis (P = 0.013). At 72 hours, eGFR (mL/min/1.73m2) significantly improved in the CA125-guided group (37.5 vs 34.8, P = 0.036), with no significant changes at 24 hours (35.8 vs 39.5, P = 0.391). CONCLUSION: A CA125-guided diuretic strategy significantly improved eGFR and other renal function parameters at 72 hours in patients with acute heart failure and renal dysfunction.


Assuntos
Antígeno Ca-125/sangue , Furosemida/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Proteínas de Membrana/sangue , Insuficiência Renal/tratamento farmacológico , Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/urina , Humanos , Testes de Função Renal , Masculino , Medicina de Precisão , Insuficiência Renal/complicações , Insuficiência Renal/urina , Urina
5.
Int J Cardiol ; 290: 15-20, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31130280

RESUMO

BACKGROUND: Growth differentiation factor 15 (GDF-15) is a marker of cell senescence. Age is a well-known determinant of GDF-15 levels, yet no study has analyzed the relationship between geriatric conditions and GDF-15. We hypothesize that geriatric conditions reflecting biological age might be stronger determinants of GDF-15 than chronological age in elderly patients with acute coronary syndrome. METHODS: A total of 208 patients (mean age = 78.3 ±â€¯7.0 years) were included. Prior to discharge, a thorough geriatric assessment was performed and GDF-15 measured. Predictors of GDF-15 (transformed by its natural logarithm) were determined with linear regression. Furthermore, Cox regression was used for the analysis of all-cause mortality. The median follow-up was 728 days. RESULTS: Median GDF-15 concentration was 2432 pg/ml. In multivariate analysis, frailty (Fried score, p = 0.001), and comorbidity (Charlson index, p = 0.003) were independent determinants of lnGDF-15 while age was not significant (p = 0.17). Other covariates included in the model were male gender (p = 0.017), diabetes (p = 0.169), Killip class ≥2 (p = 0.046) and glomerular filtration rate (p = 0.001). The Fried score and Charlson index provided significant incremental value in the R2 model (0.362 vs 0.447; p = 0.0001). A total of 66 (32%) patients died. LnGDF-15 was a significant mortality predictor (HR = 1.82, 95% CI 1.12-2.94, p = 0.015) along with the Fried score (p = 0.013) and the Charlson index (p = 0.030). CONCLUSIONS: Geriatric conditions are strong determinants of GDF-15 levels on top of age in acute coronary syndromes. Furthermore, GDF-15 was associated with mortality independently of geriatric status. Geriatric assessment and GDF-15 are complementary tools.


Assuntos
Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/diagnóstico , Avaliação Geriátrica/métodos , Fator 15 de Diferenciação de Crescimento/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Alta do Paciente/tendências
6.
Rev. esp. cardiol. (Ed. impr.) ; 72(4): 317-323, abr. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187897

RESUMO

Introducción y objetivos: En el infarto agudo de miocardio con elevación del segmento ST, el ADN libre circulante podría originarse de los leucocitos activados en la lesión coronaria. El objetivo fue investigar la relación entre el ADN libre y la reperfusión coronaria. Métodos: Se incluyó a 116 pacientes, tratados con angioplastia primaria y tromboaspiración. Se cuantificó el ADN libre coronario (durante la aspiración) y periférico (al final del procedimiento), así como la troponina T ultrasensible y la mieloperoxidasa. El objetivo primario fue la no resolución del segmento ST (RST) (≥ 70%) y el secundario la ausencia de flujo Thrombolysis In Myocardial Infarction 3 (TIMI 3) final. Resultados: Se obtuvo RST en 51 (44%) pacientes y flujo TIMI 3 en 97 (84%). Los pacientes sin RST y flujo TIMI 3 tuvieron un menor gradiente ADN libre periférico-coronario (p = 0,02 y p = 0,04, respectivamente). Un gradiente pequeño de ADN libre (< 1,82 ng/ml) se asoció a una mayor frecuencia de no RST (65 frente al 30%; p = 0,001) y de falta de flujo TIMI 3 (21 frente al 3%; p = 0,05. Tras el ajuste multivariable, un gradiente de ADN libre pequeño fue predictivo de no RST (OR = 4,50; IC95%, 1,60-12,62; p = 0,004), en tanto que hubo una tendencia no significativa para el flujo TIMI 3 (p = 0,14). El ADN libre no se correlacionó con la troponina o la mieloperoxidasa. Conclusiones: Un gradiente pequeño de ADN libre periférico-coronario, como expresión de una alta carga de ADN libre coronario, se asocia con no RST en el infarto agudo de miocardio. El ADN libre coronario podría reflejar la activación de los neutrófilos. La potencial contribución de este fenómeno al fracaso de la tromboaspiración requiere nuevos estudios


Introduction and objectives: Cell-free DNA (cfDNA) in ST-segment elevation myocardial infarction might originate from hyperactivated leukocytes at the coronary lesion. Our aim was to investigate the relationship between cfDNA and coronary reperfusion. Methods: We studied 116 patients treated with primary angioplasty using thrombus aspiration. Coronary (during aspiration) and peripheral (at the end of the procedure) blood samples were drawn for cfDNA, as well as high-sensitivity troponin T and myeloperoxidase quantification. The primary endpoint was no ST-segment resolution (STR) (≥ 70%) and the secondary endpoint was lack of final Thrombolysis In Myocardial Infarction flow 3 (TIMI 3). Results: ST-segment resolution was achieved in 51 (44%) patients and TIMI 3 flow in 97 (84%). Patients without STR and TIMI 3 flow had a smaller peripheral-coronary cfDNA gradient (P = .02 and P = .04 respectively). A small cfDNA gradient (< 1.82 ng/mL) was associated with a higher rate of no STR (65% vs 30%; P = .001) and lack of TIMI 3 flow (21% vs 3%; P = .05). After multivariable adjustment, the small cfDNA gradient was predictive of no STR (OR, 4.50; 95%CI, 1.60-12.62; P = .004), while there was a nonsignificant trend for final TIMI 3 flow (P = .14). Cell-free DNA levels did not correlate with troponin T or myeloperoxidase. Conclusions: A small peripheral-coronary cfDNA gradient, as an expression of high coronary cfDNA burden, is associated with no STR in acute myocardial infarction. Intracoronary cfDNA might reflect neutrophil activation. Whether this phenomenon contributes to thrombus aspiration failure requires further study


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Intervenção Coronária Percutânea/métodos , Ácidos Nucleicos Livres/análise , Angioplastia/métodos , Reperfusão Miocárdica/métodos , Trombectomia/métodos , Troponina/análise , Peroxidase/análise , Estudos Prospectivos
7.
J Card Fail ; 25(5): 319-327, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30347272

RESUMO

BACKGROUND: Recent evidence endorses gut microbiota dysregulation in the pathophysiology of heart failure (HF). Small intestinal bacterial overgrowth (SIBO) might be present in HF and associated with poor clinical outcomes. Lactulose breath testing is a simple noninvasive test that has been advocated as a reliable indicator of SIBO. In patients with HF, we aimed to evaluate the association with clinical outcomes of the exhaled hydrogen (H2) and methane (CH4) concentrations through the lactulose breath test. METHODS AND RESULTS: We included 102 patients with HF in which lactulose SIBO breath tests were assessed. Cumulative gas was quantified by the area under the receiver operating characteristic curve of CH4 (AUC-CH4) and H2 (AUC-H2). Clinical end points included the composite of all-cause death with either all-cause or HF hospitalizations, recurrent all-cause hospitalizations, and recurrent HF hospitalizations. Medians (interquartile ranges) of AUC-H2 and AUC-CH4 were 1290 U (520-2430) and 985 U (450-2120), respectively. In multivariable analysis, AUC-H2 (per 1000 U) was associated with all-cause death/all-cause hospitalization (hazard ratio [HR] 1.21, 95% CI 1.04-1.40; P = .012), all-cause death/HF hospitalization (HR 1.20, 95% CI 1.03-1.40; P = .021), and an increase in the rate of recurrent all-cause (incidence rate ratio [IRR] 1.31, 95% CI 1.14-1.51; P < .001) and HF (IRR 1.41, 95% CI 1.15-1.72; P = .001) hospitalizations. AUC-CH4 was not associated with any of these end points. CONCLUSIONS: AUC-H2, a safe and noninvasive method for SIBO estimation, is associated with higher risk of long-term adverse clinical events in patients with HF. In contrast, AUC-CH4 did not show any prognostic value.


Assuntos
Testes Respiratórios , Insuficiência Cardíaca/mortalidade , Hospitalização/estatística & dados numéricos , Hidrogênio/análise , Metano/análise , Idoso , Idoso de 80 Anos ou mais , Bactérias/crescimento & desenvolvimento , Expiração , Feminino , Seguimentos , Microbioma Gastrointestinal , Humanos , Intestino Delgado/microbiologia , Masculino , Estudos Prospectivos
8.
Rev Esp Cardiol (Engl Ed) ; 72(4): 317-323, 2019 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29655768

RESUMO

INTRODUCTION AND OBJECTIVES: Cell-free DNA (cfDNA) in ST-segment elevation myocardial infarction might originate from hyperactivated leukocytes at the coronary lesion. Our aim was to investigate the relationship between cfDNA and coronary reperfusion. METHODS: We studied 116 patients treated with primary angioplasty using thrombus aspiration. Coronary (during aspiration) and peripheral (at the end of the procedure) blood samples were drawn for cfDNA, as well as high-sensitivity troponin T and myeloperoxidase quantification. The primary endpoint was no ST-segment resolution (STR) (≥ 70%) and the secondary endpoint was lack of final Thrombolysis In Myocardial Infarction flow 3 (TIMI 3). RESULTS: ST-segment resolution was achieved in 51 (44%) patients and TIMI 3 flow in 97 (84%). Patients without STR and TIMI 3 flow had a smaller peripheral-coronary cfDNA gradient (P = .02 and P = .04 respectively). A small cfDNA gradient (< 1.82 ng/mL) was associated with a higher rate of no STR (65% vs 30%; P = .001) and lack of TIMI 3 flow (21% vs 3%; P = .05). After multivariable adjustment, the small cfDNA gradient was predictive of no STR (OR, 4.50; 95%CI, 1.60-12.62; P = .004), while there was a nonsignificant trend for final TIMI 3 flow (P = .14). Cell-free DNA levels did not correlate with troponin T or myeloperoxidase. CONCLUSIONS: A small peripheral-coronary cfDNA gradient, as an expression of high coronary cfDNA burden, is associated with no STR in acute myocardial infarction. Intracoronary cfDNA might reflect neutrophil activation. Whether this phenomenon contributes to thrombus aspiration failure requires further study.


Assuntos
Ácidos Nucleicos Livres/metabolismo , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Feminino , Humanos , Leucócitos/fisiologia , Ativação Linfocitária/fisiologia , Masculino , Microvasos/patologia , Pessoa de Meia-Idade , Reperfusão Miocárdica/efeitos adversos , Traumatismo por Reperfusão Miocárdica/patologia , Peroxidase/metabolismo , Estudos Prospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Resultado do Tratamento , Troponina T/metabolismo
9.
J Investig Med ; 66(1): 17-21, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28822973

RESUMO

Familial combined hyperlipidemia (FCH) is a primary atherogenic dyslipidemia with insulin resistance and increased cardiovascular risk. Plasminogen activator inhibitor type 1 (PAI-1) and myeloperoxidase (MPO) activity are associated with proinflammatory and atherothrombotic risk. Our aim was to study the role played by PAI-1 and MPO activity in the carotid atherosclerosis prevalence in FCH subjects. 36 FCH unrelated subjects (17 women) were matched by age and body weight with 36 healthy normolipidemic subjects (19 female). Blood lipids, glucose, insulin, insulin resistance (homeostasis model assessment (HOMA)), MPO, and PAI-1 were determined in both groups. Carotid intima media thickness (IMT) was measured by the same investigator by standardized protocol. No differences in age, body mass index (BMI) or waist circumference were observed between the two groups. HOMA and PAI-1 values were higher in the FCH group, reaching statistical significance in those subjects with insulin resistance. In addition, PAI-1 values correlated significantly with metabolic syndrome components and carotid IMT. It is known that the elevated cardiovascular risk that characterizes FCH is frequently associated with insulin resistance. We have detected that two known proinflammatory and proatherothrombotic factors (MPO and PAI-1) are significantly elevated in FCH subjects with insulin resistance. These results could partly explain the high cardiovascular risk present in FCH subjects.


Assuntos
Doenças das Artérias Carótidas/sangue , Doenças das Artérias Carótidas/complicações , Hiperlipidemia Familiar Combinada/sangue , Hiperlipidemia Familiar Combinada/complicações , Resistência à Insulina , Inibidor 1 de Ativador de Plasminogênio/sangue , Adulto , Doenças das Artérias Carótidas/metabolismo , Estudos de Casos e Controles , Feminino , Humanos , Hiperlipidemia Familiar Combinada/metabolismo , Masculino , Pessoa de Meia-Idade , Peroxidase/metabolismo
10.
Circulation ; 137(13): 1320-1330, 2018 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-29025765

RESUMO

BACKGROUND: The prognostic value of long-term potassium monitoring and dynamics in heart failure has not been characterized completely. We sought to determine the association between serum potassium values collected at follow-up with all-cause mortality in a prospective and consecutive cohort of patients discharged from a previous acute heart failure admission. METHODS: Serum potassium was measured at every physician-patient encounter, including hospital admissions and ambulatory settings. The multivariable-adjusted association of serum potassium with mortality was assessed by using comprehensive state-of-the-art regression methods that can accommodate time-dependent exposure modeling. RESULTS: The study sample included 2164 patients with a total of 16 116 potassium observations. Mean potassium at discharge was 4.3±0.48 mEq/L. Hypokalemia (<3.5 mEq/L), normokalemia (3.5-5.0 mEq/L), and hyperkalemia (>5 mEq/L) were observed at the index admission in 77 (3.6%), 1965 (90.8%), and 122 (5.6%) patients, respectively. At a median follow-up of 2.8 years (range, 0.03-12.8 years), 1090 patients died (50.4%). On a continuous scale, the multivariable-adjusted association of potassium values and mortality revealed a nonlinear association (U-shaped) with higher risk at both ends of its distribution (omnibus P=0.001). Likewise, the adjusted hazard ratios for hypokalemia and hyperkalemia, normokalemia as reference, were 2.35 (95% confidence interval, 1.40-3.93; P=0.001) and 1.55 (95% confidence interval, 1.11-2.16; P=0.011), respectively (omnibus P=0.0003). Furthermore, dynamic changes in potassium were independently associated with substantial differences in mortality risk. Potassium normalization was independently associated with lower mortality risk (P=0.001). CONCLUSIONS: Either modeled continuously or categorically, serum potassium levels during long-term monitoring were independently associated with mortality in patients with heart failure. Likewise, persistence of abnormal potassium levels was linked to a higher risk of death in comparison with patients who maintained or returned to normal values.


Assuntos
Insuficiência Cardíaca/patologia , Potássio/sangue , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Feminino , Taxa de Filtração Glomerular , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Humanos , Hiperpotassemia/complicações , Hiperpotassemia/patologia , Hipopotassemia/complicações , Hipopotassemia/patologia , Masculino , Pessoa de Meia-Idade , Potenciometria , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Risco , Análise de Sobrevida
11.
Rev. esp. cardiol. (Ed. impr.) ; 70(12): 1067-1073, dic. 2017. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-169305

RESUMO

Introducción y objetivos: El tratamiento óptimo de pacientes con insuficiencia cardiaca aguda (ICA) y síndrome cardiorrenal tipo 1 (SCR-1) no está bien definido. La hipoperfusión arterial y la congestión venosa tienen un papel fundamental en la fisiopatología del SCR-1. El antígeno carbohidrato 125 (CA125) ha emergido como marcador indirecto de sobrecarga de volumen en la ICA. El objetivo de este estudio es evaluar la utilidad del CA125 para el ajuste del tratamiento diurético de pacientes con SCR-1. Métodos: Ensayo clínico multicéntrico, abierto y paralelo, que incluye a pacientes con ICA y creatinina ≥ 1,4 mg/dl al ingreso, aleatorizados a: a) estrategia convencional: titulación basada en la evaluación clínica y bioquímica habitual, o b) estrategia basada en CA125: dosis altas de diuréticos si CA125 > 35 U/ml y bajas en caso contrario. El objetivo principal es el cambio en la función renal a las 24 y las 72 h tras el comienzo del tratamiento. Como objetivos secundarios: a) cambios clínicos y bioquímicos a las 24 y las 72 h, y b) cambios en la función renal y eventos clínicos mayores a 30 días. Resultados: Los resultados de este estudio aportarán datos relevantes sobre la utilidad del CA125 para guiar el tratamiento diurético en el SCR-1. Además, permitirá ampliar el conocimiento de la fisiopatología de esta compleja entidad clínica. Conclusiones: La hipótesis del presente estudio es que las concentraciones de CA125 aumentadas pueden identificar a una población de pacientes con SCR-1 para quienes una estrategia diurética más intensa puede ser beneficiosa. Por el contrario, las concentraciones bajas de esta glucoproteína seleccionarían a los pacientes para los que serían perjudiciales las dosis altas de diuréticos (AU)


Introduction and objectives: The optimal treatment of patients with acute heart failure (AHF) and cardiorenal syndrome type 1 (CRS-1) is far from being well-defined. Arterial hypoperfusion in concert with venous congestion plays a crucial role in the pathophysiology of CRS-I. Plasma carbohydrate antigen 125 (CA125) has emerged as a surrogate of fluid overload in AHF. The aim of this study was to evaluate the clinical usefulness of CA125 for tailoring the intensity of diuretic therapy in patients with CRS-1. Methods: Multicenter, open-label, parallel clinical trial, in which patients with AHF and serum creatinine ≥ 1.4 mg/dL on admission will be randomized to: a) standard diuretic strategy: titration-based on conventional clinical and biochemical evaluation, or b) diuretic strategy based on CA125: high dose if CA125 > 35 U/mL, and low doses otherwise. The main endpoint will be renal function changes at 24 and 72 hours after therapy initiation. Secondary endpoints will include: a) clinical and biochemical changes at 24 and 72 hours, and b) renal function changes and major clinical events at 30 days. Results: The results of this study will add important knowledge on the usefulness of CA125 for guiding diuretic treatment in CRS-1. In addition, it will pave the way toward a better knowledge of the pathophysiology of this challenging situation. Conclusions: We hypothesize that higher levels of CA125 will identify a patient population with CRS-1 who could benefit from the use of a more intense diuretic strategy. Conversely, low levels of this glycoprotein could select those patients who would be harmed by high diuretic doses (AU)


Assuntos
Humanos , Insuficiência Cardíaca/terapia , Nefropatias/complicações , Biomarcadores , Diuréticos/uso terapêutico , Insuficiência Cardíaca/complicações , Análise Estatística
12.
Rev Esp Cardiol (Engl Ed) ; 70(12): 1067-1073, 2017 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28341415

RESUMO

INTRODUCTION AND OBJECTIVES: The optimal treatment of patients with acute heart failure (AHF) and cardiorenal syndrome type 1 (CRS-1) is far from being well-defined. Arterial hypoperfusion in concert with venous congestion plays a crucial role in the pathophysiology of CRS-I. Plasma carbohydrate antigen 125 (CA125) has emerged as a surrogate of fluid overload in AHF. The aim of this study was to evaluate the clinical usefulness of CA125 for tailoring the intensity of diuretic therapy in patients with CRS-1. METHODS: Multicenter, open-label, parallel clinical trial, in which patients with AHF and serum creatinine ≥ 1.4mg/dL on admission will be randomized to: a) standard diuretic strategy: titration-based on conventional clinical and biochemical evaluation, or b) diuretic strategy based on CA125: high dose if CA125 > 35 U/mL, and low doses otherwise. The main endpoint will be renal function changes at 24 and 72hours after therapy initiation. Secondary endpoints will include: a) clinical and biochemical changes at 24 and 72hours, and b) renal function changes and major clinical events at 30 days. RESULTS: The results of this study will add important knowledge on the usefulness of CA125 for guiding diuretic treatment in CRS-1. In addition, it will pave the way toward a better knowledge of the pathophysiology of this challenging situation. CONCLUSIONS: We hypothesize that higher levels of CA125 will identify a patient population with CRS-1 who could benefit from the use of a more intense diuretic strategy. Conversely, low levels of this glycoprotein could select those patients who would be harmed by high diuretic doses.


Assuntos
Acetazolamida/uso terapêutico , Antígeno Ca-125/sangue , Síndrome Cardiorrenal/tratamento farmacológico , Clortalidona/uso terapêutico , Diuréticos/uso terapêutico , Furosemida/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Proteínas de Membrana/sangue , Desequilíbrio Hidroeletrolítico/tratamento farmacológico , Doença Aguda , Síndrome Cardiorrenal/sangue , Síndrome Cardiorrenal/complicações , Creatinina/sangue , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Humanos , Planejamento de Assistência ao Paciente , Desequilíbrio Hidroeletrolítico/sangue , Desequilíbrio Hidroeletrolítico/etiologia
13.
Am J Cardiol ; 118(11): 1631-1635, 2016 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-27665208

RESUMO

Decision-making in acute chest pain remains challenging despite normal (below ninety-ninth percentile) high-sensitivity troponin (hs-cTn). Some studies suggest that undetectable hs-cTn, far below the ninety-ninth percentile, might rule out acute coronary syndrome. We investigated clinical data in comparison to undetectable hs-cTnT. The study comprised 682 patients (November 2010 to September 2011) presenting at the emergency department with chest pain and normal hs-cTnT (<14 ng/l). The main end point was major adverse cardiac events (MACE: death, myocardial infarction, readmission for unstable angina, or revascularization) at a 4-year median follow-up; secondary end point was 30-day MACE. A clinical score was built by assigning points according to hazard ratios of the independent predictive variables: 1 point (male and effort-related pain) and 2 points (recurrent pain and prior ischemic heart disease). The negative predictive values of the clinical score and undetectable hs-cTnT (<5 ng/l), were tested. A total of 72 (10.6%) patients suffered long-term MACE. The C-statistics of the clinical score for long-term (0.75) and 30-day (0.88) MACE were higher than with the TIMI(Thrombolysis In Myocardial Infarction) risk (0.68, 0.77) or GRACE(Global Registry of Acute Coronary Events) (0.50, 0.47) scores. Likewise, the negative predictive values of score = 0 (97.5%, 100%) and ≤1 point (95.9%, 100%) were higher than using undetectable hs-cTnT (91.9%, 98.1%). Both clinical scores of 0 and ≤1 better classified patients at risk of MACE (p = 0.0001, log-rank test) than hs-cTnT <5 ng/l (p = 0.06). In conclusion, clinical data can guide decision-making and perform at least equally well as undetectable hs-cTnT, in patients presenting at the emergency department with chest pain and normal hs-cTnT.


Assuntos
Dor Aguda/sangue , Dor no Peito/sangue , Tomada de Decisão Clínica , Troponina T/sangue , Dor Aguda/diagnóstico , Dor Aguda/epidemiologia , Biomarcadores/sangue , Dor no Peito/diagnóstico , Dor no Peito/epidemiologia , Diagnóstico Diferencial , Eletrocardiografia , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Espanha/epidemiologia
16.
Eur J Intern Med ; 26(1): 42-8, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25592074

RESUMO

BACKGROUND: Traditionally, procalcitonin (PCT) is considered a diagnostic marker of bacterial infections. However, slightly elevated levels of PCT have also been found in patients with heart failure. In this context, it has been suggested that PCT may serve as a proxy for underrecognized infection, endotoxemia, or heightened proinflammatory activity. Nevertheless, the clinical utility of PCT in this setting is scarce. We aimed to evaluate the association between PCT and the risk of long-term outcomes. METHODS AND RESULTS: We measured at admission PCT of 261 consecutive patients admitted for acute heart failure (AHF) after excluding active infection. Cox and negative binomial regression methods were used to evaluate the association between PCT and the risk of death and recurrent rehospitalizations, respectively. At a median follow-up of 2years (IQR: 1.0-2.8), 108 deaths, 170 all-cause rehospitalizations and 96 AHF-rehospitalizations were registered. In an adjusted analysis, including well-established risk factors such as natriuretic peptides and indices of renal function, the logarithm of PCT was associated with a higher risk of death (HR=1.43, CI 95%: 1.12-1.82; p=0.004), all-cause rehospitalizations (IRR=1.22, CI 95% 1.02-1.44; p=0.025) and AHF-rehospitalizations (IRR=1.28, CI 95%: 1.02-1.61; p=0.032). The association with these endpoints persisted after adjustment for other inflammatory biomarkers such as white blood cells, C-reactive protein and interleukins. CONCLUSION: In patients with AHF and no evidence of infection, PCT was independently and positively associated with the risk of long-term death and recurrent rehospitalizations.


Assuntos
Infecções Bacterianas/sangue , Calcitonina/sangue , Endotoxinas/sangue , Insuficiência Cardíaca/sangue , Hospitalização , Readmissão do Paciente/estatística & dados numéricos , Precursores de Proteínas/sangue , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Peptídeo Relacionado com Gene de Calcitonina , Estudos de Coortes , Citocinas/sangue , Feminino , Insuficiência Cardíaca/mortalidade , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco
17.
Heart Vessels ; 30(6): 703-11, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24989970

RESUMO

Acute kidney injury (AKI) is a common complication after coronary angiography. Early biomarkers of this disease are needed since increase in serum creatinine levels is a late marker. To assess the usefulness of urinary kidney injury molecule-1 (uKIM-1), neutrophil gelatinase-associated lipocalin (uNGAL) and liver-type fatty acid-binding protein (uL-FABP) for early detection of AKI in these patients, comparing their performance with another group of cardiac surgery patients. Biomarkers were measured in 193 patients, 12 h after intervention. In the ROC analysis, AUC for KIM-1, NGAL and L-FABP was 0.713, 0.958 and 0.642, respectively, in the coronary angiography group, and 0.716, 0.916 and 0.743 in the cardiac surgery group. Urinary KIM-1 12 h after intervention is predictive of AKI in adult patients undergoing coronary angiography, but NGAL shows higher sensitivity and specificity. L-FABP provides inferior discrimination for AKI than KIM-1 or NGAL in contrast to its performance after cardiac surgery. This is the first study showing the predictive capacity of KIM-1 for AKI after coronary angiography. Further studies are still needed to answer relevant questions about the clinical utility of biomarkers for AKI in different clinical settings.


Assuntos
Síndrome Coronariana Aguda/complicações , Lesão Renal Aguda/diagnóstico , Proteínas da Fase Aguda/urina , Angiografia Coronária/efeitos adversos , Proteínas de Ligação a Ácido Graxo/urina , Insuficiência Cardíaca/complicações , Lipocalinas/urina , Glicoproteínas de Membrana/urina , Proteínas Proto-Oncogênicas/urina , Lesão Renal Aguda/etiologia , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Biomarcadores/urina , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Creatinina/sangue , Feminino , Receptor Celular 1 do Vírus da Hepatite A , Humanos , Lipocalina-2 , Masculino , Pessoa de Meia-Idade , Curva ROC , Receptores Virais , Sensibilidade e Especificidade , Espanha
19.
Eur Heart J Acute Cardiovasc Care ; 3(4): 347-53, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24676027

RESUMO

BACKGROUND: Acute glycometabolic derangement in non-diabetic patients with acute myocardial infarction (AMI) has been reported with discrepant prognostic results. The aim of the present study was to assess the prognostic impact of glycated haemoglobin (HbA1c) levels, reflecting long-term glycometabolic disturbance, in a population of patients without known diabetes mellitus. METHODS: We examined 601 consecutive prospective patients diagnosed with AMI and unknown diabetes mellitus. We analysed metabolic function as a stratified variable using three groups of patients according to HbA1c: Group 1 (< 5.5%): 222 patients (37%); Group 2 (5.5 to 6.4%): 337 patients (56%); Group 3 (>6.4%): 42 patients (7%). Association between HbA1c groups and classic cardiovascular risk factor and in-hospital outcomes were assessed through univariate and multivariate analysis. RESULTS: In-hospital mortality was 5% (32/601 patients). Higher HbA1c was associated with poor glycometabolic control, older patients, obesity, hypertension, Killip's class>1, increased heart rate, initial bundle branch block, atrial fibrillation and higher mortality during follow-up. In a multivariate adjusted risk, in-hospital mortality was associated with age (odds ratio (OR)= 1.056; 1-1.1; p=0.006), Killip's class>1 (OR=2.4; 1-6.1; p=0.05) and HbA1c (OR=1.5; 1.15-1.9; p=0.002). Hypertension (OR=0.39; 0.18-0.87; p=0.022) and angiotensin-converting enzyme inhibitors (OR=0.28; 0.12-0.69; p=0.005) were protective factors. CONCLUSIONS: HbA1c is an important risk marker in the absence of a history of diabetes mellitus in patients with AMI. The optimal management strategy in these patients may contribute to decreased in-hospital mortality.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Cardiomiopatias Diabéticas/diagnóstico , Hemoglobina A Glicada/metabolismo , Infarto do Miocárdio/complicações , Análise de Variância , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/mortalidade , Cardiomiopatias Diabéticas/complicações , Cardiomiopatias Diabéticas/mortalidade , Feminino , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/mortalidade , Prognóstico , Estudos Prospectivos
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