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1.
Zhonghua Yi Xue Za Zhi ; 99(35): 2750-2755, 2019 Sep 17.
Artigo em Chinês | MEDLINE | ID: mdl-31550797

RESUMO

Objective: To assess whether acute-phase plasma PCSK9 levels predict recurrent cardiovascular (CV) events in acute myocardial infarction (AMI) patients without receiving reperfusion therapy. Methods: Plasma PCSK9 levels were measured during the acute phase (≤24 hours) in 882 patients who did not undergo reperfusion therapy from the China PEACE-Prospective AMI Study (2012-2014). Associations of acute-phase PCSK9 tertiles with patient characteristics and recurrent CV events at 1 year were assessed using multivariable logistic and Cox proportional hazards regression models. Results: Female gender (odds ratio [OR] 2.86, 95% confidence interval [CI] 1.36-5.98), premature coronary heart disease (CHD) (OR 2.82, 95%CI 1.43-5.53), higher high-sensitivity C-reactive protein (OR 1.69, 95%CI 1.35-2.13), and higher triglycerides (OR 1.93, 95%CI 1.10-3.38) were associated with higher baseline PCSK9 levels. Patients with PCSK9 levels in the highest tertile (versus lowest) did not have an increased risk of 1-year recurrent CV events (HR 0.77, 95%CI 0.44-1.34). Conclusion: Acute-phase plasma PCSK9 levels are associated with levels of inflammation and triglycerides, premature CHD, and gender in AMI patients without reperfusion therapy, however it do not predict recurrent CV events at 1 year.


Assuntos
Infarto do Miocárdio/sangue , Pró-Proteína Convertase 9/sangue , China , Doença das Coronárias/epidemiologia , Feminino , Humanos , Inflamação , Masculino , Infarto do Miocárdio/diagnóstico , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Prospectivos , Recidiva , Fatores Sexuais , Triglicerídeos/sangue
2.
Vasc Health Risk Manag ; 15: 221-227, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31410012

RESUMO

Background: High sensitivity C-reactive protein (hsCRP) predicts myocardial dysfunction after acute coronary syndromes. We aimed to study the association of hsCRP estimation at first acute myocardial infarction (AMI) with myocardial dysfunction and heart failure. Methods: This research was carried out at the Department of Physiology and Department of Emergency Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. In this prospective study, 227 patients were studied. hsCRP levels were estimated when patients came to the emergency department at AMI, 7 days post AMI, and at 12 weeks of follow up after AMI. The outcome was change in myocardial functions, especially heart failure, 12 months after the attack. Results: Based on a cutoff mean value of hsCRP levels at admission (10.05±12.68 mg/L), patients were grouped into high and low C-reactive protein (CRP.) The ejection fraction was significantly lower at follow up in the high CRP group (37.29±12.97) compared to the low CRP group (43.85±11.77, p<0.0198). hsCRP had significant inverse correlation with left ventricular ejection fraction (r=-0.283, p<0.01). About 38.1% patients showed heart failure, with 23.6% in the high CRP group and 14.5% in the low CRP group (OR 2.4, p=0.028). Receiver operating characteristic curve analysis showed that CRP levels at AMI had a specificity of 79% and sensitivity of 83% to predict heart failure. Conclusion: A high hsCRP level measured at first AMI predicts myocardial dysfunction and heart failure. It is suggested that hsCRP plays an important role in the development of heart failure after myocardial infarction.


Assuntos
Proteína C-Reativa/análise , Insuficiência Cardíaca/etiologia , Infarto do Miocárdio/sangue , Adulto , Idoso , Biomarcadores/sangue , Progressão da Doença , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/fisiopatologia , Admissão do Paciente , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Arábia Saudita , Volume Sistólico , Fatores de Tempo , Função Ventricular Esquerda
3.
N Engl J Med ; 380(26): 2529-2540, 2019 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-31242362

RESUMO

BACKGROUND: Data regarding high-sensitivity troponin concentrations in patients presenting to the emergency department with symptoms suggestive of myocardial infarction may be useful in determining the probability of myocardial infarction and subsequent 30-day outcomes. METHODS: In 15 international cohorts of patients presenting to the emergency department with symptoms suggestive of myocardial infarction, we determined the concentrations of high-sensitivity troponin I or high-sensitivity troponin T at presentation and after early or late serial sampling. The diagnostic and prognostic performance of multiple high-sensitivity troponin cutoff combinations was assessed with the use of a derivation-validation design. A risk-assessment tool that was based on these data was developed to estimate the risk of index myocardial infarction and of subsequent myocardial infarction or death at 30 days. RESULTS: Among 22,651 patients (9604 in the derivation data set and 13,047 in the validation data set), the prevalence of myocardial infarction was 15.3%. Lower high-sensitivity troponin concentrations at presentation and smaller absolute changes during serial sampling were associated with a lower likelihood of myocardial infarction and a lower short-term risk of cardiovascular events. For example, high-sensitivity troponin I concentrations of less than 6 ng per liter and an absolute change of less than 4 ng per liter after 45 to 120 minutes (early serial sampling) resulted in a negative predictive value of 99.5% for myocardial infarction, with an associated 30-day risk of subsequent myocardial infarction or death of 0.2%; a total of 56.5% of the patients would be classified as being at low risk. These findings were confirmed in an external validation data set. CONCLUSIONS: A risk-assessment tool, which we developed to integrate the high-sensitivity troponin I or troponin T concentration at emergency department presentation, its dynamic change during serial sampling, and the time between the obtaining of samples, was used to estimate the probability of myocardial infarction on emergency department presentation and 30-day outcomes. (Funded by the German Center for Cardiovascular Research [DZHK]; ClinicalTrials.gov numbers, NCT00470587, NCT02355457, NCT01852123, NCT01994577, and NCT03227159; and Australian New Zealand Clinical Trials Registry numbers, ACTRN12611001069943, ACTRN12610000766011, ACTRN12613000745741, and ACTRN12611000206921.).


Assuntos
Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Medição de Risco/métodos , Troponina/sangue , Adulto , Idoso , Biomarcadores/sangue , Estudos de Coortes , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Sensibilidade e Especificidade , Troponina I/sangue
4.
Clin Biochem ; 70: 34-38, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31173734

RESUMO

BACKGROUND AND AIMS: The release of N-terminal pro-B-type natriuretic peptide (NT-proBNP) is strongly triggered by myocardial ischemia. We aimed to investigate whether the addition of NT-proBNP to high-sensitivity cardiac troponin (hs-cTnI) at presentation could provide better performance in risk stratification and thus early rule-out of acute myocardial infarction (AMI) in patients of the "observe zone". METHODS: Emergency department (ED) patients presenting with symptoms suspicious for AMI were consecutively enrolled. Blood samples were obtained at presentation and tested for hs-cTnI and NT-proBNP. All available medical records pertaining to the patient from ED presentation to 30-day follow-up were used for adjudication of the primary outcome. The incremental diagnostic value added by NT-proBNP to hs-cTnI was evaluated by receiver operating characteristic (ROC) analysis, continuous net reclassification improvement (cNRI), and integrated discrimination improvement (IDI). Sensitivity, specificity, positive and negative predictive values were used to assess the diagnostic accuracy of different approaches for early rule out. RESULTS: Of the 165 patients we analyzed, 55 (33.3%) had index AMI. For hs-cTnI alone, area under the curve for index AMI was not significantly increased after adding NT-proBNP (0.773 vs 0.809; p = .076). Adjustment of hs-cTnI by NT-proBNP improved the predictive value of hs-cTnI, showed by cNRI (0.418, 95%CI 0.102-0.735, p = .009) and IDI (0.055, 95%CI 0.017-0.092, p = .004). Compared to hs-cTnI, the combined test identified 14% more patients as low-risk and safe for early discharge. CONCLUSIONS: Combination of presentation hs-cTnI and NT-proBNP provided better predictive performance for AMI in patients of the observe zone presenting with symptoms of chest pain as compared to hs-cTnI alone. The combined test outperformed hs-cTnI by correctly identifying nearly 14% more patients as low-risk and safe for early discharge. Future multi-center studies are needed to verify the results and to determine the best clinical use of the combination of NT-proBNP and hs-cTnI in the early diagnosis of AMI.


Assuntos
Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Troponina I/sangue , Idoso , Diagnóstico Diferencial , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
5.
Georgian Med News ; (289): 84-90, 2019 Apr.
Artigo em Russo | MEDLINE | ID: mdl-31215885

RESUMO

The study was aimed at investigation of the effect of the "low triiodothyronin syndrome" (LT3S) on the course of heart failure (HF) developed on the background of post-infarction cardiosclerosis. The biennial study included 157 patients with HF (with a myocardial infarction on the background of coronary heart disease). During hospitalization, a standardized assessment was carried out, hemodynamic parameters, clinical and biochemical blood tests, levels of thyroid hormones (thyroid stimulating hormone (TSH), free T3f and T4f, reverse T3r) were determined. Statistical analysis has shown that for the diagnosis of LT3S in patients with HF on the background of post-infarction cardiosclerosis, it is advisable to use serum T3f level, ≤2.07 pmol/l. The frequency of LT3S in patients with HF during hospitalization is 17.8%. Patients with LT3S are younger, have larger left ventricular size, lower ejection fraction, a high relative risk of re-hospitalization within 2 years due to decompensation of HF (2.224 [1.363-3.630]). A regression model of the re-hospitalization of patients with HF has been described, which included: weight, thyroxine and triiodothyronine concentrations, non-toxic goiter, growth, total cholesterol levels and LDL cholesterol, blood granulocyte content. It is shown that the risk of re-hospitalization of patients with HF due to decompensation of the disease increases when the equation of this model exceeds ≥1,321 (sensitivity - 93.78% and specificity - 40.45%, p=0.0001).


Assuntos
Insuficiência Cardíaca , Infarto do Miocárdio , Tri-Iodotironina , Insuficiência Cardíaca/sangue , Hospitalização , Humanos , Infarto do Miocárdio/sangue , Hormônios Tireóideos , Tri-Iodotironina/sangue
6.
Int J Nanomedicine ; 14: 2451-2464, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31040668

RESUMO

Background: Acute myocardial infarction (AMI), usually caused by atherosclerosis of coronary artery, is the most severe manifestation of coronary artery disease which results in a large amount of death annually. A new diagnosis approach with high accuracy, reliability and low measuring-time-consuming is essential for AMI quick diagnosis. Purpose: The objective of this study was to develop a new point-of-care testing system with high accuracy and reliability for AMI quick diagnosis. Patients and methods: 50 plasma samples of acute myocardial infarction patients were analyzed by developed Smartphone-Assisted Pressure-Measuring-Based Diagnosis System (SPDS). The concentration of substrate was firstly optimized. The effect of antibody labeling and matrix solution on measuring result were then evaluated. And standard curves for cTnI, CK-MB and Myo were built for clinical sample analysis. The measuring results of 50 clinical samples were finally evaluated by comparing with the measuring result obtained by CLIA. Results: The concentration of substrate H2O2 was firstly optimized as 30% to increase measuring signal. A commercial serum matrix was chosen as the matrix solution to dilute biomarkers for standard curve building to minimize matrix effect on the accuracy of clinical plasma sample measuring. The standard curves for cTnI, CK-MB and Myo were built, with measuring dynamic range of 0-25 ng/mL, 0-33 ng/mL and 0-250 ng/mL, and limit of detection of 0.014 ng/mL, 0.16 ng/mL and 0.85 ng/mL respectively. The measuring results obtained by the developed system of 50 clinical plasma samples for three biomarkers matched well with the results obtained by chemiluminescent immunoassay. Conclusion: Due to its small device size, high sensitivity and accuracy, SPDS showed a bright potential for point-of-care testing (POCT) applications.


Assuntos
Pressão Sanguínea , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/fisiopatologia , Smartphone , Anticorpos/metabolismo , Biomarcadores/sangue , Catálise , Feminino , Humanos , Peróxido de Hidrogênio/análise , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Nanopartículas/química , Platina/química , Padrões de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Eletricidade Estática
7.
Georgian Med News ; (288): 55-60, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31101776

RESUMO

The aim of current study was to investigate the level of Myeloperoxidase (MPO) in chronic heart failure patients with different severity and find the correlation with cardiac structural and functional markers and disease outcome. Initially eighty-six patients with different stages of CHF and ten healthy persons were included in our study. Excluded criteria were myocardial infarction or other concomitant acute diseases, renal failure (creatinine >250 µmol/L) in past 3 months. All patients underwent ECG, echocardiographic evaluation, anthropometric and other clinical examination, as well as plasma samples were collected for further analysis. MPO level (ng/ml) was measured by ELISA method, hs-CRP (mg/L) was measured by turbidimetric immunoassay and Leukocyte level (109/L) - by flow cytometry. Echocardiographic studies were performed using standard methods by parasternal and apical view. Statistical analyses were performed using IBM SPSS Statistics 16.0. After 6 month follow up we investigate our research primary outcome (mortality). The data were collected by telephone follow up from patients or members of family. Collection of information had been became possible in 79% of total cases (68 patients), from which 10 patients died: 8 cases were cardiovascular mortality, 1 case - suicide and 1 case from cancer. We found that MPO levels in the patients with CHF (mean value 9.3±7) are different from control group (mean value 4.19±2). MPO correlates with HF severity. MPO significantly were elevated in mortality group p<0,007 , as the level of hs-CRP p˂ 0.001. Changes of RV (right ventricule) sizes from normal ranges also were associated to worse outcome ( p<0.005). Depending on our data certain level of MPO (˃7.1 ng/ml) in studied patients and increased RVDD have independent importance for identification of patients with worse outcome.


Assuntos
Insuficiência Cardíaca , Infarto do Miocárdio , Peroxidase , Biomarcadores , Ecocardiografia , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Humanos , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Peroxidase/sangue , Prognóstico
8.
Iran J Allergy Asthma Immunol ; 18(2): 200-208, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31066256

RESUMO

Unstable angina pectoris (USAP) is a complex condition in which widespread coronary inflammatory processes have important implications for clearer understanding of its pathogenesis and also its treatment. This study aimed at evaluating the diagnostic as well as prognostic value of serum inflammatory markers of pentraxin-3 (PTX-3), Von Willebrand Factor (vWf) and C-X-C Motif Chemokine Ligand 13 (CXCL13) in such patients. Out of sixty-nine patients, thirty-nine had USAP, thirty had stable angina pectoris (SAP), and thirty-nine were healthy controls. For all participants, serum PTX-3, vWf and CXCL13 levels were measured using ELISA. For each patient with USAP, the Thrombolysis in Myocardial Infarction (TIMI) and the scores of Global Registry of Acute Coronary Events (GRACE) were calculated to determine the severity of the disease. We, then, analyzed the relation of PTX-3, vWf and CXCL13 levels with TIMI and GRACE scores in patients with USAP. Serum PTX-3, vWf and CXCL13 levels were significantly higher in USAP group than those in either SAP or control groups (p˂0.001). Strong correlation was observed between CXCL13 level and TIMI risk score (p=0.019). In receiver operating characteristic (ROC) curves, area under the curve (AUC) values of PTX3, vWf and CXCL13 for detection of USAP were 0.755, 0.751, and 0.906, respectively. The levels of serum PTX3, vWf and CXCL13 increased in patients with USAP. The notable correlation implied that CXCL13 might be a sensitive and specific biomarker for the diagnosis of USAP as well as its severity. It might also show additional diagnostic values when measured in combination with vWf.


Assuntos
Angina Instável/diagnóstico , Proteína C-Reativa/análise , Quimiocina CXCL13/sangue , Infarto do Miocárdio/diagnóstico , Componente Amiloide P Sérico/análise , Fator de von Willebrand/análise , Adulto , Idoso , Angina Instável/sangue , Biomarcadores/sangue , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Valor Preditivo dos Testes , Prognóstico , Sensibilidade e Especificidade , Índice de Gravidade de Doença
9.
Clin Biochem ; 70: 1-7, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31132347

RESUMO

Left ventricular remodeling after acute myocardial infarction affects cardiac function and increases the risk of developing heart failure. Despite the emergence of biomarkers associated with remodeling, the ideal biomarker to accurately predict the risk of developing heart failure after acute myocardial infarction is still to be discovered. Female and male hearts cope differently with ischemic stress, leading to different consequences on cardiac morphology and function. As biomarkers reflect the pathogenesis of remodeling, utilization of sex-specific biomarkers might improve risk stratification. Expressed in cardiac and inflammatory cells, microRNAs regulate several biological pathways triggering the remodeling process. In addition, circulating microRNAs are associated with the risk of developing heart failure after acute myocardial infarction, hence their biomarker potential. Interestingly, multiple microRNAs display sex-specific expression profiles as they can be modulated by sexual hormones and escape X-inactivation, for those located on the X-chromosome. This review article aims to discuss the potential of circulating microRNAs to predict heart failure after acute myocardial infarction in a sex-specific manner.


Assuntos
MicroRNA Circulante/sangue , Insuficiência Cardíaca/sangue , Infarto do Miocárdio/sangue , Animais , Biomarcadores/sangue , Feminino , Humanos , Fatores Sexuais , Remodelação Ventricular
10.
Rev Med Suisse ; 15(652): 1087-1090, 2019 May 22.
Artigo em Francês | MEDLINE | ID: mdl-31116524

RESUMO

The interpretation of troponin elevation whitout a typical myocardial infarction symptomatology is a daily challenge in the acute care setting. Using current investigative techniques, doctors navigate between the five types of myocardial infarction established by the Fourth Universal Definition. However, due to the development of ultrasensitive troponin assays, the myocardial injury without ischemia, acute or chronic, is became a more common entity. The purpose of this article is to describe the situations without typical symptoms of myocardial ischemia and their mechanisms to better differentiate them.


Assuntos
Infarto do Miocárdio , Isquemia Miocárdica , Troponina , Biomarcadores , Eletrocardiografia , Humanos , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Isquemia Miocárdica/sangue , Isquemia Miocárdica/diagnóstico , Troponina/sangue
11.
J Clin Neurosci ; 64: 83-88, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31014907

RESUMO

Troponin elevations due to Type II myocardial infarction (T2MI) are associated with hemorrhagic and ischemic strokes but there is little data on stroke severity, troponin elevation and outcome. We studied 1655 patients from a tertiary medical center between 1/2013-4/2015 using multivariate regression analysis for demographics, vascular risk factors, admission stroke severity, laboratory tests, echocardiogram results and discharge disposition. Troponin levels were classified as normal <0.04 ng/ml and high >0.04 ng/ml (critical if >0.5 ng/ml). A T2MI was diagnosed by a trending troponin elevation; patients with type I MI, patients with subdural and epidural hematoma, or hemorrhagic metastatic disease and patients younger than 18 years old were excluded. We had 818 patients with ischemic stroke, 306 with intracerebral hemorrhage (ICH) and 169 with subarachnoid hemorrhage (SAH). Troponin was elevated (>0.04 ng/ml) in 24.1% of ischemic stroke patients, 27.1% in the ICH group, and in 39% of SAH patients. High initial and peak troponin levels were associated with higher National Institutes of Health Stroke Scale (NIHSS) in patients with ischemic stroke (OR 1.04; CI 95%, 1.02-1.07, p = .001) and (OR 1.05; CI 95%, 1.03-1.07, p < .001). In ICH patients, higher initial and peak troponin levels were not associated with worse ICH scores (OR 1.21; CI 95%, 0.66-2.22, p = .53) and (OR 1.36; CI 95%, 0.77-2.41, p = .29). In SAH patients, higher initial and peak troponin levels was associated with higher Hunt and Hess scores (OR 4.2; CI 95%, 1.6-11.4, p = .005) and (OR 3.14; CI 95%, 1.5-6.5, p = .002). In patients with high troponin levels mortality was 14.7% in ischemic stroke patients, 31.3% in our ICH patients, and 43.8% in our SAH. After adjusting for demographics and clinical risk factors, only high troponin ischemic stroke patients were associated with higher mortality (OR 6.16; CI95%, 2.46-15.4, p < .001), and worse discharge disposition (OR 2.3; CI 95%, 1.19-4.45, p = .01). High troponin levels were not associated with change of outcomes in patients with SAH and ICH after adjusting for demographics and clinical risk factors. Elevated troponin due to T2MI is common in patients with ischemic strokes, ICH, and SAH. It is significantly associated with stroke severity, poor discharge disposition, and high mortality. Troponin levels should be considered on admission for acute strokes.


Assuntos
Biomarcadores/sangue , Hemorragia Cerebral/sangue , Infarto do Miocárdio/complicações , Acidente Vascular Cerebral/sangue , Troponina/sangue , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/sangue , Isquemia Encefálica/etiologia , Isquemia Encefálica/mortalidade , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/sangue , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Hemorragia Subaracnóidea/sangue , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/mortalidade
12.
Mediators Inflamm ; 2019: 9483647, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31011288

RESUMO

CD4+ T-cells play crucial roles in the injured heart. However, the way in which different CD4+ T subtypes function in the myocardial infarction/reperfusion (MI/R) heart is still poorly understood. We aimed to detect the dynamic profile of distinct CD4+ subpopulation-associated cytokines/chemokines by relying on a closed-chest acute murine MI/R model. The protein levels of 26 CD4+ T-cell-associated cytokines/chemokines were detected in the heart tissues and serum of mice at day 7 and day 14 post-MI/R or sham surgery. The mRNA levels of IL-4, IL-6, IL-13, IL-27, MIP-1ß, MCP-3, and GRO-α were measured in blood mononuclear cells. The protein levels of IL-4, IL-6, IL-13, IL-27, MIP-1ß, MCP-3, and GRO-α increased in both injured heart tissues and serum, while IFN-γ, IL-12P70, IL-2, IL-1ß, IL-18, TNF-α, IL-5, IL-9, IL-17A, IL-23, IL-10, eotaxin, MIP-1α, RANTES, MCP-1, and MIP-2 increased only in MI/R heart tissues in the day 7 and day 14 groups compared to the sham group. In serum, the IFN-γ, IL-23, and IL-10 levels were downregulated in the MI/R model at both day 7 and day 14 compared to the sham. Compared with the protein expressions in injured heart tissues at day 7, IFN-γ, IL-12P70, IL-2, IL-18, TNF-α, IL-6, IL-4, IL-5, IL-9, IL-17A, IL-23, IL-27, IL-10, eotaxin, IP-10, RANTES, MCP-1, MCP-3, and GRO-α were reduced, while IL-1ß and MIP-2 were elevated at day 14. IL-13 and MIP-1ß showed higher levels in the MI/R serum at day 14 than at day 7. mRNA levels of IL-4, IL-6, IL-13, and IL-27 were increased in the day 7 group compared to the sham, while MIP-1ß, MCP-3, and GRO-α mRNA levels showed no significant difference between the MI/R and sham groups in blood mononuclear cells. Multiple CD4+ T-cell-associated cytokines/chemokines were upregulated in the MI/R hearts at the chronic stage. These results provided important evidence necessary for developing future immunomodulatory therapies after MI/R.


Assuntos
Linfócitos T CD4-Positivos/metabolismo , Quimiocinas/metabolismo , Citocinas/metabolismo , Infarto do Miocárdio/metabolismo , Traumatismo por Reperfusão Miocárdica/metabolismo , Animais , Quimiocina CCL3/sangue , Quimiocina CCL3/metabolismo , Interleucina-10/sangue , Interleucina-10/metabolismo , Interleucina-13/sangue , Interleucina-13/metabolismo , Interleucina-4/sangue , Interleucina-4/metabolismo , Interleucina-6/sangue , Interleucina-6/metabolismo , Leucócitos Mononucleares/metabolismo , Masculino , Camundongos , Infarto do Miocárdio/sangue , Traumatismo por Reperfusão Miocárdica/sangue
13.
Clin Biochem ; 69: 26-29, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31028731

RESUMO

BACKGROUND: Because the 99th percentile is of such importance in defining myocardial injury and myocardial infarction, it is important to know whether there are real age-related differences in troponin 99th percentiles. METHODS: We went to our database from the Canberra Heart Study where 1062 apparently healthy subjects were extensively screened for occult cardiac disease, and looking at persons aged <65 years and >65 years, for men and women separately, we compared a variety of cutpoints from the 99th percentile down to the 50th percentile. RESULTS: With our rigorous criteria for defining cardiac health, we excluded 67.2% of males aged >65 years and 53.8% of women aged 65 years and older. Even with these rigorous exclusions we found that at every cutpoint examined between the 99th percentile and the 50th percentile, persons aged <65 years had lower troponin I concentrations that persons aged 65 years and older. Similarly, at every cutpoint examined, women had lower troponin I concentrations than did men. For the 4 separate groups examined (men and women, age < 65 years and 65 years and older) after the exclusions of persons with subclinical cardiac disease, the distributions were not significantly different to a Gaussian distribution. CONCLUSIONS: With the rigorous exclusions of persons with subclinical cardiac disease, and the fact that our populations have a Gaussian distribution, our data suggests that age-related hs-cTnI concentrations are real. This has important implications particularly when assessing older persons in the Emergency Department.


Assuntos
Fatores Etários , Troponina I/sangue , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue
14.
Int J Mol Med ; 43(6): 2451-2461, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31017253

RESUMO

Ischemic postconditioning (IPoC) has been demonstrated to prevent myocardial ischemia­reperfusion injury (MIRI), but its cardioprotective effect is abrogated by hypercholesterolemia. The aim of the present study was to determine whether lycopene (LP), a type of carotenoid, can restore the cardioprotective effect of IPoC in hypercholesterolemic rats. Male Wistar rats were fed a cholesterol­enriched diet for 12 weeks to establish a hypercholesterolemic model. The rat hearts were isolated and subjected to 30 min ischemia and 60 min reperfusion using a Langendorff apparatus. LP was administered to the rats intraperitoneally for 5 consecutive days prior to ischemia and reperfusion. Myocardial pathological changes, infarct size and cell apoptosis were measured by hematoxylin and eosin, triphenyltetrazolium chloride and TUNEL staining, respectively. The changes in endoplasmic reticulum (ER) stress markers, the reperfusion injury salvage kinase (RISK) pathway and mitochondrial apoptosis­related proteins were detected by western blotting. Overall, the results demonstrated that low­dose LP in combination with IPoC ameliorated myocardial histopathological changes, reduced the infarct size and release of cardiac enzymes, and decreased cardiomyocyte apoptosis in hypercholesterolemic rats, but no beneficial effects were achieved by the same dose of LP or IPoC treatment were used alone. Furthermore, the combination of LP and IPoC inhibited the expression of glucose­regulated protein 78 and C/EBP homologous protein, increased the phosphorylation levels of AKT, ERK1/2 and glycogen synthase kinase­3ß, repressed mitochondrial permeability transition pore opening, and reduced the expression of cytochrome c, cleaved caspase­9 and cleaved caspase­3. Collectively, these findings demonstrated that LP can restore the cardioprotective effects of IPoC on MIRI in hypercholesterolemic rats, and this restoration by LP was mediated by inhibition of ER stress and reactivation of the RISK pathway in hypercholesterolemic rat myocardium.


Assuntos
Hipercolesterolemia/complicações , Pós-Condicionamento Isquêmico , Licopeno/uso terapêutico , Traumatismo por Reperfusão Miocárdica/complicações , Traumatismo por Reperfusão Miocárdica/terapia , Substâncias Protetoras/uso terapêutico , Animais , Hipercolesterolemia/sangue , Hipercolesterolemia/patologia , Pós-Condicionamento Isquêmico/métodos , Lipídeos/sangue , Masculino , Infarto do Miocárdio/sangue , Infarto do Miocárdio/complicações , Infarto do Miocárdio/patologia , Infarto do Miocárdio/terapia , Traumatismo por Reperfusão Miocárdica/sangue , Traumatismo por Reperfusão Miocárdica/patologia , Miocárdio/patologia , Ratos Wistar
15.
Clin Lab ; 65(4)2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30969071

RESUMO

BACKGROUND: Cardiac troponin I (TnI) is one of the most crucial biomarkers for the management of acute coronary syndrome. However, the TnI values can vary when using commercial TnI assays from different vendors. We assessed the feasibility of TnI harmonization using plasma and serum samples. METHODS: Leftover plasma and serum samples were collected from patients and stored for further analysis (n = 200). TnI measurements were performed using 3 different analyzers. The TnI values for plasma and serum were compared, and the mathematical recalibration was performed using the mean of 3 values from each analyzer as a reference value. The number of biased cases was counted before and after recalibration. RESULTS: The final analysis was performed in a total of 140 plasma and serum samples, and constant and/or proportional differences for each analyzer were observed. Mathematical recalibration of the TnI values resulted in improved correlation to the reference values. The number of TnI values that were remote from the reference values decreased after recalibration. The effects were more evident for serum samples. CONCLUSIONS: In this study, we reassured the possibility of TnI harmonization among 3 different immunoassays using plasma and serum samples. It is important to note the differences between sample types during TnI harmonization.


Assuntos
Biomarcadores/sangue , Técnicas de Laboratório Clínico/instrumentação , Técnicas de Laboratório Clínico/métodos , Imunoensaio/normas , Plasma , Soro , Troponina I/sangue , Síndrome Coronariana Aguda/sangue , Calibragem , Humanos , Modelos Teóricos , Infarto do Miocárdio/sangue , Valores de Referência , Troponina T/sangue
16.
Bull Exp Biol Med ; 166(6): 747-750, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31020589

RESUMO

Antithrombotic activity of a novel tricyclic derivative of diazepino[1,2-α]benzimidazole (DAB-15) was examined on the model of arterial thrombosis developed in rats without concomitant pathology and in rats with experimental myocardial infarction. DAB-15 demonstrated high antithrombotic efficacy in modeled thrombosis of carotid artery in rats without the concomitant pathology surpassing that of the reference drugs acetylsalicylic acid and clopidogrel by 5.1 and 4.8 times, respectively. In rats with experimental noncoronary myocardial infarction, DAB-15 increased the thrombus formation time by 86.2% in comparison with experimental control level in non-treated rats with similar myocardial infarction.


Assuntos
Azepinas/farmacologia , Benzimidazóis/farmacologia , Fibrinolíticos/farmacologia , Infarto do Miocárdio/tratamento farmacológico , Trombose/prevenção & controle , Animais , Animais não Endogâmicos , Aspirina/farmacologia , Azepinas/síntese química , Benzimidazóis/síntese química , Testes de Coagulação Sanguínea , Cloretos/administração & dosagem , Clopidogrel/farmacologia , Modelos Animais de Doenças , Compostos Férricos/administração & dosagem , Fibrinolíticos/síntese química , Masculino , Infarto do Miocárdio/sangue , Infarto do Miocárdio/patologia , Agregação Plaquetária/efeitos dos fármacos , Ratos , Trombose/sangue , Trombose/induzido quimicamente , Trombose/patologia
17.
Vasc Health Risk Manag ; 15: 57-67, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30936712

RESUMO

Background: Acute myocardial infarction (AMI) with no evidence of relevant stenosis of the coronary artery, known as myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA), has a prevalence of up to 14%. The various causes of MINOCA lead to damage of the myocardium, and there are marked differences in diagnoses, prognoses, and treatments. Although the number of patients affected is considerable owing to the high prevalence of acute coronary syndrome (ACS), the causes of MINOCA have received little attention with the result that some patients may not receive appropriate treatment. Awareness of this disease among clinicians has started only to improve since the beginning of the current century. The aim of this study was to develop a score that enables patients with MINOCA to be distinguished from patients with MI with coronary artery disease (MI-CAD) and thus to facilitate appropriate diagnosis and therapy. Patients and methods: A multicenter observational cohort study was designed. All patients aged ≥18 years from the ARIAM-SEMICYUC (Analysis of Delay in AMI-Spanish Society of Intensive Care Medicine and Coronary Unit) registry, diagnosed with AMI, and admitted to critical care units or coronary care units (CCUs) were included. Patients were classified into two groups: MINOCA, comprising patients with no significant lesions on angiography, and MI-CAD, comprising patients with lesions of the coronary artery tree. Results: A score based on standard variables to assess the probability of MINOCA on admission was designed, showing a maximum value corresponding to a 40% probability of MINOCA. The discriminative power of the model was 0.756 (P-value for the Hosmer-Lemeshow test was >0.05). At 30-day follow-up, the mortality rate was higher for MI-CAD patients. Conclusion: Patients with MINOCA constitute a population that differs from other patients with AMI. Their differential characteristics require a certain diagnostic effort to align therapy with the disease causing the ischemic event. This score could prove useful in establishing additional diagnostic procedures.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Estenose Coronária/diagnóstico , Técnicas de Apoio para a Decisão , Infarto do Miocárdio/diagnóstico , Fatores Etários , Idoso , Biomarcadores/sangue , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/terapia , Estenose Coronária/sangue , Estenose Coronária/epidemiologia , Estenose Coronária/terapia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologia , Troponina/sangue , Regulação para Cima
18.
Lipids Health Dis ; 18(1): 95, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971288

RESUMO

BACKGROUND: The incidence of premature myocardial infarction (PMI) has gradually increased in recent years. Genetics plays a central role in the development of PMI. Familial hypercholesterolemia (FH) is one of the most common genetic disorders of cholesterol metabolism leading to PMI. OBJECTIVE: This study investigated the relationship between FH-associated genes and the phenotype of PMI to clarify the genetic spectrum of PMI diseases. METHOD: This study enrolled PMI patients (n = 225) and detected the mutations in their FH-associated genes (LDLR, APOB, PCSK9, LDLRAP1) by Sanger sequencing. At the same time, patients free of PMI (non-FH patients, n = 56) were enrolled as control, and a logistic regression analysis was used to identify risk factors associated with PMI. The diagnosis of FH was confirmed using "2018 Chinese expert consensus of FH screening and diagnosis" before the prevalence and clinical features of FH were analyzed. RESULTS: Pathogenic mutations in LDLR, APOB, PCSK9 and LDLRAP1 genes were found in 17 of 225 subjects (7.6%), and all mutations were loss of function (LOF) and heterozygous. The genotype-phenotype relationship of patients carrying FH-associated mutations showed high heterogeneity. The logistic regression analysis showed that the smoking history, obesity and the family history of premature CHD were independent risk factors of PMI. In this study, a total of 19 patients (8.4%) were diagnosed as FH, and the proportion of smoking subjects in FH patients was higher than that in non-FH patients. CONCLUSIONS: FH-associated gene mutations were present in about 7.6% of Chinese patients with PMI. In addition to genetic factors, smoking history, lifestyle and other environmental factors may play a synergistic role in determining the phenotype of PMI. TRIAL REGISTRATION: Essential gene mutation of cholesterol metabolism in patients with premature myocardial infarction. ChiCTR-OCH-12002349.Registered 26 December 2014, http://www.chictr.org.cn/showproj.aspx?proj=7201 .


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Apolipoproteína B-100/genética , Hiperlipoproteinemia Tipo II/diagnóstico , Mutação , Infarto do Miocárdio/diagnóstico , Pró-Proteína Convertase 9/genética , Receptores de LDL/genética , Proteínas Adaptadoras de Transdução de Sinal/sangue , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Apolipoproteína B-100/sangue , Estudos de Casos e Controles , Feminino , Expressão Gênica , Predisposição Genética para Doença , Heterozigoto , Humanos , Hiperlipoproteinemia Tipo II/sangue , Hiperlipoproteinemia Tipo II/complicações , Hiperlipoproteinemia Tipo II/genética , Padrões de Herança , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/genética , Obesidade , Fenótipo , Pró-Proteína Convertase 9/sangue , Receptores de LDL/sangue , Fatores de Risco , Análise de Sequência de DNA , Fumar
19.
Medicine (Baltimore) ; 98(14): e15061, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946353

RESUMO

AIMS: Phosphoinositide 3-kinases (PI3Ks) are a family of enzymes that phosphorylate the 3'-OH of inositol ring of phosphatidylinositol (PI) and regulate a broad range of signaling pathways. PIK3C2A is structurally distinct from the other members of this class and is expressed in endothelial cells, vascular endothelium, and smooth muscle. In ischemic cardiovascular diseases, such as coronary artery disease, pathology is associated with endothelial damage and inflammation, downregulation of the EPC cell population and function, and impaired angiogenesis. This study aims to make an assessment on whether expression of PIK3C2A gene can be used as a biomarker for predicting the risk of acute myocardial infarction (AMI). METHODS: We collected peripheral blood from 84 subjects with non-coronary heart disease and 70 patients with AMI. The real-time quantitative PCR test was applied to measure levels of PIK3C2A gene expression at mRNA level in peripheral blood. RESULTS: Our results indicated that the level of PIK3C2A gene expression in peripheral blood of AMI patients was significantly lower than one in the non-coronary heart disease subjects. Binary logistic regression analysis showed that low expression of PIK3C2A gene was an independent risk factor of AMI and increased the risk of AMI by 2.231 folds. Moreover, it was found that low expression of PIK3C2A gene was not associated with level of fasting blood glucose, platelet count, Gensini score of coronary artery, and quantity of cardiac troponin. CONCLUSION: The level of PIK3C2A gene expression in patients with AMI is significantly lower than that of healthy people. Low expression of PIK3C2A gene is an independent risk factor of AMI. Low expression of PIK3C2A could serve as a potential biomarker to predict risk of AMI.


Assuntos
Expressão Gênica , Infarto do Miocárdio/genética , Fosfatidilinositol 3-Quinases/genética , Idoso , Biomarcadores/sangue , Glicemia/metabolismo , Estudos de Casos e Controles , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Fosfatidilinositol 3-Quinases/sangue , RNA Mensageiro , Estudos Retrospectivos , Fatores de Risco
20.
Mediators Inflamm ; 2019: 8276180, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30983881

RESUMO

Macrophage migration inhibitory factor (MIF), a widely expressed pleiotropic cytokine, is reportedly involved in several cardiovascular diseases, in addition to inflammatory diseases. Plasma MIF levels are elevated in the early phase of acute cardiac infarction. This study is aimed at investigating the correlation between plasma MIF levels and cardiac function and prognosis in patients with acute ST-segment elevation myocardial infarction (STEMI) with or without diabetes mellitus. Overall, 204 patients with STEMI who underwent emergency percutaneous coronary intervention were enrolled: 57 and 147 patients in the diabetes and nondiabetes STEMI groups, respectively. Sixty-five healthy people were selected as controls. Plasma MIF levels were measured at the time of diagnosis. Basic clinical data and echocardiographic findings within 72 h of admission were collected. Patients were followed up, and echocardiograms were reviewed at the 12-month follow-up. Plasma MIF levels were significantly higher in the diabetes and nondiabetes STEMI groups than in the control group and in patients with Killip grade ≥ II STEMI than in those with Killip grade I. Plasma MIF levels were negatively correlated with the left ventricular ejection fraction (LVEF) of myocardial infarction in patients with or without diabetes in the acute phase of infarction, whereas the left ventricular diastolic dysfunction (LVDD) was positively correlated. MIF levels in the nondiabetes STEMI group were positively correlated with N-terminal pro-b-type natriuretic peptide levels and were associated with LVEF and LVDD at the 12-month follow-up. The risk of adverse cardiovascular and cerebrovascular events was significantly higher in the MIF high-level group (≥52.7 ng/mL) than in the nondiabetes STEMI group 36 months after presentation. Thus, MIF levels in STEMI patients with or without diabetes can reflect acute cardiac function. In STEMI patients without diabetes, MIF levels can also indicate cardiac function and long-term prognosis at the 12-month follow-up.


Assuntos
Biomarcadores/sangue , Diabetes Mellitus/sangue , Oxirredutases Intramoleculares/sangue , Fatores Inibidores da Migração de Macrófagos/sangue , Infarto do Miocárdio/sangue , Infarto do Miocárdio/patologia , Adulto , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Disfunção Ventricular Esquerda/sangue
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