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1.
Medicine (Baltimore) ; 98(43): e16989, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651833

RESUMO

Periprocedural myocardial injury (PMI) and contrast-induced nephropathy (CIN) are frequent complications of percutaneous coronary intervention (PCI) associated with early and late major adverse cardiovascular events. Both conditions are associated with similar risk factors, which could imply their possible association. The aim of our study was to assess the correlation of PMI and early postprocedural creatinine shift (ECS) as a marker of renal injury.A total of 209 hospitalized patients with stable coronary artery disease (CAD) were enrolled, who underwent an elective PCI in a period of 12 months. All patients had their serum high-sensitivity troponin I (hsTnI) measured at baseline and 16 hours after the PCI. PMI was defined according to the elevation of postprocedural hsTnI using criteria provided by both the most recent consensus documents as well as evidence-based data. Renal injury was evaluated using the ECS concept. Serum creatinine (SCr) was also measured at baseline and at 16 hours. ECS was defined as SCr >5% at 16 hours compared to baseline.Although incidence of both PMI (77.5%) and ECS (44.5%) were high, no association of these 2 conditions could be found. Further analyses of our data showed that diabetes is associated with a higher incidence of ECS, while patients on beta-blocker therapy had a lower incidence of ECS.In our study, no association between PMI and ECS was found. Additional studies with a larger number of patients and longer patient observation are needed to assess the correlation between PMI and CIN as well as to validate the attractive, but controversial, concept of ECS as an early marker of CIN.


Assuntos
Lesão Renal Aguda/epidemiologia , Meios de Contraste/efeitos adversos , Traumatismos Cardíacos/epidemiologia , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Lesão Renal Aguda/sangue , Lesão Renal Aguda/induzido quimicamente , Idoso , Biomarcadores/sangue , Doença da Artéria Coronariana/cirurgia , Creatinina/sangue , Estudos Transversais , Procedimentos Cirúrgicos Eletivos , Feminino , Traumatismos Cardíacos/sangue , Traumatismos Cardíacos/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Fatores de Risco , Troponina I/sangue
2.
Medicine (Baltimore) ; 98(43): e17023, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651834

RESUMO

Stanford type A aortic dissection (AD) is a lethal disease requiring surgery. Evidence regarding the prognostic ability of perioperative myocardiac markers on long-term outcome is limited.In this cohort study, we measured perioperative myocardiac markers level in 583 surgical patients with type A AD in our hospital between 2015 and 2017. All patients were followed up after surgery for a median period of 864 days to determine short- and long-term mortality.About one-fifth of patients has a positive preoperative myocardial markers, which was increased significantly after operation. Increase log10 post-creatine kinase MB isoenzyme (CK-MB) (hazard ratio [HR], 4.64; 95% confidence interval [CI] 1.89-11.43; P = .0008), log10 post-TnI (HR, 3.11; 95% CI 1.56-6.21; P = .0013), log10 post-Mb (HR, 3.00; 95% CI 1.40-6.43; P = .0048), log10 pre-CK-MB (HR,1.82; 95% CI 1.03-3.21; P = .0377), and upper tertile of post-CK-MB (HR,1.52; 95% CI 1.05-2.20; P = .0261) were the independent risk factor for 30 days mortality adjusted for potential confounders. None of cardiac markers was significantly associated with long-term outcome independent of other factors.Perioperative myocardiac predicts early outcome in type A AD patients undergoing surgery. Increasing perioperative myocardial markers do not appear to be a predictor for long-term all-cause mortality.


Assuntos
Aneurisma Dissecante/sangue , Aneurisma Dissecante/mortalidade , Creatina Quinase Forma MB/sangue , Troponina I/sangue , Adulto , Aneurisma Dissecante/cirurgia , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Valor Preditivo dos Testes , Período Pré-Operatório , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
3.
Klin Lab Diagn ; 64(9): 525, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31610103

RESUMO

The multimarker approach more accurately reflects the key mechanisms of pathogenesis and biochemical interactions, compared with the use of individual indicators. It is a reason of steadily growing interest in the development and use of various combinations of biomarkers in assessing the prognosis and stratification of cardiovascular risk in patients with a wide range of cardiological profiles. Multiplex analysis technology on the Luminex platform is the best tool for the simultaneous quantitative determination of a complex of different biomarkers in a single. Using the MILLIPLEX® MAP Human Cardiovascular Disease Panel, a multiplefold increase of FABP, Troponin I, CK-MB, BNP, Nt-proBNP, BNP in the first 24 hours after MI, decreasing in 6 months with a high degree of confidence, was shown. There were no differences in the content of LIGHT between the stages of observation, as well as in comparison with the reference range. The content of LIGHT on the first day of MI showed strong positive associations with markers of damage of myocardium and myocardial stress. On the first day of MI, a significant increase in the content of ESM-1, decreasing in 6 months after MI to the reference values was found. Strong positive associations of ESM-1 with Troponin I and BNP levels were established. A significant increase of proinflammatory cytokine OSM on the first day of MI, decreasing in the late post-infarction period to reference values was shown. Correlation analysis revealed direct relationships of OSM with Troponin I, CK-MB, Nt-proBNP and BNP. The use of the MILLIPLEX® MAP Human Cardiovascular Disease Panel 1 diagnostic multimarker panel allowed for the simultaneous quantitative analysis of 11 biochemical parameters, associated with inflammation, atherogenesis, endothelial dysfunction, ischemia and myocardial necrosis. The results can be used to improve the effectiveness of complex diagnostics in patients with primary myocardial infarction with ST segment elevation.


Assuntos
Biomarcadores/sangue , Infarto do Miocárdio/diagnóstico , Creatina Quinase Forma MB/sangue , Proteínas de Ligação a Ácido Graxo/sangue , Humanos , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Troponina I/sangue
6.
Medicine (Baltimore) ; 98(30): e16566, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348283

RESUMO

RATIONALE: Cardiac transthyretin amyloidosis is a progressive and fatal cardiomyopathy for which several promising therapies are in development. The diagnosis is frequently delayed or missed because of the limited specificity of clinical manifestations, routine electrocardiogram, echocardiography and the traditional requirement for endomyocardial biopsy confirmation. PATIENT CONCERNS: A 68-year-old female had suffered from lumbago for 5 years with progressive weakness, numbness in both lower limb. DIAGNOSIS: The patient's clinical signs were not specific, but cardiac amyloidosis was suspected based on relative left ventricular apical sparing of longitudinal strain on echocardiography and continuous elevated serum levels of cardiac biomarkers (ultrasensitive cardiac troponin I and NT-proBNP). She was finally diagnosed hereditary transthyretin-related cardiac amylodosis by specific findings of cardiovascular magnetic resonance imaging (CMR), -technetium pyrophosphate (Tc-PYP) scintigraphy and genetic testing. INTERVENTIONS: The patient received medications including diuretics, beta-blockers and angiotensin-converting enzyme inhibitors at the time of hospitalization. Ultimately, however, she refused further treatments and requested discharge from our hospital. OUTCOMES: A series of noninvasive technique enables the diagnosis of hereditary transthyretin-related cardiac amyloidosis. LESSONS: While endomyocardial biopsy is not able to performed, this case demonstrates that a combination of noninvasive techniques, especially CMR, nuclear imaging, and genetic testing, may help us to make a correct diagnosis of hereditary transthyretin-related cardiac amyloidosis.


Assuntos
Neuropatias Amiloides Familiares/diagnóstico , Técnicas de Imagem Cardíaca/métodos , Testes Genéticos/métodos , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Troponina I/sangue , Idoso , Ecocardiografia/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Cintilografia/métodos , Compostos Radiofarmacêuticos , Pirofosfato de Tecnécio Tc 99m
7.
BMC Vet Res ; 15(1): 237, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288807

RESUMO

BACKGROUND: Exercise testing in conjunction with measurement of cardiac biomarkers NT-proBNP and cTnI is a useful tool for monitoring the effect of treatment on cardiac patients. Administering Pimobendan in dogs with degenerative mitral valve disease (DMVD) and cardiomegaly results in delaying the onset of clinical symptoms and prolonging life. Its effect in dogs with DMVD without cardiomegaly has not been well examined. The aim of the current study was to investigate the effect of administering Pimobendan in dogs with DMVD without cardiomegaly using exercise testing in conjunction with measuring cardiac biomarkers in addition to echocardiography. Twenty-one dogs with asymptomatic DMVD without echocardiographic signs of cardiomegaly participated in a randomised, double-blinded trial. Dogs were divided into a Pimobendan-group (n = 11) and a placebo-group (n = 10) in a double-blinded study design and underwent a standardised submaximal exercise test (SSET). One dog in the Pimobendan-group was retrospectively removed from the study after being diagnosed with Leishmaniosis. Cardiac biomarkers NT-proBNP and cTnI were measured before and after exercise. Follow-up appointments were performed at days 90 and 180. RESULTS: Dogs in the Pimobendan-group had significantly lower post-exercise NT-proBNP-levels after being administered Pimobendan than at the beginning of the study. They also had lower pre- and post-exercise-NT-proBNP-levels than those dogs in the placebo-group. There was neither a significant difference regarding the measured cTnI levels nor an increase in cTnI between the groups at any time. CONCLUSIONS: Pimobendan lowers NT-proBNP in dogs with presymptomatic mitral valve disease without cardiomegaly before and after submaximal exercise. This indicates a reduction in cardiac wall stress. If dogs with asymptomatic DMVD without cardiomegaly benefit from treatment with Pimobendan (for example, through a longer survival time) warrants further investigation.


Assuntos
Doenças do Cão/sangue , Doenças do Cão/tratamento farmacológico , Teste de Esforço/veterinária , Doenças das Valvas Cardíacas/veterinária , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Piridazinas/uso terapêutico , Troponina I/sangue , Animais , Biomarcadores/sangue , Cães , Feminino , Doenças das Valvas Cardíacas/sangue , Doenças das Valvas Cardíacas/tratamento farmacológico , Masculino , Condicionamento Físico Animal/fisiologia , Piridazinas/farmacologia , Distribuição Aleatória , Estresse Fisiológico/efeitos dos fármacos , Resultado do Tratamento
8.
Int J Cardiovasc Imaging ; 35(7): 1265-1275, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31165941

RESUMO

Assessment of global longitudinal strain (GLS) is superior to ejection fraction (EF) in the evaluation of left ventricular (LV) function in patients with stable coronary artery disease (CAD). However, the role of mechanical dispersion (MD) in this context remains unresolved. We aimed to evaluate the potential role of MD as a marker of LV dysfunction and long-term prognosis in stable CAD. EF, GLS and MD were assessed in 160 patients with stable CAD, 1 year after successful coronary revascularization. Serum levels of high-sensitivity cardiac troponin I (hs-cTnI) and amino-terminal pro B-type natriuretic peptide (NT-proBNP) were quantified as surrogate markers of LV dysfunction. The primary endpoint was defined as all-cause mortality, the secondary endpoint was defined as the composite of all-cause mortality and hospitalization for acute myocardial infarction or heart failure during follow-up. Whereas no associations between EF and the biochemical markers of LV function were found, both GLS and MD correlated positively with increasing levels of hs-cTnI (R = 0.315, P < 0.001 and R = 0.442, P < 0.001, respectively) and NT-proBNP (R = 0.195, P = 0.016 and R = 0.390, P < 0.001, respectively). Median MD was 46 ms (interquartile range [IQR] 37-53) and was successfully quantified in 96% of the patients. During a median follow-up of 8.4 (IQR 8.2-8.8) years, 14 deaths and 29 secondary events occurred. MD was significantly increased in non-survivors, and provided incremental prognostic value when added to EF and GLS. NT-proBNP was superior to the echocardiographic markers in predicting adverse outcomes. MD may be a promising marker of LV dysfunction and adverse prognosis in stable CAD.


Assuntos
Doença da Artéria Coronariana/cirurgia , Ecocardiografia , Revascularização Miocárdica , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Idoso , Biomarcadores/sangue , Causas de Morte , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/efeitos adversos , Revascularização Miocárdica/mortalidade , Peptídeo Natriurético Encefálico/sangue , Readmissão do Paciente , Fragmentos de Peptídeos/sangue , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Troponina I/sangue , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/terapia
9.
Life Sci ; 232: 116547, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31176780

RESUMO

AIMS: This study aims to investigate the value of the expression of miR-208, miR-494, miR-499 and miR-1303 in the early diagnosis of acute myocardial infarction (AMI). MAIN METHODS: Patients were divided into two groups: AMI group (n = 41), and Stable angina pectoris (SAP) group (n = 32). Peripheral venous blood was sampled from these patients at the time of admission (T0), 6 h after onset (T6) and 12 h after onset (T12), while blood was sampled once from healthy subjects who underwent physical examination in the same time period (control group, n = 10). The expression of miR-208, miR-494, miR-499 and miR-1303 in serum were detected by real-time quantitative polymerase chain reaction (qRT-PCR), and differences in miRNA expression among these three groups of patients were analyzed. KEY FINDINGS: Serum miR-208, miR-494, miR-499 and miR-1303 expression levels at different time points were significantly higher in the AMI group than in the SAP group and control group. The differences among these groups were statistically significant (P < 0.05), while the difference between the SAP group and control group was not statistically significant (P > 0.05). Variation trend: The miRNA levels above began to increase at T0 in the AMI group, the peak levels of miR-208, miR-494 and miR-499 appeared before T12, and the peak level of miR-1303 appeared between T6 and T12, or after T12. SIGNIFICANCE: miR-208, miR-494, miR-499 and miR-1303 were not superior to hs-cTnI as myocardial markers in the diagnosis of early acute myocardial infarction.


Assuntos
MicroRNAs/genética , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/genética , Idoso , Angina Estável/genética , Angina Estável/metabolismo , Biomarcadores/sangue , Estudos de Casos e Controles , Diagnóstico Precoce , Feminino , Humanos , Masculino , MicroRNAs/análise , Pessoa de Meia-Idade , Curva ROC , Reação em Cadeia da Polimerase em Tempo Real , Transcriptoma/genética , Troponina I/análise , Troponina I/sangue , Troponina T/análise , Troponina T/sangue
10.
Nat Rev Dis Primers ; 5(1): 39, 2019 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-31171787

RESUMO

ST-segment elevation myocardial infarction (STEMI) is the most acute manifestation of coronary artery disease and is associated with great morbidity and mortality. A complete thrombotic occlusion developing from an atherosclerotic plaque in an epicardial coronary vessel is the cause of STEMI in the majority of cases. Early diagnosis and immediate reperfusion are the most effective ways to limit myocardial ischaemia and infarct size and thereby reduce the risk of post-STEMI complications and heart failure. Primary percutaneous coronary intervention (PCI) has become the preferred reperfusion strategy in patients with STEMI; if PCI cannot be performed within 120 minutes of STEMI diagnosis, fibrinolysis therapy should be administered to dissolve the occluding thrombus. The initiation of networks to provide around-the-clock cardiac catheterization availability and the generation of standard operating procedures within hospital systems have helped to reduce the time to reperfusion therapy. Together with new advances in antithrombotic therapy and preventive measures, these developments have resulted in a decrease in mortality from STEMI. However, a substantial amount of patients still experience recurrent cardiovascular events after STEMI. New insights have been gained regarding the pathophysiology of STEMI and feed into the development of new treatment strategies.


Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Biomarcadores/análise , Biomarcadores/sangue , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/fisiopatologia , Ecocardiografia/métodos , Eletrocardiografia/métodos , Humanos , Programas de Rastreamento/métodos , Intervenção Coronária Percutânea/métodos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Resultado do Tratamento , Troponina I/análise , Troponina I/sangue
11.
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
12.
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
13.
Biochem Med (Zagreb) ; 29(2): 020901, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31223265

RESUMO

Introduction: The knowledge of high sensitivity cardiac troponin I (hsTnI) distribution in a reference population is mandatory for its introduction in clinical practice. The aim of this study was to define the Upper Reference Limit (URL) of hsTnI measured by Single Molecule Counting technology (SMC) in an accurately selected reference population. Materials and methods: In the study 1140 blood donors were included and selected on the basis of medical history and biomarkers. High sensitivity cardiac troponin I was measured by SMC technology (Clarity, Singulex, Alamed, USA). The 99th percentile was calculated by the non-parametric method according to the Clinical and Laboratory Standard Institute - CLSI C28-A3. Results: The median age was 41 years (IQR: 28 - 50) and 69% were males. The overall 99th percentile was 5 ng/L (90% CI: 4.2 - 5.6). When considering sex-related differences, we found slight differences between the 99th percentile in males and females. Moreover, the 99th percentile trended with age, especially in females. Conclusions: We defined the 99th percentile of hs-cTnI measured by SMC technology in a highly selected healthy population, with only minor differences between males and females. Our findings provide the basic criteria for the reliable interpretation of hsTnI concentrations measured by the SMC technology in clinical settings.


Assuntos
Vasos Coronários/química , Troponina I/sangue , Adolescente , Adulto , Idoso , Doadores de Sangue , Feminino , Voluntários Saudáveis , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Valores de Referência , Adulto Jovem
14.
Pediatr Cardiol ; 40(6): 1171-1174, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31177303

RESUMO

The objective of this study was to describe a cohort of patients with clinical myocarditis and normal left ventricular (LV) systolic function on admission. A retrospective chart review at seven tertiary pediatric hospitals identified patients aged < 19 years admitted with an ICD-9 code of myocarditis between 2008 and 2012. Patients were excluded if admission LV systolic ejection fraction was < 50%, fractional shortening (FS) was < 28% or if the admitting or consulting cardiologist did not suspect myocarditis. A total of 75 patients met inclusion criteria. The median age was 15.5 years with an Interquartile Range (IQR) of 13.6-16.6. 33% were female. Patients presented most commonly with chest pain (75%) and dyspnea (24%). On admission, median B-type natriuretic peptide (BNP) was 132 pg/mL (IQR 57-689) and median troponin I (TnI) was 8.4 ng/mL (IQR 2.0-20.3). Electrocardiogram revealed ST elevation in the majority (55%). Magnetic resonance imaging was obtained on 40%, with 63% of those showing evidence of inflammation. Therapies included inotropic support (15%), mechanical ventilation (12%), antiarrhythmic medications (9%), and Extracorporeal Membrane Oxygenation (5%). Those with poor outcomes were noted to have significantly higher BNP, TnI, and creatine kinase levels on presentation. One patient was transplanted and 35% were discharged on heart failure medications. At one year follow-up one patient had died of unspecified causes, 15% required readmission for cardiac reasons, and 21% continued on heart failure medications. The risk associated with clinical myocarditis in the setting of normal ventricular function at presentation may be higher than previously suspected.


Assuntos
Miocardite/diagnóstico , Função Ventricular Esquerda/fisiologia , Adolescente , Antiarrítmicos/uso terapêutico , Cardiotônicos/uso terapêutico , Dor no Peito/etiologia , Eletrocardiografia , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Feminino , Humanos , Masculino , Miocardite/mortalidade , Miocardite/terapia , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Troponina I/sangue
15.
Clin Biochem ; 69: 52-56, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31063741

RESUMO

BACKGROUND: Siemens Healthcare Diagnostics has four commercially available assays on different analytical platforms using different methodologies to generate signal. We assessed the analytical performance of the Dimension EXL hs-cTnI assay (LOCI method) across different matrices and compared it to two different acridinium ester-based hs-cTnI assays (ADVIA Centaur and Abbott ARCHITECT). METHODS: The analytical sensitivity and precision below the 99th-percentile was determined for the Dimension EXL hs-cTnI assay. Method comparisons were performed between the Dimension EXL contemporary cTnI and the hs-cTnI assays, between different matrices for the EXL hs-cTnI assay (serum, lithium heparin and EDTA plasma), and between different hs-cTnI assays (EXL versus ADVIA Centaur or Abbott ARCHITECT) using non-parametric analyses. RESULTS: The limit of blank and detection were 0.9 ng/L and 1.7 ng/L, respectively, with imprecision of 5.8% at 8.6 ng/L and 3.2% at 47.5 ng/L. Comparison between the EXL contemporary cTnI and hs-cTnI assay (range: 2.6-4214 ng/L) yielded proportional lower concentrations for the hs-cTnI assay (slope = 0.86; 95%CI: 0.81 to 0.96, n = 40); however, there was no difference in concentrations below 100 ng/L between the assays (median difference = -2.7 ng/L; 95%CI: -9.8 to 9.3). Passing-Bablok regression analysis with EDTA plasma yielded proportionally higher concentrations with the EXL hs-cTnI versus Abbott hs-cTnI (slope = 1.45; 95%CI: 1.02-1.86, n = 40) with proportionally lower concentrations with EDTA versus lithium heparin plasma with the EXL hs-cTnI assay alone (slope = 0.93; 95%CI: 0.90 to 0.99, n = 40). Comparison with Abbott hs-cTnI concentrations below 100 ng/L in the three matrices, indicated that the EXL hs-cTnI assay yielded higher concentrations (median difference range: 3.4-9.4 ng/L), with differences also evident when comparing the EXL hs-cTnI assay to the ADVIA Centaur hs-cTnI assay. CONCLUSION: The Siemens EXL hs-cTnI assay meets the analytical criteria for a high-sensitivity assay, with assay specific cutoffs important to maximize clinical performance.


Assuntos
Troponina I/sangue , Testes Diagnósticos de Rotina , Feminino , Humanos , Limite de Detecção , Masculino , Pessoa de Meia-Idade
16.
J Vet Intern Med ; 33(3): 1242-1250, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30990935

RESUMO

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is the most common cardiac disease in cats. However, most cats are not diagnosed until they develop congestive heart failure, arterial thromboembolism (ATE), or sudden cardiac death. Thus, an affordable screening test for early detection of HCM is desirable. HYPOTHESIS/OBJECTIVES: Evaluation of a sensitive cardiac troponin I (cTnI) assay as a screening test for HCM in cats and determination of a cutoff for its early detection. ANIMALS: One hundred sixty-six client-owned cats (male, n = 97) of various breeds were evaluated and classified using echocardiography as being healthy (n = 87), equivocal (n = 15), or having HCM (mild, n = 16; moderate, n = 10; severe, n = 34) or ATE (n = 4). METHODS: All cats were prospectively evaluated by echocardiography, and serum cTnI concentration was determined using the currently most sensitive assay (Siemens ADVIA Centaur TnI-Ultra). RESULTS: The median cTnI concentration was significantly different between study groups (P < .000001). A cutoff of 0.06 ng/mL provided good discrimination between healthy cats and cats with HCM (sensitivity, 91.7%; specificity, 95.4%; area under the curve [AUC], 0.95; 95% confidence interval [CI], 0.899-0.978). Even for asymptomatic cats with HCM, sensitivity and specificity for a cutoff of >0.06 ng/mL remained high at 87.8% and 95.4%, respectively (AUC, 0.93; 95% CI, 0.864-0.964). CONCLUSIONS AND CLINICAL IMPORTANCE: Cardiac troponin I can be used as a sensitive and specific screening test for the diagnosis of HCM in otherwise healthy cats (cutoff, >0.06 ng/mL). However, echocardiography is needed to confirm the diagnosis.


Assuntos
Cardiomiopatia Hipertrófica/veterinária , Doenças do Gato/diagnóstico , Troponina I/sangue , Animais , Biomarcadores/sangue , Cardiomiopatia Hipertrófica/diagnóstico , Doenças do Gato/sangue , Gatos , Ecocardiografia/veterinária , Feminino , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade
17.
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
18.
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
19.
Biosens Bioelectron ; 134: 49-56, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30954926

RESUMO

The accurate detection of biomarkers for acute myocardial infarction (AMI) plays an important role in clinical diagnosis and management process. In this work, we developed an electrochemical biosensor by using magnetic metal organic framework (MMOF) nanocatalysts and DNA nanotetrahedron (NTH) based dual-aptamer probes for nonenzymatic detection of cardiac troponin I (cTnI), a gold standard biomarker for the early diagnosis of AMI. Firstly, the NTH-assisted dual-aptamer (Tro4 and Tro6) capture probes were immobilized on the screen-printed gold electrode (SPGE) for the highly enhanced capture the target cTnI with steady support and optimized interface density. Then, the MMOF Fe3O4@UiO-66 nanozymes were decorated by bimetallic Cu@Au nanoparticles and two kinds of aptamer. This fabricated nonenzymatic nanoprobe1 (NP1) can be applied for recognizing the cTnI specifically and amplifying the current signal by catalyzing the oxidation of hydroquinone (HQ) to benzoquinone (BQ) with H2O2. The target proteins were captured to fabricate a supersandwich-like structure on a SPGE interface. Furthermore, the nanoprobe2 (NP2) of Cu@Au nanozymes labeled with dual-complementary DNA (cDNA) to the dual-aptamer, were anchored on the NP1 through DNA hybridization, leading to the formation of cluster-based nanoprobes for further enhancing detection sensitivity. Finally, this enzyme-free electrochemical aptasensor exhibited great analytical performance with a dynamic range of 0.05-100 ng/mL, a low detection limit of 16 pg/mL, high selectivity and good repeatability. The fabricated aptasensor has great potential development in the field of clinic disease diagnostics for AMI.


Assuntos
Aptâmeros de Nucleotídeos/química , Técnicas Biossensoriais/métodos , Técnicas Eletroquímicas/métodos , Imãs/química , Estruturas Metalorgânicas/química , Troponina I/sangue , Técnicas Biossensoriais/instrumentação , Técnicas Eletroquímicas/instrumentação , Humanos , Limite de Detecção , Conformação de Ácido Nucleico
20.
Int Heart J ; 60(3): 648-655, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31019180

RESUMO

Apelin was proved to attenuate cardiac interstitial fibrosis. However, the association between apelin level and myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM) is still unclear.This study aims to determine whether apelin is associated with myocardial fibrosis in HCM and investigate the predictive values of apelin for myocardial fibrosis in HCM.One hundred sixteen patients with HCM were enrolled in this study. Plasma apelin-13 and high-sensitivity cardiac troponin I (cTNI) were measured. The cardiac systolic and diastolic functions were evaluated by echocardiography, and the presence and extent of cardiac fibrosis were assessed by cardiac magnetic resonance. All statistical data were analyzed by SPSS version 21.0.The percentage of late gadolinium enhancement (LGE) was negatively correlated with apelin and positively correlated with cTNI, maximum wall thickness (MWT), and left ventricular mass index in the overall patients with HCM and LGE. Apelin, cTNI, MWT, and left ventricular ejection fraction were independent predictors of the presence of LGE. The cutoff values of apelin, cTNI, and MWT were 1.24 pg/mL, 0.031 ng/mL, and 19 mm, respectively, for the prediction of LGE. The combined measurements of MWT ≥ 19 mm and/or apelin ≤ 1.24 pg/mL, as well as the combined measurements of MWT ≥ 19 mm and/or cTNI ≥ 0.031 ng/mL, obtained higher specificity and higher sensitivity, thus, indicating the presence of LGE.Plasma apelin and cTNI are independent predictors of myocardial fibrosis. The combined measurements of serum apelin and MWT, as well as cTNI and MWT, showed higher predictive values for predicting myocardial fibrosis in patients with HCM.


Assuntos
Apelina/sangue , Cardiomiopatia Hipertrófica/complicações , Fibrose Endomiocárdica/diagnóstico por imagem , Troponina I/sangue , Adulto , Biomarcadores/sangue , Cardiomiopatia Hipertrófica/metabolismo , Fibrose Endomiocárdica/metabolismo , Feminino , Gadolínio/metabolismo , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
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