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1.
J Am Heart Assoc ; 11(1): e022010, 2022 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-34970914

RESUMO

Background Myocardial injury in patients with COVID-19 is associated with increased mortality during index hospitalization; however, the relationship to long-term sequelae of SARS-CoV-2 is unknown. This study assessed the relationship between myocardial injury (high-sensitivity cardiac troponin T level) during index hospitalization for COVID-19 and longer-term outcomes. Methods and Results This is a prospective cohort of patients who were hospitalized at a single center between March and May 2020 with SARS-CoV-2. Cardiac biomarkers were systematically collected. Outcomes were adjudicated and stratified on the basis of myocardial injury. The study cohort includes 483 patients who had high-sensitivity cardiac troponin T data during their index hospitalization. During index hospitalization, 91 (18.8%) died, 70 (14.4%) had thrombotic complications, and 126 (25.6%) had cardiovascular complications. By 12 months, 107 (22.2%) died. During index hospitalization, 301 (62.3%) had cardiac injury (high-sensitivity cardiac troponin T≧14 ng/L); these patients had 28.6%, 32.2%, and 33.2% mortality during index hospitalization, at 6 months, and at 12 months, respectively, compared with 4.1%, 4.9%, and 4.9% mortality for those with low-level positive troponin and 0%, 0%, and 0% for those with undetectable troponin. Of 392 (81.2%) patients who survived the index hospitalization, 94 (24%) had at least 1 readmission within 12 months, of whom 61 (65%) had myocardial injury during the index hospitalization. Of 377 (96%) patients who were alive and had follow-up after the index hospitalization, 211 (56%) patients had a documented, detailed clinical assessment at 6 months. A total of 78 of 211 (37.0%) had ongoing COVID-19-related symptoms; 34 of 211 (16.1%) had neurocognitive decline, 8 of 211 (3.8%) had increased supplemental oxygen requirements, and 42 of 211 (19.9%) had worsening functional status. Conclusions Myocardial injury during index hospitalization for COVID-19 was associated with increased mortality and may predict who are more likely to have postacute sequelae of COVID-19. Among patients who survived their index hospitalization, the incremental mortality through 12 months was low, even among troponin-positive patients.


Assuntos
COVID-19 , Traumatismos Cardíacos , COVID-19/complicações , COVID-19/terapia , Traumatismos Cardíacos/epidemiologia , Hospitalização , Humanos , Estudos Prospectivos , Resultado do Tratamento , Troponina T/sangue
2.
J Card Surg ; 37(1): 151-161, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34758148

RESUMO

BACKGROUND AND AIM OF THE STUDY: Guidelines indicate for type 5 myocardial infarction (MI) that postoperative troponin need not be exclusively ischemic but may also be caused by epicardial injury. Complexity arises from the introduction of high-sensitive troponin. This study attempts to contribute to the understanding of postoperative high-sensitive cardiac troponin T (hs-cTnT) increase. METHODS: The median enzyme increase of different cardiac operations was compared. Linear regression analyses were used to determine correlations between enzyme rise and independent parameters. Receiver-operating characteristics (ROC) served to evaluate the discriminatory power of enzyme rise in detecting ischemia and to determine possible thresholds. RESULTS: Among 400 patients, 2.8% had intervention-related ischemia analogous to type 5 MI definition. The median postoperative hs-cTnT/creatine kinase myocardial band (CK-MB) increase varied according to types of surgery, with highest increase after mitral valve and lowest after off-pump coronary surgery. After ruling out patients with preoperatively elevated hs-cTnT, regression analysis confirmed Maze procedure (p < .001), intra-pericardial defibrillation (p = .002), emergency intervention (p = .01), blood transfusions (p = .02), and cardiopulmonary bypass time (p = .03) as significant factors associated with hs-cTnT increase. In addition, CK-MB increase was associated with mortality (p = .002). ROC confirmed good discriminatory power for hs-cTnT and CK-MB with ischemia-indicating thresholds of 1705.5 ng/L (hs-cTnT) and 113 U/L (CK-MB) considering different types of operations. CONCLUSIONS: The Influence of the type of surgery and intervention-related parameters on hs-cTnT increase was confirmed. Potential thresholds indicating perioperative ischemia appear to be significantly elevated for high sensitive markers.


Assuntos
Troponina T , Troponina , Biomarcadores , Creatina Quinase , Humanos , Infarto , Período Pós-Operatório
3.
J Card Surg ; 37(1): 162-164, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34689381

RESUMO

In the past few years, many have disputed the optimal biomarker for confirming or ruling out a diagnosis of periprocedural myocardial infarction (PMI) and the optimal cut-off concentrations to apply. In this issue of the Journal of Cardiac Surgery, Niclauss et al. performed a retrospective analysis of CK-MB and high-sensitivity cardiac troponin T (hs-cTnT) dynamics and peak concentrations following different cardiac surgical interventions in 400 patients during a 2-year period in a single center. The authors found that CK-MB and hs-cTnT predict PMI with a comparable diagnostic accuracy and discriminatory power >95%. They also attempted to propose an improved, more sensitive threshold of hs-cTnT for PMI. Their findings could have implications for clinical practice, but more research is warranted to identify more appropriate cut-offs. This could include hs-cTnT release pattern, slope steepness, and changes. Ultimately, this could results in patient-specific model, able to predict expected and abnormal ranges of hs-cTnT release, enabling an improved and timely diagnosis of PMI.


Assuntos
Infarto do Miocárdio , Troponina T , Biomarcadores , Creatina Quinase Forma MB , Humanos , Infarto do Miocárdio/diagnóstico , Estudos Retrospectivos
4.
Rev Fac Cien Med Univ Nac Cordoba ; 78(4): 415-422, 2021 11 29.
Artigo em Espanhol | MEDLINE | ID: mdl-34962733

RESUMO

The expansion and discovery of new diagnostic possibilities for the use of many biomarkers of cardiovascular diseases (CVDs), including cardiospecific troponin isoforms (cTnI, cTnT), is due to improved laboratory methods for their determination. Throughout a long history of the creation and improvement of immunochemical methods for the determination of cTnI and cTnT, significant changes were observed in the concept of biology and its diagnostic value as CVD biomarkers. The obsolete methods of detection of cTnI, cTnT, named low sensitivity and moderate, were distinguished by a relatively low sensitivity, which led to the confirmation late in the diagnosis of acute myocardial infarction (AMI) and, therefore, such methods were gradually replaced by new methods of high and moderate sensitivity, such as definitions of methods, ultra-sensitive (hs-cTnI, hs-cTnT). With the introduction of hs-cTnI and hs-cTnT in clinical practice, the possibility of early diagnosis and exclusion of AMI through the evaluation of the kinetics of the concentration of hs-cTnI and hs-cTnT in the first hours (0-1 hour, 0-2 hours, 0-3 hours) from the moment the patient enters the emergency room. In addition, some of our ideas about the biology of cardiac troponins have changed, and promising new opportunities for their use in medicine have emerged. This manuscript analyzes the key analytical characteristics of hs-cTnI and hs-cTnT detection methods compared to moderately sensitive methods, and reports on new biological data and some new diagnostic possibilities for the use of hs-cTnI and hs-cTnT in modern clinical practice.


La expansión y el descubrimiento de nuevas posibilidades de diagnóstico para el uso de muchos biomarcadores de enfermedades cardiovasculares (ECV), incluidas las isoformas de troponina cardioespecíficas (cTnI, cTnT), se debe a la mejora de los métodos de laboratorio para su determinación. A lo largo de una prolongada historia de la creación y mejora de métodos inmunoquímicos para la determinación de cTnI y cTnT, se observaron cambios significativos en el concepto de biología y su valor diagnóstico como biomarcadores de ECV. Los métodos obsoletos de detección de cTnI, cTnT, llamados de sensibilidad baja y moderada, se distinguieron por una sensibilidad relativamente baja, lo que llevó a la confirmación tardía del diagnóstico de infarto agudo de miocardio (IAM) y, por lo tanto, dichos métodos fueron reemplazados gradualmente por nuevos métodos de alta y moderada sensibilidad, como definiciones de métodos ultrasensibles (hs-cTnI, hs-cTnT). Con la introducción de hs-cTnI y hs-cTnT en la práctica clínica, la posibilidad de diagnóstico precoz y exclusión del IAM mediante la evaluación de la cinética de la concentración de hs-cTnI y hs-cTnT en las primeras horas (0-1 hora, 0-2 horas, 0-3 horas) desde el momento en que el paciente ingresa a urgencias. Además, algunas de nuestras ideas sobre la biología de las troponinas cardíacas han cambiado, y han surgido nuevas oportunidades prometedoras para su uso en medicina. En este artículo se discuten las características analíticas clave de los métodos de detección de hs-cTnI y hs-cTnT en comparación con métodos moderadamente sensibles, e informa sobre nuevos datos biológicos y algunas nuevas posibilidades de diagnóstico para el uso de hs-cTnI y hs-cTnT en la práctica clínica moderna.


Assuntos
Infarto do Miocárdio , Troponina T , Biomarcadores , Diagnóstico Precoce , Humanos , Infarto do Miocárdio/diagnóstico , Troponina I
5.
West J Emerg Med ; 22(6): 1291-1294, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34787553

RESUMO

INTRODUCTION: The diagnosis of non-ST-elevated myocardial infarction (NSTEMI) depends on a combination of history, electrocardiogram, and cardiac biomarkers. The most sensitive and specific biomarkers for cardiac injury are the troponin assays. Many hospitals continue to automatically order less sensitive and less specific biomarkers such as creatine kinase (CK) alongside cardiac troponin (cTn) for workup of patients with chest pain. The objective of this systematic review was to identify whether CK testing is useful in the workup of patients with NSTEMI symptoms. METHODS: We undertook a systematic review to ascertain whether CK ordered as part of the workup for NSTEMI was useful in screening patients with cardiac chest pain. The MEDLINE, Embase, and Cochrane databases were searched from January 1995-September 2020. Additional papers were added after consultation with experts. We screened a total of 2,865 papers, of which eight were included in the final analysis. These papers all compared CK and cTn for NSTEMI diagnosis. RESULTS: In each of the eight papers included in the analysis, cTn showed a greater sensitivity and specificity than CK in the diagnosis of NSTEMI. Furthermore, none of the articles published reliable evidence that CK is useful in NSTEMI diagnosis when troponin was negative. CONCLUSION: There is no evidence to continue to use CK as part of the workup of NSTEMI acute coronary syndrome in undifferentiated chest pain patients. We conclude that CK should not be used to screen patients presenting to the emergency department with chest pain.


Assuntos
Infarto do Miocárdio sem Supradesnível do Segmento ST , Troponina , Biomarcadores , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Creatina Quinase , Eletrocardiografia , Humanos , Troponina T
6.
J Sports Med Phys Fitness ; 61(9): 1301-1308, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34610731

RESUMO

BACKGROUND: It remains uncertain whether exercise modality (high-intensity interval [HIE]; moderate-intensity continuous [MCE]) mediates exercise-induced changes in markers of pro-arrhythmogenic state and/or cardiac damage. This study examines heart rate variability (HRV) and cardiac troponin T (cTnT) kinetic responses to HIE and MCE. METHODS: Fourteen sedentary, overweight/obese females completed two trials including HIE (2-min running at 90% V̇O2max followed by 2-min running at 50% V̇O2max, repeated for 60 min) and MCE (70% V̇O2max steady-state running for 60 min) in a randomized, counterbalanced fashion. Supine HRV was evaluated as root mean square of successive differences (RMSSD), normalized low-frequency (LF) and high-frequency (HF) spectral power, as well as the LF/HF ratio before (PRE), immediately (0 HR), 3 (3 HR) and 24 (24 HR) hours after exercise. Serum cTnT was assessed using a high-sensitivity assay at the same time-points and the values were corrected for plasma volume changes. RESULTS: Exercise temporarily altered all HRV indices (i.e. RMSSD and HF decreased; LF and LF/HF ratio increased at 0 HR, all P<0.05) but a rebound increase of RMSSD was observed at 24 HR, and the kinetic responses of HRV were similar between exercise modalities. The cTnT was significantly elevated (P<0.05) after exercise at 3 HR (by 688%) and 24 HR (by 374%) with no between-modality differences. There was no significant correlation between delta change in cTnT and HRV metrics. CONCLUSIONS: Exercise modality (workload-equivalent HIE vs. MCE) did not mediate exercise-induced alteration in autonomic activity and cTnT elevation, and it seems these are largely separate exercise-induced phenomena.


Assuntos
Sistema Nervoso Autônomo , Exercício Físico , Feminino , Frequência Cardíaca , Humanos , Sobrepeso , Troponina T
7.
Int J Cardiol ; 344: 199-204, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34600979

RESUMO

INTRODUCTION: We investigated the associations of high-sensitivity cardiac Troponin T (hs-cTnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels with risk of developing clinical peripheral artery disease (PAD) or a low ankle-brachial index (ABI). METHODS: Hs-cTnT and NT-proBNP were measured in 6692 and 5458 participants respectively without baseline PAD between 2000 and 2002 in the Multi-ethnic Study of Atherosclerosis. A significant number also had repeat biomarker measurement between 2004 and 2005. Incident clinical PAD was ascertained through 2017. Incident low ABI, defined as ABI <0.9 and decline of ≥0.15 from baseline, was assessed among 5920 eligible individuals who had an ABI >0.9 at baseline and at least one follow-up ABI measurement 3-10 years later. Multivariable Cox proportional hazards and logistic regression modeling were used to determine the association of these biomarkers with clinical PAD and low ABI, respectively. RESULTS: Overall, 121 clinical PAD and 118 low ABI events occurred. Adjusting for demographic and clinical characteristics, each log unit increment in hs-cTnT and NT-proBNP was associated with a 30% (adjusted hazard ratio (HR) 1.3, 95% confidence interval (CI): 1.1, 1.6) and 50% (HR) 1.5, 95% CI: 1.2, 1.8) higher risk of clinical PAD respectively. No significant associations were observed for incident low ABI. Change in these biomarkers was not associated with either of the PAD outcomes. CONCLUSIONS: NT-proBNP and hs-cTnT are independently associated with the development of clinical PAD. Further study should determine whether these biomarkers can help to better identify those at higher risk for PAD.


Assuntos
Aterosclerose , Doença Arterial Periférica , Índice Tornozelo-Braço , Aterosclerose/diagnóstico , Aterosclerose/epidemiologia , Biomarcadores , Humanos , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Fatores de Risco , Troponina T
9.
Anal Chim Acta ; 1185: 339082, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34711328

RESUMO

Cardiac troponin I (cTnI) is a sensitive biomarker for cardiovascular disease (CVD). Rapid determination of cTnI concentration in blood can greatly reduce the potential of significant heart damage and heart failure. Herein, we demonstrate a new electrochemical immunosensor for selective affinity binding and rapid detection of cTnI in blood plasma by an electrochemical method. A conductive film of "poly 2,5-bis(2-thienyl)3,4-diamine-terthiophene (PDATT)" was deposited onto an Indium Tin Oxide (ITO) electrode using chronoamperometry. Anti-cardiac troponin I antibody was then attached to the two amine (NH2) groups substituted on the central thiophene of terthiophene repeating unit of the polymer chain via amide bond formation. The gaps on the surface of the antibody coated immunosensor were backfilled with bovine serum albumin (BSA) to prevent nonspecific binding of interfering molecules. Differential pulse voltammetry (DPV) was used to determine cTnI upon the formation of cTnI immunocomplex on the sensing surface, appearing a peak at 0.27 V. The response range was 0.01-100 ng mL-1 with limit of quantification down to 0.01 ng mL-1. The developed immunosensor was used to determine cTnI in spiked blood plasma without interference from cardiac troponin T (cTnT). Therefore, this new sensor can be utilised for the detection of cTnI biomarker in pathological laboratories and points of care in less than 15 min.


Assuntos
Técnicas Biossensoriais , Troponina I , Anticorpos Imobilizados , Técnicas Eletroquímicas , Humanos , Imunoensaio , Limite de Detecção , Plasma , Polímeros , Troponina T
10.
Clin Cardiol ; 44(11): 1594-1601, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34545585

RESUMO

BACKGROUND: Circulating high sensitivity cardiac troponin T (hs-cTnT) is associated with incidence of atrial fibrillation (AF), but the association of changes in hs-cTnT over time on incident AF has not been explored. HYPOTHESIS: Six-year increase in circulating hs-cTnT will be associated with increased risk of AF and will contribute to improved prediction of incident AF. METHODS: We conducted a prospective cohort analysis of 8431 participants from the Atherosclerosis Risk in Communities (ARIC) study. hs-cTnT change was categorized at visit 2 and 4 as undetectable (<5 ng/L), detectable (≥5 ng/L, <14 ng/L), or elevated (≥14 ng/L). We used Cox regression to examine the association between the combination of hs-cTnT categories at two visits and incident AF. We also assessed the impact of adding absolute hs-cTnT change on risk discrimination for AF by C-statistics and net reclassification improvement (NRI). RESULTS: Over a mean follow-up of 16.5 years, 1629 incident AF cases were diagnosed. Among participants with undetectable hs-cTnT at visit 2, the multivariable HR of AF was 1.28 (95% CI 1.12-1.48) among those with detectable or elevated hs-cTnT at visit 4 compared to those in which hs-cTnT remained undetectable. Among those with detectable hs-cTnT at visit 2, compared to those who remained in the detectable hs-cTnT group, reduction to undetectable at visit 4 was associated with lower risk of AF (HR 0.74, 95% CI 0.59-0.94), while increment to elevated was associated with higher AF risk (HR 1.30, 95% CI 1.01-1.68). Adding hs-cTnT change to our main model with baseline hs-cTnT did not result in significant improvement in the C-statistic or substantial NRI. CONCLUSION: Six-year increase in circulating hs-cTnT was associated with elevated risk of incident AF.


Assuntos
Aterosclerose , Fibrilação Atrial , Troponina T/sangue , Aterosclerose/diagnóstico , Aterosclerose/epidemiologia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Biomarcadores/sangue , Humanos , Estudos Prospectivos , Fatores de Risco
11.
Int J Mol Sci ; 22(18)2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34575863

RESUMO

Sepsis is a life-threatening condition caused by the dysregulated and overwhelming response to infection, accompanied by an exaggerated pro-inflammatory state and lipid metabolism disturbance leading to sequential organ failure. Meldonium is an anti-ischemic and anti-inflammatory agent which negatively interferes with lipid metabolism by shifting energy production from fatty acid oxidation to glycolysis, as a less oxygen-demanding pathway. Thus, we investigated the effects of a four-week meldonium pre-treatment on faecal-induced sepsis in Sprague-Dawley male rats. Surprisingly, under septic conditions, meldonium increased animal mortality rate compared with the meldonium non-treated group. However, analysis of the tissue oxidative status did not provide support for the detrimental effects of meldonium, nor did the analysis of the tissue inflammatory status showing anti-inflammatory, anti-apoptotic, and anti-necrotic effects of meldonium. After performing tissue lipidomic analysis, we concluded that the potential cause of the meldonium harmful effect is to be found in the overall decreased lipid metabolism. The present study underlines the importance of uninterrupted energy production in sepsis, closely drawing attention to the possible harmful effects of lipid-mobilization impairment caused by certain therapeutics. This could lead to the much-needed revision of the existing guidelines in the clinical treatment of sepsis while paving the way for discovering new therapeutic approaches.


Assuntos
Fezes/microbiologia , Metilidrazinas/farmacologia , Sepse/prevenção & controle , Glândulas Suprarrenais/efeitos dos fármacos , Animais , Anti-Inflamatórios/farmacologia , Apoptose , Biomarcadores , Epinefrina/metabolismo , Ácidos Graxos/metabolismo , Inflamação , Metabolismo dos Lipídeos/efeitos dos fármacos , Peroxidação de Lipídeos , Lipidômica , Masculino , Norepinefrina/metabolismo , Estresse Oxidativo , Oxigênio/química , Ratos , Ratos Sprague-Dawley , Temperatura , Resultado do Tratamento , Triglicerídeos/metabolismo , Troponina T/sangue
12.
Am J Manag Care ; 27(9): e293-e300, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34533911

RESUMO

OBJECTIVES: High-sensitivity troponin T (hsTnT) testing was approved in the United States to better facilitate diagnosis of acute coronary syndrome (ACS). Although hsTnT has been widely studied internationally, the impact of hsTnT on discharge diagnoses and health care utilization within the United States is less known. We sought to evaluate the effects of implementing hsTnT on diagnosis patterns and stress testing utilization. STUDY DESIGN: We performed a retrospective cohort analysis consisting of patients with suspected ACS undergoing either conventional troponin I (n = 14,631) or hsTnT (n = 7237) testing between January 2016 and February 2019. METHODS: Log-binomial regression with interrupted time series modeled diagnosis patterns, and logistic regression with segmented time trends modeled stress testing rates. Observed trends were compared with expected trends using average marginal effect (AME). RESULTS: Rates of acute myocardial infarction-related diagnoses were similar in the post-hsTnT period (AME, -0.6%; P = .065). Post hsTnT introduction, patients were more likely to receive a diagnosis of heart failure (2.1%; P < .001) or atrial fibrillation/flutter (0.9%; P < .001) and less likely to receive a diagnosis of hypertensive heart disease (-10.2%; P < .01) or hypertensive heart disease with chronic kidney disease (-3.7%; P < .001). Likelihood of receiving stress testing increased after hsTnT implementation (2.3%; P < .001). CONCLUSIONS: Variations in discharge diagnosis patterns and increases in stress test utilization were observed following hsTnT implementation. Hospitals can expect similar changes, which may have long-term implications on health care utilization, cost, and hospital reimbursement.


Assuntos
Teste de Esforço , Troponina , Biomarcadores , Humanos , Estudos Retrospectivos , Troponina T
13.
BMJ Open ; 11(9): e044342, 2021 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-34535471

RESUMO

OBJECTIVE: To describe the association between intraoperative tissue oxygenation and postoperative troponin elevation in patients undergoing major spine surgery. We hypothesised that a decrease in intraoperative skeletal muscle tissue oxygenation (SmO2) was associated with the peak postoperative cardiac troponin value. DESIGN: This is a prospective cohort study. SETTING: Single-centre, University of California San Francisco Medical Center. PARTICIPANTS: Seventy adult patients undergoing major elective spine surgery. PRIMARY AND SECONDARY OUTCOME MEASURES: High-sensitivity troponin T (hsTnT) was measured in plasma preoperatively and on the first and second day after surgery to assess the primary outcome of peak postoperative hsTnT. Secondary outcomes included MINS and intensive care unit (ICU) admission within 30 days. Skeletal cerebral tissue oxygenation and SmO2 was measured continuously with near-infrared spectroscopy during surgery. The primary exposure variable was time-weighted area under the curve (TW AUC) for SmO2. RESULTS: Mean age was 65 (33-85) years and 59% were female. No significant association was found between TW AUC for SmO2 and peak hsTnT (Spearman's correlation, rs=0.17, p=0.16). A total of 28 (40%) patients had MINS. ICU admission occurred in 14 (40%) in lower vs 25 (71%) in upper half of patients based on TW AUC for SmO2, p=0.008. CONCLUSIONS: Decrease in SmO2 was not a statistically significant predictor for peak troponin value following major spine surgery but is a potential predictor for other postoperative complications. TRIAL REGISTRATION NUMBER: NCT03518372.


Assuntos
Complicações Pós-Operatórias , Coluna Vertebral , Adulto , Idoso , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Estudos Prospectivos , Coluna Vertebral/cirurgia , Troponina T
14.
Medicine (Baltimore) ; 100(36): e27046, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34516494

RESUMO

ABSTRACT: To investigate how high-intensity exercise influences an athlete's myocardial resilience and the correlation between myocardial resilience and markers of myocardial ischemic injury.Fifteen swimmers participated in high-intensity exercises. Cardiac ultrasound was performed before and after exercise on each subject. Left ventricular general strain, systolic general strain rate, and the differences (▴general strain and ▴ general strain rate, respectively), before and after exercise were analyzed. Blood was collected at the morning of the exercise day and 6 hours after exercise to measure cardiac enzyme indicators.The correlation between myocardial resilience and markers of myocardial injury were evaluated. Most cardiac enzymes concentrations increased after exercise (P < .05). Cardiac troponin I, creatine kinase MB, and cardiac troponin T were all correlated with the degree of ▴ peak strain (differential value of posterior wall basal segment before and after exercise) and ▴ peak strain rate (differential value before and after exercise) (P < .05).After high-intensity exercise, the concentrations of creatine kinase MB and cardiac troponin T in the blood are positively correlated with two-dimensional ultrasound deformation indices, proving the fact that the seindices can be used as a diagnostic basis for myocardial injury, and are more sensitive than general strain. The two-dimensional strain echocardiogram is non-invasive and easily accepted by the patient. It can make up for the shortage of myocardial enzymes in the injury areas, including weak timeliness and the inability to locate injury.


Assuntos
Atletas , Creatina Quinase Forma MB/sangue , Exercício Físico , Miocárdio , Natação , Troponina T/sangue , Função Ventricular Esquerda/fisiologia , Adolescente , Biomarcadores/sangue , Ecocardiografia , Feminino , Humanos , Masculino
15.
Neurol India ; 69(4): 944-949, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507417

RESUMO

Background: Neurogenic stress cardiomyopathy (NSC), also known as stress-induced cardiomyopathy (SIC), is a significant complication of aneurysmal subarachnoid hemorrhage and an important contributor to morbidity mortality. Objective: This prospective observational study assessed whether the high sensitive troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NTproBNP) helps in the prediction of NSC after SAH. Methods: The consecutive patients with aSAH without any cardiac history were included prospectively over 12 months. Neurological assessment for the grade of SAH (Hunt & Hess and WFNS grade), electrocardiogram, and echocardiography done at admission. The serial measurements of serum hsTnT and NTproBNP for consecutive 7 days done. The NSC is defined as transient hypokinesia of the ventricular wall on echocardiography. Results: The study included 69 patients, and 7 (10.1%) were diagnosed with NSC. The NSC had a positive correlation with Hunt and Hess grade (P = 0.010), and the serum levels of hsTnT and NTproBNP were higher in patients with NSC in comparison to without NSC over all 7 days. The peak levels of hsTnT and NTproBNP were significantly higher in patients with cardiomyopathy (P = 0.000 and 0.032, respectively). The best cut-off level of peak hsTnT was 0.032 pg/dl to predict cardiomyopathy with sensitivity and specificity of 100% and 80%, respectively, and NTproBNP was 430.6 ng/dL with sensitivity and specificity of 86% and 73%, respectively. Conclusion: The peak levels of hsTnT and NTproBNP with abnormal ECG and echocardiography at admission help identify NSC in the early phase of aSAH.


Assuntos
Hemorragia Subaracnóidea , Cardiomiopatia de Takotsubo , Biomarcadores , Humanos , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Hemorragia Subaracnóidea/complicações , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/etiologia , Troponina T
16.
FEBS Lett ; 595(20): 2544-2557, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34482543

RESUMO

We developed an integrated platform for analysis of parameterized data from human disease models. We report a non-negative blind deconvolution (NNBD) approach to quantify calcium (Ca2+ ) handling, beating force and contractility in human-induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) at the single-cell level. We employed CRISPR/Cas gene editing to introduce a dilated cardiomyopathy (DCM)-causing mutation in troponin T (TnT), TnT-R141W, into wild-type control iPSCs (MUT). The NNDB-based method enabled data parametrization, fitting and analysis in wild-type controls versus isogenic MUT iPSC-CMs. Of note, Cas9-edited TnT-R141W iPSC-CMs revealed significantly reduced beating force and prolonged contractile event duration. The NNBD-based platform provides an alternative framework for improved quantitation of molecular disease phenotypes and may contribute to the development of novel diagnostic tools.


Assuntos
Sistemas CRISPR-Cas , Cardiomiopatia Dilatada/patologia , Edição de Genes , Células-Tronco Pluripotentes Induzidas/patologia , Modelos Biológicos , Miócitos Cardíacos/patologia , Cardiomiopatia Dilatada/genética , Humanos , Mutação , Troponina T/genética
17.
Am J Cardiol ; 158: 45-52, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34465464

RESUMO

We evaluated the association of longitudinal changes in circulating levels of N-terminal pro B-type natriuretic peptide (NT-proBNP) and high sensitivity cardiac troponin T (hs-cTnT) with the burden of arrhythmias as captured by 2-week ambulatory ECG monitoring. This study included 1,930 Atherosclerosis Risk in Communities Study participants who wore a leadless, ambulatory ECG monitor (Zio XT Patch) at visit 6 (2016 to 2017) and had cardiac biomarkers measured at visit 6 and visit 4 (median of 19 years earlier). The mean age of participants at V6 was 79 ± 5 years, 41% were men, and 22% were black. Adjusting for demographics, body mass index, smoking, diabetes, hypertension, stroke, left ventricular mass, cardiac medications, patch wear time, visit 4 levels of NT-proBNP and hs-cTnT, and relative change in hs-cTnT, each log-transformed unit relative increase in NT-proBNP was associated with a higher likelihood of nonsustained ventricular tachycardia (odds ratio 1.29, 95% confidence interval [CI] 1.12 to 1.48), a higher number of daily atrial tachycardia episodes (geometric mean ratio [GMR] 1.16, 95% CI 1.10 to 1.21), and a higher daily ectopic burden (premature ventricular contractions -GMR 1.42, 95% CI 1.25 to 1.62; premature atrial contractions -GMR 1.40, 95% CI 1.25 to 1.57). In fully adjusted analyses, each log-transformed unit relative increase in hs-cTnT was only found to be weakly associated with a higher daily premature ventricular contraction burden (GMR 1.31, 95% CI 1.01 to 1.70). In conclusion, longitudinal change in NT-proBNP was associated with an increased atrial and ventricular arrhythmia burden.


Assuntos
Arritmias Cardíacas/sangue , Arritmias Cardíacas/epidemiologia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Troponina T/sangue , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/diagnóstico , Biomarcadores/sangue , Eletrocardiografia Ambulatorial , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Fatores de Tempo
19.
Br J Anaesth ; 127(4): 547-555, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34399982

RESUMO

BACKGROUND: Nitric oxide (NO) is an important signalling molecule in the cardiovascular system with protective properties in ischaemia-reperfusion injury. Inorganic nitrate, an oxidation product of endogenous NO production and a constituent in our diet, can be recycled back to bioactive NO. We investigated if preoperative administration of inorganic nitrate could reduce troponin T release and other plasma markers of injury to the heart, liver, kidney, and brain in patients undergoing cardiac surgery. METHODS: This single-centre, randomised, double-blind, placebo-controlled trial included 82 patients undergoing coronary artery bypass surgery with cardiopulmonary bypass. Oral sodium nitrate (700 mg×2) or placebo (NaCl) were administered before surgery. Biomarkers of ischaemia-reperfusion injury and plasma nitrate and nitrite were collected before and up to 72 h after surgery. Troponin T release was our predefined primary endpoint and biomarkers of renal, liver, and brain injury were secondary endpoints. RESULTS: Plasma concentrations of nitrate and nitrite were elevated in nitrate-treated patients compared with placebo. The 72-h release of troponin T did not differ between groups. Other plasma biomarkers of organ injury were also similar between groups. Blood loss was not a predefined outcome parameter, but perioperative bleeding was 18% less in nitrate-treated patients compared with controls. CONCLUSION: Preoperative administration of inorganic nitrate did not influence troponin T release or other plasma biomarkers of organ injury in cardiac surgery. CLINICAL TRIAL REGISTRATION: NCT01348971.


Assuntos
Ponte Cardiopulmonar/métodos , Ponte de Artéria Coronária/métodos , Traumatismo por Reperfusão Miocárdica/terapia , Nitratos/farmacologia , Idoso , Biomarcadores/sangue , Perda Sanguínea Cirúrgica , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Nitratos/administração & dosagem , Óxido Nítrico/metabolismo , Cuidados Pré-Operatórios/métodos , Troponina T/sangue
20.
Int J Cardiol ; 340: 88-93, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34454965

RESUMO

BACKGROUND: Right ventricle strain serum biomarkers, such as high-sensitivity cardiac troponin T (hs-cTnT) and NT-pro-brain natriuretic peptide (NT-proBNP), are prognostic in patients with pulmonary embolism (PE). Prognosis accuracy in patients with discordancy between serum biomarkers remains, however, unknown. METHODS: We performed a retrospective analysis in patients with intermediate or high risk PE and discordant serum biomarkers of RV strain as follows: high hs-cTnT and low NT-proBNP ('high troponin discordance'), compared to patients with low hs-cTnT and high NT-proBNP ('high NT-proBNP discordance'). Cut-off values for high hs-cTnT were ≥14 pg/mL in patients <75 years and ≥45 pg/mL in patients >75-year. Cut-off values for high NT-proBNP were ≥600 pg/mL. The primary end-point was a composite of death, resuscitated cardiac arrest, mechanical ventilation, and inotrope use at one month. 'High troponin discordance', age, sex and body mass index (BMI) were included in a logistic regression model. Time to event analysis was performed using Kaplan Meier curves and Log-rank test. RESULTS: 73 patients were included. 'High troponin discordance' patients (n=41) were younger, presented with a higher heart rate, more frequent bilateral PE, and received more thrombolytics as treatment compared with 'high NT-proBNP discordance' patients (n = 32). Primary end-point was significantly higher in the 'high troponin discordance' patients (29.3% vs 9.4%, p=0.045). 'High troponin discordance' was independently associated with the primary end-point after adjusting for age, sex and BMI. Log rank test confirmed worse outcome in the high troponin discordance group (p=0.037). CONCLUSIONS: High troponin discordance' patients with intermediate/high risk PE, had worse outcomes than patients with high BNP discordance.


Assuntos
Ventrículos do Coração , Embolia Pulmonar , Idoso , Biomarcadores , Humanos , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Prognóstico , Embolia Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Troponina T
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