Multifaceted role of cardiovascular biomarkers

Cardiovascular diseases, a global health issue, claim the lives of many every year. Lifestyle changes and genetic predisposition are the key drivers for the development of CVDs. In many of the patients, the disease is detected at the end stage making heart transplantation the only treatment option. Hence every attempt should be made to identify the risk at an early stage and initiate preventive measures to improve the quality of their life. Biomarkers are one of the critical factors that aid in the early diagnosis of CVDs. More specific and highly sensitive biomarkers have been discovered lately and have been employed for prognosis and diagnosis of CVDs. The present review briefs about the various categories of cardiovascular biomarkers with emphasis on novel biomarkers and discusses the biomarkers employed for different purposes in CVDs. The biomarkers have also helped in identifying COVID-19 patients with increased risk for developing cardiovascular complications. Being non-invasive makes biomarkers advantageous over other methods for evaluating the pathophysiological status of CVDs.

Insuficiencia cardíaca de novo: Un reto diagnóstico / Di novo heart failure: A diagnostic challenge

Introducción: El término insuficiencia cardíaca de novo hace referencia a pacientes sin diagnóstico previo de dicha enfermedad. La revisión de este tema deviene de un problema real, pues muchos pacientes acuden a la atención secundaria sin diagnóstico previo de insuficiencia cardíaca y además en estadios avanzados. Objetivo: Describir los elementos claves para el diagnóstico precoz de insuficiencia Cardíacas. Métodos: Se llevó a cabo una búsqueda bibliográfica en las siguientes bases de datos: Pubmed, SciELO, ESBCO, Cochrane y BVS, así como en diferentes webs médicas durante tres meses entre febrero de 2021 al 31 de mayo de 2021. Conclusiones: El diagnóstico precoz de insuficiencia cardíaca permitió disminuir el número de pacientes que llegan a la Atención Secundaria sin diagnóstico previo. Existen clasificaciones que identifican estadios tempranos de la enfermedad y la de la ACC/AHA es relevante para lograr este objetivo. En atención primaria esto es un reto si no se emplean pruebas diagnósticas como el ecocardiograma. Es importante la determinación de las concentraciones circulantes del péptido natriurético tipo B (BNP) y del fragmento N-terminal de su protohormona (N-terminal BNP). Este biomarcador debería estar accesible en las consultas ambulatorias para pacientes que presentan sospecha clínica de insuficiencia cardíaca «de novo»(AU)

Introduction: The term di novo heart failure refers to patients without a previous diagnosis of this disease. The review of this issue comes from a real problem, since a group of patients attend secondary care without a previous diagnosis of heart failure and also have in advanced stages. Objective: The objective is to provide a clue that facilitates the early diagnosis of heart failure. Methods: A bibliographic search was carried out in the following databases: Pubmed, SciELO, ESBCO, Cochrane and BVS, as well as in different medical websites for three months (February 1, 2021 to May 31, 2021). Conclusions: The early diagnosis of heart failure will allow us to reduce the number of patients who arrive at Secondary Care without a previous diagnosis. There are classifications that identify early stages of the disease, being in our opinion the ACC / AHA classification the one that should carry the most weight. In primary care this can be a challenge if diagnostic tests such as echocardiography are not used. Dosification of serum levels of type B natriuretic peptide (BNP) and the N-terminal fragment of its protohormone (N-terminal BNP) is very useful. This biomarker should be accessible in outpatient clinics for patients with clinical suspicion of di novo heart failure(AU)

Clinical significance of serum cystatin C and neutrophil gelatinase associated lipocalin combined with cardiac biomarkers in children with sepsis induced kidney injury / 中国小儿急救医学

Objective:To investigate the clinical value of serum cystatin C(Cys C) and neutrophil gelatinase associated lipocalin(NGAL) combined with cardiac biomarkers in the evaluation of sepsis with renal injury in children.Methods:The clinical data of 130 children with sepsis(67 cases in sepsis non AKI group and 63 cases in septic AKI group)admitted to pediatric intensive care unit(PICU) at Hunan Children′s Hospital from May 2018 to December 2019 were retrospectively analyzed.The differences of serum Cys C, NGAL and cardiac related biomarkers between sepsis and septic kidney injury were analyzed and compared.Results:The levels of serum Cys C, NGAL and amino-terminal pro-brain natriuretic peptide(NT-proBNP) in children with septic AKI were significantly higher than those in children of sepsis non AKI group(all P<0.01). There were no significant differences in creatine kinase isoenzyme(CK-MB)and high-sensitivity troponin T(cTnT-hs) between two groups (all P>0.05). The levels of CK-MB, cTnT-hs, NT-proBNP, Cys C and NGAL in the dead children were significantly higher than those in the surviving children ( P<0.05). In terms of predicting of AKI, the area under the ROC curve of NGAL, Cys C and NT proBNP were 0.724, 0.759 and 0.747, respectively.Regarding predicting the survival and death of sepsis, the area under the ROC curve of NGAL, Cys C and NT proBNP were 0.719, 0.722 and 0.769, respectively.In predicting the prognosis of children with sepsis and kidney injury, the area under the ROC curve of NGAL, Cys C and NT proBNP were 0.683, 0.651 and 0.682, respectively.The binary Logistic regression equation was established by Cys C, NGAL and NT-proBNP, Y=0.970 NGAL+ 0.9441 BNP+ 1.815 Cys C-2.944.In predicting kidney injury, evaluating prognosis of sepsis and predicting prognosis of sepsis with kidney injury, the area under ROC curve of new variable Y were 0.882, 0.802 and 0.808, respectively. Conclusion:NGAL, Cys C and NT-proBNP can be used to judge sepsis and sepsis with kidney injury alone.The evaluation value of combined detection of three indexes is better than that of single index.Therefore, the combined use of the three indicators may be better to judge the condition of children with sepsis and kidney injury.

Valor pronóstico de biomarcadores cardíacos en la enfermedad por COVID-19 / value of cardiac biomarkers in COVID-19 disease

Resumen Introducción: En la enfermedad por COVID-19 se ha establecido que los pacientes con enfermedad cardiometabólica de base tienen mayor riesgo de presentar desenlaces adversos. Esto ha incrementado el interés en estudiar variables cardiovasculares relevantes, para plantear su correlación con los desenlaces clínicos en esta población. Objetivo: Describir el valor pronóstico de los biomarcadores cardíacos en la enfermedad por COVID-19. Métodos: Revisión no sistemática de la literatura en bases de datos como PubMed, Google Scholar, Clinical Key, SciELO, entre otras, utilizando palabras clave, términos planos y términos MeSh. Resultados: Se eligieron 22 bibliografías, entre ellas artículos de revisión de tema, revisiones sistemáticas, metaanálisis, estudios observacionales y artículos originales publicados hasta la fecha (mayo 13 de 2020), que en su mayoría describen la alteración de biomarcadores cardiacos y su relación con la evolución clínica de los pacientes con COVID-19. Discusión: Se encontró que la troponina y el péptido natriurético se comportan como factores de riesgo independientes para compromiso clínico severo, requerimiento de soporte ventilatorio o hemodinámico, estancia en la UCI, y aumento de la mortalidad. Conclusiones: Es razonable plantear el uso de estos biomarcadores en la estratificación del riesgo en pacientes con COVID-19 y enfermedad cardiovascular establecida.

Abstract Introduction: It has been established that patients with an underlying cardiometabolic disease and COVID-19 infections, have a higher risk of an adverse outcome. This has led to an increase in the interest of studying relevant cardiovascular variables, in order to establish their association with clinical outcomes in this population. Objective: To describe the prognostic value of cardiac biomarkers in disease caused by COVID-19. Methods: A non-systematic review of the literature was carried out in data bases that included PubMed, Google Scholar, Clinical Key, SciELO, using the key words, plain terms, and MeSH terms. Results: A total of 22 articles were chosen. They consisted of review articles on the subject, systematic reviews, meta-analyses, observational studies, and original articles published up until 13 May 2020. The majority of them described the changes in cardiac biomarkers and their relationship with the clinical outcome of patients COVID-19. Discussion: It was found that Troponin and Natriuretic Peptide behaved as independent risk factors for severe clinical compromise, requiring ventilatory or haemodynamic support, admission to ICU, and an increase in mortality. Conclusions: It is reasonable to recommend the use of these biomarkers in the risk stratification in patients with COVID-19 and an established cardiovascular disease.

Anestesia cardiovascular en cirugía no cardiaca / Cardiovascular anesthesia in noncardiac surgery

Clinical evaluation remains one of the main issues while considering anesthetic and surgical risk. Different scores for cardiac evaluation in non-cardiac surgery are traditionally based on the exclusion of active cardiac conditions, the risk of surgery, the functional capacity of the patient and the presence of specific cardiac risk factors. In recent decades, new guidelines incorporate an association between cardiac biomarkers and adverse cardiac events. For the management of coronary patients receiving double antiplatelet therapy, derived for non-cardiac surgery, the risk of stent thrombosis, the consequences of delaying the surgical procedure and the risk of bleeding must be considered. At this moment, there is no evidence regarding which is the best anesthetic management that decreased peri-operative cardiovascular complications in this group of patients. This article refers to the differences in preoperative assessment for non-cardiac surgery incorporated in the guidelines of the American College of Cardiology, the American Heart Association, the European Society of Cardiology and the Canadian Cardiovascular Society. Consideration are also given to the management of coronary patients on double antiplatelet therapy and its main complications as well as intraoperative management maneuvers that may decrease cardiovascular complications.

La valoración clínica sigue siendo uno de los pilares fundamentales en la evaluación del riesgo anestésico-quirúrgico. Los scores de riesgo para la evaluación cardiovascular y cirugía no cardíaca se basan tradicionalmente en la exclusión de condiciones cardíacas activas, la determinación del riesgo de cirugía, la capacidad funcional del paciente y la presencia de factores de riesgo cardíaco. En las últimas décadas, nuevas guías incorporan una asociación entre los biomarcadores cardiacos y los eventos cardiacos adversos. Para el manejo de pacientes coronarios en tratamiento antiagregante doble, derivados a cirugía no cardiaca, hay que considerar el riesgo de trombosis del stent, las consecuencias de retrasar el procedimiento quirúrgico y el aumento del riesgo de hemorragia. Hasta la fecha no existe evidencia acerca de cuál es el mejor manejo anestésico que disminuya las complicaciones cardiovasculares perioperatorias en este grupo de pacientes. Este artículo, hace referencia a las diferencias de la valoración preoperatoria para cirugía no cardiaca incorporados en las guías del American College of Cardiology, la American Heart Association, la European Society of Cardiology y la Canadian Cardiovascular Society. Algunas consideraciones acerca del manejo de pacientes coronarios, terapia antiplaquetaria dual y eventuales complicaciones. Se incluyen algunas estrategias farmacológicas, así como consideraciones específicas para el perioperatorio, con el fin de reducir morbilidad de origen cardiovascular.

Biomarcadores en la falla cardíaca / Biomarkers in heart failure

RESUMEN La insuficiencia o falla cardíaca es una enfermedad cada día más prevalente y precisa de complementarios que no solo confirmen lo presumido clínicamente, sino que también sean útiles en la evaluación pronóstica de quienes la padecen. En ese contexto aparecen en las guías de insuficiencia cardíaca, a inicios del año 2000, los biomarcadores con utilidad práctica. Con indicaciones diagnósticas, pronósticas y evolutivas, en cada momento clínico de esta enfermedad, tanto en fase aguda como crónica, su utilización traza pautas y estrategias en el tratamiento adecuado de estos enfermos. En este artículo de revisión se hace un breve acercamiento al tema.

ABSTRACT Heart failure is an increasingly prevalent disease, which requires additional blood tests that not only confirm what is clinically presumed, but also be useful in the prognostic evaluation of those who suffer from it. In this context, biomarkers with practical utility appeared in the heart failure guidelines, at the beginning of the year 2000. With diagnostic, prognostic and evolutionary indications in each clinical stage of this disease, both in acute and chronic stages, its use draws guidelines and strategies in the adequate treatment of these patients. In this review article, a brief approach to the subject is made.

Biomarkers of cardio-renal syndrome in uremic myocardiopathy animal model / Biomarcadores de síndrome cardiorrenal em modelo animal de miocardiopatia urêmica

ABSTRACT Introduction: Cardio-renal syndrome subtype 4 (CRS4) is a condition of primary chronic kidney disease that leads to reduction of cardiac function, ventricular hypertrophy, and risk of cardiovascular events. Objective: Our aim was to understand the mechanisms involved on the onset of CRS4. Methods: We used the nephrectomy 5/6 (CKD) animal model and compared to control (SHAM). Serum biomarkers were analyzed at baseline, 4, and 8 weeks. After euthanasia, histology and immunohistochemistry were performed in the myocardium. Results: Troponin I (TnI) was increased at 4 weeks (W) and 8W, but nt-proBNP showed no difference. The greater diameter of cardiomyocytes indicated left ventricular hypertrophy and the highest levels of TNF-α were found at 4W declining in 8W while fibrosis was more intense in 8W. Angiotensin expression showed an increase at 8W. Conclusions: TnI seems to reflect cardiac injury as a consequence of the CKD however nt-proBNP did not change because it reflects stretching. TNF-α characterized an inflammatory peak and fibrosis increased over time in a process connecting heart and kidneys. The angiotensin showed increased activity of the renin-angiotensin axis and corroborates the hypothesis that the inflammatory process and its involvement with CRS4. Therefore, this animal study reinforces the need for renin-angiotensin blockade strategies and the control of CKD to avoid the development of CRS4.

RESUMO Introdução: A síndrome cardiorrenal (SCR) tipo 4 é uma afecção da doença renal crônica primária que leva a redução da função cardíaca, hipertrofia ventricular e risco de eventos cardiovasculares. Objetivo: O objetivo do presente estudo foi compreender os mecanismos envolvidos no surgimento da SCR tipo 4. Métodos: Um modelo animal de nefrectomia 5/6 (DRC) foi comparado a animais de controle (Placebo). Biomarcadores séricos foram analisados no início do estudo e com quatro e oito semanas de estudo. Após eutanásia, foram realizados exames histológicos e de imunoistoquímica no tecido miocárdico. Resultados: Troponina I (TnI) estava aumentada nas semanas quatro (S4) e oito (S8), mas o NT-proBNP não apresentou diferenças. O diâmetro maior dos cardiomiócitos indicava hipertrofia ventricular esquerda. Os níveis mais elevados de TNF-α foram identificados na S4 com redução na S8, enquanto fibrose foi mais intensa na S8. A expressão de angiotensina mostrou elevação na S8. Conclusões: TnI parece sugerir lesões cardíacas em consequência da DRC, porém o NT-proBNP não sofreu alterações por refletir alongamento. O TNF-α evidenciou um pico inflamatório e a fibrose aumentou ao longo do tempo devido ao processo de conexão entre rins e coração. A angiotensina mostrou aumento da atividade do eixo renina-angiotensina, corroborando a hipótese do processo inflamatório e seu envolvimento com SCR tipo 4. Portanto, o presente estudo em modelo animal reforça a necessidade de em adotar estratégias com bloqueadores de renina-angiotensina e controle da DRC para evitar o desenvolvimento de SCR tipo 4.

Serum albumin perturbations in cyanotics after cardiac surgery: Patterns and predictions.

Introduction: Hypoalbuminemia is a well‑recognized predictor of general surgical risk and frequently occurs in patients with cyanotic congenital heart disease (CCHD). Moreover, cardiopulmonary bypass (CPB)‑induced an inflammatory response, and the overall surgical stress can effect albumin concentration greatly. The objective of his study was to track CPB‑induced changes in albumin concentration in patients with CCHD and to determine the effect of hypoalbuminemia on postoperative outcomes. Materials and Methods: Prospective observational study conducted in 150 patients, Group 1 ≤18 years (n = 75) and Group 2 >18 years (n = 75) of age. Albumin levels were measured preoperatively (T1), after termination of CPB (T2) and 48 h post‑CPB (T3). Primary parameters (mortality, duration of postoperative ventilation, duration of inotropes and duration of Intensive Care Unit [ICU] stay) and secondary parameters (urine output, oliguria, arrhythmias, and hemodynamic parameters) were recorded. Results: The albumin levels in Group 1 at T1, T2, and T3 were 3.8 ± 0.48, 3.2 ± 0.45 and 2.6 ± 0.71 mg/dL; and in Group 2 were 3.7 ± 0.50, 3.2 ± 0.49 and 2.7 ± 0.62 mg/dL respectively. All patients showed a significant decrease in albumin concentration 48 h after surgery (P < 0.01). Analysis between the groups, however, showed no statistical difference. Eleven patients expired during the study period, and nonsurvivors showed significantly lower serum albumin concentration 48 h after surgery 2.3 ± 0.62 mg/dL versus 3.7 ± 0.56 mg/dL in the survivors (P < 0.05). Receiver operating characteristic curve showed that a baseline albumin cut‑off value of 3.3 g/dL predicts mortality with a positive predictive value 47.6% and a negative predictive value of 99.2% (P < 0.05). A strong correlation was seen between albumin levels at 48 h with duration of CPB (r2 = 0.6321), ICU stay (r2 = 0.7447) and incidence of oliguria (r2 = 0.8803). Conclusions: The study demonstrated similar fall in albumin concentration in cyanotic patients (both adult and pediatric) in response to CPB. Low preoperative serum albumin concentrations (<3.3 g/dL) can be used to identify and prognosticate subset of cyanotics predisposed to additional surgical risk.

Comparison of the effects of inhalational anesthesia with desflurane and total intravenous anesthesia on cardiac biomarkers after aortic valve replacement.

Objective (s): The aim of this study was to compare the effects of using inhalational anesthesia with desflurane with that of a total intravenous (iv) anesthetic technique using midazolam‑fentanyl‑propofol on the release of cardiac biomarkers after aortic valve replacement (AVR) for aortic stenosis (AS). The specific objectives included (a) determination of the levels of ischemia‑modified albumin (IMA) and cardiac troponin I (cTnI) as markers of myocardial injury, (b) effect on mortality, morbidity, duration of mechanical ventilation, length of Intensive Care Unit (ICU) and hospital stay, incidence of arrhythmias, pacing, cardioversion, urine output, and serum creatinine. Methodology and Design: Prospective randomized clinical study. Setting: Operation room of a cardiac surgery center of a tertiary teaching hospital. Participants: Seventy‑six patients in New York Heart Association classification II to III presenting electively for AVR for severe symptomatic AS. Interventions: Patients included in the study were randomized into two groups and subjected to either a desflurane‑fentanyl based technique or total IV anesthesia (TIVA). Blood samples were drawn at preordained intervals to determine the levels of IMA, cTnI, and serum creatinine. Measurements and Main Results: The IMA and cTnI levels were not found to be significantly different between both the study groups. Patients in the desflurane group were found to had significantly lower ICU and hospital stays and duration of postoperative mechanical ventilation as compared to those in the TIVA group. There was no difference found in mean heart rate, urine output, serum creatinine, incidence of arrhythmias, need for cardioversion, and 30‑day mortality between both groups. The patients in the TIVA group had higher mean arterial pressures on weaning off cardiopulmonary bypass as well as postoperatively in the ICU and recorded lower inotrope usage. Conclusion: The result of our study remains ambiguous regarding the overall protective effect of desflurane in patients undergoing AVR although some benefit in terms of shorter duration of postoperative mechanical ventilation, ICU and hospital stays, as well as cTnI, were seen. However, no difference in overall outcome could be clearly established between patients who received desflurane and those that were managed solely with IV anesthetic technique using propofol.

The Role of Cardiac Biomarkers in the Diagnosis and Management of Patients Presenting with Suspected Acute Coronary Syndrome

Myocardial infarction (MI) is the leading cause of death in the developed world. Biomarkers have an essential role in diagnosis, risk stratification, guiding management and clinical decision making in the setting of patients presenting with signs and symptoms of MI. Cardiac troponin (cTn) rose to prominence during the 1990s and has evolved to be the cornerstone for diagnosis of MI. The current criteria for MI diagnosis include a rise and/or fall in cTn with at least one value above the 99th percentile of the upper reference limit. Along with cTn, the natriuretic peptides B-type natriuretic peptide (BNP) and amino-terminal proBNP (NT-proBNP) have an important role in determining prognosis and guiding management. As assays for cTn have been evolved that are capable of reliably detecting smaller and smaller quantities in the blood, a dilemma has emerged as to how to use this new information. Several studies have attempted to answer this question and have shown that these lower concentrations of cTn have important prognostic significance and, more importantly, that intervention in these patients leads to improved clinical outcomes. New algorithms incorporating BNP, NT-proBNP, and more sensitive cTn assays hold promise for more rapid diagnosis or rule-out of MI, allowing for appropriate management steps to be initiated and more efficient and effective utilization of healthcare resources.

Função renal, hepática e cardíaca de cães hígidos sob terapia prolongada com celecoxibe / Renal, hepatic and cardiac function in healthy dogs during long-term celecoxib therapy

O presente estudo teve como objetivo avaliar os efeitos da terapia prolongada com celecoxibe sobre a função renal, hepática e cardíaca em cães hígidos. Foram utilizados 12 cães fêmeas, divididos em 2 grupos: Gcelecoxibe: terapia com celecoxibe, na dose de 5mg kg-1 por via oral, a cada 12 horas, durante 20 dias (peso médio de 8,9±1,6); Gcontrole: terapia com placebo, a cada 12 horas, por via oral, 20 dias (peso médio de 9,8±1,8). O exame físico, a função renal (urinálise; gamaglutamil transpeptidase -GGT e sódio urinários; ureia, creatinina, sódio e potássio séricos; e clearance endógeno de creatinina), tempo de coagulação (TC), biomarcadores cardíacos (creatinofosfoquinase -CK e creatinofosfoquinase fração MB- CK-MB) e função hepática (alanina aminotransferase -ALT, aspartato aminotransferase -AST e albumina) foram avaliados antes, aos 5, 10 e 20 dias (T0, T5, T10 e T20) do tratamento. No Gcelecoxibe, os valores de clearance de creatinina revelaram diminuição significativa no T20, em relação ao T0 e T5, bem como redução em relação ao Gcontrole em T10 e T20. A urinálise, sódio, potássio, ureia e creatinina séricos, enzima GGT urinária e o TC não apresentaram variação entre os momentos ou grupos avaliados. Houve aumento significativo de CK-MB no T20 e ALT no T5, T10 e T20 no Gcelecoxibe, entretanto, com valores dentro da normalidade para cães. Conclui-se que o celecoxibe revelou-se seguro em relação ao perfil cardíaco e hepático em cães sadios, mesmo sob terapia prolongada. Sob vigência de terapia prolongada, deve ser usado cautelosamente em cães portadores de alterações renais.

The aim of this study was to evaluate the effects of long-term celecoxib therapy on renal, hepatic and cardiac profiles in healthy dogs. Twelve female were randomly assigned to 2 groups (G): Gcelecoxib: treated with celecoxib orally (5mg kg-1), every 12 hours, for 20 days (8.9±1.6 body weight); Gcontrol: received placebo orally, every 12 hours, for 20 days (9.8±1.8 body weight). Physical examination, renal function (urinalysis, urinary sodium and gamma-glutamyl transpeptidase -GGT), serum urea, creatinine, potassium and sodium, and endogenous creatinine clearance), clotting time (CT), cardiac biomarkers (creatine phosphokinase -CK and CK-MB) and liver function (aspartate aminotransferase -AST, alanine aminotransferase -ALT and albumin) were evaluated before, at 5, 10 and 20 days (T0, T5, T10 and T20) of treatment. The creatinine clearance values showed significant decrease at T20, in relation to T0 and T5 in the Gcelecoxib, and reduction in relation to Gcontrol at T10 and T20. The urinalysis, values of sodium, potassium, urea and creatinine serum and urinary GGT enzyme showed no difference through the study between moments or groups. There was a significant increase on CK values at T20 and on ALT values at T5, T10 and T20 in the Gcelecoxib, however with normal range values for dogs. Celecoxib revealed to be safe in relation to cardiac and hepatic profiles, even under prolonged therapy. However, it should be used judiciously during long-term therapy in dogs with renal dysfunction.

Cardiac markers: profile in rats experimentally infected with Toxocara canis / Marcadores cardíacos: perfil em ratos infectados experimentalmente com Toxocara canis

The aim of this study was to evaluate the profile of the enzymes creatine kinase (CK), creatine kinase MB (CK-MB) and lactate dehydrogenase (LDH) in Wistar rats infected with 250 (GI, n = 24) or 1000 (GII, n = 24) Toxocara canis eggs. Animals were evaluated on days 7, 15, 30, 60, 120 and 180 post-infection (DPI). Only the GI rats showed an increase in CK and CK-MB, at 15 and 30 DPI, respectively. Anti-Toxocara spp. antibodies were detected by ELISA in infected animals. Despite of the presence of eosinophilic infiltrate in the heart of three infected animals, none larva was recovered from the organ neither by acid digestion nor by Baermann procedure. Eosinophilia was observed in both groups but there was no significant difference in the eosinophil counts between GI and GII (p = 0.2239). It is possible to consider that cardiac lesion is an eventual finding in murine model for toxocariasis

O objetivo do presente estudo foi avaliar o perfil das enzimas creatinoquinase (CK), creatinoquinase-MB (CK-MB) e lactato desidrogenase (LDH) em ratos Wistar infectados com 250 (GI, n = 24) ou 1000 (GII, n = 24) ovos de Toxocara canis. Os animais foram avaliados nos dias 7, 15, 30, 60, 120 e 180 pós-infecção (DPI). Observou-se que apenas os animais do GI apresentaram aumento da atividade de CK e CK-MB aos 15 e 30 DPI, respectivamente. Anticorpos anti-T. canis foram detectados por ELISA nos animais infectados. Apesar da presença de infiltrado eosinofílico em três animais infectados, nenhuma larva foi recuperada do coração pela digestão ácida ou pela técnica de Baermann. Eosinofilia foi observada em todos os momentos em GI e GII, sem diferença significativa entre os grupos (p = 0,2239). Pode-se considerar que as lesões cardíacas foram um achado eventual no modelo murino para toxocaríase.

Role of biomarkers in risk stratification of acute coronary syndrome.

Diagnosis of acute coronary syndrome (ACS) encompasses a wide spectrum of myocardial ischaemia varying from assuredly benign to potentially fatal. Cardiac biomarkers have had a major impact on the management of this disease and are now the cornerstone in its diagnosis and prognosis. In this review we discuss both the established and the newer emerging biomarkers in ACS and their role in highlighting not only myocardial necrosis but also different facets of the pathophysiology of ACS. The future of cardiac biomarker testing may be in multimarker testing to better characterize each patient of ACS and thus tailor both short-term and long-term therapy accordingly. This novel concept, however, needs to be tested in clinical trials for its incremental value and cost-effectiveness.