The Correlation between GDF15 and sudden death / 中华急诊医学杂志

Objective:To explore the early warning and prediction value of GDF15 for sudden death patients.Methods:From January to December 2018, 49 patients with sudden death who were treated in the Emergency Department of the First Clinical Center of PLA General Hospital were included in the case group, and 46 healthy physical examiners in the Physical Examination Center of the Hospital were randomly selected as the control group. The general situation, comparison of myocardial markers and analysis of the basic data of the case group were carried out, so as to evaluate the early warning value of each myocardial marker in sudden death.Results:Patients aged 40-49 years old accounted the highest proportion among sudden death cases, reaching 26.54%. Sudden death under 60 years old accounted for 59.19%, and the ratio of male to female was 3.83:1. There were significant differences between the case group and the control group in CK-MB [(41.35±98.38) vs. (3.13±2.17), P=0.009], CK [(2652.82±6845.66) vs. (102.73±47.93), P=0.012], and GDF15 [(549.80±809.79) vs. (115.70±167.42), P=0.001]. At the same time, the AUC value of GDF15 was 0.816, which has the highest diagnostic value for sudden death. And CK-MB, CK and GDF15 had no correlation with age. Conclusions:GDF15, as a biological marker, has a good early warning function in sudden death.

Clinical correlation of cardiac functions and troponin I and CPK-MB in dengue fever in children

Background: Dengue is the most rapidly spreading mosquito-borne viral disease in the World. The spectrum of manifestations includes mild fever to severe and life-threatening disease, though uncommon complications such as myocarditis have also been reported in many cases. We conducted this study to analyze association between Clinical Profile, Cardiac Functions and Troponin I and CPK-MB (cardiac biochemical markers) in children with Dengue Fever. Aims and objectives of the study was the association between Clinical Profile, Cardiac Functions and Troponin I and CPK-MB (cardiac biochemical markers) in children with Dengue Fever.Methods: This was a prospective observational study in which 80 paediatric patients who were hospitalized anddiagnosed to be having Dengue fever were included. All patients were stratified into either of the 3 groups- Dengue without warning signs, Dengue with warning signs and severe Dengue. A detailed history and thorough clinical examination were done for all patients. A complete blood count, electrolytes, hepatic and renal function tests were done in all children. Cardiac function was assessed by 2D Echo, CPK-MB and Troponin-I, p value less than 0.05 was taken as statistically significant.Results: Of the 80 studied cases there were 53 (66.25%) males and 27 (33.75%) females with a M:F ratio of 1.9:1. Dengue with and without warning signs was seen in 27.5% and 60% cases respectively whereas severe dengue was seen in 12.5% cases. The ejection fraction was comparable across the 3 groups. On 2D echo ejection fraction was 62.95%, 63.21% and 65.1% in cases with warning signs, without warning signs and severe dengue respectively. Additionally, ECG abnormalities were seen in 8.75% patients. All 80 patients had a normal CPK-MB and Troponin-I levels.Conclusions: Cardiac markers (CPK-MB and Troponin-I) remain unaffected during Dengue illness and do not have significant correlation between Dengue without warning signs, Dengue with warning signs and severe Dengue.

Effect of Methanolic Extract of Ocimum gratissimum on Blood Pressure, Some Electrolytes, Renal and Cardiac Biomarkers in 8% NaCl Induced Hypertensive Male Wistar Rats

Background: Ocimum gratissimum (OG) is a shrub belonging to the family of Lamiaceae. It is commonly called scent leaf or clove basil and it is found in many tropical countries. Studies have shown that the leaf extract of Ocimum gratissimum possess medicinal properties. Aim: The effect of methanolic extract of Ocimum gratissimum on blood pressure, electrolytes, renal and cardiac biomarkers in 8% NaCl- induced hypertensive male Wistar rats. Methodology: Forty Wistar rats (120-160) g were assigned to 5 groups of eight rats each. Group 1, 2, 3, 4 and 5 constitute the normal, hypertensive group, OG (200 mg/kg bwt) group, OG (400 mg/kg bwt) group and reference drugs (lisinopril, 30 mg/kg) group respectively. Group 3, 4 and 5 were given the extract and reference drug through oral gavage. All groups except group 1 were induced with 8% NaCl from 0-4weeks before treatment with OG and reference drug from 5-8 weeks. Electrolytes and other biochemical parameters were assayed using standard methods. Results: The phytochemical results revealed the presence of phenol, flavonoids, alkaloids, phytate, tannis and saponin. At 4 weeks (after induction), systolic blood pressure (SBP), diastolic blood pressure (DBP), serum sodium, chloride, urea, and creatinine significantly (p<0.05) increased while serum potassium significantly (p<0.05) decreased in all the groups except group 1. At 8 weeks, after treatment with OG (200 mg/kgbwt), OG (400 mg/kgbwt) and lisinopril (30 mg/kg), SBP, DBP, serum sodium, chloride, urea, and creatinine significantly(p<0.05) decreased while serum potassium significantly (p<0.05) increased. Creatine kinase (CK) and CK-MB however, were not significantly altered after the 4th and 8th week. Conclusion: OG extract possesses an antihypertensive effect and enhances the proper functioning of the kidney. It may also be useful in hypertensive condition due to its nephroprotective effect at 200mg/kgbwt and 400 mg/kgbwt.

Significance of heart-type fatty acid binding protein and brain glycogen phosphorylase isoenzyme type in septic myocardial injury / 中国小儿急救医学

Objective@#To demonstrate the relevance of heart-type fatty acid binding protein(H-FABP) and brain glycogen phosphorylase isoenzyme type(GPBB) with myocardial injury in sepsis.To explore the effect of H-FABP and GPBB on the severity of disease and clinical prognosis.@*Methods@#A total of 40 cases of children with sepsis were selected in this study from January 1, 2017 to October 31, 2017.According to the illness severity, they were divided into sepsis group(n=15), severe sepsis group(n=13) and septic shock group(n=12), 19 cases of children with non-infectious diseases were selected as the control group for the same period.The levels of serum WBC, C-reactive protein, procalcitonin, cTnI, CK, CK-MB, CK-MB isoenzyme quality and NT-proBNP were collected within 24 hours of admission.The APECHEⅡ scores were calculated for each child.The peripheral blood of the patients within 24 hours after admission was used to determine the levels of serum H-FABP and GPBB by ELISA method.The differences of clinical indicators among the groups were analyzed.According to the survival of patients with sepsis, they were divided into 37 cases in the improved group and 3 cases in the death group.All patients with sepsis were divided into left ventricular ejection fraction(LVEF) normal group(n=26) and LVEF decreased group(n=14). According to whether the serum cTnI was elevated, all children with sepsis were divided into cTnI normal group (n=29) and cTnI increased group (n=11). The differences of H-FABP and GPBB levels were compared.According to the presence or absence of LVEF decline, the area under the ROC curve was used to evaluate the predictive power of each index for myocardial injury in sepsis.Based on the decrease of LVEF, the area under the ROC curve was used to evaluate the prediction of each index for myocardial injury in sepsis.@*Results@#There were significant differences in H-FABP and GPBB levels among the control group, sepsis group, severe sepsis group and the septic shock group (H=42.241, P<0.05; H=32.486, P<0.05). Although there was no significant difference between the improved group and the death group(P>0.05), there was an elevated trend of H-FABP and GPBB in the death group.The levels of H-FABP (t=-3.770, P=0.001) and GPBB (Z=-2.113, P=0.033) were statistically significant in the LVEF normal group and the LVEF decreased group (LVEF≤60%). There were no significant differences in the levels of H-FABP and GPBB between the cTnI normal group and the cTnI increased group (P>0.05), but the cTnI increased group had an increasing trend.The area under the ROC curve in the diagnosis of myocardial injury in sepsis were H-FABP 0.821, NT-ProBNP 0.738, GPBB 0.661, CK 0.560, cTnI 0.512, in which the sensitivity(0.833) and specificity(0.786)of H-FABP were both higher.@*Conclusion@#The serum H-FABP and the GPBB levels can be used to monitor for myocardial damage, and it has a correlation with the severity of the disease and the prognosis.H-FABP has a significant advantage over traditional myocardial markers in sensitivity and specificity to determine the myocardial injury of sepsis.

Correlation of heart-type fatty acid-binding protein and glycogen phosphorylase enzyme BB in brain with septic myocardial injury / 中国小儿急救医学

The incidence of sepsis is on the rise, and the mortality is also high. Myocardial injury caused by sepsis is one of the important causes of death. However,there is no clear and unified diagnostic criteria to sepsis complicated with myocardial injury. The clinical diagnostic criteria of myocardial injury is mainly based on cardiac ultrasound,myocardial markers and so on. But the measurement of ejection fraction is needed to consider the impact of preload and afterload of left ventricula,also the subjective level of opera-tors. So cardiac markers play an important role in the detection of myocardial injury in sepsis and can reflect the severity of myocardial injury and sepsis,especially in the early diagnosis and prognosis. Heart-type fatty acid binding protein and brain glycogen phosphorylase isoenzyme type exhibit higher sensitivity, specificity and stability compared to other traditional cardiac markers in the clinical diagnosis of myocardial injury, which are worth to be studied and applied in the clinical diagnosis of myocardial injury.

Effect of ethanolic extract of Cyperus rotundus L. against isoprenaline induced cardiotoxicity.

Interruption of blood supply to heart results in acute myocardial infarction (AMI) and further leads to damaging of the heart muscles. Available drugs for the treatment MI have one or other side effects, and there is a need for development of better alternative drugs. Here comes the role of herbal sources. In this study, we evaluated cardioprotective effect of Cyperus rotundus on isoprenaline-induced myocardial infarction. Thirty five Wistar rats, aged 60-100 days with body wt. 150-200 g, pretreated with ethanolic extract of Cyperus rotundus L. (@ 250 and 500 mg/kg body wt.) orally before induction of myocardial necrosis by administrating isoprenaline (85 mg/kg, s.c.) on 19th and 20th day of the pretreatment period. The treated rats were examined for gross functioning of heart, heart weight/body wt. Ratio, and also observed histopathologically. Further, activities of various cardiac enzymes such as aspartate transaminase, alanine transaminase, creatinine kinase-myoglobulin, lactate dehydrogenase, and the gold marker troponin-I were also determined. The levels altered by isoproterenol were found to be restored significantly by the test extracts especially at higher dose. Biochemical observations viz., serum ALT (P<0.0001), AST (P<0.0001), creatine kinase-myoglobulin (CK-MB) (P<0.0001), LDH (P<0.0001) demonstrated significant cardioprotective activity of the ethanolic extract of C. rotundus(500 mg/kg body wt.), against isoprenaline induced myocardial infarction. These results were also substantiated by physical parameters and histopathological observations. All these results were comparable with that of two standard drugs metoprolol (10 mg/kg/day), ramipril (3 mg/kg/day) as well as polyherbal formulation Abana (50 mg/kg/day).

Efeito da suplementação com vitamina E sobre os metabolismos oxidativo e cardíaco em equinos submetidos a exercício de alta intensidade / Effect of vitamin E on oxidative and cardiac metabolism in horses submitted to high intensity exercise

A suplementação antioxidante visa prevenir os danos oxidativos induzidos pelo exercício físico em diversos tecidos, como o miocárdio. Nesse contexto, este estudo objetivou avaliar os marcadores cardíacos e a lipoperoxidação em equinos no teste de exercício de rápida aceleração e curta duração (TRA), em esteira de alta velocidade, antes e após a suplementação com vitamina E. Para tanto, foram utilizados 10 equinos sem treinamento, que realizaram o primeiro TRA (TRA1) com carga de trabalho fundamentada no consumo máximo de oxigênio individual (VO2max) e que induziu a concentração de lactato maior que 4mmol/L, sendo considerado predominantemente anaeróbico. Em seguida, os equinos receberam vitamina E (dl-alfa-tocoferol) na dose de 1.000UI/dia, por via oral, durante 52 dias, e, posteriormente, realizaram um segundo TRA (TRA2) com o mesmo protocolo de TRA1. As amostras de sangue foram colhidas nos momentos antes do exercício, imediatamente após o término do teste e em 1h, 3h, 6h, 12h e 24h subsequentes. Determinou-se o malondialdeído (MDA) plasmático como índice de lipoperoxidação, e as concentrações séricas de troponina I cardíaca (cTnI), isoenzima MB da creatinoquinase (CK-MB) e mioglobina, como marcadores cardíacos. Como efeito do exercício, observou-se aumento discreto de MDA, de cTnI e de CK-MB, sendo significativo apenas para CK-MB. A suplementação foi capaz de amenizar a produção das espécies reativas de oxigênio, evidenciada pela menor concentração de MDA em TRA2, em 24h, além de causar um efeito protetor no miocárdio, devido ao menor valor de cTnI em 6h no TRA2 em relação ao TRA1. Não houve grandes alterações na concentração de mioglobina. Concluiu-se que o exercício de alta intensidade promoveu estresse no miocárdio nos equinos avaliados, bem como houve efeito benéfico da vitamina E na proteção miocárdica e sobre a lipoperoxidação.

Antioxidant supplementation aims to prevent oxidative damage induced by physical exercise in several tissues, including myocardium. This study aimed to assess cardiac and lipid peroxidation markers of horses submitted to a high intensity and short duration exercise test (TRA) on a high speed treadmill, before and after vitamin E supplementation. Ten untrained horses performed the first TRA test (TRA1), with workload based on maximal oxygen uptake (VO2max), which induced a blood lactate higher than 4mmol/L, i.e. predominantly anaerobic exercise test. After TRA1, the horses were supplemented with oral vitamin E (dl-alpha-tocopherol) at a daily dose of 1,000IU for 52 days. Then they performed the second test (TRA2) with the same protocol of TRA1. Blood samples were collected before exercise, immediately after and at 1h, 3h, 6h, 12h and 24h after the end of test. Plasma malondialdehyde (MDA), as lipid peroxidation index, and serum cardiac troponin I (cTnI), creatine kinase isoenzyme MB (CK-MB) and myoglobin, as cardiac markers, were determined. There was a slight increase in MDA, cTnI and CK-MB levels caused by the exercise, but statistically significant only for CK-MB levels. Vitamin E was effective on scavenging reactive oxygen species, as evidenced by lower MDA level after supplementation (TRA2) at 24h. Also, vitamin E caused myocardial protection showed by lower cTnI concentration at 6h in TRA2 when compared to TRA1. There were no changes on myoglobin levels. In conclusion, high intensity exercise induced myocardial stress in horses and we also verified the beneficial effect of vitamin E on myocardial protection and lipid peroxidation.

Role of Serum Cardiac Markers in Myocardial Infarction.

Background: Acute Myocardial Infarction (AMI) has become one of the major causes of mortality in the world at present, and it is for this reason various researches are being done for its diagnosis and prognostic assessment. Serum enzyme estimation is an important tool for it. Aim: To study changes in serum cardiac markers, after acute attack of MI Before & 2 hours after reperfusion and to establish usefulness of enzymes in early diagnosis of AMI. Methodology: A study of changes in serum cardiac markers CK-MB, LDH and AST, after acute attack of MI-before and 2 hours after reperfusion was conducted at govt. hospital. Total 100 patients were studied. All the patients were confirmed cases of AMI, admitted in the intensive care unit of hospital. Blood samples were collected in plain bulb, at the time of admission and at 90 minutes (i.e. after reperfusion) and enzyme estimation was done for all 3 enzymes. Result: It was found that the serum CK-MB is the first and earliest enzyme released in compare to AST and LDH, and after reperfusion it increases 6-7 folds. The mean levels of all enzymes were higher after reperfusion, suggestive of good prognosis in case of early reperfusion after an attack of AMI.

Changes of the electrocardiograms and the cardiac markers in patients with acute insular infarction / 中国医师进修杂志

Objective To investigate the changes of the electrocardiograms (ECG) and the cardiac markers in patients with acute insular infarction,and analyze the relationship between them and the prognosis.Methods A total of 202 patients with acute middle cerebral artery territory infarction (patients group) and 150 control subjects (control group) was selected in this study.Patients included insular infarction (insular infarction group,136 cases),non-insular infarction (non-insular infarction group,66 cases),left-side insular infarction(71 cases) and right-side insular infarction(65 cases).ECG recordings and plasma cardiac troponin I (cTnI),creatine kinase-MB (CK-MB) were measured and compared.Death in 6 months was followed-up.Results There was significant difference in the incidence of abnormal changes of ECG and plasma cTnI,CK-MB increasing between patients group and control group (P ＜0.01).The incidence of abnormal changes of ECG and fatality rate were higher in insular infarction group than those in non-insular infarction group [80.88％(110/136) vs.46.97％(31/66) and 11.76％ (16/136) vs.3.03％ (2/66),P ＜ 0.05 or ＜ 0.01].The incidences of ectopy and prolonged QT were higher in right-side insular infarction patients than those in left-side insular infarction patients [44.62％(29/65) vs.11.27％ (8/71),P ＜0.01 ; 55.38％ (36/65) vs.35.21％ (25/71),P ＜ 0.05].The incidences of sinus bradycardia and ST segment deviation were higher in left-side insular infarction patients than those in right-side insular infarction patients [22.54％(16/71) vs.7.69％(5/65),P ＜ 0.05 ;47.89％(34/71) vs.13.85％ (9/65),P ＜ 0.05].The increased rates plasma cTnI and CK-MB level were mainly seen in insular infarction [insular infarction group:47.79％ (65/136),34.56％ (47/136); non-insular infarction group:4.55％ (3/66),1.52％ (1/66),P ＜ 0.01].The incidence of plasma cTnI increasing in right-side insular infarction patients was higher than that in left-side insular infarction patients [67.69％(44/65) vs.29.58％(21/71),P＜ 0.05].There was no significant difference in the incidence of plasma CK-MB increasing between left-side insular infarction patients and right-side insular infarction patients(P ＞ 0.05).The fatality rates in plasma cTnI,CK-MB increasing patients were higher than those in normal plasma cTnI,CK-MB patients [16.18％ (11/68) vs.5.22％ (7/134),P ＜0.05;29.17％ (14/48) vs.2.60％ (4/154),P ＜0.01].Conclusions The effects of acute hemispheric cerebral infarction on heart are mainly associated with destruction of insula.Patients with insular infarction have more abnormal changes of cardiac markers and ECG,which is correlated with poor prognosis.

Comparison of human heart-type fatty acid-binding protein used as an early diagnostic cardiac marker of acute coronary syndrome with combination of cardiac troponin-T and creatine kinasemyocardial band / 中华急诊医学杂志

Objective To evaluate the early diagnostic value of human heart-type fatty acid- binding protein (H-FABP) of acute coronary syndrome (ACS) and compare the diagnostic accuracy of different combination regimens of cardiac markers. Methods A total of 103 consecutive patients with chest pain (within 6 h after admission to Peking University Third Hospital,emergency department) suggestive of ACS were recruited for the analysis from April,2010 to June,2011.The blood levels of H-FABP,cardiac troponin-T (cTnT) and creatine kinase-myocardial band (CK-MB) were obtained at admission. The sensitivity,specificity,positive predictive value and negative predictive value together with the sensitivity and specificity in different phases of illness at admission were analyzed and compared among H-FABP,cTnT,CK-MB and different combinations by using SPSS version 17.0 software.Results Within 6 h of onset of symptom,the overall sensitivities of H-FABP,cTnT and CK-MB were 62.5％,30.6％ and 33.3％ respectively for patients with ACS.The sensitivity of H-FABP was significantly higher than that of cTnT and CK-MB (P ＜0.01 ).There were no differences in specificity and positive predictive value.The combination of H-FABP with cTnT had the greatest negative predictive value (53.8％ ).The sensitivity of H-FABP was higher during 3 - 6 h (77.8％ ) than during 0 - 3 h (53.3 ％ ) after chest pain onset (P =0.038).Within 0 - 3 h of onset of AMI,the overall sensitivities of the combination of H-FABP with cTnT and H-FABP with CK-MB (55.6％) were significantly higher than the combinaton of cTnT with CK-MB ( 24.4％ ) ( P =0.003 ).The sensitivity of the combination of H-FABP with cTnT was higher than that of single H-FABP during 0- 3 h and 3 -6 h after onset of AMI with increment in 3.3％ and 7.4％ respectively.The combination of H-FABP with cTnT had the greatest sensitivity ( 85.2％ ) during 3 - 6 h after onset.Conclusions H-FABP is the most sensitive cardiac marker in diagnosing of ACS in the early phase within 6 h,especially during 3 -6 h after onset.The sensitivity of the combination of H-FABP with cTnT is higher than that of H-FABP alone.The combination of H-FABP with cTnT has the best diagnostic value during 3 -6 h after onset of ACS.

Postmortem Biochemistry (I) : Cardiac Markers / 대한법의학회지

In cases of atherosclerotic occlusion of coronary artery, is it appropriate to conclude that myocardial infarction is the true cause of death? More sensitive and specific diagnostic methods for the postmortem diagnosis of myocardial infarction are sometimes necessary because macroscopic or microscopic changes associated with early-phase acute myocardial injuries or myocardial infarct are sometimes absent in sudden cardiac death. Postmortem biochemical assessment of cardiac markers may help to evaluate the pathological cardiac status in sudden unexpected death without obvious cause. However, forensic pathologists are generally interested only in the macroscopic and microscopic findings for postmortem diagnosis of myocardial diseases and hesitate to use postmortem biochemical data because of the risk of postmortem changes. There are several clinically useful cardiac markers antemortem cardiac events such as myocardial injuries, infarct, or heart failure and postmortem data on cardiac markers in autopsy cases of sudden death have been reported. This review of postmortem data on cardiac markers in blood, other body fluids, and myocardial tissue will serve to introduce the recent international research trends and provide a foundation for a new field in postmortem biochemistry.

HS-CRP levels in myocardial infarction patients in relation to cardiac markers.

Studies have provided strong evidence for the importance of primary or secondary inflammatory processes in the pathogenesis of atherosclerosis. A growing number of studies report that inflammation plays a crucial role in the cell biology of atherosclerosis. The aim of the study was to know the relationship between hs-CRP and cardiac markers in acute myocardial infarction patients. This case control study was conducted at the department of Biochemistry and department of Medicine, JSS Medical College, Mysore, Karnataka. The study protocol was approved by Research Ethics Committee of JSS Medical College. A total 60 subjects were included in the study in the age group of 50-68 years. CK-MB, LDH, AST and hs-CRP were estimated. There was a statistically significant difference between the hs- CRP levels of two groups. Cardiac marker values were significantly higher in cases compared to controls. But there was no correlation between cardiac markers and hs-CRP levels in cases. The CRP measurement has a lot of advantages. Firstly it is a stable compound and secondly it can be measured at any time of the day without regards to biological clock. In contrast to results for cytokines such as IL-6, no circadian variation appears to exist for hsCRP. Thus, clinical testing for hsCRP can be accomplished without regard for time of day. In conclusion we would like to say that hs-CRP levels could be used as risk assessment, diagnostic and prognostic marker in myocardial infarction patients.

Changes of Th17 cells in systemic lupus erythematosus with cardiac involvement / 中华风湿病学杂志

ObjectiveTo investigate the role of Thl7 cells in the pathogenesis of SLE patients with cardiac involvement,and to understand the value of cardiac markers in SLE patients with cardiac involvement.MethodsSerum IL-17A levels were measured by enzyme-linked immunosorbent assay in 47 SLE patients with cardiac involvement (group Ⅰ ),55 SLE patients without cardiac involvement (group Ⅱ ) and 38 healthy controls(group Ⅲ ).The ADVIA Centaur(R)-XP immunoassay analysis system and Olympus AU2700 automatic biochemical system were used to measure cardiac markers.Then real time-quantitative polymerase chain reaction was used to measureRORγt mRNA in 13 SLE patients with cardiac involvement,14 SLE patients without cardiac involvement and 13 healthy controls.Kruskal-Wallis test,Mann-Whitney U test,F test and Spearman correlation were used for statistical analysis.Results① Serum levels of IL-17A were markedly increased in group Ⅰ than group Ⅱ and Ⅲ [27.98 (8.44-138.81) vs 11.12 (3.64-22.30) vs 5.77 (2.22-9.60) pg/ml,both P＜0.05].② Serum levels of BNP were significantly higher in group Ⅰ than group Ⅱ and Ⅲ [49(13.50-107.50) vs 17(9-26) vs 7.50(4.75-13) pg/ml,both P＜0.01 ].③ Age,course,SLEDAI were significantly higher in group Ⅰ SLE patients than group Ⅱ (P＜0.01 or P＜0.05).④ The level of RORγt mRNA were significantly elevated in group Ⅰ compared to group Ⅱ and Ⅲ [2.2(0.79-2.83) vs 0.72(0.39-1.14) vs 0.19(0.15-0.75),P＜0.05].Conclusion① Th17 cells may contribute to the inflammation of heart in SLE.② The older age,longer course and higher disease activity of SLE patients are risk factors for cardiac involvement in SLE.③ Serum BNP may be a useful indicator in SLE patients with heart involvement.

Dosagem de marcadores cardíacos CK-MB e TnIc e eletrólitos no envenenamento experimental por veneno de sapo em cães / Determination of cardiac markers and CK-MB TnIc and electrolyte in experimental poisoning by poison frog in dogs

Dentre os sinais sistêmicos causados pelo envenenamento por veneno de sapo (bufotoxina) em cães, os efeitos cardiotóxicos são um dos mais importantes. O objetivo deste estudo foi avaliar as potenciais alterações no músculo cardíaco de cães envenenados experimentalmente por veneno de sapo e observar as alterações eletrolíticas que podem ocorrer nesse tipo de envenenamento. Utilizaram-se 20 cães divididos em grupo controle (n=5) e grupo envenenado (n=15). O veneno de sapo foi extraído por meio de compressão manual das glândulas paratóides. Após anestesia geral, os cães do grupo controle receberam placebo (solução fisiológica) e os do grupo envenenado uma alíquota do veneno por sonda orogástrica. As colheitas de sangue para dosagem dos marcadores cardíacos foram realizadas seis e 24 horas após o envenenamento. As colheitas de sangue para dosagem dos eletrólitos foram realizadas antes e duas, quatro, seis e 12 horas após o envenenamento. A análise estatística empregada foi o teste não-paramétrico de Mann-Withney (P<0,05). Os cães envenenados por veneno de sapo apresentaram elevação dos níveis dos marcadores cardíacos CK-MB e TnIc, confirmando a cardiotoxicidade do veneno. Hipocalemia e hipocalcemia foram também observadas nos cães envenenados.

Among the systemic signs of toad venom (bufotoxin) poisoning in dogs, the cardiotoxic effects are one of the most important. Thus, the objective of this experiment was to evaluate potential changes in the cardiac muscle in dogs poisoned experimentally by toad venom and to observe the eletrolyte alterations which may occur in this condition. Twenty dogs divided into control group (n=5) and poisoned group (n=15) were utilized. The toad venom was extracted by manual compression of the paratoidic glands. After general anesthesia, dogs in the control group received placebo and dogs in the poisoned group received the venom by orogastric catheter. Samples for dosage were collected 6 hours and 24 hours after poisoning and 0, 2, 4, 6 and 12 hours after poisoning for electrolytes dosage. The Man-Withney test was used for statistical analysis (P<0.05). The poisoned dogs showed (saline) elevated levels of cardiac markers CK-MB and TnIc, confirming the cardiotoxic effect of the bufotoxin. Hypokalemia and hypocalcemia were also observed.

Value of heart-type fatty acid-binding protein in early diagnosis of acute myocardial infarction / 中国医师进修杂志

Objective To explore the value of heart-type fatty acid-binding protein (H-FABP) in the early diagnosis of acute myocardial infarction (AMI). Methods Sixty confirmed AMI patients were observed, the data of H-FABP, cardiac troponin T (cTnT), creatine kinase MB (CK-MB) were detected in < 6 h and 6-12 h after the symptoms appeared, and the sensitivity of the three markers was calculated. The specificity was compared with 15 uncertain AMI patients and 45 healthy subjects. Results The early diagnosis sensitivity of H-FABP in < 6 h was 94% in AMI, which was higher than that of cTnT (50%) and CK-MB (56%) (P < 0.05 ). The diagnosis sensitivity of H-FABP, CTnT, CK-MB in 6-12 h was 100%, 92%, 92% respectively (P> 0.05 ). There was no significant difference in the specificity among the three markers (P > 0.05). Conclusions H-FABP has more sensitivity and specificity in the early diagnosis of AMI. It is applicable in the screening of patients who suffered chest pain and the diagnosis of early AMI.

Investigation of Elevated Cardiac Troponin T in Chronic Renal Failure Patients Undergoing Hemodialysis / 대한진단검사의학회지

BACKGROUND: The aim of this study was to investigate the prevalence and clinical significance of abnormal values of cardiac markers, high sensitivity CRP (hsCRP) and homocysteine occurring in hemodialysis patients without clinical evidence of acute coronary ischemia. METHODS: We determined the concentrations of cardiac troponin T (cTnT), troponin I (cTnI), creatine kinase MB (CK-MB), myoglobin, hsCRP, homocysteine and other biochemical parameters 35 patients with chronic renal failure (CRF) and 22 healthy controls. All CRF patients were followed in for 3 years. RESULTS: All of the measured parameters except cholesterol were significantly elevated in the patients, comparing with controls (P0.05). A good association was present between cTnT and CK-MB, cTnT and myoglobin, myoglobin and creatinine, and BUN and creatinine. Inquiries about underlying diseases of CRF revealed that diabetes mellitus group showed significantly higher cTnT values than in hypertension group or inflammation group. cTnT was elevated above cutoff value in about 17% of patients, while cTnI was in none of them. During one-year follow-up period, 6 patients (18.2%) died and 3 of them had initially elevated cTnT values. Four patients had cardiac events, but none of them had any increase in the values of the cardiac markers. The patients with increased cTnT values above cutoff value (> or =0.1 ng/ mL) showed a significantly higher mortality rate than the patients with cTnT values below the cutoff value in 3-year follow-up (P<0.05). CONCLUSIONS: Mildly elevated cardiac markers, hsCRP and homocysteine are common in CRF patients undergoing hemodialysis. It is recommended that cTnI values be used for diagnosis of ischemic heart disease in CRF patients. The three-year follow-up outcome suggests that cTnT is a potential prognostic marker of mortality in CRF patients.

Tests for Acute Coronary Syndrome / 영남의대학술지

The enzyme activities of creatine kinase(CK), its isoenzyme MB(CK-MB) and of lactate dehydrogenase isoenzyme 1(LD-1) have been used for years in diagnosing patients with chest pain in order to differentiate patients with acute myocardial infarction(AMI) from non-AMI patients. These methods are easy to perform as automated analyses, but they are not specific for cardiac muscle damage. During the early 90's the situation changed. First, creatine kinase MB mass(CK-MB mass) replaced the measurement of CK-MB activity. Subsequently cardiac-specific proteins, troponin T(cTnT) and troponin I(cTnI) appeared and displacing LS-1 analysis. However troponin concentration in blood increase only from four to six hours after onset of chest pain. Therefore a rapid marker such as myoglobin, fatty acid binding protein or glycogen phosphorylase BB could be used in early diagnosis of AMI. On the other hand, CK-MB isoforms alone may also be useful in rapid diagnosis of cardiac muscle damage. Myoglobin, CK-MB mass, cTnT and cTnI are nowadays wisely used in diagnosing patients with acute chest pain. Myoglobin is not cardiac-specific and therefore requires supplementation with some other analysis such as troponins to support the myoglobin value. Troponins are very highly cardiac-specific. Only the sera of some patients with severe renal failure, which requires hemodialysis, have elevated cTnT and/or cTnI without there being any evidence of cardiac damage. The latest studies have shown that elevated troponin levels in sera of hemodialysis patients point to an increased risk of future cardiac events in a similar manner to the elevated troponin values in sera of patiets with unstable angina pectoris. In addition, the bedside tests for cTnT and cTnI alone or together with myoglobin and CK-MB mass can be used instead of quantitative analyses in the diagnosis of patients with chest pain. These rapid tests are easy to perform and they do not require expensive instrumentation. For the diagnosis patients with chest pain, routinely myoglobin and CK-MB mass measurements should be performed whenever they are requested (24 h/day) and cTnT and cTnI on admission to the hospital and then 4-6 and 12 hours later and maintained less than 10% imprecision.