ABSTRACT
Abstract Background: The strain parameters of Real-Time Three-Dimensional Spot Tracking Echocardiography (RT3D-STE) are GLS, GAS, GRS, and GCS, while each index can significantly diagnose Acute Myocardial Infarction (AMI) patients, but none of them can distinguish between NSTEMI and STEMI. MicroRNAs (miRNAs) play essential roles in Acute Myocardial Infarction (AMI), but little is known about the value of exosome miRNA combined with RealTime Three-Dimensional Spot Tracking Echocardiography (RT3D-STE) between ST-segment Elevation Myocardial Infarction (STEMI) and Non-ST-segment Elevation Myocardial Infarction (NSTEMI). Aim: To estimate the exosomal miRNAs related to strain parameters of RT3D-STE as biomarkers for early detection of STEMI and NSTEMI. Methods: The present study collected plasma samples from thirty-four (34) patients with AMI (including STEMI and NSTEMI) and employed high-throughput sequence technology and real-time quantitative polymerase chain reaction (RT-qPCR) to identify the differentially expressed miRNAs. The Pearson correlation coefficient is used to measure the strength of a linear association between differentially expressed miRNAs and strain parameters of RT3D-STE. Results: Twenty-eight (28) differentially expressed exosomal miRNAs were universally identified between STEMI, NSTEM, and normal groups. Among them, there are 10 miRNAs (miR-152-5p, miR-3681-5p, miR-193a-5p, miR-193b-5p miR-345-5p, miR-125a-5p, miR-365a-3p, miR-4520-2-3p, hsa-miR-193b-3p and hsa-miR-5579-5p) with a Pearson correlation greater than 0.6 with RT3D-STE strain parameters. Especially, miR-152-5p and miR-3681-5p showed the most significant correlation with RT3D-STE strain parameters. Target genes of these 10 miRNAs are analyzed for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways enrichment, and they were found to be mainly involved in the cellular metabolism processes and HIF-1 signaling pathway. RT-qPCR verified the significant differential expression of miR-152-5p and miR-3681-5p between STEMI and NSTEM groups. Conclusion: RT3D-STE and exosome miRNAs can be used as a hierarchical diagnostic system in AMI. If the RT3D-STE is abnormal, the exosome miRNAs can be detected again to obtain more detailed and accurate diagnostic results between STEMI and NSTEM groups. Exosomal miR-152-5p and miR-3681-5p may serve as potential biomarkers for ST-segment elevation myocardial infarction. HIGHLIGHTS RT3D-STE and exosome miRNAs can be used as a hierarchical diagnostic system in AMI. Exosomal miR-152-5p and miR-3681-5p function as potential biomarkers for ST-segment elevation myocardial infarction.
ABSTRACT
BACKGROUND: Morbidity and mortality from acute coronary syndrome (ACS) primarily depends on prompt evaluation and management of patients. Despite available recommendations on ACS management, there is limited data regarding Filipino physician's knowledge and adherence with these guidelines in the emergency room (ER).OBJECTIVES: To describe the initial management of ACS patients by Filipino physicians at the ER and to document their adherence with the 2007 American College of Cardiology/American Heart Association (ACC/AHA) ACS guidelines for the management of patients with unstable angina (UA)/ non-ST-segment elevation myocardial infraction (NSTEMI) and ST-segment elevation myocardial infraction (STEMI).METHODS: This was an open-label, descriptive, multicenter, non-interventional study that enrolled patients ? 18 years of age, seen at the ER and suspected to have UA or MI with or without ST-segment elevation. Patient demographics, medical history, physical and laboratory examinations, medications or interventions done at the ER and the specialty of physicians who provided the initial management were recorded. Adherence with the 2007 ACC/AHAACS guidelines was also assessed. Data were summarized using descriptive statistics.RESULTS: A total of 1,398 eligible patients (mean age 61.58+ 12.03 years) were included in the study. At least one cardiac enzyme test was requested in up to 93% of patients, with troponin I being the most common (72.53%). Upon diagnosis, 95.78% of patients were given antiplatelet therapy (16.95% clopidogrel alone, 15.31% aspirin alone and 1.07% other antiplatelet drugs), the combination therapy. Moreover, 86.27% were given anticoagulant therapy (75.75% enoxaparin, 5.94% fondaprinux and 3.97% IV UFH). Ninety-eight percent of patients we subsequently admitted in the hospital and 26.68% of patients were considered to undergo percutaneous coronary intervention (PCI). Majority of these patients were initially managed by ER physicians (52.22%).CONCLUSION: Filipino physicians at the ER provide an appropriate management strategy to individual ACS patients because their management adheres to the 2007 and the current ACC/AHA ACS guidelines. The outcome and impact of these strategies should be assessed to encourage more physicians to conform with available recommendations. Moreover, a review of adherence of physicians to other disease management guidelines should be conducted to further improve care and outcomes in ER.