Cardiovascular disease risk prediction in scleroderma

SUMMARY OBJECTIVE: Cardiovascular disease risk prediction in scleroderma is important. In this study of scleroderma patients, the aim was to investigate the relationship between cardiac myosin-binding protein-C, sensitive troponin T, and trimethylamine N-oxide and cardiovascular disease risk with the Systematic COronary Risk Evaluation 2 model of the European Society of Cardiology. METHODS: Systematic COronary Risk Evaluation 2 risk groups of 38 healthy controls and 52 women with scleroderma were evaluated. Cardiac myosin-binding protein-C, sensitive troponin T, and trimethylamine N-oxide levels were analyzed with commercial ELISA kits. RESULTS: In scleroderma patients, cardiac myosin-binding protein-C and trimethylamine N-oxide levels were higher than healthy controls but sensitive troponin T was not (p<0.001, p<0.001, and p=0.274, respectively). Out of 52 patients, 36 (69.2%) were at low risk, and the other 16 (30.8%) patients were at high-moderate risk with the Systematic COronary Risk Evaluation 2 model. At the optimal cutoff values, trimethylamine N-oxide could discriminate high-moderate risk with sensitivity 76%, specificity 86% and cardiac myosin-binding protein-C with sensitivity 75%, specificity 83%. Patients with high trimethylamine N-oxide levels (≥10.28 ng/mL) could predict high-moderate- Systematic COronary Risk Evaluation 2 risk 15 times higher than those with low trimethylamine N-oxide (<10.28 ng/mL) levels (odds ratio [OR]: 15.00, 95%CI 3.585-62.765, p<0.001). Similarly, high cardiac myosin-binding protein-C (≥8.29 ng/mL) levels could predict significantly higher Systematic COronary Risk Evaluation 2 risk than low cardiac myosin-binding protein-C (<8.29 ng/mL) levels (OR: 11.00, 95%CI 2.786-43.430). CONCLUSION: Noninvasive cardiovascular disease risk prediction indicators in scleroderma, cardiac myosin-binding protein-C, and trimethylamine N-oxide could be recommended to distinguish between high-moderate risk and low risk with the Systematic COronary Risk Evaluation 2 model.

Effect of co-morbid chronic kidney disease on the accuracy of cardiac troponin levels for diagnosis of acute myocardial infarction / 南方医科大学学报

OBJECTIVE@#To evaluate the accuracy of cardiac troponin (cTn) levels in the diagnosis of acute myocardial infarction (AMI) in patients with chronic kidney disease (CKD) and explore a potential strategy for improving the diagnostic accuracy.@*METHODS@#We retrospectively analyzed the data from patients with high-risk chest pain admitted in Zhujiang Hospital from January, 2018 to December, 2020, including 126 patients with and 272 patients without CKD, and 122 patients diagnosed to have AMI and 276 patients without AMI. The baseline clinical data of the patients and blood test results within 12 h after admission were collected.@*RESULTS@#In patients without AMI, cTnT level was significantly higher in those with co-morbid CKD than in those without CKD (P < 0.001), and showed a moderate negative correlation with eGFR (rs=- 0.501, P < 0.001), while cTnI level did not differ significantly between the two groups (P=0.72). In patients with CKD, the optimal cutoff level was 0.177 μg/L for cTnT and 0.415 ng/mL for cTnI for diagnosis of AMI, for which cTnI had a higher specificity than cTnT. The diagnostic model combining both cTnT and cTnI levels [P=eY/(1+ eY), Y=6.928 (cTnT)-0.5 (cTnI)-1.491] had a higher AUC value than cTn level alone.@*CONCLUSION@#In CKD patients, the cutoff level of cTn is increased for diagnosing AMI, and cTnI has a higher diagnostic specificity than cTnT. The combination of cTnT and cTnI levels may further improve diagnostic efficacy for AMI.

Principal component analysis of categorized parameters in periprocedural myocardial injury following percutaneous coronary intervention

Objective: The elevation of troponin-T (Trop-T) or creatinine kinase myocardial isoform (CKMB) is very common during the percutaneous coronary intervention (PCI). A study was attempted to determine the correlation between elevated Trop-T or CKMB and the parameters of PCI by using multivariate analysis, especially principal component analysis (PCA). Materials and Methods: A prospective observational study was carried out among 100 patients who underwent PCI for stable coronary artery disease in which 31 and 37 patients were found to have elevated Trop-T and CKMB (>3 times) following PCI. The correlation was studied between Trop-T or CKMB (dependent variable) and different parameters, viz., total stent length (mm), fluoroscopy time (min), lesion strength, left ventricular (LV) function, procedural complications, type of lesions, vessels treated with drug eluting stent (DES), and major adverse cardiac events (MACE) as independent variables. Results: For Trop-T, the principal component (PC)-1 and PC-2 obtained 63.49% and 30.88% of the original variation. For PC-1 and PC-2, maximum positive loading was recorded for stent length followed by fluoroscopy time and for LV but negative loading for the type of lesion and type of stent (DES vs bare metal stent [BMS]). For CKMB, the PC-1 and PC-2 obtained 61.22% and 32.08% of the original variation. For PC-1 and PC-2, maximum positive loading was recorded for stent length and fluoroscopy time followed by vessel treated but negative loading for the type of stent and MACE, and maximum positive loading recorded for LV function but negative loading for the type of lesion. Conclusion: This study indicates which factors are most important in preventing periprocedural myocardial injury during PCI and may be a suitable tool to prevent myocardial injury and for subsequent less MACE and better patient outcomes.

Desempenho Diagnóstico da Angiotomografia Computadorizada e da Avaliação Seriada de Troponina Cardíaca Sensível em Pacientes com Dor Torácica e Risco Intermediário para Eventos Cardiovasculares / Diagnostic Performance of Coronary Tomography Angiography and Serial Measurements of Sensitive Cardiac Troponin in Patients With Chest Pain and Intermediate Risk for Cardiovascular Events

Resumo Fundamento A angiotomografia coronária (ATC) tem sido usada para avaliação de dor torácica principalmente em pacientes de baixo risco, e poucos dados existem com pacientes em risco intermediário. Objetivo Avaliar o desempenho de medidas seriadas de troponinas sensíveis e de ATC em pacientes de risco intermediário. Métodos Um total de 100 pacientes com dor torácica, TIMI score 3 ou 4 e troponina negativa foram prospectivamente incluídos. Todos os pacientes foram submetidos à ATC, e aqueles com obstruções ≥ 50% foram encaminhados à cineangiocoronariografia. Pacientes com lesões < 50% recebiam alta hospitalar, receberam alta e foram contatados 30 dias depois por telefonema para avaliação dos desfechos clínicos. Os desfechos foram hospitalização, morte, e infarto agudo do miocárdio em 30 dias. A comparação entre os métodos foi realizada pelo teste de concordância kappa. O desempenho das medidas de troponina e da ATC na detecção de lesões coronárias significativas e desfechos clínicos foi calculado. Os resultados foram considerados estatisticamente significativos quando p <0,05. Resultados Estenose coronária ≥ 50% na ATC foi encontrada em 38% dos pacientes e lesões coronárias significativas na angiografia coronária foram encontradas em 31 pacientes. Dois eventos clínicos foram observados. A análise de concordância Kappa mostrou baixa concordância entre as medidas de troponina e ATC na detecção de lesões coronárias significativas (kappa = 0,022, p = 0,78). O desempenho da ATC para detectar lesões coronárias significativas na angiografia coronária ou para prever eventos clínicos em 30 dias foi melhor que as medidas de troponina sensível (acurácia de 91% versus 60%). Conclusão ATC teve melhor desempenho que as medidas seriadas de troponina na detecção de doença coronariana significativa em pacientes com dor torácica e risco intermediário para eventos cardiovasculares.

Abstract Background Coronary tomography angiography (CTA) has been mainly used for chest pain evaluation in low-risk patients, and few data exist regarding patients at intermediate risk. Objective To evaluate the performance of serial measures of sensitive troponin and CTA in intermediate-risk patients. Methods A total of 100 patients with chest pain, TIMI risk scores of 3 or 4, and negative troponin were prospectively included. All patients underwent CTA and those with coronary stenosis ≥ 50% were referred to invasive coronary angiography. Patients with coronary lesions <50% were discharged and contacted 30 days later by a telephone call to assess clinical outcomes. Outcomes were hospitalization, death, and myocardial infarction at 30 days. The comparison between methods was performed by Kappa agreement test. The performance of troponin measures and CTA for detecting significant coronary lesions and clinical outcomes was calculated. Results were considered statistically significant when p < 0.05. Results Coronary stenosis ≥ 50% on CTA was found in 38% of patients and significant coronary lesions on coronary angiography were found in 31 patients. Two clinical events were observed. Kappa agreement analysis showed low agreement between troponin measures and CTA in the detection of significant coronary lesions (kappa = 0.022, p = 0.78). The performance of CTA for detecting significant coronary lesions on coronary angiography or for predicting clinical events at 30 days was better than sensitive troponin measures (accuracy of 91% versus 60%). Conclusion CTA performed better than sensitive troponin measures in the detection of significant coronary disease in patients with chest pain and intermediate risk for cardiovascular events.

Cytoprotective Effect of Dietary Squalene Supplementation on Experimentally Induced Cardiomyopathy in Rats

Background: Adriamycin is a broadspectrum, potent, older chemotherapy drug and antineoplastic agent used in the treatment of several cancers such as solid tumours, leukaemias, and lymphomas, playing a major role in cancer chemotherapy. Long-term use of this drug results in congestive heart failure and to overcome this effect dietary squalene intake reduces the adverse effects of adriamycin-mediated cardiotoxicity and cellular oxidative stress. Methods: The current study aims to investigate the cytoprotective effects of dietary squalene supplementation on adriamycin-induced cardiomyopathy in rats in terms of alterations in Troponin T, homocysteine, diagnostic marker enzymes, and cardiac tissue histology. Results: The findings show that a 1.5 percent dose of dietary squalene supplementation for 21 days reduced adriamycin-induced changes in homocysteine, troponin T, diagnostic marker enzymes, and lesions in cardiac tissues. Conclusion: The outcomes of the study specified squalene's cytoprotective action which stabilizes membranes against adriamycin-induced oxidative membrane degradation, which is primarily responsible for heart cell irreversible necrosis.

Early-warning value of PCT/PLT ratio on sepsis-induced myocardial injury / 中华急诊医学杂志

Objective:To investigate the diagnostic and early-warning value of laboratory test indicators for sepsis-induced myocardial injury (SIMD).Methods:The clinical data of 183 patients with sepsis admitted to the Department of Emergency and Critical Care Medicine of Guangdong Provincial People's Hospital from August 2016 to October 2020 were collected. The patient's age, gender, past medical history, vital signs and pathogen culture results were extracted. Cardiac function, blood routine, liver function, renal function, inflammatory factors, coagulation function, APACHE Ⅱ and SOFA scores were recorded at enrollment and 72 h after admission. SIMD was defined as cTnT ≥300 pg/mL and NT-proBNP ≥1243 pg/mL twice in 72 h intervals between enrolled cases, and the early-warning factors of patients with SIMD were analyzed. The differences in various indicators between the two groups were compared, and Logistic regression analysis was used to explore the diagnostic efficacy of cTnT and NT-proBNP combined for SIMD, and the correlation between PCT/PLT ratio and the occurrence of SIMD.Results:Among 250 patients, 67 patients were excluded for lack of the main indicators, and 183 patients (including 62 patients with history of cardiac disease) were enrolled finally. Among 183 patients with sepsis, 105 patients (57.38%) with cTNT ≥300 pg/mL and NT-proBNP ≥1 243 pg/mL, were diagnosed as myocardial injury; after excluding 62 patients with history of cardiac disease, 59 patients (48.76%) with cTNT ≥300 pg/mL and NT-proBNP ≥1 243 pg/mL were diagnosed as myocardial injury. Logistic regression analysis showed that increased PCT/PLT ratio ( OR=1.585, 95% CI: 1.124-2.237, P=0.009) was an independent risk factor for early-warning of SIMD. The PCT/PLT ratio ( OR= 1.850, 95% CI: 1.103-3.102, P=0.020) could stably predict the occurrence of SIMD in patients without previous history of heart disease. ROC curve analysis showed that PCT/PLT ratio could effectively predict the occurrence of SIMD (AUC=0.693, 95% CI: 0.617-0.769, P<0.001), the optimal cut-off value was 0.177 (sensitivity: 65.7%, specificity: 66.7%). The PCT/PLT ratio was still effective in predicting the occurrence of SIMD after excluding patients with previous history of heart disease (AUC=0.733, 95% CI: 0.643-0.823, P<0.001), and the optimal cut-off value was 0.429 (sensitivity: 55.9%, specificity: 83.9%). Conclusions:The combination of cTnT and NT-proBNP has certain diagnostic value for SIMD, and the PCT/PLT ratio could warn the occurrence of SIMD.

The Correlation between Cardiac Enzymes and Cardiotrophin-1 Levels in Patients with Acute Coronary Syndrome

Abstract Background In the current era, there is always search for better cardiovascular biomarkers to early diagnose the disease. Objectives We aimed to investigate the association between a novel biomarker, cardiothropin-1 (CT-1), and standard markers of myocardial ischemia in patients with acute coronary syndrome (ACS) in Turkey. Patients and Methods In this prospective cohort study, patients who were admitted to our institution between July 2012 and July 2013 with the diagnosis of ACS were included. The standard markers of myocardial necrosis and CT-1 were evaluated at the time of admission and after 6 hours. Changes in laboratory parameters were statistically tested and correlated with routinely used markers of myocardial ischemia. The distribution of the data was analyzed by the Kolmogorov-Smirnov test. Proportional analysis and changes in laboratory parameters were evaluated with Chi-Square test and Fisher Exact test. Statistical significance was defined as p<0.05. Results The study enrolled 24 patients (14 male, 10 female) with ST-segment elevation myocardial infarction (STEMI) and 16 patients (9 male, 7 female) with non-ST-segment elevation myocardial infarction (NSTEMI) with elevated cardiac enzymes such as creatine kinase (CK), creatine kinase-MB (CK-MB) and Troponin-T (Tn-T). The average age of the patients was 61.45 ± 11.04 years. Increasing CT-1 levels were correlated with the increasing CK (p=0.035 and p=0.018, respectively), CK-MB (p=0.006 and p=0.096, respectively), and Tn-T (p=0.041 and p=0.000, respectively) at first and at the 6th hour measurements. The CT-1 values were found to be more increased in the STEMI group (p=0.0074). Conclusion CT-1 is one of the novel biomarkers for cardiac injury. It is correlated with standard markers of myocardial ischemia and the results suggest that CT-1 can be used as a new biomarker.

Quantification of Acute Myocardial Damage Secondary to Implantation of Electrodes for the Left Bundle Branch Area Pacing

ABSTRACT Background: Different from the traditional right ventricular pacing, the left bundle branch area pacing (LBBAP) is accomplished with deeper lead implantation and more attempts. However, myocardial damage is unclear in LBBAP. Objective: The objective of the study was to observe the change of troponin T and explore possible factors associated with greater myocardial damage in LBBAP. Methods: Patients with an indication for pacemaker implantation underwent attempts for LBBAP by transventricular septal method. Levels of troponin T were determined before operation, 12 h and 1 week after the operation. Parameters of intraoperation and follow-up were recorded and analyzed. Results: In total, successful LBBAP was achieved in 126 patients. The levels of troponin T increased significantly at 12 h after the operation compared with those before operation (96.45 ± 11.07 [69.06] vs. 16.59 ± 1.84 [11.92] ng/L, p < 0.001), while there were no significant differences between pre- and post-operative levels at 1 week. Correlation and regression analysis showed that only the number of attempts was an independent factor related to the change of troponin T. During 1 year of follow-up, LBBAP was safe and feasible with few complications. Conclusions: Myocardial damage of LBBAP was clinically significant. The number of attempts was an independent factor related to the myocardial damage.

Comparison between different tricuspid valve procedures through postoperative inflammation and myocardial enzymes

Abstract Introduction: The thoracoscopic procedure for tricuspid valve (TV) diseases is a minimally invasive method of treatment. This study focuses on comparing the changes in postoperative inflammatory reaction and myocardial injury markers after thoracoscopic and sternotomy/thoracotomy TV procedures. Methods: We retrospectively analyzed 88 patients (53 males, aged 50.9±16.2 years) with TV diseases (single-valve disease) (72 cases of TV plasty) between January 2018 and April 2019. A total of 56 patients underwent thoracoscopic procedure (50 cases of TV plasty). The leukocyte and C-reactive protein (CRP) levels were monitored as indicators of systemic inflammatory reaction. The lactate dehydrogenase, creatine kinase, creatine kinase myocardial band, aspartate aminotransferase, and troponin-T levels were recorded as markers of myocardial injury. Results: The CRP and white blood cells levels of patients in the sternotomy approach group were continuously higher than those in patients in the thoracoscopic approach group. And the levels of myocardial enzymes in patients in the thoracoscopic approach group were significantly lower than those in patients in the sternotomy approach group. Conclusion: Compared with sternotomy/thoracotomy procedures on TV, the thoracoscopic procedure can reduce postoperative myocardial injury significantly and systemic inflammatory reaction to a certain extent. It is technically feasible, safe, effective, and worthy of widespread adoption in clinical practice.

Comparison of del nido cardioplegia and blood cardioplegia in terms of development of postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting

Abstract Objective: Del Nido cardioplegia (DNC) has been used in pediatric cardiac surgery for many years with a single dose application and its usage in adult cardiac surgery has been increasing in recent years, with results being published. In this study, we aimed to investigate the effect of DNC on the development of postoperative atrial fibrillation (PoAF). Methods: In this retrospective observational comparative study, 255 patients who underwent isolated on-pump coronary artery bypass grafting, between January 2019 and November 2019, were enrolled. The patients were divided into two groups: DNC (n=132) and blood cardioplegia (BC) (n=123). Intraoperative and postoperative data were evaluated and compared in terms of the development of PoAF. Results: We found that the development of PoAF and the length of hospital stay remain significantly higher in the BC group (P=0.044, P<0.001, respectively). In addition, the aortic cross-clamp time and the cardioplegia volume delivered were significantly lower in the DNC group (P=0.042, P<0.001, respectively). In multivariate logistic regression analysis, only higher cardioplegia volume was determined as an independent predictor for PoAF development (OR 1.001; 95% CI 1.000-1.001; P=0.033). We did not found difference between groups in terms of troponin T, inotropic drug support, need for intraaortic balloon pump and mortality. Conclusion: This study showed that DNC can be used safely in adult coronary bypass surgery and PoAF development effect is reduced.

Does decreased snx10 serve as a novel risk factor in atrial fibrillation of the valvular heart disease? - a case-control study

Abstract Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia. Sorting nexin 10 (SNX10) has been reported to be an important regulator in embryonic development and human diseases, however, little is known about its role in cardiac disease. The aim of this study was to investigate the clinical significance of SNX10 expression in AF. Methods: Nineteen valvular heart disease patients with AF and nine valvular heart disease patients with sinus rhythm (SR) were enrolled. Atrial tissue samples from patients undergoing open heart surgery were examined. Atrial tissues of normal hearts were obtained from two cases' autopsies. The SNX10 expression and its associations with the degree of fibrosis were analyzed by immunohistochemistry and Masson's trichrome staining. Results: SNX10 expression was detected in the cytoplasm of cardiac cells in human myocardial tissue. The SNX10 expression level was higher in the SR group than in the AF group (P=0.023). SNX10 expression was negatively associated with the degree of fibrosis (P=0.017, Spearman rho=-0.447), the New York Heart Association degree (P=0.003, Spearman rho=-0.545), left atrial diameter (P=0.038, Spearman rho=-0.393), right atrial diameter (P=0.043, Spearman rho=-0.386), and the brain natriuretic peptide (BNP) level 24 hours after surgery (P=0.030, Spearman rho=-0.426), but not the BNP level before surgery and 72 hours after surgery. No statistical significance was observed between SNX10 and the level of troponin T and C-reactive protein. Conclusion: Decreased SNX10 might serve as a potential risk factor in AF of the valvular heart disease.

The value of growth differentiation factor 15 in early diagnosis of acute chest pain / 中华急诊医学杂志

Objective:To explore the value of growth differentiation factor 15 (GDF15) in the early diagnosis of acute chest pain.Methods:A total of 96 patients with acute chest pain admitted to the Emergency Department of Hainan Hospital of PLA General Hospital from January to November 2020 were retrospectively collected. The sex, age, troponin T, creatine kinase, creatine kinase isoenzyme, GDF15 and B-type natriuretic peptide of patients within 30 min after admission were recorded, and the differences of each index in different groups were compared. ROC curve was drawn to evaluate the diagnostic value of GDF15 and TNT/BNP in acute coronary syndrome (ACS). The Gensini score, left ventricular ejection fraction, length of stay in hospital and the number of stents were calculated, and the correlation between these indexes and GDF15 concentration was evaluated.Results:The general trend of acute chest pain was more male than female (72.92% vs. 27.08%) , the oldest group was the UA group (64.67 ± 13.87) years old , the youngest group was cardiac arrest group (47.29 ± 9.99) years old . There were higher rates of hypertension in the STEMI group, NSTEMI group and UA group, and none of the groups showed significant advantage in diabetes. The GDF15 concentration was higher in ACS related chest pain group [(2.360 ± 1.710) ng/mL vs. (1.380 ± 1.040) ng/mL, P<0.01]. The area under the Receiver Operating Characteristic Curve (AUC) of GDF15 combined with TNT was up to 0.863. GDF15 concentration was negatively correlated with ejection fraction, positively correlated with Gensini score, positively correlated with the number of stents implanted, and positively correlated with the length of hospital stay. Conclusions:GDF15 is valuable in the diagnosis and prognosis of acute chest pain. The combination of GDF15 and TNT can improve the diagnostic rate of ACS.

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.

Valor Prognóstico da Troponina T e do Peptídeo Natriurético Tipo B em Pacientes Internados por COVID-19 / Prognostic Value of Troponin-T and B-Type Natriuretic Peptide in Patients Hospitalized for COVID-19

Resumo Fundamento: A COVID-19 causa grave acometimento pulmonar, porém o sistema cardiovascular também pode ser afetado por miocardite, insuficiência cardíaca e choque. A elevação de biomarcadores cardíacos tem sido associada a um pior prognóstico. Objetivos: Avaliar o valor prognóstico da Troponina T (TnT) e do peptídeo natriurético tipo B (BNP) em pacientes internados por Covid-19. Métodos: Amostra de conveniência de pacientes hospitalizados por COVID-19. Foram coletados dados dos prontuários com o objetivo de avaliar a relação da TnT e o BNP medidos nas primeiras 24h de admissão com o desfecho combinado (DC) óbito ou necessidade de ventilação mecânica. Análise univariada comparou os grupos com e sem DC. Modelo multivariado de Cox foi utilizada para determinar preditores independentes do DC. Resultados: Avaliamos 183 pacientes (idade=66,8±17 anos, sendo 65,6% do sexo masculino). Tempo de acompanhamento foi de 7 dias (1 a 39 dias). O DC ocorreu em 24% dos pacientes. As medianas de TnT e BNP foram 0,011 e 0,041 ng/dl (p<0,001); 64 e 198 pg/dl (p<0,001) respectivamente para os grupos sem e com DC. Na análise univariada, além de TnT e BNP, idade, presença de doença coronariana, saturação de oxigênio, linfócitos, dímero-D, proteína C reativa titulada (PCR-t) e creatinina, foram diferentes entre os grupos com e sem desfechos. Na análise multivariada boostraped apenas TnT (1,12[IC95%1,03-1,47]) e PCR-t (1,04[IC95%1,00-1,10]) foram preditores independentes do DC. Conclusão: Nas primeiras 24h de admissão, TnT, mas não o BNP, foi marcador independente de mortalidade ou necessidade de ventilação mecânica invasiva. Este dado reforça ainda mais a importância clínica do acometimento cardíaco da COVID-19. (AArq Bras Cardiol. 2020; 115(4):660-666)

Abstract Background: COVID-19 causes severe pulmonary involvement, but the cardiovascular system can also be affected by myocarditis, heart failure and shock. The increase in cardiac biomarkers has been associated with a worse prognosis. Objectives: To evaluate the prognostic value of Troponin-T (TNT) and natriuretic peptide (BNP) in patients hospitalized for Covid-19. Methods: This was a convenience sample of patients hospitalized for COVID-19. Data were collected from medical records to assess the association of TnT and BNP measured in the first 24 hours of hospital admission with the combined outcome (CO) of death or need for mechanical ventilation. Univariate analysis was used to compare the groups with and without the CO. Cox's multivariate model was used to determine independent predictors of the CO. Results: We evaluated 183 patients (age = 66.8±17 years, 65.6% of which were males). The time of follow-up was 7 days (range 1 to 39 days). The CO occurred in 24% of the patients. The median troponin-T and BNP levels were 0.011 and 0.041ng/dL (p <0.001); 64 and 198 pg/dL (p <0.001), respectively, for the groups without and with the CO. In the univariate analysis, in addition to TnT and BNP, age, presence of coronary disease, oxygen saturation, lymphocytes, D-dimer, t-CRP and creatinine, were different between groups with and without outcomes. In the bootstrap multivariate analysis, only TnT (1.12 [95% CI 1.03-1.47]) and t-CRP (1.04 [95% CI 1.00-1.10]) were independent predictors of the CO. Conclusion: In the first 24h of admission, TnT, but not BNP, was an independent marker of mortality or need for invasive mechanical ventilation. This finding further reinforces the clinical importance of cardiac involvement in COVID-19. (Arq Bras Cardiol. 2020; 115(4):660-666)

Função Diastólica e Biomarcadores de Participantes de Caminhada de Longa Distância / Diastolic Function and Biomarkers of Long-Distance Walking Participants

Resumo Fundamento: Os efeitos da caminhada de longa distância sobre o sistema cardiovascular são pouco estudados. Objetivos: O objetivo geral deste estudo foi verificar esses efeitos sobre o comportamento da função diastólica e dos biomarcadores cardíacos CK-MB (massa), troponina T e NT-proBNP em atletas amadores. Método: Este estudo longitudinal realizado em 2015 avaliou os participantes nas 5 etapas seguintes: A0 (basal) antes de iniciar o percurso, e as demais, A1, A2, A3 e A4 ao final de cada dia, totalizando 244,7 km. Em todas as etapas foram dosados os biomarcadores NT-proBNP, CK-MB (massa) e troponina T. Realizou-se ecocardiograma para análise das ondas E, A e E'. Adotado p < 0,05 como significativo. Resultados: Foram avaliados 25 participantes com média de idade de 46 ± 10,5 anos e índice de massa corporal de 20,2 ± 2,3 kg/m2. Encontrou-se aumentos dos valores de NT-proBNP de A0 para A1, A2, A3 e A4 (p < 0,001), CK-MB (massa) de A0 para A2 (p < 0,001) e da onda E' de A0 para A1, A2, A3 e A4 (p < 0,001). Foram identificadas correlações entre os seguintes: CK-MB (massa) e troponina T (A1: r = 0,524, p = 0,010; A4: r = 0,413, p = 0,044); CK-MB (massa) e NT-proBNP (A4: r = 0,539, p = 0,006); e E/A e E' (A0: r = 0,603, p < 0,001; A1: r = 0,639, p < 0,001; A4: r = 0,593, p = 0,002); e correlação negativa entre CK-MB (massa) com E/A (A1: r = −0,428, p = 0,041). Conclusão: Os efeitos da atividade física intensa, prolongada e intercalada foram verificados a partir das variações significativas no comportamento da CK-MB (massa), NT-proBNP e E'. Apesar das alterações encontradas, não houve critérios sugestivos de dano ao miocárdio.

Abstract Background: The effects of long-distance walking on the cardiovascular system have been little studied. Objectives: The general objective of this study was to verify these effects on the behavior of diastolic function and the cardiac biomarkers CK-MB (mass), troponin T, and NT-proBNP, in amateur athletes. Method: This longitudinal study, conducted in 2015, evaluated participants during the following 5 stages: E0 (baseline) before starting the trajectory and the others, E1, E2, E3, and E4, at the end of each day, totaling 244.7 km. At all stages, the biomarkers NT-proBNP, CK-MB (mass), and troponin T were measured. Echocardiogram was performed to analyze the E, A and E' waves. P < 0.05 was adopted as significant. Results: The study evaluated 25 participants, with an average age of 46 ± 10.5 years and body mass index of 20.2 ± 2.3 kg/m2. Increased values were found for NT-proBNP from E0 to E1, E2, E3, and E4 (p < 0.001), CK-MB (mass) from E0 to E2 (p < 0.001), and E' wave from E0 to E1, E2, E3, and E4 (p < 0.001). Positive correlations were identified between the following: CK-MB (mass) and troponin T (E1: r = 0.524, p = 0.010; E4: r = 0.413, p = 0.044); CK-MB (mass) and NT-proBNP (E4: r = 0.539, p = 0.006); and E/A and E' (E0: r = 0.603, p < 0.001; E1: r = 0.639, p < 0.001; E4: r = 0.593, p = 0.002). A negative correlation was found between CK-MB (mass) and E/A (E1: r = −0.428, p = 0.041). Conclusion: The effects of intense, prolonged, and interspersed physical activity were verified based on significant variations in the behavior of CK-MB (mass), NT-proBNP, and the E' wave. Notwithstanding the alterations found, there were no criteria suggestive of myocardial damage

Relationship of Off-Pump Coronary Artery Bypass Surgery with the Cardiac Enzyme Troponin T, LVEF, TAPSE and Post-Operative Recovery.

Cardiovascular diseases (CVD) are the leading cause of death globally including India. Ischemic heart disease is the most common cause of death. There is a sharp rise in Off Pump Coronary Artery Bypass Surgery (OPCAB), which increases cardiac enzymes like Troponin T, that is used as prognostic guide. In triple vessel disease 40 to 50% cases involve right ventricle, therefore along with left ventricular ejection fraction (LVEF), Tricuspid Annular Plane Systolic Excursion (TAPSE) can be used as a prognostic guide, which can be measured by noninvasive doppler echocardiography.METHODSPatients with specific criteria who underwent OPCAB surgery from January 2018 to March 2019 were studied. Both pre- and post-operative (14-16 hours) Troponin T (TropT) sensitivity tests were done and only preoperative Trop T negative patients were selected for the study. Postoperative patients were divided into 2 groups, TropT positive and negative. Echocardiography was done on the day before surgery, on postoperative day 5 (POD5) and postoperative day 30 (POD30). Results were compared between the two groups.RESULTSAmong 88 patients thus selected, 34 patients (38.63%) were Trop T positive, and 54 patients (61.37%) were Trop T negative. On post-operative day 5, increase in brain natriuretic peptide (BNP), decrease in TAPSE and decrease in haemoglobin were significant in Trop T positive group. Need for ventilation and postoperative hospital stay were significantly prolonged in positive groups. In POD30, decrease in albumin, decrease in LVEF and TAPSE all are significant in TropT positive group.CONCLUSIONSIt is important to determine the prognosis of OPCAB patients in early postoperative period. Troponin T has a significant prognostic value in OPCAB patients supported by LVEF and TAPSE.

MiRNA-148a promotes the differentiation of human induced pluripotent stem cells into cardiomyocyte-like cells / 中国组织工程研究

BACKGROUND: Studies have shown that miRNA-148a can promote human bone marrow mesenchymal stem cells to differentiate into mature cardiomyocyte-like cells, but the effect of miRNA-148a on the differentiation of human induced pluripotent stem cells into cardiomyocyte-like cells has not been reported. OBJECTIVE: To investigate the effect of miRNA-148a on the differentiation of human induced pluripotent stem cells into cardiomyocyte-like cells. METHODS: Human induced pluripotent stem cells differentiating into cardiomyocyte-like cells were divided into three groups. Cells in the control group were not treated. Cells in the low expression group were treated with miRNA-148a for 28 days, and those in the high expression group were treated with mimics of miRNA-148a for 28 days. In addition, human induced pluripotent stem cells cultured for 28 days were taken as the blank control group. CCK-8 was used to detect cell proliferation activity. qRT-PCR was used to detect the expression of miRNA-148a. Immunofluorescence staining and western blot analysis were performed to detect the expression of MHC and cTnT protein. RESULTS AND CONCLUSION: The expression of intracellular miR-148a mRNA and cell proliferation activity in the low expression group were lower than those in the blank control and control groups, while those in the high expression group were significantly higher than those in the other three groups (P < 0.01). There were no positive expression of MHC and cTnT in the blank control group. There were positive expressions of MHC and cTnT in the control, low expression and high expression groups. The expression of MHC and cTnT protein in the low expression group was significantly lower than that in the control group, and that in the high expression group was significantly higher than that in the other three groups (P < 0.01). These results suggest that miRNA-148a can promote the differentiation of human induced pluripotent stem cells into cardiomyocyte-like cells.

Lo mejor del Congreso Uruguayo de Cardiología 2018 / The best of the 2018 Uruguayan Congress of Cardiology / O melhor do Congresso Uruguaio de Cardiologia 2018

Resumen: El 34° Congreso Uruguayo de Cardiología, celebrado en Montevideo del 2 al 4 de diciembre del pasado año, nuevamente destacó por las excelentes presentaciones de los temas más relevantes del ámbito cardiológico, así como también por sus invitados de renombre, nacionales e internacionales. Acompañando el gran nivel del Congreso se expusieron 32 temas libres que abarcaron diferentes áreas de la cardiología de los cuales comentaremos cuatro trabajos premiados: - Riesgo de trombosis en bioprótesis aórtica y eventos clínicos según uso de anticoagulación. Metaanálisis de la evidencia actual. - Uso de NT-ProBNP como predictor de evolución en el posoperatorio de cirugía cardíaca. - Prevalencia de septal pouch en una cohorte derivada para ecocardiograma transesofágico. - Incidencia de troponina T ultrasensible en rango anormal y su correlación con la anatomía coronaria en pacientes en valoración por enfermedad coronaria estable.

Summary: The 34th Uruguayan Congress of Cardiology, celebrated last year in Montevideo from December 2nd to 4th, again stood out for the excellent presentations of the most relevant topics in the field of cardiology, as well as for its renowned national and international guests. Accompanying the great level of the Congress, 32 articles that covered different topics in the cardiological area were presented, of which we will comment four awarded: - Risk of thrombosis in aortic bioprosthesis and clinical events according to the use of anticoagulation. Meta-analysis of current evidence. - Use of NT-ProBNP as a predictor of evolution in the postoperative period of cardiac surgery. - Prevalence of septal pouch in a cohort derived for transesophageal echocardiography. - Incidence of ultrasensitive troponin T in abnormal range and its correlation with coronary anatomy in patients in assessment for stable coronary disease.

Resumo: O 34º Congresso Uruguaio de Cardiologia, realizado em Montevidéu entre os dias 2 e 4 de dezembro no ano passado, voltou a destacar-se pelas excelentes apresentações dos temas mais relevantes no campo da cardiologia, bem como por seus renomados convidados, nacionais e internacionais. Acompanhando o grande nível do Congresso, tinham 32 temas livres que cobriam diferentes áreas da cardiologia, dos quais comentaremos quatro artigos premiados: - Risco de trombose na bioprótese aórtica e eventos clínicos de acordo com o uso de anticoagulação. Meta-análise da evidência atual. - Uso de NT-ProBNP como preditor de evolução no pós-operatório de cirurgia cardíaca. - Prevalência de bolsa septal em uma coorte derivada para ecocardiografia transesofágica. - Incidência de troponina T ultrassensível em faixa anormal e sua correlação com a anatomia coronariana em pacientes em avaliação para doença coronariana estável.