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1.
Arq. bras. cardiol ; 116(5): 928-937, nov. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1248895

ABSTRACT

Resumo Fundamento: Embora a elevação não isquêmica da troponina seja frequentemente observada em pacientes admitidos no pronto-socorro (PS), não há consenso quanto ao seu manejo. Objetivos: Este estudo teve como objetivo caracterizar os pacientes admitidos no PS com elevação da troponina não-isquêmica e identificar potenciais preditores de mortalidade nessa população. Métodos: Este estudo observacional retrospectivo incluiu pacientes do PS com resultado positivo no teste da troponina entre junho e julho de 2015. Pacientes com diagnóstico clínico de síndrome coronariana aguda (SCA) foram excluídos. Os dados demográficos dos pacientes e as variáveis clínicas e laboratoriais foram extraídos dos prontuários médicos. Os dados do seguimento foram obtidos por 16 meses ou até a ocorrência de morte. O nível de significância estatística foi de 5%. Resultados: A elevação da troponina sem SCA foi encontrada em 153 pacientes no PS. A mediana (IIQ) de idade dos pacientes foi de 78 (19) anos, 80 (52,3%) eram do sexo feminino e 59 (38,6%) morreram durante o seguimento. A mediana do período de seguimento (IIQ) foi de 477 (316) dias. Os sobreviventes eram significativamente mais jovens 76 (24) vs. 84 (13) anos; p=0,004) e apresentaram uma maior proporção de elevação da troponina isolada (sem elevação da creatina quinase ou mioglobina) em duas avaliações consecutivas: 48 (53,9%) vs. 8 (17,4%), p<0,001. Os sobreviventes também apresentaram menor taxa de tratamento antiplaquetário e internação no mesmo dia. Na regressão logística multivariada com ajuste para variáveis significativas na análise univariada, a elevação isolada da troponina em duas avaliações consecutivas mostrou hazard ratio = 0,43 (IC95% 0,17-0,96, p=0,039); hospitalização, tratamento antiplaquetário anterior e idade permaneceram independentemente associados à mortalidade. Conclusões: A elevação isolada da troponina em duas medidas consecutivas foi um forte preditor de sobrevida em pacientes no PS com elevação da troponina, mas sem SCA.


Abstract Background: Although non-ischemic troponin elevation is frequently seen in patients admitted to the emergency department (ED), consensus regarding its management is lacking. Objectives: This study aimed to characterize patients admitted to the ED with non-ischemic troponin elevation and to identify potential mortality predictors in this population. Methods: This retrospective observational study included ED patients with a positive troponin test result between June and July of 2015. Patients with a clinical diagnosis of acute coronary syndrome (ACS) were excluded. Data on patient demographics and clinical and laboratory variables were extracted from medical records. Follow-up data were obtained for 16 months or until death occurred. The statistical significance level was 5%. Results: Troponin elevation without ACS was found in 153 ED patients. The median (IQR) patient age was 78 (19) years, 80 (52.3%) were female and 59(38.6%) died during follow-up. The median (IQR) follow-up period was 477(316) days. Survivors were significantly younger 76 (24) vs. 84 (13) years; p=0.004) and featured a higher proportion of isolated troponin elevation (without creatine kinase or myoglobin elevation) in two consecutive evaluations: 48 (53.9%) vs. 8 (17.4%), p<0.001. Survivors also presented a lower rate of antiplatelet treatment and same-day hospitalization. In the multivariate logistic regression with adjustment for significant variables in the univariate analysis, isolated troponin elevation in two consecutive evaluations showed a hazard ratio= 0.43 (95%CI 0.17-0.96, p=0.039); hospitalization, previous antiplatelet treatment and age remained independently associated with mortality. Conclusions: Isolated troponin elevation in two consecutive measurements was a strong predictor of survival in ED patients with troponin elevation but without ACS.


Subject(s)
Humans , Male , Female , Aged , Troponin I , Acute Coronary Syndrome/diagnosis , Prognosis , Biomarkers , Emergency Service, Hospital , Hospitalization
3.
Acta méd. colomb ; 45(2): 6-13, Jan.-June 2020. tab
Article in English | LILACS, COLNAL | ID: biblio-1130685

ABSTRACT

Abstract Objectives: to identify the clinical and paraclinical behavior of myocardial infarctions in an intensive care unit of a medium-size city during 2017. Methods: a descriptive, cross-sectional study which included 99 medical records with a diagnosis of myocardial infarction on ICU discharge. The variables were described and analysis of variance and Chi2tests were performed, using a p-value less than 0.05 for statistically significant differences. Results: the prevalence of myocardial infarction in the ICU was 11.8%. The average age was 66.8 years. Chest pain was present in 82.8% with an average duration of 335 minutes. The pain most often radiated to the left arm (13.1%). Non-ST segment elevation myocardial infarction was the most frequent (50.5%), and the electrocardiogram located the infarctions on the inferior surface in 28.2%. The average ultrasensitive troponin I was 28.2 ng/mL. A total of 54.5% had complications. Mortality was 14.1%. Hospital stay was 6.5 and critical care stay was three days. There was a statistically significant relationship between chest pain and ST segment elevation (p<0.001) and between troponin I plus hospital stay and ST segment elevation (p=0.007 and p=0.003, respectively). Conclusion: the study showed that 11.8% of patients admitted to ICU are admitted for myocardial infarction, and there is a statistically significant relationship between chest pain and an elevated ST segment and between increased troponin I plus a longer hospital stay and ST segment elevation. (Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1498).


Resumen Identificar el comportamiento clínico y paraclínico del infarto de miocardio en una unidad de cuidados intensivos de una ciudad intermedia durante el 2017. Métodos: estudio descriptivo de corte transversal, incluyó 99 registros con diagnóstico de infarto del miocardio al egreso de UCI. Se describieron las variables y se realizaron análisis de varianza y chi2y se consideró un valor de p<0.05 para diferencias estadísticamente significativas. Resultados: la prevalencia de infarto del miocardio fue 11.8% en UCI. La edad promedio fue 66.8 años. El dolor precordial estuvo presente en 82.8% con una duración promedio de 335 minutos. La irradiación del dolor fue más frecuente a miembro superior izquierdo (13.1%). El infarto sin elevación del complejo ST fue más frecuente (50.5%). Y la localización electrocardiográfica fue en la cara inferior en 28.2%. El promedio de troponina I ultrasensible fue de 28.2 ng/mL. Presentaron complicaciones el 54.5%. La mortalidad fue de 14.1%. La estancia hospitalaria fue 6.5 y la estancia en cuidados críticos tres días. Se encontró relación estadísticamente significativa entre dolor precordial y elevación del segmento ST (p<0.001) y entre troponina I con estancia hospitalaria y elevación del segmento ST (p=0.007 y p=0.003 respectivamente). Conclusión: se identificó que 11.8% de los pacientes que ingresan a la UCI, lo hacen por infarto del miocardio, y una relación estadísticamente significativa entre dolor precordial con elevación del segmento ST y entre el aumento de troponina I con mayor estancia hospitalaria y elevación del segmento ST.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1498).


Subject(s)
Humans , Male , Female , Adult , Myocardial Infarction , Troponin I , Critical Care , Electrocardiography , Intensive Care Units
4.
Rev. colomb. cardiol ; 27(3): 186-188, May-June 2020. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1289210

ABSTRACT

Resumen La troponina cardiaca es el marcador bioquímico más sensible y específico de daño/necrosis miocárdica, de ahí que desempeñe un papel crucial en el diagnóstico del síndrome coronario agudo. Sin embargo, en ocasiones, como en el caso clínico que se describirá, la elevación anormal de troponina no siempre obedece a un síndrome coronario agudo trombótico, sino a causa cardiaca sin enfermedad coronaria significativa, causa extracardiaca o alteración analítica (verdaderos falsos positivos). El interés de este caso radica en que siempre debería tenerse en mente la posibilidad de que se produzca un falso positivo de troponina por causa analítica, en especial en situaciones clínicas sin una razón obvia de daño miocárdico y cuando no sea evidente la confirmación de daño miocárdico mediante pruebas complementarias.


Abstract Cardiac troponin is the most sensitive and specific biochemical marker for myocardial damage / necrosis, and thus has a crucial role in the diagnosis of acute coronary syndrome. However, occasionally, as in the clinical case that will be described, the abnormal elevation of troponin does not always obey that of an acute coronary syndrome, but also to a cardiac cause with no significant coronary disease, extra-cardiac cause, or analytical change (true false positives). The interest in this case lies in that it should always be borne in mind that a false positive troponin can be produced due to an analytical cause. This can be the case in clinical situations with no obvious reason for myocardial damage and when the confirmation of myocardial damage may not be evident using complementary tests.


Subject(s)
Humans , Male , Middle Aged , Troponin I , False Positive Reactions , Lifting , Coronary Disease , Acute Coronary Syndrome
6.
Article in English | WPRIM | ID: wpr-762461

ABSTRACT

BACKGROUND: Rapid and accurate diagnosis of acute myocardial infarction (AMI) is critical for initiating effective treatment and achieving better prognosis. We investigated the performance of copeptin for early diagnosis of AMI, in comparison with creatine kinase myocardial band (CK-MB) and troponin I (TnI). METHODS: We prospectively enrolled 271 patients presenting with chest pain (within six hours of onset), suggestive of acute coronary syndrome, at an emergency department (ED). Serum CK-MB, TnI, and copeptin levels were measured. The diagnostic performance of CK-MB, TnI, and copeptin, alone and in combination, for AMI was assessed by ROC curve analysis by comparing the area under the curve (AUC). Sensitivity, specificity, negative predictive value, and positive predictive value of each marker were obtained, and the characteristics of each marker were analyzed. RESULTS: The patients were diagnosed as having ST elevation myocardial infarction (STEMI; N=43), non-ST elevation myocardial infarction (NSTEMI; N=25), unstable angina (N=78), or other diseases (N=125). AUC comparisons showed copeptin had significantly better diagnostic performance than TnI in patients with chest pain within two hours of onset (AMI: P=0.022, ≤1 hour; STEMI: P=0.017, ≤1 hour and P=0.010, ≤2 hours). In addition, TnI and copeptin in combination exhibited significantly better diagnostic performance than CK-MB plus TnI in AMI and STEMI patients. CONCLUSIONS: The combination of TnI and copeptin improves AMI diagnostic performance in patients with early-onset chest pain in an ED setting.


Subject(s)
Acute Coronary Syndrome , Angina, Unstable , Area Under Curve , Chest Pain , Creatine Kinase , Diagnosis , Early Diagnosis , Emergencies , Emergency Service, Hospital , Humans , Myocardial Infarction , Prognosis , Prospective Studies , ROC Curve , Sensitivity and Specificity , Troponin I
7.
Rev. bras. cir. cardiovasc ; 34(5): 517-524, Sept.-Oct. 2019. tab
Article in English | LILACS | ID: biblio-1042055

ABSTRACT

Abstract Objective: To evaluate the effect of high-dose vitamin C on cardiac reperfusion injury and plasma levels of creatine kinase-muscle/brain (CK-MB), troponin I, and lactate dehydrogenase (LDH) in patients undergoing coronary artery bypass grafting (CABG). Methods: This is a double-blind randomized clinical trial study. Fifty patients (50-80 years old) who had CABG surgery were selected. The intervention group received 5 g of intravenous vitamin C before anesthesia induction and 5 g of vitamin C in cardioplegic solution. The control group received the same amount of placebo (normal saline). Arterial blood samples were taken to determine the serum levels of CK-MB, troponin I, and LDH enzymes. Left ventricular ejection fraction was measured and hemodynamic parameters were recorded at intervals. Results: High doses of vitamin C in the treatment group led to improvement of ventricular function (ejection fraction [EF]) and low Intensive Care Unit (ICU) stay. The cardiac enzymes level in the vitamin C group was lower than in the control group. These changes were not significant between the groups in different time intervals (anesthesia induction, end of bypass, 6 h after surgery, and 24 h after surgery) for CK-MB, LDH, and troponin I. Hemodynamic parameters, hematocrit, potassium, urinary output, blood transfusion, arrhythmia, and inotropic support showed no significant difference between the groups. Conclusion: Vitamin C has significantly improved the patients' ventricular function (EF) 72 h after surgery and reduced the length of ICU stay. No significant changes in cardiac biomarkers, including CK-MB, troponin I, and LDH, were seen over time in each group. IRCT code: IRCT2016053019470N33


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Ascorbic Acid/administration & dosage , Myocardial Reperfusion Injury/prevention & control , Coronary Artery Bypass/methods , Antioxidants/administration & dosage , Arrhythmias, Cardiac/prevention & control , Time Factors , Biomarkers/blood , Myocardial Reperfusion Injury/blood , Double-Blind Method , Reproducibility of Results , Ventricular Function/drug effects , Treatment Outcome , Statistics, Nonparametric , Troponin I/blood , Creatine Kinase, BB Form/blood , Creatine Kinase, MM Form/blood , Hemodynamics/drug effects , Intensive Care Units , L-Lactate Dehydrogenase/blood
8.
Arq. bras. cardiol ; 112(3): 230-237, Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-989327

ABSTRACT

Abstract Background: High-sensitivity cardiac troponin I (hs-cTnI) has played an important role in the risk stratification of patients during the in-hospital phase of acute coronary syndrome (ACS), but few studies have determined its role as a long-term prognostic marker in the outpatient setting. Objective: To investigate the association between levels of hs-cTnI measured in the subacute phase after an ACS event and long-term prognosis in a highly admixed population. Methods: We measured levels of hs-cTnI in 525 patients 25 to 90 days after admission for an ACS event; these patients were then divided into tertiles according to hs-cTnI levels and followed for up to 7 years. We compared all-cause and cardiovascular mortality using Cox proportional hazards models and adopting a significance level of 5%. Results: After a median follow-up of 51 months, patients in the highest tertile had a greater hazard ratio (HR) for all-cause mortality after adjustment for age, sex, known cardiovascular risk factors, medication use, and demographic factors (HR: 3.84, 95% CI: 1.92-8.12). These findings persisted after further adjustment for estimated glomerular filtration rate < 60 ml/min/1.73 m2 and left ventricular ejection fraction < 0.40 (HR: 6.53, 95% CI: 2.12-20.14). Cardiovascular mortality was significantly higher in the highest tertile after adjustment for age and sex (HR: 5.65, 95% CI: 1.94-16.47) and both in the first (HR: 4.90, 95% CI: 1.35-17.82) and second models of multivariate adjustment (HR: 5.89, 95% CI: 1.08-32.27). Conclusions: Elevated hs-cTnI levels measured in the stabilized phase after an ACS event are independent predictors of all-cause and cardiovascular mortality in a highly admixed population.


Resumo Fundamento: A troponina cardíaca de alta sensibilidade I (TnI-as) tem desempenhado um papel importante na estratificação de risco dos pacientes durante a fase intra-hospitalar da síndrome coronariana aguda (SCA), mas poucos estudos determinaram seu papel como marcador prognóstico de longo prazo no ambiente ambulatorial. Objetivo: Investigar a associação entre os níveis de TnI-as medidos na fase subaguda após um evento de SCA e o prognóstico a longo prazo, em uma população altamente miscigenada. Métodos: Medimos os níveis de TnI-as em 525 pacientes em um período de 25 a 90 dias após a entrada em hospital por um evento de SCA; esses pacientes foram então divididos em tercis conforme os níveis de TnI-as, e acompanhados por até 7 anos. Comparamos as mortalidades por todas as causas e cardiovascular através de modelos de riscos proporcionais de Cox e adotando um nível de significância de 5%. Resultados: Após um acompanhamento médio de 51 meses, os pacientes no tercil mais alto apresentaram uma taxa de risco (HR) maior para mortalidade por todas as causas, após ajustes para idade, sexo, fatores de risco cardiovascular conhecidos, uso de medicação e fatores demográficos (HR: 3,84 IC 95%: 1,92-8,12). Esses achados persistiram após um ajuste adicional para uma taxa de filtração glomerular (TFG) estimada < 60 ml/min/1,73 m2 e uma fração de ejeção do ventrículo esquerdo < 0,40 (HR: 6,53; IC95%: 2,12-20,14). A mortalidade cardiovascular foi significativamente maior no tercil mais alto, após ajustes para idade e sexo (RR: 5,65; IC95%: 1,94-16,47) e tanto no primeiro modelo de ajuste multivariado (HR: 4,90; IC 95%: 1,35-17,82) quanto no segundo (HR: 5,89; IC95%: 1,08-32,27). Conclusões: Níveis elevados de TnI-as, medidos na fase estabilizada após um evento de SCA, são preditores independentes de mortalidade por todas as causas e de mortalidade cardiovascular em uma população altamente miscigenada.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Troponin I/blood , Acute Coronary Syndrome/mortality , Prognosis , Brazil/epidemiology , Biomarkers/blood , Proportional Hazards Models , Risk Factors , Follow-Up Studies , Cause of Death , Troponin T/blood , Myocardial Infarction/diagnosis
10.
Rev. bras. ter. intensiva ; 31(1): 93-105, jan.-mar. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1003622

ABSTRACT

RESUMO As troponinas cardíacas T e I são marcadores considerados altamente sensíveis e específicos para o diagnóstico de infarto agudo do miocárdio. Atualmente, com o advento dos ensaios ultrassensíveis, uma série de anormalidades não primariamente cardíacas pode se manifestar por meio da elevação destes ensaios. A redução de seu limiar de detecção promoveu maior precocidade no diagnóstico e na utilização de medidas terapêuticas baseadas em evidência, no entanto, esta característica aumentou o espectro de doenças cardíacas não coronarianas detectáveis, trazendo desafios para a caracterização das síndromes coronarianas agudas e um novo papel para estes testes nas desordens conhecidas no ambiente das unidades de tratamento intensivo, em especial na sepse. A abordagem de pacientes por meio de um maior entendimento do comportamento destes marcadores deve ser redimensionada para sua correta interpretação.


ABSTRACT Cardiac troponins T and I are considered highly sensitive and specific markers for the diagnosis of acute myocardial infarction. Currently, a series of nonprimary cardiac abnormalities may manifest as an elevation in high-sensitive assays. The reduction in their detection limits has allowed earlier diagnosis and the use of evidence-based therapeutic measures; however, this characteristic has increased the spectrum of detectable noncoronary heart diseases, which poses challenges for characterizing acute coronary syndromes and creates a new role for these tests in known disorders in intensive care units, especially sepsis. Management of patients through a greater understanding of how these markers behave should be re-evaluated to ensure their correct interpretation.


Subject(s)
Humans , Troponin I/blood , Troponin T/blood , Heart Diseases/diagnosis , Biomarkers/blood , Sensitivity and Specificity , Early Diagnosis , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/blood , Heart Diseases/blood , Intensive Care Units , Myocardial Infarction/diagnosis , Myocardial Infarction/blood
11.
Article in Korean | WPRIM | ID: wpr-759871

ABSTRACT

Acute myocardial infarction is one of the most common causes of unexpected deaths, but there are limitations to its diagnosis in postmortem inspection. In this study, we aimed to investigate the usefulness of cardiac marker analysis for the diagnosis of acute myocardial infarction in postmortem inspection. This study was conducted on 30 postmortem inspection cases conducted by the National Forensic Service from 2016 to 2018. Tests for three myocardial enzymes (myoglobin, creatinine kinase-MB, and cardiac troponin I) were performed in each case, and the relationships between enzyme levels, cause of death, and factors affecting the postmortem tests were analyzed. Cardiac enzyme concentrations were not significantly different between the heart disease group and other disease groups, and the false-positive rate was increased due to postmortem changes. Therefore, we can conclude that it is not appropriate to use cardiac enzyme analysis for the diagnosis of acute myocardial infarction in postmortem inspection.


Subject(s)
Cause of Death , Creatinine , Diagnosis , Heart Diseases , Myocardial Infarction , Postmortem Changes , Troponin , Troponin I
12.
Article in Korean | WPRIM | ID: wpr-758486

ABSTRACT

OBJECTIVE: Although a left ventricular (LV) diastolic dysfunction is an important prognostic factor in myocardial dysfunction in septic shock, emergency departments (EDs) have limited capability of performing echocardiography. Cardiac troponin is a specific marker of a myocardial injury. On the other hand, little is known about the LV diastolic dysfunction in septic shock patients. This study examined the associations between troponin-I (TnI) level and LV diastolic dysfunction. METHODS: A 5-year retrospective cohort study was conducted between January 2011 and December 2015, including adult septic shock patients who were treated with protocol-driven resuscitation bundle therapy and had the TnI tested at the ED. The LV diastolic dysfunction was defined as E/e′ratios above 15 in echocardiography. RESULTS: Of the 442 septic shock patients with an abnormal TnI (≥0.04 ng/mL) at admission, echocardiography was performed on 255 patients and 81 patients (31.8%) showed a LV diastolic dysfunction. The TnI level at ED admission was higher in the LV diastolic dysfunction group compared to the non-dysfunction group (0.08 [0.03–0.25] ng/mL vs. 0.14 [0.05–0.43] ng/mL, P=0.035). On the other hand, according to multivariate logistic regression and chronic kidney disease (odds ratio, 1.74; 95% confidence interval, 1.02–2.99) was the only factor associated with a LV diastolic dysfunction. Receiver operating characteristic analysis revealed the area under the curve of the initial TnI to be only 0.589 (P=0.038) and no correlation was observed between the initial TnI and E/e′(r=0.079, P=0.199). CONCLUSION: A LV diastolic dysfunction occurred in approximately quarter of septic shock patients with TnI elevation, but the TnI test showed a weak association with diastolic dysfunction. Further studies will be needed to identify the predictors for a diastolic dysfunction in septic shock patients.


Subject(s)
Adult , Biomarkers , Cardiomyopathies , Cohort Studies , Critical Illness , Echocardiography , Emergency Service, Hospital , Hand , Humans , Logistic Models , Renal Insufficiency, Chronic , Resuscitation , Retrospective Studies , ROC Curve , Shock, Septic , Troponin I , Troponin
13.
Korean Circulation Journal ; : 1010-1018, 2019.
Article in English | WPRIM | ID: wpr-759413

ABSTRACT

BACKGROUND AND OBJECTIVES: Microvascular damage due to distal embolization during percutaneous coronary intervention (PCI) is an important cause of periprocedural myocardial infarction. We assessed the lipid-core plaque using near-infrared spectroscopy (NIRS) and microvascular dysfunction invasively with the index of microcirculatory resistance (IMR) and evaluated their relationship. METHODS: This study is pilot retrospective observational study. We analyzed 39 patients who performed NIRS before and after PCI, while fractional flow reserve, thermo-dilution coronary flow reserve (CFR) and IMR were measured after PCI. The maximum value of lipid core burden index (LCBI) for any of the 4-mm segments at the culprit lesion (culprit LCBI(4mm)) was calculated at the culprit lesion. We divided the patients into 2 groups using a cutoff of culprit LCBI(4mm) ≥500. RESULTS: Mean pre-PCI LCBI was 333±196 and mean post-PCI IMR was 20±14 U. Post-PCI IMR was higher (15.6±7.3 vs. 42.6±17.6 U, p<0.001) and post-PCI CFR was lower (3.7±2.2 vs. 2.1±1.0, p=0.029) in the high LCBI group. Pre-PCI LCBI was positively correlated with post-PCI IMR (ρ=0.358, p=0.025) and negatively correlated with post-PCI CFR (ρ=−0.494, p=0.001). The incidence of microvascular dysfunction (IMR ≥25 U) was higher in the high LCBI group (9.4% vs. 85.7%, p<0.001). However, there were no significant differences in the incidences of creatine Kinase-MB (9.4% vs. 14.3%, p=0.563) and troponin-I elevation (12.5% vs. 14.3%, p=1.000). CONCLUSIONS: A large lipid-core plaque at the ‘culprit’ lesion is observed higher incidence of post-PCI microvascular dysfunction after PCI. Prospective study with adequate subject numbers will be needed.


Subject(s)
Coronary Artery Disease , Creatine , Humans , Incidence , Microvessels , Myocardial Infarction , Observational Study , Percutaneous Coronary Intervention , Prospective Studies , Retrospective Studies , Spectroscopy, Near-Infrared , Troponin I
14.
Article in English | WPRIM | ID: wpr-785627

ABSTRACT

OBJECTIVE: The predictors of poor prognosis in heat stroke (HS) remain unknown. This study investigated the predictive factors of poor prognosis in patients with HS.METHODS: Data were obtained and analyzed from the health records of patients diagnosed with heat illness at Ajou university hospital between January 2008 and December 2017. Univariate and multivariate analyses were performed to identify the independent predictors of poor prognosis.RESULTS: Thirty-six patients (median age, 54.5 years; 33 men) were included in the study. Poor prognosis was identified in 27.8% of the study population (10 patients). The levels of S100B protein, troponin I, creatinine, alanine aminotransferase, and serum lactate were statistically significant in the univariate analysis. Multiple regression analysis revealed that poor prognosis was significantly associated with an increased S100B protein level (odds ratio, 177.37; 95% confidence interval, 2.59 to 12,143.80; P=0.016). The S100B protein cut-off level for predicting poor prognosis was 0.610 μg/L (area under the curve, 0.906; 95% confidence interval, 0.00 to 1.00), with 86% sensitivity and 86% specificity.CONCLUSION: An increased S100B protein level on emergency department admission is an independent prognostic factor of poor prognosis in patients with HS. Elevation of the S100B protein level represents a potential target for specific and prompt therapies in these patients.


Subject(s)
Alanine Transaminase , Biomarkers , Creatinine , Emergency Service, Hospital , Heat Stroke , Hot Temperature , Humans , Lactic Acid , Multivariate Analysis , Prognosis , Sensitivity and Specificity , Troponin I
15.
Article in English | WPRIM | ID: wpr-785596

ABSTRACT

OBJECTIVE: Despite increased survival in patients with cardiac arrest, it remains difficult to determine patient prognosis at the early stage. This study evaluated the prognosis of cardiac arrest patients using brain injury, inflammation, cardiovascular ischemic events, and coagulation/fibrinolysis markers collected 24, 48, and 72 hours after return of spontaneous circulation (ROSC).METHODS: From January 2011 to December 2016, we retrospectively observed patients who underwent therapeutic hypothermia. Blood samples were collected immediately and 24, 48, and 72 hours after ROSC. Neuron-specific enolase (NSE), S100-B protein, procalcitonin, troponin I, creatine kinase-MB, pro-brain natriuretic protein, D-dimer, fibrin degradation product, antithrombin-III, fibrinogen, and lactate levels were measured. Prognosis was evaluated using Glasgow-Pittsburgh cerebral performance categories and the predictive accuracy of each marker was evaluated. The secondary outcome was whether the presence of multiple markers improved prediction accuracy.RESULTS: A total of 102 patients were included in the study: 39 with good neurologic outcomes and 63 with poor neurologic outcomes. The mean NSE level of good outcomes measured 72 hours after ROSC was 18.50 ng/mL. The area under the curve calculated on receiver operating characteristic analysis was 0.92, which showed the best predictive power among all markers included in the study analysis. The relative integrated discrimination improvement and category-free net reclassification improvement models showed no improvement in prognostic value when combined with all other markers and NSE (72 hours).CONCLUSION: Although biomarker combinations did not improve prognostic accuracy, NSE (72 hours) showed the best predictive power for neurological prognosis in patients who received therapeutic hypothermia.


Subject(s)
Biomarkers , Brain Injuries , Creatine , Discrimination, Psychological , Fibrin , Fibrinogen , Heart Arrest , Humans , Hypothermia, Induced , Inflammation , Lactic Acid , Phosphopyruvate Hydratase , Prognosis , Retrospective Studies , ROC Curve , Troponin I
16.
Chinese Medical Journal ; (24): 1390-1399, 2019.
Article in English | WPRIM | ID: wpr-771220

ABSTRACT

BACKGROUND@#Mental stress-induced myocardial ischemia (MSIMI) is closely associated with adverse cardiac events in patients with coronary artery disease (CAD) and we aimed to determine whether biomarkers and blood pressure could be potential predictors of MSIMI.@*METHODS@#This study enrolled 82 patients with documented CAD between June 1, 2017 and November 9, 2017. Patient blood samples were obtained at resting period and at the end of mental arithmetic. Then, patients were assigned to MSIMI positive group and MSIMI negative group. The main statistical methods included linear regression, receiver operating characteristic (ROC) curves, and logistic regression.@*RESULTS@#Patients with CAD with MSIMI had significantly greater median resting N-terminal pro-brain natriuretic peptide (NT-proBNP, 141.02 [45.85-202.76] pg/mL vs. 57.95 [27.06-117.64] pg/mL; Z = -2.23, P = 0.03) and mean systolic blood pressure (SBP) (145.56 ± 16.87 mmHg vs. 134.92 ± 18.16 mmHg, Z = -2.13, P = 0.04) when compared with those without MSIMI. After 5-min mental stress task, those who developed MSIMI presented higher elevation of median post-stressor high sensitivity cardiac troponin I (hs-cTnI, 0.020 [0.009-0.100] ng/mL vs. 0.009 [0.009-0.010] ng/mL; Z = -2.45, P = 0.01), post-stressor NT-proBNP (138.96 [39.93-201.56] pg/mL vs. 61.55 [25.66-86.50] pg/mL; Z = -2.15, P = 0.03) compared with those without MSIMI. Using the ROC curves, and after the adjustment for basic characteristics, the multiple logistic regression analysis showed that patients presenting a post-stressor hs-cTnI ≥ 0.015 ng/mL had seven-fold increase in the risk of developing MSIMI (odds ratio [OR]: 7.09; 95% confidence interval [CI]: 1.65-30.48; P = 0.009), a rest NT-proBNP ≥ 80.51 pg/mL had nearly eight-fold increase (OR: 7.85; 95% CI: 1.51-40.82; P = 0.014), a post-stressor NT-proBNP ≥ 98.80 pg/mL had 35-fold increase (OR: 34.96; 95% CI: 3.72-328.50; P = 0.002), a rest SBP ≥ 129.50 mmHg had 11-fold increase (OR: 11.42; 95% CI: 1.21-108.17; P = 0.034).@*CONCLUSIONS@#The present study shows that CAD patients with higher hs-cTnI level, and/or greater NT-proBNP and/or SBP are at higher risk of suffering from MSIMI when compared with those without MSIMI, indicating that hs-cTnI, NT-proBNP, SBP might be potential predictors of MSIMI.


Subject(s)
Aged , Anxiety , Blood , Biomarkers , Blood , Blood Pressure , Physiology , C-Reactive Protein , Metabolism , Coronary Artery Disease , Blood , Depression , Blood , Electrocardiography , Female , Humans , Male , Middle Aged , Myocardial Ischemia , Blood , Natriuretic Peptide, Brain , Blood , Odds Ratio , Peptide Fragments , Blood , Predictive Value of Tests , Prospective Studies , ROC Curve , Stress, Psychological , Blood , Tomography, Emission-Computed, Single-Photon , Troponin I , Blood , Troponin T , Blood
17.
Acta cir. bras ; 33(8): 664-672, Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-949374

ABSTRACT

Abstract Purpose: To investigate the correlation of inhaled nitric oxide (NO) on plasma levels of cardiac troponin I (cTnI) and von Willebrand factor (vWF), glycoprotein (GP) IIb/IIIa, granule membrane protein 140 (GMP-140) in rabbits with acute massive pulmonary embolism (PE). Methods: Thirty apanese white rabbits were divided into 3 groups, thrombus were injected in model group (n = 10), NO were inhalated for 24 h after massive PE in NO group (n = 10), saline were injected in control group (n = 10). The concentrations of vWF, GP IIb/IIIa, GMP-140 and cTnI were tested at 4, 8, 12, 16, 20, and 24 h, Correlation analyses were conducted between cTnI and vWF, GP IIb/IIIa, and GMP-140 by Pearson's correlation. Results: The concentration of cTnI and vWF, GP IIb/IIIa, and GMP-140 was increased in the model group, compared to control group. In the inhaled group, the concentrations of cTnI, vWF, GP IIb/IIIa, and GMP-140 were reduced compared to model group. There was a positive correlation between cTnI and vWF, GP IIb/IIIa, and GMP-140. Conclusion: Inhaled nitric oxide can lead to a decrease in levels of cardiac troponin I, von Willebrand factor, glycoprotein, and granule membrane protein 140, after an established myocardial damage, provoked by acute massive pulmonary embolism.


Subject(s)
Animals , Rabbits , Pulmonary Embolism/blood , von Willebrand Factor/analysis , Platelet Glycoprotein GPIIb-IIIa Complex/analysis , Platelet Glycoprotein GPIIb-IIIa Complex/drug effects , P-Selectin/blood , Troponin I/blood , Nitric Oxide/administration & dosage , Pulmonary Embolism/pathology , Pulmonary Embolism/drug therapy , Reference Values , Time Factors , Administration, Inhalation , von Willebrand Factor/drug effects , Reproducibility of Results , Treatment Outcome , P-Selectin/drug effects , Troponin I/drug effects , Disease Models, Animal , X-Ray Microtomography , Heart Ventricles/pathology , Myocardium/pathology
18.
Acta cir. bras ; 33(7): 577-587, July 2018. tab, graf
Article in English | LILACS | ID: biblio-949362

ABSTRACT

Abstract Purpose: To investigate changes in the plasma concentrations of cardiac troponin I (CTnI), thromboxane A2 (TXA2), prostaglandin I2 (PGI2) and endothelin-1 (ET-1) in rabbits with massive pulmonary embolism (AMPE) and the impact of nitric oxide inhalation (NOI) on these indices. Methods: A total of 30 Japanese rabbits were used to construct an MPE model and were divided into 3 groups equally (n=10), including an EXP group (undergoing modeling alone), an NOI group (receiving NOI 2 h post-modeling) and a CON group (receiving intravenous physiological saline). Results: In the model group, plasma concentration of CTnI peaked at 16 h following modeling (0.46±0.10 µg/ml) and significantly decreased following NOI. Plasma levels of TXB2, PGI2 and ET-1 peaked at 12, 16 and 8 h following modeling, respectively, and significantly decreased at different time points (0, 2, 4, 8, 12, 16, 20 and 24 h) following NOI. A significant correlation was observed between the peak plasma CTnI concentration and peak TXB2, 6-keto prostaglandin F1α and ET-1 concentrations in the model and NOI groups. Conclusion: Increases in plasma TXA2, PGI2 and ET-1 levels causes myocardial damage in a rabbit model of AMPE; however, NOI effectively down regulates the plasma concentration of these molecules to produce a myocardial-protective effect.


Subject(s)
Animals , Male , Female , Rabbits , Pulmonary Embolism/drug therapy , Pulmonary Embolism/blood , Thromboxane A2/blood , Bronchodilator Agents/pharmacology , Epoprostenol/blood , Endothelin-1/blood , Troponin I/blood , Nitric Oxide/pharmacology , Pulmonary Embolism/pathology , Reference Values , Time Factors , Administration, Inhalation , Enzyme-Linked Immunosorbent Assay , Random Allocation , Down-Regulation , Acute Disease , Reproducibility of Results , Treatment Outcome
19.
J. bras. nefrol ; 40(2): 105-111, Apr.-June 2018. graf
Article in English | LILACS | ID: biblio-954543

ABSTRACT

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.


Subject(s)
Animals , Male , Rats , Peptide Fragments/blood , Tumor Necrosis Factor-alpha/blood , Troponin I/blood , Natriuretic Peptide, Brain/blood , Cardio-Renal Syndrome/etiology , Cardio-Renal Syndrome/blood , Uremia/complications , Uremia/blood , Biomarkers/blood , Rats, Wistar , Disease Models, Animal , Cardiomyopathies/etiology , Cardiomyopathies/blood
20.
Arq. bras. cardiol ; 110(1): 68-73, Jan. 2018. tab, graf
Article in English | LILACS | ID: biblio-888007

ABSTRACT

Abstract Introduction: Despite having higher sensitivity as compared to conventional troponins, sensitive troponins have lower specificity, mainly in patients with renal failure. Objective: Study aimed at assessing the sensitive troponin I levels in patients with chest pain, and relating them to the existence of significant coronary lesions. Methods: Retrospective, single-center, observational. This study included 991 patients divided into two groups: with (N = 681) and without (N = 310) significant coronary lesion. For posterior analysis, the patients were divided into two other groups: with (N = 184) and without (N = 807) chronic renal failure. The commercial ADVIA Centaur® TnI-Ultra assay (Siemens Healthcare Diagnostics) was used. The ROC curve analysis was performed to identify the sensitivity and specificity of the best cutoff point of troponin as a discriminator of the probability of significant coronary lesion. The associations were considered significant when p < 0.05. Results: The median age was 63 years, and 52% of the patients were of the male sex. The area under the ROC curve between the troponin levels and significant coronary lesions was 0.685 (95% CI: 0.65 - 0.72). In patients with or without renal failure, the areas under the ROC curve were 0.703 (95% CI: 0.66 - 0.74) and 0.608 (95% CI: 0.52 - 0.70), respectively. The best cutoff points to discriminate the presence of significant coronary lesion were: in the general population, 0.605 ng/dL (sensitivity, 63.4%; specificity, 67%); in patients without renal failure, 0.605 ng/dL (sensitivity, 62.7%; specificity, 71%); and in patients with chronic renal failure, 0.515 ng/dL (sensitivity, 80.6%; specificity, 42%). Conclusion: In patients with chest pain, sensitive troponin I showed a good correlation with significant coronary lesions when its level was greater than 0.605 ng/dL. In patients with chronic renal failure, a significant decrease in specificity was observed in the correlation of troponin levels and severe coronary lesions.


Resumo Fundamento: Apesar de apresentar maior sensibilidade em comparação às troponinas convencionais, as troponinas sensíveis apresentam menor especificidade, principalmente em pacientes com insuficiência renal. Objetivo: Avaliar os valores de troponina I sensível em pacientes com dor torácica, relacionando-os à presença de lesões coronarianas significativas. Métodos: Estudo retrospectivo, unicêntrico e observacional. Foram incluídos 991 pacientes, divididos em dois grupos: com (N = 681) ou sem lesão coronariana (N = 310). Para análise posterior, os pacientes foram separados em outros dois grupos: com (N = 184) ou sem insuficiência renal (N = 807). A troponina utilizada pertence ao kit comercial ADVIA Centaur® TnI-Ultra (Siemens Healthcare Diagnostics). A análise foi feita por curva ROC para identificar a sensibilidade e a especificidade do melhor ponto de corte da troponina como discriminador de probabilidade de lesão coronariana. As associações foram consideradas significativas quando p < 0,05. Resultados: Cerca de 52% dos pacientes eram do sexo masculino e a idade mediana da amostra foi de 63 anos. A área sob a curva ROC entre os valores de troponina e lesões coronarianas significativas foi de 0,685 (IC 95%: 0,65 - 0,72). Em pacientes sem e com insuficiência renal, as áreas sob a curva foram 0,703 (IC 95%: 0,66 - 0,74) e 0,608 (IC 95%: 0,52 - 0,70), respectivamente. Os melhores pontos de corte para discriminar a presença de lesão coronária significativa foram: 0,605 ng/dL (sensibilidade de 63,4%, especificidade de 67%) no grupo geral, 0,605 ng/dL (sensibilidade de 62,7% e especificidade de 71%) em pacientes sem insuficiência renal e 0,515 ng/dL (sensibilidade de 80,6% e especificidade de 42%) no grupo com insuficiência renal crônica. Conclusão: Na população avaliada de pacientes com dor torácica, a troponina I sensível apresentou boa correlação com lesões coronarianas significativas quando acima de 0,605 ng/dL. Em pacientes com insuficiência renal crônica, observamos uma queda importante de especificidade na correlação dos valores com lesões coronarianas graves.


Subject(s)
Humans , Male , Female , Middle Aged , Chest Pain/diagnosis , Troponin I/blood , Coronary Disease/diagnosis , Kidney Failure, Chronic/blood , Chest Pain/blood , Biomarkers/blood , Retrospective Studies , ROC Curve , Sensitivity and Specificity , Coronary Disease/blood
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