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2.
Arq. bras. cardiol ; 115(4): 620-627, out. 2020. tab, graf
Article in Portuguese | SES-SP, LILACS, SES-SP | ID: biblio-1131355

ABSTRACT

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


Subject(s)
Humans , Adult , Middle Aged , Walking , Natriuretic Peptide, Brain , Peptide Fragments , Biomarkers , Longitudinal Studies , Troponin T , Creatine Kinase, MB Form
3.
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
4.
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
5.
Article in Chinese | WPRIM | ID: wpr-775078

ABSTRACT

In recent years, high-sensitivity cardiac troponin T (hs-cTnT) has been recognized as an effective marker for myocardial injury in adults and can be used to diagnose acute myocardial injury and predict major adverse cardiovascular events. It is the gold standard for the diagnosis of acute myocardial infarction in adults. Neonates are a special group, and due to the changes of various physiological processes during the perinatal period, many laboratory markers used in adults may have a low clinical value in neonates. So far, for example, there is still no suitable cardiac serum biomarker that can reflect the true condition of neonatal myocardial injury. In recent years, new breakthroughs have been made in the application of hs-cTnT in the field of neonates. In order to fully understand the role of hs-cTnT in neonatal diseases, this article reviews the research advances in the biological and physiological features of hs-cTnT and its application in neonates.


Subject(s)
Biomarkers , Heart , Humans , Infant, Newborn , Infant, Newborn, Diseases , Myocardial Infarction , Troponin T
6.
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
7.
Article in English | WPRIM | ID: wpr-785829

ABSTRACT

BACKGROUND AND OBJECTIVES: Most studies in cardiac regeneration have explored bone marrow mesenchymal stem cells (BM-MSC) with variable therapeutic effects. Amniotic fluid MSC (AF-MSC) having extended self-renewal and multi-potent properties may be superior to bone marrow MSC (BM-MSC). However, a comparison of their cardiomyogenic potency has not been studied yet.METHODS: The 5-azacytidine (5-aza) treated AF-MSC and BM-MSC were evaluated for the expression of GATA-4, Nkx2.5 and ISL-1 transcripts and proteins by quantitative RT-PCR and Western blotting, respectively as well as for the expression of cardiomyogenic differentiation markers cardiac troponin-T (cTNT), beta myosin heavy chain (βMHC) and alpha sarcomeric actinin (ASA) by immunocytochemistry.RESULTS: The AF-MSC as compared to BM-MSC had significantly higher expression of GATA-4 (183.06±29.85 vs. 9.80±0.05; p<0.01), Nkx2.5 (8.3±1.4 vs. 1.82±0.32; p<0.05), and ISL-1 (39.59±4.05 vs. 4.36±0.39; p<0.01) genes as well as GATA-4 (2.01±0.5 vs. 0.6±0.1; p<0.05), NKx2.5 (1.9±0.14 vs. 0.8±0.2; p<0.01) and ISL-1 (1.7±0.3 vs. 0.9±0.1; p<0.05) proteins. The AF-MSC also had significantly elevated expression of cTNT (5.0×10⁴±0.6×10⁴ vs. 3.5 ×10⁴±0.8×10⁴; p<0.01), β-MHC (15.7×10⁴±0.9×10⁴ vs. 8.2×10⁴±0.6×10⁴; p<0.01) and ASA (18.6×10⁴±4.9×10⁴ vs. 13.1×10⁴±3.0×10⁴; p<0.05) than BM-MSC.CONCLUSIONS: Our data suggest that AF-MSC have greater cardiomyogenic potency than BM-MSC, and thus may be a better source of MSC for therapeutic applications in cardiac regenerative medicine.


Subject(s)
Actinin , Amniotic Fluid , Antigens, Differentiation , Azacitidine , Blotting, Western , Bone Marrow , Female , Humans , Immunohistochemistry , Mesenchymal Stem Cells , Regeneration , Regenerative Medicine , Therapeutic Uses , Troponin T , Ventricular Myosins
8.
Article in English | WPRIM | ID: wpr-741461

ABSTRACT

OBJECTIVE: To investigate the association of myocardial blood flow (MBF) quantified by dynamic computed tomography (CT) myocardial perfusion imaging (MPI) with troponin level and left ventricle (LV) function in patients with ST-segment elevated myocardial infarction (STEMI). MATERIALS AND METHODS: Thirty-five STEMI patients who successfully had undergone reperfusion treatment within 1 week of their infarction were consecutively enrolled. All patients were referred for dynamic CT-MPI. Serial high-sensitivity troponin T (hs-TnT) levels and left ventricular ejection fraction (LVEF) measured by echocardiography were recorded. Twenty-six patients with 427 segments were included for analysis. Various quantitative parameters derived from dynamic CT-MPI were analyzed to determine if there was a correlation between hs-TnT levels and LVEF on admission and again at the 6-month mark. RESULTS: The mean radiation dose for dynamic CT-MPI was 3.2 ± 1.1 mSv. Infarcted territories had significantly lower MBF (30.5 ± 7.4 mL/min/100 mL versus 73.4 ± 8.1 mL/min/100 mL, p < 0.001) and myocardial blood volume (MBV) (2.8 ± 0.9 mL/100 mL versus 4.2 ± 1.1 mL/100 mL, p = 0.044) compared with those of reference territories. MBF showed the best correlation with the level of peak hs-TnT (r = −0.682, p < 0.001), and MBV showed a moderate correlation with the level of peak hs-TnT (r = −0.437, p = 0.026); however, the other parameters did not show any significant correlation with hs-TnT levels. As for the association with LV function, only MBF was significantly correlated with LVEF at the time of admission (r = 0.469, p = 0.016) and at 6 months (r = 0.585, p = 0.001). CONCLUSION: MBF quantified by dynamic CT-MPI is significantly inversely correlated with the level of peak hs-TnT. In addition, patients with lower MBF tended to have impaired LV function at the time of their admission and at 6 months.


Subject(s)
Blood Volume , Echocardiography , Heart Ventricles , Humans , Infarction , Myocardial Infarction , Myocardial Perfusion Imaging , Reperfusion , Stroke Volume , Troponin T , Troponin
10.
Acta cir. bras ; 33(12): 1067-1077, Dec. 2018. graf
Article in English | LILACS | ID: biblio-973486

ABSTRACT

Abstract Purpose: To investigate the effect of alprostadil on myocardial ischemia/reperfusion (I/R) in rats. Methods: Rats were subjected to myocardial ischemia for 30 min followed by 24h reperfusion. Alprostadil (4 or 8 μg/kg) was intravenously administered at the time of reperfusion and myocardial infarct size, levels of troponin T, and the activity of creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH) in the serum were measured. Antioxidative parameters, nitric oxide (NO) content and phosphorylated endothelial nitric oxide synthase 3 (p-eNOS) expression in the left ventricles were also measured. Histopathological examinations of the left ventricles were also performed. Results: Alprostadil treatment significantly reduced myocardial infarct size, serum troponin T levels, and CK-MB and LDH activity (P<0.05). Furthermore, treatment with alprostadil significantly decreased malondialdehyde (MDA) content (P<0.05) and markedly reduced myonecrosis, edema and infiltration of inflammatory cells. Superoxide dismutase and catalase activities (P<0.05), NO level (P<0.01) and p-eNOS (P<0.05) were significantly increased in rats treated with alprostadil compared with control rats. Conclusion: These results indicate that alprostadil protects against myocardial I/R injury and that these protective effects are achieved, at least in part, via the promotion of antioxidant activity and activation of eNOS.


Subject(s)
Animals , Male , Alprostadil/pharmacology , Myocardial Reperfusion Injury/prevention & control , Nitric Oxide Synthase Type III/metabolism , Antioxidants/pharmacology , Superoxide Dismutase/analysis , Myocardial Reperfusion Injury/metabolism , Myocardial Reperfusion Injury/pathology , Catalase/analysis , Random Allocation , Blotting, Western , Reproducibility of Results , Treatment Outcome , Rats, Sprague-Dawley , Oxidative Stress/drug effects , Troponin T/drug effects , Troponin T/blood , Enzyme Activation/drug effects , Creatine Kinase, MB Form/drug effects , Creatine Kinase, MB Form/blood , Heart Ventricles/drug effects , Heart Ventricles/pathology , L-Lactate Dehydrogenase/drug effects , L-Lactate Dehydrogenase/blood , Malondialdehyde/analysis , Myocardial Infarction/pathology , Nitric Oxide/analysis
11.
Rev. colomb. cardiol ; 25(4): 243-248, jul.-ago. 2018. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-985466

ABSTRACT

Resumen El dolor torácico es uno de los principales motivos de consulta al sistema de urgencias, y este es secundario a condiciones como el síndrome coronario agudo entre otras. Para su diagnóstico se requiere no sólo el resultado de la troponina, sino una evaluación clínica completa en la que se tengan en cuenta factores de riesgo cardiovascular, características del dolor y hallazgos electrocardiográficos. La interpretación inadecuada de las troponinas ultrasensibles lleva a que se someta al paciente a riesgos innecesarios a causa de estudios como el cateterismo cardiaco. Se llevó a cabo un estudio de corte trasversal en un hospital de Bogotá, en el que la causa principal de consulta en el servicio de urgencias fue el dolor torácico, y la primera causa de hospitalización en Cardiología el síndrome coronario agudo. Se recolectaron datos de 411 pacientes a quienes se les realizó arteriografía coronaria, la mayoría hombres con factores de riesgo como hipertensión arterial, tabaquismo y un evento coronario previo. Dentro de los estudios paraclínicos, la fracción de eyección promedio estuvo cercana al 50% y sólo en 201 pacientes se encontraron lesiones epicárdicas significativas.De la muestra analizada, el 13% tenía creatinina mayor de 1,5 mg/dl como causa alterna de elevación del biomarcador y 28% tenía disfunción ventricular izquierda de algún grado. La mayoría de los pacientes en quienes no se documentaron lesiones angiográficamente significativas en el cateterismo cardiaco, la troponina no cumplía criterios de positividad con base en el aumento del 20% respecto al valor inicial si este era positivo o de 50% en caso de que el primer valor fuese negativo. Adicionalmente, del grupo de pacientes con enfermedad coronaria angiográficamente significativa fue más frecuente la combinación de tres o más factores de riesgo cardiovascular en presencia de biomarcador positivo.


Abstract Chest pain is one of the main reasons for consulting the Emergency Department, and it is secondary to conditions, such as acute coronary syndrome. For its diagnosis, it not only requires a Troponin result, but also a full clinical evaluation, in which factors like cardiovascular risk have to be taken into account, as well as characteristics of the pain and the findings on the electrocardiogram. The poor interpretation of the ultrasensitive Troponins leads to the patient being subjected to unnecessary risks due to studies such as cardiac catheterisation. A cross-sectional study was conducted in a hospital in Bogota, in which chest pain was the main reason for consulting the Emergency Department, and acute coronary syndrome the first cause of admission to Cardiology. The study included a total of 411 patients on whom a coronary angiography was performed. The majority were males with risk factors such as arterial hypertension, smokers, and with a previous coronary event. Among the para-clinical studies, the mean ejection fraction was around 50%, and significant epicardial lesions were found in only 201 patients.Of the sample analysed, 13% had a creatinine greater than 1.5 mg/dl as an alternative cause of the elevation of the biomarker, and 28% had some degree of left ventricular function. the majority of patients that did not have significant angiographic lesions in the cardiac catheterisation documented, the Troponin did not meet the criteria for being positive, based on an increase of 20% as regards the initial value if this was positive or 50% in the case where the first value was negative. Furthermore, of the patient group with significant angiographic coronary disease, the combination of three or more cardiovascular risk factors was the most frequent in the presence of a positive biomarker.


Subject(s)
Humans , Male , Female , Acute Coronary Syndrome , ST Elevation Myocardial Infarction , Angina Pectoris , Coronary Angiography , Troponin T , Myocardial Infarction
13.
Rev. Salusvita (Online) ; 37(2): 437-448, 2018.
Article in Portuguese | LILACS | ID: biblio-1050611

ABSTRACT

Introdução: o Infarto Agudo do Miocárdio (IAM) é a mais importante e frequente cardiopatia isquêmica ocasionada por necrose do músculo cardíaco (miocárdio) em consequência de isquemia prolongada, sendo mais frequente em adultos e idosos. O diagnóstico é baseado no quadro clínico, alterações eletrocardiográficas e resultados de exames de sangue com elevação dos marcadores bioquímicos de necrose miocárdica: Troponina T, CKMB (creatina-quinase-fraçãoMB) e CK (creatina-quinase-total) que são liberadas pelas células assim que o suprimento de sangue fica bloqueado, sendo a Troponina o principal marcador por estar presente na estrutura do músculo cardíaco. A bioquímica clínica desempenha papel fundamental no diagnóstico laboratorial do IAM, pois as dosagens devem ser analisadas rapidamente para melhor prognóstico, eficácia do tratamento e sobrevida do paciente. Embasados na alta prevalência das doenças cardiovasculares, no envelhecimento populacional e na importância do diagnóstico laboratorial. O objetivo desta revisão bibliográfica foi descrever a importância dos principais marcadores bioquímicos quanto à sensibilidade e especificidade com ênfase para a Troponina T. Trata-se de um estudo transversal descritivo por revisão da literatura de artigos científicos completos, capítulos de livros, dissertações e teses nos idiomas português e inglês, nas bases de dados SCIELO, LILACS, BIREME, BIBLIOTECA VIRTUAL DE SAÚDE. Após a revisão, evidencia-se a importância da emergência médica com o diagnóstico laboratorial preciso e confiável da Troponina T que é liberada em 3 horas após o IAM e que pode ser dosada por imunocromatografia ou quantitativamente, e deve estar inserida na rotina dos laboratórios privados e hospitalares para melhor qualidade de vida do paciente.


Introduction: acute Myocardial Infarction (AMI) is the most important and frequent ischemic heart disease caused by cardiac (myocardial) muscle necrosis as a consequence of prolonged ischemia, being more frequent in adults and the elderly. The diagnosis is based on the clinical picture, electrocardiographic changes and results of blood tests with elevation of biochemical markers of myocardial necrosis: Troponin T, CKMB (creatine kinase-MB fraction) and CK (creatine kinase-total) that are released by the cells as soon as the blood supply is blocked, Troponin being the main marker because it is present in the structure of the heart muscle. Clinical biochemistry plays a fundamental role in the laboratory diagnosis of AMI, since the dosages should be analyzed quickly for better prognosis, treatment efficacy and patient survival. Based on the high prevalence of cardiovascular diseases, population aging and the importance of laboratory diagnosis, the objective of this literature review was to describe the importance of the main biochemical markers for sensitivity and specificity with emphasis on Troponin T. This is a cross-sectional study descriptive literature review of complete scientific articles, book chapters, dissertations and theses in the Portuguese and English languages, in the databases SCIELO, LILACS, BIREME, VIRTUAL HEALTH LIBRARY. After the review, the importance of the medical emergency with the accurate and reliable laboratory diagnosis of Troponin T, which is released within 3 hours after AMI and can be quantified by immunochromatography or quantitatively, should be included in the routine of the private and the quality of life of the patient.


Subject(s)
Biomarkers , Troponin T , Myocardial Infarction
14.
Article in English | WPRIM | ID: wpr-714194

ABSTRACT

Cyclophosphamide-induced cardiotoxicity is an uncommon complication especially in patients who have never undergone mediastinal irradiation or cardiotoxic chemotherapy and do not have underlying cardiac diseases. Here, we describe the case of a 19-year-old female with chronic myeloid leukemia. She was previously treated with oral tyrosine kinase inhibitors and developed cardiomyopathy after receiving infusion of 60 mg/kg intravenous cyclophosphamide for two days with a conditioning regimen for allogenic hematopoietic stem cell transplantation. Severe thickening of the left ventricle and reduced ejection fraction without triggering agents were characteristic for cyclophosphamide-induced cardiomyopathy. Her NT-pro BNP and troponin T concentrations surged to >70,000 pg/mL (0=130 pg/mL) and 2,031 pg/mL (0-14 pg/mL), respectively, during the course of the therapy and multiple organ failure seemed imminent evidenced by unresponsive decline in blood pressure. However, with close monitoring and persistent conservative management which consisted of intravenous hydration, continuous hemodialysis, and mechanical ventilation, her condition recovered.


Subject(s)
Blood Pressure , Cardiomyopathies , Cardiotoxicity , Cyclophosphamide , Drug Therapy , Female , Heart Diseases , Heart Failure , Heart Ventricles , Heart , Hematopoietic Stem Cell Transplantation , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Multiple Organ Failure , Protein-Tyrosine Kinases , Renal Dialysis , Respiration, Artificial , Troponin T , Young Adult
15.
Article in Korean | WPRIM | ID: wpr-714040

ABSTRACT

OBJECTIVE: A method of early diagnosis of acute myocardial infarction (AMI) using high-sensitivity cardiac troponin-T (hs-TnT) has been introduced. This study was conducted to evaluate the accuracy of hs-TnT in patients with suspected AMI. METHODS: Patients who were more than 20 years old with symptoms of AMI and who underwent hs-TnT and coronary angiography or echocardiography were included. Risk factors associated with AMI and basic characteristics were collected. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated. The effects of time from symptom onset to emergency department (ED) visit on test accuracy were analyzed. RESULTS: The final analysis included 102 patients, of which 37 were AMI. The sensitivity and specificity of the hs-TnT was 59.5% (95% confidence interval [CI], 42.1% to 75.2%) and 67.7% (95% CI, 54.9% to 78.8%), respectively. In patients with typical chest pain, the sensitivity and specificity of the hs-TnT was 58.1% (95% CI, 39.1% to 75.5%) and 73.2% (95% CI, 57.1% to 85.8%), respectively. The NPV and sensitivity increased, and the PPV and specificity decreased as time from symptom onset to ED visit increased. CONCLUSION: The accuracy of the hs-TnT test was not as good in patients who visited the ED for symptoms suggestive of AMI. Therefore, to rule-in or rule-out AMI by using hs-TnT in ED, it is necessary to consider the electrocardiogram and clinical features, or to check variations by repeated measurement of hs-TnT.


Subject(s)
Chest Pain , Coronary Angiography , Early Diagnosis , Echocardiography , Electrocardiography , Emergencies , Emergency Service, Hospital , Humans , Methods , Myocardial Infarction , Risk Factors , Sensitivity and Specificity , Troponin , Troponin T
16.
Article in English | WPRIM | ID: wpr-776922

ABSTRACT

Cardiac dysfunction, a common consequence of sepsis, is the major contribution to morbidity and mortality in patients. Sodium tanshinone IIA sulfonate (STS) is a water-soluble derivative of Tanshinone IIA (TA), a main active component of Salvia miltiorrhiza Bunge, which has been widely used in China for the treatment of cardiovascular and cerebral system diseases. In the present study, the effect of STS on sepsis-induced cardiac dysfunction was investigated and its effect on survival rate of rats with sepsis was also evaluated. STS treatment could significantly decrease the serum levels of C-reactive protein (CRP), procalcitonin (PCT), cardiac troponin I (cTn-I), cardiac troponin T (cTn-T), and brain natriuretic peptide (BNP) in cecal ligation and puncture (CLP)-induced) septic rats and improve left ventricular function, particularly at 48 and 72 h after CLP. As the pathogenesis of septic myocardial dysfunction is attributable to dysregulated systemic inflammatory responses, several key cytokines, including tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-10 (IL-10) and high mobility group protein B1 (HMGB1), were detected to reveal the possible mechanism of attenuation of septic myocardial dysfunction after being treated by STS. Our study showed that STS, especially at a high dose (15 mg·kg), could efficiently suppress inflammatory responses in myocardium and reduce myocardial necrosis through markedly reducing production of myocardial TNF-α, IL-6 and HMGB1. STS significantly improved the 18-day survival rate of rats with sepsis from 0% to 30% (P < 0.05). Therefore, STS could suppress inflammatory responses and improve left ventricular function in rats with sepsis, suggesting that it may be developed for the treatment of sepsis.


Subject(s)
Animals , C-Reactive Protein , Genetics , Allergy and Immunology , Cecum , General Surgery , Drugs, Chinese Herbal , Chemistry , Female , Heart , Humans , Interleukin-6 , Genetics , Allergy and Immunology , Ligation , Male , Myocardium , Allergy and Immunology , Phenanthrenes , Chemistry , Punctures , Rats , Salvia miltiorrhiza , Chemistry , Sepsis , Drug Therapy , Allergy and Immunology , Troponin T , Genetics , Allergy and Immunology , Tumor Necrosis Factor-alpha , Genetics , Allergy and Immunology
17.
Article in Chinese | WPRIM | ID: wpr-776418

ABSTRACT

To investigate the spectrum-activity relationship of Trichosanthis Fructus and Trichosanthis Fructus strip pieces for rat myocardial ischemia-reperfusion injury. HPLC fingerprints of Trichosanthis Fructus and Trichosanthis Fructus strip pieces were established, and the values of creatinekinase-MB (CK-MB), myoglobin (MYO) and cardiac troponin-T (cTNT) in 3 dose groups (2.25, 13.5, 27.0 g·kg⁻¹, equivalent to the crude herb g·kg⁻¹) of Trichosanthis Fructus and Trichosanthis Fructus strip pieces with myocardial ischemia-reperfusion injury in rats were measured, and the grey relational analysis was used to study the spectrum-activity relationship of Trichosanthis Fructus and Trichosanthis Fructus strip pieces for rat myocardial ischemia-reperfusion injury. With the dosage increase from 2.25 g·kg⁻¹ to 27.0 g·kg⁻¹, the correlation degree of spectrum-activity relationship of Trichosanthis Fructus and Trichosanthis Fructus strip pieces was also enhanced, but the change trend was different between these two groups. According to the frequency of the top 10 peaks in the correlation degree, peak 17, 14, 16, 19, 32, 12, 26, 30, 4, 6 and 2 were the basic effective substances group of Trichosanthis Fructus, peak 6,14,12,32,30,4 and 6 were the basic effective substances group of Trichosanthis Fructus strip pieces. Peak 6, 14, 12, 32, 30, 4 and 26 in fingerprints of Trichosanthis Fructus and Trichosanthis Fructus strip pieces were the main common pharmacodynamic substance base, among them, peak 6 was 5-hydroxymethyl furfural, peak 14 was vanillic acid and the peak 28 was rutin, but the correlation degree with the efficacy was different. The effect of Trichosanthis Fructus and Trichosanthis Fructus strip pieces on rat myocardial ischemia-reperfusion injury was due to the synergistic effect of the effective substance groups related to the dosage. The essential pharmacodynamic substance groups of Trichosanthis Fructus and Trichosanthis Fructus strip pieces were different, but they shared a common active ingredient group.


Subject(s)
Animals , Chromatography, High Pressure Liquid , Creatine Kinase, MB Form , Blood , Cucurbitaceae , Chemistry , Drugs, Chinese Herbal , Pharmacology , Fruit , Chemistry , Myocardial Reperfusion Injury , Drug Therapy , Myoglobin , Blood , Rats , Troponin T , Blood
18.
Article in English | WPRIM | ID: wpr-812344

ABSTRACT

Cardiac dysfunction, a common consequence of sepsis, is the major contribution to morbidity and mortality in patients. Sodium tanshinone IIA sulfonate (STS) is a water-soluble derivative of Tanshinone IIA (TA), a main active component of Salvia miltiorrhiza Bunge, which has been widely used in China for the treatment of cardiovascular and cerebral system diseases. In the present study, the effect of STS on sepsis-induced cardiac dysfunction was investigated and its effect on survival rate of rats with sepsis was also evaluated. STS treatment could significantly decrease the serum levels of C-reactive protein (CRP), procalcitonin (PCT), cardiac troponin I (cTn-I), cardiac troponin T (cTn-T), and brain natriuretic peptide (BNP) in cecal ligation and puncture (CLP)-induced) septic rats and improve left ventricular function, particularly at 48 and 72 h after CLP. As the pathogenesis of septic myocardial dysfunction is attributable to dysregulated systemic inflammatory responses, several key cytokines, including tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-10 (IL-10) and high mobility group protein B1 (HMGB1), were detected to reveal the possible mechanism of attenuation of septic myocardial dysfunction after being treated by STS. Our study showed that STS, especially at a high dose (15 mg·kg), could efficiently suppress inflammatory responses in myocardium and reduce myocardial necrosis through markedly reducing production of myocardial TNF-α, IL-6 and HMGB1. STS significantly improved the 18-day survival rate of rats with sepsis from 0% to 30% (P < 0.05). Therefore, STS could suppress inflammatory responses and improve left ventricular function in rats with sepsis, suggesting that it may be developed for the treatment of sepsis.


Subject(s)
Animals , C-Reactive Protein , Genetics , Allergy and Immunology , Cecum , General Surgery , Drugs, Chinese Herbal , Chemistry , Female , Heart , Humans , Interleukin-6 , Genetics , Allergy and Immunology , Ligation , Male , Myocardium , Allergy and Immunology , Phenanthrenes , Chemistry , Punctures , Rats , Salvia miltiorrhiza , Chemistry , Sepsis , Drug Therapy , Allergy and Immunology , Troponin T , Genetics , Allergy and Immunology , Tumor Necrosis Factor-alpha , Genetics , Allergy and Immunology
19.
Article in Korean | WPRIM | ID: wpr-717560

ABSTRACT

OBJECTIVE: The evidence that hyperbaric oxygen (HBO) therapy is more effective for improving the acute neuropsychological status (ANS) of carbon monoxide poisoning than normobaric oxygen (NBO) therapy is not convincing. This is because the levels of carboxyhemoglobin (COHb) do not correlate with the clinical severity of carbon monoxide poisoning and there is no universally accepted severity scale of carbon monoxide poisoning. This paper suggests a new scale for the clinical and neurological severity of carbon monoxide poisoning, called the ANS, and assesses the effect of HBO therapy for each level of ANS compared to NBO therapy. METHODS: A total of 217 patients who had been hospitalized because of carbon monoxide poisoning from January 2009 to July 2013 were studied. ANS was suggested as a new severity scale of carbon monoxide poisoning considered in the Glasgow Coma Scale, acute neuro-psychologic signs and symptoms, or cardiac ischemia on the initial medical contact. HBO therapy is indicated in those who have a loss of consciousness, seizure, coma, abnormal findings on a neurological examination, pregnancy, persistent cardiac ischemia, level of COHb >25%, or severe metabolic acidosis (pH < 7.2). The end point is the day of discharge, and recovery is defined as a normal neuro-psychological status without any sequelae. RESULTS: The levels of troponin T and creatinine increased significantly with increasing ANS score. In the moderate to severe group (ANS 2 and 3), the recovery rate was significantly higher when treated with HBO therapy than with NBO therapy (P=0.030). On the other hand, the development of delayed neuro-psychological sequelae (DNS) did not correlate with any level of ANS, type of oxygen therapy, or recovery on discharge. CONCLUSION: In the moderate to severe poisoned group, HBO therapy is more effective for improving the ANS from carbon monoxide poisoning than NBO therapy. On the other hand, the development of DNS of HBO therapy is no more preventable than with NBO therapy. Although the level of ANS is low, the patient needs to be provided with sufficient information and a follow-up visit is recommended for any abnormal symptoms because the ANS does not correlate with the development and degree of DNS.


Subject(s)
Acidosis , Carbon Monoxide Poisoning , Carbon Monoxide , Carbon , Carboxyhemoglobin , Coma , Creatinine , Follow-Up Studies , Glasgow Coma Scale , Hand , Humans , Hyperbaric Oxygenation , Ischemia , Neurologic Examination , Oxygen , Pregnancy , Seizures , Severity of Illness Index , Troponin T , Unconsciousness
20.
Laboratory Medicine Online ; : 135-139, 2018.
Article in Korean | WPRIM | ID: wpr-717398

ABSTRACT

BACKGROUND: The point-of-care (POC) troponin T assay has been used in various clinical settings. Recently, a POC troponin T assay with an extended measurable range (40 ng/L-2,000 ng/L) was introduced. We aimed to evaluate the analytical performance of the Roche Cardiac POC Troponin T assay (POC TnT, Roche Diagnostics, Switzerland) using the cobas h 232 POC system. METHODS: The repeatability and within-laboratory imprecision of the POC TnT assay were evaluated using the Roche Cardiac POC Troponin T level 2 control. Repeatability was also assessed using patient samples. Linearity of the POC TnT assay was evaluated using patient samples containing five different concentrations of troponin T. Performance of the Elecsys Troponin T high sensitivity assay (hs-TnT) was compared with that of the POC TnT assay using 40 patient samples. RESULTS: The repeatability (%CV), and within-laboratory imprecision (%CV) using the level 2 control solution (mean troponin T, 441.6 ng/L) were 8.5% and 8.6%, respectively. The repeatability of patient samples containing 88.7 ng/L and 454.6 ng/L TnT was 7.5% and 7.2%, respectively. The POC TnT assay was confirmed to produce linear data between 54.0 ng/L and 1,347.7 ng/L. Relative to the hs-TnT assay, the Passing-Bablok linear regression equation (correlation coefficient) was y=0.8933x+6.24 (r=0.988). At a troponin T concentration of 40 ng/L, the estimated bias of the POC TnT assay was 1.972 ng/L (4.93%). CONCLUSIONS: Our data suggest that the Roche Cardiac POC Troponin T assay is reliable in cases where POC troponin T testing is required.


Subject(s)
Bias , Humans , Linear Models , Point-of-Care Systems , Trinitrotoluene , Troponin T , Troponin
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