Diagnostic efficacy of myeloperoxidase for the detection of acute coronary syndromes.

BACKGROUND: Early diagnosis of acute coronary syndrome (ACS) is frequently a challenging task, while immediate risk stratification remains crucial for the prompt implementation of appropriate therapy in this setting. Employing markers that increase rapidly after the symptom onset may enhance triage and therapeutic decision-making in patients suspected for ACS. Myeloperoxidase (MPO) exerting proinflammatory and pro-oxidative properties is suggested as a reliable early marker for ACS associated with unfavourable clinical outcome. We assessed the diagnostic efficacy of plasma MPO alone or in combination with cardiac troponin I (cTnI) for detecting ACS in patients presenting with chest pain initiating within 6h before the hospital admission. MATERIAL AND METHODS: A study group consisted of 253 patients diagnosed with ACS and 47 subjects having other heart disease or unspecified chest pain. Clinically healthy volunteers (n=124) served as controls. MPO concentration was measured in plasma (Abbott Diagnostics, USA), while serum was assayed for cTnI, creatine-kinase MB, lipids, glucose, creatinine, brain natriuretic peptide type B and C-reactive protein. RESULTS: Both MPO and cTnI values were significantly lower in non-ACS subjects than in patients with ACS. At 97·5th percentile as cut-off, the superiority of MPO over cTnI was observed in patients with unstable angina and non-ACS subjects. Considerably higher MPO concentrations were demonstrated in the troponin-negative ACS patients on admission who became troponin-positive after 6h. Combined evaluation of MPO and cTnI possessed remarkably higher sensitivity than assessment of cTnI alone in all patients with ACS. CONCLUSIONS: Myeloperoxidase substantially facilitates the early diagnosis of ACS.

The Impact of Sex and Age on Serum Prohepcidin Concentration in Healthy Adults.

INTRODUCTION: Within the last 8 years, it has become evident that hepcidin has a diagnostic and therapeutic potential. Therefore, it is a great need to establish the reference interval for hepcidin and its precursor. The aim of this study was to assess the impact of age and sex on serum prohepcidin concentration in healthy adults. MATERIAL AND METHODS: 100 healthy volunteers were enrolled during the 18 months of the study - 56 males and 44 females, mean age 34.8±10.1 yrs. Serum prohepcidin, ferritin, soluble transferring receptor (sTfR) and plasma erythropoietin were examined by enzyme-linked immunosorbent assay (ELISA) kits. Serum iron and unsaturated iron binding capacity were determined on ARCHITECT ci8200 (Abbott Diagnostics) according to the manufacturer's instructions. RESULTS: Serum prohepcidin concentrations ranged from 74.9 ng/ml to 300.4 ng/ml in healthy adults of both sexes. However, prohepcidin levels were significantly higher in males (median value 145.7 ng/ml) than in females (median 127.3 ng/ml) (p=0.0016). Serum prohepcidin was not associated with age in the group of healthy adults. CONCLUSIONS: Serum prohepcidin concentrations were found to be related to sex. Significantly lower prohepcidin levels were observed in females compared with males.

Local calcitriol injections as a suppressive treatment of secondary hyperparathyroidism in chronic dialysis patients.

AIM: A prospective study was made of the effectiveness of repeatable local calcitriol injections therapy to suppress secondary hyperparathyroidism resistant to conventional therapy in chronic dialysis patients. METHODS: Under ultrasonographic guidance, six injections at an interval of two days were performed in 14 chronic dialysis patients. The total amount of calcitriol to be injected each time was estimated as 100% of the calculated gland volume. Calcitriol was given in doses 1 mug of medicine per 1 cubic cm (as measured by USG) of parathyroid tissue. Parathormone concentration, total calcium, ionized calcium, phosphate, and alkaline phosphatase levels were assessed on the first and last day of the treatment period. RESULTS: Prior to therapy, the mean gland volumes were 0.62 (0.15-3.0) ml, and they increased to 0.85 (0.2-3.9) after 14 days (NS). Seven patients were found to have decreased their PTH levels to 909 +/- 387 pg/mL after 14 days of treatment when compared with the first day mean values of 1588 +/- 440 pg/mL (p < 0.05). After completion of the therapy, four patients were reported to be free from any clinical symptoms of ostalgia or arthralgia. Others reported an alleviation of pain. CONCLUSIONS: Parathyroid adenoma injection is an alternative method of treatment for some patients resistant to treatment by means of vitamin D3 pulses or intravenous administration of calcitriol. The success of treatment is to a great extent determined by proper selection of patients and the taking of decisions when the period of secondary hyperparathyroidism is not very advanced.