Diagnostic value of copeptin in acute myocardial infarction.

OBJECTIVE: The aim of this study was to investigate the effectiveness of copeptin in the early diagnosis of acute myocardial infarction (AMI), and to compare the diagnostic efficacy of copeptin with other cardiac markers. PATIENTS AND METHODS: A total of 160 cases were enrolled in the study. All were over 18 years of age, and consisted of 54 non-ST elevation MI (NSTEMI), 54 ST segment elevation MI (STEMI), and 52 healthy subjects (controls). Serum troponin-I, CK-MB mass, copeptin and CRP levels were measured in each of the cases, and were compared between the three groups for statistical differences. RESULTS: The copeptin levels in the STEMI (p < 0.001) and NSTEMI (p = 0.042) groups were found to be significantly higher than the control group. Spearman's correlation analysis showed a significant positive correlation between the level of copeptin and the presence of AMI (r = 0.285, p < 0.001), CK-MB mass (r = 0.246, p = 0.002), and troponin-I (r = 0.199, p = 0.012). Sensitivity, specificity, and AUC values of the tests, according to ROC analysis performed for the diagnosis of AMI were; troponin-I > 0.1 ng/mL (71.0%, 100.0%, and 0.855); CK-MB mass > 3.59 ng/mL (77.8%, 92.3%, and 0.911); CRP > 6.37 mg/L (53.7%, 88.5%, and 0.769); and copeptin > 2.47 ng/mL (66.7%, 75.0%, and 0.676), respectively (p < 0.001). CONCLUSIONS: Cardiac troponin remains the gold standard biomarker for the diagnostic evaluation of AMI. Copeptin can be used as a diagnostic marker in patients with suspected AMI in combination with other biomarkers, but, copeptin alone should not be considered as a single diagnostic marker in patients with suspected AMI.

High hemodialysis vascular access flow and impaired right ventricular function in chronic hemodialysis patients.

There are limited data showing right ventricular preload increase due to high-flow arteriovenous fistulas (AVFs). This cross-sectional study investigated whether high AVF flow had an impact on right ventricular function in patients undergoing hemodialysis. Sixty-four patients aged between 18 and 85 years who were on routine hemodialysis with >2 hemodialysis sessions per week for at least 3 months via an AVF were studied. Patients with inadequate flow fistulas, severe chronic obstructive pulmonary disease, history of pulmonary embolism, primary pulmonary hypertension, severe mitral, aortic or pulmonary regurgitation, and/or stenosis were excluded. After an initial evaluation, 44 patients (mean age: 58.50 ± 16.84, male:female = 23:21) were considered eligible. Right ventricular function was assessed by tricuspid annular plane systolic excursion (TAPSE). AVF blood flow was measured with duplex ultrasound. There were 15 patients (34.1%) with a TAPSE of <16 mm. AVF blood flow was significantly higher in patients with impaired versus normal right ventricular function (1631.53 ± 738.17 vs. 1060.55 ± 539.92 min/ml, respectively, P = 0.003). Low left ventricular ejection fraction (odds ratio [OR]: 1.15, 95% confidence intervals [CI]: 1.007-1.334, P = 0.04), high interventricular septum thickness (OR: 1.64, 95% CI: 1.104-2.464, P = 0.01), and high AVF blood flow (OR: 1.00, 95% CI: 1.000-1.003, P = 0.03) were independent predictors of impaired right ventricular function. In addition to known risk factors that predominantly increase right ventricular afterload, excessive AVF blood flow was found to be independently associated with impaired right ventricular function, possibly by increasing right ventricular preload.

Ureteral obstruction owing to over pressure of a normal right common iliac artery: a case report.

We report a case in which a normal right common iliac artery in a normal anatomical relationship to the right ureter at the crossing point caused partial urinary tract obstruction apparently by an over pressure effect. The ureter was attached to the promontorium periosteum following ureterolysis to relieve the obstruction. To our knowledge, such a condition has not been reported previously. We believe that over pressure of the common iliac artery should be considered in the differential diagnosis of extrinsic ureteral obstruction, particularly in muscular subjects.