Evaluación del estado emocional de personas con diabetes mellitus en la práctica ambulatoria / Evaluation of the emotional state of people with diabetes mellitus in outpatient practice

La aparición de una enfermedad crónica, como la diabetes mellitus (DM), pone a prueba la respuesta del universo físico y psíquico de un individuo. Como objetivo general, se propone evaluar el estado emocional de las personas con DM en la consulta ambulatoria. Como objetivo particular, detectar y monitorear las necesidades psicológicas que deben formar parte integral del cuidado de la DM mediante el uso de métodos validados. El cuestionario WHO-5 se incluye como índice de bienestar general, el PAID-5 revela la existencia de una posible angustia emocional vinculada a la enfermedad, y el PHQ- 9 como índice de depresión. Ante esta situación, el Comité de Aspectos Psicosociales recomienda explorar estos aspectos para optimizar el control y el tratamiento de la enfermedad, proponiendo estas herramientas para que el equipo de salud las emplee en la detección y el reconocimiento del estado emocional de las personas con DM

Occurrence of a chronic disease, such as diabetes, prove the response of the physical and psychic universe of individuals. As a general objective, is proposed to evaluate emotional state of people with diabetes in the outpatient clinic. As principal objective, detection and monitoring the psychological needs should be a main part of diabetes care, using validated tools to evaluate this aspect. WHO-5 questionnaire is included as an index of general well-being, PAID-5, reveals the existence of a possible emotional distress linked to disease, and PHQ-9 is used as an index of depression. At this situation, the Committee on Psycho-Social Aspects recommends explore these psychological aspects, as a way to optimize the control and treatment of disease, and propose the cited tools, to be used by the health team, in detection and recognition of emotional state in people with diabetes.

Evaluación del estado emocional de personas con diabetes mellitus en la práctica ambulatoria / Evaluation of the emotional state of people with diabetes mellitus in outpatient practice

Resumen La aparición de una enfermedad crónica, como la diabetes mellitus (DM), pone a prueba la respuesta del universo físico y psíquico de un individuo. Como objetivo general, se propone evaluar el estado emocional de las personas con DM en la consulta ambulatoria. Como objetivo particular, detectar y monitorear las necesidades psicológicas que deben formar parte integral del cuidado de la DM mediante el uso de métodos validados. El cuestionario WHO-5 se incluye como índice de bienestar general, el PAID-5 revela la existencia de una posible angustia emocional vinculada a la enfermedad, y el PHQ-9 como índice de depresión. Ante esta situación, el Comité de Aspectos Psicosociales recomienda explorar estos aspectos para optimizar el control y el tratamiento de la enfermedad, proponiendo estas herramientas para que el equipo de salud las emplee en la detección y el reconocimiento del estado emocional de las personas con DM.

Abstract Occurrence of a chronic disease, such as diabetes, prove the response of the physical and psychic universe of individuals. As a general objective, is proposed to evaluate emotional state of people with diabetes in the outpatient clinic. As principal objective, detection and monitoring the psychological needs should be a main part of diabetes care, using validated tools to evaluate this aspect. WHO-5 questionnaire is included as an index of general well-being, PAID-5, reveals the existence of a possible emotional distress linked to disease, and PHQ-9 is used as an index of depression.

Hydroxypyridinethione Inhibitors of Human Insulin-Degrading Enzyme.

Insulin-degrading enzyme (IDE) is a human mononuclear Zn2+ -dependent metalloenzyme that is widely regarded as the primary peptidase responsible for insulin degradation. Despite its name, IDE is also critically involved in the hydrolysis of several other disparate peptide hormones, including glucagon, amylin, and the amyloid ß-protein. As such, the study of IDE inhibition is highly relevant to deciphering the role of IDE in conditions such as type-2 diabetes mellitus and Alzheimer disease. There have been few reported IDE inhibitors, and of these, inhibitors that directly target the active-site Zn2+ ion have yet to be fully explored. In an effort to discover new, zinc-targeting inhibitors of IDE, a library of ∼350 metal-binding pharmacophores was screened against IDE, resulting in the identification of 1-hydroxypyridine-2-thione (1,2-HOPTO) as an effective Zn2+ -binding scaffold. Screening a focused library of HOPTO compounds identified 3-sulfonamide derivatives of 1,2-HOPTO as inhibitors of IDE (Ki values of ∼50 µM). Further structure-activity relationship studies yielded several thiophene-sulfonamide HOPTO derivatives with good, broad-spectrum activity against IDE that have the potential to be useful pharmacological tools for future studies of IDE.

Quantitative, High-Throughput Assays for Proteolytic Degradation of Amylin.

Amylin is a pancreatic peptide hormone that regulates glucose homeostasis but also aggregates to form islet amyloid in type-2 diabetes. Given its role in both health and disease, there is renewed interest in proteolytic degradation of amylin by insulin-degrading enzyme (IDE) and other proteases. Here, we describe the development and detailed characterization of three novel assays for amylin degradation, two based on a fluoresceinated and biotinylated form of rodent amylin (fluorescein-rodent amylin-biotin, FrAB), which can be used for any amylin protease, and another based on an internally quenched fluorogenic substrate (FRET-based amylin, FRAM), which is more specific for IDE. The FrAB-based substrate can be used in a readily implemented fluorescence-based protocol or in a fluorescence polarization (FP)-based protocol that is more amenable to high-throughput screening (HTS), whereas the FRAM substrate has the advantage of permitting continuous monitoring of proteolytic activity. All three assays yield highly quantitative data and are resistant to DMSO, and the FRAM and FP-based FrAB assay are ideally suited to HTS applications.

Cathepsin D regulates cerebral Aß42/40 ratios via differential degradation of Aß42 and Aß40.

BACKGROUND: Cathepsin D (CatD) is a lysosomal protease that degrades both the amyloid ß-protein (Aß) and the microtubule-associated protein, tau, and has been genetically linked to late-onset Alzheimer disease (AD). Here, we sought to examine the consequences of genetic deletion of CatD on Aß proteostasis in vivo and to more completely characterize the degradation of Aß42 and Aß40 by CatD. METHODS: We quantified Aß degradation rates and levels of endogenous Aß42 and Aß40 in the brains of CatD-null (CatD-KO), heterozygous null (CatD-HET), and wild-type (WT) control mice. CatD-KO mice die by ~ 4 weeks of age, so tissues from younger mice, as well as embryonic neuronal cultures, were investigated. Enzymological assays and surface plasmon resonance were employed to quantify the kinetic parameters (KM, kcat) of CatD-mediated degradation of monomeric human Aß42 vs. Aß40, and the degradation of aggregated Aß42 species was also characterized. Competitive inhibition assays were used to interrogate the relative inhibition of full-length human and mouse Aß42 and Aß40, as well as corresponding p3 fragments. RESULTS: Genetic deletion of CatD resulted in 3- to 4-fold increases in insoluble, endogenous cerebral Aß42 and Aß40, exceeding the increases produced by deletion of an insulin-degrading enzyme, neprilysin or both, together with readily detectable intralysosomal deposits of endogenous Aß42-all by 3 weeks of age. Quite significantly, CatD-KO mice exhibited ~ 30% increases in Aß42/40 ratios, comparable to those induced by presenilin mutations. Mechanistically, the perturbed Aß42/40 ratios were attributable to pronounced differences in the kinetics of degradation of Aß42 vis-à-vis Aß40. Specifically, Aß42 shows a low-nanomolar affinity for CatD, along with an exceptionally slow turnover rate that, together, renders Aß42 a highly potent competitive inhibitor of CatD. Notably, the marked differences in the processing of Aß42 vs. Aß40 also extend to p3 fragments ending at positions 42 vs. 40. CONCLUSIONS: Our findings identify CatD as the principal intracellular Aß-degrading protease identified to date, one that regulates Aß42/40 ratios via differential degradation of Aß42 vs. Aß40. The finding that Aß42 is a potent competitive inhibitor of CatD suggests a possible mechanistic link between elevations in Aß42 and downstream pathological sequelae in AD.

Examining the Relationship Between Engagement and Perceived Stress-Related Cognitive Complaints in the Argentinian Working Population.

Stress has a negative impact on cognitive functioning and occupational well-being. The aim of this study was to assess the relationship among perceived stress, cognitive complaints and work engagement in public employees from Córdoba, Argentina. In this cross-sectional study, self-report questionnaires were administered to 240 participants. Spanish versions of the following instruments were used: Perceived Stress Scale (PSS), Utrecht Work Engagement Scale (UWES), Memory Failures in Everyday (MFE), Executive Complaint Questionnaire (ECQ). Statistical analysis included ANOVA, path analysis, and multiple logistic regression. Stressed workers showed lower work engagement and more cognitive complaints, even after adjusting for demographic variables. Negative associations were also observed between work engagement and cognitive complaints, suggesting that cognitive difficulties are related to engagement. Given the relation among stress, cognition, and work engagement, it is important to consider these factors to foster workers' health and work productivity.

Auditory processing self-report: How do normal-hearing individuals perceive themselves? / Autorreporte del procesamiento auditivo: ¿Cómo se perciben los individuos normoacúsicos?

Background: Hearing results from processes of modulation of the acoustic signal performed by the auditory pathway and cortical activity. Sound detection, location, discrimination, intelligibility in noise and silence require integrity of the auditory system. Objective: To recognize the auditory variability in competent users and examine the relationship of auditory processing abilities with peripheral sensitivity. Methods: 97 normal-hearing participants with comprehensive listening in a second language and/or music were studied with the Spanish version of the Amsterdam Inventory for Auditory Disability and Handicap (S-AIADH), audiometry and impedanciometry. Correlations between S-AIADH scores and audiometric tonal and acoustic thresholds were calculated. Results: Scores in sound distinction, intelligibility in noise and location showed the greatest dispersion. Auditory processing abilities did not correlate significantly with acoustic thresholds and reflexes, except for the intelligibility in noise that was positively associated with the tonal threshold at frequencies 500 and 1000 Hz in both ears. Conclusion: These results indicate a paradox, which reinforces the differentiation between hearing and listening. For a comprehensive approach, the study of hearing requires addressing both peripheral and central auditory processing, where the use of self-report instruments is important.

Introducción: la audición resulta de procesos de modulación de la señal acústica que realiza la vía auditiva y la actividad cortical. La detección de los sonidos, localización, discriminación, inteligibilidad del habla en ruido y en silencio requieren de la integridad funcional del sistema auditivo. Objetivo: reconocer la variabilidad auditiva en usuarios competentes y examinar la relación de las habilidades del procesamiento auditivo con la sensibilidad periférica. Métodos: un total de 97 participantes normoacúsicos con antecedentes de escucha comprensiva en una segunda lengua y/o música fueron valorados con el Inventario de Ámsterdam para la Discapacidad y Rendimiento Auditivo versión español (S-AIADH), audiometría e impedanciometría. Se calcularon las correlaciones entre los puntajes del S-AIADH y los umbrales tonales audiométricos y del reflejo estapedial. Resultados: los subtotales intratest con mayor dispersión pertenecen a la distinción de sonidos, inteligibilidad en ruido y localización. Las habilidades del procesamiento auditivo no se correlacionaron significativamente con los umbrales de detección de sonido y los reflejos estapediales, a excepción de la inteligibilidad en ruido que se asoció positivamente con el umbral tonal en las frecuencias 500 y 1000 Hz en ambos oídos. Conclusión: Estos resultados indican una paradoja, lo cual refuerza la diferenciación entre oír y escuchar. Para un abordaje integral, el estudio de la audición requiere de abordar tanto el procesamiento auditivo periférico como el central, donde el uso de instrumentos de autorreporte es de gran importancia.

[Answers and latencies dichotic digit test normoacoustic majoring in hearing]. / Patrón de repuestas y latencias ern test de dígitos dicóticos en normoacústicos con especialización auditiva.

Neurocognitive assessment by dichotic digit test provides selective stimulation of auditory pathway with contralateral suppression of the ipsilateral showing interhemispheric differences in concurrent tasks. In order to recognize the pattern of responses, recovery order of digits and latencies heard the original test was modified with the addition of a record of an audio track of the responses. The sample includes subjects with a history in hearing specialization linked to the music and listen to comprehensive second language, normoacoustic without otologic diseases or neurological. Sets 20 pairs of dichotic digits with a digital recording for recording the subject's responses was used. The results reveal: right ear advantage in the pattern of correct answers and the order in which the information provided is retrieved. As for the pattern of intrasets latencies an increase to the fourth repeated / digit recovered and more blunder is observed. Declining intratest latencies in the second part of the test suggest positive training. These modifications allow new prospects and existing applications with behavioral tests.

[Psychosocial risk of fossilization by occupationally-used non-native Englishin information and communication technologists of Argentina]. / El riesgo psicosocial de fosilización en el uso laboral del ingles no nativo en tecnólogos de informática y tecnología de Argentina.

AIMS: Companies use non-native language (L2) as a service tool, and they may incur in occupational psychosocial risks. Interlanguage can be chronic under poor communicative situations, leading to fossilization. It could be an adverse effect because of its impact in productivity and occupational health. Thus, our aim was to establish factors of this psychosocial risk. METHODS: 348 information and communication technologists (ICT) were analyzed. They were native Spanish speakers with normal hearing, and used English as a work tool. Age, gender, L2 stages and errors were recorded in relation to fossilization risk. Statistical methods were applied for categorical data (p<0.05). RESULTS: After gender and age adjustments, a significant inverse association was found between L2 stages and fossilization risk (p<0.0001), with higher risk being in the acquisition stage. Also, L2 errors showed a significant direct relation with fossilization risk (p=0.0005). CONCLUSIONS: Summing up, ICT in acquisition L2 had upper psychosocial risk to fossilization with mechanistic execution of it, under poorer communicative formats. This results have high sanitary impact given they involved a massively demanded professionals.

Valor pronóstico de la respuesta serológica debida a Helicobacter pylori en la evolución a largo plazo del síndrome coronario agudo / Prognostic Value of the Serological Response to Helicobacter pylori in Long-Term Outcomes of Acute Coronary Syndrome

Introducción La respuesta serológica a Helicobacter pylori (HP) se ha reconocido como un factor de riesgo cardiovascular. Sin embargo, su utilidad pronóstica en síndromes coronarios agudos (SCA) fue escasamente evaluada. Objetivos Identificar prevalencia y pronóstico a largo plazo de anormalidades en niveles de anticuerpos IgG contra HP (HP-IgG) en pacientes con SCA. Material y métodos La población estuvo constituida por 67 sujetos consecutivos hospitalizados por SCA (angina inestable [AI]/infarto agudo de miocardio [IAM]) dentro de las 24 horas del inicio de los síntomas, entre abril de 2003 y diciembre de 2003, quienes fueron evaluados mediante un kit inmunoenzimático comercial (Meridian Diagnostics, USA). Resultados Durante el seguimiento (12 ± 3 meses) se registraron 10 (14,6%) eventos (muerte/infarto/ rehospitalización por AI). El área bajo la curva ROC de HP-IgG para predecir eventos fue de 0,85 ± 0,06 (IC 95% 0,74-0,96); el punto de corte de 185 UI mostró una sensibilidad del 70% y una especificidad del 82%. Según el nivel de HP-IgG por encima o por debajo de 185 UI, los pacientes se dividieron en grupo 1 (25,4%) y grupo 2. Ambos fueron comparables. La supervivencia anual libre de eventos fue del 67% versus el 90% en los grupos 1 y 2, respectivamente (prueba de rangos logarítmicos, p = 0,01). Al ingreso, un nivel de HP-IgG > 185 UI (hazard ratio [HR] = 5,588; p = 0,039), la hipotensión arterial (HR = 1,109; p = 0,035) y niveles elevados de creatinina (HR = 1,997; p = 0,019) fueron predictores independientes de eventos. Conclusiones En uno de cada cuatro pacientes con SCA se detectaron tempranamente niveles elevados de HP-IgG. Títulos mayores de 185 UI se asociaron con peor evolución a largo plazo.

Background The serological response to Helicobacter pylori (HP) has been recognized as a cardiovascular risk factor. Yet, its prognostic usefulness in acute coronary syndromes (ACS) has not been extensively evaluated. Objectives To identify the prevalence and long-term prognosis of abnormalities in the level of IgG antibodies against HP (HP-IgG) in patients with ACS. Material and Methods From April 2003 to December 2003, a total of 67 consecutive patients hospitalized due to ACS (unstable angina [UA], acute myocardial infarction [AMI]) within 24 hours from symptoms onset were evaluated using a commercial immunoassay kit (Meridian Diagnostics, USA). Results During follow-up (12±3 months) 10 (14.6%) events were reported (death/AMI/rehospitalization due to UA). The area under the ROC curve using HP-IgG to predict events was 0.85±0.06 (95% CI, 0.74-0.96); the cut-off point of 185 IU had a sensitivity of 70% and a specificity of 82%. Patients were divided into 2 groups: group 1 (HP-IgG >185 IU, 25.4%) and group 2 (HP-IgG <185 IU). Both groups were comparable. Annual survival free from events was 67% versus 90% in groups 1 and 2, respectively (log-rank test, p=0.01). The variables identified at admission as independent predictors of events were HP-IgG >185 UI (hazard ratio [HR]=5.588; p=0.039), hypotension (HR=1.109; p=0.035) and elevated oreatinine levéis (HR=1.997; p=0.019). Conclusions Early elevation of HP-IgG levéis was present in 25% of patients with ACS and levéis > 185 IU were associated with poor long-term outcomes.

Importance of early combined N-terminal pro-brain natriuretic peptide and cardiac troponin T measurements for long-term risk stratification of patients with decompensated heart failure.

BACKGROUND: Markers of myocardial necrosis and natriuretic peptides are risk predictors in decompensated heart failure (DHF). We prospectively studied the optimal timing of combined cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) measurements for long-term risk stratification. METHODS: cTnT and NT-proBNP were measured upon admission, and before discharge in 76 patients hospitalized for DHF (mean age 62.3 +/- 15 years; 71% men). RESULTS: During a mean follow-up of 252 +/- 120 days, 39.5% of patients died or were re-hospitalized for DHF. From receiver-operator-characteristic (ROC) curves, the selected cut-off values for cTnT and NT-proBNP were 0.026 ng/ml and 3,700 pg/ml on admission, and 0.030 ng/ml and 3,200 pg/ml, respectively, at discharge. Depending upon measurements above vs below cut-off, the population was distributed on admission and before discharge for three groups: both negative (24% and 30% of patients); one positive (43% and 42%); and both positive (33% and 28%). For the admission groups, the 1-year DHF-free re-hospitalization survival rates were 85%, 60% and 34%, respectively (p = 0.0047). One-year survival rates for DHF-free re-hospitalization were 63%, 71% and 26% (p = 0.0029), respectively, for the discharge groups. In the Cox proportional hazards model, systolic blood pressure (hazard ratio [HR]: 0.98; 95% confidence interval [CI]: 0.96 to 0.99), heart rate (HR: 0.97; 95% CI: 0.94 to 0.98), one positive biomarker on admission (HR: 10.5; 95% CI: 1.3 to 83.7) and two positive biomarkers on admission (HR: 13.9; 95% CI: 1.8 to 98.5) were independent predictors of long-term outcomes. However, NT-proBNP on admission was the most important predictor of long-term prognosis (HR: 5.1; 95% CI: 2.3 to 12.2). CONCLUSIONS: The combined measurements of cTnT and NT-proBNP on hospital admission were more reliable than their measurements before discharge in the long-term risk stratification of DHF. A single positive measurement on admission predicted a poor long-term outcome.

Atorvastatin has an important acute anti-inflammatory effect in patients with acute coronary syndrome: results of a randomized, double-blind, placebo-controlled study.

BACKGROUND: C-reactive protein (CRP) levels are associated with cardiovascular risk. We assessed the hypothesis that atorvastatin might have anti-inflammatory effects in acute coronary syndromes (ACS) as shown by CRP reduction. METHODS: This study was a prospective, randomized, double-blind, placebo-controlled study of 90 consecutive patients admitted within 48 hours of onset of ACS with CRP levels > or =1.4 mg/dL. Patients were assigned to atorvastatin 40 mg daily or placebo over 30 days. C-reactive protein levels, lipid profiles, serum fibrinogen, white cell count, and erythrocyte sedimentation rate were measured at entry, hospital discharge, and 1 month later. RESULTS: Baseline clinical characteristics did not differ between atorvastatin and placebo groups (mean age 59.3 +/- 13.4 vs 61.1 +/- 11.5, P = ns); myocardial infarction 52.3% versus 67.4% ( P = ns). In both groups, median baseline CRP levels were comparable (5.97 +/- 6.2 vs 4.64 +/- 4.2 mg/dL, P = ns). C-reactive protein levels were lower in the atorvastatin group versus control group at discharge (1.68 +/- 1.65 vs 4.12 +/- 4.18 mg/dL) and at 30 days (0.50 +/- 0.71 vs 2.91 +/- 2.68 mg/dL, both P < .0001). C-reactive protein levels significantly decreased from baseline to discharge and 1 month later in placebo and atorvastatin groups (both P < .0001); however, the reduction was greater in the atorvastatin group (62% vs 11% at discharge [P < .0001]; 84% vs 30% at 1 month [P < .0001]). In addition, atorvastatin was associated with a reduction in total and low-density lipoprotein cholesterol and erythrocyte sedimentation rate at discharge and at 30 days (P < .0001 for all comparisons). No correlation was found between changes in CRP and cholesterol levels. CONCLUSIONS: C-reactive protein levels in ACS were rapidly reduced with atorvastatin. These data provide evidence that statins have fast and early anti-inflammatory effects in addition to lipid-lowering effects in ACS.

Minor myocardial damage detected by troponin T is a powerful predictor of long-term prognosis in patients with acute decompensated heart failure.

BACKGROUND: The progression of chronic heart failure (CHF) is characterized by frequent exacerbation requiring hospitalization and high mortality. Clinical deterioration is triggered by many factors that could promote ongoing myocytes injury. We sought to determine whether a specific marker of cardiac injury, troponin T (cTnT), is associated with prognosis in acute decompensated heart failure (ADHF). METHODS: One hundred and eighty-four consecutive patients with ADHF were enrolled in the absence of an acute coronary syndrome. A cTnT value> or =0.1 ng/ml in samples drawn at 6, 12 or 24 h after hospital admission was considered abnormal. RESULTS: Increased levels of cTnT were found in 58 patients (31.5%, group 1). There were no significant differences between group 1 and patients with cTnT<0.1 ng/ml (group 2) in terms of demographic and clinical characteristics, although ischemic etiology was more prevalent in group 1 (51.7% vs. 31.7%, p=0.009). During follow-up, the mortality in groups 1 and 2 was 31% and 17.5% (p=0.038, OR=2.13, 95% CI: 1.03-4.69), respectively. The 3-year free-CHF readmission survival in group 1 and 2 was 25% and 53% (log rank test p=0.015). In a Cox proportional hazard model, poor tissue perfusion (HR=2.46, 95% CI=1.31-4.6), previous infarction (HR=1.99, 95% CI=1.02-3.9) and cTnT> or =0.1 ng/ml (HR=1.74, 95% CI=1.05-2.9) emerged as the independent predictors of long-term outcome. CONCLUSIONS: One third of patients with decompensated CHF had elevated levels of cTnT. Troponin T was an independent long-term prognostic marker of morbidity and mortality and it suggests a role of biochemical risk stratification in this setting.

Ongoing myocardial injury in stable severe heart failure: value of cardiac troponin T monitoring for high-risk patient identification.

BACKGROUND: The progression of chronic heart failure (CHF) is related to ongoing myocyte loss, which can be detected by cardiac troponin T (cTnT). We examined the prevalence and prognostic value of increased cTnT concentrations in serial blood specimens from patients with severe CHF. METHODS AND RESULTS: Clinical, echocardiographic, and 6-minute walk test data were collected prospectively at baseline and at 1 year in 115 outpatients (mean age, 61+/-11 years; 75% men; 62% coronary heart disease) with CHF and a left ventricular ejection fraction <40%. Blood samples were collected at baseline and at 3, 6, and 12 months of follow-up. cTnT concentrations > or =0.02 ng/mL were considered abnormal, and a Tn index (highest cTnT measurement/0.02 ng/mL) was calculated. In 62 patients (54%), cTnT was consistently <0.02 ng/mL (group 1); 28 (24%) had a single abnormal cTnT result (group 2); and 25 (22%) had > or =2 abnormal cTnT results (group 3). At 18 months, CHF hospitalization-free survival was 63%, 46%, and 17%, respectively (P=0.0001). In a Cox proportional-hazards model, hospitalization for worsening CHF in the previous year (HR=2.1; 95% CI, 1.1 to 4.1), functional class III-IV (HR=2.3; 95% CI, 1.1 to 4.6), and number of abnormal cTnT samples (HR=1.6; 95% CI, 1.1 to 2.4) were independently associated with prognosis. A cTnT rise of 0.020 ng/mL in any sample was associated with an excess of 9% (95% CI, 1% to 18%) in the incidence of combined end point. CONCLUSIONS: Abnormal cTnT concentrations were detected in >50% of outpatients with advanced CHF. This ongoing myocardial necrosis was a strong predictor of worsening CHF, suggesting a role of cTnT-based monitoring to identify high-risk patients.

High levels of troponin T are associated with ventricular remodeling and adverse in-hospital outcome in heart failure.

BACKGROUND: Heart failure progression is associated with ventricular remodeling and ongoing myofibrillar degradation. We hypothesized that myocardial damage, detected by high levels of troponin T, would correlate with echocardiographic measurements of left ventricular remodeling and worse in-hospital course in decompensated heart failure. MATERIAL/METHODS: 159 patients with decompensated heart failure without acute coronary event were included. A troponin T value >0.2 ng/ml in samples taken 6, 12 or 24 hours after admission was considered abnormal. RESULTS: High troponin T levels were identified in 24 patients (15%) (Group 1). Mean age for group 1 was 65.9 vs. 63.7 years in patients with troponin T<0.2 (Group 2) (p=ns). Ischemic etiology in groups 1 and 2 was found in 58.3 and 38.5% (p=0.07). Two-dimensional echocardiograms in groups 1 and 2 revealed higher left ventricular diameters, diastolic (61.7+/-10 vs. 56.9+/-10.3 mm, p=0.041) as well as systolic (49.4+/-13.5 vs. 42.0+/-12.0 mm, p=0.012), and lower ejection fraction (30.1+/-14 vs. 39.0+/-17.7%, p=0.03). Incidence of combined end point of death or refractory heart failure was 20.8 and 3.7% in groups 1 and 2 (p=0.007; OR=6.8; CI95%=1.5-31.2). In a multiple regression model, a history of infarction and chronic obstructive pulmonary disease, tissue hypoperfusion, radiographic pulmonary edema, and high troponin T levels emerged as the independent predictors. CONCLUSIONS: High troponin T levels were found in 15% of patients with acute exacerbation of heart failure; this finding was independently associated with worse prognosis. Echocardiograms suggested that more severe ventricular remodeling is one subjacent mechanism related with biochemically detected myocardial injury in this setting.

Cardiac troponin T levels are associated with poor short- and long-term prognosis in patients with acute cardiogenic pulmonary edema.

BACKGROUND: The clinical determinants of increased cardiac troponin T (cTnT) in patients with acute cardiogenic pulmonary edema are not well defined, and the ability of this marker to predict long-term mortality has not yet been documented. METHODS: Eighty-four patients with acute cardiogenic pulmonary edema without acute myocardial infarction were prospectively enrolled. cTnT was measured in samples obtained 6 and 12 hours after admission. RESULTS: cTnT levels of 0.1 ng/mL or greater were found in 46 patients (55%). Thirty-two patients (38%) died during follow-up. The area under the receiver operating characteristic curve for cTnT was 0.70 and 0.69 at 6 and 12 hours (P =.47), and the cTnT cutoff value of 0.1 ng/mL was 66% and 69% sensitive and 63% and 71% specific, respectively, in predicting subsequent mortality. Patients were assigned to group 1 if they had cTnT lower than 0.1 ng/mL and to group 2 if they had cTnT levels of 0.1 ng/mL or greater. A history of coronary artery disease was present in 72% of group 2 versus 50% of group 1 patients (P =.04). Patients in group 2 were also older than those in group 1 (mean age, 68 years vs 61 years; P =.021). The 3-year survival in group 1 was 76% compared with 29% in group 2 (log-rank test, P <.001). In a Cox proportional hazards model, elevated cTnT emerged as the only prognostic marker of long-term mortality (risk ratio [RR] = 2.31; 95% CI, 1.011-5.280; P =.047). CONCLUSIONS: A cTnT level of 0.1 ng/mL or greater was associated with poor long-term survival and emerged as a powerful independent predictor of mortality in patients with acute cardiogenic pulmonary edema.

Indicadores pronósticos en la angina inestable: papel de la troponina T cuantitativa / Prognostic markers in unstable angina: role of the quantitative T-troponine determination

Con el objetivo de identificar marcadores pronósticos en la angina inestable fueron incluídos en este estudio 335 pacientes, a quienes se les realizaron determinaciones de CPK, CK-MB y troponina T entre 6 y 24 horas. A 30 días el 21,9 por ciento tuvo una angina refractaria y el 11,4 por ciento sufrió infarto o murió. Una troponina T mayor o igual 0,1 ng/ml fue considerada positiva, detectándose en el 23,7 por ciento. La angina recurrente y una troponina T > 0,1 ng/ml se asociaron, en el análisis multivariado, con la evolución a infarto o muerte; mientras que ambos predictores, el angor de reposo y el alto riesgo inicial, son marcadores independientes de la evolución a infarto, óbito o angina refractaria

Indicadores pronósticos en la angina inestable: papel de la troponina T cuantitativa / Prognostic markers in unstable angina: role of the quantitative T-troponine determination

Con el objetivo de identificar marcadores pronósticos en la angina inestable fueron incluídos en este estudio 335 pacientes, a quienes se les realizaron determinaciones de CPK, CK-MB y troponina T entre 6 y 24 horas. A 30 días el 21,9 por ciento tuvo una angina refractaria y el 11,4 por ciento sufrió infarto o murió. Una troponina T mayor o igual 0,1 ng/ml fue considerada positiva, detectándose en el 23,7 por ciento. La angina recurrente y una troponina T > 0,1 ng/ml se asociaron, en el análisis multivariado, con la evolución a infarto o muerte; mientras que ambos predictores, el angor de reposo y el alto riesgo inicial, son marcadores independientes de la evolución a infarto, óbito o angina refractaria (AU)