Dog-Assisted Therapy vs Relaxation for Children and Adolescents with Fetal Alcohol Spectrum Disorder: A Randomized Controlled Study.

The rationale of this study was to evaluate the efficacy of Dog-assisted Therapy (DAT) in children and adolescents with Fetal Alcohol Spectrum Disorder (FASD). We conducted a randomized controlled trial in a cohort of 71 children and adolescents with FASD. Participants were randomly assigned either to DAT group (n = 38) or Relaxation Group (control group) (n = 33). Results revealed that participants who were assigned to the DAT group experienced significantly reduced externalizing symptoms (CBCL Externalizing Inattention: t (69) = 2.81, p = .007; d = 0.7); CBCL Opposition: t (69) = 2.54, p = .013; d = 0.6), reduced internalizing symptoms (CBCL Social problems: t (69) = 3.21, p = .002; d = 0.8) as well as improvements on social skills (SSIS-P Problem behavior: t (68) = 2.55, p = .013; d = 0.6), and quality of life (KidScreen Autonomy and Parents: t (51) = - 2.03, p = .047; d = 0.5) compared to the relaxation control group. The relaxation control group obtained significant differences between the pre- and post-treatment evaluation, diminishing withdraw symptoms (t (32) = 3.03, p = .005; d = 0.2). Results suggest that DAT and relaxation may be promising adjunctive treatments for children and adolescents with FASD.Clinical trial registration information: http://clinicaltrials.gov/ ; NCT04038164.

Coronary Plaque Erosion after Abemaciclib Treatment Onset: An Unknown Side Effect?

The current article describes a 72-year-old woman who suffered an acute myocardial infarction due to plaque erosion (PE) 2 weeks after abemaciclib treatment onset due to advanced breast cancer. Abemaciclib is a cyclin-dependent kinase 4 and 6 inhibitor that has recently demonstrated efficacy and safety in advanced breast cancer. Of major concern, however, reported thromboembolic rates in randomized clinical trials testing this drug range from 0.6 to 5%. To the best of our knowledge this is the first thrombotic coronary side effect ever reported. We suggest that a treatment that increases thromboembolic risk, such abemaciclib, may have triggered PE in our patient, 15 days after abemaciclib initiation. New molecules are promising in cancer treatment; however, care must be paid to their potential cardiotoxic effects.

Valoración del maltrato psicológico por su pareja en las mujeres inmigrantes residentes en una zona básica de salud / Evaluation of psychological maltrate for its partner in immigrant women resident in basic health zone

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Valores seriados de galectina-3 a corto plazo en pacientes hospitalizados por insuficiencia cardiaca aguda / Short-term serial measurement of galectin-3 in hospitalized patients with acute heart failure

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TWEAK and NT-proBNP levels predict exercise capacity in hypertrophic cardiomyopathy.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is characterized by inappropriate hypertrophy, myocyte disarray and increased interstitial fibrosis. The tumour necrosis factor-like weak inducer of apoptosis (TWEAK) is a cell surface cytokine with biological activities including stimulation of cell growth, induction of inflammatory cytokines and stimulation of apoptosis. There are controversial data about the potential role of TWEAK in different cardiovascular pathologies. NT-proBNP is an established biomarker of myocardial wall stress, associated with poor functional class in HCM. We hypothesized that effort capacity in patients with HCM could be related to serum levels of these biomarkers. MATERIALS AND METHODS: We included 40 haemodynamic stable HCM patients and 53 healthy controls with similar sex and age. We studied exercise capacity by maximal oxygen consumption in a limited treadmill exercise test. TWEAK and NT-proBNP were assayed by ELISA method and automated Elecsys® platform, respectively. We obtained 46 samples of myocardial tissues by septal myectomy in patients with HCM and evaluated myocardial fibrosis, immunoreaction with TWEAK antibody and apoptosis with TUNEL assay. RESULTS: We found raised TWEAK and NT-proBNP serum levels in patients when compared with control levels (both P < 0.001). In a multivariate analysis, TWEAK and NT-proBNP levels, as well as sex, remained independently associated with the effort capacity (all P < 0.05). We found an association between immunoreaction degree and the degree of myocardial fibrosis (P = 0.021), as well as apoptosis (P = 0.002) in the tissue samples from patients undergoing septal myectomy. CONCLUSIONS: TWEAK and NT-proBNP levels are biomarkers of disease severity independently associated with the effort capacity in patients with HCM.

Interleucina 6 y proteína C reactiva ultrasensible para la predicción de la evolución clínica en síndromes coronarios agudos sin elevación del segmento ST / Interleukin-6 and high-sensitivity C-reactive protein for the Prediction of outcomes in non-ST-segment elevation acute coronary syndromes

Introducción y objetivos. Las concentraciones basales de interleucina 6 y proteína C reactiva elevadas comportan un aumento del riesgo de muerte en el síndrome coronario agudo sin elevación del segmento ST. El objetivo del estudio es delucidar si las determinaciones seriadas de interleucina 6 y proteína C reactiva ultrasensible aportan información pronóstica adicional a las determinaciones basales para la estratificación del riesgo a largo plazo de los pacientes con síndrome coronario agudo sin elevación del segmento ST. Métodos. Se incluyó prospectivamente en el estudio a 216 pacientes consecutivos con síndrome coronario agudo sin elevación del segmento ST. Se obtuvieron muestras de sangre en un plazo de 24 h tras el ingreso en el hospital y a los 30 días de seguimiento. La variable de valoración principal fue la combinación de muerte por todas las causas, infarto de miocardio no mortal e insuficiencia cardiaca aguda descompensada. Resultados. Las concentraciones tanto de interleucina 6 como de proteína C reactiva ultrasensible se redujeron del día 1 al día 30, con independencia de los eventos adversos aparecidos (p < 0,001 en ambos casos). Los valores de interleucina 6 en los dos momentos de valoración (día 1, por pg/ml; hazard ratio = 1,006; intervalo de confianza del 95%, 1,002-1,010; p = 0,002; día 30, por pg/ml; hazard ratio = 1,047; intervalo de confianza del 95%, 1,021-1,075; p < 0,001) fueron predictores independientes de eventos adversos, pero no los de proteína C reactiva ultrasensible del día 1 y el día 30. Los pacientes con interleucina 6 el día 1 <= 8,24 pg/ml y el día 30 <= 4,45 pg/ml fueron los que presentaron la tasa de eventos adversos más baja (4,7%), mientras que los pacientes con valores superiores a la mediana de ambos parámetros fueron los que tuvieron la tasa de eventos adversos más alta (35%). Después de la adición de la interleucina 6 del día 30 al modelo multivariable, el índice C aumentó de 0,71 (intervalo de confianza del 95%, 0,63-0,78) a 0,80 (intervalo de confianza del 95%, 0,72-0,86, p = 0,042) y la mejora neta de la reclasificación fue de 0,39 (intervalo de confianza del 95%, 0,14-0,64; p = 0,002). Conclusiones. En esta población, tanto la concentración de interleucina 6 como la de proteína C reactiva ultrasensible se reducen tras la fase aguda. La determinación de las concentraciones de interleucina 6 en muestras seriadas mejora la estratificación pronóstica del riesgo en estos pacientes (AU)

Introduction and objectives. High baseline levels of interleukin-6 and C-reactive protein confer an increased risk of mortality in non-ST-segment elevation acute coronary syndrome. The aim of the study was to determine whether serial measurements of interleukin-6 and high-sensitivity C-reactive protein provide additional information to baseline measurements for risk stratification of non-ST-segment elevation acute coronary syndrome. Methods. Two hundred and sixteen consecutive patients with non-ST-segment elevation acute coronary syndrome were prospectively included. Blood samples were obtained within 24h of hospital admission and at 30 days of follow-up. The endpoint was a composite of all-cause death, nonfatal myocardial infarction, or acute decompensated heart failure. Results. Both interleukin-6 and high-sensitivity C-reactive protein levels decreased from day 1 to day 30, regardless of adverse events (both P<.001). Interleukin-6 levels at 2 time points (interleukin-6 day 1, per pg/mL; hazard ratio=1.006, 95% confidence interval, 1.002-1.010; P=.002 and interleukin-6 day 30, per pg/mL, hazard ratio=1.047, 95% confidence interval, 1.021-1.075, P<.001) were independent predictors of adverse events, whereas high-sensitivity C-reactive protein day 1 and high-sensitivity C-reactive protein day 30 levels were not. Patients with interleukin-6 day 1<=8.24 pg/mL and interleukin-6 day 30<=4.45 pg/mL had the lowest event rates (4.7%), whereas those with both above the median values had the highest event rates (35%). After addition of interleukin-6 day 30 to the multivariate model, C-index increased from 0.71 (95% confidence interval, 0.63-0.78) to 0.80 (95% confidence interval, 0.72-0.86), P=.042, and net reclassification improvement was 0.39 (95% confidence interval, 0.14-0.64; P=.002). Conclusions. In this population, both interleukin-6 and high-sensitivity C-reactive protein concentrations decreased after the acute phase. Serial samples of interleukin-6 concentrations improved the prognostic risk stratification of these patients (AU)

Sexual dimorphism in renal heme-heme oxygenase system in the streptozotocin diabetic rats.

Heme Oxygenase (HO) -1 and -2 exert antioxidant, cytoprotective and vascular actions in male diabetic rats. However, there is no information about the expression and functional significance of the renal HO system in diabetic females. The present study tested the hypothesis that the HO system is differentially regulated in the kidney of female Sprague Dawley diabetic rats, protecting it from nitrosative and glomerular functional damage. Two weeks after the administration of streptozotocin (STZ; 65 mg/kg. i.p), males (DM) and females (DF) showed hyperglycemia, polyuria and elevated kidney/body weight ratio, compared to their control males (CM) and females (CF). In conscious animals, creatinine clearance was higher (0.5 ± 00 vs. 0.3 ± 00; ml/min/100g BW; p<0.05) and urinary albumin excretion was lower (0.7 ± 0.3 vs 3.1 ± 0.7; mg/day) in DF compared to DM. Acute administration of a HO inhibitor stannous mesoporphyrin (SnMP 40 mol/kg, i.v.) induced a greater renal vasoconstrictor response in DF than in DM. Western blot analysis of renal tissue revealed higher renal cortex HO-1 protein levels in DF compared to all other groups; by immunohistochemistry this induction of HO-1 in DF was localized in tubular segments and glomeruli. Furthermore, renal cortical concentration of nitrosylated protein was higher in DM than in DF animals and inversely related with HO-1 levels in both renal cortex and medulla. These data demonstrate that the HO-1 protein is induced in females, associated with renal vasodilation, decreased renal nitrosative stress and reduced albuminuria, indicating that the HO system is protecting the kidney from diabetes-induced damage specifically in females.

Interleukin-6 and high-sensitivity C-reactive protein for the prediction of outcomes in non-ST-segment elevation acute coronary syndromes.

INTRODUCTION AND OBJECTIVES: High baseline levels of interleukin-6 and C-reactive protein confer an increased risk of mortality in non-ST-segment elevation acute coronary syndrome. The aim of the study was to determine whether serial measurements of interleukin-6 and high-sensitivity C-reactive protein provide additional information to baseline measurements for risk stratification of non-ST-segment elevation acute coronary syndrome. METHODS: Two hundred and sixteen consecutive patients with non-ST-segment elevation acute coronary syndrome were prospectively included. Blood samples were obtained within 24 h of hospital admission and at 30 days of follow-up. The endpoint was a composite of all-cause death, nonfatal myocardial infarction, or acute decompensated heart failure. RESULTS: Both interleukin-6 and high-sensitivity C-reactive protein levels decreased from day 1 to day 30, regardless of adverse events (both P<.001). Interleukin-6 levels at 2 time points (interleukin-6 day 1, per pg/mL; hazard ratio=1.006, 95% confidence interval, 1.002-1.010; P=.002 and interleukin-6 day 30, per pg/mL, hazard ratio=1.047, 95% confidence interval, 1.021-1.075, P<.001) were independent predictors of adverse events, whereas high-sensitivity C-reactive protein day 1 and high-sensitivity C-reactive protein day 30 levels were not. Patients with interleukin-6 day 1≤8.24 pg/mL and interleukin-6 day 30≤4.45 pg/mL had the lowest event rates (4.7%), whereas those with both above the median values had the highest event rates (35%). After addition of interleukin-6 day 30 to the multivariate model, C-index increased from 0.71 (95% confidence interval, 0.63-0.78) to 0.80 (95% confidence interval, 0.72-0.86), P=.042, and net reclassification improvement was 0.39 (95% confidence interval, 0.14-0.64; P=.002). CONCLUSIONS: In this population, both interleukin-6 and high-sensitivity C-reactive protein concentrations decreased after the acute phase. Serial samples of interleukin-6 concentrations improved the prognostic risk stratification of these patients.

La concentración sérica de adiponectina como biomarcador de calcificación arterial coronaria y lesiones coronarias graves / Serum adiponectin level as a biomarker of coronary artery calcification and severe coronary lesions

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[Hospitalized children's parents' anxiety in critical care units]. / Ansiedad en padres de niños hospitalizados en unidades críticas.

UNLABELLED: Child hospitalization is a potentially stressful process that affects both patients and family members. OBJECTIVE: Describe the anxiety that the parents of admitted children at a Intensive Care Units, Pediatric (PICU) and/or Neonatal (NICU) during the first week of hospitalization. MATERIAL AND METHOD: Observational study descriptive, transversal conducted at the Gregorio Marañón Hospital, in PICU and NICU. The inclusion criteria were: patients who didn't exceed the week admitted but they were at hospital more than one day, patients whose therapeutic effort wasn't limited and spanish-speaker parents. The sample size was 60 parents. We designed a questionnaire to measure sociodemographic variables and others related with the social support. The resulting variable, anxiety like State Anxiety (SA) and Trait Anxiety (TA) were determined by the STAI inventory. RESULTS: All the parents showed anxiety the average females SA was 44.59 (+/- 8.02) while the average of men was 44.32 (+/- 6.69). The results show a TA average of 34.73 (+/- 4.09) in woman and 34.95 (+/- 4.93) in men. 83% of the parents of the sample participated in their child caring, having this variable relationship with level of SA (p<0.05). Moreover 98% of parents understood the information given and were satisfied with it. CONCLUSION: All the parents presented anxiety, both SA and TA. They felt informed and supported by nurse. All these actions are directed towards an integral attention taking into account the family as the unit.

Highly sensitive troponin T for risk stratification of acutely destabilized heart failure.

BACKGROUND: A highly sensitive assay for troponin T (hsTnT) has been recently developed, which allows for the detection of even minor myocardial necrosis with high precision. It remains unexplored whether hsTnT provides incremental prognostic accuracy beyond conventional (c)TnT in patients with acutely decompensated heart failure (ADHF). METHODS: A total of 202 consecutive patients admitted with ADHF and without criteria for acute myocardial infarction were studied. Troponin T was measured using the highly sensitive assay and compared with the conventional method. Patients were clinically followed up at a median of 406 days, with a primary outcome measure of all-cause mortality. RESULTS: The high-sensitive assay detected measurable TnT in 98% of patients vs 56% for cTnT; 81% had an hsTnT above the 99th percentile for a healthy reference population, and it reclassified 60% of those with undetectable cTnT. Both TnT methods predicted the risk of death in adjusted multivariable Cox regression analyses, without a superiority of hsTnT over cTnT in the entire population (area under the curve 0.67 vs 0.71, P = .2). Among patients with a cTnT below 0.03 ng/mL (the lowest cut-point with <10% imprecision; n = 134), solely hsTnT improved the prediction of death over clinical risk factors (relative integrated discrimination improvement +36%, P = .01) and hsTnT above 20 pg/mL identified a significant higher risk of death (hazard ratio 4.7, 95% CI 1.6-13.8, P = .005). CONCLUSION: Among patients with ADHF, myocardial necrosis (as detected with the hsTnT assay) was nearly ubiquitous. The highly sensitive assay for TnT provides comparable prognostic information to cTnT overall, but among those in whom the cTnT method was less precise or frankly negative, the hsTnT assay provided prognostic information.

Ansiedad en padres de niños hospitalizados en unidades críticas / Hospitalized children's parents' anxiety in critical care units

La hospitalización infantil es un proceso potencialmente estresante que afecta al paciente y su familia. Objetivo: describir la ansiedad de padres de pacientes ingresados en Unidades de Cuidados Intensivos Pediátricas (UCIP) y/o Neonatales (UCIN), durante la primera semana de hospitalización. Material y método: estudio observacional descriptivo transversal desarrollado en el Hospital Universitario Gregorio Marañón, en UCIP y UCIN. Los criterios de inclusión fueron: padres de pacientes que no excedieran de una semana ingresados pero que lo estuvieran más de un día, de pacientes sin esfuerzo terapéutico limitado y padres hispano hablantes. La muestra consta de 60 padres. A través de un cuestionario de elaboración propia se midieron variables sociodemográficas y relacionadas con el apoyo social. La variable resultado ansiedad, como ansiedad estado (AE) y rasgo (AR) se determinó con el cuestionario STAI. Resultados: toda la muestra presentó ansiedad, la media en mujeres indicó AE 44,59 ('b18,02), y en hombres de 44,32('b16,69). La AR en mujeres supuso 34,73 ('b14,09) y en hombres de 34,95('b14,93). El 83% de los padres participó en el cuidado de su hijo, teniendo esta relación variable con la AE (p<0,05). Además un 98% entendió la información y se sintió satisfecha con ella. Conclusión: todos los padres presentan ansiedad, tanto AE como AR. Destacamos que se sintieron informados y apoyados por el personal de enfermería. Todas estas acciones nos encaminan hacia una atención integral, teniendo en cuenta a la familia como unidad asistencial(AU)

Child hospitalization is a potentially stressful process that affects both patients and family members. Objective: Describe the anxiety that the parents of admitted children at a Intensive Care Units, Pediatric (PICU) and/or Neonatal (NICU) during the first week of hospitalization. Material and method: Observational study, descriptive, transversal conducted at the Gregorio Marañón Hospital, in PICU and NICU. The inclusion criteria were: patients who didn’t exceed the week admitted but they were at hospital more than one day, patients whose therapeutic effort wasn’t limited and spanish-speaker parents. The sample size was 60 parents. We designed a questionnaire to measure sociodemographic variables and others related with the social support. The resulting variable, anxiety, like State Anxiety (SA) and Trait Anxiety (TA) were determined by the STAI inventory. Results: All the parents showed anxiety, the average females SA was 44.59 ('b18.02) while the average of men was 44.32('b16.69). The results show a TA average of 34.73 ('b14.09) in woman and 34.95('b14.93) in men. 83% of the parents of the sample participated in their child caring, having this variable relationship with level of SA (p<0.05). Moreover, 98% of parents understood the information given and were satisfied with it. Conclusion: All the parents presented anxiety, both SA and TA. They felt informed and supported by nurse. All these actions are directed towards an integral attention taking into account the family as the unit(AU)

High-sensitivity troponin T and copeptin in non-ST acute coronary syndromes: implications for prognosis and role of hsTnT and copeptin in non-STEACS.

UNLABELLED: High-sensitivity TnT (hsTnT) has been proposed to improve the diagnosis and stratification in acute coronary syndromes. Copeptin has been proposed for a rapid and accurate rule out of acute myocardial infarction, but some doubts exist about its use out of the first hours from admission. Abnormalities of serum hsTnT and copeptin levels in non-STEACS and negative TnT, could have prognostic implications. METHODS: We included 122 non-STEACS patients without raised TnT, 33 disease controls and 43 healthy controls. We measured hsTnT and copeptin levels. Clinical follow-up at 12 months was performed for adverse endpoints. RESULTS: Non-STEACS patients had raised hsTnT compared with both control groups (P = 0.036 and P < 0.001). Copeptin levels were higher in non-STEACS patients than healthy controls (P = 0.021), without differences with disease controls. Raised levels of hs-TnT presented prognostic implications [HR 3.29 (95%CI: 1.33-7.49), P = 0.010]. hs-TnT could be used for invasive approach decision, as it shows prognostic relevance in conservative approach-patients whereas remains unrelevant for catheterized-patients. Copeptin levels were not associated with adverse events. CONCLUSION: hsTnT levels increased in non-STEACS, were predictive of adverse events and could be important for recommending an invasive management. We cannot confirm a predictive role of copeptin out of the first hours from admission.

Growth differentiation factor-15, a novel biomarker related with disease severity in patients with hypertrophic cardiomyopathy.

BACKGROUND: The growth differentiation factor 15 (GDF-15) has been shown up-regulated in stress conditions and to have regulatory actions in myocyte hypertrophy. We hypothesized that GDF-15 could be related to disease severity and functional status in patients with hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS: We performed a study which includes 102 consecutive outpatient HCM subjects, 73% males, aged 47.1±14.6 years. A complete history and clinical examination was performed, including 12-lead electrocardiogram, echocardiography, symptom-limited treadmill exercise, 24-hour ECG-Holter monitoring, and magnetic resonance with Gadolinium. Several biomarkers, associated with myocardial remodeling and damage, were compared to GDF-15 levels. The assays were performed with commercial ELISAs or standardized methods when available. There was a significant association between GDF-15 levels and comorbidities, being higher in hypertension (p=0.001), diabetes (p=0.030), atrial fibrillation (p=0.012), dyspnea (p=0.020) and NYHA≥II functional class (p=0.037). GDF-15 levels were positively correlated with clinical variables (age, worse exercise capacity and mild renal dysfunction) and biomarkers of interstitial remodeling, such as metalloproteinase-2 (r: 0.40; p=0.009), N-terminal pro-B-type natriuretic peptide (r: 0.28; p=0.049), high-sensitivity troponin T (r: 0.30; p=0.003) and von Willebrand factor (r: 0.33; p=0.001). Multivariate analysis was assessed to estimate the involvement of these different factors in the GDF-15 levels, confirming the independent implication of severe dyspnea and functional status. CONCLUSIONS: The present results show that higher levels of GDF-15 are associated to conditions of severe disease in HCM. Hence, GDF-15 is suggested as a novel marker related to the severity and could represent a further useful tool in monitoring functional capacity of HCM patients.

Utilidad de la prueba de troponina T de alta sensibilidad en la detección de rechazo agudo en trasplante cardiaco / Usefulness of high sensitivity troponin T assay in detecting acute allograft rejection after heart transplantation

Introducción y objetivos. La detección del rechazo agudo en pacientes trasplantados cardiacos mediante métodos no invasivos representa un reto. La disponibilidad de un nuevo método de alta sensibilidad para la determinación de troponina T podría ayudar a su detección. Métodos. Estudio case-crossover, en el que cada paciente sirvió como control de sí mismo, mediante la selección de muestras obtenidas en episodios de rechazo agudo tratados (29 casos) y muestras sin rechazo obtenidas inmediatamente antes y/o después (38 controles). La determinación de alta sensibilidad de troponina T se realizó mediante un nuevo test precomercial (Elecsys Troponina T HS). Resultados. La troponina T fue detectable en todas las muestras: mediana, 0,068 [intervalo intercuartílico, 0,030-0,300] ng/l. Sus concentraciones se correlacionaron con la presión auricular derecha (r=0,37; p=0,002), la fracción aminoterminal del propéptido natriurético cerebral (r=0,67; p<0,001) y el tiempo transcurrido desde el trasplante (r=–0,81; p<0,001). Las concentraciones de troponina T fueron mayores en presencia de rechazo (0,155 frente a 0,047 ng/l; p=0,006). En el análisis operador-receptor, el área bajo la curva fue 0,67 (intervalo de confianza del 95%, 0,53-0,77) y el mejor punto de corte, 0,035 ng/l, que se asoció con mayor riesgo de rechazo (odds ratio=3,7; intervalo de confianza del 95%, 1,2-11,9; p=0,02). Durante los primeros 2 meses, el área bajo la curva aumentó hasta 0,86 (intervalo de confianza del 95%, 0,66-0,97), con un punto de corte óptimo de 1,1 ng/l (sensibilidad, 58% [28-85%]; especificidad, 100% [74-100%]). Conclusiones. El análisis de alta sensibilidad detectó troponina T en todas las muestras tras el trasplante, en mayor concentración en caso de rechazo agudo, si bien su utilidad en la monitorización se limitaría a servir como apoyo ante la sospecha clínica o histológica, especialmente en los primeros meses (AU)

Introduction and objectives. Detection of acute allograft rejection in heart transplant recipients by noninvasive methods is a challenge in the management of these patients. In this study, the usefulness of a new highly sensitive method for the measurement of troponin T is evaluated. Methods. We designed a case-crossover study, in which each patient served as his or her own control, by selecting samples from treated acute rejection episodes (29 cases) and samples obtained immediately before and/or after rejection (38 controls). The highly sensitive troponin T was measured by a new pre-commercial test (Elecsys Troponin T HS). Results. In all samples, highly sensitive troponin was detectable, with a median of 0.068 ng/mL (IQR, 0.030-0.300 ng/mL). The levels correlated with right atrial pressure (r=0.37; P=.002), N-terminal pro-brain natriuretic peptide concentration (r=0.67; P<.001), and time since transplantation (r=–0.81; P<.001). The highly sensitive troponin concentrations were higher in patients with rejection (0.155 ng/mL vs 0.047 ng/mL; P=.006). In the receiver operating characteristic analysis, the area under the curve was 0.67 (95% confidence interval, 0.53-0.77) and the best cutoff was 0.035 ng/mL, which was associated with rejection (odds ratio=3.7; 95% confidence interval, 1.2-11.9; P=.02). By restricting the analysis to the first 2 months, the area under the curve increased to 0.86 (95% confidence interval 0.66-0.97), with an optimal cutoff of 1.10 ng/mL (S=58% [28%-85%]; E=100% [74%-100%]). Conclusions. Troponin T was detectable in all samples when a new highly sensitive assay was used, and at higher concentrations in the presence of acute rejection; however, the usefulness of this test in patient management is limited to support for clinical or histological suspicion of rejection, especially in the early post-transplant period (AU)

[Usefulness of high sensitivity troponin T assay in detecting acute allograft rejection after heart transplantation]. / Utilidad de la prueba de troponina T de alta sensibilidad en la detección de rechazo agudo en trasplante cardiaco.

INTRODUCTION AND OBJECTIVES: Detection of acute allograft rejection in heart transplant recipients by noninvasive methods is a challenge in the management of these patients. In this study, the usefulness of a new highly sensitive method for the measurement of troponin T is evaluated. METHODS: We designed a case-crossover study, in which each patient served as his or her own control, by selecting samples from treated acute rejection episodes (29 cases) and samples obtained immediately before and/or after rejection (38 controls). The highly sensitive troponin T was measured by a new pre-commercial test (Elecsys Troponin T HS). RESULTS: In all samples, highly sensitive troponin T was detectable, with a median of 0.068 ng/L (IQR, 0.030-0.300 ng/L). The levels correlated with right atrial pressure (r=0.37; P=.002), N-terminal pro-brain natriuretic peptide concentration (r=0.67; P<.001), and time since transplantation (r=-0.81; P<.001). The highly sensitive troponin T concentrations were higher in patients with rejection (0.155 ng/mL vs 0.047 ng/mL; P=.006). In the receiver operating characteristic analysis, the area under the curve was 0.67 (95% confidence interval, 0.53-0.77) and the best cutoff was 0.035 ng/mL, which was associated with rejection (odds ratio=3.7; 95% confidence interval, 1.2-11.9; P=.02). By restricting the analysis to the first 2 months, the area under the curve increased to 0.86 (95% confidence interval 0.66-0.97), with an optimal cutoff of 1.10 ng/mL (S=58% [28%-85%]; E=100% [74%-100%]). CONCLUSIONS: Troponin T was detectable in all samples when a new highly sensitive assay was used, and at higher concentrations in the presence of acute rejection; however, the usefulness of this test in patient management is limited to support for clinical or histological suspicion of rejection, especially in the early post-transplant period.