CHA2DS2-VASC score predicts coronary artery disease progression and mortality after ventricular arrhythmia in patients with implantable cardioverter-defibrillator.

AIM: The CHA2DS2-VASC score has expanded its use beyond the initial purpose of predicting the risk of stroke in patients with atrial fibrillation. We aimed to investigate the value of the CHA2DS2-VASC score as a risk assessment tool to predict relevant coronary artery disease (CAD) leading to percutaneous coronary intervention (PCI), and all-cause mortality after detected ventricular arrhythmia (VA) in patients with an Implantable Cardioverter-Defibrillator (ICD). METHODS: A total of 183 ICD-patients who underwent coronary angiography after VA were included and classified according to their CHA2DS2-VASC score in a low(1-3), intermediate(4-5) and high(6-8) score group. We evaluated the predictive value of CHA2DS2-VASC score for the presence of relevant CAD leading to percutaneous coronary intervention (PCI), as well as late all-cause mortality. RESULTS: A total of 60 patients (32.8%) had significant CAD and underwent successful PCI. After adjustment for relevant parameters such as ischemic cardiomyopathy, angina pectoris, left ventricular ejection fraction, CHA2DS2-VASC score remained the only independent predictor of CAD leading to PCI [HR 1.73 (1.07-2.80)]. The Area under curve was 0.64 (0.56-72, p = 0.002). Kaplan-Meier analysis and log-rank showed an increased three-year mortality of ICD-patients with an intermediate or high score after VA (p = 0.003). Multivariate cox-regression analysis revealed that CHA2DS2-VASC score was also independently associated with all-cause mortality following adjustment for clinically relevant variables (HR 2.20, 1.17-4.14). CONCLUSIONS: CHA2DS2-VASC score can be a predictor of CAD leading to PCI in ICD-patients after VA. ICD-Patients with a high score have an increased risk for reduced three-year all-cause mortality after VA.

Prognostic performance of combined use of high-sensitivity troponin T and creatine kinase MB isoenzyme in high cardiovascular risk patients with end-stage renal disease.

BACKGROUND: The principal goal of this study was to determine the importance of high-sensitivity troponin T (hs-TnT) and creatine kinase MB isoenzyme (CK-MB) in predicting cardiovascular events in asymptomatic end-stage renal disease (ESRD) patients. METHODS: This study included 110 participants; 54 ESRD patients undergoing hemodialysis and 56 healthy control participants. Biochemical parameters and cardiac markers were estimated. Comparative utilities were assessed through logistic regression and receiver operating characteristic (ROC) analyses. RESULTS: We found that 96.3% of ESRD patients had an elevated level of hs-TnT (mean, 0.049 ± 0.0324 µg/L) compared to healthy participants. Among patients with ESRD, hs-TnT showed significant correlations with the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (HDL-C) (P = 0.042, r = 0.278) and total cholesterol/HDL-C (P = 0.044, r = 0.276) ratios. CK-MB (odds ratio [OR], 1.138; P = 0.04) and hs-TnT (OR, 2.153; P = 0.017) predicted cardiovascular events on logistic regression analysis, and the prediction was improved by the model that combined two cardiac markers. The diagnostic performance of hs-TnT and CK-MB alone and the combination of the two biomarkers was assessed by the area under the ROC curve (AUC). The highest AUC was produced by the combination of hs-TnT and CK-MB markers (0.920) compared to hs-TnT or CK-MB alone. CONCLUSION: In asymptomatic patients with ESRD, hs-TnT appeared to be an important predictor for cardiovascular mortality, and its diagnostic accuracy improved with CK-MB. This study provides new insights into the predictive value of multiple biomarkers for identifying cardiovascular events in ESRD patients on hemodialysis.

Serum Creatine Kinase-MB Isoenzyme Activity among Subjects with Uncomplicated Essential Hypertension: Any Sex Differences.

Hypertension (high blood pressure) is a major health challenge and more women than men are affected by the condition. Complications as a result of this condition often lead to disabilities and premature death. The objective of this study was to evaluate creatine kinase-MB (CK-MB) activity in uncomplicated hypertension and to know whether sex differences exist in the activity of the enzyme. Serum creatine kinase-MB isoenzyme activity, troponin I, and lipid profile were evaluated in 140 male and 100 female Nigerians with hypertension. The control group was comprised of 100 (50 males and 50 females) normotensive subjects. Measured parameters were assayed using Selectra Pros chemistry analyzer. The means were compared between males and females using Students't-test. The mean CK-MB activity of the female hypertensive subjects was significantly higher (p < 0.001) than the males. Similarly, the mean cardiac troponin I (cTnI) of the female hypertensive subjects was significantly higher (p < 0.001) than the males. Conversely, the mean CK-MB activity of the female normotensive subjects was significantly lower (p < 0.001) than the male counterparts. There was no difference in the levels of cTnI between male and female normotensive subjects. Serum CK-MB activity was higher in female than male hypertensive subjects. In the light of these results, cardiac markers should be routinely done in the evaluation of hypertensive subjects and sex-specific consideration may be recognized in the management of these patients.

Prognostic performance of combined use of high-sensitivity troponin T and creatine kinase MB isoenzyme in high cardiovascular risk patients with end-stage renal disease

BACKGROUND: The principal goal of this study was to determine the importance of high-sensitivity troponin T (hs-TnT) and creatine kinase MB isoenzyme (CK-MB) in predicting cardiovascular events in asymptomatic end-stage renal disease (ESRD) patients. METHODS: This study included 110 participants; 54 ESRD patients undergoing hemodialysis and 56 healthy control participants. Biochemical parameters and cardiac markers were estimated. Comparative utilities were assessed through logistic regression and receiver operating characteristic (ROC) analyses. RESULTS: We found that 96.3% of ESRD patients had an elevated level of hs-TnT (mean, 0.049 ± 0.0324 μg/L) compared to healthy participants. Among patients with ESRD, hs-TnT showed significant correlations with the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (HDL-C) (P = 0.042, r = 0.278) and total cholesterol/HDL-C (P = 0.044, r = 0.276) ratios. CK-MB (odds ratio [OR], 1.138; P = 0.04) and hs-TnT (OR, 2.153; P = 0.017) predicted cardiovascular events on logistic regression analysis, and the prediction was improved by the model that combined two cardiac markers. The diagnostic performance of hs-TnT and CK-MB alone and the combination of the two biomarkers was assessed by the area under the ROC curve (AUC). The highest AUC was produced by the combination of hs-TnT and CK-MB markers (0.920) compared to hs-TnT or CK-MB alone. CONCLUSION: In asymptomatic patients with ESRD, hs-TnT appeared to be an important predictor for cardiovascular mortality, and its diagnostic accuracy improved with CK-MB. This study provides new insights into the predictive value of multiple biomarkers for identifying cardiovascular events in ESRD patients on hemodialysis.

Comprehensive Evaluation of the Diagnostic Value of the Combined Detection of IMA,NLR,hs-CRP and CK-MB for Acute Myocardial Infarction Based on ROC Curve and Logistic Regression Analysis / 现代检验医学杂志

Objective To assess the diagnostic value of IMA,NLR,hs-CRP and CK-MB individually and the combined detec-tion for early acute myocardial infarction using ROC curve and Logistic regression.Methods To detect levels of IMA,NLR, hs-CRP,CK-MB and cTnI in serum or whole blood of AMI patients that had chest pain within 3 hours or between 3 and 6 hours,compared with 60 healthy people from Physical Examination Center.Applied Logistic regression,plotted ROC curve and calculated the area under ROC curve (AUC)to assess the diagnostic value of each index.Results The serum IMA,hs-CRP,CK-MB and cTnI or whole blood NLR levels of AMI patients with 3 hours were remarkably higher than normal con-trol,showing significant statistical difference (P<0.01)(AMI group:mean values of IMA,NLR,hs-CRP,CK-MB and cTnI were 96.04 U/L,3.77,13.39 mg/L,43.26 U/L and 0.063 ng/ml;normal control group:mean values of IMA,NLR,hs-CRP,CK-MB and cTnI were 78.10 U/L,2.02,3.12 mg/L,19.37 U/L and 0.040 ng/ml.The serum IMA,NLR,hs-CRP, CK-MB and cTnI levels of AMI patients in the group between 3~6 hours were higher than in the group within 3 hours (P<0.05).The AUC of combined detection of IMA,NLR,hs-CRP and CK-MB for early AMI was 0.98,higher than solo de-tection of IMA,NLR,hs-CRP and CK-MB,which were 0.89,0.83,0.79 and 0.85 respectively.Meanwhile,the AUC of com-bined detection for four markers also surpassed that of cTnI alone that was recognized as a classic serological marker to diag-nose AMI (AUC=0.78).Conclusion The combined detection of IMA,NLR,hs-CRP and CK-MB is superior to a single in-dex detection,which can significantly improve diagnostic efficiency for early AMI.

New insights in the pathophysiology of acute myocardial infarction detectable by a contemporary troponin assay.

OBJECTIVES: ST-elevation and non-ST-elevation myocardial infarction (STEMI, NSTEMI) are considered two distinct pathophysiologic entities. We evaluated cardiac troponin I (cTnI) release in STEMI and NSTEMI using a "contemporary" (CV>10 to 20% at the 99th percentile concentration) cTnI assay for patients undergoing early percutaneous coronary intervention (PCI). DESIGN AND METHODS: 856 patients with suspected acute coronary syndrome consecutively admitted to the Emergency Department of the Maggiore Hospital of Novara (225 STEMI and 135 NSTEMI) were selected according to: 1) early (≤ 4 h from admission) and successful PCI; and 2) cTnI measurements at ED presentation and within 24h. The influence of the MI type on cTnI concentrations at baseline and after PCI as well as the velocity of cTnI [cTnI V=absolute increase (after log conversion of cTnI measurements)/delay between the two measurements] was studied by multiple regression analysis, adjusting for patient parameters. RESULTS: A statistically significant interaction between MI type and time from symptoms was reported on cTnI concentrations (p<0.0001): STEMI and NSTEMI differed for cTnI releases at admission and after revascularization. Higher cTnI V in STEMI was detectable in patients admitted within 6h from symptoms. Baseline cTnI concentrations were lower in patients with a history of coronary artery disease (CAD) and increased with aging (p<0.0001). In the elderly (>75 years), the cTnI V was significantly increased. CONCLUSION: STEMI and NSTEMI patients have different patterns and dynamics of cTnI release influenced by the interaction with time from symptoms, by aging and history of CAD.

Changes in SGOT and CK - MB Levels during for Open Heart Surgery Anesthesia / 대한마취과학회지

The purpose of this study were to investigate the changes in serum SGOT, CK and CK-MB levels and the significance of these changes during general anesthesia for open heart surgery. Fourteen patients, who had open heart surgery at Kyungpook National University hospital, were chosen at random their serum SGOT, CK and CK-MB levels were recorded before anesthesia(control group), pre cardiopulmonary bypass, during cardiopulmonary bypass and in the recovery room. The results were as follows: The serum SGOT levels were 21.83+/-4.91 IU/L, 27.20+/-11.83, 34.81+/-16.60 and 72.58+/-37.77, respectively. They very significantly increased (p<0.01) during cardiopulmonary bypass and recovery room compared with pre anesthesia. The serum CK levels were 58.07+/-6.31 IU/L, 91.79+/-44.58, 141.93+/-66.55 and 347.43+/-84.61 respectively. They significantly increased (p<0.05) at pre cardiopulmonary bypass, very significantly increased(p<0.01) during cardiopulmonary hypass and recovery room compared with the preanesthesia. The serum CK-MB levels were 0.00 U/L, 4.54+/-11.80, 14.66+/-17.61 and 80.07+/-34.72 respectively. They very significantly increased(p<0.01) during the cariopulmonary bypass and recovery room.