Diagnostic and prognostic value of neopterin and RNA-ase in patients with STEMI and NSTEMI

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Ciobanu ◽  
I Popovici ◽  
V Ivanov ◽  
V Cobet ◽  
M Ivanov ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diagnostic Value ◽  
Public Institution ◽  
Funding Source ◽  
Extracellular Rna ◽  
Diagnosis And Prognosis ◽  
Markers Of Inflammation ◽  
Neopterin Level ◽  
Diagnostic And Prognostic Value

Abstract Background Neopterin and RNA-ase are markers of inflammation with low disclosed role in diagnosis and prognosis of either STEMI or NSTEMI, although inflammation is well documented as a leader pathogenic mechanism in these pathologies. Aim Evaluation of serum admission levels of neopterin and ARN-ase in pts with STEMI and NSTEMI and their prediction value concerning the risk of MACE in 1 year of follow up period. Material and methods The admission serum concentration of neopterin and ARN-ase was determined by ELISA in 94 pts with STEMI and 92 pts with NSTEMI which was compared with normal markers appreciated in 32 healthy persons. Likewise, the rate of MACE in both groups was estimated during 1 year of post-infarction period. Diagnostic worth and MACE prediction power of markers have been established using respectively ROC curve and odds ratio. Results In patients with STEMI the serum level of neopterin was significantly increased compared with normal index by 3,5 times (11,6±3,4 vs 3,3±1,4 nM/L), but RNA-ase was significantly decreased by 43,4% (24,1±3,2 vs 42,6±5,2 nM/ml). In pts with NSTEMI neopterin level was lesser than STEMI, but significantly elevated by 39% (4,6±2,5 vs 3,3±1,4 nM/L) vs normal marker. RNA-ase level didn't significantly differ from normal level. However, adjusted to diabetes mellitus established in 19 pts, RNA-ase significantly diminished (36,4±3,9 vs 42,6±5,2 nM/ml), and its diagnostic value of NSTEMI according to ROC was 69,6% (RNA-ase level indicates inversely inflammation response, such as it breaks down extracellular RNA which has proinflammatory ability). Both markers in pts with NSTEMI and diabetes mellitus demonstrated a diagnostic value of 77,6%. In pts with STEMI highest tertile level of neopterin and lowest tertile level of ARN-ase had 2,8fold (adds ratio=2,8; CI=1,98–4,62; p<0,05) and 2,3fold (adds ratio=2,3; CI=1,71–3,89; p<0,05) higher risk of MACE development. In pts with NSTEMI the combination of these markers (highest and lowest quartile levels) also had a significant prediction regarding MACE risk (adds ratio=2,1; CI=1,86–3,77; p=0,029). Conclusions 1. In STEMI both neopterin and RNA-ase could be as diagnostic markers, due to their significant change. In NSTEMI neopterin significantly elevated, but RNA-ase didn't shift from normal. In diabetic pts with NSTEMI, however, their combination demonstrated in ROC estimation a diagnostic value of 77,6%. 2. Prediction value of markers combination regarding MACE risk in pts with NSTEMI is significant and close to each marker in partly prediction of MACE for pts with STEMI. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Research Institute of Cardiology, Moldova Republic of

Coronary sinus catalase and ceruloplasmin levels predict all-cause mortality in patients with end-stage heart failure awaiting heart transplantation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W Szczurek ◽  
M Gasior ◽  
M Skrzypek ◽  
G Kubiak ◽  
A Kuczaj ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Coronary Sinus ◽  
Public Institution ◽  
Funding Source ◽  
Organ Shortage ◽  
Number Of Patients ◽  
End Stage ◽  
Medical University

Abstract   Background, As a consequence of the worldwide increase in life expectancy and due to significant progress in the pharmacological and interventional treatment of heart failure (HF), the proportion of patients that reach an advanced phase of disease is steadily growing. Hence, more and more numerous group of patients is qualified to the heart transplantation (HT), whereas the number of potential heart donors has remained invariable since years. It contributes to deepening in disproportion between the demand for organs which can possibly be transplanted and number of patients awaiting on the HT list. Therefore, accurate identification of patients who are most likely to benefit from HT is imperative due to an organ shortage and perioperative complications. Purpose The aim of this study was to identify the factors associated with reduced survival during a 1.5-year follow-up in patients with end-stage HF awating HT. Method We propectively analysed 85 adult patients with end-stage HF, who were accepted for HT at our institution between 2015 and 2016. During right heart catheterization, 10 ml of coronary sinus blood was additionally collected to determine the panel of oxidative stress markers. Oxidative-antioxidant balance markers included glutathione reductase (GR), glutathione peroxidase (GPx), glutathione transferase (GST), superoxide dismutase (SOD) and its mitochondrial isoenzyme (MnSOD) and cytoplasmic (Cu/ZnSOD), catalase (CAT), malondialdehyde (MDA), hydroperoxides lipid (LPH), lipofuscin (LPS), sulfhydryl groups (SH-), ceruloplasmin (CR). The study protocol was approved by the ethics committee of the Medical University of Silesia in Katowice. The endpoint of the study was mortality from any cause during a 1.5 years follow-up. Results The median age of the patients was 53.0 (43.0–56.0) years and 90.6% of them were male. All included patients were treated optimally in accordance with the guidelines of the European Society of Cardiology. Mortality rate during the follow-up period was 40%. Multivariate logistic regression analysis showed that ceruloplasmin (odds ratio [OR] = 0.745 [0.565–0.981], p=0.0363), catalase (OR = 0.950 [0.915–0.98], p=0.0076), as well as high creatinine levels (OR = 1.071 [1.002–1.144], p=0.0422) were risk factors for death during 1.5 year follow-up. Conclusions Coronary sinus lower ceruloplasmin and catalase levels, as well as higher creatinine level are independently associated with death during 1.5 year follow-up. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of SIlesia, Katowice, POland

The GLP-1 receptor agonist Semaglutide decreases vascular inflammation in a rabbit model of advanced atherosclerosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Kildevang Jensen ◽  
C Grandjean Poulsen ◽  
T Binderup ◽  
S Bentsen ◽  
B Follin ◽  
...  
Keyword(s):  
Molecular Imaging ◽  
Receptor Agonist ◽  
Vascular Inflammation ◽  
Rabbit Model ◽  
Public Institution ◽  
Ct Scans ◽  
Control Group ◽  
Funding Source ◽  
Pet Ct

Abstract Introduction Atherosclerosis is one of the most common inflammatory disorders leading to cardiovascular disease. Incretin therapies such as Glucagon like peptide 1 (GLP-1) receptor agonists has demonstrated efficacy in reducing major adverse cardiovascular events among high risk populations, possibly due to a reduction in vascular inflammation. Positron emission tomography (PET) is a promising modality in the study of atherosclerosis since it has the ability to evaluate physiological processes in vivo. The somatostaton receptor 2 (SSTR2) targeting tracer [64Cu]Cu-DOTA-TATE (DOTATATE) has high specificity for activated macrophages, which are one on the key instigators of atherosclerosis. Two other radiotracers, more commonly used to study atherosclerosis are Na[18F]F (NaF) a radiotracer used for detection of vascular microcalcifications, and [18F]FDG (FDG) used for visualization of inflammatory metabolic activity. Purpose The purpose of this study was to evaluate the anti-atherosclerotic and anti-inflammatory effects of the GLP-1 receptor agonist Semaglutide, using molecular imaging with DOTATATE, NaF and FDG, in a rabbit model of advanced atherosclerosis. Methods A total of 23 female New Zealand White rabbits were fed a high cholesterol diet for 4 months and endothelial denudation of the aorta was performed twice (Fig 1A). The animals underwent baseline PET/CT scans using DOTATATE and FDG. They were then randomly allocated to an intervention group (n=12) or control group (n=11) receiving bi- weekly subcutaneous injections of either Semaglutide in a dose escalating regimen up to 44 μg/kg/week, or placebo (n=11). The intervention period was 16 weeks for both groups. At follow-up, the animals underwent PET/CT scans with DOTATATE, FDG and NaF. Regions of interest were drawn on all CT scans of the aorta from the right renal artery to the iliac bifurcation, and SUVmax was measured from the superimposed PET scans. Data are presented as means ± SEM. Results SUVmax for FDG and DOTATATE were similar in the 2 groups at baseline (DOTATATE: 7.59±0.48 vs 6.69±0.28, P=0.13 and FDG: 2.63±0.12 vs 2.86±0.19 P=0.29). At follow-up, the Semaglutide group had a significantly lower uptake of both DOTATATE and FDG, although the largest difference was observed for DOTATATE (DOTATATE: 5.83±0.24 vs 7.10±0.33, P=0.001 and FDG: 2.49±0.13 vs 2.99±0.15, P=0.034) (Fig 1BC). Microcalcifications visualized using NaF PET, showed no difference at follow-up between the Semaglutide and the control group (4.15±0.30 vs 3.92±0.34, P=0.62) (Fig 1D). Increase in body weight was significantly attenuated in the Semaglutide group compared to the control group at follow-up (0.25±3.29% vs 10.68±3.01%, P=0.0016). Conclusions Semaglutide decreases vascular uptake of the SSTR2 tracer, DOTATATE, and FDG but not NaF. This supports the hypothesis that Semaglutide reduces inflammation by means of decreased macrophage activity and metabolism in the arterial wall. Figure 1 Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark

scholarly journals AV delay optimisation in LV only CRT: constant fusion pacing is easier in patients with first degree AV block

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Vacarescu ◽  
C.T Luca ◽  
L Petrescu ◽  
A Ionac ◽  
C Mornos ◽  
...  
Keyword(s):  
Public Institution ◽  
Dose Titration ◽  
Special Focus ◽  
Funding Source ◽  
Exercise Load ◽  
Av Conduction ◽  
Pr Interval ◽  
Rate Adaptive ◽  
The Impact

Abstract Background LV only pacing is non-inferior to BiV pacing, and recent publications showed that DDD CRT without RV lead is safe in patients with normal atrioventricular (AV) conduction, although there are no device algorithms available for fusion pacing and PR interval variability is understudied in this population. Purpose To analyse AV behaviour in patients with DDD CRT and the impact to effective fusion maintenance. Methods Consecutive patients with right atrium/left ventricle leads DDD CRT pacing system were included. Prospective data were collected at every 6 months follow-up visits: device interrogation, exercise test (ET), echocardiography. CRT assessment during ET analysed loss of LV capture with special focus on maintaining constant fusion pacing during exercise. We defined 2 groups of patients: longer PR interval patients (200–250 ms) and normal PR interval patients (<200 ms). In case of LV loss of capture or unsatisfactory LV fusion pacing, device reprogramming was performed individualised for each patient and BB/ivabradine dose titration was done to achieve stability of PR spontaneous interval. Patients were rescheduled in no later one month to be reassessed by ET. Results 55 patients (29 male) aged 62±11 y.o. were included, 36 patients with normal PR and 19 patients with longer PR. During follow-up (45±19 months), a total of 235 ETs were performed with mean exercise load 118±35 watts. In the normal PR group, 14 patients (39%) had inadequate pacing or loss of LV capture during ET due to physiological shortening of PR interval vs. 4 patients (21%) in the longer PR group. Loss of LV capture by exceeding maximum tracking rate (MTR) was noted in 6 patients (17%) with normal PR vs. 2 patients (11%) with long PR. Post ET device optimisation included: reprogramming rate adaptive AV interval (23±8 ms decrease in normal PR patients vs. 12±7 ms in longer PR patients, p<0.0001) and individualised programming of MTR. BB/ivabradine optimisation was performed in 32% of patients with normal PR vs. 13% of patients with longer PR. Conclusions A lower rate of optimisations after ET was needed in patients with a slightly longer AV conduction to achieve stability of fusion pacing DDD CRT, without device algorithms. Larger studies are needed to assess AV conduction variability and the benefits of fusion pacing CRT in patients with longer PR interval. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): University of Medicine and Pharmacy “Victor Babes”, Timisoara; Timisoara Institute of Cardiovascular Diseases

scholarly journals LINC01232 Sponges Multiple miRNAs and Its Clinical Significance in Pancreatic Adenocarcinoma Diagnosis and Prognosis

2021 ◽  
Vol 20 ◽  
pp. 153303382098852
Author(s):  
Wenyan Du ◽  
Chengbin Lei ◽  
Yanzhen Wang ◽  
Yiwen Ding ◽  
Peng Tian
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Clinical Significance ◽  
Prognostic Value ◽  
Prognostic Significance ◽  
Diagnostic Value ◽  
Characteristic Analysis ◽  
Tissue Samples ◽  
Real Time Quantitative Pcr ◽  
Diagnosis And Prognosis ◽  
Diagnostic And Prognostic Value

Background: Long noncoding RNAs have been demonstrated to play important roles in different kinds of human malignancy. The purpose of this study was to evaluate the diagnostic and prognostic value of long intergenic non-protein coding RNA 1232 (LINC01232) in patients with pancreatic adenocarcinoma (PAAD) and further explore the clinical significance of the potential miRNAs that might be sponged by LINC01232. Methods: The potential target miRNAs that might be sponged by LINC01232 were analyzed using bioinformatics analysis. The Real-Time quantitative PCR was adopted to measure the relative expression of LINC01232 and target miRNAs in PAAD serum and tissue samples. The diagnostic and prognostic value of LINC01232 was evaluated using the receiver operating characteristic analysis and Kaplan-Meier survival analysis, respectively. Results: LINC01232 expression was upregulated in PAAD serum and tissues and associated with patients’ TNM stage. Serum LINC01232 expression had diagnostic value, and the high levels of LINC01232 could predict unfavorable prognosis in PAAD patients. miR-204-5p, miR-370-5p and miR-654-3p were proposed as 3 targets of LINC01232 in PAAD, and their decreased expression levels in PAAD patients showed certain clinical significance in diagnosis and prognosis. Conclusion: The data of this study revealed that LINC01232 expression is upregulated in PAAD serum and tissue samples with considerable diagnostic and prognostic significance. In addition, miR-204-5p, miR-370-5p and miR-654-3p may be sponged by LINC01232 in PAAD, which also show potencies in PAAD diagnosis and prognosis.

scholarly journals Effects of catheter ablation on left atrial performance in different types of atrial fibrillation: a strain study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Katbeh ◽  
T De Potter ◽  
P Geelen ◽  
E Stefanidis ◽  
K Iliodromitis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Time Course ◽  
Public Institution ◽  
P Value ◽  
Funding Source ◽  
Functional Changes ◽  
Af Recurrence

Abstract Background Atrial structural and functional changes may develop as a result of catheter ablation (CA) in patients with paroxysmal and persistent atrial fibrillation (AF). However, the relation between AF recurrence and atrial performance following CA is still under debate. Our aim is to describe the long-term effects of CA on LA remodeling and its correlates to the maintenance of sinus rhythm (SR). Methods We prospectively enrolled 178 consecutive patients (age: 63±9 years, 35% females) with paroxysmal AF undergoing first-CA (67%) or redo-CA (22%), and 20 individuals (11%) with long-standing persistent AF (PAF) undergoing first CA. All patients underwent comprehensive transthoracic echocardiography at baseline and at 12-month follow-up, including the assessment of reservoir and contractile strain (LAS) using two dimensional speckle tracking echocardiography in all three apical views. The study population was divided in two sub-groups according to AF recurrence during follow-up. Results During one-year follow-up, 144 (81%) patients maintained SR whereas 34 (19%) patients had AF recurrence [first-CA group 16 (13%), redo-CA group 8 (20%) and PAF group 10 (50%)]. Improvement of LAS was observed only in patients with paroxysmal and long-standing persistent AF who underwent the first CA and who remained in SR (Figure 1A, 1C). In contrast, recurrent AF was associated with absence of LAS improvement (Figure 1A, 1C). Different time course of LA performance was observed in the redo-CA group, i.e. LAS remained unchanged from baseline regardless of long-term maintenance of SR (Figure 1B). Moreover, at follow-up, no significant differences in LAS between redo-CA patients with SR versus AF were observed. Of note, in patients with long-standing persistent AF and SR, follow-up LAS increased to values observed in the redo-CA group. Conclusion LA performance following CA is strongly affected by complex interplay between extent of atrial electro-structural remodeling and CA procedure. Repeated wide CA might affects negatively LA compliance and contractility despite SR restoration. Figure 1. Reservoir and contractile LAS at Baseline and 12-month follow-up in the First-CA (1A), the Redo-CA (1B) and the long-standing persistent AF (1C) groups in patients who maintained SR versus patients who had AF recurrence. *p value <0.05 (baseline vs. follow-up). Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): International PhD programme in Cardiovascular Pathophysiology and Therapeutics (CardioPaTh).

scholarly journals Association between variation of troponin and prognosis of acute myocardial infarction before and after primary percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Z.X.X Zhao ◽  
W.Y Wang ◽  
L.C Liu ◽  
Z.P Zhou ◽  
S.Z.X Sheng ◽  
...  
Keyword(s):  
Angina Pectoris ◽  
Roc Curve ◽  
Troponin I ◽  
Cox Regression ◽  
Public Institution ◽  
Funding Source ◽  
Medical Sciences ◽  
Discrimination Power ◽  
Cox Regression Analysis

Abstract Background Circulating levels of cardiac troponin I (cTnI) after STEMI were considered prognostic factors for predicting MACE. ΔcTnI is the difference between peak cTnI post-primary PCI and cTnIon initial admission. Purpose Study aimed to assess the relationship between ΔcTnI, the ratio of ΔcTnI to cTnI on initial admission and MACE during the follow-up period. Methods A total of 2596 patients with cTnI measured upon admission and one-time measurement of cTnI during hospitalization were enrolled. Results In the adjusted models of the survival ROC curve, ΔcTnI and the ratio of ΔcTnI to cTnI on initial admission have stronger discrimination power of MACE [AUC 0.730 and 0.717] compared with peak cTnI post-PPCI and cTnI at admission (AUC 0.590, 0.546). Multivariate Cox regression analysis identified ΔcTnI [HR 1.018, 95% CI 1.001 to 1.035] as a relevant factor for MACE during follow-up. On the K-M survival curves,the incidence of MACE, mortality and angina pectoris were significantly higher in the group with maximum ΔcTnI (p=0.035, 0.049, 0.026). Conclusion ΔcTnI level and the ratio have stronger discrimination power of MACE. The group with maximum ΔcTnI has higher incidence of MACE, mortality and angina pectoris during the follow-up period. Flow chart + survival ROC curve + K-M curve Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): This study was supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences

Pulmonary vein isolation procedure may be associated with intracranial artery microembolism and increased risk of acute neurological incidents

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Lasek-Bal ◽  
P Puz ◽  
J Wieczorek ◽  
S Nowak ◽  
A.M Wnuk-Wojnar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Middle Cerebral Artery ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Cerebral Artery ◽  
Public Institution ◽  
Funding Source ◽  
Radiological Investigation ◽  
Cerebral Microembolism

Abstract Background Atrial fibrillation ablation can be associated with the microembolism detected in intracranial arteries and risk of acute neurological incidents. Purpose The aims of this study were a quantitative and a qualitative evaluation of microembolic signals (MES) during pulmonary vein isolation (PVI) and establishing the potential significance of MES for damage of brain assessed in radiological investigation and neurological state of patients. Methods To the prospective project we qualified patients with atrial fibrillation undergoing percutaneous pulmonary vein isolation (radiofrequency ablation / balloon cryoablation) with ultrasound monitoring of microembolisms in right middle cerebral artery. Baseline and up to 12 months post pulmonary vein isolation the neurological examination and brain MRI were performed in all participants. Results The study enrolled 80 patients at a mean age of 58 years. Microembolisms during the monitoring of the flow in the right middle cerebral artery were recorded in 61 (76.3%) patients in the amount of 51–489 (mean 239). Most often the microembolic signals were registered during the trans-septal puncture and the stage of ablation. In 89%, microembolisms were gaseous. Mean score on Fazekas scale for the whole group before ablation: 0.87±0.7 (0–3, med. 1); after: 0.93±0.71. In 3 (4.3%) patients the lesions worsened during the follow-up period. None of the patients revealed a cardiovascular event during the follow-up period and no changes were observed in the neurological status. Conclusions The majority of cerebral microembolism generated during PVI are gaseous in nature. The cerebral microembolism associated with PVI probably result from the technical aspects of the procedure and do not cause neither the permanent brain damage in the radiological investigation nor neurological deficit. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of Silesia, Katowice, Poland - statutory work

New insights into the pathophysiology of mitral valve disease: molecular characterisation and comparison of the different aetiologic subtypes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Garcia De La Pena Urtasun ◽  
J Ibarrola Ulzurrun ◽  
V Arrieta Paniagua ◽  
A Fernandez De Celis ◽  
A Navarro Echeverria ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Disease ◽  
Molecular Mechanisms ◽  
Public Institution ◽  
Valve Disease ◽  
Funding Source ◽  
Molecular Characterisation ◽  
Markers Of Inflammation ◽  
Tnf Α ◽  
Myxomatous Degeneration

Abstract Introduction Mitral valve disease (MVD) is a frequent cause of heart failure and death. Data regarding its molecular basis are scarce, although current evidences show that primary MVD is an active process with the involvement of several molecular pathways. However, there are no studies that compare such mechanisms among the different subtypes of primary MVD. ST-2/interleukin (IL)-33 pathway is a potential pathophysiological mediator of cardiovascular diseases, although its role in heart valve diseases has not been explored. Purpose We aimed to analyse the molecular and cellular mechanisms involved in the main subtypes of primary chronic MVD: myxomatous degeneration, calcific or senile degeneration and rheumatic MVD. Methods 200 patients undergoing mitral valve replacement due to chronic primary MVD were enrolled. We classified them in the three main aetiologic subtypes according to echocardiographic features and surgeon's description: myxomatous degeneration (89 patients), senile or calcific degeneration (54 patients) and rheumatic disease (57 patients). In all patients the resected valve tissue and blood samples were collected. RT-PCR, Western Blot and ELISA were performed to analyse markers of inflammation (C-reactive protein, Rantes, IL-6, IL-1β/IL-1F2, tumor necrosis factor (TNF)-α), calcification (osteopontin, bone morphogenic protein (BMP)-2 and -4 and periostin), valvular endothelial cells (CD-31, E-cadherin), extracellular matrix remodeling (matrix metalloproteinase (MMP)-1, -2 and -9, tissue inhibitor of MMP-1 and -2), proteoglycans (aggrecan, hyaluronan, lumican, biglycan, syndecan-1, decorin) fibrosis (collagen-1, fibronectin, galectin-3, Transforming growth factor (TGF)-β) and ST-2/IL-33 system. Results Each aetiologic subtype showed a distinct marker profile. As compared with the other subtypes, myxomatous valves presented significantly higher levels of inflammatory markers (Rantes, IL-6), fibronectin, proteoglycans (hyaluronan, lumican and biglycan), ST-2 and IL-33. Senile degenerative valves presented significantly higher levels of calcification markers (osteopontin, BMP-2 and -4). Rheumatic valves were characterized by high levels of TNF-α and TGF-β compared to other subtypes and a significant increase in the expression and activity of matrix degradation enzymes (MMP-1 and -2). Conclusions Our study provides for the first time the molecular characterisation of the main aetiologic subtypes of chronic MVD. Proteoglycans accumulation, fibrosis and inflammation are the main features of myxomatous changes, whereas calcification define senile degeneration. Rheumatic valves exhibit elevated TNF-α and TGF-β and a dramatic increase in matrix turnover. Moreover, myxomatous valves overexpress the ST-2/IL-33 system, suggesting that this pathway could play a role in the development of myxomatous changes. Unravelling the underlying molecular mechanisms of each aetiology is essential to identify new therapeutic targets. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Fondo de Investigaciones Sanitarias

GLP-1 is an independent predictor of long-term mortality in patients with myocardial infarction complicated by cardiogenic shock – a substudy of the IABP-SHOCK II trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Fuernau ◽  
M Lehrke ◽  
C Jung ◽  
F Kahles ◽  
C Lebherz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Independent Predictor ◽  
Funding Source ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Landmark Analysis ◽  
Markers Of Inflammation

Abstract Background The incretin hormone Glucagon-like-peptide 1 (GLP-1) is a major stimulus for glucose dependent insulin secretion and holds cardioprotective efficacy. This has made the GLP-1 system a preferred target for diabetes therapy. Secretion of GLP-1 happens in response to nutritional but also inflammatory stimuli. Consequently, marked elevation of circulating GLP-1 levels were found in critically ill patients featuring marked association to markers of inflammation. Purpose Our study sought to investigate GLP-1 levels in patients with cardiogenic shock (CS) complicating myocardial infarction and a possible prognostic correlation to short- and long-term outcome. Methods We serially assessed circulating GLP-1 levels in a prospectively planned biomarker substudy in the IABP-SHOCK II trial. Blood samples were drawn during index PCI and at day 2. The blood was centrifuged immediately, and serum was frozen at −87°C. GLP-1 was measured with a standard ELISA-kit. All-cause mortality at short- (30 days), intermediate- (1 year) and long-term (6 years) follow-up was used for outcome assessment. Results In this study we found circulating GLP-1 to be markedly elevated in patients with myocardial infarction complicated by CS (n=172) at time of index PCI. Patients with fatal short-term outcome (n=70) exhibited higher GLP-1 levels (86 [45–130] pM) at ICU admission in comparison to patients with 30-day survival (48 [33–78] pM; p<0.001) (n=102). In repeated measures ANOVA the course of GLP-1 levels between baseline and day 2 showed a significant interaction between survivors and non-survivors (p=0.04). By univariate Cox-regression analysis GLP-1 levels >median were predictive of short- (hazard ratio [HR] 2.43; 95% confidence interval [CI] 1.50–3.94; p<0.001), intermediate- (HR 2.46; 95% CI 1.62–3.76; p<0.001) and long-term (HR 2.12; 95% CI 1.44–3.11; p<0.001) outcome. This association remained after multivariable correction (HR 2.01; 95% CI 1.37–3.07; p<0.001). In a landmark analysis we found a significant higher mortality in patients with GLP-1 levels >median from day 30 to 1 year (HR 2.56; 95% CI 1.08–6.09; p=0.03). In contrast, beyond 1 year up to 6 years no difference has been observed anymore (HR 1.02; 95% CI 0.41–2.58; p=0.96). Conclusions Elevated plasma levels of GLP-1 are an independent predictor for impaired prognosis in patients with myocardial infarction complicated by CS at short-, intermediate and long-term follow-up. In a landmark analysis this prognostic effect is sustained up to 1 year. The functional relevance of GLP-1 in this context is currently unknown and needs further investigations. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Research Foundation (DFG), German Heart Research Foundation

Copeptin, albumin and routine inflammatory markers are predictors of one-year mortality in patients with advanced heart failure underwent cardiac transplantation evaluation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Szygula Jurkiewicz ◽  
W Szczurek ◽  
M Skrzypek ◽  
E Romuk ◽  
M Gasior
Keyword(s):  
Heart Failure ◽  
Inflammatory Markers ◽  
Public Institution ◽  
Funding Source ◽  
Serum Concentrations ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
One Year ◽  
Medical University

Abstract Introduction Despite significant advances in the prevention and treatment of heart failure (HF), the prognosis for patients with advanced stage of the disease is still poor. Therefore, a better understanding of the underlying HF pathophysiological mechanisms is crucial to improve prognosis in patients with advanced HF. One important research area is the role of inflammation in the pathophysiology of HF. Purpose This study aimed to investigate factors associated with mortality in HF patients with particular emphasis placed on inflammatory markers. Methods This is a prospective analysis of 282 optimally treated HF patients hospitalised in Cardiology Department between 2016 and 2018 for heart transplantation (HT) evaluation. Patients with contraindications to HT were excluded from the study. At the baseline echocardiography, routine laboratory tests, an ergospirometric exercise test, and right heart catheterisation were performed in all patients. In addition, 10 ml of peripheral blood was collected to determine inflammatory biomarkers. Human procalcitonin and copeptin concentrations were measured by the sandwich enzyme-linked immunosorbent assay (ELISA) with the commercially available kit. A highly sensitive latex-based immunoassay was used to detect plasma C-reactive protein (CRP) using the COBAS Integra 70 analyzer. The end-point of the study was all-cause mortality during one-year follow-up. The study protocol was approved by the Local Ethics Committee of our medical university. All patients provided informed, voluntary consent to participate in the study. Results The median age of patients was 57 (51–60) and 87.6% of them were male. A total of 79 (28%) patients died during a one-year follow-up. Multivariate analysis of the Cox proportional hazard model confirmed that procalcitonin [hazard ratio (HR) 1.003 (1.002–1.003), p<0.001], high sensitivity C-reactive protein (CRP) [HR 1.109 (1.039–1.183), p<0.002], copeptin [HR 1.109 (1.019–1.207), p<0.02] and albumin [HR 0.925 (0.873–0.979), p<0.01] serum concentrations, as well as Erythrocyte Sedimentation Rate (ESR) [HR 1.031 (1.001–1.063) p<0.05] were associated with mortality during a one-year follow-up. Conclusions Our study demonstrated that higher procalcitonin, CRP and copeptin serum concentrations as well as higher ESR and lower albumin serum concentrations are independently associated with reduced survival in patients with advanced HF. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of Silesia

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