scholarly journals A case report on transient cardiomyopathy with cytokine storm in SARS-CoV-2

2020 ◽  
Author(s):  
Tushar Tarun ◽  
Senthil Kumar ◽  
Jeremy Johnson ◽  
Anand Chockalingam
Keyword(s):  
Patient Outcomes ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Case Summary ◽  
Cardiac Manifestations ◽  
Improve Patient ◽  
New Onset

Abstract Background Cardiac manifestations during Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) pandemic have included acute coronary syndrome, arrhythmias, myocarditis, and stress cardiomyopathy. However, the combination of cardiomyopathy and negative cardiac biomarkers has not yet been reported. Case summary A 49-year-old man admitted for respiratory failure secondary to SARS-CoV-2 developed new-onset cardiomyopathy with negative cardiac biomarkers. Left ventricular ejection fraction and strain improved 7 days after the initial echocardiogram, after administration of Tocilizumab, coinciding with clinical recovery, and improvement in inflammatory markers. Discussion As experience of cardiovascular manifestations of SARS-CoV-2 increases, more patients will likely present with cardiovascular manifestations; the recognition and proper management of these may improve patient outcomes.

scholarly journals New onset of atrial fibrillation in cardiogenic shock

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
H Santos ◽  
T Vieira ◽  
J Fernandes ◽  
AR Ferreira ◽  
M Rios ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiogenic Shock ◽  
Linear Regression Analysis ◽  
Clinical Signs ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
The Impact ◽  
New Onset

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The development of cardiogenic shock (CS) is associated with worse prognosis, and can produce several hemodynamic manifestations. Then, is not surprised the manifestation of new-onset atrial fibrillation (AF) in these patients. Purpose Evaluate the impact of cardiovascular previous history, clinical signs and diagnosis procedures at admission as predictors of new-onset of AF in CS. Methods Single-centre retrospective study, engaging patients hospitalized for CS between 1/01/2014-30/10/2018. 222 patients with CS are included, 40 of them presented new onset of AF. Chi-square test, T-student test and Mann-Whitney U test were used to compare categorical and continuous variables. Multiple linear regression analysis was performed to evaluate predictors of new-onset AF in CS patients. Results CS patients without AF had a mean age of 61.08 ± 13.77 years old, on the other hand new-onset of AF patients in the setting of CS had a mean age of 67.02 ± 14.21 years old (p = 0.016). Nevertheless, no differences between the two groups was detected regarding the sex cardiovascular history (namely arterial hypertension, diabetes, dyslipidemia, obesity, smoker status, alcohol intake, previous acute coronary syndrome, history of angina, previous cardiomyopathy), neoplasia history, cardiac arrest during the CS, clinical signs at admission (like heart rate, blood pressure, respiratory rate), blood results (hemoglobin, leukocytes, troponin, creatinine, C-Reactive protein), left ventricular ejection fraction and the culprit lesion. New-onset of AF in CS patient had not impact in mortality rates. Multiple logistic regression reveals that only age was a predictor of new onset of AF in CS patients (odds ratio 1.032, confident interval 1.004-1.060, p = 0.024). Conclusions Age was the best predictor of new-onset AF in CS patients. The presence of this arrhythmia can have a hemodynamic impact, however, seems not influenced the final outcome.

Factors which Influence the Levels of ST-2, Galectin-3 and MMP-9 in Acute Coronary Syndrome

2020 ◽  
Vol 20 (1) ◽  
pp. 64-73 ◽  
Author(s):  
Luxitaa Goenka ◽  
Durga Jha ◽  
Masum Sharma ◽  
V.E. Dhandapani ◽  
Melvin George
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Laboratory ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Left Ventricular Ejection ◽  
Total Leukocyte Count ◽  
Enzyme Linked Immunosorbent Assay ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Galectin 3

Background: Several cardiac biomarkers are being studied to explore their potential in the prognostication of Acute Coronary Syndrome (ACS). However, there are limited studies exploring the relationship between these biomarkers and clinical, laboratory and demographic characteristics. Objective: We sought to determine the factors which influence the concentration of novel cardiac biomarkers such as Galectin-3, suppression of tumorigenicity-2 (ST-2) and Matrix Metallopeptidase-9 (MMP-9) in patients with ACS. Methods: A total of 122 patients with ACS were enrolled in the study. The study patients were categorized into two groups namely: STEMI (n=58) and NSTEMI/UA (n=64). Plasma samples were used to determine the level of biomarkers, Galectin-3 and ST-2, and serum samples were used to determine the levels of MMP-9 using the Enzyme-linked immunosorbent assay (ELISA). The association between the plasma and serum levels of biomarkers and, demographic, clinical and laboratory variables were determined. Statistical analyses for the study were performed using SPSS 16.0 software (SPSS Inc., Chicago, IL, USA). Results: Elderly aged [0.107 (0.012-0.969); p=0.047] patients had higher ST-2. Galectin-3 was higher among female patients [3.693(1.253-10.887); p=0.018] and patients with low left ventricular ejection fraction [2.882 (1.041-7.978); p=0.042]. Patients with lower body mass index [3.385 (1.241-9.231); p=0.017], diabetes [3.650 (1.302-10.237); p=0.014] and high total leukocyte count [2.900 (1.114-7.551; p=0.029] had higher MMP-9 levels. Conclusion: The concentration of galectin-3, ST-2 and MMP-9 are independently influenced by demographic, clinical and laboratory characteristics. It is estimated that these factors should be accounted for when interpreting the results of the biomarker assays.

Serum biomarkers for detection of cardiomyopathy in survivors of childhood cancer: A report from the St. Jude Lifetime Cohort.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e21526-e21526
Author(s):  
Stephanie Dixon ◽  
Carrie R. Howell ◽  
Lu Lu ◽  
Kirsten K. Ness ◽  
Juan Plana ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Troponin T ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
New Onset

e21526 Background: Childhood cancer survivors are at increased risk for cardiovascular morbidity and mortality. Little is known about the utility of cardiac biomarkers (NT-proBNP, cardiac troponin-T [TnT]) for long-term surveillance. Methods: Cross-sectional analyses of 1213 survivors ≥18 years of age and ≥10 years from cancer diagnosis (786 exposed to cardiotoxic therapy [174 radiation therapy (RT) alone, 366 anthracycline alone, 246 both] and 427 unexposed). TnT > 0.01 ng/ml and NT-proBNP levels > 97.5th percentile age- and sex-specific cutoffs were considered abnormal. Three-dimensional left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), diastolic function and cardiomyopathy (CM) according to the CTCAE v4.03 were evaluated. Generalized linear models estimated risk ratios (RR) and 95% confidence intervals (CI). Results: Among survivors (median 8.7 [range 0.0-23.6] years at diagnosis; 35.5 [range 19.1-62.2] years at evaluation), NT-proBNP and TnT were abnormal in 22.5% and 0.4%, respectively. A dose-dependent increased risk for abnormal NT-proBNP was seen with exposure to chest RT (referent no RT, 1- < 20 Gy RR 1.62 [CI 1.07-2.46], 20- < 30 Gy RR 1.68 [1.23-2.30], ≥30 Gy RR 3.66 [2.89-4.64]; p for trend < 0.0001) and anthracycline (referent no anthracycline, 1-200mg/m2 RR 1.39 [1.01-1.91], 201-350mg/m2 RR 2.28 [1.74-2.99], > 350mg/m2 RR 2.99 [2.27-3.95]; p for trend < 0.0001). Survivors with CM at the time of evaluation had abnormal NT-proBNP (grade 2 CM RR 1.46, CI 1.08-1.99; grade 3-4 CM 2.66, 2.02-2.39). However, among exposed survivors previously undiagnosed with clinical CM, NT-proBNP had poor sensitivity and moderate specificity in identifying those with new onset of abnormal LVEF ( < 53%), GLS or diastolic dysfunction: sensitivity (29%, 30%, 33%), specificity (75%, 77%, 76%). Also, 132 (20.2%) had abnormal NT-proBNP with normal LVEF (≥53%). Conclusions: Abnormal NT-proBNP levels were prevalent and associated with prior cardiotoxic therapy and established CM but were not sensitive for detection of new onset CM. Longitudinal follow-up is needed to determine whether abnormal NT-proBNP in the large number of survivors without CM is predictive of future CM.

scholarly journals 265 Incidence, determinants and prognostic relevance of HS-troponin and natriuretic peptides elevation at admission in hospitalized COVID-19 pneumonia patients

2020 ◽  
Vol 22 (Supplement_N) ◽  
pp. N65-N79
Author(s):  
Luca Arcari ◽  
Michelangelo Luciano ◽  
Luca Cacciotti ◽  
Maria Beatrice Musumeci ◽  
Valerio Spuntarelli ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Natriuretic Peptides ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Good Ability ◽  
Myocardial Involvement ◽  
D Dimer

Abstract Aims myocardial involvement in the course of Coronavirus disease 2019 (COVID-19) pneumonia has been reported, though not fully characterized yet. Aim of the present study is to undertake a joint evaluation of hs-Troponin and natriuretic peptides (NP) in patients hospitalized for COVID-19 pneumonia. Methods and results in this multicenter observational study, we analyzed data from n = 111 COVID-19 patients admitted to dedicated “COVID-19” medical units. Hs-Troponin was assessed in n = 103 patients and NP in n = 82 patients on admission; subgroups were identified according to values beyond reference range. increased hs-Troponin and NP were found in 38% and 56% of the cases respectively. As compared to those with normal cardiac biomarkers, these patients were older, had higher prevalence of cardiovascular diseases (CVD) and more severe COVID-19 pneumonia by higher CRP and D-dimer and lower PaO2/FIO2. Two-dimensional echocardiography performed in a subset of patients (n = 24) showed significantly reduced left ventricular ejection fraction in patients with elevated NP only (p = 0.02), whereas right ventricular systolic function (tricuspid annular plane systolic excursion) was significantly reduced both in patients with high hs-Troponin and NP (p = 0.022 and p = 0.03 respectively). On multivariable analysis, independent associations were found of hs-Troponin with age, PaO2/FIO2 and D-dimer (B = 0.419, p = 0.001; B=-0.212, p = 0.013 and B = 0.179, p = 0.037 respectively), and of NP with age and previous CVD (B = 0.480, p &lt; 0.001 and B = 0.253, p = 0.001 respectively). In patients with in-hospital mortality (n = 23, 21%) hs-Troponin and NP were both higher (p = 0.001 and p = 0.002 respectively), while increasing hs-troponin and NP were associated with worse in-hospital prognosis [OR 4.88 (95% CI 1.9-12.2), p = 0.001 (adjusted OR 3.1 (95% CI 1.2-8.5), p = 0.025) and OR 4.67 (95% CI 2-10.8), p &lt; 0.001 (adjusted OR 2.89 (95% CI 1.1-7.9), p = 0.04) respectively]. Receiver operator characteristic curves showed good ability of hs-Troponin and NP in predicting in-hospital mortality (AUC = 0.869 p &lt; 0.001 and AUC = 0.810, p &lt; 0.001 respectively). Conclusion myocardial involvement at admission is common in COVID-19 pneumonia and associated to worse prognosis, suggesting a role for cardiac biomarkers assessment in COVID-19 risk stratification. Independent associations of hs-Troponin with markers of disease severity and of NP with underlying CVD might point towards existing different mechanisms leading to their elevation in this setting.

scholarly journals A pebble clogging a river: a case report of thrombosed coronary aneurysmal ectasia

2020 ◽  
Author(s):  
Akshar Jaglan ◽  
Tarek Ajam ◽  
Steven C Port ◽  
Tanvir Bajwa ◽  
A Jamil Tajik
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Treatment Options ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Artery Ectasia ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Patient Reported

Abstract Background Coronary artery ectasia (CAE) is a rare anomaly that can present at any age. Predisposing risk factors include Kawasaki disease in a younger population and atherosclerosis in the older generation. We present a unique case of the management of a young woman diagnosed with multivessel CAE with aneurysmal changes in the setting of acute coronary syndrome and subsequently during pregnancy. Case summary A 23-year-old woman presented with acute onset chest pain. Electrocardiogram revealed no ischaemic changes; however, troponin I peaked at 16 ng/mL (reference range 0–0.04 ng/mL). Echocardiogram showed apical dyskinesis with preserved left ventricular ejection fraction. Coronary angiography showed multivessel CAE along with significant thrombus burden in an ectatic lesion of the left anterior descending artery. Since the patient was haemodynamically stable, conservative management with dual antiplatelet therapy and anticoagulation was started. On follow-up, coronary computed tomographic angiogram illustrated resolution of the coronary thrombi and echocardiogram showed improvement to the apical dyskinesis. It was presumed that Kawasaki disease was the most likely aetiology of her disease. Subsequently the patient reported that, contrary to medical advice, she was pregnant, adding another layer of complexity to her case. Discussion Coronary artery ectasia can be discovered as an incidental finding or can present with an acute coronary syndrome. Management is challenging in the absence of randomized trials and large-scale data. Treatment options include medications, percutaneous intervention, and surgical revascularization. Close surveillance is required in these patients to assess progression of disease. Here we discuss treatment options during acute coronary syndrome and pregnancy.

Abstract 13303: Cardio-ankle Vascular Index Predicts New Onset Stroke in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yu Hotsuki ◽  
Akiomi YOSHIHISA ◽  
Yu Sato ◽  
Yasuhiro Ichijo ◽  
Koichiro Watanabe ◽  
...  
Keyword(s):  
Heart Failure ◽  
Regression Tree ◽  
Left Ventricular ◽  
Classification And Regression Tree ◽  
Left Ventricular Ejection ◽  
Chronic Obstructive ◽  
Post Discharge ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure ◽  
New Onset

Aim: We aimed to evaluate the implication of cardio-ankle vascular index (CAVI) to predict new onset stroke in patients with heart failure (HF). Methods and Results: This was a prospective observational study, which recruited clinical data of a total of 898 patients hospitalized for HF. According to the survival classification and regression tree analysis, the accurate cut-off value of CAVI in predicting post-discharge stroke was 9.6. We divided patients into two groups: the high CAVI group (CAVI > 9.6, n = 230, 25.6%) and the low CAVI group (CAVI ≤ 9.6, n = 668, 74.4%). We compared the patients’ characteristics and occurrence of new onset stroke. The high CAVI group was older (73.5 vs. 66.0 years old, P < 0.001) and had a higher prevalence of male sex (74.3% vs. 62.0%, P = 0.001) and prior stroke (23.5% vs. 17.5%, P = 0.047). The high CAVI group showed higher levels of B-type natriuretic peptide (246.0 vs. 165.1 pg/mL, P < 0.001) and lower levels of estimated glomerular filtration rate (51.6 vs. 61.8 mL/kg/1.73 m2, P < 0.001). In contrast, left ventricular ejection fraction, and prevalence of other co-morbidities such as hypertension, diabetes mellitus, dyslipidemia, chronic obstructive pulmonary disease was comparable between the two groups. The Kaplan-Meier analysis demonstrated that rate of new onset stroke was higher in the high CAVI group than in the low CAVI group ( Figure , log-rank P = 0.001). After adjusting for potential confounding factors, high CAVI was an independent predictor of new onset stroke (hazard ratio 2.359, 95% confidence interval 1.223-4.513, P=0.010). Conclusions: CAVI independently predicts new onset stroke in patients with HF.

Elderly woman presenting with multivessel coronary artery disease and Takotsubo syndrome

2021 ◽  
Vol 14 (7) ◽  
pp. e242367
Author(s):  
Hari Vivekanantham ◽  
Martin Scoglio ◽  
Philipp Suter ◽  
Stephane Cook ◽  
Yann Roux ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Takotsubo Syndrome ◽  
Left Main ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Left Anterior Descending Artery ◽  
Artery Disease

Takotsubo syndrome is an acute and often reversible condition, with initial presentation mimicking acute coronary syndrome. Typically, patients present with left ventricular regional wall motion abnormalities, without a corresponding coronary artery obstruction on angiography. Coexistence of a coronary artery disease is possible and may render the distinction between the two entities particularly challenging. We report the case of a 94-year-old woman with chest pain after an emotional upset and acute myocardial injury. Transthoracic echocardiogram (TTE) revealed a severely reduced left ventricular ejection fraction (LVEF) with apical ballooning. Coronary angiogram showed significant stenosis of the distal left main coronary artery and of the mid-left anterior descending artery, as well as a 30%–50% stenosis of the mid-distal right coronary artery. Revascularisation was deferred and antiplatelet as well as heart failure therapy begun. A repeat TTE 6 days later revealed a quasi-normalised LVEF. Ultimately, percutaneous coronary revascularisation of the left main and left anterior descending artery was performed, with favourable outcome at 6-month follow-up.

scholarly journals Is Troponin really a reliable marker in patients with acute ischemic stroke?

2018 ◽  
Vol 56 (4) ◽  
pp. 250-256 ◽  
Author(s):  
Zeynep Yildiz ◽  
Abdulkadir Koçer ◽  
Şahin Avşar ◽  
Göksel Cinier
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Troponin I ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Anterior Circulation ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Reliable Marker

Abstract Background and purpose. Cardiac troponin I (cTnI) is a reliable marker to diagnose acute myocardial infarction, but the pathophysiological explanation for the increase in cTnI levels in patients with acute ischemic stroke (IS) remains unknown. To overcome this question, we aimed to compare serum cTnI levels in acute coronary syndrome (ACS) concomitant with and without stroke. By doing like this, we thought that we could demonstrate the effect of stroke on TrpI level. Methods. Serum cTnI levels of 41 patients having ACS with acute IS during hospitalization were compared with 97 control patients having only ACS. Cranial CT was performed to evaluate the lesions. The severity of IS was evaluated objectively by national institutes of health stroke scale. Results. cTnI levels were found to be similar in both groups. Presence of diabetes mellitus, coronary artery disease and previous myocardial infarction were more frequent in patients with acute IS. The cTnI levels in the patients with the cranial lesion in the anterior circulation was higher (p = 0.039). Presence of acute IS, cTnI level higher than 20 ng/mL and left ventricular ejection fraction < 40% were found to be independent risk factors for mortality (p < 0.05). Conclusions. We found that abnormal troponin levels were more likely to be due to cardiac causes than cerebral ones in this first study evaluating the cTnI levels in patients with ACS concomitant with acute IS. The severity of IS, lesion location in the anterior circulation and higher troponin levels were associated with mortality.

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