P5513Relation of thyroid hormones level to the extent of myocardial injury in patients with acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Badran ◽  
G Soltan ◽  
A Belal
Keyword(s):  
Acute Coronary Syndrome ◽  
Thyroid Hormones ◽  
Myocardial Injury ◽  
Troponin I ◽  
Thyroid Stimulating Hormone ◽  
Gensini Score ◽  
Thyroid Status ◽  
Free Triiodothyronine ◽  
Coronary Syndrome ◽  
Significant Difference

Abstract Objective Previous studies have identified that abnormal thyroid hormonal status is associated with worse prognosis especially in coronary artery disease (CAD). The present study further explores whether thyroid hormones associated with size of myocardial injury and extent of CAD in patients with acute coronary syndrome (ACS). Methods In this study, we enrolled 120 consecutive patients (52% male, mean age 54.2±6.4 years) who were admitted to ICU with ACS and having coronary angiography. All patients underwent testing for thyroid function status [thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4)], cardiac troponin I (cTnI), cardiac enzymes, C-reactive protein (CRP). Risk profile, clinical characteristics and angiographic results (Gensini score) were also analyzed. Results 43.3% of patients presented with STEMI, 33.3% with NSTEMI and 23.3% unstable angina. CK-MB, troponin and CRP were significantly higher in STEMI compared with NSTEMI group (P<0.0001). Abnormal thyroid status was prevalent in 13.4% of total population; Low FT3 syndrome in 6.7%, subclinical hypothyroidism in 5% and clinical hypothyroidism in 1.7%. Lower thyroid hormone levels showed significantly lower HDL (P<0.02), higher triglyceride level& CRP and cTnI (P<0.007), higher rate of in hospital complications including recurrent angina, CHF and cardiogenic shock (P<0.001) and more severe CAD using Gensini score (P<0.0001). However, there was no significant difference in abnormal thyroid status between STEMI and NSTEMI. After adjusting for conventional risk factors, FT3 showed direct correlation to LV EF% (r=0.62, P<0.000) and inverse correlation to LV internal dimension (r=−0.57, P<0.0001), troponin (r=−0.27, P<0.03), CRP (r=−0.39, P<0.003), Gensini score (r=−0.48, P<0.0001) and number of in hospital complications (r=−0.62, P<0.0001). From a linear stepwise regression analysis low EF% (β: 0.032, 95% CI: 0.009–0.055, P<0.007) and presence of complications (β: 0.625, 95% CI: 1.194–0.056, P<0.03) are independent predictors of low FT3. Conclusions In ACS, the lower thyroid hormones levels are associated with larger myocardial injury, more severe CAD and higher rate of complications especially during their hospital course.

Associations of Thyroid Hormones and Resting Heart Rate in Patients Referred to Coronary Angiography

2020 ◽  
Vol 52 (12) ◽  
pp. 850-855
Author(s):  
Eva Steinberger ◽  
Stefan Pilz ◽  
Christian Trummer ◽  
Verena Theiler-Schwetz ◽  
Markus Reichhartinger ◽  
...  
Keyword(s):  
Heart Rate ◽  
Coronary Angiography ◽  
Thyroid Hormones ◽  
Thyroid Stimulating Hormone ◽  
Resting Heart Rate ◽  
Free Triiodothyronine ◽  
Free Thyroid Hormones ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
Significant Difference

AbstractResting heart rate (RHR) is associated with increased risk of cardiovascular morbidity and mortality. Thyroid hormones exert several effects on the cardiovascular system, but the relation between thyroid function and RHR remains to be further established. We evaluated whether measures of thyroid hormone status are associated with RHR in patients referred to coronary angiography. Thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxin (FT4), and RHR were determined in 2795 participants of the Ludwigshafen Risk and Cardiovascular Health (LURIC) Study. Median (25th to 75th percentile) serum concentrations were 1.25 (0.76–1.92) mU/l for TSH, 4.8 (4.2–5.3) pmol/l for FT3 and 17.1 (15.4-19.0) pmol/l for FT4, and mean (±standard deviation) RHR was 68.8 (±11.7) beats/min. Comparing the highest versus the lowest quartile, RHR (beats/min) was significantly higher in the fourth FT4 quartile [3.48, 95% confidence interval (CI): 2.23–4.73; p <0.001] and in the fourth FT3 quartile (2.30, 95% CI: 1.06–3.55; p <0.001), but there was no significant difference for TSH quartiles. In multiple linear regression analyses adjusting for various potential confounders, FT3 and FT4 were significant predictors of RHR (p <0.001 for both). In subgroups restricted to TSH, FT3, and FT4 values within the reference range, both FT3 and FT4 remained significant predictors of RHR (p <0.001 for all). In conclusion, in patients referred to coronary angiography, FT3 and FT4 but not TSH were positively associated with RHR. The relationship between free thyroid hormones and RHR warrants further investigations regarding its diagnostic and therapeutic implications.

Women and men diagnosed with acute coronary syndrome – sex-related differences

2018 ◽  
Vol 87 (2) ◽  
pp. 92-98
Author(s):  
Magdalena Dudek ◽  
Marta Kałużna-Oleksy ◽  
Jacek Migaj ◽  
Ewa Straburzyńska-Migaj
Keyword(s):  
Acute Coronary Syndrome ◽  
Troponin I ◽  
Sudden Cardiac Arrest ◽  
Coronary Intervention ◽  
Cardiac Biomarkers ◽  
Invasive Treatment ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Choice Of Treatment ◽  
Artery Disease

Background. Coronary artery disease (CAD) is one of the most important causes of death in both men and women. There are many gender differences among patients with CAD, including risk factors and acute coronary syndrome (ACS) outcomes. The latest reports showed that mortality due to CAD is higher in women than in men. Cardiac biomarkers play an important role in risk stratification and choice of treatment strategy in patients with ACS, however some of cardiac biomarkers show worse sensitivity and specificity in women.Aim. The aim was to investigate the sex-related differences in patients with acute coronary syndrome and to compare their sex-related risk of in-hospital mortality.Material and Methods. Single-center study of patients diagnosed with ACS who underwent precutaneous coronary intervention (PCI). Patients were diagnosed and treated according to ESC Guidelines. Statistical analysis was performed using StatSoft Statistica.Results. Of the 297 patients included in this study, 32% were women and 68% were men. There were 26.94% STEMI patients, 22.22% NSTEMI patients and 50.84% unstable angina patients. Compared with males, females were significant older (68.2 ± 10.6 vs. 64.8 ± 11.0; p = 0.0175). Levels of biomarkers of myocardial injury were significantly lower in women: CK-MB (p = 0.0241), troponin I (p = 0.0417) and CK (p = 0.0035) than in men. Women were less frequently treated with PCI or CABG (p = 0.0016) but the in-hospital outcomes (cardiogenic shock, sudden cardiac arrest or cardiac death) were similar in both groups (p = 0.8557).Conclusions. Women with ACS were older and have higher incidence of non-ST-elevation ACS than men.. In-hospital mortality show no significant difference between genders. Women were less likely to receive invasive treatment.

Troponin I as a specific marker of myocardial injury: from theory to clinical practice in the diagnosis of acute coronary syndrome

2004 ◽  
Vol 15 (8) ◽  
pp. 499-504 ◽  
Author(s):  
Chiara Bucciarelli-Ducci ◽  
Cristina Rasile ◽  
Paola Proietti ◽  
Massimo Mancone ◽  
Cristina Volponi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Practice ◽  
Myocardial Injury ◽  
Troponin I ◽  
Specific Marker ◽  
Coronary Syndrome

scholarly journals Pattern and Prevalence of Dyslipidemia among Patients with Acute Coronary Syndrome Admitted in a Tertiary Level Hospital

2019 ◽  
Vol 34 (1) ◽  
pp. 31-36
Author(s):  
Dilshad Parvin ◽  
Sunil Krishna Baul ◽  
SM Rahat Hossain ◽  
Swati Munshi ◽  
Md Hadiuzzaman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Lipid Profile ◽  
Troponin I ◽  
Serum Levels ◽  
Modifiable Risk Factors ◽  
Coronary Syndrome ◽  
Control Subjects ◽  
Significant Difference ◽  
Artery Disease

Background: The leading cause of mortality in men and women worldwide is coronary artery disease (CAD). For hospitalization in our country, acute coronary syndrome (ACS) is a major reason. Dyslipidemia is found one of the most important modifiable risk factors for CAD. Aim: The aim of the study was to determine the pattern and prevalence of dyslipidemia among patients with ACS admitted in National Institute of Cardiovascular Diseases (NICVD), Dhaka. Subjects and methods: One thousand (1000) patients with ACS were included and classified according to clinical presentation, the findings on the admission electrocardiogram (ECG) and the results of serial cardiac troponin levels, into myocardial infarction(MI), either STelevation or non ST- elevation MI, and unstable angina(UA) subgroups. In the other group 500 healthy subjects were included as controls. All subjects were subjected determination lipid profile. ECG and Troponin- I were done for diagnosis and follow up of the patients. Results: In patients with ACS, high levels of TC (>200 mg/dl) were found in 60.67%,high levels of LDL (> 130 mg/dl) were found in 58%, high levels of TG (>150 mg/ dl) were found in 63.33%, however, low levels of HDL (< 40 mg/dl) were found in 66%. There was a statistically significant elevation in TC, LDL, TG serum levels in patients with ACS compared to control subjects (p<0.05) while the HDL was significantly low in ACS patient compared to control subjects (p <0.05). TC/HDL > 5 and TG/HDL> 4 were significantly higher in patients with ACS than controls. There was no significant difference between MI and UA patients regarding all lipid profile parameters. TC, LDL, TG were significantly higher in males than in females while HDL was significantly higher in females compared to males. Also TC/HDL and TG/HDL ratios were significantly higher in males compared to females. All lipid components were significantly more prevalent in males than in females except TG where there was no significant difference between males and females. Stepwise regression analysis of lipid parameters revealed that TC/HDL and TG/HDL ratios were independent risk factors for ACS. Conclusion: Dyslipidemia is one the major risk factors which is widely prevalent in patients with ACS and is more prevalent in males than in females. We recommend paying more attention to serum lipids and other modifiable risk factors for prevention of ACS and more studies about them as risk factors of atherosclerosis and its impact on other systems is advised. Bangladesh Heart Journal 2019; 34(1) : 31-36

scholarly journals Thyroid Hormones—An Underestimated Player in Dilated Cardiomyopathy?

2021 ◽  
Vol 10 (16) ◽  
pp. 3618
Author(s):  
Karolina Zawadzka ◽  
Radosław Dziedzic ◽  
Andrzej Surdacki ◽  
Bernadeta Chyrchel
Keyword(s):  
Thyroid Hormones ◽  
Dilated Cardiomyopathy ◽  
Systolic Dysfunction ◽  
Thyroid Stimulating Hormone ◽  
Left Ventricular ◽  
Thyroid Status ◽  
Free Triiodothyronine ◽  
Beneficial Effects ◽  
Low T3 ◽  
Altered Thyroid

Dilated cardiomyopathy (DCM) is the most prevalent cardiomyopathy, typified by left ventricular dilation and systolic dysfunction. Many patients with DCM have altered thyroid status, especially lower levels of free triiodothyronine (T3) and elevated levels of thyroid-stimulating hormone. Moreover, growing evidence indicates that even subtle changes in thyroid status (especially low T3) are linked with a worse long-term prognosis and a higher risk of mortality. Notably, recent discoveries have shown that not only local myocardial thyroid hormones (THs) bioavailability could be diminished due to impaired expression of the activating deiodinase, but virtually all genes involved in TH biosynthesis are also expressed in the myocardium of DCM patients. Importantly, some studies have suggested beneficial effects of TH therapy in patients suffering from DCM. Our aim was to discuss new insights into the association between TH status and prognosis in DCM, abnormal expression of genes involved in the myocardial synthesis of TH in DCM, and the potential for TH use in the future treatment of DCM.

scholarly journals Cardiac troponins I and T in patients with suspected acute coronary syndrome: a comparative study in a routine setting

1998 ◽  
Vol 44 (7) ◽  
pp. 1430-1436 ◽  
Author(s):  
Øyvind Hetland ◽  
Kenneth Dickstein
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Troponin ◽  
Myocardial Injury ◽  
Troponin I ◽  
Clinical Performance ◽  
Troponin T ◽  
Coronary Syndrome ◽  
Initial Sensitivity ◽  
Acute Myocardial Injury ◽  
Recent Origin

Abstract We compared cardiac troponin I (cTnI), using Access®, Sanofi Pasteur, and cardiac troponin T (cTnT), using Elecsys®, Boehringer Mannheim, in the first two routine blood samplings in a routine panel of cardiac markers for the biochemical diagnostic evaluation of patients with symptoms of acute myocardial infarction (AMI). No significant differences in the overall clinical performances of cTnI and cTnT were observed for the diagnosis of AMI (n = 68), but cTnI demonstrated lower initial sensitivity and higher specificity compared with cTnT. cTnT was increased to higher relative values than cTnI (P = 0.023). Discordances were found between cTnI and cTnT in sample I but not in sample II; positive cTnT/negative cTnI was more common than the opposite discordance (P = 0.027). cTnT was more frequently increased in patients with unstable angina pectoris (UAP) than cTnI (P = 0.038), with no significant differences between sample I and sample II; discordant results with respect to cTnI and cTnT appeared in 6 (33%) of these patients, all of which were positive for cTnT and negative for cTnI. Four patients with UAP (22%) developed AMI within 4 months; three were associated with increased cTnI and cTnT at the time of initial testing, and one was discordant (positive cTnT). In patients classified with no acute coronary syndrome (n = 84), five concordant positives for cTnI and cTnT were observed, indicating the existence of a myocardial injury of recent origin in these patients. AMI evolved in one of these patients 5 months later. We conclude that cTnT and cTnI detect acute myocardial injury with equal clinical performance in AMI patients classified by WHO criteria. cTnT was more frequently increased in patients with UAP than cTnI, but the clinical significance of this discordance could not be determined from this study.

scholarly journals The effect of obstructive sleep apnoea on timing of acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.H Muhmad Hamidi ◽  
H Sani ◽  
M.A Ibrahim ◽  
K.S Ibrahim ◽  
A.B Md Radzi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Systolic Function ◽  
Strong Association ◽  
Multiple Logistic Regression Analysis ◽  
Sleep Apnoea ◽  
Neck Circumference ◽  
Coronary Syndrome ◽  
Obstructive Sleep ◽  
Significant Difference

Abstract Background and objective Acute coronary syndrome (ACS) remains the principal cause of death in Malaysia. It is estimated about 20% of ACS occurs at nighttime during sleep between 12am to 6am. Factors associated with nocturnal ACS are unknown. Acute nocturnal pathophysiological response to obstructive sleep apnea (OSA) may increase risk of nocturnal ACS. We hypothesized that OSA risk is associated with timing of ACS onset. Methodology This study included 200 patients with ACS who underwent coronary angiogram for which the time of chest pain onset was clearly identified and divided into 2 groups; nocturnal ACS (12am-5.59am) and non-nocturnal ACS (6am–11.59pm). Two validated questionnaires, STOP-BANG and Epworth Sleepiness Scale (ESS) were self-administered by subjects to determine OSA risk. All subjects timing of ACS onset, OSA risk, demography, anthropometric measurements, comorbidities and echocardiographic characteristics were analyzed. Results Acute coronary syndrome occurs nocturnally in 19% of ACS patients. The prevalence of high risk OSA individuals among ACS patients is 43%. There is significantly higher prevalence of high risk OSA individuals in nocturnal ACS group of 95% compared to 30% of high risk OSA individuals in non-nocturnal ACS group (p=0.001). Nocturnal ACS patients was significantly younger (50.1±8.7yrs, p=0.001), had higher BMI (33.9±4.3kg/m2, p=0.005), waist circumference (106.7±10.3cm, p=0.003) and larger neck circumference (44.6±3.3cm, p=0.001) compared to non-nocturnal ACS group. These groups had similar prevalence of other comorbidities for ACS and showed no significant difference between left and right ventricular systolic function. In multiple logistic regression analysis, the most significant predictors for nocturnal ACS are OSA risk, neck circumference and age. Conclusion There is a strong association between high risk OSA individuals and nocturnal ACS onset. Patient with nocturnal ACS onset should be screened for OSA and prioritized for polysomnography. OSA prevalence according to ACS onset Funding Acknowledgement Type of funding source: None

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