Abstract P413: Latent Class Trajectory Modeling Identifies Distinct Clinical Phenotypes in a Cohort of Patients With Elevated Troponin Levels

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Michael C Wang ◽  
Lucia Petito ◽  
Anna Pawlowski ◽  
Daniel Schneider ◽  
Lowie Van Assche ◽  
...  
Keyword(s):  
Latent Class ◽  
Myocardial Damage ◽  
Information Criterion ◽  
Final Model ◽  
Trajectory Modeling ◽  
Clinical Phenotypes ◽  
Severe Group ◽  
St Elevation ◽  
One Year ◽  
Enterprise Data Warehouse

Introduction: Clinicians widely use cardiac troponins I and T, sensitive and specific biomarkers of myocardial damage, as diagnostic criteria for myocardial infarction (MI). A common approach, dichotomizing based on whether troponin levels meet thresholds for MI, may miss meaningful heterogeneity in degree and pattern of troponin elevation, with wider clinical implications. Hypothesis: Using latent class trajectory modeling (LCTM) with patients’ patterns of troponin elevations will yield trajectories that represent clinically and prognostically distinct groups of patients. Methods: We used Northwestern Medicine’s Enterprise Data Warehouse to identify patients with at least 3 troponin measurements of which at least one was elevated during their inpatient stay. We built a LCTM to capture troponin trajectories from 13,432 patients with 65,162 measurements since 2000, using Bayesian Information Criterion to select the final model (# of classes varied from 3-7). We then described the clinical and prognostic factors associated with trajectory class membership. Results: LCTM identified 3 troponin trajectories: stable low (77.3%), moderate rise (9.5%), and severe rise-fall (13.2%). The average posterior probability of assignment was >0.95 for all classes. The low group had the most comorbidities vs moderate/severe groups, including cancer (21.9% vs 13.9%/11.3%), heart failure (12.6% vs 8.9%/7.5%), and COPD (15.0% vs 11.8%/10.1%). The moderate/severe rising trajectories had a greater rate of clinically-diagnosed MI than the stable group (34.5%/44.1% vs 5.6%), with relatively more ST-elevation MI in the severe group (19.8% vs 5.3%) and Non-ST-elevation MI in the moderate group (29.3% vs 24.3%). One-year mortality was greatest in the low group vs moderate/severe groups (25.5% vs 21.4%/18.8%). Conclusions: In a cohort of hospitalized patients with elevated troponins, LCTM identified 3 distinct, clinically interpretable troponin trajectories which were associated with differing clinical phenotypes.

The current treatment and predictors of outcome in elderly patients with non-ST-elevation myocardial infarction in an all comers population: the POPular Age registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.E Gimbel ◽  
D.R.P.P Chan Pin Yin ◽  
R.S Hermanides ◽  
F Kauer ◽  
A.H Tavenier ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Elderly Patients ◽  
Major Bleeding ◽  
Oral Anticoagulation ◽  
Dual Antiplatelet Therapy ◽  
Bleeding Risk ◽  
Cardiovascular Death ◽  
St Elevation ◽  
One Year

Abstract Background Elderly patients form a large and growing part of the patients presenting with non-ST-elevation myocardial infarction (NSTEMI). Choosing the optimal antithrombotic treatment in these elderly patients is more complicated because they frequently have characteristics indicating both a high ischaemic and high bleeding risk. Purpose We describe the treatment of elderly patients (>75 years) admitted with NSTEMI, present the outcomes (major adverse cardiovascular events (MACE) and bleeding) and aim to find predictors for adverse events. Methods The POPular AGE registry is an investigator initiated, prospective, observational, multicentre study of patients aged 75 years or older presenting with NSTEMI. Patients were recruited between August 1st, 2016 and May 7th, 2018 at 21 sites in the Netherlands. The primary composite endpoint of MACE included cardiovascular death, non-fatal myocardial infarction and non-fatal stroke at one-year follow-up. Results A total of 757 patients were enrolled. During hospital stay 76% underwent coronary angiography, 34% percutaneous coronary intervention and 12% coronary artery bypass grafting (CABG). At discharge 78.6% received aspirin (non-users mostly because of the combination of oral anticoagulant and clopidogrel), 49.7% were treated with clopidogrel, 34.2% with ticagrelor and 29.6% were prescribed oral anticoagulation. Eighty-three percent of patients received dual antiplatelet therapy (DAPT) or dual therapy consisting of oral anticoagulation and at least one antiplatelet agent for a duration of 12 months. At one year, the primary outcome of cardiovascular death, myocardial infarction or stroke occurred in 12.3% of patients and major bleeding (BARC 3 or 5) occurred in 4.8% of the patients. The risk of MACE and major bleeding was highest during the first month and stayed high over time for MACE while the risk for major bleeding levelled off. Independent predictors for MACE were age, renal function, medical history of CABG, stroke and diabetes. The only independent predictor for major bleeding was haemoglobin level on admission. Conclusion In this all-comers registry, most elderly patients (≥75 years) with NSTEMI are treated with DAPT and undergoing coronary angiography the same way as younger NSTEMI patients from the SWEDEHEART registry. Aspirin use was lower as was the use of the more potent P2Y12 inhibitors compared to the SWEDEHEART which is very likely due to the concomitant use of oral anticoagulation in 30% of patients. The fact that ischemic risk stays constant over 1 year of follow-up, while the bleeding risk levels off after one month may suggest the need of dual antiplatelet therapy until at least one year after NSTEMI. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): AstraZeneca

scholarly journals Clinical phenotypes of cardiac sarcoidosis by latent class analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Q Dai ◽  
B Bose ◽  
P Li ◽  
B Liu ◽  
L Jin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Latent Class Analysis ◽  
Clinical Outcomes ◽  
Ventricular Arrhythmias ◽  
Latent Class ◽  
Cardiac Sarcoidosis ◽  
Information Criterion ◽  
Cardiometabolic Syndrome ◽  
Study Population ◽  
Myocardial Involvement

Abstract Background Sarcoidosis is a systemic granulomatous disease with cardiac involvement reported in 20–27% of patients [1]. Cardiac sarcoidosis (CS) can lead to atrial or ventricular arrhythmias, various conduction system disorders, heart failure or sudden cardiac death, depending on the location of myocardial involvement [2]. Previous studies have investigated the possible types of CS based on the distribution of myocardial involvement on imaging as well as the role of genetic factors [3,4]. However, there are no studies describing the clinical heterogeneity of CS patients. Purpose In order to determine if clinical clusters exist in CS, we carried out a latent class analysis (LCA) to explore potential phenotypes in a large sample of CS patients from the National Inpatient Sample (NIS). Methods We identified 848 patients with a diagnosis of CS from the NIS in 2016–2018. A LCA was performed based on comorbidities. Utilizing the Bayesian information criterion and Akaike's information criterion we divided our study population into 3 cohorts. We subsequently applied the LCA model for our study population to fit each patient into one of the 3 cohorts. Finally, we compared the clinical outcomes among the 3 groups. Results Following LCA, patients in cohort 3 were strongly associated with a cardiometabolic syndrome profile with the highest prevalence of congestive heart failure (CHF, 95.1%), chronic kidney disease (CKD, 69.7%), diabetes mellitus (68.9%), hyperlipidemia (52.5%) and obesity (45.1%). Patients in cohort 2 had an intermediate prevalence of cardiometabolic syndrome with a universal diagnosis of hypertension (100%) but with the lowest number of CHF (32.5%) patients and none with CKD. Finally, patients in cohort 1 had the least comorbidities in comparison to the other groups but there was a higher prevalence of CHF (71.7%). There was no significant difference in mortality among the 3 groups, but acute respiratory failure was the highest in cohort 3. However, ventricular arrhythmias were more prevalent in cohort 1 patients (Table). Conclusion We identified 3 different types of CS based on their clinical phenotype. The clinical outcomes varied among the cohorts with ventricular arrhythmias being the most prevalent in patients with the least cardiometabolic comorbidities. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals A Suspected COVID-19-associated Myocarditis Case Mimicking Life-threatening STEMI: a Shark Fin Appearance

2021 ◽  
Vol 2 (1) ◽  
pp. 23
Author(s):  
Ratna Mariana Tamba ◽  
Andika Sitepu
Keyword(s):  
Chest Pain ◽  
Rapid Test ◽  
Myocardial Damage ◽  
Ground Glass Opacity ◽  
Normal Coronary Artery ◽  
Proinflammatory Response ◽  
Cardiac Biomarker ◽  
Life Threatening ◽  
History Of ◽  
St Elevation

Some cases of myocarditis have been reported associated to Covid-19. The presence of proinflammatory response from immune cells suggested occurs by binding to membrane protein ACE-2 leading to myocardial damage. Our hospital got a refferal from a non-PCI-capable hospital with a 51-years-old woman chest pain and progressive heavy breath with history of fever two days ago. She was diagnosed with anterior STEMI and cardiogenic shock on vassopressors. Her electrocardiogram showed shark fin appearance suggesting life-threatening STEMI. Her rapid test for covid-19 are non-reactive for both IgM and IgG. Her NCCT-thorax showed ground glass opacity in both lungs. Her laboratories finding showed elevated inflammatory markers and elevated cardiac biomarker. We took her naso-oro-pharingeal swab in the same day and process her with emergency PCI. Surprisingly, her angiography showed normal coronary artery without any significant stenosis. From There was no SARS-CoV-2 detected. In myocarditis, patient can mimick the same symptoms as STEMI such as chest pain and heavy breath with elevated cardiac biomarker, but the electrocardiogram usually shows widespread concave ST-elevation with PR-segment depression. Shark fin appearance is usually seen in life-threatening STEMI. In our patient, the NCCT-thorax showed GGO suggested Covid-19 involvement. But, the first swab was negative for SARS-CoV-2. Unfortunately, the patient was discharged without doctor’s consent, so we can not process the second swab and echocardiography to evaluate the function of myocardium. We still can not confirmed this case if it is true myocarditis-associated covid-19 and how was the involvement of the myocardium creating a shark fin mimicking life-threatening STEMI.

scholarly journals Recovery Trajectories Over Six Weeks in Patients Selected for A High-Intensity Physiotherapy Program After Total Knee Arthroplasty: A Latent Class Analysis

2020 ◽  
Author(s):  
K.E.M. Harmelink ◽  
R. Dandis ◽  
P.J. Wees ◽  
A.V.C.M. Zeegers ◽  
M.W. Nijhuis-van der Sanden ◽  
...  
Keyword(s):  
Latent Class Analysis ◽  
Physical Functioning ◽  
Latent Class ◽  
Class Analysis ◽  
Timed Up And Go ◽  
Surgery Outcome ◽  
Post Surgery ◽  
Multivariable Regression ◽  
The Difference ◽  
One Year

Abstract Background: Recovery trajectories differ between individual patients and it is hypothesizes that they can be used to predict if an individual patient is likely to recover earlier or later. Primary aim of this study was to determine if it is possible to identify recovery trajectories for physical functioning and pain during the first six weeks in patients after TKA. Secondary aim was to explore the association of these trajectories with one-year outcomes. Methods: Prospective cohort study of 218 patients with the following measurement time points: preoperative, and at three days, two weeks, six weeks, and one year post-surgery. Outcome measures were performance-based physical functioning (Timed Up and Go [TUG]), self-reported physical functioning (Knee injury and Osteoarthritis Outcome Score-Activities of Daily Living [KOOS-ADL]), and pain (Visual Analogue Scale [VAS]). Latent Class Analysis was used to distinguish classes based on recovery trajectories over the first six weeks postoperatively. Multivariable regression analyses were used to identify associations between classes and one year outcomes.Results: TUG showed three classes: “gain group” (n=203), “moderate gain group” (n=8) and “slow gain group” (n=7), KOOS showed two classes: “gain group” (n=86) and “moderate gain group” (n=132), and VAS-pain three classes: “no/very little pain” (n=151), “normal decrease of pain” (n=48) and “sustained pain” (n=19). The ”low gain group” scored 3.31 [95% CI 1.52, 5.09] seconds less on the TUG than the “moderate gain group” group, and the KOOS “gain group” scored 11.97 [95% CI 8.62, 15.33] points better than the “moderate gain group” after one year.Patients who had an early trajectory of “sustained pain” had less chance to become free of pain at one year than those who reported “no or little pain” (odds ratio 0.11 [95% CI 0.03,0.42]. Conclusion: The findings of this study indicate that different recovery trajectories can be detected. Especially the difference in TUG and KOOS-ADL between the “gain” and “moderate gain” group was considered clinically relevant, while for VAS scores differences between “no/very little pain,” and “sustained pain” were statistically significant but small.

Circulating Erythrocyte Microparticles and the Biochemical Extent of Myocardial Injury in ST Elevation Myocardial Infarction

Cardiology ◽  
2016 ◽  
Vol 136 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Georgios Giannopoulos ◽  
Dimitrios A. Vrachatis ◽  
Georgios Oudatzis ◽  
Georgios Paterakis ◽  
Christos Angelidis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Injury ◽  
Troponin I ◽  
Multivariable Analysis ◽  
Area Under The Curve ◽  
Myocardial Damage ◽  
Primary Angioplasty ◽  
St Elevation Myocardial Infarction ◽  
Vascular Effects ◽  
St Elevation

Objectives: Red blood cell microparticles (RBCm) have potential adverse vascular effects and they have been shown to be elevated in ST elevation myocardial infarction (STEMI). The purpose of this study is to investigate their relationship with biochemical infarct size. Methods: RBCm were quantified with flow cytometry in blood drawn from 60 STEMI patients after a primary angioplasty. The creatine kinase-myocardial brain fraction (CK-MB) was measured at predefined time points and the area under the curve (AUC) was calculated. Results: RBCm count was correlated with CK-MB AUC (Spearman's ρ = 0.83, p < 0.001). The CK-MB AUC values per RBCm quartile (lower to upper) were: 3,351 (2,452-3,608), 5,005 (4,450-5,424), 5,903 (4,862-10,594), and 8,406 (6,848-12,782) ng × h/ml, respectively. From lower to upper quartiles, the maximal troponin I values were: 42.2 (23.3-49.3), 49.6 (28.8-54.1), 59.2 (41.4-77.3), and 69.1 (48.0-77.5) ng/ml (p = 0.005). In multivariable analysis, RBCm remained a significant predictor of CK-MB AUC (standardized β = 0.63, adjusted p = 0.001). Conclusions: Erythrocyte microparticles appear to be related to the total myocardial damage biomarker output. The exact pathophysiologic routes, if any, for this interaction remain to be identified. However, these results suggest that erythrocytes may be a - thus far virtually ignored - player in the pathogenesis of ischemic injury.

P4574Marked changes in the incidence of subendocardial and ST elevation myocardial infarctions: a twenty-one year study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
W J Kostis ◽  
S Zinonos ◽  
J B Kostis ◽  
J Cabrera ◽  
A E Moreyra
Keyword(s):  
Myocardial Infarction ◽  
New Jersey ◽  
Unstable Angina ◽  
Marked Change ◽  
Myocardial Infarctions ◽  
Secular Change ◽  
Annual Number ◽  
St Elevation ◽  
One Year ◽  
New Biomarkers

Abstract Background/Introduction The use of new biomarkers, pharmacologic and interventional therapies have resulted in marked changes of the type of myocardial infarction. Purpose The purpose of this study is to report on the changes in the incidence of subendocardial and ST elevation myocardial infarctions (STEMI) in the state of New Jersey from 1994 to 2015 and describe possible explanations for this secular change. Methods The rate of occurrence of ST elevation myocardial infarction (ICD9 410.00) and of subendocardial (NSTEMI, ICD9 410.70 to 410.72) myocardial infarction was studied using the Myocardial Infarction Data Acquisition System (MIDAS), a statewide database of all admissions for acute myocardial infarction in New Jersey with more than 30 years longitudinal follow up. Admissions for myocardial infarction and unstable angina as well as for conditions associated with troponemia (heart failure ICD9 418.XX, chronic kidney disease ICD9 584.XX, 585.XX, 403.XX, diabetes ICD9 250.XX) were also identified. Associations among variables were examined using logistic regression and linear error in variables (LEIV) models. Results During the time period under consideration, there was a decrease in the total number of MIs in New Jersey by 17.5%, the number of STEMIs decreased by 67.4%, while the rate of NSTEMIs increased by 85.8% (top panel). There was a complementary relationship between the annual number of admissions for unstable angina to the annual number of admissions for NSTEMIs (bottom panel). The effect was more pronounced between 1994 and 2002 and plateaued thereafter corresponding to widespread use of troponins in the diagnosis of acute coronary syndromes. Conclusions The marked change in the type of myocardial infarction was due in part to the use of troponins that resulted in the classification of patients with unstable angina as patients with subendocardial infarction. These data support regionalization of facilities specializing in immediate intervention in STEMI patients.

One-year follow up of cardiac anxiety after a myocardial infarction: A latent class analysis

2012 ◽  
Vol 73 (5) ◽  
pp. 362-368 ◽  
Author(s):  
M.H.C.T. van Beek ◽  
M. Mingels ◽  
R.C. Oude Voshaar ◽  
A.J.L.M. van Balkom ◽  
M. Lappenschaar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Latent Class Analysis ◽  
Latent Class ◽  
Class Analysis ◽  
Cardiac Anxiety ◽  
One Year

scholarly journals Autoantibodies to Cardiac Troponin Associate with Higher Initial Concentrations and Longer Release of Troponin I in Acute Coronary Syndrome Patients

2009 ◽  
Vol 55 (5) ◽  
pp. 938-945 ◽  
Author(s):  
Kim Pettersson ◽  
Susann Eriksson ◽  
Saara Wittfooth ◽  
Emilia Engström ◽  
Markku Nieminen ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Myocardial Damage ◽  
Prognostic Impact ◽  
Serum Samples ◽  
Igg Antibody ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Autoantibody Formation

Abstract Background: Cardiac troponin (cTn) is an established marker of myocardial infarction. Pronounced heterogeneity and the minute amounts released into the circulation constitute significant challenges for cTn detection. Recently, autoantibody formation to cTn was shown to be common and to interfere with immunoassay performance. In this study, we investigated cTn autoantibodies and cardiac troponin I (cTnI) in acute coronary syndrome (ACS) patients over a 1-year period after the index event. Methods: We used a second-generation cTnI assay designed to reduce the interference of cTn autoantibodies. The assay for cTn autoantibodies used 2 anti-cTnI antibodies to capture the ternary cTnI-complex, enabling unrestricted binding of the autoantibodies, which were detected with a labeled antihuman IgG antibody. We analyzed serum samples from 81 non–ST-elevation ACS patients taken at admission and after 1 week and 3 and 12 months. Results: We found 14 cTn autoantibody–positive patients (21%) among the 67 cTnI-positive and none among the 14 cTnI-negative patients. Nine were autoantibody-positive at admission, and 5 became positive at 1 week. Autoantibody signals significantly increased in the 1-week and 3-month samples. At all time points, cTnI was significantly increased in the autoantibody-positive group relative to the negative group. Persistent cTnI elevations at 3 and 12 months were seen in the patients already autoantibody positive at admission. Conclusions: During ACS, patients with cTn autoantibodies have higher cTnI release and therefore larger myocardial damage than patients without autoantibodies. Their cTnI release also lasts longer, at least months. The possible prognostic impact of these observations must be evaluated in larger clinical cohorts.

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