Free Triiodothyronine Level Indicates the Degree of Myocardial Injury in Patients with Acute Myocardial Infarction

Objective. The pathophysiologic mechanism of how thyroid function is related to the development and prognosis of acute myocardial infarction (AMI) remains under explored, and there has been a lack of clinical investigations. In this study, we investigate the relationship between triiodothyronine (T3) level and cardiac ejection fraction (EF) as well as probrain natriuretic peptide (NT-proBNP) on admission and subsequent prognosis in AMI patients. Methods. We measured admission thyroid function, NT-proBNP, and EF by echocardiography in 345 patients diagnosed with AMI. Simple and multiregression analyses were performed to investigate the correlation between T3 level and EF as well as NT-proBNP. Major adverse cardiovascular events (MACE), including new-onset myocardial infarction, acute heart failure, and cardiac death, were documented during the follow-up. 248 participants were separated into three groups based on T3 and free triiodothyronine (FT3) levels for survival analysis during a 2-year follow-up. Results. 345 patients diagnosed with AMI were included in the initial observational analysis. 248 AMI patients were included in the follow-up survival analysis. The T3 levels were found to be significantly positively correlated with EF (R square=0.042, P<0.001) and negatively correlated with admission NT-proBNP levels (R square=0.059, P<0.001), which is the same with the correlation between FT3 and EF (R square=0.053, P<0.001) and admission NT-proBNP levels (R square=0.108, P<0.001). Kaplan-Meier survival analysis revealed no significant difference with regard to different T3 or FT3 levels at the end of follow-up. Conclusions. T3 and FT3 levels are moderately positively correlated with cardiac function on admission in AMI patients but did not predict a long-time survival rate. Further studies are needed to explain whether longer-term follow-up would further identify the prognosis effect of T3 on MACE and all-cause mortality.

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Pattern of serum cardiac troponin-I in symptomatic acute myocardial infarction patients in national institute of cardiovascular disease in Bangladesh

Bangladesh Medical Journal ◽

10.3329/bmj.v42i1.18969 ◽

2014 ◽

Vol 42 (1) ◽

pp. 3-6

Author(s):

SS Shahina ◽

JU Ahmed ◽

S Ahmed ◽

E Shahriar ◽

MN Uddin ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

Acute Myocardial Infarction ◽

Myocardial Injury ◽

Troponin I ◽

Clinical Symptoms ◽

Cardiac Injury ◽

Circadian Variation ◽

Assay Method ◽

Ctni Level

Troponin I (cTnI) isoform is cardiac muscle specific protein and shown to have several features as a preferred marker of myocardial injury. It rises early in acute myocardial infarction (AMI) and attains levels that are clearly separated from baseline values. It remains elevated for several days providing a long window for detection of cardiac injury. The objective of the study was to evaluate for the profile of cTnI level among symptomatic AMI patients. The study was conducted at National Institute of Cardiovascular Disease, Dhaka, Bangladesh from July 2007 to June 2008 and total 9552 patients with type 1 or type 2 MI were included. Blood Sample was taken within 3 days of symptoms and cTnI was measured by chemiluminescent immunometric assay method. cTnI was considered positive when the value was >1ng/ml and study population was divided as per age, sex and cTnI level. The mean (+ SD) age of all patients was 55(+ 12.8) years and majority was males (82.20%). Seasonal variation showed highest positive cases in winter. In case of circadian variation positive cTnI results were suggestive of morning peak of AMI. Positive results were obtained in 32.3% of Cases. cTnI is now considered as a better indicator of myocardial injury. Further study in depth is necessary to correlate with clinical symptoms and other diagnostic tests to make a complete profile of AMI according to the latest subtypes. DOI: http://dx.doi.org/10.3329/bmj.v42i1.18969 Bangladesh Med J. 2013 Jan; 42 (1): 3-6

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Assessment of myocardial injury by serum tumour necrosis factor alpha measurements in acute myocardial infarction

European Heart Journal ◽

10.1093/oxfordjournals.eurheartj.a014803 ◽

1996 ◽

Vol 17 (12) ◽

pp. 1852-1859 ◽

Cited By ~ 29

Author(s):

M. M. Hirschl ◽

M. Gwechenberger ◽

T. Binder ◽

M. Binder ◽

S. Graf ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Tumour Necrosis Factor ◽

Tumour Necrosis ◽

Myocardial Injury ◽

Tumour Necrosis Factor Alpha ◽

Necrosis Factor Alpha ◽

Factor Alpha ◽

Necrosis Factor ◽

Serum Tumour

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Biochemical Markers of Myocardial Injury Test Turnaround Time: A College of American Pathologists Q-Probes Study of 7020 Troponin and 4368 Creatine Kinase–MB Determinations in 159 Institutions

Archives of Pathology & Laboratory Medicine ◽

10.5858/2004-128-158-bmomit ◽

2004 ◽

Vol 128 (2) ◽

pp. 158-164 ◽

Cited By ~ 2

Author(s):

David A. Novis ◽

Bruce A. Jones ◽

Jane C. Dale ◽

Molly K. Walsh

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Creatine Kinase ◽

Biochemical Markers ◽

Myocardial Injury ◽

Turnaround Time ◽

Test Results ◽

Cardiac Marker ◽

Laboratory Personnel ◽

Creatine Kinase Mb

Abstract Context.—Rapid diagnosis of acute myocardial infarction in patients presenting to emergency departments (EDs) with chest pain may determine the types, and predict the outcomes of, the therapy those patients receive. The amount of time consumed in establishing diagnoses of acute myocardial infarction may depend in part on that consumed in the generation of the blood test results measuring myocardial injury. Objective.—To determine the normative rates of turnaround time (TAT) for biochemical markers of myocardial injury and to examine hospital and laboratory practices associated with faster TATs. Design.—Laboratory personnel in institutions enrolled in the College of American Pathologists Q-Probes Program measured the order-to-report TATs for serum creatine kinase–MB and/or serum troponin (I or T) for patients presenting to their hospital EDs with symptoms of acute myocardial infarction. Laboratory personnel also completed detailed questionnaires characterizing their laboratories' and hospitals' practices related to testing for biochemical markers of myocardial injury. ED physicians completed questionnaires indicating their satisfaction with testing for biochemical markers of myocardial injury in their hospitals. Setting.—A total of 159 hospitals, predominantly located in the United States, participating in the College of American Pathologists Q-Probes Program. Results.—Most (82%) laboratory participants indicated that they believed a reasonable order-to-report TATs for biochemical markers of myocardial injury to be 60 minutes or less. Most (75%) of the 1352 ED physicians who completed satisfaction questionnaires believed that the results of tests measuring myocardial injury should be reported back to them in 45 minutes or less, measured from the time that they ordered those tests. Participants submitted TAT data for 7020 troponin and 4368 creatine kinase–MB determinations. On average, they reported 90% of myocardial injury marker results in slightly more than 90 minutes measured from the time that those tests were ordered. Among the fastest performing 25% of participants (75th percentile and above), median order-to-report troponin and creatine kinase–MB TATs were equal to 50 and 48.3 minutes or less, respectively. Shorter troponin TATs were associated with performing cardiac marker studies in EDs or other peripheral laboratories compared to (1) performing tests in central hospital laboratories, and (2) having cardiac marker specimens obtained by laboratory rather than by nonlaboratory personnel. Conclusion.—The TAT expectations of the ED physicians using the results of laboratory tests measuring myocardial injury exceed those of the laboratory personnel providing the results of those tests. The actual TATs of myocardial injury testing meet the expectations of neither the providers of those tests nor the users of those test results. Improving TAT performance will require that the providers and users of laboratory services work together to develop standards that meet the needs of the medical staff and that are reasonably achievable by laboratory personnel.

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