scholarly journals Additional Value of Non-contrast Chest CT in the Prediction of Adverse Cardiovascular Events in Patients With Novel Coronavirus Disease 2019 (COVID-19)

2021 ◽  
Vol 8 ◽  
Author(s):  
Shuang Li ◽  
Xiaojun Wang ◽  
Hongyao Hu ◽  
Jing Xu ◽  
Jian He ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Troponin I ◽  
Cardiac Injury ◽  
Multivariable Analysis ◽  
Area Under The Curve ◽  
Chest Ct ◽  
Major Adverse Cardiovascular Events ◽  
Wall Thickening ◽  
Cardiothoracic Ratio ◽  
Additional Value

Background: Coronavirus disease 2019 (COVID-19) has outbroken in China and subsequently spread worldwide since the end of 2019. Chest computed tomography (CT) plays an important role in the diagnosis of lung diseases, but its value in the diagnosis of cardiac injury remains unknown.Methods: We enrolled 241 consecutive hospitalized patients (aged 61 ± 16 years, 115 males) with laboratory-confirmed COVID-19 at Renmin Hospital of Wuhan University from January 11 to March 2, 2020. They were divided into two groups according to whether major adverse cardiovascular events (MACEs) occurred during the follow-up. The anteroposterior diameter of the left atrium (LAD), the length of the left ventricle (LV), and cardiothoracic ratio (CTR) were measured. The values of myocardial CT were also recorded.Results: Of 241 patients, 115 patients (47.7%) had adverse cardiovascular events. Compared with no MACEs, patients with MACEs were more likely to have bilateral lesions (95.7% vs. 86.5%, p = 0.01). In multivariable analysis, bronchial wall thickening would increase the odds of MACEs by 13.42 (p = 0.01). LAD + LV and CTR was the best predictor for MACEs (area under the curve = 0.88, p < 0.001) with a sensitivity of 82.6% and a specificity of 80.2%. Plasma high-sensitivity troponin I levels in patients with cardiac injury showed a moderate negative correlation with minimum CT value (R2 = −0.636, p < 0.001).Conclusions: Non-contrast chest CT can be a useful modality for detection cardiac injury and provide additional value to predict MACEs in COVID-19 patients.

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.

Abstract 17331: Elevated Troponin Levels Predict Major Adverse Cardiovascular Outcomes and Mortality in COVID-19 Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Chirag Patel ◽  
Farukh Ikram ◽  
Nicholas Nguyen ◽  
Hao Nguyen ◽  
Priyanka Acharya ◽  
...  
Keyword(s):  
Chest Pain ◽  
Cardiovascular Events ◽  
Troponin I ◽  
Cardiovascular Complications ◽  
Hospitalized Patients ◽  
Cardiac Biomarkers ◽  
Major Adverse Cardiovascular Events ◽  
Care Hospital ◽  
Elevated Troponin ◽  
Chi Square

Introduction: Measurement of cardiac biomarkers such as troponin-I (TnI) are useful in assessing for the presence of cardiovascular events. Chest pain is often not a presenting complaint of COVID-19 patients, yet there have been many cases of patients experiencing possible cardiovascular complications. We sought to examine the value of elevated TnI in predicting the occurrence of major adverse cardiovascular events (MACE) and mortality in COVID-19 patients Methods: A retrospective review was performed on 225 hospitalized patients that tested positive for COVID-19 between March and May 2020 at our quaternary care hospital. Baseline characteristics and clinical outcomes of their disease course were identified. During the chart review, we documented the admission and peak TnI levels available in the medical record, and noted the occurrence of MACE (a composite of myocardial infarction, stroke, pulmonary embolism, deep venous thrombosis, or shock requiring vasopressor support) or death. Data were analyzed using Pearson’s chi square test and logistic regression to adjust for age. Results: Of the 225 hospitalized patients, only 31(14.83%) complained of chest pain on admission. Among patients with elevated TnI, 49.15% had MACE/ Mortality, compared to 21% with non-elevated TnI. Patients with elevated TnI were nearly 4 times more likely to have MACE/Mortality than patients with non-elevated TnI (p = 0.0001; OR = 3.97; 95% CI [1.88, 8.41]). They were also 3.63 times more likely to have MACE alone (p < 0.0001; OR = 3.63; 95% CI [1.70, 7.79]). Median peak TnI values were higher in patients who had a MACE compared to those who did not (0.0275 ng/mL [IQR 0.012-0.152] vs 0.012 ng/mL [IQR 0.012-0.152], p <0.05). For every one-unit increase in peak TnI levels, the age-adjusted odds of having MACE increased by a factor of 4468.37 (95% CI [9.07 2200316.00]; p = 0.008). Conclusions: Based on our data, elevated troponin-I levels predict the occurrence of MACE in patients who are hospitalized with COVID-19. Furthermore, there is an association between elevated troponin-I and eventual MACE, mortality, or both. This suggests that checking troponin-I levels in COVID-19 patients holds prognostic value, irrespective of the presence of chest pain as a presenting complaint.

Homocysteine as a potential predictive factor for high major adverse cardiovascular events risk in female patients with premature acute coronary syndrome

2019 ◽  
Author(s):  
Mei Wei ◽  
Le Wang ◽  
Yongsheng Liu ◽  
Mingqi Zheng ◽  
Fangfang Ma ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Predictive Factor ◽  
Cardiovascular Events ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Major Adverse Cardiovascular Events ◽  
Free Survival ◽  
Female Patients ◽  
Coronary Syndrome ◽  
Kaplan Meier

Abstract Background We aimed to investigate correlation of homocysteine (Hcy) level with clinical characteristics, and explore its predictive value for major adverse cardiovascular events (MACE) risk in female patients with premature acute coronary syndrome (ACS).Methods Serum Hcy level was detected from 1,299 female patients with premature ACS. According to the tertile of Hcy level, patients were divided into three groups: lowest tertile group (≤9.1 µmol/L), middle tertile group (9.2~11.6 µmol/L) and highest tertile group (>11.6 µmol/L). MACE incidence was recorded and MACE-free survival was caculated with the median follow-up duration of 28.3 months.Results Increased Hcy correlated with older age ( P <0.001), higher creatinine level ( P <0.001) and enhanced uric acid level ( P =0.001), while reduced fasting glucose concentration ( P <0.001). MACE incidence was 10.7% and it was highest in highest tertile group (22.1%), followed by middle tertile group (7.7%) and lowest tertile group (2.4%) ( P <0.001). Receiver operating characteristic curve showed that Hcy distinguished MACE patients from non-MACE patients with the area under the curve of 0.789 (95% CI: 0.742-0.835). Kaplan-Meier curves revealed that MACE-free survival was shortest in Hcy highest tertile group, followed by middle tertile group and lowest tertile group ( P <0.001). Multivariate Cox’s analyses further showed that higher Hcy level was an independently predictive factor for poor MACE-free survival (middle tertile vs. lowest tertile ( P =0.001, HR: 3.615, 95% CI: 1.661-7.864); highest tertile vs. lowest tertile ( P <0.001, HR: 11.023, 95% CI: 5.356-22.684)).Conclusion Hcy serves as a potential predictive factor for increased MACE risk in female patients with premature ACS.

Are glycoprotein inhibitors safe during percutaneous coronary intervention in patients on chronic warfarin treatment?

2009 ◽  
Vol 102 (12) ◽  
pp. 1227-1233 ◽  
Author(s):  
Heli Lahtela ◽  
Pasi Karjalainen ◽  
Matti Niemelä ◽  
Saila Vikman ◽  
Kari Kervinen ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Major Bleeding ◽  
Cardiovascular Events ◽  
Warfarin Therapy ◽  
Multivariable Analysis ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
Bleeding Events ◽  
Hospital Variation ◽  
Percutaneous Coronary

SummaryThe aim of this study was to evaluate the safety of glycoprotein IIb/IIIa inhibitors (GPIs) during percutaneous coronary intervention (PCI) in patients on chronic warfarin therapy due to atrial fibrillation (AF).We analysed all consecutive AF patients (N = 377, mean age 70 years, male 71%) on warfarin therapy referred for PCI in seven centres. Major bleeding, access site complications and major adverse cardiovascular events were recorded during hospitalisation. A total of 111 patients (29%) received periprocedural GPIs with a wide inter-hospital variation in their use (range 3–68%).The use of GPIs increased with the severity of the disease presentation and 49% of patients with ST-elevation myocardial infarction received GPIs. Mean periprocedural international normalised ratio (INR) of patients who received GPIs was 1.89 (range 1.1–3.3). Major bleeding was more common in the patients treated with GPIs (9.0% vs. 1.5%, p = 0.001) than in those without GPIs, but there was no difference in major adverse cardiovascular events between the groups. In multivariable analysis, use of GPIs (odds ratio [OR]???????????5.1, 95% confidence interval [CI]???????????1.3–20.6, p = 0.02) and old age (OR 1.2, 95% CI 1.0–1.3, p = 0.02) remained as the only independent predictors of major bleeding. Also after adjusting for propensity score, GPIs remained as a significant predictor of major bleeding (OR 3.8, 95% CI 1.03–14.1, p = 0.045). In the GPI group, major bleeding was not predicted by INR level or warfarin pause. GPIs increase the risk of major bleeding events irrespective of periprocedural INR levels and should be used with caution in this fragile patient group.

scholarly journals Distinct Characteristics of VEGF‐D and VEGF‐C to Predict Mortality in Patients With Suspected or Known Coronary Artery Disease

2020 ◽  
Vol 9 (9) ◽  
Author(s):  
Hiromichi Wada ◽  
Masahiro Suzuki ◽  
Morihiro Matsuda ◽  
Yoichi Ajiro ◽  
Tsuyoshi Shinozaki ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Cardiovascular Events ◽  
Troponin I ◽  
Cardiovascular Death ◽  
Major Adverse Cardiovascular Events ◽  
All Cause Mortality ◽  
Artery Disease ◽  
Cardiovascular Biomarkers

Background VEGF‐D (vascular endothelial growth factor D) and VEGF‐C are secreted glycoproteins that can induce lymphangiogenesis and angiogenesis. They exhibit structural homology but have differential receptor binding and regulatory mechanisms. We recently demonstrated that the serum VEGF‐C level is inversely and independently associated with all‐cause mortality in patients with suspected or known coronary artery disease. We investigated whether VEGF‐D had distinct relationships with mortality and cardiovascular events in those patients. Methods and Results We performed a multicenter, prospective cohort study of 2418 patients with suspected or known coronary artery disease undergoing elective coronary angiography. The serum level of VEGF‐D was measured. The primary outcome was all‐cause death. The secondary outcomes were cardiovascular death and major adverse cardiovascular events defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke. During the 3‐year follow‐up, 254 patients died from any cause, 88 died from cardiovascular disease, and 165 developed major adverse cardiovascular events. After adjustment for possible clinical confounders, cardiovascular biomarkers (N‐terminal pro‐B‐type natriuretic peptide, cardiac troponin‐I, and high‐sensitivity C‐reactive protein), and VEGF‐C, the VEGF‐D level was significantly associated with all‐cause death and cardiovascular death but not with major adverse cardiovascular events.. Moreover, the addition of VEGF‐D, either alone or in combination with VEGF‐C, to the model with possible clinical confounders and cardiovascular biomarkers significantly improved the prediction of all‐cause death but not that of cardiovascular death or major adverse cardiovascular events. Consistent results were observed within patients over 75 years old. Conclusions In patients with suspected or known coronary artery disease undergoing elective coronary angiography, an elevated VEGF‐D value seems to independently predict all‐cause mortality.

scholarly journals Clinical Evaluation of a New High-Sensitivity Cardiac Troponin I Assay for Diagnosis and Risk Assessment of Patients with Suspected Acute Myocardial Infarction

Cardiology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Masayuki Shiozaki ◽  
Kenji Inoue ◽  
Satoru Suwa ◽  
Chien-Chang Lee ◽  
Shuo-Ju Chiang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Diagnostic Accuracy ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Area Under The Curve ◽  
High Sensitivity ◽  
Major Adverse Cardiovascular Events ◽  
Primary Analysis ◽  
Rule Out

<b><i>Introduction:</i></b> Current assays based on the 0-hour/1-hour (0-/1-h) algorithm using high-sensitivity cardiac troponin (hs-cTn) are limited to only Abbott Architect hs-cTnI, Siemens Vista hs-cTnI, and Roche Elecsys hs-cTnT. <b><i>Objective:</i></b> This study aimed to evaluate this new hs-cTnI assay, LumipulsePresto hs Troponin I, for diagnosis of acute myocardial infarction (AMI) on admission and on 0-/1-h algorithm to stratify AMI patients precisely. <b><i>Methods:</i></b> This prospective cohort study included 442 patients with suspected non-ST-elevation myocardial infarction in three hospitals in Japan and Taiwan from June 2016 to January 2019. We enrolled patients presenting to the emergency department with symptoms suggestive of AMI and collected blood samples on admission and 1 hour later. Two independent cardiologists centrally adjudicated final diagnoses; all clinical information was reviewed twice: first, using serial hs-cTnT (Roche-Elecsys, primary analysis) and Lumipulse Presto Lumipulse Presto, second, using the Lumipulse Presto hs-cTnI measurements. At first, we compared diagnostic accuracy quantified using receiver operating characteristic (ROC) curves for AMI. Then, we evaluated major adverse cardiovascular events (cardiac death, AMI) in the rule-out group according to a 0-hour/1-hour algorithm at the 30-day follow-up. <b><i>Results:</i></b> Diagnostic accuracy at presentation by the ROC curve for AMI was very high and similar for the LumipulsePresto hs-cTnI and hs-cTnT,(area under the curve [AUC]: LumipulsePresto hs-cTnI, 0.89, 95% confidence interval [CI] 0.86–0.93; hs-cTnT, 0.89, 95% CI 0.85–0.93; <i>p</i> = 0.82). In early presenters, the LumipulsePresto hs-cTnI appeared to maintain the diagnostic performance of hs-cTn for patients with &#x3c;3 h (AUC: LumipulsePresto hs-cTnI, 0.87, 95% CI 0.81–0.92; hs-cTnT, 0.86, 95% CI 0.80–0.92; <i>p</i> = 0.81). The algorithm using the LumipulsePresto hs-cTnI ruled out AMI in 200 patients with negative predictive value and sensitivity of 100% (95% CI 97.3%–100%) and 100% (95% CI 92.7%–100%), respectively, in the rule-out group. <b><i>Conclusion:</i></b> Diagnostic accuracy and clinical utility of the novel LumipulsePresto hs-cTnI assay are high and comparable with the established hs-cTn assays.

scholarly journals TROPONIN-I PREDICTS MAJOR ADVERSE CARDIOVASCULAR EVENTS AND RISK OF MORTALITY IN COVID-19 PATIENTS

2021 ◽  
Vol 77 (18) ◽  
pp. 3178
Author(s):  
Chirag Patel ◽  
Farukh Ikram ◽  
Nicholas Nguyen ◽  
Hao Nguyen ◽  
Chijioke Ukoha ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Troponin I ◽  
Major Adverse Cardiovascular Events ◽  
Risk Of Mortality

scholarly journals Deep Learning Prediction of Biomarkers from Echocardiogram Videos

2021 ◽  
Author(s):  
J Weston Hughes ◽  
Neal Yuan ◽  
Bryan He ◽  
Jiahong Ouyang ◽  
Joseph Ebinger ◽  
...  
Keyword(s):  
Deep Learning ◽  
Troponin I ◽  
Learning Algorithm ◽  
Area Under The Curve ◽  
Clinical Value ◽  
Disease States ◽  
Deep Learning Algorithm ◽  
Phenotypic Information ◽  
Additional Value ◽  
Physiologic State

AbstractLaboratory blood testing is routinely used to assay biomarkers to provide information on physiologic state beyond what clinicians can evaluate from interpreting medical imaging. We hypothesized that deep learning interpretation of echocardiogram videos can provide additional value in understanding disease states and can predict common biomarkers results. Using 70,066 echocardiograms and associated biomarker results from 39,460 patients, we developed EchoNet-Labs, a video-based deep learning algorithm to predict anemia, elevated B-type natriuretic peptide (BNP), troponin I, and blood urea nitrogen (BUN), and abnormal levels in ten additional lab tests. On held-out test data across different healthcare systems, EchoNet-Labs achieved an area under the curve (AUC) of 0.80 in predicting anemia, 0.82 in predicting elevated BNP, 0.75 in predicting elevated troponin I, and 0.69 in predicting elevated BUN. We further demonstrate the utility of the model in predicting abnormalities in 10 additional lab tests. We investigate the features necessary for EchoNet-Labs to make successful predictions and identify potential prediction mechanisms for each biomarker using well-known and novel explainability techniques. These results show that deep learning applied to diagnostic imaging can provide additional clinical value and identify phenotypic information beyond current imaging interpretation methods.

P5674Direct comparison of three high-sensitivity cardiac troponins in syncope

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Du Fay De Lavallaz ◽  
P B Badertscher ◽  
T Z Zimmermann ◽  
J W Walter ◽  
I S Strebel ◽  
...  
Keyword(s):  
Troponin I ◽  
Area Under The Curve ◽  
Clinical Information ◽  
High Sensitivity ◽  
Final Diagnosis ◽  
Major Adverse Cardiovascular Events ◽  
Prognostic Information ◽  
Cardiovascular Research ◽  
Prognostic Accuracy ◽  
Cardiac Syncope

Abstract Background It is unknown, whether high-sensitivity cardiac troponin I (hs-cTnI) or hs-cTnT provide higher accuracy for the diagnosis and risk-stratification of patients with syncope. Methods We directly compared the diagnostic and prognostic accuracy of hs-cTnI and hs-cTnT in a prospective international multicenter study enrolling patients older than 40 years presenting with syncope to the emergency department (ED). Hs-cTnI/T concentrations were measured in a blinded fashion using three assays. Cardiac syncope, as adjudicated by two independent physicians using all available clinical information including 1-year follow-up, was the diagnostic endpoint. Death and nonfatal major adverse cardiovascular events (MACE) at 5, 30 and 720 days were the prognostic endpoints. Results Among 1219 patients, cardiac syncope was the adjudicated final diagnosis in 204 (16.7%). All three hs-cTn showed higher concentrations in patients with cardiac syncope compared with other causes (all p<0.01, Figure 1) and remained independent predictors of cardiac syncope in multivariable models. While the diagnostic accuracy of the three assays for cardiac syncope was similar (area under the curve (AUC) of 0.76–0.77 (95% CI, 0.72–0.80, p>0.05 for all direct comparisons)), the percentage of patients above/below the assay-specific cut-off strongly varied (Figure 1). The prognostic accuracy of hs-cTnI/T was comparable among the assays and very high for imminent (within 5 days) death (AUC 0.93–0.94), and high for 30 and 720-day death (AUC 0.74–0.8), as well as MACE (AUC 0.74–0.78). Figure 1 Conclusion Hs-cTnI/T concentrations may have clinical utility in patients presenting with syncope as they provide diagnostic as well as prognostic information. Acknowledgement/Funding Swiss National Science Foundation, Swiss Heart Foundation, Cardiovascular Research Foundation, Basel (Switzerland), University Basel (Switzerland)

Sign in / Sign up

Export Citation Format

Share Document