scholarly journals Serum Organ-Specific Anti-Heart and Anti-Intercalated Disk Autoantibodies as New Autoimmune Markers of Cardiac Involvement in Systemic Sclerosis: Frequency, Clinical and Prognostic Correlates

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2165
Author(s):  
Alida Linda Patrizia Caforio ◽  
Giacomo De Luca ◽  
Anna Baritussio ◽  
Mara Seguso ◽  
Nicoletta Gallo ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Troponin I ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
Autoimmune Myocarditis ◽  
Diagnostic Features ◽  
Heart Involvement ◽  
Dismal Prognosis ◽  
Organ Specific ◽  
Intercalated Disk

Background: Heart involvement (HInv) in systemic sclerosis (SSc) may relate to myocarditis and is associated with poor prognosis. Serum anti-heart (AHA) and anti-intercalated disk autoantibodies (AIDA) are organ and disease-specific markers of isolated autoimmune myocarditis. We assessed frequencies, clinical correlates, and prognostic impacts of AHA and AIDA in SSc. Methods: The study included consecutive SSc patients (n = 116, aged 53 ± 13 years, 83.6% females, median disease duration 7 years) with clinically suspected heart involvement (symptoms, abnormal ECG, abnormal troponin I or natriuretic peptides, and abnormal echocardiography). All SSc patients underwent CMR. Serum AHA and AIDA were measured by indirect immunofluorescence in SSc and in control groups of non-inflammatory cardiac disease (NICD) (n = 160), ischemic heart failure (IHF) (n = 141), and normal blood donors (NBD) (n = 270). AHA and AIDA status in SSc was correlated with baseline clinical, diagnostic features, and outcome. Results: The frequency of AHA was higher in SSc (57/116, 49%, p < 0.00001) than in NICD (2/160, 1%), IHF (2/141, 1%), or NBD (7/270, 2.5%). The frequency of AIDA was higher (65/116, 56%, p < 0.00001) in SSc than in NICD (6/160, 3.75%), IHF (3/141, 2%), or NBD (1/270, 0.37%). AHAs were associated with interstitial lung disease (p = 0.04), history of chest pain (p = 0.026), abnormal troponin (p = 0.006), AIDA (p = 0.000), and current immunosuppression (p = 0.01). AHAs were associated with death (p = 0.02) and overall cardiac events during follow-up (p = 0.017). Conclusions: The high frequencies of AHA and AIDA suggest a high burden of underdiagnosed autoimmune HInv in SSc. In keeping with the negative prognostic impact of HInv in SSc, AHAs were associated with dismal prognosis.

scholarly journals Impact of sarcopenia in advanced and metastatic soft tissue sarcoma

2021 ◽  
Author(s):  
Dennis Strassmann ◽  
Bennet Hensen ◽  
Viktor Grünwald ◽  
Katharina Stange ◽  
Hendrik Eggers ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Cox Regression ◽  
Therapy Response ◽  
Prognostic Impact ◽  
Patient Counseling ◽  
Skeletal Muscle Index ◽  
Prognostic Parameter ◽  
Dismal Prognosis ◽  
Metastatic Soft Tissue Sarcoma

Abstract Introduction Advanced or metastatic soft tissue sarcoma (a/mSTS) is associated with a dismal prognosis. Patient counseling on treatment aggressiveness is pivotal to avoid over- or undertreatment. Recently, evaluation of body composition markers like the skeletal muscle index (SMI) became focus of interest in a variety of cancers. This study focuses on the prognostic impact of SMI in a/mSTS, retrospectively. Methods 181 a/mSTS patients were identified, 89 were eligible due to prespecified criteria for SMI assessment. Baseline CT-Scans were analyzed using an institutional software solution. Sarcopenia defining cut-off values for the SMI were established by optimal fitting method. Primary end point was overall survival (OS) and secondary endpoints were progression free survival (PFS), disease control rate (DCR), overall response rate (ORR). Descriptive statistics as well as Kaplan Meier- and Cox regression analyses were administered. Results 28/89 a/mSTS patients showed sarcopenia. Sarcopenic patients were significantly older, generally tended to receive less multimodal therapies (62 vs. 57 years, P = 0.025; respectively median 2.5 vs. 4, P = 0.132) and showed a significantly lower median OS (4 months [95%CI 1.9–6.0] vs. 16 months [95%CI 8.8–23.2], Log-rank P = 0.002). Sarcopenia was identified as independent prognostic parameter of impaired OS (HR 2.40 [95%-CI 1.4–4.0], P < 0.001). Moreover, DCR of first palliative medical treatment was superior in non-sarcopenic patients (49.2% vs. 25%, P = 0.032). Conclusion This study identifies sarcopenia as a prognostic parameter in a/mSTS. Further on, the data suggest that sarcopenia shows a trend of being associated with first line therapy response. SMI is a promising prognostic parameter, which needs further validation.

Prognostic impact of SYNTAX II score in patients with cardiogenic shock complicating ST-elevation myocardial infarction: analysis of an 10-year all-comers registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Juskova ◽  
P Tasende Rey ◽  
B Cid Alvarez ◽  
B Alvarez Alvarez ◽  
J.M Garcia Acuna ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
Prognostic Information ◽  
St Segment Elevation ◽  
All Cause Mortality

Abstract Background The SYNTAX II score (SS-II) can predict 4-year outcomes in patients with complex coronary artery disease and ST-segment elevation myocardial infarction (STEMI). Nonetheless, the prognostic value of SS-II for a cardiogenic shock (CS) in the setting of STEMI has not been assessed. Purpose This study aimed to investigate the predictive impact of SS-II in patients with CS complicating STEMI undergoing primary percutaneous coronary intervention, and whether SS-II adds prognostic information to predict major adverse cardiac events (MACE) and all-cause death in this population. Methods This prospective cohort study included 1965 consecutive patients with STEMI who underwent primary-PCI between January 2008 and December 2017. The cohort of patients with CS (n=153) was identified and divided into three groups based on SS-II tertiles [SS-II low tertile &lt;38 (n=51), ≥38 SS-II intermediate tertile &lt;47 (n=51), and SS-II high tertile ≥48 (n=51)]. Results Amongst the cohort of patients with CS mean age was 68.4±14.0 years, 69.2% were male and 51.6% presented with anterior STEMI (mean SSII was 45.1±14). In-hospital mortality was significantly higher in the high SS-II tertile (85.7% vs. 38.9% vs 24.4%, p≤0.001) compared with SS-II intermediate and low tertiles. During follow-up (median 2.5 years), SS-II was positively correlated with MACE (89.3% (high SS-II) vs. 52.8% (int SS-II) vs. 42.2% (low SS-II), p≤0.001), and with all-cause mortality (89.3% vs 44.4% vs 26.7%, p≤0.001). The SS-II was also an independent predictor of MACE (HR=1.042, 95% CI: 1.020–1.063, p=0.000) and all-cause mortality during follow-up (HR=1.056, 95% CI: 1.033–1.079, p=0.000) Conclusion In a real-world cohort of patients with STEMI related CS, the SS-II added important prognostic information, being an independent predictor of MACE and all-cause mortality during follow-up. Image 1 Funding Acknowledgement Type of funding source: None

Carvedilol Inhibits Matrix Metalloproteinase-2 Activation in Experimental Autoimmune Myocarditis: Possibilities of Cardioprotective Application

2017 ◽  
Vol 23 (1) ◽  
pp. 89-97 ◽  
Author(s):  
Monika Skrzypiec-Spring ◽  
Katarzyna Haczkiewicz ◽  
Agnieszka Sapa ◽  
Tomasz Piasecki ◽  
Joanna Kwiatkowska ◽  
...  
Keyword(s):  
Heart Failure ◽  
Troponin I ◽  
Heart Function ◽  
Heart Diseases ◽  
Acute Myocarditis ◽  
Study Groups ◽  
Matrix Metalloproteinase 2 ◽  
Autoimmune Myocarditis ◽  
Experimental Autoimmune Myocarditis ◽  
Experimental Autoimmune

Aims: Acute myocarditis is a potentially lethal inflammatory heart disease that frequently precedes the development of dilated cardiomyopathy and subsequent heart failure. At present, there is no effective standardized therapy for acute myocarditis, besides the optimal care of heart failure and arrhythmias in accordance with evidence-based guidelines and specific etiology-driven therapy for infectious myocarditis. Carvedilol has been shown to be cardioprotective by reducing cardiac pro-inflammatory cytokines present in oxidative stress in certain heart diseases. However, effects of carvedilol administration in acute myocarditis with its impact on matrix metalloproteinases’ (MMPs) activation have not been elucidated. Methods and Results: Carvedilol in 3 doses (2, 10, and 30 mg/kg) was given daily to 3 study groups of rats (n = 8) with experimental autoimmune myocarditis by gastric gavage for 3 weeks. In comparison to untreated rats (n = 8) with induced myocarditis, carvedilol significantly prevented the left ventricle enlargement and/or systolic dysfunction depending on the dose in study groups. Performed zymography showed enhanced MMP-2 activity in untreated rats, while carvedilol administration reduced alterations. This was accompanied by prevention of troponin I release and myofilaments degradation in cardiac muscle tissue. Additionally, severe inflammatory cell infiltration was detected in the nontreated group. Carvedilol in all doses tested, had no impact on severity of inflammation. The severity of inflammation did not differ between study groups and in relation to the untreated group. Conclusions: The protective effects of carvedilol on heart function observed in the acute phase of experimental autoimmune myocarditis seem to be associated with its ability to decrease MMP-2 activity and subsequently prevent degradation of myofilaments and release of troponin I while not related to suppression of inflammation.

A rapid troponin I assay is not optimal for determination of troponin status and prediction of subsequent cardiac events at suspicion of unstable coronary syndromes

2004 ◽  
Vol 93 (2-3) ◽  
pp. 113-120 ◽  
Author(s):  
Stefan K. James ◽  
Bertil Lindahl ◽  
Paul Armstrong ◽  
Robert Califf ◽  
Maarten L. Simoons ◽  
...  
Keyword(s):  
Troponin I ◽  
Cardiac Events ◽  
Coronary Syndromes

scholarly journals Serum autotaxin level predicts future cardiac events in patients with dilated cardiomyopathy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Araki ◽  
T Okumura ◽  
T Mizutani ◽  
Y Kimura ◽  
S Kazama ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Dilated Cardiomyopathy ◽  
Volume Fraction ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Left Ventricular Ejection ◽  
Myocardial Inflammation ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction

Abstract Background Autotaxin (ATX) has been reported to promote myocardial inflammation and subsequent cardiac remodeling through lysophosphatidic acid (LPA) production. However, the prognostic impact of ATX has not been clarified in dilated cardiomyopathy (DCM). Purpose We aimed to investigate the prognostic impact of ATX in patients with DCM. Methods We enrolled 104 DCM patients (49.8 years, 76 males). The subjects underwent blood sampling, echocardiography, cardiac catheterization, and endomyocardial biopsy. Gender differences in serum ATX levels have been reported, thus we divided the subjects into two groups using median serum ATX levels for men and women: High-ATX group and Low-ATX group. All patients were followed up by expert cardiologists. The cardiac event was defined as a composite of cardiac death and hospitalization for worsening heart failure. Results Eighty-nine percent of the subjects were classified as New York Heart Association functional class I or II. Female patients had higher serum ATX levels than male patients, with median values of 257.0 ng/mL and 203.5 ng/mL, respectively (Figure A). The average left ventricular ejection fraction and brain natriuretic peptide levels were 30.6% and 122.5 pg/mL. In survival analysis, cumulative event-free probability was significantly lower in High ATX group (p=0.007, Figure B). In Cox proportional hazards analysis, High-ATX was one of the independent predictors of composite cardiac events (Hazards Ratio, 2.575; p=0.043). On the other hand, high sensitive C-reactive protein and collagen volume fraction in myocardial samples were not significant predictors. Conclusion High serum ATX level was associated with poor prognosis in patients with DCM. FUNDunding Acknowledgement Type of funding sources: None. Gender difference in autotaxin levels Survival analysis of cardiac events

scholarly journals Improvement of outcome prediction of hospitalized patients with COVID-19 by a dual marker strategy using high-sensitive cardiac troponin I and copeptin

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C K Kaufmann ◽  
A A Ahmed ◽  
M K Kassem ◽  
M F Freynhofer ◽  
B J Jaeger ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Hospitalized Patients ◽  
Cardiac Troponin I ◽  
Prognostic Impact ◽  
Care Hospital ◽  
Vasopressin Release ◽  
Individual Measurement ◽  
Icu Admission

Abstract Background COVID-19 has been associated with a high prevalence of myocardial injury and increased cardiovascular morbidity. Copeptin, a marker of vasopressin release, has been previously established as a risk marker in both infectious and cardiovascular disease. Purpose Investigate the prognostic impact of copeptin and high-sensitive cardiac troponin I (hs-cTnI) in COVID-19. Methods This prospective, observational study of patients with laboratory-confirmed COVID-19 infection was conducted from June 6th to November 26th, 2020 in a tertiary care hospital. Copeptin and hs-cTnI levels on admission were collected and tested for their association with the primary composite endpoint of ICU admission or 28-day mortality. Results A total of 213 eligible patients with COVID-19 were included of whom 55 (25.8%) reached the primary endpoint. Median levels of copeptin and hs-cTnI at admission were significantly higher in patients with an adverse outcome (Copeptin 29.6 pmol/L, [IQR, 16.2–77.8] vs 17.2 pmol/L [IQR, 7.4–41.0] and hs-cTnI 22.8 ng/L [IQR, 11.5–97.5] vs 10.2 ng/L [5.5–23.1], P&lt;0.001 respectively). ROC analysis demonstrated an optimal cut-off of 19.6 pmol/L for copeptin and 16.2 ng/L for hs-cTnI and an increase of either biomarker was significantly associated with the primary endpoint. The combination of raised hs-cTnI and copeptin yielded a superior prognostic value to individual measurement of biomarkers and was a strong prognostic marker upon multivariable logistic regression analysis (OR 4.274 [95% CI, 1.995–9.154], P&lt;0.001). Addition of copeptin and hs-cTnI to established risk models improved C-statistics and net reclassification indices. Conclusion The combination of raised copeptin and hs-cTnI upon admission is an independent predictor of deterioration (ICU admission) or 28-day mortality in hospitalized patients with COVID-19. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Bürgermeisterfond der Stadt WienLudwig Boltzmann Cluster for Cardiovascular ResearchAssociation for the Promotion of Research on Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB) Copeptin and hs-cTnI in COVID-19 Biomarker based risk assessment

Abstract 557: The Utility of Serial Enzymes to Rule out Myocardial Injury in Pateints with Non-Critical Disease by CT Angiography

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Brian J O’Neil ◽  
Patrick Medado ◽  
James Wegner ◽  
Michael Gallagher ◽  
Gil Raff
Keyword(s):  
Myocardial Injury ◽  
Troponin I ◽  
Low Risk ◽  
Blood Collection ◽  
Cardiac Events ◽  
Cardiac Enzymes ◽  
Coronary Syndrome ◽  
Normal Limits ◽  
Risk Patients ◽  
Over Time

Coronary Computed Tomography Angiography (CCTA) is a diagnostic test shown to have a high negative predictive value for coronary artery disease and major cardiac events at three months. Many emergency department, (ED), protocols mandate serial enzymes prior to discharge to capture possible myocardial injury even with normal CCTAs. Determine the value of serial cardiac enzymes in low risk patients (TIMI Risk Score <3) presenting to the ED with chest pain who have a normal or intermediate CTA, (< 25% stenosis). 307 patients received CCTA as part of clinical trials. All patients presented to the ED with suspected acute coronary syndrome and had a TIMI Risk <3, non diagnostic ECGs and negative initial enzymes. All patients had serial enzymes sampling at least 4 hours apart per protocol. Structured telephone follow up and chart review was completed at 30 and 90 days post ED visit. All data was analyzed using descriptive statistics. 68% of all CTA patients were classified as normal < 25% stenosis, with another 8% considered intermediate < 50% stenosis. Average time between blood collection was 4:30+/−1:28. All patients had normal serial Troponin I values (Normal <0.05 ng/mL) with no appreciable delta over time. 39 patients had an increase in Myoglobin values with 10 having a delta ≥20% but <50%, none of these patients had a level above our normal range (< 98 ng/ml). Only one myoglobin values was above our normal limits, but did change over time. There were no deaths or adverse cardiac events at 90 days in this population. In this study of low risk patients with suspected cardiac ischemia (TIMI <3) and a normal or intermediate CCTA, serial cardiac enzymes have no utility.

Frequency and Outcomes of Transient Myocardial Ischemia in Critically Ill Adults Admitted for Noncardiac Conditions

2003 ◽  
Vol 12 (6) ◽  
pp. 508-517 ◽  
Author(s):  
Kathy J. Booker ◽  
Karyn Holm ◽  
Barbara J. Drew ◽  
Dorothy M. Lanuza ◽  
Frank D. Hicks ◽  
...  
Keyword(s):  
At Risk ◽  
Myocardial Ischemia ◽  
Critically Ill ◽  
Troponin I ◽  
Advanced Age ◽  
Elevated Troponin ◽  
Cardiac Events ◽  
Transient Myocardial Ischemia ◽  
Critically Ill Adults ◽  
Ill Adults

• Background Critically ill adults admitted for noncardiac conditions are at risk for acute myocardial ischemia.• Objectives To detect myocardial ischemia and injury in patients admitted for noncardiac conditions and to examine the relationship of myocardial ischemia, injury, and acuity to cardiac events.• Methods Transient myocardial ischemia, acuity, elevations in serum troponin I, and in-hospital cardiac events were examined in 76 consecutive patients. Transient myocardial ischemia, determined by using continuous electrocardiography, was defined as a 1-mm (0.1-mV) change in ST level from baseline to event in 1 or more leads lasting 1 or more minutes. Acuity was determined by scores on Acute Physiology and Chronic Health Evaluation II.• Results A total of 37 ischemic events were detected in 8 patients (10.5%); 32 (86%) were ST-segment depressions, and 35 (96%) were silent. Twelve patients (15.8%) had elevated levels of troponin I. Transient myocardial ischemia, elevated troponin I levels, and advanced age were significant predictors of cardiac complications (R2 = 0.387, F = 15.2, P &lt; .001). Acuity correlated only modestly with increased length of stay in the intensive care unit (r = 0.26, P = .02) and elevated troponin I levels (r = 0.25, P = .03). Patients with transient myocardial ischemia had significantly higher rates of elevations in troponin I (P &lt; .001) and cardiac events (P &lt; .001) than did patients without.• Conclusions Transient myocardial ischemia and advanced age are predictors of cardiac events and may indicate patients at risk for cardiac events.

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