scholarly journals Biomarkers Predict In-Hospital Major Adverse Cardiac Events in COVID-19 Patients: A Multicenter International Study

2021 ◽  
Vol 10 (24) ◽  
pp. 5863
Author(s):  
Michael Y. Henein ◽  
Giulia Elena Mandoli ◽  
Maria Concetta Pastore ◽  
Nicolò Ghionzoli ◽  
Fouhad Hasson ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Myocarditis ◽  
White Blood Cells ◽  
Composite Endpoint ◽  
High Sensitivity ◽  
Systemic Hypertension ◽  
Chronic Obstructive ◽  
Imaging Data ◽  
Cardiac Events ◽  
Cardiocirculatory Arrest

Background: The COVID-19 pandemic carries a high burden of morbidity and mortality worldwide. We aimed to identify possible predictors of in-hospital major cardiovascular (CV) events in COVID-19. Methods: We retrospectively included patients hospitalized for COVID-19 from 10 centers. Clinical, biochemical, electrocardiographic, and imaging data at admission and medications were collected. Primary endpoint was a composite of in-hospital CV death, acute heart failure (AHF), acute myocarditis, arrhythmias, acute coronary syndromes (ACS), cardiocirculatory arrest, and pulmonary embolism (PE). Results: Of the 748 patients included, 141(19%) reached the set endpoint: 49 (7%) CV death, 15 (2%) acute myocarditis, 32 (4%) sustained-supraventricular or ventricular arrhythmias, 14 (2%) cardiocirculatory arrest, 8 (1%) ACS, 41 (5%) AHF, and 39 (5%) PE. Patients with CV events had higher age, body temperature, creatinine, high-sensitivity troponin, white blood cells, and platelet counts at admission and were more likely to have systemic hypertension, renal failure (creatinine ≥ 1.25 mg/dL), chronic obstructive pulmonary disease, atrial fibrillation, and cardiomyopathy. On univariate and multivariate analysis, troponin and renal failure were associated with the composite endpoint. Kaplan–Meier analysis showed a clear divergence of in-hospital composite event-free survival stratified according to median troponin value and the presence of renal failure (Log rank p < 0.001). Conclusions: Our findings, derived from a multicenter data collection study, suggest the routine use of biomarkers, such as cardiac troponin and serum creatinine, for in-hospital prediction of CV events in patients with COVID-19.

scholarly journals Clinical relevance of biological variation of cardiac troponins

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Aldo Clerico ◽  
Andrea Padoan ◽  
Martina Zaninotto ◽  
Claudio Passino ◽  
Mario Plebani
Keyword(s):  
Cardiovascular Risk ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Troponin T ◽  
High Sensitivity ◽  
Systemic Hypertension ◽  
Diagnostic Process ◽  
Chronic Obstructive ◽  
Screening Programs ◽  
Cardiac Troponins

AbstractThe high-sensitivity immunoassays for cardiac troponin I (hs-cTnI) and cardiac troponin T (hs-cTnT) are recommended by all the most recent international guidelines as gold standard laboratory methods for the detection of myocardial injury and diagnosis of acute myocardial infarction (AMI). In this review article, the Authors aimed at discussing the relevant biochemical, physiological, and clinical issues related to biological variability of cTnI and cTnT. Cardiac troponins, measured with hs-cTn methods, show a better clinical profile than the other cardio-specific biomarkers (such as the natriuretic peptides, BNP and NT-proBNP). In particular, the hs-cTn methods are characterized by a low intra-individual index of variation (<0.6) and reduced analytical imprecision (about 5% CV) at the clinical cut-off value (i.e., the 99th percentile URL value). Moreover, recent studies have reported that differences between two hs-cTn measured values (RCV) >30% can be considered statistically significant. These favourable biological characteristics and analytical performance of hs-cTn methods significantly improved the accuracy in the diagnostic process of acute coronary syndromes (ACS) in patients admitted to emergence department. In addition, several studies have demonstrated the clinical usefulness of cardiovascular risk evaluation with hs-cTn methods in some groups of patients with clinical conditions at high cardiovascular risk (such as systemic hypertension, severe obesity, diabetes mellitus, renal insufficiency, and chronic obstructive pulmonary disease). However, screening programs in the general population with hs-cTn methods for cardiovascular risk stratification require further investigation to define the optimal target populations, timing of measurement, and preventive interventions.

scholarly journals Periodontal disease characterization in dogs with normal renal function or chronic renal failure

2004 ◽  
Vol 34 (1) ◽  
pp. 113-118 ◽  
Author(s):  
Glenda Ramalho Barbudo-Selmi ◽  
Marileda Bonafim Carvalho ◽  
André Luis Selmi ◽  
Silvio Emílio Cuevas Martins
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Chronic Renal Failure ◽  
Periodontal Disease ◽  
Normal Renal Function ◽  
White Blood Cells ◽  
Gingival Recession ◽  
Plaque Index ◽  
Urine Specific Gravity ◽  
Bacterial Plaque

The purpose of this study was to evaluate periodontal disease (PD) in dogs with chronic renal failure (CRF) and to compare it to PD in dogs with normal renal function (NRF). Twelve dogs with CRF and 24 dogs with NRF, all presenting dental pocket formation, were compared. In all dogs, serum creatinine, blood urea nitrogen, urine specific gravity and total red and white blood cells were determined. A complete oral examination was also performed including evaluation of bacterial plaque, gingivitis, gingival recession, pocket, calculus, dental mobility, dental loss, and ulcers. These data were used to calculate plaque index (PI), gingival index (GI) and periodontal destruction index (PDI). PD was graded as mild, moderate or severe based on the results. Mild, moderate or severe PD was observed in dogs with NRF, whereas dogs with CRF presented either mild or severe PD. Dogs with NRF showed higher involvement of the maxillary teeth, whereas dogs with CRF showed a higher involvement of the mandibular teeth. Plaque index was significantly higher in dogs with NRF. It was concluded that lesion distribution and periodontal disease progression may be altered in dogs with CRF, and gingival inflammatory response differs in dogs with NRF and CRF regarding to the stage of periodontal disease.

Usefulness of Heart Rate to Predict Cardiac Events in Treated Patients With High-Risk Systemic Hypertension

2012 ◽  
Vol 109 (5) ◽  
pp. 685-692 ◽  
Author(s):  
Stevo Julius ◽  
Paolo Palatini ◽  
Sverre E. Kjeldsen ◽  
Alberto Zanchetti ◽  
Michael A. Weber ◽  
...  
Keyword(s):  
Heart Rate ◽  
High Risk ◽  
Systemic Hypertension ◽  
Cardiac Events

scholarly journals Assessing Risk in Patients with Stable Coronary Disease: When Should We Intensify Care and Follow-Up? Results from a Meta-Analysis of Observational Studies of the COURAGE and FAME Era

Scientifica ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Umberto Barbero ◽  
Fabrizio D’Ascenzo ◽  
Freek Nijhoff ◽  
Claudio Moretti ◽  
Giuseppe Biondi-Zoccai ◽  
...  
Keyword(s):  
Stable Angina ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Stable Coronary Artery Disease ◽  
Random Effect ◽  
Composite Endpoint ◽  
Major Adverse Cardiovascular Event ◽  
Cardiac Events ◽  
Adverse Cardiovascular Event

Background. A large number of clinical and laboratory markers have been appraised to predict prognosis in patients with stable angina, but uncertainty remains regarding which variables are the best predictors of prognosis. Therefore, we performed a meta-analysis of studies in patients with stable angina to assess which variables predict prognosis.Methods. MEDLINE and PubMed were searched for eligible studies published up to 2015, reporting multivariate predictors of major adverse cardiac events (MACE, a composite endpoint of death, myocardial infarction, and revascularization) in patients with stable angina. Study features, patient characteristics, and prevalence and predictors of such events were abstracted and pooled with random-effect methods (95% CIs). Major adverse cardiovascular event (MACE) was the primary endpoint.Results. 42 studies (104,559 patients) were included. After a median follow-up of 57 months, cardiovascular events occurred in 7.8% of patients with MI in 6.2% of patients and need for repeat revascularization (both surgical and percutaneous) in 19.5% of patients. Male sex, reduced EF, diabetes, prior MI, and high C-reactive protein were the most powerful predictors of cardiovascular events.Conclusions. We show that simple and low-cost clinical features may help clinicians in identifying the most appropriate diagnostic and therapeutic approaches within the broad range of outpatients presenting with stable coronary artery disease.

scholarly journals Presarcopenia and chronic cough due to chronic obstructive pulmonary disease successfully treated with nutraceutical supplements and physical exercise

2021 ◽  
Vol 8 (4) ◽  
pp. 1
Author(s):  
Jozélio Freire De Carvalho ◽  
Aaron Lerner
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Physical Exercise ◽  
Pulmonary Disease ◽  
Muscle Mass ◽  
Chronic Cough ◽  
Laboratory Tests ◽  
Handgrip Strength ◽  
Systemic Hypertension ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Objective: To describe a patient with presarcopenia and chronic cough secondary to chronic obstructive pulmonary disease (COPD) successfully treated with supplements and physical exercise.Case report: A 75-year-old female patient with a positive past medical history of systemic hypertension, dyslipidemia, heart arrhythmia, and smoking during 20 years evolved with chronic cough due to a chronic obstructive pulmonary disease diagnosed ten years ago. She came to our private clinic due to low weight, low energy. Her weight was 44.8 kg, her height 1.57 m, body mass index of 18.18 kg/m2. Laboratory tests showed SDHEA 76.3, vitamin D of 15.6 ng/ml (nr: > 30 ng/ml), C-reactive protein (CRP) of 55 mg/ml. Computed tomography showed bronchiectasis. She had an skeletal muscle mass index of 5.0 kg/m2 (nr: > 5.5 kg/m2) by DXA. A diagnosis of presarcopenia was determined based on DXA evaluation with low muscle mass but normal gait speed handgrip strength. We suggested to the patient to increase physical exercise and prescribed a supplement formula. After five months, she returned asymptomatic, without cough, marked improvement of fatigue, increased energy levels, and weight increased to 50 kg, BMI of 20.28 kg/m2. Laboratory tests showed SDHEA to 140, vitamin D3 to 64.5 ng/ml, reduced CRP reduced to 5 mg/dl, and amlodipine was excluded due to better blood pressure control. Currently, two years later, the patient continues without cough and has dyspnea only with high efforts, without fatigue, and her weight is 52 kg and BMI 21.1 kg/m2. She also reduced her conventional treatment for COPD, using only a bronchodilator on-demand, without topical corticoids.Conclusions: This case illustrates an interesting case of a patient with presarcopenia and chronic cough, refractory to conventional approach, successfully treated with a combination of nutraceuticals and physical exercises.

scholarly journals Systemic inflammation induced by exacerbation of COPD or pneumonia in patients with COPD induces cardiac troponin elevation

2021 ◽  
Vol 8 (1) ◽  
pp. e000997
Author(s):  
Vidar Søyseth ◽  
Natalia Kononova ◽  
Anke Neukamm ◽  
Nils Henrik Holmedahl ◽  
Tor-Arne Hagve ◽  
...  
Keyword(s):  
Acute Exacerbation ◽  
Systemic Inflammation ◽  
Cardiac Troponin ◽  
Troponin T ◽  
Geometric Mean ◽  
Stable State ◽  
High Sensitivity ◽  
Chronic Obstructive ◽  
Troponin Elevation ◽  
Exacerbation Of Copd

BackgroundTroponin is a biomarker of myocardial injury. In chronic obstructive pulmonary disease (COPD), troponin is an important determinant of mortality after acute exacerbation. Whether acute exacerbation of COPD (AECOPD) causes troponin elevation is not known. Here, we investigated whether troponin is increased in AECOPD compared to stable COPD.MethodsWe included 320 patients with COPD in the stable state and 63 random individuals from Akershus University hospital’s catchment area. All participants were ≥40 years old (mean 65·1 years, SD 7·6) and 176 (46%) were females. The geometric mean of high-sensitivity cardiac troponin T (hs-cTnT) was 6·9 ng/L (geometric-SD 2·6). They were followed regarding hospital admission for the subsequent 5 years.ResultsDuring the 5-year follow-up, we noted 474 hospitalisations: Totally, 150 and 80 admissions were due to AECOPD or pneumonia, respectively. The geometric mean ratio with geometric SE (GSE) between cTnT at admission and stable state in AECOPD and pneumonia was 1·27 (GSE=1.11, p=0·023) and 1·28 (GSE=1.14, p=0·054), respectively. After inclusion of blood leucocyte count and C reactive protein at hospitalisation, these ratios attenuated to zero. However, we estimated an indirect of AECOPD and pneumonia on the ratio between hs-cTnT at admission and the stable state to 1·16 (p=0·022) and 1·22 (p=0·008), representing 91% (95% CI 82% to 100%) and 95% (95% CI 83% to 100%) of the total effects, respectively.ConclusionAECOPD and pneumonia in patients with COPD is associated with higher cTnT levels. This association appears to be mediated by systemic inflammation.

scholarly journals Prognostic value of biomarkers and co-morbidities in patients with acute heart failure: One-year follow-up study

2017 ◽  
Vol 145 (3-4) ◽  
pp. 118-123
Author(s):  
Dejan Petrovic ◽  
Marina Deljanin-Ilic ◽  
Sanja Stojanovic
Keyword(s):  
Heart Failure ◽  
Renal Failure ◽  
Chronic Renal Failure ◽  
Acute Heart Failure ◽  
Troponin I ◽  
Prognostic Significance ◽  
Systolic Pressure ◽  
High Sensitivity ◽  
Clinical Group ◽  
One Year

Introduction/Objective. Clinical risk stratification of patients hospitalized due to acute heart failure (AHF) applying B-type natriuretic peptide (BNP), troponin I (TnI), and high-sensitivity C-reactive protein (hsCRP) biochemical markers can contribute to early diagnosis of AHF and lower mortality rates. The aim of this study was to investigate the prognostic significance of biomarkers (BNP, TnI, and hsCRP) and co-morbidities concerning one-year mortality in patients with AHF. Methods. Clinical group comprised 124 consecutive unselected patients, age 60?80 years, treated at the Coronary Care Unit of the Niska Banja Institute, Nis. The patients were monitored for one year after the discharge. During the first 24 hours after admission, BNP, TnI, and hsCRP were measured in fasting serum. Results. Total one-year mortality was 29.8%. The levels of serum BNP were significantly higher in the group of non-survivors compared to the group of survivors (1353.8 ?} 507.8 vs. 718.4 ?} 387.6 pg/mL, p < 0.001). We identified several clinical and biochemical prognostic risk factors by univariate and multivariate analysis. Independent predictors of one-year mortality were the following: BNP, TnI, depression, hypotension, chronic renal failure, ejection fraction, and right-ventricle systolic pressure. Conclusion. The presence of BNP and TnI biomarkers and several co-morbidities such as depression or chronic renal failure have significant influence on one-year mortality in patients with AHF.

scholarly journals P982 Correlation between electrocardiographic and imaging data in patients with acute myocarditis: a single centre retrospective analysis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Caretta ◽  
L A Leo ◽  
V L Paiocchi ◽  
G M Viani ◽  
S A Schlossbauer ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Wall Motion ◽  
Acute Myocarditis ◽  
Left Ventricular Ejection ◽  
Imaging Data ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
St Segment ◽  
Wall Motion Abnormalities ◽  
Ecg Abnormalities

Abstract Funding Acknowledgements None Background Acute myocarditis is a clinical and pathological condition defined as an inflammation of the myocardium. Its diagnosis is often challenging and requires multiple information derived from different diagnostic modalities. Purpose The aim of the study is to evaluate the correlation between electrocardiographic and imaging data in patients with acute myocarditis. Methods We made a retrospective analysis of 102 patients admitted to our Centre between January 2012 and April 2019 for suspected acute myocarditis. Diagnosis was confirmed with cardiac magnetic resonance (CMR) by identification of myocardial edema in T2-weighted images and/or typical subepicardial or midwall pattern of late gadolinium enhancement (LGE). Significant coronary artery disease was ruled out with coronary angiography. Electrocardiogram (ECG) was analysed on admission - in order to evaluate the presence of ST segment abnormalities, atrio-ventricular or bundle-branch block and heart rhythm disorders - and at the time of discharge. Every patient underwent echocardiography and CMR: from both these exams we reported the presence of regional wall motion abnormalities and left ventricular ejection fraction (LVEF). Results Mean age of our population was 39 ± 18 years; 92 people (90%) were males. At admission, 85 patients (83%) presented ECG abnormalities; the most frequent was ST-segment elevation (65 cases). Conduction or rhythm disorders were observed in 26 cases (25%). At the time of discharge, 41 out of 85 patients had complete regression of ECG changes. Mean value of LVEF measured with echocardiography was 56.4 ± 7.6%. In patients with normal ECG on admission it was 59.9 ± 3.1%, whereas in patients with abnormal ECG 55.7 ± 7.9% (p = 0.045). Considering CMR, mean LVEF in the population was 58.5 ± 8.6%, varying between 64.0 ± 8.9% in the group with normal ECG and 57.4 ± 10.1% in the group with ECG abnormalities (p = 0.02). Moreover, subjects with altered ECG on admission had a higher prevalence of wall motion abnormalities both in echocardiography (47/85 – 55% vs 3/17 – 18%, p &lt; 0.01) and in CMR (45/85 – 53% vs 3/17 – 18%, p &lt; 0.01). Patients with ECG normalization at discharge had a higher prevalence of ST-segment elevation (88 vs 66%, p = 0.02), while the group with persistent ECG alterations had a higher incidence of AV or bundle-branch block (23 vs 7%, p = 0.048). No statistical difference was noted between these two groups regarding echocardiographic or CMR values. Conclusion In our experience evaluation of ECG at admission in patients with suspected acute myocarditis identifies a subgroup of individuals with lower values of LVEF and a higher prevalence of wall motion abnormalities both in echocardiography and in CMR, while data derived by imaging techniques had no significant predictive value on ECG evolution at the time of discharge.

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