scholarly journals Value of Cardiac Biomarkers in the Early Diagnosis of Takotsubo Syndrome

2020 ◽  
Vol 9 (9) ◽  
pp. 2985
Author(s):  
Charlotte Dagrenat ◽  
Jean Jacques Von Hunolstein ◽  
Kensuke Matsushita ◽  
Lucie Thebaud ◽  
Stéphane Greciano ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Troponin I ◽  
Early Stage ◽  
Cardiac Biomarkers ◽  
Takotsubo Syndrome ◽  
Gender History ◽  
Cardiac Biomarker ◽  
History Of ◽  
St Elevation ◽  
Bedside Diagnosis

Background: Bedside diagnosis between Takotsubo syndrome (TTS) and ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction remains challenging. We sought to determine a cardiac biomarker profile to enable their early distinction. Methods: 1100 patients (TTS n = 314, STEMI n = 452, NSTEMI n = 334) were enrolled in two centers. Baseline clinical and biological characteristics were compared between groups. Results: At admission, cut-off values of BNP (B-type natriuretic peptide)/TnI (Troponin I) ratio of 54 and 329 distinguished respectively STEMI from NSTEMI, and NSTEMI from TTS. Best differentiation was obtained by the use of BNP/TnI ratio at peak (cut-of values of 6 and 115 discriminated respectively STEMI from NSTEMI, and NSTEMI from TTS). We developed a score including five parameters (age, gender, history of psychiatric disorders, LVEF, and BNP/TnI ratio at admission) enabling good distinction between TTS and STEMI (77% specificity and 92% sensitivity, AUC 0.93). For the distinction between TTS and NSTEMI, a four variables score (gender, history of psychiatric disorders, LVEF, and BNP at admission) achieved a good diagnostic performance (89% sensitivity, 85% specificity, AUC 0.94). Conclusion: A distinctive cardiac biomarker profile enables at an early stage a differentiation between TTS and ACS. A four (NSTEMI) or five variables score (STEMI) permitted a better discrimination.

Takotsubo syndrome in bipolar affective disorder with alcohol withdrawal syndrome

2020 ◽  
Vol 13 (10) ◽  
pp. e236070
Author(s):  
Deshwinder Singh Sidhu ◽  
Richard Farrelly ◽  
John Lally
Keyword(s):  
Affective Disorder ◽  
Troponin I ◽  
Epigastric Pain ◽  
Bipolar Affective Disorder ◽  
Alcohol Withdrawal Syndrome ◽  
Takotsubo Syndrome ◽  
History Of ◽  
Alcohol Dependence Syndrome ◽  
Background History ◽  
St Elevation

A 40-year-old woman presented to the emergency department with epigastric pain and agitation. She recently separated from her husband and was consuming 30 units of alcohol daily for 5 days. She had a history of bipolar affective disorder, borderline personality disorder and alcohol dependence syndrome. Investigations revealed the following: elevated troponin I levels, ST elevation, early Q waves and prolonged QTc. Emergency angiogram confirmed Takotsubo’s appearance. Medications with QTc prolongation propensity were held. A multidisciplinary apporach was required. She was discharged 10 days later when medically stabilised. It was later discovered that she died unexpectedly the following month. Takotsubo syndrome is a rare but unique cause of cardiac failure. This case highlights the need to consider the differential of Takotsubo syndrome in people presenting with possible acute ischaemic events, particularly in those with a history of combined emotional and physical stressors and a background history of mood disorder.

Cardiac cephalalgia: severe, non-exertional headache presenting as unstable angina

2018 ◽  
Vol 19 (2) ◽  
pp. 173-175
Author(s):  
Jonathan Lazari ◽  
Andrew Money-Kyrle ◽  
Benjamin R Wakerley
Keyword(s):  
Clinical Characteristics ◽  
Troponin I ◽  
Coronary Intervention ◽  
Severe Stenosis ◽  
Exertional Headache ◽  
Percutaneous Coronary ◽  
History Of ◽  
St Elevation ◽  
Cardiac Cephalalgia

Cardiac cephalalgia is a migraine-like headache that occurs during episodes of myocardial ischaemia. Clinical characteristics of the headache vary widely but are often severe in intensity, worsen with reduced myocardial perfusion and resolve with reperfusion. It can present along with typical symptoms of angina pectoris, although not always. We present a 64-year-old man with a 6-month history of severe, non-exertional headaches occurring with increasing frequency. A resting ECG showed ST elevation in the inferior leads. His serum troponin I was not elevated. Coronary angiography showed severe stenosis of his right coronary artery, which was successfully stented by percutaneous coronary intervention. He remains headache free at 2-year follow-up.

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.

Abstract 19143: Role of Cardiac Biomarkers in Diagnosing Takotsubo Cardiomyopathy from Left Anterior Descending Artery ST Elevation Myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ghulam Akbar ◽  
Marwan Badri ◽  
Catherine Prince ◽  
Wajeeha Saeed ◽  
Ghazi Mirrani ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Observational Studies ◽  
Troponin I ◽  
Cardiac Biomarkers ◽  
Lv Function ◽  
St Elevation ◽  
Subsequent Improvement ◽  
Echocardiographic Findings ◽  
Rule Out

Introduction: Takostubo cardiomyopathy (TK) and STEMI in the proximal to mid LAD territory (LAD-S) may have similar clinical, ECG and echocardiographic presentation. The two can only be differentiated using coronary angiography. Hypothesis: We hypothesized that the ratio of serum BNP to troponin-I(TnI) will help in distinguishing TK from LAD-S. Previously it has been studied in TK and STEMI from any coronary artery lesion. This is the first study to tease out LAD-S and TK by using BNP/TnI ratio . Methods: We retrospectively compared patients who presented with LAD-S and patients with TK (confirmed with non-obstructive coronary angiography, classic echocardiographic appearance and subsequent improvement of LV function). Patients who did not have BNP and TnI available were excluded. Results: Out of 313 patients with LAD-S and 464 with possible TK, 39 and 62 patients were included respectively. Mean BNP and TnI levels were 788, 57.6ng/dl and 923, 3.4ng/dl in LAD-S and TK respectively. A BNP/TnI ratio of ≤6.4 was 100% sensitive and 41% specific to diagnose LAD-S, and therefore has 100% negative predictive value. A BNP/TnI ratio of ≥2388 was 80% sensitive and 93% specific for diagnosing TK. Conclusion: BNP/TnI ratio <6.4 is reliable to rule out TK and lead to the diagnosis of LAD-S in patients with typical echocardiographic findings. Further, larger observational studies are needed to validate the use of biomarkers for this purpose.

scholarly journals Redefining Cardiac Biomarkers in Predicting Mortality of Inpatients With COVID-19

Hypertension ◽  
2020 ◽  
Vol 76 (4) ◽  
pp. 1104-1112 ◽  
Author(s):  
Juan-Juan Qin ◽  
Xu Cheng ◽  
Feng Zhou ◽  
Fang Lei ◽  
Gauri Akolkar ◽  
...  
Keyword(s):  
Natriuretic Peptide ◽  
Troponin I ◽  
Cox Model ◽  
Cardiac Injury ◽  
High Sensitivity ◽  
Cardiac Biomarkers ◽  
Cardiac Biomarker ◽  
Increased Risk ◽  
Poor Outcomes ◽  
Prognostic Power

The prognostic power of circulating cardiac biomarkers, their utility, and pattern of release in coronavirus disease 2019 (COVID-19) patients have not been clearly defined. In this multicentered retrospective study, we enrolled 3219 patients with diagnosed COVID-19 admitted to 9 hospitals from December 31, 2019 to March 4, 2020, to estimate the associations and prognostic power of circulating cardiac injury markers with the poor outcomes of COVID-19. In the mixed-effects Cox model, after adjusting for age, sex, and comorbidities, the adjusted hazard ratio of 28-day mortality for hs-cTnI (high-sensitivity cardiac troponin I) was 7.12 ([95% CI, 4.60–11.03] P <0.001), (NT-pro)BNP (N-terminal pro-B-type natriuretic peptide or brain natriuretic peptide) was 5.11 ([95% CI, 3.50–7.47] P <0.001), CK (creatine phosphokinase)-MB was 4.86 ([95% CI, 3.33–7.09] P <0.001), MYO (myoglobin) was 4.50 ([95% CI, 3.18–6.36] P <0.001), and CK was 3.56 ([95% CI, 2.53–5.02] P <0.001). The cutoffs of those cardiac biomarkers for effective prognosis of 28-day mortality of COVID-19 were found to be much lower than for regular heart disease at about 19%–50% of the currently recommended thresholds. Patients with elevated cardiac injury markers above the newly established cutoffs were associated with significantly increased risk of COVID-19 death. In conclusion, cardiac biomarker elevations are significantly associated with 28-day death in patients with COVID-19. The prognostic cutoff values of these biomarkers might be much lower than the current reference standards. These findings can assist in better management of COVID-19 patients to improve outcomes. Importantly, the newly established cutoff levels of COVID-19–associated cardiac biomarkers may serve as useful criteria for the future prospective studies and clinical trials.

scholarly journals Noncompaction and Takotsubo Syndrome in a Neuromuscular Disorder

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Josef Finsterer ◽  
Claudia Stöllberger ◽  
Walter Benedikt Winkler
Keyword(s):  
Chest Pain ◽  
Beta Blockers ◽  
Liver Cyst ◽  
Neuromuscular Disorder ◽  
Sudden Onset ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Troponin Elevation ◽  
History Of ◽  
St Elevation

Background. Takotsubo syndrome (TTS) in patients with left ventricular hypertrabeculation/noncompaction (LVHT) has been reported in four patients, and a TTS plus LVHT plus a neuromuscular disorder (NMD) was only reported once so far. Here, we present the fifth patient with LVHT and TTS and the second patient with LVHT, TTS, and a NMD. Methods and Results. The patient is a 68 yo female hobby choir singer with a history of skin dermatofibroma, skin fibrokeratoma, arterial hypertension, hyperlipidemia, hypothyroidism, anemia, hyponatremia, diverticulosis, LVHT detected at age 60 y, five syncopes, a liver cyst, and carotid endarterectomy 2 months prior to admission because of sudden-onset chest pain. Workup revealed ST elevation, troponin elevation, and mild coronary artery sclerosis. Ventriculography and transthoracic echocardiography (TTE) showed the apical type of a TTS. ECG normalised within 10 w and TTE within 6 w under beta-blockers and ATII-blockers. The TTS was triggered by being offended of being unable to sing anymore after endarterectomy. Neurological workup suggested the presence of a NMD. Conclusions. This case shows that LVHT occurs in NMD patients and that patients with LVHT and a NMD may develop a TTS. Whether patients with LVHT and a NMD are particularly prone to develop a TTS requires further confirmation. NMD patients with LVHT should avoid stress not to trigger a TTS.

scholarly journals Sandwich Immunoassay for Soluble Glycoprotein VI in Patients with Symptomatic Coronary Artery Disease

2011 ◽  
Vol 57 (6) ◽  
pp. 898-904 ◽  
Author(s):  
Boris Bigalke ◽  
Oliver Pötz ◽  
Elisabeth Kremmer ◽  
Tobias Geisler ◽  
Peter Seizer ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Troponin I ◽  
Early Stage ◽  
Surface Expression ◽  
Sandwich Immunoassay ◽  
Platelet Glycoprotein ◽  
Glycoprotein Vi ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Artery Disease

BACKGROUND Platelet glycoprotein VI (pGPVI) expression is increased in acute coronary syndrome (ACS), reflecting platelet activation. There is no reliable method available to measure pGPVI. Our aim was to develop a bead-based sandwich immunoassay to measure soluble GPVI (sGPVI). METHODS Based on antibodies for sGPVI developed earlier, we established and validated a bead-based sandwich immunoassay in 2438 consecutive patients with stable angina pectoris (SAP; n = 1371), non–ST-elevation myocardial infarction (NSTEMI; n = 724), and ST-elevation MI (STEMI; n = 343). In a subgroup (n = 1011), we measured surface expression of pGPVI using flow cytometry. RESULTS The assay revealed a working range of 8–500 ng/L. Intra- and interassay imprecision was &lt;7% and &lt;14%, respectively. Patients with NSTEMI and STEMI showed significantly lower mean sGPVI concentrations than patients with SAP [mean (SD), 8.4 (3.6) μg/L and 8.6 (4.1) μg/L vs 9.8 (4.8) μg/L; P = 0.002], whereas subgroup analysis revealed significantly enhanced pGPVI in NSTEMI (n = 276) and STEMI (n = 80) patients compared with SAP (n = 655) [mean fluorescence intensity (SD), 21.2 (8.1) and 19.8 (6.8) vs 18.5 (7.7); P = 0.002 and P = 0.018]. pGPVI and sGPVI were inversely correlated (r = −0.076; P = 0.023). Area under the ROC curve was 0.716, 95% CI 0.681–0.751, for sGPVI, distinguishing patients with SAP from those with ACS, and was superior (P = 0.044) to the curve of subgroup analysis for pGPVI (0.624, 95% CI 0.586–0.662). sGPVI (P = 0.023) and pGPVI (P = 0.028) had better association with the development of ACS than troponin I (P = 0.055) in the very early stage of disease, based on logistic regression analysis. CONCLUSIONS This sandwich immunoassay reliably measures sGPVI and may help to identify patients with ACS earlier than other laboratory markers.

scholarly journals Evaluation of the Efficiency of N-terminal Pro-B-type Natriuretic Peptide for Diagnosis of Acute Myocardial Infarction

2020 ◽  
Author(s):  
Abuagla M. Dafalla ◽  
Leena A. Dafalla ◽  
ShamsEldein M. Ahmed ◽  
Yousif A. Mohammed ◽  
Adam D. Abakar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Natriuretic Peptide ◽  
Predictive Value ◽  
Troponin I ◽  
Venous Blood ◽  
Cardiac Biomarkers ◽  
Control Group ◽  
Heart Cell ◽  
Cardiac Biomarker

Background: Cardiac diseases are one of the major causes of death worldwide with increasing incidence rate per year, particularly in developing countries such as Sudan owing to urbanization and changing lifestyle. Myocardial infarction is a consequence of the imbalance between the heart blood supply and the required heart cell; this disorder leads to necrosis of myocardium and may cause death. It could be diagnosed by at least two of the following criteria: chest pain, electrocardiography (ECG) elevation, and levels on cardiac biomarkers. This study aimed to evaluate the efficiency of N-terminal pro-B-type natriuretic peptide (NTproBNP) for the diagnosis of acute myocardial infarction (AMI).  Methods: This analytical case–control hospital-based study was conducted on a total of 70 individuals, of which 40 participants were suspected of or diagnosed with AMI, while 30 healthy subjects  were included as a control group. Three ml of venous blood were collected in lithium heparin containers. Troponin I (TnI) as a cardiac biomarker was measured by TOSOH AIA-360, while the NTproBNP level was detected using I-Chroma II. Personal and clinical data were collected directly from each participant using a predesigned questionnaire. Results: A significant increase in the TnI level (mean: 13.13 ± 18.9 ng/ml) and NTproBNP (mean: 5756.5 ± 8378.2 pg/mL) in AMI patients were detected when compared with control mean (0.02 ± 0.00 ng/ml and 57.8 ± 42.32 pg/mL, respectively). Conclusions: NTproBNP gave a high sensitivity (87.5%), specificity (100%), positive predictive value (100%), and negative predictive value (85.7%) in the diagnosis of AMI when compared with another cardiac biomarker such as TnI. Keywords: acute myocardial infarction, NTproBNP, troponin I, Medani Heart Center, Sudan

Abstract P375: Secular Trends in Validity of Troponin I Assays for Myocardial Infarction Classification Among Four US Communities: Findings From the ARIC Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Matthew S Loop ◽  
Jason P Fine ◽  
Aaron R Folsom ◽  
Wayne Rosamond
Keyword(s):  
Myocardial Infarction ◽  
Sensitivity And Specificity ◽  
Troponin I ◽  
Cardiac Biomarkers ◽  
Computer Algorithm ◽  
Assay Sensitivity ◽  
Cardiac Biomarker ◽  
Upper Limit ◽  
Aric Study

Introduction: The Atherosclerosis Risk In Communities (ARIC) study conducted community surveillance of hospitalized myocardial infarction (MI) from 1987 to 2014 among four US communities (Jackson MS, Forsyth County NC, Washington County MD, and Minneapolis MN). Surveillance of MI during the troponin era (1996 - ) has been complicated by increasing sensitivity of troponin I assays. It is unclear to what extent increased assay sensitivity has affected the validity of event classification. We hypothesized that among events that would have been classified as a definite/probable MI or a suspect/no MI regardless of cardiac biomarkers, the sensitivity and specificity of troponin I assays to identify abnormal enzyme levels (ARIC community surveillance criterion: 2x upper limit of normal) has changed over time in hospitals participating in ARIC community surveillance. Methods and results: From 33,995 community hospitalizations with suspicion of MI or coronary heart disease with a troponin I measurement that occurred between 1996 and 2014, 2,143 met ARIC criteria as MI cases (ARIC computer algorithm classification of definite or probable MI regardless of cardiac biomarker levels) and 9,909 we considered noncases (ARIC computer algorithm classification of no or suspect MI regardless of cardiac biomarker levels). In order to be an MI case, the event had to include an evolving diagnostic ECG. To be an noncase, the event had to include no chest pain and an equivocal or absent/uncodable ECG. We used survey-weighted logistic regression models to predict sensitivity and specificity from 1996 - 2014. The sensitivity of troponin I assay being abnormal was approximately 50% for most of the time period, with a potential increase to 70% after 2010. The specificity was approximately 90% in the late 1990s and early 2000s, but fell to 68% (95% confidence interval: 63% - 73%) by 2014. The median upper limit normal (ULN) for troponin I among all 33,995 hospitalizations dropped from 1.4 ng/mL in 1996 to 0.045 ng/mL in 2014. Conclusions: For most of the troponin era among the four ARIC communities, hospitalizations that were classified as an MI regardless of cardiac biomarker levels were equally likely to have or not have abnormal troponin I. In recent years, the likelihood that hospitalizations that were classified as no MI regardless of cardiac biomarker levels had normal troponin I decreased, potentially affecting the usefulness of troponin I measurements to separate hospitalized MIs from non-MIs in the context of community surveillance, particularly among hospitalizations with few other signs of MI. These shifts in assay validity were likely due in part to a decrease in ULN for troponin I in the four ARIC communities.

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