Use of Troponin I as a Biochemical Marker for Diagnostics of Asphictic State in Mechanical Asphyxia

The purpose of the study was to determine the quantitative content of the biochemical marker of myocardial damage (subunits of the troponin complex: Troponin I) in the blood as a diagnostic criterion for asphyxia in mechanical asphyxia. Materials and methods. To determine the presence of asphyxia, the quantitative content of Troponin I in the blood of 12 dead people was studied and analyzed, among which violent death was observed in 7 cases and non-violent – in 5 cases. The study for biochemical detection of Troponin I used a method based on enzyme-linked immunosorbent assay followed by statistical processing of the results using the MedStat package. Results and discussion. Among the biochemical markers for the diagnosis of asphyxia in hanging and aspiration asphyxia, the most indicative is the determination of the quantitative content of Troponin I in the blood, which is also used in clinical practice to substantiate the diagnosis of cardiac pathology. Therefore, it is important to conduct a differential diagnosis of changes in quantitative indicators of biochemical markers depending on the cause and genesis of death. During the study of the quantitative content of Troponin I in the blood of those who died of mechanical asphyxia (hanging, aspiration asphyxia), it was found that the content of troponin I is from 140 ng/ml to 170 ng/ml. The quantitative content of Troponin I in the blood of those who died of acute and chronic coronary heart disease (control group) is from 10.1 ng/ml to 120 ng/ml. The average value of the quantitative content of Troponin I in two samples was found: in the blood of those who died of mechanical asphyxia – 156 ng/ml±4.4 ng/ml; in the blood of those who died of acute and chronic coronary heart disease – 45.62 ng/ml±22.4 ng/ml. The study revealed a difference in quantitative indicators of biochemical markers depending on the cause and genesis of death, found that the quantitative content of Troponin I in the blood of the dead from mechanical asphyxia (hanging, aspiration asphyxia) compared with the quantitative content of Troponin I in the blood of the dead with chronic coronary heart disease is higher, at the level of significance p=0.008. Conclusion. Thus, in the course of research, the feasibility of using changes in quantitative indicators of the biochemical marker Troponin I to determine the asphyxiation in violent death (mechanical asphyxia) and differential diagnosis in cases of non-violent death (acute and chronic coronary heart disease) was proved, which significantly increases efficiency and reliability of forensic medical examinations

Myeloperoxidase/high-density lipoprotein cholesterol ratio in patients with arterial hypertension and chronic coronary heart disease

BACKGROUND: Myeloperoxidase (MPO), the enzyme of leukocytes, catalyzes the production of reactive halogen species, which can modify the structure of lipoproteins. Chlorination and nitration of tyrosine residues in apolipoprotein A-1 lead to the formation of dysfunctional high-density lipoproteins (HDL-p), thus blocking the reverse cholesterol transport. Low level of high-density lipoprotein cholesterol (HDL-C) is associated with exacerbation of coronary heart disease, but the prognostic value of this index is not fully assessed. AIM: The aim of this study was to examine a possible contribution of MPO to the atherosclerotic plaque development (the stable growth or the erosion and rupture) via the modification of HDL-p. That is to say we investigated the diagnostic values of measuring the total MPO (MPO-T), the active MPO (MPO-A) and the MPO/HDL-С relation in patients with hypertension and various forms of chronic coronary heart disease. MATERIALS AND METHODS: The cohort under study included 44 patients with arterial hypertension and chronic coronary heart disease. All patients were divided into three groups according to the diagnosis: arterial hypertension without coronary heart disease (Group I, n = 20); arterial hypertension and the initially stable chronic coronary heart disease without acute complications in the anamnesis (Group II, n = 14); arterial hypertension and myocardial infarction (acute coronary syndrome) in the anamnesis (Group III, n = 10). The enzyme-linked immunosorbent assay (ELISA) for MPO-T and specific immuno-extraction followed by enzymatic detection (SIEFED) by fluorogenic substrate for MPO-A were applied. After that the ratio MPO-T/HDL-C or MPO-A/HDL-C was calculated. RESULTS: The MPO-A and MPO-A/HDL-C ratio were significantly increased in the group III of patients with old myocardial infarction as compared with the patients of group II who had the initially stable coronary heart disease (p = 0.009 and p = 0.003, respectively). Besides, the level of HDL-C in the group III was significantly reduced (p = 0.013). Our measurements revealed the negative correlation between MPO-A and HDL-C concentrations (r = 0.31; p 0.05), which is in line with the presumption of the study accomplished. Surprisingly, the correlation between MPO-T/HDL-C ratio and that MPO-A/HDL-C was stronger (r = 0.72; p 0.05), than between MPO-T and MPO-A (r = 0.36; p 0.05). CONCLUSIONS: Our study demonstrates the importance of assessing MPO-T and MPO-A plasma concentrations and of calculating the ratio MPO/HDL-C as promising biomarkers in the complicated cases of chronic coronary heart disease. MPO-A and MPO-A/HDL-C values were elevated in the patients with old myocardial infarction, while the concentration of HDL-C remained decreased upon the transition from the acute to chronic phase of the disease.

Clinical characteristics and management of hyperlipoproteinemia in patients with chronic coronary heart disease in Slovakia

IntroductionA reduction of LDL-cholesterol is beneficial for high-risk patients, including patients with previously documented coronary heart disease (CHD). Data on the overall composition, risk profile, and management of these patients is very limited in Slovakia.Material and methodsThis cross-sectional multicentre observational study was conducted by cardiologists and internists providing outpatient care at 35 sites across Slovakia between 11/2015 and 01/2016. All patients had documented CHD and fulfilled the very high CV risk criteria (ESC recommendations).ResultsA total of 349 patients were recruited, had a mean age of 67.8 years, 67.9% were male, 41% had diabetes and a mean BMI of 29.5 kg/m2. As many as 65.3% had prior myocardial infarction, 59.2% underwent PCI, and 24.1% CABG. At baseline 90.5% of patients reported taking a statin, 10.3% ezetimibe and 5.4% a fibrate. The mean LDL-C level was 2.69±1.02 mmol/L with only 18.6% meeting their treatment target of <1.8 mmol/L. Mean values for TC (4.44mmol/L), HDL-C (1.20 mmol/L, and triglycerides (1.68 mmol/L) were within normal limits. A higher age (aOR 3.40; 95%CI 1.77-6.53) and the use of more than 20 mg per day atorvastatin equivalent dose of a statin (aOR 2.20; 95%CI 1.13-4.28) were associated with treatment target achievement in a multivariable adjusted model while female gender conferring a reduced likelihood (aOR 0.48; 95%CI 0.24-0.99).ConclusionsPatients at high cardiovascular risk in Slovakia are far off the <1.8 mmol/L LDL-C level recommended for the protection from adverse events and achieve their treatment targets less often (18.6%) than in the mean of other countries globally (29.4%).

Instrumental diagnostic methods for chronic coronary heart disease

The review provides modern insights into methods for identifying a variety of scenarios that are currently classified as chronic coronary syndrome and involve different risks for subsequent cardiovascular events. The assessment of pre-test probability and determinants that enhance and reduce the possibility of diagnosing coronary heart disease are considered. The necessity and sequence of application of both simple instrumental methods of diagnostics of chronic coronary disease (electrocardiography, ambulatory electrocardiogram monitoring, exercise electrocardiogram, echocardiography) and more complex ones requiring specially trained personnel and modern equipment (stress echocardiography, computed tomography and invasive coronary angiography) are discussed. The recommended modern diagnostic algorithm in symptomatic patients with suspected coronary heart disease is presented.

An advanced nurse-led clinic for patients following percutaneous coronary intervention

Percutaneous coronary intervention (PCI) is internationally recognised as the preferred initial treatment for acute coronary syndrome and as a treatment option for chronic coronary heart disease. The use of PCI has led to shorter inpatient stays. However, reduced length of stay can mean less opportunity for patient education. Once discharged from hospital, timely outpatient review encompassing symptom reassessment, advanced physical assessment, medication and cardiovascular risk management is a key component of patient care. In an Irish acute hospital setting, cardiology clinical nurse specialists and advanced nurse practitioners have established an advanced nurse-led post-PCI clinic. This article describes the post-PCI clinic and provides an overview of the patient profile and outcomes over a 2-year period, with an emphasis on advanced nursing roles and patient symptoms.

Possibilities for treating aspirin-i lesions of the stomach and duodenum in patients with chronic coronary heart disease

To evaluate possibilities of aspirin-induced gastroduodenopathy treatment in the patients with chronic ischemic heart disease by means of applying the internal endogenous prostaglandins stimulant. Material and methods. 340 patients suffering from chronic coronary heart disease and receiving a long-term acetylsalicylic acid (ASA) therapy were examined on the base of the cardiovascular care unit of The Nizhny Novgorod Regional Clinical Hospital named after N.A. Semaschko. There were evaluated frequency, nature and severity of the aspirin-induced gastroduodenopathy. The patients with coronary heart disease and aspirin-induced gastroduodenopathy were divided in two groups. In the first group of patients there was applied rebamipide therapy (in a single daily dose 300 mg) in combination with the proton pump inhibitor (PPI) — pantoprazole. In the second group there was applied only pantoprazole therapy. For the purpose of specification of AIG pathogenetic mechanisms development, all the examined chronic coronary heart disease cases were tested on the prostaglandin E2 (PGE2) level in blood serum before the therapy beginning and after the treatment. The control group was formed of chronic coronary heart disease patients showing no AIG evidence. Statistical processing of the received data was fulfilled with the program «Statistika 10.0». Results. AIG was registered in 15% out of 340 chronic coronary heart disease patients. According to the endoscopic examination erosive disease of the body and antrum prevailed among the patients. The PGE2 level in the blood serum was significantly lower (р = 0,00087) in these patients in comparison with the control group. In association with PPI and rebamipide mixed therapy, esophagogastroduodenoscopy results showed no pathological findings in gastrointestinal mucosa and statistically significant (р = 0,00067) blood serum PGE2 level growing in all the treated patients. As a result of exclusive PPI therapy there was marked positive dynamics in endoscopic view in 19 out of 25 patients and a tendency to normalization of PGE2 level in the blood serum. However, PGE2 level growing was insignificant. Conclusion. The presented research demonstrates the possibility of AIG treatment with the use of internal endogenous prostaglandins stimulant — rebamipide in complex with proton pump inhibitor PPI therapy.

Do the patients with peripheral atherosclerosis need to a medical therapy before the revascularization?

In the review article are provided the approaches to the therapy for improvement of prognosis in patients with peripheral and multifocal atherosclerosis which are available now; some limitations and a real situation are designated for the antithrombotic therapy in this category of patients. According to the clinical trial COMPASS the prospects of wide use of a combination of acetylsalicylic acid and a rivaroxsaban of 2.5 mg 2 times a day in the patients with chronic coronary heart disease and/or symptom peripheral atherosclerosis are designated.