Cardiac Markers In Patients Research Articles

Correlation of osteopontin hormone with TIMI score and cardiac markers in patients with acute coronary syndrome presenting with chest pain.

Rapid evaluation of patients with acute coronary syndrome (ACS) attending the emergency service under emergency room conditions and using appropriate risk scoring would improve treatment success. Calcium levels accumulate in the tissue in people with coronary artery disease and this has been found to correlate with osteopontin levels in some studies. It is predicted that osteopontin level could be used as a biomarker to detect coronary artery calcification. In this study, we aimed to evaluate the use of osteopontin levels in the differential diagnosis of ACS in conjunction with cardiac troponin I (cTnI) levels, and HEART (history, ECG, age, risk factors, troponin) and thrombolysis in myocardial infarction (TIMI) scores in patients with chest pain who attended the emergency service. This study was conducted as a prospective observational clinical study in the Department of Emergency Medicine, Faculty of Medicine, Ataturk University. There was a total of 90 participants, including 60 patients and 30 healthy individuals in the control group. All participants' demographic information, electrocardiography (ECG) findings, cTnI level, TIMI and HEART score, and osteopontin level were evaluated. The patients' mean age was 51.61 ± 17.56 years and 63.3% (n = 57) were male. The body mass index (BMI) of the patients was 25.63 ± 4.67 kg/m2. Patients with chest pain [CP(+)] and high cardiac troponin I levels [cTnl(+)] were found to be older and to have higher HEART and TIMI scores than individuals with CP(+) and normal cardiac troponin I levels [cTnl(-)] and the healthy control group (p < 0.001). While the HEART score was zero in 22 (24.4%) of the patients, the TIMI score was zero in 42 (46.7%). In terms of gender distribution, vital signs and serum osteopontin levels, there was no significant difference between the patient groups (p > 0.05). It was found that patients with CP(+) and cTnl(+) had a higher rate of ECG abnormalities than the CP(+) and cTnl (-) group and the healthy control group (p = 0.13 and p < 0.001, respectively). In 65 (72.2%) of the patients, the ECG results were normal. ST-segment elevation was detected in 13 (14.4%) patients. In our study, cTnl levels were found to be positively correlated with age (r = 0.624), BMI (r = 0.291), HEART score (r = 0.794) and TIMI score (r = 0.805) (p = 0.001, p = 0.005, p = 0.001 and p = 0.001, respectively). In our study, we discovered that osteopontin levels could not reach the differential diagnostic level for ST-elevation myocardial infarction or non-ST-elevation myocardial infarction. No statistically significant difference was found in osteopontin levels between the groups (p > 0.05). While very positive results were obtained in this approach to the ACS diagnosis using HEART and TIMI scores in patients with chest pain who attended the emergency service and were diagnosed with ACS, no significant results could be obtained regarding the use of osteopontin levels as a biomarker. More comprehensive, multicentre studies involving a large number of appropriately selected patients are considered to be necessary.

Effect of Continuous Positive Airway Pressure Therapy on Pro-Brain Natriuretic Peptide, C-Reactive Protein, Homocysteine, and Cardiac Markers in Patients with Obstructive Sleep Apnea.

Obstructive sleep apnea is associated with increased morbidity and mortality, especially cardiovascular and cerebrovascular, and affects a significant proportion of the population. The study was aimed to determine the levels of pro-brain natriuretic peptide, C-reactive protein, homocysteine, and cardiac markers (creatine kinase, creatine kinase isoenzyme MB, troponin T) and evaluate the effectiveness of continuous positive airway pressure therapy in patients with obstructive sleep apnea. Pro-brain natriuretic peptide, C-reactive protein, homocysteine, and cardiac markers (creatine kinase, creatine kinase isoenzyme MB, troponin T) were assessed in blood samples collected before and after continuous positive airway pressure treatment from the 30 patients included in the study, and their results were compared. There was a significant decrease between the baseline pro-brain natriuretic peptide and the 6-month pro-brain natriuretic peptide values after continuous positive airway pressure therapy (P < .05). There was a significant increase in creatine kinase-MB and troponin T values 6 months after continuous positive airway pressure therapy compared to baseline values (P < .05). A significant decrease was observed in pro-brain natriuretic peptide values after continuous positive airway pressure therapy in obstructive sleep apnea patients without cardiac failure, while a more significant decrease was especially observed among hypertension patients. This finding suggests that pro-brain natriuretic peptide may be used as an early indicator of cardiac dysfunction in obstructive sleep apnea patients without any heart diseases except for hypertension.

Laboratory features of cardiovascular injury in COVID-19 and other acute respiratory viral infections

The article presents data from a study of specific cardiac markers in patients with acute respiratory viral infection (ARVI) or coronavirus disease 2019 (COVID-19). COVID-19 caused by severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) is characterized by cardiovascular injury. However, with other ARVIs, the prevalence of heart involvement is also high and, according to the literature data, is about 20%. At the same time, laboratory characteristics of these lesions have significant differences in ARVI and COVID-19, which necessitates different approaches to therapy.Aim. To determine the most significant markers for the diagnosis of cardiovascular involvement in patients with COVID-19.Material and methods. A total of 60 patients were included in the study: main group (n=30), COVID-19 was laboratory confirmed; comparison group (n=30), other ARVI pathogens were verified. The groups were completely comparable in sex, age and severity of disease course. The average values of troponin, creatine kinase MB, N-terminal pro-brain natriuretic peptide (NT-proBNP) and D-dimer were compared in patients of both groups in the acute disease phase, corresponding from 1 to 8 days from the symptoms’ onset. Data analysis was performed using a two-sided independent samples t-test using SPSS Statistics version 23.Results. The higher levels of troponin-I and D-dimer were significantly more common in the main group. The mean value of creatine kinase MB did not exceed the upper limits of reference values. There were no significant differences in NTproBnP levels between the groups. At the same time, in both groups, its level significantly exceeded the age reference values.Conclusion. The most effective markers of cardiovascular complications in COVID-19 patients should be considered troponin-I, D-dimer and NT-proBNP. Early diagnosis and laboratory monitoring in dynamics is important for the timely detection of cardiac pathology and alteration of therapy regimen.

Circulating CX3CR1+CD163+ M2 monocytes markedly elevated and correlated with cardiac markers in patients with acute myocardial infarction.

BackgroundVulnerable plaques have been generally recognized to play a role in the pathogenesis of acute myocardial infarction (AMI), however, the role of circulating CX3CR1+CD163+ M2 monocytes has not been studied properly. We aim to evaluate the features of CX3CR1+CD163+ M2 monocytes and its relationship with cardiac specific markers in AMI patients.MethodsThe circulating M2 monocytes were identified in AMI patients (n=35) and healthy controls (HCs, n=10) by flow cytometry using two staining methods: CD68+CD163+ (cytoplasmic staining) and CX3CR1+CD163+ (surface staining). CX3CR1+ monocytes were purified by magnetic cell sorting. The expression level of peroxisome proliferator-activated receptor γ (PPARγ) and arginase-1 (Arg-1) were measured by real-time quantitative PCR and Western Blot in CX3CR1+ monocytes.ResultsCirculating M2 monocytes extremely expanded in AMI patients compared with HCs (P<0.01). Positive linear correlation was confirmed between CD68+CD163+ and CX3CR1+CD163+ cell populations in AMI patients (r=0.39, P=0.02). The percentage of circulating CX3CR1+CD163+ M2 monocytes positively correlated with cardiac specific markers (cTNT, CK-MB) and acute phase markers (glucose, hs-CRP) (cTNT, r=0.63, P<0.01, CK-MB, r=0.54, P<0.01, glucose, r=0.62, P<0.01, hs-CRP, r=0.58, P<0.01). CX3CR1+ monocytes in AMI patients expressed higher levels of PPARγ and Arg-1 than those in HCs (P<0.01).ConclusionsCirculating M2 monocytes increased in AMI patients and positively correlated with the elevation of both cardiac specific and acute phase markers. CX3CR1+CD163+ M2 monocytes might have application value for the early diagnosis of AMI.

Biological variation of cardiac markers in patients with aortic valve stenosis

ObjectiveCardiac biomarkers hold promise for follow-up and management of aortic valve stenosis (AVS). When interpreting serial biomarker measurements of patients with AVS, it can be challenging to distinguish ‘real changes’...

Status of Cardiac Markers in Patients With Peripheral Arterial Disease and Critical Limb Ischemia

Status of Cardiac Markers in Patients With Peripheral Arterial Disease and Critical Limb Ischemia

Evaluation of Cardiac Markers in Patients with Myocardial Infarction

Evaluation of Cardiac Markers in Patients with Myocardial Infarction

Elevated cardiac troponin I, creatine kinase and myoglobin and their relationship with cardiovascular risk factors in patients with type 2 diabetes

BackgroundElevated cardiac troponin I, Creatine kinase (CK-MB) and Myoglobin levels are observed in the setting of acute myocardial damage. However sub-clinical elevations occur in patients with diabetes mellitus. This study was carried out to determine the relationship between the presence of multiple cardiovascular risk factors and the metabolic syndrome and elevations in cardiac markers in patients with type2 diabetes mellitus. Subjects and methodsConsecutive stable out-patients with type2 diabetes mellitus at the University of Port Harcourt Teaching Hospital, Nigeria were recruited. Non-diabetic individuals such as hospital staff and the general public acted as controls. Baseline demographic data collection was done and waist circumference, weight, height and blood pressure were measured. Venous samples were assayed for CTnI, CK-MB and Myoglobin levels using ELISA. Data was analysed using SPSS v 20. ResultsThere were 188 DM patients, who were older than the 200 control subjects (56.1 ± 13.1 years and 42.7 ± 5.7 years, p < 0.001). Mean duration of diabetes was 7.1(5.7) years. Hypertension was present in 59%, 84.6% had dyslipidaemia, while 76.1% had metabolic syndrome. All the cardiac markers were significantly higher in DM patients than controls. The presence of hypertension or dyslipidaemia was not significantly associated with the cardiac markers (p > 0.05 for all), however the DM patients with metabolic syndrome had higher levels of CK-MB and myoglobin but not CTnI than those without. ConclusionDiabetes mellitus is associated with chronic sub-clinical elevation of cardiac markers and this is more in those with multiple cardiovascular risk factors and/or the metabolic syndrome.

High-sensitive cardiac troponin, NT-proBNP, hFABP and copeptin levels in relation to glomerular filtration rates and a medical record of cardiovascular disease

BackgroundElevation of cardiac markers in patients with renal dysfunction has not been fully assessed reducing the diagnostic usefulness of these biomarkers. ObjectiveTo examine the effects of renal function and a medical record of cardiovascular disease on levels of cardiac biomarkers. MethodsSerum samples were collected from 489 patients referred for GFR measurement using Cr51-EDTA or iohexol plasma clearance (measured GFR). The cardiac biomarkers Troponin T (hs-cTnT), Troponin I (hsTnI), N-Terminal pro-Brain Natriuretic Peptide (NTproBNP), Copeptin, Human Fatty Acid-Binding Protein (hFABP), as well as the kidney function biomarkers creatinine and cystatin C, were measured. Regression was used to analyse the relationship between biomarker levels and the glomerular filtration rate (GFR) between 15 and 90mL/min/1.73m2. ResultsCompared with normal kidney function, the estimated increases in the studied cardiac biomarkers at a GFR of 15mL/min/1.73m2 varied from 2-fold to 15-fold but were not very different between patients with or without a medical record of cardiovascular disease and were most prominent for cardiac biomarkers with low molecular weight. hs-cTnT levels correlated more strongly to measured GFR and increased more at low GFR compared to hs-cTnI. For hFABP and NTproBNP increases at low kidney function were more correctly predicted by a local Cystatin C-based eGFR formula compared with creatinine-based eGFR (using the MDRD or CKD-EPI equations). ConclusionThe extent of the elevation of cardiac markers at low renal function is highly variable. For hFABP and NTproBNP Cystatin C-based eGFR provides better predictions of the extent of elevation compared to the MDRD or CKD-EPI equations.

High frequency home-based exercise decreases levels of vascular endothelial growth factor in patients with stable angina pectoris

In coronary artery disease (CAD), circulating angiogenic factors have been seen to increase, possibly as a response to ischaemia. Regular physical activity (PA) is recommended for prevention and treatment of CAD, but more research is needed to optimise PA regimes. We investigated the effect of home-based high frequency exercise (HFE) on angiogenic cytokines and cardiac markers in patients with stable CAD. This was a randomised case-control study Sixty-two patients, with stable CAD, were randomised to HFE (n = 33), (aerobic exercise 70% of max, 30 min, five times/week and resistance exercise three times/week), performed at home, or usual lifestyle (control, n = 29). After eight weeks, percutaneous coronary intervention (PCI) was performed in both groups, and the HFE group continued another six months of exercise. Serum vascular endothelial growth factor (VEGF) and stromal derived factor-1 (SDF-1), plasma N-terminal-brain natriuretic peptide (NT-proBNP), high-sensitive troponin T (TnT) and copeptin were analysed. Data are presented as median (25(th), 75(th) percentile) of relative changes (%) from baseline. Values of p are given for the difference between the HFE and controls. HFE decreased circulating VEGF levels, before PCI (-5% (-15%, -2%)), while VEGF levels increased in the control group (5% (-3%, 20%) p = 0.004). A significant difference in VEGF remained at three months post-PCI (HFE (-1%(-12%, 5%), control (7% (0%, 14%), p = 0.04), but not at six months after PCI. SDF-1, NT-proBNP, TnT and copeptin levels did not differ significantly. In addition, VEGF levels were positively correlated to NT pro-BNP. Home-based HFE decreased circulating VEGF in patients with stable CAD, suggesting a reduced ischaemic burden. HFE does not increase markers of cardiac dysfunction, suggesting that it is a safe therapeutic intervention in these patients.

Sedation with sevoflurane improves reperfusion in acute myocardial infarction

Background: Experimental evidence suggests that the inhalation anesthetic sevoflurane has a cardioprotective effect. Methods: We randomized 47 patients with a first acute ST elevation myocardial infarction, treated by primary PCI within 6 h from symptom onset, to inhalation of sevoflurane or control (oxygen+midazolam). Sevoflurane and oxygen were administered using a tight fitting mask by the anesthesia team. Coronary flow at the end of PCI was assessed by corrected TIMI frame count (CTFC). Myocardial reperfusion was assessed by ST segment resolution. Infarct size was assessed by release of CK and troponin T. Results: 25 patients (age 62±12, 6 females) were randomized to sevoflurane and 22 (age 62±11, 5 females) to control. Time from first contact to balloon was similar in both groups (mean 78 min). In the sevoflurane group, the proportion of patients with anterior MI was higher (64% vs 36%), as was the total ST elevation (11.6±10.7 vs 8.4±6.2mm). The use of thrombectomy (56%) and administration of IIbIIIa inhibitors (90%) were similar. CTFC was 12.3±1.5 with sevoflurane and 15.6±9.1 in control, p=0.16. There was more ST resolution in patients treated by sevoflurane 80.7±25.8% vs 56.6±35.7%, p=0.01. There was no difference in troponin T or CK release between groups (AUC or peak). However, there was a trend to lower peak CK (1725±1589 vs 3206±1795 IU/L, p=0.05), and peak troponin T (4.4±3.9 vs 7.3±3.7 μg/L, p=0.1) in the sevoflurane group patients with anterior MI (Figure). Infarct size Conclusions: In this pilot randomized study, sevoflurane administration during primary PCI was associated with improvement in ST segment elevation resolution. There was a decrease in cardiac markers in patients with anterior STEMI who received sevoflurane. These results should be confirmed in a larger clinical trial.

High-sensitivity cardiac troponin T for earlier diagnosis of acute myocardial infarction in patients with initially negative troponin T test—Comparison between cardiac markers

Background and purposeAn early diagnosis is essential for therapeutic decision and risk stratification in patients with suspected acute myocardial infarction (AMI). We analyzed and compared the diagnostic value of high-sensitivity troponin T (hs-TnT) and other cardiac markers in patients with an initially negative troponin T test at presentation. Methods and subjectsThe present study was a prospective, multicenter study including five participating emergency cardiovascular tertiary centers in Japan. From November 2009 through January 2011, patients with suspected AMI at the emergency room with an initial troponin T (c-TnT) test <100ng/L were enrolled. ResultsA total of 85 patients were prospectively assigned from five participating emergency cardiovascular tertiary centers in Japan. The median time from the onset of chest pain to the T0 sampling was 165min [IQR 120–180]. The final diagnoses according to the recent universal definition and other standard cut-off values were AMI in 47, unstable angina in 12, and non AMI in 38 patients. The overall ROC-AUC value of hs-TnT, c-TnT, creatine kinase MB, and heart-type fatty acid-binding protein were 0.810, 0.716, 0.782, and 0.880, respectively. The diagnostic sensitivity and negative predictive value of hs-TnT were both 100% for the patients admitted more than 120min from the onset, however the specificity was limited for the whole time-windows (71%). The absolute value change of the hs-TnT from T0 to T3 sampling 3h later improved the ROC-AUC up to 0.972 and the specificity was 92% at 22ng/L (ROC-optimized cut-off) and 100% at 105ng/L (rule-in cut-off). ConclusionsThe hs-TnT displayed 100% sensitivity and negative predictive value for the patients admitted more than 120min from the onset, however the specificity was limited. The absolute change from T0 to T3 (22ng/L) improved the total diagnostic performance.

Prognostic role of biomarkers and right ventricular dysfunction in pulmonary embolism

Pulmonary embolism is morbidity and mortality remain high. The short-term prognosis of pulmonary embolism depends on haemodynamic status and underlying disease massive pulmonary embolism, defined as pulmonary embolism that is associated with systemic hypotension which increases up to 50% in hospital mortality. However, the in-hospital mortality of patients with normal blood pressure pulmonary embolism has been reported to vary from 3 to 15%. Right ventricular dysfunction showed by echocardiography or computerized tomography and elevated cardiac enzymes have been used to determine mortality in these patients with pulmonary embolism. In this article; we reviewed the prognostic value of right ventricular dysfunction as evaluated by echocardiography or spiral computerized tomography, and the prognostic value of increased levels of cardiac markers in patients with pulmonary embolism.

Comparative diagnostic accuracy of serum levels of neutrophil activating peptide-2 and pentraxin-3 versus troponin-I in acute coronary syndrome

We measured the levels of neutrophil activating peptide-2 (NAP-2) and pentraxin-3 (PTX-3) in acute coronary syndromes (ACS) patients and compared their diagnostic accuracy with cardiac troponin I (cTnI). We conducted a prospective cohort study to determine the diagnostic accuracy of PTX-3, NAP-2 and cTnI for the prediction of ACS. Consecutively eighty-three patients with sudden chest pain admitted to Dicle University Emergency Department within the first six hours of symptom onset were included in our study. Mean serum levels of PTX-3, NAP-2 and cTnI were compared between control and patient groups and ACS subgroups. Their sensitivities and specificities in early diagnosis of ACS were identified. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic validity of the markers, and areas under the ROC curve (AUC) were compared. In the patient group, mean serum concentrations of NAP-2 (53.03+22.77 ng/ml) and PTX-3 (1.73+0.82 ng/ml) were considerably higher than those of the control group (24.54+9.50 and 0.50+0.39 ng/ml, respectively) (p<0.01). When compared with the control group, PTX-3 levels of all three ACS subtypes (unstable angina pectoris (USAP) - 1.62+0.41 ng/ml, non-ST elevation myocardial infarction (NSTEMI) -1.63+0.31 ng/ml and ST-elevation myocardial infarction (STEMI) - 1.75+0.89 ng/ml) were higher, whereas NAP-2 levels were higher in USAP (56.29+22.60 ng/ml) and STEMI (52.05+20.99 ng/ml) patients (p<0.01). For diagnosing ACS within the first six hours of presentation, PTX-3 sensitivity was 98.5% and specificity was 92.3%, and NAP-2 sensitivity - 98.1% and specificity - 41.3%. The ROC curve AUC values were: 0.962 for PTX-3 (95% CI 0.802 - 1.073), 0.840 for NAP-2 (95% CI 0.684 - 0.991), and 0.683 for cTnI (95% CI 0.610 - 0.940). Pentraxin-3 is a sensitive and specific marker for ACS diagnosis when compared with cardiac markers in patients admitted to the emergency department (ED) within the first six hours of onset of chest pain.

N-Terminal Pro-BNP in Acute Coronary Syndrome Patients with ST Elevation versus Non ST Elevation Myocardial Infarction

The study aimed to evaluate the differences in secretion of NT-proBNP and conventional cardiac markers in patients with STE-ACS vs NSTE-ACS as a trial to solve the dilemma of the early detection of myocardial ischemia in NSTE-ACS. Sixty two patients with acute coronary syndrome (ACS) divided into 2 groups according to ECG: group1 with elevated ST segment in ECG (STE-ACS) and group 2 with non elevated ST segment (NSTE-ACS).Twenty healthy subjects with matched age and sex were enrolled as control group in this study. In the sera of all subjects, levels of NT –proBNP, CK-MB and troponin-T were measured by different kits. CK-MB and TnT were both significantly higher in STE-ACS patients compared to NSTE-ACS patients. Conversely, NT-proBNP was significantly higher in NSTE-ACS patients than STE-ACS especially within 4 hours from onset of chest pain. Comparison between NT-proBNP, TnT and CK-MB levels by ROC curves revealed area under the curves = 0.68, 0.31, 0.17 respectively. NT-proBNP at cutoff 415 pg/mL in NSTE-ACS patients had higher sensitivity and specificity (92%, 39%; respectively) than other markers that will help in earl diagnosis of NSTE-ACS.

Impact of CPAP treatment on cardiac biomarkers and pro-BNP in obstructive sleep apnea syndrome

To evaluate the effect of continuous positive airway pressure (CPAP) therapy on pro-brain natriuretic peptide (BNP) and cardiac markers in patients with obstructive sleep apnea syndrome and normal cardiac function. Thirty-three consecutive patients with sleep apnea syndrome were analysed for serum pro-BNP and cardiac markers prior to and after 6 months of CPAP therapy. Twenty five patients had normal (83.3%) while remaining five (16.7%) revealed high pro-BNP values. We did not detect any significant difference between severity of obstructive sleep apnea syndrome and serum pro-BNP levels (p = 0.534). A statistically significant difference was not observed between basal and sixth-month creatine kinase (CK), creatine kinase-MB (CK-MB), troponin I, pro-BNP, aspartate transaminase (AST), and CK levels in patients with sleep apnea syndrome (p > 0.05). Obstructive sleep apnea syndrome does not induce myocardial damage enough to increase serum pro-BNP, CK, CK-MB, troponin I, and AST levels. Markers sensitive to ischemia could be preferred to evaluate effect of obstructive sleep apnea syndrome.

L-carnitine as an Adjunct Therapy to Percutaneous Coronary Intervention for Non-ST Elevation Myocardial Infarction

To evaluate the effects of L: -carnitine as an adjunct therapy to percutanenous coronary intervention (PCI) for non-ST elevation acute coronary syndrome (NSTEMI). Ninety-six consecutive patients with NSTEMI were randomized into treatment group (L: -carnitine 5 g IV bolus followed by 10 g/day IV infusion for 3 days), and control group. All patients also underwent PCI within 24 h from the onset of chest pain. The peak values of creatine kinase-MB and troponin-I before and after PCI were observed. In the treatment group, the peak values of creatine kinase-MB were significantly lower than the control group at 12 h and 24 h after PCI (P < 0.01). The peak values of troponin-I in the treatment group were also lower than the control group at 8 h after PCI (P < 0.01). Multivariate regression analysis showed that L: -carnitine therapy was an independent predictor for the reduction of creatine kinase-MB (r = 0.596, P < 0.001) or troponin-I (r = 0.633, P < 0.001). L: -carnitine adjunct therapy appears to be associated with a reduced level of cardiac markers in patients with NSTEMI. These results support a larger clinical trial to investigate the effect of L: -carnitine on cardiac events following PCI.

Serum cardiac markers in patients with acute myocardial infarction: oxidative stress, C-reactive protein and N-terminal probrain natriuretic Peptide.

The aim of this study was to investigate the predictive value of an oxidative stress, C-reactive protein (CRP) and N-terminal probrain natriuretic peptide (NT-proBNP) biomarkers in acute myocardial infarction (AMI). The study population contained 100 patients with AMI and 40 healthy subjects. Malondialdehyde (MDA) was measured as thiobarbituric acid reactive substances. Total antioxidant status (TAC) was assayed with colorimetric method. CRP and NT-proBNP was quantitated by immunoassay. MDA, CRP and NT-proBNP levels were found significantly high in patients with AMI as compared to healthy controls (p<0.01). Patients were divided into six groups based on the presence of disease history before AMI. In patients with non-disease before AMI. MDA, CRP and NT-proBNP levels were lowest among the patient groups. MDA levels in patients with hyperlipidemia/ diabetes/renal disease were higher than the other groups. TAC levels in patients with hypertension were lower than as compared to healthy controls (p<0.05). CRP levels in hypertension + hyperlipidemia patients and NT-proBNP levels in cardiovascular + hypertension patients were found high as compared to other patient groups. It is concluded that serum levels of MDA, CRP and NT-proBNP were significantly increased in patients with AMI and these markers were strongly predictive in AMI.

Heart dysfunction evaluated by troponin, stroke work analysis and QT dispersion can predict outcome in patients with septic shock

Sepsis is the leading cause of mortality in ICUs. The mortality rate approaches 29%. As far as the heart is concerned, adequately volume-resuscitated patients in septic shock present a hyperdynamic circulatory state with high cardiac output and reduced systemic vascular resistance, and this profile seems to persist throughout the septic event regardless of the outcome. Myocardial depression in patients with septic shock is characterized by biventricular dilatation and decreased systolic contractile function, all in the presence of an overall hyperdynamic circulation. In addition, sepsis and septic shock is characterized by an impaired sympathetic modulation of the heart, suggesting that a central autonomic regulatory impairment contributes to the circulatory failure that is seen. The purpose of this study was to analyze echocardiographic, ultrasonographic, hemodynamic and serum cardiac markers in patients with septic shock and to evaluate their relationship to the outcome.

Difference in Elevation of N-Terminal Pro-BNP and Conventional Cardiac Markers Between Patients With ST Elevation vs Non-ST Elevation Acute Coronary Syndrome

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is elevated in patients with acute coronary syndrome (ACS), and is a powerful predictor of long-term mortality. Differences in the clinical utility and pathophysiological implication of NT-proBNP and conventional cardiac markers in patients with ST elevation (STE) vs non-STE (NSTE) ACS were investigated in the present study. Ninety consecutive patients admitted with acute chest pain and a diagnosis of unstable angina or acute myocardial infarction were analyzed. Patients with >or=Killip class II were excluded to focus on the effect of myocardial ischemia on the release of cardiac markers. The markers were measured on admission and analyzed according to the time from onset. Conventional cytosolic marker (creatine kinase-MB) and myofibril marker (troponin T: TnT) were both significantly higher in STE-ACS patients compared with NSTE-ACS patients. Conversely, NT-proBNP was significantly higher in NSTE-ACS patients than STE-ACS especially within 3 h of onset, suggesting a larger ischemic insult despite the smaller extent of myocardial necrosis compared with STE-ACS patients. There was no significant correlation between NT-proBNP level and left ventricular ejection fraction (LVEF) obtained at acute-phase echocardiography in either NSTE-ACS patients (LVEF 57.7+/-11.2%) or STE-ACS patients (LVEF 55.1+/-12.7%). Comparison between NT-proBNP and TnT levels revealed a marked difference of elevations, with significantly augmented elevation of NT-proBNP (p<0.001) in NSTE-ACS patients as compared with prominent elevation of TnT in STE-ACS patients. NT-proBNP is an early sensitive marker of myocardial ischemia that rises much higher in the earlier phase as compared with conventional markers of myocardial damage, especially in NSTE-ACS patients.