Chest ECG Research Articles

The impact of myocardial bridge on coronary artery spasm and long-term clinical outcomes in patients without significant atherosclerotic stenosis

Background and aimsMyocardial bridge (MB) and coronary artery spasm (CAS) can induce a sustained chest pain, acute coronary syndrome (ACS) and even sudden cardiac death. The aim of this study is to evaluate the relationship between MB and CAS and its impact on long-term clinical outcomes. MethodsA total of 812 patients with MB without significant coronary artery disease (CAD), who underwent acetylcholine (ACH) provocation test, were enrolled. Significant CAS was defined as ≥70% temporary narrowing by ACH test, and MB was defined as the characteristic phasic systolic compression of the coronary artery with a decrease of more than 30% in diameter on the angiogram after intracoronary nitroglycerin infusion. To adjust baseline confounders, logistic regression analysis was performed. The primary endpoint was incidence of CAS, and secondary endpoints were major adverse cardiac events (MACE) and recurrent angina requiring repeat coronary angiography (CAG) at 5 years. ResultsMB is closely implicated in a high incidence of CAS, spontaneous spasm, ischemic ECG change and chest pain during ACH provocation test. In addition, MB of various severity and reference vessel size was substantially implicated in CAS incidence, and severe MB was a strong risk factor of CAS. MB patients with CAS were shown to have a higher rate of recurrent angina compared with MB patients without CAS, up to a 5-year follow-up. However, there were no differences regarding the incidence of MACE. ConclusionsSevere MB was associated with high incidence of CAS, and MB patients with CAS were likely to have a higher incidence of recurrent angina. Intensive medical therapy and close clinical follow-up are needed for better clinical outcomes in MB patients with CAS.

Mitral Stenosis: A Review

Mitral stenosis due to rheumatic heart disease is not common in the United States but is common in the developing world because rheumatic fever is still occurring frequently. Symptoms usually gradually occur in the young adult (most commonly female). Atrial fibrillation is a common accompanying rhythm in patients with proven mitral stenosis. The main physiologic event is a pressure gradient between the left atrium and the left ventricle. Diagnosis is relatively straight forward using physical exam and simple laboratory studies such as Chest X-Ray (elevated Left main stem bronchus, Double Density indicating enlarged left atrium) and ECG (P-Mitrale). Cardiac ultrasound confirms the clinical diagnosis (Doming of mitral valve in diastole, Hockey stick deformity of the anterior mitral valve leaflet, large left atrium, Doppler estimation of valve gradient). Mitral commisurotomy (surgical or Balloon) is warranted if the valve is pliable and not heavily calcified.

Pericarditis in a Swiss regional hospital

Chest pain and ECG changes are the most common clinical findings in the emergency department and outcome is generally favourable with low recurrence rates.

Diagnostic Accuracy of a New High-Sensitivity Troponin I Assay and Five Accelerated Diagnostic Pathways for Ruling Out Acute Myocardial Infarction and Acute Coronary Syndrome

This diagnostic accuracy study describes the performance of 5 accelerated chest pain pathways, calculated with the new Beckman's Access high-sensitivity troponin I assay. High-sensitivity troponin I was measured with presentation and 2-hour blood samples in 1,811 patients who presented to an emergency department (ED) in Australia. Patients were classified as being at low risk according to 5 rules: modified accelerated diagnostic protocol to assess patients with chest pain symptoms using troponin as the only biomarker (m-ADAPT), the Emergency Department Assessment of Chest Pain Score (EDACS) pathway, the History, ECG, Age, Risk Factors, and Troponin (HEART) pathway, the No Objective Testing Rule, and the new Vancouver Chest Pain Rule. Endpoints were 30-day acute myocardial infarction and acute coronary syndrome. Measures of diagnostic accuracy for each rule were calculated. Data included 96 patients (5.3%) with acute myocardial infarction and 139 (7.7%) with acute coronary syndrome. The new Vancouver Chest Pain Rule and No Objective Testing Rule had high sensitivity for acute myocardial infarction (100%; 95% confidence interval [CI] 96.2% to 100% for both) and acute coronary syndrome (98.6% [95% CI 94.9% to 99.8%] and 99.3% [95% CI 96.1% to 100%]). The m-ADAPT, EDACS, and HEART pathways also yielded high sensitivity for acute myocardial infarction (96.9% [95% CI 91.1% to 99.4%] for m-ADAPT and 97.9% [95% CI 92.7% to 99.7%] for EDACS and HEART), but lower sensitivity for acute coronary syndrome (≤95.0% for all). The m-ADAPT, EDACS, and HEART rules classified more patients as being at low risk (64.3%, 62.5%, and 49.8%, respectively) than the new Vancouver Chest Pain Rule and No Objective Testing Rule (28.2% and 34.5%, respectively). In this cohort with a low prevalence of acute myocardial infarction and acute coronary syndrome, using the Beckman's Access high-sensitivity troponin I assay with the new Vancouver Chest Pain Rule or No Objective Testing Rule enabled approximately one third of patients to be safely discharged after 2-hour risk stratification with no further testing. The EDACS, m-ADAPT, or HEART pathway enabled half of ED patients to be rapidly referred for objective testing.

Preliminary quantitative proteomics analysis in chronic and latent Keshan disease by iTRAQ labeling approach.

Keshan disease is a congestive cardiomyopathy. Dietary selenium deficiency combined with additional stressors are recognized to cause the cardiomyopathies. In this study, clinical condition of individuals with different subtypes including chronic and latent were analyzed. ECG abnormalities, chest radiography, echocardiography and blood selenium concentration were assessed. Subsequently, in effort to uncover proteins that were reliably changed in patients, isobaric tags for absolute and relative quantitation technology was applied. Bioinformatics analysis of the differentially expressed proteins were performed by means of Gene Ontology classification, KEGG pathway, and Ingenuity Pathway Analysis. ELISA experiment was used to detect the interesting proteins. As a result, chronic patients showed more EGC abnormalities compared to Latent. All patients had low blood selenium level. Proteomics data revealed 28 differentially expressed proteins. By ELISA variation, LGALS3BP was increased in chronic patients. PZP was elevated specially in latent patients. The above results might be beneficial for further biomarkers discovery and Keshan disease pathological mechanism study.

Protocolo de diagnóstico y tratamiento de la valvulopatía aórtica

Aortic stenosis. Diagnostic evaluationClinical evaluation, baseline ECG, and chest x-ray (Rx) are mandatory in the initial diagnostic evaluation. Transthoracic echocardiography (TTE) is the main tool for diagnosis and follow-up. Other diagnostic techniques are also useful. Therapeutic managementPatients with severe symptomatic aortic stenosis should be involved, especially with aortic valve replacement surgery, and if the surgical risk is high, transcatheter aortic valve implantation (TAVI) may be an adequate alternative. Asymptomatic individuals will only be involved according to several factors predictive of onset of symptoms and adverse events. Aortic insufficiency. Diagnostic assessmentclinical evaluation, baseline ECG, and simple chest x-ray are also mandatory in the initial diagnostic evaluation. The ETT is the main diagnostic and monitoring tool. Therapeutic managementAcute severe aortic insufficiency (AI) should undergo urgent surgery. In chronic severe AI, when symptoms and/or systolic dysfunction of the left ventricle appear, aortic valve surgery must be performed; The asymptomatic patients will be operated according to several factors regarding left ventricular systolic size and function. Sometimes aortic root and ascending aorta surgery must be performed irrespective of the severity of the AI.

Stress-Induced Cardiomyopathy in Cancer Patients

Takotsubo syndrome, also known as stress-induced cardiomyopathy (SC), is underrecognized in cancer patients. This study aims to investigate the incidence, natural history, and triggers of SC in cancer patients and its impact on cancer therapy and overall survival. A total of 30 subjects fulfilled the diagnostic criteria for SC at MD Anderson Cancer Center over a 6-year period. Clinical presentation, electrocardiogram, laboratory data, and transthoracic echocardiogram results registered during the acute phase and follow-up were collected. All patients underwent coronary angiography. The most frequent presenting symptoms were chest pain in 63.3% of the patients and shortness of breath/dyspnea on exertion in 27% of the patients. T-wave inversion was a more common electrocardiographic presentation (60%) than ST elevation (13.3%). The median and interquartile range of peak creatine kinase MB fraction, troponin I, and brain natriuretic peptide were creatine kinase MB fraction 8.9, 4.6 to 21.1; troponin I 1.31, 0.7 to 3.3; and brain natriuretic peptide 1,124, 453.5 to 2,369.5. The most common complication of SC was cardiogenic shock requiring inotropic agents (20%). Of the 21 patients who required ongoing cancer treatment, 16 were able to resume chemotherapy, 5 underwent surgery, and 4 received radiation treatment. Median time to resume cancer treatment was 20 days after SC. None of the patients experienced recurrence of SC and other cardiac events. In conclusion, SC should be considered in the differential diagnosis of cancer patients who present with chest pain and ECG findings characteristic of acute coronary syndrome. Most of these patients normalize ejection fraction and may resume cancer therapy early.

SURVEILLANCE OF HOSPITAL ACQUIRED INFECTIONS IN A MEDICAL INTENSIVE CARE UNIT

Introduction: Hospitalized patients are at risk to develop sepsis from infections due to colonized intravenous lines, surgical wounds, and/or bedsores. Multidrug resistant Acinetobacter commonly colonizes patients in the intensive care unit (ICU) and can cause serious infections. The APACHE II severity score has shown a good calibration and discriminatory value across a wide range of disease processes, and remains the most commonly used international severity scoring system worldwide. Aim of work: to evaluate the patients having different types of hospital-acquired infections in the medical ICU, especially infections caused by multidrug resistant organisms (as Acinetobacter spp.), in a specific period of time, applying the APACHE II scoring system of severity. Materials and methods: The study included 148 patients from the medical ICU in Cairo University Hospital. Routine laboratory investigations were done together with chest X-rays, ECG, abdominal ultrasound and bacterial cultures,and APACHE II scores were calculated for all patients. Results: We found that the mostcommon cause of death in ICU patients in our study was sepsis (48% of all deaths). Most frequently reported isolated organisms were Klebsiella spp. (24.4%), E-coli (21.8%), and Acinetobacter spp. (17.1%). There was a meaningful association between observed mortality rates in patients in ICU and their APACHE II score evaluation, so APACHEII score had a strong positive correlation with actual mortality rate. Conclusion: Sepsis was the cause of high mortality rates in medical ICU, and the most important step in the prevention and control of infection in the ICU is continuous application of effective infection control measures.

ACUTE CORONARY SYNDROME;

Introduction: Atherosclerosis is intrinsically an inflammatory disease. Numerousstudies has shown that elevated levels of C-reactive protein (CRP) are associated with increasedcardiovascular risk. The objectives of this study was to determine the correlation of clinicaloutcome in terms of 30 day mortality with various level of C-reactive proteins among patientspresenting with acute coronary syndrome Study Design: Descriptive. Setting: Department ofCardiology, Punjab Institute of Cardiology Lahore. Period: 06 months. Material and Methods:Total 250 patients presented in emergency department and diagnosed as cases of acutecoronary syndrome base on history of chest pain, ECG and cardiac biochemical markers wereincluded in the study. Management of ACS was continued while CRP levels of each patientwere measured by latest Agglutination method. Results: Our study included 250 patients withacute coronary syndrome with a mean age of 52.90±10.34 years. Male patients were 220(88%). Regarding the clinical presentation of patients, 20 (8%) had unstable angina, 95(38%)had NSTEMI and 135 (54%) had STEMI.CRP level were measured, 184(73.6%) patients hadCRP levels < 22mg/L with mortality of 12 (6.5%) at 30 days and 66 (26.4%) patients hadCRP levels >22mg/L with mortality of which 13(19.6%) at 30 days. The mean CRP level was17.9±12.47, 18.08±15.73 and 22.38 + 17.92 for patients with unstable angina, NSTEMI andSTEMI respectively. The stratification of data for effect modifiers showed that 60(24%) patientshad diabetes, 138 (55.2%) patients had hypertension and 65(26%) patients were smokers.Conclusion: Patients having higher CRP levels had higher risk of 30 day mortality.

Activation of Inflammatory and Pro-Thrombotic Pathways in Acute Stress Cardiomyopathy.

Stress cardiomyopathy (SCM) is a unique cardiac disorder that more often occurs in women. SCM presents in a similar fashion as acute myocardial infarction (AMI), with chest pain, ECG changes, and congestive heart failure. The primary distinguishing feature is the absence of thrombotic coronary occlusion in SCM. How this reduction in cardiac function occurs in the absence of coronary occlusion remains unknown. Therefore, we tested the hypothesis that a targeted proteomic comparison of patients with acute SCM and AMI might identify relevant mechanistic differences. Blood was drawn in normal controls (n = 6), women with AMI (n = 12), or women with acute SCM (n = 15). Two-week follow-up samples were available in AMI (n = 4) and SCM patients (n = 11). Relative concentrations of 1,310 serum proteins were measured in each of the 48 samples using the SOMAscan assay. Women with AMI had greater myocyte necrosis, as reflected by a higher peak troponin I concentration (AMI 32.03 ± 29.46 vs. SCM 2.68 ± 2.6 ng/ml, p < 0.05). AMI and SCM patients had equivalent reductions in left ventricular ejection fraction [LVEF (%) 39 ± 12 vs. 37 ± 12, p = 0.479]. In follow-up, women with SCM had a greater improvement in cardiac function [LVEF (%) 60 ± 7 vs. 45 ± 13, p < 0.001]. No differentially expressed proteins were detected (absolute log2-fold change >1; q < 0.05) between AMI and SCM in the acute or recovery phase. However, when we compared normal controls to patients with AMI, there was differential expression of 35 proteins. When we compared normal controls to patients with SCM, 45 proteins were differentially expressed. In comparison to normal controls, biological processes such as complement, coagulation, and inflammation were activated in both AMI and SCM. There were four proteins that showed a non-significant trend to be increased in acute SCM vs. AMI (netrin-1, follistatin-like 3, kallikrein 7, kynureninase). Despite a lesser degree of myocardial necrosis than AMI, SCM is characterized by a similar activation of inflammatory, complement, and coagulation pathways. These findings may explain reported thromboembolic complications in the short term and elevated risk of mortality in the long term of SCM.

English

Introduction: Atherosclerosis is intrinsically an inflammatory disease. Numerousstudies has shown that elevated levels of C-reactive protein (CRP) are associated with increasedcardiovascular risk. The objectives of this study was to determine the correlation of clinicaloutcome in terms of 30 day mortality with various level of C-reactive proteins among patientspresenting with acute coronary syndrome Study Design: Descriptive. Setting: Department ofCardiology, Punjab Institute of Cardiology Lahore. Period: 06 months. Material and Methods:Total 250 patients presented in emergency department and diagnosed as cases of acutecoronary syndrome base on history of chest pain, ECG and cardiac biochemical markers wereincluded in the study. Management of ACS was continued while CRP levels of each patientwere measured by latest Agglutination method. Results: Our study included 250 patients withacute coronary syndrome with a mean age of 52.90±10.34 years. Male patients were 220(88%). Regarding the clinical presentation of patients, 20 (8%) had unstable angina, 95(38%)had NSTEMI and 135 (54%) had STEMI.CRP level were measured, 184(73.6%) patients hadCRP levels &lt; 22mg/L with mortality of 12 (6.5%) at 30 days and 66 (26.4%) patients hadCRP levels &gt;22mg/L with mortality of which 13(19.6%) at 30 days. The mean CRP level was17.9±12.47, 18.08±15.73 and 22.38 + 17.92 for patients with unstable angina, NSTEMI andSTEMI respectively. The stratification of data for effect modifiers showed that 60(24%) patientshad diabetes, 138 (55.2%) patients had hypertension and 65(26%) patients were smokers.Conclusion: Patients having higher CRP levels had higher risk of 30 day mortality.

Clinical Application of Grace Risk Score in Patients with Acute Coronary Syndrome

Objectives: To determine clinical application of GRACE risk score in patients with acute coronary syndrome (ACS).Patients and Methods: It was an observational analytical study conducted in the Cardiology ward of Mayo hospital, Lahore from April to July 2015. Patients with Acute STEMI, NSTEMI or Unstable angina (UA) were selected on the basis of typical chest pain, ECG changes or cardiac biomarkers .For all eligible cases, at presentation GRS was calculated using online calculator. Also, GRACE risk categories and predicted in-hospital mortality were determined. Patients with previous episodes of STEMI/ NSTEMI, old Left Bundle Branch Block (LBBB), stable angina pectoris, acute pericarditis, myocarditis, acute rheumatic fever or pulmonary embolism were excluded. Data was analyzed on SPSS 20 and the R project for statistical computing. Individual components of GRS were compared among discharged and expired cases using t-test. A p-value of &lt;0.05 was considered significant.Results: A total of 165 patients with STEMI and ACS were included. The mean GRS among males andfemales was 137.4 ± 39 and 151.5 ± 50.6. The observed in-hospital mortality was 12.12% with 60% patients of STEMI. Among expired cases, 90% patients had high GRS, predominantly from STEMI group. Important determinants of adverse outcome were advanced age, tachycardia, low systolic blood pressure and presence of cardiac failure.Conclusion: STEMI was the major acute cardiac event. The mean GRS of expired patients was significantly higher than discharged group. GRS accurately identified low risk cases with low probability of in-hospital death. GRS over estimate probability of in-hospital death among STEMI high risk cases that had higher scores and discharged uneventfully. Grace Risk Score is a reliable predictor of risk category and adverse outcomes and its use by clinicians should be strongly recommended.

104 A service review and comparison of resource?utilisation with the change in recommendations from nice 2010 cg95 to the nice 2016update (chest pain of recent onset: assessment and diagnosis)

BackgroundNICE 2010 guidelines (CG95) proposed investigation according to pre-test likelihood (PTL) of coronary artery disease (CAD) in patients presenting with stable chest pain; low risk patients are referred for CT...

Evaluation of cardiac murmurs in 8647 children at primary school-age children in the Province of Malatya, Eastern Turkiye

We assessed prospectively the prevalence 01 pathologic and Innocent murmurs in childhood, to determine the efficacy of clinical evaluation, to compare the results of physical examinations performed by pediatricians and pediatric cardiologists and echocardiographic evaluations, and to contribute to the determination of the limits of echocardiography indications in children with murmurs. A number of 8647 children, aged 6.5-15 years, 4092 females, 4455 males in ten different primary schools belonging to different socioeconomic levels in Malatya, Eastern Turkey. Those children with a murmur were evaluated by a pediatric cardiologist. Chest X-ray, electrocardiography, and echocardlography were obtained in all subjects having a murmur. The results of physical examinations performed by the pediatricians and the pediatric cardiologist were compared, and the final diagnoses were reached by evaluation of chest X-ray, ECG and chocardiography. The incidence of Innocent murmurs was found to be 3.4% and that of pathological murmurs 0.54% In the population eximaned. The statistical comparison of the results revealed that pediatricians have a tendency toward Innocent murmurs in the interpretation of murmurs (p&lt;0.05). There was not a statistically significant difference between the results of physical examinations of the pediatric cardiologist and the results of echocardlographic examination. Pediatricians can diagnose pathologic cases with a sensitivity of 63.8% whereas pediatric cardiologist could diagnose those cases with a sensitivity of 95.7% and specificity of 99.7%. Our findings support the policy that children with a cardiac murmur should be referred to a pediatric cardiologist, in order to verify clinical diagnosis.

Abstract 12825: Feasibility of Amplitude Spectrum Area Estimation in Ventilation Pauses During Cardiopulmonary Resuscitation

Introduction: Amplitude spectral area (AMSA) calculated from ventricular fibrillation (VF) waveform not only predicts defibrillation outcome, but may also reflect effectiveness of chest compressions. However, reliable VF waveform analysis usually requires rescuers to stop compressions. In the present study, we investigated whether AMSA could be accurately estimated in ventilation pauses during cardiopulmonary resuscitation (CPR). Methods: A total of 40 out-of-hospital cardiac arrest patients with VF as the initial rhythm were included in this study. All patients received resuscitation with a 30:2 compressions to ventilation ratio. ECG data and chest compression waveforms before first defibrillation were extracted. Each episode included at least one full resuscitation cycle consisting of 30 compressions followed by a ventilation pause, further compressions, and a pre-shock pause with artifact-free VF signal. AMSA was continuously calculated using a sliding window of 2 seconds duration with sliding step size of 1 sampling point. Ventilation pauses were identified by the chest compression waveforms. Mean AMSA value during chest compression (AMSA_c) and minimal AMSA value during ventilation pause (AMSA_p) were compared with the AMSA value measured in noise-free VF (AMSA_nf) during the pre-shock pause. Results: Twenty patients received mechanical CPR and other 20 patients received manual chest compressions. The ventilation pause was 3.19±0.62 sec for mechanical CPR and 5.96±2.06 for manual CPR. AMSA_c was significantly higher than AMSA_p (32.4±30.0 mVHz vs. 6.6±3.9 mVHz, p &lt;0.01) and AMSA_nf (32.4±30.0 mVHz vs. 6.0±3.5 mVHz, p &lt;0.01). As shown in Figure 1, AMSA_nf was strongly correlated with AMSA_p (r=0.90, p &lt;0.01) but not with AMSA_c (r=0.50, p =0.11). Conclusions: AMSA could be reliably determined in ventilation pauses during CPR but not during chest compressions.

Tako-Tsubo cardiomyopathy after cardiopulmonary resuscitation during emergency Cesarean section in a 28 year old patient in the 31st week of pregnancy

Objective: Tako-Tsubo Cardiomyopathy is an extremely rare, reversible cardiomyopathy. The signs and symptoms can mimic myocardial infarction, including chest pressure, dyspnea, ECG abnormalities, and elevated cardiac enzymes. Although Tako-Tsubo primarily affects postmenopausal women ages 60 – 70, rare cases in younger patients have been described. A 28 year old patient in the 31st week of pregnancy presented with fetal bradycardia on admission. An emergency Cesarean section was performed. We describe a case of Tako-Tsubo Cardiomyopathy following intraoperative cardiopulmonary resuscitation (CPR).

Multiple Intervention in Single Setting: Report on Cases over One Year

Background: Association of various types of congenital lesions in a single patient is a very common finding in congenital heart disease cases. Many such lesions are amenable to nonsurgical interventions in single setting. Such interventions along with surgical intervention are also possible in hybrid laboratories. Here we are reporting on our experience of twelve cases of multiple interventions in the year 2015.Methods: This is a retrospective review of double or multiple interventions done on cases from January 2015 to December 2015 In Lab aid cardiac hospital and Combined Military Hospital Dhaka. Type of Congenital lesions were identified from chest x-ray, ECG, and colour Doppler Echocardiography and combination of interventions were planned accordingly.Results: Out of twelve cases, 66.66% were male and 33.34% were female. Majority of cases (50%) were in 4-8 years age group. Most common type of disease combination was Atrial Septal Defect (ASD) with Patient Ductus Arteriosus (PDA). Association of Ventricular Septal Defect (VSD) with PDA was found in 16.67% cases, combination of PDA with coarctation of aorta was found in 16.67% cases and combination of ASD and VSD was found in 16.67% cases. Combination of ASD, VSD, PDA was also found with aortic and pulmonary stenosis in some cases. Outcome of multiple interventions in all the cases were good.Conclusion: Existence of multiple simple congenital heart lesions is a commonly encountered problem in Pediatric cardiac Practice. Multiple Interventions can be done on these lesions safely. Multiple interventions can be done on complex cases also for life saving purpose. One years experience of multiple intervention reported in this study showed excellent outcome.Cardiovasc. j. 2016; 9(1): 36-42

Towards 24/7 continuous heart rate monitoring.

Heart rate (HR) and HR variability (HRV) carry rich information about physical activity, mental and physical load, physiological status, and health of an individual. When combined with activity monitoring and personalized physiological modelling, HR/HRV monitoring may be used for monitoring of complex behaviors and impact of behaviors and external factors on the current physiological status of an individual. Optical HR monitoring (OHR) from wrist provides a comfortable and unobtrusive method for HR/HRV monitoring and is better adhered by users than traditional ECG electrodes or chest straps. However, OHR power consumption is significantly higher than that for ECG based methods due to the measurement principle based on optical illumination of the tissue. We developed an algorithmic approach to reduce power consumption of the OHR in 24/7 HR trending. We use continuous activity monitoring and a fast converging frequency domain algorithm to derive a reliable HR estimate in 7.1s (during outdoor sports, in average) to 10.0s (during daily life). The method allows >80% reduction in power consumption in 24/7 OHR monitoring when average HR monitoring is targeted, without significant reduction in tracking accuracy.

Assessment of myocardial enhancement during coronary CT angiography in critically ill patients

There are still challenges and unmet needs for the imaging techniques, such as conditions of uncertain origin in patients with clinically serious, life-threatening conditions with unknown cause that are not associated with dominant chest pain, ECG changes or other symptoms indicating a possible primarily cardiac or coronary cause. The contribution of the myocardial enhancement evaluation of urgent cardiac CTA scans significantly improves to determining the diagnosis of acute myocardial injury and choosing appropriate treatment. When incorporating the myocardial enhancement assessment into the imaging algorithm of an emergency department, emphasis is placed on a uniform imaging procedure and a uniform evaluation approach. The color coded images of the myocardial enhancement in emergency situations helps identify the most serious pathologies and shorten the time to adequate targeted therapy in patients.

The value of YKL-40 in ischemic heart disease patients

Atherosclerotic coronary artery disease is considered to be the most common cause of myocardial ischemia. YKL-40, a chitin-binding acute phase glycoprotein, has been found to be expressed by macrophages in atherosclerotic plaques. The YKL-40 could potentially be a new useful biomarker to monitor severity and predict early diagnosis of acute coronary syndrome (ACS) in ischemic heart disease (IHD) patients. The aim of this study was to measure the level of serum YKL-40 in IHD patients and to clarify its role as a potentially beneficial diagnostic marker in those patients. Serum YKL-40 was measured in 60 IHD patients and 30 healthy controls. According to chest pain analysis, ECG changes, and cardiac enzymes, the IHD patients were categorized into patients with stable angina and patients with ACS. The median level of YKL-40 (pg/ml) was significantly elevated in patients with IHD compared with the control group (2080 (575.5–5974.6) vs 522.6 (133.2–769.5), respectively; P<0.001). The median level of YKL-40 was also significantly higher in patients with ACS compared with patients with stable angina (2436 (576–5975) vs 1015 (675–1822), respectively; P<0.001). There was a positive correlation between YKL-40 levels and high-sensitivity C-reactive protein (mg/dl) in all studied groups of IHD patients. However, no significant correlation was detected between YKL-40 and age, systolic or diastolic blood pressure, and lipid profile in patients with IHD. YKL-40 might play an important role as a diagnostic and prognostic marker in patients with IHD and in patients with ACS.