CK-MB Values Research Articles

Effectiveness of laboratory tests in tracking severely COVID-19 infections

AIM: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a virus that causes COVID-19 (Coronavirus Disease 2019), and poses serious difficulties in terms of healthcare systems and global public health. With the large number of publications on COVID-19, clinicians need a synthesis of evidence to provide guidance when dealing with patients with COVID-19. Emerging studies reveal the existence of numerous demographic, clinical, immunological, biochemical and radiographic data that may be useful for clinicians to predict the severity and mortality of COVID-19. The aim is of this study; To determine laboratory parameters that can predict the course and severity of COVID-19 disease in patients with diagnosed solely SARS-CoV 2 PCR test positivity results and independently of the clinic status of selected patients and based on laboratory findings. MATERIALS AND METHODS: This study is a retrospective cross-sectional study conducted at Karacabey State Hospital between January and April 2022. Among the patients who applied to the COVID-19 outpatient clinic, 469 patients (261 females, 208 males) over the age of 18 and positive for SARS-CoV-2 RT-PCR were included in the study. The patients were divided into groups as outpatients, inpatients and patients in need of intensive care (intensive care unit, ICU). Demographic data (age, gender), COVID-19 RT-PCR results, and simultaneous laboratory parameters of the patients were scanned retrospectively. RESULTS: When CRP, urea, ferritin, LEU, NEU, MONO, RBC, HGB, HCT, MCV, NLR, PLR, CRP-NR, and SII index values were taken into consideration, a statistically significant difference was found between the groups. Creatinine, ALT, AST, LDH, troponin I, mass CK-MB, D dimer, LYM, EOS, PLT, ELR, and PNR values were not significantly different between the groups. CONCLUSIONS: Advantages of this study; Comparing the changes in the patient's other laboratory findings based on a single positive PCR test result and finding meaningful rates in terms of serious covid risk. The disadvantage of this study is that it is a study independent of the patient's clinic and disease stage. CRP, urea, ferritin, and indexes such as NLR, PLR, CRP-NR, and SII index values can be used to predict the severity of the disease.

Mitigating Doxorubicin-Induced Cardiotoxicity through Quercetin Intervention: An Experimental Study in Rats.

Doxorubicin (DOX) is an effective anticancer drug, but its use is limited by dose-dependent heart toxicity. Quercetin is a natural antioxidant frequently studied for its beneficial properties. Moreover, a wide range of dietary supplements are available for human use. This in vivo study aimed to explore the potential cardioprotective effects of quercetin in chronic DOX treatment. A total of 32 Wistar rats were randomly divided into four groups: control, DOX, DOX/Q-50, and DOX/Q-100, treated with saline, 2.5 mg/kg body-weight DOX, 2.5 mg/kg body-weight DOX + 50 mg quercetin, and 2.5 mg/kg body-weight DOX + 100 mg quercetin, respectively, for two weeks. Rats were monitored using cardiac ultrasound (US) and markers for cardiac injury. Oxidative damage and ultrastructural changes in the heart were investigated. Chronic DOX treatment led to a decline in cardiac function and elevated values of NT pro-BNP, troponin I, and CK-MB. Quercetin treatment slightly improved certain US parameters, and normalized serum NT pro-BNP levels. Furthermore, DOX-induced SOD1 depletion with consequent Nrf2 activation and DNA damage as shown by an increase in γH2AX and 8HOdG. Quercetin treatment alleviated these alterations. Oral administration of quercetin alleviated serum markers associated with DOX-induced cardiotoxicity. Furthermore, it exhibited a favorable impact on the cardiac US parameters. This suggests that quercetin may have potential cardioprotective properties.

Successful percutaneous coronary intervention in a congenital single right coronary artery with acute myocardial infarction: A case report and literature review.

Single coronary artery (SCA) is a rare coronary artery malformation. SCA combined with atherosclerotic plaques can cause severe and widespread myocardial ischemia and infarction, leading to hemodynamic instability and even sudden death. A 48-year-old Chinese man was admitted for treatment of persistent chest tightness and panic for 5 hours. The patient was a lorry driver with high work intensity and mental stress, with body mass index of 33.78, history of smoking and alcohol consumption, but no history of hypertension and diabetes. Admission examination showed Troponin was 183.083 µg/L and CK-MB value was >300 µg/L. The patient was diagnosed with a congenital single right coronary artery (RCA) with acute myocardial infarction (AMI) by coronary angiography (CAG). Due to atherosclerotic plaques rupture, a complete occlusion of the proximal RCA with thrombolysis in myocardial infarction grade 0 of distal blood flow were found. The patient was treated with thrombus aspiration and thrombolytic therapy by percutaneous coronary intervention under the support of intra-aortic balloon pump. Postoperative the chest tightness and panic were relieved, and CAG revealed that the proximal thrombus of the RCA was reduced, and distal blood flow was restored to thrombolysis in myocardial infarction grade 3. After 2 weeks of intensive antithrombotic and lipid-regulating drug therapy, the patient was successfully discharged. Follow-up for 6 months, the patient was able to live and work normally without experiencing chest tightness and chest pain. Computed tomography angiography (CTA) confirmed a congenital single RCA with patent lumen and no severe stenosis. The congenital single RCA is very rare, and it is fatal in conjunction with acute coronary syndrome. Early detection and appropriate treatment is critical for AMI patient with single RCA. CAG is the gold standard for diagnosis of single RCA, and CTA is a necessary to describe the anatomical course of abnormal coronary arteries.

Safety and myocardio-necrosis laboratory data trend in patients undergoing atrial fibrillation catheter ablation: pulsed field ablation vs. radiofrequency ablation

Abstract Background Pulsed Field Ablation (PFA) is an innovative technology to perform atrial fibrillation (AF) catheter ablation. No form of thermal energy is used, but an irreversible electroporation mechanism that causes selective cardiomyocytes death, sparing the cells of adjacent tissues. There are few data in the literature about peri-procedural trend of myocardium-necrosis laboratory data in patients undergoing PFA versus those with radiofrequency (RF). Purpose Compare the short-term safety and the peri-procedural trend of myocardium-necrosis laboratory data in patients undergoing PFA with those undergoing standard-power (40W) RF catheter ablation. Methods 50 patients undergoing paroxysmal AF catheter ablation with pulmonary veins isolation were retrospectively enrolled, 25 treated with PFA and 25 with RF (matched for age, sex, BMI, left atrium size). The PFA protocol involved four two-second deliveries with the penta-spline catheter in the "basket" and in the "flower" configuration; about RF ablation, circular lesions were carried out at the antrum of each pulmonary vein. All patients underwent serial blood samples including troponin I (TnI, n.v. 0-50 ng/L) and CKMB (n.v 0-5 ng/mL) at time 0 and at 3, 24 and 48 post-procedure hours. Complication were evaluated at pre-discharge visit and at 3-month follow-up. Results The clinical and echocardiographic patient’s characteristics are summarized in Table 1. The TnI and CKMB baseline values were within normal range for all patients, both those treated with PFA and those treated with RF, and there were no statistically significant differences between the two group. Regarding the TnI and CKMB values temporal increase, a statistically significant increase was observed in patients treated with PFA (Table 2). The TnI percentage decrease over the 48 hours in RF-treated patients, although not statistically significant, is slower compared to patients treated with PFA. This data could be explained by considering that PFA causes acute damage (myocardiocytes necrosis by electroporation) with less inflammation and a less progressive nature, while RF causes damage with greater irritation and progression (coagulative necrosis) that may result in myocardial necrosis even in the subsequent hours. Despite evidence of greater myocardial necrosis, there were not procedural complications in those treated with PFA. Therefore, the TnI increase is indicative of selective myocardial damage, likely more antral. Conclusion The increase of myocardio-necrosis laboratory data appears to be higher using PFA compared to RF, and it is not associated with greater adverse events. The trend of the myocardio-necrosis laboratory data shows different reduction curves between PFA and RF, probably related to different ablation power source; these data will need to be re-analysed with a greater number of cases.Table 1Table 2

Clinical characteristics and risk factors in patients with SARS-CoV-2 Omicron variant infection complicated with cardiovascular diseases.

To investigate the clinical characteristics and risk factors of patients with SARS-CoV-2 Omicron variant infection complicated with cardiovascular diseases. A retrospective analysis of general clinical data was conducted on patients with SARS-CoV-2 omicron infection complicated with hypertension, coronary heart disease, and heart failure admitted to one hospital in Guangdong Province from December 1, 2022, to February 28, 2023. Clinical symptoms, laboratory tests, imaging examinations, treatment, and clinical outcomes were collected. Multivariate logistic regression analysis was used to analyze the risk factors for mortality in patients with SARS-CoV-2 Omicron variant infection complicated with cardiovascular diseases. ROC curves were drawn to evaluate the predictive value of CRP, D-dimer, and CK-MB in predicting the risk of death. A total of 364 confirmed cases were included, divided into the asymptomatic group, mild to moderate group, and severe to critically ill group based on the symptoms of COVID-19. There were 216 males (59.34%) and 148 females (40.66%), with a median age of 75 years. The differences between the three groups in terms of sex and age were statistically significant (p < 0.05). The top three underlying diseases were hypertension (288 cases, 79.12%), coronary heart disease (100 cases, 27.47%), and diabetes (84 cases, 23.08%). The differences in unvaccinated and triple-vaccinated patients among the three groups were statistically significant (p < 0.05). The common respiratory symptoms were cough in 237 cases (65.11%) and sputum production in 199 cases (54.67%). In terms of laboratory tests, there were statistically significant differences in neutrophils, lymphocytes, red blood cells, C-reactive protein, D-dimer, aspartate aminotransferase, and creatinine among the three groups (p < 0.05). In imaging examinations, there were statistically significant differences among the three groups in terms of unilateral pulmonary inflammation, bilateral pulmonary inflammation, and bilateral pleural effusion (p < 0.05). There were statistically significant differences among the three groups in terms of antibiotic treatment, steroid treatment, oxygen therapy, nasal cannula oxygen inhalation therapy, non-invasive ventilation, and tracheal intubation ventilation (p < 0.05). Regarding clinical outcomes, there were statistically significant differences among the three groups in terms of mortality (p < 0.05). Multivariate logistic regression analysis showed that CRP (OR = 1.012, 95% CI = 1.004-1.019) and D-dimer (OR = 1.117, 95% CI = 1.021-1.224) were independent risk factors for patient mortality. The predictive value of CRP, D-dimer, and CK-MB for the risk of death was assessed. D-dimer had the highest sensitivity (95.8%) in predicting patient mortality risk, while CRP had the highest specificity (84.4%). For patients with COVID-19 and concomitant cardiovascular diseases without contraindications, early administration of COVID-19 vaccines and booster shots can effectively reduce the mortality rate of severe cases. Monitoring biomarkers such as CRP, D-dimer, and CK-MB and promptly providing appropriate care can help mitigate the risk of mortality in patients.

Two cases of cancer patients with CK-MB value higher than total CK

Two cases of cancer patients with CK-MB value higher than total CK

Diagnostic value of the creatine kinase-MB/creatine kinase and neutrophil/lymphocyte ratios in acute myocardial infarction

ObjectiveTo investigate the clinical significance of the creatine kinase (CK)-MB/total CK ratio, neutrophil/lymphocyte ratio (NLR) and red blood cell distribution width in acute myocardial infarction (AMI).MethodsA retrospective analysis was conducted of 196 AMI cases from our hospital’s cardiology department; healthy people were selected over the same period as the control. The two groups’ test indexes were compared through multivariate logistic regression analysis to screen for AMI risk factors; the receiver operating characteristic (ROC) curve was used to evaluate their AMI predictive values.ResultsThe serum CK, CK-MB, CK index, neutrophils and NLR values in the AMI group were significantly higher compared with those in the control group (p < 0.05); however, the levels of serum lymphocytes were significantly lower compared with those in the control group (p < 0.05). Multivariate logistic regression analysis showed that elevated CK-MB and NLR levels were risk factors for AMI (p < 0.05). The ROC curve showed that the area under the curve of the NLR and CK levels were 0.917 and 0.594, respectively.ConclusionThe CK index and NLR have a clinical predicting value for AMI and could be used as a clinical auxiliary diagnostic index for the assessment of patients with AMI.

Influence of cardiac biomarkers on predicting significant coronary artery disease in hypertrophic cardiomyopathy patients.

In this study, our aim was to investigate the role of cardiac biomarkers in predicting the presence of significant coronary artery disease in hypertrophic cardiomyopathy (HCM) patients. The study population was composed of hypertrophic cardiomyopathy patients who underwent coronary angiography at a single center between June 2021 and March 2023, and whose cardiac biomarkers were evaluated before the procedure. HCM patients were screened retrospectively. Significant CAD was defined as > 50% stenosis of the left main coronary artery or > 70% stenosis in a major coronary vessel. Demographic, echocardiographic and cardiac biomarker values were compared between the two groups. A total of 123 patients were evaluated. Significant CAD was detected in 39 (31.7%) patients. Patients with significant CAD had higher CK-MB values than those without CAD [2.8 (2.1-4.0) vs. 3.4 (2.8-4.6), p = 0.036], and a higher level of high-sensitivity troponin T (hs-TnT) than those without CAD (24 vs. 17.8, p = 0.022). the NT-proBNP/hs-TnT ratio was found to be significantly lower in patients with CAD than in those with CAD (31.4 vs. 21.4, p = 0.019). In multivariate anaylsis, NT-proBNP/hs-TnT was determined as an independent predictor for significant CAD. In ROC analysis, NT-proBNP/hs-TnT ratio lower than the cut-off value of 30.7 could detect the presence of significant CAD with 76.9% sensitivity and 53.6% specificity (AUC: 0.632, 95% CI: 0.528-0.736, p = 0.019). To sum up, we suggest that cardiac biomarkers were valuable and simple parameters in terms of significant CAD in HCM patients.

The Prognostic Value of Creatine Kinase-MB Dynamics after Primary Angioplasty in ST-Elevation Myocardial Infarctions.

In STEMIs, the evaluation of the relationship between biomarkers of myocardial injury and patients' prognoses has not been completely explored. Increased levels of CK-MB in patients with a STEMI undergoing primary angioplasty are known to be associated with higher mortality rates, yet the correlation of these values with short-term evolution remains unknown. The research encompassed a sample of 80 patients diagnosed with STEMIs, and its methodology entailed a retrospective analysis of the data collected during their hospital stays. The study population was then categorized into three distinct analysis groups based on the occurrence or absence of acute complications and fatalities. The findings indicated that there is a notable correlation between rising levels of CK-MB upon admission and peak CK-MB levels with a reduction in left ventricular ejection fraction. Moreover, the CK-MB variation established a point of reference for anticipating complications at 388 U/L, and a cut-off value for predicting death at 354 U/L. CK-MB values are reliable indicators of the progress of patients with STEMIs. Furthermore, the difference between the peak and admission CK-MB levels demonstrates a high accuracy of predicting complications and has a significant predictive power to estimate mortality risk.

Abnormal release of cardiac biomarkers in the presence of myocardial oedema evaluated by cardiac magnetic resonance after uncomplicated revascularization procedures.

To analyse the association of myocardial oedema (ME), observed as high T2 signal intensity (HT2) in cardiac magnetic resonance imaging, with the release of cardiac biomarkers, ventricular ejection, and clinical outcomes after revascularization. Patients with stable coronary artery disease with the indication for revascularization were included. Biomarker levels [troponin I (cTnI) and creatine kinase MB (CK-MB)] and T2-weighted and late gadolinium enhancement (LGE) images were obtained before and after the percutaneous or surgical revascularization procedures. The association of HT2 with the levels of biomarkers, with and without LGE, evolution of left ventricular ejection fraction (LVEF), and 5-year clinical outcomes were assessed. A total of 196 patients were divided into 2 groups: Group 1 (HT2, 40) and Group 2 (no HT2, 156). Both peak cTnI (8.9 and 1.6 ng/mL) and peak CK-MB values (44.7 and 12.1 ng/mL) were significantly higher in Group 1. Based on the presence of new LGE, patients were stratified into Groups A (no HT2/LGE, 149), B (HT2, 9), C (LGE, 7), and D (both HT2/LGE, 31). The peak cTnI and CK-MB values were 1.5 and 12.0, 5.4 and 44.7, 5.0 and 18.3, and 9.8 and 42.8 ng/mL in Groups A, B, C, and D, respectively, and were significantly different. The average LVEF decreased by 4.4% in Group 1 and increased by 2.2% in Group 2 (P = 0.057). ME after revascularization procedures was associated with increased release of cardiac necrosis biomarkers, and a trend towards a difference in LVEF, indicating a role of ME in cardiac injury after interventions.

Correlation between novel echocardiographic indices and biomarkers of myocardial injury in patients with NSTEMI

Abstract Funding Acknowledgements Type of funding sources: None. Introduction / Purpose The extent of myocardial injury is a prognostic factor in patients with myocardial infarction presenting without persistent ST elevation (NSTEMI). The purpose of this study was the assessment of possible correlation between novel echocardiographic indices and biomarkers of myocardial injury in patients with NSTEMI and normal left ventricular ejection fraction (LVEF). Methods Patients with NSTEMI (18 to 80 years old) who were examined at the echocardiography laboratory of our general hospital, from May 2021 until August 2022, were enrolled in this study. All patients had no former history of cardiac disease or other significant comorbidities, and they all had LVEF ≥55% and normal wall motion score index. After coronography all of them were diagnosed with significant coronary artery disease. Among the novel echocardiographic indices, global longitudinal strain (GLS), and the parameters of myocardial work, global work index (GWI), global constructive work (GCW), global wasted work (GWW) και global work efficiency (GWE) were examined. The biomarkers were maximum high sensitive troponin I (hsTNI) during hospitalization, creatine phosphokinase (CPK) and its myocardial isoenzyme (CK-MB). Correlation between the variables was examined with Spearman method, and a p value &amp;lt;0.05 was considered statistically significant. Results In this study 34 patients with NSTEMI (26 males), of mean age 60.1 years (SD 10.5 years) participated. Median |GLS| was 17.9%, GWI 1957.7mmHg%, GCW 2231.0mmHg%, GWW 141.7mmHg% and GWE 92.2% (Table 1). As for the biomarkers, median maximum hsTNI value was 1718.0ng/l, CPK 172.0U/l and CK-MB 31.0U/l. A negative correlation was shown between hsTNI and GWE (Spearman’s rs =−0.515, p = 0.002), and a positive between hsTNI and GWW (Spearman’s rs =−0.426, p = 0.013). Also, CK-MB values had a negative correlation with |GLS| (Spearman’s rs =−0.411, p = 0.017) and GWE (Spearman’s rs =−0.425, p = 0.014). No correlation was found between CPK and the echocardiographic indices. Conclusion Novel echocardiographic indices were correlated with biomarkers of myocardial injury in patients presenting with NSTEMI and normal LVEF.

The use of high-sensitivity cardiac troponin T and creatinine kinase-MB as a prognostic markers in patients with acute myocardial infarction and chronic kidney disease

Background High-sensitivity cardiac troponin T (hs-cTnT) and creatine kinase (CK)-MB are the most commonly used biomarkers for the diagnosis and prognosis of acute myocardial infarction (AMI). Chronic kidney disease (CKD) often leads to elevated hs-cTnT levels in non-AMI patients. However, studies comparing the prognostic value of both hs-cTnT and CK-MB in patients with AMI and CKD are lacking. Methods We conducted a retrospective study on AMI patients diagnosed between January 2015 and October 2020. Patients were categorized based on renal function as normal or CKD. Peak hs-cTnT and CK-MB levels during hospitalization were collected, and their diagnostic value was evaluated using receiver operating characteristic (ROC) curves. The impact on in-hospital mortality was analyzed using multivariate logistic regression. The relationship between the hs-cTnT/CK-MB ratio and in-hospital death was examined using a restricted cubic spline (RCS) curve. Results The study included 5022 AMI patients, of whom 797 (15.9%) had CKD. The AUCs of Hs-cTnT and CK-MB were higher in the CKD group [0.842 (95% CI: 0.789–0.894) and 0.821 (95% CI: 0.760–0.882)] than in the normal renal function group [0.695 (95% CI: 0.604-0.790) and 0.708 (95% CI: 0.624-0.793)]. After full adjustment for all risk factors, hs-cTnT (OR, 2.82; 95% CI, 1.03–9.86; p = 0.038) and CK-MB (OR, 4.91; 95% CI, 1.54–14.68; p = 0.007) above the cutoff values were independent predictors of in-hospital mortality in patients with CKD. However, in patients with normal renal function, only CK-MB above the cutoff (OR, 2.45; 95% CI, 1.02–8.24; p = 0.046) was a predictor of in-hospital mortality, whereas hs-cTnT was not. There was an inverted V-shaped relationship between the hs-cTnT/CK-MB ratio and in-hospital mortality, with an inflection point of 19.61. The ratio within the second quartile (9.63-19.6) was an independent predictor of in-hospital mortality in patients with CKD (OR 5.3, 95% CI 1.66–16.86, p = 0.005). Conclusions Hs-cTnT independently predicted in-hospital mortality in AMI patients with CKD, whereas its predictive value was not observed in patients with normal renal function. CK-MB was an independent predictor of in-hospital mortality regardless of renal function. Moreover, the hs-cTnT/CK-MB ratio may aid in risk stratification of AMI patients with CKD.

Spectrum of Biochemical Derangements in Patients with Covid-19 Infection

Objectives: To evaluate the biochemical derangements in COVID-19 patients according to disease severity. Place and Duration of Study: This Cross-Sectional Study was conducted at Chemical Pathology Department of Armed Forces Institute of Pathology, Rawalpindi from March to August 2021. Methodology: A total of 996 patients of age between 20 to 75 years admitted at Pak Emirates Military Hospital Rawalpindi with COVID-19 were selected and further categorized into mild, moderate, and severe groups. Serum samples were collected and analyzed for various biochemical parameters. A mean comparison of the results of these biochemical markers amongst three groups was carried out by applying a one-way analysis of variance (ANOVA), p value = 0.05 was statistically significant. Results: The values of total bilirubin, ALT, AST, CK, CK MB, troponin I, LDH, urea, creatinine, CRP, PCT, and ferritin increased with the severity of the disease. Whereas the values of albumin and total protein decreased with the severity of the disease. The difference in these parameters amongst all three groups was found to be statistically significant with p value &lt;0.05. However, the values of GGT, total cholesterol, and TG were found non-significant amongst all three groups (p value&gt;0.05). Conclusion: Derangement of biochemical parameters increased proportionately with the severity of the disease. Hence these markers can provide significant assistance to categorize patients into different severity groups as well as monitoring and prognosis of the disease. In this way, earlier and more accurate medical interventions can be provided to patients for a better outcome from this pandemic.

Analysis and correlation of small dense low-density lipoprotein-cholesterol (sdLDL-C) with various lipoproteins and cardiac markers in acute coronary syndrome patients associated with normal Low-density lipoprotein-cholesterol (LDL-C) level: A cross sectional study.

Title of the article: Analysis and correlation of small dense low-density lipoprotein-cholesterol (sdLDL-C) with various lipoproteins and cardiac markers in acute coronary syndrome patients associated with normal Low-density lipoprotein-cholesterol (LDL-C) level: A cross-sectional study. Aim: To analyze the levels of sdLDL cholesterol in acute coronary syndrome patients (ACS) with normal LDL cholesterol (LDL-C) and correlate with various lipoproteins and cardiac markers. Methodology: The present study included 100 patients diagnosed with ACS with normal LDL-C. Demographic details and cardiac markers were correlated with sdLDL levels. A detailed history was elicited from the patients and the details of clinical examination and laboratory findings such as cardiac Troponin, C- reactive protein, and CK-MB were obtained from patient case files. Results: The results are expressed in mean±sd. The mean age of study participants was 39.5±10.5yrs. The majority of the participants were men (69%) between the age group of 31-40 years. Mean values of total cholesterol, VLDL, sdLDL, Trop-I, CRP, and CKMB are at higher levels in men when compared to women. Whereas, mean values of triglycerides, LDL, and HDL are higher in women when compared to men. The majority of participants were having unstable angina (42%) followed by STEMI (33%) and NSTEMI (25%). Correlation between sdLDL and other parameters was carried out using Mann–Whitney–Wilcoxon test. The result showed a statistically significant correlation between sdLDL and VLDL, Trop-I, and CRP with p &lt;0.05. Patients with sdLDL of &gt; 25mg/dl had a higher incidence of unstable angina and STEMI. Conclusion: Our study result suggests that ACS with normolipidemic patients has a positive correlation with sdLDL levels and sdLDL can be a new diagnostic marker along with cardiac troponins in ACS.

Effect of geographical factors on reference values of creatine kinase isoenzyme.

The aim of this study was to investigate the geographical spatial distribution of creatine kinase isoenzyme (CK-MB) in order to provide a scientific basis for clinical examination. The reference values of CK-MB of 8697 healthy adults in 137 cities in China were collected by reading a large number of literates. Moran index was used to determine the spatial relationship, and 24 factors were selected, which belonged to terrain, climate, and soil indexes. Correlation analysis was conducted between CK-MB and geographical factors to determine significance, and 9 significance factors were extracted. Based on R language to evaluate the degree of multicollinearity of the model, CK-MB Ridge model, Lasso model, and PCA model were established, through calculating the relative error to choose the best model PCA, testing the normality of the predicted values, and choosing the disjunctive kriging interpolation to make the geographical distribution. The results show that CK-MB reference values of healthy adults were generally correlated with latitude, annual sunshine duration, annual mean relative humidity, annual precipitation amount, and annual range of air temperature and significantly correlated with annual mean air temperature, topsoil gravel content, topsoil cation exchange capacity in clay, and topsoil cation exchange capacity in silt. The geospatial distribution map shows that on the whole, it is higher in the north and lower in the south, and gradually increases from the southeast coastal area to the northwest inland area. If the geographical factors are obtained in a location, the CK-MB model can be used to predict the CK-MB of healthy adults in the region, which provides a reference for us to consider regional differences in clinical diagnosis.

Protective Effect of Nicorandil on Contrast-Induced Acute Kidney Injury After Emergency Percutaneous Coronary Intervention.

Objective: To investigate the protective effect of nicorandil on contrast-induced acute kidney injury (CIAKI) in patients with acute ST-segment elevation myocardial infarction (STEMI) after emergency percutaneous coronary intervention (PCI). Methods: This is a single-center, retrospective control study. A total of 156 patients with STEMI were divided into the nicorandil group (n = 55) and the control group (n = 101). The incidence of CIAKI, defined as an increase of >25% or absolute values > 44.2 μmol/L in serum creatinine (Scr) from baseline within 72 h of exposure to a contrast agent after exclusion of other causes, was the primary endpoint. The secondary endpoints were: (1) changes of Scr, estimated glomerular filtration rate (eGFR), uric acid, and β2-microglobulin at 24/48/72 h and 5 to 7 days after PCI; (2) the peak value difference of creatine kinase isoenzymes (CK-MB) after PCI; (3) adverse events within 6 months after PCI. Results: The overall incidence of CIAKI was 21.8%; the incidence of CIAKI in the nicorandil group was significantly lower (12.7% [7/55]) than in the control group (26.7% [27/101]) (P = .043). Compared with the control group, Scr, uric acid, and β2-microglobulin levels were lower, and the level of eGFR was higher in nicorandil group (P all < .05). The peak value of CK-MB in the nicorandil group was lower than that in the control group (105.30 [56.61, 232.04] vs 178.00 [77.08, 271.91]U/L, P = .042). There was no significant difference in adverse events between the 2 groups within 6 months after PCI. Moreover, multivariate logistic regression analysis showed that hypertension and diabetes were independent risk factors for CIAKI, while nicorandil treatment was a protective factor. Conclusion: Our data suggest that intravenous nicorandil after emergency PCI has a protective effect on the occurrence of CIAKI in STEMI patients.

43 CARDIAC TROPONINS AND COVID-19: WHAT DO WE KNOW ABOUT HETEROPHILIC ANTIBODIES?

Abstract Background During the Coronavirus disease-19 (COVID-19) pandemic, a significant increase in cardiovascular events and death for acute Myocardial Infarction (AMI) has been widely described. In turn, cardiac troponins represent the main serum diagnostic biomarkers of AMI. However, several mechanisms of troponins elevation other than AMI could be identified such as the analytic interference due to the Heterophilic Antibodies (HA), which represents a less explored and underestimated cause. Methods The research of the following keywords “Heterophilic” or “Heterophile Antibodies” associated with “Troponin”, “Troponin I”, “Troponin T” or “High-sensitive Troponin” have identified 73 works in the most popular bibliographic databases such as PubMed, Scopus, and Web of Science, in which the first was published in 1998. In our systematic review, the inclusion criteria have considered all the works in which clinical information about the patients are described. The results have included 55 papers for an overall population of 128 cases that have presented HA's interference in troponins’ assay. In the great part of the works, HA's capture test has been performed to diagnose this interference. The association between HA and COVID-19 has also been explored with the identification of three works in scientific literature. In addition, we reported a clinical case of a young patient with persistent high serum ultra-sensitive Troponin levels due to HA, during the COVID-19 pandemic. Results The results have indicated the most at-risk population in patients with a history of multiple hospitalizations and with poor cardiovascular risk factors, who usually complained of atypical chest pain combined with persistent elevation of cardiac troponins without high CK-MB values. Instead, only a few data could be isolated in the literature about HA's interference on troponins essay in COVID-19 patients. However, has been widely ascertained how increased serum levels of cardiac troponins have been identified in most of the SARS-COV-2 swabs positive populations, and several cardiac and extracardiac mechanisms may explain this condition. Conclusions The description of the most common clinical features of patients with HA's interference could help clinicians to early recognize this phenomenon, reducing the number of instrumental examinations and the hospitalization period of these patients. Therefore, the analytical mistake due to HA could be always considered in AMI differential diagnosis, and the use of HA's capture test in the at-risk population may determine an early diagnosis. Finally, the HA's phenomenon could increase during the COVID-19 period, considering how infections and vaccinations may stimulate heterophile's activity.

Evaluation of Biochemical Parameters among Diabetes Patients and Healthy Participants in a Nigerian Tertiary Hospital

Background: Diabetes mellitus (DM) burden is one of the key concerns in developing countries like Nigeria. This study aimed to evaluate the biochemical parameters among diabetes patients and healthy persons in Abuja, Nigeria. Methodology: The study was a cross-sectional prospective study that included 60 DM patients (case) and 48 healthy individuals (control) aged 19 to 80 years from April 1 and June 30, 2018. Five ml of venous fasting blood samples were obtained under aseptic precautions and biochemical parameters were evaluated: fasting blood glucose (FBS) and liver enzymes were determined using Bio systems; A 25 fully automated biochemistry analyzer while hemoglobin A lc (HbAlc) was estimated by High-performance liquid chromatography (HPLC) method. Data analysis was performed using IBM SPSS version 25 and a value of P &lt;0.05 was taken as statistically significant. Results: Mean FBS, HBA1c, AST, ALT, and LDH were significantly higher in DM than control (P&lt;0.05). Mean values of FBS and HBA1c in DM were 9.00mg/d1 and 5.99% respectively while liver enzymes; ALT and AST and ALP were 25.77U/L, 28.87U/L, and 214.35U/L respectively. The mean values of cardiac enzymes; LDH and CK-MB normal were 438.87U/L and 75.47U/L respectively. The mean values of HBAlc, AST, ALT, ALP, LDH and CK-MB were higher than normal range in 48.3%, 16.0%, 15.0%, 23.3%, 26.6%, and 36.6% DM respectively. Conclusion: Thus these liver enzymes can be used as a biomarker for the assessment of diabetes. With a thorough study about the level of liver enzymes, it is possible to monitor complications of diabetes.

A retrospective study on the clinical picture of COVID-19 patients associated with type 2 diabetes mellitus in India

Background: The clinical characterization of COVID varies from mild to severe. In the initial phases of the disease, symptoms like fever, cough, and dyspnea can occur. The severity and outcome of COVID vary with preexisting conditions, particularly type 2 diabetes mellitus (T2DM). Objective of current study was to assess the clinical presentation and laboratory derangements of COVID-19 patients associated with T2DM.Methods: The present retrospective study was started after the approval of the Institutional Ethics Committee. Various clinical (Sp02, final diagnosis, co-morbidity, and outcome) and biochemical parameters (CBC, LFT, RFT, LDH, Trop I, CK-MB D-dimer, CRP, ferritin levels, RBS, HbA1c) of Covid-19 patients were collected from Central Laboratory and &amp; Medical Record Department of our institution. Patient names were anonymized and data were analyzed. The results are expressed in percentages.Results: A total of 24 COVID-19 patients (with T2DM) details were collected from the medical record department and central laboratory. Out of 24 patients, 16 (66.6%) were male, and the remaining 08 (33.3%) were female. Out of 24, 05 patients had mild covid, 02 were moderate and the remaining 17 suffered from severe COVID. The mean values of oxygen saturation, LDH, D-dimer, Troponin-I, CRP, Ferritin, Procalcitonin, and CK-MB were 76%, 797.3 U/l, 1614.2 ng/ml, 6.93 ng/ml, 72.6 mg/dl, 521.2 µg/l, 2.33 µg/l and 40.59 ng/ml respectively. The average random blood sugar level and glycosylated hemoglobin were 308.8 mg/dl and HbA1c 10.22%. Mean values of 42.5 mg/dl and 1.54 mg/dl were recorded for blood urea and S. creatinine. Regarding liver function test, mean values of 0.87 mg/dl, 0.37 mg/dl, 0.49mg/dl, 344.8U/l, 115.6U/l,108U/l respectively noted for total bilirubin, direct, indirect, SGOT, SGPT and ALP. Regarding patient outcome, 09 (37.5%) patients recovered and 15 (62.5%) died due to COVID. The values of glycosylated Hb and random blood sugar among the 15 patients who died due to covid infection suggested uncontrolled diabetes Mellitus in 7 of them with associated hypertension and died due to septic shock. Conclusions: Though the laboratory mean values of the liver function test and renal function test shows moderate variations the mean values of CRP, LDH, Procalcitonin, and Ferritin which are the acute inflammatory markers are highly disrupted when compared to normal ranges.

A Retrospective Review of Cardiac Events Pre-RT and Post-RT in a Lung Cancer Population

<h3>Purpose/Objective(s)</h3> The aim of this retrospective review is to evaluate whether an increased mean heart dose (MHD) leads to more cardiac events by reviewing critical Troponin and CKMB values before and after radiation treatment. <h3>Materials/Methods</h3> Additional information was collected from patients in a lung cancer database treated from 2007-2020. They were separated into 4 groups based on elevated troponin and CKMB values. Troponin of ≥0.03 ng/mL and CKMB ≥6.0 ng/mL were quantified as a cardiac event. Additionally, Framingham scores were calculated to standardize patient risk among groups. MHD was compared and an ANOVA analysis was performed to determine relationships between groups. <h3>Results</h3> Among 528 patients, 353 did not have an event pre-RT or post-RT, 49 had an event pre-RT, 94 had an event post-RT, and 32 had an event pre-RT and post-RT. The average MHD in each group were 12.75 Gy, 10.84 Gy, 14.47 Gy, 12.28 Gy, respectively. The average Framingham scores in each group were 12.1, 14.0, 13.8, 14.4, respectively. For t-tests comparing for MHD pre-RT vs post-RT, for those who had a pre-RT event and those with no pre-RT event, the difference was significant (p=0.031) with an average MHD difference of 3.63 Gy. When comparing cardiac event risks among groups, Framingham scores were all significant (p <0.001). <h3>Conclusion</h3> Increased MHD was associated with higher incidence of post-RT events with similar Framingham Scores of patients' groups. This represented the first in a series of retrospective analyses on this population to dive deeper in the type and cause of such events. LAD contours will be extracted to see if there are other correlations along with characterizations of the cardiac events as well as time to event.