Creatine Phosphokinase Myocardial Band Research Articles

Better cardioprotection in atrial septal defect patients treated with cardiopulmonary bypass beating heart technique without the application of aortic cross clamp

Background and objectives: Creatine phosphokinase-myocardial band fraction (CPK-MB) and cardiac troponin I (cTnI) are cardiac specific biochemical markers which are raised in myocardial ischemia. The aim of this study was to determine cardiac injury by comparing the levels of cardiac enzymes CPK-MB and cTnI in atrial septal defect (ASD) patients whose operative repair was done under cardiopulmonary bypass (CPB) using beating heart technique with and without the application of aortic cross clamp. Materials and Methods: This study was carried out in the Department of Cardiothoracic and Vascular Surgery in a Tertiary Care Hospital over a period of 2 years. A total of 60 atrial septal defect (ASD) patients were operated and repair of the defect was done under the CPB using beating heart technique. Aortic cross clamp was applied in 22 patients (Group-A) while 38 patients were operated without cross clamp (Group-B) during the procedure. Blood samples were collected 24 hours prior and 12 hours post procedure for the estimation of CPK MB and cTnI levels. Results: Mean age of the atrial septal defect patients was 23.83±10.97 years and 60% and 40% of the patients were females and children (age < 18 years) respectively. Serum CPK-MB and cTnI l levels were in the normal range in all the patients before surgery and increased significantly post procedure. Twelve hours after surgery, the mean CPK-MB and cTnI levels were significantly low in Group-B patients compared to Group-A patients (CPK-MB: 56.39±23.55 U/L vs. 34.38±15.97U/L , p= 0.0004; cTnI: 9.37±4.97 ng/ml vs. 5.92±4.17ng/ml, p = 0.009). Conclusion: Post surgery CPK-MB and cTnI levels were significantly higher in ASD patients who underwent CPB surgery with aortic cross clamp compared to those in whom aortic cross clamp was not applied. Therefore, application of aortic cross clamp during the procedure induces greater levels of ischemic injury to the heart. IMC J Med Sci. 2023; 17(1): 001. DOI: https://doi.org/10.55010/imcjms.17.001 *Correspondence: Feroze Mohammad Ganai, Department of CVTS, Superspeciality Hospital, Shireen Bagh, Srinagar, Jammu and Kashmir, India. Email address: ferose999@yahoo.com

Early cardiovascular involvement in dengue fever: A prospective study with two-dimensional speckle tracking echocardiography

Cardiac abnormalities in dengue infection have been conventionally identified by clinical manifestations. The primary objective of our prospective observational study was to assess true cardiovascular involvement and early myocarditis in 150 hospitalised, confirmed cases of dengue fever, through myocardial strain detection using two-dimensional speckle tracking echocardiography. Myocarditis was defined on the basis of European Society of Cardiology (ESC) 2013 criteria. Cardiac biomarkers, namely, creatine phosphokinase myocardial band was elevated in 28.6% and Troponin-T in 23.3% patients. Electrocardiography was abnormal in 64.6% while 6% patients had two-dimensional structural echocardiographic abnormalities. Myocardial dysfunction was suspected in 27.3% based on ESC criteria and strain analysis. The severe dengue group had lower longitudinal strain [-16.4 (6.3)] and circumferential strain [-15.7 (6.7)]. Two-dimensional speckle tracking echocardiography was found to be useful in improving the understanding of early myocardial mechanics in dengue fever.

Correlation of Vitamin D levels with markers of bone metabolism in COVID-19 patients

Introduction: Low serum Vitamin D levels are common in orthopedic patients in India. Low serum Vitamin D levels are implicated in COVID-19 worsening the illness. With this background, we assessed serum Vitamin D levels in COVID-19 patients presenting to us and correlated them with other markers of bone metabolism and systemic immune response. Materials and Methods: A cross-sectional analytical study was done on 107 COVID-19 patients. The sample was taken for serum calcium, serum Vitamin D, serum phosphate, bone-specific alkaline phosphatase (ALP), serum parathyroid hormone, creatine phosphokinase (CPK), CPK myocardial band (MB), serum protein, C-reactive protein, erythrocyte sedimentation rate, and hemoglobin in these patients. The levels were correlated with each other to assess their relations in COVID-19 patients. Results: One hundred out of 107 patients had low serum Vitamin D levels. In these patients, serum lactate dehydrogenase and serum ALP levels were high, and creatine kinase MB levels were low. The illness was found more in diabetic/hypertensive and rheumatoid arthritis patients. The values and findings correlate with increased disease activity and osteopenia with no obvious muscular injury. Conclusion: Managing Vitamin D deficiency (VDD) has been taken up as a major step in COVID-19 affection. The markers of bone metabolism and their correlation with serum Vitamin D were equivocal in COVID-19-affected and not affected Indian populations. The risk of infection has been more in diabetic, hypertensive, and rheumatoid arthritis patients, all of whom were also suffering from VDD.

Cilnidipine and magnesium sulfate supplement ameliorates hyperglycemia, dyslipidemia and inhibits oxidative-stress in fructose-induced diabetic rats

The study was designed to evaluate the safety and efficacy of cilnidipine (CLN) and Mg-supplementation in fructose-induced diabetic rats. Diabetes was induced into male Wister rats by feeding fructose (10% solution) in drinking water for 8 weeks. Diabetic rats were subjected for the oral administration of CLN1 (1 mg/kg/day) and CLN10 (10 mg/kg/day), and/or methyl cellulose (0.5%) as vehicle for 28 days. After 14 days of CLN treatment, MgSO4 (1%) was added to CLN1 and CLN10 groups for another 14 days. Age-matched healthy rats were used as normal control. After 28 days body weights were measured and organ weight to body ratio was calculated. Serum samples were analysed for fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), uric acid, lipid profiles, tri-iodothyronine (T3) and thyroid stimulating hormone (TSH), serum glutamic pyruvic transaminase (SGPT), serum glutamic oxaloacetic transaminase (SGOT), creatine phosphokinase myocardial-band (CK-MB), creatinine, albumin, electrolytes. Oral glucose tolerance tests (OGTT), liver histopathology and in-vivo antioxidant activities were also performed. The survival rate in diabetic rats was 100% after the oral administration of CLN, Mg-supplement and/or vehicle. A significant reduction in FBS levels and improvement in OGTT were observed in CLN10, CLN1+Mg and CLN10 + Mg groups after 28 days. Further, the treatment ameliorated serum lipid profile, uric acid, and albumin levels. The groups CLN10 and CLN10 + Mg improved HbA1c, liver glycogen, creatinine, T3, TSH levels and electrolytes in diabetic rats. Moreover, liver from CLN10 and CLN10 + Mg groups showed preservation of cellular architecture as evidenced by attenuation of inflammatory markers SGPT, SGOT and CK-MB; and the levels of superoxide dismutase (SOD), catalase (CAT), glutathione, malondialdehyde (MDA), markers of oxidative stress were significantly improved. CLN exerted prominent effects in the amelioration of hyperglycemia, dyslipidemia and reduced hepatic inflammation; and Mg-supplementation might have some beneficial effects on diabetic complications and oxidative stress in fructose-induced diabetic rats.

Prior angina reduces ıschemic mitral regurgitation in patients with ST-Elevation myocardial ınfarction, role of ıschemic preconditioning.

Mitral regurgitationmay develop due to left ventricular (LV) remodeling within 3months following acute myocardial infarction (AMI) and is called ischemic mitral regurgitation (IMR).Ischemic preconditioning (IPC) has been reported as the most important mechanism of the association between prior angina and the favorable outcome. The aim of this study was to investigate the effect of prior angina on the development and severity of IMR at 3rdmonth in patients with ST elevation MI (STEMI). Fourty five (45) patients admitted with STEMI and at least mild IMR, revascularized by PCI were enrolled. According topresence of prior angina within 72h before STEMI, patients were then divided into two groups as angina (+) (n:26; 58%) and angina (-) (n:19; 42%). All patients underwent 2D transthoracic echocardiography at1st, 3rddays and 3rdmonth. IMR was evaluated byproximal isovelocity surface area (PISA) method: PISA radius (PISA-r), effective regurgitant orifice area (EROA), regurgitant volume (Rvol). LV ejection fraction (EF %) was calculated by Simpson's method. High sensitive troponin T (hs-TnT), creatine phosphokinase myocardial band (CK-MB) and N-terminal pro-brain natriuretic peptid (NTpro-BNP) levels were compared between two groups. Although PISA-r, EROA and Rvol were similar in both groups at 1stand 3rddays, all were significantly decreased (p = 0.012, p = 0.007, p = 0.011, respectively) and EF was significantly increased (p< 0.001) in angina (+) group at 3rdmonth. NTpro-BNP and hs-TnT levels at 1stday and 3rdmonth were similar, however CK-MB level at 3rdmonth was found to be significantly lower in the angina (+) group (p = 0.034). At the end of the 3rdmonth, it was observed that the severity of IMR evaluated by PISA method was decreased and EF increased significantly in patients who defined angina within 72h prior to STEMI, suggesting a relation withIPC.

Clinical, haematological and blood biochemical parameters in Arabian one-humped camels (Camelus dromedarius) with Babesia caballi infection

This study was conducted to diagnose Babesia caballi in one-humped camels in Nineveh governorate, Iraq, using microscopic examination and conventional polymerase chain reaction (PCR) and to evaluate the clinical, haematological and blood biochemical parameters in camels. A total of 62 camels from local breeds, 2-7 years old from both sexes, reared in Nineveh Governorate, were naturally infected with B. caballi and 12 clinically healthy camels were used as controls based on clinical and laboratory examination. Babesia caballi was diagnosed as pear-shaped organisms, existing mainly in pairs within the erythrocytes in blood smears stained by Giemsa, with mean parasitaemia rate 8.59±0.13%. Blood smears stained by acridine orange and conventional PCR confirmed B. caballi diagnosis. Infected camels were found to be suffering from partial or total loss of appetite, emaciation, pale mucous membranes, irregular heart beats, rough hair coat, digestive disturbances, haemoglobinuria and presence of ticks on various body parts. There was considerably elevated body temperature, respiratory and heart rates among infected camels in comparison with control groups. Haematological examinations indicated a statistically significant (P&lt;0.05) decrease in red blood cell counts, haemoglobin and haematocrit with macrocytic hypochromic anaemia. Additionally, leukocytosis due to significant (P&lt;0.05) rise in total leukocyte count and lymphocytes in infected camels in comparison with controls besides a significant (P&lt;0.05) decrease in platelet count and fibrinogen were demonstrated. On the other hand, the mean platelet volume, platelet distribution width, clotting time, prothrombin time and activated partial thromboplastin time were significantly (P&lt;0.05) elevated in infected camels vs control. Biochemical analysis revealed significant (P&lt;0.05) rise in troponin I, creatine phosphokinase myocardial band and lactate dehydrogenase in infected camels compared to healthy animals. This study concluded that B. caballi infected camels might be endemic in Nineveh governorate, Iraq. Babesia caballi in camels causes clinical, haematological, and blood biochemical changes.

Normothermic regional cerebro-myocardial perfusion in newborns undergoing aortic arch repair

Introduction Regardin the data of Andropoulos et al. perfusion volume speed should be individually chosen based on deep oxymetria and transcranial dopplerography [1]. Luciani et al. showed advantages of cerebral and myocardial perfusion under moderate hypothermia in comparison to standard perfusion [2]. They showed that standard perfusion and low cerebro-myocardial flow are predictors of myocardial dysfunction. We eventually have come to a decision to abstain from cardioplegia and hypothermia that way, first, removing myocardial dysfunction risk factors; second, shortening perfusion time, and third, preserving brain flow self-regulation. Methods After obtaining the ethics committee approval we prospectively analyzed results of neonatal aortic arch reconstruction in our clinic since July 2015. In this period of time we performed 36 operations for hypoplastic aortic arch in newborn. All the procedures were performed in normothermic (above 34 C) antegrade regional cerebral perfusion and coronary perfusion. We used transcranial doppler, deep cerebral oximetry and ECG to assess perfusion efficacy. Results Mean age was 12.3 (6-23) days, weight – 3.2 (2.4-4.4) kg. Perfusion time was 70 (61.5;83.5) minutes, selective perfusion (antegrade regional cerebral and coronary) time was 28 (24;33.5) minutes. Perfusion flow was 118.5 (106;131.5) ml/kg/minute. Middle cerebral artery flow was 28 (22.5;33.25) cm/s on the right and 24 (18;27) cm/s on the left. ECG and deep cerebral oxygenation was stable through whole perfusion. Four (13.8%) patients required delayed sternal closure. In 6 hours after the operation vasoactive inotropic score was 10 (5;14.5), in 48 hours after the operation it was 5 (3;10). Lactate level was 3.2 (2.8;4.3) mmol/L in 6 hours after the procedure and 2.2 (1.85-3) mmol/L in 48 hours. Creatine phosphokinase (CPK) and creatine phosphokinase myocardial band (CPKMB) levels were 445.5 (302.75;632.5) U/L and 64 (51.25;96.5) U/L, respectively, in 6 hours and decreased to 126 (97;233) U/L and 50 (23;96) U/L in 48 hours after the operation. Troponin I level in 6 hours was 1.35 (0.95;1.5) ng/ml and in 48 hours – 0.62 (0.55;0.76) ng/ml. All patients regained consciousness in 24-48 hours after the operation with no neurologic deficiency. Mean ventilation time was 4.4 (1-11) days, mean ICU stay time was 5.9 (2-22) days. Hospital mortality was 2.8% (1 patient). Discussion Normothermic antegrade regional cerebral perfusion with coronary perfusion is a safe and decent technique in neonatal aortic arch reconstruction. It allows to avoid such detrimental risk factors as circulatory arrest, hypothermia, extensive perfusion and cardioplegia.

Azathioprine Hypersensitivity Syndrome in an Asian Woman

Azathioprine Hypersensitivity Syndrome in an Asian Woman

Coronary Sinus Filling Time as a Predictor of Coronary Microvascular Obstruction and Future Cardiovascular Events after Elective Left Anterior Descending Artery Stenting

Abstract Objective The main objective of this article is to study the usefulness of coronary sinus filling time (CSFT) as a predictor of coronary microvascular obstruction (CMVO) and future cardiovascular (CV) events after percutaneous coronary intervention (PCI) for left anterior descending (LAD) in stable coronary artery disease patients. Materials and Methods We analyzed 50 patients with stable angina who underwent elective PCI for single LAD significant stenosis. After stent deployment, coronary sinus was visualized in left anterior oblique 40 degree cranial 30 degree views, CSFT, and corrected thrombolysis in myocardial infarction frame count (cTFC) calculated from frame count. Post-procedure electrocardiographic changes noted and cardiac biomarker creatine phosphokinase and creatine phosphokinase-myocardial band levels estimated, and follow-up was done for 6 months. Patients classified into two groups: Group 1 with major adverse cardiac events (MACE) and Group 2 (without MACE). CSFT and cTFC measurements were compared among the two groups. Results Out of 50 patients who were recruited in the study, Group 1 comprises 20 patients, and Group 2 comprises 30 patients. Among the Group 1, 40% were females, while in Group 2, they were 16%. Group 1 showed high CSFT values compared to Group 2, and such are post-procedure ST, T changes (90% in Group 1, 20% in Group 2), cardiac biomarkers elevation (80% in Group 1, 23.3% in Group 2). At 6 months follow-up ejection fraction was lower in Group 1 (31.8 ± 6.4%) compared with Group 2 (58.8 ± 5.8%) at p &lt; 0.0001, and angina (85%) versus (20%). Mean CSFT was significantly more in Group 1 (5.77 ±0.75s) compared with Group 2 (4.61 ± 0.55s) at p &lt; 0.0001. With respect to cTFC, no significant differences were seen between the two groups (p &lt; 0.5628). Receiver operating characteristic curve analysis showed CSFT of &gt; 5.2s was the best cutoff value to differentiate the two groups. Conclusion CSFT significantly prolonged in patients with adverse cardiac events, and it may be used as a simple and quantitative predictor of CMVO and future CV events after elective PCI.

The Prognostic Value of CK-MB in Acute Myocardial Infarction in Developing Countries: A Descriptive Study

Background: Acute myocardial infarction is a common condition among developing countries with access-tocare issues. However, scarce information is available on the association between prognostic markers and patient outcomes in areas around the globe with scarcere sources. Aim: To evaluate the association between creatine phosphokinase myocardial band (CK-MB) and outcomes measured up to six months after the infarction. Methods: This is a longitudinal cohort study evaluating patients with a diagnosis of myocardial infarction up to six months after the ischemic event. Patients underwent catheterization up to 12 hours after the first symptoms. The primary predicting variable was CK-MB level, with outcome variables including re-infarction, death, and functional level status at 30 days and 6 months after infarction. Results: The average time of arrival was seven hours after the start of pain. When combining all adverse outcomes, 13.7% presented with either a myocardial re-infarction or death. When evaluating the association between serial CK-MB measurements and various outcomes of interest, there was usually no significant association with re-infarction, death or functional class at the 30-day and six-month follow-up evaluations. However, increased CK-MB measurements at admission, 18 and 72 hours continued to be significantly associated with increased length of hospital stay after adjusting for age and gender. CK-MB levels greater than 124 mg/dl after 18 hours after first symptoms were significant predictors of all combined adverse outcomes. Conclusion: CK-MB represents an alternative when it comes to prognostic predictors of combined outcomes including myocardial re-infarction, re-intervention or death.

Sleep deprivation-induced multi-organ injury: role of oxidative stress and inflammation.

Sleep deprivation affects all aspects of health. Adverse health effects by sleep deviation are still underestimated and undervalued in clinical practice and, to a much greater extent in monitoring human health. We hypothesized that sleep deprivation-induced mild organ injuries; oxidative stress and inflammation might play a crucial role in inducing multi-organ injury. Male C57BL/6J mice (n = 6-7) were sleep-deprived for 0-72 h using a modified multiple platform boxes method. Blood and tissue were collected. Liver, heart, kidney, lung, and pancreatic injuries were evaluated using biochemical and histological analyses. Glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), total billirubin (TBIL), creatine phosphokinase (CPK), creatine phosphokinase-myocardial band (CKMB), lactic dehydrogenase (LDH), creatinine (CRE), and blood urea nitrogen (BUN) were assayed in blood. Malondialdehyde (MDA), nitric oxide (NO), tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6 levels were measured. Histology revealed mild-to-moderate liver and lung injury in sleep-deprived mice. Sleep-deprived mice had significantly higher GOT, GPT, TBIL, CPK, CKMB, LDH, BUN, and α-amylase (AMYL) levels, which indicated liver, heart, kidney, and pancreatic injuries. Serum IL-1β at 24 h and IL-6 at 72 h were significantly higher in sleep-deprived than in control mice. Hepatic TNF-α and IL-1β were significantly higher, but IL-6 significantly lower in mice that had been sleep-deprived for 72 h. Sleep deprivation-mediated inflammation may be associated with mild to moderate multi-organ damage in mice. The implication of this study indicates sleep deprivation in humans may induce multi-organ injury that negatively affects cardiovascular and gastrointestinal health.

Acute Myocarditis Associated With Coxsackievirus B4 Mimicking Influenza Myocarditis

A previously healthy 40-year-old man was admitted to our hospital complaining of dyspnea at rest and flu-like symptoms. Influenza virus type A was detected in the mucus from his nasal cavity. Chest radiographs showed an infiltrative shadow in the right upper lung field, so influenza pneumonia was diagnosed. An ECG showed newly developed complete right bundle-branch block, and ST-T–segment elevation was observed in all leads except for III, aVR, and aVF (Figure 1A). Because the cardiac enzymes, creatine phosphokinase (1023 U/L; normal value <200 U/L) and creatine phosphokinase myocardial band (38 ng/mL; normal value <7.5 ng/mL), were elevated and the troponin T quick assay was positive, we performed a transthoracic echocardiogram. Left ventricular (LV) wall motion was reduced diffusely, and the LV …

The Potential Predictive Value of Preoperative Brain Natriuretic Peptide Levels in Coronary Artery Bypass Grafting Surgery

Aims: The aim of this study was to assess whether preoperative and postoperative brain natriuretic peptide (BNP) levels could be used as predictors of postoperative complications and outcome in patients with coronary artery dis- ease and ischemic heart failure undergoing on-pump or off-pump coronary artery bypass grafting surgery (CABG). Methods and Results: Fifty-eight patients (56 males and two females) with a median age of 65.3±9.9 years were included in the study. Thirty-eight patients (65.5%) underwent on-pump CABG, and 20 patients (34.5%) underwent off-pump CABG. BNP levels were determined within 24 hours before CABG and serially at 6 hours, 24 hours, 3, 7 and 30 days af- ter CABG. Creatine phosphokinase myocardial band (CK-MB) levels were measured 1, 3, and 7 days after CABG. BNP and CK-MB levels did not differ significantly between the two groups at any time point. Preoperative BNP levels inde- pendently predicted the occurrence of cardiogenic shock and more importantly, short-term mortality. Neither preoperative left ventricular ejection fraction nor postoperative BNP or CK-MB levels at any time point showed any significant inde- pendent prognostic value for any postoperative complication. Conclusion: Our results suggest that it may be prudent to more closely monitor patients with higher preoperative BNP levels for possible postoperative complications.

Role of p38 mitogen‐activated protein kinase pathway on heart failure in the infant rat after burn injury

We examined the hypothesis that post-burn activation of the p38 mitogen-activated protein kinase (MAPK) pathway is one aspect of the signalling cascade culminating in post-burn secretion of tumour necrosis factor (TNF)-alpha which contributes to post-burn myocardial apoptosis. Studies were designed to determine the time course of the induction of p38MAPK, TNF-alpha and myocardial apoptosis after burn injury. Our quantitative bacterial culture data demonstrated that viable bacteria reached the heart, and Western blotting data identified the increase in the phosphorylation of p38MAPK at an early time after burn. The peak incidence of myocardial apoptosis was also seen at an early time after burn. The expression of TNF-alpha mRNA, infiltrated neutrophils and serum creatine phosphokinase myocardial band data peaked at a late time after burn. FR167653, a specific inhibitor of p38MAPK, prevented the induction of myocardial apoptosis, TNF-alpha expression and myocardial injury after burn. Presumably, the bacterial LPS-induced activation of p38MAPK pathway occurring at an early time after burn induced the subsequent myocardial apoptosis. The p38MAPK-induced activation of pro-inflammatory cytokine appeared to promote the degenerative myocardial injury at a late time after burn. Our present data provided evidence for the hypothesis that the p38MAPK pathway controls both myocardial apoptosis and the pro-inflammatory mediator.

123I-MIBG imaging can be used to evaluate microvascular disturbance caused by embolization by microdebris after rotational atherectomy

During rotational atherectomy (RA), the coronary atherosclerotic plaque is largely pulverized into microdebris, which may cause serious hemodynamic instability owing to significant segmental left ventricular asynergy embolization of the distal microvasculature by atheromatous debris and associated vasospasm. To evaluate the usefulness of 123I-metaiodobenzylguanidine (123I-MIBG) in the examination of microvascular embolization after RA. Nineteen patients with stable effort angina pectoris who had undergone RA were evaluated in this study. Left ventricular ejection fraction (LVEF) was determined by left ventriculography immediately before and after RA. The serum concentration of creatine phosphokinase (CPK), creatine phosphokinase-myocardial band (CPK-MB) isozyme, and cardiac troponin-T was determined after RA. 99mTc-methoxyiso-butylisonitrile (99mTc-MIBI) and 123I-MIBG scintigraphic examinations were also performed 1 day after RA. The regional defect score (RDS) was determined from 99mTc-MIBI scintigraphic findings, while early and delayed RDS, heart-to-mediastinum count ratios (H/M ratios), and washout rate (WR) were determined from 123I-MIBG scintigraphy. After RA, the left ventriculographic LVEF mildly decreased by <10% in ten patients (group A), but it decreased by >10% in the remaining nine patients (group B). There were no differences in baseline clinical characteristics between the two groups. The CPK, CPK-MB isozyme, troponin-T, RDS by 99mTc-MIBI, H/M ratios, and WR after RA were similar in the two groups. However, the RDSs determined from early and delayed 123I-MIBG in group A were significantly lower than those in group B (4.5 +/- 3.8 vs. 13.4 +/- 10.8, P < 0.05; 9.0 +/- 6.3 vs. 17.7 +/- 10.0, P < 0.05, respectively). Moreover, there were significant correlations between delta LVEF and troponin-T (r = 0.54, P < 0.05) and RDSs of early and delayed 123I-MIBG (r = 0.46, P < 0.05; r = 0.64, P < 0.05, respectively). These findings suggest that 123I-MIBG imaging can be used to evaluate microvascular disturbance caused by embolization by microdebris after RA.

Parvovirus B19–Associated Active Myocarditis With Biventricular Thrombi Results of Endomyocardial Biopsy Investigations and Cardiac Magnetic Resonance Imaging

A previously healthy 39-year-old man was admitted to our department with biventricular cardiac decompensation (New York Heart Association class IV) and acute onset of angina pectoris after a flulike disease 1 week earlier. The ECG on admission displayed ST elevations in II, III, and aVF. Troponin T on admission was increased (2.20 mg/L, normal value<0.03 mg/L), with increased creatine phosphokinase (503 U/L; normal value<171 U/L) and creatine phosphokinase myocardial band (45 U/L; normal value=10 U/L). N-terminal pro-brain natriuretic peptide was highly elevated (15,848 pg/mL; normal value<125 pg/mL). Coronary artery disease was excluded by coronary angiography. Multiple nonsustained ventricular tachycardias were recorded by Holter monitoring and telemetry. Endomyocardial biopsies obtained from the right ventricular septum demonstrated active myocarditis by histological investigations according to the Dallas criteria (Figure 1A). By immunohistological staining of endomyocardial biopsies1 and quantification using digital image analysis, highly increased focal lymphocytic (CD3+: 267.4/mm2, CD11a/LFA-1+: 498.9/mm2; Figure 1B) and macrophage infiltrates (CD11b/Mac-1+: 481.6/mm2), sarcolemmal human leukocyte antigen class I expression (area fraction of human leukocyte antigen class I=35.6%; Figure 1C), and focal abundance …

Prevalence of myocardial ischemia during mechanical ventilation and weaning and its effects on weaning success

Myocardial ischemia may be considered both a consequence of weaning from ventilation and a potential cause of weaning failure. A limited number of investigations have evaluated myocardial ischemia during mechanical ventilation and weaning and its effect on weaning success. The purpose of this pilot investigation was to determine the prevalence of myocardial ischemia in a diverse group of medical intensive care unit (MICU) patients during baseline mechanical ventilation, during weaning using continuous positive airway pressure, and up to 24 hours after extubation and to evaluate the relationship between ischemia and weaning failure. This study was a prospective, repeated-measure, descriptive investigation that studied 43 ventilated MICU patients. Slightly more than half of participants were male (53%), and participants had a mean age of 51.1 +/- 14.6 years and were ventilated an average of 11.7 +/- 11.3 days. Myocardial ischemia was evaluated by examination of plasma cardiac troponin I, creatine phosphokinase-myocardial band (CK-MB), and ST-segment changes on electrocardiogram. Continuous electrocardiographic data were obtained by a calibrated, frequency-modulated, continuous 3-channel electrocardiographic recorder using leads I, II, and V2. Seventy percent of these participants (n = 30) exhibited ST-segment deviation at some point during data collection (baseline mechanical ventilation, during weaning, after extubation). Twenty-four participants exhibited ST-segment deviation at baseline, 7 during weaning, and 8 after extubation. Nine participants exhibited ST-segment deviation at >1 data collection time point. None had ST-segment deviation at all 3 time points. Cardiac enzyme concentrations were highly variable; five participants demonstrated clinically important increases in either CK-MB and/or troponin I. Thirty-five percent of participants required >1 weaning trial. Participants who exhibited ST-segment deviation during baseline ventilation were 60% more likely to fail their initial weaning trial. There were no significant differences in CK-MB or troponin I levels between those participants who were successfully weaned with 1 trial and those who failed to wean during that first trial. Silent myocardial ischemia was a common occurrence in this diverse group of MICU patients, although only 21% had previously diagnosed coronary disease. Clinicians must be aware of the potential for silent ischemia, monitor and evaluate their patients for such, and intervene to promote optimal cardiovascular function, particularly during the stress of ventilator weaning.

Cytokine and lipid mediator blood concentrations after coronary artery surgery.

This study investigates whether increased levels of cytokines and lipid mediators may be associated with complications after coronary artery bypass grafting (CABG) with extracorporeal circulation (ECC). Hemodynamic measurements and blood samples were obtained in 32 patients before and after the end of ECC and at the 6th and the 24th postoperative hours. Coagulation and pulmonary and cardiovascular functions were specifically assessed postoperatively at the same time. Patients with cardiovascular dysfunction had higher interleukin 8 (IL-8) levels. Higher platelet-activating factor (PAF) and decreased PAF acetylhydrolase activity (AHA, the enzyme that inactivates PAF) levels were found in patients with moderate cardiovascular dysfunction. Interleukin 6 (IL-6), IL-8, and AHA levels correlated with most hemodynamic parameters and creatine phosphokinase myocardial band levels obtained after surgery. Patients with severe lung injury had lower PAF, 6-keto prostaglandin (Pg)F1alpha, and PgE2 levels and higher thromboxane (Tx) B2 concentrations compared with patients without lung injury. Increased IL6 levels were only associated with moderate lung injury. Impaired hemostasis was associated with higher IL6 levels. AHA, IL-6, and IL-8 seem to be associated with cardiovascular dysfunction. The IL-6 blood levels and the ratio of TxB2/6 keto-PgF1alpha blood levels are increased during post-CABG lung injury. These results identify an association between specific post-CABG complications and the systemic inflammatory response. The clinical significance of this association remains to be evaluated. Patients with pulmonary, cardiovascular, or hemostasis dysfunction after cardiopulmonary bypass demonstrate aberrancies in a variety of cytokines and lipid mediators in arterial blood or plasma. The relationship between these findings and inflammatory response-induced complications remains to be determined.

Cardiac Contusion

In the past, myocardial contusions after blunt thoracic trauma have been frequently overlooked or missed unless hemodynamic instability or dramatic electrocardiographic findings were observed. We now know that this entity is more common than once believed. However, our understanding of cardiac contusions remains unclear and obscure because of the inability to diagnose the condition accurately. Chest roentgenograms, electrocardiograms, and radionuclide imaging have had less than optimal success. We believe that the serial determination of creatine phosphokinase-myocardial band isoenzymes and subsequent two-dimensional echocardiographic sector scanning are the most sensitive indicators of structural and functional cardiac injury presently available.