Diagnosis Of Acute Myocardial Infraction Research Articles

Inventor and innovator: cardiac troponin T.

When I started my research fellowship in 1978 in Edgar Haber’s Lab at the MGH in Boston, blood testing for acute myocardial infraction (AMI) commonly employed CK- and CKMB-activity measurements, which were neither sensitive nor specific for AMI nor very useful for risk prediction. Research in Edgar Haber’s Lab was focused on antibody diversity and the use of antibodies as diagnostic and therapeutic tools. In this thrilling environment, we hypothesized in 1979 that cardiac sarcomere proteins, due to their high intracellular mass and their expression as tissue specific isoforms, may improve diagnosis of AMI if detected in blood by highly sensitive assays. The advent of the hybridoma technology for production of monoclonal antibodies (first reported by Köhler and Milstein in Nature 1975) opened new avenues for the predictive engineering of immuno-assays according to the affinity and epitope specificity of selected antibody molecules. Using preselected monoclonal antibodies, we engineered in 1980 a novel assay format (double sandwich assay) and used this sandwich assay modality to measure cardiac myosin light chains.1 Using this cardiac myosin light chain assay, we were the first to show that sarcomere biomarker outperform CKMB in risk prediction of chest pain patients and detection of AMI.2

Cellulose acetate-MoS2 nanopetal hybrid: A highly sensitive and selective electrochemical aptasensor of Troponin I for the early diagnosis of Acute Myocardial Infarction

In this work, a novel aptamer-based CA-MoS2 hybrid biosensor was developed for diagnosis of Acute Myocardial Infraction (AMI). Specifically, a novel petal-like MoS2 nanoflower was used as the active material on the Screen-Printed Electrode (SPE) for AMI biomarker determination. The aptamer-based CA-MoS2–24 hybrid was able to attain a low limit of detection (LOD) and sensitivity to 10 fM at a linear range from 10 fM to 1 nM with good reproducibility based on an electrochemical impedance spectroscopy and a ~4 folds higher selectivity of troponin I compared to the signal from other biomolecules in human serum, retaining a 91% stability after 6 weeks. This novel CA-MoS2 aptamer-based biosensor with a 2.3% RSD value has the potential to revolutionize medical diagnosis by conducting multiple biomolecule detection on a single sensing platform.

THE VALUE OF HEART-FATTY ACID BINDING PROTEIN (H-FABP) IN THE EARLY DIAGNOSTIC OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Cardiac biomarkers play an important role in early diagnosis of Acute Myocardial Infraction (AMI). Conventional cardiac markers such as CK (creatine kinase) - MB isoform (CK-MB), cardiac specific troponin I appear in blood stream too late. Hence the search for a novel biomarker which its highly

P17 In-hospital mortality and clinical features of Japanese patients with acute myocardial infarction diagnosed by universal definition in real world from kanagawa-acute cardiovascular registry (K-ACTIVE)

Abstract Background Cardiac troponin (cTn) has been used as the preferred biomarker of myocardial injury for diagnosis of acute myocardial infraction (AMI) by universal definition. A large number of patients formerly classified by creatine kinase (CK) as unstable angina with the WHO criteria in Japan are now diagnosed by cTn as non-ST elevation myocardial infarction (NSTEMI). In this report, we aimed to understand its prevalence and clinical features of AMI diagnosed by using universal definition and the WHO criterial in real world. Method This registry is a cross-sectional study of 53 facilities in Kanagawa prefecture of Japan. 4372 AMI patients were enrolled who received primary percutaneous coronary intervention (PCI) between October 1, 2015 and January 29, 2019. Patients were divided into 3 groups, 3268 patients with ST elevation myocardial infarction (STEMI), 628 patients with NSTEMI patients who satisfied the WHO criteria with CK elevation beyond twice upper limit of normal (NSTEMI + CK), and 476 patients with NSTEMI who didn’t satisfy the WHO criteria without CK elevation (NSTEMI-CK). Result Baseline clinical characteristics of the study patients are shown in Table 1. In-hospital mortality was significantly lower in patients with NSTEMI-CK (1.9%) than in STEMI (6.0%, P < 0.001) and NSTEMI + CK (5.3%, P < 0.004) (Figure 1). Kaplan-Meier analyses for 0-30 days of cardiac death are shown in Figure 2. From day 0, the Kaplan-Meier curves began to diverge in favor of NSTEMI-CK for up to 30 days. Conclusion AMI patients showed distinct clinical features depends on the type. We should be aware of the difference for the diagnosis of AMI by using universal definitions. Table 1. STEMI (n = 3268) NSTEMI + CK (n = 628) NSTEMI-CK (n = 476) STEMI vs NSTEMI + CK P value STEMI vs NSTEMI-CK P value NSTEMI + CK vs NSTEMI-CK P value Age(years) 68(59-77) 69(61-78) 70(61-79) Male 76% 77% 75% 0.54 0.74 0.47 Concomitant diseases Hypertention 65.4% 70.5% 69.3% 0.013 0.097 0.65 Diabetes 33.5% 36.5% 37.3% 0.15 0.11 0.78 Dyslipidemia 56.1% 61.2% 61.3% 0.018 0.03 0.96 Hemodialysis 2.3% 2.1% 6.8% 0.86 <0.001 0.01 Smoking 66.3% 63.1% 64.6% 0.13 0.48 0.62 Atrial fibrillation 9.6% 10.7% 14.4% 0.57 0.04 0.23 Previous MI 8.3% 17.3% 15.7% <0.001 <0.001 0.47 In-hospital mortality 6.0% 5.3% 1.9% 0.49 <0.001 0.004 Abstract P17 Figure 1. 2.

The Development of a Multiparametric Immunochromatographic Test System for the Analysis of Cardiomarkers

Abstract—An immunochromatographic test system for the combined analysis of two cardiomarkers, such as fatty acid binding protein (FABP) and troponin I (TnI), in serum and whole blood is developed. The main stages of the design of a multiparametric system are investigated, including the influence of the antibody position and gold nanoparticle size on the results. The detection limits of the method are found to be 10 ng/mL for FABP and 1 ng/mL for TnI, and the coefficient of variation did not exceed 10%. The developed test system allows us to confirm the diagnosis of acute myocardial infraction (N = 9). The analysis time is 15 min.

Direct immunomagnetic detection of low abundance cardiac biomarker by aptamer DNA nanocomplex

An early and rapid diagnosis of acute myocardial infraction (MI) by serum biomarker quantification is vital for boosting up treatment efficacy and survival rate; however, it still remains challenging due to ultralow biomarkers content and the emergent nature of the disease. In view of these challenges, a single-step target capturing method for cardiac Troponin I (cTnI), the major cardiac biomarker of MI, was developed. The detection of target cTnI was performed by coupling the capture antibody modified magnetic silica nanoparticle (mSiO2) and an aptamer-based DNA nanostructure produced by hybridization chain reaction (aptHCR). cTnI in sample was first directly captured by mSiO2 and aptHCR in 30 min. The as formed nanocomplex was then labelled by a customized DNA turn on fluorescent dye SPM. By reading the strengthened fluorescent signal using total internal reflection fluorescence microscope (TIRFM), the detection platform has accomplished an impressive LOD of 8.5 fM with high specificity towards cTnI. The advantages of the short immunoreaction time (30 min) and the pre-treatment free property of the method have addressed the urgent diagnostic requirements of MI. The detection platform offers a potential solution to tackle insufficient sensitivity and tedious turnaround time of clinically approved assays for cTnI detection.

Highly Sensitive Aptamer-Based Method for the Detection of Cardiac Biomolecules on Silicon Dioxide Surfaces

ABSTRACTIn this work, we report on fabrication of the thin-films of silicon oxide dielectric layers on silicon with back-side contact and utilization of the structure to study the detection of human Troponin antigen (cTnI) molecules: the cardiac biomarkers for the early diagnosis of acute myocardial infraction. Aptamers are selectively bound to the target molecules and can block the binding epitope for further reaction like immobilization or interaction to any other molecules. In contrast to antibodies, the aptamers are smaller in size, which allows target molecules to be brought closer to the surface of the biosensor and, therefore, to enhance the molecular signal. The target molecule in this work is cTnI, which is located in the cardiac muscle tissue. As a reliable indicator of heart failure and injury, it is specifically considered for the diagnosis of myocardial infarctions. The solutions of Troponin molecules were studied in different concentrations range from 10 pg/μL to 1 ng/μL. For the electrical detection of cTnI, we used the field-effect capacitive electrolyte-insulator-semiconductor (EIS) technique, which is a robust method for the quantitative characterization of molecular layers. The measured values of capacitances and flat band voltages were used to acquire information about the properties of the molecular layers obtained using solutions with different troponin concentrations. It was shown that this method demonstrates high sensitivity to target cardiac biomolecules and opens up new perspectives for highly selective and sensitive cardiac biosensors developed on the basis of silicon nanowire structures.

Better, higher, lower, faster: increasingly rapid clinical decision making using high-sensitivity cardiac troponin assays

The diagnosis of acute myocardial infraction has undergone a noticeable transformation since the introduction of the high-sensitivity cardiac troponin assays. The clear shift towards increasingly rapid clinical decision making is reflected in the most recent European Society of Cardiology guidelines, which include a 0-/1-hour algorithm for the diagnosis of non-ST-elevation myocardial infarction. The use of this algorithm enables rule-in or rule-out in approximately 70–75% of all patients after a second cardiac troponin measurement after one hour. In a minority of patients rule-in or rule-out is achievable even faster; after only a single blood draw at presentation. Since rapid clinical decision making has several advantages, like fast initiation of treatment for those who need it and preventing prolonged patient anxiety, various recent studies have tried to further optimize these cut-off values at presentation.

Health insurance and quality and efficiency of medical care for patients with acute myocardial infraction in tertiary hospitals in Shanxi, China: a retrospective study

BackgroundPrevious studies have shown that health insurance type affects patient outcomes, but empirical research on the effect of health insurance on quality and efficiency of care in China is scarce. This study aimed to determine whether there are health insurance-related differences in hospital care for acute myocardial infraction. MethodsPatients with a principal diagnosis of acute myocardial infraction were identified from inpatient discharge records of 27 tertiary hospitals in Shanxi, China from September 1, 2013, to October 31, 2014. Patients were classified into four health insurance categories: Urban Employee Basic Medical Insurance (UEBMI), Urban Residents Basic Medical Insurance (URBMI), the New Rural Cooperative Medical Scheme (NCMS), or uninsured (out-of-pocket). The outcomes of interest were in-hospital mortality, length of stay, and total cost. Multilevel logistic regression was applied for in-hospital mortality, and multilevel linear regression for log transformed LOS and total cost. All models were adjusted for patient and hospital characteristics. Limited information from patient medical records was extracted from a database and all records were anonymised. As such, no ethical approval was required for this study. FindingsWe analysed records for 9075 patients. Compared with UEBMI group, in-hospital mortality was significantly lower for NCMS group (OR 0·613 [95% CI 0·438–0·859]) and uninsured group (0·477 [0·281–0·810]). Excluding patients who died during hospitalisation, compared with UEBMI group length of stay was shorter in the URBMI (coefficient of variable, −0·074 [95% CI −0·115 to −0·034]), NCMS (−0·116 [–0·139 to −0·093]) and uninsured (−0·146 [–0·177 to −0·114]) groups and total cost was lower in the URBMI (−0·067 [–0·130 to −0·004]), NCMS (−0·118 [–0·154 to −0·082]) and uninsured (−0·115 [–0·165 to −0·066]) groups. InterpretationFor patients hospitalized for acute myocardial infarction, health insurance type is significantly associated with quality and efficiency of care under current health policies in Shanxi, China. The underlying mechanism justifying this association should be explored further. FundingNone.

Complications of Streptokinase during infusion in acute myocardial infarction

Background: Myocardial infarction is one of the most common causes of death worldwide. The cornerstone of therapy is thrombolytic therapy. Coronary thrombolysis helps restore coronary patency, preserves left ventricular function and improves survival. The most common thrombolytic agent used is streptokinase. But thrombolytic therapy is at times associated with some complications. This comparative study was aimed to find out the complications occurring during streptokinase infusion in patients presenting with acute myocardial infarction in Mayo Hospital, Lahore. Material & Methods: Two hundred patients with definite diagnosis of acute myocardial infraction, who presented to East Medical Ward, Mayo Hospital, Lahore, were included in this study. All patients presenting with AMI were considered for SK therapy. Those who were actually given SK constituted the SK group and those who were not fit for SK, but otherwise SK was indicated, constituted the control group. In SK group 100 patients were given standard t reatment of acute myocardial infarction including streptokinase. In control group 100 patients were given standard treatment of acute myocardial infarction except streptokinase due to non-eligibility. Patients with typical chest pain of at least 30 minutes duration, serial ECG changes and serial cardiac enzyme changes were entered in the study. Study design: Comparative / interventional Results: Post SK changes in blood pressure were significant (p= 0.011). There was post SK hypotension in 48 (24%) and post SK hypertension in 20 (10%) patients. Allergic reaction was present in 4 (2%) only (p=0.044). Arrhythmias were significantly less prominent in SK group (p=0.000). Post SK bleeding occurred in 3 (1.5%) only (p=0.082). 37 patients died (18.5%) in total, out of which 5 (2.55) patients died in SK group and 32 in control group (p=0.000). CVA occurred in 1 SK group patient only, which was found to be hemorrhagic on CT scan (p= 0.31). Conclusions: Early administration of SK lowers in-hospital mortality (p= 0.00 0). Major complications during SK therapy are Hypotension (p= 0.011), Arrhythmias (p= 0.000), Allergic reactions (p= 0.044)

Survey of the effect of streptokinase on ventricular repolarization by examining the QT dispersion in patients with acute myocardial infraction in Seyed-Al-Shohada hospital, Urmia.

Cardiovascular events are the most common cause of morbidity and mortality throughout the world and myocardial infarction is the most common cause of these accidents. Myocardial infarction impairs the mechanical and electrical activity of the heart that these disorders predispose the patient to cardiac arrhythmias including ventricular tachycardia. QT dispersion is an important parameter to evaluate the heterogeneity of ventricular repolarization that minimal and the maximum interval is QTc in 12-lead EKG. In this study, 200 patients with the diagnosis of acute myocardial infraction with ST-segment elevation were hospitalized and treated with streptokinase. Patient records were extracted from the medical records department. EKG was studied before receiving streptokinase, an hour after receiving streptokinase and 4 days later for calculating and comparing QTd. It was concluded that QTd mean in EKG one hour after receiving streptokinase is decreased compared to pre-operation but this decline is not statistically significant. QTd mean in EKG day 4 after MI is slightly increased compared to the baseline, which is not statistically significant.

Acute myocardial infarction in the obstetric patient.

Acute myocardial infraction (AMI) in the obstetric patient is a rare event, although the incidence is rising due to advancing maternal age and pre-existing cardiac risk factors and medical co-morbidities. While atherosclerotic disease is the leading cause of AMI, coronary artery dissection is an important consideration in pregnancy and in the postpartum period. The physiological changes of pregnancy as well as pregnancy-specific risk factors can predispose the obstetric patient to AMI. Diagnosis of AMI can be challenging as symptoms may be atypical. Furthermore, diagnostic tests must be interpreted in the context of pregnancy. While the overall management of the obstetric patient with AMI is similar to that outside of pregnancy, drug therapy requires modification as some medications may be contraindicated in pregnancy and breastfeeding. There is limited information about prognosis and risk stratification but it is anticipated that future studies will address this issue.

Left ventricular mural thrombus after anterior ST-segment-elevation acute myocardial infarction in the era of aggressive reperfusion therapy ??? still a frequent complication

Left ventricular mural thrombus (LVMT) is a well-known complication of anterior ST-elevation acute myocardial infraction (AMI). It remains unknown how modern therapies have impacted on its occurrence. To define the frequency of LVMT among contemporary patients with anterior ST-elevation AMI, the clinical and echocardiographic predictors of LVMT formation, and the intermediate-term outcomes of patients with LVMT. We retrospectively analysed patients (in the years 1997-2002) with a diagnosis of anterior ST-elevation AMI and no prior AMI, and who underwent a thorough echocardiographic assessment within 72 h of admission. Stepwise logistic regression analysis was used to define predictors of LVMT formation. Survival was calculated by the Kaplan-Meier product-limit method. Of the 153 patients with complete data, LVMT was detected in 36 (23.5%). There were no significant differences in baseline demographic and clinical variables between LVMT and non-LVMT patients, or in treatments (all patients received reperfusion treatment). The mean wall motion score index was higher in LVMT than non-LVMT patients (0.88+/-1.79 versus 0.65+/-0.36, respectively; P=0.01), indicating worse cardiac systolic function. LVMT patients were treated with warfarin for 3-6 months. The incidence of death was similar between the groups (11.1% for LVMT patients versus 12.8% for non-LVMT patients, P=0.79) over a mean follow-up of 71-72 months. The only independent predictor found for LVMT occurrence was worse regional wall motion of the apex (odds ratio, 2.04, 95% confidence interval, 1.39-3.03; P<0.001). In the contemporary 'real-world scenario', despite aggressive reperfusion treatment and anti-aggregant use, the incidence of LVMT remained high after anterior ST-elevation AMI. LVMT was not related to increased intermediate-term mortality when patients were treated with warfarin, and the only predictor of LVMT occurrence was regional function of the apex.