Elevated cTnI Research Articles

Changes in the level of cardiac troponine and disorders in pulmonary gas exchange as predictors of short- and long-term outcomes of patients with aneurysm subarachnoid haemorrhage

Subject: Cardiopulmonary abnormalities are common after aneurysmal subarachnoid haemorrhage (aSAH). However, the relationship between short- and long-term outcome is poorly understood. In this paper, we present how cardiac troponine elevations (cTnI) and pulmonary disorders are associated with short- and long-term outcomes assessed by the Glasgow Outcome Scale (GOS) and Extended Glasgow Outcome Scale (GOSE).Methods: A total of 104 patients diagnosed with aSAH were analysed in the study. The non-parametric U Mann-Whitney test was used to evaluate the difference between good (GOS IV-V, GOSE V-VIII) and poor (GOS I-III, GOSE I-IV) outcomes in relation to cTnI elevation and pulmonary disorders. Outcome was assessed at discharge from the hospital, and then followed up 6 and 12 months later. Pulmonary disorders were determined by the PaO2/FiO2 ratio and radiography. The areas under the ROC curves (AUCs) were used to determine the predictive power of these factors.Results: In the group with good short-term outcomes cTnI elevation on the second day after aSAH was significantly lower (p = .00007) than in patients with poor short-term outcomes. The same trend was observed after 6 months, although there were different results 12 months from the onset (p = .024 and n.s., respectively). A higher peak of cTnI was observed in the group with a pathological X-ray (p = .008) and pathological PaO2/FiO2 ratio (p ≪ .001). cTnI was an accurate predictor of short-term outcomes (AUC = 0.741, p ≪ .001) and the outcome after 6 months (AUC = 0.688, p = .015).Conclusion: The results showed that cardiopulmonary abnormalities perform well as predictive factors for short- and long-term outcomes after aSAH.

The BD Barricor blood collection tube is an acceptable and robust alternative to the PST for use with the Beckman AccuTnI+3 assay

ObjectivesBD Canada recently released a blood collection tube with a novel mechanical separator called the Barricor. We evaluated this tube as an alternate sample type for cardiac troponin I (cTnI) testing using the Beckman Coulter AccuTnI+3 assay. Design and methods3014 paired patient specimens (Barricor, plasma separator tube or PST) were obtained from the emergency departments and cardiac care units of nine hospitals in and around Edmonton, Alberta. After centrifugation, each plasma sample was analyzed for cTnI using the Beckman Coulter AccuTnI+3 assay. In addition, selected samples were analyzed multiple times within a single run or over 4–5days to generate imprecision data for the assay. ResultsRepeatability and within-laboratory studies revealed an imprecision of <10% at concentrations above 0.025μg/L for the Barricor as well as BD's traditional PST. Paired patient sample comparisons over the full range of the assay yielded linear regression slopes ranging from 0.956 to 1.011 and Pearson correlation coefficients ranging from 0.993 to 0.999. At a lower range of results closer to the manufacturer's 99th percentile cutoffs correlation was slightly worse, but still acceptable, with linear regression slopes ranging from 0.967 to 1.211 and Pearson correlation coefficients ranging from 0.983 to 0.987. Notably, at these lower concentrations the agreement between individual PST and Barricor results worsened with decreasing cTnI concentration. Differences between pairs of results became particularly large (−50 to +400%) at PST cTnI concentrations ≤0.015μg/L. Closer inspection of the data around the 0.02 and 0.04μg/L 99th percentile cutoffs revealed a number of discordances between PST and Barricor results, with at least some of these attributable to false elevations in the PST results. ConclusionsTogether, our results suggest that the Barricor blood collection tube is good alternative to the traditional PST for cTnI testing using the AccuTnI+3 assay. The Barricor appears to minimize spurious, nonreproducible, and false elevations in cTnI results for a subset of patients but additional studies are needed to determine if it reduces overall false elevations. cTnI results below 0.04μg/L may still be of questionable accuracy even with the use of this new tube.

Characteristics of elevated cardiac troponin I in patients with acute ischemic stroke.

ObjectiveTo study prognostic characteristics of cardiac troponin I (cTnI) elevation in acute ischemic stroke.MethodsWe retrospectively studied patients (n = 248) with acute ischemic stroke, acute ST-segment elevation myocardial infarction, and acute non-ST-elevation myocardial infarction who were treated between January 2013 and October 2015. Baseline demographic data and changes in cTnI levels among these three groups were compared. Patients with acute ischemic stroke were assigned to either the cTnI elevation group (cTnI > 0.034 ng/mL) or the no cTnI elevation group (cTnI ≤ 0.034 ng/mL). Logistic regression analysis was used to identify risk factors associated with elevated serum cTnI in patients with acute ischemic stroke. Moreover, the duration of hospital stay and incidence of major cardiovascular outcomes were compared in patients with acute ischemic stroke, with or without elevated cTnI.ResultsIn this study population of patients with acute ischemic stroke (n = 178), acute ST-segment elevation myocardial infarction (n = 35), and acute non-ST-elevation myocardial infarction (n = 35), patients with acute ischemic stroke with elevated cTnI comprised 18.5% of subjects. Patients with elevated cTnI were older and more likely to have a history of hypertension. In addition, these patients had higher levels of inflammatory markers, reduced renal functions, increased D-dimer levels, higher NIH stroke scores, and lower left ventricular ejection fractions. Logistic regression analysis showed that both percentage of neutrophil and NIH stroke scores were elevated; estimated glomerular filtration rate and left ventricular ejection fraction were decreased in patients with acute ischemic stroke who had elevated cTnI, and they had more frequent major cardiovascular events during hospital stay.ConclusionElevated cTnI detected in patients with acute ischemic stroke, indicated a greater likelihood of poor short-term prognosis during hospital stay.

Correlation Of Serum Cardiac Troponin I With Significant Left Ventricular Systolic Dysfunction In Patients With Chronic Heart Failure

Objective: The aim of the study was to observe the relationship between elevated levels of serum cardiac Troponin I (cTnI) and in-hospital morbidity &amp; mortality in chronic heart failure with LV systolic dysfunction.Background: Chronic heart failure is a public health problem in the United Kingdom and also in our country. Serum Cardiac troponin I (cTnI) has been validated as a sensitive and specific marker of cardiac myocyte damage and is elevated in some patients with chronic heart failure with LV systolic dysfunction and predicts adverse outcome.Materials and Methods: This study was prospective, cross sectional and observational study. The study was carried out among chronic heart failure with LV systolic dysfunction patients in the Department of Cardiology, National Institute of Cardiovascular Diseases, Sher-E-Bangla Nagar, Dhaka, during the period of April 2004 to December 2004. In this Study, total 740 patients of heart failure were evaluated Among 740 patients, initially 100 patients were selected as chronic heart failure on the basis of inclusion &amp; exclusion criteria, history, physical examination, biochemical, X-ray, ECG &amp; other relevant investigations. Finally, 60 patients were selected by echocardiography who had ejection fraction of 40%. Cardiac troponin I was measured in each and every studied patient. In-hospital outcome was observed in terms of morbidity &amp; mortality. So hospitalised patients were followed up clinically and by investigation. Results: The results of this study revealed that serum cTnI was significantly elevated (cTnI 0.04 ng/ml) in serum of 29 patients (48.33%) and low or insignificant (cTnI 0.04 ng/ml) in serum of 31 patients (51.67%). Patients with significantly elevated serum cardiac troponin I (cTnI) level (group-A) had significantly higher inhospital morbidity &amp; mortality than patients who had insignificant serum cardiac troponin I (cTnI) level (group-B). In-hospital mortality was 15% (number of death 09) out of total 60 patients. All expired patients were in NYHA class-IV. On the other hand, there was no mortality in group-B. In-hospital morbidity was 2.75 times higher among the patients who had significantly elevated serum cTnI level. A significant correlation was found between the patients who had significantly elevated serum cTnI level (cTnI level &gt; 0.04 ng/ml) and the patients who had insignificant serum cTnI level (cTnI level &lt; 0.04 ng/ml) in consideration to in-hospital morbidity &amp; mortality.Conclusion: Conclusion of this study is that serum cardiac troponin I (cTnI) level is significant predictor of increased morbidity &amp; mortality in chronic heart failure. with LV systolic dysfunction. Serum Cardiac troponin I (cTnI) level may be a useful tool for identification, selection of therapeutic strategies and assessment of prognosis in patients with chronic heart failure who are at increased risk of ventricular systolic dysfunction and death. So it is a message for the physician as well as patients.KYAMC Journal Vol. 5, No.-2, Jan 2015, Page 503-508

Pattern and consequences of cardiologic medications management for patients with elevated troponin I upon admission into an intensive care unit not linked to type 1 acute myocardial infarction: A prospective observational cohort study

No recommendations are currently available to help the clinician with the pharmacological management of intensive care unit (ICU) patients with elevated cardiac troponin (cTn) not linked to type 1 AMI. The aim of this study was to evaluate the pattern of cardiologic medications for patients with elevated cTnI in ICU not link to type 1 AMI and their effects on in-hospital mortality. A prospective observational cohort study conducted in two ICU units. Patients with increased plasma concentration of cTnI at admission not linked to type 1 AMI were consecutively included. One hundred and ninety of the 835patients admitted (23%) had an increased plasma concentration of cTnI not related to type 1 AMI. Antiplatelet therapy (AT) and statin were prescribed in 56 (29.5%) and 50 (26.3%) of patients, respectively. Others cardiologic medications were prescribed in less than 5% of all cases and were considered as contraindicated in more than 50% of cases. Antiplatelet therapy was the only cardiologic treatment associated with reduction of in-hospital mortality following uni- and multivariate analysis. The death rate was 23% and 40% in these patients treated with and without AT, respectively (aOR=0.39 [95% CI: 0.15-0.97]). Statin and AT were frequently prescribed to patients with a cTnI elevation not linked to type 1 AMI. This study suggests that AT in patients with an increased plasma concentration of cTnI, not related to type1 AMI in ICU, could reduce in-hospital mortality.

The impact of hepatitis B carrier on cardiac troponin I in 100-km ultramarathon runners

BackgroundProlonged endurance exercise is known to cause elevation of cardiac troponin I (cTnI). Previous studies have reported the correlation of several factors with exercise-induced cTnI release. However, the investigation of the predictors for elevated cTnI and postrace kinetics of cTnI after ultramarathon running is lacking, especially in an Oriental population. MethodsTwenty-six participants, including eight hepatitis B virus carrier (HBVc) runners, who finished a 100-km ultramarathon in Taiwan were enrolled. For each participant, blood samples were collected 1 week before the race, as well as immediately and 24 hours after the finish. ResultsThe results showed that 19 runners (73.1%) had postrace elevated cTnI levels and eight (30.8%) had elevated cTnI values lasting more than 24 hours after the run. A multiple linear regression analysis demonstrated that the HBV status was a factor related to the high level of cTnI after 24 hours of running (β=0.03, p=0.08). The recovery of plasma cTnI levels was delayed in ultramarathon runners with latent HBV infection. Among HBVc runners, multiple linear regression analyses showed age (β=−0.01), previous running experience (β=−0.06), training distance (β=0.37), and 4 hours of running distance (β=−0.04) as significant predictors of higher postrace cTnI levels. ConclusionFor most athletes, cTnI values significantly increased immediately following the race in the absence of adverse clinical sequelae, and HBVc runners had higher and prolonged cTnI levels. While several factors are identified for such HBV effects, the specific causes need further elucidation.

The injured heart: early cardiac effects of hematopoietic stem cell transplantation in children and young adults.

We hypothesized that subclinical cardiac injury in the peri-transplant period is more frequent than currently appreciated in children and young adults. We performed echocardiographic screening on 227 consecutive patients prior to hematopoietic stem cell transplantation (HSCT), and 7, 30 and 100 days after transplant. We measured cardiac biomarkers cardiac troponin-I (cTn-I), and soluble suppressor of tumorigenicity 2 (sST2) prior to transplant, during conditioning, and days +7, +14, +28 and +49 in 26 patients. We subsequently analyzed levels of cTn-I every 48-72 h in 15 consecutive children during conditioning. Thirty-two percent (73/227) of patients had a new abnormality on echocardiogram. New left ventricular systolic dysfunction (LVSD) occurred in 6.2% of subjects and new pericardial effusion in 27.3%. Eight of 227 (3.5%) patients underwent pericardial drain placement, and 5 (2.2%) received medical therapy for clinically occult LVSD. cTn-I was elevated in 53.0% of all samples and sST2 in 38.2%. At least one sample had a detectable cTn-I in 84.6% of patients and an elevated sST2 in 76.9%. Thirteen of fifteen patients monitored frequently during condition had elevation of cTn-I. Echocardiographic and biochemical abnormalities are frequent in the peri-HSCT period. Echocardiogram does not detect all subclinical cardiac injuries that may become clinically relevant over longer periods.

Correction: Elevated plasma levels of cardiac troponin-I predict left ventricular systolic dysfunction in patients with myotonic dystrophy type 1: A multicentre cohort follow-up study.

[This corrects the article DOI: 10.1371/journal.pone.0174166.].

Brief Myocardial Ischemia Produces Cardiac Troponin I Release and Focal Myocyte Apoptosis in the Absence of Pathological Infarction in Swine

In a porcine model of brief ischemia leading to reversible stunning in the absence of tissue necrosis, we demonstrated delayed release of cTnI that exceeded the 99th percentile for normals 60-minutes after reperfusion and rose to readily detectable levels 24-hours later. While tissue analysis at 60-minutes showed no evidence of infarction, TUNEL staining demonstrated isolated myocytes undergoing apoptosis, which was absent after 24-hours. These results demonstrate that cTnI elevations occur after ischemia of a duration that is insufficient to produce myocyte necrosis and reflect myocyte injury associated with delayed apoptosis in the absence of pathological evidence of infarction.

Elevated plasma levels of cardiac troponin-I predict left ventricular systolic dysfunction in patients with myotonic dystrophy type 1: A multicentre cohort follow-up study.

ObjectiveHigh sensitivity plasma cardiac troponin-I (cTnI) is emerging as a strong predictor of cardiac events in a variety of settings. We have explored its utility in patients with myotonic dystrophy type 1 (DM1).Methods117 patients with DM1 were recruited from routine outpatient clinics across three health boards. A single measurement of cTnI was made using the ARCHITECT STAT Troponin I assay. Demographic, ECG, echocardiographic and other clinical data were obtained from electronic medical records. Follow up was for a mean of 23 months.ResultsFifty five females and 62 males (mean age 47.7 years) were included. Complete data were available for ECG in 107, echocardiography in 53. Muscle Impairment Rating Scale score was recorded for all patients. A highly significant excess (p = 0.0007) of DM1 patients presented with cTnI levels greater than the 99th centile of the range usually observed in the general population (9 patients; 7.6%). Three patients with elevated troponin were found to have left ventricular systolic dysfunction (LVSD), compared with four of those with normal range cTnI (33.3% versus 3.7%; p = 0.001). Sixty two patients had a cTnI level < 5ng/L, of whom only one had documented evidence of LVSD. Elevated cTnI was not predictive of severe conduction abnormalities on ECG, or presence of a cardiac device, nor did cTnI level correlate with muscle strength expressed by Muscle Impairment Rating Scale score.ConclusionsPlasma cTnI is highly elevated in some ambulatory patients with DM1 and shows promise as a tool to aid cardiac risk stratification, possibly by detecting myocardial involvement. Further studies with larger patient numbers are warranted to assess its utility in this setting.

Cardiac troponin-I as a predictor of mortality in patients with first episode acute atrial fibrillation.

Recent-onset atrial fibrillation (AF) is a frequent cause for presentation to the emergency department. Recent studies proposed that the addition of biomarker information might improve the prediction of clinical outcomes by enabling identification of patients at high risk. We aimed to examine the role of cardiac troponin I as a predictor of clinical outcome in patients with first episode acute AF. Patients, 18 years or older, presenting to our hospital with a primary diagnosis of first episode acute AF were included in this retrospective study. The association between elevated cTnI with mortality or the composite endpoint (mortality, stroke or heart failure) was examined in a univariate Cox regression model. Of the 274 study patients, 111 had elevated cTnI levels (41%). Increased cTnI was associated with older age, history of myocardial infarction, higher creatinine levels and higher heart rate (All P < 0.01). Elevated cTn was associated with an adjusted hazard ratio of 1.86 [95% confidence interval (CI) 1.17-2.96; P = 0.009] for mortality and 1.89 (95% CI 1.27-2.84; P = 0.002) for the combined endpoint. Elevated cardiac Troponin I is a significant predictor of mortality and a composite endpoint of mortality, stroke or heart failure in patients presenting with first episode acute AF.

Abstract WMP68: Evidence of Cardiac Stress in Acute Cerebral Venous Thrombosis

Background: Plasma cardiac troponin (cTnI) elevation has been associated with death after ischemic stroke and elevation has been theorized to result from an exaggerated sympathetic response. To our knowledge, no investigation into the cardiac effects of cerebral venous thrombosis (CVT) has been conducted. We hypothesized that acute CVT could result in similar cardiac stress manifesting as electrocardiogram (ECG) changes or cTnI elevation. Methods: In this retrospective cohort study of all consecutive patients admitted to Johns Hopkins Hospital from 2005-2015 with CVT by ICD9/10 code, patient data (sex, race, risk factors, CVT location/number, venous bleed/stroke, cTnI, ECG) were obtained from hospital records. Results: Of 81 patients identified with CVT, 53 (66%) had clot in at least one vein and had available ECG data; this group constituted our study population. Included patients had an average age of 41 years (range 1-80); 71% were white and 66% female. The left transverse sinus was most commonly involved (47%) and 66% of patients had &gt;2 clots. 22(41%) had cTnI elevation, defined as &gt;0.06. Odds of cTnI elevation increased per each additional vein involved (age-adjusted OR 2.64, 95%CI 1.14, 6.13] Of those with deep clots (deep veins, straight sinus; n=8), 37.5% had cTnI elevation compared to 4.44% without deep clots (p=0.02). The mean cTnI of those individuals with venous infarct (n=15) was higher than those without (0.14 vs 0.02, p=0.009) but lost significance after adjusting for age/race. cTnI elevation was not associated with venous hemorrhage. No significant association was found between ECG parameters and clot number/venous infarct. Conclusions: Clots in multiple veins and deep veins increased odds of cTnI elevation in a retrospective cohort of acute CVT patients irrespective of age and race. The cardiac effects of acute CVT should be recognized and further investigated to elucidate pathophysiology, and significance.

Different methods of remote ischemic preconditioning and its effect on outcome of elective percutaneous coronary intervention

Objective The purpose of this study was to assess and compare different methods of remote ischemic preconditioning (RIPC) to reduce cardiac myonecrosis as measured by evaluating cardiac troponin I (cTnI) after elective percutaneous coronary intervention (PCI) and to reduce major adverse cardiac event rate at 6 months of follow-up. Background RIPC is a way to reduce cardiac myonecrosis. Patients and methods This study was conducted on 120 symptomatic patients with coronary heart disease who were scheduled for elective PCI. Patients were randomized into three groups: group A included 40 patients who underwent RIPC immediately before PCI through the upper arm; group B included 40 patients who underwent RIPC immediately before PCI through the upper thigh; and group C (the control group) included 40 patients with no RIPC. Results Results of the current study showed that ST-segment deviation during intervention was statistically significantly lower (P Conclusion RIPC is a simple, cheap, well-tolerated procedure that has a significant effect on the reduction in postprocedural elevations of cTnI. RIPC increases the tolerance of the myocardium to ischemia, reduces ischemic chest discomfort during coronary balloon occlusion, reduces ST-segment deviation during intervention, reduces the rise in cTnI release after elective PCI, and appears to reduce subsequent cardiovascular events. RIPC using the upper thigh or upper arm has same protective effects on the myocardium.

Thromboelastographic evaluation of hemostatic functionin dogs with dilated cardiomyopathy

This study aimed to evaluate the hemostatic function by thromboelastography (TEG) and determine if there was an association between the changes in hemostatic parameters and serum cardiac troponin I (cTnI) in dogs with dilated cardiomyopathy (DCM). DCM was diagnosed by echocardiography in 19 dogs. Ten healthy dogs were selected as controls. Myocardial injury was confirmed by increased serum cTnI levels. Coagulation was assessed by TEG evaluating clot kinetics (reaction time [R] and kinetic time [K]), clot strengthening (alpha [α] angle and G value), platelet function (maximum amplitude [MA] and coagulation-index [CI]), clot stability (LY30, the percentage of lysis 30 min after MA), and global clotting times (activated partial thromboplastin time [aPTT] and prothrombin time [PT]). Dogs with DCM had higher R and K times but lower MA, α-angle, G, and CI compared to controls (P < 0.05). LY30 and PT did not statistically differ between groups, but the aPTT in dogs with DCM was higher than that of the controls. Serum cTnI (median [range], ng/mL) was higher in dogs with DCM (0.25 [0.13-3.1]) than in healthy dogs (0.03 [0.01-0.06]). There was no statistical relation between cTnI and coagulation parameters. This study showed that alterations of the coagulation status in dogs with DCM could develop independently of serum cTnI elevations.

The impact of a single episode of remote ischemic preconditioning on myocardial injury after elective percutaneous coronary intervention.

IntroductionMyocardial injury after percutaneous coronary intervention (PCI) occurs in approximately 30% of procedures, and is related to worse prognosis. Effects of remote ischemic preconditioning (RIPC) on reperfusion injury have been investigated before, yielding conflicting results.AimTo assess the impact of a single episode of RIPC on myocardial injury after elective PCI.Material and methodsOne hundred and four patients undergoing elective PCI, with normal baseline cardiac troponin-I (cTn-I) values, were randomized to two groups. Two patients were excluded due to data loss, and 102 patients were analyzed. Five minutes of ischemic preconditioning was delivered just before the intervention to the preconditioning group, by inflating the blood pressure cuff up to 200 mm Hg on the non-dominant arm. Postprocedural 16th hour cTn-I, ΔcTn-I (difference between the 16th h and baseline cTn-I values) and the prevalence of type 4a myocardial infarction were compared between the two groups.ResultsMedian cTn-I values after the procedure were compared. 16th hour cTn-I was insignificantly lower in the preconditioning arm (0.026 μg/l vs. 0.045 μg/l, p = 0.186). The incidence of cTn-I elevation 5-fold above the upper reference limit (URL) (> 0.115 μg/l) was lower in the preconditioning group, but it was also not significant (21.6% vs. 11.8%, p = 0.184).ConclusionsA single episode of RIPC before elective PCI demonstrated less troponin elevation but failed to show a significant effect.

Effect of Intensive Atorvastatin Therapy on Periprocedural PTEN Expression in CD4+T Lymphocytes of Patients with Unstable Angina Undergoing Percutaneous Coronary Intervention

&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To investigate the effects of intensive atorvastatin therapy on PTEN expression by CD4+ T lymphocytes in patients with unstable angina (UA) that received PCI.&lt;strong&gt; &lt;/strong&gt;&lt;strong&gt;Methods: &lt;/strong&gt;All&lt;strong&gt; &lt;/strong&gt;patients with UA were randomly divided into the pretreatment with an intensive atorvastatin (ATV) group (80mg 12h before PCI, with a further 20mg every day after PCI, n = 56) or a conventional (control) group (only 20 mg/day, n = 56). Circulating CD4+ T cells were subsequently obtained prior to PCI and 18–24 h after successful PCI, using a magnetic cell sorting system. Plasma cTnI, CK-MB, hsCRP, IL-10 and TNF-a levels were measured just prior to the PCI and 18–24 h after PCI. PTEN mRNA and protein were determined by Real-time PCR and western blots, respectively. &lt;strong&gt;Results:&lt;/strong&gt; PTEN mRNA and protein were dramatically decreased in ATV group (p &amp;lt; 0.05). In contrast, TNF-α and hsCRP significantly increased following PCI in two groups, with the ATV group being higher than control group (p &amp;lt; 0.05). IL-10 also markedly increased following PCI for the two groups. However, higher values were associated with the ATV group (p &amp;lt; 0.05). Compared to the control group, the incidence of elevated cTnI levels post-PCI was lower in the ATV group( p &amp;lt; 0.05); however, no difference could be found between the two groups regarding the incidence of elevated CK-MB post-PCI (p &amp;gt;0.05).&lt;strong&gt; &lt;/strong&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Intensive atorvastatin treatment reduced the post-PCI myocardial inflammatory response in patients with UA, possibly by enhancing PTEN expression in CD4+ T lymphocytes.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;

Assessment of Multiple Cardiac Biomarkers in Acute STEMI Patients without Clinical Manifestation of Heart Failure in NICVD

Background: In patients with acute coronary syndrome (ACS), Cardiac Troponin I (cTnI) elevation is indicative of myocardial damage. After acute myocardial infarction (AMI), level of Pro-BNP rises rapidly during the first 24 hours and tends to stabilize thereafter.Objective: The present study tried to explore the pattern of multiple cardiac biomarkers (cTnI, CK-MB, Pro-BNP, SGOT and LDH) in newly diagnosed acute ST-elevation myocardial infarction (STEMI) patients without clinical symptoms of heart failure.Materials and method: This was a prospective study. Total 82 acute STEMI patients were recruited purposively from National Institute of Cardiovascular Disease (NICVD), Dhaka, Bangladesh, within 24 hours of symptoms having normal serum creatinine level. cTnI and pro-BNP elevation were defined &gt;1mg/mL and &gt;125 pg/mL respectively. The study population was sub grouped according to age: group A (&lt;40 years), group B (40-50 years), group C (&gt;51-60 years) and group D (&gt;60 years).Results: The mean±SD age of patients was 53.3±11.6 years and 42.70% population belonged to relatively younger age group (group B). Smoking was found on the top of the list (73.20%) as a risk factor. There was no difference among the groups regarding atherosclerotic marker and no other cardiac markers except pro-BNP. Only Pro-BNP (pg/mL) showed gradual and progressive increment with increasing age. No significant difference was observed between CRP positive and negative groups in different age groups (cut off value &lt;6mg/dL). Group B (40-50 years) seems to be the most vulnerable as the anterior and the extensive anterior myocardial infarctions (worst prognosis) were highest in this group.Conclusion: Worst prognosis is associated with increased age and raised pro-BNP level.Delta Med Col J. Jul 2016 4(2): 55-60

Predictors of significant coronary artery disease in atrial fibrillation: Are cardiac troponins a useful measure

BackgroundCardiac Troponin I (cTnI) is frequently measured in patients presenting with symptomatic atrial fibrillation (AF). The significance of elevated cTnI levels in this patient cohort is unclear. We investigated the value of cTnI elevation in this setting and whether it is predictive for significant coronary artery disease (sCAD). MethodsWe conducted a retrospective, single-center, case–control study of 231 patients who presented with symptomatic AF to The Prince Charles Hospital emergency department, Brisbane, Australia between 2006 and 2014. Patients who underwent serial cTnI testing and assessment for CAD were included. Clinical variables that are known to predict CAD and could potentially predict cTnI elevation were collected. Binary logistic regression was performed to identify predictors of sCAD and cTnI elevation. ResultsCardiac Troponin I elevation above standard cut off was not predictive for sCAD after adjustment for other predictors (OR 1.62, 95% CI 0.79–3.32. p=0.19). However, the highest cTnI concentration value (cTnI peak) was predictive for sCAD (OR 2.02, 95% CI 1.02–3.97, p=0.04).Dyspnea on presentation (OR 4.52, 95% CI 1.87–10.91, p=0.001), known coronary artery disease (OR 3.44, 95% CI 1.42–8.32, p=0.006), and ST depression on the initial electrocardiogram (OR 2.57, 95% CI 1.11–5.97, p=0.028) predicted sCAD in our cohort, while heart rate on initial presentation was inversely correlated with sCAD (OR 0.99, 95% CI 0.971–1.00, p=0.034). ConclusionTroponin elevation is common in patients presenting to hospital with acute symptomatic AF and it is not a reliable indicator for underlying sCAD in this patient cohort. However, cTnI peak was a predictor of significant coronary artery disease.

Chest pain after percutaneous coronary intervention in patients with stable angina

BackgroundPercutaneous coronary intervention (PCI) has been widely used to treat acute coronary syndrome but is only recommended as an additional treatment to medical therapy and risk modification in patients with refractory or progressing angina. The number of PCI in this patient population is still increasing. Post-PCI chest pain (PPCP) is one of the common problems of PCI. Its presentation and causes in patients with stable angina are poorly understood.Patients and methodsThis study retrospectively collected clinical information of 167 patients who had stable angina and underwent elective PCI, including 70 patients with PPCP 24 hours after procedure and 97 patients without PPCP. The incidence and predictors of PPCP were analyzed.ResultsThe incidence of PPCP was 41.9% (70/167). Compared with non-PPCP patients, PPCP patients had more abnormal post-PCI electrocardiogram (ECG) changes (new Q-waves, ST-segment shifts, or T-waves inversion) and serum cardiac troponin I (cTnI) elevation, more PCI vessels, and stent placement (all P<0.05). More PPCP patients required repeat revascularization than non-PPCP patients after PCI (P=0.043). PPCP was correlated with abnormal post-PCI ECG changes (P<0.0001), cTnI elevation (P<0.0001), post-PCI serum level of cTnI (P<0.0001), number of stents placed (P=0.009), and pre-PCI cTnI level (P=0.049). The strongest predictors of PPCP were abnormal post-PCI ECG changes (P<0.0001), post-PCI cTnI level (P<0.0001), and cTnI elevation (P<0.0001), followed by the number of stents placed (P=0.048).ConclusionPPCP is common in patients with stable angina in our cohort. It is associated with abnormal ECG changes, cTnI elevation, and number of stents placed.

NT-proBNP and cardiac troponin I concentrations in dogs with tick paralysis caused by Ixodes holocyclus.

The purpose of this study was to determine through measurement of cardiac biomarkers whether there was cardiac involvement in dogs infested with Ixodes holocyclus. Dogs with tick paralysis and no-mild (group 1; n = 44) or moderate-severe respiratory compromise (group 2; n = 36) and a control group of dogs (n = 31) were enrolled. Plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP), serum cardiac troponin I (cTnI) and serum creatinine concentrations were determined. For most of the affected dogs SpO2 was determined. SpO2 readings did not differ between groups 1 and 2. Three animals in group 2 had an SpO2 reading <90%. NT-proBNP concentrations were lower in both groups 1 and 2 compared with the control group. There was no difference in cTnI concentrations among groups, although they were elevated in four dogs, including the three dogs in group 2 with SpO2 readings <90%. Creatinine concentrations were within the reference interval for all dogs, but did differ among the groups, with control dogs having the highest values, followed by group 1 and then group 2. This study did not detect significant cardiac involvement in dogs with tick paralysis induced by I. holocyclus. Evidence for reduced preload in dogs with tick paralysis was provided by lower NT-proBNP concentrations compared with control dogs. Severe hypoxaemia may not be a significant component of the clinical picture in many of the dogs presenting with tick paralysis. Dogs with severe hypoxaemia may have loss of cardiomyocyte integrity, reflected by elevated cTnI concentrations.