Kinase MB Fraction Research Articles

Health status biomarkers and hemato-biochemical indices in Nile tilápia

Considering the aquatic environment, fish are notorious bioaccumulators of persistent pollutants, and that Oreochromis niloticus (Nile tilapia) is a species of great economic interest and an excellent model for ecotoxicological experimental studies. Because of this, establishing baseline reference parameters for this healthy animal is extremely valuable for comparison. Thus, our aim is to establish reference values for Nile tilapia for comparative purposes for: (i) functional activation of the alternative pathway of the complement system (ACH50), (ii) some serum biochemical parameters of liver, kidney and muscle tissue integrity, and (iii) hematological profile of Nile tilapia under controlled conditions. Juvenile specimens of O. niloticus were obtained from the fish farming and acclimatized for 15 days. Blood samples were collected without and with anticoagulants (heparin and EDTA) and submitted to hematological assays for leukogram and erythrogram evaluation. Serum was used for the alternative complement and biochemical assays. A mean of 137.6 U/mL was found for ACH50, 52.3 U/mL for alanine aminotransferase, 81.7 U/mL for aspartate aminotransferase, 30.3 U/mL for alkaline phosphatase, 4.3 g/dL for albumin, 8.4 mg/dL for urea, 1.9 mg/dL for uric acid, 3654 U/L for total creatine kinase, 1329.9 U/L for creatine kinase MB fraction, 260.2 U/L for lactic dehydrogenase, 227.2 mg/dL for glucose, 5.6 g/dL for total protein, 252.7 mg/dL for triglycerides, 169.5 md/dL for cholesterol, 19.1 mg/dL for high-density lipoprotein, and 12.5 mg/dL for low-density lipoprotein. For all hematological parameters we found a difference between the lack and presence of the anticoagulants, being the lack and heparin the conditions that presented more stability of the cell numbers along the time. Thus, in this study we establish baseline health parameters for Nile tilapia and it will be applied as an essential and comparative tool for monitoring fish health and physiological fitness at various experimental levels, such as bioassays and environmental biomonitoring.

Reactive Hyperglycaemia Connected with Low Glycated Haemoglobin – Risk Factor for Cardiovascular Adverse Events

Introduction: Concomitance of glucose metabolism disturbances and ischemic heart disease is well known and connected to several times higher incidence of cardiovascular events resulted from atherosclerosis. Aim of this study was to assess impact of reactive hyperglycaemia accompanying chronic and not always optimally treated hyperglycaemia assessed with glycated haemoglobin level on cardiovascular prognosis among patient hospitalised in the course of acute myocardial infarction. Methods: 92 patients diagnosed with ST – segment elevation myocardial infarction (STEMI) qualified to primary percutaneous coronary intervention (pPCI) was included in the study. Study population was divided into subgroups, depending glucose level on admission (reactive hyperglycaemia) and HbA1c concentration: subgroup A (HbA1c <6.5%, Glc<7.8 mmol/l: n = 37; 40,2%), subgroup B (HbA1c <6.5%, Glc ≥.,8 mmol/l: n = 27; 29,3%), subgroup C (HbA1c ≥6.5%, Glc ≥7.8 mmol/l: n = 20; 21,7%) and subgroup D (HbA1c ≥6.5% Glc<7.8 mmol/l: n = 8; 8.7%). Level of myocardium damage was assessed on the basis of concentration of myocardial necrosis enzymes: creatine kinase (CK) and creatine kinase MB fraction (CK-MB) in the 0 and 90th minute and thereafter 8, 16, 24 and 48 hours after hospital admission and also echocardiographic examination. Prognosis in long and short term observation was assessed by major adverse cardiovascular events (MACE) such as death, myocardial infarction, stroke, heart failure requiring hospitalisation and repeated revascularisation and level of glucose metabolism disturbances in intrahospital phase, 4 months and 4 years follow up observation. Results: Results in study population revealed significant change of average value of creatine kinase (p<0,001) and its MB fraction (p<0,001) during first 48 hours of hospitalisation in particular subgroups of patients. Mean values of CK and CK-MB assessed in subsequent hours of hospitalisation (1,5, 8, 16 and 48 hours) were significantly higher in subgroup B (CKp=0,034 and CK-MB p=0,01, respectively). It means that area under curve was significantly higher for subgroup B. In 4 months and 4 year follow up observation, statistically significant difference in frequency of MACE in particular subgroups of patients has been shown (p=0,016; p=0,01). Conclusions: Patients with STEMI undergoing pPCI, who were diagnosed with disturbed carbohydrate metabolism, have inferior clinical outcomes in long term follow up observation. Noticeable difference was observed particularly in subgroup B (HbA1c <6.5%, Glc ≥7.8 mmol/l).

Extracorporeal Membrane Oxygenation for Fulminant Myocarditis: Increase of Cardiac Enzyme and SOFA Score Is Associated with High Mortality.

We aimed to evaluate the outcomes of patients with fulminant myocarditis and investigate the factors associated with mortality. This is a retrospective single-center cohort study that included adult and pediatric patients with fulminant myocarditis treated at Samsung Medical Center between September 2004 and December 2019. The primary outcome was in-hospital mortality. Among 100 patients, 71 underwent veno-arterial extracorporeal membrane oxygenation (ECMO) (ECMO group). Comorbidities were not significantly different between the ECMO and non-ECMO groups. Cardiac enzymes, creatinine, and median sequential organ failure assessment (SOFA) score at intensive care unit admission were significantly different between the groups. Twenty patients (28.7%) in the ECMO group and two (6.9%) in the non-ECMO group died in-hospital (p = 0.02). The significant risk factors of in-hospital mortality were creatine kinase MB fraction (CK-MB) and SOFA score (p = 0.009 and p = 0.001, respectively) in the ECMO group. In the receiver-operating characteristic curve analysis, the cutoffs of SOFA score and CK-MB were 12 and 94.74 ng/mL, respectively. The patients with both variables above the cutoffs showed significantly worse outcomes (p < 0.001). ECMO can be an effective treatment option for fulminant myocarditis. SOFA score and CK-MB are significant risk factors for in-hospital mortality.

Rosuvastatin corrects oxidative stress and inflammation induced by LPS to attenuate cardiac injury by inhibiting the NLRP3/TLR4 pathway.

Rosuvastatin has been found to possess antioxidant and anti-inflammatory properties. The aim of the current study was to evaluate whether rosuvastatin was effective in attenuating cardiac injury in lipopolysaccharide (LPS) - challenged mice and H9C2 cells and identify the underlying mechanisms, focusing on the nod-like receptor protein 3 (NLRP3)/toll-like receptor 4 (TLR4) pathway. Cardiac injury, cardiac function, apoptosis, oxidative stress, inflammatory response, and the NLRP3/TLR4 pathway were evaluated in both in vivo and in vitro studies. LPS-induced cardiomyocyte injury was markedly attenuated by rosuvastatin treatment, evidenced by increased cell proliferation of H9C2 cells, rescued cardiac function, and improved morphological changes in mice and reduced lactate dehydrogenase (LDH), creatine kinase MB fraction (CK-MB), and troponin I (cTnI) in serum. Apoptosis was clearly ameliorated in myocardial tissue and H9C2 cells co-treated with rosuvastatin. In addition, after LPS challenge, excessive oxidative stress was present, indicated by increases in malondialdehyde (MDA) content, NADPH activity, and reactive oxygen species (ROS) production and decreased superoxide dismutase (SOD) activity. Rosuvastatin improved all the indicators of oxidative stress, with an effect similar to that of N-acetylcysteine (NAC) (an ROS scavenger). Notably, LPS-exposed H9C2 cells and mice showed significant NLRP3 and TLR4/nuclear factor-κB (NF-κB) pathway activation and inflammatory responses. Administration of rosuvastatin reduced the increases in NLRP3, apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), pro-caspase-1, TLR4, and p65 expression and decreased the tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), IL-18, and IL-6 contents, with an effect similar to that of MCC950 (an NLRP3 inhibitor). In conclusion, inhibition of the inflammatory response and oxidative stress contributes to cardioprotective effect of rosuvastatin against cardiac injury induced by LPS, and the effect of rosuvastatin was achieved through inactivation of the NF-κB/NLRP3 pathway.

The relation between platelet/lymphocyte ratio and the occurrence of no reflow in patients with ST-segment elevation myocardial infarction managed by primary percutaneous coronary intervention

Introduction: No reflow phenomenon following primary percutaneous coronary intervention (PCI) is a strong predictor of mortality. Platelet/lymphocyte ratio (PLR) is an indicator of long-term outcome in ischemic heart disease patients. The aim of this study was to assess the relation between PLR measured on admission and the occurrence of no-reflow phenomenon in patients presenting with acute ST-segment elevation myocardial infarction (STEMI) managed by primary PCI. Methods: This was a prospective study including 100 patients with acute STEMI managed by primary PCI. Venous blood samples were obtained on admission to assess hemoglobin level, platelet count, and lymphocyte count. Thrombolysis in myocardial infarction (TIMI) flow grade, myocardial blush grade (MBG), and TIMI thrombus scale were assessed immediately following revascularization. During hospital stay, peak creatinine kinase MB fraction (CK-MB) was recorded, and transthoracic echocardiography was performed to assess left ventricular ejection fraction (LVEF). Results: Patients were divided into two groups based on the TIMI flow grade following PCI: Normal coronary flow group (TIMI 3 flow grade, n = 71) and reduced coronary flow (no-reflow) group (TIMI 0, 1, and 2, n = 29). There was a larger proportion of diabetic patients in the no-reflow group (P = 0.028). In addition, patients in the no-reflow group had a more advanced Killip class on presentation (P = 0.001), a lower LVEF (P

Early Differentiation of Stress Cardiomyopathy from Acute Anterior Wall Myocardial Using Changing Cardiac Enzyme Patterns.

BACKGROUNDMost patients with acute anterior wall ST elevation myocardial infarction (STEMI) or stress cardiomyopathy (SCMP) show elevations in cardiac enzymes that peak within 24 hours. The changing pattern of cardiac enzymes can be an early clue to the differentiation of anterior STEMI and SCMP.METHODSThis study was a retrospective analysis (matching cases and respective control subjects) performed at a single center. We compared 27 patients with SCMP and 30 patients with anterior STEMI. We used laboratory data included cardiac marker, such as the initial creatine kinase MB (CK-MB) fraction and troponin T (Tn-T), at admission and peak CK-MB and Tn-T at follow up.RESULTSThe mean age was 69.3 ± 14.1 years, and 38.6% of patients were female. The SCMP patients were older, more often female, and had lower left ventricular ejection fractions than the anterior STEMI patients. The initial CK-MB was higher in the anterior STEMI group than in the SCMP group. In contrast, the initial Tn-T level was not significantly different between the 2 groups. Peak CK-MB and Tn-T levels and change from initial levels were significantly greater in the anterior STEMI group than they were in the SCMP group. SCMP could be differentiated from anterior STEMI based on peak CK-MB > 46.65 ng/mL or Tn-T > 1.56 ng/mL.CONCLUSIONSFollow-up changes in cardiac enzymes can be an effective early tool for differentiating SCMP from anterior STEMI.

C jak COVID-19 — powikłania układu sercowo-naczyniowego u młodego pacjenta

The authors present the case of a 27-year-old patient with cardiovascular complications after undergoing severe acute respiratory syndrome-related coronavirus 2 infection. The first symptoms included muscle aches and somnolence, severe sore throat, and enlargement of submandibular and cervical lymph nodes, followed by dyspnoea and chest pain with body temperature 37.5°C. Because of the medical profession, the patient underwent a routine reverse-transcription polymerase chain reaction test for coronavirus infection, which was positive, before returning to work. In an electrocardiogram, it was observed pathological Q waves in II, III, aVF, V6, and 1 mm of ST elevation in V1–V3. The laboratory tests showed normal levels of cardiac troponin T, creatine kinase MB fraction, and N-terminal pro-B-type natriuretic peptide. Transthoracic echocardiography revealed the hypokinesis of the middle and apical segment of the anterior and lateral wall with preserved left ventricular ejection fraction (LVEF) — 54%. The magnetic resonance imaging (MRI) revealed the normal volume and global left ventricular systolic function (LVEF 52%) with segmental wall motion abnormalities. Subepicardial banded foci of late gadolinium enhancement (LGE), located in the lower right and left ventricular segments of the basal, central and apical segments of the inferior wall suggested inflammatory aetiology of changes found. It may be assumed that the suspected myocarditis was caused by coronavirus disease 2019 (COVID-19) infection. Since LGE was present in the inferior wall, the patient may be considered having a low risk of major cardiac events and heart failure hospitalizations, referring to the ITAMY study. In patients without a history of cardiovascular diseases with COVID-19, cardiac MRI may reveal preserved, mid-range, or reduced LVEF. The patient requires further follow-up. The coronavirus is the most dangerous for the elderly, but it can also affect the hearts of otherwise healthy people, including young adolescents.

Protective effects of recombinant human brain natriuretic peptide on the myocardial injury induced by acute carbon monoxide poisoning.

To investigate the protective effect of recombinant human brain natriuretic peptide (rhBNP) on myocardial injury after acute carbon monoxide poisoning (ACOP). We retrospectively reviewed medical records of patients with ACOP and high risk of cardiac events admitted to our hospital, and grouped them into rhBNP group and control group according treatments they received. Patients in control group received conventional treatment while those in rhBNP group were treated with rhBNP intravenously for 72 hours on the basis of conventional treatment. Levels of amino-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), serum creatine kinase MB fraction (CK-MB), aldosterone (ALD), angiotensin II (AT II), and endothelin-1 (ET-1) prior to and after treatment of rhBNP or conventional treatment were collected. Corrected QT dispersion (QTcd) results were calculated based on the electrocardiography data. The left ventricular end diastolic diameter (LVEDD), interventricular septal thickness (IVS), left ventricular ejection fraction (LVEF), and stroke output (SV) were measured using color Doppler echocardiography. Major adverse cardiovascular events (MACEs) that occurred within 1 month after treatment were recorded. A total of 135 patients in the rhBNP group and 136 patients in the control group were enrolled. Baseline characteristics between the two groups were similar at admission. Levels of cTnI, CK-MB, and ET-1 in the rhBNP group were significantly lower than those in the control group at day 1, 2 and 3 after treatment (P<0.05). Compared with the control group, levels of QTcd, ALD and AT II in the rhBNP group were significantly lower at day 3 after treatment (P<0.05). After 7 days of treatment, the reduction of NT-proBNP in the rhBNP group was significantly greater than that in the control group at each day (P<0.05), and LVEF, SV and LVEDD in the rhBNP group were all greater than those in the control group. After 1 month of treatment, the incidence of MACEs in the rhBNP group was significantly lower than that in the control group. For patients with ACOP and high risk of cardiac events, early treatment of rhBNP can protect injured cardiomyocytes, prevent the injury of carbon monoxide on heart, and reduce the incidence of MACE.

Protective Effect of Methylxanthine Fractions Isolated from Bancha Tea Leaves against Doxorubicin-Induced Cardio- and Nephrotoxicities in Rats.

Doxorubicin is an anthracycline antibiotic that is used for the treatment of various types of cancer. However, its clinical usage is limited due to its potential life-threatening adverse effects, such as cardio- and nephrotoxicities. Nonetheless, simultaneous administration of doxorubicin and antioxidants, such as those found in green tea leaves, could reduce cardiac and renal tissue damage caused by oxidative stress. The methylxanthine fraction isolated from Bancha tea leaves were tested in vitro for its antioxidant activity and in vivo for its organoprotective properties against doxorubicin-induced cardio- and nephrotoxicities in a rat model. The in vivo study was conducted on male Wistar rats divided into 6 groups. Methylxanthines were administered at high (5 mg/kg body weight) and low (1 mg/kg body weight) doses, while doxorubicin was administered at a cumulative dose of 20 mg/kg body weight. Serum creatinine, uric acid, and urea concentrations, as well as serum enzyme levels (creatinine kinase (CK), creatinine kinase MB fraction (CK-MB), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH)) and electrolytes (Na+, K+, and Cl−), were analysed. In addition, histological analysis was performed to assess cardiac and renal tissue damage. The concomitant administration of Bancha methylxanthines and doxorubicin showed a dose-dependent reduction in the serum biochemical parameters, indicating a decrease in the cardiac and renal tissue damage caused by the antibiotic. Histological analysis showed that pretreatment with methylxanthines at the dose of 5 mg/kg resulted in an almost normal myocardial structure and a significant decrease in the morphological kidney changes caused by doxorubicin exposure compared with the group that received doxorubicin alone. The putative mechanism is most likely related to a reduction in the oxidative stress caused by doxorubicin.

Cardiac biomarkers and left ventricular systolic function in acute myocardial infarction with ST- segment elevation in diabetes mellitus type 2 patients.

Aim To determine a status of systolic function in patients with diabetes mellitus (DM) type 2 with ST-segment elevation acute myocardial infarction (STEMI), to determine values of cardiac biomarkers in patients with DM type 2 with STEMI and correlate the parameters with ejection fraction of left ventricle (EFLV). Methods A total of 80 patients were divided into two groups, the study group (group I) consisting of 40 patients admitted with the diagnosis of DM type 2 and STEMI, and a control group (group II) with 40 patients with STEMI without diagnosed DM type 2. Cardiac biomarkers - creatine kinase MB fraction (CKMB), and troponin I were monitored. The EFLV was evaluated echocardiographically (using Simpson method) five days after primary percutaneous coronary intervention (pPCI). Results In the group I the EFLV five days after pPCI was significantly correlated with troponin values (with a minimum r = -0.47; p=0.002, a maximum r = -0.339; p = 0.032, as well as with an average value of r = -0.389; p=0.013), and with an average CK value (r = -0.319; p=0.045). In the group II there was a significant negative correlation of EFLV with the maximum value of troponin (r = -0.309; p=0.05). Conclusion Troponin values have an effect on the EFLV after STEMI, and thus on the left ventricular status, as well as on the pharmacological modality itself.

Rhabdomyolysis After Cocaine Consumption-Case Report

Clinical laboratory measurement of serum showed a significant increase in the levels of indirect markers of muscle lysis. Serum creatine kinase fraction MM (CK) level increased up to 99.500 U/L and creatine kinase MB fraction (CK-MB) up to 6.500U/L. Changes in electrolytes also increased (sodium=1.730mmol/L, potassium=42.1mmol/L, phosphorus =48.3mg/dl, chlorine =1.243mmol/L and magnesium=36.1mg/dl). Changes in kidney functions also occurred (urea =302.6mg/dl and creatinine=11.1mg/dL). The levels of albumin (33.4g/dl) and lactate dehydrogenase LDH (22,545U/L) also increased. Further, qualitative tests for troponin and myoglobin were positive. Intervention: The soldier stayed in the intensive care unit (ICU) for five days.

Evaluation of Cardioprotective activity of Asparagus racemosus against Doxorubicin induced cardiotoxicity in albino rats: an experimental study

Background: Cardiotoxicity is one of the most feared side effects of anticancer agents like Doxorubicin. Asparagus racemosus is a widely used medicinal plant in Indian system of medicine known for its antioxidant activity. In certain studies ethanol extract of Asparagus racemosus has shown to possess cardioprotective activity in experimental animals while in some other studies cardioprotective potential of Asparagus racemosus has not been demonstrated. Therefore, due to the controversial action, the present study was designed to explore the cardioprotective effect of aqueous effect of Asparagus racemosus against doxorubicin induced cardiotoxity.Methods: Following approval from Institutional Animal Ethics Committee of L.L.R.M Medical College registered under CPCSEA, India, this study was conducted in which 30 rats were randomized into five groups of six rats each. Group I received 2 ml/kg b.w. normal saline p.o for 21 days, group II apart from receiving pellet diet and normal saline for 21 days were treated with Doxorubicin in a single dose of 20 mg/kg intraperitoneally on the 21st day, group III and group IV received aqueous extract of Asparagus racemosus in doses of 250 mg/kg/day and 500 mg/kg/day respectively p.o. for 21 days followed by administration of Doxorubicin (20 mg/kg i.p.) on the 21st day, Group V received Carvedilol in doses of 30 mg/kg/day p.o. for 21 days followed by administration of Doxorubicin (20mg/kg i.p) on the 21st day. Then they were anaesthetized and blood sample was collected from abdominal aorta for performing blood test i.e. Creatinine kinase MB fraction (CK-MB), Lactate dehydrogenase (LDH), Serum glutamate oxaloacetate transaminase (SGOT), Serum glutamate pyruvate transaminase (SGPT). After blood collection the animals were sacrificed and heart was dissected out for histopathological study. The data obtained was organized and analysed by suitable statistical methods i.e. ANOVA followed by Post Hoc test.Results: CK-MB, LDH, SGOT and SGPT levels were found to be significantly raised (p&lt;0.001) in Doxorubicin treated group. Asparagus racemosus pretreated groups exhibited significant limitation (p&lt;0.001) in rise in levels of CK-MB,LDH,SGOT and SGPT levels in a dose dependent manner following Doxorubicin administration which were comparable to the group treated with the standard cardioprotective drug Carvedilol. Histopathological changes further corroborated cardioprotective potential of Asparagus racemosus.Conclusions: The present study concluded that aqueous extract of Asparagus racemosus possess cardioprotective potential against Doxorubicin induced cardiotoxicity.

Improving the Diagnosis of Culprit Left Circumflex Occlusion With Acute Myocardial Infarction in Patients With a Nondiagnostic 12-Lead ECG at Presentation: A Retrospective Cohort Study.

BackgroundLeft circumflex culprit is often missed by the standard 12‐lead ECG. Extended lead systems (body surface potential map [BSPM]) should improve the diagnosis of culprit left circumflex stenosis with myocardial infarction.Methods and ResultsRetrospective analysis of a hospital research registry (August 2000–August 2010) comprising consecutive patients with (1) ischemic‐type chest pain at rest; (2) 12‐lead ECG and 80‐lead BSPM at first medical contact; and (3) cardiac troponin‐T 12 hours after symptom onset and/or creatine kinase MB fraction, were undertaken. Enrolled in the cohort were patients with culprit left circumflex stenosis (thrombolysis in myocardial infarction flow grade 0/1) at angiography. Acute myocardial infarction AMI was defined as cardiac troponin‐T ≥0.1 μg/L and/or creatine kinase MB fraction >2 upper limits of normal. Enrolled were 482 patients: 168 had exclusion criteria. Of the remaining 314 (age 64±11 years; 62% male), 254 (81%) had AMI: of these, 231 had BSPM STE—sensitivity 0.91, specificity 0.72, positive predictive value 0.93, negative predictive value 0.65, and c‐statistic 0.803 for AMI (P<0.001). Of those with BSPM STE and AMI (n=231), STE was most frequently detected in the posterior (n=111, 48%), lateral (n=53, 23%), inferior (n=39, 17%), and right ventricular (n=21, 9%) territories.ConclusionsAmong patients with 12‐lead ECG non‐ST‐segment–elevation myocardial infarction and culprit left circumflex stenosis, initial BSPM identifies ST‐segment elevation beyond the territory of the 12‐lead ECG. Greater use of the BSPM may result in earlier identification of AMI, which may lead to more rapid reperfusion.

HOMOCYSTEINE: A NEWER AND NOVEL INDEPENDENT RISK FACTOR AND CARDIAC MARKER FOR ACUTE MI

Objective: The objective of this study was to estimate homocysteine levels in myocardial infarction (MI) patients (troponin-T positive) and normal healthy individuals (troponin-T negative) subsequently to make comparisons with other cardiac markers.&#x0D; Methods: A cross-sectional study consisting of 172 subjects involving 100 patients of non-diabetic MI and 72 apparently healthy controls with no history of diabetes and/or MI was done between December 2017 and May 2018. The diagnosis of MI was established with electrocardiogram findings and troponin-T estimation. Blood samples were collected and processed for the estimation of homocysteine, troponin-T, creatine kinase MB fraction (CK-MB), and lactate dehydrogenase.&#x0D; Results: In the present study, a total of 100 troponin-T positive cases and 72 troponin-T negative as controls were studied. The mean age in the cases was 62.15±7.75 years and in the controls was 61.49±8.35 years (p=0.592). The mean value of homocysteine in the troponin-T positive group was 30.56±19.79 μmol/l and in the troponin-T negative group was 10.28±4.03 μmol/l (p&lt;0.0001). Homocysteine was deranged in 98% troponin-T positive group and in only 18.06% in troponin-T negative group. The difference was statistically significant (p&lt;0.0001). No significant correlation was found between homocysteine and CK-MB and LDH in troponin-T positive and negative patients individually.&#x0D; Conclusion: This study indicated that homocysteine is sensitive cardiac markers for the diagnosis of MI but shows no specific correlation with other cardiac markers and thus it should be predicted independently.

Liver enzyme trends in patients taking uninterrupted metformin before and after coronary surgery.

Metformin is an oral antidiabetic agent belonging to the biguanide class of antidiabetics. Possible novel applications for metformin in cardiovascular disease might exist. The aim of this study was to verify a possible association between pre-operative metformin administration and protection against ischemia-induced liver injury in diabetic patients undergoing coronary artery bypass grafting (CABG) surgery. A retrospective case-control series was conducted at a single center. Two hundred consecutive diabetic patients underwent isolated on-pump CABG during a 12-month span (July 2015 - July 2016). Metformin was uninterrupted in patients who took this drug prior to CABG; 68 patients were metformin users (34%) while 132 patients were taking other antidiabetic agents (66%). Liver enzymes and other organ markers were consecutively recorded daily for 7 days after surgery and expressed as medians with interquartile range (IQR). Both the metformin and non-metformin group of patients had similar pre-operative demographic characteristics. The median (IQR) post-operative cardiac enzyme creatinine kinase (CK) MB fraction was significantly lower in the metformin group [46.4 U/L (35.8-66.5) vs. 66.5 U/L (44-94.5), P=0.005]. Total bilirubin [0.58 (0.48-0.82) mg/dL vs. 0.67 (0.56-0.95) mg/dL, P=0.021], the transaminase aspartate aminotransferase (AST) [32.5 U/L (25.0-42.0) vs. 37.5 U/L (28.5-56), P=0.011], the transaminases alanine aminotransferase (ALT) [48.5 U/L (40.0-64.0) vs. 57.0 U/L (44.0-77.0), P=0.040] and lactate dehydrogenase (LDH) [320.0 U/L (273.5-367.2) vs. 356.5 U/L (289.5-427), P=0.014] were significantly lower in the metformin group. No differences were noted in clinical outcomes. In this limited retrospective study, the diabetic patients who took metformin before and after undergoing CABG appeared to have a reduced post-operative surge in the total bilirubin and transaminase liver enzymes. Metformin's role in mitigating oxidative stress in liver cells might explain this observation. Further experimental studies are warranted to verify this possible effect.

Effectiveness to identify acute myocardial infarction using the Manchester screening in patients with chest pain at the emergency service.

Among cardiovascular diseases (CVD), acute coronary syndrome (ACS) is the main manifestation, corresponding to signs and symptoms that occur with ischemia and outcome of angina or acute myocardial infarction (AMI). The aim of this study was to investigate the performance of biochemical markers eligible in a chest pain protocol, using Point of care Test (POCT), in patients in a reference emergency room. In this study, 1380 medical records of patients of both genders were evaluated, ranked by applying chest pain protocol using the Manchester Triage System (MTS). Markers for myocardial injury were measured in serial analysis including myoglobin (Mgb), creatine kinase MB fraction mass (CK-MB), and cardiac troponin I (cTnI). Acute myocardial infarction was predominant in males (P<.001), in patients with hypertension (P<.001), and in those with previous myocardial infarction (P<.026) and significant electrocardiogram (ECG) data for AMI screening (P<.001). A multivariate regression model showed as predictors for AMI the variables ECG data by admittance at the emergency room, previous AMI history, levels of both Mgb at the third hour, and cTnI at the sixth hour after admission. This study showed the importance of a rapid and serial test as a cardiac marker for AMI screening, as well as has indicated the importance of time between the onset of chest pain and admission to the emergency room as an efficient aid in diagnosing this life-threatening disease.

Cyclosporine A to reduce myocardial reperfusion injury: A systematic review and meta-analysis of randomized controlled trials

Previous experimental and clinical trials suggest that cyclosporine A (CsA) reduces myocardial ischemia-reperfusion injury (IRI) but its clinical benefits are uncertain. To assess CsA effect on IRI evaluated by cardiac biomarkers. Pubmed, Cochrane, Web of Science and Embase databases were screened for randomized controlled trials assessing at least one cardiac biomarker and comparing CsA to placebo in situations at risk of IRI: acute myocardial infarction (AMI), cardiac surgery and successfully resuscitated cardiac arrest. Main outcome was troponin, creatine kinase (CK) and CK MB fraction (CK-MB) peak and area under the curve (AUC). Secondary outcomes were ST-segment resolution, left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV) and major adverse cardiovascular events (MACE). Risk ratios (RR) for dichotomous data and standard mean differences (SMD) for continuous data were reported with their 95% confidence intervals (CI). Heterogeneity was assessed by sub-group and sensitivity analysis. Six trials were selected totalling 1677 patients with AMI and elective cardiac surgery receiving an intra-venous bolus of CsA or placebo at the time of reperfusion. CsA did not reduce troponin (SMD −0.44, 95% CI [−0.93, 0.05]; P = 0.08) and CK (SMD −0.75, 95% CI [−2.41, 0.91]; P = 0.37) AUC nor troponin (SMD −0.30, 95% CI [−0.72,0.13]; P = 0.17), CK (SMD −0.09, 95% CI [−0.37, 0.20]; P = 0.56) and CK-MB (SMD −0.20, 95% CI [−0.50, 0.09]; P = 0.18) peak in random-effect model (REM), with high heterogeneity. CsA was not associated with significant ST-segment resolution, LVEF improvement or MACE reduction but was associated with an increased LVEDV (SMD 0.13, 95% CI [0.01, 0.25]; P = 0.03) assessed by echography in studies of 100 patients or more, using a REM, with no heterogeneity. Results suggest no benefit from CsA to reduce IRI and potential long-term adverse left ventricular remodelling.

Ergosterol Attenuates LPS-Induced Myocardial Injury by Modulating Oxidative Stress and Apoptosis in Rats

Background/Aims: Ergosterol (ER) is the primary sterol found in fungi and is named after the ergot fungus. A variety of pharmacological activities have been reported for ER, including antioxidative, anti-proliferative, and anti-inflammatory effects, although its role in sepsis remains unclear. Methods: The protective effect of ER on lipopolysaccharide (LPS)-induced sepsis myocardial injury was evaluated both in vivo and in vitro. Rats were pretreated with ER and then with LPS. Histopathology of heart tissues was first performed. Subsequently, the levels of superoxide dismutase (SOD), malondialdehyde (MDA), creatine kinase MB fraction (CK-MB), and lactate dehydrogenase (LDH) in serum and heart tissues were assessed by enzyme-linked immunosorbent assay kits. Western blotting was further used to evaluate the expression of antioxidant proteins (HO-1 and cytochrome c) and apoptosis associated proteins (Bcl-2, Bax, cleaved-caspase-3, cleaved-caspase-9, and cleaved-PARP). In addition, the effects of ER on oxidative stress biomarkers and apoptosis proteins were also detected in LPS-treated H9C2 cells. Moreover, small interfering Nrf2 RNA was transfected to H9C2 cells to study the role of Nrf2 signaling in connection with the protective effects of ER. Results: Pretreatment with ER ameliorated the histopathological changes in heart tissue induced by LPS injection, increased SOD activity, and reduced MDA content, and CK-MB and LDH levels. Furthermore, ER restored the expression of Nrf-2 and HO-1 in rat hearts, attenuating apoptotic damage via up-regulation of Bcl-2 in combination with the inhibition of Bax, cytochrome c, cleaved-caspase-3 and 9, and PARP, as revealed by western blot. When Nrf2 was blocked by siRNA, the effects of ER on SOD and MDA activity, as well as the expression of the antioxidant proteins and apoptosis-associated proteins were abolished. Conclusions: We demonstrated that ER has a cardioprotective effect in LPS-induced sepsis model through modulation of the antioxidant activity and anti-apoptosis effects and this process might be regulated by Nrf2 signaling.

Cardiac Status in Hepatitis B Virus and Hepatocellular Carcinoma in Egyptian Adolescents

Hepatitis B virus (HBV) is the major risk factor of hepatocellular carcinoma (HCC) in all age groups. There is a need to find the effect of them on the cardiac status in adolescence age by laboratory and physical examination for assessment of different outcomes of both diseases. Cross sectional study included 15 adolescents with HBV, another 15 with HBV complicated by HCC and 15 healthy persons served as control with age range 12 up to 18 years (14.4±3.58). They were selected for laboratory interleukin 6 (IL-6), Troponine I and Creatin Kinase MB fraction (CK MB) testing and further were examined at the Cardiology Unit in Pediatric department of Ain Shams University hospitals for complete echocardiographic and anthropometric evaluation. 15 patients have HCC with HBV were examined with mean age 14.15±3.01 years and another 15 are having HCV (14.64±4.13 years). The duration of HCC was 2.16 ± 2.89 years while the exposure of HBV was 2.27 ±3.35 years in the HCV group. Differences were found between both groups regards IL-6 as mean values were 0.26 pg/ml in HBV and 0.721 pg/ml in HCC group while no differences between groups were detected regards cardiac markers ; troponine I and CK MB and anthropometric evaluations. In adolescent patients with HBV and HBV with HCC , there is no change in the cardiac status.

Stress-Induced Cardiomyopathy in Cancer Patients

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