Troponin T Levels Research Articles

Abstract 13069: Left Atrial Mechanics in Patients With Hypertrophic Cardiomyopathy

Background: Patients with hypertrophic cardiomyopathy (HCM) frequently have diastolic dysfunction (DD) characterized by elevated filling pressures. Speckle-tracking analysis of the left atrium (LA) is an imaging tool for quantifying DD, however, its value in HCM is not well established. Methods. Transthoracic echocardiographic images of consecutive HCM patients with a septal thickness ≥15 mm and no aberrant loading conditions at an academic tertiary care center were evaluated. Peak atrial longitudinal strain (PALS) was determined by averaging the atrial strain over all segments in the 4- and 2-chamber views ( Figure ). Results. Among 205 HCM patients, 108 patients (52 years, 40% female) had sinus rhythm and sufficient image quality to be included. The median interventricular wall thickness was 20 mm (IQR 17-23), the relative wall thickness ratio was 0.65 mm (IQR 0.46-0.87), and the LV mass index was 164.0 g/m 2 (IQR 131.5-188.5). The mean PALS was 18.5% (± 8.8%) and did not differ between men and women. PALS significantly (all p <0.05) correlated with septal thickness (r=-0.31), LA volume index (r=-0.60), E/A ratio (r=-0.25), E/E’ (r=-0.63), systolic pulmonary pressure (r=-0.31), and high sensitivity troponin-T levels (r=-0.43). Moreover, PALS correlated with resting gradients in patients with relevant LV outflow tract obstruction (n=53 [49%]; r=-0.29). Among patients who underwent cardiac magnetic resonance imaging (81%), PALS was significantly correlated with LA ejection fraction (r=0.59) and late gadolinium enhancement of the total LV mass (r=-0.42). In addition, PALS was the only echocardiographic parameter reflecting DD that was significantly associated with the presence of LGE (Odds Ratio 0.93, 95%CI 0.88-0.99). Conclusion. PALS is a useful tool for quantifying DD in HCM patients and is associated with the presence of LGE. Future research will need to evaluate its significance in early identification of HCM patients at risk of sudden cardiac death.

Reversible T-wave inversions during left bundle branch area pacing.

Our clinical observation found that T-wave inversions (TWIs) appeared during left bundle branch area pacing (LBBAP); however, the incidence and influencing factors were unclear. The study aimed to investigate the effects of LBBAP on T-wave and explore possible factors associated with TWIs. This was a retrospective cohort study. An electrocardiogram (ECG) was acquired at baseline and after LBBAP. Baseline characteristics, ECG parameters, LBBAP parameters, and troponin T (TnT) levels were compared between the non-TWIs and TWIs groups. Multivariable logistic analyses were performed to adjust for potential confounders to identify the predictive factors of TWIs during LBBAP. A total of 398 consecutive patients who underwent successful LBBAP were assessed for inclusion between May 2017 and Jan 2021, and 264 (66.3%) patients had TWIs. The mean (standard deviation [SD]) baseline QRS duration (QRSd) was longer in the TWIs group compared to the non-TWIs group (125.9 [34.5] ms vs. 98.2 [18.1] ms; P <0.001). Multivariable logistic regression analysis suggested that QRSd >120 ms was an independent predictor for TWIs. TWIs were partially or com-pletely recovered in 151/172 (87.8%) patients during follow-up, the median (interquartile range [IQR]) follow-up duration was 10 days (7 days to 5.5 months). TWIs in patients with complete left bundle branch block (CLBBB) occurred more frequently in inferior wall leads (II, III, and aVF) and anterior wall leads (V1-V4) (P <0.05). Patients with complete right bundle branch block (CRBBB) were more prone to TWIs in high lateral wall leads (I and aVL) (P <0.05). There were no significant differences in TnT levels between the TWIs and non-TWIs groups. TWIs during LBBAP were clinically frequent and recoverable. QRSd >120 ms was independently associated with TWIs.

Inflammatory Glycoprotein YKL-40 Is Elevated after Coronary Artery Bypass Surgery and Correlates with Leukocyte Chemotaxis and Myocardial Injury, a Pilot Study.

The aim of the present study was to investigate the levels of YKL-40 during and after coronary artery bypass grafting surgery (CABG) and to establish possible connections between YKL-40 and markers of oxidative stress, inflammation, and myocardial injury. Patients undergoing elective CABG utilizing cardiopulmonary bypass (CPB) were recruited into the study. Blood samples were collected at the onset of anesthesia, during surgery and post-operatively. Levels of YKL-40, 8-isoprostane, interleukin-8 (IL-8), monocyte chemotactic protein-1 (MCP-1) and troponin T (TnT) were measured by immunoassay. YKL-40 levels increased significantly 24 h after CPB. Positive correlation was seen between post-operative TnT and YKL-40 levels (r = 0.457, p = 0.016) and, interestingly, baseline YKL-40 predicted post-operative TnT increase (r = 0.374, p = 0.050). There was also a clear association between YKL-40 and the chemotactic factors MCP-1 (r = 0.440, p = 0.028) and IL-8 (r = 0.484, p = 0.011) linking YKL-40 to cardiac inflammation and fibrosis following CABG. The present results show, for the first time, that YKL-40 is associated with myocardial injury and leukocyte-activating factors following coronary artery bypass surgery. YKL-40 may be a factor and/or biomarker of myocardial inflammation and injury and subsequent fibrosis following heart surgery.

The Clinical Implementation of NEWS, SOFA, and CALL Scores in Predicting the In-Hospital Outcome of Severe or Critical COVID-19 Patients.

To date, there is no specific validated coronavirus disease 2019 score to assess the disease severity. This study aimed to evaluate the performance of the National Early Warning Score, Sequential Organ Failure Assessment, and Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase scores in predicting the in-hospital outcome of critical or severe coronavirus disease 2019 patients. Single-centered analytical study was carried out in the coronavirus disease 2019 high dependency unit from April to August 2020. National Early Warning Score, Sequential Organ Failure Assessment, and Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase scores were calculated for each critical to severely ill coronavirus disease 2019 patient. The diagnostic accuracy of these 3 scores in determining the in-hospital outcome of coronavirus disease 2019 patients was assessed by area under the receiver operating characteristic curve. The cut-off value of each score along with sensitivity, specificity, and positive and negative likelihood ratio were calculated by Youden index. Predictors of outcome in coronavirus disease 2019 patients were analyzed by Cox-regression analysis. The area under the curve was highest for the Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase score (area under the curve=0.85) while the Sequential Organ Failure Assessment score had an area under the curve of 0.72. The cut-off values for National Early Warning Score score was 8 (sensitivity=72.34%, specificity=76.10%), Sequential Organ Failure Assessment score was 3 (sensitivity=68.97%, specificity=67.42%), and Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase score was 8 (sensitivity=88.89%, specificity=66.67%). The pairwise comparison showed that the difference between the area under the curve of these 3 scores was statistically insignificant (P > .05). The rate of mortality and invasive ventilation was significantly high in groups with high National Early Warning Score, Sequential Organ Failure Assessment, and Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase scores (P > .0001). These 3 scores, age, low platelets, and high troponin-T levels were found to be statistically significant predictors of outcome Conclusion:Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase score had a good area under the curve, the highest sensitivity of its cut-off value, required only 4 parameters, and is easy to calculate so it may be a better tool among the 3 scores in outcome prediction for coronavirus disease 2019 patients.

Predictive value of high-sensitivity troponin for significant coronary artery disease in new-onset atrial fibrillation with rapid ventricular response.

High-sensitivity troponin-T (HS-cTnT) levels are often measured in patients presenting with atrial fibrillation (AF), with many subjected to unnecessary invasive assessments. The significance of a normal or mildly raised HS-cTnT in this context is poorly understood. This study aimed to determine the predictive value of HS-cTnT for significant coronary artery disease (CAD) in new AF with rapid ventricular response. We also compared the discriminative ability of HS-cTnT to suspected angina for significant CAD. We examined patients presenting with new AF to two tertiary Irish centers in a defined period. Those included had HS-cTnT taken at presentation and subsequent ischemic evaluation. Of 5350 cases screened for inclusion, 281 were deemed eligible. Of these, 148 and 133 patients had a positive and negative index HS-cTnT, respectively. Of those with negative HS-cTnT, 13 (9.8%) had significant CAD versus 51 (34.5%) with positive HS-cTnT (P < 0.001). Positive Hs-cTnT status remained significant upon multivariate analysis (OR, 2.9; 95% CI, 1.37-6.14; P = 0.005). A similar model where HS-cTnT was replaced with suspected angina produced an OR of 1.64 (95% CI, 0.75-3.59; P = 0.213). A logistic model determined optimal cutoff value for HS-cTnT to be less than 30 ng/l, producing a negative predictive value of 91.8% and area under the receiver operative curve of 83.36. HS-cTnT exhibits potential as an effective screening biomarker to predict nonsignificant CAD in new rapid AF, allowing more targeted and rationalized ischemic testing. HS-cTnT may also be a more accurate predictor of significant CAD than clinically suspected stable angina.Graphical abstract: http://links.lww.com/MCA/A540.

P.62 Increased skeletal muscle extracellular volume fraction in patients with Becker muscular dystrophy assessed by quantitative magnetic resonance imaging

Quantitative magnetic resonance imaging (MRI) is increasingly proposed in clinical trials related to dystrophinopathies, including Becker muscular dystrophy (BMD). Extracellular volume fraction (ECV) is a candidate variable to characterize muscle tissues microstructure. Previous studies have demonstrated that the myocardium of BMD patients presented increased ECV. Given that cardiac muscle shares important structural features with skeletal muscles, we hypothesize that ECV could also be a sensitive biomarker to monitor pathological alterations of the skeletal muscle structure in BMD patients. We established the sensitivity of ECV quantification using magnetic resonance fingerprinting with water and fat separation (MRF T1-FF) as an imaging biomarker of skeletal muscle tissue alterations in BMD, by comparison with fat fraction (FF) and water relaxation time quantification. Data from the thighs of 28 BMD patients and 8 healthy volunteers were acquired. The MRI exam comprised FF mapping, water T2 mapping and water T1 mapping before and after an intravenous injection of a gadolinium-based contrast agent using MRF T1-FF from which ECV was calculated. Mann-Whitney tests, Kruskal-Wallis tests, ROC curves analysis and Spearman-rank correlation tests were performed. ECV was higher in dystrophic patients than in controls (0.20 [0.16 – 0.28] vs 0.07 [0.06 – 0.07], p<.001). In muscles of BMD patients with normal FF, ECV was also higher than in muscles of healthy controls (0.11 [0.10 – 0.13] vs 0.07 [0.06 – 0.09], p<.001). ECV classified dystrophic muscles with high sensitivity and specificity (AUC, 0.98; 95%CI: 0.96-0.99, p <.001), and correlated significantly with FF (ρ = .62, p < .001), water T2 (ρ = .56, p = .002), Walton score (ρ = .58, p = .001) and serum cardiac troponin-T level (ρ = .63, p < .001). In conclusion, muscle ECV measured with MRF represents a promising imaging biomarker for the early detection of skeletal muscle involvement in patients with Becker muscular dystrophy.

Effect of thymoquinone on sepsis-induced cardiac damage via anti-inflammatory and anti-apoptotic mechanisms.

ObjectiveSepsis is a systemic and deleterious host reaction to severe infection. Cardiac dysfunction is an established serious outcome of multiorgan failure associated with this condition. Therefore, it is important to develop drugs targeting sepsis-induced cardiac damage and inflammation. Thymoquinone (TQ) has anti-inflammatory, anti-oxidant, anti-fibrotic, anti-tumor, and anti-apoptotic effects. This study examined the effects of thymoquinone on sepsis-induced cardiac damage.MethodsMale BALB/c mice were randomly segregated into four groups: control, TQ, cecal ligation and puncture (CLP), and CLP + TQ groups. CLP was performed after gavaging the mice with TQ for 2 weeks. After 48 hours, we estimated the histopathological changes in the cardiac tissue and the serum levels of cardiac troponin-T. We evaluated the expression of factors associated with inflammation, apoptosis, oxidative stress, and the PI3K/AKT pathway.ResultsTQ significantly reduced intestinal histological alterations and inhibited the upregulation of interleukin-6, tumor necrosis factor-α, Bax, NOX4, p-PI3K, and p-AKT. TQ also increased Bcl-2, HO-1, and NRF2 expression.ConclusionThese results suggest that TQ effectively modulates pro-inflammatory, apoptotic, oxidative stress, and PI3K/AKT pathways, making it indispensable in the treatment of sepsis-induced cardiac damage.

Post-operative troponin levels and left ventricular function in patients with d-transposition of the great arteries following the arterial switch operation.

The aim of this study was to assess the significance of post-operative troponin levels as a surrogate for left ventricular (LV) dysfunction measured by global longitudinal strain (GLS) in patients with dextro-transposition of the great arteries (d-TGA) who undergo an arterial switch operation (ASO), and to explore the LV GLS recovery in the mid-term follow-up period. Seventy-eight neonates were included, of whom 41 had troponin-I measurements and 37 had troponin-T measurements. The primary outcome of LV GLS was assessed and compared with healthy controls at the pre-operative stage and time of discharge, 3months, 6months and 12months of age. Secondary outcomes included deaths or transplantations and other clinical markers such as length of hospital stay. D-TGA patients had worse LV GLS post-operatively compared to age-matched controls (p < 0.01) which improved by 12months of age (p = 0.53). No association was found between changes in troponin-I or troponin-T levels and LV GLS at the time of discharge (r = 0.4, p = 0.64 and r = -0.5, p = 0.91, respectively). In addition, there were no deaths or transplantations in this cohort over a period of 12months. LV GLS appears to worsen in the early post-operative period for d-TGA patients who undergo neonatal ASO but this recovers through the first post-operative year. Troponin levels have limited value in predicting early or midterm LV dysfunction and recovery.

Correlation between troponin T and N-Terminal brain natriuretic peptide levels and cardiac structure and function and cardiovascular disease in elderly maintenance hemodialysis patients

With the development of chronic kidney disease (CKD), the patients showed a gradual decline in renal function, which eventually progressed to end-stage renal disease (ESRD), accompanied by various cardiovascular and cerebrovascular events. Maintenance hemodialysis (MHD) is one of the effective methods to treat ESRD, but some patients still die from cardiovascular and cerebrovascular complications. The purpose of this study was to investigate the relationship between troponin T (TnT), n-terminal brain natriuretic peptide (NT-proBNP), cardiac structure and function and cardiovascular disease in maintenance hemodialysis patients. In this experimental study, 100 patients with MHD were randomly selected as research objects. According to the level of NT-proBNP before dialysis, they were divided into two groups, namely the low NT-proBNP group and the high NT-proBNP group. The clinical and biological indicators and the average value of echocardiography were detected in the two groups. The degree of CKD disease was divided into six stages according to GFR, and the influence of different stages on the cardiac function of CKD patients was detected. The experimental results showed that the levels of TnT and NT-proBNP in MHD patients were significantly increased, and the levels of TnT and NT-proBNP and cardiac function were correlated with the patients with cardiovascular diseases. Cardiac ultrasound confirmed that the NT-proBNP level of patients with left ventricular hypertrophy was significantly higher than that of patients without left ventricular hypertrophy, and the difference between the two was statistically significant (P<0.005).

Levels of cardiac troponin-T and LDL-C to HDL-C ratio of hospitalized COVID-19 patients: A case-control study

Background: People with coronavirus disease 2019 (COVID-19) are frequently at higher risk of developing cardiovascular and metabolic disorders, which are strongly related to the development of long-term illness and higher mortality. These effects may be caused by several interrelated processes, including the IL-6 driven cytokine storm or uncontrolled angiotensin II stimulation. In addition, the direct viral infection of cardiac myocytes is thought to cause cardiac injury because it increases metabolic demand, activates the immune system, and causes vasculature disruption. The objective of this study was to determine whether there is a relationship between cardiac troponin-T (cTnT) and low-density lipoprotein cholesterol (LDL-C) to high-density lipoprotein cholesterol (HDL-C) ratio values with COVID-19. Methods: During the data collection stage, 90 participants were included, 45 healthy controls and 45 hospitalized patients diagnosed with COVID-19 using reverse transcription-quantitative PCR (RT-qPCR). Each participant provided 5 ml venous blood to begin analyzing cTnT and LDL-C:HDL-C ratio levels in their blood to see whether there is an association between the level of any of these markers and COVID-19 infection using SPSS version 23. Results: This research reported a significant rise in the measured values of cTnT and LDL-C:HDL-C ratio in patients' blood compared to controls, with P-values of 0.025 and 0.000, respectively, in which alpha values &lt; 0.05, These biomarkers hold the promise in predicting COVID-19 severity, and early treatment may help reduce complications. Conclusions: Due to the fact that cTn is a diagnostic marker of disease activity and a strong independent predictor of negative events, its usage in emergency rooms may well be advantageous. If cTn is elevated, hospitalization may be indicated. A difference in the blood LDL-C:HDL-C ratio of COVID-19 patients demonstrated an association with the illness. Because lipid studies are inexpensive and reliable to do, they may aid clinicians in identifying the severity of COVID-19.

Compatibility and function of human induced pluripotent stem cell derived cardiomyocytes on an electrospun nanofibrous scaffold, generated from an ionomeric polyurethane composite.

Synthetic scaffolds are needed for generating organized neo-myocardium constructs to promote functional tissue repair. This study investigated the biocompatibility of an elastomeric electrospun degradable polar/hydrophobic/ionic polyurethane (D-PHI) composite scaffold with human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs). The composite material was electrospun to generate scaffolds, with nanofibres oriented in aligned or random directions. These features enabled the authors to evaluate the effect of characteristic elements which mimic that of the native extracellular matrix (alignment, chemical heterogeneity, and fiber topography) on hiPSC-CMs activity. The functional nature of the hiPSC-CM cultured on gelatin and Matrigel-coated scaffolds were assessed, investigating the influence of protein interactions with the synthetic substrate on subsequent cell phenotype. After 7 days of culture, high hiPSC-CM viability was observed on the scaffolds. The cells on the aligned scaffold were elongated and demonstrated aligned sarcomeres that oriented parallel to the direction of the fibers, while the cells on random scaffolds and a tissue culture polystyrene (TCPS) control did not exhibit such an organized morphology. The hiPSC-CMs cultured on the scaffolds and TCPS expressed similar levels of cardiac troponin-T, but there was a higher expression of ventricular myosin light chain-2 on the D-PHI composite scaffolds versus TCPS, indicating a higher proportion of hiPSC-CM exhibiting a ventricular cardiomyocyte like phenotype. Within 7 days, the hiPSC-CMs on aligned scaffolds and TCPS beat synchronously and had similar conductive velocities. These preliminary results show that aligned D-PHI elastomeric scaffolds allow hiPSC-CMs to demonstrate important cardiomyocytes characteristics, critical to enabling their future potential use for cardiac tissue regeneration.

Quantum dots / TiO2 hybrid photonic crystal: Fabrication and application for highly sensitive and visible region-responsive biosensor

In this work, by combining a photonic crystal (PhC) and highly luminescent material, we developed an extremely sensitive PhC sensor that allows detection by single wavelength fluorescence intensity change in the visible wavelength region. We fabricated a titanium dioxide (TiO2) PhC containing quantum dots (QDs) inside the PhC structure and confirmed that the fluorescence intensity of the QDs was enhanced. Fluorescence enhancement occurs because of the total reflection and light confinement of the QD fluorescence inside the TiO2 PhC structure. The response to changes in the surrounding refractive index and protein adsorption was confirmed. Furthermore, for biosensing applications, troponin T (TnT), an acute myocardial marker, was determined using an antigen-antibody reaction. It was found that a TnT level of 100 fg/mL, which is considerably less than the cutoff value of 100 pg/mL, was successfully detected. The lower limit of detection (LOD) was found to be 58.2 fg/mL, which is 1/40 of that of the conventional enzyme-linked immunosorbent assay (ELISA) method (LOD: 2 pg/mL). It was demonstrated that the present TiO2 PhC-containing QDs can be used as a sensor device for the highly sensitive detection and determination of disease biomarkers.

Cancer Therapy-Related Cardiac Dysfunction in Patients Treated with a Combination of an Immune Checkpoint Inhibitor and Doxorubicin.

Simple SummaryImmune checkpoint inhibitors (ICIs) have demonstrated promising efficacy against various types of cancer. Although ICIs exhibit strong anti-cancer effects, they can cause adverse cardiac events. However, only a few case reports have focused on whether ICIs and cardiotoxic agents increase the risk of cancer therapy-related cardiac dysfunction (CTRCD). Therefore, we evaluated cardiac dysfunction in patients with sarcoma who were receiving doxorubicin with or without ICI using echocardiography and left ventricular global longitudinal strain (LVGLS). This study shows that ICIs may increase the risk of CTRCD when used concomitantly with cardiotoxic agents. Furthermore, the serum troponin-T level was significantly elevated in patients receiving doxorubicin with ICIs. Therefore, CTRCD should be monitored in patients who are being treated with ICIs by cardiac biomarkers and echocardiography including myocardial strain.Backgrounds: There are scarce data on whether immune checkpoint inhibitors (ICIs) increase the risk of cardiac dysfunction when used with cardiotoxic agents. Thus, we evaluated cardiac dysfunction in patients with sarcoma receiving doxorubicin with or without ICI using echocardiography and left ventricular global longitudinal strain (LVGLS). Methods: A total of 95 patients were included in this study. Echocardiography and LVGLS were evaluated at baseline and follow-up (at 3 and 6 months of chemotherapy) and compared with the doxorubicin (Dox; n = 73) and concomitant ICI with doxorubicin (Dox-ICI; n = 22) groups. Cancer therapy-related cardiac dysfunction (CTRCD) was defined as a left ventricular ejection fraction (LVEF) drop of >10% and LVEF of <50% (definite CTRCD), LVEF drop of >10%, LVEF of ≥50%, and LVGLS relative reduction of >15% (probable CTRCD) at six months. Results: There were no significant differences in age, cumulative dose of doxorubicin, and cardiovascular risk factors between the two groups. At baseline, the LVEF was similar in the Dox and Dox-ICI groups (p = 0.493). In the Dox group, LVEF decreased to 59 ± 6% (Δ −7 ± 1.3%, p < 0.001) and LVGLS decreased from −17.3 ± 3.2% to −15.4 ± 3.2% (Δ −10.1 ± −1.9%, p < 0.001) at six months. In the Dox-ICI group, LVEF decreased to 55 ± 9% (Δ −9 ± 2.1%, p < 0.001), along with a significant decrease in LVGLS (from −18.6 ± 1.9% to −15.3 ± 3.6%, Δ −12.4 ± −2.4%, p < 0.001). Over a median follow-up of 192 days, there were no cases with clinical manifestations of fulminant myocarditis. In the Dox group, definite and probable CTRCD were observed in seven (10.1%) and five (7.4%) patients, respectively. In the Dox-ICI group, definite and probable CTRCD were observed in four (19%) and four (19%) patients, respectively. The total number of patients who developed CTRCD was significantly higher in the Dox-ICI group than in the Dox group (38.1% vs. 17.4%, p = 0.042). Serum troponin-T level was significantly higher in the Dox-ICI group than in the Dox group (53.3 vs. 27.5 pg/mL, p = 0.023). Conclusions: ICIs may increase the risk of CTRCD when used with cardiotoxic agents. CTRCD should be monitored in patients treated with ICIs by cardiac biomarkers and echocardiography, including LV-GLS.

EFFECT OF EXTRACT ACALYPHA INDICA L. ON LIPID PROFILE AND CARDIAC TROPONIN-T OF RATS FED WITH HIGH FRUCTOSE AND CHOLESTEROL DIET

Consumption of high-fructose and high-fat foods has increased dramatically in the last decade has been developing metabolic syndrome. This study aimed to investigate how Acalypha indica L. impacts cardiac damage and hyperlipidemia, leading to metabolic syndrome through a high-fructose-cholesterol diet (HFCD) in rats. Twenty-four Sprague-Dawley rats were induced with HFCD for 12 weeks. These rats were randomly classified into four treatment groups: HFCD, 31 mg/kg BW/day of gemfibrozil, 400 mg/kg BW/day of Acalypha indica, and 400 mg/kg BW/day of Acalypha indica combined with 31 mg/kg BW/day of gemfibrozil. They were then treated according to their respective groups for eight weeks. Cardiac damage parameters used in this study were troponin and lipid profile. After eight weeks of treatment, there were significant reductions in lipid profile (p&lt;0.001), the most significant in the Acalypha indica + gemfibrozil group, with triglyceride levels decreasing as much as 63.57%, low-density lipoprotein 55.33%, total cholesterol 51.59%, troponin 73.17%, and high-density lipoprotein level increased by 80.55% compared to the group without therapy. Therefore, it was concluded that HFCD could increase the risk of cardiac damage through rising lipid profile and troponin-T levels. Administration of Acalypha indica as an adjuvant to gemfibrozil was proven to give the highest protection to the heart.

The effect of fenofibrate, a peroxisome proliferator-activated receptor α agonist, on cardiac damage from sepsis in BALB/c mice.

Cardiac dysfunction can be a fatal consequence of sepsis and lead to increased inflammatory responses or reduced fatty acid oxidation and final ATP depletion. Fenofibrate, which is an agonist of peroxisome proliferator-activated receptor α, has been used primarily in hypercholesterolemia and mixed dyslipidemia. Recent studies found that fenofibrate could alleviate energy metabolism and inflammation caused by cardiac damage during sepsis, and thus it had been paid great attention. This study was to investigate the possible protective roles of fenofibrate against cardiac damage in septic BALB/c mice. Methods: Forty male BALB/c mice aged 8 weeks old were divided randomly into four groups: control group; fenofibrate group; cecal ligation and puncture (CLP) group; and fenofibrate + CLP group. After administering fenofibrate or saline for 2 weeks, CLP was performed. Cardiac tissue and plasma were obtained 48 hours later. Plasma Troponin-T (Tnt), ATP, ADP and reactive oxygen species (ROS) levels were determined. PPARα and 53 protein levels were detected using western blotting. IL-6 and tumor necrosis factor-α (TNFα) were also assayed. We found that fenofibrate decreased plasma cTnT, ROS and increased the ratio of ATP/ADP. The elevations of IL-6, TNFα and P53 induced by sepsis were significantly suppressed by fenofibrate. Our results suggest that fenofibrate can regulate energy metabolism efficiently, which makes it a possible agent for treating sepsis-induced cardiac damage.

Effects of early myocardial reperfusion and perfusion on myocardial necrosis/dysfunction and inflammation in patients with ST-segment and non-ST-segment elevation acute coronary syndrome: results from the PLATelet inhibition and patients Outcomes (PLATO) trial.

AimsRestoration of myocardial blood flow and perfusion during percutaneous coronary intervention (PCI) measured using Thrombolysis in Myocardial Infarction (TIMI) flow grade (TFG) and perfusion grade (TMPG) is associated with improved outcomes in acute coronary syndrome (ACS). Associations between TFG/TMPG and changes in biomarkers reflecting myocardial damage/dysfunction and inflammation is unknown.Methods and resultsAmong 2606 patients included, TFG was evaluated in 2198 and TMPG in 1874 with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment ACS (NSTE-ACS). Biomarkers reflecting myocardial necrosis [troponin T (TnT)], myocardial dysfunction [N-terminal prohormone brain natriuretic peptide (NT-proBNP)], inflammation [interleukin-6 (IL-6) and C-reactive protein (CRP)], and oxidative stress/ageing/inflammation [growth differentiation factor-15 (GDF-15)] were measured at baseline, discharge, and 1- and 6-month post-randomization. Associations between TFG/TMPG and changes in biomarker levels were evaluated using the Mann–Whitney–Wilcoxon signed test. In total, 1423 (54.6%) patients had STEMI and 1183 (45.4%) NSTE-ACS. Complete reperfusion after PCI with TFG = 3 was achieved in 1110 (85.3%) with STEMI and in 793 (88.5%) with NSTE-ACS. Normal myocardial perfusion with TMPG = 3 was achieved in 475 (41.6%) with STEMI and in 396 (54.0%) with NSTE-ACS. Levels of TnT, NT-proBNP, IL-6, CRP, and GDF-15 were substantially lower at discharge in patients with complete vs. incomplete TFG and STEMI (P < 0.01). This pattern was not observed for patients with NSTE-ACS. Patients with normal vs. abnormal TMPG and NSTE-ACS had lower levels of NT-proBNP at discharge (P = 0.01).ConclusionsSuccessful restoration of epicardial blood flow in STEMI was associated with less myocardial necrosis/dysfunction and inflammation. Attainment of normal myocardial perfusion was associated with less myocardial dysfunction in NSTE-ACS.

Clinical implications of troponin-T elevations following TAVR

Abstract Funding Acknowledgements Type of funding sources: None. Background Baseline and post-procedural elevations in serum troponin-T levels are associated with increased morbidity and mortality following transcatheter aortic valve replacement (TAVR). However, the prognostic impact of change in serum troponin-T level following TAVR remains unknown. Methods Among the patients with severe aortic stenosis who underwent TAVR, those with baseline serum troponin-T level ≥51.5 ng/L were excluded. The impact of increases in serum troponin-T level to an abnormally high range (≥51.5 ng/L) following TAVR on 2-year cardiovascular death or heart failure readmissions was investigated. Results Among 189 included patients (median 86 years old, 28% men), serum troponin-T level increased in 79 patients following TAVR. An increase in serum troponin-T was associated with a higher rate of 30-day adverse events, predominantly due to pacemaker implantation for complete atrio-ventricular block, and a higher 2-year cumulative incidence of the primary endpoint (hazard ratio 3.97, 95% confidence interval 1.51-10.4, p = 0.005) adjusted for the use of balloon-expandable valve and post-TAVR pacemaker implantation (Figure 1). Conclusion Post-procedural increase in serum troponin-T level was associated with adverse clinical outcomes following TAVR. Abstract Figure. Cumulative incidence of endpoint

Clinical predictors of acute cardiac injury and normalization of troponin after hospital discharge from COVID-19.

SummaryBackgroundAlthough acute cardiac injury (ACI) is a known COVID-19 complication, whether ACI acquired during COVID-19 recovers is unknown. This study investigated the incidence of persistent ACI and identified clinical predictors of ACI recovery in hospitalized patients with COVID-19 2.5 months post-discharge.MethodsThis retrospective study consisted of 10,696 hospitalized COVID-19 patients from March 11, 2020 to June 3, 2021. Demographics, comorbidities, and laboratory tests were collected at ACI onset, hospital discharge, and 2.5 months post-discharge. ACI was defined as serum troponin-T (TNT) level >99th-percentile upper reference limit (0.014ng/mL) during hospitalization, and recovery was defined as TNT below this threshold 2.5 months post-discharge. Four models were used to predict ACI recovery status.ResultsThere were 4,248 (39.7%) COVID-19 patients with ACI, with most (93%) developed ACI on or within a day after admission. In-hospital mortality odds ratio of ACI patients was 4.45 [95%CI: 3.92, 5.05, p<0.001] compared to non-ACI patients. Of the 2,880 ACI survivors, 1,114 (38.7%) returned to our hospitals 2.5 months on average post-discharge, of which only 302 (44.9%) out of 673 patients recovered from ACI. There were no significant differences in demographics, race, ethnicity, major commodities, and length of hospital stay between groups. Prediction of ACI recovery post-discharge using the top predictors (troponin, creatinine, lymphocyte, sodium, lactate dehydrogenase, lymphocytes and hematocrit) at discharge yielded 63.73%-75.73% accuracy.InterpretationPersistent cardiac injury is common among COVID-19 survivors. Readily available patient data accurately predict ACI recovery post-discharge. Early identification of at-risk patients could help prevent long-term cardiovascular complications.FundingNone

Remote ischemic preconditioning can extend the tolerance to extended drug-coated balloon inflation time by reducing myocardial damage during percutaneous coronary intervention

BackgroundRemote ischemic preconditioning (RIPC) alleviates myocardial ischemia-reperfusion injury (IRI) that occurs during percutaneous coronary intervention (PCI) and increases the myocardial tolerance to ischemia and hypoxia. Prolonged inflation time of drug-coated balloons (DCBs) can improve the treatment effects of PCI and the long-term prognosis of patients. This study investigated whether preoperative RIPC improves the tolerance to extended DCB inflation time. Methods and resultsOverall, 345 patients with coronary artery disease (CAD) were enrolled; 90, 96, 83, and 76 of these were randomized into the upper limb RIPC, lower limb RIPC, upper limb control, and lower limb control groups, respectively. Their baseline data were collected. Data on cardiac markers were analyzed. The DCB inflation time was recorded. The baseline data and cardiac marker levels before operation did not differ between RIPC and control groups. The post-PCI high-sensitivity troponin-T levels were lower in the RIPC groups (35.81 ± 14.02 and 34.65 ± 14.86 pg/mL) than in the control groups (41.63 ± 18.31 and 42.24 ± 14.38 pg/mL) (P = 0.001). The DCB inflation tolerance time was higher in the lower limb RIPC group (120 s [120,120]) than in the upper limb RIPC group (120 s [110,120]), and was the lowest in the upper limb control (100 s [90, 120]) and the lower limb control (100 s [90, 115]) groups (P < 0.001). ConclusionsRIPC reduces the level of myocardial damage that occurs during PCI and prolongs tolerance to increased DCB inflation time. The larger the ischemic area in RIPC, the better the improvement in the tolerance to extended DCB inflation time.

Value of troponin T measurements for prediction of postoperative course and length of ICU stay of children after surgical correction of congenital heart disease.

The development of surgical and anaesthetic techniques improved the outcomes in children with congenital heart disease (CHD). After repair of defects using cardiopulmonary bypass (CPB) children often require prolonged respiratory or inotropic support in the intensive care unit (ICU). The aim of the study was to assess troponin T (TnT) values as a predictor of postoperative requirements and ICU length of stay (ICU-LOS) after cardiac surgery. We included 41 patients who underwent corrective surgery for CHD between August and December 2017. TnT level was measured after induction of anaesthesia, 12 h after CPB (t2) and 24 h following CPB (t3). The Aristotle Basic Score for procedure complexity was calculated, total times of CPB and aortic cross-clamping were measured, and maximal Vasoactive-Inotropic Score and ICU-LOS were determined. Statistical relationships between TnT levels and the mentioned parameters were estimated. The median age of the patients was 37 months (14 days to 17 years). Three patients died. The median ICU-LOS was 42.7 hours. A positive correlation was found between ICU-LOS and TnT values at t2 ( Rs = 0.62, P = 0.008) and t3 ( Rs = 0.44, P = 0.018). TnT concentrations at t2 correlated significantly with: Aristotle score ( Rs = 0.50, P = 0.001), total time of CPB ( R s =0.58, P = 0.001), CC time ( Rs = 0.47, P = 0.002) and VIS ( Rs = 0.42, P = 0.001). TnT levels did not discriminate between survivors and non-survivors. Troponin T concentration is a useful tool to anticipate postoperative course and ICU-LOS in children after cardiac surgery.