Maximum Troponin Research Articles

The role of biomarkers on hemodynamics in atherosclerotic artery

Atherosclerosis, a chronic inflammatory cardiovascular disease, leads to arterial constriction caused by the accumulation of lipids, cholesterol, and various substances within artery walls. Such plaque can rupture, resulting in a blood clot that obstructs major arteries and may initiate myocardial infarction, ischemic stroke, etc. Atherosclerotic plaque formation begins with the accumulation of foam cells and macrophages within the intima layer of the arterial wall. At the latter stage, the smooth muscle cells migrated from deeper artery wall layers, contributing to the fibrous cap formation and plaque stabilizing. A developed plaque gradually enters the lumen and narrows down the lumen to impede blood flow. We introduce a two-phase and macroscopic model to investigate the progression of plaque growth in its advanced stage and analyze the minimum gap (Lumen Clearance) within an atherosclerotic artery so that blood cells can pass through. Cardiac troponin, a high specificity and sensitivity biomarker, facilitates early detection of elevated myocardial infarction, ischemic stroke risks, etc. This study aims at establishing a relationship between the troponin concentration in atherosclerotic arteries and their internal clearance, which could significantly improve our understanding of disease progression. Our observations show that the plaque undergoes rapid evolution in its initial stages, gradually slowing down over time to reach a stable state. A positive correlation exists between the maximum plaque depth and cardiac troponin concentration in the blood. However, the lumen clearance exhibits the opposite behavior. The speed of blood cells slows down at an enhanced plaque depth within atherosclerotic arteries.

Skin manifestations and related clinical characteristics of Multisystem Inflammatory Syndrome in Children (MIS-C): a descriptive retrospective cohort study at Texas Children’s Hospital

BackgroundLittle is known about the dermatologic manifestations of MIS-C in children and adolescents ObjectiveWe sought to describe the demographic background, key clinical features, and the clinical consequences of developing rash manifestations in MIS-C patients at Texas Children’s Hospital. MethodsDescriptive retrospective cohort study of 290 hospitalized eligible patients between May 2020 and April 2022. ResultsAmong MIS-C patients, 51% exhibited a rash. We found that younger children (8.62 vs. 9.49 years of age, p=0.006) and white children (p=0.002) had a higher likelihood of developing a rash in association with MIS-C. Additionally, patients without a rash had increased maximum troponin levels (0.11 ng/mL vs. 0.07 ng/mL, p=0.02) and a higher incidence of cardiac involvement (83.1% vs. 72.3%, p=0.03) compared to those with a rash but did not significantly affect the length of hospital stay or clinical course. The most commonly observed rash was an erythematous and maculopapular rash on the trunk and/or extremities. LimitationsRash characteristics were initially described by a variety of physicians on the pediatric primary care services. ConclusionRash manifestations in MIS-C patients is associated with lower Cardiac involvement and decreased troponin levels.

Optimal timing of revascularization for patients with non-ST segment elevation myocardial infarction and severe left ventricular dysfunction.

Optimal timing of revascularization for patients who presented with non-ST segment elevation myocardial infarction (NSTEMI) and severe left ventricular (LV) dysfunction is unclear. A total of 386 NSTEMI patients with severe LV dysfunction from the nationwide, multicenter, and prospective Korea Acute Myocardial Infarction Registry V (KAMIR-V) were enrolled. Severe LV dysfunction was defined as LV ejection fraction ≤ 35%. Patients with cardiogenic shock were excluded. Patients were stratified into two groups: PCI within 24 hours (early invasive group) and PCI over 24 hours (selective invasive group). Primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) including all-cause death, non-fatal MI, repeat revascularization, and stroke at 12 months after index procedure. Early invasive group showed higher incidence of in-hospital death (9.4% vs 3.3%, P = .036) and cardiogenic shock (11.5% vs 4.6%, P = .030) after PCI. Early invasive group also showed higher maximum troponin I level during admission (27.7 ± 44.8 ng/mL vs 14.9 ± 24.6 ng/mL, P = .001), compared with the selective invasive group. Early invasive group had an increased risk of 12-month MACCE, compared with selective invasive group (25.6% vs 17.1%; adjusted HR = 2.10, 95% CI 1.17-3.77, P = .006). Among NSTEMI patients with severe LV dysfunction, the early invasive strategy did not improve the clinical outcomes. This data supports that an individualized approach may benefit high-risk NSTEMI patients rather than a routine invasive approach.

Troponin levels in transient ischemic attack and ischemic stroke: does “transient” in your brain mean “better” for your heart?

PurposeTransient ischemic attack (TIA) is defined as a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction. In this type of ischemic event, there are no data about a possible cardiac injury tested with troponin. After a stroke, it is well established the cardiac involvement due to a neuro-inflammatory response (recently defined as Stroke Heart Syndrome). The aim of this study is to compare the troponin elevation after a stroke with the troponin elevation after a TIA. Materials and methodsThis is a retrospective, single center study on 565 patients (73 TIAs, 492 stroke). We collected demographic characteristics, cardiovascular risk factors, cardiac data such as troponin, NT-proBNP, left atrial dilatation, etiology of the ischemic event (TOAST classification). ResultsWe compare IS and TIA for each TOAST subtype. In all groups no substantial differences were found in demographic and past medical history (p > 0.05). However, the maximum troponin level reached were significantly lower in TIAs than IS (p < 0.05), except in lacunar etiology were troponin elevation was low also in IS group. We found a trend in favor to IS in the rise and fall troponin elevation over 30% in all the TOAST subgroups, but only in the cryptogenic etiology the difference was significant. About the others cardiac markers of injury, a significant higher rate of elevated NT-proBNP was found in the IS cohort. ConclusionsTroponin level after TIAs is significantly lower than after IS. Troponin elevation after an ischemic event may be more relevant in patients with higher NT-proBNP levels and older age. More studies are needed to better understand the pathophysiology of this phenomenon after an ischemic event.

Development and validation of a machine learning predictive model for perioperative myocardial injury in cardiac surgery with cardiopulmonary bypass

BackgroundPerioperative myocardial injury (PMI) with different cut-off values has showed to be associated with different prognostic effect after cardiac surgery. Machine learning (ML) method has been widely used in perioperative risk predictions during cardiac surgery. However, the utilization of ML in PMI has not been studied yet. Therefore, we sought to develop and validate the performances of ML for PMI with different cut-off values in cardiac surgery with cardiopulmonary bypass (CPB).MethodsThis was a second analysis of a multicenter clinical trial (OPTIMAL) and requirement for written informed consent was waived due to the retrospective design. Patients aged 18–70 undergoing elective cardiac surgery with CPB from December 2018 to April 2021 were enrolled in China. The models were developed using the data from Fuwai Hospital and externally validated by the other three cardiac centres. Traditional logistic regression (LR) and eleven ML models were constructed. The primary outcome was PMI, defined as the postoperative maximum cardiac Troponin I beyond different times of upper reference limit (40x, 70x, 100x, 130x) We measured the model performance by examining the area under the receiver operating characteristic curve (AUROC), precision-recall curve (AUPRC), and calibration brier score.ResultsA total of 2983 eligible patients eventually participated in both the model development (n = 2420) and external validation (n = 563). The CatboostClassifier and RandomForestClassifier emerged as potential alternatives to the LR model for predicting PMI. The AUROC demonstrated an increase with each of the four cutoffs, peaking at 100x URL in the testing dataset and at 70x URL in the external validation dataset. However, it’s worth noting that the AUPRC decreased with each cutoff increment. Additionally, the Brier loss score decreased as the cutoffs increased, reaching its lowest point at 0.16 with a 130x URL cutoff. Moreover, extended CPB time, aortic duration, elevated preoperative N-terminal brain sodium peptide, reduced preoperative neutrophil count, higher body mass index, and increased high-sensitivity C-reactive protein levels were identified as risk factors for PMI across all four cutoff values.ConclusionsThe CatboostClassifier and RandomForestClassifer algorithms could be an alternative for LR in prediction of PMI. Furthermore, preoperative higher N-terminal brain sodium peptide and lower high-sensitivity C-reactive protein were strong risk factor for PMI, the underlying mechanism require further investigation.

PREDICTIVE VALUE OF FIBROSIS-4 INDEX FOR HIGHER TROPONIN LEVELS IN ACUTE CORONARY SYNDROME

Objective: Non-alcoholic fatty liver disease, a condition that affects nearly one-third of the population, is associated with cardiovascular disease and is the leading cause of death. Studies have found that peak troponin level is a strong predictor of all- cause death and infarct area width in the left ventricle after acute coronary syndrome. The fibrosis-4 (FIB-4) index is a noninvasive clinical tool that combines four laboratory parameters to measure liver fibrosis. The relationship between the FIB-4 index and peak troponin level is unclear. We speculated that a higher FIB-4 index might be associated with higher peak troponin levels, as it is linked to cardiovascular disease. We aimed to explore the relationship between peak troponin levels and the FIB-4 index in patients with acute coronary syndrome. Material and Methods: This was an observational, cross- sectional cohort study. A total of 302 inpatients with acute coronary syndrome admitted to our clinic between June and September 2023 were enrolled. The FIB-4 index and peak troponin levels were evaluated. The maximum mean troponin level was determined, and two patient groups were formed and compared according to whether it was below or above this level. Results: We demonstrated for the first time that the FIB-4 index is a strong indicator of peak troponin levels in patients with acute coronary syndrome (odds ratio: 2.301, 95% CI 1.667-3.172, p

Dynamic assessment of T-lymphocytes and humoral immunity in patients with acute coronary syndrome, with and without COVID-19, depending on the content of CD3+CD8+T-lymphocytes

Objective: to evaluate the dynamics of the T- and B-cell immunity in patients with acute coronary syndrome (ACS) who have and have not had COVID-19, depending on the number of CD3+CD8+T-lymphocytes.Materials and methods: 65 men with ACS who underwent coronary artery stenting were examined. Immunological parameters were studied using flow cytometry, a complete blood count at baseline and 28 days after admission.Results: The maximum troponin level was observed in individuals with ACS who had recovered from COVID-19 and had a normal level of CD3+CD8+T cells. Stent thromboses and deaths occurred only among patients with a history of COVID-19, mainly with reduced CD3+CD8+T- cells, for which indicators of immune status were determined over time. The absolute numbers of T lymphocytes, T helper cells, late activated T lymphocytes, B lymphocytes (CD3-CD19+CD5+), B lymphocytes (CD45+CD3-CD19+) were minimal in individuals with low CD3+CD8+ T lymphocytes who had previously suffered from COVID-19, and significantly increased in their dynamics after 28 days. Natural killer cells significantly increased in dynamics in patients with initially low and normal CD3+CD8+T-lymphocytes who suffered from COVID-19.Conclusions: after stenting of the coronary arteries over time, in people with reduced CD3+CD8+Tlymphocytes and patients with COVID-19, T-lymphocytes (CD45+CD3+CD19-), T-helper cells, CD3+CD8+T-lymphocytes significantly increased, T-NK lymphocytes, NK lymphocytes, late-activated T-lymphocytes, T-regulatory lymphocytes and late-activated T-regulatory cells, B-lymphocytes, immunoglobulin G and complement fragment C3a decreased. T-regulatory lymphocytes and late-activated T-regulatory cells were significantly reduced in patients without prior COVID-19 with baseline low CD3+CD8+T-lymphocytes. In individuals with normal CD3+CD8+T-lymphocytes who recovered from COVID-19, T-lymphocytes (CD45+CD3+CD19-), NK-lymphocytes, and late-activated T-lymphocytes increased over time.

Baseline predictors of final infarct size in patients with ST elevation myocardial infarction undergoing primary PCI

Abstract Background In patients with coronary artery disease, the presence and extent of myocardial scar determined from cardiac magnetic resonance (CMR) imaging have recognized associations with major adverse cardiac events. Therefore, in patients presenting with ST elevation myocardial infarction (STEMI), early prediction of final infarct size (IS) has important prognostic and therapeutic implications. Purpose We sought to determine the predictors of final IS from baseline clinical, laboratory, and CMR imaging variables in patients presenting with STEMI and undergoing successful primary PCI (pPCI). Methods After successful pPCI, 76 STEMI patients underwent baseline (within 48-hours) and 3-months follow-up CMR imaging. The baseline CMR study was used to measure left ventricular (LV) volumes, ejection fraction (EF), and global longitudinal strain (GLS), the latter calculated using feature tracking from cine images. Final IS was measured in the 3-months follow up study using signal intensity quantification by the full width at half maximum method from late gadolinium enhancement images and expressed as a percentage of the total LV mass. Serum ST2 was drawn within 48 hours of STEMI presentation. Maximum values of ECG ST elevation prior to pPCI and serum Troponin I during index hospitalization were measured. Non-collinear baseline variables deemed significantly associated with the final IS on univariable linear regression and captured in all patients were entered into a multivariable model, adjusting for age and sex. Results Mean age was 54.1±10.9 years, 64 patients (78%) being males. Mean LV EF was 43.5±9.8%. Univariable predictors of final IS included hypertension, baseline maximum troponin, ST2, maximum ST elevation, LV volumes and EF, GLS, total angiographic procedure time, the presence of multi-vessel CAD, use of thrombectomy, TIMI flow and myocardial blush grades at baseline and after wiring, and prescription of loop diuretics and potassium-sparing diuretics on discharge (Table 1). A final multivariable linear model was constructed including age, sex, maximum troponin, maximum ST elevation, ST2, LV EF and GLS. In this model, baseline LV EF, maximum troponin, and maximum ST elevation remained independently associated with the final IS. Respective beta coefficients [95% CI] were -0.63 [-1- (-0.26)], 0.22 [0.11-0.33], and 0.90 [0.22-1.58]; p=0.001, &amp;lt;0.001, and 0.01) (Table 2; adjusted R2=0.6, p&amp;lt;0.001). ST2 and GLS were no longer associated with the IS. Conclusion After successful pPCI, baseline LV EF, maximum troponin I, and maximum ST elevation were independent predictors of final IS. These simple markers can identify patients at high risk of final IS who might benefit from advanced therapeutics. Future studies are warranted to confirm the prognostic value of risk scores incorporating these markers. Advanced laboratory (ST2) and imaging (strain) markers were not independently associated with IS.

Developing a brief intervention to communicate cardiovascular risk to patients presenting to the emergency department with chest pain: a co-production approach

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Brittish Heart Foundation Background The majority of patients who present to the Emergency Department with suspected acute coronary syndrome (ACS) will be discharged once ACS has been ruled out. High-sensitivity cardiac troponin (hs-cTn) is a highly specific biomarker for myocardial injury and is the biomarker of choice for the diagnosis of ACS. However, our previous research on hs-cTn has demonstrated that patients with elevated levels that do not meet the diagnostic threshold for ACS are at increased risk of future cardiac events. These patients are often discharged with no further investigation or understanding of their risk of future cardiac events, despite the potential benefits of preventative strategies. Purpose The aim of this study was to co-design a brief intervention with patients and healthcare professionals to promote cardiovascular health in patients where the diagnoses of ACS has been ruled out but hs-cTn concentrations indicate higher risk of future cardiac events. Methods Patients who presented to the Emergency Department with symptoms suggestive of ACS and a maximum high-sensitivity troponin between 5 ng/L and the 99th centile were invited to attend a focus group or participate in one-to one interviews. We also interviewed healthcare professionals involved in the care of this group. Patients were recruited using electronic medical records and staff were recruited through social media and posters. Recruitment continued until data saturation was reached. The data was analyzed using thematic analysis. We created protypes based upon the initial data which we presented back to patients and staff for feedback to help refine our brief intervention. Results We identified several themes from the data which included; experience of the Emergency Department, previous experience of cardiovascular risk communication, desired information, format of intervention, delivery mode of intervention, timing of delivery, language used and potential barriers. The patients did not have strong preferences on what information should be included in the intervention, however, most patients were receptive to receiving information about their cardiovascular risk guided by hs-cTn. Patients voiced that the intervention should not contain any medical terminology and information should be understood by a lay audience. Many patients and staff felt that the pressures currently faced in the Emergency Department may act as a barrier in delivering the cardiovascular brief intervention. Conclusion We have co-produced a cardiovascular brief intervention in collaboration with patients and healthcare professionals. The effect of this brief intervention on cardiovascular outcomes will be tested in a future randomised controlled trial.

Correlation between novel echocardiographic indices and biomarkers of myocardial injury in patients with NSTEMI

Abstract Funding Acknowledgements Type of funding sources: None. Introduction / Purpose The extent of myocardial injury is a prognostic factor in patients with myocardial infarction presenting without persistent ST elevation (NSTEMI). The purpose of this study was the assessment of possible correlation between novel echocardiographic indices and biomarkers of myocardial injury in patients with NSTEMI and normal left ventricular ejection fraction (LVEF). Methods Patients with NSTEMI (18 to 80 years old) who were examined at the echocardiography laboratory of our general hospital, from May 2021 until August 2022, were enrolled in this study. All patients had no former history of cardiac disease or other significant comorbidities, and they all had LVEF ≥55% and normal wall motion score index. After coronography all of them were diagnosed with significant coronary artery disease. Among the novel echocardiographic indices, global longitudinal strain (GLS), and the parameters of myocardial work, global work index (GWI), global constructive work (GCW), global wasted work (GWW) και global work efficiency (GWE) were examined. The biomarkers were maximum high sensitive troponin I (hsTNI) during hospitalization, creatine phosphokinase (CPK) and its myocardial isoenzyme (CK-MB). Correlation between the variables was examined with Spearman method, and a p value &amp;lt;0.05 was considered statistically significant. Results In this study 34 patients with NSTEMI (26 males), of mean age 60.1 years (SD 10.5 years) participated. Median |GLS| was 17.9%, GWI 1957.7mmHg%, GCW 2231.0mmHg%, GWW 141.7mmHg% and GWE 92.2% (Table 1). As for the biomarkers, median maximum hsTNI value was 1718.0ng/l, CPK 172.0U/l and CK-MB 31.0U/l. A negative correlation was shown between hsTNI and GWE (Spearman’s rs =−0.515, p = 0.002), and a positive between hsTNI and GWW (Spearman’s rs =−0.426, p = 0.013). Also, CK-MB values had a negative correlation with |GLS| (Spearman’s rs =−0.411, p = 0.017) and GWE (Spearman’s rs =−0.425, p = 0.014). No correlation was found between CPK and the echocardiographic indices. Conclusion Novel echocardiographic indices were correlated with biomarkers of myocardial injury in patients presenting with NSTEMI and normal LVEF.

Prediction of in-hospital mortality in patients with acute pulmonary embolism requiring invasive mechanical ventilation: comparation of risk scores

Abstract Funding Acknowledgements Type of funding sources: None. Introduction High-risk pulmonary embolism (PE) is a life-threatening disorder associated with high mortality and morbidity. Multiple scores are used to predict in-hospital mortality of patients admitted to intensive care units. The purpose of this study is to assess which risk score is best at predicting in-hospital mortality in a specific population of patients requiring invasive mechanical ventilation. Methods Retrospective analysis of 33 patients admitted for high-risk pulmonary embolism requiring invasive mechanical ventilation in a general intensive care unit during a period of 15 years. Clinical, analytical, and imaging parameters were evaluated. The PESI, Apache II, SAPS II, and SOFA scores were obtained at ICU admission. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of each score for in-hospital mortality. Results Mean age was 59,1±16 years; 55% were men. 27% presented with a cardiorespiratory arrest at admission. Mean values risk scores were: PESI 138±51, Apache II 23±9, SAPS II 49±23, and SOFA 8±3. In-hospital mortality was 45,4%. The mean duration of hospitalization was 14,8±17,9 days. Mean pulmonary systolic arterial pressure was 51,5±14,63mmHg. Mean values of maximum troponin I and d-dimers were 2,97±7,99 and 6603±5541 ng/mL, respectively. ROC curve analysis revealed that Apache II (AUC 0,752; p=0,02; CI 95% 0,58;0,92), SAPS II (AUC 0,718; p=0,04; CI 95% 0,52;0,91) and PESI (AUC 0,754; p=0,02; CI 95% 0,6;0,91) had best predictive performance for in-hospital mortality compared to SOFA (AUC 0,641; p=0,2; CI 95% 0,42;0,9). The following cut-off values were obtained: PESI of 130 (sensitivity (S)≈85% and specificity (E)≈53%), Apache II of 26 (S≈62% and E≈77%), and SAPS II of 52 (S≈69% and E≈70%). Conclusion In this population, PESI, Apache II, and SAPS II scores were better predictors of in-hospital compared to SOFA score.

Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia.

Our object was to examine how the pre- and post-pandemic COVID-19 impacted the care of acute ST-segment elevation myocardial infarction (STEMI) patients in county hospitals. Using January 20, 2020, as the time point for the control of a unique coronavirus pneumonia epidemic in Jieshou, 272 acute STEMI patients were separated into pre-epidemic (group A, n = 130) and epidemic (group B, n = 142). There were no significant differences between the two groups in terms of mode of arrival, symptom onset-to-first medical contact time, door-to-needle time, door-to-balloon time, maximum hypersensitive cardiac troponin I levels, and in-hospital adverse events (P > 0.05). Emergency percutaneous coronary intervention (PCI) was much less common in group B (57.7%) compared to group A (72.3%) (P = 0.012), and the proportion of reperfusion treatment with thrombolysis was 30.3% in group B compared to 13.1% in group A (P < 0.001). Logistic regression analysis showed that age ≥76 years, admission NT-proBNP levels ≥3,018 pg/ml, and combined cardiogenic shock were independent risk factors for death. Compared with thrombolytic therapy, emergency PCI treatment further reduced the risk of death in STEMI. In conclusion, the county hospitals treated more acute STEMI with thrombolysis during the COVID-19 outbreak.

634: GLOBAL LONGITUDINAL STRAIN IS ASSOCIATED WITH MORTALITY AFTER PEDIATRIC CARDIAC ARREST

Introduction: Depressed left ventricular function is associated with mortality after pediatric cardiac arrest (CA). Echocardiographic global longitudinal strain (GLS) is more sensitive for poor outcomes than ejection fraction (EF) and shortening fraction (SF), with few studies in children. We aimed to identify the frequency of impaired GLS after pediatric CA and its association with hospital mortality. We hypothesized abnormal GLS is associated with mortality. Methods: This is a retrospective single-center cohort study of children < 18 years of age treated in the pediatric intensive care unit after in- and out-of-hospital CA, with echocardiogram performed within 24 hours of admission between 2013-2020. Patients with congenital heart disease, extracorporeal support, or inability to measure GLS were excluded. EF and SF measurements were abstracted and GLS measured post hoc by an investigator blinded to outcome. Abnormal left ventricular GLS was defined as >-18%. Correlation between GLS, EF and SF were calculated with Spearman’s rho. Logistic regression tested association of GLS with mortality. Area under the receiver operator characteristic (AUROC) curve was calculated for discriminative utility of GLS, EF, and SF with mortality. Results: GLS was measured in 124 subjects and abnormal in 49 (40%). Subjects with abnormal GLS were older (median 8 vs 2 years, p< 0.001), had more ventricular tachycardia/fibrillation as initial rhythm (18% vs 4%, p=0.008) and higher maximum troponin in 24 hours (median 2.6 ng/mL vs 0.5, p=0.002). There was no difference between arrest location or CPR duration based on GLS. Subjects with abnormal GLS had lower median EF (43% vs 63%) and SF (24% vs 37%), with strong inverse correlation between GLS and EF (rho -0.76) and SF (rho -0.71), all p< 0.001. Abnormal GLS had higher mortality (57% vs 33%, p=0.009) and GLS was associated with mortality when controlling for age and initial rhythm [aOR 1.17 per 1% increase in GLS (95% CI 1.09-1.26), p< 0.001]. GLS (AUROC 0.69), EF (0.71) and SF (0.71) had similar discrimination for mortality. Conclusions: Post-arrest GLS is a novel complementary metric, strongly correlated with EF and SF and associated with mortality. Future prospective studies should investigate the prognostic utility of GLS alongside SF and EF.

Relationship Between Frailty, Sociodemographic and Clinical Characteristics, and Disease Severity of Older Adults With Acute Coronary Syndrome.

This study aimed to evaluate the relationship between frailty, sociodemographic and clinical characteristics, and disease severity of older adults with acute coronary syndrome (ACS). A total of 57 hospitalized patients ≥60 years with ACS were assessed for frailty through the Tilburg Frailty Indicator. Disease severity was assessed by the Global Registry of Acute Coronary Events, by the maximum troponin level, and by the number of severely obstructed coronary arteries. The relationship between variables was assessed by Mann Whitney's test, Pearson's chi-square test, likelihood-ratio test, Fisher's exact test, or Student's t test. Analyses were bootstrapped to 1,000 to reduce potential sample bias. About 54.4% were frail. Frailty was associated with ethnicity (p = .02), marital status (p = .05), ischemic equivalents (p = .01), self-perceived health (p = .002), arthritis/rheumatism/arthrosis (p = .002), and number of severely obstructed coronary arteries (p = .05). These relationships can support intensified surveillance planning for the elderly at greatest risk, structuring of transitional care, appropriate nurse-coordinated secondary prevention delivery in primary care, and cardiac rehabilitation following ACS.

Troponin and non-traumatic subarachnoid haemorrhage

Introduction: Subarachnoid haemorrhage (SAH) is a devastating event, with a mortality of up to 50%. Acute cardiac dysfunction is common after such an event, and it is known to have a negative impact on the outcome of these patients. Cardiac troponin release occurs frequently after SAH and represents an early biomarker for neurogenic cardiac dysfunction.&#x0D; Objective: The present study aimed to evaluate the impact of a raised troponin value on the outcome of SAH patients.&#x0D; Methods: This is a prospective observational study held between 2014-2017 at the University Emergency Hospital, Bucharest. Data on clinical admission status, high-sensitivity troponin I, ECG and echocardiographic evaluation results, ICU length of stay and in-hospital mortality rate. Statistical analysis was performed using non-parametrical Mann-Whitney and chi-square tests. The results were considered significant at p&lt;0.05.&#x0D; Results: A total of 335 consecutive patients with non-traumatic SAH were admitted during the study period. 92 of them were excluded and 243 were analyzed, 203 with aneurysmal SAH and 40 with non-aneurysmal, non-traumatic SAH. High-sensitivity troponin I reached its peak level 48 to 72 hours after SAH and was higher in patients with aneurysmal SAH. For all SAH patients, its median and peak values on days 1 and 2 were correlated with the ICU length of stay and inversely correlated with in-hospital length of stay. For the first 3 days, the median and maximum troponin values are higher in patients who died compared with those who survived and were discharged home (p-value &lt; 0.001). Predictors of an elevated troponin on day 1 are loss of consciousness at ictus, a high Hunt and Hess and Fisher Scale grade, intraventricular haemorrhage and cerebral midline shift.&#x0D; Conclusions: The release of cardiac troponin is a valuable marker of neurogenic cardiac dysfunction in the first 3 days after SAH. The study replicates other data in the literature and highlights the association between SAH severity, early troponin elevation and in-hospital death.

Patients with rheumatic disease experiencing ST-elevation myocardial infarction have increased inflammatory- and neurohormonal response and higher 1-year mortality

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): This work was supported by Righospitalets Forskningsfond (Grant number: 07IO). Lundbeck Foundation (R186-2015-2132). Background Patients with rheumatoid diseases have been reported to have increased risk of ST-elevation myocardial infarction (STEMI). However, little is known about mortality risk following STEMI in these patients. Furthermore, STEMI patients with increased neurohormonal- and inflammatory response have higher mortality compared to patients with low response. Purpose We sought to assess whether patients with a rheumatic disease (RD) have an increased inflammatory- and neurohormonal response to a STEMI and whether 1-year mortality was higher in these patients compared to patients without rheumatic disease. Methods In 1700 consecutive STEMI patients (comatose cardiac arrest- and cardiogenic shock patients were excluded) from two Danish tertiary heart centres were studied. Biomarkers reflecting neurohormonal activation (pro-atrial natriuretic peptide (proANP), copeptin, and mid-regional pro-adrenomedullin (MRproADM)) and inflammatory response (C-reactive protein (CRP) and ST2) were measured at in the catheterization laboratorium before the acute coronary angiogram was performed. Patients were stratified according to known RD or not. Results In total, 88 (5.2%) STEMI patients had a RD diagnosis. From these 28 (32%) had RA, 9 (10%) had psoriasis arthritis, and 23 (26%) had gout, while 28 (32%) had other RDs. Patients in the two groups were similar of age (no RD vs. RD, mean (SD): 63 (13) vs. 65 (14) years, p=0.22), mostly male (n (%) 1194 (74) vs 57 (66), p=0.08) with similar number of comorbidities, same LVEF (median (IQR) 50 (40-55) vs. 50 (40-55), p=0.58), and similar infarct size (maximum troponin T concentration 3050 (1150-6885) vs. 3030 (1500-7260) ng/L, p=0.79). In RD patients, admission concentration of MRproADM (median (IQR) 0.77 (0.63-0.98) vs. 0.71 (0.58-0.90) nmol/L, p=0.04), ST2 (43 (33-64) vs 39 (29-55) ng/ml, p=0.04), and CRP (6.8 (2.9-14) vs 3.3 (1.4-8.2) mg/L, p&amp;lt;0.0001) was higher compared to patients without RD. No difference in proANP and copeptin was detected. One-year all-cause mortality was higher in patients with RD (11% vs. 5.5%, p=0.02). When including patients with CS and patients comatose after cardiac arrest, the signal remained intact. Conclusion STEMI patients with RD have higher admission inflammatory response and neurohormonal activation compared to patients without. Furthermore, patients with RD have higher 1-year all-cause mortality.

Clinical Characteristics Predicting Mortality Risk in Hospitalized Geriatric Patients with COVID-19 Pneumonia: a Retrospective Study

Coronavirus disease 2019 (COVID-19) is a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Geriatric patients with COVID-19 are more likely to progress to severe disease, and they are at increased risk of hospitalization and mortality. In this study we aimed to investigate the risk factors for predicting mortality in geriatric patients with COVID 19 by reviewing the clinical data of survivors and non-survivors. This was a retrospective study of 189 geriatric patients with COVID- 19 pneumonia who were hospitalized in pulmonology clinic, in Duzce University, Medical Faculty Hospital between March 2020 and January 2021 in Turkey. In the study, 60.3% (n = 114) of the patients were male and the median age was 75. 80.4% (n = 152) of the patients were discharged. The presence of cardiovascular disease, chronic renal failure, malignancy, increased number of comorbidities, complaints of anorexia, no fever, decreased oxygen saturation value, increased pulse rate, high values of maximum (max) D-dimer, aspartate aminotransferase, urea, creatinine, troponin, lactate dehydrogenase (LDH), max LDH, ferritin and max ferritin, C-reactive protein (CRP), max CRP, procalcitonin, max procalcitonin, potassium values and low albumin values, complications as bacterial infection, cardiac disease, acute respiratory distress syndrome, liver function tests failure, arrhythmia and shock, the need for corticosteroid and pulse corticosteroid therapy increased the mortality. According to multiple logistic regression model, the de-velopment of cardiac disease, acute respiratory distress syndrome, bacterial infection, the need for pulse steroids, and the max ferritin value increased the risk of mortality by between 1.001 and 28.715 times. Both clinical and laboratory parameters predicting mortality in geriatric patients with COVID-19 pneumonia should be monitored very carefully. Complications that develop should be evaluated and multidisciplinary and necessary treatments should be initiated without delay.

Male carriers of HLA-C*04:01 have increased risk of cardiac injury in COVID-19

Identification of factors that lead to the severe clinical course of COVID-19 is crucial for timely allocation of resources. The purpose of this study was to evaluate possible sex differences in cardiac injury associated with HLA-C*04:01. High sensitivity troponin T on admission (hs-TnTa) and maximum high sensitivity troponin T (hs-TnTmax) were used to assess for cardiac injury in patients with COVID-19 (n = 435). We tested for the association of elevated hs-TnT with HLA-C* 04:01 and evaluated for potential sex-specific differences. An association between hs-TnTa and the severity of clinical course was identified. In addition, our study revealed that hs-TnTmax was higher in men who were carriers of HLA-C*04:01 compared to men without the risk allele. Male carriers of HLA-C*04:01 with COVID-19 developed higher hs-TnTmax, suggesting a larger extent of cardiac injury. This association suggests the presence of different pathomechanisms in COVID-19 based on sex.

Use of troponins in the classification of myocardial infarction from electronic health records. The Atherosclerosis Risk in Communities (ARIC) Study

ObjectiveElectronic health record (EHR) data are underutilized for abstracting classification criteria for heart disease. We compared extraction of EHR data on troponin I and T levels with human abstraction. MethodsUsing EHR for hospitalizations identified through the Atherosclerosis Risk in Communities (ARIC) Study in four US hospitals, we compared blood levels of troponins I and T extracted from EHR structured data elements with levels obtained through data abstraction by human abstractors to 3 decimal places. Observations were divided randomly 50/50 into training and validation sets. Bayesian multilevel logistic regression models were used to estimate agreement by hospital in first and maximum troponin levels, troponin assessment date, troponin upper limit of normal (ULN), and classification of troponin levels as normal (< ULN), equivocal (1-2× ULN), abnormal (>2× ULN), or missing. ResultsEstimated overall agreement in first measured troponin level in the validation data was 88.2% (95% credible interval: 65.0%-97.5%) and 95.5% (91.2-98.2%) for the maximum troponin level observed during hospitalization. The largest variation in probability of agreement was for first troponin measured, which ranged from 66.4% to 95.8% among hospitals. ConclusionExtraction of maximum troponin values during a hospitalization from EHR structured data is feasible and accurate.

Abstract 11859: Elevated Troponins and Ischemic Cardiomyopathy Are Predictive of Percutaneous Coronary Intervention in Patients With Pulmonary Embolism

Introduction: Pulmonary embolism is a common cause of myocardial strain. As such, patients with pulmonary embolism will have evidence of myocardial injury on laboratory assessment. This can be measured using a troponin assay. Of the patients who present with elevated troponins and pulmonary embolism, there is minimal evidence to guide the decision on whether a patient will benefit from left heart catheterization and coronary angiography. We sought to analyze troponin levels and risk factors for percutaneous coronary intervention (PCI) in a large dataset of patients hospitalized with pulmonary embolism. Methods: This was a retrospective study of 3929 patients who were admitted with pulmonary embolism in 2018 and 2019 at HCA Healthcare hospitals across the United States. Patients with other factors that could cause troponin elevation, such as a ST elevation myocardial infarction, chronic kidney disease, and sepsis, were excluded. Binary logistic regression model was utilized to examine risk factors for PCI. Results: Troponin I level was elevated in 68.9% (2707) of patients, 7.68% (208) of those patients with an elevated troponin had a left heart catheterization, and, of the patients that underwent a left heart catheterization, 26.92% (56) had PCI. The mean age of all subjects was 65.1 years and 52.4% of subjects were female. A total of 73.07% (2871) of subjects had coronary artery disease. Multivariable logistic regression showed maximum troponin value was associated with increased chance of PCI. For every ng/mL increase in troponin level, the odds of PCI increased by 2.5% (p=0.017). Patients with ischemic cardiomyopathy were 4.4-times more likely to have PCI than those without (p=0.010). Race, gender, and age were not significantly associated with risk of PCI. Conclusions: Elevated troponin is common in patients admitted with pulmonary embolism. In our dataset 7.7% of patients with elevated troponin received left heart catheterization and 26.9% of left heart catheterizations resulted in PCI. Higher troponin and known ischemic cardiomyopathy were independently associated with increased likelihood of PCI. Further analysis may help find additional factors to suggest which patients with elevated troponin should have left heart catheterization.