Creatine Phosphokinase MB Fraction Research Articles

Интракоронарное применение левокарнитина при стентировании коронарных артерий у пациентов высокого риска

The main causes of postoperative mortality associated with percutaneous coronary interventions involving the coronary artery stent insertion are perioperative myocardial infarction and acute heart failure due to inadequate protection of the myocardium against ischemia/reperfusion. The standard therapy includes beta blockers, anticoagulants, antiplatelet drugs. Two clinical cases of successful use of intravenous levocarnitine for cardioprotection in senile patients with acute forms of coronary heart disease with multivessel lesions are reported. The postoperative period went well, smooth dynamics of biomarker levels (troponin I, creatine phosphokinase, MB fraction of creatine phosphokinase) was observed, and ischemic ECG changes were relatively small. The expected results of the technique application include reduction of intraoperative and postoperative complications of ischemia/reperfusion and the increase in effectiveness of the stent insertion clinical outcomes in high-risk patients.

Frequency and Prognostic Value of Acute Periprocedural Myocardial Injury in Elective Percutaneous Coronary Interventions

Background. Periprocedural myocardial injury (PMI) is an acute complication of percutaneous coronary interventions (PCI) in patients with stable coronary artery disease. Its frequency and relationship with the prognosis of the disease are especially important in elective interventions due to the low risk of ischemic events in this cohort of patients. However, according to the literature, there are significant differences in the criteria for PMI and type 4a myocardial infarction (MI), and, accordingly, their frequency and their prognostic value. Aim. To study the frequency and magnitude of PMI during elective PCI in terms of the level of periprocedural increase in cardiospecific biomarkers, as well as to determine the relationship of PMI with long-term adverse events in patients with chronic coronary artery disease. Materials and methods. A single-center open retrospective cohort study was conducted, which included 435 patients (367/84.4 % men, mean age 58.3±8.6 years) from the elective PCI registry. PMI was diagnosed with an increase in the level of creatine phosphokinase MB fraction (CK-MB) or or cardiac troponin I (cTn I) >1×99 percentile URL (Upper Reference Limit), while the level of increase in biomarkers >1, 2, 3, 4 or >5×99 percentile URL was recorded. An increase in biomarkers >5x99 URL percentile was assessed as a large PMI, and in the presence of clinical and imaging evidence of new loss of viable myocardium, as periprocedural MI type 4a. Depending on the level of periprocedural increase in biomarkers, the relative risk (RR) of developing long-term (within 5 years after index PCI) adverse cardiovascular events, death, as well as clinically significant bleeding and newly diagnosed malignant oncological diseases was calculated. In addition, the correlation between PMI and the above endpoints was summarized using Kaplan-Meier analysis. Results. The frequency of periprocedural PMI diagnosed by increased biomarkers >1×99 percentile URL was 40.2 %, >2×99 percentile URL — 9.7 %, >3×99 percentile URL — 6.7 %, >4×99 percentile URL — 4.8 %, >5×99 percentile URL — 3.5 %, type 4a MI — in 2 patients (0.46 %). An association of “major” PMI (>5x99 percentile URL) with cardiovascular complications within 3 years after elective PCI, including fatal ones, was revealed: for acute myocardial infarction (AMI), RR — 6.516, confidence interval (CI) [2.375-17.881]; for death from cardiovascular causes RR — 6.538, CI [1.695-25.227]. An association of “moderate” PMI (>3, but <5 ×99 URL percentile) with acute ischemic events within 3 years after elective PCI was shown: for AMI, RR was 4.073, CI [1.598 — 10.378]. An association of “minor” AKI (>1, but <5 ×99 URL percentile) with acute ischemic events within 3 years after elective PCI was shown: for AMI, RR was 4.073, CI [1.598 — 10.378]. An association of “minor” AKI (>1, but <3 ×99 URL percentile) with newly diagnosed malignant oncological diseases within 5 years after index PCI was revealed: RR 2.319; CI [1.248- 4.310]. An association of late thrombotic events, such as stent thrombosis (index and re-interventions), stent occlusion (index and non-index) as a reason for re-intervention within 5 years after index PCI, was found with most PMI subgroups. Kaplan-Meier analysis of the dependence of clinically significant bleeding within 5 years after index PCI on the development of “moderate” PMI (p=0.003), as well as the association of non-cardiovascular death within 5 years after index PCI with “minor” PMI (p= 0.007). Conclusion. Registration of periprocedural increase in cardiac biomarkers should be carried out during planned PCI not only for the purpose of diagnosing and predicting acute and late ischemic events, but also for assessing the risk of developing stent occlusion, clinically significant bleeding and prognostically important comorbidities in the long-term (5-year) period in order to identification of groups of patients requiring active monitoring, additional examination and selection of an optimal treatment regimen at the outpatient stage of rehabilitation.

Cardioprotection with levocarnitine intracoronary administration during percutaneous coronary interventions

Currently, the number of percutaneous coronary interventions (PCI) performed in acute and chronic forms of coronary heart disease continues to grow: every year their number reaches at least 5,000,000 worldwide, and more than 200,000 of them in Russia. The main causes of postoperative mortality are perioperative myocardial infarction and acute heart failure due to inadequate protection of the myocardium from ischemia/reperfusion under conditions of balloon expansion and stenting of the affected coronary arteries. The review presents experimental and clinical literature data on the successful use of levocarnitine for cardioprotection in patients with various forms of coronary heart disease and patients with chronic heart failure, both with intravenous administration and as part of a cardioplegic solution during heart surgery. The intracoronary route of administration of levocarnitine solution during PCI in high-risk patients (elderly and senile patients, with multivessel lesions of the coronary bed, difficulties in conducting the intervention) is substantiated. The description of two clinical cases of the use of the technique in elderly patients with acute forms of coronary heart disease with multivessel lesion is given. The postoperative period proceeded without complications with smooth dynamics of biomarkers (troponin I, total creatinephosphokinase, MB-fraction of creatinephosphokinase, lactate dehydrogenase), ischemic ECG shifts were little pronounced. The expected results of the application of the technique are a reduction in intraoperative and postoperative complications of ischemia/ reperfusion and an increase in the effectiveness of the clinical results of PCI in high-risk patients.

Significance of Markers of Transient Myocardial Ischemia and Hemodynamic Overload in Critically Ill Neonates

Monitoring of cardiospecific markers is significant during intensive care.The objective: to compare the diagnostic and prognostic significance of cardiac markers in newborns with somatic and surgical pathology.Subjects and Methods. The study included 76 newborns aged 1 to 14 days with somatic or surgical disorders. The changes in the concentration of cardiomarkers in newborns and their relationship with echocardiography data and non-invasive hemodynamic parameters are presented, their prognostic ability is assessed.Results. Rigidity of non-invasive hemodynamic parameters, and echocardiography data was revealed. In the somatic group, regression of NT-proBNP from 8,307 ng/ml (3,600; 9,000) to 1,717 ng/ml (1,041; 5,011) was regarded as a marker of resolution of hypervolemia against the background of cardiovascular maladaptation. The increase in NT-proBNP from 4,710 ng/ml (3,400; 6,989) to 7,987 ng/ml (3,397; 9,000) in the postoperative period requires a revision of the infusion therapy program with the priority of volume restriction.Conclusions. Stabilization of the condition of patients in the groups is accompanied by a decrease in the concentration of markers of myocardial tension (MB-fraction of creatine phosphokinase, troponin T).Measurement of NT-proBNP concentration allows assessment of fluid overload in critically ill neonates.

Clinical and laboratory markers of the new coronavirus disease SARS-CoV-2 COVID-19 in hospitalized patients

The prognostic predictors of an unfavorable course of coronavirus disease (COVID-19) and its complications with manifestations of pneumonia and the need for oxygen support and connection to the invasive mechanical ventilation were studied. Clinical and laboratory associations in hospitalized patients with COVID-19 were evaluated, the possible predictors of connection to the invasive mechanical ventilator in 37 patients were identified. Patients were hospitalized on day 6.65±3.32 of the disease, blood oxygen saturation (SpO2) depended on the severity of the disease and response to therapy. Positive significant correlations between the level of growth stimulating factor (ST2) and D-Dimer, creatine phosphokinase MB fraction (CPK-MB) and D-dimmer, CPK-MB and ST2 were revealed, as well as of ferritin and D-Dimer with ST2. There were no significant associations with troponin. C-reactive protein (CRP) probably correlated with CPK-MB and ferritin. The International Normalized Ratio (INR) indicator had significant correlations with D-dimmer, ST2 and CPK-MB. Cox regression analysis showed that the survival curve has a stepwised nature and the highest risk of deterioration, which requires mechanical ventilation, was noted on the 6th day of illness (95.0% CI = 0.9-1.0, with an average SpO2 level =87.3%). ROC analysis showed the presence of a possible relationship between D-Dimer, ST2 protein, CPK-MB and the risk of developing a critical condition requiring mechanical ventilation in patients. The study showed that COVID-19 disease has a phase nature, when after the first phase of the disease, the pulmonary phase and hypercytokinemia progress in some patients with the development of hypoxia, a decrease in SpO2. Therefore, the identification of markers of disease progression is essential for predicting the course and possible prevention of the development of acute respiratory distress syndrome with the use of invasive mechanical ventilation.

Characteristics of heart rate variability in patients with acute coronary syndrome without ST segment elevation in comparison with clinical and biochemical parameters

BACKGROUND: The search for rational methods of primary, secondary, and tertiary prevention of coronary heart disease. To date, there are several publications on heart rate variability in ischemic heart disease.
 AIM: To study the state of the regulatory systems in the organism of patients with acute coronary syndrome without ST segment elevation based on the heart rhythm, and their relationship with the clinical, biochemical and instrumental parameters of the disease.
 MATERIALS AND METHODS: The open comparative study included 76 patients (62 men, 14 women) of mean age, 61.0 0.9 years, who were admitted to the Emergency Cardiology Department diagnosed of acute coronary syndrome without ST segment elevation. On admission, cardiointervalometry was performed using Varicard 2.51 apparatus, and a number of clinical and biochemical parameters were evaluated
 RESULTS: Multiple correlations of parameters of heart rate variability and clinical, biochemical and instrumental parameters were observed. From this, a cluster analysis of cardiointervalometry was performed, thereby stratifying patients into five clusters. Two extreme variants of dysregulation of the heart rhythm correlated with instrumental and laboratory parameters. A marked increase in the activity of the subcortical nerve centers (maximal increase of the spectral power in the very low frequency range with the underlying reduction of SDNN) in cluster 1 was associated with reduction of the left ventricular ejection fraction: cluster 147.0 [40.0; 49.0], cluster 260.0 [58.0; 64.0], cluster 360.0 [52.5; 64.5] % (the data are presented in the form of median and interquartile range; Me [Q25; Q75], p 0,05). Cluster 5 showed significant reduction in SDNN (monotonous rhythm), combined with increased level of creatine phosphokinase (CPC): cluster 5446,0 [186.0; 782.0], cluster 4141.0 [98.0; 204.0] IU/l; Me [Q25; Q75], p 0.05) and MВ-fraction of creatine phosphokinase; cluster 532.0 [15.0; 45.0], 4 cluster 412.0 [9.0; 18.0] IU/l; Me [Q25; Q75], p 0.05).
 CONCLUSIONS: In patients with acute coronary syndrome without ST segment elevation, cluster analysis of parameters of heart rate variability identified different peculiarities of regulation of the heart rhythm. Pronounced strain of the regulatory systems of the body was found to be associated with signs of severe pathology: the predominance of VLF (spectral power of the curve enveloping a dynamic range of cardiointervals in the very low frequency range) in spectral analysis with an underlying reduced SDNN is characteristic of patients with a reduced ejection fraction, and a monotonous rhythm is characteristic of patients with an increased level of creatine phosphokinase and MB-fraction of creatine phosphokinase.

Assessment of quality of markers of myocardial damage using sigmametry

The purpose. To evaluate study quality markers of myocardial damage using Sigmametry.Materials and methods. The study was conducted in a Federal Centre for Cardiovascular Surgery. Data were collected in 2017–2018. Daily there controlled the following indicators: high-sensitivity troponin T, myoglobin, the MB fraction of creatine phosphokinase. The study was performed on an automatic immunochemical electrochemiluminescence analyzer cobas e411. The sigmametry values were calculated using CV (coefficient of variation), systematic error (bias), and total analytical error (TEmax).Results. The analysis of the quality of laboratory studies using the calculation of sigma values in 2017 revealed: sigma values less than 4 are noted in the study of the second level of the control material for highly sensitive troponin T, at the same time in the study of the first level of the control material sigma values more than 4 and amounted to 6.26. Analysis of the quality of laboratory studies in 2018, showed the following: the values of sigma is less than 4 it is noted in the study of the first level of the control material at a fraction of MB – creatine phosphokinase, at the same time in the study of level 2 control material values of sigma greater than 4, and amounted to 4.14.Conclusions. Оn the basis of sigmametry (calculation of sigma values) changes in the tactics of intralaboratory analysis were held, what allowed to improve the quality of laboratory studies.

Експериментальне дослідження кардіопротекторної дії 2-гідрокси-N-нафтален1-іл-2-(2-oксо-1,2-дигідро-індол-3-іліден)ацетаміду

Сучасні принципи лікування коморбідних пацієнтів із серцево-судинними захворюваннями та тяжкими психічними розладами спрямовані на обмеження поліпрагмазії. Тому перспективним є пошук препаратів полімодальної дії, здатних одночасно виявляти як кардіопротекторну, так і нейромодулювальну дію. У цьому аспекті привертають увагу похідні 2-оксоіндолін-3-гліоксилової кислоти, яким притаманний широкий спектр нейротропної активності. Мета дослідження – визначити вплив потенційного нейротропного засобу – 2-гідрокси-N-нафтален-1-іл-2-(2-oксо-1,2-дигідро-індол-3-іліден)-ацетаміду (умовна назва – сполука 18) – на перебіг експериментального ураження серця щурів. Досліди проведено на 38 статевозрілих рандомбредних білих щурах самцях. Адреналіновий міокардит моделювали шляхом одноразового підшкірного введення розчину адреналіну гідротартрату («Адреналін-Дарниця», розчин для ін’єкцій, 1,8 мг/мл, ФК «Дарниця», Україна) у дозі 1 мг/кг. Досліджувану речовину в дозі 12 мг/кг і препарат порівняння етилметилгідроксипіридину сукцинат («Армадин», розчин для для ін’єкцій, 50 мг/мл, ЗАТ «Лекхім-Харків», Україна) у дозі 100 мг/кг вводили внутрішньоочеревинно в лікувально-профілактичному режимі за 30 хв до і через 1 год після моделювання ураження міокарда. Функціональний стан міокарда оцінювали за показниками електрокардіограми. Виразність деструктивних процесів у серцевому м’язі визначали за активністю МВ-фракції креа тинфосфокінази, маркерних ферментів цитолізу – аспартатамінотрансферази та аланінамінотрансферази в плазмі крові щурів. Інтенсивність процесів пероксидного окиснення ліпідів визначали за вмістом активних продуктів, що реагують з тіобарбітуровою кислотою, у плазмі крові та гомогенаті міокарда щурів, стан антиоксидантної системи – за активністю супероксиддисмутази та каталази в гомогенаті міокарда. Досліджували морфологічний стан серця щурів. Встановлено, що адреналіновий міокардит у щурів супроводжується як функціональними (електрокардіографічними та біохімічними) змінами, так і дифузними морфологічними ознаками ішемії міокарда (спазм тонкостінних судин, венозний застій), дистрофії серцевого м’яза (набряк, втрата поперечної посмугованості) і некрозу кардіоміоцитів. У той самий час сполука 18 за умов адреналінового міокардиту чинить виразну кардіопротекторну дію, що її встановлено за відновленням електрокардіографічних показників і біохімічних індикаторів функціонального стану міокарда, а також морфологічно – за редукцією проявів ішемії та дистрофії серцевого м’яза тварин. Визначено також, що кардіопротекторний ефект сполуки 18 значно перевищує дію препарату порівняння етилметилгідроксипіридину сукцинату за експериментального адреналінового ураження серця щурів.

Grace Risk Score 2.0 predicts acute coronary syndrome outcomes: what marker of myocardial injury should we use?

Aim . To compare the effectiveness of various markers of myocardial injury (creatine phosphokinase MB-fraction (CK-MB), cardiac troponin I, measured by standard and high sensitivity methods (cTnI and hs-TnI), and heart-type fatty acids binding protein (H-FABP)) in predicting the ACS course using the GRACE 2.0 score. Methods . 183 patients with a verified diagnosis of ACS were included in the study. The levels of CK-MB, cTnl, hs-Tnl and H-FABP were measured at admission. Qualitative assessment of H-FABP was performed by immunochromatographic express-tests “CARD-INFO” and “CardioFABP”. Risk assessment of death in the in-hospital period and within the 12-months follow-up period, as well as death and/or acute myocardial infarction (AMI) within the 12-months follow-up was estimated using the GRACE 2.0 score with alternate inclusion of the various cardiomarkers. The effectiveness of the resultant prognostic scales was evaluated using the ROC-analysis and comparison of the areas under the curve (AUC). Results . 114 patients (62.3%) were diagnosed with AMI and 69 (37.7%) with unstable angina. 10 patients (5.5%) died during the indexed hospitalization. Four patients died within the follow-up and 8 patients (4.4%) had Ami. 94 patients (51.3%) had elevated hs-Tnl levels at admission, 90 patients (49.2%) - cTnl, 45 patients (24.6%) - CK-MB. H-FABP levels were elevated in 70 (38.3%). The express-test “CARD-INFO” was positive in 86 patients (47.0%), the “CardioFABP” - in 125 (68.3%). There were no significant differences found between the stratification of ACS patients by the GRACE 2.0 score into high and non-high risk groups in terms of complications (p<0.05). Similarly, there were no significant differences found between the AUC values of the cardiomarkers in terms of developing the endpoints using the GRACE 2.0 score (p<0.05). Conclusion . The introduction of H-FABP in the GRACE 2.0 scale is non-inferior to traditional markers of myocardial damage and may be used to stratify risk in patients with ACS.

Metabolic profile and content of the connective tissues’ biopolymers in the blood serum of service boars at the different regime of reproductive loading

It is necessary to carry out not only the evaluation of sexual activity of breeder boars and the quality of their sperm, but carefully investigate the metabolic status by laboratory methods during the medical examination. It helps to determine the optimal parameters for the implementation of the reproductive potential of the breeder boars. Biochemical methods of research can establish imbalance in metabolism, the nature and localization of cytolytic processes by the degree of enzymes activity in serum. However, in order to detect inflammatory or destructive changes in the connective tissue structures, in particular the musculoskeletal system, the most informative indexes will be biopolymers of the connective tissue – glycoproteins and proteoglycans. The results of a complex examination of clinically healthy breeder boars with different regime of their production use, which includes an extended set of biochemical tests with the determination of glycoprotein, chondroitin sulfate, total glycosaminoglycans and their fractions, are presented in this paper. It was found that the level of such parameters as the total protein and its fractions, urea, aspartate and alanine aminotransferase activity, and the MB fraction of creatine phosphokinase did not have any significant differences. For breeder boars that were used in reproductive events irregularly (group I), there was an indicative higher level of creatinine and glycosaminoglycans. In animals with regular use as the herd (group II), the level of creatinine and fractions of glycosaminoglycans (GAG) was lower, but there was an increasing in cholesterol, β-lipoproteins, and activity of total creatine phosphokinase. The probable difference in these indicators can be explained by the difference in the intensity of the energy metabolism processes in muscle tissue. Indeed, during long-term hard work of skeletal muscles, not only glycogen stores are used, but also the use of lipids is of great importance. In addition, the raising of cholesterol and β-lipoproteins may be due to their active involvement in the synthesis of steroid hormones. Increasing the activity of total creatine phosphokinase in blood serum of animals with the intensive use in technology probably is the evidence of severe physical activity and the development of destructive processes in muscle tissue (hyperenzymemia is detected in early stages of myopathy). The absence of the most inflammatory processes was evidenced by the unchanged level of serum glycoproteins, which are known as the acute phase tests. Differences in the parameters of the state of connective tissue were determined at the levels of general GAG, their I and III fractions (chondroitin-6-sulfate and heparan sulfate, respectively). In the first group of boars, there was a higher level of I fraction of GAG, that indicated a significant load on the joints' cartilages and the gradual development of destructive processes in them. About the III fraction of GAG, an increasing of their blood content could indicate the reaction of the vascular flow, changes in ventilation of the lungs, the course of anti-inflammatory processes in animals with the appearance of intense physical activity.

The influence of cytoflavin staged therapy on dynamics of
 laboratory values in professional athletes during first stage of preparation for the game season.

The observation program was attended by 50 professional hockey players, divided into 2 groups, respectively, teams (25 people).The participants of the main group received step therapy with cytoflavin: first intravenously drip 10 ml of the drug diluted in 200 ml of 5% glucose solution, for 10 days, then 2 tablets 2 times a day for 25 days. Pharmacological support of participants in the comparison group were excluded the preparations of succinic acid or other metabolic means. Laboratory parameters were evaluated in dynamics: before the training (point 1), in the middle of the preparatory stage (point 2) and 35 days after the start of training (after the entire course of step therapy) (point 3). According to the results of the study revealed that the parameters of red blood (number of red blood cells, hemoglobin level, average red blood cell volume, average hemoglobin content in the red blood cell (MCH), the average concentration of hemoglobin in the red blood cell (MCHC) were more stable against the background of the use of cytoflavin, and the values of aspartataminotransferase and creatinine decreased during the observation in the main group and increased in the comparison group so that at the point 3 level aspartataminotransferase (AST) in the main group became significantly lower than in the comparison group (p=0.039*), and the level of creatinine was equal at initially higher rate in the main group (p= 0.012*). MB - fraction of creatine phosphokinase (MB-CPK) in the blood decreased in the main group of athletes (in the evaluation test of Pillai p=0,004), did not significantly change in the comparison group. There were no significant differences in the indicators of cortisol and testosterone between the groups, although the level of cortisol decreased in the athletes of the main group, and testosterone - increased, while in the comparison group the situation was the opposite. By the end of the follow-up, a statistically significant decrease in lactate levels before and after training was revealed in the group of athletes taking cytoflavin.

Impact of a modified Maze procedure on the atrial hormonal function and level of myocardial damage markers

Surgical treatment of atrial fibrillation (AF) in patients with valvular heart disease remains one of the most pressing problems in cardiac surgery. The purpose of the study was to determine the dynamics of proANP and myocardial damage markers depending on a modification of the radiofrequency (RF) Maze procedure used. The study involved 86 patients operated over a period from November 2007 to December 2010. A concomitant RF Maze procedure during mitral valve (MV) surgery was performed in two groups of the cohort; in group 1 it was the standard Maze IV scheme, in group 2 it was the modified one. In both groups we assessed the levels of proANP and myocardial damage markers. In group 1 a more significant decrease in proANP (by 4 times) was seen as compared to group 2 (by half). In group 1, the pleural effusion rate was 46.2%, and thoracocentesis rate reached 25.6%. In group 2, the corresponding rates were lower,14.9% and 27.7%. During the first postoperative day there was an increase in creatine phosphokinase MB fraction and Troponin T in both groups, and the rise was significantly higher in group 1. It should be noted that modified Maze IV RF ablation results in 80% freedom from AF, which is consistent with that of the standard Maze IV scheme. In patients with left atrial ablation the proANP secretion is less prominent early after surgery, and myocardial damage is lower in comparison with biatrial ablation.

PROTEIN MARKERS OF CARDIONECROSIS IN THE DYNAMICS OF ACUTE CORONARY SYNDROME

The aim of this study was to compare and analyze the effectiveness of protein markers of myocardial necrosis - heart-type fatty acid-binding protein (H-FABP) and the MB fraction of creatine phosphokinase (CPK-MB) in the dynamics of acute coronary syndrome. Material and methods. A total of 49 patients (57.1 ± 11,0 years) were examined, including 36 male patients (73.5 %) who were admitted to the City Clinical Hospital No. 34 of Novosibirsk with suspected acute coronary syndrome. The content of H-FABP in whole venous blood was evaluated for all patients upon admission to the hospital with the means of the immunochromatographic rapid test «CardioPBFA» (NPO «Biotest», Novosibirsk) with a sensitivity of 15 ng/ml. Determination of CPK-MB was carried out repeatedly in the first 48 hours from the beginning of the clinical manifestations of the disease, using immunochemiluminometric assay. Results and discussion. It was revealed that in patients with myocardial infarction (MI), CPK-MB content after 6-24 hours and also after 24-48 hours from the onset of pain was significantly higher than in patients without MI. H-FABP content 15 ng/ml and more, determined in the majority of patients in the first 6 hours from the onset of pain, was recorded much more often in MI presence than in MI absence. Using partial correlation analysis, it was determined that age influenced the association of MI with CPK-MB 6-24 hours after the onset of pain (which is probably due to the increase in the influence of a number of factors modulating the level of protein cardiac markers with age), and the correlation of MI with CPK-MB in 24-48 hours from the onset of pain did not depend on this factor ( r = 0.322; p = 0.46). In the regression model (χ² = 13.6; p = 0.001) it was revealed that H-FABP content 15 ng/ml and more regardless of age ( p = 0.006) is associated with the presence of MI in the patients, which confirms information about the high significance of identifying this H-FABP level in early diagnosis of myocardial infarction.

Metabolic markers of heart strain in athletes (a review)

Both specific and nonspecific metabolic transformations, occurring in the body of athlete under intensive and prolonged physical loads, have been characterized in the review paper. It has been emphasized that oxidative stress, which belongs to general pathogenic factors of further myocardium pathology formation, and load induced hypoxia, which is later associated with tissue hypoxia of metabolic origin, represent the initial link of subsequent homeostatic balance changes. Changes in the activity of creatine phosphokinase-MB fraction, content of cardiac troponins I and T as well as terminal natriuretic peptides are referred to specific markers of myocardium strain. Wider range of myocardium strain nonspecific markers includes both alterations of lipid metabolism and numerous, oxidative stress mediated, metabolic changes at the level of cellular and subcellular membranes of cardiomyocytes, followed by changes in the activity of membrane-bound enzymes and lysosomal proteinase ejection first into extracellular matrix and then – into circulatory bed as well as erythrocyte membranes and their ATP content that are accompanied by deterioration of blood oxygen transport function. The above mentioned negatively influences myocardial contractility and leads to the development of hypertrophic cardiomyopathy. Identification of the markers of athlete heart strain allows timely to be corrected by pharmacological means, aimed at normalization of metabolic disorders and prevention of myocardial hypertrophy, which is the major cause of sudden coronary death among athletes.

Experimentally induced tick toxicosis in rats bitten by Ornithodoros brasiliensis (Chelicerata: Argasidae): A clinico-pathological characterization

Ornithodoros brasiliensis, also known as the mouro tick, is an argasid tick only found in the highlands of Southern Brazil. O. brasiliensis parasitism is associated with severe reactions in its hosts ranging from local pruritus and pain to systemic disturbances. Recently, the re-emergence of O. brasiliensis parasitism in humans and dogs drew attention to the clinical findings induced by its bite, which are poorly understood and described. Moreover, rare experimental data about tick bite effects under controlled conditions were available. Thus, this study aimed to describe clinical and pathological findings induced by O. brasiliensis bites in experimentally parasitized rats. Ticks feed for ∼40 min in rats, and their weight increased by approximately four times after the blood meal. Rats bitten by five adult ticks showed hyperemia of the oral/ocular mucosa, piloerection, tachypnea, claudication, ocular and nasal discharge, pruritus, and swollen and erythemic lesions. A large hemorrhagic lesion was observed on rat skin in tick attachment sites, reaching ∼17 mm in diameter 12 h after a bite. Bitten rats also presented an increased bleeding tendency (∼50%) 6 h after a tick bite, evaluated by the tail-cut rat model of bleeding. Blood samples of bitten rats were taken, and clinical pathology analysis showed significant alterations in the eosinophil and basophil counts, in creatine phosphokinase (CPK) and CPK MB fraction, and lactate dehydrogenase (LDH) activity, and fibrinogen level. Histopathological analysis revealed marked subcutaneous hemorrhage, edema and slight muscle degeneration at the bite site. Also, muscle degeneration and necrosis were observed in the myocardium of bitten rats 72 h after bites by histopathology and immunohistochemistry against troponin C. This work showed the ability of O. brasiliensis to cause severe disturbances in experimentally parasitized rats, compatible with a tick toxicosis syndrome. This observation associated with the re-emergence of O. brasiliensis parasitism makes this parasite as a public health hazard in southern Brazil.

THE EFFICACY OF COMBINED BIOMARKER TESTS IN EARLY DIAGNOSTICS OF ACUTE MYOCARDIAL INFARCTION AFTER CLINICAL SYMPTOMS ONSET: ROLE OF HEART-TYPE FATTY ACID-BINDING PROTEIN

Aim. To evaluate the diagnostic value of heart-type fatty acid-binding protein (H-FABP) introduction to standard cardiac biomarkers in diagnostics of myocardial infarction (MI) early after clinical symptoms onset. Material and methods. Patients aged 18 years and older admitted to the hospital with acute coronary syndrome (ACS) during first 6 hours after ACS symptoms onset were enrolled into the study. At hospitalization level of biomarkers of myocardial damage (creatine phosphokinase-MB fraction - CPK-MB, troponin T) and qualitative tests on FABP were assessed in all patients. Serum troponin T concentration measured in 12 hours after the hospitalization was used to confirm diagnosis of MI. Moreover , diagnosis of MI was verified by echocardiography with the assessment of local reduction in myocardial contractility. Results. 101 patients were included into the study (27% female; aged 59.9±12.4). At the moment of hospitalization 71 (70%) patients were diagnosed with ACS with ST-segment elevation, and 30 (30%) patients - ACS without ST-segment elevation. In total, period between clinical symptoms onset and hospitalization was 3.6±1.4 hours. Analysis of diagnostic value of tests during the first 6 hours after ACS symptoms onset showed higher sensitivity of H-FABP in comparison with troponin T and CPK-MB (72.5, 56.2 and 49.5%, respectively). Specificity of these tests during the first 6 hours after onset of clinical signs of ACS was 90, 100 и 90%, respectively. Sensitivity and specificity were 87.7 and 100.0%, respectively , when H-FABP , troponin T and CPK-MB were used in combination as a “block test” in patients hospitalized during the first 6 hours after ACS symptoms onset. Sensitivity and specificity were 74.3 и 100.0%, respectively , when “block test” was used in patients hospitalized during the first 3 hours after ACS symptoms onset; between 3 and 6 hours after ACS symptoms onset sensitivity and specificity of tests reached 100%. Conclusion. “Block test” with H-FABP , troponin T and CPK-MB early after ACS symptoms onset is more sensitive in comparison with separate use of the tests.

INTERRELATION BETWEEN PERSISTENT NECROSIS OF CARDIOMYOCYTES AND PROGNOSIS IN PATIENTS WITH CHRONIC HEART FAILURE

Background. Chronic heart failure (CHF) progression is accompanied by remodeling of muscular, collagen and vascular elements of myocardium. This can lead to increase in serum concentrations of myocardial lesion markers (cardiac troponin I (TrI) and myoglobin) which seem to correlate with poor prognosis in patients with CHF. Aim. To estimate correlations between cardiac TrI, myoglobin, creatine phosphokinase MB-fraction (MB-CPK) serum concentrations and disease severity and prognosis in CHF patients. Material and methods. Fifty eight patients with CHF of different etiology were included into the study. Physical examination, clinical and biochemical blood assays, chest X-ray study, echocardiography and ECG daily monitoring (initially and at the end of the study) were carried out. TrI and myoglobin levels were estimated by immunoenzymometric assay. The follow-up period was 6 months. The following end points were used: CHF worsening caused hospital admission, acute myocardial infarction, and lethal outcome. Results. Mean TrI and myoglobin concentrations equaled 0.04 [0.02; 0.06] ng/ml and 62.95 [35.86; 77.28] μg/l, respectively. Demographic characteristics of patients (gender, age) did not influence these markers levels. TrI concentration correlated with CHF severity: it was significantly higher in patients with CHF of functional class (FC) III-IV than in those with CHF of FC I-II (p<0.001). Negative correlation was revealed between TrI level and ejection fraction (p<0.001). TrI concentration was significantly higher in patients with life-threatening ventricular arrhythmia than in patients without it (p=0.001). Besides, TrI level was significantly higher in patients with registered end points than in those with stable CHF course (p=0.001). Conclusion. TrI correlates with CHF severity and probably has prognostic value in these patients.

Pregnancy complicated by myocardial infarction

A 37-year-old woman with a coronary thrombosis was transferred to the obstetricward because shewas in the 33rdweek of pregnancy. The thrombosis was indicated by a creatine phosphokinase MB fraction of 38 ng/mL, along with an ST-segmentelevation in leadsV1 throughV3on theelectrocardiogram. We detected the blockage of a thin anterior interventricular artery on coronography, which was immediately performed, and ventriculography revealed important anteroapical akinesia. Following a right interventricular transluminal angioplasty, the patient was treated with 200 mg per day of metoprolol, 20 mg of furosemide twice per day, and 160 mg per day of salicylic acid, and remained stable. The maximal concentration of creatine phosphokinase was measured 7 hours after treatment initiation. Corticosteroid therapy was initiated for lung maturation even though the fetal signs were reassuring. The findings of a clinical examination were all within normal limits a week later, but a control electrocardiogram showed a Q wave infarction and a control echocardiography showed a small anteroapical area of akinesia. The ejection fraction of the left ventricle was 40%. The remainder of the pregnancy was uneventful, with satisfactory maternal and fetal vitality, and vaginal delivery was allowed. The patient gave birth at 36 weeks to a female neonate weighing 2700 g with an Apgar score of 10 at 5 minutes. She returned home 10 days postpartum with the same pharmacologic treatment. Coronary thrombosis can arise at any age and in all phases of pregnancy, but mostly during the third trimester. The coronary affection frequently affects only 1 vessel. Most maternal deaths arise at the time of infarction or in the 2 weeks following infarction, which often coincide with delivery. Fetal death in utero is often concomitant with maternal death, and maternal and fetal mortality from maternal myocardial infarction is 35% and 34%, respectively [1]. Diagnosis is generally delayed in pregnant women because of a low threshold of suspicion for myocardial infarction during pregnancy, even though the clinical signs are the same for pregnant women and the general population. Once myocardial infarction has been evoked as a possibility, diagnosis is confirmed by an electrocardiogram, the measurement of myocardial necrosis enzymes, and magnetic resonance imaging [2]. As a rule, pregnancy does not affect the diagnostic and therapeutic plans. In cases of arterial obstruction, early reperfusion by transluminal coronary angioplasty is the preferred option because it has fewer contraindications than thrombolysis [3]. The choice between angioplasty and thrombolysis will depend on team experience, time since the infarction, extent and severity of the infarct, and pregnancy duration. The remainder of the pregnancy is most often uneventful, with normal fetal development, which makes a cesarean delivery unwarranted in most cases. Outside of obstetric indications, a cesarean delivery is necessary in women with an unstable cardiac function or a hemorrhagic syndrome [4]. Women who experience myocardial infarction during pregnancy will benefit from a cardiovascular evaluation after delivery to assess the left ventricular function. At that ⁎ Corresponding author. 7 Rue de l'Arabie Saoudite, 4011 HammamSousse, Tunisia. Tel.: +216 72 285 633; fax: +216 73 21 94 86. E-mail address: youssef_benbrahim@yahoo.fr (Y.B. Brahim). ava i l ab l e a t www.sc i enced i r ec t . com

A case of acute myocardial infarction due to indirect lightning strike

Lightning strike is a natural phenomenon with potentially devastating effects and represents one of the leading causes of cardiac arrest and death from environmental phenomena. Almost every organ system may be impaired as lightning passes through the human body prefering the pathways that the lowest resistance betweem the contact points. Lightning can also have widespread effects on the cardiovascular system, producing extensive catecholamine release or autonomic stimulation. The victim may develop hypertension, tachycardia, nonspecific electrocardiographic changes (including prolongation of the QT interval and transient T-wave inversion), and myocardial necrosis with release of creatine phosphokinase-MB fraction. We present the case of a 13-year-old boy with acute myocardial infarction secondary to an indirect lightning strike.

Risk of Cardiovascular Events in Patients Receiving Celecoxib: A Meta-Analysis of Randomized Clinical Trials

Some nonsteroidal anti-inflammatory drugs (NSAIDs), including cyclooxygenase-2 selective inhibitors, have been associated with increased cardiovascular (CV) events in recent clinical trials or observational studies. To determine whether the cyclooxygenase-2 selective inhibitor celecoxib affects CV risk, the incidence of CV events was analyzed in patients treated with celecoxib, placebo, or nonselective NSAIDs in the clinical trial database for celecoxib using defined Antiplatelet Trialists' Collaboration end points of nonfatal myocardial infarction, nonfatal stroke, and CV death. Patient data were derived from studies in osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, low back pain, and Alzheimer's disease. This meta-analysis included (1) 7,462 patients exposed to celecoxib 200 to 800 mg/day for 1,268 patient-years compared with 4,057 patients treated with placebo for 585 patient-years, and (2) 19,773 patients treated with celecoxib 200 to 800 mg/day for 5,651 patient-years compared with 13,990 patients treated with nonselective NSAIDs (diclofenac, ibuprofen, naproxen, ketoprofen, and loxoprofen) for 4,386 patient-years. CV events were adjudicated by a 3-member expert end point committee (WBW, JSB, PBG) blinded to treatment group and study. The incidence rates of the combined CV events were not significantly different between patients treated with celecoxib and placebo or between those treated with celecoxib and nonselective NSAIDs. Event rates were similar for adjudicated and nonadjudicated data. Dose of celecoxib, the use of aspirin, or the presence of CV risk factors did not alter these results. In conclusion, these analyses failed to demonstrate an increased CV risk with celecoxib relative to placebo and demonstrated a comparable rate of CV events with celecoxib treatment compared with nonselective NSAIDs.