Mean Troponin Research Articles

Cardiac biomarkers in premature calves with respiratory distress syndrome.

The aim of this study was to determine the clinical relevance of cardiac biomarkers [troponin I and T, creatine kinase-MB fraction (CK-MB) and lactate dehydrogenase (LDH)] in premature calves with respiratory distress syndrome. Seventy premature calves were admitted to the clinic within 24 h after birth. Respiratory distress syndrome was diagnosed in premature calves by clinical examination and venous blood gas analysis. Ten healthy calves, aged 5 days, were used as control. Cardiac troponin I and T were analysed using ELISA and ELFA, respectively. Serum CK-MB and LDH were also analysed in an automatic analyser. The calves had low venous pH, pO2, O2 saturation and high pCO2 values consistent with dyspnoea, hypoxaemia, and inadequate oxygen delivery. Mean serum troponin I, troponin T, CK-MB and LDH levels were increased in the premature calves compared to the control group. In conclusion, the results in this study demonstrated that serum CK-MB, troponin I and troponin T concentrations could be used for evaluating myocardial injury in premature calves with respiratory distress syndrome.

Cardiac biomarker changes with neoadjuvant epirubicin-based chemotherapy

Aim: A major concern with epirubicin-based neoadjuvant chemotherapy, a mainstay of neoadjuvant treatment for breast cancer in Nigeria, is their association with cardiotoxicity. We investigated for possible changes in the level of cardiac markers, troponin T, and N-terminal pro-brain natriuretic peptide (NT-ProBNP) detectable after least three cycles of epirubicin in the neoadjuvant setting. Methods: Thirty consenting female patients who had received at least three cycles of epirubicin-based neoadjuvant chemotherapy were recruited from the Surgical Oncology Unit of the University College Hospital. Patients who were eligible for neoadjuvant chemotherapy for breast cancer but who had not commenced the same were recruited to serve as controls. Samples for troponin T and NT-ProBNP were collected on the day of commencement of the next cycle, before the administration of the dose. Results: The mean troponin T and median NT-ProBNP values were significantly higher among the women on epirubicin-based chemotherapy (0.76 ng/ml vs. 0.68 ng/ml, P = 0.047 and 114.5 pg/ml vs. 103 pg/ml, P = 0.007), respectively. Values of NT-ProBNP exceeding 200 pg/ml were significantly more frequently observed in the same group (40% vs. 16.7%, P = 0.01). A significant relationship between the number of cycles received and level of NT-ProBNP was observed (P = 0.015). A similar relationship was not observed with troponin T. Conclusion: Epirubicin-based chemotherapy may be associated with increased elaboration of the cardiac markers, NT-ProBNP, and troponin T early during neoadjuvant chemotherapy. The potential clinical utility of these markers in predicting cardiotoxicity needs to be further evaluated in prospective studies.

Analysis of patients presenting to the emergency department with carbon monoxide intoxication

ObjectivesCarbon monoxide is a potentially fatal form of poisoning. The exact incidence is unclear, due to cases being undiagnosed or reported as fewer than the real number. Hyperbaric oxygen therapy (HBOT) is of proven efficacy in the treatment of CO intoxication.The purpose of this study was to describe the general characteristics of carbon monoxide (CO) intoxications presenting to the emergency department and to investigate troponin I values and the effectiveness of hyperbaric oxygen therapy (HBOT) in these patients. Material and methodsPatients presenting to the emergency department with CO intoxication over one year and patients with such intoxications receiving HBOT were examined retrospectively. ResultsOne hundred seventy-one patients were included; 140 (81.9%) were poisoned by stoves, 18 (10.5%) by hot water boilers and 10 in (5.8%) by fires. COHb levels were normal in 49 of the 163 patients whose values were investigated, and were elevated in 114 patients. Mean COHb value was 16.6. Troponin I values were investigated in 112 patients. These were normal in 86 patients and elevated in 26. Mean troponin I value was 0.38 ng/ml. One hundred twenty-three of the 171 patients in the study were discharged in a healthy condition after receiving normobaric oxygen therapy, while 48 patients received HBOT. Forty-two (87.5%) of the patients receiving HBOT were discharged in a healthy condition while sequelae persisted in five (10.4%). One patient died after 15 session of HBOT. ConclusionAlthough elevated carboxyhemoglobin confirms diagnosis of CO intoxication, normal levels do not exclude it. Troponin I levels may rise in CO intoxication. No significant relation was observed between carboxyhemoglobin and receipt of HBOT. A significant correlation was seen, however, between troponin I levels and receipt of HBOT.

Abstract 10880: Impact of Post-Extrasystolic Potentiation on Takotsubo Cardiomyopathy

Introduction: Takotsubo cardiomyopathy (TCM) is an increasingly recognized condition that presents with transient and reversible left ventricular (LV) dysfunction despite angiographically unobstructed coronary arteries. However the detailed pathophysiology of the stunned myocardium remains to be determined. Post-extrasystolic potentiation (PESP) is an increase in contractility after an extrasystole, thought at least in part due to a net increase in myocardial calcium. When PESP occurs in akinetic LV segments, it is a marker of myocardial viability. Obviously the myocardium in TCM is viable, thus we hypothesized that the affected myocardium in TCM would demonstrate PESP. Methods: We retrospectively reviewed 61 cases of TCM diagnosed by the Mayo criteria between the periods of October 2004 to May 2015. The 24 cases wherein left ventriculography fortuitously provoked extra systoles (PVCs) were evaluated. Results: In our study, the baseline characteristics of TCM were 93.4% female patients with mean age of 67. Mean ejection fraction was 38% and mean troponin I elevation was 5.5. Apical type was the predominant (72.1%) compared to the mid-ventricular type (23.0%). None of the 24 patients in whom ventriculographic PVCs occurred demonstrated PESP in the affected region of the LV, while all did in the unaffected portion. Conclusions: Extra-systoles in TCM fail to elicit PESP in affected LV segments despite proven viability in those segments while unaffected segments behave as predicted. Since increased calcium is thought to be the basis for PESP, it is possible in TCM that either there is failure of calcium release in the affected areas or that the presumed catecholamine excess of TCM has already caused maximum calcium release so PCVs cannot enhance contractility further.

Troponin I can be Determined in Intraosseous Aspirates in a Porcine Shock Model.

Determination of troponin I may be important in the management of the critically ill patient. In medical emergencies, especially when vascular access is difficult to achieve, the use of intraosseous (10) needles is recommended. We aimed to perform a descriptive study, aiming to elucidate whether IO needles can be used to evaluate troponin I in a porcine model of human shock. Eight pigs were anesthetized and challenged with a 6 hours continuous intravenous infusion of E. coli endotoxin. An IO needle (EZ-IO®) was inserted in the proximal tibia of each pig. Circulatory variables were monitored and troponin I was sampled from arterial and venous blood and also from bone marrow aspirates. Circulatory deterioration developed in all endotoxemic animals, which was reflected by a profound deterioration of left ventricular stroke work index. Troponin I levels were nearly identical in both arterial, venous, and IO samples during the first hour of endotoxemia. At 1 hour, all mean troponin I levels had more than doubled as compared to baseline. The troponin I levels continued to increase over time and were markedly elevated versus baseline levels during the 2nd and 6th hours, regardless of sampling site. At 3 hours, IO troponin I reached a plateau, whereas troponin I in both arterial and venous blood continued to increase. This investigation has shown that troponin I can be analyzed in bone marrow aspirates in a shock model. This may be useful in medical emergencies, where cardiac damage is suspected to be involved. The levels of IO troponin I increased during the first 3 hours of shock, after which it remained at a high level. During this initial period there was, in parallel, a progressive circulatory deterioration.

The effect of sevoflurane versus propofol anesthesia on troponin I after congenital heart surgery, a randomized clinical trial.

Background:The ischemic preconditioning phenomenon can save myocardium against move severe ischemic damages and reduce infarction size and furthermore a heart rhythm disturbance. In this study we examine relationship between troponin I (as a structural myocardial protein) level and anesthetic agents in the children.Materials and Methods:In this study 84 children under 12 years age before cardiac surgery were divided randomly into two groups of 42 each. For anesthetic maintenance sevoflurane with dose of 0.5-1 MAC was used in Group 1 and 100-150 mg/kg/min of intravenous propofol in Group 2 for maintenance of anesthesia. Troponin I level was assessed 2 before and 1 hour after anesthetic induction. Outcome measures included the serum cardiac troponin I level in children before and after surgery in two study groups.Results:There was no significant difference between two groups in indices and both groups were homogenous in this point of view. The troponin I level after surgery was significantly increased in two groups. In the sevoflurane group it was 0.04 ± 0.12 to 0.05 ± 0.09 ng/ml (P value = 0.003) and the propofol group was 0.12 ± 0.26 to 0.19 ± 0.38 ng/ml (P value = 0.001).Conclusions:In this study two Anesthetic regimens were compared to assess the mean troponin I level before and after pediatric closed heart surgery, and it was shown that mean troponin level before and after surgery in the sevoflurane group was less than the propofol group. But this result was not statistically significant. These results indicate that although more protective effects of sevoflurane on myocardial injuries during pediatric cardiac surgery is predominant but this effect has no significant difference in the propofol group.

0443: Primary percutaneous coronary intervention for ST elevation myocardial infarction in nonagenarians: a multicentre study

There are limited data on outcomes following primary percutaneous coronary intervention (PCI) for ST-segment elevation acute myocardial infarction (STEMI) in nonagenarian patients. We conducted a multicentre retrospective study between 2006 and 2013 in 5 international high-volume centers and included 145 nonagenarians treated with primary PCI for STEMI. Cardiogenic shock was present at admission in 21%. Mean delay between symptom onset and balloon was 5,8±7,6 hours and 60% of procedures were performed through the transradial approach. Successful revascularization of the culprit vessel was obtained in 86% of the cases (TIMI flow of 2 or 3). Major or clinically-relevant bleeding was observed in 4% of patients. Mean cardiac troponin Ic was 65±79 ng/ml and mean LVEF post-PCI was 42±13%. The in-hospital mortality was 24% with 6 months and 1 year survival of 58% and 49% respectively. In our study, primary PCI in nonagenarians with STEMI was successful and feasible through a transradial approach. It is associated with a high rate of successful reperfusion of the infarct-related artery and nearly 50% survival at one year. These results suggest that primary PCI should be offered in selected nonagenarians with acute myocardial infarction (table next page). Abstract 0443 – TableProcedural FindingsTime from symtoms to PCI (h)5.8±7.6Catheterizzation access (%)Radial60Single Vessel Coronary Disease (%)53Single Vessel Coronary PCI (%)74Infarct-related coronary artery (%)Left main4Left anterior descending41Circumflex14Right45CABG3Thrombus aspiration (%)14TMI flow grade after procedure (%)0121126381Coronary stenting (%)BMS75DES9POBA10Procedure success (%)Successful PCI86Failed PCI11Complicated PCI3Use of protection device (%)2IABP (%)0Use of inotropes during procedure (%)26 Abstract 0443 – Table

Pregnancy-associated plasma protein A and procalcitonin as markers of myocardial injury in patients with acute coronary syndrome.

To evaluate pregnancy-associated plasma protein A (PAPP-A), ischemia-modified albumin (IMA), procalcitonin, and troponin I levels as diagnostic markers of acute coronary syndrome in patients admitted to the emergency department. The serum PAPP-A, IMA, procalcitonin, and troponin I levels were measured in 100 patients with acute coronary syndrome admitted to the emergency department and 100 healthy control subjects. Patients with acute coronary syndrome had significantly greater mean serum PAPP-A (patients, 10 ± 10 mIU/L; control subjects, 6 ± 10 mIU/L; P < 0.001), procalcitonin (patients, 2 ± 10 µg/L; control subjects, 0.4 ± 2 µg/L; P < 0.001), and troponin I levels (patients, 6 ± 8 µg/L; control subjects, 0.2 ± 0.3 µg/L; P < 0.001) than control subjects. There was no difference in mean IMA levels between patients and control subjects. There were no significant correlations between PAPP-A levels and IMA, procalcitonin, or troponin I levels in patients with acute coronary syndrome. The PAPP-A, procalcitonin, and troponin I levels were increased in patients with acute coronary syndrome. Therefore, elevated PAPP-A and procalcitonin levels, in addition to troponin I levels, may be useful markers of myocardial injury on admission to the emergency department.

Effect of Timing and Route of Methylprednisolone Administration During Pediatric Cardiac Surgical Procedures

We compared the antiinflammatory and cardioprotective effects of the two most common regimens of corticosteroid administration in pediatric cardiac surgical procedures: a single dose delivered either at anesthesia induction or by cardiopulmonary bypass (CPB) prime. Forty-five children, aged between 1 and 18 months and undergoing ventricular septal or atrioventricular septal defect correction, were randomized in double-blind fashion into three groups. The anesthesia induction group received 30 mg/kg methylprednisolone intravenously after anesthesia induction, and the CPB-prime group received 30 mg/kg methylprednisolone by CPB circuit. The placebo group received saline solution. Plasma concentrations of methylprednisolone, interleukin (IL)-6, IL-8 and IL-10, and troponin were measured at anesthesia induction before the study drug, 30 minutes on CPB, after patients were weaned from CPB, and 6 hours after cessation of CPB. Equally high methylprednisolone concentrations were detected in both methylprednisolone groups, but the measured peak concentration occurred earlier in the induction group. Significantly lower IL-8 concentrations were observed just after patients were weaned from and 6 hours after CPB in the anesthesia induction group compared with the placebo (p = 0.002, p = 0.001) and prime groups (p = 0.003, p = 0.006). Significant reductions of troponin were detected in both methylprednisolone groups compared with placebo (induction, p = 0.001; prime, p = 0.002) 6 hours after patients were weaned from CPB. Methylprednisolone administration at anesthesia induction was superior in terms of antiinflammatory action. Methylprednisolone administration in CPB-prime only a few minutes before aortic cross-clamping and cardioplegia resulted in mean troponin reductions similar to those of administration at anesthesia induction. Corticosteroids may have direct cardioprotective properties, as reported in experimental studies.

Losmapimod, a novel p38 mitogen-activated protein kinase inhibitor, in non-ST-segment elevation myocardial infarction: a randomised phase 2 trial

p38 MAPK inhibition has potential myocardial protective effects. We assessed losmapimod, a potent oral p38 MAPK inhibitor, in patients with non-ST-segment elevation myocardial infarction (NSTEMI) in a double-blind, randomised, placebo-controlled trial. From October, 2009, to November, 2011, NSTEMI patients were assigned oral losmapimod (7·5 mg or 15·0 mg loading dose followed by 7·5 mg twice daily) or matching placebo in a 3:3:2 ratio. Safety outcomes were serious adverse events and alanine aminotransferase (ALT) concentrations over 12 weeks, and cardiac events (death, myocardial infarction, recurrent ischaemia, stroke, and heart failure) at 90 days. Efficacy outcomes were high-sensitivity C-reactive protein (hsCRP) and B-type natriuretic peptide (BNP) concentrations at 72 h and 12 weeks, and troponin I area under the curve (AUC) over 72 h. The losmapimod groups were pooled for analysis. This trial is registered with ClinicalTrials.gov, number NCT00910962. Of 535 patients enrolled, 526 (98%) received at least one dose of study treatment (losmapimod n=388 and placebo n=138). Safety outcomes did not differ between groups. HsCRP concentrations at 72 h were lower in the losmapimod group than in the placebo group (geometric mean 64·1 nmol/L, 95% CI 53·0-77·6 vs 110·8 nmol/L, 83·1-147·7; p=0·0009) but were similar at 12 weeks. Early geometric mean BNP concentrations were similar at 72 h but significantly lower in the losmapimod group at 12 weeks (37·2 ng/L, 95% CI 32·3-42·9 vs 49·4 ng/L, 38·7-63·0; p=0·04). Mean troponin I AUC values did not differ. p38 MAPK inhibition with oral losmapimod was well tolerated in NSTEMI patients and might improve outcomes after acute coronary syndromes. GlaxoSmithKline.

79 Diagnostic Accuracy of Myocardial Fractional Flow Reserve for Reversible Perfusion Abnormalities in Patients with Recent Non-ST Elevation Myocardial Infarction

BackgroundMyocardial fractional flow reserve (FFR) has uncertain validity in patients with recent myocardial infarction and the use of FFR in this setting is controversial. We performed a prospective study to...

(667) - Extracorporeal Membrane Oxygenation (ECMO) Practices for Bridging to Lung Transplantation in North America: A Multi-Center Survey

s S247 University of Pittsburgh Medical Center, Pittsburgh, PA; 2Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; 3Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA; 4Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA. Purpose: Acute myocardial infarction (AMI) has been associated with higher mortality rates in the female population. The aim of this study was to evaluate gender-specific outcomes with the use of Extracorporeal Membrane Oxygenation (ECMO) as circulatory support in patients with AMI complicated by profound cardiogenic shock (CS). Methods: This retrospective review included 41 patients (32 men, 9 women) supported on veno-arterial (VA) ECMO for AMI-induced CS in a single center between July 2003 and April 2013. Comparisons were performed between males and females groups regarding demographics, risk factors for coronary artery disease, revascularization, support strategies , complications, and outcomes. Results: There were no differences in age or risk factors for coronary artery disease among the groups. Men had a higher use of intra-aortic balloon pump (IABP) during admission (96.9% vs. 66.7%, p= 0.03) but similar rates of CPR (37.5% vs. 33.3%, p= 1.00) and PCI (78.1% vs. 55.5%, p= 0.22). There were no differences in mean lactate, troponin, and liver transaminases among the groups prior to ECMO implantation (p= 0.38, p= 0.31, p= 0.15, p= 0.38). Complication rates including renal failure necessitating dialysis, sepsis, pneumonia, cerebrovascular accidents, and ischemia requiring fasciotomy or amputation were comparable among both groups, but females were more likely to suffer bleeding complications (66.7% vs. 25.0%, p= 0.04). The average time of ECMO support was 88 h (SD 78h), with no difference between groups (p= 0.23). Females showed overall lower survival to discharge (11.1% vs. 53.1%, p= 0.05). Multivariate analysis showed association of only female sex with in-hospital mortality with HR 2.86 (1.16-7.14, 95%CI, p= 0.02). Conclusion: In this single center experience ,women requiring ECMO support for AMI-CS present a significantly higher mortality risk than men.

Mean platelet volume in patients with acute coronary syndromes: a supportive diagnostic predictor.

Platelets and their activity have a crucial role in acute coronary events. Larger platelets are enzymatically and metabolically more active and have a higher potential thrombotic ability as compared with smaller platelets. The aim of this study is to investigate whether there is an association between mean platelet volume (MPV) measurement and cardiac Troponin I( cTn I ) in patients admitted with a suspected diagnosis of ACS and to assess the potential diagnostic efficiency of MPV in the diagnostic workup for ACS. After thorough evaluation of 215 eligible patients, 3 ml. Venous blood collected using Becton, Dickinson and company vacutainer and MPV measured within 1-2 hr of sample collection. Sample for cTn I collected at 6 hr and at 12 hrs, if required and level measured using Biosite analyzer. Mean platelet volume (MPV) was found to be higher among ACS patients as compared to non ACS, 11.44±1.23 vs 9.91±1.27 fl (p-value<0.001). The NPV of MPV in the diagnostic workup of chest pain suggestive of ACS within 6 hours of presentation were found to be 82.53% . In this study the MPV is significantly higher in patients with ACS than in those with chest pain of non-cardiac origin and its negative predictive value of 82.53%, it might be useful as an assisting rule-out test in conjunction with other markers in the early prediction of the risk of ACS.

Abstract 9936: Hypoxanthine is a Biomarker of Ischemia

We hypothesize that hypoxanthine (HX) is an early biomarker of ischemia. Our goal was to assess early HX values in patients presenting with acute chest pain (ACP) and late troponin elevation (n=27) compared to those with known coronary artery disease (CAD) presenting for elective CABG (n=10) and normal controls without known CAD (n=24). Methods: In a retrospective manner after IRB approval was obtained, we examined residual plasma for HX in 27 patients presenting to the emergency room with troponin samples requested by the clinician as per routine clinical practice. Patients with a non diagnostic troponin level for myocardial infarction (MI) at the time of presentation but who subsequently ruled in for MI (troponin of &gt; .39 μg/L) were included in the study. Significant differences between the groups was determined using a standard t test. Results: Initial sample results for the ACP patient group who subsequently ruled in for MI by troponin show a mean troponin of 0.07+/-0.014(SEM)μg/L and a mean HX level of 27.38 +/- 3.53 μM compared to normal controls whose mean HX was 4.03 +/- 0.32 μM (p&lt;.05). Ten patients without ACP presenting for elective CABG had a mean HX of 5.09+/- 0.67 μM. In the figure below, we demonstrate that HX is elevated in ACP patients who on subsequent sampling rule in by troponin criteria for MI. Reported HX levels in normal volunteers are approximately 3.5 μM consistent with our controls. Conclusion: HX is elevated prior to troponin elevation in patients presenting with ACP that subsequently rule in for MI by troponin criteria. These levels were elevated relative to normal control patients as well as in 10 patients with known CAD without ACP presenting for elective CABG. Therefore, HX is potentially an early maker of ischemia in the acute clinical setting.

P131 Myocardial Injury and Dysfunction during COPD Exacerbations

IntroductionCardiac biomarkers of myocardial injury and dysfunction are commonly raised in patients hospitalised with COPD exacerbations and are independent predictors of mortality. The relevance of this to the majority of...

The diagnostic significance of NT-proBNP and troponin I in emergency department patients presenting with palpitations

OBJECTIVE:This prospective study investigated the diagnostic significance of the N-terminal pro-brain natriuretic (NT-proBNP) and troponin I peptides in emergency department patients presenting with palpitations.METHODS:Two groups of patients with palpitations but without documented supraventricular tachycardia were compared: a group with supraventricular tachycardia (n = 49) and a control group (n = 47). Both groups were diagnosed using electrophysiological studies during the study period. Blood samples were obtained from all of the patients to determine the NT-proBNP and troponin I levels within the first hour following arrival in the emergency department.RESULT:The mean NT-proBNP levels were 207.74±197.11 in supraventricular tachyarrhythmia group and 39.99±32.83 pg/mL in control group (p<0.001). To predict supraventricular tachycardia, the optimum NT-proBNP threshold was 61.15 pg/mL, as defined by the receiver operating characteristic (ROC) curve, with a non-significant area under the ROC curve of 0.920 (95% CI, 0.86-0.97, p<0.001). The NT-proBNP cut-off for diagnosing supraventricular tachycardia had 81.6% sensitivity and 91.5% specificity. Supraventricular tachycardia was significantly more frequent in the patients with NT-proBNP levels ≥61.15 pg/mL (n = 44, 90.9%, p>0.001). The mean troponin I levels were 0.17±0.56 and 0.01±0.06 pg/mL for the patients with and without supraventricular tachycardia, respectively (p<0.05). Of the 96 patients, 21 (21.87%) had troponin I levels ≥0.01: 2 (4.25%) in the control group and 19 (38.77%) in the supraventricular tachycardia group (p<0.001).CONCLUSION:Troponin I and, in particular, NT-proBNP peptide were helpful for differentiating supraventricular tachycardia from non- supraventricular tachycardia palpitations. Further randomized, large, multicenter trials are needed to define the benefit and diagnostic role of NT-proBNP and troponin I in the management algorithm of patients presenting with palpitations in emergency departments.

The importance of early bedside echocardiography in children with scorpion envenomation

Scorpion sting may cause myocardial injury and heart failure (HF). Clinical signs of failure may develop several hours or even days after the sting, while electrocardiography (ECG) and blood examination soon after the sting may be normal. We sought to examine whether normal echocardiographic (echo) examination performed shortly after hospital arrival would exclude subsequent HF. We also sought to check if blood troponin and natriuretic peptide values measured shortly after arrival may predict or exclude subsequent HF. Natriuretic peptide activities have not been measured in scorpion sting victims. We also wanted to check if HF occurs in envenomated young infants. In a 3-year prospective study we looked at the demographic, clinical, laboratory, ECG, and echo data of all patients with general envenomation who arrived at the emergency department (ED) after scorpion sting. Clinical, laboratory, ECG, and echo results on arrival and 24 h after arrival were checked and compared between groups of patients with normal and abnormal echo on arrival. We then looked for differences in clinical course, therapy, and outcome between groups. The study included 98 children aged 80 days to 19 years (median 53.1 months), 25 were below the age of 2 years. Envenomation by the “yellow scorpion”Leiurus quinquestriatus was suspected in 74 cases. Median time between sting and ED arrival was 80 min. Echo was performed on arrival in 93 of the 98 patients, (in 5 occasions it was not performed or not recorded) 74 were normal and 19 were abnormal. Abnormal echo included hypokinesia and low fractional shortening and ejection fraction of the left ventricle. Clinical signs, abnormal ECG, and laboratory results were not discriminative between groups on arrival. Mean troponin T was higher in patients with abnormal echo, but within normal range in 13 of the 19 patients with abnormal echo and above normal in 2 of the 74 patients with normal echo – missing sensitivity and specificity. Mean N-terminal pro B-type natriuretic peptide was above normal in both groups but within normal range in 5 patients with abnormal echo and above normal range in 24 patients with normal echo – missing sensitivity and specificity. None of the patients with normal echo had subsequent HF and none of the children younger than 2 years of age had HF. All patients survived the intoxication and were discharged home without sequel. We conclude that early echo examination is an important procedure. In our study, normal examination excluded subsequent HF. Abnormal examination accelerated cardiac therapy which might have contributed to our favorable outcome. HF did not occur in infants younger than two years of age.

Abstract TP427: Comparison of Clinical Characteristics of Neurogenic Stunned Myocardium in Patients with Subarachnoid Hemorrhage and Acute Ischemic Stroke

Aim: Neurogenic stunned myocardium (NSM) after subarachnoid hemorrhage (SAH) is well known, but there is paucity of data regarding its occurrence following acute ischemic stroke. The aim of this study is to contrast the characteristics of NSM in SAH and acute stroke. Methods: An electronic literature search was performed with Medline and Google Scholar, for English-language articles using the terms “subarachnoid hemorrhage” along with “stunned myocardium” or “Takotsubo cardiomyopathy”. The search revealed 35 articles, from which 10 studies were selected based on the following criteria: prospective studies, non-traumatic SAH, N &gt;25 patients and documentation of regional wall motion abnormalities (RWMA). For studies from the same institutional database, the one with most comprehensive documentation of cardiac parameters was selected. Another search was conducted using the terms “acute ischemic stroke” along with “stunned myocardium” or “Takotsubo cardiomyopathy” resulted in only 7 case reports/series. Results: In this descriptive study, 98 out of 504 SAH patients had NSM, evidenced by RWMA (23%). The mean age was 54.8 years and 68% of patients were females, mean Hunt Hess grade was 2.5 and mean LVEF was 55.8%. The mean troponin level was 1.24. The most commonly involved segments were mid-ventricular, basal and apical, in that order. A significant improvement in LVEF occurred in 70.4% of patients. Among stroke patients, the mean age for NSM was 72.5 years and 77% were females. Insular cortex was involved in 46% of cases. Mean troponin elevation was 0.64 and mean LVEF was 34.4%. Regarding outcomes, 84.6% of patients had significant improvement in LVEF, with full recovery in 53.8%. Conclusion: NSM was more common in females, with favorable prognosis. Mid-ventricular segment was most commonly involved in SAH. The mean troponin was twice higher in SAH, raising the possibility that sympathetic overdrive is stronger in these patients. Only half the patients with NSM following stroke had insular involvement, implying other structures may be involved in the neuro-cardiac axis. Lack of prospective studies in stroke patients, and reports only describing Takotsubo cardiomyopathy, which selectively involves apical segments, are limiting factors.

Troponin Elevation in Subarachnoid Hemorrhage Does not Impact In-hospital Mortality

Cardiac dysfunction is a well-known complication of subarachnoid hemorrhage (SAH). Our objective was to determine the frequency of troponin abnormalities in SAH and determine its impact on in-hospital mortality. With IRB approval, we retrospectively reviewed 225 consecutive SAH patients admitted to our institution from August 1, 2006 to June 1, 2009. Traumatic SAH patients were excluded. Data were collected on demographics, Hunt and Hess score (HH), in-hospital mortality, and peak troponin values on admission. CT images were independently reviewed and graded by the study neurologist for Fisher grade (FG) and the presence of intraventricular hemorrhage (IVH). Among the 225 SAH patients, the mean age was 57.3 years (range, 21-90). The majority of patients were female (67%), FG 3 (75%), and had IVH (62%). Among the 201 patients with troponin I values, the mean troponin level was 0.93 (range, 0.01-25.8 ng/mL) and 47 (23%) had elevated troponin I levels. In unadjusted analysis, elevated troponin I level was significantly associated with in-hospital mortality. With multivariable logistic regression adjusting for age, HH, FG, and IVH, elevated troponin I level was no longer associated with in-hospital mortality (p. 0.34). In multivariate analysis, the independent predictors of in-mortality were age and severe grade HH (4-5). Troponin I elevation after SAH is not an independent predictor of in-hospital mortality.

Quantitation of Late Gadolinium Enhancement in Tako-Tsubo Cardiomyopathy—A Cardiac Magnetic Resonance Study

Background: Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) has been recommended to distinguish Tako-Tsubo cardiomyopathy (TTC) from either acute myocardial infarction or myocarditis. Method: Forty-four consecutive patients with confirmed Mayo Clinic criteria for TTC underwent CMR imaging at 1.5 Tesla during the acute phase. LGE was quantitated at two signal thresholds (CircleCVi software) at >2 and >5 standard-deviations (SD)above reference myocardium, and compared to biomarkers. Findings: Mean door-to-CMR time was 57 h. Eighteen patients (41%) had LGE >2SD localised to the area of abnormal wall motion, representing 28.9 ± 11.2% LV mass. In 16 of these 18 patients (89%) LGE was >5 SD above normal myocardium, representing 12.1 ± 10% LV mass. Mean troponin was significantly higher in LGE positive patients (2.5 ± 1.8 vs 4.4 ± 6.9, p = 0.001). Mean ejection fraction (EF) by CMR was 45 ± 8.7% in LGE-negative, and 40 ± 7.1 in LGE-positive patients (p = 0.37). Recovery of segmental function was confirmed at follow-up, mean EF was 59% in both groups. Conclusion: LGE was present in 41% of cases of TTC, 89% of which had intense enhancement >5 SD above normal myocardium. Presence of LGE was associated with worse myocardial injury in the acute setting, with no difference in recovery of function.