Peak Troponin T Levels Research Articles

Akut koroner sendromlarda sistemik immün-inflamasyon indeksi ve yüksek duyarlılıklı kardiyak troponin T

Aim: Acute coronary syndromes (ACSs) are classified as ST-segment elevated myocardial infarction (STEMI), non-ST-segment elevated myocardial infarction (NSTEMI) and unstable angina pectoris (USAP). Cardiac troponins constitute the cornerstone biomarkers for the laboratory diagnosis of ACS. In this study, we aimed to investigate whether systemic immune-inflammation index (SII) is associated with peak cardiac troponin T (TnT) levels in ACS.Methods: Consecutive patients with ACS whose coronary angiography was performed were included in the present study (n=397). Admission SII was determined as platelet count x neutrophil count/lymphocyte count. Serum levels of cardiac enzymes, including high-sensitivity TnT and creatine kinase-myocardial band (CK-MB), were measured at the time of admission and repeated daily during patients’ hospital stay.Results: Patients were categorized as namely STEMI (n=92) and NSTEMI/USAP (n=141). The findings obtained in this study showed that the median of SII levels was higher in STEMI than NSTEMI/USAP at a significant level. Correlation analysis of SII with various clinical and laboratory parameters demonstrated a significant correlation with C-reactive protein, peak CK-MB (r=0.52, p<0.001), peak TnT (r=0.49, p<0.001) and left ventricular ejection fraction (r= -0.48, p<0.001). Multivariate linear regression analysis identified age and log-SII (Beta Coefficient: 1.29, 95% Confidence Interval: 0.93-1.66, p<0.001) as independent predictors of peak TnT levels.Conclusion: SII is an independent predictor of peak TnT levels and significantly correlates with peak CK-MB levels in patients with ACS. SII significantly and inversely correlates with left ventricular systolic functions.

Immature platelet fraction over time and clinical outcomes in patients with acute myocardial infarction.

Immature platelets in the circulation can be measured as immature platelet fraction (IPF). Limited data exist regarding IPF during the course of an acute myocardial infarction (AMI), the association between IPF and extent of cardiac damage, and the long-term prognostic implications of IPF in patients with AMI. To examine the temporal course of IPF during the first month after AMI, the association between IPF and extent of cardiac damage, and the long-term prognostic effect of IPF in AMI patients. Patients with AMI treated with percutaneous coronary intervention (PCI) were examined. IPF was evaluated by a Sysmex XN-3000 autoanalyzer, at 4 time points: baseline; one day post-PCI; 3days post-PCI, and 30days post-PCI. The association between peak troponin-T levels and IPF was evaluated. One-year clinical outcomes (cardiac hospitalization, urgent revascularization, or death) were assessed. One hundred patients were included, mean age was 59.5±11.3years, 82 were men, 27 had diabetes, and 54 were hospitalized with ST-segment elevation myocardial infarction (STEMI) and 46 with non-ST segment elevation myocardial infarction (NSTEMI). The levels of IPF modestly decreased a day after PCI but did not change in subsequent measurements. Peak troponin-T level was significantly associated with the levels of IPF at all 4 time points. IPF levels three days post-PCI were associated with the composite clinical outcome at 1year. The levels of IPF following AMI remain relatively stable over a one-month period. Higher levels of IPF during the acute phase of AMI appear to be associated with worse cardiac outcomes at 1year.

Post-resuscitation myocardial dysfunction in out-of-hospital cardiac arrest patients randomized to immediate coronary angiography versus standard of care

BackgroundImmediate coronary angiography with subsequent percutaneous coronary intervention (PCI) has the potential to reduce post-resuscitation myocardial dysfunction in out-of-hospital cardiac arrest (OHCA) patients. The aim of this study was to see if immediate coronary angiography, with potential PCI, in patients without ST-elevation on the ECG, influenced post-resuscitation myocardial function and cardiac biomarkers. MethodsA secondary analysis of the Direct or Subacute Coronary Angiography in Out-of-Hospital Cardiac Arrest (DISCO) trial (ClinicalTrials.gov ID: NCT02309151). Patients with bystander-witnessed OHCA, without ST-elevations on the ECG were randomly assigned to immediate coronary angiography within two hours of cardiac arrest (n = 38) versus standard-of-care with deferred angiography (n = 40). Outcome measures included left ventricle ejection fraction (LVEF) at 24 h, peak Troponin T levels, lactate clearance and NT-proBNP at 72 h. ResultsIn the immediate-angiography group, median LVEF at 24 h was 47% (Q1-Q3; 30–55) vs. 46% (Q1-Q3; 35–55) in the standard-of-care group. Peak Troponin-T levels during the first 24 h were 362 ng/L (Q1-Q3; 174–2020) in the immediate angiography group and 377 ng/L (Q1-Q3; 205–1078) in the standard-of-care group. NT-proBNP levels at 72 h were 931 ng/L (Q1-Q3; 396–2845) in the immediate-angiography group and 1913 ng/L (Q1-Q3; 489–3140) in the standard-of-care group. ConclusionIn this analysis of OHCA patients without ST-elevation on the ECG randomized to immediate coronary angiography or standard-of-care, no differences in post-resuscitation myocardial dysfunction parameters between the two groups were found. This finding was consistent also in patients randomized to immediate coronary angiography where PCI was performed compared to those where PCI was not performed.

Serum Fatty Acids, Traditional Risk Factors, and Comorbidity as Related to Myocardial Injury in an Elderly Population with Acute Myocardial Infarction.

Background. Epidemiological and randomized clinical trials indicate that marine polyunsaturated n-3 fatty acids (n-3 PUFAs) may have cardioprotective effects. Aim. Evaluate the associations between serum fatty acid profile, traditional risk factors, the presence of cardiovascular diseases (CVD), and peak Troponin T (TnT) levels in elderly patients with an acute myocardial infarction (AMI). Materials and Methods. Patients (n = 299) consecutively included in the ongoing Omega-3 fatty acids in elderly patients with myocardial infarction (OMEMI) trial were investigated. Peak TnT was registered during the hospital stay. Serum fatty acid analysis was performed 2–8 weeks later. Results. No significant correlations between peak TnT levels and any of the n-3 PUFAs were observed. However, patients with a history of atrial fibrillation had significantly lower docosahexaenoic acid levels than patients without. Significantly lower peak TnT levels were observed in patients with a history of hyperlipidemia, angina, MI, atrial fibrillation, intermittent claudication, and previous revascularization (all p < 0.02). Conclusions. In an elderly population with AMI, no association between individual serum fatty acids and estimated myocardial infarct size could be demonstrated. However, a history of hyperlipidemia and the presence of CVD were associated with lower peak TnT levels, possibly because of treatment with cardioprotective medications.

Abstract 314: The Safety of Preoperative Vardenafil in Patients Undergoing Coronary Bypass Surgery.

Objectives Advances in cardiac surgery have significantly improved the outcomes for patients with myocardial ischemia. However, ischemia/ reperfusion injury represents a mechanism that continues to limit the effectiveness of coronary bypass graft surgery (CABG). Phosphodiesterase 5 inhibitors have been shown to exhibit powerful cardioprotective effects in animal models of ischemia-reperfusion injury. We evaluated the safety of vardenafil in patients undergoing cardiac surgery. Methods 10 male patients undergoing CABG with or without valve surgery were enrolled in the study. Subjects were given a onetime dose of 10 mg oral vardenafil on the morning of surgery. They were monitored for adverse events and left ventricular ejection fraction changes; pertinent clinical parameters were also recorded. Their postoperative parameters and outcomes were also compared with 47 patients who underwent CABG in the same period of time (control group). Results The study drug was tolerated well. There were no episodes of hypotension or deaths in the group receiving vardenafil. The left ventricular ejection fraction did not change significantly after surgery (0.54±0.08 vs 0.53±0.09; P=0.76) in the vardenafil group. The vardenafil group and the control group were similar in terms of clinical characteristics. The type of operation and operative parameters were also similar between the two groups. Peak troponinT levels were not significantly lower in the vardenafil group compared to the control group (9.1 ± 8.3 vs 12.5 ± 9.3 ng/mL; P = 0.26, respectively). The median duration of intubation was not significantly different in the vardenafil group compared to the control group (21.4 ± 10.1 vs 27.4 ± 15.2 h; P = 0.14). The length of hospital stay was also not significantly different between the vardenafil group and the control group (11.1 ± 13.2 vs 10.0 ± 4.7 days; P=0.80, respectively). Conclusions Vardenafil is well tolerated when given to patients immediately prior to CABG surgery and appears safe especially in the setting of the intensive care unit where blood pressure and other vital signs are closely monitored. A larger trial is needed to document the cardioprotective effects of the drug in these patients.

Obstructive sleep apnea and acute myocardial infarction severity: ischemic preconditioning?

Obstructive sleep apnea (OSA) is characterized by intermittent hypoxia (IH). In animal models, IH has been shown to protect the myocardium during periods of ischemia by reducing infarct size. However, this phenomenon of "ischemic preconditioning" has not been investigated among OSA patients with acute myocardial infarction (MI). This study investigates the role of OSA on MI severity as measured by cardiac enzymes, specifically troponin-T, among patients with an acute MI. This is an observational cohort study of patients ≥18 years of age who were hospitalized with an acute MI. Each participant underwent portable sleep monitoring (Apnea Link Plus); OSA was defined as an apnea-hypopnea index ≥5/h. Multivariable regression analysis was conducted to assess the relationship between OSA and highly sensitive troponin-T levels. In our entire cohort of acute MI patients (n = 136), 77 % of the sample had evidence of sleep disordered breathing, with 35 % of the sample having OSA (i.e., an AHI >5). Higher AHI was associated with lower peak troponin-T levels in partially adjusted models (β = -0.0320, p = 0.0074, adjusted for age, gender, and race) and fully adjusted models (β = -0.0322, p = 0.0085) (additionally adjusted for smoking, hypertension, hyperlipidemia, body mass index, history of prior cardiovascular or cerebrovascular disease, diabetes and baseline admission creatinine levels). The mean value of the log-transformed peak troponin-T variable was used to dichotomize the outcome variable. In both partially (OR 0.949, CI 0.905-0.995, p = 0.03) and fully adjusted (OR 0.918, CI 0.856-0.984, p = 0.0151) logistic regression models, the OR for AHI suggests a protective effect on high troponin-T level. Our study demonstrates that patients with OSA have less severe cardiac injury during an acute non-fatal MI when compared to patients without OSA. This may suggest a cardioprotective role of sleep apnea during acute MI via ischemic preconditioning.

Angiographic patterns of myocardial reperfusion after primary angioplasty and ventricular remodeling

No reflow after primary percutaneous coronary intervention is a dynamic process and its reversibility may affect left ventricular (LV) remodeling. We aimed at assessing in-hospital evolution of angiographic no reflow, predictors of its reversibility, and its impact on LV function at follow-up (FU). Fifty-three consecutive patients (age, 60±10 years; male sex, 79%) presenting with ST-elevation myocardial infarction and undergoing primary percutaneous coronary intervention within 12 h of symptom onset were enrolled. No reflow was defined as a final thrombolysis in myocardial infarction (TIMI) flow of 2 or final TIMI flow of 3 with myocardial blush grade (MBG) of less than 2. The evolution of angiographic no reflow was assessed by repeat in-hospital coronary angiography. Patients with no reflow found to have an improvement of TIMI and/or MBG leading to a final TIMI 3 and MBG of greater than or equal to 2 were classified as reversible no reflow; the remaining patients were classified as sustained no reflow. Variables predicting the patterns of no reflow, recorded on admission, were assessed among clinical, angiographic and laboratory data. FU echocardiographic data (at 6 months) were compared with those obtained in-hospital according to no reflow evolution. Thirty-six patients (68%) exhibited myocardial reperfusion; 17 patients (32%) showed no reflow. Among these, six patients (age, 58±10 years; male sex, 83%) showed sustained no reflow, whereas 11 patients (age, 55±8 years; male sex, 82%) showed reversible no reflow. Patients with sustained no reflow had longer time to percutaneous coronary intervention (261±80 min) compared with those with myocardial reperfusion (216±94 min) or reversible no reflow (237±76 min; P=0.008 and 0.05, respectively). Moreover, patients with sustained no reflow had a higher peak troponin-T levels (14.5 ng/ml; range, 7.5-20.2 ng/ml) compared with those presenting with myocardial reperfusion (3.9 ng/ml; range, 3.3-9.1 ng/ml) and reversible no reflow (7.7 ng/ml; range, 3.6-29.9 ng/ml; P=0.03 and 0.07, respectively). At multivariate ordinal logistic regression, time pre-PCI retained its statistical significant association with angiographic no reflow evolution (odds ratio=2.54; 95% confidence interval: 1.45-6.53; P=0.04), with troponin T levels showing a borderline statistical significance (odds ratio=3.12; 95% confidence interval: 1.07-6.23; P=0.09). Finally, in patients with sustained no reflow only both end-diastolic and end-systolic volumes significantly increased at FU (P<0.001 and 0.001, respectively). Sustained no reflow is associated with a longer ischemic time and predicts worse LV remodeling. No reflow, however, shows an in-hospital reversibility calling for therapeutic interventions when its prevention fails.

Evaluation of Troponin T Criteria for Periprocedural Myocardial Infarction in Patients With Acute Coronary Syndromes

In patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI), the diagnosis of periprocedural myocardial infarction is often problematic when the pre-PCI levels of cardiac troponin T (TnT) are elevated. Thus, we examined different TnT criteria for periprocedural myocardial infarction when the pre-PCI TnT levels were elevated and also the associations between the post-PCI cardiac marker levels and outcomes. We established the relation between the post-PCI creatine kinase-MB (CKMB) and TnT levels in 582 patients (315 with acute coronary syndromes and 272 with stable coronary heart disease). A post-PCI increase in the CKMB levels to 14.7 μg/L (3 × the upper reference limit [URL] in men) corresponded to a TnT of 0.23 μg/L. In the 85 patients with acute coronary syndromes and normal CKMB, but elevated post peak TnT levels before PCI (performed at a median of 5 days, interquartile range 3 to 7), the post-PCI cardiac marker increases were as follows: 21 (24.7%) with a ≥ 20% increase in TnT, 10 (11.8%) with an CKMB level >3 × URL, and 12 (14%) with an absolute TnT increase of >0.09 μg/L (p <0.005 for both). In the patients with stable coronary heart disease and post-PCI cardiac markers > 3× URL compared to those without markers elevations, the rate of freedom from death or nonfatal myocardial infarction was 88% for those with TnT elevations versus 99% (p <0.001, log-rank) and 84% for those with CKMB elevations versus 98% (p <0.001, log-rank). Of the patients with acute coronary syndromes, the post-PCI marker levels did not influence the outcomes. In conclusion, in patients with acute coronary syndromes and elevated TnT levels undergoing PCI several days later, ≥20% increases in TnT were more common than absolute increments in the TnT or CKMB levels of >3× URL. Also, periprocedural cardiac marker elevations in patients with acute coronary syndromes did not have prognostic significance.

Left Atrial Changes with Varying Grades of Valvular Mitral Regurgitation

(death, reinfarction, heart failure or revascularization)was determined at 12 months. Results: A total of 20 patients (21%) had RFP on day 3. The symptom-to-reperfusion time in the RFP group was 413± 287 compared to 252± 138 minutes in the non-RFP group (p= 0.014). Logistic regression identified symptom-to-reperfusion time (HR 1.008, 95%CI 1.002–1.014, p= 0.045) and infarct size by peak Troponin-T levels (HR 1.537, 95%CI 1.130–2.089, p= 0.006) as independent predictors of RFP. MACE occurred in 10 patients (50%) in the RFP group compared to 6 patients (8%) in the non-RFP group (univariate Cox HR 8.389, 95%CI 3.036–23.178, p< 0.001). On multivariate Cox analysis, RFP was the only independent predictor ofMACEat 12months (HR 3.8, 95%CI 1.7–7.2, p< 0.001). Conclusions: Delayed reperfusion following acute myocardial infarction was associated with severe diastolic dysfunction, which in turn was strongly correlated with adverse long-term outcomes. Diastolic dysfunction represents a pathophysiologic link between duration of ischaemia and outcomes. doi:10.1016/j.hlc.2010.06.452

Abstract 6246: Impact of Dysglycemia on Left Ventricular Functional Reserve in Acute Myocardial Infarction

Background Abnormal glucose metabolism is common in patients with acute myocardial infarction (AMI), and is associated with excess morbidity and mortality. The reason for this is unclear but could be associated with an unfavourable effect on left ventricular (LV) functional reserve. Methods Low-dose dobutamine stress echocardiography (LDDE) was performed in 165 consecutive patients during admission for AMI. Peak early diastolic mitral annular velocity (E′), peak systolic mitral annular velocity (S′), and LV ejection fraction (LVEF) were measured at rest and during low dose dobutamine infusion. Glucose metabolism was assessed using an oral glucose tolerance test in patients without a previous diagnosis of diabetes. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were also measured. Results After adjustment for age, gender, hypertension, atrial fibrillation, peak troponin-T levels, diastolic blood pressure, heart rate, and body mass index, an inverse association between glucose metabolism and LV function was observed for E′ ( P =.005) and S′ ( P =.008) when measured during LDDE, but not when measured at rest (E′: P =.10; S′: P =.22). Neither rest nor stress LVEF was significantly associated with the degree of dysglycemia (rest: P =.67; LDDE: P =.19). All parameters measured during LDDE were significant predictors of NT-proBNP levels after adjustment for resting values (all variables: P &lt;.05). Conclusions In patients with a recent AMI, abnormal glucose metabolism is associated with impaired LV function during LDDE but not at rest; this is suggestive of depressed functional reserve.

Relationship Between the Generation and the Facilitated Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction-Analysis Based on the Fibrinolysis and Subsequent Transluminal Trial-

The purpose of the present study was to evaluate the efficacy and safety of facilitated percutaneous coronary intervention (PCI) in comparing young and elderly patients with acute myocardial infarction. The present study enrolled 168 initial myocardial infarction patients within 12 h of the symptom onset between 40 and 80 years of age who were indicated on the fibrinolysis and subsequent transluminal (FAST-3) trial. The patients were divided into 4 groups according to their age, peak creatine kinase (CK), peak CK-MB and peak troponin T (Tn-T) levels, and cardiac function were compared between the 4 groups. There were no differences between the 4 groups in terms of the time from arrival at the emergency room (ER) to the achievement of TIMI-3 patency. There were also no significant differences between the 4 groups in terms of the peak CK, peak CK-MB or peak Tn-T levels. Furthermore, there were no significant differences between the 4 groups in terms of the mortality rate or the incidence of hemorrhagic complications at 30 days. Facilitated PCI is considered to have an important potential role in the treatment of myocardial infarction in Japan, in which the age of the population is steadily increasing.

901-83 Troponin T and Perioperative Ischemia in Noncardiac Surgery

To evaluate troponin T (TnT) as a marker for perioperative ischemia, we prospectively studied 1028 patients (PTS) undergoing major noncardiac procedures. Clinical data included preoperative examinations, daily clinical follow-up, and serial electrocardiograms, CK/CK-MB, and TnT levels. Major cardiac complications (COMPS) were classified by reviewers blinded to TnT data in 29 (3%) of PTS, including acute myocardial infarction (AMI). pulmonary edema, cardiac arrest, complete heart block, and sustained ventricular tachycardia or fibrillation. AMI was diagnosed using CK-MB criteria in 14 (1.4%) PTS, for whom peak TnT levels were &gt; 0.1 mcg/l in 86% and &gt; 0.2 mcg/l in 62%. No postoperative clinical complications occurred to the two PTS with CK-MB criteria for AMI but normal TnT levels. Among the 1014 PTS without CK-MB criteria for AMI, COMPS occurred in 5 (0.6%) of 855 PTS with TnT ≤ 0.1 mcg/l versus 10 (6%) of 159 with higher peak TnT levels (p &lt; 0.0001). This table shows the distribution of peak TnT levels by procedure type:ProcedureTnT &lt; 0.10.1-0.2 &gt; 0.2Abdom. Aortic Aneur.39 (66%)13 (22%)7 (12%)Other vascular160 (79%)20 (10%)23 (11%)Thoracic75 (64%)30 (26%)12( 10%)Abdominal99 (89%)8 (7%)4 (4%)Orthopedic304 (92%)16 (5%)12 (4%)Other180 (87%)16 (8%)10 (5%) We conclude that Tnt correlates with rates of COMP after major noncardiac surgery even among PTS without AMI by CK-MB criteria. In this cohort, elevated TnT levels were more common with procedures generally associated with a higher risk of COMPS. Long term follow-up is needed to determine whether elevated TnT levels in patients without COMPS were false positive results or subclinical ischemic events.