Predictor Of Myocardial Injury Research Articles

Perioperative myocardial injury in patients with coronary artery disease during elective lower limb surgery

Aim. To assess the prevalence of ischemic myocardial injury and the cardioprotective effect of nicorandil by assessing high-sensitivity cardiac troponin (hs-cTn) in patients with stable coronary artery disease (CAD) during elective lower limb surgery, as well as to identify predictors of adverse cardiac events.Material and methods. The study included 70 patients with stable coronary artery disease hospitalized for elective autogenous femoropopliteal bypass (FPB) surgery. After randomization, all patients were divided into two following groups: control group — 35 patients; main group — 35 patients, who, in addition to standard therapy, were prescribed nicorandil (Cordinic, PIQ-PHARMA) in a single dose of 20 mg 2 hours before surgery. In the postoperative period, the incidence of myocardial injury was assessed by hs-cTn increase. The obtained primary data were subjected to mathematical processing using the R-Studio software package (R language).Results. At baseline, patients in both groups were comparable in clinical characteristics, therapy, and duration of vascular surgery. In the main group of patients receiving nicorandil, a significant decrease in the incidence of perioperative myocardial injury was noted. In 5 patients of the control group, hs-cTn level 24 hours after surgery exceeded the threshold value, which indicated myocardial injury in the early postoperative period. In the nicorandil group, there was no hs-cTn increase (14% vs 0%, p=0,027). Regression analysis identified a predictor of perioperative myocardial injury — left ventricular ejection fraction (LVEF) <50%. LVEF <50% increases the risk of myocardial injury in the early postoperative period by 7,36 times (p=0,04) and 9,15 times (p=0,048) according to univariate and multivariate regression analysis, respectively.Conclusion. Perioperative myocardial injury is a common complication in patients with CAD undergoing lower extremity revascularization. The use of nicorandil (Cordinic, PIQ-PHARMA) before elective revascularization surgery helps reduce the incidence of ischemic myocardial injury in the early postoperative period and is not accompanied by adverse reactions, which rationales this approach to improve the clinical outcomes of lower extremity revascularization in patients with stable CAD. A predictor of myocardial injury, determined by hs-cTn, is a LVEF <50%.

Risk factors for myocardial injury and death in patients with COVID-19: insights from a cohort study with chest computed tomography.

AimsWhether pulmonary artery (PA) dimension and coronary artery calcium (CAC) score, as assessed by chest computed tomography (CT), are associated with myocardial injury in patients with coronavirus disease 2019 (COVID-19) is not known. The aim of this study was to explore the risk factors for myocardial injury and death and to investigate whether myocardial injury has an independent association with all-cause mortality in patients with COVID-19.Methods and ResultsThis is a single-centre cohort study including consecutive patients with laboratory-confirmed COVID-19 undergoing chest CT on admission. Myocardial injury was defined as high-sensitivity troponin I >20 ng/L on admission. A total of 332 patients with a median follow-up of 12 days were included. There were 68 (20.5%) deaths; 123 (37%) patients had myocardial injury. PA diameter was higher in patients with myocardial injury compared with patients without myocardial injury [29.0 (25th–75th percentile, 27–32) mm vs. 27.7 (25–30) mm, P < 0.001). PA diameter was independently associated with an increased risk of myocardial injury [adjusted odds ratio 1.10, 95% confidence interval (CI) 1.02–1.19, P = 0.01] and death [adjusted hazard ratio (HR) 1.09, 95% CI 1.02–1.17, P = 0.01]. Compared with patients without myocardial injury, patients with myocardial injury had a lower prevalence of a CAC score of zero (25% vs. 55%, P < 0.001); however, the CAC score did not emerge as a predictor of myocardial injury by multivariable logistic regression. Myocardial injury was independently associated with an increased risk of death by multivariable Cox regression (adjusted HR 2.25, 95% CI 1.27–3.96, P = 0.005). Older age, lower estimated glomerular filtration rate, and lower PaO2/FiO2 ratio on admission were other independent predictors for both myocardial injury and death.ConclusionsAn increased PA diameter, as assessed by chest CT, is an independent risk factor for myocardial injury and mortality in patients with COVID-19. Myocardial injury is independently associated with an approximately two-fold increased risk of death.

Characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019.

AimsTo investigate the characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019 (COVID-19).Methods and resultsWe enrolled 671 eligible hospitalized patients with severe COVID-19 from 1 January to 23 February 2020, with a median age of 63 years. Clinical, laboratory, and treatment data were collected and compared between patients who died and survivors. Risk factors of death and myocardial injury were analysed using multivariable regression models. A total of 62 patients (9.2%) died, who more often had myocardial injury (75.8% vs. 9.7%; P < 0.001) than survivors. The area under the receiver operating characteristic curve of initial cardiac troponin I (cTnI) for predicting in-hospital mortality was 0.92 [95% confidence interval (CI), 0.87–0.96; sensitivity, 0.86; specificity, 0.86; P < 0.001]. The single cut-off point and high level of cTnI predicted risk of in-hospital death, hazard ratio (HR) was 4.56 (95% CI, 1.28–16.28; P = 0.019) and 1.25 (95% CI, 1.07–1.46; P = 0.004), respectively. In multivariable logistic regression, senior age, comorbidities (e.g. hypertension, coronary heart disease, chronic renal failure, and chronic obstructive pulmonary disease), and high level of C-reactive protein were predictors of myocardial injury.ConclusionThe risk of in-hospital death among patients with severe COVID-19 can be predicted by markers of myocardial injury, and was significantly associated with senior age, inflammatory response, and cardiovascular comorbidities.

Endothelial dysfunction and myocardial injury after major emergency abdominal surgery: a prospective cohort study

BackgroundPreoperative endothelial dysfunction is a predictor of myocardial injury and major adverse cardiac events. Non-cardiac surgery is known to induce acute endothelial changes. The aim of this explorative cohort study was to assess the extent of systemic endothelial dysfunction after major emergency abdominal surgery and the potential association with postoperative myocardial injury.MethodsPatients undergoing major emergency abdominal surgery were included in this prospective cohort study. The primary outcome was the change in endothelial function expressed as the reactive hyperemia index from 4-24 h after surgery until postoperative day 3–5. The reactive hyperemia index was assessed by non-invasive digital pulse tonometry. Secondary outcomes included changes in biomarkers of nitric oxide metabolism and bioavailability. All assessments were performed at the two separate time points in the postoperative period. Clinical outcomes included myocardial injury within the third postoperative day and major adverse cardiovascular events within 30 days of surgery.ResultsBetween October 2016 and June 2017, 83 patients were included. The first assessment of the endothelial function, 4–24 h, was performed 15.8 (SD 6.9) hours after surgery and the second assessment, postoperative day 3–5, was performed 83.7 (SD 19.8) hours after surgery. The reactive hyperemia index was suppressed early after surgery and did not increase significantly; 1.64 (95% CI 1.52–177) at 4–24 h after surgery vs. 1.75 (95% CI 1.63–1.89) at postoperative day 3–5, p = 0.34. The L-arginine/ADMA ratio, expressing the nitric oxide production, was reduced in the perioperative period and correlated significantly with the reactive hyperemia index. A total of 16 patients (19.3%) had a major adverse cardiovascular event, of which 11 patients (13.3%) had myocardial injury. The L-arginine/ADMA ratio was significantly decreased at 4–24 h after surgery in patients suffering myocardial injury.ConclusionThis explorative pathophysiological study showed that acute systemic endothelial dysfunction was present early after major emergency abdominal surgery and remained unchanged until day 3–5 after the procedure. Early postoperative disturbances in the nitric oxide bioavailability might add to the pathogenesis of myocardial injury. This pathophysiological link should be confirmed in larger studies.Trial registrationclinicaltrials.gov no. NCT03010969.

HEART-TYPE FATTY ACID BINDING PROTEIN RATHER THAN TROPONIN I ASSOCIATES WITH INCREASED RISK OF MYOCARDIAL INJURY AND ADVERSE EVENTS IN PATIENTS RECEIVING ELECTIVE PERCUTANEOUS CORONARY INTERVENTION

Myocardial injury after percutaneous coronary intervention (PCI) has previously been reported to be associated with a worse outcome and Heart-type fatty acid binding protein (H-FABP) has recently been considered as a new predictor for myocardial injury in patients with coronary artery disease (CAD

The Determinants and Outcomes of Myocardial Injury After Transcatheter Aortic-Valve Implantation: SAPIEN 3 Study

BackgroundThe effect of myocardial injury (MI) post-transcatheter aortic valve implantation (TAVI) on clinical outcomes is controversial. This study aimed to evaluate the effect of MI severity on clinical outcome and left ventricle function 30 days post-TAVI and determine MI post-TAVI predictors. MethodsOverall, 138 consecutive patients who underwent successful transfemoral TAVI using SAPIEN3 and diagnosed using echocardiography and computed tomography were analyzed. High-sensitivity cardiac troponin T (TnT) was evaluated at baseline, immediately, and at 24, 48, and 72 h post-TAVI. Echocardiography findings and N-terminal pro-B-type natriuretic peptide (Nt-pro BNP) levels were evaluated 30 days post-TAVI. ResultsMean age and STS score were 84.4 ± 3.5 years and 6.4 ± 3.2%, respectively. All cases showed severe aortic valve stenosis. Peri-procedural MI was observed in 48 of 100 patients (48.0%). Patients were grouped into MI (n = 48) and non-MI (n = 52), without significant difference in characteristics. Pre-balloon aortic valvuloplasty rate and total pacing time were significantly higher in MI vs non-MI. Total rapid pacing time (TRPT) was an independent predictor for MI (OR 1.06; 95% CI 1.01–1.16; p = 0.04). Echocardiography and Nt-pro BNP changes 30 days post-TAVI were similar between groups. ConclusionPeri-procedural MI, assessed by TnT changes, was observed in 48% of patients. The MI was not associated with overt cardiac dysfunction, and the recovery of left ventricular function and Nt-pro BNP level occurred similarly by 30 day post-TAVI between both groups. In multivariate analysis, TRPT was associated with MI after SAPIEN3 implantation. Trial registration numberUMIN000036669.

Reticulated Platelets as Predictor of Myocardial Injury and 30 Day Mortality After Non-cardiac Surgery.

A pre-operative marker for identification of patients at risk of peri-operative adverse events and 30 day mortality might be the percentage of young, reticulated platelets (pRP). This study aimed to determine the predictive value of pre-operative pRP on post-operative myocardial injury (PMI) and 30 day mortality, in patients aged≥60 years undergoing moderate to high risk non-cardiac surgery. The incidence of PMI (troponin I>0.06μg/L) and 30 day mortality was compared for patients with normal and high pRP (≥2.82%) obtained from The Utrecht Patient Orientated Database. The predictive pRP value was assessed using logistic regression. A prediction model for PMI or 30 day mortality with known risk factors was compared with a model including increased pRP using the area under the receiving operator characteristics curve (AUROC). In total, 26.5% (607/2289) patients showed pre-operative increased pRP. Increased pRP was associated with more PMI and 30 day mortality compared with normal pRP (36.1% vs. 28.3%, p<.001 and 8.6% vs. 3.6%, p<.001). The median pRP was higher in patients suffering PMI and 30 day mortality compared with not (2.21 [IQR: 1.57-3.11] vs. 2.07 [IQR: 1.52-1.78], p=.002, and 2.63 [IQR: 1.76-4.15] vs. 2.09 [IQR: 1.52-3.98], p<.001). pRP was independently related to PMI (OR: 1.28 [95% CI: 1.04-1.59], p=.02) and 30 day mortality (OR: 2.35 [95% CI: 1.56-3.55], p<.001). Adding increased pRP to the predictive model of PMI or 30 day mortality did not increase the AUROC 0.71 vs. 0.72, and 0.80 vs. 0.81. In patients undergoing major non-cardiac surgery, increased pre-operative pRP is related to 30 day mortality and PMI.

Predictors of myocardial injury in patients with cirrhosis presenting with upper gastrointestinal bleeding

BackgroundMyocardial injury in conditions other than coronary artery disease (CAD), known as type 2 myocardial infarction, is mostly related to mismatch between myocardial oxygen supply and demand. Cirrhotic patients with acute upper gastrointestinal bleeding (UGIB) are usually hemodynamically unstable. Hypovolemia, hypotension, and decreased oxygen-carrying capacity as consequences of UGIB may precipitate subclinical heart failure and myocardial injury.Aim of workAssessment of the prevalence and potential risk factors of myocardial injury in patients with liver cirrhosis with acute UGIB.Patients and methodsThe study was conducted on 132 patients diagnosed with liver cirrhosis presenting by UGIT bleeding at Mansoura University Hospitals during one year. Patients were divided into 2 groups: group 1 (76 patients) with myocardial injury or ischemic heart disease and group 2 (60 patients) without.ResultsThe incidence of myocardial injury in this study (elevated troponin levels above cutoff value and/or ECG changes) was 55% of patients. Troponin I was positive in 25% of patients. ECG ischemic changes were found in 36.3% of patients in the form of ST-segment deviation or T-wave inversion. On univariate analysis, predictors of myocardial injury in patients with UGIB included MELD score and variceal source of GI bleeding. On multivariate analysis variceal source of GI bleeding is an independent predictor of myocardial injury. Variceal bleeding was found in 95 % of the ischemic group versus 63% in the other group.ConclusionMore than half of the study patients presented with UGIB have suffered from unnoticed subclinical myocardial injury. Variceal source of GI bleeding was found to be an independent predictor of myocardial injury.

P607Myocardial injury in systemic lupus erythematosus defined by cardiac magnetic resonance imaging: clinical and echocardiographic characteristics

Abstract Background Lupus myocarditis (LM) occurs in 5–10% of patients with systemic lupus erythematosus (SLE). Subclinical myocardial inflammation is detected in 37% at post mortem. Echocardiographic strain analyses (speckle tracking [STE]) supports subclinical myocardial dysfunction in SLE. Tissue characterization by cardiac magnetic resonance (CMR) identifies myocardial inflammation, necrosis/fibrosis, detecting clinical and subclinical myocardial injury (MIN). It is the non-invasive diagnostic modality of choice for myocarditis (all types) based on the Lake Louise criteria (LLC). The utility of CMR is limited by cost (in resource limited settings) as well as intolerance of / contra-indications to CMR. Purpose Determine prevalence of MIN in SLE (as per LLC). Compare clinical and echocardiographic features of patients with and without MIN. Identify echocardiographic predictors of MIN. Methods A prospective crossectional study was done at Tygerberg Hospital, Western Cape, South Africa. Adult inpatients, fulfilling the 2012 classification criteria for SLE were screened for inclusion. Echocardiography (echo) included strain analyses (segmental and global [GLS]) through STE and regional function assessment (wall motion score (WMS)). Patients were grouped according to CMR evidence of MIN (absent LLC [AC]; single criterion [SC]; fulfilling LLC). Clinical, laboratory and echo parameters were compared between groups. Logistic regression and ROC were used to determine predictors of MIN. Results 49/106 SLE patients screened were included (Figure 1). The median age was 27 years (IQR: 22–35) and 88% were female. 46.9% of patients had MIN (≥1 criterion): 12.2% fulfilled LLC and 34.7% had a SC. Demographic features, cardiac risk factors (including antiphospholipid syndrome) and renal disease were similar among groups. Compared to the AC group, SLE disease activity was higher in patients fulfilling LLC (p=0.022), but not in the SC group (p=0.813). A clinical and echo diagnosis of LM was made in all patients fulfilling LLC (p&lt;0.001), in 17.6% of patients in the SC group (p=0.026) vs none in the AC group. Anti-DsDNA (p=0.054) and anti-B2GP1 (p=0.081) were more frequently positive in the SC vs AC group. The WMS was higher in LLC and SC groups (p=0.006; p=0.083) with mid and basal strain more impaired in patients with MIN (p=0.043; p=0.047). LVID and mid STE score (number of segments with impaired STE) combined was the best predictor of MIN (OR: 2.1; 95% CI: 1.2–3.5; p=0.008). The predictive model had an AUC of 0.791 (PPV: 81.8%; NPV: 86.4%). Figure 1 Conclusion CMR is limited by a high exclusion rate in SLE, mainly due to renal disease. CMR evidence of MIN is common in SLE, even in the absence of clinical myocardial dysfunction or high lupus activity. Impaired echo regional and global function occurs more frequently in patients with MIN. STE combined with LVID predicts the presence of MIN detected by CMR and has potential as a cost effective screening tool.

STUDY OF THE RISK FACTORS FOR CORONARY ARTERY DISEASE AND THEIR CORRELATION WITH THYROID HORMONE PROFILE AMONGST WOMEN WITH ST SEGMENT ELEVATION IN ACUTE MYOCARDIAL INFARCTION

Background: To assess risk factors for coronary artery disease and their correlation with thyroid hormone profile amongst women with ST segment elevation in acute myocardial infarction.&#x0D; Method: A total number of 78 females having ST elevation myocardial infarction diagnosed through detailed clinical history and ECG evaluations were included after they satisfy the eligibility criteria. Patients were subsequently evaluated for presence of risk factors of ischemic heart disease such age, marital status, parity, and menopause, use of oral contraceptives, family history, obesity, diabetes mellitus, hypertension, hypercholesterolemia and hypertriglyceridemia. Their thyroid hormone profiles (T3, T4, TSH) were done and were correlated with risk factors for ischemic heart disease.&#x0D; Result: A total 78 patient included in the study. Most of the study population belongs to the age group of 40 to 50 years (43.6 %). Hypertension was the most common clinical features amongst study population (59%) followed by Diabetes (50%). most of the study population had Normal Thyroid status (57.69%) followed by Hypothyroidism (25.64%) and Hyperthyroidism (16.67%). and SERUM TSH is the most sensitive test for evaluation. Diabetes Mellitus was statistically significant risk factor (p value &lt;0.05) in patients with STEMI with different levels of thyroid.&#x0D; Conclusion: Patients with coronary artery disease especially in the presence of other risk factors should be screened for diabetes and also for thyroid dysfunction as in our study cases of Hypothyroidism was seen in 25.64% of the population under study. Hence it can be postulated that hypothyroidism may be a predictor for myocardial injury in STEMI. Here we recommend that tests for thyroid disorders in acute coronary syndrome can give predictor for risk of morbidity and mortality in those subjects.&#x0D; These results also may warrant further larger study to investigate whether reversing the hypothyroidism could benefit the STEMI patients.&#x0D; Keywords: STEMI- ST segment elevation myocardial infarction, MI- Myocardial Infarction, Hyperthyroidism, Hypothyroidism, TSH- Thyroid Stimulating Hormone

Incidence and predictors of myocardial and kidney injury following endovascular aortic repair: a retrospective cohort study

PurposeWe performed a retrospective cohort study in patients who underwent endovascular aneurysm repair (EVAR) to determine the incidence and predictors of myocardial injury and acute kidney injury (AKI).MethodsWe included 267 consecutive patients who underwent EVAR at two tertiary centres in Canada and Poland. The primary outcome was myocardial injury during hospital stay after EVAR defined as a troponin elevation (ultra-sensitivity troponin I Vidas ≥ 19 ng·L−1, non-high-sensitivity troponin I Vidas ≥ 0.01 µg·L−1, high-sensitivity troponin T ≥ 20 ng·L−1, non-high-sensitivity troponin T ≥ 0.03 ng·mL−1). The secondary outcome was AKI defined using the stage 1 of the Acute Kidney Injury Network criteria.ResultsMyocardial injury occurred in 78/267 patients (29%; 95% confidence interval [CI], 24.1 to 34.9) and with AKI occurring in 25/267 (9.4%; 95% CI, 6.4 to 13.5). In a multivariable analysis, the following variables were associated with an increased risk of myocardial injury: age (adjusted odds ratio [aOR], 1.65 per ten-year increase; 95% CI, 1.09 to 2.49), Revised Cardiac Risk Index score ≥3 (aOR, 2.85; 95% CI, 1.26 to 6.41), The American Society of Anesthesiology physical status score 4 (aOR, 2.24; 95% CI, 1.12 to 4.47), duration of surgery (aOR, 1.27 per each hour; 95% CI, 1.00 to 1.61), and perioperative drop in hemoglobin (aOR, 3.35 per 10 g·dL−1 decrease; 95% CI, 1.00 to 11.3). Predictors of AKI were duration of surgery (aOR, 1.72 per hour; 95% CI, 1.36 to 2.17), a preoperative estimated glomerular filtration rate (eGFR) of 30-59 mL·min−1 (aOR, 3.82; 95% CI, 1.42 to 10.3), and an eGFR < 30 mL·min−1 (aOR, 37.0; 95% CI, 7.1 to 193.8).ConclusionMyocardial injury and AKI are frequent during hospital stay after EVAR and warrant further investigation in prospective studies.

Correlation between the Level of Serum Free Triiodothyronine and the Degree of Myocardial Injury in Patients with Acute ST Segment Elevation Myocardial Infarction

Background: Previous studies have suggested that hypothyroidism correlated with coronary artery diseases (CAD) mortality in long-term cohort studies, but whether the thyroid function status is associated with myocardial injury in acute ST-elevation myocardial infarction (STEMI) has not been investigated sufficiently. Aim: We aimed to investigate whether the lower free triiodothyronine level in acute STEMI is associated with more severe myocardial injury. Methods: This was a prospective observation cohort study that was conducted from August 2016 to April 2017 and included 50 patients presented to the coronary care Unit in Al Mataryia teaching hospital with acute STEMI and treated with thrombolysis. All patients were subjected to complete clinical assessment, serial ECGs, Echo, full labs, thyroid hormones, cardiac biomarkers, C-reactive protein (CRP). Results: There were 8 patients (16%) who had hypothyroidism including low-T3-syndrome (4 patients, 8%), subclinical hypothyroidism (3 patients, 6%) and clinical hypothyroidism (1 patient, 2%). After adjusting for conventional risk factors (age, gender, smoking, diabetes mellitus, dyslipidemia, hypertension), free triiodothyronine (FT3) was significantly and negatively correlated with CKMB (r=-0.294, P=0.038), cTnI (r=-0.368, P=0.009), and positively correlated with EF (r=0.385, P=0.006), indicating that the lower thyroid hormone level correlates with the more severe cardiac injury in STEMI patients. FT3 also had a negative correlation with CRP (r=-0.404, P=0.004), which might indicate that hypothyroidism may activate the inflammation response. Conclusion: The lower FT3 level correlates with higher level of cardiac biomarkers and lower left ventricular ejection fraction (LVEF), Low T3 syndrome may be a predictor for myocardial injury in STEMI. These results may warrant further study to investigate whether reversing the hypothyroidism could benefit the STEMI patients.

Insular infarct size but not levosimendan influenced myocardial injury triggered by cerebral ischemia in rats.

Cerebral injuries can trigger stress-related cardiomyopathy. The extent of cerebral injury and the involvement of the insular cortex influence the incidence and extent of myocardial injury (MI), and drugs with proven neuroprotective and cardioprotective properties such as levosimendan might be beneficial. This hypothesis was addressed in a rat model of transient middle cerebral artery occlusion. Transient brain ischemia was induced for 60 min by intraluminal occlusion of the middle cerebral artery in 40 male Wistar rats. Treatment with levosimendan (24 µg/kg) was started briefly before reperfusion. Hemodynamic parameters were recorded and cerebral and MI quantified after 24 h. Levosimendan treatment significantly reduced cerebral infarct size in the cortex, but not in the striatal and insular regions. However, its effects on survival (28 vs. 45%), incidence of MI (8 vs. 33%) as indicated by a troponin I (sTnI) threshold of 4.8 µg/L and large insular infarcts of ≥10 mm(3) (23 vs. 50%) failed to reach statistical significance. Blood pressure demonstrated significant differences related to insular infarct size during reperfusion. Levosimendan demonstrated no relevant effects on markers of MI (sTnI = 1.5 ± 2.8 vs. 5.3 ± 7.2 µg/L, P = 0.121). Insular infarct size could be identified as the only predictor of MI (odds ratio = 1.86, P = 0.037). In conclusion, the current investigation confirmed insular infarct size as a predictor of MI and source of hemodynamic compromise, but failed to demonstrate an effect of levosimendan on MI trigged by brain ischemia. A hardly protectable insular region might explain this.

Myocardial injury following aortic valve replacement for severe aortic stenosis: risk factor of postoperative myocardial injury and its impact on long-term outcomes.

BackgroundAs hypertrophied myocardium predisposes the patient to decreased tolerance to ischemia and increased reperfusion injury, myocardial protection is of utmost importance in patients undergoing aortic valve replacement (AVR) for severe aortic valve stenosis (AS).MethodsConsecutive 314 patients (mean age, 62.5±10.8 years; 143 females) with severe AS undergoing isolated AVR were included. Postoperative myocardial injury (PMI) was defined as 1) maximum postoperative creatinine kinase isoenzyme MB or troponin-I levels ≥10 times of reference, 2) postoperative low cardiac output syndrome or episodes of ventricular arrhythmia, or 3) left ventricular ejection fraction of less than 55% and decrease in left ventricle (LV) ejection fraction of more than 20% of the baseline value.ResultsThere were 90 patients (28.7%) who developed PMI. There were five cases of early death (1.6%), all of whom had PMI. On multivariable analysis, the use of histidine-tryptophan-ketoglutarate (HTK) solution instead of blood cardioplegia (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.63 to 5.77; p=0.001), greater LV mass (OR, 1.04; 95% CI, 1.01 to 1.07; p=0.007), and increased cardiac ischemic time (OR, 1.13; 95% CI, 1.05 to 1.22; p<0.001) were independent predictors for PMI. Patients who had PMI showed significantly inferior long-term survival than those without PMI (p=0.049).ConclusionPMI occurred in a considerable proportion of patients undergoing AVR for severe AS and was associated with poor long-term survival. HTK cardioplegia, higher LV mass, and longer cardiac ischemic duration were suggested as predictors of myocardial injury.

Predictors of myocardial injury in patients with acute upper gastrointestinal bleeding

UPPER gastrointestinal bleeding (UGIB) is a common, potentially life-threatening condition. Myocardial injury may complicate UGIB. Previous studies were conducted to evaluate causes and consequences of UGIB after acute myocardial infarction (AMI). Acute MI adds additional risk to already critically ill patients of UGIB and markedly worsens their prognosis. However, little data are known about the prediction of MI in patients with acute UGIB. The aim of the work was to study the predictive risk factors for acute myocardial infarction in patients with acute upper gastrointestinal bleeding. One hundred and five patients with UGIB (67 males and 38 females) with mean age of 52.9 ± 9.3 years were enrolled in the study. Patients were excluded from the study if there was one or more of the following: age younger than 35 years, initial systolic blood pressure > 100 mmHg, initial hemoglobin ⩾ 12 gm/dl, history of previous ischemic heart disease, or contraindication for upper GIT endoscopy. All patients were submitted to full history taken and clinical examination, emergency upper gastrointestinal endoscopy, 12-leads electrocardiography (ECG), CK, CK-MB, Troponin I, complete blood picture, liver and kidney function tests, bleeding profile, arterial blood gases and electrolytes, lipid profile, fasting and postprandial blood glucose level, abdominal ultrasonography, and echocardiographic assessment. According to the presence of myocardial injury, patients were divided into two groups: Group I; included 66 patients without myocardial injur. Group II: included 39 patients with myocardial injury. Population characteristics were comparable in all groups. In patients with myocardial injury, there were significantly more hypertensive patients, more smokers, more patients with liver cirrhosis, and more patients with rebleeding than among those without myocardial injury. In patients with myocardial injury, mean body mass index, mean C-reactive protein, and mean hospital were significantly higher than in patients without myocardial injury. Logistic regression analysis showed that the most significant predictors for myocardial injury in descending order were: hypertension (score = 14.48, odd ratio = 7.057, p < 0.00001), cigarette smoking (score = 10.425, odd ratio = 5.425, p < 0.0001), liver cirrhosis (score = 7.845, odd ratio = 4.972, p = 0.0017), body mass index > 25 kg/m 2 (score = 7.132, odd ratio = 4.214, p = 0.0073), and C-reactive protein level > 5 mg/dl (score = 6.321, odd ratio = 3.986, p = 0.0159). Among patients with UGIB, patients with myocardial injury had significantly more incidence of hypertension, smoking, liver cirrhosis, and rebleeding than those without myocardial injury. Mean body mass index, mean C-reactive protein level, and mean hospital stay were significantly higher in patients with myocardial injury. The most significant predictors for myocardial injury in patients with UGIB in descending order were hypertension, cigarette smoking, liver cirrhosis, body mass index > 25 kg/m 2 , and C-reactive protein level > 5 mg/dl.

Free triiodothyronine level indicates the degree of myocardial injury in patients with acute ST-elevation myocardial infarction

Background Previous studies have suggested that hypothyroidism correlated with coronary heart diseases (CHD) mortality in long-term cohort, but whether the thyroid function status is associated with myocardial injury in acute ST-elevation myocardial infarction (STEMI) has not been investigated sufficiently. Methods Five hundred and eighty-two hospitalized patients from January 2010 to December 2011, with the diagnosis of STEMI, were enrolled in this study. All patients underwent testing for thyroid function status, cardiac troponin I (cTnI), cardiac enzymes, C-reactive protein (CRP). We investigated the association between thyroid hormone levels and cardiac markers (creatine kinase-MB and cTnI), and thus evaluated the potential role of thyroid function status in predicting the myocardial injury. Results There were 76 patients (13.06%) who had hypothyroidism including low-T3-syndrome (34 patients, 5.84%), subclinical hypothyroidism (28 patients, 4.81%) and clinical hypothyroidism (14 patients, 2.41%). After adjusting for conventional risk factors (age, gender, smoking, diabetes mellitus, dyslipidemia, hypertension), free triiodothyronine (FT3) was significantly and negatively correlated with log-CKMB (r=-0.244, P &lt;0.001) and log-cTnI (r=-0.290, P &lt;0.001), indicating that the lower thyroid hormone level correlates with the severer cardiac injury in STEMI patients. FT3 also had a moderate negative correlation with CRP (r=-0.475, P &lt;0.001), which might indicate that hypothyroidism may activate the inflammation response. No significant correlation was found between other thyroid parameters (TSH, FT4) and cardiac markers. Conclusions As the lower FT3 level correlates with higher level of cardiac markers and lower left ventricular ejection fraction (LVEF), the hypothyroidism may be a predictor for myocardial injury in STEMI. And these results may warrant further study to investigate whether reversing the hypothyroidism could benefit the STEMI patients.

Features and predictors of myocardial injury in carbon monoxide poisoned patients

Background and purposeBy contrast with neurologic injury, myocardial injury associated with carbon monoxide (CO) poisoning has not been well investigated. Therefore, this study assessed features and predictors of myocardial injury...

Incidence and Pre-operative Predictors of Myocardial Injury after Non Cardiac Surgery

age 62± 3 years). Seventy-two (75%) of the intervention groupattended forESTcompared to38 (31%)of thecontrol group,p< 0.001afteradjustment fordifferences inbaseline variables. A poor understanding of the rationale for EST was a significant factor in patient non-attendance. There was a non-statistically significant trend toward improved 30-day outcome in the intervention group, however the study was not powered for this outcome. Conclusions: Pre-booked appointment times for EST improve timely attendance among patients discharged from the Emergency Department with intermediate risk acute coronary syndrome. Compliance may improve further with patient education. http://dx.doi.org/10.1016/j.hlc.2012.05.619 609 Incidence and Pre-operative Predictors of Myocardial Injury after Non Cardiac Surgery J. Mooney1,4,∗, G. Hillis 1,2, J. Jagnoor1, J. Makinen1, R. Halliwell 3, A. Thiagalingam4, P. Kovoor4, S. Li 5, M. Clough5, C. Chow1,4 1 The George Institute for Global Health, Australia 2 Dept ofCardiology,ConcordRepatriation&GeneralHospital, Australia 3 Dept. of Anaesthesia, Westmead Hospital, Australia 4 5

Abstract 1553: Comparative Gene Expression Analysis of Blood and Heart Identifies Genomic Predictors of Myocardial Injury Following Cardiopulmonary Bypass and Cardioplegic Arrest in the Rat

Background: Perioperative myocardial injury (PMI) complicating cardiac surgery remains poorly predicted by clinical risk factors. In a novel rat model of cardiopulmonary bypass (CPB) and cardioplegic arrest (CA) we tested the hypothesis that microarray expression profiles in peripheral blood leukocytes (PBL) can accurately predict degree of PMI, and compared genomic signatures in left ventricular myocardium (LVM) and PBL to identify PMI-associated genes that generalize across tissues. Methods: Male rats subjected to CPB only (75 min), CPB with CA (30 min), and sham surgery (n=5 each) had plasma heart fatty acid binding protein (HFABP) and cardiac troponin I (cTnI) measured 1 hour post CPB and microarray profiling of total RNA from LVM and PBL. PMI genomic classification models were constructed using shotgun stochastic search approach and Bayesian model averaging and their accuracy tested by five-fold cross validation. Results: A spectrum of PMI was observed in the experimental groups as well as robust deregulation of gene expression in a stimulus and tissue-specific manner (Figure ). Estimates of PMI classification accuracy from PBL and LVM are presented in Table . Conclusions: Cardiac surgery induces changes in leukocyte gene expression that predict the spectrum of PMI, with potential applications in perioperative risk stratification and selection of cardioprotective strategies. Predictive accuracy of tissue-specific myocardial injury genomic classifiers

Editorial on “Residual platelet reactivity is an independent predictor of myocardial injury in acute myocardial infarction patients on antiaggregant therapy” by Marcucci et al.

Editorial on “Residual platelet reactivity is an independent predictor of myocardial injury in acute myocardial infarction patients on antiaggregant therapy” by Marcucci et al. -