Ultrasensitive Troponin Research Articles

The Triglycerides - Glucose Index: An independent predictor of late subclinical cardiotoxicity in adult survivors of childhood, adolescent and young adult cancer

Abstract Introduction The Triglycerides - Glucose index (TyG index) has been identified as a reliable alternative for estimating insulin resistance (IR). Numerous recent studies have provided strong statistical evidence suggesting that this index is associated with the development and prognosis of cardiovascular pathologies. Objectives The aim of this study was to investigate the predictive role of the TyG index on the decrease in left ventricular longitudinal global strain (GLS) assessed on two-dimensional echocardiography in asymptomatic adult survivors of childhood, adolescent and young adult cancer. Methods The study included patients aged 18 years and older, asymptomatic cardiovascular survivors of childhood, adolescent and young adult cancer treated with anthracyclines with or without mediastinal radiotherapy. Anthropometric characteristics, cardiovascular risk factors and cancer treatment-related characteristics were collected. The TyG index was calculated using the formula: ln [fasting triglycerides (mg/dl) × fasting glucose (mg/dl)/2]. GLS was assessed and expressed as an absolute value. A GLS equal to 17.3% was retained as the threshold value after calculation in a referent group matched to patients according to age and gender. Cardiac biomarkers GDF 15, ultra-sensitive troponin I and NT-proBNP levels were measured in addition to fasting blood glucose and lipid profiles. Multivariate analysis using linear regression was performed to identify associations between these different parameters. Results A total of 105 cancer survivors from childhood, adolescence and young adulthood were included. The sex ratio was 1.3. The mean age of the patients was 25 years, the mean time since completion of cancer treatment was 10.6 years, the mean cumulative doses of anthracyclines and mediastinal radiotherapy were successively 245.75 ± 75.14 mg/m2 and 34.6 ± 6.19 Gy. Mean GLS was 18.5 ± 2.83%, mean LVEF 60.6 ± 5.69%. None of the patients had any known diabetes or treatment to lower blood glucose or triglyceride levels. No patient had a history of cardiovascular disease. In the univariate study, the factors associated with lower GLS were patient age at recruitment (p = 0.03), mean time since completion of cancer treatment when this was greater than ten years (p = 0.005), dyslipidemia (p = 0.012), obesity (p = 0.037) and TyG (p = 0.037). In multivariate analysis, lower GLS was related to mean time since completion of cancer treatment (p = 0.015) and TyG index (p = 0.002). Conclusion Our results suggest that the TyG index, as a simple and inexpensive marker of insulin resistance, could help identify cancer survivors from childhood, adolescence and young adulthood who would be at risk of subclinical cardiac dysfunction. Prospective studies with larger numbers are needed to confirm these findings.

A rapid and ultrasensitive cardiac troponin I aptasensor based on an ion-sensitive field-effect transistor with extended gate

Acute myocardial infarction (AMI) is a life-threatening disease with a short course and a high mortality rate. However, it is still a great challenge to achieve the on-site diagnosis of this disease within minutes, meaning there is an urgent need to develop an efficient technology for realizing the rapid diagnosis and early warning of AMI in clinical emergencies. In this study, an ultrasensitive electrochemical aptasensor based on an extended-gate ion-sensitive field-effect transistor (EGISFET) was designed to achieve the quantitative assay of cardiac troponin I (cTnI), which is a highly sensitive and specific biomarker of AMI, within only 5 min. The EGISFET exhibits extremely high detection sensitivity due to its separated structure with a large sensing area and the surface-modified Prussian blue-gold nanoparticles (PB-AuNPs) composite, which serves as a signal magnifier and DNA loading platform for good electrocatalytic ability with a large specific area. Additionally, a target-induced strand-release strategy is proposed to shorten the recognition time of cTnI using a particular DNA strand. Under optimal conditions, the as-prepared aptasensor exhibits a wide linear range of 1–1000 pg/mL, an ultralow detection limit of 0.3 pg/mL, and reliable detection results in real serum samples. It is highly anticipated that this EGISFET-based aptasensor will have broad applications in the early warning and rapid diagnosis of AMI and other acute diseases in emergency treatment.

Adverse myocardial and vascular side effects of immune checkpoint inhibitors: a prospective multimodal cardiovascular assessment.

Immune checkpoint inhibitors (ICIs) can induce cardiovascular toxicities. To prospectively assess the incidence of major cardiovascular events (MACE) on ICIs in solid cancer patients: myocarditis, pericarditis, acute coronary syndrome, heart failure, high-degree conduction abnormalities or sustained ventricular arrhythmias, or cardiovascular death at 6weeks (early MACE), including asymptomatic clinical changes by an independent adjudication committee using current recommended diagnostic criteria. The secondary objective was the incidence of the above-mentioned events adding atrial fibrillation (AF) at 6months (late MACE). Participants underwent pre-ICIs and repeated multimodality cardiac imaging (echocardiogram, cardiac magnetic resonance (CMR)), serum biomarkers (ultrasensitive troponin I), and rhythm surveillance (ambulatory ECG monitoring) at 6weeks and 6months. Forty-nine patients (38 (77.6%) male; mean age 64.3 (SD 11.0) years old) were included (June 2020-December 2021). Early MACE were observed in 9 (18.4%) patients at mean 40.1 (SD 5.9) days, with heart failure (HF) in 5 (10.2%), ventricular arrhythmias, or new conduction disorders in 4 (8.2%) patients. History of AF (HR 4.49 (CI 1.11-18.14), P = 0.035) predicted early MACE. At 6months follow-up, 18 MACE were observed in 15/49 (31%) patients, with 6 (12.2%) HF events, 5 (10.2%) significant ventricular arrhythmias, or conduction disorders, and 4 (8.2%) AF. There was a significant decline in LVEF (P < 0.001) in patients with no MACE (P = 0.003) or HF (P = 0.0028). Higher creatinine at inclusion (HR 0.99 [0.98-1.00], P = 0.006) predicted HF on multivariate analysis. There were no significant T1 or T2 mapping changes in our study cohort on repeated CMR. Cardiotoxicity on ICIs is more frequent than previously described when using a thorough detection strategy, consisting mainly in HF and asymptomatic rhythm disorders.

Abstract 2099: Coronary Artery Thrombosis Due To Intramural Hematoma

BJMC ,male 61 years old, presented with acute chest pain and non ST acute myocardial infarction. ECG showed ST segment depression on anterior and lateral precordial leads and ST elevation on aVR. Ultra-sensitive Troponin T rised . Coronary angiography showed calcified Left main(LM) with critical lesion extending to anterior descending artery. Percutaneous Coronary Intervention (PCI) was performed succesfully with stent implantation. Two hours later he started with epigastric discomfort , anxiety ,chest pain , diaphoresis , tachycardia and acute ECG changes , irresponsive to intravenous nitroglycerin . He evolved to ventricular tachycardia and cardiac arrest , with CPR. New PCI was followed with immediate clinical improvement . Clinical symptoms of ischemia and hemodynamic instability were due to significant (LM) caliber reduction .IMH is a pathological process were blood accumulate within the media space, suggesting new stenosis or spasm. IMH is unfrequent - may occur in initial hours and even at several days after apparently succesfull intervention. IMH causes acute lumen obstruction and thrombosis. The diagnosis is frequently missed and the clinical course can be dramatic and life threatening. Intravascular ultrasound (IVUS) is a very importante tool to identify IMH and should be available in complex cases interventions.

Application Value of NLR, PLR, LMR, HEART score, and POCT in Early Warning and Accurate Graded Diagnosis of High-Risk Chest Pain in Emergency Medicine

Objective: To evaluate the application value of neutrophils/lymphocytes (NLR), platelets/lymphocytes (PLR), lymphocytes/monocytes (LMR), HEART (history, electrocardiogram, age, risk factors, and troponin) score, and point-of-care testing (POCT) in the early warning and precise diagnosis of high-risk chest pain in emergency medicine. Methods: A total of 157 patients with acute chest pain who were admitted to the emergency department and chest pain treatment unit of our hospital between August 2022 and September 2023 were selected. Rapid testing of bedside myocardial markers (ultrasensitive troponin (hs-cTnI), myoglobin (MYO), creatine kinase isoenzyme (CK-MB), D-dimer (D-Dimer), and N-terminal B-type natriuretic peptide precursor (NT-proBNP)) was performed on the patients using a POCT device (ThermoKing BioMQ60proB). A HEART score was used to classify the patients into low (n = 53), intermediate (n = 59), and high-risk (n = 45) groups, and the NLR, PLR, and LMR were calculated. The NLR, PLR, and LMR values were compared among the three groups of patients, and the optimal cutoff values as well as sensitivity and specificity were determined based on receiver operating characteristic (ROC) analysis. Results: The HEART scores of patients in the low-risk, intermediate-risk, and high-risk groups were (2.72 ± 0.24), (4.75 ± 0.56), and (5.32 ± 0.73) respectively, and the differences were statistically significant (P &lt; 0.05). Compared with the low-risk group, the intermediate-risk group and high-risk group had a significantly higher NLR and PLR, and a significantly lower LMR; the high-risk group had higher NLR and PLR and lower values of LMR as compared to the other two groups, and the difference was statistically significant (P &lt; 0.05). The ROC curves suggested that the area under the curve, sensitivity, and specificity of the combined diagnosis of NLR, PLR, LMR, HEART score, and POCT were greater than those of LR, PLR, and LMR with HEART score and POCT alone. Conclusion: The combined application of NLR, PLR, LMR, HEART score, and POCT has significant application value in the early warning and precise diagnosis of emergency high-risk chest pain. It provides a more simple, easy-to-access, and efficient assessment index for the clinical prediction and treatment of emergency high-risk chest pain.

An Evaluation of the Appropriateness of Prescribing Ultrasensitive Cardiac Troponin I in the Emergency Department of the Mohammed V Military Training Hospital in Rabat

In emergency medicine, Troponin Ic is a useful diagnostic and prognostic biomarker in the management of ischemic cardiac pathologies. However, its prescription often exceeds international recommendations. The aim of this study is to evaluate practices concerning the prescription of Troponin assays in the emergency department of the Mohammed V Military Training Hospital in Rabat. This is a prospective study. Was included in this study, every patient admitted to the emergency department of the Mohammed V Military Training Hospital in Rabat and having at least one troponin assay during the period from December 25, 2020 to January 12, 2021. The assay was performed using the "ARCHITECT STAT Highly sensitive troponin-I" method. 135 patients for whom have prescribed a Troponin assay during the period of study. A total of 219 assays were performed. The mean age was 64 years, with a predominance of males. The main reasons for admission were chest pain (29.6%), dyspnea (26.6%), neurological disorders (16.3%) and respiratory distress (10.3%). A high Troponin Ic value during the first determination was observed in almost 37% of cases. In 63% of cases, the value was negative. 53.3% of prescriptions were considered as irrelevant according to pre-established criteria. A repeated Troponin Ic assays were performed in 31% (n=127) of cases. They were deemed relevant in 25% of cases. In 6% of patients, the appropriateness of repeat assays was not demonstrated. Compliance with good prescribing practices for Troponin significantly reduces the number of unjustified samples, with a real economic impact.

Diferencias clínicas entre la amiloidosis cardiaca por transtirretina y la cardiopatía hipertensiva

IntroductionA significant percentage of patients eventually diagnosed with cardiac transthyretin amyloidosis (TTRA) was previously diagnosed with hypertensive heart disease (HHD), since both conditions usually present with heart failure (HF) with preserved ejection fraction (HFpEF) and ventricular hypertrophy. Our objectives were to evaluate the clinical, electrocardiographic and echocardiographic differences, and to analyse whether there exists a differential prognosis between these two nosological entities. Materials and methodsWe retrospectively included all patients with HHD for whom a cardiac scintigraphy with 99mTc-diphosphonate (GDPD) and a free light chains test in blood and urine were ordered for ATTR screening in our centre, in the period between 2016 and 2021. Those diagnosed with other types of amyloidosis were excluded from the analysis. ResultsA total of 72 patients were analyzed: 33 were finally diagnosed with TTRA and 39 with CHTA. Patients with TTRA had higher levels of ultrasensitive troponin I (TnI-US) and N-terminal brain natriuretic propeptide (NT-ProBNP); in electrocardiography (ECG) they presented a pseudo-infarction pattern more frequently as well as conduction disturbances; in echocardiography (TTE) they presented a higher degree of ventricular hypertrophy, left ventricular dysfunction and worse diastolic function parameters, with elevated filling pressures. In the 4-year follow-up, the ATTR group showed greater need for pacemaker (PCM), with no evidence regarding mortality, development of atrial fibrillation (AF), or more admissions for heart failure (HF). ConclusionsIn our series, patients with TTRA showed clinical, electrocardiographic and echocardiographic differences compared to patients with HHD, with increased risk of need for PCM.

Usefulness of the baseline risk assessment guidelines to predict cancer therapy-related cardiac dysfunction in early-stage HER2 positive breast cancer

Abstract Introduction Treatment of HER 2-positive breast cancer (HER2+BC) with anthracyclines and HER2-targeted therapy is associated with a high incidence of cancer therapy-related cardiac dysfunction (CTRCD). Baseline risk assessment is crucial to determine patients at high risk of developing CTRCD. Heart Failure Association-International Cardio-Oncology (HFA-ICOS) risk stratification has recently been developed but validation with the new definition of CTRCD is needed (1). Purpose To investigate whether the HFA-ICOS baseline risk stratification is useful to identify patients at risk for CTRCD in patients with early-stage HER2+BC. Methods 95 patients with early-stage HER2+BC were consecutively included in a specialized cardio-oncology unit. In this cohort, patients with previous exposure to antineoplastic treatment, patients with left ventricular ejection fraction (LVEF) &amp;lt; 50% and patients with moderate-severe valvular heart disease had been excluded. All patients underwent a baseline echocardiography study and every 3 months until the end of the chemotherapy. Ultrasensitive troponin I was determined before and immediately after each cycle of chemotherapy. Results In our cohort, 48.4% of patients received sequential treatment with anthracyclines and anti-HER2 therapy, while 51.6% received anti-HER2 therapy without anthracyclines. HFA-ICOS baseline risk assessment identified 40 (42,1%) patients with low risk, 27 (28,4%) with moderate risk and 28 (29,5%) with high risk of CTRCD. Table 1 showed the distribution of HFA-ICOS risk factors in our cohort. Only 1 patient with high risk and 3 patients with moderate risk received cardioprotective drugs. At a median follow-up of 13,6 months, 38 patients (40%) did not develop CTRCD, 53 (55,8%) mild-CTRCD, 3 (3,2%) moderate-CTRCD, 1 (1,1%) severe-CTRCD. 3 out of the 4 patients who presented with moderate or severe CTRCD were properly identified as moderate or high risk. However, 52,5% of patients with low risk of CTRCD developed some degree of CTRCD and 19 out of the 38 patients (69,4%) who did not present CTRCD were wrongly identified as moderate or high risk. Table 2 showed the relation between HFA-ICOS risk assessment and the development of CTRCD. Conclusions Treatment of early-stage HER2+BC was associated with a high incidence of CTRCD. In our cohort of early-stage HER2+BC, HFA-ICOS baseline risk assessment was useful in identifying patients at risk of developing moderate or severe CTRCD, but was not useful in identifying patients at low risk of CTRCD.HFA-ICOS risk factors and CTRCDHFA-ICOS risk assessment and CTRCD

Myocardial Work in Apical Hypertrophic Cardiomyopathy

Pressure-strain loop analysis is a novel echocardiographic technique to calculate myocardial work indices that has not been applied to patients with apical hypertrophic cardiomyopathy (ApHCM). We hypothesized that myocardial work indices differ between patients with ApHCM and those with non-apical HCM (non-ApHCM). This study aimed to (1) evaluate myocardial work indices in patients with ApHCM compared to those with non-ApHCM, (2) describe associations with relevant clinical variables, and (3) examine associations with significant late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR). We retrospectively identified 48 patients with ApHCM and 69 with non-ApHCM who had measurements of global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). We evaluated available CMR data on 34 patients with ApHCM and 51 with non-ApHCM. Multivariable regression models correcting for traditional cardiac risk factors were used to evaluate the associations of myocardial work indices with relevant clinical variables. Median GLS (-11% vs -18%, p < .001), GWI (966 mmHg% vs 1803 mmHg%, p < .001), and GCW (1050 mmHg% vs 1988 mmHg%, p < .001) were significantly impaired in patients with ApHCM compared to those with non-ApHCM. Increasing NT-ProBNP, abnormal ultra-sensitive troponin, and increasing maximal LV wall thickness were significantly associated with reduced GWI and GCW in patients with ApHCM (p < .05). GCW had only modest accuracy (AUC 0.70) to predict LGE in patients with ApHCM. However, in patients with non-ApHCM, GLS was the strongest predictor of LGE (AUC 0.91), with a -17% cutoff yielding 81% sensitivity and 80% specificity. Myocardial work indices are significantly impaired in patients with ApHCM compared to those with non-ApHCM and correlate with important clinical variables. GLS, GWI, and GCW are more strongly predictive of fibrosis in patients with non-ApHCM than ApHCM.

Platelet index alterations in acute ST-elevation myocardial infarct: A retrospective pilot study

Abstract Introduction: Cardiovascular diseases (CVD) are responsible for approximately 17.9 millions of deaths every year, with a higher impact on low and middle-income populations. Despite traditional risk factors, asymptomatic individuals with atherosclerosis have been identified, and new biomarkers are being sought to better predict CVD risk. This study aims to investigate the relationship between platelets indices and biochemical variability in the first day after patient admission in the hospital. Methods: A pilot study was conducted to analyze 73 medical records of patients who experienced acute myocardial infarction, to analyze the association among mean platelet volume (MPV), platelet count (PC), creatine phosphokinase (CPK), creatine phosphokinase-MB (CKMB) and ultra-sensitive cardiac troponin I (TnI-us) between the first and second sampling (1-hour intervals), to investigate acute ST-segment elevation myocardial infarction. Results and conclusion: The biochemical analysis showed no significant difference in CPK CK MB, TnI-us, MPV and PC levels between the first and second samples. A negative correlation between PC and MPV and a moderate negative correlation between PC and CPK were found in our AMI patients within 24 hours of hospital admission.

Pre-hospital management of acute pericarditis based on a case study

Aim: Indication of appropriate treatment of the emergency medical team towards a patient with acute pericarditis being a life-threatening condition. Material and method: The retrospective study included two men to whom EMT (Emergency Medical Team) was called for chest pain and in the second case due to the correlation of chest pain, ECG changes and pathological results of ultrasensitive cardiac troponin and CRP. Both patients developed acute pericarditis as a result of the infection they were currently undergoing. In this paper, the case study method was used. The research material was obtained through the analysis of medical rescue cards, EMT departure order cards and hospital treatment information cards. Conclusions: Among cardiac patients with stenocardial pain, regardless of age and other factors, an examination should always be carried out and discriminatory diagnostics should be implemented, m.in. for suspected acute pericarditis. Medical interview, in particular epidemiological history, plays an important role.

43 CARDIAC TROPONINS AND COVID-19: WHAT DO WE KNOW ABOUT HETEROPHILIC ANTIBODIES?

Abstract Background During the Coronavirus disease-19 (COVID-19) pandemic, a significant increase in cardiovascular events and death for acute Myocardial Infarction (AMI) has been widely described. In turn, cardiac troponins represent the main serum diagnostic biomarkers of AMI. However, several mechanisms of troponins elevation other than AMI could be identified such as the analytic interference due to the Heterophilic Antibodies (HA), which represents a less explored and underestimated cause. Methods The research of the following keywords “Heterophilic” or “Heterophile Antibodies” associated with “Troponin”, “Troponin I”, “Troponin T” or “High-sensitive Troponin” have identified 73 works in the most popular bibliographic databases such as PubMed, Scopus, and Web of Science, in which the first was published in 1998. In our systematic review, the inclusion criteria have considered all the works in which clinical information about the patients are described. The results have included 55 papers for an overall population of 128 cases that have presented HA's interference in troponins’ assay. In the great part of the works, HA's capture test has been performed to diagnose this interference. The association between HA and COVID-19 has also been explored with the identification of three works in scientific literature. In addition, we reported a clinical case of a young patient with persistent high serum ultra-sensitive Troponin levels due to HA, during the COVID-19 pandemic. Results The results have indicated the most at-risk population in patients with a history of multiple hospitalizations and with poor cardiovascular risk factors, who usually complained of atypical chest pain combined with persistent elevation of cardiac troponins without high CK-MB values. Instead, only a few data could be isolated in the literature about HA's interference on troponins essay in COVID-19 patients. However, has been widely ascertained how increased serum levels of cardiac troponins have been identified in most of the SARS-COV-2 swabs positive populations, and several cardiac and extracardiac mechanisms may explain this condition. Conclusions The description of the most common clinical features of patients with HA's interference could help clinicians to early recognize this phenomenon, reducing the number of instrumental examinations and the hospitalization period of these patients. Therefore, the analytical mistake due to HA could be always considered in AMI differential diagnosis, and the use of HA's capture test in the at-risk population may determine an early diagnosis. Finally, the HA's phenomenon could increase during the COVID-19 period, considering how infections and vaccinations may stimulate heterophile's activity.

Usefulness of ultra-sensitive troponin to predict anthracyclines and trastuzumab related cardiac dysfunction

Abstract Background Cancer therapeutics–related cardiac dysfunction usually known as cardiotoxicity (CTX) is a common adverse effect of anthracyclines and anti-Her2 agents. In recent years, evidence of usefulness of ultrasensitive troponin for early diagnosis of CTX has increased, however the cut-off values of this biomarker remain uncertain. Purpose To assess the usefulness of ultrasensitive troponin T (UsTnT) to identify patients at risk of developing CTX and determine cut-off values for this biomarker. Methods Patients with diagnosis of solid or hematologic malignancies scheduled to receive therapy including anthracyclines and/or trastuzumab were prospectively included. Echocardiogram was performed prior to chemotherapy, and repeated 3 and 6 months later. UsTnT was measured at baseline and 3 months after starting chemotherapy and the increase of this biomarker from baseline was calculated. This UsTnT has a range of 3–10,000 pg/mL with a 99th percentile &amp;lt;15 pg/mL. Receiver operating characteristic curve was used to find out the best cut-off values followed by a multivariate analysis. The primary endpoint was the presence of CTX defined as a decline of left ventricular ejection fraction (LVEF) ≥10% at 6 months from baseline. Results A total of 141 patients were included (mean age 56±15 years, 85,8% were women, the most frequent diagnosis being breast cancer: 61.7%). Thirty-three patients (23.4%) met criteria of the primary endpoint of CTX. Patients with CTX showed significantly higher values of UsTnT at 3 months (18.2±14,9 vs 11.8±10,7 pg/mL, p=0.008) and also showed a higher increase of UsTnT from baseline (11.8±12.8 vs 5±8.2 pg/ml, p&amp;lt;0.001) (figure 1). The value of UsTnT at 3 months ≥13 pg/mL and an increase of UsTnT from baseline ≥14 pg/mL were selected as the best cut-off values. Figure 2 resumes sensitivity, specificity and predictive values. Those patients who had UsTnT at 3 months ≥13 pg/mL had a 3.8 fold increased risk of developing CTX in a multivariate analysis adjusted by age and left ventricular hypertrophy (OR: 3.8 [95% CI: 1.6–9.3], p=0.003) while an increase of UsTnT from baseline ≥14 pg/mL showed almost 12 fold increased risk for the primary endpoint in the same model (OR: 11.95 [95% CI: 3.9–36.6], p&amp;lt;0.001). Conclusions UsTnT is a good biomarker for detecting early myocardial injury which allows the identification of patients at risk for developing CTX with only two measurements during cancer treatment. Funding Acknowledgement Type of funding sources: None.

Association between obesity and hypertrophic cardiomyopathy phenotype, validation in a latin american cohort

Abstract Objectives Hypertrophic Cardiomyopathy (HCM) is the most common genetic cardiomyopathy. The influence of obesity on the disease phenotype is not well established. A recent publication sought to answer this gap. Our objective is to assess the relationship of a obesity on the phenotype of our cohort and compare it to the published literature. Methods We performed a retrospective observational study of consecutive patients diagnosed with HCM at a single center in Argentina. We included 1331 patients between March 1993 and December 2021. We excluded patients &amp;lt;18 years of age, metabolic diseases &amp; syndromes and patients who were lost on follow up. We defined Obesity as a body mass index ≥30 kg/m2. Results 1168 patients had available data for analysis. 54 (10.4%) patients were obese. Mean age was 54±28 years and 33 (61%) were male. Average maximal left ventricular wall thickness (LVWT) in this group was 20 mm ± 5 mm. When comparing obese vs non-obese patients we found no statistically significant differences for gender, age, family history of HCM, family history of sudden death (SD), previous VF/VT/NSVT, ESC low, intermediate or high risk for SD groups, fibrosis, apical aneurism, LV diameter, maximum LVWT, high risk genetic mutation, abnormal BP response to exercise, device implant, septal alcohol ablation, reduced EF on follow up, nor death/HF/Stroke/AICD appropriate therapy/AF development. We did find that obese patients had less unexplained syncope (6% vs 13%, OR 0.43, p=0.03), had more frequently an NYHA &amp;gt; III/IV (15.3% vs 8.9%, OR 1.8, p=0,03), a trend to having less frequently a LVWT &amp;gt;30 mm (3.5% vs 8.1%, OR 0.41, p=0.07) but more frequently had systolic anterior motion of the mitral valve on echocardiography (45% vs 34%, OR 1.58, p=0.04). We noted a trend to being more frequently indicated LV myectomy (9.2% vs 5%, OR 1.9, p=0,07) and significantly having elevated ultrasensitive troponin I (7.8% vs 3.7%, OR 2.2, p=0,04). Conclusions We found that obese patients from our cohort, as described in other series, had more advanced symptoms. In our set of obese patients they were more frequently sent to myectomy rather than alcohol septal ablation as described in other series. AF was not more prevalent among our obese patients and maximum wall thickness and fibrosis were not higher either. We did find that obese patients had more frequently elevated biomarkers. As HCM is so frequent it is important to characterize cohorts and compare data. Funding Acknowledgement Type of funding sources: None.

Magnetic Rolling Circle Amplification-Assisted Single-Particle Collision Immunosensor for Ultrasensitive Detection of Cardiac Troponin I.

Owing to its simplicity, high throughput, and ultrasensitivity, single-particle collision electrochemistry (SPCE) has attracted great attention in biosensing, especially labeled SPCE. However, the low signal conversion efficiency and much interference from complex samples limit its wide application. Here, a new and robust SPCE immunosensor was proposed for ultrasensitive cardiac troponin I (cTnI) detection by combining target-driven rolling circle amplification (RCA) with magnetic beads (MBs). Antibody-modified MBs have good stability, dispersity, and magnetic response capacity in complex samples, enabling efficient capture and separation of cTnI with high specificity and anti-interference ability. The presence of cTnI could specifically drive the formation of magnetic immunocomplexes followed by triggering RCA and enzyme digestion reaction. By using Pt nanoparticles (Pt NPs)-modified ssDNA as signal probes, one cTnI molecule could induce the release of 4.5 × 104 Pt NPs for collision experiments, greatly enhancing signal conversion efficiency and detection sensitivity. Based on the integration of MBs with RCA, the SPCE immunosensor realized 0.57 fg/mL cTnI detection with a wide linear range of 1 fg/mL to 50 ng/mL. Furthermore, cTnI detection in serum samples of myocardial infarction patients was successfully performed, demonstrating great application prospect of the SPCE immunosensor in clinical diagnosis.

Wellens Syndrome: A Case like No Other!

Introduction: Wellens syndrome or anterior interventricular artery (AIV) disease is an electrocardiographic abnormality defined by the presence, apart from painful episodes, of biphasic T waves in the anterior leads (type 1), or deeply inverted T waves (type 2) in association with critical stenosis of the proximal AIV. It warrants aggressive management given the rather high incidence of death and re-infarction. Objectif: To report an atypical form of this syndrome through this observation and to provide an update on this rare entity through a literature review. Case report: A 48-year-old patient, chronic smoker with 40 BPs still active, admitted following an episode of infarct chest pain. At admission, the patient was asymptomatic. The clinical examination was unremarkable. The ECG showed biphasic T waves, negative in its terminal part in V2-V3-V4, without planed R waves, nor Q waves of necrosis or significant ST abnormality evoking a WELLENS type 1 syndrome. Ultrasensitive troponin was measured at 260 ng/L. The evolution was marked by the appearance of a fleeting negativation of T waves, without chest pain. Chest echocardiography showed a non-dilated left ventricle with preserved systolic function and no detectable segmental or global kinetic disorders, associated with concentric left ventricular hypertrophy. The coronary angiography performed in emergency shows tritroncular lesions, a very tight stenosis of the middle interventricular and the first diagonal, a tight stenosis of the middle circumflex and the middle right coronary, revealing a coronary artery bypass graft. Discussion and conclusion: Wellens syndrome is characterized by T-wave abnormalities that often fluctuate (from type 1 to type 2 or vice versa) during pain-free intervals, reflecting spontaneous reperfusion and the unstable nature of the coronary lesion found, which is represented mainly by involvement of the proximal AVI. Involvement of the middle IVA associated with other lesions is rarely observed. It is associated with a greater risk of anterior infarction or sudden death if not recognized and treated rapidly, so it seems essential to recognize the electrocardiographic criteria of this syndrome in order to propose coronary angiography for early revascularization.

P35 A RARE CASE OF VENTRICULAR ARRHYTHMIA STORM AND COMPLETE ATRIOVENTRICULAR BLOCK IN A PATIENT WITH BECKER MUSCULAR DYSTROPHY

Abstract A 68 year–old male presented to the Emergency Department of our Institute with palpitations for the last 20 minutes. The patient suffered from Becker’s muscular dystrophy (BMD) with hypotonic tetraparesis and dilated cardiomyopathy with moderate left ventricular dysfunction. The patient had also arterial hypertension and a previous ischemic stroke treated with thrombolysis and subsequently with warfarin. On the admission, the patient was alert, blood pressure was 90/60 mmHg and heart rate 180 bpm. An ECG (Fig. 1) showed regular, wide–complex tachycardia (QRS duration of 240 msec) with right branch block morphology with left axial deviation. A bolus of amiodarone 200 mg ev was administered without efficacy followed by a bolus of lidocaine 50 mg. The patient developed symptomatic hypotension, so external electrical cardioversion was performed with a single DC shock at 200J, effective in restoring sinus rhythm. Amiodarone and beta blocker therapy was started. On laboratory tests, the main values were normal, including the ultrasensitive troponin hs–cTnI. Echocardiography showed a mildly dilated left ventricle with diffuse hypokinesia conditioning severe reduction of systolic function (FE 35%) (Fig. 2). On subsequent telemetric ECG monitoring, no recurrences of sustained ventricular tachycardia (VT) were recorded, but it was observed an episode of complete atrioventricular (AV) block conditioning a symptomatic 9.5–second asystole, treated with atropine. Then the patient underwent CRT–D implantation in secondary prevention. The day after the procedure, an arrhythmic storm occurred and was effectively treated with multiple attempts of antitachycardia pacing and device shock. In the following days, the patient continued to present with episodes of VT despite antiarrhythmic drugs. Hence, an endo–epicardial ablation of the arrhythmic substrate was evaluated in Heart team. In view of an intubation and the high anesthesiological risk, it was indicated to continue the optimized medical therapy. Mexiletine 200 mg tid was added to metoprolol 100 mg bid and amiodarone 200 mg od. In the following days, no arrhythmic recurrences were recorded on continuous ECG monitoring. The patient was discharged from the hospital asymptomatic and with no sign of heart failure. At 2 years of follow–up, the patient remained asymptomatic, with no arrhythmic events recorded by the device and in the absence of any adverse effects caused by mexiletine.

Acute Coronary Syndrome without ST Elevation: is The Level of Ultrasensitive Troponin T Correlated to the Severity of Coronary Involvement?

Introduction: Acute coronary syndromes without ST segment elevation are heterogeneous entities. Troponins contribute to the early identification of patients at high risk for cardiac complications. The objective of this work is to study the severity of coronary artery disease according to the ultrasensitive troponin T (T us) level. Methods: We have performed a descriptive retrospective of patients hospitalized in the cardiology department of CHU Mohammed VI in Marrakech, between January 2018 and February 2022 for acute coronary syndromes without ST segment elevation. Patients were divided into two groups according to the rate of troponin Tus. Results: 50 patients were included, comprising 35 men and 15 women. Group 1, made of 20 patients whose ultrasensitive troponin T level is less than 4 times normal, group 2, whose troponin T level is more than 4 times normal, made of 30 patients. Demographic analysis shows that there is no significant difference between the two groups in terms of average age and sex. Hypertension is slightly more common in Group 1 (45% vs. 43.3%). De novo angor was more frequent in group 1 compared to group 2 (10% vs 6.7%;p=0.01). At electrocardiogram, subendocardial lesions are more in Group 2 (15% vs. 43.3%; p=0.0006). Group 1 had angiographical coronaries more frequently normal or non-significant coronary involvement compared to group 2 (40% vs 6.67%; p&lt;0.001). Tritroncular lesions are more frequently found in Group 2 (33.3% vs. 5%;p=0.02). Monotroncular and bi-roncular lesions are recorded identically in both groups. Ischemic recurrences are more common in Group 2 (35% vs. 46.6%;p=0.02). Conclusion: Stable Troponin US levels are associated with the degree of coronary involvement, and frailty measurements were significantly associated with the severity of coronary lesions, this could help to identify patients who are at a high risk of death. These findings may help clinicians guide further diagnostic assessment.

Early Change in Area Strain Detected by 3D Speckle Tracking Is Associated With Subsequent Cardiotoxicity in Patients Treated With Low Doses of Anthracyclines.

ObjectiveTo evaluate the prognostic impact of the parameters of myocardial deformation using three-dimensional speckle tracking echocardiography (3DSTE) in patients with breast cancer who underwent chemotherapy with low doses of anthracyclines.BackgroundChemotherapy-related cardiotoxicity has an important prognostic impact on cancer survivors. Three-dimensional STE has revealed more consistent data than two-dimensional techniques and may represent a more accurate tool in the evaluation of myocardial function in patients who underwent chemotherapy.MethodsWe evaluated patients with breast cancer who were treated with anthracyclines (associated or not with trastuzumab) in five stages: baseline, after cumulative doses of 120 and 240 mg/m2 of doxorubicin, and then, after 6 months and at least 1 year after anthracyclines. Ultrasensitive troponin I (US-TnI) and a standard echocardiography study were performed at each stage. We analyzed left ventricular ejection fraction (LVEF) by Simpson's method, two-dimensional speckle tracking (2DSTE) with longitudinal and radial strain values, and 3DSTE with longitudinal, radial, and circumferential strain as well as twist, torsion, rotation, and three-dimensional global area strain (3DGAS). Cardiotoxicity was defined as a decrease in LVEF by more than 10 percentage points to a value lower than 53%.ResultsWe evaluated 51 female patients who were aged 50.6 ± 11 years. After the cumulative dose of 240 mg/m2 of doxorubicin, US-TnI was increased (>34 pg/ml) in 21 patients (45%, p > 0.001), LVEF remained unchanged (p = 0.178), while 2DSTE longitudinal strain was decreased (from −17.8% to −17.1%, p < 0.001) and 3DSTE detected changes in longitudinal, radial, circumferential, and area strain. After a lower cumulative dose of doxorubicin (120 mg/m2), 3DGAS (p < 0.001) was the only parameter that was changed. In the follow-up, 7 (13%) patients presented a decrease in LVEF. Three-dimensional GAS early changed to abnormal values was the only variable associated with a subsequent decrease in LVEF (definitive cardiotoxicity).ConclusionIn patients with breast cancer, 3DSTE detected early changes in area strain after very low doses of doxorubicin. The 3DGAS early changed to abnormal values was associated with a subsequent decrease in LVEF, representing a promising technique to predict chemotherapy-induced cardiomyopathy.

The Value Of Ultra-Sensitive Troponin-I In Determining Mortality In Patients With Suspected Acute Coronary Syndrome

Abstract:&#x0D; Objective: This study investigated the role of the reference value of ultra-sensitive troponin kits used in daily practice in determining mortality.&#x0D; Material-methods: This study was conducted in the emergency department (ED) of Akdeniz University Hospital between January 1, 2018, and June 30, 2019. All patients admitted to the emergency department within a period of eighteen months and who had the result of the ultra-sensitive troponin level in the range of 0.06-0.1 ng/mL were included in the study. The recurrent admissions of the patients to the ED were included, and only the first troponin values of the patients were taken as s reference for the study.&#x0D; &#x0D; &#x0D; &#x0D; Result: It was determined that 1029 troponin values of 591 patients with initial troponin I value in the range 0.06-0.1 ng/mL were measured. It was found that 332 of these patients were discharged from the emergency department, and the others were hospitalized. It was found that 168 (28.43%) of the patients died. Considering the gender distribution of the patients who died, it was observed that 101 (60.11%) patients were male, and 67 (39.89%) patients were female. A statistically significant difference was found between the ages of the patients who died (mean 71.38±12.25) and the age of patients alive (mean 61.78 ± 15.89) (p