Value For Myocardial Infarction Research Articles

HETEROPHILE ANTIBODIES – A RARE BUT SIGNIFICANT CAUSE OF FALSE POSITIVE CARDIAC TROPONIN LEVELS

HighlightsPractitioners regularly encounter unexplained (false-positive) causes and mechanisms of increased concentrations of cardiac troponins. One of the most significant and common causes of false increases in cardiac troponin levels are heterophile antibodies. There are no articles in domestic and foreign databases that systematize in detail information about the prevalence, mechanisms of increase and ways to combat this cause of false-positive increase in cardiac troponin concentration, which was the purpose of this manuscript. AnnotationAccording to traditional concepts, cardiospecific troponins (cTnT and cTnI) are the most important laboratory biomarkers with high diagnostic value in myocardial infarction (MI). The development of new generations of methods for determining cTnT and cTnI, also called high- and ultra-sensitive methods, has expanded the diagnostic capabilities of cardiac troponins in relation to other diseases in which myocardial tissue is involved in the pathological process, thereby carrying additional prognostic value. Given the wide scope for use of cTnT and cTnI, which is not limited to the diagnosis of MI, there is an urgent need to carefully identify all factors that can in any significant way affect or distort the result of laboratory testing of blood serum for cTnT and cTnI. Among all known factors affecting the concentration of cTnT and cTnI, heterophile antibodies are the most significant in terms of the degree of change (increase) in serum levels. In this review, we will consider the main causes of the formation of heterophile antibodies, the mechanisms of their influence on the concentration of cTnT and cTnI, as well as methods for detecting and combating heterophile antibodies.

Perioperative infarction during coronary bypass surgery: an attempt to refine the diagnostic criteria using data from a retrospective case-control study.

The definition of coronary artery bypass graft (CABG)-associated myocardial infarction (MI) is controversial because the postoperative increases in cardiac enzyme activities are multifactorial in origin. We performed a retrospective case-control study of patients who experienced perioperative MI (cardiac enzyme release, electrocardiographic changes, dysfunction on echocardiography) and those without ischemia to identify risk factors and enzyme activity thresholds. The estimated incidence of CABG-associated MI was 2.8%. The risk factors were a family history of cardiovascular disease (odds ratio (OR) 2.8), tobacco abuse (OR 3.8), recent MI (OR 3.6), and triple-vessel disease (OR 2.8). The MI group showed higher mortality (OR 2.3), prolonged intubation (OR 3.1), and a prolonged stay in intensive care (OR 4.3). The type 5 MI threshold (10 times the upper limit of the reference range (URL)) was exceeded in 88.4% (troponin I) and 96% (high-sensitivity troponin T; hs-cTnT) of patients without ischemia. The frequent exceeding of conventional MI-indicating thresholds in patients without ischemia indicates their low specificity. An enzyme activity increase alone is of limited diagnostic value for perioperative MI, which is associated with greater mortality. Finally, the use of a higher threshold for hs-cTnT (>45 × URL) may increase its specificity for graft failure.

Acute kidney injury in relation to high-sensitivity cardiac troponin T levels in the emergency department

Abstract Background The clinical implications of high-sensitivity cardiac troponin T (hs-cTnT) measurements in all-comers with AKI in the emergency department (ED) is largely unknown. Purpose To investigate the prevalence of myocardial injury, associations between serum-creatinine concentrations (SCC) and hs-cTnT kinetics, and the accuracy of established hs-cTnT-based myocardial infarction (MI) risk stratification algorithm criteria in patients with AKI. Methods This observational cohort study was based on patient visits to 7 EDs in Sweden from December 9, 2010 to August 31, 2017. All visits by patients ≥18 years fulfilling criteria for AKI with ≥1 hs-cTnT measurement and the exposure was dynamic change in SCC (ΔSCC) during the visits. Linear mixed models were used to estimate linear predictors of kinetic change in hs-cTnT (Δhs-cTnT). Logistic regression models were applied to calculate odds ratios (ORs) for Δhs-cTnT indicative of acute myocardial injury (Δhs-cTnT >20% and elevated hs-cTnT) in relation to ΔSCC among patients without MI, and to assess the diagnostic performance of hs-cTnT for MI in a subgroup of patients presenting with chest pain. Results A total of 15,211 visits by patients with AKI were included, of whom 1174 (8%) had an MI. Four of five (81%) patients without MI had myocardial injury (hs-cTnT >14 ng/l), and almost one of three (31%) had acute myocardial injury. These entities were common in both cardiac and non-cardiac conditions. The Δhs-cTnT in non-MI patients was 1.8-fold (β: 1.78, 95% CI: 1.62-1.96) in the highest quartile of ΔSCC and was paralleled by a 2-fold risk of acute myocardial injury (OR: 2.32, 95% CI: 2.08-2.59), compared with the lowest ΔSCC quartile. Using a 0 h hs-cTnT cut-off ≥52 ng/l assigned 627 (26%) patients to a high-risk group in whom the specificity and positive predictive value (PPV) for MI was low (78.5% (95% CI: 76.7-80.2) and 27.6% (95% CI: 24.1-31.3), respectively). Conclusions Hs-cTnT concentrations indicative of acute myocardial injury are frequently observed among all-comers with AKI in the ED and are associated with dynamic changes in SCC. These observations are accompanied by poor performance of recommended hs-cTnT-based algorithms for MI risk stratification in patients with chest pain.

Acute Kidney Injury and High-Sensitivity Cardiac Troponin T Levels in the Emergency Department

The clinical implications of high-sensitivity cardiac troponin T (hs-cTnT) measurements in patients with acute kidney injury (AKI) in the emergency department (ED) are largely unknown. To investigate associations between serum creatinine (SCr) concentrations and hs-cTnT kinetics, as well as the clinical accuracy of hs-cTnT for myocardial infarction (MI) in patients with AKI. This retrospective cohort study included 15 111 patient visits to 7 EDs in Sweden from December 9, 2010, to August 31, 2017, by patients 18 years or older fulfilling AKI criteria with 2 or more SCr measurements and 1 or more hs-cTnT measurement. Statistical analysis was performed from October 2, 2022, to September 28, 2023. Dynamic change in SCr during the ED visits. Linear mixed-effects models were used to estimate the log-linear regression of kinetic change in hs-cTnT. Logistic regression models were applied to calculate odds ratios (ORs) for change in hs-cTnT indicating acute myocardial injury (Δhs-cTnT >20% and elevated hs-cTnT >14 ng/L) in association with change in SCr, and to assess the diagnostic performance of hs-cTnT for MI in patients with chest pain. There was a total of 15 211 visits by 13 638 patients (median age, 74 years [IQR, 64-83 years]; 8709 men [57%]), of whom 1174 (8%) had an MI. Overall, 11 353 of patients at 14 037 visits without an MI diagnosis (81%) had myocardial injury, and 4396 patients at 14 037 visits (31%) had acute myocardial injury. The change in hs-cTnT among patients without MI was 1.8-fold higher in the highest vs the lowest change in SCr quartile (64.7% [95% CI, 58.4%-71.5%] vs 36.3% [95% CI, 32.4%-40.7%]; exponentiated β coefficient, 1.78 [95% CI, 1.62-1.96]). Patients in the former group were twice as likely to have acute myocardial injury (39% [1378 of 3516 visits] vs 23% [817 of 3507 visits]; adjusted OR, 2.32 [95% CI, 2.08-2.59]). Using a 0 hours hs-cTnT cutoff value of 52 ng/L or higher assigned 627 of 2388 patients (26%) with chest pain to a high-risk group in whom the specificity and positive predictive value for MI was low (78.5% [95% CI, 76.7%-80.2&] and 27.6% [95% CI, 24.1%-31.3%], respectively). This cohort study of patients in the ED suggests that dynamic change in SCr among patients with AKI was associated with hs-cTnT concentrations indicative of acute myocardial injury. These observations were accompanied by poor performance of recommended hs-cTnT-based algorithms for MI risk stratification.

Validation of the ACC Expert Consensus Decision Pathway for Patients With Chest Pain

BackgroundThe American College of Cardiology (ACC) recently published an Expert Consensus Decision Pathway for chest pain. ObjectivesThe purpose of this study was to validate the ACC Pathway in a multisite U.S. cohort. MethodsAn observational cohort study of adults with possible acute coronary syndrome was conducted. Patients were accrued from 5 U.S. Emergency Departments (November 1, 2020, to July 31, 2022). ECGs and 0- and 2-hour high-sensitivity troponin (Beckman Coulter) measures were used to stratify patients according to the ACC Pathway. The primary safety outcome was 30-day all-cause death or myocardial infarction (MI). Efficacy was defined as the proportion stratified to the rule-out zone. Negative predictive value for 30-day death or MI was assessed among the whole cohort and in a subgroup of patients with coronary artery disease (CAD) (prior MI, revascularization, or ≥70% coronary stenosis). ResultsACC Pathway assessments were complete in 14,395 patients, of whom 51.7% (7,437 of 14,395) were women with a median age of 56 years (Q1-Q3: 44-68 years). Known CAD was present in 23.5% (3,386 of 14,395) and 30-day death or MI occurred in 8.1% (1,168 of 14,395). The ACC Pathway had an efficacy of 48.1% (95% CI: 47.3%-49.0%). Among patients in the rule-out zone, 0.3% (22 of 6,930) had death or MI at 30 days, yielding a negative predictive value of 99.7% (95% CI: 99.5%-99.8%). In patients with known CAD, 20.0% (676 of 3,386) were classified to the rule-out zone, of whom 1.5% (10 of 676) had death or MI. ConclusionsThe ACC expert consensus decision pathway was safe and efficacious. However, it may not be safe for use among patients with known CAD.

Echocardiographic and Angiographic Assessment of Right Ventricular Function and Right Coronary Artery Stenosis in Acute Inferior Wall Myocardial Infarction.

Cardiovascular diseases (CVDs) are a global concern. CVD remains a primary cause of death despite reduced coronary heart disease death rates. Acute coronary syndrome (ACS) involves myocardial infarction (MI) and unstable angina, sharing mechanisms such as plaque instability. Our study assesses the right ventricular (RV) function's predictive value in acute inferior wall MI (IWMI) to identify high-risk patients with an elevated likelihood of experiencing severe cardiac complications, hemodynamic instability, or a higher mortality risk following an acute IWMI. The research was conductedin the Department of Cardiology at theRajendra Institute of Medical Sciences (RIMS), Ranchi, from July 2021 to June 2022, following the necessary ethical approval. A cohort of 140 patients with IWMI, carefully chosen according to rigorous criteria, clearly understood the study's objectives before providing informed consent. The evaluations were conducted in the following order: clinical assessments, followed by blood testing, then echocardiography, and finally, coronary angiography. Furthermore, the study examined risk factors and utilized statistical methods to elucidate the associations between qualities and results. The study included 140 participants, with 61% being male and 39% female. Among the participants, 14% were aged 30-45, 50% were aged 46-60, and 30% were over 60. Age shows significant proportions in different categories. Diabetes, dyslipidemia, hypertension, and smoking/tobacco addiction did not differ among stenosis groups. Proximal right coronary artery (RCA) stenosis patients had elevated jugular venous pressure (JVP). The echocardiograms were performed within 48 hours of post-percutaneous coronary intervention, and significant differences between groups were observed. Participants with proximal stenosis had lower tricuspid annular plane systolic excursion (TAPSE) and right ventricular fractional area change (RVFAC), which showedcompromised RV systolic function. Proximal stenosis patients had reduced systolic motion velocity (Sm), indicating impaired myocardial contraction. Echocardiographic parameters such as early diastolic velocity (Em), atrial contraction velocity (Am), Em/Am ratio (a marker of diastolic function), isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), and ejection time (ET) between groups were different, indicating distinct cardiac functions. Proximal stenosis increased the myocardial performance index (MPI), indicating cardiac impairment. The left ventricular ejection fraction (LVEF) was comparable in the two stenosis groups, indicating similar left ventricular performance. Echocardiography showed significant RV function differences in acute inferior wall ST-segment elevation myocardial infarction (STEMI) patients with proximal and distal RCA lesions. RV dysfunction is linked to right ventricle myocardial infarction (RVMI), and echocardiographic markers can provide valuable insights. Results emphasizethat acute inferior wall STEMI is diagnosed by electrocardiogram (ECG) criteria, particularly ST-segment elevation. However, these markers emphasize the importance of RV assessment in RCA involvement assessment. These findings suggest that RV function can help diagnose acute inferior wall STEMI RCA involvement. In acute inferior STEMIs, RV function echocardiography is essential for RCA lesion location.

Suspected myocardial infarction in the emergency department: An evaluation of clinical thresholds for the Beckman Coulter Access hsTnI high-sensitivity cardiac troponin I assay.

The primary objective was to determine rapid rule-out (RRO) criteria for the outcome of myocardial infarction (MI) using the Beckman Coulter Access high-sensitivity cardiac troponin I (hs-cTnI) assay. Secondary objectives were to explore cut-points for rapid rule-in (RRI) and amount of change at 3-h (3-h delta) indicative of MI. A retrospective study included ED patients with suspected MI between June and September 2019. hs-cTnI levels were performed at baseline and after 3 h. The performance benchmark for RRO criteria was a negative predictive value (NPV) for MI with a lower 95% confidence limit >99%, and for RRI and 3-h delta cut-points was a positive predictive value (PPV) for MI >70%. Delta calculation required rising hs-cTnI levels, with at least one above the 99th percentile of the upper reference limit. Analyses utilised receiver operating characteristic (ROC) curves and contingency tables. Baseline hs-cTnI levels from 935 patients were available for RRO analyses. Of tested criteria, baseline hs-cTnI <6 ng/L (females) or <11 ng/L (males) plus symptom onset >2 h met the performance benchmark (NPV: 100% [95% confidence interval 99-100]). hs-cTnI levels were available for RRI and 3-h delta analyses from 935 and 52 patients, respectively. A 3-h delta cut-point >35 ng/L met the performance benchmark (PPV: 81% [95% confidence interval 58-95]) but no RRI cut-point did so. For the Beckman Coulter Access hs-cTnI assay, RRO criteria of baseline hs-cTnI <6 ng/L (females) or <11 ng/L (males) plus symptom onset >2 h met our performance benchmark. A 3-h delta cut-point >35 ng/L met the performance benchmark, but poor precision means further adequately powered research is required.

Abnormal T-Wave Alternans In Coronary Artery Disease Left Ventricle Ejection Fraction &gt;40% With Myocardial Infarction

Coronary artery disease (CAD) may present with or without myocardial infarction, with the left ventricle ejection fraction (LVEF) &lt;40% or &gt;40%. Myocardial infarction with LVEF &lt;40% has been reported to cause abnormal T-wave alternans (TWA) value. The data about abnormal TWA value in myocardial infarction with LVEF &gt;40% is still limited. A case-control analytic study was held at Dr. Sardjito general hospital Since March 2021 until April 2022 on adult CAD subjects with LVEF &gt;40%. The TWA value was obtained from treadmill test which was then divided into the case group if the TWA value was abnormal and into the control group if the TWA value was normal. The data about myocardial infarction was retrospectively evaluated afterwards. Hypothesis testing was performed by Chi-Square test. Multivariate analysis using logistic regression test was conducted to determine the effect of confounding variables on TWA value. A total of 124 subjects were included in this study (62 subjects in the case group with abnormal TWA value, and 62 subjects in the control group with normal TWA value) with the mean age of 55,48 ± 8,6 years old and 83,8% were male subjects The proportion of subjects with abnormal TWA value with myocardial infarction and without myocardial infarction were 74,6% and 16,7% respectively. The Chi-Square test showed an association between PAH and abnormal TWA with OR 14,395 (CI 95%: 5,88-35,21; p&lt;0,001). After multivariate analysis, myocardial infarction was the only remaining variable independently associated with abnormal TWA values. Abnormal TWA value occurred more frequently in subjects with myocardial infarction compared to subjects without myocardial infarction, in population of CAD LVEF &gt;40%, with the possibility of 14,395 times more frequent

Bioinformatics analysis identifies ferroptosis‑related genes in the regulatory mechanism of myocardial infarction.

Since ferroptosis is considered to be a notable cause of cardiomyocyte death, inhibiting ferroptosis has become a novel strategy in reducing cardiac cell death and improving cardiopathic conditions. Therefore, the aim of the present study was to search for ferroptosis-related hub genes and determine their diagnostic value in myocardial infarction (MI) to aid in the diagnosis and treatment of the disease. A total of 10,286 DEGs were identified, including 6,822 upregulated and 3.464 downregulated genes in patients with MI compared with healthy controls. After overlapping with ferroptosis-related genes, 128 ferroptosis-related DEGs were obtained. WGCNA successfully identified a further eight functional modules, from which the blue module had the strongest correlation with MI. Blue module genes and ferroptosis-related differentially expressed genes were overlapped to obtain 20 ferroptosis-related genes associated with MI. Go and KEGG analysis showed that these genes were mainly enriched in cellular response to chemical stress, trans complex, transferring, phosphorus-containing groups, protein serine/threonine kinase activity, FoxO signaling pathway. Hub genes were obtained from 20 ferroptosis-related genes through the PPI network. The expression of hub genes was found to be down-regulated in the MI group. Finally, the miRNAs-hub genes and TFs-hub genes networks were constructed. The GSE141512 dataset and the use of RT-qPCR assays on patient blood samples were used to confirm these results. The results showed that ATM, PIK3CA, MAPK8, KRAS and SIRT1 may play key roles in the development of MI, and could therefore be novel markers or targets for the diagnosis or treatment of MI.

Incremental prognostic value of stress CMR for cardiovascular risk stratification after a cryptogenic ischemic stroke

Abstract Background One-third of ischemic strokes are “cryptogenic” without clearly identified etiology. Although coronary artery disease (CAD) is the main cause of death after stroke, the interest of CAD screening in patients with cryptogenic stroke is still debated. Purpose The aim of the study was to assess the incremental prognostic value of stress cardiovascular magnetic resonance (CMR) beyond traditional risk factors for predicting cardiovascular events in patients with a prior cryptogenic ischemic stroke. Methods Between 2008 and 2021, consecutive patients with prior cryptogenic strokes referred for stress CMR were included and followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction (MI). Univariable and multivariable Cox regressions were performed to determine the prognostic value of unrecognized MI and silent ischemia. Results Of 542 patients (55.2% male, mean age 71.4±8.8 years) who completed the follow-up (median 5.9 years), 66 (12.2%) experienced MACE. Silent ischemia and unrecognized MI were detected in 18% and 17% of patients, respectively. Using Kaplan-Meier analysis, silent ischemia and unrecognized MI were associated with the occurrence of MACE (hazard ratio, HR: 8.43 [95% CI: 5.11–13.9]; HR: 7.87 [95% CI: 4.80–12.9]; respectively, p&amp;lt;0.001). In multivariable analysis, silent ischemia and unrecognized MI were independent predictors of MACE (HR: 8.08 [95% CI: 4.21–15.5]; HR: 6.65 [95% CI: 3.49–12.7]; respectively, p&amp;lt;0.001). After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors (C-statistic improvement: 0.13; NRI=0.428; IDI=0.048). Conclusions In patients with prior cryptogenic stroke, stress CMR findings have an incremental prognostic value to predict MACE over traditional risk factors. Funding Acknowledgement Type of funding sources: None.

Additional prognostic value of stress cardiovascular magnetic resonance for cardiovascular risk stratification after a cryptogenic ischemic stroke.

BackgroundOne-third of ischemic strokes are “cryptogenic” without clearly identified etiology. Although coronary artery disease (CAD) is the main cause of death after stroke, the interest in CAD screening in patients with cryptogenic stroke is still debated.AimThe aim of the study was to assess the incremental prognostic value of stress cardiovascular magnetic resonance (CMR) beyond traditional risk factors for predicting cardiovascular events in patients with a prior cryptogenic ischemic stroke.Materials and methodsBetween 2008 and 2021, consecutive patients with prior cryptogenic strokes referred for stress CMR were included and followed for the occurrence of major adverse cardiovascular events (MACEs), defined by cardiovascular death or non-fatal myocardial infarction (MI). Univariable and multivariable Cox regressions were performed to determine the prognostic value of unrecognized MI and silent ischemia.ResultsOf 542 patients (55.2% male, mean age 71.4 ± 8.8 years) who completed the follow-up (median 5.9 years), 66 (12.2%) experienced MACE. Silent ischemia and unrecognized MI were detected in 18 and 17% of patients, respectively. Using Kaplan–Meier analysis, silent ischemia and unrecognized MI were associated with the occurrence of MACE [hazard ratio, HR: 8.43 (95% CI: 5.11–13.9); HR: 7.87 (95% CI: 4.80–12.9), respectively, p < 0.001]. In multivariable analysis, silent ischemia and unrecognized MI were independent predictors of MACE [HR: 8.08 (95% CI: 4.21–15.5); HR: 6.65 (95% CI: 3.49–12.7), respectively, p < 0.001]. After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors (C-statistic improvement: 0.13; NRI = 0.428; IDI = 0.048).ConclusionIn patients with prior cryptogenic stroke, stress CMR findings have an incremental prognostic value to predict MACE over traditional risk factors.

Frequency and outcomes of periprocedural myocardial infarction in patients with chronic coronary syndromes undergoing percutaneous coronary intervention.

Various definitions of periprocedural myocardial infarction (MI) have been proposed by academic groups and professional societies differing in terms of biomarker thresholds and ancillary criteria for myocardial ischemia. The incidence and clinical significance of periprocedural MI substantially varies according to the definitions applied. In this review, we summarize available clinical data on the frequency and outcomes of periprocedural MI according to various MI definitions in patients undergoing percutaneous coronary intervention (PCI). Numerous clinical studies and meta-analyses have investigated the incidence and prognostic relevance of periprocedural MI following PCI. The incidence of periprocedural MI was higher when defined by universal definition of myocardial infarction (UDMI), which applies a lower biomarker threshold with broader ancillary criteria compared with the Society for Cardiovascular Angiography and Intervention (SCAI) and academic research consortium (ARC)-2. The prognostic impact of periprocedural MI defined by SCAI and ARC-2 on mortality was consistently greater compared with the UDMI definition. Among chronic coronary syndrome patients undergoing PCI, the frequency and prognostic value of periprocedural MI varies considerably based on definitions. Periprocedural MI defined by the ARC-2 and SCAI occurred 3-6 times less frequently and were prognostically more relevant as compared with the UDMI. Clinically relevant definitions should be used in daily practice and clinical trials.

Clinical assessment and molecular mechanism of the upregulation of Toll-like receptor 2 (TLR2) in myocardial infarction

ObjectiveThe prevalence and mortality of cardiovascular diseases remain ranked first worldwide. Myocardial infarction (MI) is the central cause of death from cardiovascular diseases, seriously endangering human health. The clinical implication of toll-like receptor 2 (TLR2) remains contradictory, and its mechanism is still unknown. Hence, the objective of this study was to elucidate the clinical value and molecular mechanism of TLR2 in MI.MethodsAll high-throughput datasets and eligible literature were screened, and the expression levels of TLR2 were collected from the MI. The integrated expression level of TLR2 was displayed by calculating the standardized mean difference (SMD) and the area under the curve (AUC) of the summary receiver operating characteristic curve (sROC). The related TLR2 genes were sent for pathway analyses by gene ontology (GO), Kyoto encyclopedia of genes and genome (KEGG), and disease ontology (DO). Single-cell RNA-seq was applied to ascertain the molecular mechanism of TLR2 in MI.ResultsNine microarrays and four reported data were available to calculate the comprehensive expression level of TLR2 in MI, including 325 cases of MI and 306 cases of controls. The SMD was 2.55 (95% CI = 1.35–3.75), and the AUC was 0.76 (95% CI = 0.72–0.79), indicating the upregulation of TLR2 in MI. The related TLR2 genes were primarily enriched in the pathways of atherosclerosis, arteriosclerotic cardiovascular disease, and arteriosclerosis, suggesting the clinical role of TLR2 in the progression of MI. Afterward, TLR2 was upregulated in myeloid cells in MI.ConclusionsTLR2 may have a crucial role in progressing from coronary atherosclerosis to MI. The upregulation of TLR2 may have a favorable screening value for MI.

Akut Myokard Enfarktüsü için Potansiyel Yeni Bir Biyobelirteç Olarak Dolaşan Uzun İntergenik Kodlamayan RNA LINC01538: Prospektif Kohort Çalışma

Objective: Non-coding RNAs are the RNAs with no protein coding function, long non-coding RNAs (LncRNAs) are the non-coding RNAs with more than 200 nucleotides. During the journey of discovering novel biomarkers for diagnosis of myocardial infarction (MI), the principle of studying the LncRNA as a potential would be always attractive, as it needs easy sample collection, has high detection sensitivity and high myocardial tissue specificity. Our main objective was to investigate the potential of LINC01538 as a novel diagnostic biomarker for MI. Material and Methods: Quantitative real-time polymerase chain reaction (RT-qPCR) was used to assess the expression of the serum LINC01538 in 50 ST Elevation MI (STEMI) patients and 48 controls. Results: The study showed a significant increase in serum level expression of LINC01538 in MI patients compared to controls [12 (6.6- 21.8) vs. 0.07 (0.01-0.2), p<0.001]. LINC01538 expression level in MI group was positively correlated with creatine kinase MB and high sensitive cardiac troponin I (hs-cTnI) (r=0.39, p=0.006 and r=0.22, p=0.007, respectively). Hs-cTnI found to have diagnostic value for MI with an area under curve (AUC) 0.917 [95% confidence interval (CI): 0.855- 0.979, p<0.001] at an optimal cutoff point of 1.45 ng/L, 90% sensitivity and 91% specificity. However, LINC01538 showed the highest diagnostic value with an AUC 0.980 (95% CI: 0.942- 1, p<0.001) at an optimal cut-off point of 1.76, 100% sensitivity and 98% specificity. Conclusion: Our findings have, for the first time, demonstrated that circulating LINC01538 are highly expressed in patients with MI, functioning as potential novel biomarker for diagnosis.

Cost-utility analysis of evolocumab in patients with ASCVD in Italy

Objective: The aim of this work was to evaluate the cost-effectiveness of evolocumab in addition to standard statin therapy with or without ezetimibe in the treatment of patients with clinically evident atherosclerotic cardiovascular disease (ASCVD) with levels of LDL-C above 100 mg/dL. Method: A theoretical cohort of patients was forecast by a Markov model that includes 11 health states for a lifetime horizon. In the base-case, the standard therapy was characterized by statins with or without ezetimibe. Two sub-populations have been considered, Recent MI (Myocardial Infarction in the last year) and Multiple events (population with multiple MI). The results were also presented for a subset of the Multiple events populations consisting of patients who have experienced a myocardial infarction (MI) in the last year. Results: For the Recent MI and Multiple events populations, ICER values of € 39,547 and € 35,744 respectively were estimated. The value of ICER was lower for the Multiple events with MI &lt; 1 year population (€ 29,949). Considering statins with ezetimibe as standard therapy, ICER values were found to be equal to € 39,781, € 35,986 and € 30,190 respectively for the populations Recent MI, Multiple events and Multiple events with MI &lt; 1 year. Conclusions: The estimated ICER values for the Recent MI, Multiple events and Multiple events populations with MI &lt; 1 year were below the cost-effectiveness threshold of € 40,000, suggesting therefore how the treatment with evolocumab in addition to the standard therapy can be a cost-effective treatment both compared to standard therapy with statins and standard therapy with statins + ezetimibe.

Microcirculation of intramyocardial hemorrhage caused by reperfused myocardial infarctions with ultrasmall superparamagnetic iron oxide cardiac magnetic resonance imaging.

The actual role of the coronary microcirculation, which is massively injured by myocardial infarction (MI), in intramyocardial hemorrhage (IMH) pathophysiology is still not fully understood. To determine the change and distribution of microcirculation of myocardial edema (ME), IMH, MI, and the remote area of early reperfusion using 7.0-T cardiovascular magnetic resonance (CMR) in a rat model of acute MI. Eight rats with 60-min myocardial ischemia followed by reperfusion were investigated. On days 2 and 7, after the acquisition of T2*-mapping and T2-mapping images, late gadolinium enhancement imaging was performed to evaluate the extent of myocardial ischemia after an injection of Gd-DTPA. On days 3 and 8, after the injection of ultrasmall superparamagnetic iron oxide (USPIO), T2*- and T2-mapping images were acquired. The R2 values of ME, IMH, MI, and remote areas were measured. From days 2 to 3, R2 values increased in the IMH, MI, ME, and remote area (all P < 0.05) following administration of USPIO, while the delta R2 value of IMH and MI was larger than remote area (P < 0.05). From day 7 to day 8, there was no significant difference in the IMH, MI, ME, and remote area (all P > 0.05). Microvascular injury of IMH and MI is the most severe among all the studied myocardial injuries in the early reperfusion of MI, while microvascular density decreased during follow-up.

Outcomes of patients admitted with high-sensitive cardiac troponin T levels meeting the new rule out criteria for myocardial infarction

Abstract Background The 2020 ESC non-ST-elevation (NSTE) acute coronary syndromes (ACS) guidelines have adopted the paradigm that patients presenting with suspected NSTE-ACS and high-sensitive cardiac troponin T (hs-cTnT) values &amp;lt;99th percentile in a single test or small increment within 1/2 hours have a high negative predictive value for myocardial infarction (MI). Their management remains controversial. Purpose We examined the clinical outcomes and resource utilization of suspected NSTE-ACS patients who presented with hs-cTnT values meeting the early rule out criteria, but were nevertheless admitted. Methods Our single center retrospective cohort study included 4,263 visits for suspected NSTE-ACS triaged in the Emergency Room (ER), had hs-cTnT values that met the early rule-out criteria, and were admitted (Figure 1). Routine quality control and dedicated tests proved a coefficient of variance of &amp;lt;10% for hs-cTnT values &amp;lt;99th percentile (14 ng/L). Results There were no deaths in-hospital and at 30 days. Discharge diagnosis of MI was documented in 10 patients (∼0.2%). Median ER stay and hospital stay were 6 hours and 3 days, respectively. In hospital evaluation included 844 gated cardiac CT angiography (CTA), 580 SPECT heart scans, 101 ECG-exercise tests, and 178 coronary angiography, of which 70 (∼1.6% of cohort) culminated in percutaneous/surgical intervention. Conclusion Our findings highlight the high negative predictive value for MI applying the early rule out algorithm and supports a policy of ER discharge for further evaluation, sparing unnecessary and resource-consuming hospital admissions. Funding Acknowledgement Type of funding sources: None. Figure 1

Frequency and prognostic impact of periprocedural myocardial infarction determined by various MI definitions in patients with chronic coronary syndromes undergoing percutaneous coronary intervention

Abstract Background Several definitions of peri-procedural myocardial infarction (MI) requiring different biomarker thresholds with or without ancillary criteria for myocardial ischemia are currently recommended without being fully validated in real-world patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI). Objectives We aimed to evaluate the prevalence and prognostic value of high-sensitivity cardiac troponin-based peri-procedural MI according to contemporary MI definitions using a large real-world PCI cohort. Methods In CCS patients undergoing elective PCI enrolled to the Bern PCI registry (NCT02241291) between 2010 and 2018, peri-procedural myocardial injury and infarction were assessed according to the 4th and 3rd universal definition of MI (UDMI), academic research consortium (ARC)-2, and Society for Cardiovascular Angiography and Interventions (SCAI) criteria. The primary endpoint was cardiac death at 1 year. Results Among 4404 CCS patients, peri-procedural MI defined by the 4th UDMI, 3rd UDMI, ARC-2, and SCAI were observed in 14.9%, 18.0%, 2.0%, and 2.0% of patients, respectively. Cardiac mortality at 1 year in patients with peri-procedural MI defined by 4th UDMI, 3rd UDMI, ARC-2, and SCAI were 3.0%, 2.9%, 5.8%, and 10.0%, respectively. After multivariate adjustments, peri-procedural MI defined by the ARC-2 and SCAI were independently associated with cardiac death at 1 year, while those defined by the 4th and 3rd UDMI were not. Conclusion Among CCS patients undergoing PCI, periprocedural MIs defined by theARC-2 and SCAI occurred 7 to 9 times less frequently as compared with the 4th and 3rd UDMI, and were the only definitions significantly associated with cardiac mortality. Funding Acknowledgement Type of funding sources: None. Cardiac death at 1 year

Outcomes of patients admitted with limit of blank high-sensitive cardiac troponin T levels versus those with levels under the limit of detection

Abstract Background Patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) and high-sensitive cardiac troponin T (hs-cTnT) values below the level of detection (5 ng/L) in a single test have a high negative predictive value for myocardial infarction (MI). Purpose We compared the clinical outcomes and resource utilization of suspected NSTE-ACS patients who were admitted despite hs-cTnT values below the limit of detection (5 ng/L) versus those with values ≤ the limit of blank (3 ng/L). Methods This single center retrospective cohort analysis included 2,081 emergency room (ER) visits for suspected NSTE-ACS that manifested single hs-cTnT value &amp;lt;5 ng/L (limit of detection) - 624 with single hs-cTnT ≤3 ng/L (limit of blank) and 1,457 with single hs-cTnT values &amp;gt;3 ng/L and &amp;lt;5 ng/L, and yet were admitted (Figure 1). Routine quality control and dedicated tests proved a coefficient of variance of &amp;lt;10% for hs-cTnT values &amp;lt;99th percentile (14 ng/L). Results There were no in-hospital or 30-day deaths in both groups. Discharge diagnosis of MI was documented only in the 3–5 ng/L hs-cTnT group – 3 cases (∼0.2%). Median ER stay were 5 and 6 hours for ≤3 ng/L and 3–5 ng/L groups, respectively. Median hospital stay was 3 days for both groups. Coronary angiographies culminating in interventions were documented in 1 case (∼0.2%) and 24 cases (∼1.6%) for ≤3 ng/L and 3–5 ng/L groups, respectively. Conclusion Suspected NSTE-ACS patients with hs-cTnT values ≤ the limit of blank are at very low risk and may not need any further evaluation. Funding Acknowledgement Type of funding sources: None. Figure 1

Myocardial Infarction Detection and Localization with Electrocardiogram Based on Convolutional Neural Network

Electrocardiogram (ECG) is widely used in Myocardial infarction (MI) diagnosis. The automatic diagnosis of MI based on the 12-lead ECG needs to consider not only the waveform change features in multi-resolution time series, but also the spatial correlation information between the leads. To this end, this work proposed multiscale spatiotemporal feature extraction method based on Convolutional neural network (CNN) for MI automatic diagnosis. First, the 12-lead ECG is first transformed into an ECG image through wavelet decomposition and 3-dimensional space reconstruction. The MI-CNN model is then constructed to identify MI using 41368 ECG images. Finally, we develop the LL-CNN model, which is utilized only after the ECG signal is identified as an MI event by the MI-CNN model, to localize MI by employing transfer learning to overcome the limited data problem. The proposed method has achieved an accuracy of 99.51% on MI detection, and a macro-F1 of 99.14% on MI localization. Moreover, the features visualization shows that U-wave has significant diagnostic value for MI. The proposed method significantly improves the performance of MI detection and localization compared with other methods. It is promising to be used for MI monitoring and diagnosis.