B-type natriuretic peptide levels - A new biomarker in the acute coronary syndrome

Currently, B-type natriuretic peptide (BNP) and N-terminal B-type natriuretic peptide (NT-pro BNP) are recommended as diagnostic and risk stratification tools in relation to heart failure (1). The main stimulus for their secretion is myocardial wall stress in response to myocyte stretch. It is assumed that the elevated BNP levels indicate the degree of the ischemia - induced left ventricular dysfunction in relation to the pathological left ventricle strain and overload in patients with ACSs (2)..

Interleukin response in cardiovascular diseases: an overview

Interleukins are important modulators of the immune response in the human body, which inevitably makes them participants in the intimate mechanisms of various diseases. Cardiovascular morbidity and mortality is high in the world as a whole, despite the ongoing primary and secondary prevention. Therefore their pathogenetic mechanisms are of significant research and clinical interest. A number of studies demonstrated changes in the interleukin status of patients with coronary heart disease, heart failure, some cardiomyopathies and rhythm conduction disorders. Significantly altered levels of basic for the immunity pro-inflammatory and anti-inflammatory cytokines were found. It was even proven, that some of them have predictive value for the manifestation of certain diseases. All this is a reason to allow interleukins to take part in the intimate mechanisms of cardiovascular diseases and consider the place of interleukin blockers in the treatment of these diseases

Decreased Activity of the Protein C Anticoagulant Pathway in the Early Hours of Paroxysmal Atrial Fibrillation

Background: Increased coagulation activity has been established in paroxysmal atrial fibrillation (PAF), but data on the anticoagulant system are scarce. Purpose: To examine the protein C anticoagulant pathway in the early hours of the disease. Materials and Methods: Fifty-one patients (26 men and 25 women; mean age 59.84 ± 1.60 years) and 52 controls (26 men and 26 women; mean age 59.50 ± 1.46 years) were selected for the study. Protein C antigen and its activity, total protein S, free protein S and its activity, soluble forms of endothelial protein C receptor (sEPCR), and thrombomodulin (sTM) were examined in the plasma. Results: The indicators were studied in patients between the 2nd and the 24th hour after the onset of arrhythmia. Levels of protein C were significantly elevated in patients compared to controls (111.40% ± 6.66% vs 94.83% ± 4.47%; P = .039). Protein C activity showed significant reduction in PAF (73.13% ± 5.80% vs 103.3% ± 3.80%; P &lt; .001). Total protein S levels did not differ significantly (108.20% ± 4.07% vs 102.40% ± 3.65%; P = .30). Free protein S (76.81% ± 6.01% vs 122.10% ± 3.97%; P &lt; .001) and its activity (71.39% ± 6.27% vs 119.50% ± 6.54%; P &lt; .001) were reduced in patients. Higher levels of sEPCR (203.10 ± 10.33 vs 133.10 ± 7.37 ng/mL; P &lt; .001) and sTM (6.50±0.40 vs 4.48±0.28 ng/mL; P &lt; .001) were measured in PAF. Conclusion: Protein C activity is reduced still in the first hours (until the 24th hour) of PAF clinical manifestation, determining reduced activity of the anticoagulant pathway as a whole. The established low levels of free protein S and its activity as well as low sEPCR and sTM levels are a possible explanation of the changes in protein C activity. </jats:sec

Paroxysmal atrial fibrillation: changes in factor VIII and von Willebrand factor impose early hypercoagulability

IntroductionParoxysmal atrial fibrillation (PAF) is a well-documented prothrombotic state that carries significant embolic risk. However, precise hemostatic changes in the very early stage of the disease are not completely studied. The aim of the study was to study von Willebrand factor (vWF) and coagulation factor VIII (FVIII) plasma levels and activity in the first hours (up to 24 h) of PAF clinical manifestation.Material and methodsWe selected consecutively 51 non-anticoagulated patients (26 men, 25 women, mean age: 59.84 ±1.60) with PAF and 52 controls (26 men, 26 women, mean age: 59.50 ±1.46 years) corresponding in gender, accompanying diseases and conducted treatment. The indicators were examined using enzyme-linked immunoassays and photometric tests.ResultsAll patients were hospitalized between the 2nd and 24th h after the onset of arrhythmia (mean: 8.14 ±0.74 h). Higher FVIII levels (107.52 ±3.48% vs. 93.85 ±2.93%, p &lt; 0.05) and activity (200.03 ±11.11% vs. 109.73 ±4.90%, p &lt; 0.001) were found in the PAF group. vWF levels (178.40 ±12.95% vs. 119.53 ±6.12%, p &lt; 0.001) and activity (200.92 ±12.45% vs. 110.80 ±5.14%, p &lt; 0.001) were also higher. These changes did not depend on age, sex, body mass index or CHA2DS2-VASc score in the PAF group (p &gt; 0.05). PAF duration was a significant predictor of increased FVIII levels and activity. Increased PAF duration was followed by increased values of the factors (r = 0.85, p &lt; 0.001; r = 0.83, p &lt; 0.001).ConclusionsThe results presented an activated coagulation cascade and endothelial injury, suggesting hypercoagulability still in the early hours of PAF. These changes in PAF did not correlate with CHA2DS2-VASc score risk factors, outlining PAF as a possible independent embolic risk factor.</jats:sec

Diagnostic Values of Some Fibrinolytic Indicators for Rejecting the Presence of Paroxysmal Atrial Fibrillation

Diagnostic tests are a cornerstone in modern medicine. They are used not only to confirm the presence of a disease but also to rule out the disease in healthy subjects. Tests with two outcome categories (i.e. presence/absence) are known as dichotomous tests. Their inherent validity is determined by sensitivity and specificity and the receiver operating characteristic (ROC) curve is known to be a simple, yet complete plot that displays the full picture of trade-off between the sensitivity (true positive rate) and (1- specificity) (false positive rate) across a series of cut-off points. Our study found that, even in the early hours of paroxysmal atrial fibrillation, there were significant changes in major indicators of fibrinolysis, namely plasminogen level, t-PA level, PAI-1 activity, α2-antiplasmin activity, vitronectin and D-dimer plasma levels. We believe that they are closely related and stem from the disease itself. This gave us reason, using these indicators as predictors, to search for a diagnostic option to rule out PAF. We used statistical models of logistic regression analysis and ROC to achieve this. Values of p&lt;0.05 were considered statistically significant. Plasma levels of vitronectin have been found to be the most reliable predictor for ruling out PAF (specificity 88%, sensitivity 83%, AUC 0.96), while D-dimer levels had the lowest diagnostic values (37% specificity, 81% sensitivity, AUC 0.56). The obtained results are not only of pure scientific but also of applied nature. They could be used to improve identification of patients at risk for PAF embolism, and assist in the choice of thromboprophylaxis.</jats:p