26 research outputs found
Exercise-Induced Cardiac Troponin Elevations: From Underlying Mechanisms to Clinical Relevance.
Serological assessment of cardiac troponins (cTn) is the gold standard to assess myocardial injury in clinical practice. A greater magnitude of acutely or chronically elevated cTn concentrations is associated with lower event-free survival in patients and the general population. Exercise training is known to improve cardiovascular function and promote longevity, but exercise can produce an acute rise in cTn concentrations, which may exceed the upper reference limit in a substantial number of individuals. Whether exercise-induced cTn elevations are attributable to a physiological or pathological response and if they are clinically relevant has been debated for decades. Thus far, exercise-induced cTn elevations have been viewed as the only benign form of cTn elevations. However, recent studies report intriguing findings that shed new light on the underlying mechanisms and clinical relevance of exercise-induced cTn elevations. We will review the biochemical characteristics of cTn assays, key factors determining the magnitude of postexercise cTn concentrations, the release kinetics, underlying mechanisms causing and contributing to exercise-induced cTn release, and the clinical relevance of exercise-induced cTn elevations. We will also explain the association with cardiac function, correlates with (subclinical) cardiovascular diseases and exercise-induced cTn elevations predictive value for future cardiovascular events. Last, we will provide recommendations for interpretation of these findings and provide direction for future research in this field
Usefulness of C-reactive protein as a marker of early post-infarct left ventricular systolic dysfunction
Objective To assess the usefulness of in-hospital measurement
of C-reactive protein (CRP) concentration in
comparison to well-established risk factors as a marker of
post-infarct left ventricular systolic dysfunction (LVSD) at
discharge.
Materials and methods Two hundred and four consecutive
patients with ST-segment-elevation myocardial
infarction (STEMI) were prospectively enrolled into the
study. CRP plasma concentrations were measured before
reperfusion, 24 h after admission and at discharge with an
ultra-sensitive latex immunoassay.
Results CRP concentration increased significantly during
the first 24 h of hospitalization (2.4 ± 1.9 vs. 15.7 ± 17.0
mg/L; p\0.001) and persisted elevated at discharge
(14.7 ± 14.7 mg/L), mainly in 57 patients with LVSD
(2.4 ± 1.8 vs. 25.0 ± 23.4 mg/L; p\0.001; CRP at discharge
21.9 ± 18.6 mg/L). The prevalence of LVSD was
significantly increased across increasing tertiles of CRP
concentration both at 24 h after admission (13.2 vs. 19.1
vs. 51.5 %; p\0.0001) and at discharge (14.7 vs. 23.5 vs.
45.6 %; p\0.0001). Multivariate analysis demonstrated
CRP concentration at discharge to be an independent
marker of early LVSD (odds ratio of 1.38 for a 10 mg/L
increase, 95 % confidence interval 1.01–1.87; p\0.04).
Conclusion Measurement of CRP plasma concentration
at discharge may be useful as a marker of early LVSD in
patients after a first STEMI
The North Sea Bicycle Race ECG project : time-domain analysis
Analysis of electrocardiogram and heart rate provides
useful information about health condition of a patient.
The North Sea Bicycle Race is an annual cycling competition
in Norway. Examination of ECG recordings collected
from participants of this race may allow defining and
evaluating the relationship between physical endurance
exercises and heart electrophysiology. Parameters reflecting
potentially alarming deviations are to be identified in
this study. This paper presents results of a time-domain
analysis of ECG data collected in 2014, implementing
K-Means clustering. A double stage analysis strategy,
aimed at producing hierarchical clusters, is proposed. The
first phase allows rough separation of data. Second stage
is applied to reveal internal structure of the majority
clusters. In both steps, discrepancies driving the separation
could stem from three sources. Firstly, they could be
signs of abnormalities in electrical activity of the heart.
Secondly, they may allow discriminating between natural
groups of participants – according to sex, age, physical
fitness. Finally, some deviations could result from faults
in data extraction, therefore serving in evaluation of the
parameters. The clusters were defined predominantly by
combinations of features: heartbeat signals correlation,
P-wave shape, and RR intervals; none of the features
alone was discriminative for all the clusters
Increased Systemic and Local Interleukin 9 Levels in Patients with Carotid and Coronary Atherosclerosis
Objective: Atherosclerosis is a chronic inflammatory disorder that involves a range of inflammatory mediators. Although
interleukin (IL)-9 has been related to inflammation, there are at present no data on its role in atherosclerosis. Here we have
examined IL-9 and IL-9 receptor (IL-9R) systemically and locally in patients with coronary and carotid atherosclerosis.
Methods: Plasma IL-9 was quantified by enzyme immunoassay and multiplex technology. IL-9 and IL-9R mRNA were
quantified by real-time RT-PCR, and their localization within the lesion was assessed by immunohistochemistry.
Results: The main findings were: (i) Patients with carotid atherosclerosis had significantly raised IL-9 plasma levels compared
with healthy controls (n = 28), with no differences between asymptomatic (n = 56) and symptomatic (n = 88) patients. (ii) On
admission, patients with acute ST-elevation myocardial infarction (STEMI) (n = 42) had markedly raised IL-9 plasma levels
which gradually declined during the first week post-MI. (iii) T cells and monocytes from patients with unstable angina
(n = 17) had increased mRNA levels of IL-9 as compared with controls (n = 11). (iv) Carotid plaques (n = 68) showed increased
mRNA levels of IL-9 and IL-9R compared to non-atherosclerotic vessels (n = 10). Co-localization to T cells (IL-9 and IL-9R) and
macrophages (IL-9) were shown by immunohistochemistry. (v) IL-9 increased IL-17 release in peripheral blood mononuclear
cells from patients with unstable angina (n = 5) and healthy controls (n = 5) with a particularly enhancing effect in cells from
the patient group.
Conclusion: Our findings show increased IL-9 levels in different atherosclerotic disorders both systemically and within the
lesion, suggesting a role for the IL-9/IL-9R axis in the atherosclerotic process, potentially involving IL-17 mediated
mechanisms. However, the functional consequences of these findings should be further investigated
Complete Versus culprit-Lesion only PRimary PCI Trial (CVLPRIT):a multicentre trial testing management strategies when multivessel disease is detected at the time of primary PCI: rationale and design
Primary percutaneous coronary intervention (PPCI) is the preferred strategy for acute ST-segment elevation myocardial infarction (STEMI), with evidence of improved clinical outcomes compared to fibrinolytic therapy. However, there is no consensus on how best to manage multivessel coronary disease detected at the time of PPCI, with little robust data on best management of angiographically significant stenoses detected in non-infarct-related (N-IRA) coronary arteries. CVLPRIT will determine the optimal management of N-IRA lesions detected during PPCI