Determinants of high sensitivity troponin T concentration in chronic stable patients with heart failure: Ischemic heart failure versus non-ischemic dilated cardiomyopathy

Background: Cardiac troponin T is a marker of myocardial injury, especially when measured by means of the high-sensitivity assay (hs-cTnT). The echocardiographic and clinical predictors of hs-cTnT may be different in ischemic heart failure (IHF) and non-ischemic dilated cardiomyopathy (DCM).Methods: Sixty consecutive patients (19 female, 41 male; mean age 56.3 ± 13.9 years) with stable congestive heart failure (33 patient with IHF and 27 patients with DCM), with New York Heart Association functional class I–II symptoms, and left ventricular ejection fraction < 40% were included.Results: In patients with IHF peak early mitral inflow velocity (E), E/peak early diastolic mitral annular tissue Doppler velocity (Em) lateral, peak systolic mitral annular tissue Doppler velocity (Sm) lateral and logBNP were univariate predictors of hs-cTnT above median. But only E/Em lateral was an independent predictor of hs-cTnT above median (p = 0.04, HR: 1.2,CI: 1–1.4). In patients with DCM; left atrial volume index, male sex, Sm lateral and global longitudinal strain (LV-GLS) were included in multivariate model and LV-GLS was detected to be an independent predictor for hs-cTnT above median (p < 0.05, HR: 0.7, CI: 0.4–1.0).Conclusions: While LV-GLS is an independent predictor of hs-cTnT concentrations in patients with DCM, E/Em lateral predicted hs-TnT concentrations in patients with IHF

Adding lipoprotein(a) levels to the GRACE score to predict prognosis in patients with non-ST elevation acute coronary syndrome

WOS: 000322659700006PubMed ID: 23907902Background: High levels of lipoprotein(a) [Lp(a)] are known to be a cardiovascular risk factor associated with premature coronary artery disease. In predicting the long term prognosis in acute coronary syndromes (ACS), the relationship between Lp(a) and risk scoring systems remains unclear. Aim: We investigated whether adding Lp(a) to the GRACE scoring system has an incremental value in predicting prognosis in ACS. Methods: 115 patients (mean age 64 +/- 11 years) with non-ST elevation acute coronary syndromes (NSTE-ACS) were enrolled in this prospective study. Patients were categorised into quartiles according to the Lp(a) levels. Statistically significant variables in the univariate analysis (haemoglobin, creatinine, age, left ventricular ejection fraction, previous myocardial infarction (MI) history, Killip class) were included in the multivariate analysis to determine the independent predictors of cardiovascular outcomes (mortality, rehospitalisation) with and without Lp(a) quartiles for one year follow-up. Results: Previous MI history and Lp(a) quartile were detected as independent predictors of combined cardiovascular events (OR: 2.969 [95% CI 1.413-6.240] and OR: 6.279 [95% CI 1.363-28.927] respectively). Lp(a) quartile also remained as an independent predictor for prognosis when added to a model based on GRACE risk score (OR: 2.589 [95% CI 1.402-4.780]). Serum Lp(a) levels were moderately correlated with GRACE risk score (r = 0.371; p < 0.001). Conclusions: Lipoprotein(a) has an additional prognostic value over GRACE risk score in predicting one-year adverse outcomes in NSTE-ACS. The combination of serum Lp(a) with GRACE risk score could provide enhanced risk stratification in patients with ACS

Dołączenie stężenia lipoproteiny (a) do skali GRACE w określaniu rokowania u chorych z ostrym zespołem wieńcowym bez uniesienia odcinka ST

Background: High levels of lipoprotein(a) [Lp(a)] are known to be a cardiovascular risk factor associated with prematurecoronary artery disease. In predicting the long term prognosis in acute coronary syndromes (ACS), the relationship betweenLp(a) and risk scoring systems remains unclear.Aim: We investigated whether adding Lp(a) to the GRACE scoring system has an incremental value in predicting prognosis in ACS.Methods: 115 patients (mean age 64 ± 11 years) with non-ST elevation acute coronary syndromes (NSTE-ACS) were enrolledin this prospective study. Patients were categorised into quartiles according to the Lp(a) levels. Statistically significant variablesin the univariate analysis (haemoglobin, creatinine, age, left ventricular ejection fraction, previous myocardial infarction (MI)history, Killip class) were included in the multivariate analysis to determine the independent predictors of cardiovascularoutcomes (mortality, rehospitalisation) with and without Lp(a) quartiles for one year follow-up.Results: Previous MI history and Lp(a) quartile were detected as independent predictors of combined cardiovascular events(OR: 2.969 [95% CI 1.413–6.240] and OR: 6.279 [95% Cl 1.363–28.927] respectively). Lp(a) quartile also remained as anindependent predictor for prognosis when added to a model based on GRACE risk score (OR: 2.589 [95% CI 1.402–4.780]).Serum Lp(a) levels were moderately correlated with GRACE risk score (r = 0.371; p &lt; 0.001).Conclusions: Lipoprotein(a) has an additional prognostic value over GRACE risk score in predicting one-year adverse outcomes inNSTE-ACS. The combination of serum Lp(a) with GRACE risk score could provide enhanced risk stratification in patients with ACS.Wstęp: Wysokie stężenia lipoproteiny (a) [Lp(a)] uważa się za czynnik ryzyka sercowo-naczyniowego związany z przedwczesnymrozwojem choroby wieńcowej. Nie są znane zależności między stężeniem Lp(a) i systemami oceny ryzyka ani ich wpływna rokowanie długoterminowe u chorych z ostrymi zespołami wieńcowymi (OZW).Cel: Celem badania było ustalenie, czy dołączenie stężenia Lp(a) do skali GRACE powoduje zwiększenie wartości prognostycznejoceny ryzyka w OZW.Metody: Do tego prospektywnego badania włączono 115 chorych (średnia wieku 64 ± 11 lat) z OZW bez uniesienia odcinkaST (NSTE-ACS). Chorych podzielono w zależności od kwartylu stężenia Lp(a). Statystycznie istotne zmienne w analizie wieloczynnikowej[hemoglobina, kreatynina, wiek, frakcja wyrzutowa lewej komory, przebyty zawał serca (MI), klasa wg Killipa]włączono do modelu analizy wieloczynnikowej, aby określić niezależne czynniki prognostyczne zdarzeń sercowo-naczyniowych(zgon, ponowna hospitalizacja) z uwzględnieniem lub pominięciem kwartyli stężenia Lp(a) w rocznej obserwacji.Wyniki: Stwierdzono, że przebyty MI i kwartyl stężenia Lp(a) były niezależnymi czynnikami prognostycznymi zdarzeń sercowo--naczyniowych (odpowiednio OR: 2,969; 95% CI 1,413–6,240 i OR: 6,279; 95% CI 1,363–28,927). Kwartyl stężenia Lp(a)pozostał niezależnym czynnikiem predykcyjnym również po dołączeniu tego parametru do skali ryzyka GRACE (OR: 2,589;95% CI 1,402–4,780). Wykazano umiarkowanie silną korelację między stężeniami Lp(a) w surowicy i punktacją w skali ryzykaGRACE (r = 0,371; p &lt; 0,001).Wnioski: Uwzględnienie stężenia Lp(a) w rokowaniu dotyczącym rocznego ryzyka niepożądanych zdarzeń sercowo-naczyniowychu chorych z NSTE-ACS powoduje zwiększenie wartości prognostycznej w porównaniu z oceną opartą wyłącznie naskali ryzyka GRACE. Połączenie stężenia Lp(a) w surowicy i punktacji w skali GRACE umożliwia lepszą stratyfikację ryzykaw tej grupie chorych

ST yükselmesiz akut koroner sendrom hastalarında TIMI risk skoru ile hemoglobin değeri arasındaki ilişkinin değerlendirilmesi

Introduction: The relationship between hemoglobin (Hb) levels at admission and the thrombolysis in myocardial infarction (TIMI) risk score in patients with non-ST elevation acute coronary syndrome (NSTEACS) was investigated. Patients and Methods: In total, 286 NSTE-ACS patients were included in the study. Hb levels and biochemical parameters were measured at admission. The patients were grouped into the following three groups according to the TIMI risk score: low-intermediate-, and high-risk groups. Results: Hb levels (in g/dL) at admission in low-, intermediate-, and high-risk groups were 13.5 &plusmn; 1.9, 12.5 &plusmn; 1.9, and 11.3 &plusmn; 1.9, respectively (p &lt; 0.001). We found a negative moderate correlation between Hb levels and TIMI risk scores (r= -0.408, p &lt; 0.001). In univariate regression analysis, it was found that with the increase in the TIMI risk score, Hb levels at admission were signifi cantly reduced (estimate= -0.406; p&lt; 0.001; 95% confi dence interval; -0.521 to -0.290). Conclusion: We found that as the TIMI risk score of patients admitted to hospital presenting with NSTEACS increased, their Hb levels at admission correspondingly decreased. Thus, the simple and commonly measured Hb level can be a useful parameter in stratifying the risks of patients presenting with NSTE-ACS during admission.Giriş: ST yükselmesiz akut koroner sendrom hastalarının geliş hemoglobin seviyesi ile TIMI risk skoru arasındaki ilişki araştırıldı.Hastalar ve Yöntem: ST yükselmesiz akut koroner sendromlu 286 hasta çalışmaya dahil edildi. Tüm hastaların geliş anında hemoglobin ve biyokimyasal parametreleri çalışıldı. Hastalar TIMI risk skoruna göre düşük, orta ve yüksek risk olarak 3 gruba ayrıldı.Bulgular: Geliş hemoglobin seviyesi (g/dL) düşük, orta ve yüksek TIMI risk grubunda sırasıyla (13.5 ± 1.9, 12.5 ± 1.9, 11.3 ± 1.9, p< 0.001) olarak saptandı. Hemoglobin seviyesi ve TIMI risk skoru arasında orta düzeyde negatif korelasyon bulundu (r: -0.408, p< 0.001). Tek değişkenli regresyon analizinde TIMI risk skoru artışı ile geliş hemoglobin seviyelerinin önemli derecede düşük olduğu saptandı (Estimate; -0.406, p< 0.001, %95 GA[-0.521-(-0.290)].Sonuç: ST yükselmesiz akut koroner sendrom ile hastaneye yatırılan hastaların risk skoru attıkça geliş hemoglobin seviyelerinin bağlantılı olarak düşük olduğu tespit edildi. Basit ve yaygın bir test olarak kullanılan hemoglobin seviyesi, ST yükselmesiz akut koroner sendrom hastalarının geliş anındaki risk durumunu belirlemede kullanılabilir