Stężenie wysokoczułej troponiny T u chorych hospitalizowanych z powodu zaostrzenia niewydolności serca

Introduction: The most common cause of heart failure is a history of myocardial infarction, and coronary heart disease is one of the most frequent causes of heart failure, which in its natural history often leads to decompensation of the circulatory system. Particular diagnostic difficulties occur in patients with diabetes, where dyspnoea may be both a symptom of exacerbation of heart failure symptoms and an equivalent of angina pectoris. Thus, any clinically relevant marker identifying patients with heart failure is important in conducting effective differential diagnosis. The aim of the study was to evaluate the association of Tn concentration with other clinical and laboratory indicators in the group of patients hospitalized due to exacerbation of heart failure. Material and methods: This study enrolled patients of both sexes, aged >18 years, who were admitted to the Department of Cardiology and Internal Diseases due to decompensated heart failure. Clinical examinations were conducted with a particular emphasis on the history of symptoms, concomitant diseases, also biochemical parameters were determined, including hsTnT and NTproBNP. During the hospitalization, echocardiography was also performed. Results: In the study group the mean value of hsTnT concentration was 106.9 ng / l. In the laboratory assessment, patients with higher hsTnT values were characterized by worse renal function, more frequent occurrence of anemia and a significantly elevated NT-proBNP concentration. Patients with higher hsTnT values presented lower LVEF and had greater volum overload assessed by impedance cardiography. Conclusions: The occurrence of elevated values of high-sensitivity troponin T in patients with exacerbation of heart failure is associated with lower LVEF, worse renal function, anemia, elevated NT-proBNP level and greater congestion. The indicated circumstances should be taken into account during the clinical interpretation of the origin of elevated concentrations of markers of myocardial necrosis in this group of patients.Wstęp: Najczęstszą przyczyną niewydolności serca jest choroba niedokrwienna serca i jej konsekwencje, w tym zawał. W tej grupie duszność może być zarówno objawem zaostrzenia objawów niewydolności serca, jak i ekwiwalentem dolegliwości dławicowych. Zatem każdy miarodajny klinicznie marker identyfikujący pacjentów z niewydolnością serca ma znaczenie w diagnostyce różnicowej. Celem pracy była ocena powiązania stężenia troponiny hsTnT (high sensitive troponin T) z innymi wskaźnikami klinicznymi i laboratoryjnymi w grupie chorych hospitalizowanych z powodu zaostrzenia niewydolności serca. Materiał i metody: Przeanalizowano 102 chorych powyżej 18 roku życia, hospitalizowanych z powodu zaostrzenia objawów niewydolności serca. W badanej grupie zebrano szczegółowy wywiad dotyczący chorób współistniejących, dokonano oceny klinicznej oraz oznaczono parametry biochemiczne w tym hsTnT oraz NTproBNP (N-terminal pro-brain natriuretic peptide). W trakcie hospitalizacji wykonano także badanie echokardiograficzne. Wyniki: W badanej grupie średnia wartość stężenia hsTnT wyniosła 106,9 ng/l. Pacjenci z wyższymi wartościami hsTnT charakteryzowali się gorszą funkcją nerek, częstszym występowaniem niedokrwistości oraz znacznie podwyższonym stężeniem NT-proBNP. Pacjenci z wyższymi wartościami hsTnT prezentowali niższą frakcję wyrzutową lewej komory (LVEF, left ventricular ejection fraction) oraz charakteryzowali się większym zastojem ocenianym metodą kardiografii impedancyjnej. Wnioski: Występowanie podwyższonych wartości wysokoczułej troponiny T u pacjentów z zaostrzeniem niewydolności serca wykazuje związek z niższą LVEF, gorszą funkcją nerek, niedokrwistością, podwyższonym poziomem NT-proBNP oraz nasileniem przewodnienia w obrębie klatki piersiowej. Wskazane okoliczności należy brać pod uwagę podczas klinicznej interpretacji pochodzenia podwyższonych stężeń markerów martwicy mięśnia sercowego w przedmiotowej grupie chorych

Clinical presentations and hemodynamic parameters in patients hospitalized due to acute heart failure stratified by the left-ventricular ejection fraction

Background: Currently, one of the most common causes of hospitalization, especially in the elderly,is heart failure (HF) exacerbation. In nearly 95% of patients, this is caused by fluid overload. Therehave been studies comparing the rates of comorbidities and biochemical disturbances in HF patients;however, their hemodynamic parameters have not yet been assessed. Thus, the aim of this studywas to compare the clinical presentations and hemodynamic parameters assessed via impedancecardiography (ICG) in patients hospitalized due to acute HF, stratified by the left-ventricular ejectionfraction (LVEF). Methods: This study enrolled 102 patients, aged > 18 years, hospitalized due to decompensated HF.Ninety-seven patients (74 men, 23 women) underwent echocardiographic examination. Biochemicaland hemodynamic parameters were assessed on the day of admission and, subsequently, everyother day during hospitalization. Based on echocardiographic findings and the ESC guidelines thestudy group was divided into the following subgroups: HFrEF (EF < 40%), HFpEF (EF > 50%), andHFmrEF (EF 40–49%). Results: The HFrEF group, which constituted 60.8% of patients (n = 58), was predominantly male (P =0.0005); and most had elevated N-terminal pro-brain natriuretic peptide levels (P = 0.0008). The HFpEF andHFmrEF subgroups, jointly (n = 38), were characterized by higher systolic blood pressure (P = 0.0001),and lower hemoglobin levels (P = 0.003). The hemodynamic assessment showed that HFrEF patientshad higher total fluid content (P = 0.005) and lower systolic time ratio (P = 0.0002). Conclusions: Despite similar clinical presentation, patients with HF exhibited different values of hemodynamicand biochemical parameters depending on their LVEF; this indicates non-homogeneity of pathomechanismsand causes of HF decompensation

Heart failure patients with a previous coronary revascularisation: results from the ESC-HF registry

Background: Coronary revascularization is common in heart failure (HF). Aims: Clinical characteristic and assessment of in-hospital and long-term outcomes in patients hospitalized for HF with or without a previous percutaneous coronary intervention (PCI) or a coronary artery bypass grafting (CABG). Methods: The primary endpoint (PE) (all-cause death) and the secondary endpoint (SE) (all-cause death or hospitalization for HF-worsening) were assessed at one-year in 649 inpatients of the ESC-HF Pilot Survey. Additionally, occurrence of death during index hospitalization was evaluated. Results: PCI/CABG-patients (32.7%) were more frequently male, smokers, had myocardial infarction, hypertension (HT), peripheral artery disease and diabetes. The non-PCI/CABG-patients more often had a cardiogenic shock and died in-hospital. The PE occurred in 33 of the 212 PCI/CABG-patients (15.6%) and in 56 of the 437 non-PCI/CABG-patients (12.8%; P=0.3). The SE occurred in 82 of the 170 PCI/CABG-patients (48.2%) and in 122 of the 346 non-PCI/CABG-patients (35.3%; P=0.01). Independent predictors of the PE in the PCI/CABG-patients were: lower left ventricular ejection fraction, use of antiplatelets; in the non-PCI/CABG-patients were: age, ACS at admission. Independent predictors of the SE in the PCI/CABG-patients were: diabetes, NYHA (New York Heart Association) class at admission, HT; in the non-PCI/CABG-patients were: NYHA class, haemoglobin at admission. Serum sodium concentration at admission was a predictor of the PE and the SE in both groups. Heart rate at discharge was a predictor of the PE and the SE in the non-PCI/CABG patients. Conclusions: The revascularized HF patients had a similar mortality and higher risk of death or hospitalizations at 12 months compared with the non-PCI/CABG-patients. The revascularized patients had more comorbidities, while the non-PCI/CABG-patients had a higher incidence of cardiogenic shock and in-hospital mortality.Background: Coronary revascularisation is common in heart failure (HF). Aim: Clinical characteristic and assessment of in-hospital and long-term outcomes in patients hospitalised for HF with or without a previous percutaneous coronary intervention (PCI) or a coronary artery bypass grafting (CABG). Methods: The primary endpoint (PE) (all-cause death) and the secondary endpoint (SE) (all-cause death or hospitalisation for HF-worsening) were assessed at one year in 649 inpatients of the ESC-HF Pilot Survey. Additionally, occurrence of death during index hospitalisation was evaluated. Results: PCI/CABG-patients (32.7%) were more frequently male, smokers, and had myocardial infarction, hypertension, pe¬ripheral artery disease, and diabetes. The non-PCI/CABG-patients more often had cardiogenic shock and died in-hospital. The PE occurred in 33 of the 212 PCI/CABG-patients (15.6%) and in 56 of the 437 non-PCI/CABG-patients (12.8%; p = 0.3). The SE occurred in 82 of the 170 PCI/CABG-patients (48.2%) and in 122 of the 346 non-PCI/CABG-patients (35.3%; p = 0.01). Independent predictors of the PE in the PCI/CABG-patients were: lower left ventricular ejection fraction and use of anti¬platelets; in the non-PCI/CABG-patients were: age and acute coronary syndrome at admission. Independent predictors of SE in the PCI/CABG-patients were: diabetes, New York Heart Association (NYHA) class at admission, and hypertension; in the non-PCI/CABG-patients they were: NYHA class and haemoglobin at admission. Serum sodium concentration at admission was a predictor of PE and SE in both groups. Heart rate at discharge was a predictor of PE and SE in the non-PCI/CABG patients. Conclusions: The revascularised HF patients had a similar mortality and higher risk of death or hospitalisation at 12 months compared with the non-PCI/CABG-patients. The revascularised patients had more comorbidities, while the non-PCI/CABG-patients had a higher incidence of cardiogenic shock and in-hospital mortality

Artykuł oryginalnyDostępność automatycznych zewnętrznych defibrylatorów na terenie miasta Warszawy – stan na maj 2009 roku

Background: The most frequent cause of sudden cardiac arrest (SCA) is ventricular fibrillation and ventricular tachycardia. Despite many efforts the prognosis in this patient group is poor. According to the European Resuscitation Council (ERC) recommendations, early defibrillation, preferably in the first 3-5 min, is a key link in the Chain of Survival after SCA. With an increasing number of available automated external defibrillators (AED) time from SCA to defibrillation may be reduced, thus resulting in the improvement of patients’ prognosis. Therefore, the ERC recommends providing AED in public locations with a high incidence of cardiac arrests. Aim: Estimation of the availability of AED in the city of Warsaw. Methods: Automated external defibrillators were identified according to the information from the City Hall, public services, foundations, companies and own research and knowledge. The AED presence was confirmed by phone at the potential locations and random locations were visited. Results: By 15 May 2009, 117 AED had been reported in 83 points in the city of Warsaw. The number of AED was the highest in the Śródmieście (29) and Włochy (28) districts. On average, there was one AED per 14 706 citizens (0.68 per 10 000 citizens) and per 4.24 km2 (2.26 per 10 km2). The highest ratio of the number of AED per 10 000 citizens was observed in the Włochy (7.06) and Śródmieście (2.25) districts, the lowest – in the Targówek (0.16), Wawer (0.15) and Bemowo (0.09) districts. The highest ratio of the number of AED per 10 km2 were in the Śródmieście (18.63), Włochy (9.78) and Żoliborz (5.9) districts, the lowest – in the Wilanów (0.27) and Wawer (0.13) districts. Conclusions: The number of AED in the city of Warsaw should be increased, additional demonstrations of AED proper usage and AED promotion should be organised. It is necessary to provide easy access to the devices. Significant differences in the number of AED can be observed between the districts. Neither authorities nor public services are aware of the number of AED in the city of Warsaw.Wstęp: Najczęstszą przyczyną nagłego zatrzymania krążenia (ang. sudden cardiac arrest, SCA) jest migotanie komór lub częstoskurcz komorowy. Mimo wielu starań rokowanie w grupie chorych z pozaszpitalnym SCA pozostaje bardzo złe. Zgodnie z rekomendacjami Europejskiej Rady Resuscytacji (European Resuscitation Council, ERC), elementem skutecznego postępowania jest szybka defibrylacja, najlepiej w ciągu pierwszych 3–5 min. Dzięki rozpowszechnieniu automatycznych zewnętrznych defibrylatorów (ang. automated external defibrillator, AED) czas od SCA do defibrylacji może ulec skróceniu, co może skutkować poprawą rokowania w tej grupie chorych. Na tej podstawie ERC zaleca rozmieszczanie AED w szeroko dostępnych miejscach publicznych. Cel: Ocena dostępności AED na terenie Warszawy. Metody: Poszukiwaniami AED objęto szeroko dostępne miejsca publiczne, m.in. budynki użyteczności publicznej. Urządzenia lokalizowano na podstawie informacji uzyskanych z Urzędu Miasta, od służb publicznych, fundacji i firm prywatnych, na podstawie własnych poszukiwań i wiedzy. Informacje potwierdzano telefonicznie w ustalonym miejscu lokalizacji AED, a w losowo wybranych lokalizacjach weryfikowano dostępność urządzenia naocznie. Wyniki: Na terenie miasta do dnia 15 maja 2009 r. zlokalizowano 117 urządzeń typu AED w 83 punktach. Najwięcej urządzeń znajdowało się na terenie dzielnic Śródmieście (29 urządzeń) i Włochy (28). Średnio jedno urządzenie przypadało na 14 706 mieszkańców Warszawy (0,68/10 000 mieszkańców) i 4,24 km2 (2,26/10 km2). Najwięcej AED na 10 tys. mieszkańców przypadało w dzielnicach: Włochy (7,06) i Śródmieście (2,25), najmniej – Targówek (0,16), Wawer (0,15) i Bemowo (0,09). Najwięcej AED na 10 km2 znajdowało się w dzielnicach Śródmieście (18,63), Włochy (9,78) i Żoliborz (5,9), najmniej – Wilanów (0,27) i Wawer (0,13). Wnioski: Należy dążyć do dalszego zwiększania liczby AED, organizować pokazy i szkolenia z zakresu ich prawidłowego użycia oraz intensyfikować działania mające na celu promocję tego typu urządzeń. Konieczne jest podjęcie kroków w celu umożliwienia jak najszerszego dostępu do AED. Dostrzega się wyraźne różnice w liczbie urządzeń w poszczególnych dzielnicach. Fakt posiadania przez jednostki administracyjne jedynie częściowych informacji o rozmieszczeniu AED potwierdza zasadność przeprowadzonej próby zlokalizowania i skatalogowania wszystkich AED na terenie Warszawy

Neuron-specific enolase concentrations for the prediction of poor prognosis of comatose patients after out-of-hospital cardiac arrest: an observational cohort study

Background: Neuron-specific enolase (NSE) is a biomarker for neurological outcomes after cardiac arrest with the most evidence collected thus far; however, recommended prognostic cutoff values are lacking owing to the discrepancies in the published data.Aims: The aim of the study was to establish NSE cutoff values for prognostication in the environment of a cardiac intensive care unit following out-of-hospital cardiac arrest (OHCA).Methods: A consecutive series of 82 patients admitted after OHCA were enrolled. Blood samples for the measurement of NSE levels were collected at admission and after 1 hour, 3, 12, 24, 48, and 72 hours. Neurological outcomes were quantified using the cerebral performance category (CPC) index. Each patient was classified into either the good (CPC ≤2) or poor prognosis (CPC ≥3) group.Results: Median NSE concentrations were higher in the poor prognosis group, and the difference reached statistical significance at 48 and 74 hours (84.4 ng/ml vs 22.9 ng/ml at 48 hours and 152.1 ng/ml vs 18.7 ng/ml at 72 hours; P <0.001, respectively). Moreover, in the poor prognosis group, NSE increased significantly between 24 and 72 hours (P <0.001). NSE cutoffs for the prediction of poor prognosis after OHCA were 39.8 ng/ml, 78.7 ng/ml, and 46.2 ng/ml for 24, 48, and 72 hours, respectively. The areas under the curve were significant at each time point, with the highest values at 48 and 72 hours after admission (0.849 and 0.964, respectively).Conclusions: Elevated NSE concentrations with a rise in levels in serial measurements may be utilized in the prognostication algorithm after OHCA

Neuron-Specific Enolase and S100B: The Earliest Predictors of Poor Outcome in Cardiac Arrest

Background: Proper prognostication is critical in clinical decision-making following out-of-hospital cardiac arrest (OHCA). However, only a few prognostic tools with reliable accuracy are available within the first 24 h after admission. Aim: To test the value of neuron-specific enolase (NSE) and S100B protein measurements at admission as early biomarkers of poor prognosis after OHCA. Methods: We enrolled 82 consecutive patients with OHCA who were unconscious when admitted. NSE and S100B levels were measured at admission, and routine blood tests were performed. Death and poor neurological status at discharge were considered as poor clinical outcomes. We evaluated the optimal cut-off levels for NSE and S100B using logistic regression and receiver operating characteristic (ROC) analyses. Results: High concentrations of both biomarkers at admission were significantly associated with an increased risk of poor clinical outcome (NSE: odds ratio [OR] 1.042 per 1 ng/dL, [1.007–1.079; p = 0.004]; S100B: OR 1.046 per 50 pg/mL [1.004–1.090; p < 0.001]). The dual-marker approach with cut-off values of ≥27.6 ng/mL and ≥696 ng/mL for NSE and S100B, respectively, identified patients with poor clinical outcomes with 100% specificity. Conclusions: The NSE and S100B-based dual-marker approach allowed for early discrimination of patients with poor clinical outcomes with 100% specificity. The proposed algorithm may shorten the time required to establish a poor prognosis and limit the volume of futile procedures performed

The Prevalence of Cardiovascular Risk Factors among Polish Soldiers: The Results from the MIL-SCORE Program

The MIL-SCORE (Equalization of Accessibility to Cardiology Prophylaxis and Care for Professional Soldiers) program was designed to assess the prevalence and management of cardiovascular risk factors in a population of Polish soldiers. We aimed to describe the prevalence of cardiovascular risk factors in the MIL-SCORE population with respect to age. This observational cross-sectional study enrolled 6440 soldiers (97% male) who underwent a medical history, physical examination, and laboratory tests to assess cardiovascular risk. Almost half of the recruited soldiers were past or current smokers (46%). A sedentary lifestyle was reported in almost one-third of those over 40 years of age. The prevalence of hypertension in a subgroup over 50 years of age was almost 45%. However, the percentage of unsatisfactory blood pressure control was higher among soldiers below 40 years of age. The prevalence of overweight and obese soldiers increased with age and reached 58% and 27%, respectively, in those over 50 years of age. Total cholesterol was increased in over one-half of subjects, and the prevalence of abnormal low-density lipoprotein cholesterol was even higher (60%). Triglycerides were increased in 36% of soldiers, and low high-density lipoprotein cholesterol and hyperglycemia were reported in 13% and 16% of soldiers, respectively. In the >50 years of age subgroup, high and very high cardiovascular risk scores were observed in almost one-third of soldiers. The relative risk assessed in younger subgroups was moderate or high. The results from the MIL-SCORE program suggest that Polish soldiers have multiple cardiovascular risk factors and mirror trends seen in the general population. Preventive programs aimed at early cardiovascular risk assessment and modification are strongly needed in this population