Diagnostic value of cardiac troponin I and N-terminal pro-B-Type Natriuretic Peptide in cardiac syncope

Objective The study aims to evaluate the diagnostic accuracy of Cardiac Troponin I(cTnI) and N-terminal pro-B-Type Natriuretic Peptide (NT-proBNP) for identifying patients with cardiac syncope. Methods This is a prospective, single-center cohort study of patients presenting with syncope hospitalized from June 21,2018 to May 30, 2019. The Evaluation of Guidelines in Syncope Study (EGSYS), a syncope-specific diagnostic score, was used for diagnostic comparator. Results A total of 118 patients were enrolled (mean age: 69.1 ​± ​12.3 years, 40% female). Compared to patients with reflex, orthostatic, or unexplained syncope, patients adjudicated to have cardiac syncope showed significantly higher cTnI and NT-proBNP plasma concentrations (p ​< ​0.001 for each comparison). The area under the curve (AUC) of cTnI and NT-proBNP were moderate-to-good [0.77–0.78; 95% confidence interval (CI) 0.66–0.86], and was similar to that of EGSYS (0.71, 95%CI 0.60–0.80). Incorporation of cTnI and/or NT-proBNP into the existing EGSYS score significantly improved the diagnostic accuracy (EGSYS ​+ ​cTnI: AUC 0.83; 95%CI 0.74–0.90; EGSYS ​+ ​NT-proBNP: AUC 0.81; 95%CI 0.71–0.89; EGSYS ​+ ​cTnI ​+ ​NT-proBNP: AUC 0.83; 95%CI 0.73–0.90). Conclusions The cTnI and NT-proBNP levels were significantly higher in patients adjudicated to have cardiac syncope and the addition of both biomarkers to the EGSYS score significantly improved the diagnostic value for cardiac syncope

Systematic review and meta-analysis of chronic kidney disease as predictor of atrial fibrillation recurrence following catheter ablation

Background: Recent observational studies have shown that patients with chronic kidney disease (CKD) have higher risk of atrial fibrillation (AF) recurrence and, therefore, the value of catheter ablation therapy in patients with CKD has been doubted. The purpose of this meta-analysis was to systematically analyze the effect of CKD on recurrence of AF following catheter ablation.Methods: PubMed and Cochrane clinical trials databases were searched until August 2012. Of the 1966 initially identified studies, 4 observational studies with 1379 patients were analyzed.Results: The meta-analysis of these studies showed that CKD was associated with higher AF recurrence rate following single catheter ablation (HR = 1.96, 95% CI 1.35–2.85, p = 0.0004) while there were significant differences between individual trials (p = 0.07 and I2 = 58%). Sensitivity analysis suggested that this outcome was stable. A subgroup analysis showed that CKD has higher recurrent risk in patients with 100% paroxysmal AF (HR = 2.45, 95% CI 1.28–4.70, p = 0.007) than in patients with non 100% paroxysmal AF (HR = 1.65, 95% CI 1.15–2.36, p = 0.006).Conclusions: CKD was associated with higher AF recurrence rate following single catheter ablation. In addition, patients with 100% paroxysmal AF have higher risk than patients with non 100% paroxysmal AF that merits special consideration when evaluating patients for catheter-based AF ablation. Given that the CKD prevalence is rapidly increasing, there is an imperative need for better risk stratification of catheter ablation candidates.

Association between atherosclerosis-related cardiovascular disease and uveitis: A systematic review and meta-analysis

Background: Uveitis is not only an intraocular inflammatory disease, but also an indicator of systemic inflammation. It is unclear whether uveitis can increase the risk of cardiovascular disease (CVD) through the atherosclerotic pathway. Methods: PubMed and Embase databases were searched until 5 September, 2022. Original studies investigating uveitis and cardiovascular events were selected. The random-effects model was used to calculate the difference of groups in pooled estimates. Results: A total of six observational studies that included mainly ankylosing spondylitis (AS) patients were included. Of these, three studies reported data on carotid plaques and carotid intima-media thickness (cIMT) and the other three studies provided data on atherosclerosis-related CVD. No significant difference was found in cIMT between uveitis and controls (MD = 0.01, 95% CI = -0.03-0.04, p = 0.66), consistent with the findings of carotid plaque incidence (OR = 1.30, 95% CI = 0.71-2.41, p = 0.39). However, uveitis was associated with a 1.49-fold increase in atherosclerosis-related CVD (HR = 1.49, 95% CI = 1.20-1.84, p = 0.0002). Conclusions: Uveitis is a predictor of atherosclerosis-related CVD in AS patients. For autoimmune disease patients with uveitis, earlier screening of cardiovascular risk factors and the implementation of corresponding prevention strategies may be associated with a better prognosis. Keywords: ankylosing spondylitis; atherosclerosis; cardiovascular risk; carotid plaques; intima-media thickness; uveiti

Inversion using a new low-dimensional representation of complex binary geological media based on a deep neural network

Efficient and high-fidelity prior sampling and inversion for complex geological media is still a largely unsolved challenge. Here, we use a deep neural network of the variational autoencoder type to construct a parametric low-dimensional base model parameterization of complex binary geological media. For inversion purposes, it has the attractive feature that random draws from an uncorrelated standard normal distribution yield model realizations with spatial characteristics that are in agreement with the training set. In comparison with the most commonly used parametric representations in probabilistic inversion, we find that our dimensionality reduction (DR) approach outperforms principle component analysis (PCA), optimization-PCA (OPCA) and discrete cosine transform (DCT) DR techniques for unconditional geostatistical simulation of a channelized prior model. For the considered examples, important compression ratios (200 - 500) are achieved. Given that the construction of our parameterization requires a training set of several tens of thousands of prior model realizations, our DR approach is more suited for probabilistic (or deterministic) inversion than for unconditional (or point-conditioned) geostatistical simulation. Probabilistic inversions of 2D steady-state and 3D transient hydraulic tomography data are used to demonstrate the DR-based inversion. For the 2D case study, the performance is superior compared to current state-of-the-art multiple-point statistics inversion by sequential geostatistical resampling (SGR). Inversion results for the 3D application are also encouraging

Research on stress intensity factors of elliptical hole in infinite body

This paper deals with such a kind of surface crack problem with an approximately same depth by using the hybrid displacement discontinuity method (a boundary element method) proposed recently by the author. Based on surface rectangular crack in infinite solid in tension and a hybrid displacement discontinuity method, a numerical approach is presented. By changing geometry parameters of elliptical hole, the effect of geometry parameters of the elliptical hole in infinite body in tension on the SIFs is revealed in detail. It is illustrated that the boundary element method is simple, yet accurate for calculating the SIFs of complex crack problems in finite plate

The value of IGF-1 and IGFBP-1 in patients with heart failure with reduced, mid-range, and preserved ejection fraction

Background: Previous studies have reported inconsistent results regarding the implications of deranged insulin-like growth factor 1 (IGF-1)/insulin-like growth factor-binding protein 1 (IGFBP-1) axis in patients with heart failure (HF). This study evaluates the roles of IGF1/IGFBP-1 axis in patients with HF with reduced ejection fraction (HFrEF), mid-range ejection fraction (HFmrEF), or preserved ejection fraction (HFpEF). Methods: Consecutive patients with HFrEF, HFmrEF, and HFpEF who underwent comprehensive cardiac assessment were included. The primary endpoint was the composite endpoint of all-cause death and HF rehospitalization at one year. Results: A total of 151 patients with HF (HFrEF: n = 51; HFmrEF: n = 30; HFpEF: n = 70) and 50 control subjects were included. The concentrations of IGFBP-1 (p < 0.001) and IGFBP-1/IGF-1 ratio (p < 0.001) were significantly lower in patients with HF compared to controls and can readily distinguish patients with and without HF (IGFBP-1: areas under the curve (AUC): 0.725, p < 0.001; IGFBP-1/IGF-1 ratio: AUC:0.755, p < 0.001; respectively). The concentrations of IGF-1, IGFBP-1, and IGFBP-1/IGF-1 ratio were similar among HFpEF, HFmrEF, and HFrEF patients. IGFBP-1 and IGFBP-1/IGF-1 ratio positively correlated with N-terminal probrain natriuretic peptide (NT-proBNP) levels (r = 0.255, p = 0.002; r = 0.224, p = 0.007, respectively). IGF-1, IGFBP-1, and IGFBP-1/IGF-1 ratio did not predict the primary endpoint at 1 year for the whole patients with HF and HF subtypes on both univariable and multivariable Cox regression. Conclusion: The concentrations of plasma IGFBP-1 and IGFBP-1/IGF-1 ratio can distinguish patients with and without HF. In HF, IGFBP-1 and IGFBP-1/IGF-1 ratio positively correlated with NT-proBNP levels

Serum autoantibodies against human oxidized low-density lipoproteins are inversely associated with severity of coronary stenotic lesions calculated by Gensini score

Background: The relationship between autoantibodies against human oxidized low-density lipoprotein (anti-oxLDL) and the progression of atherosclerotic diseases is unclear. This study aimed to investigate the association between serum anti-oxLDL titers and the severity and extent of coronary stenotic lesions. Methods: We measured the titers of IgG anti-oxLDL by enzyme-linked immunosorbent assay (ELISA) in 154 consecutive patients undergoing coronary angiography for suspected coronary heart disease (CHD). The severity and extent of coronary stenotic lesions were evaluated on coronary angiography findings by Gensini score. Results: The anti-oxLDL titers were significantly lower in 117 patients with CHD than those in 37 controls (p < 0.01). The serum anti-oxLDL titers were significantly correlated to serum levels of globulin (r = 0.405), conjugated bilirubin (r = 0.280), high-density lipoprotein (HDL) cholesterol (r = 0.238), homeostatic model assessment for insulin resistance (HOMA-IR) (r = &#8211;0.267), high sensitivity C-reactive protein (hs-CRP) (r = &#8211;0.230), triglyceride (r = &#8211;0.207), advanced glycation end products (AGEs) (r = &#8211;0.200), and malondialdehyde (r = &#8211;0.165). However, only HDL cholesterol and AGEs remained independent predictors of the anti-oxLDL titers after adjusting for confounders. Multivariate regression analysis showed that the anti-oxLDL titers, as well as serum levels of hs-CRP, fasting glucose, and albumin, were significantly associated with Gensini scores. Conclusions: Titers of anti-oxLDL are inversely associated with complicated proatherogenic metabolic risk factors, and the severity of coronary stenotic lesions calculated by Gensini scores, supporting a protective role for anti-oxLDL against the progression of atherosclerosis. (Cardiol J 2011; 18, 4: 364&#8211;370

Impaired atrial electromechanical function and atrial fibrillation promotion in alloxan-induced diabetic rabbits

Background: Diabetes mellitus (DM) is an independent risk factor for atrial fibrillation (AF). However, the underlying mechanisms are still not clearly elucidated. The aim of this study was to evaluate the atrial electromechanical function, atrial electrophysiological changes and AF inducibility in alloxan-induced diabetic rabbits. Methods: In 8 alloxan-induced diabetic rabbits and 8 controls, we evaluated atrial electromechanical function by tissue Doppler imaging. Isolated Langendorff-perfused rabbit hearts were prepared to measure atrial refractory effective period (AERP) and its dispersion (AERPD), interatrial conduction time (IACT) and vulnerability to AF. Atrial interstitial fibrosis was evaluated by Sirius-Red staining. Results: Compared with controls, left atrial lateral wall Pa’-start interval (Pastart) and right atrial wall Pastart were increased in diabetic rabbits. AERPD was increased and IACT was prolonged in diabetic rabbits. Inducibility of AF in diabetic group was significant higher than controls (6/8 vs. 1/8, p &lt; 0.05). Extensive interstitial fibrosis was observed in the DM group (p &lt; 0.01). Correlation analysis showed that right atrial wall Pastart, Pa’-peak interval (Papeak) and total electromechanical activity (TEMA); left atrial lateral wall Papeak and TEMA, left atrial posterior wall TEMA, and IACT were correlated with atrial areas of fibrosis. Conclusions: Atrial electromechanical function is impaired in diabetic rabbits, and is associated with atrial fibrosis and interatrial electrical conduction delay