Zero Calcium Score as a Filter for Further Testing in Patients Admitted to the Coronary Care Unit with Chest Pain

<div><p>Abstract Background: The accuracy of zero coronary calcium score as a filter in patients with chest pain has been demonstrated at the emergency room and outpatient clinics, populations with low prevalence of coronary artery disease (CAD). Objective: To test the gatekeeping role of zero calcium score in patients with chest pain admitted to the coronary care unit (CCU), where the pretest probability of CAD is higher than that of other populations. Methods: Patients underwent computed tomography for calcium scoring, and obstructive CAD was defined by a minimum 70% stenosis on invasive angiography. Results: In 146 patients studied, the prevalence of CAD was 41%. A zero calcium score was present in 35% of the patients. The sensitivity and specificity of zero calcium score yielded a negative likelihood ratio of 0.16. After logistic regression adjustment for pretest probability, zero calcium score was independently associated with lower odds of CAD (OR = 0.12, 95%CI = 0.04-0.36), increasing the area under the ROC curve of the clinical model from 0.76 to 0.82 (p = 0.006). Zero calcium score provided a net reclassification improvement of 0.20 (p = 0.0018) over the clinical model when using a pretest probability threshold of 10% for discharging without further testing. In patients with pretest probability < 50%, zero calcium score had a negative predictive value of 95% (95%CI = 83%-99%), with a number needed to test of 2.1 for obtaining one additional discharge. Conclusion: Zero calcium score substantially reduces the pretest probability of obstructive CAD in patients admitted to the CCU with acute chest pain. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)</p></div

Lack of association between serum syndecan-4, myocardial fibrosis and ventricular dysfunction in subjects with chronic Chagas disease

<div><p>Background</p><p>Syndecan-4 is a transmembrane glycoprotein associated with inflammation and fibrosis. Increased syndecan-4 levels were previously detected after acute myocardial infarction and in subjects with heart failure. However, the levels of syndecan-4 in subjects with Chagas disease have not so far been investigated. The aim of this study was to investigate the potential role of serum sydencan-4 as a novel biomarker for myocardial fibrosis and cardiac dysfunction in subjects with Chagas disease.</p><p>Methods</p><p>This study comprised subjects with Chagas disease (n = 56), being 14 (25%) with the indeterminate form, 16 (29%) with the cardiac form without ventricular dysfunction, and 26 (46%) with the cardiac form with ventricular dysfunction.</p><p>Results</p><p>Syndecan-4 serum concentrations did not correlate with presence or absence of myocardial fibrosis (P = 0.386) nor disease severity in subjects with Chagas disease (P = 0.918). Additionally, no correlation was found either between the degree of myocardial fibrosis and serum syndecan-4 [r = 0.08; P = 0.567] or between left ventricular ejection fraction and syndecan-4 [r = 0.02; P = 0.864]. In contrast, NT-proBNP levels correlated with ejection fraction and myocardial fibrosis.</p><p>Conclusions</p><p>Our results demonstrate the lack of correlations between serum syndecan-4, myocardial fibrosis and cardiac dysfunction in subjects with Chagas disease. Further studies are required to show if syndecan-4 concentrations can be marker for prognosis assessment or disease progression.</p></div

Echocardiographic and CMR findings in subjects with Chagas disease.

<p>Echocardiographic and CMR findings in subjects with Chagas disease.</p

Correlation between LVEF and serum concentration of syndecan-4 and NT-ProBNP.

<p>A: Pearson’s correlation, LVEF assessed by Simpson’s method, r = 0.02, P = 0.864. B = Pearson’s correlation, LVEF assessed by Simpson’s method, r = 0.687, P<0.001.</p

Clinical and demographic characteristics of subjects with Chagas disease.

<p>Clinical and demographic characteristics of subjects with Chagas disease.</p

Correlation between percentage of myocardial fibrosis assessed by cardiovascular MRI and concentration of syndecan-4 and NT-ProBNP.

<p>A: Pearson’s correlation, r = 0.08, P = 0.567. B: Pearson’s correlation, r = 0.469, P<0.001.</p

Serum concentration of syndecan-4 assessed by ELISA in subjects with different forms of Chagas disease.

<p>ANOVA, P = 0.918. Circle = outlier, * = extreme outlier, P = 0.395.</p

Serum concentration of syndecan-4 assessed by ELISA in subjects with and without delayed enhancement detected by magnetic resonance imaging.

<p>Circle = outlier, * = extreme outlier, <i>t</i> test, P = 0.386.</p

Echocardiographic data in subjects with heart failure.

<p>Echocardiographic data in subjects with heart failure.</p