The prognostic value of N- terminal pro-brain natriuretic peptide in patients with ST segment elevation myocardial infarction

AMAÇ: B tipi Natriütetik peptid düzeyi akut koroner sendromlu hastalarda prognozu belirlemede kullandığımız belirteçlerdendir. Bu çalışmada natriüretik peptid ailesinden N Terminal (NT) proBNP' nin ST segment yükselmeli miyokard enfarktüslü olgulardaki prognostik değerini araştırmayı amaçladık. GEREÇ ve YÖNTEM: Uludağ Üniversitesi Tıp Fakültesi Kardiyoloji Kliniği yoğun bakım ünitesinde akut ST segment yükselmeli miyokard enfarktüsü tanısı ile izlenen 57 hasta incelendi. Olgulardan 6 ve 36. saatte plazmada NT-proBNP bakılmak üzere venöz kan örnekleri alındı. Eş zamanlı EKG'leri çekildi ve kardiyak enzimleri çalışıldı. Üçüncü ayda hastalar, istenmeyen major kardiyak olaylar (ölüm, revaskülarizasyon, tekrarlayan miyokard enfarktüsü ve angina) açısından değerlendirilirken NT-proBNP değerleri ölçüldü. Her üç NT-proBNP değeri ile istenmeyen major kardiyak olaylar arasındaki ilişki araştırıldı. BULGULAR: Hastalar ST segment yükselmesine göre anterior MI geçiren (Grup A) ve inferior MI geçiren (Grup B) hastalar olarak iki gruba ayrıldı. Grup A' da sol ventrikül ejeksiyon fraksiyonunun daha düşük, duvar hareket skor indeksinin daha yüksek olduğu saptandı. Üçüncü ay sonunda en az bir istenmeyen major kardiyak olay geçirenlerle hiç geçirmeyenler arasında NT-proBNP seviyeleri açısından anlamlı istatistiksel fark elde edilemedi (p>0,05). 36. saatte saptanan ortalama NT-proBNP düzeyi 6. saat ortalama NT-proBNP düzeyi ile kıyaslandığında grup A olgularında 10,6±26,2 kat artış gösterdiği, grup B olgularında 3,6±4,7 kat artış gösterdiği saptandı ve bu değer her iki grup arasında istatiksel olarak anlamlı farklılık saptandı (p=0,016). Sol ventrikül ejeksiyon fraksiyonu ve NT-proBNP düzeyleri arasında ilişki saptanmadı. 36. saat NT-proBNP düzeylerinin 300 pg/ml'nin üzerinde olması kötü prognozun öngörücüsüydü. SONUÇ: NT-proBNPdüzeyleri istenmeyen major kardiyak olayları öngörmede önemli katkı sağlayabilir. Özellikle 36. saat NT-proBNP değerlerinin 300 pg/ml'nin üzerinde olması istenmeyen major kardiyak olayların önceden tespitinde ve önlem alınmasında yararlı olabilir.OBJECTIVE: B-type natriuretic peptide levels has been used as a biological marker for prognosis in patients with acute coronary syndrome (ACS). We sought to determine the prognostic value of N-Terminal (NT) proBNP in patients with ST segment elevation myocardial infarction. MATERIALS and METHODS: 57 patients from Uludağ University Cardiology Department Intensive Care Unit with ST segment elevation myocardial infarction if they matched the inclusion criteria after the standart treatment was began to patients were enrolled. We measured the NT-proBNP in plasma specimens in the 6th and 36th hours after hospitalization. The cardiac markers were measured and taken ECG records at the same times. After follow up of third month the major advers cardiovascular events (MACE) were evaluated and NTproBNPwas measured again. The relation between MACE and each of NT-proBNP levels were analysed. RESULTS: The patients which were included to the study were divided in two groups in terms of ST segment elevation. These groups are anterior MI (Group A) and inferior MI (Group B) patients. In Group A the left ventricle ejection fraction was found lower and wall motion score index was found higher but they were not statistically significant (p>0,05). After the third month there was no statistically difference in NT-proBNPlevels between the group which had minimally one MACE and the other group which had no MACE (p>0,05). The 36th hours mean NT-proBNP levels compared with sixth hours mean NT-proBNP levels was statistically different in two groups. In Group A, NT-proBNPlevelsincreased 10,6±26,2 timesand in Group B NT-proBNPlevels increased 3,6±4,7 times (p=0,016). There was no correlation between left ventricle ejection fraction and NTproBNP levels. Especially we found that the patients which had 36th hours NT-proBNP level sover 300 pg/ml showed worse prognosis depending on major cardiovascular advers events. CONCLUSION: Circulating NT-proBNP levels appear elevated in patients with ST Elevation ACS. 36th hours NT-proBNP value sover 300 pg/ml, are associated with worse prognosis depending on major cardiovascular events

The effects of cigarette smoking on the Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio

Background. Cigarette smoking increases the risk of sudden cardiac death. Smoking may predispose individuals to ventricular fibrillation and sudden cardiac death by altering ventricular repolarization and stimulating sympathetic nervous system activity. Objectives. The aim of the study was to investigate the instantaneous effects of smoking on ventricular repolarization. Material and Methods. The study included 47 healthy subjects; 24 long-term heavy smokers (10 women, mean age: 40 ± 5 years) constituted the study group, and 23 non-smokers (10 women, mean age: 42 ± 10 years) constituted the control group. ECGs were performed on all the subjects. The Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio were measured and compared between the groups. Results. There were no significant differences between smokers and nonsmokers in the basic clinical and echocardiographic variables (p > 0.05). The QT interval and QTc interval were similar in both groups. The Tp-e interval (p = 0.02) and Tpe/QT ratio (p = 0.001) were higher in the heavy smokers than in the non-smokers. The Tpe/QTc ratio (p = 0.001) was also higher in the smokers. Other ECG parameters were similar between the smokers and nonsmokers. Conclusions. The results show that chronic cigarette smoking is associated with a prolonged Tp-e interval, increased Tp-e/QT ratio and Tp-e/QTc ratio. These observations may indicate that there may be a relationship between smoking and altered ventricular repolarization. Abnormal ventricular repolarization values on an ECG may explain the increased cardiovascular event risk in long-term heavy cigarette smokers

S100A1 as a Potential Diagnostic Biomarker for Assessing Cardiotoxicity and Implications for the Chemotherapy of Certain Cancers.

This study examined the value of blood marker S100A1 in detecting cardiotoxicity induced by chemotherapy agents; trastuzumab and lapatinib, in normal rat heart. The rats were divided into three groups: control (n = 8, no treatment), T (n = 8, one time ip treatment with 10 mg/kg trastuzumab) and L (n = 8, oral treatment with 100 mg/kg/day lapatinib for 7 days). The activities of oxidative stress parameters Malondialdehyde (MDA), Superoxide dismutase (SOD), Catalase (CAT) and Glutathione (GSH) were measured from the extracted cardiac tissues. The levels of troponinI and S100A1 expressions were measured from blood samples. All biomarkers responded to the treatments as they exhibited alterations from their normative values, validating the chemically induced cardiotoxicity. S100A1 expression attenuated significantly (75%), which made the sensitive detection of cardiotoxicity feasible. Assessment of cardiotoxicity with S100A1 may be a valuable alternative in clinical oncology of cancers in some organs such as breast and prostate, as they do not overexpress it to compete against

Levels of cardiac injury parameters as measured from the bloods collected from all experimental groups (each with n = 8).

<p>Panels show graphs for the markers TroponinI and S100A1. Multi group Kruskal Wallis test yielded <i>P</i> = 0.0280 and 0.0354, respectively. * indicates statistically significant difference against the control group C (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0145418#pone.0145418.t001" target="_blank">Table 1</a>).</p

Oxidative stress parameters as measured from the cardiac tissues extracted from the animals in all experimental groups (each with n = 8).

<p>Panels show graphs for the biochemical markers Malonyldialdehyde (MDA); Superoxide dismutase (SOD); Catalase (CAT); Glutathione (GSH). Multi group Kruskal Wallis test yielded <i>P</i> = 0.0003, 0.0003, 0.0002 and 0.0005, respectively. * indicates statistically significant difference against the control group C (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0145418#pone.0145418.t001" target="_blank">Table 1</a>).</p