Abstract 13546: Chromogranin-A Levels Differentiate Takotsubo From Acute Coronary Syndrome and Congestive Heart Failure in Women: A Single-center Case-control Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nicola Tarantino ◽  
Francesco Santoro ◽  
Luigi Di Biase ◽  
Vito Di Terlizzi ◽  
Domenico G Della Rocca ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Acute Coronary Syndrome ◽  
Symptom Onset ◽  
Chromogranin A ◽  
Troponin I ◽  
Predictive Values ◽  
Coronary Syndrome ◽  
Group 2 ◽  
Group 1

Background: Takotsubo syndrome (TTS) has been reported in up to 10% of women with a clinical presentation suggestive of acute coronary syndrome (ACS), making the differential diagnosis challenging. Chromogranin-A (CgA) is a pro-hormone co-released with catecholamines. Elevated levels of CgA are found in ACS and in exacerbations of congestive heart failure (CHF), indicating an imbalance of the neuroendocrine system. Hypothesis: CgA levels in women with TTS might differ from levels in other conditions featuring acute heart failure. Methods: We systematically screened CgA levels in 54 consecutive women admitted with TTS (n=29) or either CHF exacerbation or ACS (n=25) between November 2016 and September 2019. Clinical parameters including left ventricle ejection fraction, in-hospital events, troponin I (TnI), creatinine, and natriuretic peptide type B (NT-pro-BNP) values were recorded. Only samples obtained within 24 hours from symptom onset were analyzed. We excluded 18 subjects with TTS and 6 with ACS/CHF because of a history of cancer, chronic kidney disease >III stage, liver cirrhosis, or autoimmune disease. Results: Patients with TTS (Group 1, n=11) were compared with patients with ACS/CHF (Group 2, n=19). Subjects in Group 1 were significantly younger (mean age 67 vs 80, p<0.01) and presented with remarkably lower levels of CgA compared to Group 2 (1.57 nMol/l, IQR 0.56-4.6 vs 7.46, IQR 1.1-17.15, normal value <3 nMol/l, p<0.002), even adjusting for confounders such as the use of proton pump inhibitors, hypertension, and renal function. When controlling for age, there was a significant association between being in Group 2 and higher mean levels of CgA (p<0.03). At ROC curve analysis, CgA was the best predictor of TTS vs ACS/CHF when compared with TnI and NT-pro-BNP levels (AUC 0.85, 95% C.I. 0.72-0.98; 0.59, 95% C.I. 0.31-0.86; 0.5, 95% C.I. 0.28-0.72, respectively). CgA levels <5.32 could discriminate TTS from ACS/CHF with positive and negative predictive values of 22 and 100% respectively (accuracy 68%). Conclusion: In our population, systemic CgA levels collected within 24 hours from symptom onset were significantly lower in women with TTS compared to ACS/CHF, possibly indicating a different acute neuroendocrine pattern.

scholarly journals Stem Cell Therapy in Acute Coronary Syndrome

2006 ◽  
Vol 4 (1) ◽  
pp. 9-12
Author(s):  
Rajib Rajbhandari
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Acute Coronary Syndrome ◽  
Stem Cell ◽  
Cell Therapy ◽  
Stem Cell Therapy ◽  
Cardiovascular Medicine ◽  
Coronary Syndrome

Acule coronary syndrome and congestive heart failure are still among challenging problems in the field of cardiovascular medicine despite many advances in the field. Stem cell therapy has come as a new hope and a promise for the hopeless.

scholarly journals The Threshold of Admission Glycemia as a Predictor of Adverse Events in Diabetic and Non-Diabetic Patients with Acute Coronary Syndrome

2009 ◽  
Vol 3 ◽  
pp. CMC.S2289 ◽  
Author(s):  
Taysir S. Garadah ◽  
Salah Kassab ◽  
Qasim M. Al-Shboul ◽  
Abdulhai Alawadi
Keyword(s):  
Acute Coronary Syndrome ◽  
Adverse Events ◽  
Diabetic Patients ◽  
Stress Hyperglycemia ◽  
Coronary Syndrome ◽  
History Of ◽  
Group 3 ◽  
Group 2 ◽  
High Level ◽  
Group 1

Recent studies indicated a high prevalence of hyperglycemia in non-diabetic patients presenting with acute coronary syndrome (ACS). However, the threshold of admission glucose (AG) as a predictor of adverse events in ACS is unclear. Objective The aim of this study was to assess the threshold of admission glucose (AG) as a predictor of adverse events including Major Acute Cardiac Events (MACE) and mortality, during the first week of admitting patients presenting with ACS. Material and Methods The data of 551 patients with ACS were extracted and evaluated. Patients were stratified according to their blood glucose on admission into three groups: group 1: <7 mmol/L (n = 200, 36.3%) and group 2: >7 mmol/L and <15 mmol/L (n = 178, 32.3%) and group 3: ≥15 mmol/L (n = 173, 31.4%). Stress hyperglycemia was arbitrarily defined as AG levels > 7 mmol/L (group 2 and 3). Patients with ACS were sub-divided into two groups: patients with unstable angina (UA, n = 285) and those with ST segment elevation myocardial Infarction (STEMI, n = 266) and data were analyzed separately using multiple regression analysis. Results The mean age of patients was 59.7 ± 14.8 years and 63% were males. The overall mortality in the population was 8.5% (5.4% in STEMI and 3.1% in UA) patients. In STEMI patients, the odds ratio of stress hyperglycemia as predictor of mortality in group 3 compared with group 1 was 3.3 (CI 0.99-10.98, P < 0.05), while in group 2 compared with group 1 was 2.4 (CI: 0.75-8.07, P = 0.065) after adjustment for age and sex. Similarly, in UA patients, the odds ratio of stress hyperglycemia in group 3 compared with group 1 was 2.7 (CI 0.37-18.98, P < 0.05), while in group 2 compared with group 1 was 2.4 (CI: 0.4-15.2, P = 0.344) after adjustment for age and sex. The incidence of more than 2 MACE in both STEMI and UA patients was higher in group 3 compared with the other two groups. Regression analysis showed that history of DM, high level of LDL cholesterol, high level of HbA1c, and anterior infarction were significant predictors of adverse events while other risk factors such as BMI, history of hypertension and smoking were of no significance. Conclusion This study indicates that the stress hyperglycemia on admission is a powerful predictor of increased major adverse events and hospital mortality in patients with acute coronary syndrome.

P4624Predictive performance of CRUSADE bleeding score in non ST elevation acute coronary syndrome patients treated with ticagrelor versus clopidogrel

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Graca Santos ◽  
F Montenegro Sa ◽  
C Ruivo ◽  
R Ribeiro Carvalho ◽  
J Correia ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Predictive Performance ◽  
Roc Curves ◽  
National Registry ◽  
Red Blood Cell Transfusion ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Group 2 ◽  
Risk Categories ◽  
Group 1

Abstract Introduction CRUSADE score is commonly used for bleeding risk stratification in the context of acute coronary syndrome (ACS). However, the study validating it was performed before ticagrelor was available. Purpose To compare the predictive performance of CRUSADE score in two groups of non-ST elevation ACS (NSTEACS) patients, one treated with ticagrelor and another with clopidogrel. Methods Retrospective study of 2077 NSTEACS patients admitted between January 2014 and September 2017 and included in a multicentre national registry. Group 1 was composed by patients medicated with ticagrelor, and Group 2 with clopidogrel. Patients with bleeding history were excluded. The primary endpoint (PE) results from a composite which includes: in-hospital major bleeding (MB) according to the Registry criteria, need for red blood cell transfusion (RBCT), or haemoglobin drop ≥2g/dL (HbD). The groups were compared according to their demographic, clinical and laboratory characteristics. The occurrence of the PE (and its components) across CRUSADE risk categories was assessed by Chi-square for linear trend. The performance of CRUSADE score for PE prediction in each cohort was assessed by Receiver Operator Characteristics (ROC) curves. Results Group 1 included 662 (31.9%) and Group 2 1415 (68.1%) patients. Mean CRUSADE score was higher in Group 2 (23.1±14.7 versus (vs) 26.7±16.3, p=0.001). No difference was observed regarding the PE (14.8% vs 17.0%, p=0.200) and its components. With the exception of MB in Group 1 (p-trend=0.425), the relative occurrence of the PE and its components increased across CRUSADE risk categories [Figure 1. panel A]. In-hospital mortality was numerically superior in Group 2, but did not reach statistical significance (1.1% vs 1.6%, p=0.368). In both groups, the performance of CRUSADE score in predicting the PE was modest (Group 1 AUC=0.59 and p=0.006, Group 2 AUC=0.62 and p<0.001), and no difference was observed when comparing the two groups (P value for ROC curves comparison = 0.899) [Figure 1. panel B and C respectively]. Figure 1 Conclusion In this study based on a national registry of NSTEACS patients, the use of ticagrelor did not influence the occurrence of bleeding related events and it did not change the predictive performance of the CRUSADE score. According to this analysis, CRUSADE score may be applied without limitation to NSTEACS patients managed with ticagrelor.

scholarly journals P977 CT phenotype of high-risk atherosclerotic plaques causing an acute coronary syndrome compared to silent vulnerable plaques

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R I Hodas ◽  
D Opincariu ◽  
N Rat ◽  
I Rodean ◽  
M Chitu ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Morphological Characteristics ◽  
Plaque Morphology ◽  
Atherosclerotic Plaques ◽  
Plaque Instability ◽  
Coronary Syndrome ◽  
Atheromatous Plaques ◽  
Group 2 ◽  
Group 1

Abstract Funding Acknowledgements PlaqueImage.- research grant no. 103544/2016, contract number 26/01.09.2016 - Background Previous studies demonstrated that plaque morphology has a crucial role in the development of an acute coronary syndrome (ACS). However, not all vulnerable coronary plaques produce an ACS and the prediction power of various vulnerability features to predict an acute coronary event in a close future, has not been elucidated so far. Objective We aimed to use multi-slice computed tomography angiography (CTA) for assessment of morphological characteristics of culprit lesions producing an ACS in the next several months after CT assessment, in comparison with morphological characteristics of unstable coronary atherosclerotic plaques which did not trigger an ACS. Material and methods We analyzed 40 patients in whom CTA revealed presence of unstable coronary lesions, exhibiting at least one marker of vulnerability: napkin ring sign (NRS), spotty calcium (SC), positive remodeling (PR) or presence of low attenuation plaque (LAP), divided in 2 groups: group 1 - 20 patients who developed an ACS in the next 6 months following CTA examination, and group 2 – 20 patients matched for age, gender and risk factors, who did not present any cardiovascular event 6 month after CTA assessment. Post-processing of multi-slice CTA images was performed in order to assess morphological characteristics and CT-derived markers of atherosclerotic plaque instability. Results Similar mean values of plaque length (17.1 +/- 5.9 mm vs 16.9 +/- 3.4 mm; p = 0.6) and total atheroma volume (188.1 +/- 104.7 mm3vs 186.4 +/- 90.7 mm3; p = 0.8) were obtained for both groups. The mean number of vulnerability markers was 1.6 in group 1 vs 1.2 in group 2 (p = 0.07). However, atherosclerotic lesions in patients from group 1 presented significantly higher values of lipid-rich atheroma (9.8 +/- 10.8 mm3vs 2.6 +/- 1.0 mm3; p = 0.01) and remodeling index (1.14 +/- 0.3 in group 1 vs 0.89 +/- 0.19 in group 2, p = 0.04). At the same time, atheromatous plaques in patients who developed an ACS during the 6-months follow-up showed in a significantly higher proportion LAP (45% in group vs 10% in group 2, p = 0.03) and PR (15%in group 1 versus 5% in group 2, p = 0.04), but not NRS (30% vs 25%, p = ns) or SC (65% vs 40%, p = 0.2). Conclusions Atherosclerotic plaques producing an ACS exhibit a different phenotype than unstable plaques that remain silent. The CTA profile of atheromatous plaques producing an ACS includes the presence of low attenuation, positive remodeling, higher RI and lipid-rich atheroma. Presence of these features in high-risk coronary plaques identifies very high risk patients, who can benefit from adapted therapeutic strategy in order to prevent the development of an ACS.

scholarly journals Risk Stratification for Heart Failure and Death in an Acute Coronary Syndrome Population Using Inflammatory Cytokines and N-Terminal Pro-Brain Natriuretic Peptide

2007 ◽  
Vol 53 (12) ◽  
pp. 2112-2118 ◽  
Author(s):  
Peter A Kavsak ◽  
Dennis T Ko ◽  
Alice M Newman ◽  
Glenn E Palomaki ◽  
Viliam Lustig ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Risk Stratification ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Troponin I ◽  
Significant Risk ◽  
Risk Of Death ◽  
Coronary Syndrome

Abstract Background: Inflammation in acute coronary syndrome (ACS) can identify those at greater long-term risks for heart failure (HF) and death. The present study assessed the performance of interleukin (IL)-6, IL-8, and monocyte chemoattractant protein-1 (MCP-1) (cytokines involved in the activation and recruitment of leukocytes) in addition to known biomarkers [e.g., N-terminal pro-brain natriuretic peptide (NT-proBNP)] for predicting HF and death in an ACS population. Methods: In a cohort of 216 ACS patients, NT-proBNP (Elecsys®; Roche) and IL-6, IL-8, and MCP-1 (evidence investigator™; Randox) were measured in serial specimens collected early after symptom onset (n = 723). We collected at least 2 specimens from each participant: an early specimen (median 2 h; interquartile range 2–4 h) and a later specimen (9 h; 9–9 h), and used the later specimens’ biomarker concentrations for risk stratification. Results: An increase in both IL-6 and NT-proBNP was observed but not for IL-8 or MCP-1 early after pain onset. Kaplan–Meier analysis demonstrated that individuals with increased NT-proBNP (&gt;183 ng/L) or cytokines (IL-6 &gt; 6.4 ng/L; above upper limit of normal for IL-8 or MCP-1) had a greater probability of death or HF in the following 8 years (P &lt;0.05). In a Cox proportional hazard model adjusted for both CRP and troponin I, increased IL-6, MCP-1, and NT-proBNP remained significant risk factors. Combining all 3 biomarkers resulted in a higher likelihood ratio for death or HF than models restricted to any 2 of these biomarkers. Conclusion: IL-6, MCP-1, and NT-proBNP are independent predictors of long-term risk of death or HF, highlighting the importance of identifying leukocyte activation and recruitment in ACS patients.

scholarly journals Association of Haemoglobin and C-Reactive Protein level with Different Risk Factors among Acute Coronary Syndrome Patients

2019 ◽  
Vol 5 (2) ◽  
pp. 156-160
Author(s):  
Md Mahboob Morshed ◽  
Md Joynul Islam ◽  
ATM Ashadullah ◽  
Khondker Shaheed Hussain ◽  
Mohammad Ahtashamul Haque
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Reactive Protein ◽  
Coronary Syndrome ◽  
Group 4 ◽  
History Of ◽  
Study Population ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Different risk factors may be related with the haemoglobin and CRP level among the acute coronary syndrome patients. Objective: The purpose of the present study was to see the association of haemoglobin and CRP level with different type of risk factors among the acute coronary syndrome patients. Methodology: This cross-sectional study was conducted in the Department of Cardiology at Mymensingh Medical College, Mymensingh, Bangladesh from December 2010 to November 2011 for a period of two (02) years. Patients of ACS who were presented within 12 hours of chest pain were included as study population. Study population were categorized in four groups according to the level of hemoglobin and C-reactive protein. Age, cardiovascular risks factor, history, family history of cardiovascular disease, treatment history and ECG were taken during admission. Blood sample was collected for baseline laboratory investigations like Troponin-I, Random Blood Sugar (RBS), Blood urea, Serum creatinine, lipid profile, Hemoglobin & CRP level. Sample were then send to standard laboratory/Biochemistry department of MMCH. Result: The mean age of the population was 52.18±8.88 years. Smoking was the highest percentage in Group 1 which was 54(50.0%) cases (P=0.001). Hypertension was found most common in group 1 (47.6%), Group 2 (33.3%), Group 3 (10.7%) and Group 4 (8.3%). Smoking (p=0.001) and hypertension (p=0.016) was found statistically significant. Diabetes was found in Group 1 (37.7%), Group 2 (43.5%), Group 3 (11.6%) and Group 4 (7.2%). Group 1 (50%) and Group 2 (50%) patients were dyslipidaemic. Family history of IHD was present group-1 (36.8%), Group 2 (44.7%), Group 3 (73.2%) and Group 4 (53%). Among the smoker patient 65.6% cases had CRP level ˃12 mg/l; 39.8% cases had CRP level ˂12mg/L. Among the nonsmoker 34.4% cases had CRP level ˃12mg/l and 60.2% cases had CRP level ˂12mg/L. The finding was statistically significant. Conclusion: In conclusion haemoglobin and CRP level is associated with different type of risk factors among the acute coronary syndrome patients. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 156-160

scholarly journals Glycemic variability in type 2 diabetes mellitus and acute coronary syndrome: liraglutide compared with insulin glargine: a pilot study

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092606
Author(s):  
Maria Isabel del Olmo-García ◽  
David Hervás Marín ◽  
Jana Caudet Esteban ◽  
Antonio Ballesteros Martin-Portugués ◽  
Alba Cerveró Rubio ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Hospital Setting ◽  
Glycemic Variability ◽  
Coronary Syndrome ◽  
Group 2 ◽  
Group 1

Objective To explore the glucagon-like peptide-1 analogue liraglutide in the hospital setting in patients with type 2 diabetes mellitus (T2DM) and acute coronary syndrome and to evaluate the safety and efficacy and its impact on hospitalization and short-term glycemic variability (GV). Methods A 12-week, open-label, prospective, randomized pilot clinical study with parallel groups that compared liraglutide (group 1) with glargine (group 2) and its impact on glycemic control and GV. Results Thirteen patients were included. During hospitalization, mean glucose was 164.75 mg/dL (standard deviation [SD] 19.94) in group 1 and 166.69 mg/dL (38.22) in group 2. GV determined by CV and SD was 20.98 (7.68) vs. 25.48 (7.19) and 34.37 (13.05) vs. 43.56 (19.53) in groups 1 and 2, respectively. Group 1 prandial insulin requirements during hospitalization were lower compared with group 2. Follow-up A1c in group 1 was 6.9% (−1.51%) and 6.5% in group 2 (−1.27). GV after discharge and hypoglycemia were lower in group 1 compared with group 2. Conclusions Liraglutide seems to reduce GV in the acute phase of acute coronary syndrome, and patients achieved optimal control with a low incidence of hypoglycemia. These results support the need to explore liraglutide in a larger multicenter trial. Trial registration: The study was approved by the National Medical Ethics Committee of Spain. The study was registered at European Clinical Trials Database (EudraCT): 2014003298-40.

scholarly journals Cyclophosphamide cardiotoxicity: an analysis of dosing as a risk factor

Blood ◽  
1986 ◽  
Vol 68 (5) ◽  
pp. 1114-1118 ◽  
Author(s):  
MA Goldberg ◽  
JH Antin ◽  
EC Guinan ◽  
JM Rappeport
Keyword(s):  
Heart Failure ◽  
Bone Marrow ◽  
Congestive Heart Failure ◽  
Aplastic Anemia ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Severe Combined Immunodeficiency ◽  
Group 2 ◽  
Group 1

Abstract Patients who undergo bone marrow transplantation are generally immunosuppressed with a dose of cyclophosphamide (CYA) which is usually calculated based on the patient's weight. At these high doses of CYA, serious cardiotoxicity may occur, but definitive risk factors for the development of such cardiotoxicity have not been described. Since chemotherapeutic agent toxicity generally correlates with dose per body surface area, we retrospectively calculated the dose of CYA in patients transplanted at our institution to determine whether the incidence of CYA cardiotoxicity correlated with the dose per body surface area. Eighty patients who were to receive CYA 50 mg/kg/d for four days as preparation for marrow grafting underwent a total of 84 transplants for aplastic anemia, Wiskott-Aldrich syndrome, or severe combined immunodeficiency syndrome. Fourteen of 84 (17%) patients had symptoms and signs consistent with CYA cardiotoxicity within ten days of receiving 1 to 4 doses of CYA. Six of the 14 patients died with congestive heart failure. The dose of CYA per body surface area was calculated for all patients and the patients were divided into two groups based on daily CYA dose: Group 1, CYA less than or equal to 1.55 g/m2/d; Group 2, CYA greater than 1.55 g/m2/d. Cardiotoxicity that was thought to be related to CYA occurred in 1/32 (3%) of patients in Group 1 and in 13/52 (25%) patients in Group 2 (P less than 0.025). Congestive heart failure caused or contributed to death in 0/32 patients in Group 1 v 6/52 (12%) of patients in Group 2 (P less than 0.25). There was no difference in the rate of engraftment of evaluable patients in the two groups (P greater than 0.5). We conclude that the CYA cardiotoxicity correlates with CYA dosage as calculated by body surface area, and that patients with aplastic anemia and immunodeficiencies can be effectively prepared for bone marrow grafting at a CYA dose of 1.55 g/m2/d for four days with a lower incidence of cardiotoxicity than patients whose CYA dosage is calculated based on weight. This study reaffirms the principle that drug toxicity correlates with dose per body surface area.

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