Aged ; Biomarkers ; blood ; Cobalt ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; Myocardial Ischemia ; diagnosis ; Serum Albumin ; metabolism ; Spectrophotometry

OBJECTIVETo investigate the changes of N-terminal pro-brain natriuretic peptide (NT-proBNP) in neonates with hypoxic-ischemic encephalopathy (HIE) complicated by myocardial ischemic injury.

METHODSThirty-five neonates with HIE (17 cases with concurrent myocardial injury and 18 cases without) were enrolled. Twenty healthy neonates were used as the control group. Plasma NT-proBNP levels were measured using enzyme immunoassay.

RESULTSThe mean plasma NT-proBNP levels in patients with myocardial injury (338.8 + or - 76.2 fmol/mL) were significantly higher than those in patients with non-myocardial injury (137.5 + or - 45.1 fmol/mL) and in the control group (113.7 + or - 53.6 fmol/mL) (p<0.01). The NT-proBNP levels in mild, moderate and severe HIE neonates were 141.3 + or - 41.6, 271.8 + or - 118.1 and 347.2 + or - 85.1 fmol/mL, respectively. Compared with the control group, the NT-proBNP levels in the moderate and the severe HIE groups significantly increased (p<0.01). There were significant differences in the NT-proBNP level among the mild, moderate and severe HIE groups (p<0.05). In patients with myocardial injury, the NT-proBNP levels significantly decreased in the convalescent phase compared with those in the acute phase (225.0 + or - 80.0 fmol/mL vs 338.8 + or - 76.2 fmol/mL (p<0.01).

CONCLUSIONSPlasma NT-proBNP levels increase in neonates with HIE complicated by myocardial ischemic injury in the acute phase. Detection of NT-proBNP levels may be useful in the diagnosis of myocardial ischemic injury and the severity evaluation of HIE.

Female ; Humans ; Hypoxia-Ischemia, Brain ; complications ; Immunoenzyme Techniques ; Infant, Newborn ; Male ; Myocardial Ischemia ; blood ; diagnosis ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood

OBJECTIVETo investigate the syndrome property of myocardial ischemic (MI) model rats, and to objectively evaluate the blood stasis pattern related information in them.

METHODSSD rats were established to MI model by left anterior descending coronary artery (LAD) ligation. Global physical signs observation, colorimetric analysis on images of auricle, plantar and tongue, as well as the hemorrheologic indices detection were conducted dynamically at various time points after modeling. LARS regression was subjected to calculate the correlation between the color and hemorrheologic indices.

RESULTSBoth colorimetric and hemorrheologic indices in MI rats were significantly different to those in sham-operated rats (control) on day 7-28 after operation, showing significant difference between them in terms of plantar R on day 7 (176.29 +/- 4.96 vs. 182.04 +/- 6.35, P < 0.05); R, G and B values of plantar on day 14, 21 and 28; G and R values of tongue on day 14 and G value of auricle on day 21 (130.38 +/- 7.52 vs. 138.02 +/- 9.32, P < 0.05), as well as B value of tongue on day 28 (93.70 +/- 4.79 vs. 85.80 +/- 6.60, P < 0.01). Results of hemorrheologic indices showed that hematocrit in MI rats was higher than that in control on day 14 and 28 (P < 0.05), it was even higher on day 21 (45.38 +/- 1.96 vs. 41.50 +/- 2.12, P < 0.01); and platelet aggregation rate (PAR) was significantly higher in MI on day 7 (49.35 +/- 6.74 vs. 37.83 +/- 9.94, P < 0.01) and day 14 (58.19 +/- 7.57 vs. 48.00 +/- 10.44, P < 0.05). Besides, various degree of changes could also be seen in whole blood apparent viscosity and reduced viscosity at different shear rate on day 7-28 in the model group. LARS regression showed there existed correlation of local colorimetric indices with levels of hematocrit and PAR.

CONCLUSIONMI model rat induced by LAD ligation can be diagnosed as the qi-deficiency and blood stasis syndrome, indications of the syndromes could be seen on 7-28 days after operation; the change of colorimetric indices of local images in MI rats might be related with their levels of hematocrit and PAR.

Animals ; Diagnosis, Differential ; Hematocrit ; Hemorheology ; Male ; Medicine, Chinese Traditional ; Myocardial Ischemia ; blood ; physiopathology ; Platelet Aggregation ; Rats ; Rats, Sprague-Dawley

Transient left bundle branch block (LBBB) is uncommon during anesthesia. It is mainly related to the changes in blood pressure or heart rate. Its occurrence can be confused with acute myocardial ischemia or ventricular tachycardia, therefore differential diagnosis is important. We report a case of transient LBBB which developed with hypoxia during monitored anesthesia care. LBBB is reversed to sinus rhythm after recovery from hypoxia.
Anesthesia* ; Anoxia* ; Blood Pressure ; Bundle-Branch Block* ; Conscious Sedation ; Diagnosis, Differential ; Heart Rate ; Myocardial Ischemia ; Tachycardia, Ventricular

OBJECTIVETo assess the value of an improved ischemia modified albumin (IMA) assay in the diagnosis of early acute myocardial infarction (AMI).

METHODSForty-three patients with AMI were enrolled in this study with 41 patients with chest pain serving as the control. Blood samples were obtained from all the patients within 6 h after the onset. IMA was measured by the albumin cobalt binding test and results were presented by absorbance units (ABSU). Receiver operator characteristic curve (ROC curve) was used to evaluate the optimal cut-off value of the assay.

RESULTSThe mean absorbance in AMI group was obviously higher than that in the control group (1.195-/+0.320 vs 0.855-/+0.068, P<0.001). The area under the receiver of ROC curve was 0.947, and at the cut-off value of 0.906 ABSU, the sensitivity and specificity of the assay were 93.0% and 82.9%, respectively.

CONCLUSIONThe improved IMA assay shows good value in early diagnosis of AMI in patients with acute chest pain.

Acute Coronary Syndrome ; Adult ; Aged ; Aged, 80 and over ; Biomarkers ; blood ; Early Diagnosis ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; blood ; diagnosis ; Myocardial Ischemia ; diagnosis ; Sensitivity and Specificity ; Serum Albumin ; Serum Albumin, Human ; Troponin T ; blood

BACKGROUND/AIMS: We examined the ischemia-modified albumin (IMA) level during exercise in patients with coronary artery disease (CAD). METHODS: Forty patients with a history of chest pain underwent both symptom-limited treadmill exercise stress testing and coronary angiography within one week. During the treadmill tests, blood samples were obtained at baseline and 5 min after exercise to measure the serum IMA level. RESULTS: Of the 40 patients, fourteen (35%, CAD group) had significant coronary artery stenosis, while the other 26 (65%, non-CAD group) did not. The baseline and post-exercise IMA levels in the two groups did not differ significantly (105.2+/-7.2 vs. 107.7+/-6.7 U/mL at baseline and 93.1+/-10.1 vs. 94.8+/-5.7 U/mL at post-exercise in the CAD and non-CAD groups, p=0.29 and 0.57, respectively). The changes in IMA after exercise did not differ either (-10.4+/-7.5 vs. -14.0+/-7.6 U/mL in the CAD and non-CAD groups, respectively, p=0.10). Similarly, the change in IMA between the exercise ECG test positive (TMT positive, n=9) and negative (TMT negative, n=20) groups did not differ (-14.63+/-5.19, vs -8.50+/-9.01 U/mL, p=0.15, in the TMT positive and negative groups, respectively). CONCLUSIONS: Our results suggest that IMA has limitation in detecting myocardial ischemia during symptom-limited exercise stress tests.
Aged ; Albumins/*diagnostic use/metabolism ; *Chest Pain ; Electrocardiography ; *Exercise Test/instrumentation ; Female ; Humans ; Lactic Acid/blood ; Male ; Middle Aged ; Myocardial Ischemia/blood/*diagnosis/physiopathology ; Pilot Projects

Since B-type natriuretic peptide (BNP) concentration has been shown by recent studies to be elevated in patients presenting acute coronary syndrome (ACS) even in the absence of overt heart failure, other mechanisms for elevating plasma BNP (p-BNP) concentrations may be suggested to exist. We have studied the correlation between p-BNP level and the extent of myocardial ischemia (EMI) in non-ST elevation (NSTE) ACS and evaluated the BNP level as an objective marker of EMI. In 204 patients with NSTE ACS, we estimated the EMI by the echocardiographic wall motion score index (WMSI) and the coronary angiographic Gensini score. As the positive control group, 44 patients with stable angina were enrolled into the study. We compared their initial p-BNP levels with WMSI and the Gensini score. Additionally, peak troponin-T level was compared with p-BNP level in NSTE myocardial infarction (MI) patients. Using the multiple regression analysis, adjustments for age, left ventricle (LV) wall stress, LV mass amount and ejection fraction (EF) were made. Patients with LVEF < 45% or age > 75 years or underlying diseases that could elevate BNP levels were excluded from the study. P-BNP level was increased in NSTE ACS patients compared with stable angina patients (133.9 +/- 87.4 vs. 12.2 +/- 9.2 pg/ml, p < 0.05). P-BNP levels were found to correlate with WMSI and the Gensini score in unstable angina (r=0.519, p < 0.01; r=0.680, p < 0.01) and NSTEMI (r=0.716, p < 0.01; r=0.684, p < 0.01) patients, respectively. Additionally, p-BNP levels correlated with the peak troponin-T level in patients with NSTEMI (r=0.700, p < 0.01). P-BNP level might be a useful marker in the assessment of EMI.
Acute Disease ; Aged ; Biological Markers ; *Electrocardiography ; Female ; Human ; Male ; Middle Aged ; Myocardial Ischemia/*blood/*diagnosis ; Natriuretic Peptide, Brain/*blood ; Severity of Illness Index ; Support, Non-U.S. Gov't

OBJECTIVETo investigate the diagnostic value of ischemia-modified albumin (IMA) for patients with acute coronary syndrome (ACS).

METHODSWe detected the IMA levels by albumin cobalt-binding (ACB) test and observed its dynamic changes in 492 patients with ACS, 74 patients with high blood pressure, 78 patients with viral myocarditis (VMC), 395 patients with acute chest pain (133 patients with acute ACS and 262 follow-up patients due to chest pain), 68 patients underwent percutaneous coronary intervention (PCI) and 830 healthy controls. Cardiac troponin I (cTnI) levels were assayed and electrocardiogram (ECG) recorded in patients with ACS.

RESULTSThe optimal diagnostic cutoff point for IMA in this study population was found to be 0.45 ABSU by ROC analysis. The IMA level (ABSU) in ACS group (0.55 +/- 0.11) was significantly higher than that in VMC group (0.38 +/- 0.11) and IMA levels in ACS and VMC groups were both higher than that in control and high blood pressure groups (0.34 +/- 0.08 and 0.35 +/- 0.08, all P < 0.05). IMA levels and the positive rates in patients with ACS were significantly higher (0.54 +/- 0.12 vs 0.44 +/- 0.12, 77.4% vs 39.3%, all P < 0.01) than those in chest pain follow-up group. In 133 patients with ACS, positive rate for IMA was significantly higher than that for cTnI within 1 h of admission (82.0% vs 40.6%, P < 0.01), and was similar at 6 - 24 h after admission (96.2% vs. 95.5%, P > 0.05). In 72 patients presenting to the emergency center within 3 h of acute chest pain and with negative cTnI, positive rate for IMA was 86.1% and for ECG 72.2%, the sensitivity for ACS diagnosis rised to 93.1% with both methods. The IMA leve was higher immediately after PCI than that before PCI (P < 0.05). IMA levels peaked 1d after hospitalization, then decreased gradually and returned to normal 14 days later.

CONCLUSIONSIMA was a useful biochemical marker for the early diagnosis of ACS.

Acute Coronary Syndrome ; diagnosis ; Adult ; Aged ; Biomarkers ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Myocardial Ischemia ; metabolism ; Serum Albumin ; analysis ; Troponin I ; blood

Establishment of a noninvasive diagnostic method to document coronary vasospasm would be useful in the management of the patients with variant angina, especially in the screening of the patients, evaluation of the therapeutic efficacy of the prescribed drugs and determination of the activity of the disease. The present study was performed to clarify the clinical feasibility and diagnostic validity of bedside intravenous ergonovine test and to determine the variables affecting the diagnostic sensitivity of the test. The study group consisted of 59 patients with chest pain in whom diagnostic coronary angiography with intracoronary acetylcholine challenge test for the induction of coronary vasospasm was performed ; 30 patients were proven to have variant angina and 29 patients to have atypical chest pain. Bedside ergonovine test was done one day after the diagnostic coronary angiography and reversible ST segment displacement(elevation or depression) and/or T wave changes in ECG with ergonovine injection was used as the only positive criteria of the test. A bolus of ergonovine maleate(0.025 or 0.050mg) was injected intravenously at 5 minute intervals up to total cumulative dosage of 0.25 mg, and blood pressure and a 12-lead ECG were recorded every 3 minutes after each injection. Intravenous nitroglycerin of 0.25mg was administered for the termination of the test when hypertension(systolic BP>200mmHg), hypotension(systolic BP<90mmHg) or significant arrhythmia was observed. Twenty seven out of 30 patients with variant angina developed chest pain or discomport during the test and among them 22 showed simultaneous reversible ECG changes. In 29 patients with atypical chest pain 11 patients(38%) complained of chest pain or discomport without reversible ECG change during the test, and the overall sensitivity and specificity of the beside ergonovine test were 73% and 100% respectively. The mean cumulative dose of ergonovine which evoked the positive reponse was 117microgram. The patterns of reversible ECG changes of the positive response were variable : 50%(11/22) showed significant ST segment elevation, while ST segment depression(18%) and T wave changes without ST segment displacement(32%) were observed with ergonovine injection. Degree of disease activity of the variant angina, number of spasm-induced vessels and presence of concomitant fixed lesion are important variables affecting the sensitivity of the test. The changes of blood pressure and heart rate were minimal during the test and there was neither significant arrhythmia nor test-related mortality. Thus we concluded that bedside intravenous ergonovine test is a safe, sensitive and highly specific test for coronary vasospasm in selected group of patients with chest pain syndrome. Further study with other methods besides ECG to document myocardial ischemia seems to be necessary for improvement of the sensitivity of bedside ergonovine test.
Acetylcholine ; Arrhythmias, Cardiac ; Blood Pressure ; Chest Pain ; Coronary Angiography ; Coronary Vasospasm ; Diagnosis* ; Electrocardiography ; Ergonovine* ; Heart Rate ; Humans ; Mass Screening ; Mortality ; Myocardial Ischemia ; Nitroglycerin ; Sensitivity and Specificity

OBJECTIVETo evaluate the value of human fatty acid binding protein (h-FABP) in predicting myocardial ischemia and injury in the perioperative period of cardiac surgery, we observed the dynamic changes of h-FABP in perioperative period of patients underwent coronary artery bypass grafting and ventricular septal defects repairing surgery, and evaluated the relationship of h-FABP and ischemia modified albumin (IMA), CK-MB, cTnI.

METHODSPatients underwent coronary artery bypass grafting (n=30) and ventricular septal defect repairing (n=30) surgery between February 2008 and December 2008 were included in this study. Venous blood sample was obtained at preoperative, aortic clamping, aortic unclamping of 10 min, 2 h, 6 h, 12 h, 24 h for the measurements of h-FABP, IMA, cTnI and CK-MB.

RESULTSh-FABP and IMA changed in the same way at various examined time points, h-FABP changes also paralleled cTnI and CK-MB changes, h-FABP peaked early during myocardial ischemia and injury and returned to baseline level at 2 h post myocardial ischemia and injury. Linear correlation analysis showed that the peak value of h-FABP was positively correlated with IMA, CK-MB and cTnI in both CABG group (r = 0.948, 0.964 and 0.961, P < 0.05) and in the VSD group (r = 0.986, 0.978 and 0.957).

CONCLUSIONSh-FABP is an early diagnostic parameter reflecting perioperative myocardial ischemia and injury in cardiac surgery. Quantitative h-FABP monitoring could predict the severity of myocardial ischemia and injury early during cardiac surgery.

Aged ; Albumins ; analysis ; Biomarkers ; blood ; Creatine Kinase, MB Form ; blood ; Fatty Acid-Binding Proteins ; blood ; Humans ; Middle Aged ; Myocardial Ischemia ; diagnosis ; surgery ; Myocardium ; metabolism ; Perioperative Period ; Predictive Value of Tests ; Thoracic Surgery ; Troponin I ; blood