BACKGROUND AND OBJECTIVES: The presence of elevated troponin after percutaneous coronary intervention (PCI) is considered to reflect irreversible myocardial injury. However, its prognostic value remains unclear. The purpose of this study was to investigate the incidence, risk factors, and clinical outcomes of troponin I (TnI) elevation after the implantation of drug-eluting stent (DES). SUBJECTS AND METHODS: We performed a retrospective analysis of 335 patients who had undergone PCI with DES. Patients who had acute coronary syndrome with elevated TnI levels before PCI were excluded. TnI levels were measured 6 and 24 hours after PCI. RESULTS: Baseline clinical characteristics were similar in the elevated TnI and normal TnI groups. Elevated postprocedural TnI (>1.5 ng/mL) occurred in 52 patients (15.5%). Univariate analysis revealed that the clinically significant variables were multi-vessel disease (p<0.001), multiple stent implantation (p=0.003), total stent length (p=0.001), side-branch occlusion (p<0.001), and bifurcation lesion (p=0.003). Multivariate analysis indicated that the independent predictors of elevated TnI after DES implantation were multi-vessel disease (p=0.019), side-branch occlusion (p=0.001), and bifurcation (p=0.011). There were no significant differences in major adverse cardiovascular events between the elevated TnI and normal TnI groups (p=0.461). CONCLUSION: Multi-vessel disease, side-branch occlusion, and bifurcation were independent predictors of elevated TnI following DES implantation. The elevation of TnI after successful PCI with DES was not associated with worse 400-day clinical outcomes.
Acute Coronary Syndrome ; Angioplasty, Balloon, Coronary ; Coronary Stenosis ; Drug-Eluting Stents ; Humans ; Incidence ; Multivariate Analysis ; Percutaneous Coronary Intervention ; Retrospective Studies ; Risk Factors ; Stents ; Troponin ; Troponin I

OBJECTIVE: To investigate the usefulness of cardiac biomarkers in the evaluation of prognosis and cardiac involvement (CI) in patients with acute aortic syndrome (AAS). METHODS: A total of 260 AAS patients with the measurements of cardiac biomarkers were divided into 2 groups; the survived (n=215, 60.6±13.7 years, 110 males) vs the dead (n=45, 64.5±13.6 years, 19 males). N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac specific troponin-I (cTnI), C-reactive protein (CRP), creatinine kinase (CK), MB fraction of CK (CK-MB), and D-dimer were compared. RESULTS: NT-proBNP and D-dimer were significantly elevated in the dead group than in the survived group (3558.7±5497.2 vs 949.9±2307.3 pg/mL, p<0.001, 4.5±5.1 vs 2.0±3.2 ug/mL, p<0.001, respectively). CI was observed in 59 patients (22.7%), and NT-proBNP was significantly elevated in patients with CI than in patients without CI (2497.7±4671.3 vs 722.5±1489.1 pg/mL, p=0.034). In univariate analysis, Stanford type A, CI, NT-proBNP, and D-dimer were significantly associated with mortality, but NT-proBNP was the only significant independent predictor of mortality in multivariate analysis. By receiver operating characteristic curve analysis, the optimal cut-off value to predict mortality was 517.0 pg/mL for NT-proBNP (area under the curve 0.797, sensitivity 86.7%, specificity 71.7%). CONCLUSION: The elevation of cardiac biomarkers is not infrequent in patients with AAS. NT-proBNP is significantly associated with CI and is an independent predictor of mortality in patients with AAS. The measurement of NT-proBNP would be useful in the risk stratification of AAS.
Biomarkers* ; C-Reactive Protein ; Creatinine ; Humans ; Mortality ; Multivariate Analysis ; Phosphotransferases ; Prognosis* ; ROC Curve ; Sensitivity and Specificity ; Troponin I

BACKGROUND: We aimed to compare the diagnostic accuracy of the Alere Triage Cardio3 Tropinin I (TnI) assay (Alere, Inc., USA) and the PathFast cTnI-II (Mitsubishi Chemical Medience Corporation, Japan) against the central laboratory assay Singulex Erenna TnI assay (Singulex, USA). METHODS: Using the Markers in the Diagnosis of Acute Coronary Syndromes (MIDAS) study population, we evaluated the ability of three different assays to identify patients with acute myocardial infarction (AMI). The MIDAS dataset, described elsewhere, is a prospective multicenter dataset of emergency department (ED) patients with suspected acute coronary syndrome (ACS) and a planned objective myocardial perfusion evaluation. Myocardial infarction (MI) was diagnosed by central adjudication. RESULTS: The C-statistic with 95% confidence intervals (CI) for diagnosing MI by using a common population (n=241) was 0.95 (0.91-0.99), 0.95 (0.91-0.99), and 0.93 (0.89-0.97) for the Triage, Singulex, and PathFast assays, respectively. Of samples with detectable troponin, the absolute values had high Pearson (R(P)) and Spearman (R(S)) correlations and were R(P)=0.94 and R(S)=0.94 for Triage vs Singulex, R(P)=0.93 and R(S)=0.85 for Triage vs PathFast, and R(P)=0.89 and R(S)=0.73 for PathFast vs Singulex. CONCLUSIONS: In a single comparative population of ED patients with suspected ACS, the Triage Cardio3 TnI, PathFast, and Singulex TnI assays provided similar diagnostic performance for MI.
Acute Coronary Syndrome/*diagnosis ; Biomarkers/analysis ; Emergency Service, Hospital ; Humans ; Laboratories/standards ; Myocardial Infarction/diagnosis ; *Point-of-Care Systems ; Prospective Studies ; Reagent Kits, Diagnostic ; Sensitivity and Specificity ; Troponin I/*analysis

BACKGROUND: There are several risk factors in the development of arteriosclerosis, including lipid parameters, inflammatory markers, and hemostatic factors. Efforts should be undertaken to identify the relationship among risk factors and underlying mechanisms of arteriosclerosis to improve long-term survival in dialysis patients. This study was performed to evaluate correlations among these risk factors and cardiac troponin T (cTnT) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). METHODS: Seventy-seven CAPD pateints (M: 50, F: 27; mean age 52.8+/-12.4 years) were enrolled in this study. We measured blood level of total cholesterol (TC), triglycerides (TG), HDL-cholesterol (HDL-C), apolipoprotein A-1 (apoA-1), apolipoprotein B (apoB), C-reactive protein (CRP), fibrinogen, d-dimer, von Willebrand factor (vWF), and cTnT monthly for three times. Thallium SPECT was performed in 32 of 77 patients. RESULTS: Significant positive correlation was found between CRP and fibrinogen (r=0.71, p<0.001). CRP was also positively correlated with vWF (r=0.29, p=0.01). Significant inverse correlation was observed between prealbumin and CRP (r=-0.33, p=0.004). HDL-C and apoA-1 were also inversely correlated with CRP (r=-0.26, p=0.04; r=-0,27, p=0.02) and apoB was positively correlated with CRP (r=0.24, p=0.02). Multivariate analysis revealed that fibrinogen, prealbumin, HDL-C, and apoA-1 correlated independently with CRP. In patients with diabetes (n=35), cTnT levels were sigificantly higher than those in patients without diabetes (p<0.001), whereas albumin and prealbumin levels were significantly lower in patients with diabetes than those in patients without diabetes (p<0.001, p=0.002). Serum apoB, triglyceride, and total cholesterol were higher among patients with positive results in thallium SPECT than those with negative results. CONCLUSION: It seems that inflammation is associated with an enhanced cardiovascular risk profile such as hemostatic factors and apolipoproteins. cTnT may be a useful predictive marker for mortality in dialysis patients.
Apolipoprotein A-I ; Apolipoproteins B ; Apolipoproteins* ; Arteriosclerosis ; C-Reactive Protein* ; Cholesterol ; Dialysis ; Fibrinogen ; Humans ; Inflammation ; Mortality ; Multivariate Analysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Prealbumin ; Risk Factors ; Thallium ; Tomography, Emission-Computed, Single-Photon ; Triglycerides ; Troponin T* ; Troponin* ; von Willebrand Factor

BACKGROUND AND OBJECTIVES: We investigated the predictors of the recovery of depressed left ventricular ejection fraction (LVEF) in patients with moderate or severe left ventricular (LV) systolic dysfunction after acute myocardial infarction (MI). SUBJECTS AND METHODS: We analyzed 1307 patients, who had moderately or severely depressed LVEF (<45%) on echocardiography soon after acute MI and who underwent a follow-up echocardiography, among 27369 patients from the Korea Working Group on the Myocardial Infarction Registry. Patients were categorized into two groups according to recovery of LVEF: group I with consistently depressed LVEF (<45%) at the follow-up echocardiography and group II with a recovery of LVEF (> or =45%). RESULTS: Recovery of LV systolic dysfunction was observed in 51% of the subjects (group II, n=663; DeltaLVEF, 16.2+/-9.3%), whereas there was no recovery in the remaining subjects (group I, n=644; DeltaLVEF, 0.6+/-7.1%). In the multivariate analysis, independent predictors of recovery of depressed LVEF were as follows {odds ratio (OR) [95% confidence interval (CI)]}: moderate systolic dysfunction {LVEF > or =30% and <45%; 1.73 (1.12-2.67)}, Killip class I-II {1.52 (1.06-2.18)}, no need for diuretics {1.59 (1.19-2.12)}, non-ST-segment elevation MI {1.55 (1.12-2.16)}, lower peak troponin I level {<24 ng/mL, median value; 1.55 (1.16-2.07)}, single-vessel disease {1.53 (1.13-2.06)}, and non-left anterior descending (LAD) culprit lesion {1.50 (1.09-2.06)}. In addition, the use of statin was independently associated with a recovery of LV systolic dysfunction {OR (95% CI), 1.46 (1.07-2.00)}. CONCLUSION: Future contractile recovery of LV systolic dysfunction following acute MI was significantly related with less severe heart failure at the time of presentation, a smaller extent of myonecrosis, or non-LAD culprit lesions rather than LAD lesions.
Diuretics ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Korea ; Multivariate Analysis ; Myocardial Infarction ; Prognosis ; Stroke Volume ; Troponin I

OBJECTIVE: The predictors of poor prognosis in heat stroke (HS) remain unknown. This study investigated the predictive factors of poor prognosis in patients with HS.METHODS: Data were obtained and analyzed from the health records of patients diagnosed with heat illness at Ajou university hospital between January 2008 and December 2017. Univariate and multivariate analyses were performed to identify the independent predictors of poor prognosis.RESULTS: Thirty-six patients (median age, 54.5 years; 33 men) were included in the study. Poor prognosis was identified in 27.8% of the study population (10 patients). The levels of S100B protein, troponin I, creatinine, alanine aminotransferase, and serum lactate were statistically significant in the univariate analysis. Multiple regression analysis revealed that poor prognosis was significantly associated with an increased S100B protein level (odds ratio, 177.37; 95% confidence interval, 2.59 to 12,143.80; P=0.016). The S100B protein cut-off level for predicting poor prognosis was 0.610 μg/L (area under the curve, 0.906; 95% confidence interval, 0.00 to 1.00), with 86% sensitivity and 86% specificity.CONCLUSION: An increased S100B protein level on emergency department admission is an independent prognostic factor of poor prognosis in patients with HS. Elevation of the S100B protein level represents a potential target for specific and prompt therapies in these patients.
Alanine Transaminase ; Biomarkers ; Creatinine ; Emergency Service, Hospital ; Heat Stroke ; Hot Temperature ; Humans ; Lactic Acid ; Multivariate Analysis ; Prognosis ; Sensitivity and Specificity ; Troponin I

BACKGROUND AND OBJECTIVES: Left ventricular (LV) remodeling (LVR) after an acute myocardial infarction (AMI) has important clinical implications. We have investigated the prognostic relevance of ventricular systolic dyssnchrony as an indicator of LVR after an AMI. SUBJECTS AND METHODS: We enrolled 92 patients (males, 72.8%; mean age, 61.0+/-13.0 years) with an AMI who underwent successful percutaneous coronary intervention. We analyzed the baseline characteristics, the laboratory and echocardiographic findings, and we performed follow-up echocardiography 6 months after the AMI. The patients were divided into two groups: 1) the presence of LVR, which was defined as an increment of LV end systolic volume (LVESV) >20% compared with the baseline examination; and 2) the absence of LVR. RESULTS: Twenty-seven patients (29.3%) developed LVR after a 6 month follow-up. There was no statistically significant difference in the clinical and angiographic findings between the two groups. With respect to the laboratory findings, the LVR group had a higher peak creatine kinase MB (CK-MB) (149.9+/-155.0 vs. 74.6+/-69.7 U/L, p=0.001) and troponin-I (70.2+/-73.3 vs. 43.2+/-39.5 ng/mL, p=0.024) level than the group without LVR. With respect to echocardiographic findings, the baseline LV ejection fraction (EF) and LVESV were not significantly different (LVESV, 73.0+/-37.3 vs. 91.3+/-52.0 mL, p=0.013; and EF, 58.3+/-13.3 vs. 55.6+/-11.8%, p=0.329) between the groups with and without LVR, respectively. The degree of LV dyssynchrony, which was assessed by tissue Doppler imaging, was significantly higher in the LVR group than the group without LVR (75.2+/-43.4 vs. 38.3+/-32.5 ms), and the degree of LV dyssynchrony was an independent predictor for LVR based on multivariate analysis {hazard ratio (HR)=0.097, p<0.001}. In receiver operating characteristics (ROC) curve analysis, the area under the curve (AUC) was 0.754 and a cutoff value of 45.9 predicted the development of LVR with 74.1% sensitivity and 72.3% specificity. CONCLUSION: The presence of LV dyssynchroncy immediately after a myocardial infarction is an important predictive factor for development LVR.
Creatine Kinase ; Echocardiography ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Myocardial Infarction ; Percutaneous Coronary Intervention ; ROC Curve ; Sensitivity and Specificity ; Troponin I ; Ventricular Remodeling

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

OBJECTIVETo investigate changes in serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor-binding protein-3 (IGFBP-3) and their significance in children with left-to-right shunt congenital heart disease (CHD) associated with heart failure (HF).

METHODSTwenty healthy children (control group), 20 children with HF, without basic heart disease (HF group), 20 children with left-to-right shunt CHD, without HF (CHD group), and 30 children with left-to-right shunt CHD associated with HF (CHD+HF group) were included in the study. These groups were compared in terms of serum IGF-1 and IGFBP-3 levels. According to the New York Heart Association (NYHA) Functional Classification, the CHD+HF group was further divided into NYHA-II, NYHA-III and NYHA-IV subgroups and the subgroups were compared in terms of serum IGF-1, IGFBP-3, and cardiac troponin I (cTnI) levels. The correlation of serum IGF-1 and IGFBP-3 levels with serum cTnI level in the CHD+HF group was analyzed.

RESULTSThe CHD group showed decreased serum IGF-1 and IGFBP-3 levels compared with the control group (P<0.01). The CHD+HF group showed a significantly decreased serum IGF-1 level compared with the control group (P<0.01) and CHD group (P<0.05). The HF group had significantly increased serum IGF-1 and IGFBP-3 levels compared with other groups (P<0.01). The NYHA-II subgroup had the highest serum IGF-1 level and the NYHA-IV subgroup had the lowest serum IGF-1 level (P<0.01). In the CHD+HF group, serum IGF-1 and IGFBP-3 levels were negatively correlated with serum cTnI level (r=-0.692, P<0.05; r=-0.530, P<0.05).

CONCLUSIONSSerum IGF-1 level can be used as an objective condition evaluation indicator for CHD, and low serum IGF-1 level is a risk factor for HF. This also provides a clinical basis for treatment of HF using exogenous IGF-1.

Child, Preschool ; Female ; Heart Defects, Congenital ; blood ; Heart Failure ; blood ; Humans ; Infant ; Insulin-Like Growth Factor Binding Protein 3 ; blood ; Insulin-Like Growth Factor I ; analysis ; Male ; Troponin I ; blood

BACKGROUND: High-sensitivity cardiac troponin I (hs-cTnI) and the soluble isoform of suppression of tumorigenicity 2 (sST2) are useful prognostic biomarkers in acute coronary syndrome (ACS). The aim of this study was to test the short term prognostic value of sST2 compared with hs-cTnI in patients with chest pain. METHODS: Assays for hs-cTnI and sST2 were performed in 157 patients admitted to the Emergency Department (ED) for chest pain at arrival. In-hospital and 30-day follow-up mortalities were assessed. RESULTS: The incidence of ACS was 37%; 33 patients were diagnosed with ST elevation myocardial infarction (STEMI), and 25 were diagnosed with non-ST elevation myocardial infarction (NSTEMI). Compared with the no acute coronary syndrome (NO ACS) group, the median level of hs-cTnI was higher in ACS patients: 7.22 (5.24-14) pg/mL vs 68 (15.33-163.50) pg/mL (P<0.0001). In all patients, the sST2 level at arrival showed higher independent predictive power than hs-cTnI (odds ratio [OR] 20.13, P<0.0001 and OR 2.61, P<0.0008, respectively). sST2 at ED arrival showed a greater prognostic value for cardiovascular events in STEMI (area under the curve [AUC] 0.80, P<0.001) than NSTEMI patients (AUC 0.72, P<0.05). Overall, 51% of the STEMI patients with an sST2 value>35 ng/mL at ED arrival died during the 30-day follow-up. CONCLUSIONS: sST2 has a greater prognostic value for 30-day cardiac mortality after discharge in patients presenting to the ED for chest pain compared with hs-cTnI. In STEMI patients, an sST2 value >35 ng/mL at ED arrival showed the highest predictive power for short-term mortality.
Acute Coronary Syndrome/diagnosis/*mortality ; Aged ; Area Under Curve ; Biomarkers/analysis ; Chest Pain ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Humans ; Interleukin-1 Receptor-Like 1 Protein/*analysis ; Male ; Middle Aged ; Odds Ratio ; Prognosis ; ROC Curve ; Troponin I/*analysis