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

OBJECTIVETo evaluate the effect of treatment with Qishen Yiqi Dripping Pills (, QSYQ) on myocardial injury and myocardial microvascular function in patients undergoing elective percutaneous coronary intervention (PCI).

METHODSEighty patients undergoing elective PCI were randomly assigned to QSYQ and control groups. The QSYQ group received QSYQ at a dosage of 0.5 g 3 times daily (3-7 days before PCI and then daily for 1 month) and regular medication, which comprised of aspirin, clopidogrel, statin, β-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker in the absence of contradiction. The control group received only the regular medication. The index of microcirculatory resistance (IMR) was measured at maximal hyperemia after PCI. The fractional flow reserve was measured before and after the procedure. Troponin I levels were obtained at baseline and 20-24 h after the procedure.

RESULTSPre-PCI troponin I levels between the two groups were similar (0.028±0.05 vs. 0.022±0.04 ng/mL, P=0.55). However, post- PCI troponin I levels in the QSYQ group were significantly lower than that in the control group (0.11±0.02 vs. 0.16±0.09 ng/mL, P<0.01). IMR values were significantly lower in the QSYQ group as compared to the control group (16.5±6.1 vs. 31.2±16.0, P<0.01). Multivariate analysis identified QSYQ treatment as the only independent protective factor against IMR >32 (odds ratio=0.29, 95% confidence interval: 0.11-0.74, P=0.01).

CONCLUSIONSThe present study demonstrated the benefit of QSYQ in reducing myocardial injury and preserving microvascular function during elective PCI.

Aged ; Coronary Angiography ; Coronary Circulation ; drug effects ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Humans ; Male ; Microvessels ; diagnostic imaging ; drug effects ; physiopathology ; Middle Aged ; Multivariate Analysis ; Myocardium ; pathology ; Percutaneous Coronary Intervention ; Pilot Projects ; 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

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 AND OBJECTIVES: Carbon monoxide (CO) poisoning can cause tissue hypoxia and left ventricular systolic dysfunction (LVSD) requiring intensive medical management. Our objectives were to find incidence and clinical course of LVSD CO intoxicated patients and make a clinical scoring to predict LVSD. SUBJECTS AND METHODS: We included all consecutive patients with CO exposure in the emergency room. LVSD was defined by LVEF <50% assessed by echocardiography. We compared their clinical, chemical, radiological and electrocardiographic patterns according to the presence of LVSD. RESULTS: From May 2009 to June 2015, we included a total of 81 patients (48 men, 47±19 years old) with CO exposure in this cohort. LVSD was found in about 25 patients (31%). Nine had regional wall motion abnormality. Follow up echocardiographic examinations were available in 21 patients. Of them, 18 patients showed complete recovery in about 3 days (mean 2.8±1.7 days). Of 3 patients without recovery, 2 had significant coronary artery stenosis. LVSD was significantly associated with initial heart rate (>100/min), pulmonary edema on chest X-ray, serum NT pro-BNP (>100 pg/mL), troponin-I (>0.1 ng/mL) and lactic acid (>4.0 mg/dL) after a univariate analysis. Combining these into a clinical score, according to their beta score after a multivariate analysis (rage=0-16), allowed prediction of LVSD with a sensitivity of 84% and specificity of 91% (reference ≥8, area under the curve=0.952, p<0.001) CONCLUSION: About 31% showed LVSD in patients with CO poisoning, and most of them (86%, 18 of 21 patients) recovered within 3 days. Patients with a higher clinical score (≥8) might have LVSD.
Anoxia ; Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Cohort Studies ; Coronary Stenosis ; Echocardiography ; Electrocardiography ; Emergency Service, Hospital ; Follow-Up Studies ; Heart Rate ; Humans ; Incidence* ; Lactic Acid ; Male ; Multivariate Analysis ; Poisoning ; Pulmonary Edema ; Sensitivity and Specificity ; Thorax ; Troponin I ; Ventricular Dysfunction, Left

OBJECTIVETo evaluate the predictive value of serum iron level for in-hospital acute heart failure (AHF) after acute ST-elevated myocardial infarction (STEMI).

METHODSThis retrospective study involved 287 patients with STEMI stratified by quartiles of admission serum iron concentration. The incidence of AHF was assessed by serum iron quartiles. We evaluated the association of serum iron levels with B-type natriuretic peptide (BNP), cardiac troponin I (cTnI), and high-sensitivity C-reactive protein (hs-CRP) levels on admission, and analyzed the correlation of serum iron levels with in-hospital AHF, death, and duration of hospital stay.

RESULTSThe average serum iron level on admission of the 287 STEMI patients was 10.20 µmol/L (6.90-14.40 µmol/L), and the quartiles (Q) of serum iron levels were ≤6.90 µmol/L (Q(1)), 6.91-10.19 µmol/L (Q(2)), 10.20-14.39 µmol/L (Q(3)), and ≥14.40 µmol/L (Q(4)). The incidences of in-hospital AHF from Q(1) to Q(4) were 79.5%, 64.3%, 50.0% and 45.9%, respectively (P<0.001). Univariate logistic regression analysis showed that low admission serum iron level (Q(1)) was an independent predictor for in-hospital AHF (OR=3.358, 95%CI 1.791- 6.294, P<0.001), and multivariate logistic regression analysis showed a similar result (OR=2.316, 95%CI 1.205-4.453, P=0.012).

CONCLUSIONSA lower admission serum iron level is an independent predictor of AHF in STEMI patients during hospitalization.

Acute Disease ; C-Reactive Protein ; analysis ; Heart Failure ; blood ; diagnosis ; Hospitalization ; Humans ; Incidence ; Iron ; blood ; Myocardial Infarction ; blood ; Natriuretic Peptide, Brain ; analysis ; Predictive Value of Tests ; Retrospective Studies ; Troponin I ; analysis

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

Cardiac Surgical Procedures ; methods ; Child ; Child, Preschool ; Combined Modality Therapy ; Coronary Aneurysm ; diagnosis ; etiology ; therapy ; Coronary Artery Disease ; diagnosis ; etiology ; therapy ; Coronary Thrombosis ; prevention & control ; Echocardiography ; Humans ; Mucocutaneous Lymph Node Syndrome ; complications ; Platelet Aggregation Inhibitors ; therapeutic use ; Thrombolytic Therapy ; methods ; Troponin I ; analysis

Anthracyclines ; administration & dosage ; adverse effects ; Antineoplastic Agents ; administration & dosage ; adverse effects ; Biomarkers ; blood ; Cardiomyopathies ; chemically induced ; diagnosis ; prevention & control ; Cardiotonic Agents ; therapeutic use ; Child ; Child, Preschool ; Echocardiography ; Heart ; drug effects ; Heart Diseases ; chemically induced ; diagnosis ; prevention & control ; Humans ; Risk Factors ; Survival Analysis ; Troponin I ; analysis