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Búsqueda Bibliografica: hs TROPONINAS – Parte IV

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58. Ann Emerg Med. 2024 Oct;84(4):399-408. doi: 10.1016/j.annemergmed.2024.04.024.Epub 2024 Jun 15.

Rapid Acute Coronary Syndrome Evaluation Over One Hour With High-Sensitivity
Cardiac Troponin I: A United States-Based Stepped-Wedge, Randomized Trial.

Miller J(1), Cook B(1), Gandolfo C(2), Mills NL(3), Mahler S(4), Levy P(5), Parikh S(2), Krupp S(1), Nour K(2), Klausner H(1), Gindi R(2), Lewandowski A(6), Hudson M(2), Perrotta G(1), Zweig B(2), Lanfear D(2), Kim H(2), Dangoulian S(5), Tang A(1), Todter E(1), Khan A(1), Keerie C(3), Bole S(1), Nasseredine H(1), Oudeif A(1), Abou Asala E(1), Mohammed M(1), Kazem A(1), Malette K(1),
Singh-Kucukarslan G(1), Xu N(5), Wittenberg S(5), Morton T(1), Gunaga S(7), Affas Z(8), Tabbaa K(8), Desai P(5), Alsaadi A(1), Mahmood S(1), Schock A(1), Konowitz N(1), Fuchs J(1), Joyce K(1), Shamoun L(4), Babel J(3), Broome A(4), Digiacinto G(7), Shaheen E(7), Darnell G(1), Muller G(7), Heath G(1), Bills G(6), Vieder J(1), Rockoff S(6), Kim B(9), Colucci A(8), Plemmons E(7), McCord J(10); RACE-IT Research Group.

Author information:
(1)Henry Ford Hospital, Detroit, MI.
(2)Heart and Vascular Institute Henry Ford Health, Detroit, MI.
(3)The Usher Institute, University of Edinburgh, Edinburgh, UK.
(4)Wake Forest University School of Medicine Winston-Salem, NC.
(5)Wayne State University School of Medicine, Detroit, MI.
(6)Henry Ford West Bloomfield Hospital, West Bloomfield, MI, USA.
(7)Henry Ford Wyandotte Hospital Wyandotte, MI.
(8)Henry Ford Macomb Hospital, Clinton Township, MI.
(9)Henry Ford Allegiance Hospital, Jackson, MI.
(10)Heart and Vascular Institute Henry Ford Health, Detroit, MI. 

STUDY OBJECTIVE: The real-world effectiveness and safety of a 0/1-hour accelerated protocol using high-sensitivity cardiac troponin (hs-cTn) to exclude myocardial infarction (MI) compared to routine care in the United States is uncertain. The objective was to compare a 0/1-hour accelerated protocol for evaluation of MI to a 0/3-hour standard care protocol.
METHODS: The RACE-IT trial was a stepped-wedge, randomized trial across 9 emergency departments (EDs) that enrolled 32,609 patients evaluated for possible MI from July 2020 through April 2021. Patients undergoing high-sensitivity cardiac troponin I testing with concentrations less than or equal to 99th percentile were included. Patients who had MI excluded by the 0/1-hour protocol
could be discharged from the ED. Patients in the standard care protocol had 0- and 3-hour troponin testing and application of a modified HEART score to be eligible for discharge. The primary endpoint was the proportion of patients discharged from the ED without 30-day death or MI.
RESULTS: There were 13,505 and 19,104 patients evaluated in the standard care and accelerated protocol groups, respectively, of whom 19,152 (58.7%) were discharged directly from the ED. There was no significant difference in safe discharges between standard care and the accelerated protocol (59.5% vs 57.8%; adjusted odds ratio (aOR)=1.05, 95% confidence interval [CI] 0.95 to 1.16). At 30 days, there were 90 deaths or MIs with 38 (0.4%) in the standard care group and 52 (0.4%) in the accelerated protocol group (aOR=0.84, 95% CI 0.43 to 1.68).
CONCLUSION: A 0/1-hour accelerated protocol using high-sensitivity cardiac troponin I did not lead to more safe ED discharges compared with standard care.

DOI: 10.1016/j.annemergmed.2024.04.024
PMID: 38888531 [Indexed for MEDLINE]

59. BMJ Open. 2024 Jun 13;14(6):e083752. doi: 10.1136/bmjopen-2023-083752.

Protocol for Improving Care by FAster risk-STratification through use of high sensitivity point-of-care troponin in patients presenting with possible acute coronary syndrome in the EmeRgency department (ICare-FASTER): a stepped-wedge cluster randomised quality improvement initiative.

Pickering JW(1)(2), Devlin G(3)(4), Body R(5), Aldous S(6), Jaffe AS(7), Apple FS(8), Mills N(9), Troughton RW(1)(6), Kavsak P(10), Peacock WF(11), Cullen L(12)(13), Lord SJ(14)(15), Müller C(16), Joyce L(2)(17), Frampton C(1), Lacey CJ(18), Richards AM(1), Pitama S(18), Than M(19)(2).

Author information:
(1)Medicine, University of Otago Christchurch, Christchurch, New Zealand.
(2)Emergency, Christchurch Hospital, Christchurch, New Zealand.
(3)Waikato District Health Board, Hamilton, New Zealand.
(4)Heart Foundation of New Zealand, Auckland, New Zealand.
(5)Division of Cardiovascular Sciences, University of Manchester, The Victoria
University of Manchester Campus, Manchester, UK.
(6)Cardiology, Christchurch Hospital, Christchurch, New Zealand.
(7)Mayo Clinic Minnesota, Rochester, UK.
(8)University of Minnesota, Minneapolis, Minnesota, USA.
(9)The University of Edinburgh Centre for Cardiovascular Science, Edinburgh, UK.
(10)McMaster University, Hamilton, UK.
(11)Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.
(12)Institute of Health and Biomedical Innovation and School of Public Health, Queensland University of Technology, Brisbane, Australia.
(13)Emergency and Trauma Centre, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia.
(14)The School of Medicine, University of Notre Dame Australia - Darlinghurst Campus, Darlinghurst, New South Wales, Australia.
(15)NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia.
(16)Division of Cardiology, University Hospital Basel, Basel, Switzerland.
(17)Surgery and Critical Care, University of Otago Christchurch, Christchurch, New Zealand.
(18)Māori Indigenous Health Institute, University of Otago Christchurch, Christchurch, New Zealand.
(19)Medicine, University of Otago Christchurch, Christchurch, New Zealand
.

INTRODUCTION: Clinical assessment in emergency departments (EDs) for possible acute myocardial infarction (AMI) requires at least one cardiac troponin (cTn) blood test. The turn-around time from blood draw to posting results in the clinical portal for central laboratory analysers is ~1-2hours. New generation, high-sensitivity, point-of-care cardiac troponin I (POC-cTnI) assays use whole blood on a bedside (or near bedside) analyser that provides a rapid (8 min) result. This may expedite clinical decision-making and reduce length of stay.
Our purpose is to determine if utilisation of a POC-cTnI testing reduces ED length of stay. We also aim to establish an optimised implementation process for the amended clinical pathway.
METHODS AND ANALYSIS: This quality improvement initiative has a pragmatic multihospital stepped-wedge cross-sectional cluster randomised design. Consecutive patients presenting to the ED with symptoms suggestive of possible AMI and having a cTn test will be included. Clusters (comprising one or two hospitals each) will change from their usual-care pathway to an amended pathway
using POC-cTnI-the 'intervention'. The dates of change will be randomised. Changes occur at 1 month intervals, with a minimum 2 month 'run-in' period. The intervention pathway will use a POC-cTnI measurement as an alternate to the laboratory-based cTn measurement. Clinical decision-making steps and logic will otherwise remain unchanged. The POC-cTnI is the Siemens (Erlangen Germany)
Atellica VTLi high-sensitivity cTnI assay. The primary outcome is ED length of stay. The safety outcome is cardiac death or AMI within 30 days for patients discharged directly from the ED.
ETHICS AND DISSEMINATION: Ethics approval has been granted by the New Zealand Southern Health and Disability Ethics Committee, reference 21/STH/9. Results will be published in a peer-reviewed journal. Lay and academic presentations will be made. Māori-specific results will be disseminated to Māori stakeholders.
TRIAL REGISTRATION NUMBER: ACTRN12619001189112.

© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2023-083752
PMCID: PMC11177684
PMID: 38871661 [Indexed for MEDLINE]

60. Cardiovasc Drugs Ther. 2025 Oct;39(5):1045-1052. doi: 10.1007/s10557-024-07594-w. Epub 2024 Jun 12.

Cardioprotection with Intralipid During Coronary Artery Bypass Grafting Surgery on Cardiopulmonary Bypass: A Randomized Clinical Trial.

Hadebe N(1)(2), Cour M(1), Imamdin A(1), Petersen T(1), Pennel T(3), Scherman J(3), Snowball J(1), Ntsekhe M(4), Zilla P(3), Swanevelder J(2), Lecour S(5).

Author information:
(1)Cardioprotection Group, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa.
(2)Department of Anaesthesia, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
(3)Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa.
(4)Division of Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
(5)Cardioprotection Group, Faculty of Health Sciences, Cape Heart Institute,University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa.
.
PURPOSE: Coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CPB) is associated with myocardial ischemia-reperfusion injury (IRI), which may limit the benefit of the surgery. Both experimental and clinical studies suggest that Intralipid, a lipid emulsion commonly used for parenteral nutrition, can limit myocardial IRI. We therefore aimed to investigate whether Intralipid
administered at reperfusion can reduce myocardial IRI in patients undergoing CABG on CPB.
METHODS: We conducted a randomized, double-blind, pilot trial in which 29 adult patients scheduled for CABG were randomly assigned (on a 1:1 basis) to receive either 1.5Â ml/kg Intralipid 20% or Ringer's Lactate 3Â min before aortic cross unclamping. The primary endpoint was the 72-h area under the curve (AUC) for troponin I.
RESULTS: Of the 29 patients randomized, 26 were included in the study (two withdrew consent and one was excluded before surgery). The 72-h AUC for troponin I did not significantly differ between the control and Intralipid group (546437 205518 versus 487561 15724 arbitrary units, respectively;
P=0.804). Other outcomes (including 72-h AUC for CK-MB, C-reactive protein, need for defibrillation, time to extubation, length of ICU and hospital stay, and serious adverse events) were similar between the two groups.
CONCLUSION: In patients undergoing CABG on CPB, Intralipid did not limit myocardial IRI compared to placebo.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02807727 (registration date: 16 June 2016).

DOI: 10.1007/s10557-024-07594-w
PMCID: PMC12602576
PMID: 38864969 [Indexed for MEDLINE]

61. Phlebology. 2024 Oct;39(9):619-628. doi: 10.1177/02683555241261321. Epub 2024 Jun 11.

Elevation of cardiac enzymes and B-type natriuretic peptides following venous recanalization and stenting in chronic venous obstruction.

Yan Y(1), Barbati ME(1), Avgerinos ED(2), Doganci S(3), Lichtenberg M(4), Jalaie H(1).

Author information:
(1)Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany.
(2)Department of Vascular and Endovascular Surgery, Athens Medical Center, Athens, Greece.
(3)Department of Cardiovascular Surgery, University of Health Sciences, Ankara, Turkey.
(4)Department Angiology, Klinikum Hochsauerland, Arnsberg, Germany.

BACKGROUND: B-type natriuretic peptides (BNP) and cardiac enzymes are both recognized biomarkers of heart health. Many studies have reported that using these indicators can assess cardiac condition and predict prognosis of patients undergoing surgery. Currently little is known on the effect of increased cardiac input after venous recanalization on cardiac physiology in patients with chronic venous obstruction (CVO).
OBJECTIVES: The aim of this study was to explore the effect of iliocaval recanalization and stenting on cardiac biomarkers in patients with CVO.
METHODS: This was a prospective study involving 60 patients in a single unit. Blood tests were collected 1Â day before and 1Â day after venous intervention.
Three groups as group 1: patients with iliofemoral post-thrombotic syndrome (PTS) but without involvement of inferior vena cava (IVC) (n = 33); group 2: patients with iliofemoral PTS and involvement of IVC (n = 19) and group 3: patients with non-thrombotic vein lesion (NIVL) (n = 8) were compared based on cardiac biomarker levels.
RESULTS: Median concentration of post-operative BNP (259.60Â pg/mL) was greater than preoperative levels (49.80Â pg/mL) [interquartile range (IQR), 147.15/414.68 versus 29.85/82.88; p < 0.001]. The levels of CK-MB [preop: 3Â U/l (IQR,
1.40/11.00) versus postop: 14Â U/l (IQR, 12/17), p < 0.001] and troponin T [preop: 3.00Â pg/mL (IQR, 3.00/5.25) versus postop: level of 6Â pg/mL (IQR, 3.00/9.50), p < 0.001]. Post-procedure increases in cardiac enzymes showed significant differences in BNP (p = 0.023) and troponin T (p = 0.007) across the three groups, while CK-MB levels were not significantly different (p > 0.05).
Intergroup comparisons of postoperative BNP: group 1 versus group 2 (p = 0.013), group 2 versus group 3 (p = 0.029), group 1 versus group 3 (p = 0.834); and postoperative troponin T: group 1 versus group 2 (p = 0.018), group 2 versus group 3 (p = 0.002), group 1 versus group 3 (p = 0.282). According to multiple linear regression analysis, length of stenting and level of preoperative BNP
were independent determinants of postoperative BNP levels (p < 0.05), and preoperative troponin T affected postoperative troponin T independently (p <0.05).
CONCLUSIONS: Troponin T, CK-MB and BNP seem to increase after venous recanalization and stent implantation, the elevation being more prominent for longer lesions.

DOI: 10.1177/02683555241261321
PMID: 38862920 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the
research, authorship, and/or publication of this article.

62. Eur Heart J Acute Cardiovasc Care. 2024 Aug 28;13(8):595-601. doi: 10.1093/ehjacc/zuae074.

Prehospital tirofiban increases the rate of disrupted myocardial infarction in patients with ST-segment elevation myocardial infarction: insights from the On-TIME 2 trial.

Rikken SAOF(1)(2), Fabris E(3), Rosenqvist T(2)(4), Giannitsis E(5), Ten Berg JM(1)(2)(6), Hamm C(7), van 't Hof A(4)(6).

Author information:
(1)Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
(2)Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
(3)Cardiothoracovascular Department, University of Trieste, Trieste, Italy.
(4)Department of Cardiology, Zuyderland Medical Center, Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands.
(5)Department of Cardiology, Universitaetsklinik, Heidelberg, Germany.
(6)Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
(7)Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany.

AIMS: In patients with ST-segment elevation myocardial infarction (STEMI), prehospital tirofiban significantly improved myocardial reperfusion. However, its impact on the rate of disrupted myocardial infarction (MI), particularly in the context of high-sensitivity cardiac troponin (hs-cTn) assays, is still unclear.
METHODS AND RESULTS: The On-TIME 2 (Ongoing Tirofiban In Myocardial infarction Evaluation 2) trial randomly assigned STEMI patients to prehospital tirofiban or placebo before transportation to a percutaneous coronary intervention (PCI) centre. In this post hoc analysis, we evaluated STEMI patients that underwent primary PCI and had measured hs-cTn levels. Troponin T levels were collected at 18-24 and 72-96 h after PCI. Disrupted MI was defined as peak hs-cTn T levels 10 times the upper limit of normal (140 ng/L). Out of 786 STEMI patients, 47 (6%) had a disrupted MI. Disrupted MI occurred in 31 of 386 patients (8.0%) in the tirofiban arm and in 16 of 400 patients (4.0%) in the placebo arm (P = 0.026). After multivariate adjustment, prehospital tirofiban remained independently associated with disrupted MI (odds ratio 2.03; 95% confidence interval 1.10-3.87; P = 0.027). None of the patients with disrupted MI died
during the 1-year follow-up, compared with a mortality rate of 2.6% among those without disrupted MI.
CONCLUSION: Among STEMI patients undergoing primary PCI, the use of prehospital
tirofiban was independently associated with a higher rate of disrupted MI. These results, highlighting a potential benefit, underscore the need for future research focusing on innovative pre-treatment approaches that may increase the rate of disrupted MI.

DOI: 10.1093/ehjacc/zuae074
PMCID: PMC11350433
PMID: 38845559 [Indexed for MEDLINE]

63. Am J Cardiol. 2024 Aug 15;225:118-124. doi: 10.1016/j.amjcard.2024.05.033. Epub 2024 Jun 4.

Cardiometabolic Co-morbidity Burden and Circulating Biomarkers in Patients With Chronic Coronary Disease in the ISCHEMIA Trials.

Hamo CE(1), Liu R(2), Wu W(2), Anthopolos R(2), Bangalore S(3), Held C(4), Kullo I(5), Mavromatis K(6), McManus B(7), Newby LK(8), Reynolds HR(3), Ruggles KV(3), Wallentin L(4), Maron DJ(9), Hochman JS(3), Newman JD(3), Berger JS(3); ISCHEMIA Biorepository Research Group.

Author information:
(1)Department of Medicine, NYU Grossman School of Medicine, New York, New York.
(2)Division of Biostatistics, Department of Population Health, NYU Langone Health, New York, New York.
(3)Department of Medicine, NYU Grossman School of Medicine, New York, New York.
(4)Department of Medical Sciences, Cardiology, Uppsala University; Uppsala, Sweden.
(5)Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
(6)Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
(7)Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
(8)Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina.
(9)Department of Medicine, Stanford University, Stanford, California.

Cardiometabolic co-morbidities, diabetes (DM), hypertension (HTN), and obesity contribute to cardiovascular disease. Circulating biomarkers facilitate prognostication for patients with cardiovascular disease. We explored the relation between cardiometabolic co-morbidity burden in patients with chronic coronary disease and biomarkers of myocardial stretch, injury, inflammation, and platelet activity. We analyzed participants from the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trials biorepository with plasma biomarkers (N-terminal probrain natriuretic peptide, high-sensitivity cardiac troponin T, high-sensitivity C-reactive protein, interleukin-6, soluble CD40 ligand, and growth differentiation factor-15) and clinical risk factors (hemoglobin A1c [HbA1c], systolic blood pressure [SBP], and body mass index [BMI]) at baseline. We defined cardiometabolic co-morbidities as DM, HTN, and obesity at baseline. Co-morbidity burden is characterized by the number and severity of co-morbidities. Controlled co-morbidities were defined as HbA1c <7% for those with DM, SBP <130 mm Hg for those with HTN, and BMI <30 kg/m2. Severely uncontrolled was defined as HbA1c 8%, SBP 160 mm Hg, and BMI 35 kg/m2. We performed linear regression analyses to examine the association between co-morbidity burden and log-transformed biomarker levels, adjusting for age, gender, estimated glomerular filtration rate controlled for hemodialysis, and left ventricular ejection fraction. A total of 752 participants (mean age 66 years, 19% women, 84% White) were
included in this analysis. Self-reported Black race, current smokers, history of myocardial infarction, and heart failure had a greater cardiometabolic co-morbidity burden. The presence of ≥1 severely uncontrolled co-morbidity was associated with significantly higher baseline levels of high-sensitivity cardiac troponin T, high-sensitivity C-reactive protein, interleukin-6, and growth differentiation factor-15 than participants with no co-morbidities.
In conclusion, increasing cardiometabolic co-morbidity burden in patients with chronic coronary disease is associated with higher levels of circulating biomarkers of myocardial injury and inflammation.

DOI: 10.1016/j.amjcard.2024.05.033
PMCID: PMC11290975
PMID: 38844195 [Indexed for MEDLINE]

64. J Pak Med Assoc. 2024 May;74(5):917-921. doi: 10.47391/JPMA.9981.

Assessment of cardiac parameters after the administration of nicorandil before primary percutaneous coronary intervention.

Ilyas M(1), Noor M(1), Haroon S(2), Farhat K(1), Ali S(1), Wahid M(1).

Author information:
(1)Department of Pharmacology, Army Medical College, Rawalpindi, Pakistan.
(2)Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan.

OBJECTIVE: To assess cardiac troponin I and creatine kinase-myocardial band levels, electrocardiogram changes and major adverse cardiac events after treatment with nicorandil before primary percutaneous coronary intervention.
METHODS: The comparative, analytical study was conducted from October to November 2022 at the Pharmacology Department of Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan, in collaboration with the Rawalpindi Institute of Cardiology, Rawalpindi. The sample comprised ST-elevated myocardial infarction patients of either gender aged at least 30 years with an
ejection fraction of at least 35% undergoing primary percutaneous coronary intervention. Participants were selected based on the above-mentioned inclusion and informed consent was taken before their enrolment in this research study.
The sample was randomised into control group A receiving conventional acute coronary syndrome treatment, and intervention group B receiving nicorandil in addition to the conventional treatment. Cardiac troponin I and creatine kinase-myocardial band levels, electrocardiogram changes, and major adverse cardiac events noted and compared. Data was analysed using SPSS 26.
RESULTS: Of the 140 patients, 70(50%) were in each of the 2 groups. In group B, 60(85.7%) patients achieved a completely settled ST segment on electrocardiogram compared to 25(35.7%) in group A (p=0.001). There was a significant inter-group
difference with respect to cardiac troponin I value 6 hours after percutaneous coronary intervention and major adverse cardiac events (p<0.05), but creatine kinase-myocardial band level was no significantly different between the groups (p=0.761).
CONCLUSION: Prophylactic use of nicorandil in ST-elevated myocardial infarction patients decreased the incidence of reperfusion injury.

DOI: 10.47391/JPMA.9981
PMID: 38783440 [Indexed for MEDLINE]

65. Eur J Heart Fail. 2024 Jun;26(6):1393-1398. doi: 10.1002/ejhf.3199. Epub 2024 May 11.

Sacubitril/valsartan and cardiovascular biomarkers among patients with recent COVID-19 infection: The PARACOR-19 randomized clinical trial.

Greene SJ(1)(2), Chambers R(3), Lerman JB(2), Harrington J(2), deFilippi CR(4), Wendell DC(2), Kim HW(2), Green CL(2), Butler J(5)(6), Felker GM(1)(2).

Author information:
(1)Duke Clinical Research Institute, Durham, NC, USA.
(2)Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.
(3)University of Virginia School of Medicine, Charlottesville, VA, USA.
(4)Inova Schar Heart and Vascular Institute, Falls Church, VA, USA.
(5)Baylor Scott and White Research Institute, Dallas, TX, USA.
(6)Department of Medicine, University of Mississippi, Jackson, MS, USA.

AIMS: The PARACOR-19 randomized controlled trial (RCT) was designed to examine the effects of sacubitril/valsartan on markers of cardiac injury, inflammation, structure and function among patients who have recovered from acute coronavirus disease 2019 (COVID-19)infection.
METHODS AND RESULTS: PARACOR-19 was a single-centre, double-blind RCT of patients with cardiovascular risk factors and a history of COVID-19 infection 4-16 weeks prior to enrolment. Patients were randomized to sacubitril/valsartan (titrated to the maximum dose of 97/103mg twice daily) versus matching placebo.
Co-primary endpoints were change from baseline to 12 weeks in high-sensitivity cardiac troponin T (hs-cTnT) and soluble ST2 (sST2). Exploratory endpoints included change from baseline to 12 weeks in additional circulating biomarkers. Overall, 42 patients were randomized between August 2021 and March 2023 (n=20 sacubitril/valsartan, n=2 placebo). Median (25th-75th) time from COVID-19
diagnosis to enrolment was 67 (48-80) days. Median age was 67 (62-71) years, 48% were female, and 91% were White. Compared with placebo, sacubitril/valsartan did not have a significant effect on the co-primary endpoints of change from baseline in hs-TnT and sST2 (all p=0.29). In exploratory analyses, sacubitril/valsartan led to a 46% greater reduction in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and 51% greater reduction in C-terminal telopeptide of collagen type I (CITP). Permanent drug discontinuation occurred
in four patients in the sacubitril/valsartan group and three patients in the placebo group. There were no deaths and one patient was hospitalized in each group.
CONCLUSION: In this pilot RCT of patients who recovered from acute COVID-19, sacubitril/valsartan did not lower hs-cTnT or sST2 compared with placebo. Exploratory analyses suggested potential benefits of sacubitril/valsartan on cardiac wall stress and collagen turnover as measured by NT-proBNP and CITP. Sacubitril/valsartan was well tolerated.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT04883528.

DOI: 10.1002/ejhf.3199
PMID: 38733160 [Indexed for MEDLINE]

66. J Am Heart Assoc. 2024 May 21;13(10):e034776. doi: 10.1161/JAHA.123.034776. Epub 2024 May 10.

Prognostic Value and Determinants of High-Sensitivity Cardiac Troponin T in Patients With a Systemic Right Ventricle: Insights From the SERVE Trial.

Ruperti-Repilado FJ(1)(2), Tran F(2), Haaf P(1), Lopez-Ayala P(2), Greutmann M(3), Schwerzmann M(4)(5), Bouchardy J(6)(7), Gabriel H(8), Stambach D(9), Rutz T(4), Schwitter J(6)(10)(11), Wustmann K(6)(10)(12), Freese M(2), Mueller C(1)(2), Tobler D(1).

Author information:
(1)Division of Cardiology University Hospital of Basel Basel Switzerland.
(2)Division of Cardiology Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland Basel Switzerland.
(3)Department of Cardiology University Heart Center, University of Zurich Zurich Switzerland.
(4)University Clinic of Cardiology, Center for Congenital Heart Disease Inselspital, University Hospital Bern Switzerland.
(5)Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.
(6)Division of Cardiology Lausanne University Hospital Lausanne Switzerland.
(7)Division of Cardiology Hôpitaux Universitaires de Genève (HUG) Genève Switzerland.
(8)Department of Cardiology Medical University of Vienna, Adult Congenital Heart Disease Program Vienna Austria.
(9)Department of Cardiology Kantonsspital St Gallen St Gallen Switzerland.
(10)Cardiac MR Center of the University Hospital Lausanne, CHUV Lausanne Switzerland.
(11)Faculty of Biology&Medicine University of Lausanne, UniL Lausanne Switzerland.
(12)Department of Congenital Heart Defects and Paediatric Cardiology, German Heart Center Munich Technical University Munich Germany.

BACKGROUND: The determinants and prognostic value of high-sensitivity cardiac troponin T (hs-cTnT) among patients with a systemic right ventricle are largely unknown.
METHODS AND RESULTS: Ninety-eight patients from the randomized controlled SERVE (Effect of Phosphodiesterase-5 Inhibition With Tadalafil on Systemic Right Ventricular Size and Function) trial were included. The correlation between baseline hs-cTnT concentrations and biventricular volumes and function quantified by cardiac magnetic resonance or cardiac multirow detector computed
tomography was assessed by adjusted linear regression models. The prognostic value of hs-cTnT was assessed by adjusted Cox proportional hazards models, survival analysis, and concordance statistics. The primary outcome was time to the composite of clinically relevant arrhythmia, hospitalization for heart failure, or all-cause death. Median age was 39 (interquartile range, 32-48)years, and 32% were women. Median hs-cTnT concentration was 7 (interquartile range, 4-11) ng/L. Coefficients of determination for the relationship between hs-cTnT concentrations and right ventricular end-systolic volume index and right ventricular ejection fraction (RVEF) were +0.368 (P=0.046) and -0.381 (P=0.018), respectively. The sex- and age-adjusted hazard ratio for the primary outcome of hs-cTnT at 2 and 4 times the reference level (5 ng/L) were 2.89 (95% CI,1.14-7.29) and 4.42 (95% CI, 1.21-16.15), respectively. The prognostic
performance quantified by the concordance statistics for age- and sex-adjusted models based on hs-cTnT, right ventricular ejection fraction, and peak oxygen uptake predicted were comparable: 0.71% (95% CI, 0.61-0.82), 0.72% (95% CI, 0.59-0.84), and 0.71% (95% CI, 0.59-0.83), respectively.
CONCLUSIONS: Hs-cTnT concentration was significantly correlated with right ventricular ejection fraction and right ventricular end-systolic volume index in patients with a systemic right ventricle. The prognostic accuracy of hs-cTnT was comparable to that of right ventricular ejection fraction and peak oxygen uptake predicted.

DOI: 10.1161/JAHA.123.034776
PMCID: PMC11179810
PMID: 38726920 [Indexed for MEDLINE]

67. J Am Heart Assoc. 2024 May 7;13(9):e030387. doi: 10.1161/JAHA.123.030387. Epub 2024 Apr 30.

Interplay Between Systemic Inflammation, Myocardial Injury, and Coronary Microvascular Dysfunction in Rheumatoid Arthritis: Results From the LiiRA Study.

Weber B(1), Weisenfeld D(2), Massarotti E(2), Seyok T(2), Cremone G(2), Lam E(2), Golnik C(2), Brownmiller S(2), Liu F(2), Huang S(2), Todd DJ(2), Coblyn JS(2), Weinblatt ME(2), Cai T(2), Dahal K(2), Kohler M(3), Yinh J(3), Barrett L(1), Solomon DH(2), Plutzky J(1), Schelbert HR(4), Campisi R(5), Bolster MB(3), Di Carli M(1), Liao KP(2).

Author information:
(1)Division of Cardiovascular, Department of Medicine, Heart and Vascular Center Brigham and Women's Hospital, Harvard Medical School Boston MA.
(2)Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA.
(3)Division of Rheumatology, Allergy and Immunology Massachusetts General Hospital, Harvard Medical School Boston MA.
(4)UCLA School of Medicine Los Angeles CA.
(5)Instituto Argentino de Diagnóstico y Tratamiento S.A. Buenos Aires Argentina.

BACKGROUND: Coronary microvascular dysfunction as measured by myocardial flow reserve (MFR) is associated with increased cardiovascular risk in rheumatoid arthritis (RA). The objective of this study was to determine the association between reducing inflammation with MFR and other measures of cardiovascular risk.
METHODS AND RESULTS: Patients with RA with active disease about to initiate a tumor necrosis factor inhibitor were enrolled (NCT02714881). All subjects underwent a cardiac perfusion positron emission tomography scan to quantify MFR at baseline before tumor necrosis factor inhibitor initiation, and after tumor necrosis factor inhibitor initiation at 24 weeks. MFR <2.5 in the absence of
obstructive coronary artery disease was defined as coronary microvascular dysfunction. Blood samples at baseline and 24 weeks were measured for inflammatory markers (eg, high-sensitivity C-reactive protein [hsCRP],interleukin-1b, and high-sensitivity cardiac troponin T [hs-cTnT]). The primary outcome was mean MFR before and after tumor necrosis factor inhibitor initiation, with Δhs-cTnT as the secondary outcome. Secondary and exploratory analyses included the correlation between ΔhsCRP and other inflammatory markers
with MFR and hs-cTnT. We studied 66 subjects, 82% of which were women, mean RA duration 7.4 years. The median atherosclerotic cardiovascular disease risk was 2.5%; 47% had coronary microvascular dysfunction and 23% had detectable hs-cTnT.
We observed no change in mean MFR before (2.65) and after treatment (2.64, P=0.6) or hs-cTnT. A correlation was observed between a reduction in hsCRP and interleukin-1b with a reduction in hs-cTnT.
CONCLUSIONS: In this RA cohort with low prevalence of cardiovascular risk factors, nearly 50% of subjects had coronary microvascular dysfunction at baseline. A reduction in inflammation was not associated with improved MFR. However, a modest reduction in interleukin-1b and no other inflammatory pathways was correlated with a reduction in subclinical myocardial injury.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02714881.

DOI: 10.1161/JAHA.123.030387
PMCID: PMC11179857
PMID: 38686879 [Indexed for MEDLINE]

68. Ann Thorac Cardiovasc Surg. 2024;30(1):23-00210. doi: 10.5761/atcs.oa.23-00210.

Dexmedetomidine Pretreatment Confers Myocardial Protection and Reduces Mechanical Ventilation Duration for Patients Undergoing Cardiac Valve Replacement under Cardiopulmonary Bypass.

Yuan B(1), Huang X(1), Wen J(1), Peng M(2).

Author information:
(1)Department of Anesthesiology, Zhongshan City People's Hospital, Zhongshan, Guangdong, China.
(2)Pharmacy Intravenous Admixture Services, Zhongshan City People's Hospital, Zhongshan, Guangdong, China.

PURPOSE: The study aims to assess the effects of dexmedetomidine (Dex) pretreatment on patients during cardiac valve replacement under cardiopulmonary bypass.
METHODS: For patients in the Dex group (n = 52), 0.5 μg/kg Dex was given before anesthesia induction, followed by 0.5 μg/kg/h pumping injection before aortic occlusion. For patients in the control group (n = 52), 0.125 ml/kg normal saline was given instead of Dex.
RESULTS: The patients in the Dex group had longer time to first dose of rescue propofol than the control group (P = 0.003). The Dex group required less total dosage of propofol than the control group (P = 0.0001). The levels of cardiac troponin I (cTnI), creatine kinase isoenzyme MB (CK-MB), malondialdehyde (MDA), and tumor necrosis factor-α (TNF-α) were lower in the Dex group than the control group at T4, 8 h after the operation (T5), and 24 h after the operation (T6) (P<0.01). The Dex group required less time for mechanical ventilation than the control group (P = 0.003).
CONCLUSION: The study suggests that 0.50 µg/kg Dex pretreatment could reduce propofol use and the duration of mechanical ventilation, and confer myocardial protection without increased adverse events during cardiac valve replacement.

DOI: 10.5761/atcs.oa.23-00210
PMCID: PMC11082494
PMID: 38684422 [Indexed for MEDLINE]

69. Diabetes Obes Metab. 2024 Jul;26(7):2741-2751. doi: 10.1111/dom.15592. Epub 2024 Apr 8.

Prediction of new-onset heart failure in patients with type 2 diabetes derived from ALTITUDE and CANVAS.

Said F(1), Arnott C(2)(3), Voors AA(1), Heerspink HJL(2)(4), Ter Maaten JM(1).

Author information:
(1)Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
(2)The George Institute for Global Health, Sydney, Australia.
(3)Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.
(4)Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands.

AIM: To create and validate a prediction model to identify patients with type 2 diabetes (T2D) at high risk of new-onset heart failure (HF), including those treated with a sodium-glucose cotransporter-2 (SGLT2) inhibitor.
METHODS: A prediction model was developed from the Aliskiren Trial in Type 2 Diabetes Using Cardiorenal Endpoints (ALTITUDE), a trial in T2D patients with albuminuria or cardiovascular disease. We included 5081 patients with baseline N-terminal pro B-type natriuretic peptide (NT-proBNP) measurement and no history of HF. The model was developed using Cox regression and validated externally in
the placebo arm of the Canagliflozin Cardiovascular Assessment Study (CANVAS), which included 996 participants with T2D and established cardiovascular disease or high cardiovascular risk, and in patients treated with canagliflozin.
RESULTS: ALTITUDE participants (mean age 64 ± 9.8 years) had a median serum NT-proBNP level of 157 (25th-75th percentile 70-359) pg/mL. Higher NT-proBNP level, troponin T (TnT) level and body mass index (BMI) emerged as significant and independent predictors of new-onset HF in both cohorts. The model further contained urinary albumin-to-creatinine ratio, glycated haemoglobin, age, haematocrit, and use of calcium channel blockers. A prediction model including these variables had a C-statistic of 0.828 (95% confidence interval [CI] 0.801-0.855) in ALTITUDE and 0.800 (95% CI 0.720-0.880) in CANVAS. The C-statistic of this model increased to 0.847 (95% CI 0.792-0.902) in patients after 1 year of canagliflozin treatment.
CONCLUSION: In patients with T2D, higher NT-proBNP level, TnT level and BMI are independent and externally validated predictors of new-onset HF, including patients using an SGLT2 inhibitor. This newly developed model may identify patients at high risk of new-onset HF, contributing to early recognition and possibly prevention.

DOI: 10.1111/dom.15592
PMID: 38584567 [Indexed for MEDLINE]

70. Am J Hypertens. 2024 Jul 15;37(8):571-579. doi: 10.1093/ajh/hpae035.

Associations of Ambulatory Blood Pressure Measurements With High-Sensitivity Troponin and Natriuretic Peptide Levels in SPRINT.

Venishetty N(1), Berry JD(2), de Lemos JA(3), Wu E(3), Lee M(4), Drawz PE(5),Nambi V(6)(7), Ballantyne CM(6), Killeen AA(8), Ix JH(9)(10), Shlipak MG(11), Ascher SB(11)(12).

Author information:
(1)Department of Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
(2)Department of Medicine, University of Texas at Tyler Health Science Center, Tyler, Texas, USA.
(3)Department of Cardiology, the University of Texas at Southwestern Medical School, Dallas, Texas, USA.
(4)Department of Biostatistics, PeterO'Donnell. School of Public Health,University of Texas Southwestern Medical Center, Dallas,Texas, USA.
(5)Division of Nephrology and Hypertension, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
(6)Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, Texas, USA.
(7)Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
(8)Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
(9)Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California, USA.
(10)Division of Nephrology-Hypertension, University of California San Diego, San Diego, California, USA.
(11)Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and University of California San Francisco, San Francisco, California, USA.
(12)Division of Hospital Medicine, University of California Davis, Sacramento,California, USA.

BACKGROUND: Nighttime blood pressure (BP) has greater prognostic importance for cardiovascular disease (CVD) than daytime BP, but less is known about nighttime and daytime BP associations with measures of subclinical CVD.
METHODS: Among 897 Systolic Blood Pressure Intervention Trial Study (SPRINT) participants with 24-hour ambulatory BP monitoring obtained near the 27-month study visit, 849 (95%) had N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) measured at the 24-month study visit. Multivariable linear regression analyses were performed to evaluate the
associations of nighttime and daytime BP with cardiac biomarker levels.
RESULTS: The mean age was 69 12 years, 28% were African American, and mean nighttime and daytime SBP were 121-16 mm Hg and 132-14 mm Hg, respectively.
In multivariable models, compared with the lowest tertile of nighttime systolic BP, the highest tertile was associated with 48% higher NT-proBNP levels (adjusted geometric mean ratio [GMR] = 1.48, 95% CI: 1.22, 1.79), and 19% higher
hs-cTnT levels (adjusted GMR=1.19, 95% CI: 1.07, 1.32). In contrast, the highest vs. lowest tertile of daytime systolic BP was not associated with NT-proBNP (adjusted GM=1.09, 95% CI: 0.88, 1.34), but was associated with 16%
higher hs-cTnT levels (adjusted GMR=1.16, 95% CI: 1.04, 1.30). Similar results were observed using diastolic BP.
CONCLUSIONS: In SPRINT, both higher nighttime and daytime BP were independently associated with higher hs-cTnT levels, but only higher nighttime BP was associated with higher NT-proBNP levels.

DOI: 10.1093/ajh/hpae035
PMCID: PMC11247134
PMID: 38554284 [Indexed for MEDLINE]

71. Acta Anaesthesiol Scand. 2024 Jul;68(6):745-752. doi: 10.1111/aas.14405. Epub 2024 Mar 26.

High-sensitive troponinT, interleukin-8, and interleukin-6 link with post-surgery risk in infant heart surgery.

Thorlacius EM(1)(2), Keski-Nisula J(3), Vistnes M(4), Ojala T(5), Molin M(6), Synnergren M(7), Romlin BS(1)(2), Ricksten SE(1)(2), WÃ¥hlander H(2)(8), Castellheim AG(1)(2).

Author information:
(1)Department of Anesthesiology and Intensive Care medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
(2)Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
(3)Department of Anesthesia and Intensive Care, Children's Hospital, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
(4)Department of Internal Medicine, Diakonhjemmet Hospital and Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.
(5)Department of Pediatric Cardiology, Children's Hospital, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
(6)Statistical Consultation Group, Gothenburg, Sweden.
(7)Department of Pediatric Thoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
(8)Department of Pediatric Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Comment in
Acta Anaesthesiol Scand. 2024 Aug;68(7):997-998. doi: 10.1111/aas.14431.

BACKGROUND: This study focuses on biomarkers in infants after open heart surgery, and examines the association of high-sensitive troponin T (hs-cTnT), interleukin-6 (IL-6), and interleukin-8 (IL-8) with postoperative acute kidney injury (AKI), ventilatory support time and need of vasoactive drugs.
METHODS: Secondary exploratory study from a double-blinded clinical randomized trial (Mile-1) on 70 infants undergoing open heart surgery with cardiopulmonary bypass (CPB). In this sub-study, the entire study population was examined without considering the study drugs. The biomarkers' peak concentration (highest concentration at 2 or 6 post-CPB) were used for statistical analyses.
RESULTS: Peak IL-8, hs-cTnT, and IL-6 occurred at 2 h post-CPB for 96%, 79%, and 63% of the patients, respectively. The odds ratio of developing AKI2-3 for IL-6 >293 pg/mL was 23.4 (95% CI 5.3;104.0), for IL-8 > 100pg/mL it was 11.5 (3.0;44.2), and for hs-cTnT >5597pg/mL it was 6.1 (1.5; 24.5). In more than two third of the patients with the highest peak concentrations of IL-8, IL-6, and
hs-cTnT, there was a need for ventilatory support for >24h and use of asoactive drugs at 24h post-CPB, while in less than one third of the patients with the lowest peak concentrations of IL-8 and hs-cTnT such requirements were observed.
CONCLUSIONS: The peak biomarker concentrations and CPB-time strongly predicted AKI2-3, with IL-6 and IL-8 emerging as strongest predictors. Furthermore, our findings suggest that measuring hs-cTnT and IL-8 just 2 h post-CPB-weaning may assist in identifying infants suitable for early extubation and highlight those at risk of prolonged ventilation.

DOI: 10.1111/aas.14405
PMID: 38531618 [Indexed for MEDLINE]

72. Circulation. 2024 Mar 19;149(12):967-969. doi:10.1161/CIRCULATIONAHA.123.066377. Epub 2024 Mar 18.

Variation of NT-proBNP and High-Sensitivity Cardiac Troponin T Across Levels of Estimated Glomerular Filtration Rate: The SPRINT Trial.

Bansal N(1), Katz R(2), Seliger S(3), deFilippi C(4), Wettersten N(5), de Lemos JA(6), Christenson R(7), Killeen AA(8), Berry JD(6), Shlipak MG(#)(9), Ix JH(#)(10).

Author information:
(1)Division of Nephrology (N.B.), University of Washington, Seattle.
(2)Department of Obstetrics and Gynecology (R.K.), University of Washington,Seattle.
(3)Division of Nephrology, University of Maryland School of Medicine, Baltimore (S.S.).
(4)Inova Health System, Falls Church, VA (C.F.).
(5)Division of Cardiology, VA San Diego Healthcare System, CA (N.W.).
(6)Division of Cardiology, University of Texas Southwestern, Dallas (J.A.L.,J.D.B.).
(7)Department of Pathology, University of Maryland, Baltimore (R.C.).
(8)Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis 
(9)Department of Medicine, University of California San Francisco, and San Francisco Veterans Affairs Hospital (M.G.S.).
(10)Division of Nephrology, University of California San Diego, and Veterans Affairs San Diego Healthcare System (J.H.I.).
(#)Contributed equally

DOI: 10.1161/CIRCULATIONAHA.123.066377
PMCID: PMC10954091
PMID: 38498611 [Indexed for MEDLINE]

73. Clin Chem Lab Med. 2024 Feb 13;62(6):1167-1176. doi: 10.1515/cclm-2023-1253. Print 2024 May 27.

Temporal biomarker concentration patterns during the early course of acute coronary syndrome.

Eggers KM(1)(2), Batra G(1)(2), Lindahl B(1)(2), Ghukasyan Lakic T(2), Lindbäck J(2), Budaj A(3), Cornel JH(4)(5), Giannitsis E(6), Katus HA(6), Storey RF(7), Becker RC(8), Siegbahn A(1), Wallentin L(1)(2).

Author information:
(1)Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
(2)Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
(3)Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland.
(4)Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands.
(5)Radboud University Medical Center, Nijmegen, The Netherlands.
(6)Department of Medicine III, University of Heidelberg, Heidelberg, Germany.
(7)Division of Clinical Medicine, University of Sheffield and NIHR Sheffield Biomedical Research Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
(8)Division of Cardiovascular Health and Diseases, University of Cincinnati, Heart, Lung & Vascular Institute, Cincinnati, USA.

OBJECTIVES: Biomarker concentrations and their changes during acute coronary syndrome (ACS) provide clinically useful information on pathophysiological processes, e.g. myocardial necrosis, hemodynamic stress and inflammation. However, current evidence on temporal biomarker patterns early during ACS is limited, and studies investigating multiple biomarkers are lacking.
METHODS: We measured concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI), NT-terminal pro-B-type natriuretic peptide, C-reactive protein, and growth-differentiation factor-15 (GDF-15) in plasma samples obtained at randomization in ACS patients from the PLATelet inhibition and patient Outcomes (PLATO) trial. Linear regressions with interaction analyses were used to investigate the associations of biomarker concentrations with the time from symptom onset and to model temporal biomarker concentration patterns.
RESULTS: The study population consisted of 16,944 patients (median age 62 years; 71.3males) with 6,853 (40.3%) having ST-elevation myocardial infarction (STEMI) and 10,141 (59.7 %) having non-ST-elevation ACS (NSTE-ACS).
Concentrations of all biomarkers were associated with time from symptom onset (pinteraction<0.001), apart for GDF-15 (pinteraction=0.092). Concentration increases were more pronounced in STEMI compared to NSTE-ACS. Temporal biomarker
patterns for hs-cTnT and hs-cTnI were different depending on sex whereas biomarker patterns for the other biomarkers were similar in cohorts defined by age and sex.
CONCLUSIONS: Temporal concentration patterns differ for various biomarkers early during ACS, reflecting the variability in the activation and duration of different pathophysiological processes, and the amount of injured myocardium.
Our data emphasize that the time elapsed from symptom onset should be considered for the interpretation of biomarker results in ACS.

© 2024 the author(s), published by De Gruyter, Berlin/Boston.

DOI: 10.1515/cclm-2023-1253
PMID: 38341860 [Indexed for MEDLINE]

74. Br J Anaesth. 2024 May;132(5):857-866. doi: 10.1016/j.bja.2024.01.010. Epub 2024 Feb 9.

Preoperative N-terminal pro-B-type natriuretic peptide and myocardial injury after stopping or continuing renin-angiotensin system inhibitors in noncardiac surgery: a prespecified analysis of a phase 2 randomised controlled multicentre trial.

Gutierrez Del Arroyo A(1), Patel A(1), Abbott TEF(1), Begum S(1), Dias P(1), Somanath S(2), Middleditch A(3), Cleland S(4), Brealey D(5), Pearse RM(1), Ackland GL(6); SPACE trial investigators.

Author information:
(1)Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
(2)County Durham and Darlington NHS Foundation Trust, Durham, UK.
(3)University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
(4)University Hospitals Plymouth NHS Trust, Plymouth, UK.
(5)Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK; UCL Hospitals Foundation Trust, London, UK.
(6)Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.

BACKGROUND: Patients with elevated preoperative plasma N-terminal pro-B-typenatriuretic peptide (NT-proBNP >100 pg ml-1) experience more complications after noncardiac surgery. Individuals prescribed renin-angiotensin system (RAS) inhibitors for cardiometabolic disease are at particular risk of perioperative myocardial injury and complications. We hypothesised that stopping RAS inhibitors before surgery increases the risk of perioperative myocardial injury, depending on preoperative risk stratified by plasma NT-proBNP concentrations.
METHODS: In a preplanned analysis of a phase 2a trial in six UK centres, patients 60 year old undergoing elective noncardiac surgery were randomly assigned either to stop or continue RAS inhibitors before surgery. The pharmacokinetic profile of individual RAS inhibitors determined for how long they were stopped before surgery. The primary outcome, masked to investigators, clinicians, and patients, was myocardial injury (plasma high-sensitivity troponin-T 15 ng L-1 or a 5 ng L-1 increase, when preoperative high-sensitivity troponin-T 15 ng L-1) within 48 h after surgery. The co-exposures of interest were preoperative plasma NT-proBNP (< or >100 pg ml -1) and stopping or continuing RAS inhibitors.
RESULTS: Of 241 participants, 101 (41.9%; mean age 71 [7] yr; 48% females) had preoperative NT-proBNP >100 pg ml -1 (median 339 [160-833] pg ml-1), of whom 9/101 (8.9%) had a formal diagnosis of cardiac failure. Myocardial injury occurred in 63/101 (62.4%) subjects with NT-proBNP