Use of N-terminal pro-brain natriuretic peptide to detect cardiac origin in critically ill cancer patients with acute respiratory failure

Objective

To assess the accuracy of plasma N-terminal-pro-B-type natriuretic peptide concentrations (NT-proBNP) as a diagnostic tool to recognize acute respiratory failure (ARF) of cardiac origin.

Methods

Prospective observational study in 100 medical intensive care unit (ICU) patients. NT-proBNP was measured at ICU admission, and diagnosis of cardiac dysfunction was performed using echocardiography.

Results

Sixteen patients had cardiac ARF, 58 patients had noncardiac ARF, and 26 patients were non-ARF controls. Median (IQR) NT-proBNP was 1,951 (617–9,320)?pg/ml and was significantly influenced by the level of renal dysfunction. Patients with noncardiac ARF had higher NT-proBNP [1,912 (704–1,922)?pg/ml] than non-ARF patients [1,022 (383–2,613)?pg/ml], but lower concentrations than cardiac ARF patients [4,536 (1,568–35,171)?pg/ml]. The area under the curve (AUC) was 0.663?±?0.078 (95% confidence interval 0.510–0.815) and was not significantly influenced by the level of renal dysfunction. In addition, using a stepwise logistic regression model, NT-proBNP failed to predict independently the presence of cardiac dysfunction. However, with specificity and negative predictive value of 100%, a NT-proBNP cutoff value of 500?pg/ml seemed useful to rule out cardiac dysfunction. Indeed, none of the 16 patients with cardiac ARF had a NT-proBNP value below 500?pg/ml, whereas it was the case in 8 (30.8%) non-ARF controls and in 12 (20.7%) noncardiac ARF patients.

Conclusions

In cancer patients with ARF, plasma NT-proBNP concentration is not a relevant tool to recognize cardiac dysfunction, but is specific enough to rule out the diagnosis in patients with plasma NT-proBNP concentrations below 500?pg/ml.

     

Analysis of N-terminal pro-B-type natriuretic peptide and cardiac index in multiple injured patients: a prospective cohort study

Introduction

Increased serum B-type natriuretic peptide (BNP) has been identified for diagnosis and prognosis of impaired cardiac function in patients suffering from congestive heart failure, ischemic heart disease, and sepsis. However, the prognostic value of BNP in multiple injured patients developing multiple organ dysfunction syndrome (MODS) remains undetermined. Therefore, the aims of this study were to assess N-terminal pro-BNP (NT-proBNP) in multiple injured patients and to correlate the results with invasively assessed cardiac output and clinical signs of MODS.

Methods

Twenty-six multiple injured patients presenting a New Injury Severity Score of greater than 16 points were included. The MODS score was calculated on admission as well as 24, 48, and 72 hours after injury. Patients were subdivided into groups: group A showed minor signs of organ dysfunction (MODS score less than or equal to 4 points) and group B suffered from major organ dysfunction (MODS score of greater than 4 points). Venous blood (5 mL) was collected after admission and 6, 12, 24, 48, and 72 hours after injury. NT-proBNP was determined using the Elecsys proBNP^® assay. The hemodynamic monitoring of cardiac index (CI) was performed using transpulmonary thermodilution.

Results

Serum NT-proBNP levels were elevated in all 26 patients. At admission, the serum NT-proBNP values were 116 ± 21 pg/mL in group A versus 209 ± 93 pg/mL in group B. NT-proBNP was significantly lower at all subsequent time points in group A in comparison with group B (P < 0.001). In contrast, the CI in group A was significantly higher than in group B at all time points (P < 0.001). Concerning MODS score and CI at 24, 48, and 72 hours after injury, an inverse correlation was found (r = -0.664, P < 0.001). Furthermore, a correlation was found comparing MODS score and serum NT-proBNP levels (r = 0.75, P < 0.0001).

Conclusions

Serum NT-proBNP levels significantly correlate with clinical signs of MODS 24 hours after multiple injury. Furthermore, a distinct correlation of serum NT-proBNP and decreased CI was found. The data of this pilot study may indicate a potential value of NT-proBNP in the diagnosis of post-traumatic cardiac impairment. However, further studies are needed to elucidate this issue.     

B-type natriuretic peptides for the diagnosis of congestive heart failure in dyspneic oldest-old patients

Objectives

To evaluate the accuracy of B-type natriuretic peptide (BNP) and amino-terminal pro-brain natriuretic peptide (NT-proBNP) for the diagnosis of congestive heart failure (CHF) in dyspneic patients aged ≥ 85 years admitted to the Emergency Department (ED), and to define threshold values in this oldest-old population.

Design and methods

This study involved 210 oldest-old patients, and 360 patients aged from 65 to 84 years (< 85 years), admitted to the ED for dyspnea.

Results

Median BNP and NT-proBNP levels were significantly higher in CHF oldest-old patients (p < 0.001). BNP and NT-proBNP threshold values were higher in oldest-old patients (290 and 2800 pg/mL, respectively) compared to that of patients < 85 years (270 and 1700 pg/mL, respectively). In a multivariate analysis, both BNP and NT-proBNP were the strongest variables associated with CHF in oldest-old patients. Neither renal function nor gender had impact on the diagnostic utility of the two tests.

Conclusion

Both BNP and NT-proBNP could potentially be reliable biomarkers for the diagnosis of CHF in oldest-old patients admitted with acute dyspnea to the ED.     

Performance of N-terminal-pro-B-type natriuretic peptide in critically ill patients: a prospective observational cohort study

Introduction

The purpose of this study was to assess the accuracy of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) as a diagnostic tool to recognize acute respiratory failure of cardiac origin in an unselected cohort of critically ill patients.

Methods

We conducted a prospective observational study of medical ICU patients. NT-proBNP was measured at ICU admission, and diagnosis of cardiac dysfunction relied on the patient's clinical presentation and echocardiography.

Results

Of the 198 patients included in this study, 102 (51.5%) had evidence of cardiac dysfunction. Median NT-proBNP concentrations were 5,720 ng/L (1,430 to 15,698) and 854 ng/L (190 to 3,560) in patients with and without cardiac dysfunction, respectively (P < 0.0001). In addition, NT-proBNP concentrations were correlated with age (ρ = 0.43, P < 0.0001) and inversely correlated with creatinine clearance (ρ = -0.58, P < 0.0001). When evaluating the performance of NT-proBNP concentrations to detect cardiac dysfunction, the area under the receiver operating characteristic (ROC) curve was 0.76 (95% confidence interval (CI) 0.69 to 0.83). In addition, a stepwise logistic regression model revealed that NT-proBNP (odds ratio (OR) = 1.01 per 100 ng/L, 95% CI 1.002 to 1.02), electrocardiogram modifications (OR = 11.03, 95% CI 5.19 to 23.41), and severity assessed by organ system failure score (OR = 1.63 per point, 95% CI 1.17 to 2.41) adequately predicted cardiac dysfunction. The area under the ROC curve of this model was 0.83 (95% CI 0.77 to 0.90).

Conclusions

NT-proBNP measured at ICU admission might represent a useful marker to exclude cardiac dysfunction in critically ill patients.     

N-Terminal pro B-type natriuretic peptide testing for short-term prognosis in breathless older adults

Background

Amino-terminal pro–brain natriuretic peptide (NT-proBNP) is useful for the triage of patients with dyspnea. Our aim was to determine whether NT-proBNP levels could predict in-hospital outcome in breathless elderly patients.

Methods

At admission, NT-proBNP plasma concentrations were determined in 324 dyspneic patients aged 75 years and older. The association between NT-proBNP values and in-hospital mortality was assessed.

Results

Median NT-proBNP concentrations were not different in deceased patients (n = 43, 13%) compared to that of survivors (n = 281, 87%) (4354 vs 2499 pg/mL, respectively; P = .06). To predict in-hospital mortality, the optimum threshold of NT-proBNP was 3855 pg/mL, as defined by the receiver operating characteristic (ROC) curve, with a nonsignificant area under the ROC curve of 0.59. Mortality was significantly higher in patients (n = 139) with NT-proBNP levels 3855 pg/mL or higher (17.9% vs 9.7%, P = .045). After multivariate analysis, NT-proBNP level 3855 pg/mL or higher at admission was predictive of mortality (odds ratio, 2.41; 95% confidence interval, 1.02-5.68; P = .04).

Conclusion

NT-proBNP higher than 3855 pg/mL is associated with in-hospital mortality in patients aged 75 years and older admitted for dyspnea.     

Ulinastatin improved cardiac dysfunction after cardiac arrest in New Zealand rabbits

Objective

The present study was designed to evaluate the effects of ulinastatin (UTI) on cardiac dysfunction after cardiopulmonary resuscitation (CPR).

Methods

A total of 48 healthy adult male New Zealand rabbits were untreated for 8 minutes after the induction of ventricular fibrillation (VF) by an external transthoracic alternating current and then treated by CPR. These rabbits were then randomly divided into the control and UTI groups after the return of spontaneous circulation (ROSC) and were observed for 8 hours after the ROSC. Before CPR and after ROSC at 2, 4, and 8 hours, blood samples were collected to determine the levels of tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), malondialdehyde (MDA), cardiac troponin I (cTnI), and N-terminal probrain natriuretic peptide (NT-proBNP), and the left ventricular ejection fraction (EF) was measured by echocardiography.

Results

Nineteen of 24 rabbits in the control group and 18 of 24 in the UTI group were successfully resuscitated. The plasma levels of TNF-α, IL-6, MDA, cTnI, and NT-proBNP were significantly increased, accompanying a deceased EF in the control group, but the cotreatment with UTI decreased the plasma levels of TNF-α, IL-6, MDA, cTnI, and NT-proBNP (P < .05), attenuating the myocardial injury and improving the EF in the UTI group. Only 9 of 19 animals in the control group but 14 of 18 animals in the UTI group survived longer than 8 hours (P = .011).

Conclusions

The progression of proinflammatory responses, oxidative stress, and myocardial injury have been linked to the reduced EF after VF/CPR, and the administration of UTI at a cardioprotective dosage preserved the cardiac function after VF/CPR.     

Associations between increased renal resistive index and cardiovascular events

Background and purpose

Chronic kidney disease is a risk factor for cardiovascular disease (CVD). Renal resistive index (RI) measured by Doppler ultrasonography is associated with renal impairment. We investigated the relationship between RI and cardiac function, and evaluated the utility of RI for predicting cardiac events in patients with CVD.

Methods and results

Renal Doppler ultrasonography and echocardiography were performed in a total of 452 patients with CVD. Correlations of RI with serum creatinine and estimated glomerular filtration rate (eGFR) were significant but not strong (r = 0.37, p < 0.001; r = ?0.42, p < 0.001, respectively). RI correlated positively with age, left atrial volume index, left ventricular mass index, and early transmitral velocity to mitral annular early diastolic velocity (e′) ratio (E/e′), and showed significant negative correlations with e′ and diastolic blood pressure. Between two subgroups—112 patients hospitalized with cardiovascular events (Group A) and 200 age- and eGFR-matched controls (Group B)—RI was significantly higher in Group A than in Group B, although age and eGFR were similar.

Conclusions

RI reflects the impairment of intrarenal hemodynamics that cannot be adequately elucidated by eGFR alone. Assessment of renal RI may be useful in conjunction with prognostic estimates for patients with CVD.

     

High circulating N-terminal pro-B-type natriuretic peptide is associated with greater systolic cardiac dysfunction and nonresponsiveness to fluids in septic vs nonseptic critically ill patients

Purpose

It is still unclear whether circulating levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) reflect cardiac filling and function in the critically ill patient, particularly during sepsis and a proinflammatory response that may induce NT-proBNP release from the heart.

Materials and Methods

We prospectively evaluated the value of NT-proBNP as a marker of cardiac loading, function, and response to fluid loading in 18 septic and 68 nonseptic, critically ill patients in the intensive care unit of a university medical center. Transpulmonary thermal dilution and pressure measurements were done, and plasma NT-proBNP was determined before and after colloid fluid loading.

Results

Compared with nonseptic patients, NT-proBNP plasma levels were higher and systolic cardiac function indices were lower in patients with sepsis than those without sepsis. N-terminal pro-B-type natriuretic peptide best related, from all hemodynamic parameters before and after fluid loading, to systolic cardiac function (rather than diastolic filling) variables, independently of confounders such as renal dysfunction (judged from serum creatinine). In addition, a high NT-proBNP (>3467 pg/mL) predicted absence of fluid responsiveness in sepsis only.

Conclusions

Our data suggest that an increased circulating NT-proBNP plasma level is an independent marker of greater systolic cardiac dysfunction, irrespective of filling status, and is a better predictor of fluid nonresponsiveness in septic vs nonseptic, critically ill patients.     

Prediction of stroke volume by global left ventricular longitudinal strain in patients undergoing assessment for cardiac transplantation

Purpose

Speckle-tracking echocardiography (STE) is a novel technique that can be used for assessment of left ventricular (LV) longitudinal deformation dynamics. Using cardiac catheterization as the reference standard, the aim of this study was to evaluate the relation between LV global longitudinal strain (GLS) assessed by STE and LV stroke volume in patients undergoing assessment for cardiac transplantation.

Methods

Conventional echocardiography and STE were performed during right-sided cardiac catheterization in 51 patients referred for cardiac transplant assessment. Thermodilution LV stroke volume indexed (LVSVI) was used as the reference standard. Univariate regression analyses and receiver operating characteristics curves were used to test correlations between LVSVI and GLS by STE.

Results

Global longitudinal strain was obtained successfully in 95.5% of patients. Among all variables analyzed, GLS best predicted the LVSVI (r = 0.79; P < .0001). Minor correlations with the LVSVI were observed for tissue Doppler–derived systolic mitral annular velocity (r = 0.51; P < .005) and for LV ejection fraction (r = 0.32; P < .05).

Conclusions

In a group of patients referred for cardiac transplant assessment, LV longitudinal deformation analysis by STE closely correlates with LVSVI, suggesting that, in this particular clinical setting, this new parameter may help provide an accurate, noninvasive, and quantitative assessment of LV function.     

S100b Immunoassay: An Assessment of Diagnostic Utility in Minor Head Trauma

Background

Over 1.4 million patients present annually to United States (US) emergency departments with minor head trauma. Many undergo unnecessary head computed tomography (HCT).

Objectives

We sought to determine the diagnostic accuracy of S100B, a central nervous system peptide, to screen for HCT+ head injury.

Methods

This study was a prospective observational study of adults with minor head trauma. Patients presenting within 6 h of injury and undergoing HCT for evaluation were eligible. All HCTs were blindly reviewed for presence of a priori defined intracranial injury (HCT+). Quantitative S100B levels were determined by enzyme-linked immunosorbent assay.

Results

A total of 346 patients were enrolled over 12 months, mean age 48 years (± 23 years), 62% male. Twenty-two (6.4%) were HCT+. Vomiting, headache, anterograde amnesia, Glasgow Coma Scale score < 15, nausea, and loss of consciousness were associated with HCT+ results. Median S100B levels were significantly elevated in HCT+ (115 ng/dL) vs. HCT− (56.0 ng/dL) patients (p = 0.032). Receiver operator characteristic analysis demonstrated an area under the curve of 0.643. Sensitivity and specificity were 86% (95% confidence interval [CI] 67–96) and 37% (95% CI 29–45%) at 42 ng/dL, 91% (95% CI 72–98%) and 24% (95% CI 17–31%) at 32 ng/dL, and 96% (95% CI 78–100%) and 13% (95% CI 9–20%) at 24 ng/dL, respectively.

Conclusion

The study demonstrates that S100B may be a sensitive but non-specific marker of HCT+ injury.     

Differential improvements in lipid profiles and Framingham recurrent risk score in patients with and without diabetes mellitus undergoing long-term cardiac rehabilitation

Carroll S, Tsakirides C, Hobkirk J, Moxon JWA, Moxon JWD, Dudfield M, Ingle L. Differential improvements in lipid profiles and Framingham recurrent risk score in patients with and without diabetes mellitus undergoing long-term cardiac rehabilitation.

Objective

To determine whether lipid profiles and recurrent coronary heart disease (CHD) risk could be modified in patients with and without diabetes mellitus undergoing long-term cardiac rehabilitation (CR).

Design

Retrospective analysis of patient case records.

Setting

Community-based phase 4 CR program.

Participants

Patients without diabetes (n=154; 89% men; mean ± SD age, 59.6±8.5y; body mass index [BMI], 27.0±3.5kg/m²) and patients with diabetes (n=20; 81% men; mean age, 63.0±8.7y; BMI, 28.7±3.3kg/m²) who completed 15 months of CR.

Interventions

Exercise testing and training, risk profiling, and risk-factor education.

Main Outcome Measures

Cardiometabolic risk factors and 2- to 4-year Framingham recurrent CHD risk scores were assessed.

Results

At follow up, a significant main effect for time was evident for decreased body mass and waist circumference and improved low-density lipoprotein cholesterol (LDL-C) level and submaximal cardiorespiratory fitness (all P<.05), showing the benefits of CR in both groups. However, a significant group-by-time interaction effect was evident for high-density lipoprotein cholesterol (HDL-C) level and total cholesterol (TC)/HDL-C ratio (both P<.05). TC/HDL-C ratio improved (5.0±1.5 to 4.4±1.3) in patients without diabetes, but showed no improvement in patients with diabetes (4.8±1.6 v 4.9±1.6).

Conclusions

We showed that numerous anthropometric, submaximal fitness, and cardiometabolic risk variables (especially LDL-C level) improved significantly after long-term CR. However, some aspects of cardiometabolic risk (measures incorporating TC and HDL-C) improved significantly in only the nondiabetic group.     

Thoracic ultrasonography: A new method for the work-up of patients with dyspnea

Objective

Differential diagnosis of dyspnea is vital for the management of respiratory failure, where routine parameters can now be integrated with thoracic ultrasound data. The objective of this study was to evaluate the validity and accuracy of this approach in a department of internal medicine.

Materials and methods

We enrolled 152 patients consecutively hospitalized with a diagnosis of dyspnea. After clinical evaluation, chest radiography, biochemical assays (NT-proBNP), and emergency treatment, patients underwent ultrasound examination of the lungs. Results were considered positive if the total number of lines B was higher than 8. The ultrasound examination and NT-proBNP assay were repeated after 48 h. The gold standard was the clinical diagnosis of heart failure made by medical experts in accordance with AHA guidelines.

Results

The group of patients with positive ultrasound findings had a higher frequency of heart failure diagnoses (X² 92.5, p < 0.005) and significantly higher values of NT-proBNP (10,384 ng/l vs 3889 ng/l, p < 0.05). Moreover, the decrease in the number of B lines at 48 h was significantly greater (p < 0.005) among patients treated for heart failure. There were no significant changes in the values of NT-proBNP (p = 0.37).

Discussion

In conclusion we have shown that even in a department of internal medicine, lung ultrasonography is a useful tool for diagnosing respiratory insufficiency and monitoring its response to therapy.     

Electrocardiographic left ventricular hypertrophy Cornell product is a feasible predictor of cardiac prognosis in patients with chronic heart failure

Background

Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular disease and is associated with heart failure development. The Cornell product is an easily measured electrocardiographic parameter for assessing LVH. However, it is undetermined whether the Cornell product can predict the cardiac prognosis of chronic heart failure (CHF) patients.

Methods and results

We performed standard 12-lead electrocardiography and calculated the Cornell product in 432 consecutive CHF patients. LV geometry was assessed as normal, concentric remodeling, concentric or eccentric hypertrophy. The Cornell product was significantly higher in patients with eccentric hypertrophy, and increased with advancing New York Heart Association functional class. During a median follow-up of 660 days, there were 121 cardiac events including 36 cardiac deaths and 85 re-hospitalizations for worsening heart failure. Multivariate Cox proportional hazard analysis showed that the Cornell product was an independent predictor of cardiac events in CHF patients. Patients in the highest quartile of Cornell product had a higher prevalence of LV eccentric hypertrophy (22, 29, 33 and 67 % for quartiles one through four). Kaplan–Meier analysis demonstrated that the highest quartile of Cornell product was associated with the greatest risk among CHF patients.

Conclusion

The Cornell product is associated with LV eccentric hypertrophy and can be used to predict future cardiac events in CHF patients.     

Elevated serum S100B protein and neuron-specific enolase levels in carbon monoxide poisoning

Objective

Carbon monoxide (CO) poisoning causes cerebral and generalized hypoxia. This study aimed to assess the possible use of serum glial marker S100B protein and neuron-specific enolase (NSE) as biochemical markers of hypoxic brain damage in acute CO poisoning.

Methods

Patients with acute CO poisoning admitted to the ED of 2 training hospitals (Ankara, Turkey) were included in this cross-sectional study. Serum levels of S100B and NSE were measured on admission. The patients were divided into 2 groups (unconscious and conscious). Twenty healthy adults were included in the study to serve as controls.

Results

A total of 70 patients poisoned by CO (mean age ± SD, 36.6 ± 16.3 years; 64.3% women) were enrolled. Although S100B concentrations were higher in patients than in the control group (P = .018), no significant difference was determined between patient and control groups with respect to NSE concentrations (P = .801). A positive correlation was noted between levels of S100B and NSE (r = 0.388; P = .001). The S100B and NSE values were higher in unconscious patients than in the control group (P = .002 and P = .013, respectively). Furthermore, S100B and NSE values were higher in unconscious vs unconscious patients (P = .047 and P = .005, respectively).

Conclusion

Elevated serum S100B and NSE levels were associated with loss of consciousness in CO poisoning in this series of patients. Serum S100B and NSE may be useful markers in the assessment of clinical status in CO poisoning.     

Post-discharge changes in NT-proBNP and quality of life after acute dyspnea hospitalization as predictors of one-year outcomes

Aims

The association of serial NT-proBNP changes and poor quality of life (QOL) with progressive heart failure (HF) and clinical outcomes in emergency department dyspnea patients is poorly understood.

Methods and results

The predictive value of changes in NT-proBNP and QOL (Minnesota Living with Heart Failure scale) from baseline to 30-day follow-up was examined for all-cause 1-year mortality and HF hospitalization. Patients with an initially elevated NT-proBNP (≥ 300 ng/L) which persisted at 30-days (no ≥ 25% decrease) were at high risk of death or HF hospitalization (HR = 6.36, 95%CI = 3.04–13.28). Combined with sustained poor QOL, these subjects with persistently elevated NT-proBNP were at highest mortality risk or HF hospitalization (HR = 8.75, 95%CI = 3.62–21.16).

Conclusions

Dyspnea patients with elevated NT-proBNP concentrations and no improvement in either NT-proBNP or QOL at 30-days are at high risk of mortality and HF hospitalization. These data highlight the value of serial biomarker measurements combined with serial evaluations for QOL.     

Clinical and cardiac features of patients with subarachnoid haemorrhage presenting with out-of-hospital cardiac arrest

Background

Subarachnoid haemorrhage (SAH) is known as one of the aetiologies of out-of-hospital cardiac arrest (OHCA). However, the mechanisms of circulatory collapse in these patients have remained unclear.

Methods and results

We examined 244 consecutive OHCA patients transferred to our emergency department. Head computed tomography was performed on all patients and revealed the existence of SAH in 14 patients (5.9%, 10 females). Among these, sudden collapse was witnessed in 7 patients (50%). On their initial cardiac rhythm, all 14 patients showed asystole or pulseless electrical activity, but no ventricular fibrillation (VF). Return of spontaneous circulation (ROSC) was obtained in 10 of the 14 patients (14.9% of all ROSC patients) although all resuscitated patients died later. The ROSC rate in patients with SAH (71%) was significantly higher than that of patients with either other types of intracranial haemorrhage (25%, n = 2/8) or presumed cardiovascular aetiologies (22%, n = 23/101) (p < 0.01). On electrocardiograms, ST-T abnormalities and/or QT prolongation were found in all 10 resuscitated patients. Despite their electrocardiographic abnormalities, only 3 patients showed echocardiographic abnormalities.

Conclusions

The frequency of SAH in patients with all causes of OHCA was about 6%, and in resuscitated patients was about 15%. The initial cardiac rhythm revealed no VF even though half had a witnessed arrest. A high ROSC rate was observed in patients with SAH, although none survived to hospital discharge.     

Risk of cardiac arrhythmias and conduction abnormalities in patients with acute myocardial infarction receiving packed red blood cell transfusions

Purpose

Although transfusion has been linked to the development of atrial fibrillation (AF) in cardiac surgical patients, this association has not been investigated in patients with acute myocardial infarction (AMI). Evidence supports an inflammatory mechanism in the development of AF, and red cell transfusions also elicit an inflammatory response. We therefore sought to evaluate whether packed red blood cell transfusion increases the risk of AF, ventricular tachycardia (VT), and other arrhythmias and conduction abnormalities in patients with AMI.

Materials and Methods

This is a retrospective study on patients with AMI and no prior history of AF, admitted to a critical care area and entered in Project Impact database from 08/2003-12/2007. Primary outcome measures were new-onset cardiac arrhythmias or conduction disturbances.

Results

Transfused patients had significantly higher incidences of AF (4.7% vs 1.3%, P = .008), cardiac arrest (9.5% vs 1.7%, P < .001) and heart block (3.4% vs 0.1%, P < .001), and a trend toward a higher incidence of VT (3.4% vs 1.3%, P = .058). Multivariate regression analysis confirmed transfusion as an independent risk factor for “non-lethal” cardiac events (AF/heart block; odds ratio [OR], 4.7 [1.9-11.9]; P = .001), “lethal” events (VT/cardiac arrest; OR, 2.4 [1.1-5]; P = .016), and all cardiac events (OR, 2.8 [1.5-65.1]; P = .001). Transfused patients had significantly longer length of stay (P < .0001) and significantly higher mortality rates than nontransfused patients (OR, 3 [1.7-5.5]; P < .001).

Conclusions

Packed red blood cell transfusion is independently associated with an increased risk of new-onset cardiac arrhythmias and conduction abnormalities in the setting of AMI, even after controlling for traditional risk factors.     

Increased plasma levels of CATS mRNA but not CATB mRNA in patients with coronary atherosclerosis

Background

We hypothesized that patients with coronary atherosclerosis have increased plasma levels of cathepsin S (CATS) and cathepsin B (CATB) mRNA, the genes that are involved in atherosclerotic plaque development and destabilization.

Methods

mRNAs were isolated from plasma of 67 patients with coronary atherosclerosis (29 with stable angina, 38 with acute coronary syndrome) and 33 healthy subjects as controls, transcribed to cDNA and quantified by real-time PCR.

Results

Plasma levels were successfully measured in all samples. Patients with coronary atherosclerosis had 2.75 times higher plasma levels of CATS mRNA than controls (median 6.10 vs. 2.22; p < 0.001). No difference was observed in CATB mRNA levels (median 5.62 vs. 6.19; p = 0.866). Patients on therapy with statins and aspirin tended to have higher plasma levels of CATS mRNA than patients without statins and aspirin (median 6.41 vs. 4.27; p = 0.028).

Conclusions

Further evaluation of plasma CATS mRNA levels in patients with coronary atherosclerosis is reasonable.     

Targeting low-normal or high-normal mean arterial pressure after cardiac arrest and resuscitation: a randomised pilot trial

Purpose

We aimed to determine the feasibility of targeting low-normal or high-normal mean arterial pressure (MAP) after out-of-hospital cardiac arrest (OHCA) and its effect on markers of neurological injury.

Methods

In the Carbon dioxide, Oxygen and Mean arterial pressure After Cardiac Arrest and REsuscitation (COMACARE) trial, we used a 2³ factorial design to randomly assign patients after OHCA and resuscitation to low-normal or high-normal levels of arterial carbon dioxide tension, to normoxia or moderate hyperoxia, and to low-normal or high-normal MAP. In this paper we report the results of the low-normal (65–75 mmHg) vs. high-normal (80–100 mmHg) MAP comparison. The primary outcome was the serum concentration of neuron-specific enolase (NSE) at 48 h after cardiac arrest. The feasibility outcome was the difference in MAP between the groups. Secondary outcomes included S100B protein and cardiac troponin (TnT) concentrations, electroencephalography (EEG) findings, cerebral oxygenation and neurological outcome at 6 months after cardiac arrest.

Results

We recruited 123 patients and included 120 in the final analysis. We found a clear separation in MAP between the groups (p?<?0.001). The median (interquartile range) NSE concentration at 48 h was 20.6 µg/L (15.2–34.9 µg/L) in the low-normal MAP group and 22.0 µg/L (13.6–30.9 µg/L) in the high-normal MAP group, p?=?0.522. We found no differences in the secondary outcomes.

Conclusions

Targeting a specific range of MAP was feasible during post-resuscitation intensive care. However, the blood pressure level did not affect the NSE concentration at 48 h after cardiac arrest, nor any secondary outcomes.

     

The importance of an exercise testing protocol for detecting changes of peak oxygen uptake in cardiac rehabilitation

Hansen D, Dendale P, Berger J, Meeusen R. The importance of an exercise testing protocol for detecting changes of peak oxygen uptake in cardiac rehabilitation.

Objective

To assess which exercise testing protocol is most sensitive for assessing peak oxygen uptake (Vo₂peak) changes as a result of cardiac rehabilitation.

Design

Prospective randomized clinical trial.

Setting

Outpatient cardiac rehabilitation center.

Participants

Forty-two cardiac patients (33 men; mean age, 65.4±8.4y).

Intervention

All patients were included into a 7-week cardiac rehabilitation program and randomized in 2 subgroups. One group of patients was evaluated by a 1-minute stage (n=21) and another group by a 3-minute stage (n=21) exercise testing protocol.

Main Outcome Measures

In both groups, maximal cardiopulmonary exercise tests on a bicycle with analysis of Vo₂peak, expiratory volume (V̇e), respiratory exchange ratio, heart rate, cycling resistance (W), and test duration were performed at the start and end of the program.

Results

Subgroups were closely matched, and no changes in β-blocker treatment occurred during this study. As result of the rehabilitation program, total test duration and Wpeak improved significantly in both groups (P<.05). Nonetheless, Vo₂peak and Vepeak increased significantly in the 1-minute stage duration group (P<.05) but not in the 3-minute stage duration group (P>.05). In addition, the change of Vo₂peak, Vepeak, and total test duration was significantly greater in the 1-minute stage duration group compared with the 3-minute stage duration group (P<.05).

Conclusions

For detecting changes of Vo₂peak as result of cardiac rehabilitation, a 1-minute stage exercise testing protocol is more sensitive when compared with a 3-minute stage exercise testing protocol.