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Takotsubo cardiomyopathy:Pathophysiology and role of cardiac biomarkers in differential diagnosis

World Journal of Cardiology 2017年第9期9卷 723-730页

作者： Prabhakaran Gopalakrishnan Ramsha Zaidi Muhammad Rizwan Sardar Division of Cardiology Department of MedicineAultman HospitalCantonOH 44710United States

Takotsubo cardiomyopathy(TC) is characterized by reversible ventricular dysfunction, not limited to the distribution of an epicardial coronary artery. A disease primarily afflicting post-menopausal women, it is frequently mistaken for acute anterior wall myocardial infarction. Alternatively called Stress Cardiomyopathy, physical or emotional triggers are identified in only three fourths of TC patients. Long considered a benign condition, recent findings suggest poor short term prognosis similar to acute coronary syndrome(ACS). Despite the widely recognized pathophysiological role of catecholamine excess, its diagnostic role is uncertain. TC is suspected based on typical wall motion abnormalities in ventriculogram or echocardiogram. Several additional electrocardiographic, laboratory and imaging parameters have been studied with the goal of clinical diagnosis of TC. While several clinical clues differentiate it from ACS, a clinical diagnosis is often elusive leading to avoidable cardiac catheterizations. Natriuretic peptides(NPs), a family of peptide hormones released primarily in response to myocardial stretch, play a significant role in pathophysiology, diagnosis as well as treatment of congestive heart failure. TC with its prominent ventricular dysfunction is associated with a significant elevation of NPs. NPs are elevated in ACS as well but the degree of elevation is typically lesser than in TC. Markers of myocardial injury such as troponin are usually elevated to a higher degree in ACS than in TC. This differential elevation of NPs and markers of myocardial injury may play a role in early clinical recognition of TC.

关键词： Takotsubo cardiomyopathy Natriuretic peptide Brain natriuretic peptide N-terminal-probrain natriuretic peptide Troponin cardiac biomarkers Acute myocardial infarction

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Release of cardiac biomarkers during a Cycling Race

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World Journal of Cardiovascular Diseases 2016年第8期6卷 285-294页

作者： Caroline Le Goff Jean-François Kaux Stéphanie D’Otreppe Sébastien Goffaux Marianne Fillet Jean-Paul Chapelle Etienne Cavalier Department of Clinical Chemistry University of Liège Liège Belgium Department of Physical Medicine and Sport Traumatology SPORTS2 FIFA Medical Centre of Excellence University of Liège Liège Belgium Department of Analytical Pharmaceutical Chemistry University of Liège Liège Belgium

Objectives: Over the past two decades, a large interest in cardiac marker elevations has developed in endurance sports events. The intense effort is not without risk. We aimed to see if the relatively cardiospecific biomarkers could show the damage on cardiac muscle cells. Methods: Fourteen cyclists were recruited for an international race (177 km). We studied different cardiac biomarkers, renal function markers and blood cytology. The subjects were submitted to three blood test: one before (T0), one just after (T1) and the last one 3 hours after the race (T3). Results: Blood cytology markers, namely erythrocytes, hemoglobin, hematocrit, and average hemoglobin concentration, were found to evolve in a similar way. Renal function markers, such as creatinin, cystatin C and uric acid, showed a post effort increase that might be related to renal blood flow depletion during exercise. cardiac and muscular markers were all increased at T1. Conclusions: Physiological stress induced by an international cycling race certainly has consequences on cardiac muscle cells. Fortunately, those blood concentration variations are more representative of a transitional state, due to an imbalance created by an intense aerobic effort maintained during several hours, rather than an irreversible injury.

关键词： Cycling cardiac biomarkers Stress biomarkers Renal Function Markers

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Level of cardiac biomarkers in Immediate Post-Operative Period after Off-Pump CABG and Its Comparison with On-Pump CABG: A Prospective Analytical Study

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World Journal of Cardiovascular Surgery 2020年第10期10卷 200-211页

作者： Sayar Kumar Munshi Ashis Halder Pares Bandyopadhyay Congenital cardiac Surgery Fortis Escorts Heart Institute New Delhi India Cardiothoracic & Vascular Surgery Nilratan Sircar Medical College & Hospital Kolkata India

Background: Coronary artery bypass grafting (CABG) is an important modality of treatment for ischemic heart disease. Both off-pump and on-pump CABG have direct effect on the level cardiac biomarkers in the perioperative period. The use of cardiopulmonary bypass (CPB) and aortic cross-clamping may cause additive myocardial damage leading to further elevation of blood markers. The present study is aimed at measuring and comparing the cardiac biomarker levels in immediate post-operative period after on-pump CABG (ONCAB) and off-pump CABG (OPCAB). Methods: All the patients who underwent CABG from January 2015 to June 2016 on elective or emergency basis at Nilratan Sircar Medical College & Hospital have been included in the study. Total 106 patients were operated for CABG of which 75 patients were operated for OPCAB and 31 patients were operated for ONCAB. For the comparison of data the blood markers Troponin-T (Trop-T) and Creatine Kinase-MB (CK-MB) are measured during anesthesia before surgery, post-operatively after 1 hour, post-operatively after 4 hours and post-operatively after 20

关键词： Coronary Artery Bypass Grafting (CABG) Perioperative Period Myocardial Damage Cardiopulmonary Bypass cardiac biomarkers

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Prognostic value of elevated cardiac and inflammatory biomarkers in patients with severe COVID-19:a single-center,retrospective study

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Emergency and Critical Care Medicine 2022年第3期2卷 122-127页

作者： Neeraj Kumar Sarfaraz Ahmad Mala Mahto Abhyuday Kumar Prabhat K.Singh Department of Trauma and Emergency All India Institute of Medical Sciences PatnaBiharIndia Department of Anaesthesiology All India Institute of Medical Sciences PatnaBiharIndia Department of Biochemistry All India Institute of Medical Sciences PatnaBiharIndia Director All India Institute of Medical Sciences PatnaBiharIndia

Background:The outbreak of coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2 in India has been declared a public health *** patients with COVID-19 experience cardiac *** with COVID-19 admitted to the intensive care unit(ICU)with acute myocardial injury showed increased high-sensitivity troponin *** troponin levels may indicate myocardial injury and are commonly associated with ***:We conducted a retrospective observational study of 44 patients with severe COVID-19 in ICU during the second *** primary end point of our retrospective study was 28-day mortality,and the time of ICU admission was designated as day *** extracted and analyzed cardiac biomarkers,such as creatine kinase(CK),creatine kinase-MB(CK-MB),B-type natriuretic peptide(BNP),and high-sensitivity cardiac troponin I(hs-cTnI),and various inflammatory markers such as C-reactive protein(CRP)level,interleukin 6(IL-6),D-dimer,ferritin,lactate dehydrogenase,IL-6,and procalcitonin in patients with severe COVID-19 at ICU admission and 72 hours after ICU admission from our electronic medical record ***:The best cutoff of BNP were 326.8 and 398.5 pg/mL,CK were 195.95 and 180.12 U/L,CK-MB were 112.10 and 108.5 U/L,and hs-cTnI were 0.035 and 0.025 ng/mL,at ICU admission and 72 hours after ICU admission for predicting 28-day mortality among ***:In patients with severe COVID-19,CK and hs-cTnI may be considered effective and valuable predictive cardiac biomarkers among nonsurvivors and predict poor prognosis.

关键词： cardiac biomarkers COVID-19 Intensive care unit Mortality Prognosis Retrospective study

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Prevalence of posttraumatic stress disorder following acute coronary syndrome and clinical characteristics of patients referred to cardiac rehabilitation

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World Journal of Psychiatry 2023年第6期13卷 376-385页

作者： Ivana Sopek Merkaš Nenad Lakušić Zdenko Sonicki Barbara Koret Sandra Vuk Pisk Igor Filipčić Department of Cardiology Special Hospital for Medical Rehabilitation Krapinske TopliceKrapinske Toplice 49217Croatia Department of Clinical Medicine Faculty of Dental Medicine and Health OsijekJ.J.Strossmayer University of OsijekOsijek 31000Croatia Department of Internal Medicine Family Medicine and History of MedicineFaculty of Medicine OsijekJ.J.Strossmayer University of OsijekOsijek 31000Croatia Department of Medical Statistics Epidemiologyand Medical InformaticsSchool of Public Health Andrija StamparSchool of MedicineUniversity of ZagrebZagreb 10000Croatia Department of Psychiatry Clinic for Psychiatry“Sveti Ivan”Zagreb 10000Croatia Department of Psychiatry and Neurology Faculty of Dental Medicine and Health OsijekJ.J.Strossmayer University of OsijekOsijek 31000Croatia Department of Psychiatry and Psychological Medicine School of MedicineUniversity of ZagrebZagreb 10000Croatia

BACKGROUND Studies have demonstrated that patients who have experienced acute coronary syndrome(ACS)have an increased risk of developing posttraumatic stress disorder(PTSD)and experiencing worse survival outcomes than those who do not develop ***,the prevalence rates of PTSD following ACS vary widely across studies,and it is noteworthy that in most cases,the diagnosis of PTSD was based on self-report symptom questionnaires,rather than being established by ***,the individual characteristics of patients who develop PTSD after ACS can differ widely,making it difficult to identify any consistent patterns or predictors of the *** To investigate the prevalence of PTSD among a large sample of patients undergoing cardiac rehabilitation(CR)after ACS,as well as their characteristics in comparison to a control *** The participants of this study are patients who have experienced ACS with or without undergoing percutaneous coronary intervention and are enrolled in a 3-wk CR program at the largest CR center in Croatia,the Special Hospital for Medical Rehabilitation Krapinske *** recruitment for the study took place over the course of one year,from January 1,2022,to December 31,2022,with a total of 504 *** expected average follow-up period for patients included in the study is about 18 mo,and currently *** self-assessment questionnaire for PTSD criteria and clinical psychiatric interview,a group of patients with a PTSD diagnosis was *** the participants who do not have a PTSD diagnosis,patients who would match those with a PTSD diagnosis in terms of relevant clinical and medical stratification variables and during the same rehabilitation period were selected to enable comparability of the two *** A total of 507 patients who were enrolled in the CR program were approached to participate in the *** patients declined to participate in the *** screening PTSD

关键词： cardiac rehabilitation Acute coronary syndrome Posttraumatic stress disorder Psychiatric interview Multidisciplinary team cardiac biomarkers

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Cardiovascular impact of COVID-19 with a focus on children: A systematic review

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World Journal of Clinical Cases 2020年第21期8卷 5250-5283页

作者： Moises Rodriguez-Gonzalez Ana Castellano-Martinez Helena Maria Cascales-Poyatos Alvaro Antonio Perez-Reviriego Pediatric Cardiology Division Puerta del Mar University HospitalCadiz 11009Spain Biomedical Research and Innovation Institute of Cadiz Puerta del Mar University HospitalCadiz 11009Spain Pediatric Nephrology Division Puerta del Mar University HospitalCadiz 11009Spain Pediatrics Division Motril-San Antonio Primary Care CenterMotril 18600Spain Pediatrics Division UGC Pediatria AG Sur GranadaSanta Ana HospitalMotril 18600Spain

BACKGROUND Since the beginning of the pandemic,coronavirus disease-2019(COVID-19)in children has shown milder cases and a better prognosis than *** the respiratory tract is the primary target for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),cardiovascular involvement is emerging as one of the most significant and life-threatening complications of SARS-CoV-2 infection in *** To summarize the current knowledge about the potential cardiovascular involvement in pediatric COVID-19 in order to give a perspective on how to take care of them during the current pandemic *** Multiple searches in MEDLINE,PubMed were performed using the search terms“COVID-19”or“SARS-CoV-2"were used in combination with“myocardial injury”or"arrhythmia"or“cardiovascular involvement”or"heart disease"or"congenital heart disease"or“pulmonary hypertension”or"long QT"or“cardiomyopathies”or“channelopathies”or"Multisystem inflammatory system"or"PMIS"or“MIS-C”or”Pediatric multisystem inflammatory syndrome"or"myocarditis"or"thromboembolism to identify articles published in English language from January 1st,2020 until July 31st,*** websites of World Health Organization,Centers for Disease control and Prevention,and the Johns Hopkins Coronavirus Resource Center were reviewed to provide up to date numbers and infection control *** lists from the articles were reviewed to identify additional pertinent *** manuscripts concerning the subject were reviewed by the authors,and the data were extracted using a standardized collection *** were subsequently analyzed with descriptive *** Pediatric multisystemic inflammatory syndrome temporally associated with COVID-19(PMIS),multiple meta-analyses were conducted to summarize the pooled mean proportion of different cardiovascular variables in this population in pseudo-cohorts of observed *** A total of 193 articles were *** publications used in

关键词： COVID-19 SARS-CoV-2 Congenital heart diseases Myocardial dysfunction Pediatric Multisystem Inflammatory Syndrome cardiac biomarkers

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Tako-tsubo cardiomyopathy

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Journal of Nanjing Medical University 2009年第3期23卷 153-156页

作者： Yan Zhuang Di Xu Department of Cardiology the First Affiliated Hospital of Nanjing Medical University Nanjing 210029 China

Tako-tsubo cardiomyopathy（TC） is a recently described acute cardiac syndrome, which the latest cardiomyopathy classification of the European Society of Cardiology describes as an unclassified cardiomyopathy. TC mimics acute myocardial infarction（AMI） and is characterised by ischaemic chest symptoms, an elevated electrocardiogram ST-segment, and moderately increased levels of cardiac disease markers. However, patients with TC have no coronary angiogram-detectable or non-obstructive coronary arterial disease（CAD）, and left ventriculography documents transient left apical and middle ventricular wall dysfunction. In this review, we describe TC and evaluate epidemiological, clinical and instrumental features, pathophysiological mechanisms, therapy and prognosis of this syndrome,with a view to raising awareness of the disease.

关键词： Tako-tsubo cardiomyopathy epidemiology pathophysiological mechanisms electrocardiography cardiac biomarkers coronary angiography left ventriculography therapy prognosis

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New Cutoff for High Sensitivity Troponin to Better Risk Stratify Patients with Non-ST Elevated Myocardial Infarction

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World Journal of Cardiovascular Diseases 2021年第1期11卷 25-33页

作者： Omar Y. Al-Assaf Anas Musa Hind H. Alkazim Sam C. Benny Azan S. Binbrek Internal Medicine Department Rashid Hospital Dubai Health Authority Dubai United Arab Emirates Cardiology Department Rashid Hospital Dubai Health Authority Dubai United Arab Emirates

Background: The diagnosis of Non-ST Elevated Myocardial Infarction (NSTEMI) is dependent on elevation of high sensitivity troponin (Hs-troponin). The current cutoff point for Hs-troponin is highly sensitive but not specific for obstructive coronary artery disease (CAD). This study aims to determine the best cutoff point for diagnosing CAD in patients presented with NSTEMI. Methods: Our study included all patients admitted as NSTEMI that underwent coronary angiography (CAG). They were grouped into two groups: A and B. Group A has obstructive CAD of 70% or more stenosis and group B with non-obstructive CAD. Patients were assessed for their demographics, clinical history, laboratory and imaging results. Using SPSS version 22, the pooled cohort of patients were analyzed at significant level 0.05 and the data were tested for significant correlations between two predetermined groups. Results: Group A comprised 87.6% of the patients and both groups had a median age of 53 years. In Group A, 91% were males, 54% diabetics, 54% hypertensives, and median Hs-troponin was 145 ng/L. While in group B, 88% were males, 39% diabetics, 60% hypertensives, and median Hs-troponin was 54 ng/L. There was significant correlation between the two groups in the percentage of diabetes and median troponin level (p

关键词： Non-Obstructive Myocardial Infarction cardiac biomarkers Coronary Angiography Non-ST Elevated Myocardial Infarction

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