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Background Cardiac amyloidosis (CA) is associated with an elevation of natriuretic peptides and troponins, predicting outcome. Nevertheless, the diagnostic yield of these biomarkers has not been extensively investigated. Aim To evaluate the diagnostic performance for CA of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT). Methods Patients with suspected CA (n=1,149) underwent a diagnostic work-up in 3 Centers in Italy, France (n=343, derivation cohort), and United Kingdom (n=806, validation cohort). Biomarker values with either 100% sensitivity or ≥95% specificity were selected as rule-out/rule-in cut-offs, respectively. Results In the derivation cohort, 227 patients (66%) had CA, and presented with higher NT-proBNP and hs-TnT. NT-proBNP 180 ng/L and hs-TnT 14 ng/L were selected as rule-out cut-offs, and hs-TnT 86 ng/L as rule-in cut-off. NT-proBNP Conclusions Cardiac biomarkers can refine the diagnostic algorithm in patients with suspected CA. NT-proBNP

Background High-sensitivity (hs) assays for the measurement of cardiac troponin T (cTnT) and cardiac troponin I (cTnI) are now used widely for the diagnosis of myocardial infarction. However, it is also increasingly apparent that troponin concentrations well below the thresholds used in acute coronary syndromes may provide diagnostic and prognostic information also for patients with chronic coronary syndromes (CCS). Purpose This study is aimed at evaluating the association of hs-cTnT and hs-cTnI with clinical/molecular profiles, measures of myocardial ischemia and coronary artery disease (CAD), and their potential role as predictors of adverse cardiovascular events in a population of patients with CCS. Methods Hs-cTnT and hs-cTnI were measured in 365 patients with CCS (mean age 61±8, 217 males) as part of the multicenter Evaluation of Integrated Cardiac Imaging (EVINCI) European study. Patients were characterized for clinical and molecular profile and underwent stress imaging to detect myocardial ischemia and coronary computed tomographic angiography (CTA) to assess the presence of CAD. An individual coronary CTA score was calculated combining extent, severity, composition, and location of plaques. All patients entered a clinical follow-up (1600±369 days). The composite cardiovascular outcome measure included all-cause mortality, non-fatal myocardial infarction, and hospitalization for unstable angina or heart failure. Clinical, molecular, and imaging parameters were used in a multivariate step-wise analysis to identify those associated with hs-cTnT and hs-cTnI. The possible role of troponins as independent predictors of adverse cardiovascular events was evaluated by Kaplan-Meier and Cox analysis. Results The median values (IQR) of hs-cTnT and of hs-cTnI were 6.4 (4.9) ng/L and 4.4 (10.3) ng/L, respectively. In a multivariate model, age, gender, diabetes, NT-proBNP, and CTA score were independently associated with plasma hs-cTnT; triglycerides, HDL-cholesterol, and ischemia were independently associated with hs-cTnI (Table 1); interleukin-6 was associated with both troponins. At Kaplan-Meier analysis, event-free survival was significantly worse in patients with levels higher than the median values of both hs-cnT and hs-cTnI (Figure 1A, B). At Cox analysis, after correction for age, gender, and risk factors (EUROscore), only high hs-cTnI remained an independent predictor of cardiovascular events (hs-cTnT: HR 2.17, 95% CI, 0.87–5.41, P=ns; hs-cTnI: HR 2.65, 95% CI, 1.09–6.44, P=0.031). Conclusion In patients with CCS, the presence and extent of coronary atherosclerosis is related with circulating levels of hs-cTnT, while the presence of ischemia is related with circulating levels of hs-cTnI, suggesting different mechanisms of release. Only high levels of hs-cTnI were independent predictors of cardiovascular events. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Grant from the European Union FP7-CPFP506-2007 (Evaluation ofIntegrated Cardiac Imaging for the Detection and Characterisation of Ischemic Heart Disease).

Background There are some concerns about the cost/benefit ratio of Covid-19 vaccination in children and young adolescents age due to the greater response to immune stimulation. Myocarditis is a feared adverse event (AE). Methods On January 4, 2022 we searched the Pubmed and EMBASE datasets for population studies assessing myocarditis events in pediatric subjects, and US nationwide data about COVID-19 vaccinations and AEs. Results The studies selected (n=10) were highly heterogeneous, and did not include subjects Conclusions The reported incidence of myocarditis in subjects aged ≥12 years is slightly higher in males and after the second dose, but extremely low. No case of myocarditis Funding Acknowledgement Type of funding sources: None.

Background The endothelial nitric oxide synthase (eNOS) gene deficiency is known to cause insulin resistance, hypertension, hypertriglyceridemia and impaired coronary vasodilating capability in animal models. In the general clinical population, the eNOS gene polymorphism (Glu298Asp, G894T), able to reduce eNOS activity, was associated either with features of the metabolic syndrome or prevalence of coronary artery disease (CAD). Purpose To investigate the possible association of Glu298Asp polymorphism with cardiometabolic risk [insulin resistance, increased triglycerides (TG) and low HDL-cholesterol (HDL-C)], obstructive CAD and inducible myocardial ischemia in stable patients with suspected coronary disease. Methods Six cardiology units enrolled a total of 506 consecutive patients (314 males; mean age 62±9 years) referred for suspected CAD within the BIOGEN-CARE Tuscan Region Italian Study. Among these, 325 patients underwent stress ECG or cardiac imaging to assess the presence of inducible ischemia and 436 patients underwent non invasive computerized tomography or invasive coronary angiography to assess the presence of obstructive CAD (>50% stenosis in at least one major coronary vessel). Blood samples were collected from each patient for genotyping and measurements of lipid and glucose parameters. The TG/HDL-C ratio and the TyG-index [ln(TG × Fasting plasma glucose/2)] were used as synthetic markers of atherogenic dyslipidemia and insulin resistance, main components of the cardiometabolic risk. Results In the whole population, 49.6% of patients were homozygous for the G894allele, 40.9% heterozygotes, and 9.5% homozygous for T894. Myocardial ischemia was documented in 160/325 (49.2%) patients undergoing stress testing and obstructive CAD in 178/436 (40.8%) patients undergoing coronary angiography. Patients carrying the T allele (dominant model TT+GT vs GG) had higher TG/HDL ratio (2.7±1.8 vs 2.5±1.9, P=0.03) (Figure) without differences in other lipid and glucose markers. Independent predictors of obstructive CAD were age, gender, obesity, diabetes and TG/HDL-C ratio but not the the T allele (OR 0.80; CI 0.51–1.25; ns). Independent predictors of inducible ischemia were age, gender, obesity and the T allele (OR 1.91; CI 01.19–3.08; P=0.007). Stratifying the population for both obstructive CAD and ischemia, the T allele was associated with increased risk of ischemia (OR 1.96; CI 1.11–3.44; P=0.02) even after adjustment for the presence of obstructive CAD (OR 3.09; CI 1.85–5.78; P Conclusions In stable patients with suspected CAD, the eNOS Glu298Asp gene polymorphism is an independent risk factor for inducible myocardial ischemia and is significantly associated with the specific cardiometabolic risk expressed by high TG and low HDL-C which independently predicts obstructive CAD. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): “BIOhumoral and GENetic predictors of CARdiac Evolving phenotype in Ischemic Heart Disease (BIOGENCARE-IHD)”; funded by Toscan Region-Programma per la ricerca regionale in materia di Salute 2009

Background To better contrast the Covid–19 pandemics, national authorities worldwide are authorizing vaccination of children and adolescents, despite some concerns of adverse reactions due to their greater response to immune stimulation. Myocarditis is a particularly feared adverse reaction. Methods On December 30, 2021 we searched the CDC dataset of all Covid–19 vaccinations in the United States (US), and the VAERS dataset, which reports adverse reactions to vaccines after any Covid–19 vaccine in the US. Results Individuals receiving at least one dose were 243,182,423 (0.017% Conclusions While the incidence is slightly higher in the pediatric age than in adult or elderly individuals, it is still equal to 24 cases of “serious” myocarditis per million people aged 6–17 years, and less than 4 cases of fatal or life–threatening myocarditis were reported. The risk of fatal or life–threatening myocarditis is about the same than being struck by lightning.

Background High–sensitivity (hs) assays allow to measure cardiac troponin T and I (cTnT/I) even in healthy individuals. The higher hs–cTn values, the higher the ongoing cardiomyocyte damage, and then reasonably the risk of developing symptomatic cardiac disease. Methods We retrieved all studies evaluating the prognostic value of hs–cTnT or I in the general population. We calculated pooled hazard ratio (HR) values for all–cause and cardiovascular death, cardiovascular events and heart failure (HF) hospitalization. Results We included 24 studies for a total of 203,202 subjects; 11 studies assessed hs–cTnT and 14 hs–cTnI. One standard deviation (SD) increase in baseline hs–cTn was associated with a 23% higher risk of all–cause death (HR 1.226, 95% CI 1.083–1.388, p Conclusions Hs–cTn values hold strong prognostic value in subjects from the general population, predicting the risk of all–cause and cardiovascular mortality, cardiovascular events, and HF hospitalization.

Aims High-sensitivity (hs) assays allow to measure cardiac troponin T and I (cTnT/I) even in healthy individuals. The higher hs-cTn values, the higher the ongoing cardiomyocyte damage, and then reasonably the risk of developing symptomatic cardiac disease. Methods and results We retrieved all studies evaluating the prognostic value of hs-cTnT or I in the general population. We calculated pooled hazard ratio (HR) values for all-cause and cardiovascular death, cardiovascular events and heart failure (HF) hospitalization. We included 24 studies for a total of 203 202 subjects; 11 studies assessed hs-cTnT and 14 hs-cTnI. One standard deviation (SD) increase in baseline hs-cTn was associated with a 23% higher risk of all-cause death (HR: 1.226, 95% CI: 1.083–1.388, P Conclusions hs-cTn values hold strong prognostic value in subjects from the general population, predicting the risk of all-cause and cardiovascular mortality, cardiovascular events, and HF hospitalization.

Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The EVINCI study was supported by a grant from the European Union FP7-CP-FP506 2007 project (GA 222915). The SMARTool study was supported by a grant from the European Union H2020-PHC-30-2015 (GA 689068). This study was also partially supported by a grant from AMGEN (Protocol N. 20167781, 2017). Background. High triglycerides (TG) and low high-density lipoprotein cholesterol (HDL-C) characterize an atherosclerotic cardiovascular disease (CAD) risk condition defined as atherogenic dyslipidemia. Aim. To assess whether atherogenic dyslipidemia defined by TG/HDL-C ratio predicts CAD related outcomes in patients with stable angina, independently of other risk factors and treatments. Methods. We studied 355 patients (60 ± 9 y, 211m) with stable angina from the EVINCI Outcome study. Patients were characterized for clinical, bio-humoral and imaging profiles, managed clinically, and followed for 4.5 ± 0.9 years. A computed tomography angiography (CTA) coronary risk score was obtained at baseline in all patients, and at follow-up in 154 of them. The primary composite outcome was all-cause mortality and non-fatal myocardial infarction. CTA scan was repeated at follow-up in 154 patients to assess CAD progression. Results. The median value of TG/HDL-C ratio was 2.095 (2.079IQR). At baseline, the proportion of males, smoking, diabetes and metabolic syndrome, as well as circulating bio-markers of abnormal glucose metabolism and myocardial damage progressively increased across quartiles of TG/HDL-C ratio. The CTA score was significantly higher in the IV quartile of the TG/HDL-C ratio and both were the only independent predictors of the primary (CTA Score: HR 1.06, 95%CI 1.03-1.09, p = 0.001; TG/HDL-C IV quartile: HR 2.85, 95%CI 1.30-6.26, p Conclusions. In patients with stable angina, the TG/HDL-C ratio expresses a cardio-metabolic atherogenic disorder which is progressive over time and is associated with CAD related outcomes independently of LDL-C levels and treatments.

C-type natriuretic peptide (CNP) is structurally related to cardiac natriuretic peptides and is currently considered as an endothelium-derived hyperpolarizing factor. Endothelial dysfunction, commonly observed in chronic heart failure (HF) patients is positively affected by physical training.To evaluate the effect of aerobic physical training on the expression of CNP, 90 HF patients on optimal pharmacological treatment (age 62+/-2 years, mean+/-SEM), randomly assigned in a 3 : 1 ratio to either control group (C, 19 patients) or home-based aerobic exercise-training program group (T, 71 patients), completed the protocol. Plasma assay of CNP, brain natriuretic peptide or B-type natriuretic peptide (BNP), and norepinephrine; echocardiogram; and cardiopulmonary-stress test were performed in all patients at enrollment and after 9 months.At baseline, in both groups, CNP plasma level was significantly related to BNP (R=0.50), ejection fraction (R=0.43), and peak oxygen uptake (VO2, R=0.43, all P0.001). After 9 months, trained patients showed an improvement in peak VO2 (P0.001) and ejection fraction (P0.05), whereas norepinephrine (P0.05), BNP (P0.001), and CNP (P0.001) decreased. No changes occurred in group C. In group T, the decrease in CNP was significantly related to the increase in peak VO2 (R=0.31, P0.01), and the relation between CNP and BNP was preserved at the end of the program (R=0.41, P0.001).Clinical and functional improvement after physical training in HF patients is associated with a decrease in adrenergic activation and in both CNP and BNP concentration. Changes in CNP plasma concentration after physical training might reflect an improvement in endothelial function.

Retrograde cardioplegia (RC) delivery may result in suboptimal myocardial protection, due to leakage of cardioplegia to the right atrium. This study was undertaken to assess the efficacy of a double balloon cannula (DBC) occluding the coronary sinus ostium during RC. Fifteen patients were randomly assigned to receive RC via a conventional cannula or via the DBC. Cardioplegia was started at 200 ml/min, and the flow rate (Q) was adjusted to obtain a perfusion pressure (P) of 25-40 mmHg. Blood samples were collected at 13 different time points. The CPK-MB and TnI levels were measured on each sample. The use of the DBC was associated with increased P (P=0.03) at a lower Q (P=0.02). The CK-MB levels were significantly increased in both groups (P

We read the interesting minireview by Goetze (1) concerning the biochemistry of pro-B-type natriuretic peptide (proBNP)-derived peptides: the main message is the potential clinical relevance of the proBNP-derived peptides, which should be considered for current clinical interpretation of plasma BNP concentrations and be the focus of ongoing research. Accordingly, the lack of accurate studies on in vivo production/secretion mechanisms and metabolism of BNP- and proBNP-related peptides explains the incomplete knowledge of the pathophysiologic significance of this hormone system. Thus, we agree with Goetze that deeper insight into the biochemistry of these peptides could pave the way for more sensitive and disease-specific assays in the clinical setting. We have some observations concerning the presence of an “endocrine paradox in heart failure” (1). The lack of encoding and processing of the precursor peptides to the mature hormones, atrial natriuretic peptide (ANP) and BNP, which have a potent diuretic and natriuretic effect, could explain the disturbed electrolyte and fluid homeostasis occurring in chronic heart failure (2)(3). However, the hypothesis of heart failure as a syndrome of cardiac natriuretic hormone (CNH) deficiency was challenged when this system was investigated in experimental animals and in humans. In fact, patients with congestive heart failure [New York Heart Association (NYHA) classes III–IV] have greatly increased plasma concentrations of CNHs compared with healthy individuals (up to 500-fold or more for plasma BNP concentration) (1)(2)(3). Goetze (1) tries to explain this paradox of heart failure (i.e., highly increased CNH concentrations in patients with sodium retention) by suggesting that a part of circulating CNH-related peptides (especially proBNP-related peptides) is not biologically active. We agree that increased concentrations of immunoreactive, but biologically inactive, proBNP-related peptides (as well as proANP-related peptides) are present in patients with heart failure. As also correctly pointed out in the … [↵][1]aAddress correspondence to this author at: Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark. Fax 45-35454640; e-mail jpg{at}dadlnet.dk. [1]: #xref-corresp-2-1

Objective: It has been suggested that cardiac surgery-related ischemia-reperfusion injury to the myocardium is caused by the oxidative stress, derived from the formation of reactive oxygen species in the early phases of the reperfusion. The availability of cysteine, mostly deriving from homocysteine (Hcy) via the trans-sulfuration pathway, is determinant for the synthesis of glutathione (GSH), which in turn acts as a first line of defence against oxidative stress. Indeed, an increased consumption of Hcy in response to oxidative stress has been described. Previous research has shown that Hcy levels increase during the first weeks or months after coronary artery bypass grafting (CABG). This study was designed to evaluate the Hcy metabolism in CABG patients during the early postoperative period. Methods: Serum Hcy and folate were measured by an automatic immunometric system on blood samples obtained from 48 (mean age 67 ^ 10 years) consecutive patients undergoing CABG, preoperatively and at 0, 12, 48, and 120 h after surgery. A subgroup of 22 of these patients was also studied 6 months postoperatively. Results: A significant decrement of Hcy and folate was observed throughout the study ðP , 0:0001Þ from 17.3 ^ 9.3 to 8.5 ^ 5.6 mmol/l at 12 h postoperatively for Hcy, and from 5.1 ^ 2.8 to 2.5 ^ 1.5 ng/ml at 48 h for folate. The reduction of Hcy and folate levels remained significant after correction for haemodilution (as assessed by measurement of plasma proteins). Furthermore, the use of cardiopulmonary bypass significantly interacted with the time of sampling in affecting the Hcy levels. Hcy levels returned to near-baseline values 48 h postoperatively, and were similar to base-line at follow-up. Conclusion: Our study indicates that serum Hcy and folate levels are markedly reduced during the early postoperative period after CABG. This reduction is at least in part independent of haemodilution, and may be caused by an altered Hcy turnover, due to an increased consumption of GSH during and soon after CABG. q 2004 Elsevier B.V. All rights reserved.

Background: Cardiac natriuretic hormones (CNHs) are a family of related peptides, including atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and other peptides derived from the N-terminal portion of the proANP and proBNP peptide chains. Assays for cardiac natriuretic peptides have been proposed to help assess clinical conditions associated with expanded fluid volume. In particular, the assays can be useful for distinguishing healthy subjects from patients in different stages of heart failure. Measurements of these hormones have also been considered for prognostic indicators of long-term survival in patients with heart failure and/or after acute myocardial infarction. The different CNHs differ in their production/secretion patterns and have different clearance rates. Furthermore, there are numerous proposed assay configurations for each of these hormones, and it is not clear which assay provides the best pathophysiological and/or clinical information. Approach: Here we review recent studies concerning the competitive (such as RIA, enzyme immunoassay, or luminescence immunoassay) and noncompetitive immunoassays (such as two-site IRMA, ELISA, or immunoluminometric assay) for the different cardiac natriuretic peptides to compare the analytical characteristics and clinical relevance of assays for the different CNHs and the different assay formats. Content: Developing sensitive, precise, and accurate immunoassays for cardiac natriuretic peptides has been difficult because of their low concentrations (on average, ∼3–6 pmol/L) in healthy subjects and because of their structural, metabolic, and physiological characteristics. Competitive assays have historically suffered from lack of sensitivity and specificity for the biologically active peptides. These usually require tedious extraction procedures prior to analysis. Recently, immunometric assays have been developed that have improved sensitivity and specificity; it appears these will be the methods of choice. Summary: To date, there is no consensus on the best assay procedure of cardiac natriuretic peptides. To facilitate widespread propagation of determination of these hormones in routine clinical practice, it will be necessary to study the new generation of noncompetitive immunometric methods that are less time-consuming and more sensitive and specific. Although several studies suggest that BNP exhibits better clinical utility than the other CNHs, more studies examining multiple CNHs in the same cohorts of patients will be necessary.

The replication-error positive (RER+) phenotype characterizes tumour cells with microsatellite instability. This 'mutator phenotype' is thought to induce spread mutations throughout the genome, thus increasing the risk of tumour development. Here we analyse spontaneously arising mutations at the tetranucleotide CCGG ( Msp I recognition site), at positions 14 067-14 070 of the p53 gene sequence, in three colon cancer cell lines, two with microsatellite instability and one without this characteristic. This restriction site covers hot-spot codon 248, which is often mutated in colon carcinomas. Using the Msp I RFLP-PCR assay we found that the mean mutation frequency at this site was not different among the cell lines considered. Taking the substitutions separately, none of the mutations involving codon 248 arose with significantly higher frequency in each of the RER+ cell lines (HCT116 and DLD1) compared with the RER-one (SW480). Only the CG transversion at nt 14 067 (codon 247) occurred with a slightly higher, but biologically insignificant, frequency in one of the RER+ cell lines (HCT116). Our in vitro data support the previously reported lack of correlation between microsatellite instability and p53 mutations in RER+ tumour specimens.

Over the last 5 years, several immunoassay methods for the measurement of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) became commercially available. Recent studies have confirmed the clinical usefulness of measurements of these cardiac natriuretic peptides for the prognostic stratification of patients with congestive heart failure, for the detection of left ventricular systolic and/or diastolic dysfunction, and for the differential diagnosis of dyspnea (1)(2)(3)(4). However, to answer the most urgent requests of current clinical practice and to allow widespread use of BNP and NT-proBNP assays, some key issues had to be solved, such as increasing the sensitivity, precision, and experimental practicability (5). The aim of the present study was to evaluate and compare the analytical and clinical performance of five commercial natriuretic peptide immunoassays. Throughout this report, the values in healthy individuals and patients are reported as the range, median, and 25th and 75th percentiles. We enrolled 172 healthy adults (89 women and 83 men; age range, 16–73 years; median age, 49.0 years; 25th percentile, 38 years; 75th percentile, 58 years). All participants were nonobese (body mass index, 19.4–27.6 kg/m2, 24 kg/m2, 22.8 kg/m2, and 25.6 kg/m2), normotensive (diastolic blood pressure, 60–85 mmHg, 70 mmHg, 70 mmHg, and 80 mmHg; systolic blood pressure, 90–140 mmHg, 120 mmHg, 102.5 mmHg, and 124.5 mmHg), and free from acute or chronic diseases. All participants had main plasma indices (including creatinine, urea nitrogen, glucose, uric acid, albumin, enzymes, electrolytes, and hemoglobin) within the appropriate reference intervals, and normal erythrocyte and leukocyte counts …

We evaluated the analytical characteristics and clinical usefulness of a commercially available IRMA kit for measuring plasma concentrations of atrial natriuretic peptide (ANP) in healthy subjects and in patients with heart failure. The method uses two monoclonal antibodies prepared against sterically remote epitopes of the ANP molecule; the first antibody is coated on the solid-phase beads, and the second is radiolabeled with 125I. Fifty-nine healthy subjects and 77 patients with heart failure were studied. After subjects had rested 20 min in a recumbent position, blood samples were collected from a brachial vein into ice-chilled disposable polypropylene tubes containing aprotinin and EDTA. Plasma samples were immediately separated by centrifugation and stored at -20 degrees C until assay. The working range (CV

We evaluated the performance and diagnostic accuracy of an electrochemiluminescence immunoassay (ECLIA) method for N-terminal pro-B-type natriuretic peptide (NT-proBNP) in healthy persons and in patients with cardiac disease, and then compared the results obtained with the ECLIA method with results from IRMA methods for BNP and atrial natriuretic peptide (ANP). We studied 58 healthy individuals [mean (SD) age, 58 (8) years; 19 women and 39 men] and 148 consecutive patients [mean age, 64 (13) years; range, 20–80 years; 47 women and 101 men] with cardiomyopathy, admitted to the Department of Cardiovascular Medicine of our Institute. The study was done from November 2001 to October 2002. All healthy participants were nonobese, normotensive, and free from acute diseases, and all denied the use of any drug during the 4 weeks before the study. All had normal values for the main plasma indices and nonpathologic erythrocyte and leukocyte counts and urine analysis. In all of the participants, a complete cardiologic examination, including electrocardiogram and echocardiographic investigation (left ventricular ejection fraction >55%), was performed; in patients >50 years of age, an effort stress test was …

We are grateful to Dr. Christian Mueller for his constructive suggestions regarding our review (1). Actually, area under the curve (AUC) values of brain natriuretic peptide (BNP) and the N-terminal part of the propeptide of BNP (NT-proBNP) (0.85 and 0.80, respectively) assays related to the study by Ray et al. (2) were erroneously inverted, whereas sensitivity and specificity were correctly indicated in Table 2 of our review (1). Nevertheless, we confirm that the conclusions of our review were correct; they were based on the diagnostic odds …

In light of recommendations on the quality (1) and clinical use (2) of troponin assays, we evaluated the analytical performance of the ADVIA Centaur and ADVIA CP® platforms (TnI-Ultra, Siemens Medical Solutions Diagnostics SrL) for measurement of cardiac troponin I (cTnI). The chemiluminescent TnI-Ultra method uses 2 monoclonal capture antibodies directed to epitopes at amino acids 41–49 and 87–91 and a tracer polyclonal goat antibody labeled with acridinium ester, directed against amino acids 27–40 (1)(3)(4). Two clinical laboratories participated in the study: the CNR Institute of Physiology in Pisa and the San Bortolo Hospital in Vicenza. The limit of detection (limit of the blank) for the TnI-Ultra method was calculated as the concentration corresponding to a signal of 3 SD above the mean of 60 replicates (obtained in 4 different runs and pooled together) for the calibrator in which cTnI was absent; a mean cTnI concentration of 0.006 μg/L was found. The total imprecision …

Purpose: Gamma-glutamyltransferase (GGT) is a well known prognostic marker in patients with cardiovascular disease. Aim of this study is to define the role of GGT levels as a predictor of mortality in patients with ST-elevation myocardial infarction. Methods: 1172 patients (male: 871, 74%; mean age: 65.8±12.5) admitted for STEMI and undergoing early revascularization were enrolled. We excluded patients with cardiogenic shock and known hepatic disease (n=117). According to lnGGT measured at hospitalization, our population was divided in two groups: Group A, characterized by lnGGT levels> 3.37 and Group B characterized by GGT

NT-proBNP is associated with several indexes of cardiac and vascular subclinical disease, but its role in screening for asymptomatic cardiovascular involvement is still debated. 810 asymptomatic people without previous cardiovascular disease underwent laboratory assessment with NT-proBNP, echocardiography and CCS and CIMT evaluation by CT and neck echography, respectively. Asymptomatic cardiovascular involvement was defined by one among LVEF 15 and/or LV mass index >115 in men or >95 g/m2 in women, LV end diastolic diameter >55 mm, CCS >400AU or CIMT >0.9 mm. 31%, 10%, 6%, 5%, 25% and 8% of subjects presented LV hypertrophy, E/E' 55 mm, CIMT >0.9 mm and CCS >400 A.U., respectively. Subjects with at least one index of cardiovascular involvement (331, 40%) showed lower hemoglobin, BMI and eCrCl with higher 10 yrs. Framingham risk score and NT-proBNP (61; 34-103 vs. 37; 22-79 ng/L, p

Introduction: It is well known that mild thyroid hormone (TH) abnormalities are associated with a poor prognosis in patients with heart failure. Aim of the this study is to define the role of free triiodothyronine (fT3) levels as a predictor of mortality in patients with ST-elevation myocardial infarction. Methods: 846 patients (mean age: 65.4±12.5 years; males: 631, 74.7%) admitted for STEMI and undergoing early revascularization were enrolled. According fT3 plasma levels measured at arrival, our population was divided in two groups: Group A (n=425, 50.2%), characterized by fT3 levels 2.06 ng/L. Follow-up (mean: 25.6±18.3 months) started at hospital admission and was interrupted in the case of cardiac and non cardiac death. Results: Group A patients were older (67.4±12.1 vs 63.1±12.7years, P