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Copyright of Revista de Educación e Investigación en Emergencias is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To determine the reliability of hospital discharge codes for heart failure (HF), acute myocardial infarction (AMI) and stroke compared with adjudicated diagnosis, and to pilot a scalable approach to adjudicate records on a population‐based sample. Methods: A population‐based sample of 685 people with diabetes admitted (1274 admissions) to one of three Australian hospitals during 2018–2020 were randomly selected for this study. All medical records were reviewed and adjudicated. Results: Cardiovascular diseases were the most common primary reason for hospitalisation in people with diabetes, accounting for ~17% (215/1274) of all hospitalisations, with HF as the leading cause. ICD‐10 codes substantially underestimated HF prevalence and had the lowest agreement with the adjudicated diagnosis of HF (Kappa = 0.81), compared with AMI and stroke (Kappa ≥ 0.91). While ICD‐10 codes provided suboptimal sensitivity (72%) for HF, the performance was better for AMI (sensitivity 84%; specificity 100%) and stroke (sensitivity 85%; specificity 100%). A novel approach to screen possible HF cases only required adjudicating 8% (105/1274) of records, correctly identified 78/81 of HF admissions and yielded 96% sensitivity and 98% specificity. Conclusions: While ICD‐10 codes appear reliable for AMI or stroke, a more complex diagnosis such as HF benefits from a two‐stage process to screen for suspected HF cases that need adjudicating. The next step is to validate this novel approach on large multi‐centre studies in diabetes. [ABSTRACT FROM AUTHOR]

Aims Evidence on the association between subclinical atherosclerosis (SA) and cardiovascular (CV) events in low-risk populations is scant. To study the association between SA burden and an ischaemic scar (IS), identified by cardiac magnetic resonance (CMR), as a surrogate of CV endpoint, in a low-risk population. Methods and results A cohort of 712 asymptomatic middle-aged individuals from the Progression of Early SA (PESA-CNIC-Santander) study (median age 51 years, 84% male, median SCORE2 3.37) were evaluated on enrolment and at 3-year follow-up with 2D/3D vascular ultrasound (VUS) and coronary artery calcification scoring (CACS). A cardiac magnetic study (CMR) was subsequently performed and IS defined as the presence of subendocardial or transmural late gadolinium enhancement (LGE). On CMR, 132 (19.1%) participants had positive LGE, and IS was identified in 20 (2.9%) participants. Individuals with IS had significantly higher SCORE2 at baseline and higher CACS and peripheral SA burden (number of plaques by 2DVUS and plaque volume by 3DVUS) at both SA evaluations. High CACS and peripheral SA (number of plaques) burden were independently associated with the presence of IS, after adjusting for SCORE2 [OR for 3rd tertile, 8.31; 95% confidence interval (CI) 2.85–24.2; P < 0.001; and 2.77; 95% CI, 1.02–7.51; P = 0.045, respectively] and provided significant incremental diagnostic value over SCORE2. Conclusion In a low-risk middle-aged population, SA burden (CAC and peripheral plaques) was independently associated with a higher prevalence of IS identified by CMR. These findings reinforce the value of SA evaluation to early implement preventive measures. Clinical Trial Registration Progression of Early Subclinical Atherosclerosis (PESA) Study Identifier: NCT01410318. [ABSTRACT FROM AUTHOR]

Copyright of Pamukkale Medical Journal is the property of Pamukkale Journal of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The research aimed to evaluate the association between heart-type fatty acid binding protein (H-FABP) and cardiovascular events. We systematically reviewed research that has been conducted to assess this relationship, aiming to determine how useful H-FABP could be as a biomarker for cardiovascular diseases, especially in the initial phases of acute myocardial infarction (AMI) and acute coronary syndrome (ACS). Our goal was to validate its diagnostic accuracy and clinical relevance. We systematically searched through PubMed, Web of Science, and Google Scholar databases to find pertinent publications related to cardiovascular diseases and H-FABP, using various permutations, abbreviations, and language variations of MeSH keywords. The final analysis included 12 studies in total. The final study comprised twelve studies, and it was concluded that H-FABP demonstrated high sensitivity (64.3-91.5) and specificity (73-100) for diagnosing Acute Myocardial Infarction (AMI) and Acute Coronary Syndrome (ACS), especially within the first hours of symptom onset. H-FABP demonstrates potential in enhancing the overall diagnostic accuracy during the initial hours following the manifestation of symptoms. However, the existing data do not provide sufficient evidence to recommend the regular utilization of H-FABP as a preliminary risk assessment approach in individuals who present with suspected cardiac events. Additional investigations, with well-defined prospective cohorts, are needed to validate the results observed. [ABSTRACT FROM AUTHOR]

Myocardial Infarction (MI) commonly referred to as a heart attack, results from the abrupt obstruction of blood supply to a section of the heart muscle, leading to the deterioration or death of the affected tissue due to a lack of oxygen. MI, poses a significant public health concern worldwide, particularly affecting the citizens of the Chittagong Metropolitan Area. The challenges lie in both prevention and treatment, as the emergence of MI has inflicted considerable suffering among residents. Early warning systems are crucial for managing epidemics promptly, especially given the escalating disease burden in older populations and the complexities of assessing present and future demands. The primary objective of this study is to forecast MI incidence early using a deep learning model, predicting the prevalence of heart attacks in patients. Our approach involves a novel dataset collected from daily heart attack incidence Time Series Patient Data spanning January 1, 2020, to December 31, 2021, in the Chittagong Metropolitan Area. Initially, we applied various advanced models, including Autoregressive Integrated Moving Average (ARIMA), Error-Trend-Seasonal (ETS), Trigonometric seasonality, Box-Cox transformation, ARMA errors, Trend and Seasonal (TBATS), and Long Short Time Memory (LSTM). To enhance prediction accuracy, we propose a novel Myocardial Sequence Classification (MSC)-LSTM method tailored to forecast heart attack occurrences in patients using the newly collected data from the Chittagong Metropolitan Area. Comprehensive results comparisons reveal that the novel MSC-LSTM model outperforms other applied models in terms of performance, achieving a minimum Mean Percentage Error (MPE) score of 1.6477. This research aids in predicting the likely future course of heart attack occurrences, facilitating the development of thorough plans for future preventive measures. The forecasting of MI occurrences contributes to effective resource allocation, capacity planning, policy creation, budgeting, public awareness, research identification, quality improvement, and disaster preparedness. [ABSTRACT FROM AUTHOR]

Objective • Myocardial infarction (MI) is a common and serious cardiovascular disease with increasing incidence and mortality rates, making it a major global public health issue. Molecular biology research has shown that the cleavage products miR-208 and miR-92a are microRNAs (miRNAs) associated with myocardial injury. Therefore, this study aims to establish a predictive model and explore the application value of the combined detection of miR208 and miR-92a in the early diagnosis of MI in microRNA. Methods • Plasma samples were collected from 231 volunteers divided into 30 healthy and 201 diseased subjects From January 1st, 2021 to December 30th, 2021. Plasma RNA was extracted using a TRIZOL kit, and levels of miR-208 and miR-92a were determined using a realtime polymerase chain reaction (PCR) assay. Subsequently, the logistic regression model, decision tree model analysis, and receiver operating characteristic (ROC) curve were used to evaluate whether miR-208 combined with miR92a could be used as a biomarker for MI early diagnosis. Results • In this study, the ROC curve evaluation of the logistic regression model and pruned decision tree model found that age, miR-208, and miR-92a had high early diagnostic accuracy for MI, and the area under the curve (AUC) reached 0.928, showing good predictive value. It was also found that the AUC, optimal threshold, sensitivity, and specificity of age, miR-208, and miR-92a were higher than those of age and miR-208. This indicates that the combination of age, miR-208, and miR-92a has more value in the early diagnosis of MI. Conclusion • The combined diagnosis of miR-208 and miR-92a is helpful for the early diagnosis of myocardial infarction, which might serve as a new marker of MI benefiting from its early diagnosis. [ABSTRACT FROM AUTHOR]

High-grade intracoronary thrombus (ICT) burden leads to greater myocardial injury following anterior myocardial infarction (MI). The modified Glasgow prohgnostic score (mGPS) is a novel immune-inflammatory index, calculated by using C-reactive protein (CRP) and albumin levels, was shown to have prognostic value in heart diseases. The present study investigated the role of mGPS in predicting high grade ICT in patients with acute anterior MI admitted between February 2017 and March 2020. Blood samples were obtained at admission and mGPS was calculated. The ICT burden was evaluated visually from angiographic images. Patients were divided into 2 groups according to the ICT burden as high and low. A total of 1132 patients were enrolled: a mean age 61 ± 12.4 years and 370 males (32.7%). Serum albumin was lower, whereas mGPS and CRP were higher in high grade ICT group. CRP (odds ratio (OR): 1.404 95% CI: 1.312–1.502; P <.001), albumin (OR:.486; 95% CI:.301–.782 P <.001), and mGPS (0 vs ≥ 1) (OR: 7.391; 95% CI: 3.910–13.972; P <.001) were independent predictors of high-grade ICT burden in the left anterior descending coronary artery. The mGPS is a novel predictor of high-grade ICT burden and may be useful for risk stratification in patients with acute anterior MI. [ABSTRACT FROM AUTHOR]

Objectives: Coronary artery disease (CAD) is the most common form of CVD that begins as stable angina pectoris (SAP) followed by unstable angina pectoris (UAP) and finally critical stage myocardial infarction (MI), which results from rupture of atherosclerotic plaque and a thrombus that blocks the coronary artery supplying the heart, resulted from the death of part of the heart muscle. The underlying cause of coronary artery disease (CAD) is atherosclerosis, which results from the formation of layers of fatty deposits on the inner walls of the arteries. Early diagnosis of MI has an important role in assisting clinicians in prompt planning for its treatment and thus reducing the number of its deaths. Methods: The present study included 20 UAP patients and 20 healthy individuals (controls). In all the cases and controls, levels of cardiac and inflammatory biomarkers were measured by special kits from Hotgen Company via phosphorous technology using UPT-3A converting phosphor immunological analyzer. Results: The levels of both cardiac and inflammatory biomarkers were significantly increased in UAP cases as compared to controls. Also, there was significant positive correlation between cardiac and inflammatory biomarkers in UAP cases. Conclusions: The positive correlation between most cardiac and inflammatory biomarkers in UAP indicates that inflammation occurs in UAP. Hence it is concluded that inflammatory biomarkers (CRP, Hs-CRP and PCT) and cardiac biomarker (cTnI, H-FABP, CK-MB, NT-proBNP and D-dimer) can be markers of UAP and can be used for diagnostic purposes in patients. [ABSTRACT FROM AUTHOR]

Introduction: Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) is a rare but serious complication often causing cardiogenic shock (CS). The timing of surgery is a difficult problem for surgeons because of high mortality and surgical complexity. We present a case of successful use of extracorporeal membrane oxygenation (ECMO) for maintaining haemodynamic stability preoperative and delaying surgical repair of VSR patient in severe CS. Case report: A 57-year-old man with AMI complicated by severe CS due to an massive VSR. Emergency surgery was considered a too high mortality risk. The patient was implanted with a percutaneous veno-arterial ECMO (VA-ECMO) system as a bridge to surgery for stabilizing general condition. On the 31th day after ECMO implantation, the ventricular septal defect was successfully repaired and weaning from the ECMO. Discussion: This case study illustrates that it may be considered to use long term ECMO preoperative to delayed surgery which leads to higher survival in cases of massive VSR patient after AMI in hemodynamically compromised patients. Still the optimal duration of mechanical circulatory support and the optimal timing for surgery need more research to define. Conclusion: This case indicates the feasibility of preoperative using of a long term VA-ECMO as a bridge to surgical repair of VSR patient after AMI in severe CS. The optimal duration of mechanical circulatory support and the optimal timing for surgery still require further investigation. [ABSTRACT FROM AUTHOR]

Background: Accurate emergency department (ED) triage in the geriatric population is an important nurse-sensitive quality indicator; however, few quality indicators are verified for impact. Purpose: To examine the relationship between triage accuracy in adults older than 65 years and Core Measures for acute myocardial infarction (AMI) and heart failure (HF). Methods: A correlational approach was used to determine strength and direction of the relationship between variables. Results: Strong positive correlations were found between triage accuracy and mortality for AMI and HF, as well as with 30-day hospital readmissions for AMI. A weak negative correlation was found between triage accuracy and 30-day hospital readmissions for HF. Conclusions: Accurate triage can lead to a more effective care trajectory for patients, better adherence to Core Measures, and better outcomes. Accuracy in triage for AMI and HF is a valid indicator of ED quality care. [ABSTRACT FROM AUTHOR]

Background: Identifying reliable predictors for ventricular recovery at the outset is crucial for patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI). Objectives: This study aimed to evaluate the role of baseline global longitudinal strain (GLS) in predicting myocardial recovery following an acute infarction. Methods: We enrolled 60 consecutive patients diagnosed with STEMI and admitted to Al-Zahra Hospital for PCI from March 2022 to March 2023. Echocardiography was performed on all patients within 48 hours after revascularization to measure baseline parameters, including left ventricular ejection fraction (LVEF) and GLS. Follow-up echocardiography was conducted 6 months later to reassess LVEF. Results: At the 6-month follow-up, 38 (63.3%) patients showed a 5% improvement in LVEF, indicating ventricular recovery. The change in GLS was significantly different between the groups (recovered: - 4.72 ± 2.00, not recovered: - 2.41 ± 2.15, P < 0.001). A baseline GLS - 4.5 and > -14.8 was predictive of either failure to recover or successful recovery of LVEF with 100% negative and positive predictive values, respectively. Baseline GLS values > - 9.2 were predictive of LV recovery with 50% sensitivity and 83.3% specificity (P = 0.0002, AUC (95% confidence interval) = 0.697 (0.594, 0.799)). The type of revascularization was linked to better prediction outcomes, with patients undergoing primary and rescue PCIs more likely to recover during the follow-up period compared to those receiving deferred PCI after 24 hours (P = 0.032). Conclusions: While certain baseline GLS value thresholds may serve as predictors of LVEF recovery in patients with STEMI undergoing primary PCI, further prospective studies with larger cohorts are needed to establish more precise cut-off values. [ABSTRACT FROM AUTHOR]

The EASY-NET network program (NET-2016-02364191)—effectiveness of audit and feedback (A&F) strategies to improve health practice and equity in various clinical and organizational settings), piloted a novel and more structured A&F strategy. This study compared the effectiveness of the novel strategy against the sole periodic dissemination of indicators in enhancing the appropriateness and timeliness of emergency health interventions for patients diagnosed with acute myocardial infarction (AMI) and ischemic stroke in the Lazio Region. The efficacy of the intervention was assessed through a prospective quasi-experimental design employing a pre- and post-intervention (2021–2022) comparison with a control group. Participating hospitals in the Lazio Region, where professional teams voluntarily engaged in the intervention, constituted the exposed group, while the control group exclusively engaged in routine reporting activities. Effectiveness analysis was conducted at the patient level, utilizing regional health information systems to compute process and outcome indicators. The effectiveness of the intervention was evaluated using difference-in-difference models, comparing pre- and post-intervention periods between exposed and control groups. Estimates were calculated in terms of the difference in percentage points (PP) between absolute risks. Sixteen facilities for the AMI pathway and thirteen for the stroke pathway participated in the intervention. The intervention yielded a reduction in the proportion of 30-day readmissions following hospitalization for ischemic stroke by 0.54 pp in the exposed patients demonstrating a significant difference of −3.80 pp (95% CI: −6.57; −1.03; 5453 patients, 63.7% cases) in the exposed group compared to controls. However, no statistically significant differences attributable to the implemented A&F intervention were observed in other indicators considered. These results represent the first evidence in Italy of the impact of A&F interventions in an emergency setting, utilizing aggregated data from hospitals involved in the Lazio Region's emergency network. [ABSTRACT FROM AUTHOR]

Copyright of Lege Artis Medicine (LAM) is the property of LifeTime Media Kft. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Multiple chronic conditions (MCCs) are common in patients hospitalized with acute myocardial infarction (AMI). We examined the association of 12 MCCs with the risk of a 30-day hospital readmission and/or dying within one year among those discharged from the hospital after an AMI. We also examined the five most prevalent pairs of chronic conditions in this population and their association with the principal study endpoints. Methods: The study population consisted of 3,294 adults hospitalized with a confirmed AMI at the three major medical centers in central Massachusetts on an approximate biennial basis between 2005 and 2015. Patients were categorized as ≤1, 2-3, and ≥4 chronic conditions. Results: The median age of the study population was 67.9 years, 41.6% were women, and 15% had ≤1, 32% had 2-3, and 53% had ≥4 chronic conditions. Patients with ≥4 conditions tended to be older, had a longer hospital stay, and received fewer cardiac interventional procedures. There was an increased risk for being rehospitalized during the subsequent 30 days according to the presence of MCCs, with the highest risk for those with ≥4 conditions. There was an increased, but attenuated, risk for dying during the next year according to the presence of MCCs. Individuals with diabetes/hypertension and those with heart failure/chronic kidney disease were at particularly high risk for developing the principal study outcomes. Conclusion: Development of guidelines that include complex patients, particularly those with MCCs and those at high risk for adverse short/medium term outcomes, remain needed to inform best treatment practices. [ABSTRACT FROM AUTHOR]

Background: Takotsubo cardiomyopathy (TC) is an emergency cardiovascular disease, with clinical and paraclinical manifestations similar to acute myocardial infarction (AMI), but it is characterized by reversible systolic dysfunction of the left ventricle (LV) in the absence (most of the time) of obstructive coronary artery disease (CAD). Management of patients with TC: TC seems to be more frequent in post-menopausal women and it is triggered by emotional or physical stress. The diagnosis of TC is based on the Mayo Clinic criteria. Initially, patients with TC should be treated as those with AMI and carefully monitored in intensive care unit. Urgent clinical and paraclinical distinction between TC and AMI is mandatory in all patients, because of the different therapeutical management between the two diseases. Chest pain and dyspnea are the most common symptoms in TC. Paraclinical diagnosis is based on cardiac biomarkers, electrocardiogram (ST-segment elevation/T wave inversion in precordial leads without reciprocal ST-segment depression in inferior leads and absence of Q waves), echocardiography (LV systolic dysfunction, regional wall motion abnormalities extended in more than one coronary territory), cardiac magnetic resonance and in most of the cases the positive diagnosis is established by performing CA to exclude obstructive CAD. The prognosis of patients with TC is considered benign in most cases, with a complete LV function recovery, but severe complications may occur, such as cardiogenic shock, LV free wall rupture, life-threatening arrhythmia, and cardiac arrest. Postoperative TC may develop after any type of surgical intervention due to acute stress and it should be differentiated from postoperative AMI. The management of patients with TC is medical and it is based on supportive care and the treatment of heart failure, while patients with AMI require myocardial revascularization. Conclusions: TC leads to transient LV dysfunction that mimics AMI from which it should be differentiated for a good therapeutic approach. Patients with TC should be carefully monitored during hospitalization because they have a high recovery potential if optimally treated. [ABSTRACT FROM AUTHOR]

The purpose of this study is to find out differential diagnosis clinical presentation and minimal risk factors – st segment elevation myocardial infarction vs myopericarditis. The condition of STEMI (ST Segment Elevation Myocardial Infarction) can resemble infectious diseases of the heart such as Myopericarditis with the presence of dominant gastrointestinal symptoms, minimal demographic characteristics and cardiovascular risk factors as well as limited supporting examinations, making it a challenge in determining the diagnosis of cardiovascular disease. Case Report: 31 year old male with complaints of pain in the pit of the stomach that was difficult to describe and discomfort that extended to the chest that was not specific, a history of fever for 2 days, nausea and vomiting and a history of the habit of only consuming alcohol without smoking and the patient doing routine physical activities. ECG examination showed sinus rhythm with ST segment elevation in the precordial (anterior and lateral), inferior and LAD (Left Axis Deviation) leads as well as PR segment depression, Troponin I increased and Echocardiography showed a hypokinetic pattern in the posterior and septal segments of the heart. Fibrinolytics improved the patient's symptoms but not serial EKGs, giving rise to suspicion of STEMI which resembles Myopericarditis. Conclusion: Differential diagnosis with the possibility of myopericarditis was based on clinical findings and minimal risk factors, history of the course of the disease, ECG examination, Cardiac Biomarkers, TTE and Coronary Angiography. [ABSTRACT FROM AUTHOR]

The coexistence of bicuspid aortic valve disease and coronary artery disease is well‐established, but the identification of cardiac amyloidosis in this population has surged with advancing imaging techniques, introducing complexities in patient management. This case report emphasizes the pivotal role of multimodality imaging in accurately diagnosing three concurrent pathologies. [ABSTRACT FROM AUTHOR]

Acute myocardial infarction (AMI) is a leading cause of mortality globally, highlighting the need for timely and accurate diagnostic strategies. Cardiac troponin has been the biomarker of choice for detecting myocardial injury. A dynamic change in concentrations supports the diagnosis of AMI in the setting of evidence of acute myocardial ischemia. The new generation of high-sensitivity cardiac troponin (hs-cTn) assays has significantly improved analytical sensitivity but at the expense of decreased clinical specificity. As a result, sophisticated algorithms are required to differentiate AMI from non-AMI patients. Establishing optimal hs-cTn cutoffs for these algorithms to rule out and rule in AMI has been the subject of intensive investigations. These efforts have evolved from examining the utility of the hs-cTn 99th percentile upper reference limit, comparing the percentage versus absolute delta thresholds, and evaluating the performance of an early European Society of Cardiology-recommended 3 h algorithm, to the development of accelerated 1 h and 2 h algorithms that combine the admission hs-cTn concentrations and absolute delta cutoffs to rule out and rule in AMI. Specific cutoffs for individual confounding factors such as sex, age, and renal insufficiency have also been investigated. At the same time, concerns such as whether the small delta thresholds exceed the analytical and biological variations of hs-cTn assays and whether the algorithms developed in European study populations fit all other patient cohorts have been raised. In addition, the accelerated algorithms leave a substantial number of patients in a non-diagnostic observation zone. How to properly diagnose patients falling in this zone and those presenting with elevated baseline hs-cTn concentrations due to the presence of confounding factors or comorbidities remain open questions. Here we discuss the developments described above, focusing on criteria and underlying considerations for establishing optimal cutoffs. In-depth analyses are provided on the influence of biological variation, analytical imprecision, local AMI rate, and the timing of presentation on the performance metrics of the accelerated hs-cTn algorithms. Developing diagnostic strategies for patients who remain in the observation zone and those presenting with confounding factors are also reviewed. [ABSTRACT FROM AUTHOR]

A case report of a 32-year-old female patient without any traditional risk factors presented with angina to our hospital within 6 h. Her electrocardiogram (ECG) showed extensive anterior wall -ST elevation myocardial infarction (MI). She was treated with thrombolytic therapy in the form of tenecteplase and was given standard treatment for acute coronary syndrome (ACS). Her history revealed three recurrent pregnancy losses and a history of preeclampsia. Echocardiography showed regional wall motion abnormalities of the mid, distal, apex, and anterior wall with severe left ventricular systolic dysfunction. Routine blood investigations showed elevated total leukocyte count with neutrophilic predominance. With a history of recurrent pregnancy loss, she was investigated for anti-phospholipid anti-phospholipid antibody syndrome (APS) and was found to have positive lupus anticoagulant 1. She underwent coronary angiography (CAG) which showed a left main shaft 40% stenosis with an ulcerative lesion containing thrombus in the ostioproximal to mid-left anterior descending artery (LAD), other coronary arteries were normal. She was managed conservatively with glycoprotein IIb/IIIa inhibitor (Tirofiban) and switched to oral anticoagulation with Vitamin K antagonist (VKA-Acenocoumarin) along with dual-antiplatelet therapy. [ABSTRACT FROM AUTHOR]

Objective: The primary objective was to determine rapid rule‐out (RRO) criteria for the outcome of myocardial infarction (MI) using the Beckman Coulter Access high‐sensitivity cardiac troponin I (hs‐cTnI) assay. Secondary objectives were to explore cut‐points for rapid rule‐in (RRI) and amount of change at 3‐h (3‐h delta) indicative of MI. Methods: A retrospective study included ED patients with suspected MI between June and September 2019. hs‐cTnI levels were performed at baseline and after 3 h. The performance benchmark for RRO criteria was a negative predictive value (NPV) for MI with a lower 95% confidence limit >99%, and for RRI and 3‐h delta cut‐points was a positive predictive value (PPV) for MI >70%. Delta calculation required rising hs‐cTnI levels, with at least one above the 99th percentile of the upper reference limit. Analyses utilised receiver operating characteristic (ROC) curves and contingency tables. Results: Baseline hs‐cTnI levels from 935 patients were available for RRO analyses. Of tested criteria, baseline hs‐cTnI <6 ng/L (females) or <11 ng/L (males) plus symptom onset >2 h met the performance benchmark (NPV: 100% [95% confidence interval 99–100]). hs‐cTnI levels were available for RRI and 3‐h delta analyses from 935 and 52 patients, respectively. A 3‐h delta cut‐point >35 ng/L met the performance benchmark (PPV: 81% [95% confidence interval 58–95]) but no RRI cut‐point did so. Conclusions: For the Beckman Coulter Access hs‐cTnI assay, RRO criteria of baseline hs‐cTnI <6 ng/L (females) or <11 ng/L (males) plus symptom onset >2 h met our performance benchmark. A 3‐h delta cut‐point >35 ng/L met the performance benchmark, but poor precision means further adequately powered research is required. [ABSTRACT FROM AUTHOR]

A 12-lead ECG is a noninvasive diagnostic tool that detects and records cardiac electrical activity and can identify cardiac pathology. This article discusses select ECG abnormalities including myocardial infarction, bundle-branch blocks, and heart blocks. This is part 2 of a two-part series. Part 1 was published in the November 2023 issue of Nursing2023. [ABSTRACT FROM AUTHOR]

BACKGROUND The optimal apolipoprotein or lipid measures for identifying statin-treated patients with coronary artery disease (CAD) at residual cardiovascular risk remain controversial. This study aimed to compare the predictive powers of apolipoprotein B (apoB), non-high-density lipoprotein cholesterol (non-HDL-C), low-density lipoprotein cholesterol (LDL-C), apoB/apolipoprotein A-1 (apoA-1) and non-HDL-C/HDL-C for myocardial infarction (MI) in CAD patients treated with statins in the setting of secondary prevention. METHODS The study included 9191 statin-treated CAD patients with a five-year median follow-up. All measures were analyzed as continuous variables and concordance/discordance groups by medians. The hazard ratio (HR) with 95% CI was estimated by Cox proportional hazards regression. Patients were classified by the clinical presentation of CAD for further analysis. RESULTS The high-apoB-low-LDL-C and the high-non-HDL-C-low-LDL-C categories yielded HR of 1.40 (95% CI: 1.04-1.88) and 1.51 (95% CI: 1.07-2.13) for MI, respectively, whereas discordant high LDL-C with low apoB or non-HDL-C was not associated with the risk of MI. No association of MI with discordant apoB versus non-HDL-C, apoB/apoA-1 versus apoB, non-HDL-C/HDL-C versus non-HDL-C, or apoB/apoA-1 versus non-HDL-C/HDL-C was observed. Similar patterns were found in patients with acute coronary syndrome. In contrast, no association was observed between any concordance/discordance category and the risk of MI in patients with chronic coronary syndrome. CONCLUSIONS ApoB and non-HDL-C better predict MI in statin-treated CAD patients than LDL-C, especially in patients with acute coronary syndrome. ApoB/apoA-1 and non-HDL-C/HDL-C show no superiority to apoB and non-HDL-C for predicting MI. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Applied Health Sciences is the property of University of Applied Health Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To explore the relationship between serum lipoprotein (a) levels and acute myocardial infarction (AMI) and aortic dissection in athletic patients and those with optimal physical health. Methods: This study involved 216 athletic patients admitted to a Chinese hospital for AMI who underwent Percutaneous Coronary Intervention (PCI) between 2018 and 2019. These patients, characterized by their athletic background and optimal physical health, were divided based on their serum lipoprotein (a) levels: 133 in the low-lipoprotein (a) group (<300 mg/L) and 83 in the high-lipoprotein (a) group (≥300 mg/L). Data including baseline demographics, laboratory tests, and details of interventional treatment were collected from medical records. All patients were followed up for two years post-discharge to record Major Adverse Cardiac Events (MACE). Factors influencing MACE were analyzed using univariate and multivariate logistic regression. Results: The low lipoprotein (a) group exhibited lower age, reduced Killip grades III-IV, lower LDL-C levels, and fewer diseased vessels than the high lipoprotein (a) group (P<0.05). The incidence of MACE was significantly lower in the low lipoprotein (a) group (5.3%, 7/133) compared to the high lipoprotein (a) group (27.87%, 51/183) (P<0.05). Univariate analysis identified significant differences in age, post-surgery β-blocker use, LDL-C levels, serum lipoprotein (a) levels, revascularization strategies, and the number of diseased vessels (P<0.05). Multivariate analysis revealed serum lipoprotein(a) as an independent predictor of MACE in athletic patients postPCI (OR=1.010, 95%CI: 1.007-1.013, P=0.000). Conclusion: Serum lipoprotein (a) levels are significantly associated with the incidence and progression of AMI and aortic dissection in athletic patients and those with optimal physical health. Athletic patients with low pre-PCI lipoprotein (a) levels had a reduced risk of MACE during the two-year follow-up. This suggests that serum lipoprotein (a) could be a valuable prognostic marker for these patients, aiding in the prediction and management of post-PCI outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Gaceta Médica de Caracas is the property of Academia Nacional de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents a case study of a 6-year-old child who developed a complication involving Streptococcus pyogenes infective endocarditis (IE) following a varicella zoster virus (VZV) infection, resulting in an embolic myocardial infarction. The patient, who was malnourished and not vaccinated against VZV, exhibited symptoms such as shortness of breath, edema, and abdominal pain after a varicella infection.

The article presents the discussion on improve favourable functional outcomes at 6 months compared to placebo. Topics include Tranexamic acid (TXA) becoming the standard of care for potentially exsanguinating trauma patients to prevent trauma coagulopathy; and patients with acute neck or back pain without identified severe underlying pathology.

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Objective: To determine the clinical efficacy of echocardiography in assessing diastolic function in football players who have experienced myocardial infarction with preserved ejection fraction heart failure. Methods: This study involved 54 football players with myocardial infarction and preserved ejection fraction heart failure, treated at our medical center from September 2020 to January 2021. They were compared to 50 healthy, physically active volunteers. Both groups underwent echocardiographic evaluations focusing on cardiac structure and function. The quality of life of the football players was assessed before and after the echocardiographic evaluations. Results: The observation group showed elevated serum levels of troponin I (cTnI) and N-terminal B-type natriuretic peptide (NT-proBNP) compared to the control group (P < 0.05). Echocardiographic findings indicated significant differences in diastolic function between groups, with the E/A ratio and E/E' ratio notably higher in the observation group. Post-treatment, the quality of life in the observation group improved significantly (P < 0.05). Conclusion: Echocardiography is a valuable clinical tool for evaluating diastolic function in football players who have suffered myocardial infarction with preserved ejection fraction heart failure, especially post-stenting. This study highlights the importance of specialized cardiac assessments in athletes to facilitate optimal recovery and athletic performance. [ABSTRACT FROM AUTHOR]

Objective: Patients discharged from the hospital with diagnoses of myocardial infarction, congestive heart failure or acute exacerbation of chronic obstructive pulmonary disease (COPD) have high rates of readmission. We sought to quantify the impact of a community paramedicine (CP) intervention on hospital readmission and emergency department (ED) and clinic utilization for patients discharged with these conditions and to calculate the difference in healthcare costs. Methods: This was a prospective, observational cohort study with a matched historical control. The groups were matched for qualifying diagnosis, age, gender, and ZIP code. The intervention group received 1-2 home visits per week by a community paramedic for 30 days. We calculated the number of all-cause hospital readmissions and ED and clinic visits, and used descriptive statistics to compare cohorts. Results: Included in the study were 78 intervention patients and 78 controls. Compared to controls, fewer subjects in the CP cohort had experienced a readmission at 120 days (34.6% vs 64.1%, P < 0.001) and 210 days (43.6% vs 75.6%, P < 0.001) after discharge. At 210 days the CP cohort had 40.9% fewer total hospital admissions, saving 218 bed days and $410,428 in healthcare costs. The CP cohort had 40.7% fewer total ED visits. Conclusion: Patients who received a post-hospital community paramedic intervention had fewer hospital readmissions and ED visits, which resulted in saving 218 bed days and decreasing healthcare costs by $410,428. Incorporation of a home CP intervention of 30 days in this patient population has the potential to benefit payors, hospitals, and patients. [ABSTRACT FROM AUTHOR]

Background & Objective: Myocardial infarction (MI) is one of the highest leading causes of death worldwide. Many biomarkers are universally accepted in clinical practice as crucial diagnostic biomarkers in acute MI. The current study aims to introduce new sensitivity biomarkers to aid the diagnosis and to facilitate faster decision-making in the emergency department. Materials & Methods: A total of 50 patients, diagnosed with acute myocardial infarction, in Nasiriyah Heart Center, and 30 age-matched healthy individuals were studied. Serum Cardiac Troponin I (cTnI), Myoglobin (MYO), Creatine kinase (CKMB), Procalcitonin (PCT), Heart-type fatty acid binding protein (H-FABP), Lipoprotein-associated phospholipase A2 (Lp-PLA2), High sensitive C reactive protein (hsCRP), were determined by electro-chemiluminescence immunoassay. Blood sugar and serum total cholesterol, triglycerides, LDL, VLDL, and HDL were determined by using Cobas C311 photometric assays. Serum IL-6 was assayed by electro-chemiluminescence immunoassay, while, IL-9, IL-1β, and TNF-α were assayed by ELISA. Results: In comparison with healthy control, patients with acute MI showed significant elevation of the serum levels of cTnI, CK-MB, MYO, CRP, H- FABP, PCT, TNF-α, IL-1β, IL-9, and IL-6. Conclusion: The present study suggests that, in addition to cTnI, CK-MB, and MYO, many other mediators such as CRP, H-FABP, PCT, and cytokines are sensitive to the diagnosis of MI. Furthermore, using human monoclonal antibodies that selectively neutralize cytokines may provide additional insight into cytokinestargeted therapies. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular sequelae may occur in patients recovered from coronavirus disease 2019 (COVID‐19). Recent studies have detected a considerable incidence of subclinical myocardial dysfunction—assessed with speckle‐tracking echocardiography—and of long‐COVID symptoms in these patients. This study aimed to define the long‐term prognostic role of subclinical myocardial dysfunction and long‐COVID condition in patients recovered from COVID‐19 pneumonia. Methods: We prospectively followed up 110 patients hospitalized at our institution due to COVID‐19 pneumonia in April 2020 and then recovered from SARS‐CoV‐2 infection. A 7‐month clinical and echocardiographic evaluation was performed, followed by a 21‐month clinical follow‐up. The primary outcome was major adverse cardiovascular events (MACE), a composite of myocardial infarction, stroke, heart failure hospitalization, and all‐cause mortality. Results: A subclinical myocardial dysfunction—defined as an impairment of left ventricular global longitudinal strain (≥−18%)—was identified at a 7‐month follow‐up in 37 patients (34%), was associated with an increased risk of long‐term MACE with a good discriminative power (area under the curve:.73) and resulted in a strong independent predictor of extended MACE in multivariate regression analyses. Long‐COVID condition was not associated with a worse long‐term prognosis, instead. Conclusions: In patients recovered from COVID‐19 pneumonia, a subclinical myocardial dysfunction is present in one‐third of the whole population at 7‐month follow‐up and is associated with a higher risk of MACE at long‐term follow‐up. Speckle‐tracking echocardiography is a promising tool to optimize the risk‐stratification in patients recovered from COVID‐19 pneumonia, while the definition of a long‐COVID condition has no prognostic relevance. [ABSTRACT FROM AUTHOR]

Heart attack which is the main cause of death for both men and women is the leader among deaths due to heart diseases. Therefore, early diagnosis is very important for patients who are having a heart attack. Therefore, the study aimed to develop a clinical decision support system for the diagnosis of a heart attack to help physicians. In the study, variables were obtained accompanied by physicians by statistical analysis methods, where the optimum variables were selected from these variables considering the patient's unconscious state in some cases. Different decision models were developed using probit regression, decision tree, SVM, and ANN methods. As a result, the developed clinical decision support models for heart attack diagnosis were compared and evaluated. Consequently, the best diagnosis model was obtained using ANN with selected variables. In addition to these, the proposed study is significantly noticed with a sensitivity of 98% and specificity of 93.7% for heart attack diagnosis with optimum variables compared to similar studies in the literature. By using the proposed decision support system, it is possible to determine whether a patient has a heart attack or not and help the physician in the process of diagnosis of a heart attack. [ABSTRACT FROM AUTHOR]

Vascular inflammation has a pivotal role in the progression of atherosclerosis and major cardiovascular events (MACE). However, there is limited data concerning to role of changes in inflammatory markers in predicting MACE. In the current study, it was investigated whether the difference between high sensitive C-Reactive Protein (hs-CRP) and systemic immune-inflammatory index values (Δhs CRP and ΔSII) measured before and after the procedure and residual SYNTAX score (rSS) in stable coronary artery patients underwent percutaneous coronary intervention (PCI) could predict MACE. 203 patients (mean age: 62.11±9.20, 75% male) were included in the study. Before the first procedure and at the 1st month after the procedure(s), their blood was drawn. rSS was calculated. MACE was determined as cardiovascular mortality, target vessel revascularization non-fatal myocardial infarction, and ischemic stroke. MACE was observed in 20 patients (9.9%). Of these patients, 3 (1.5%) had cardiovascular mortality, 3 (1.5%) had a non-fatal myocardial infarction, 12 (5.9%) had target vessel revascularization due to unstable angina, and the remaining 2 (1.0%) had an ischemic stroke. The area under the curve (AUC) to predict MACE diagnosis was 0.548 for ΔSII and 0.647 for Δhs-CRP and 0.766 for rSS. In multiple regression analysis, only rSS > 4 was an independent predictor for MACE (HR=3.41, 95% CI: 1.39-8.35, p=0.007). The change in SII and hs-CRP after PCI was found to be insufficient to predict MACE, while rSS was the only independent predictor for MACE. [ABSTRACT FROM AUTHOR]

Remodeling of the left ventricle (LV) after myocardial infarction (MI) is a process of infarct enlargement. Despite the relevance of the inflammatory response and healing process in LV remodeling after MI, the mechanisms that begin and govern these processes remain unknown. Based on the important information highlighted in different studies, the current research aims to investigate potential biomarkers for left ventricular remodeling after acute MI based on the interpretation of the explainable artificial intelligence (XAI). The project research from which the public dataset was obtained was designed in an experimental type. A cohort study involving 66 patients with coronary heart disease and 34 healthy community controls provided the platelet samples for the current research, which used available omics data on those samples. For discovering significant mechanistic connections between metabolites and glycans, the metabolomics and glycomics datasets were analyzed using biostatistics/metabolomics and explainable artificial intelligence techniques. Metabolomics data of 100 patients (AMI=66; Control=34) including 75 males and 25 females were evaluated in this study. As a result of experimental omics analyses, 102 metabolite levels of the patients were obtained. When FC values were examined, creatinine and dl-pipecolic acid levels were 0.50 and 0.55-fold down-regulated and glutamine, myoinositol, and cytosine levels were 1.34, 1.33, and 1.53-fold up-regulated in the AMI group compared to the control group. Findings of metabolomics data and XAI analyses revealed that five lipid metabolites may be used as potential predictors of AMI. [ABSTRACT FROM AUTHOR]

Circulating circular RNAs (circRNAs) are emerging as novel biomarkers for cardiovascular diseases (CVDs). Machine learning can provide optimal predictions on the diagnosis of diseases. Here we performed a proof-of-concept study to determine if combining circRNAs with an artificial intelligence approach works in diagnosing CVD. We used acutemyocardial infarction (AMI) as a model setup to prove the claim. We determined the expression level of five hypoxia-induced circRNAs, including cZNF292, cAFF1, cDENND4C, cTHSD1, and cSRSF4, in the whole blood of coronary angiography positive AMI and negative non-AMI patients. Based on feature selection by using lasso with 10-fold cross validation, prediction model by logistic regression, and ROC curve analysis, we found that cZNF292 combined with clinical information (CM), including age, gender, body mass index, heart rate, and diastolic blood pressure, can predict AMI effectively. In a validation cohort, CM + cZNF292 can separate AMI and non-AMI patients, unstable angina and AMI patients, acute coronary syndromes (ACS), and non-ACS patients. RNA stability study demonstrated that cZNF292 was stable. Knockdown of cZNF292 in endothelial cells or cardiomyocytes showed anti-apoptosis effects in oxygen glucose deprivation/reoxygenation. Thus, we identify circulating cZNF292 as a potential biomarker for AMI and construct a prediction model "CM + cZNF292.". [ABSTRACT FROM AUTHOR]

Background: Acute myocardial infarction (AMI) is one of the leading causes of death worldwide. Contradictory findings are available regarding the effects of changes in electrolytes in patients with an AMI. Objectives: We aimed to investigate the effect of electrolyte changes on the 3-month outcome. Methods: A total of 168 patients with AMI managed at Dr. Heshmat Hospital in Rasht, Iran, were investigated in this prospective cohort study by a census method. AMI was confirmed by biochemical, electrocardiographic, or angiographic evidence. Electrolyte serum levels, demographic characteristics, myocardial infarction type, ejection fraction (EF), and underlying diseases were collected in a checklist in the early hours after each patient entered the hospital. Information about patients' outcomes and echocardiographic data were collected after three months. All data were analyzed using SPSS software version 22. Results: Out of 162 patients with AMI, most (44%) were aged between 50 to 59 years, and 76.8% were men. In all models, the odds of non-recovery remained constant with increasing electrolytes. On uni-variable and multi-variable models, sodium showed a significant positive association with initial EF (unstandardized coefficient = 0.8 in both uni-variable and multi-variable models, approximately), and phosphorus displayed a significant negative association with initial EF (unstandardized coefficient = -4.5 in both uni-variable and multi-variable models, approximately). There was no significant association of electrolytes with follow-up EF in all models. Conclusions: In this study, the phosphorus and sodium serum levels were significantly related to the initial EF. However, none of the studied electrolytes impacted the 3-month outcome in AMI patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prescription rate of short-term systemic use of glucocorticoids during hospitalization in patients with cardiogenic shock (CS), and outcomes related with glucocorticoid use. Methods: We extracted patients' information from the Medical Information Mart for Intensive Care IV version 2.0 (MIMIC-IV v2.0) database. The primary endpoint was 90-day all-cause mortality. Secondary safety endpoints were infection identified by bacterial culture and at least one episode of hyperglycemia after ICU admission. Propensity score matching (PSM) was used to balance baseline characteristics. The difference in cumulative mortality rate between these treated with and without glucocorticoids was assessed by Kaplan–Meier curve with log-rank test. Independent risk factors for endpoints were identified by Cox or Logistic regression analysis. Results: A total of 1528 patients were enrolled, and one-sixth of these patients received short-term systemic therapy of glucocorticoids during hospitalization. These conditions, including rapid heart rate, the presence of rheumatic disease, chronic pulmonary disease and septic shock, high lactate level, the requirements of mechanical ventilation and continuous renal replacement therapy, were associated with an increase in glucocorticoid administration (all P ≤ 0.024). During a follow-up of 90 days, the cumulative mortality rate in patients treated with glucocorticoids was significantly higher than that in these untreated with glucocorticoids (log-rank test, P < 0.001). Multivariable Cox regression analysis showed that glucocorticoid use (hazard ratio 1.48, 95% confidence interval [CI] 1.22–1.81; P < 0.001) was independently associated with an increased risk for 90-day all-cause mortality. This result was consistent irrespective of age, gender, the presence of myocardial infarction, acute decompensated heart failure and septic shock, and inotrope therapy, but was more evident in low-risk patients as assessed by ICU scoring systems. Additionally, multivariable Logistic regression analysis showed that glucocorticoid exposure was an independent predictor of hyperglycemia (odds ratio 2.14, 95% CI 1.48–3.10; P < 0.001), but not infection (odds ratio 1.23, 95% CI 0.88–1.73; P = 0.221). After PSM, glucocorticoid therapy was also significantly related with increased risks of 90-day mortality and hyperglycemia. Conclusions: Real-world data showed that short-term systemic use of glucocorticoids was common in CS patients. Importantly, these prescriptions were associated with increased risks of adverse events. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases, specifically acute myocardial infarction (AMI), are the leading cause of death worldwide. In this review, we explain the characteristics of AMI in Iran. Methods: We searched PubMed, Google, and Google Scholar for articles containing myocardial infarction, STEMI, and MI+ Iran in English and Persian words. Results: The age-standardized incidence rate of MI was 73.3 per 100 000. The mean±SD age of patients was 61.20±13.40 years. In-hospital mortality of patients with AMI in the IMIR was 12.1%. Concerning AMI complications reported in the IMIR, 5.8% of patients experienced ventricular tachycardia, and 2.5% experienced ventricular fibrillation. The 1-year mortality rate in the IPACE2 study was 4.3%. Conclusion: Only a few national studies are available in Iran regarding patients with AMI. A federal surveillance program continuously monitoring and tracking coronary events is essential to improve the general population's health. [ABSTRACT FROM AUTHOR]