The aim of this study was to investigate the prognosis associated with bundle branch block (BBB) depending on location, time of appearance, and duration in patients with myocardial infarction (MI). ...From January 1998 to January 2008, we recruited 5,570 patients with acute MI. Thirty-day and 7-year all-cause mortality, according to BBB location, time of appearance, and duration were analyzed by multivariable analyses. BBB was present in 964 patients (17.3%); right BBB (RBBB) 10.6% and left BBB (LBBB) 6.7%. Overall mortality rate at 30 days was 13.2% (n = 738) and 7 years was 6.34 deaths per 100 patient-year. Both RBBB and LBBB were more frequently previous, 42.9% and 58.8%. Compared with non-BBB, all BBB groups showed higher prevalence of co-morbidities, especially rates of diabetes (49.0% vs 34.3%, p <0.001) and more often heart failure during hospitalization (54.5% vs 26.6%, p <0.001). Compared with RBBB, patients with LBBB had a higher prevalence of co-morbidities and a higher mortality, especially the new BBB, 30 days: 52.5% versus 31.6% and 7 years (incident rate): 27.2 versus 13.3 per 100 patient-year. New transient BBB had lower heart failure on admission (42.6% vs 58.3%, p = 0.008) and 30-day mortality (20.3% vs 69.6%, p <0.001) compared with permanent in both locations. New permanent RBBB was independently associated with 30-day (hazard ratio HR 2.01, 95% confidence interval CI 1.45 to 2.79) and 7-year mortality (HR 3.12, 95% CI 2.38 to 4.09). New-permanent LBBB was independently associated with 30-day (HR 2.15, 95% CI 1.47 to 3.15) and 7-year mortality (HR 2.91, 95% CI 2.08 to 4.08). In conclusion, in patients with acute MI, the appearance of a new BBB was independently associated with a higher 30-day and 7-year all-cause mortality.
Background
Myocardial injury is a common finding in COVID‐19 strongly associated with severity. We analysed the prevalence and prognostic utility of myocardial injury, characterized by elevated ...cardiac troponin, in a large population of COVID‐19 patients, and further evaluated separately the role of troponin T and I.
Methods
This is a multicentre, retrospective observational study enrolling patients with laboratory‐confirmed COVID‐19 who were hospitalized in 32 Spanish hospitals. Elevated troponin levels were defined as values above the sex‐specific 99th percentile upper reference limit, as recommended by international guidelines. Thirty‐day mortality was defined as endpoint.
Results
A total of 1280 COVID‐19 patients were included in this study, of whom 187 (14.6%) died during the hospitalization. Using a nonspecific sex cut‐off, elevated troponin levels were found in 344 patients (26.9%), increasing to 384 (30.0%) when a sex‐specific cut‐off was used. This prevalence was significantly higher (42.9% vs 21.9%; P < .001) in patients in whom troponin T was measured in comparison with troponin I. Sex‐specific elevated troponin levels were significantly associated with 30‐day mortality, with adjusted odds ratios (ORs) of 3.00 for total population, 3.20 for cardiac troponin T and 3.69 for cardiac troponin I.
Conclusion
In this multicentre study, myocardial injury was a common finding in COVID‐19 patients. Its prevalence increased when a sex‐specific cut‐off and cardiac troponin T were used. Elevated troponin was an independent predictor of 30‐day mortality, irrespective of cardiac troponin assay and cut‐offs to detect myocardial injury. Hence, the early measurement of cardiac troponin may be useful for risk stratification in COVID‐19.
Abstract The 6-minute walk test distance (6MWD) has been shown to predict prognosis in selected cohorts of patients with heart failure, and outcomes after surgical or transcatheter aortic valve ...implantation (AVI) in patients with symptomatic severe aortic valve stenosis (AS). Our objective was to evaluate the association between the 6MWD and outcome in patients with severe AS while remain under medical treatment. In a prospective observational cohort study, a total of 149 patients diagnosed with severe AS by Doppler echocardiography underwent a 6-minute walk test (6MWT). The single endpoint was a composite of all-cause death or hospitalization for heart failure. Patients receiving an AVI were censored from follow-up at the time of their AVI, so that only the events that occurred while the patients remained under medical treatment were included in the analysis. During follow-up (median: 12.9 months) the endpoint occurred in 65 patients (43.6%). Univariate analysis showed an association between the 6MWD and the endpoint ( P <.001). After adjustment for symptoms, left ventricular ejection fraction, aortic valve area, Charlson comorbidity score, and anemia, the 6MWD independently predicted the endpoint (adjusted hazard ratio: 0.63; 95% confidence interval: 0.45 to 0.89; P = 0.010). The incidence rate of the composite endpoint was 12 per 100 patient-years among patients with a 6MWD >331 m compared to 86 per 100 patient-years in those with a 6MWD ≤331 m ( P <.001). In conclusion, while patients with severe AS remain under medical treatment, the 6MWD is independently associated with all-cause death or hospitalization for heart failure.
MR‐proADM as marker of endotheliitis predicts COVID‐19 severity García de Guadiana‐Romualdo, Luis; Calvo Nieves, María Dolores; Rodríguez Mulero, María Dolores ...
European journal of clinical investigation,
20/May , Volume:
51, Issue:
5
Journal Article
Peer reviewed
Open access
Background
Early identification of patients at high risk of progression to severe COVID‐19 constituted an unsolved challenge. Although growing evidence demonstrates a direct association between ...endotheliitis and severe COVID‐19, the role of endothelial damage biomarkers has been scarcely studied. We investigated the relationship between circulating mid‐regional proadrenomedullin (MR‐proADM) levels, a biomarker of endothelial dysfunction, and prognosis of SARS‐CoV‐2‐infected patients.
Methods
Prospective observational study enrolling adult patients with confirmed COVID‐19. On admission to emergency department, a blood sample was drawn for laboratory test analysis. Primary and secondary endpoints were 28‐day all‐cause mortality and severe COVID‐19 progression. Area under the curve (AUC) and multivariate regression analysis were employed to assess the association of the biomarker with the established endpoints.
Results
A total of 99 patients were enrolled. During hospitalization, 25 (25.3%) cases progressed to severe disease and the 28‐day mortality rate was of 14.1%. MR‐proADM showed the highest AUC to predict 28‐day mortality (0.905; CI 95%: 0.829‐0.955; P < .001) and progression to severe disease (0.829; CI 95%: 0.740‐0.897; P < .001), respectively. MR‐proADM plasma levels above optimal cut‐off (1.01 nmol/L) showed the strongest independent association with 28‐day mortality risk (hazard ratio HR: 10.470, 95% CI: 2.066‐53.049; P < .005) and with progression to severe disease (HR: 6.803, 95% CI: 1.458‐31.750; P = .015).
Conclusion
Mid‐regional proadrenomedullin was the biomarker with highest performance for prognosis of death and progression to severe disease in COVID‐19 patients and represents a promising predictor for both outcomes, which might constitute a potential tool in the assessment of prognosis in early stages of this disease.
To the Editor, We have read with great interest the results of the ISCHEMIA trial1 of 5179 patients with moderate or severe ischemia who were randomized to receive an early invasive strategy of ...angiography plus revascularization, when necessary, or a conservative strategy of early optimal medical therapy and angiography if the medical therapy failed. As already known, the conclusion is that an early invasive strategy does not reduce the risk of cardiovascular ischemic events or all-cause mortality at the follow-up. However, it had beneficial effects because it reduced the occurrence of spontaneous myocardial infarction at the expense of a number of peri-PCI myocardial infarctions. Currently, this observation is under discussion probably because a different result was expected by researchers. In an interesting article2 it has been argued that the ISCHEMIA trial did not compare the benefits of coronary revascularization vs medical therapy, but assessed an early strategy of medical therapy vs early invasive treatment with angiography. In this sense, 79.4% of the patients from the invasive group were percutaneous or surgically revascularized vs 21.0% of the patients from the conservative group. A careful review of the supplementary data of the original publication1 reveals interesting additional data that we wish to share. A...
Natriuretic peptides are a laboratory tool with significant implications for the diagnosis and prognosis of heart failure (HF). The International Federation of Clinical Chemistry and Laboratory ...Medicine (IFCC) recommended that assays must be examined for sample stability because there appears to be assay dependent. We aimed to evaluate the in vitro stability of B-type natriuretic peptide (BNP) under different handling conditions and using a BNP assay from Fujirebio Diagnostics (Tokyo, Japan). BNP concentrations were measured in plasma EDTA samples from 11 subjects to evaluate the in vitro stability at room temperature and at 4 °C and in 10 subjects to check the in vitro stability of samples stored at -20 °C during 1 and 3 months. Stability limit was defined according to Spanish Society of Laboratory Medicine (SEQC-ML) recommendations. At room temperature and 4 °C, BNP concentrations decreased progressively in samples collected in both groups, remaining stable within four hours from collection. BNP concentrations also were stable within four hours from collection in whole blood at room temperature. Finally, at -20 °C, BNP concentrations remained stable in both groups at 1 and 3 months, respectively. According to our results, BNP, stored at room temperature or at 4 °C, should be assayed in the first four hours after collection. Besides, BNP was shown to be stable in whole blood for at least four hours at room temperature. If the testing cannot be performed within the first four hours, the plasma should be frozen and kept at -20 °C for up to 3 months.
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