BACKGROUND: Cardiac arrest in children is associated with high morbidity and mortality, primarily due to neurological injury. Biomarkers linked to brain injury, released into circulation from compromised elements of the...BACKGROUND: Cardiac arrest in children is associated with high morbidity and mortality, primarily due to neurological injury. Biomarkers linked to brain injury, released into circulation from compromised elements of the neurovascular unit, act as significant prognostic indicators in patients suffering from hypoxic-ischemic brain injury (HIBI) subsequent to the restoration of spontaneous circulation (ROSC) after pediatric cardiac arrest. The aim of this systematic review and meta-analysis is to evaluate the prognostic utility of brain injury biomarkers in predicting neurological outcomes and survival in patients following cardiac arrest in the pediatric population. METHODS: Bibliographic databases (PubMed, the Cochrane Library, and Embase) were searched from their inception to November 2024. A random-effect model was used for all analyses. RESULTS: Our meta-analysis demonstrates significant associations between various biomarkers and survival or neurological outcomes after cardiac arrest. Neuron-specific enolase (NSE) levels were consistently elevated in non-survivors and patients with unfavorable neurological outcomes, with pronounced differences observed on Days 2 and 3 (e.g., Day 3 mean difference: -88.48, 95%CI: -146.77 to -30.19, P = 0.003). Emerging biomarkers, including UCH-L1 and GFAP, showed striking differences, such as elevated UCH-L1 levels on Day 1 (mean difference: -415.41, 95%CI: -474.41 to -356.61, P < 0.001) and GFAP levels exceeding 4000 ng/mL in non-survivors on Day 2 (P < 0.001). CONCLUSIONS: Our findings underscore the significant prognostic value of biomarkers in predicting survival and neurological outcomes following cardiac arrest. Neuron-specific enolase (NSE) consistently demonstrated its reliability across multiple time points, while emerging biomarkers like UCH-L1 and GFAP showed promising potential for early outcome stratification.
BACKGROUND: This study evaluates the impact of pre-existing comorbidities and in-hospital complications on COVID-19 mortality rates. METHODS: A retrospective single-center study was conducted using electronic health reco...BACKGROUND: This study evaluates the impact of pre-existing comorbidities and in-hospital complications on COVID-19 mortality rates. METHODS: A retrospective single-center study was conducted using electronic health records from 640 COVID-19 patients hospitalized at the University Clinical Centre in Gdansk, Poland, between November 2020 and May 2021. Patients were categorized based on disease severity into stable or ICU wards based on the disease severity. Data on demographics, comorbidities, complications, and treatments were collected and verified. Statistical analyses, including odds ratios (ORs) and confidence intervals (CIs), assessed mortality risk factors supported by python-based processing. RESULTS: The mean patient age was 67 years (SD ± 15.89), comprising 39% females (n = 250) and 60.94% males (n = 390). Mortality risk was highest in patients aged 65 years and older (OR 3.00; 95% CI, 1.97-4.60). Among the pre-existing comorbidities, chronic kidney disease (OR 3.28; 95% CI, 2.12-5.09), atrial fibrillation (OR 2.43; CI 95%, 1.63-3.61), and heart failure (OR 2.89; 95% CI, 1.91-4.37) were significant predictors of mortality. In hospital complications, such as severe respiratory failure requiring ICU ventilation (OR 23.59; 95% CI, 2.81-197.87), myocardial infarction (OR 25.43; 95% CI, 3.16-204.97), acute kidney injury requiring renal replacement therapy (OR 19.15; 95% CI, 6.49-56.51), sepsis (OR 7.22, 95% CI, 3.77-13.84), stroke, further increased mortality risk. CONCLUSIONS: COVID-19 patients with pre-existing renal and cardiovascular conditions face a higher risk of fatal outcomes. Early diagnosis and intervention targeting these complications are vital to in reducing mortality. Further research is needed to reconcile disparities with existing literature.
Galectin-3 (Gal-3), a β-galactoside-binding lectin, has emerged as a potential diagnostic and prognostic biomarker for various diseases, including certain heart and kidney diseases, as well as cancer. Its significance is...Galectin-3 (Gal-3), a β-galactoside-binding lectin, has emerged as a potential diagnostic and prognostic biomarker for various diseases, including certain heart and kidney diseases, as well as cancer. Its significance is particularly notable in the context of congenital heart defects (CHD), which are the most prevalent congenital malformations, occurring in 6 to 8 out of every 1000 live births. Symptoms of heart failure (HF) in patients with congenital heart defects can manifest early in life, but in some cases, the disease progresses gradually, leading to a gradual decline in quality of life and the development of various complications. This variability underscores the need for early biomarkers to detect HF development in pediatric patients. Gal-3 plays a key role in myocardial remodeling, making it a promising candidate for advancing the diagnosis and management of HF in CHD patients. It is especially relevant in pediatric care, where early detection and intervention can significantly alter disease progression and patient outcomes. This review aims to consolidate current knowledge on the utility of Gal-3 in predicting HF among pediatric patients with CHD, highlighting its potential in changing the direction of diagnosis and treatment in this vulnerable patient population.
Pruc M, Swieczkowski D, Cander B
… +13 more, Jaguszewski MJ, Galwankar S, Di Somma S, Lateef F, Sardesai I, El-Menyar A, Zembala M, Kubica J, Evrin T, Katipoglu B, Rafique Z, Peacock FW, Szarpak L
BACKGROUND: The role of Cystatin C (CysC) in the diagnosis and prognosis of cardiovascular disease, particularly acute coronary syndrome (ACS), is increasingly significant. The goal of this meta-analysis was to assess th...BACKGROUND: The role of Cystatin C (CysC) in the diagnosis and prognosis of cardiovascular disease, particularly acute coronary syndrome (ACS), is increasingly significant. The goal of this meta-analysis was to assess the diagnostic and prognostic value of CysC in patients with ACS, as well as its association with major adverse cardiovascular events (MACE), defined as mortality, myocardial infarction, heart failure, and stroke. METHODS: The present study is a systematic review and meta-analysis. Using PubMed, Web of Science, Cochrane Library, and Embase, a literature review of cohort and case control studies reporting MACE and using the terms ACS and Cystatin C was conducted, excluding studies published after August 1, 2024. the meta-analysis using a random effects model. RESULTS: CysC concentrations were significantly higher in patients with ACS compared to controls [mean difference (MD) = 0.36, p < 0.001], and in acute myocardial infarction (AMI) vs. unstable angina (MD = 0.18, p < 0.001). No significant differences were observed between ST elevation myocardial infarction (STEMI) and Non-ST elevation myocardial infarction (NSTEMI). Patients with MACE had higher CysC levels than those without (MD = 0.25, p < 0.001). Hospital survivors had lower CysC levels compared to those who died (MD = -0.25, p < 0.001). Higher CysC concentrations were associated with increased risks of MACE, cardiac death, overall mortality, myocardial reinfarction, and stroke, both during hospitalization and beyond. CONCLUSIONS: CysC is a promising biomarker for both diagnosis and prognosis in patients with ACS, especially in the context of predicting MACE, mortality and heart failure risk. The use of CysC may improve risk stratification and support therapeutic decision-making in clinical practice.
BACKGROUND: This study aimed to identify factors associated with the 10-year risk of fatal and non-fatal cardiovascular disease (CVD) events in apparently healthy individuals aged 40-69 years. METHODS: 148 patients witho...BACKGROUND: This study aimed to identify factors associated with the 10-year risk of fatal and non-fatal cardiovascular disease (CVD) events in apparently healthy individuals aged 40-69 years. METHODS: 148 patients without established CVD were divided into low-risk (70 patients) and high-risk (78 patients) groups based on their CVD risk in SCORE2. RESULTS: High-risk patients presented with higher left atrial volume index (LAVI) (p = 0.003), left ventricular mass index (LVMI) (p < 0.001), and ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion (E/E') (p < 0.001) but lower oxygen uptake at anaerobic threshold (VO₂AT) (p = 0.02) and maximal oxygen uptake (VO2max) (p = 0.008), compared to their counterparts. High-risk patients also had higher values of high-sensitivity cardiac troponin T (hs-cTnT) (p < 0.001) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (p<0.001), and lower level of glomerular filtration rate (GFR) (p < 0.001). In a multiple logistic regression model, E/E' > 6.75 cm/s (OR 3.9, 95% CI: 1.5-10.3; p = 0.004) andhs-cTnT > 4.8 pg/ml (OR 6.02, 95% CI: 2.3-15.8; p < 0.001) were independently associated with high and very high CVD risk. SCORE2 (%) correlated positively with metabolic age (R Spearman = 0.79; p < 0.001), hs-cTnT (R = 0.6; p < 0.001), and NT-proBNP (R = 0.5; p < 0.001) and negatively with GFR (R = -0.5; p < 0.001) and VO2max (ml/min/kg) (R = -0.3; p < 0.001). CONCLUSIONS: Elevated E/E' and higher hs-cTnT level independently predict high and very high risk in SCORE2. The increasing 10-year cardiovascular disease risk correlates with higher metabolic age, higher levels of NT-proBNP and hs-cTnT, and lower level of GFR.
BACKGROUND: Patients with non-ischemic cardiomyopathy exhibit a range of myocardial fibrosis (MF) patterns on cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) imaging. Data suggests that ring-lik...BACKGROUND: Patients with non-ischemic cardiomyopathy exhibit a range of myocardial fibrosis (MF) patterns on cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) imaging. Data suggests that ring-like MF is associated with worse prognosis. In the present study it was sought to analyze the prevalence of parametric mapping abnormalities in ring-like MF and their prognostic value for arrhythmic events. METHODS: Patients undergoing clinical CMR at 1.5T/3T were evaluated for ring-like MF defined as midwall/subepicardial fibrosis involving ≥ 3 contiguous left ventricular segments. CMR protocol included cine imaging, T1 and T2 mapping, and LGE. Mean native T1, ECV, and T2 values and a number of mid short axis segments with elevated values were calculated. LGE extent was assessed segmentally. Arrhythmic outcomes were defined as appropriate device shock, premature ventricular contractions ≥ 10%, non-sustained/sustained ventricular tachycardia, or ventricular fibrillation. RESULTS: In total 49 patients (53 ± 17 years, 26.5% female) were analyzed. Many patients had elevated global/segmental mapping values: 45%/76% in native T1, 57%/57% in T2, and 57%/78% in ECV. During median follow-up of 12 months, arrhythmic events occurred in 65% of patients. There was no association between native T1/T2 elevation or number of LGE segments and arrhythmic outcomes. There was a significant association between ECV and arrhythmic outcomes, both septal ECV (p = 0.036) and any segmental ECV elevation (p = 0.03). CONCLUSION: T1 and T2 myocardial tissue abnormalities are common in patients with ring-like MF. ECV elevation was associated with arrhythmic events in this cohort. Further studies are needed to establish the diagnostic and prognostic value of parametric mapping in patients with ring-like MF.
Kubica J, Adamski P, Gajda R
… +21 more, Kubica A, Ostrowska M, Casu G, Gorog DA, Gurbel PA, Hajdukiewicz T, Jaguszewski M, Jeong YH, Kosobucka-Ozdoba A, Motovska Z, Niezgoda P, Piasecki M, Podhajski P, Raggi P, Rahimov U, Siller-Matula JM, Skonieczny G, Szarpak Ł, Szymański P, Tantry U, Navarese EP
According to the ESC guidelines, cangrelor may be considered in P2Y12-inhibitor-naïve acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). The aim of this review is to summarize ava...According to the ESC guidelines, cangrelor may be considered in P2Y12-inhibitor-naïve acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). The aim of this review is to summarize available evidence on the optimal maintenance therapy with P2Y12 receptor inhibitor after cangrelor. Transitioning from cangrelor to a thienopyridine, but not ticagrelor, can be associated with a drug-drug interaction (DDI); therefore, a ticagrelor loading dose (LD) can be given any time before, during, or at the end of a cangrelor infusion, while a LD of clopidogrel or prasugrel should be administered at the time the infusion of cangrelor ends or within 30 minutes before the end of infusion in the case of a LD of prasugrel. Administration of any oral antiplatelet agent at the end of a cangrelor infusion will also result in a transient period of increased platelet reactivity. The inter-individual variability of this period is difficult to predict because it depends on many factors related to the patient and the treatment. In addition, experimental studies indicate that cangrelor may exert a cardioprotective effect beyond the blockade of platelet aggregation. Considering the available data, the potential use of cangrelor in ACS patients goes well beyond the current indications. Furthermore, we believe that it might be prudent to avoid use of thienopyridines during and soon after a cangrelor infusion until conclusive data on the effect of the DDI on the clinical outcome are available. On the other hand, ticagrelor seems to be an optimal oral agent for continuation of P2Y12 inhibition in patients receiving cangrelor infusion.
BACKGROUND: To investigate whether the antiPCSK9 vaccine can affect the CRP and oxidative stress (OS) during acute systemic inflammation. METHODS: Male albino mice were randomly divided into three groups: non-treated mic...BACKGROUND: To investigate whether the antiPCSK9 vaccine can affect the CRP and oxidative stress (OS) during acute systemic inflammation. METHODS: Male albino mice were randomly divided into three groups: non-treated mice (the sham group), treated with a nonspecific stimulator of the immune response - Freund's complete adjuvant (CFA; the CFA group), and vaccinated mice treated with CFA (the vaccine group). The vaccine group was subcutaneously immunized with the antiPCSK9 formulation, 4 × in bi-weekly intervals. To induce inflammation, all mice were subjected to the CFA challenge after the vaccination plan. The hsCRP level and OS status were evaluated by a mouse CRP ELISA kit and the pro-oxidant antioxidant balance (PAB) assay, respectively. RESULTS: The vaccine induced a high-titter IgG antiPCSK9 antibody, which was accompanied with a significant PCSK9 reduction (-24.7% and -28.5% compared with the sham and CFA group, respectively), and the inhibition of PCSK9/LDLR interaction (-27.8% and -29.4%, respectively). hsCRP was significantly increased in the vaccine and CFA groups by 225% and 274% respectively, when compared with the sham group; however, it was non-significantly decreased (-18%; p = 0.520) in the vaccine group in comparison with the CFA group. The PAB values indicated that OS was significantly increased in the CFA group (by 72.7%) and the vaccine group (by 76%) when compared to the sham group; however, there was no significant difference in the PAB values between the vaccine and CFA groups. CONCLUSION: The antiPCSK9 vaccine failed to significantly reduce the serum hs-CRP and OS induced in the CFA-challenged albino mice.
BACKGROUND: The aim of this study was to assess the incidence and clinical significance of depression in patients with cardiac resynchronization therapy with an implantable cardioverter-defibrillator (CRT-D). The study w...BACKGROUND: The aim of this study was to assess the incidence and clinical significance of depression in patients with cardiac resynchronization therapy with an implantable cardioverter-defibrillator (CRT-D). The study was also to evaluate the impact of shock therapy on depression development and long-term prognosis. METHODS: The prospective study encompassed 396 consecutive heart failure (HF) patients implanted with CRT-D. All patients completed the Beck Depression Inventory (BDI-II) and underwent a psychiatric examination at baseline. 221 patients free of depressive symptoms at baseline were included into the final analysis. The assessment of psychiatric status was routinely repeated every 6 months as well as after the shock delivery. The primary outcome was a composite endpoint of death or hospitalization for HF. RESULTS: During long-term observation (median 37.1 months) 52 (23.5%) patients suffered from an implantable cardioverter-defibrillator (ICD) shock, whereas 48 (21.8%) subjects developed depression. The incidence of new-onset depression was significantly higher in patients after shock delivery (Shock Group), CRT non-responders and subjects with atrial fibrillation. The risk for a composite endpoint was higher in the Shock Group than subjects without an ICD intervention: 57.7% vs. 25.4% and in patients with new-onset depression compared to the population free of this disorder: 62.5% vs. 24.9% (all p < 0.001). New-onset depression (HR 1.7) and an ICD shock (HR 2.1) were strong independent predictors of poor prognosis. CONCLUSIONS: Depression is a common mental disorder in CRT-D recipients, that adversely affects long-term prognosis. Subjects suffering from ICD shocks and those with HF progression are at higher risk of experiencing depressive symptoms.
BACKGROUND: Little is known about the similarity of microcirculation assessment outcomes performed with regadenoson and adenosine. The aim of the current study was to compare coronary flow reserve (CFR) and index of micr...BACKGROUND: Little is known about the similarity of microcirculation assessment outcomes performed with regadenoson and adenosine. The aim of the current study was to compare coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) assessment using adenosine and regadenoson, and to evaluate predictors regarding the size of differences. METHODS: 44 patients were enrolled and diagnosed between 2021 and 2023. Fractional flow reserve (FFR), CFR and IMR were measured twice in the circumflex (Cx) (n = 8) or left anterior descending (LAD) (n = 36) artery: once with continuous infusion of adenosine (Adenocor 140 µg/kg/min) and 10 minutes later with regadenoson (Rapiscan 400 µg i.v.). RESULTS: Averaged results were quantified with adenosine and regadenoson for FFR (0.81 [0.75 ÷ 0.89] vs. 0.80 [0.73 ÷ 0.88]), CFR (3.84 [1.67 ÷ 4.08] vs. 3.97 [1.78 ÷ 4.32]) and IMR (20.01 [11 ÷ 24.5] vs. 20.25 [10.75 ÷ 23]), respectively. None of the differences were statistically significant. Among the significant (p < 0.05) predictors of greater ΔCFR, the following can be noted: prior percutaneous transluminal angioplasty/carotid artery stenting (β = 2.35), oral anticoagulant usage (β = 0.89), and prior stroke/transient ischaemic attack (TIA) (β = 1.09), with the latter being also confirmed for greater ΔIMR (β = 8.89). Moreover, patients with New York Heart Association (NYHA) class II/III, as compared to those with NYHA class I, were more likely to have greater ΔIMR (β = 11.89). CONCLUSIONS: Regadenoson may be a feasible alternative to adenosine in coronary microcirculation assessment, as it produces similar outcomes. Selected factors were found to be predictors of greater differences in IMR, CFR and FFR values according to the agent used for coronary hyperemia.