Borislav Ivanov

Serum levels of RIPK3 and troponin I as potential biomarkers for predicting impaired left ventricular function in patients with myocardial infarction with ST segment elevation and normal troponin I levels prior percutaneous coronary intervention

The current study examined the serum levels of receptor-interacting protein kinase 3 (RIPK3) in 51 patients with New York Heart Association (NYHA) class III-IV heart failure, 53 patients with myocardial infarction with ST elevation (STEMI), and 19 healthy subjects serving as a control group. An enzyme-linked immunoadsorbent assay (ELISA) was used to measure the levels of RIPK3 expression in serum. The area under the receiver operating characteristic curve (AUC) was then used to evaluate the predictive performance of RIPK3 and troponin I in patients with STEMI. In patients with normal levels of troponin I prior to percutaneous coronary intervention (PCI), serum levels of RIPK3 and troponin I after PCI were sufficient to differentiate patients with a preserved left ventricular ejection fraction (LVEF) from those with impaired left ventricular function after PCI (AUC = 0.780 (95% CI: 0.565-0.995, p = 0.043) with a sensitivity of 76.9% and a specificity of 71.4% vs. AUC = 0.735 (95% CI: 0.530-0.941, p = 0.038) with a sensitivity of 88.2% and a specificity of 63.6% at the optimal cutoff values, respectively). Moreover, elevated levels of troponin I after PCI were associated with an increased risk of an LVEF < 50% prior to discharge (odds ratio, 1.014; 95 % CI, 1.001 to 1.027; p = 0.03), while elevated levels of RIPK3 were not associated with such a risk. The current findings suggest that in patients with normal levels of troponin I prior to PCI, serum levels of RIPK3 and troponin I can serve as a potential marker to identify patients with a decreased LVEF, thus possibly allowing an early shift to more intensive therapy.

Amyotrophic Lateral Sclerosis and Effects of Vibrations

Amyotrophic lateral sclerosis (ALS) is a severe and fatal neurodegenerative disorder affecting both the upper and lower motor neurons. We present the clinical cases of four patients with ALS and vibration syndrome. All patients had over 20 years of exposure to general and local vibrations and common subjective complaints: pain, paresthesia, twitching and weakness of limb muscles. Evidence of ALS syndrome was demonstrated by the abnormal neurological examination (pseudobulbar syndrome and pyramidal signs) as well as by neurophysiological studies (peripheral motor neuron degeneration). We discuss the possible relationship between the exposure to general and local vibrations and the ALS syndrome in our patients, and the role of vibrations as a possible risk factor for the disease. Occupational contact with chemicals and pesticides is also discussed as a risk factor.