Gavin Hickey

The prognostic significance of troponin I elevation in acute ischemic stroke

BACKGROUND The significance of cardiac troponin I (TnI) levels in patients with acute ischemic stroke remains unclear. METHODS Data were prospectively collected on 1718 patients with acute ischemic stroke (2009-2010). Patients with positive TnI (peak TnI ≥0.1 μg/L) were assigned to the myocardial infarction (MI) group if they met diagnostic criteria. The remaining patients with positive TnI were assigned to the no-MI group. Patients were followed up for 1.4 ± 1.1 years. Primary outcome was inhospital and long-term all-cause mortality. RESULTS Positive TnI was present in 309 patients (18%), 119 of whom (39%) were classified as having MI. Positive TnI was independently associated with older age, hypertension, smoking, peripheral arterial disease, heart failure, higher systolic blood pressure, higher serum creatinine, and lower heart rate (P < .01). Patients with MI had the highest inpatient mortality (P < .001) and the lowest survival rate by Kaplan-Meier analysis (P < .0001). Peak TnI greater than or equal to 0.5 μg/L, particularly if satisfying criteria for MI, was independently associated with long-term mortality (P < .0001); peak TnI less than 0.5 μg/L alone was not when adjusted for covariates. CONCLUSION Positive TnI greater than or equal to 0.5 μg/L in patients with acute ischemic stroke was independently associated with worse outcomes. Patients with diagnosis of MI represent a particularly high-risk subgroup.

Obstructive sleep apnea is associated with increased readmission in heart failure patients

Heart failure (HF) readmission rates have become an increasingly important quality metric since the advent of the Hospital Readmissions Reduction Program. Despite many well‐intentioned efforts to reduce readmissions, clinicians continue to struggle with the problem of high HF readmission rates.

TROPONIN I ELEVATION IN ACUTE ISCHEMIC STROKE

Acute ischemic strokes are often accompanied by cardiac events. The prevalence, associated factors, and implications of elevated troponin I (TnI) in acute ischemic stroke merit further study. We reviewed our prospective registry of hospitalized patients with acute ischemic stroke from 2009 to 2010

Pulmonary vascular resistance determines mortality in end-stage renal disease patients with pulmonary hypertension

The multifactorial etiology of pulmonary hypertension (PH) in end‐stage renal disease (ESRD) includes patients with and without elevated pulmonary vascular resistance (PVR). We explored the prognostic implication of this distinction by evaluating pretransplant ESRD patients who underwent right heart catheterization and echocardiography. Demographics, clinical data, and test results were analyzed. All‐cause mortality data were obtained. Median follow‐up was 4 years. Of the 150 patients evaluated, echocardiography identified 99 patients (66%) with estimated pulmonary artery (PA) systolic pressure > 36 mm Hg, which correlated poorly with mortality (HR = 1.28, 95% CI 0.72‐2.27, P = .387). Right heart catheterization identified 88 (59%) patients with mean PA pressure ≥ 25 mm Hg. Of these, 70 had PVR ≤ 3 Wood units and 18 had PVR > 3 Wood units. Survival analysis demonstrated a significant prognostic effect of an elevated PVR in patients with high mean PA pressures (HR = 2.26, 95% CI 1.07‐4.77, P = .03), while patients with high mean PA pressure and normal PVR had equivalent survival to those with normal PA pressure. Despite the high prevalence of PH in ESRD patients, elevated PVR is uncommon and is a determinant of prognosis in patients with PH. Patients with normal PVR had survival equivalent to those with normal PA pressures.

PULMONARY VASCULAR RESISTANCE PREDICTS MORTALITY IN END-STAGE RENAL DISEASE PATIENTS WITH PULMONARY HYPERTENSION

Introduction: The multifactorial etiology of pulmonary hypertension (PH) in end-stage renal disease (ESRD) includes patients with and without elevated pulmonary vascular resistance (PVR). We explored the prognostic implication of this distinction. Methods: We evaluated pre-transplant ESRD patients

YIELD OF MYOCARDIAL PERFUSION IMAGING IN ACUTE CHEST PAIN PATIENTS WITH NEGATIVE ECG AND BIOMARKERS

Patients presenting to the emergency department (ED) with chest pain and a non-ischemic presenting electrocardiogram (ECG) are usually admitted for serial ECG and Troponin (Tn) assays and if negative, stress testing. We evaluated the additive value of stress myocardial perfusion imaging (MPI) in

CARDIOMYOPATHY IN ACUTE ISCHEMIC STROKE

Cardiomyopathy (CM) in patients admitted with acute ischemic stroke has not been investigated previously. A prospective registry of 1,761 patients admitted with diagnosis of acute ischemic stroke from 2009-2010 was used to identify patients with systolic CM. Echocardiography was performed on 1,594

MYOCARDIAL INFARCTION IN THE SETTING OF ACUTE ISCHEMIC STROKE

Acute ischemic stroke is a cause of troponin elevation which is often attributed to demand, type 2 myocardial infarction (MI). The incidence of spontaneous, type 1 MI is unknown. We reviewed our prospective hospital registry of acute ischemic stroke (2009–2010). All patients had ≥3 troponin I (