Omar Batal

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.

Resistant Hypertension: A Comprehensive Overview

Hypertension is a common, undertreated disease and a major risk factor for cardiovascular, cerebrovascular and renal disease. As many as 20-30% of hypertensive patients have resistant hypertension, defined as uncontrolled blood pressure despite 3 or more antihypertensive drugs including a diuretic, typically combined with a calcium-channel blocker and an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Patients with resistant hypertension can often be controlled by adding a mineralocorticoid receptor antagonist and/or vasodilating beta-blocker. A significant number of patients will have a treatable secondary cause of resistant hypertension such as obesity, sleep apnea, renal insufficiency, primary aldosteronism or renal artery stenosis. For patients whose hypertension is refractory to preferred antihypertensives, use of third-line antihypertensives such as sympatholytics or vasodilators may be effective but consideration should be given to investigational device-based antihypertensive therapies. Renal artery angioplasty/ stenting can be useful in selected cases of renal artery stenosis, while renal sympathetic denervation holds promise for resistant essential hypertension.

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

AN ECHOCARDIOGRAPHIC RISK SCORE FOR PREDICTION OF MORTALITY IN PATIENTS WITH PULMONARY HYPERTENSION

Pulmonary hypertension (PH) is a progressive disease with variable prognosis and expanding treatment options. Guidelines have supported individual echocardiographic prognostic markers, but their ability to predict mortality remain unclear. The aim was to assess the prognostic significance of

Echocardiographic Sizing of the Left Atrium of the Transplanted Heart

The left atrium (LA) in the transplanted heart (TH) is a surgically created chamber from variable portions of donor and recipient LA. The American Society of Echocardiography (ASE) recommends measuring LA size in native hearts using biplane LA volume index (LAVI) as a more accurate measurement than LA anterior‐posterior diameter (LA‐APD). We hypothesized that LA‐APD underestimates LA size when compared with LAVI in the TH.

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 (

DOES OBESITY AFFECT BRAIN NATRIURETIC PEPTIDE LEVELS IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION

Results: Median survival was 2.7 ± 2.4 yrs. There were 45 deaths and 4 lung transplants. Obese patients had lower median BNP (interquartile range): 182 (64, 459) vs 373 (89,810) pg/ml, p=0.015. Diabetes mellitus was more frequent in obese patients (p = 0.01) but other comorbidities were not. Age, sex, % idiopathic PAH, PAH medications, WHO functional class (WHO FC), hemodynamics, TTE parameters, and creatinine were similar. Multivariable regression analysis showed significant association of BNP and BMI independent of age, hypertension, diabetes, WHO FC, hemodynamics, or creatinine (p=0.016). BNP was associated with death/transplant and was predictive of 2-year outcomes only in non-obese patients (p=0.001, figure).