Rafael Carlos Miranda

Elevated Troponin Levels after Prolonged Supraventricular Tachycardia in Patient with Normal Coronary Angiography

The European Society of Cardiology and the American College of Cardiology redefined the concept of myocardial infarction in the presence of highly positive markers of myocardial injury associated with at least one of the following: ischemic symptoms; development of pathologic Q waves on the ECG or ECG changes indicative of ischemia (positive or negative deviation of the ST segment), making troponins one of the most important aspects in the evaluation and stratification of patients with chest pain in the emergency room. However, although troponin gives excellent accuracy in the identification of myocardial necrosis, it is known that it can also be elevated in a series of nonatherosclerotic heart diseases. We present the case of a 49-year-old female patient admitted to the Chest Pain Unit with a history of supraventricular tachycardia associated with chest discomfort, nausea and diaphoresis. During risk stratification, the patient presented with a high serum troponin T level (0.143 ng/ml) but with a normal coronary angiography.

Acute kidney injury after on-pump coronary artery bypass graft surgery.

FUNDAMENTO: Lesion renal aguda (LRA) es una compleja enfermedad, la que, actualmente, no tiene definicion patron acepta. AKIN (Acute Kidney Injury Network) representa una tentativa de estandardizacion de criterios para el diagnostico y estadiamiento de LRA basado en los criterios RIFLE (risk, injury, failure, loss, y end-stage kidney disease) publicados recientemente. OBJETIVO: Evaluar la incidencia y mortalidad asociada a LRA en pacientes sometidos a revascularizacion del miocardio (RM) con circulacion extracorporea (CEC). METODOS: El total de 817 pacientes fueron divididos en dos grupos: LRA negativa (-), con 421 pacientes (51,5%), y LRA positiva (+), con 396 pacientes (48,5%). LRA fue considerada la elevacion de creatinina en 0,3 mg/dl el aumento en 50% de creatinina en relacion a su valor basal. RESULTADOS: La mortalidad dentro de 30 dias de los pacientes con y sin LRA ha sido de 12,3 y 1,4%, respectivamente (p 14 dias), 14 versus 2%; p<0,0001. CONCLUSION: En la poblacion estudiada, mismo una discreta alteracion de la funcion renal basada en los criterios AKIN ha sido predictora independiente de obito, en 30 dias tras RM con CEC. (Registro ClinicalTrials.gov - NCT00780845).BACKGROUND The acute kidney injury (AKI) is a complex disease for which there is no accepted standard definition nowadays. The Acute Kidney Injury Network (AKIN) represents an attempt to standardize the criteria for diagnosis and staging of acute renal dysfunction based on recently published RIFLE criteria, that means, (Risk, Injury, Failure, Loss, and End-stage kidney disease). OBJECTIVES To evaluate the incidence and associated mortality of AKI in patients submitted to on-pump coronary artery bypass graft surgery (on-pump CABG). METHODS A total of 817 patients were divided into two groups: negative AKI (-), with 421 patients (51.5%), and positive AKI (+), with 396 patients (48.5%). Increase of 0.3 mg/dL in creatinine or of 50% in creatinines basal value was considered as AKI. RESULTS The rate of patients mortality with or without AKI within 30 days after cardiac surgery was 12.6% and 1.4%, respectively (p<0.0001). In a multivariate logistic regression model, AKI after on-pump CABG was an independent predictor of death within 30 days (OR=6.7; p=0.0002). This group of patients presented a longer period of permanency in intensive care unit (ICU) [median 2 days (2 to 3) versus 3 days (2 to 5); p=0.0001] and a bigger proportion of patients with prolonged permanence in intensive care (>14 days) (14 versus 2%; p=0.0001). CONCLUSION In the studied population, even a discrete alteration in renal function, based on AKIN criteria, was an independent predictor of death in 30 days after on-pump CABG.

Lesão renal aguda após revascularização do miocárdio com circulação extracorpórea

FUNDAMENTO: Lesion renal aguda (LRA) es una compleja enfermedad, la que, actualmente, no tiene definicion patron acepta. AKIN (Acute Kidney Injury Network) representa una tentativa de estandardizacion de criterios para el diagnostico y estadiamiento de LRA basado en los criterios RIFLE (risk, injury, failure, loss, y end-stage kidney disease) publicados recientemente. OBJETIVO: Evaluar la incidencia y mortalidad asociada a LRA en pacientes sometidos a revascularizacion del miocardio (RM) con circulacion extracorporea (CEC). METODOS: El total de 817 pacientes fueron divididos en dos grupos: LRA negativa (-), con 421 pacientes (51,5%), y LRA positiva (+), con 396 pacientes (48,5%). LRA fue considerada la elevacion de creatinina en 0,3 mg/dl el aumento en 50% de creatinina en relacion a su valor basal. RESULTADOS: La mortalidad dentro de 30 dias de los pacientes con y sin LRA ha sido de 12,3 y 1,4%, respectivamente (p 14 dias), 14 versus 2%; p<0,0001. CONCLUSION: En la poblacion estudiada, mismo una discreta alteracion de la funcion renal basada en los criterios AKIN ha sido predictora independiente de obito, en 30 dias tras RM con CEC. (Registro ClinicalTrials.gov - NCT00780845).BACKGROUND The acute kidney injury (AKI) is a complex disease for which there is no accepted standard definition nowadays. The Acute Kidney Injury Network (AKIN) represents an attempt to standardize the criteria for diagnosis and staging of acute renal dysfunction based on recently published RIFLE criteria, that means, (Risk, Injury, Failure, Loss, and End-stage kidney disease). OBJECTIVES To evaluate the incidence and associated mortality of AKI in patients submitted to on-pump coronary artery bypass graft surgery (on-pump CABG). METHODS A total of 817 patients were divided into two groups: negative AKI (-), with 421 patients (51.5%), and positive AKI (+), with 396 patients (48.5%). Increase of 0.3 mg/dL in creatinine or of 50% in creatinines basal value was considered as AKI. RESULTS The rate of patients mortality with or without AKI within 30 days after cardiac surgery was 12.6% and 1.4%, respectively (p<0.0001). In a multivariate logistic regression model, AKI after on-pump CABG was an independent predictor of death within 30 days (OR=6.7; p=0.0002). This group of patients presented a longer period of permanency in intensive care unit (ICU) [median 2 days (2 to 3) versus 3 days (2 to 5); p=0.0001] and a bigger proportion of patients with prolonged permanence in intensive care (>14 days) (14 versus 2%; p=0.0001). CONCLUSION In the studied population, even a discrete alteration in renal function, based on AKIN criteria, was an independent predictor of death in 30 days after on-pump CABG.

Lesión renal aguda post-revascularización del miocardio con circulación extracorpórea

FUNDAMENTO: Lesion renal aguda (LRA) es una compleja enfermedad, la que, actualmente, no tiene definicion patron acepta. AKIN (Acute Kidney Injury Network) representa una tentativa de estandardizacion de criterios para el diagnostico y estadiamiento de LRA basado en los criterios RIFLE (risk, injury, failure, loss, y end-stage kidney disease) publicados recientemente. OBJETIVO: Evaluar la incidencia y mortalidad asociada a LRA en pacientes sometidos a revascularizacion del miocardio (RM) con circulacion extracorporea (CEC). METODOS: El total de 817 pacientes fueron divididos en dos grupos: LRA negativa (-), con 421 pacientes (51,5%), y LRA positiva (+), con 396 pacientes (48,5%). LRA fue considerada la elevacion de creatinina en 0,3 mg/dl el aumento en 50% de creatinina en relacion a su valor basal. RESULTADOS: La mortalidad dentro de 30 dias de los pacientes con y sin LRA ha sido de 12,3 y 1,4%, respectivamente (p 14 dias), 14 versus 2%; p<0,0001. CONCLUSION: En la poblacion estudiada, mismo una discreta alteracion de la funcion renal basada en los criterios AKIN ha sido predictora independiente de obito, en 30 dias tras RM con CEC. (Registro ClinicalTrials.gov - NCT00780845).BACKGROUND The acute kidney injury (AKI) is a complex disease for which there is no accepted standard definition nowadays. The Acute Kidney Injury Network (AKIN) represents an attempt to standardize the criteria for diagnosis and staging of acute renal dysfunction based on recently published RIFLE criteria, that means, (Risk, Injury, Failure, Loss, and End-stage kidney disease). OBJECTIVES To evaluate the incidence and associated mortality of AKI in patients submitted to on-pump coronary artery bypass graft surgery (on-pump CABG). METHODS A total of 817 patients were divided into two groups: negative AKI (-), with 421 patients (51.5%), and positive AKI (+), with 396 patients (48.5%). Increase of 0.3 mg/dL in creatinine or of 50% in creatinines basal value was considered as AKI. RESULTS The rate of patients mortality with or without AKI within 30 days after cardiac surgery was 12.6% and 1.4%, respectively (p<0.0001). In a multivariate logistic regression model, AKI after on-pump CABG was an independent predictor of death within 30 days (OR=6.7; p=0.0002). This group of patients presented a longer period of permanency in intensive care unit (ICU) [median 2 days (2 to 3) versus 3 days (2 to 5); p=0.0001] and a bigger proportion of patients with prolonged permanence in intensive care (>14 days) (14 versus 2%; p=0.0001). CONCLUSION In the studied population, even a discrete alteration in renal function, based on AKIN criteria, was an independent predictor of death in 30 days after on-pump CABG.