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The Journal of Maternal-fetal &... Oct 2016We systematically review the literature for potential alterations in cardiac troponin I (cTnI) in patients who suffer from pre-eclampsia. (Review)
Review
OBJECTIVE
We systematically review the literature for potential alterations in cardiac troponin I (cTnI) in patients who suffer from pre-eclampsia.
METHODS
We used the Medline (1966-2015), Scopus (2004-2015), Popline (1974-2015), ClinicalTrials.gov (2008-2015) and Cochrane Central Register of Controlled Trials (CENTRAL) (1999-2015) databases for our primary search; we also employed the reference lists of the full-text articles that we retrieved electronically.
RESULTS
We included nine studies involving 719 women. Five of these studies suggested that cTnI increases in pre-eclamptic patients above the normal threshold. However, all studies reported outcomes at a single time point, and they failed to perform consecutive measurements to observe whether this effect was long lasting and whether it evolved during the course of pregnancy.
CONCLUSIONS
Current evidence suggests that cTnI might be elevated in pre-eclamptic pregnant women, although this observation is not always reported. Future studies are necessary to consistently observe cTnI levels throughout the prenatal period and during the first few postnatal weeks. A concurrent evaluation of other cardiovascular hemodynamic parameters could be of use in mechanistic models for predicting future cardiovascular morbidity in these women.
Topics: Female; Humans; Pre-Eclampsia; Pregnancy; Troponin I
PubMed: 26745550
DOI: 10.3109/14767058.2015.1127347 -
International Journal of Cardiology Jul 2015Cardiovascular disease, especially ischemic heart disease, is a major comorbidity in chronic obstructive pulmonary disease (COPD) patients. Several studies suggested... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cardiovascular disease, especially ischemic heart disease, is a major comorbidity in chronic obstructive pulmonary disease (COPD) patients. Several studies suggested that after acute exacerbation of COPD (AECOPD), there is a significant increase of mortality (cardiac and all-cause) and of myocardial infarction. Whether cardiac troponin (Tn) elevation during AECOPD could be considered a prognostic marker of all-cause mortality is still debated.
METHODS
To assess the prognostic role of cardiac Tn elevation during AECOPD, we performed a systematic review and meta-analysis. We included studies with patients admitted to the hospital for AECOPD, with at least one Tn assessment and reporting the relationship (after multivariable analysis) between Tn elevation and all-cause mortality. Secondarily, studies were stratified according to: i) type of troponin (Tn I or Tn T), and ii) follow-up length (≤6 months vs. >6 months).
RESULTS
Ten studies were included in the systematic review and 8 in the meta-analysis. Cardiac Tn elevation ranges from 18% to 73%. We found that cardiac Tn elevation was significantly related to an increased risk for all-cause mortality (OR 1.69; 95% CI 1.25-2.29; I(2) 40%). This finding was independent to the follow-up length of studies (≤6 months: OR 3.22; 95% CI 1.31-7.91; >6 months: OR 1.38; 95% CI 1.02-1.86). Finally, Tn T seems to be more helpful in predicting all-cause mortality as compared to Tn I (OR 1.54; 95% CI 1.2-1.96 vs. OR 3.39, 95% CI 0.86-13.36, respectively).
CONCLUSIONS
In patients admitted to the hospital for AECOPD, cardiac Tn elevation emerged as an independent predictor of increased risk of all-cause mortality.
Topics: Acute Disease; Disease Progression; Humans; Mortality; Observational Studies as Topic; Patient Admission; Pulmonary Disease, Chronic Obstructive; Troponin T
PubMed: 25965630
DOI: 10.1016/j.ijcard.2015.05.006 -
Critical Care (London, England) Jul 2020Cardiac injury is now a common complication of coronavirus disease (COVID-19), but it remains unclear whether cardiac injury-related biomarkers can be independent... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cardiac injury is now a common complication of coronavirus disease (COVID-19), but it remains unclear whether cardiac injury-related biomarkers can be independent predictors of mortality and severe disease development or intensive care unit (ICU) admission.
METHODS
Two investigators searched the PubMed, EMBASE, Cochrane Library, MEDLINE, Chinese National Knowledge Infrastructure (CNKI), Wanfang, MedRxiv, and ChinaXiv databases for articles published through March 30, 2020. Retrospective studies assessing the relationship between the prognosis of COVID-19 patients and levels of troponin I (TnI) and other cardiac injury biomarkers (creatine kinase [CK], CK myocardial band [CK-MB], lactate dehydrogenase [LDH], and interleukin-6 [IL-6]) were included. The data were extracted independently by two investigators.
RESULTS
The analysis included 23 studies with 4631 total individuals. The proportions of severe disease, ICU admission, or death among patients with non-elevated TnI (or troponin T [TnT]), and those with elevated TnI (or TnT) were 12.0% and 64.5%, 11.8% and 56.0%, and 8.2% and. 59.3%, respectively. Patients with elevated TnI levels had significantly higher risks of severe disease, ICU admission, and death (RR 5.57, 95% CI 3.04 to 10.22, P < 0.001; RR 6.20, 95% CI 2.52 to 15.29, P < 0.001; RR 5.64, 95% CI 2.69 to 11.83, P < 0.001). Patients with an elevated CK level were at significantly increased risk of severe disease or ICU admission (RR 1.98, 95% CI 1.50 to 2.61, P < 0.001). Patients with elevated CK-MB levels were at a higher risk of developing severe disease or requiring ICU admission (RR 3.24, 95% CI 1.66 to 6.34, P = 0.001). Patients with newly occurring arrhythmias were at higher risk of developing severe disease or requiring ICU admission (RR 13.09, 95% CI 7.00 to 24.47, P < 0.001). An elevated IL-6 level was associated with a higher risk of developing severe disease, requiring ICU admission, or death.
CONCLUSIONS
COVID-19 patients with elevated TnI levels are at significantly higher risk of severe disease, ICU admission, and death. Elevated CK, CK-MB, LDH, and IL-6 levels and emerging arrhythmia are associated with the development of severe disease and need for ICU admission, and the mortality is significantly higher in patients with elevated LDH and IL-6 levels.
Topics: Biomarkers; COVID-19; Coronavirus Infections; Heart Injuries; Hospitalization; Humans; Intensive Care Units; Pandemics; Pneumonia, Viral; Predictive Value of Tests; Risk Assessment; Severity of Illness Index; Troponin I
PubMed: 32723362
DOI: 10.1186/s13054-020-03183-z -
International Journal of Molecular... Mar 2020Cardiac complications after a stroke are the second leading cause of death worldwide, affecting the treatment and outcomes of stroke patients. Cardiac biomarkers such as... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cardiac complications after a stroke are the second leading cause of death worldwide, affecting the treatment and outcomes of stroke patients. Cardiac biomarkers such as cardiac troponin (cTn), brain natriuretic peptide (BNP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) have been frequently reported in patients undergoing a stroke. The aim of the present study is to meta-analyze the relationship between changes in such cardiac biomarkers and stroke and to present a systematic review of the previous literature, so as to explore the brain-heart axis.
METHODS
We searched four online databases pertinent to the literature, including PubMed, Embase, the Cochrane Library, and the Web of Science. Then, we performed a meta-analysis to investigate changes in cTn, BNP, and NT-proBNP associated with different types of stroke.
RESULTS AND CONCLUSIONS
A significant increase in cTnI concentration was found in patients exhibiting a brain hemorrhage. BNP increased in cases of brain infarction, while the NT-proBNP concentration was significantly elevated in patients suffering an acute ischemic stroke and brain hemorrhage, indicating cardiac damage and dysfunction after a stroke. Our analysis suggests that several potential mechanisms may be involved in the brain-heart axis. Finally, clinicians should pay careful attention to monitoring cardiac function in the treatment of cerebrovascular diseases in order to provide a timely and more accurate treatment.
Topics: Biomarkers; Heart Diseases; Humans; Intracranial Hemorrhages; Natriuretic Peptide, Brain; Peptide Fragments; Stroke; Troponin I
PubMed: 32231119
DOI: 10.3390/ijms21072347 -
Indian Journal of Dental Research :... 2021The aim of this study is to review studies evaluating the role of genetics in skeletal class II malocclusion. (Review)
Review
AIM
The aim of this study is to review studies evaluating the role of genetics in skeletal class II malocclusion.
OBJECTIVE
To assess the scientific evidence associating the role of genes in skeletal class II malocclusion. Materials and Methods: A complete search across the electronic database through PubMed, Cochrane, LILACS, BMC and manual hand search of orthodontic journals were done till May 2019. The keywords for the search included: "Genetics", "class II malocclusion", "maxillary prognathism", "mandibular retrognathism".
DATA COLLECTION AND ANALYSIS
Studies were selected based on PRISMA guidelines.
RESULTS
Articles were selected based on the inclusion and exclusion criteria. A total of 11 cross-sectional studies satisfied the inclusion criteria and were analyzed for the role of genes in skeletal class II malocclusion. Almost all the studies except for one revealed a positive correlation of genes with skeletal class II malocclusion.
CONCLUSIONS
Out of the 11 studies included, a positive correlation of the genes with the skeletal II malocclusion was found in 10 studies. Genes FGFR2, MSX1, MATN1, MYOH1, ACTN3, GHR, KAT6B, HDAC4, AJUBA were found to be positively linked to skeletal class II malocclusion.
Topics: Actinin; Cephalometry; Cross-Sectional Studies; Histone Acetyltransferases; Humans; LIM Domain Proteins; Malocclusion; Malocclusion, Angle Class II; Malocclusion, Angle Class III
PubMed: 35229783
DOI: 10.4103/ijdr.IJDR_59_20 -
JAMA Nov 2017High-sensitivity cardiac troponin I testing is widely used to evaluate patients with suspected acute coronary syndrome. A cardiac troponin concentration of less than 5... (Meta-Analysis)
Meta-Analysis Review
IMPORTANCE
High-sensitivity cardiac troponin I testing is widely used to evaluate patients with suspected acute coronary syndrome. A cardiac troponin concentration of less than 5 ng/L identifies patients at presentation as low risk, but the optimal threshold is uncertain.
OBJECTIVE
To evaluate the performance of a cardiac troponin I threshold of 5 ng/L at presentation as a risk stratification tool in patients with suspected acute coronary syndrome.
DATA SOURCES
Systematic search of MEDLINE, EMBASE, Cochrane, and Web of Science databases from January 1, 2006, to March 18, 2017.
STUDY SELECTION
Prospective studies measuring high-sensitivity cardiac troponin I concentrations in patients with suspected acute coronary syndrome in which the diagnosis was adjudicated according to the universal definition of myocardial infarction.
DATA EXTRACTION AND SYNTHESIS
The systematic review identified 19 cohorts. Individual patient-level data were obtained from the corresponding authors of 17 cohorts, with aggregate data from 2 cohorts. Meta-estimates for primary and secondary outcomes were derived using a binomial-normal random-effects model.
MAIN OUTCOMES AND MEASURES
The primary outcome was myocardial infarction or cardiac death at 30 days. Performance was evaluated in subgroups and across a range of troponin concentrations (2-16 ng/L) using individual patient data.
RESULTS
Of 11 845 articles identified, 104 underwent full-text review, and 19 cohorts from 9 countries were included. Among 22 457 patients included in the meta-analysis (mean age, 62 [SD, 15.5] years; n = 9329 women [41.5%]), the primary outcome occurred in 2786 (12.4%). Cardiac troponin I concentrations were less than 5 ng/L at presentation in 11 012 patients (49%), in whom there were 60 missed index or 30-day events (59 index myocardial infarctions, 1 myocardial infarction at 30 days, and no cardiac deaths at 30 days). This resulted in a negative predictive value of 99.5% (95% CI, 99.3%-99.6%) for the primary outcome. There were no cardiac deaths at 30 days and 7 (0.1%) at 1 year, with a negative predictive value of 99.9% (95% CI, 99.7%-99.9%) for cardiac death.
CONCLUSIONS AND RELEVANCE
Among patients with suspected acute coronary syndrome, a high-sensitivity cardiac troponin I concentration of less than 5 ng/L identified those at low risk of myocardial infarction or cardiac death within 30 days. Further research is needed to understand the clinical utility and cost-effectiveness of this approach to risk stratification.
Topics: Acute Coronary Syndrome; Adult; Biomarkers; Death; Humans; Male; Myocardial Infarction; Prognosis; Prospective Studies; Risk Assessment; Troponin I
PubMed: 29127948
DOI: 10.1001/jama.2017.17488 -
Journal of Sports Sciences Jan 2021The aim of this review was to assess the association of R577X and I/D polymorphisms with athlete status in football and determine which allele and/or genotypes are... (Meta-Analysis)
Meta-Analysis
The aim of this review was to assess the association of R577X and I/D polymorphisms with athlete status in football and determine which allele and/or genotypes are most likely to influence this phenotype via a meta-analysis. A comprehensive search identified 17 and 19 studies. Significant associations were shown between the presence of the R allele and professional footballer status (OR = 1.35, 95% CI: 1.18-1.53) and the D allele and youth footballers (OR = 1.18, 95% CI: 1.01-1.38). More specifically, the RR genotype (OR = 1.48, 95% CI: 1.23-1.77) and DD genotype (OR = 1.29, 95% CI: 1.02-1.63) exhibited the strongest associations, respectively. These findings may be explained by the association of the RR genotype and DD genotype with power-orientated phenotypes and the relative contribution of power-orientated phenotypes to success in football. As such, the results of this review provide further evidence that individual genetic variation may contribute towards athlete status and can differentiate athletes of different competitive playing statuses in a homogenous team-sport cohort. Moreover, the R577X and I/D polymorphisms are likely (albeit relatively minor) contributing factors that influence athlete status in football.
Topics: Humans; Actinin; Alleles; Genotype; Peptidyl-Dipeptidase A; Polymorphism, Genetic; Soccer
PubMed: 32856541
DOI: 10.1080/02640414.2020.1812195 -
Lung Oct 2015Various biomarkers have been evaluated to risk stratify patients with acute pulmonary embolism (PE). We aimed to summarize the available evidence to compare the... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Various biomarkers have been evaluated to risk stratify patients with acute pulmonary embolism (PE). We aimed to summarize the available evidence to compare the prognostic value of three most widely studied biomarkers in normotensive patients with acute PE.
METHOD
A systematic literature review of database, including Pubmed, EMBASE and Cochrane, was done. Studies were included if those were done on patients with acute PE and serum troponin or brain natriuretic peptide and N-terminal proBNP (BNP/NT-proBNP) or Heart-type fatty acid-binding protein (H-FABP) assay was done. The primary end point was short-term all-cause mortality. The secondary end points were PE-related mortality and serious adverse events.
RESULTS
All three biomarkers were significantly associated with increased risk for short-term all-cause mortality, PE-related mortality and serious adverse events. All-cause mortality: troponin [odds ratio (OR) 4.80; 95% CI 3.25-7.08, I(2) = 54%], BNP or NT-proBNP (OR 7.98; 95% CI 4.34-14.67, I(2) = 0%); PE-related mortality: troponin (OR 3.80; 95% CI 2.74-5.27, I(2) = 0%), BNP or NT-proBNP (OR 7.57; 95% CI 2.89-19.81, I (2) = 0%) and H-FABP (OR 25.97; 95% CI 6.63-101.66, I(2) = 40%). H-FABP has the lowest negative likelihood ratio (NLR) of 0.17 for mortality followed by high-sensitive cardiac troponin T (hs-cTnT) with NLR of 0.21.
CONCLUSION
None of the biomarker identifies a subgroup of patients who can be managed as an outpatient versus patients who may get benefit from thrombolytics with certainty; however, H-FABP and hs-cTnT showed some promising results and should be investigated further.
Topics: Acute Disease; Biomarkers; Cause of Death; Fatty Acid Binding Protein 3; Fatty Acid-Binding Proteins; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Pulmonary Embolism; Troponin
PubMed: 26134045
DOI: 10.1007/s00408-015-9752-4 -
PloS One 2019Increased postoperative cardiac troponin (cTn) independently predicts short-term mortality. Previous studies suggest that preoperative cTn also predicts major adverse... (Meta-Analysis)
Meta-Analysis
Prognostic performance of preoperative cardiac troponin and perioperative changes in cardiac troponin for the prediction of major adverse cardiac events and mortality in noncardiac surgery: A systematic review and meta-analysis.
BACKGROUND
Increased postoperative cardiac troponin (cTn) independently predicts short-term mortality. Previous studies suggest that preoperative cTn also predicts major adverse cardiovascular events (MACE) and mortality after noncardiac surgery. The value of preoperative and perioperative changes in cTn as a prognostic tool for adverse outcomes has been sparsely investigated.
METHODS AND FINDINGS
A systematic review and meta-analysis of the prognostic value of cTns for adverse outcome was conducted. Adverse outcome was defined as short-term (in-hospital or <30 days) and long-term (>30 days) MACE and/or all-cause mortality, in adult patients undergoing noncardiac surgery. The study protocol (CRD42018094773) was registered with an international prospective register of systematic reviews (PROSPERO). Preoperative cTn was a predictor of short- (OR 4.3, 95% CI 2.9-6.5, p<0.001, adjusted OR 5.87, 95% CI 3.24-10.65, p<0.001) and long-term adverse outcome (OR 4.2, 95% CI 1.0-17.3, p = 0.05, adjusted HR 2.0, 95% CI 1.4-3.0, p<0.001). Perioperative change in cTn was a predictor of short-term adverse outcome (OR 10.1, 95% CI 3.2-32.3, p<0.001). It was not possible to conduct pooled analyses for adjusted estimates of perioperative change in cTn as predictor of short- (a single study identified) and long-term (no studies identified) adverse outcome. Further, it was not possible to conduct pooled analyses for unadjusted estimates of perioperative change in cTn as predictor of long-term adverse outcome, since only one study was identified. Bivariate analysis of sensitivities and specificities were performed, and overall prognostic performance was summarized using summary receiver operating characteristic (SROC) curves. The pooled sensitivity and specificity for preoperative cTn and short-term adverse outcome was 0.43 and 0.86 respectively (area under the SROC curve of 0.68). There were insufficient studies to construct SROCs for perioperative changes in cTn and for long-term adverse outcome.
CONCLUSION
Our study indicates that although preoperative cTn and perioperative change in cTn might be valuable predictors of MACE and/or all-cause mortality in adult noncardiac surgical patients, its overall prognostic performance remains uncertain. Future large, representative, high-quality studies are needed to establish the potential role of cTns in perioperative cardiac risk stratification.
Topics: Biomarkers; Humans; Musculoskeletal Diseases; Nervous System Diseases; Perioperative Care; Preoperative Care; Prognosis; Risk Assessment; Survival Rate; Troponin I; Urologic Diseases
PubMed: 31009468
DOI: 10.1371/journal.pone.0215094 -
Annals of Emergency Medicine May 2001We sought to evaluate quantitatively the evidence on the diagnostic performance of presentation and serial biochemical markers for emergency department diagnosis of... (Meta-Analysis)
Meta-Analysis Review
STUDY OBJECTIVE
We sought to evaluate quantitatively the evidence on the diagnostic performance of presentation and serial biochemical markers for emergency department diagnosis of acute cardiac ischemia (ACI), including acute myocardial infarction (AMI) and unstable angina.
METHODS
We conducted a systematic review and meta-analysis of the English-language literature published between 1966 and December 1998. We examined the diagnostic performance of creatine kinase, creatine kinase-MB, myoglobin, and troponin I and T testing. Diagnostic performance was assessed by using estimates of test sensitivity and specificity and was summarized by summary receiver-operating characteristic curves.
RESULTS
Only 4 studies were found that evaluated all patients with ACI; 73 were found that focused only on a diagnosis of AMI. To diagnose ACI, presentation biomarker tests had sensitivities of 16% to 19% and specificities of 96% to 100%; serial biomarker tests had sensitivities of 31% to 45% and specificities of 95% to 98%. Considering only the diagnosis of AMI, presentation biomarker tests had summary sensitivities of 37% to 49% and summary specificities of 87% to 97%; serial biomarker tests had summary sensitivities of 79% to 93% and summary specificities of 85% to 96%. Variation of test sensitivity was best explained by test timing. Longer symptom duration or time between serial tests yielded higher sensitivity.
CONCLUSION
The limited evidence available to evaluate the diagnostic accuracy of biomarkers for ACI suggests that biomarkers have very low sensitivity to diagnose ACI. Thus, biomarkers alone will greatly underdiagnose ACI and will be inadequate to make triage decisions. For AMI diagnosis alone, multiple testing of individual biomarkers over time substantially improves sensitivity, while retaining high specificity, at the expense of additional time. Further high-quality studies are needed on the clinical effect of using biomarkers for patients with ACI in the ED and on optimal timing of serial testing and in combination with other tests.
Topics: Acute Disease; Angina, Unstable; Bias; Biomarkers; Creatine Kinase; Creatine Kinase, MB Form; Emergency Treatment; Evidence-Based Medicine; Humans; Isoenzymes; Myocardial Infarction; Myocardial Ischemia; Myoglobin; Reproducibility of Results; Research Design; Sensitivity and Specificity; Time Factors; Triage; Troponin I; Troponin T
PubMed: 11326184
DOI: 10.1067/mem.2001.114905