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Amezcua-Guerra B, Amezcua-Castillo LM, Guerra-López JA, Díaz-Domínguez KA, Sánchez-Gloria JL, Cruz-Melendez A, Hernández-Díazcouder A, Juárez-Vicuña Y, Sánchez-Muñoz F, Huang F, Tavera-Alonso C, Brianza-Padilla M, Varela-López E, Sierra-Lara D, Arias-Mendoza A, Fonseca-Camarillo G, Márquez-Velasco R, González-Pacheco H, Springall R, Amezcua-Guerra LM. Diagnostic Performance of Serum MicroRNAs for ST-Segment Elevation Myocardial Infarction in the Emergency Department. Biomedicines 2023; 11:2422. [PMID: 37760864 PMCID: PMC10525983 DOI: 10.3390/biomedicines11092422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Prompt diagnosis of ST-segment elevation myocardial infarction (STEMI) is essential for initiating timely treatment. MicroRNAs have recently emerged as biomarkers in cardiovascular diseases. This study aimed to evaluate the discriminatory capacity of serum microRNAs in identifying an ischemic origin in patients presenting with chest discomfort to the Emergency Department. The study included 98 participants (78 with STEMI and 20 with nonischemic chest discomfort). Significant differences in the expression levels of miR-133b, miR-126, and miR-155 (but not miR-1, miR-208, and miR-208b) were observed between groups. miR-133b and miR-155 exhibited 97% and 93% sensitivity in identifying STEMI patients, respectively. miR-126 demonstrated a specificity of 90% in identifying STEMI patients. No significant associations were found between microRNAs and occurrence of major adverse cardiovascular events (MACE). However, patients with MACE had higher levels of interleukin (IL)-15, IL-21, IFN-γ-induced protein-10, and N-terminal pro B-type natriuretic peptide compared to non-MACE patients. Overall, there were significant associations among the expression levels of microRNAs. However, microRNAs did not demonstrate associations with either inflammatory markers or cardiovascular risk scores. This study highlights the potential of microRNAs, particularly miR-133b and miR-126, as diagnostic biomarkers for distinguishing patients with STEMI from those presenting with nonischemic chest discomfort to the Emergency Department.
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Affiliation(s)
| | - Luis M. Amezcua-Castillo
- Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (L.M.A.-C.); (D.S.-L.); (A.A.-M.); (H.G.-P.)
| | - Jazmín A. Guerra-López
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.A.G.-L.); (K.A.D.-D.); (J.L.S.-G.); (A.H.-D.); (Y.J.-V.); (F.S.-M.); (M.B.-P.); (G.F.-C.); (R.M.-V.)
| | - Kietseé A. Díaz-Domínguez
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.A.G.-L.); (K.A.D.-D.); (J.L.S.-G.); (A.H.-D.); (Y.J.-V.); (F.S.-M.); (M.B.-P.); (G.F.-C.); (R.M.-V.)
| | - José L. Sánchez-Gloria
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.A.G.-L.); (K.A.D.-D.); (J.L.S.-G.); (A.H.-D.); (Y.J.-V.); (F.S.-M.); (M.B.-P.); (G.F.-C.); (R.M.-V.)
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, USA
| | - Andrés Cruz-Melendez
- Core Lab, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (A.C.-M.); (C.T.-A.)
| | - Adrián Hernández-Díazcouder
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.A.G.-L.); (K.A.D.-D.); (J.L.S.-G.); (A.H.-D.); (Y.J.-V.); (F.S.-M.); (M.B.-P.); (G.F.-C.); (R.M.-V.)
- Research Laboratory of Obesity and Asthma, Hospital Infantil de Mexico Federico Gómez, Mexico City 06720, Mexico;
| | - Yaneli Juárez-Vicuña
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.A.G.-L.); (K.A.D.-D.); (J.L.S.-G.); (A.H.-D.); (Y.J.-V.); (F.S.-M.); (M.B.-P.); (G.F.-C.); (R.M.-V.)
| | - Fausto Sánchez-Muñoz
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.A.G.-L.); (K.A.D.-D.); (J.L.S.-G.); (A.H.-D.); (Y.J.-V.); (F.S.-M.); (M.B.-P.); (G.F.-C.); (R.M.-V.)
| | - Fengyang Huang
- Research Laboratory of Obesity and Asthma, Hospital Infantil de Mexico Federico Gómez, Mexico City 06720, Mexico;
| | - Claudia Tavera-Alonso
- Core Lab, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (A.C.-M.); (C.T.-A.)
| | - Malinalli Brianza-Padilla
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.A.G.-L.); (K.A.D.-D.); (J.L.S.-G.); (A.H.-D.); (Y.J.-V.); (F.S.-M.); (M.B.-P.); (G.F.-C.); (R.M.-V.)
| | - Elvira Varela-López
- Translational Research Unit UNAM–INC, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
| | - Daniel Sierra-Lara
- Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (L.M.A.-C.); (D.S.-L.); (A.A.-M.); (H.G.-P.)
| | - Alexandra Arias-Mendoza
- Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (L.M.A.-C.); (D.S.-L.); (A.A.-M.); (H.G.-P.)
| | - Gabriela Fonseca-Camarillo
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.A.G.-L.); (K.A.D.-D.); (J.L.S.-G.); (A.H.-D.); (Y.J.-V.); (F.S.-M.); (M.B.-P.); (G.F.-C.); (R.M.-V.)
| | - Ricardo Márquez-Velasco
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.A.G.-L.); (K.A.D.-D.); (J.L.S.-G.); (A.H.-D.); (Y.J.-V.); (F.S.-M.); (M.B.-P.); (G.F.-C.); (R.M.-V.)
| | - Héctor González-Pacheco
- Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (L.M.A.-C.); (D.S.-L.); (A.A.-M.); (H.G.-P.)
| | - Rashidi Springall
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.A.G.-L.); (K.A.D.-D.); (J.L.S.-G.); (A.H.-D.); (Y.J.-V.); (F.S.-M.); (M.B.-P.); (G.F.-C.); (R.M.-V.)
| | - Luis M. Amezcua-Guerra
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.A.G.-L.); (K.A.D.-D.); (J.L.S.-G.); (A.H.-D.); (Y.J.-V.); (F.S.-M.); (M.B.-P.); (G.F.-C.); (R.M.-V.)
- Health Care Department, Universidad Autónoma Metropolitana-Xochimilco, Mexico City 14387, Mexico
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Díaz-Domínguez KA, Cruz-Melendez A, Amezcua-Castillo LM, Guerra-López JA, Tavera-Alonso C, González-Pacheco H, Amezcua-Guerra LM. Should a recent SARS-CoV-2 infection be considered a risk or prognostic factor for ST-segment elevation myocardial infarction? Arch Cardiol Mex 2022; 93:16-21. [PMID: 36075089 DOI: 10.24875/acm.22000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The aim of the study was to assess whether a recent SARS-CoV-2 infection could by itself be a risk or prognostic factor for ST-segment elevation myocardial infarction (STEMI). Method An observational study in unvaccinated patients with STEMI confirmed by cardiac catheterization was conducted. A recent or concurrent SARS-CoV-2 infection was identified by the presence of serum IgG against the nucleocapsid protein, or a positive polymerase chain reaction test on nasopharyngeal swabs. Baseline cardiovascular risk factors, clinical STEMI severity, main catheterization findings, and occurrence of major adverse cardiovascular events (MACE) during hospitalization were compared between study subgroups. Results Of a total of 89 patients recruited, 14 (16%) had a recent SARS-CoV-2 infection. Patients with STEMI and recent SARS-CoV-2 infection had a markedly lower frequency of high blood pressure (20% versus 55%; P = 0.03) as well as a tendency to have fewer comorbidities. Regarding the clinical presentation, there were no differences in the severity of the STEMI. Furthermore, the main findings during cardiac catheterization including the atherosclerotic burden and the number of vessels affected, as well as the occurrence of MACE during follow-up, were not significantly different between the groups. Conclusions A recent SARS-CoV-2 infection appears to facilitate the triggering of STEMI, as these patients have fewer traditional cardiovascular risk factors than their uninfected counterparts. However, this does not seem to affect the clinical presentation or the in-hospital course of STEMI patients.
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Affiliation(s)
- Kietseé A Díaz-Domínguez
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Andrés Cruz-Melendez
- Core Lab, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Luis M Amezcua-Castillo
- Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Jazmin A Guerra-López
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Claudia Tavera-Alonso
- Core Lab, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Héctor González-Pacheco
- Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Luis M Amezcua-Guerra
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
- Department of Health Care, Universidad Autónoma Metropolitana-Xochimilco, Ciudad de México, México
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Guerra-López JA, Amezcua-Castillo LM, González-Pacheco H, Amezcua-Guerra LM. Levels of Vascular Endothelial Growth Factor and Its Association with Pulmonary Embolism in COVID-19. J Interferon Cytokine Res 2022; 42:444-448. [PMID: 35559721 DOI: 10.1089/jir.2022.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is associated with pulmonary embolism, a condition mechanistically related to vascular endothelial growth factor (VEGF). Our objective was to identify whether VEGF levels, measured at hospital admission, may predict the occurrence of pulmonary embolism (and other thrombosis) during hospitalization. Of a total of 139 patients included in the study, a pulmonary embolism occurred in 4%, other thrombosis in 16%, and 80% remained thrombus free. Clinical and laboratory data at admission were similar among groups. VEGF levels were elevated in COVID-19 patients compared with 38 healthy controls (50.7 versus 15.0 pg/mL; P < 0.001), with an area under the receiver operating characteristic curve of 0.776. At a cutoff point >15.7 pg/mL, VEGF showed 64.7% sensitivity, 92.1% specificity, and a positive likelihood ratio of 8.2 to discriminate COVID-19. In COVID-19, VEGF levels were not different in patients with pulmonary embolism, other thrombosis, and thrombus-free patients (15.0 versus 84.0 versus 48.5 pg/mL, respectively; P = 0.19). VEGF correlated with C-reactive protein (ρ = 0.25), fibrinogen (ρ = 0.28), ferritin (ρ = 0.18), and the neutrophil-to-lymphocyte ratio (ρ = 0.20). Our study showed that VEGF is elevated in sera from patients with COVID-19 on arrival at the hospital and its levels correlate with inflammatory markers, although they are unable to predict the appearance of pulmonary embolism during hospitalization.
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Affiliation(s)
- Jazmin A Guerra-López
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | | | - Luis M Amezcua-Guerra
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.,Department of Health Care, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico
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Castillo-Martínez D, Amezcua-Castillo LM, Granados J, Pineda C, Amezcua-Guerra LM. Is Takayasu arteritis the result of a Mycobacterium tuberculosis infection? The use of TNF inhibitors may be the proof-of-concept to demonstrate that this association is epiphenomenal. Clin Rheumatol 2020; 39:2003-2009. [PMID: 32198554 DOI: 10.1007/s10067-020-05045-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/21/2020] [Accepted: 03/10/2020] [Indexed: 02/07/2023]
Abstract
Although the association between Takayasu arteritis (TA) and latent or active Mycobacterium tuberculosis infection has been suggested for a long time, studies conducted in recent years are challenging this notion. Until recently, the possibility of a pathogenic relationship between TA and tuberculosis (TB) was considered a medical curiosity, but the advent of tumor necrosis factor (TNF) inhibitors as therapy for recalcitrant TA cases, as well as the widespread use of Bacille Calmette-Guérin (BCG) for vaccination purposes, has relocated this association as a top priority issue. In an attempt to define whether both diseases are pathogenically linked or if their association is only epiphenomenal in nature, we conduct a thorough literature search on the development of TB in patients with TA receiving TNF inhibitors. From a total of 13 studies that included 214 patients, the occurrence of TB was observed only in two individuals exposed to infliximab. This frequency of 0.93% is similar to that encountered in patients with other rheumatic diseases exposed to TNF inhibitors. Finally, we propose a novel pathogenic model that could reconcile the epidemiological, clinical, and immunological evidence that links TA and TB, while providing rationality for the use of TNF inhibitors in patients with TA.
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Affiliation(s)
- Diana Castillo-Martínez
- Dermatology Clinic, Hospital General de Zona 32, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Julio Granados
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Carlos Pineda
- Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Luis M Amezcua-Guerra
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, 14080 Tlalpan, Mexico City, Mexico. .,Department of Health Care, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico.
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