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Juknevičienė R, Simonavičius J, Mikalauskas A, Čerlinskaitė-Bajorė K, Arrigo M, Juknevičius V, Alitoit-Marrote I, Kablučko D, Bagdonaitė L, Vitkus D, Balčiūnas M, Zuozienė G, Barysienė J, Žaliaduonytė D, Stašaitis K, Kavoliūnienė A, Mebazaa A, Čelutkienė J. Soluble CD146 in the detection and grading of intravascular and tissue congestion in patients with acute dyspnoea: analysis of the prospective observational Lithuanian Echocardiography Study of Dyspnoea in Acute Settings (LEDA) cohort. BMJ Open 2022; 12:e061611. [PMID: 36581965 PMCID: PMC9438196 DOI: 10.1136/bmjopen-2022-061611] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To evaluate the potential of soluble cluster of differentiation 146 (sCD146) in the detection and grading of congestion in patients with acute dyspnoea. DESIGN Subanalysis of the prospective observational Lithuanian Echocardiography Study of Dyspnoea in Acute Settings (LEDA) cohort. SETTING Two Lithuanian university centres. PARTICIPANTS Adult patients with acute dyspnoea admitted to the emergency department. METHODS Congestion was assessed using clinical and sonographic parameters. All patients underwent sCD146 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing. RESULTS The median value of sCD146 concentration in the study cohort (n=437) was 405 (IQR 315-509) ng/mL. sCD146 was higher in patients with peripheral oedema than in those without (median (IQR) 472 (373-535) vs 400 (304-501) ng/mL, p=0.009) and with pulmonary rales than in those without (439 (335-528) vs 394 (296-484) ng/mL, p=0.001). We found a parallel increase of estimated right atrial pressure (eRAP) and sCD146 concentration: sCD146 was 337 (300-425), 404 (290-489) and 477 (363-572) ng/mL in patients with normal, moderately elevated and high eRAP, respectively (p=0.001). In patients with low NT-proBNP, high sCD146 distinguished a subgroup with a higher prevalence of oedema as compared with patients with low levels of both biomarkers (76.0% vs 41.0%, p=0.010). Moreover, high sCD146 indicated a higher prevalence of elevated eRAP, irrespective of NT-proBNP concentration (p<0.05). CONCLUSION sCD146 concentration reflects the degree of intravascular and tissue congestion assessed by clinical and echocardiographic indices, with this association maintained in patients with low NT-proBNP. Our data support the notion that NT-proBNP might represent heart stretch while sCD146 rather represents peripheral venous congestion.
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Affiliation(s)
- Renata Juknevičienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Emergency Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Justas Simonavičius
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Aurimas Mikalauskas
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Kamilė Čerlinskaitė-Bajorė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Anesthesiology and Critical Care, Assistance Publique des Hopitaux de Paris, Paris, France
- Cardiovascular Markers in Stress Conditions (MASCOT), Inserm UMR-S 942, Paris, France
| | - Mattia Arrigo
- Department of Internal Medicine, Triemli Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Vytautas Juknevičius
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Irina Alitoit-Marrote
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Denis Kablučko
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Loreta Bagdonaitė
- Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Dalius Vitkus
- Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Mindaugas Balčiūnas
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Gitana Zuozienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Jūratė Barysienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Diana Žaliaduonytė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kęstutis Stašaitis
- Department of Emergency Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aušra Kavoliūnienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care, Assistance Publique des Hopitaux de Paris, Paris, France
- Cardiovascular Markers in Stress Conditions (MASCOT), Inserm UMR-S 942, Paris, France
- Université de Paris, Paris, France
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre for Innovative Medicine, State Research Institute, Vilnius, Lithuania
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Juknevičienė R, Juknevičius V, Jasiūnas E, Raščiūtė B, Barysienė J, Matačiūnas M, Vitkus D, Laucevičius A, Šerpytis P. Chest pain in the emergency department: From score to core-A prospective clinical study. Medicine (Baltimore) 2022; 101:e29579. [PMID: 35866759 PMCID: PMC9302355 DOI: 10.1097/md.0000000000029579] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
High-sensitivity troponin assay brought new challenges as we detect elevated concentration in many other diseases, and it became difficult to distinguish the real cause of this elevation. In this notion, diagnosis of acute coronary syndrome (ACS) remains a challenge in emergency department (ED). We aim to examine different approaches for rule-in and rule-out of ACS using risk scores, copeptin, and coronary computed tomography angiography (CCTA). A prospective observational study was designed to evaluate chest pain patients. Consecutive adult patients admitted to the ED with a chief complaint of chest pain due to any cause were included. All patients were followed-up for 6 months after discharge for major adverse cardiovascular events and readmissions. Admission data, ED processes, and diagnoses were analyzed. One hundred forty-six patients were included, average age was 63 ± 13.4 years, and 95 (65.1%) were male. Global Registry of Acute Coronary Events (GRACE) and History, ECG, Age, Risk factors, Troponin (HEART) scores showed good prognostic abilities, but HEART combination with copeptin improves diagnoses of myocardial infarction (area under the curve [AUC] 0.764 vs AUC 0.864 P = .0008). Patients with elevated copeptin were older, had higher risk scores, and were more likely to be admitted to hospital and diagnosed with ACS in ED. For copeptin, AUC was 0.715 (95% confidence interval 0.629-0.803), and for combination with troponin, AUC of 0.770 (0.703-0.855) did not improve rule-in of myocardial infarction. High-sensitivity troponin I assay alongside prior stroke, history of carotid stenosis, dyslipidemia, use of diuretics, and electrocardiogram changes (left bundle branch block or ST depression) are good predictors of myocardial infarction (χ² = 52.29, AUC = 0.875 [0.813-0.937], P < .001). The regression analysis showed that combination of copeptin and CCTA without significant stenosis can be used for ACS rule-out (χ² = 26.36, P < .001, AUC = 0.772 [0.681-0.863], negative predictive value of 96.25%). For rule-in of ACS, practitioner should consider not only scores for risk stratification but carefully analyze medical history and nonspecific electrocardiogram changes and even with normal troponin results, we strongly suggest thorough evaluation in chest pain unit. For rule-out of ACS combination of copeptin and CCTA holds great potential.
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Affiliation(s)
- Renata Juknevičienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Emergency Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- *Correspondence: Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariškių g. 2, 08661 Vilnius, Lithuania (e-mail: )
| | - Vytautas Juknevičius
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Eugenijus Jasiūnas
- Centre of Informatics and Development, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Beatričė Raščiūtė
- Centre of Emergency Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Jūratė Barysienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Mindaugas Matačiūnas
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Miomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Dalius Vitkus
- Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Aleksandras Laucevičius
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Pranas Šerpytis
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Clinic of Emergency Medicine, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Juknevičius V, Berūkštis A, Juknevičienė R, Jasiūnas E, Šerpytis P, Laucevičius A. Long-Term Effects of Renal Artery Denervation. Medicina (Kaunas) 2021; 57:662. [PMID: 34199107 PMCID: PMC8305318 DOI: 10.3390/medicina57070662] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Renal artery denervation (RDN) procedure is a broadly discussed method in the treatment of resistant hypertension. Many studies report short-term (3-12 months) results for blood pressure and arterial stiffness. The primary endpoints were changes in 24 h mean systolic blood pressure (BP) and office systolic BP 48 months after RDN. The secondary endpoints were changes in aortic pulse wave velocity and impact of polypharmacy on these variables. Materials and Methods: Renal artery denervation was performed in 73 patients treated for resistant hypertension; 49 patients remained in final analysis. Patient examination was carried out before the procedure, and subsequently at 3, 6, 12, 24, and 48 months later. Patients' antihypertensive and overall medication regimens were carefully analysed. Results: Mean 24 h arterial blood pressure lowered and was sustained at lower levels for up to 48 months; median (interequartile range-IQR) from 158(23.5)/100(14.2) to 140(26.5)/86(16.2) mmHg. Mean reduction in 24 h ambulatory systolic BP was -11 ± 25 mmHg (95% CI, -20 to -2; p < 0.001), while office systolic BP reduced by -7 ± 23 mmHg (95%CI, -24 to -1; p < 0.02). A significant reduction in median aortic pulse wave velocity 12 months after the procedure (drop from baseline 11.2 [3.15] m/s (95%CI 6.1 to 16.2) to 9.8 [2.1] m/s (95%CI 6.1 to 13.7; p = 0.002)). After 48 months, there was no worsening compared to the baseline level of 10.3 [4.0] m/s (95% CI 6.9 to 17.8) (p > 0.05). The total mean number of antihypertensive drugs remained unchanged: 5.97(±1.1) vs. 5.24 (±1.45). A higher number of pills after 48 months was associated with higher aortic pulse wave velocity (1-5 pill group: 8.1 ± 1.6 m/s; 6-10 pill group: 10.9 ± 1.8 m/s; >11 pill group: 15.1 ± 2.6 m/s) (p = 0.003). Conclusions: Antihypertensive effect after renal denervation lasts up to 48 months with no worsening of arterial stiffness compared to baseline. In our study, polypharmacy was associated with increased arterial stiffness 48 months after the procedure.
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Affiliation(s)
- Vytautas Juknevičius
- Clinic of Heart and Vessel Diseases, Institute of Clinical Medicine at the Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (A.B.); (R.J.); (P.Š.); (A.L.)
| | - Andrius Berūkštis
- Clinic of Heart and Vessel Diseases, Institute of Clinical Medicine at the Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (A.B.); (R.J.); (P.Š.); (A.L.)
| | - Renata Juknevičienė
- Clinic of Heart and Vessel Diseases, Institute of Clinical Medicine at the Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (A.B.); (R.J.); (P.Š.); (A.L.)
| | - Eugenijus Jasiūnas
- Center of Informatics and Development, Vilnius University Hospital Santaros Clinics, LT-08661 Vilnius, Lithuania;
| | - Pranas Šerpytis
- Clinic of Heart and Vessel Diseases, Institute of Clinical Medicine at the Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (A.B.); (R.J.); (P.Š.); (A.L.)
| | - Aleksandras Laucevičius
- Clinic of Heart and Vessel Diseases, Institute of Clinical Medicine at the Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (A.B.); (R.J.); (P.Š.); (A.L.)
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