Aortic dissection is a life-threatening cardiovascular disease with devastating complications and high mortality. It requires rapid and accurate diagnosis and a focus on prognosis. Many laboratory tests are routinely performed in patients with aortic dissection including D-dimer, brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin. D-dimer shows vital performance in the diagnosis of aortic dissection, and brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin exhibits important value in risk stratification and prognostic effect in aortic dissection patients. Our review summarized the clinical utility of these laboratory tests in patients with aortic dissection, aiming to provide advanced and comprehensive evidence for clinicians to better understand these laboratory tests and help their clinical practice.
ObjectiveTo evaluate the predictive value of the high-sensitivity cardiac troponin I (hs-cTnI) in patients with acute pulmonary embolism (APE). MethodsIn a retrospective cohort study,272 consecutive patients with APE were reviewed and the 30-days death and in-hospital adverse events were evaluated. The patients were classified according to hs-cTnI value into a high hs-cTnI group and a low hs-cTnI group. The simple pulmonary embolism severity index (sPESI) was used for clinical risk determination. The adverse event was defined as intravenous thrombolytic therapy,noninvasive ventilator support to maintain oxygen saturation >90% and suffered with severe complications. The correlations of hs-cTnI with sPESI score,30-days adverse events and mortality were analyzed. The Kaplan-Meier curves and the log-rank test were used to compare time-to-event survival. Stepwise multivariate logistic regression analysis models were used to determine the incremental prognostic value of sPESI score and hs-cTnI. ResultsThe incidence of 30-day death (6.1%),renal failure (14.6%),bleeding (13.4%) and thrombolytic therapy (7.9%) were higher in the high hs-cTnI group than those in the low hs-cTnI group (P values were 0.009,<0.001,0.018 and 0.003,respectively). The patients with sPESI ≥1 and low hs-cTnI had greater free adverse events survival (P=0.005). hs-cTnI provided incremental predictive value for in-hospital adverse events,beyond the sPESI score (P<0.001). Conclusionhs-cTnI has excellent negative predictive value of APE prognosis,especially when used combined with sPESI score.
Objective To investigate the prognostic value of troponin I ( cTNI) , brain natriuretic peptide ( BNP) and D-dimer in acute pulmonary embolism ( APE) .Methods The plasma levels of cTNI, BNP, and D-dimer were measured in 98 consecutive patients with APE at the time of admission. The relationship between these parameters and mortality were evaluated. Results APE was diagnosed in 98 consecutive patients during January 2009 to December 2010, in which 49 were males and 49 were females. 14 ( 14. 3% ) patients died at the end of follow-up. The patients with positive cTNI tests had more rapid heart rates, higher rate of syncope, cardiogenic shock and mortality than the patients with normal serumcTNI. However the age and blood pressure were lower in the patients with abnormal serum cTNI ( P lt; 0. 05) . A receiver-operating characteristic curve analysis identified BNP≥226. 5 ng/L was the best cut-off value ( AUC 0. 829, 95% CI 0. 715-0. 942) with the negative predictive value of 97. 1% for death. The mortality of the patients whose serum D-dimer level ranging from 500 to 2499 ng/mL, 2500 to 4999 ng/mL, and ≥5000 ng/mL was 7. 8% , 12% , and 41. 2% , respectively ( P = 0. 009) . Upon multivariate analysis, cardiogenic shock ( OR=2. 931, 95% CI 0. 828-12. 521, P =0.000) , cTNI≥0. 3 ng/mL ( OR=1. 441, 95% CI 0. 712-4. 098, P = 0. 0043) , BNP gt; 226. 5 ng/L ( OR = 1. 750, 95% CI 0. 690-6. 452, P = 0. 011) and D-dimer≥5000 ng/mL( OR = 1. 275, 95% CI 0. 762-2. 801, P = 0. 034) were independent predictors of death. Conclusions Combined monitoring of cTNI, BNP or D-dimer levels is helpful for prognosis prediction and treatment decision for APE patients.
目的 探讨血浆脑钠肽（BNP）及血清肌钙蛋白I（cTNI）含量改变在老年患者发生充血性心力衰竭时的临床意义。 方法 选择2010年7月－2012年8月住院的各种老年心脏病患者117例，根据纽约心功能分级分为4组（心功能Ⅰ级组、Ⅱ级组、Ⅲ级组、Ⅳ级组），分别检测血浆BNP、血清cTNI及心肌酶[肌酸磷酸激酶（CK）、肌酸磷酸激酶同工酶（CK-MB）]进行组间比较，同时与健康老年组进行对比。 结果 ① 老年慢性充血性心力衰竭各组（心功能Ⅱ～Ⅳ级）血浆BNP水平均高于健康对照组及心功能正常组（心功能Ⅰ级组）；且心功能Ⅳ级组BNP水平＞心功能Ⅲ级组＞心功能Ⅱ级组。各组之间比较差异有统计学意义，但心功能Ⅰ级组与健康对照组血浆BNP水平无明显差异。② 各组之间CK及CK-MB水平差异均无统计学意义。③ 充血性心力衰竭各组（心功能Ⅱ～Ⅳ级组血清cTNI水平均高于健康对照组及心功能正常组（心功能Ⅰ级组）；且心功能Ⅳ级组cTNI水平＞心功能Ⅲ级组＞心功能Ⅱ级组。各组之间比较差异有统计学意义，而心功能Ⅰ级组及健康对照组血清cTNI水平差异无统计学意义。 结论 血浆BNP水平及血清cTNI水平在老年患者发生心力衰竭时随心力衰竭程度加重而逐渐升高，两者均对慢性充血性心力衰竭的临床诊断具有重要参考意义。
ObjectiveTo investigate diagnostic and prognostic value of pulmonary embolism severity index (PESI), troponin I (cTnI) and brain natriuretic peptide (BNP) in patients with acute pulmonary embolism (APE). MethodsA total of 96 patients confirmed with APE were collected from January 2010 to January 2013, and 50 cases of non-APE controls were also selected in the same period. According to the PESI scores, patients were divided into low-risk, mid-risk, and highrisk group. According to the results of cTnI and BNP, patients were divided into positive group and negative group. Then, we evaluated the diagnostic and prognostic value of the PESI score, cTnI and BNP for patients with APE. ResultsFor the APE patients, the higher the risk was, the higher the constituent ratio of massive and sub-massive APE was (P<0.01). In the cTnI positive group, massive and sub-massive APE accounted for 82.9%, and in the cTnI negative group, non-massive APE was up to 81.9%; in the BNP positive group, massive and sub-massive APE accounted for 73.3%, and in the BNP negative group, non-massive APE was up to 86.3%. The patients with positive cTnI and BNP had a higher rate of right ventricular dysfunction, cardiogenic shock and mortality than the negative group (P<0.01). ConclusionThe combined detection of cTnI, BNP and PESI score is important in the diagnosis and risk stratification in APE patients.
ObjectiveTo compare early postoperative outcomes of Chinese patients undergoing off-pump coronary artery bypass grafting (OPCAB) with or without preoperative discontinuation of aspirin. MethodsClinical data of 354 patients who underwent elective OPCAB in Department of Cardiac Surgery, People's Hospital of Peking University from 2011 to 2012 were retrospectively analyzed. There were 132 patients during year 2011 who discontinued aspirin more than 5 days before OPCAB and were defined as a discontinuation group, including 93 males and 39 females with their age of 36-83 (61.70±8.74) years. There were 222 patients during year 2012 who continued aspirin treatment before OPCAB and were defined as an aspirin group, including 162 males and 60 females with their age of 37-82 (63.26±8.94) years. Postoperative chest drainage, incidence of reexploration for bleeding, in-hospital morbidity and mortality were compared between the 2 groups. Serum cardiac troponin I (cTnI) levels during 4-6 hours, 12-18 hours and 24-48 hours after OPCAB were also compared. ResultsPreoperative clinical characters were not statistically different between the 2 groups (P>0.05). Average number of grafts in the discontinuation group was significantly smaller than that in the aspirin group (3.00±0.89 vs. 3.43±0.93, P=0.001). There was no significant difference in postoperative chest drainage (1 063.75±511.50 ml vs. 1 131.35±460.13 ml, P=0.201), incidence of reexploration for bleeding(0 case vs. 1 case, P=1.000), perioperative myocardial infarction(2 cases vs. 1 case, P=0.647), postoperative acute renal failure(4 cases vs. 7 cases, P=1.000), stroke(1 case vs. 4 cases, P=0.726), mechanical ventilation time(41.46±85.50 hours vs. 52.07±143.59 hours, P=0.441), length of ICU stay(81.46±116.90 hours vs. 79.07±136.43 hours, P=0.867), or in-hospital mortality(0.8% vs. 0.9%, P=1.000)between the 2 groups. Serum cTnI levels during 4-6 hours after OPCAB were not statistically different between the 2 groups (P=0.506). Serum cTnI levels during 12-18 hours and 24-48 hours after OPCAB were statistically different between the 2 groups (P=0.002 and P=0.000). The percentages of patients with cTnI level higher than 4.0 ng/ml during 12-18 hours and 24-48 hours after OPCAB in the aspirin group were significantly lower than those in the discontinuation group (5.4% vs. 16.7%, P=0.001;5.9% vs. 17.4%, P=0.000). ConclusionOPCAB without preoperative discontinuation of aspirin does not increase the risk of postoperative bleeding, in-hospital morbidity or mortality, but can decrease postoperative myocardial injury of Chinese patients undergoing OPCAB.