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| 2. |
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| 3. |
- Diderholm, Erik, et al.
(författare)
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The prognostic and therapeutic implications of increased troponin T levels and ST depression in unstable coronary artery disease : the FRISC II invasive troponin T electrocardiogram substudy
- 2002
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Ingår i: American Heart Journal. - : Elsevier BV. - 0002-8703 .- 1097-6744. ; 143:5, s. 760-767
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In unstable coronary artery disease, both increased troponin T level and occurrence of ST-segment depression are associated with a worse prognosis. In the Fast Revascularisation in InStability in Coronary disease trial II invasive study, we evaluated whether the troponin T level, alone and combined with ST depression, identified more severe coronary artery disease or a greater efficacy of an early invasive strategy. METHODS: In the study, 2457 patients with unstable coronary artery disease were randomized to early invasive or noninvasive strategy. Troponin T value and admission electrocardiogram results were available in 2286 patients. RESULTS: In the noninvasive cohort, death or myocardial infarction occurred in 16.6% with troponin T level > or =0.03 microg/L versus 8.5% with troponin T level < 0.03 microg/L (P <.001). In the invasive group, 49% of patients with both ST depression and troponin T level > or =0.03 microg/L had 3-vessel or left main disease compared with 17% if neither finding was present (P <.001). The invasive strategy reduced death/myocardial infarction at 12 months in the cohort with both ST depression and troponin T level > or =0.03 microg/L from 22.1% to 13.2% (risk ratio, 0.60; 95% confidence interval, 0.43 to 0.82; P =.001). In the cohort with either ST depression or troponin T level > or =0.03 microg/L or neither of these findings, the absolute gain of the invasive strategy was smaller and more uncertain. CONCLUSION: Patients with unstable coronary artery disease with the combination of troponin T level > or =0.03 microg/L and ST depression have a poor prognosis and, in half of the cases, 3-vessel or left main disease. In these patients, an early invasive strategy will substantially reduce death/myocardial infarction.
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| 4. |
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| 5. |
- Jernberg, Tomas, et al.
(författare)
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Reply.
- 2004
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Annan publikation (övrigt vetenskapligt/konstnärligt)
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| 6. |
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| 8. |
- Björklund, Erik, et al.
(författare)
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Admission Troponin T and measurement of ST-segment resolution at 60 min improve early risk stratification in ST-elevation myocardial infarction
- 2004
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Ingår i: Eur Heart J. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 25:2, s. 113-20
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The prognostic value of admission troponin T (tnT) levels and the resolution of the ST-segment elevation in ST-elevation myocardial infarction (STEMI) is well established. However, the combination of these two early available markers for predicting risk has not been evaluated. METHODS AND RESULTS: We evaluated 516 patients with fibrinolytic treated STEMI from the ASSENT-2 and ASSENT-PLUS studies, which had both admission tnT and ST-monitoring available. We used a prospectively defined cut-off value of tnT of 0.1microg/l. For ST-segment resolution, a cut-off of 50% measured after 60min was used. Both a tnT >/=0.1microg/l (n=116) and ST-segment resolution <50% (n=301) were related to higher one-year mortality, 13% vs 4% (P<0.001) and 8.4% vs 2.8% (P=0.009), respectively. In a multivariate analysis ST-segment resolution was and tnT showed a strong trend to be independently related to mortality. The combination of both further improved risk stratification. The one-year mortality in the group with elevation of tnT and without ST-segment resolution compared to the group without tnT elevation and with ST-segment resolution was 18.2% vs 2.8% (P<0.001). CONCLUSIONS: Both tnT on admission and ST-segment resolution after 60min are strong predictors of one-year mortality. The combination of both gives additive early information about prognosis and further improves risk stratification.
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| 9. |
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| 10. |
- Björklund, Erik, et al.
(författare)
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Outcome of ST-elevation myocardial infarction treated with thrombolysis in the unselected population is vastly different from samples of eligible patients in a large-scale clinical trial
- 2004
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Ingår i: American Heart Journal. - : Elsevier BV. - 0002-8703 .- 1097-6744. ; 148:4, s. 566-573
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Patients in clinical trials of fibrinolytic agents have been shown to be younger, less often female, and to have lower risk characteristics and a better outcome compared with unselected patients with ST-elevation myocardial infarction. However, a direct comparison of patients treated with fibrinolytic agents and not enrolled versus those enrolled in a trial, including a large number of patients, has not been performed.METHODS:Prospective data from the Swedish Register of Cardiac Intensive Care on patients admitted with acute myocardial infarction treated with thrombolytic agents in 60 Swedish hospitals were linked to data on trial participants in the ASsessment of Safety and Efficacy of a New Thrombolytic (ASSENT)-2 trial of fibrinolytic agents. Baseline characteristics, treatments, and long-term outcome were evaluated in 729 trial participants (A2), 2048 nonparticipants at trial hospitals (non-A2), and 964 nonparticipants at other hospitals (non-A2-Hosp).RESULTS:Nontrial patients compared with A2 patients were older and had higher risk characteristics and more early complications, although the treatments were similar. Patients at highest risk of death were the least likely to be enrolled in the trial. The 1-year mortality rate was 8.8% versus 20.3% and 19.0% (P <.001 for both) among A2 compared with non-A2 and non-A2-Hosp patients, respectively. After adjustment for a number of risk factors, the 1-year mortality rate was still twice as high in nontrial compared with A2 patients.CONCLUSIONS:The adjusted 1-year mortality rate was twice as high in patients treated with fibrinolytic agents and not enrolled in a clinical trial compared with those enrolled. One major reason for the difference in outcome appeared to be the selection of less critically ill patients to the trial.
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| 15. |
- Eggers, Kai, et al.
(författare)
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Diagnostic value of serial measurement of cardiac markers in patients with chest pain : limited value of adding myoglobin to troponin I for exclusion of myocardial infarction
- 2004
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Ingår i: American Heart Journal. - : Elsevier BV. - 0002-8703 .- 1097-6744. ; 148:4, s. 574-581
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Despite improved laboratory assays for cardiac markers and a revised standard for definition of myocardial infarction (AMI), early detection of coronary ischemia in unselected patients with chest pain remains a difficult challenge.METHODS:Rapid measurements of troponin I (TnI), creatine kinase MB (CK-MB), and myoglobin were performed in 197 consecutive patients with chest pain and a nondiagnostic electrocardiogram for AMI. The early diagnostic performances of these markers and different multimarker strategies were evaluated and compared. Diagnosis of AMI was based on European Society of Cardiology/American College of Cardiology criteria.RESULTS:At a given specificity of 95%, TnI yielded the highest sensitivity of all markers at all time points. A TnI cutoff corresponding to the 10% coefficient of variation (0.1 microg/L) demonstrated a cumulative sensitivity of 93% with a corresponding specificity of 81% at 2 hours. The sensitivity was considerably higher compared to CK-MB and myoglobin, even considering patients with a short delay until admission. Using the 99th percentile of TnI results as a cutoff (0.07 microg/L) produced a cumulative sensitivity of 98% at 2 hours, but its usefulness was limited due to low specificities. Multimarker strategies including TnI and/or myoglobin did not provide a superior overall diagnostic performance compared to TnI using the 0.1 microg/L cutoff.CONCLUSION:A TnI cutoff corresponding to the 10% coefficient of variation was most appropriate for early diagnosis of AMI. A lower TnI cutoff may be useful for very early exclusion of AMI. CK-MB and in particular myoglobin did not offer additional diagnostic value.
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| 16. |
- Eggers, Kai Marten, et al.
(författare)
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Analytic Performance of a Point-of-Care Instrument for Measurement of Cardiac Markers : An Evaluation Under Clinical Conditions
- 2003
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Ingår i: Point of Care. - : Lippincott Williams & Wilkins. - 1533-029X .- 1533-0303. ; 2:4, s. 235-242
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Tidskriftsartikel (refereegranskat)abstract
- Point-of-care testing of cardiac markers has been widely introduced into clinical practice. In this study, the authors examined the analytic qualities and the feasibility of a point-of-care device—the Stratus CS STAT Fluorometric Analyzer—under clinical conditions. Measurements of myoglobin, creatine kinase–MB (CK-MB), and troponin I (TnI) were performed in 197 consecutive patients admitted to the coronary care unit because of chest pain suggestive of a myocardial infarction. Additionally, all cardiac markers were determined on the AxSYM analyzer used as a comparative device. The Stratus CS demonstrated an average analytic imprecision (or coefficient of variation [CV]) of 4.0 to 5.1% for the TnI assay, 2.9 to 5.5% for CK-MB, and 3.7 to 4.7% for myoglobin. This was superior to CVs of AxSYM measurements, in particular concerning the lower range of TnI concentrations. The method comparison showed 17 to 22% lower Stratus CS myoglobin results and 24 to 29% lower Stratus CS CK-MB results. For TnI, Stratus CS results were factor 5 or factor 10 lower compared with AxSYM measurements and showed a great dispersion of values as a result of the higher CV of the AxSYM TnI assay. The diagnostic sensitivities and specificities of all 3 markers correlated well on both test systems. In conclusion, the Stratus CS showed an overall good performance, with analytic qualities and clinical performance as least as good as those of the AxSYM analyzer.A large number of patients are admitted to coronary care units (CCUs) with chest pain suggestive of an acute coronary syndrome (ie, unstable angina or acute myocardial infarction [AMI]). The diagnosis of AMI is immediately established only in case of ST elevation in the electrocardiogram (EKG). The large majority of chest pain patients, however, will have a nondiagnostic EKG for AMI. In those patients, confirmation of AMI is mainly dependent on serial testing of biochemical markers of myocardial damage, which currently is a time-consuming procedure.Fast evaluation of patients with chest pain leads to several advantages. First, tests or procedures for establishing a definite or alternative diagnosis can be initiated earlier or avoided in appropriate circumstances. Second, rapid identification of patients suitable for treatment aimed at reducing morbidity and mortality (eg, percutaneous coronary intervention or Gp IIb/IIIa receptor antagonist treatment) may be possible. Furthermore, considerable economic gains might be achieved by early identification of patients who are at sufficiently low risk to be discharged or transferred from the CCU to a less resource-demanding unit. 1–3To achieve fast assessment of chest pain patients, a short-assay turnaround time (TAT) is necessary. Normally, TAT includes the delay in the delivery of the sample to the laboratory, the preanalytic steps necessary to prepare the sample, the analysis time itself, and the effort it takes to deliver results to the ordering physician. To reach a TAT of less than 30 minutes, point-of-care (POC) instruments for analysis of cardiac markers have been developed, combining advantages such as near-patient assessment, a short sample-to-diagnosis time, and reasonable costs.The aim of the current study was to examine and validate the feasibility of such a POC instrument—the Stratus CS STAT Fluorometric Analyzer (Dade Behring, Deerfield, IL)—in a routine setting of patients presenting with chest pain suggestive of an AMI but without confirming EKG changes. The analytic qualities and clinical performance of the assays of the commonly used cardiac markers troponin I (TnI), creatine kinase–MB (CK-MB), and myoglobin were studied and compared with results obtained from the central laboratory. Additionally, clinical characteristics such as user friendliness and TAT were evaluated.
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| 17. |
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| 18. |
- Frostfeldt, Gunnar, et al.
(författare)
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Possible reasons for the prognostic value of troponin-T on admission in patients with ST-elevation myocardial infarction
- 2001
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Ingår i: Coronary Artery Disease. - 0954-6928 .- 1473-5830. ; 12:3, s. 227-237
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In patients with acute myocardial infarction and ST-segment elevation, increased troponin-T (TnT) on admission implies an increased mortality. OBJECTIVE: To elucidate the underlying mechanisms of the prognostic value of TnT. METHODS AND RESULTS: One hundred and one patients were included and all received thrombolytic treatment. The patients were compared according to TnT level on admission (cut-off 0.1 microg/l). Elevation of TnT was associated with long-term mortality and also with longer delay, more episodes of chest pain during the last 24 h and fewer noninvasive signs of reperfusion at 90 min. In the group with elevated TnT, the coronary angiography at 24 h showed a strong trend towards lower patency in the infarct-related artery. TnT was also associated with increased infarct size if a higher cut-off level (0.43 microg/l) was used. In univariate analysis, elevated TnT, longer delay, repeated chest pain, Q-waves on admission and reduced left ventricular (LV) function were significantly associated with long-term mortality. In multivariate models, only reduced LV function and less than TIMI (thrombolysis in myocardial infarction) grade 3 flow turned out to be significant independent risk factors. CONCLUSIONS: The prognostic value of TnT level on admission regarding long-term mortality was confirmed and seems mainly to be explained by its association with longer delay and recent myocardial damage, but its association with reduced effect of thrombolytic treatment, larger infarct size and impaired LV function might also be of importance.
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| 19. |
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| 20. |
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| 21. |
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| 22. |
- James, Stefan K., et al.
(författare)
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A rapid troponin I assay is not optimal for determination of troponin status and prediction of subsequent cardiac events at suspicion of unstable coronary syndromes.
- 2004
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Ingår i: International Journal of Cardiology. - 0167-5273 .- 1874-1754. ; 93:2-3, s. 113-120
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Troponin is a specific marker of myocardial damage. For early prediction of coronary events in patients with suspicion of acute coronary syndromes the assay also needs to be highly sensitive. METHODS AND RESULTS: A rapid troponin I assay was performed prior to inclusion in 4447 acute coronary syndrome patients in the GUSTO-IV trial. A quantitative troponin T analysis was later performed on blood samples obtained at randomization by a central laboratory. There was an agreement between the rapid troponin I assay and troponin T (< or =/>0.1 microg/l) in 3596 (80.9%) patients. A positive rapid troponin I was identifying any elevation of troponin T (>0.01 microg/l) in 1990 patients (90.4%) whereas a negative rapid troponin I was corresponding to negative troponin T (< or =0.01 microg/l) in only 1217 patients (54.2%). Patients with a positive versus negative rapid troponin I had an increased risk of death or myocardial infarction at 30 days (9.3 vs. 5.9%; odds ratio, O.R. 1.64; 95% confidence interval, 1.31-2.06). Troponin T elevation (>0.1 microg/l) provided a better (10.5 v. 4.9%, O.R. 2.26; C.I. 1.79-2.85) risk stratification. Regardless of a positive or a negative rapid troponin I, the troponin T result (>0.1 vs. < or =0.1 microg/l) stratified the patients into high and low risk of events at 30 days, (10.3 vs. 5.7%, P=0.002) and (11.5 vs. 4.8%, P<0.001), respectively. CONCLUSION: In a population with non-ST elevation acute coronary syndrome a positive rapid troponin I assay is a specific indicator of troponin elevation and a predictor of early outcome. However, a negative rapid troponin I is not a reliable indicator of the absence of myocardial damage and does not indicate a low risk of subsequent cardiac events. A rapid troponin I assay was performed prior to inclusion in 4447 acute coronary syndrome patients in the GUSTO-IV trial and related to a centrally analyzed quantitative troponin T test. A positive rapid troponin I was well corresponding to any elevation of troponin T (>0.01 microg/l) and predicted an unfavorable outcome at 30 days. However, a negative rapid troponin I was corresponding to troponin T < or =0.01 microg/l in only half of the patients. Troponin T >0.1 microg/l vs. < or =0.1 microg/l provided a better risk stratification than the rapid troponin I result. For patients with troponin T elevation (>0.1 microg/l) the 30 day event rate was high regardless of the rapid troponin I result.
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| 23. |
- James, Stefan, et al.
(författare)
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N-Terminal Pro–Brain Natriuretic Peptide and Other Risk Markers for the Separate Prediction of Mortality and Subsequent Myocardial Infarction in Patients With Unstable Coronary Artery Disease : A Global Utilization of Strategies To Open occluded arteries (GUSTO)-IV Substudy
- 2003
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Ingår i: Circulation. - 0009-7322 .- 1524-4539. ; 108:3, s. 275-281
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Biochemical markers are useful for prediction of cardiac events in patients with non-ST-segment-elevation acute coronary syndrome (ACS). The associations between N-terminal pro-brain natriuretic peptide (NT-proBNP) and other biochemical and clinical risk indicators, as well as their prognostic value concerning the individual end points of death and myocardial infarction (MI), were elucidated in a large cohort of ACS patients. METHODS AND RESULTS: NT-proBNP, troponin T, and C-reactive protein (CRP) were analyzed in blood samples obtained at a median of 9.5 hours from symptom onset in 6809 of 7800 ACS patients in the Global Utilization of Strategies To Open occluded arteries-IV (GUSTO-IV) trial. Levels of NT-proBNP were correlated independently with age, female gender, low body weight, diabetes, renal dysfunction, history of MI, heart failure, heart rate, ongoing myocardial damage, and time since onset of ischemia. Increasing quartiles of NT-proBNP were related to short- and long-term mortality that reached 1.8%, 3.9%, 7.7%, and 19.2%, (P<0.001), respectively, at 1 year. Levels of troponin T, CRP, heart rate, and creatinine clearance, in addition to ST-segment depression, were also correlated independently with 1-year mortality, but NT-proBNP was the marker with the strongest relation. In contrast, only troponin T, creatinine clearance, and ST-segment depression were independently related to future MI. The combination of NT-proBNP and creatinine clearance provided the best prediction, with a 1-year mortality of 25.7% with both markers in the top quartile vs 0.3% with both markers in the bottom quartile. CONCLUSIONS: The use of NT-proBNP appears to add critical prognostic insight to the assessment of patients with ACS.
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| 24. |
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| 25. |
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| 26. |
- James, Stefan, et al.
(författare)
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Troponin T levels and risk of 30-day outcomes in patients with the acute coronary syndrome : prospective verification in the GUSTO-IV trial
- 2003
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Ingår i: American Journal of Medicine. - 0002-9343 .- 1555-7162. ; 115:3, s. 178-184
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A third-generation troponin T assay with improved precision and a lower detection limit has been developed. However, the appropriate cutoff for identifying patients with the acute coronary syndrome who are at low risk of subsequent mortality has not been established. METHODS: A retrospective evaluation of data from the Fragmin and fast Revascularization during InStability in Coronary artery disease II (FRISC-II) trial suggested that a cutoff below 0.1 microg/L for troponin T levels might be more useful in risk stratification. A prospective validation of two cutoff levels (0.03 microg/L and 0.01 microg/L) was performed in 7115 patients with non-ST-elevation acute coronary syndrome from the Global Utilization of Strategies To open Occluded arteries IV (GUSTO-IV) trial. RESULTS: Patients with troponin T levels >0.1 microg/L had greater 30-day mortality (5.5% [201/3679]) than did those with levels CONCLUSION: Using a cutoff of
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| 27. |
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| 28. |
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| 31. |
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| 32. |
- Jernberg, Tomas, et al.
(författare)
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N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation
- 2002
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Ingår i: Journal of the American College of Cardiology. - 0735-1097 .- 1558-3597. ; 40:3, s. 437-445
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- OBJECTIVES: The study evaluated the prognostic value of single measurement of N-terminal pro brain natriuretic peptide (NT-proBNP) obtained on admission in patients with symptoms suggestive of an acute coronary syndrome and no ST-segment elevation. BACKGROUND: Patients with symptoms suggestive of an acute coronary syndrome and no ST-segment elevation constitute a large and heterogeneous population. Early risk stratification has been based on clinical background factors, electrocardiography (ECG) and biochemical markers of myocardial damage. The neurohormonal activation has, so far, received less attention. METHODS: The NT-proBNP was analyzed on admission in 755 patients admitted because of chest pain and no ST-segment elevation. Patients were followed concerning death for 40 months (median). RESULTS: The median NT-proBNP level was 400 (111 to 1646) ng/l. Compared to the lowest quartile, patients in the second, third and fourth quartiles had a relative risk of subsequent death of 4.2 (1.6 to 11.1), 10.7 (4.2 to 26.8) and 26.6 (10.8 to 65.5), respectively. When NT-proBNP was added to a Cox regression model including clinical background factors, ECG and troponin T, the NT-proBNP levels were independently associated with prognosis. CONCLUSIONS: A single measurement of NT-proBNP on admission will substantially improve the early risk stratification of patients with symptoms suggestive of an acute coronary syndrome and no ST-segment elevation. A combination of clinical background factors, ECG, troponin T and NT-proBNP obtained on admission will provide a highly discerning tool for risk stratification and further clinical decisions.
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| 33. |
- Jernberg, Tomas, et al.
(författare)
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Natriuretic peptides in unstable coronary artery disease
- 2004
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 25:17, s. 1486-1493
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Patients with unstable coronary artery disease (CAD), i.e., unstable angina or non-ST-elevation myocardial infarction, vary widely in clinical presentation, prognosis and response to treatment. To select appropriate therapy, early risk stratification has become increasingly important. This review focuses on the emerging role of natriuretic peptides in the early assessment of patients with unstable CAD. We conclude that levels of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are strongly associated to mortality and the risk of future congestive heart failure, and carry important prognostic information independent from previously known risk factors in unstable CAD. There are some data indicating that these markers can also be helpful in the selection of appropriate therapy in these patients but further studies are needed. Before a routine use of BNP or NT-proBNP in unstable CAD can be recommended, the cost-effectiveness of adding these new markers to the currently routine markers and their impact on selection of treatment needs further evaluation.
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| 34. |
- Jernberg, Tomas, et al.
(författare)
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NT-proBNP in unstable coronary artery disease : experiences from the FAST, GUSTO IV and FRISC II trials
- 2004
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 6:3, s. 319-325
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Risk stratification is important in patients with unstable coronary artery disease (CAD), i.e. unstable angina or non-ST-elevation myocardial infarction. This article focuses on the emerging role of N-terminal pro brain natriuretic peptide (NT-proBNP) and the results from the FAST, GUSTO IV and FRISC II trials. METHODS: In the FAST study, NT-proBNP was measured on admission in 755 patients admitted because of symptoms suggestive of unstable CAD. Follow up was performed after 40 months. The GUSTO IV and the FRISC II-trials included patients with unstable CAD and NT-proBNP was analyzed in 6806 and 2019 patients, with follow up after 1 and 2 years, respectively. RESULTS: In the FAST study, patients in the 2nd, 3rd, and 4th NT-proBNP quartile had a relative risk of subsequent death of 4.2 (1.6-11.1), 10.7 (4.2-26.8) and 26.6 (10.8-65.5), respectively. In the GUSTO IV trial, increasing quartiles of NT-proBNP were related to short and long term mortality which at 1 year was; 1.8%, 3.9%, 7.7% and 19.2% (P<0.001), respectively. In multivariable analyses including well-known predictors of outcome, NT-proBNP level was independently associated to mortality in all three studies. In the FRISC II trial, the NT-proBNP level, especially if combined with a marker of inflammation, identified those with the greatest benefit from an early invasive strategy. CONCLUSION: NT-proBNP is strongly associated with mortality in patients with suspected or confirmed unstable CAD and, combined with a marker of inflammation, seems helpful in identifying those with greatest benefit from an early invasive strategy.
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| 35. |
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| 36. |
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| 37. |
- Johanson, Per, 1963, et al.
(författare)
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Prognostic value of ST-segment resolution-when and what to measure.
- 2003
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Ingår i: European heart journal. - 0195-668X. ; 24:4, s. 337-45
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Tidskriftsartikel (refereegranskat)abstract
- Analyses of ST-segment resolution during acute myocardial infarction has, during recent years, challenged coronary angiography as gold-standard for predicting myocardial reflow and future risk. We have previously reported that continuous ST-monitoring can be done accurately in the clinical setting. We now set out to compare the prognostic value of previously suggested cut-offs for ST-segment resolution, and determine the times to measure these.
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| 38. |
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| 39. |
- Johnston, Nina, et al.
(författare)
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Biochemical indicators of cardiac and renal function in a healthy elderly population
- 2004
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Ingår i: Clinical Biochemistry. - : Elsevier BV. - 0009-9120 .- 1873-2933. ; 37:3, s. 210-216
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Tidskriftsartikel (refereegranskat)abstract
- Objectives:To examine the distributions of NT-proBNP and cystatin C and their relation to age, gender, and other physiological factors in an apparently healthy elderly population.Method:NT-proBNP and cystatin C were analyzed in 407 and 408 healthy individuals, median age: 65 (range 40–76).Results:Increasing age, female gender and CRP were independently associated to higher NT-proBNP levels. Age, body mass index, and CRP level were independently associated to the cystatin C level. In women and men, ≤65 years, the 97.5th percentile value for NT-proBNP was 268 ng/l and 184 ng/l, in those older, 391 ng/l and 269 ng/l. For those ≤65 years the 97.5th percentile value for cystatin C was 1.12 mg/l, and for those older 1.21 mg/l.Conclusion:In a healthy elderly population, NT-proBNP is influenced by age and gender, whereas cystatin C is influenced by age but not by gender. Both markers seem to be associated to the CRP level.
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| 40. |
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| 41. |
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| 42. |
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| 43. |
- Lindahl, Bertil, et al.
(författare)
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Mechanisms behind the prognostic value of troponin T in unstable coronary artery disease : a FRISC II substudy
- 2001
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Ingår i: Journal of the American College of Cardiology. - 0735-1097 .- 1558-3597. ; 38:4, s. 979-986
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This study was designed to elucidate possible mechanisms for the prognostic value of troponin T (tnT). BACKGROUND: The reasons for the adverse prognosis associated with elevation of troponins in unstable coronary artery disease are poorly understood. METHODS: Patients enrolled in the Fast Revascularization during InStability in CAD (FRISC-II) trial were included. Clinical characteristics, findings at echocardiography and coronary angiography, and prognosis were evaluated in relation to different tnT levels. RESULTS: Absence of significant coronary stenosis was more frequent and three-vessel disease or left main stem stenosis was less frequent in patients without, compared with, detectable tnT. The occurrence of visible thrombus increased with rising levels of tnT. In the group with the highest levels of tnT, occlusion of the left circumflex artery was more common than in the three other tnT groups, as was a left ventricular ejection fraction below 0.45. The one-year risk of death in the noninvasive arm of the study increased by increasing levels of tnT (1.6% to 4.6%), whereas the risk of myocardial infarction showed an inverted U-shaped curve and was lower in the lowest (5.5%) and highest (8.4%) tnT groups than in the two intermediate groups (17.5% and 16.2%). CONCLUSIONS: Any detectable elevation of tnT raises the probability of significant coronary stenosis and thrombus formation and is associated with an increased risk of reinfarction and death. However, at a more pronounced elevation of troponin, a higher proportion of patients has a persistent occlusion of the culprit vessel and reduced left ventricular function, associated with a high mortality but a modest risk of reinfarction.
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| 44. |
- Lindahl, Marika, et al.
(författare)
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The thylakoid FtsH protease plays a role in the light-induced turnover of the photosystem II D1 protein
- 2000
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Ingår i: The Plant Cell. - : Oxford University Press (OUP). - 1040-4651 .- 1532-298X. ; 12:3, s. 419-431
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Tidskriftsartikel (refereegranskat)abstract
- The photosystem II reaction center D1 protein is known to turn over frequently. This protein is prone to irreversible damage caused by reactive oxygen species that are formed in the light, the damaged, nonfunctional D1 protein is degraded and replaced by a new copy. However, the proteases responsible for D1 protein degradation remain unknown. In this study, we investigate the possible role of the FtsH protease, an ATP-dependent zinc metalloprotease, during this process. The primary light-induced cleavage product of the D1 protein, a 23-kD fragment, was found to be degraded in isolated thylakoids in the dark during a process dependent on ATP hydrolysis and divalent metal ions, suggesting the involvement of FtsH. Purified FtsH degraded the 23-kD D1 fragment present in isolated photosystem II core complexes, as well as that in thylakoid membranes depleted of endogenous FtsH. In this study, we definitively identify the chloroplast protease acting on the D1 protein during its light-induced turnover. Unlike previously identified membrane-bound substrates for FtsH in bacteria and mitochondria, the 23-kD D1 fragment represents a novel class of FtsH substrate - functionally assembled proteins that have undergone irreversible photooxidative damage and cleavage.
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- Modig, Lars, et al.
(författare)
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Cancerframkallande ämnen i tätortsluft : Exponering och halter i Umeå 2001
- 2002
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Exponeringen för ett antal cancerframkallande ämnen undersöktes i ett slumpmässigt urval av allmänbefolkningen i Umeå, 2001. Den huvudsakliga studien genomfördes från slutet av september till mitten av oktober som personburna 7-dygns mätningar på totalt 60 personer, medan några av mätningarna genomfördes i januari 2002. Parallellt med de personburna mätningarna genomfördes även mätningar vid två stationära platser i Umeå, bibliotekstaket och E4:an. Mätningarna omfattade bensen, 1,3-butadien, formaldehyd, acetaldehyd, PAH (polyaromatiska kolväten) samt kvävedioxid (NO2). Mätningarna genomfördes med passiva provtagare med undantag för PAH där provtagningen genomfördes med hjälp av en pump. Resultatet från de personburna provtagningarna av bensen gav medianvärdet 1,5 μg/m3, vilket kan jämföras med resultatet från fjolårets studie i Göteborg (1μg/m3) och den av Institutet för miljömedicin (IMM) föreslagna lågrisknivån 1,3μg/m3. Exponeringen för bensen var signifikant associerad till tiden som deltagarna vistats inomhus, utomhus på arbetsplatsen, i rum med rökning samt om de var rökare. Det var marginell skillnad mellan medianhalten uppmätt vid E4:an och den personburna halten (1,6 μg/m3 och 1,5 μg/m3) medan halten på bibliotekstaket låg lägre (1,0 μg/m3). Medianvärdet för butadien var 0,4 μg/m3, vilket är samma som halten uppmätt vid E4:an men högre jämfört med halten på bibliotekstaket (0,12 μg/m3). Det var signifikant skillnad mellan rökare och icke-rökare (p=0,007), och tid som tillbringats i rum med rökning var signifikant förknippat med ökad exponering för butadien. Mätningar genomfördes för både formaldehyd och acetaldehyd, dock redovisas enbart resultaten för formaldehyd på grund av problem med provtagningen av acetaldehyd. Bland mätningarna som genomfördes personburet var medianhalten formaldehyd 15 μg/m3 vilket kan jämföras med resultaten från samma studie i Göteborg förra året (19 μg/m3). Resultatet ligger inom det intervall som angivit som lågrisknivå (IMM, 12-60 μg/m3). Halterna som uppmättes vid E4:an och Biblioteket var nästintill lika (3,5 μg/m3 och 3,0 μg/m3), dock var de betydligt lägre jämfört med den halt som uppmättes personburet. Bostadstyp (villa alt lägenhet), framstod som den enda variabeln som var signifikant associerad till den personburna halten formaldehyd. PAH-mätningarna genomfördes stationärt hemma hos 10 deltagare ur befolkningsurvalet, samt personburet och stationärt på 10 personer i anknytning till forskargruppen. Mediankoncentrationen av bens(a)pyren, mätt personburet, var 0,08 ng/m3 vilket är i nivå med resultaten från Göteborg. Halterna hemma hos personerna från befolkningsurvalet samt de med anknytning till kliniken var 0,17 respektive 0,07 ng/m3. De stationära utomhusmätningarna visade att halten vid E4:an var betydligt högre jämfört med halten på Bibliotekstaket (0,3 respektive 0,1 ng/m3). Kvävedioxid (NO2) mättes som ett lokalt tillägg i syfte att undersöka samband mellan NO2, som trafikindikator, och övriga ämnen. Median halten för mätningarna som gjordes personburet var 8 μg/m3 medan resultaten från de stationära mätningarna var betydligt högre. NO2 uppvisade ingen signifikant korrelation till övriga ämnen mätta personburet. Vidare sågs inga samband till vistelse i specifika miljöer.
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| 47. |
- Modig, Lars, et al.
(författare)
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Cancerframkallande ämnentätortsluft - Umeå 2001
- 2002
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Exponeringen för ett antal cancerframkallande ämnen undersöktes i ett slumpmässigturval av allmänbefolkningen i Umeå, 2001. Den huvudsakliga studien genomfördesfrån slutet av september till mitten av oktober som personburna 7-dygns mätningar påtotalt 60 personer, medan några av mätningarna genomfördes i januari 2002. Parallelltmed de personburna mätningarna genomfördes även mätningar vid två stationäraplatser i Umeå, bibliotekstaket och E4:an. Mätningarna omfattade bensen, 1,3-butadien, formaldehyd, acetaldehyd, PAH (polyaromatiska kolväten) samtkvävedioxid (NO2). Mätningarna genomfördes med passiva provtagare med undantagför PAH där provtagningen genomfördes med hjälp av en pump.Resultatet från de personburna provtagningarna av bensen gav medianvärdet1,5 μg/m3, vilket kan jämföras med resultatet från fjolårets studie i Göteborg (1μg/m3)och den av Institutet för miljömedicin (IMM) föreslagna lågrisknivån 1,3μg/m3.Exponeringen för bensen var signifikant associerad till tiden som deltagarna vistatsinomhus, utomhus på arbetsplatsen, i rum med rökning samt om de var rökare. Detvar marginell skillnad mellan medianhalten uppmätt vid E4:an och den personburnahalten (1,6 μg/m3 och 1,5 μg/m3) medan halten på bibliotekstaket låg lägre (1,0μg/m3).Medianvärdet för butadien var 0,4 μg/m3, vilket är samma som halten uppmätt vidE4:an men högre jämfört med halten på bibliotekstaket (0,12 μg/m3). Det varsignifikant skillnad mellan rökare och icke-rökare (p=0,007), och tid som tillbringats irum med rökning var signifikant förknippat med ökad exponering för butadien.Mätningar genomfördes för både formaldehyd och acetaldehyd, dock redovisas enbartresultaten för formaldehyd på grund av problem med provtagningen av acetaldehyd.Bland mätningarna som genomfördes personburet var medianhalten formaldehyd15 μg/m3 vilket kan jämföras med resultaten från samma studie i Göteborg förra året(19 μg/m3). Resultatet ligger inom det intervall som angivit som lågrisknivå (IMM,12-60 μg/m3). Halterna som uppmättes vid E4:an och Biblioteket var nästintill lika(3,5 μg/m3 och 3,0 μg/m3), dock var de betydligt lägre jämfört med den halt somuppmättes personburet. Bostadstyp (villa alt lägenhet), framstod som den endavariabeln som var signifikant associerad till den personburna halten formaldehyd.PAH-mätningarna genomfördes stationärt hemma hos 10 deltagare urbefolkningsurvalet, samt personburet och stationärt på 10 personer i anknytning tillforskargruppen. Mediankoncentrationen av bens(a)pyren, mätt personburet, var 0,08ng/m3 vilket är i nivå med resultaten från Göteborg. Halterna hemma hos personernafrån befolkningsurvalet samt de med anknytning till kliniken var 0,17 respektive 0,07ng/m3. De stationära utomhusmätningarna visade att halten vid E4:an var betydligthögre jämfört med halten på Bibliotekstaket (0,3 respektive 0,1 ng/m3).Kvävedioxid (NO2) mättes som ett lokalt tillägg i syfte att undersöka samband mellanNO2, som trafikindikator, och övriga ämnen. Median halten för mätningarna somgjordes personburet var 8 μg/m3 medan resultaten från de stationära mätningarna varbetydligt högre. NO2 uppvisade ingen signifikant korrelation till övriga ämnen mättapersonburet. Vidare sågs inga samband till vistelse i specifika miljöer.
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