心血管疾患と診断

Introduction: Chronic elevation of high sensitivity troponin (hs-cTnT) and N-terminal brain-natriuretic peptide (Nt-pro-BNP) in end-stage renal disease is associated with worse cardiovascular outcomes. Little is known about how hemodialysis (HD) parameters acutely influence those biomarkers and prognosis.

Objective: To determine if the variation of those biomarkers on the short term is influenced by factors that are already associated with hemodialysisinduced cardiac injury and if it has a prognostic value.

Methods: Forty participants undergoing HD at our institution were enrolled. Factors known to influence hs-cTnT and Nt-pro-BNP levels were the principal exclusion criteria. Eight patients were excluded mainly for EF<40%. Six consecutive serum samples were analysed for hs-cTnT and Nt-pro-BNP before and after three HD sessions. Hs-cTnT and Nt-pro-BNP percentage variation after HD were analysed in respect with HD weight reduction percentage, ultrafiltration rate, Kt/V (HD adequacy parameter), presence of diastolic dysfunction, indexed left ventricular mass, peridialysis hypotension, blood filtration rate and with the other biomarker. Linear regression analysis was used in a fixed-effect model for multivariate assessment with variables already mentionned. Major adverse clinical events (hospitalization for heart failure, acute coronary syndrome and cardiovascular death) were recorded for a period of 21 months to analyze the sensitivity and specificity of biomarker fluctuation for predicting clinical events.

Results: Mean decrease after dialysis for hs-cTnT was 38.3% +- 3.9%, while it was 56% +- 3.5% for Nt-pro-BNP. There was a fair and significant association between variation in hs-cTnT and Nt-pro-BNP and the model’s variables (Pearson coefficient of 0.646 (p<0.001) and 0. 0.53 (p=0.001), respectively). Variables having the most important influences on the biomarkers fluctuation were ultrafiltration rate (β = -0.558, p=0.001) and interdialytic weight decrease percentage (β = 0.399, p=0.020). Smaller troponin decrease (25th percentile) showed fair sensitivity (80%) for adverse clinical events. Hs-cTnT and Nt-pro-BNP levels are diminished after HD in a manner that is reproducible for the same patient and they change in a parallel manner.

Conclusion: Hs-cTnT and Nt-pro-BNP changes are highly reproducible for the same patient and vary parallelly. While seeming contradictory, but consistent with past literature, higher total fluid removal and slower ultrafiltration rates are associated with more important biomarker decreases. Since static levels of those biomarkers correlate with mortality, adopting a slower fluid removal during hemodialysis and prolonging sessions could improve mortality over the long run. This could be assessed in future dedicated studies.

Introduction: SARS-CoV-2 can infect host cells through ACE2 with possible damage to the myocardium. Likewise, cytokine storm in later stages of COVID-19 infection may cause progressive inflammatory phenomenon. We reported 12 pediatric patients having different severity of cardiac complications with history of COVID-19 in themselves or their older family members. In all of these pediatric cases there was a family history of positive laboratory reports for SARS-CoV-2 infection in older family members.

Methods: This is a case series study. We were being randomly consulted for possible cardiovascular involvement of pediatric COVID-19 patients in corona intensive care unit. During the past six months, we confronted twelve children from corona intensive care unit with various findings of myocarditis and/or Kawasaki-like disease on echocardiographic evaluation. These patients were treated appropriately depending on their cardiovascular disorders. We followed these pediatric patients with intermittent echocardiographic evaluation for the following 2 to 6 months.

Results: In spite of preceding optimistic attitude regarding COVID-19 in children, we found a series of recent pediatric cases with treatable cardiac complications. Myocardial and coronary artery involvement were the main problems in these young patients. Fortunately, on follow up, all of these cardiac complications were appropriately managed by our therapeutic protocol with satisfying outcomes.

Conclusion: We emphasize on especial concern about cardiac involvement in children and adolescents with recent COVID-19 in their family. This can be achieved by echocardiographic evaluation in suspicious younger individuals during one to two months of SARS-CoV-2 infection in the older family members.