1. Increase of troponin/BNP was common in our sample, higher in patients with worse in-hospital prognosis (consistently shown in literature). Take into account epidemiological characteristics of the population: older age, high rate of comorbidity and fatal outcome.
2. Troponin and BNP generally had parallel increase, both in relation to A) markers of disease severity (D-dimer, CRP, P/F) and B) pre-existing condition of vulnerability (age, previous CVD, renal insufficiency etc.). However,
3. troponin was more closely (independently) associated to the firsts. Possible explanations include hypoxia, inflammatory myocardial involvement (nicely shown here jamanetwork.com/journals/jamac…) and, hypothetically, thrombosis of coronary microvessels (thelancet.com/journals/lanmi…)
4. BNP was more closely (independently) associated to the latters, especially previous CVD. Overall, increasing age remained the main determinant of both troponin/BNP increase. Trying to draw some conclusions:
5. Keep assessing troponin/BNP in #COVID19 for
A) Risk stratification (in-hospital mortality) and
B) (still speculative) phenotyping, where troponin=higher inflammatory driver and BNP=pre-existing diseases complicating outcome.
(1/9) Interesting study recently published in @ehj_ed providing a comprehensive description of microvascular function in an animal model of 💔#takotsubo💔 - however, can we call it a microvascular disease? Some thoughts to challenge this view (thread 🧵)academic.oup.com/eurheartj/arti…
(2/9) The authors used transaortic contriction to elicit #takotsubo in mice. They performed it on mice null for Kv1.5 channels and double transgenic mice with inducible Kv1.5 (plus controls): this elegantly reiterates the role of microvascular dysfunction (MD)...
(3/9)...as a relevant predisposing or contributing factor for #takotsubo, yet it does not demonstrate its pivotal action. In an animal model of isoprenaline induced #takotsubo MD was absent minutes after ballooning onset, implying that...academic.oup.com/ehjcimaging/ar…
Myocardial edema largely represented, correlations with interstitial expansion, ECG changes and systolic function. Some considerations below 🧵
1/ In #takotsubo syndrome myocardial edema features the acute phase: #WhyCMR T1 and T2 mapping have the advantage of a parametric quantification of edema. T2 specific for water, but native T1 can read it too (ahajournals.org/doi/full/10.11…) and ECV not water-independent in this setting
1/8 Males represent approx. 10% of #Takotsubo patients within the registry. As comapred with females, they have ⬆️comorbid burden (malignancies, COPD etc.), ⬆️physical trigger ⬇️LVEF, worse in-hospital and long-term outcome.
2/8 These results were expected, when looking at smaller previously published studies, but why is that? Is the #takotsubo attack itself worse in men or do they just suffer because of the vulnerable comorbid background?
1/ Premessa - “Nell’università italiana il reclutamento segue nei fatti logiche slegate dai regolamenti concorsuali ”
Senza polemiche e moralismi, se si nega questo stato dell’arte, si può interrompere qua la lettura
2/ Il reclutamento nell’accademia è fatto di cooptazione, in Italia come nel resto del mondo. Necessariamente, per selezionare, il giudizio deve essere espresso da chi è esperto della materia, il cortocircuito è inevitabile e i grandi grant internazionali non ne sono esenti
We found independent associations between increasing natriuretic peptide/hsTropT on one side and myocardial involvement as assessed by native T1 and T2 mapping on the other ➡️ cardiac biomarkers=cardiac involvement (not only reduced elimination). (1/3)
Is cardiac involvement characterized by diffuse fibrosis only? Likely not: increased T2=contribution of myocardial edema. ❗️❗️T2 decreases after hemodialysis, proportionally to revomed volume❗️❗️ (2/3)