Acute and Critical Care

Original Article

Cardiology
Evaluation of neopterin levels and kynurenine pathway in patients with acute coronary syndrome: Ibrahim Kember, Sonia Sanajou, Bilge Kilicarslan, Gözde Girgin, Terken Baydar; Acute Crit Care. 2023;38(3):325-332. Published online August 30, 2023; DOI: https://doi.org/10.4266/acc.2023.00024

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Background
Coronary atherosclerosis is the leading cause of coronary artery disease. Several investigations have indicated that tear-sensitive plaques contain macrophages and T cells. Neopterin is an essential cellular immune response biomarker. The main goal of this study was to see if there were any changes in biomarkers like unconjugated pteridines, neopterin, and biopterin, as well as kynurenine pathway enzymes like indoleamine 2,3-dioxygenase (IDO), which catalyzes the rate-limiting step in tryptophan degradation, in patients with the acute coronary syndrome (ACS) caused by angiographic atherosclerosis.
Methods
High-performance liquid chromatography was used to determine the amounts of neopterin, biopterin, and creatinine in urine samples, as well as tryptophan and kynurenine in serum samples. The enzyme-linked immunosorbent assay was used to assess the amounts of neopterin in serum samples. The measured parameters were evaluated between ACS patients and controls.
Results
The measured levels of neopterin, biopterin and the kynurenine to tryptophan ratio reflecting IDO activity, and the specifically known biomarkers such as cardiac troponin, creatine kinase, myoglobin, and natriuretic peptides are statistically higher in ACS patients compared to control subjects. On the other hand, the measured parameters are inadequate to classify the conventional kinds of ACS, ST-elevation- and non-ST-elevation- myocardial infarction.
Conclusions
The study found that determining and using neopterin and IDO parameters as biomarkers in individuals with the ACS can support traditional biomarkers. However, it can be concluded that evaluating pteridine biomarkers solely have no privilege to clinical findings in ACS diagnosis and classification.

Citations

Citations to this article as recorded by

Kynurenines as a Novel Target for the Treatment of Inflammatory Disorders
Adrian Mor, Anna Tankiewicz-Kwedlo, Marianna Ciwun, Janina Lewkowicz, Dariusz Pawlak
Cells.2024; 13(15): 1259. CrossRef
Biomarkers to monitor the prognosis, disease severity, and treatment efficacy in coronary artery disease
Armand N. Yazdani, Michaela Pletsch, Abraham Chorbajian, David Zitser, Vikrant Rai, Devendra K. Agrawal
Expert Review of Cardiovascular Therapy.2023; 21(10): 675. CrossRef
Evaluation of Neopterin as a Neuroinflammatory Marker for Peripheral Neuropathy in Type 2 Diabetic Patients
Israa Abdelmalik Salem, Sura Ahmed Abdulsattar, Haider Fadhil Alrubaye
Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ).2023; 5(1S): S183. CrossRef

Case Report

Cardiology
Acute perimyocarditis mimicking acute myocardial infarction in a 12-year-old boy with duchenne muscular dystrophy: Ho Jung Choi, Hye Won Kwon, Kyung Jin Oh, Mi Kyoung Song; Acute Crit Care. 2022;37(2):258-262. Published online November 16, 2021; DOI: https://doi.org/10.4266/acc.2021.00290

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Abstract PDF Supplementary Material

Differential diagnosis of chest pain in the pediatric population is important but can be challenging. A 12-year-old boy with Duchenne muscular dystrophy presented with chest pain, cardiac enzyme elevation, and convex ST elevations in the inferior leads with reciprocal ST depression in the anterior leads on electrocardiogram. Echocardiography on admission revealed normal left ventricular function. Suspecting acute myocardial infarction, we performed invasive coronary angiography, which revealed normal coronary arteries. A follow-up electrocardiogram showed an acute pericarditis pattern with concave ST elevations in most leads and PR depression, and follow-up echocardiography revealed global left ventricular dysfunction, suggestive of acute perimyocarditis. Ibuprofen was administered for acute pericarditis, and a continuous milrinone infusion was commenced for myocardial dysfunction. The chest pain improved by the next day, and the ST segment elevations normalized on day 4. Echocardiography on day 9 revealed improved left ventricular function. The patient was discharged on day 11, and he is doing well without chest pain through 12 months of follow-up. The last electrocardiogram showed normal sinus rhythm without ST change. Differential diagnosis of acute myocardial infarction and acute perimyocarditis is important for proper treatment strategies and the different prognoses of these two conditions.

Citations

Citations to this article as recorded by

Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department
Szu-Wei Huang, Ying-Kuo Liu
Diagnostics.2024; 14(5): 526. CrossRef
Case Report: Acute myocarditis in a patient with Duchenne muscular dystrophy
Xinyuan Zhang, Yingkun Guo, Huayan Xu
Frontiers in Cardiovascular Medicine.2024;[Epub] CrossRef
Successful treatment of acute myocardial injury of Duchenne muscular dystrophy with steroids: a case report
Merve Oğuz, Dolunay Gürses, Furkan Ufuk, Münevver Yılmaz, Olcay Güngör
Journal of Cardiothoracic Surgery.2023;[Epub] CrossRef
Comprehensive cardiac magnetic resonance T1, T2, and extracellular volume mapping to define Duchenne cardiomyopathy
Sudeep D. Sunthankar, Kristen George-Durrett, Kimberly Crum, James C. Slaughter, Jennifer Kasten, Frank J. Raucci, Larry W. Markham, Jonathan H. Soslow
Journal of Cardiovascular Magnetic Resonance.2023; 25(1): 44. CrossRef

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