The pathogenesis of post-cardiac injury syndronme was studied prospectively in 62 patients who underwent coronary bypass grafting. Preoperative and serial postoperative titres of actin and myosin antibodies were measured by an enzyme linked immunosorbent assay. Perioperative cumulative release of serum aspartate and alanine aminotransferases, lactate dehydrogenase, and creatine kinase was calculated by approximation formulas that are used to estimate infarct size. Complete post-cardiac injury syndrome developed in eight (13%) patients and an incomplete syndrome developed in 16 (26%). There was a significant correlation between frequency and intensity of the syndrome and the ratio of postoperative to preoperative titres of actin and myosin antibodies. Furthermore, there was a significant correlation between the cumulative release of lactate dehydrogenase, serum aspartate aminotransferase, and creatine kinase and the number of coronary vessels that were grafted, but no correlation was found between the incidence of post-cardiac injury syndrome and the number of coronary bypasses grafted or between the cumulative enzyme release and the postoperative immunological response against the major contractile proteins, actin and myosin. The amount of enzymes released during coronary bypass surgery seems to be a good indicator of the extent of myocardial damage during operation but it does not determine either the incidence of post-cardiac injury syndrome or the postoperative immunological response against the main contractile proteins actin and myosin.Post-cardiac injury syndrome is a frequent complication of cardiac surgery' -7; it is seen less often after acute myocardial infarction,7 8 despite the generally more severe myocardial damage produced by infarction. Furthermore, post-cardiac injury syndrome was found to be significantly more frequent after valve replacement surgery than after coronary bypass operation.69 According to Engle et al more severe myocardial damage after valve replacement explains this observation.9 Aortic valve replacement gives rise to a greater cumulative enzyme release of creatine kinase, creatine kinase MB, and a hydroxybutyrate dehydrogenase than coronary artery bypass grafting which in turn gives rise to greater cumulative enzyme release than mitral valve replacement.10o 1 Thus the reason for the significantly Requests for reprints to Dr Ivan De Scheerder, higher frequency of post-cardiac injury syndrome after valve replacement surgery than after coronary artery bypass grafting remains controversial. De Scheerder etal demonstrated that the difference in occurrence of post-cardiac injury syndrome after cardiac surgery and acute myocardial infarction correlated well with the difference of post-cardiac injury humoral immune response against myocardial tissue and the major contractile proteins, actin and myosin,7 suggesting that this immune response is important in the pathogenesis or postcardiac injury syndrome.We have studied the correlation between the tissue damage during coronary artery bypas...
BackgroundRheumatoid factor (RF) and anti-citrullinated protein/peptide antibodies (ACPA) are important biomarkers for diagnosis of rheumatoid arthritis (RA). However, there is poor harmonisation of RF and ACPA assays. The aim of this study was to refine RF and ACPA interpretation across commercial assays.Materials and methodsSix total RF isotype-non-specific assays, 3 RF IgM isotype-specific assays and 9 ACPA immunoglobulin G assays of 13 different companies were evaluated using 398 diagnostic samples from patients with RA and 1073 disease controls.ResultsUsing cut-offs proposed by the manufacturer, there was a large variability in diagnostic sensitivity and specificity between assays. Thresholds of antibody levels were determined based on predefined specificities and used to define test result intervals. Test result interval-specific likelihood ratios (LRs) were concordant across the different RF and ACPA assays. For all assays, the LR for RA increased with increasing antibody level. Higher LRs were found for ACPA than for RF. ACPA levels associated with LRs >80 were found in a substantial fraction (>22%) of patients with RA.ConclusionDefining thresholds for antibody levels and assigning test result interval-specific LRs allows alignment of clinical interpretation for all RF and ACPA assays.
Objective In this study, the performance of 2 commercially available SARS-CoV-2 antibody assays is evaluated. Methods The Siemens SARS-CoV-2 Total (COV2T) and IgG (COV2G) antibody tests were evaluated on a Siemens Atellica IM1300 analyzer. Imprecision was assessed with the CLSI EP15 protocol using positive controls. Ninety control group specimens were analyzed for specificity, and 175 specimens from 58 patients with polymerase chain reaction–confirmed SARS-CoV-2 were measured for the sensitivity and kinetics of the antibody response. Results Within-run and total imprecision were acceptable for both assays. Both tests showed a specificity of 100%. Sensitivity earlier in the disease state was greater for the COV2T assay than for the COV2G assay, but sensitivity >14 days after onset of symptoms approached 100% for both. For all patients, antibody titers remained above the seroconversion cutoff for all follow-up specimens. Conclusion This study shows acceptable performance for both the Siemens COV2T and COV2G test, although seroconversion occurs earlier with the COV2T test.
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