101
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The role of postictal laboratory blood analyses in the diagnosis and prognosis of seizures. Seizure 2017; 47:51-65. [DOI: 10.1016/j.seizure.2017.02.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 12/18/2022] Open
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102
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Slagman A, von Recum J, Möckel M, Holert F, Meyer zum Büschenfelde D, Müller C, Searle J. Diagnostic performance of a high-sensitive troponin T assay and a troponin T point of care assay in the clinical routine of an Emergency Department: A clinical cohort study. Int J Cardiol 2017; 230:454-460. [DOI: 10.1016/j.ijcard.2016.12.085] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/15/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
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Stiermaier T, Thiele H, Eitel I. Clinical utility of novel biomarkers in acute myocardial infarction. ANNALS OF TRANSLATIONAL MEDICINE 2017; 4:491. [PMID: 28149853 DOI: 10.21037/atm.2016.12.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Thomas Stiermaier
- Department of Cardiology, Angiology, Intensive Care Medicine, Medical Clinic II, University Heart Center of Lübeck, Lübeck, Germany; ; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Holger Thiele
- Department of Cardiology, Angiology, Intensive Care Medicine, Medical Clinic II, University Heart Center of Lübeck, Lübeck, Germany; ; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Department of Cardiology, Angiology, Intensive Care Medicine, Medical Clinic II, University Heart Center of Lübeck, Lübeck, Germany; ; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
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104
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Boeddinghaus J, Reichlin T, Nestelberger T, Twerenbold R, Meili Y, Wildi K, Hillinger P, Giménez MR, Cupa J, Schumacher L, Schubera M, Badertscher P, Corbière S, Grimm K, Puelacher C, Sabti Z, Widmer DF, Schaerli N, Kozhuharov N, Shrestha S, Bürge T, Mächler P, Büchi M, Rentsch K, Miró Ò, López B, Martin-Sanchez FJ, Rodriguez-Adrada E, Morawiec B, Kawecki D, Ganovská E, Parenica J, Lohrmann J, Buser A, Keller DI, Osswald S, Mueller C. Early diagnosis of acute myocardial infarction in patients with mild elevations of cardiac troponin. Clin Res Cardiol 2017; 106:457-467. [DOI: 10.1007/s00392-016-1075-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 12/27/2016] [Indexed: 01/19/2023]
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105
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Cullen LA, Mills NL, Mahler S, Body R. Early Rule-Out and Rule-In Strategies for Myocardial Infarction. Clin Chem 2017; 63:129-139. [PMID: 28062616 DOI: 10.1373/clinchem.2016.254730] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/09/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with chest pain comprise a large proportion of emergency presentations and place a major burden on healthcare resources. Therefore, efforts to safely and rapidly identify those with and without acute myocardial infarction (AMI) are needed. The challenge for clinicians is to accurately identify patients with acute coronary syndromes, while balancing the need to safely and rapidly reassure and discharge those without serious conditions. CONTENT This review summarizes the evidence to date on optimum accelerated strategies for the rule-in and rule-out of AMI, using strategies focused on optimum use of troponin results. Evidence based on both sensitive and highly sensitive troponin assay results is presented. The use of novel biomarkers is also addressed and the combination of biomarkers with other clinical information in accelerated diagnostic strategies is discussed. SUMMARY The majority of patients, who are not at risk of myocardial infarction or other serious harm, may be suitable for discharge directly from the emergency setting using approaches focused on troponin algorithms and accelerated diagnostic protocols. Evidence about the clinical and health economic impact of use of such strategies is needed, as they may have major benefits for both patients and healthcare providers.
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Affiliation(s)
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | - Simon Mahler
- Wake Forest School of Medicine, Winston-Salem, NC
| | - Richard Body
- Central Manchester University Hospitals NHS Foundation Trust, UK
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106
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Zhang R, Liu J, Zhang Y, Liu Q, Li T, Cheng L. Association Between Circulating Copeptin Level and Mortality Risk in Patients with Intracerebral Hemorrhage: a Systemic Review and Meta-Analysis. Mol Neurobiol 2017; 54:169-174. [PMID: 26732599 DOI: 10.1007/s12035-015-9626-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 12/08/2015] [Indexed: 10/25/2022]
Abstract
Copeptin has been identified as a biomarker of disease severity and is associated with mortality risk in several common diseases. This study sought to determine the association between circulating copeptin level and mortality risk in patients with intracerebral hemorrhage. PubMed, Web of Science, and Wanfang Medicine Database were searched for studies assessing the association between circulating copeptin level and mortality risk in patients with intracerebral hemorrhage. The pooled hazard ratio (HR) of mortality was calculated and presented with 95 % confidence interval (95 % CI). Data from 1332 intracerebral hemorrhage patients were derived from 9 studies. Meta-analysis showed that intracerebral hemorrhage patients with poor prognosis had much higher copeptin levels than those survivors (standardized mean difference = 1.68, 95 % CI 1.26-2.11, P < 0.00001). Meta-analysis of 8 studies with HRs showed that high circulating copeptin level was associated with higher risk of mortality in patients with intracerebral hemorrhage (HR = 2.42, 95 % CI 1.60-3.65, P < 0.0001). Meta-analysis of 6 studies with adjusted HRs showed that high circulating copeptin level was independently associated with higher risk of mortality in patients with intracerebral hemorrhage (HR = 1.67, 95 % CI 1.26-2.22, P = 0.0003). Our study suggests that there is an obvious association between circulating copeptin level and mortality in patients with intracerebral hemorrhage. High circulating copeptin level is independently associated with higher risk of mortality in patients with intracerebral hemorrhage.
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Affiliation(s)
- Ruoyu Zhang
- Department of Geriatrics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, People's Republic of China.
| | - Jin Liu
- Department of Geriatrics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, People's Republic of China
| | - Ying Zhang
- Neuroscience Care Unit, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Qiang Liu
- Department of Geriatrics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, People's Republic of China
| | - Tianlang Li
- Department of Geriatrics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, People's Republic of China
| | - Lei Cheng
- Department of Neurosurgery, The Affiliated Hospital of Shandong University, Jinan, 250019, China
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107
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Hollander JE, Than M, Mueller C. State-of-the-Art Evaluation of Emergency Department Patients Presenting With Potential Acute Coronary Syndromes. Circulation 2016; 134:547-64. [PMID: 27528647 DOI: 10.1161/circulationaha.116.021886] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
It is well established that clinicians cannot use clinical judgment alone to determine whether an individual patient who presents to the emergency department has an acute coronary syndrome. The history and physical examination do not distinguish sufficiently between the many conditions that can cause acute chest pain syndromes. Cardiac risk factors do not have sufficient discriminatory ability in symptomatic patients presenting to the emergency department. Most patients with non-ST-segment-elevation myocardial infarction do not present with electrocardiographic evidence of active ischemia. The improvement in cardiac troponin assays, especially in conjunction with well-validated clinical decision algorithms, now enables the clinician to rapidly exclude myocardial infarction. In patients in whom unstable angina remains a concern or there is a desire to evaluate for underlying coronary artery disease, coronary computed tomography angiography can be used in the emergency department. Once a process that took ≥24 hours, computed tomography angiography now can rapidly exclude myocardial infarction and coronary artery disease in patients in the emergency department.
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Affiliation(s)
- Judd E Hollander
- From Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (J.E.H.); Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand (M.T.); and Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland (C.M.)
| | - Martin Than
- From Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (J.E.H.); Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand (M.T.); and Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland (C.M.)
| | - Christian Mueller
- From Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (J.E.H.); Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand (M.T.); and Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland (C.M.)
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108
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Stengaard C, Sørensen JT, Ladefoged SA, Lassen JF, Rasmussen MB, Pedersen CK, Ayer A, Bøtker HE, Terkelsen CJ, Thygesen K. The potential of optimizing prehospital triage of patients with suspected acute myocardial infarction using high-sensitivity cardiac troponin T and copeptin. Biomarkers 2016; 22:351-360. [DOI: 10.1080/1354750x.2016.1265008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Carsten Stengaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob T. Sørensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren A. Ladefoged
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Jens F. Lassen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Rigshospitalet Copenhagen University, Copenhagen, Denmark
| | | | | | - Antoine Ayer
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Abstract
AbstractmicroRNAs are promising biomarkers for diverse cardiovascular diseases. While quantification of the small non-coding RNAs is routinely performed in the research laboratory, clinical-grade assessment of microRNAs in central laboratory environments or point-of-care testing is still in its infancy. In this review, we provide an overview on microRNAs as biomarkers for acute coronary syndromes and highlight promising technical approaches for microRNA-based assays systems.
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110
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Sinning C, Ojeda F, Zeller T, Zengin E, Rupprecht HJ, Lackner KJ, Bickel C, Blankenberg S, Schnabel RB, Westermann D. Cardiovascular Mortality in Chest Pain Patients: Comparison of Natriuretic Peptides With Novel Biomarkers of Cardiovascular Stress. Can J Cardiol 2016; 32:1470-1477. [DOI: 10.1016/j.cjca.2016.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/09/2016] [Accepted: 05/16/2016] [Indexed: 12/01/2022] Open
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111
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Giannitsis E, Katus HA. Taking a closer look into the diagnosis of acute coronary syndrome. Diagnosis (Berl) 2016. [DOI: 10.1515/dx-2016-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Hugo A. Katus
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Germany
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112
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Möckel M, Slagman A, Searle J. Biomarker strategies: the diagnostic and management process of patients with suspected AMI. Diagnosis (Berl) 2016. [PMID: 29536898 DOI: 10.1515/dx-2016-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Security standards of our times largely exclude a discharge of patients with chest pain from the emergency departments (EDs) based on clinical assessment alone. Given the increasing use and consequently crowding of EDs worldwide and the large proportion of patients who present to the EDs with, however vague, signs and symptoms of acute coronary syndrome, there is a strong clinical and public health need to achieve a faster but safe rule-in and rule-out of acute myocardial infarction (AMI) to direct patients onto the correct management pathway. A number of approaches for a faster rule-in and rule-out of AMI are currently under research and evaluation and some have already been integrated into current guidelines and/or implemented into the clinical routine in selected centers. This article summarizes these different diagnostic strategies for patients with suspected AMI, using cardiac troponin alone or in combination with copeptin.
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Affiliation(s)
- Martin Möckel
- 1Division of Emergency Medicine/Chest Pain Units, Campus Virchow Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Slagman
- 1Division of Emergency Medicine/Chest Pain Units, Campus Virchow Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Searle
- 1Division of Emergency Medicine/Chest Pain Units, Campus Virchow Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
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113
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Copeptin for the early rule-out of non-ST-elevation myocardial infarction. Int J Cardiol 2016; 223:797-804. [DOI: 10.1016/j.ijcard.2016.08.304] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 08/19/2016] [Indexed: 12/19/2022]
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114
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Beri N, Marston NA, Daniels LB, Nowak RM, Schreiber D, Mueller C, Jaffe A, Diercks DB, Wettersten N, DeFilippi C, Peacock WF, Limkakeng AT, Anand I, McCord J, Hollander JE, Wu AHB, Apple FS, Nagurney JT, Berardi C, Cannon CM, Clopton P, Neath SX, Christenson RH, Hogan C, Vilke G, Maisel A. Necessity of hospitalization and stress testing in low risk chest pain patients. Am J Emerg Med 2016; 35:274-280. [PMID: 27847253 DOI: 10.1016/j.ajem.2016.10.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/10/2016] [Accepted: 10/28/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Copeptin is a marker of endogenous stress including early myocardial infarction(MI) and has value in early rule out of MI when used with cardiac troponin I(cTnI). OBJECTIVES The goal of this study was to demonstrate that patients with a normal electrocardiogram and cTnI<0.040μg/l and copeptin<14pmol/l at presentation and after 2 h may be candidates for early discharge with outpatient follow-up potentially including stress testing. METHODS This study uses data from the CHOPIN trial which enrolled 2071 patients with acute chest pain. Of those, 475 patients with normal electrocardiogram and normal cTnI(<0.040μg/l) and copeptin<14pmol/l at presentation and after 2 h were considered "low risk" and selected for further analysis. RESULTS None of the 475 "low risk" patients were diagnosed with MI during the 180day follow-up period (including presentation). The negative predictive value of this strategy was 100% (95% confidence interval(CI):99.2%-100.0%). Furthermore no one died during follow up. 287 (60.4%) patients in the low risk group were hospitalized. In the "low risk" group, the only difference in outcomes (MI, death, revascularization, cardiac rehospitalization) was those hospitalized underwent revascularization more often (6.3%[95%CI:3.8%-9.7%] versus 0.5%[95%CI:0.0%-2.9%], p=.002). The hospitalized patients were tested significantly more via stress testing or angiogram (68.6%[95%CI:62.9%-74.0%] vs 22.9%[95%CI:17.1%-29.6%], p<.001). Those tested had less cardiac rehospitalizations during follow-up (1.7% vs 5.1%, p=.040). CONCLUSIONS In conclusion, patients with a normal electrocardiogram, troponin and copeptin at presentation and after 2 h are at low risk for MI and death over 180days. These low risk patients may be candidates for early outpatient testing and cardiology follow-up thereby reducing hospitalization.
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Affiliation(s)
- Neil Beri
- Department of Internal Medicine, University of California, San Diego, La Jolla, CA, United States.
| | - Nicholas A Marston
- Department of Internal Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Lori B Daniels
- Division of Cardiology, Department of Internal Medicine, University of California, San Diego, La Jolla, California, United States
| | - Richard M Nowak
- Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, United States
| | - Donald Schreiber
- Department of Emergency Medicine, Stanford University, Palo Alto, CA, United States
| | - Christian Mueller
- Division of Cardiology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Allan Jaffe
- Division of Cardiology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX, United States
| | - Nicholas Wettersten
- Division of Cardiology, Department of Internal Medicine, University of California, San Diego, La Jolla, California, United States
| | - Christopher DeFilippi
- Division of Cardiology, Department of Internal Medicine, University of Maryland, Baltimore, MD, United States
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States
| | | | - Inder Anand
- Division of Cardiology, Department of Internal Medicine, Veterans Affairs Medical Center, Minneapolis, MN, United States
| | - James McCord
- Division of Cardiology, Department of Internal Medicine, Henry Ford Health System, Detroit, MI, United States
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States
| | - Alan H B Wu
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, CA, United States
| | - Fred S Apple
- Department of Pathology, Hennepin County Medical Center and University of Minnesota, Minneapolis, United States
| | - John T Nagurney
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Cecilia Berardi
- School of Medicine, "La Sapienza" University of Rome, Rome, Italy
| | - Chad M Cannon
- Department of Emergency Medicine, University of Kansas, Kansas City, KS, United States
| | - Paul Clopton
- Statistics, Veterans Affairs Medical Center, San Diego, CA, United States
| | - Sean-Xavier Neath
- Department of Emergency Medicine, University of California, San Diego, La Jolla, CA, United States
| | | | - Christopher Hogan
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, United States
| | - Gary Vilke
- Department of Emergency Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Alan Maisel
- Division of Cardiology, Department of Internal Medicine, University of California, San Diego, La Jolla, California, United States
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115
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Polk A, Shahmarvand N, Vistisen K, Vaage-Nilsen M, Larsen FO, Schou M, Nielsen DL. Incidence and risk factors for capecitabine-induced symptomatic cardiotoxicity: a retrospective study of 452 consecutive patients with metastatic breast cancer. BMJ Open 2016; 6:e012798. [PMID: 27798021 PMCID: PMC5073470 DOI: 10.1136/bmjopen-2016-012798] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Case reports of capecitabine cardiotoxicity resemble those seen with intravenous 5-fluorouracil (5-FU) with chest pain as the predominant manifestation, but few studies of capecitabine cardiotoxicity are available. We aimed to determine the incidence of symptomatic cardiotoxicity from capecitabine in patients with breast cancer and to identify risk factors. METHODS We reviewed medical records of consecutive women with breast cancer treated with capecitabine (1000 mg/m2 two times per day) from 2002 to 2012 at one institution. RESULTS 22 of 452 patients (4.9%) (95% CI 2.9% to 6.9%) had symptoms of cardiotoxicity (chest pain: n=13, dyspnoea: n=9, palpitations: n=2). 11 patients had changes on ECG (atrial fibrillation: n=5, ST deviations: n=3, T-wave abnormalities: n=2 and QTc prolongation: n=1). 2 patients (0.4%) sustained acute myocardial infarction. 1 patient (0.2%) developed cardiac arrest with lethal outcome. 4 of 6 patients (66%) retreated with capecitabine had recurrent symptoms at retreatment. Cardiac comorbidity (p=0.001), hypercholesterolaemia (p=0.005) and current smoking (p=0.023) were risk factors for cardiotoxicity in univariate analyses and remained significant when adjusted for age. Patients with cardiac comorbidity were 5.5 times (95% CI 2.0 to 14.8) more likely to develop cardiotoxicity. In the subgroup of patients with apparently no cardiac comorbidity, the incidence of cardiotoxicity was lower (3.7%) and hypercholesterolaemia (p=0.035) and current smoking (p=0.020) were risk factors of cardiotoxicity. CONCLUSIONS The incidence of cardiotoxicity from capecitabine resembles that of intravenous 5-FU (≈5%). Cardiac comorbidity, hypercholesterolaemia and current smoking were associated with development of cardiotoxicity.
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Affiliation(s)
- Anne Polk
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Nahid Shahmarvand
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Kirsten Vistisen
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Merete Vaage-Nilsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Finn Ole Larsen
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Dorte Lisbeth Nielsen
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
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116
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Sörensen NA, Shah AS, Ojeda FM, Peitsmeyer P, Zeller T, Keller T, Johannsen SS, Lackner KJ, Griffiths M, Münzel T, Mills NL, Blankenberg S, Schnabel RB. High-sensitivity troponin and novel biomarkers for the early diagnosis of non-ST-segment elevation myocardial infarction in patients with atrial fibrillation. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2016; 5:419-427. [PMID: 26460326 DOI: 10.1177/2048872615611108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/21/2015] [Indexed: 09/17/2023]
Abstract
AIMS To evaluate the diagnostic performance of high-sensitivity troponin I (hsTnI) and other novel biomarkers for diagnosing non-ST-segment elevation myocardial infarction (NSTEMI) in patients with atrial fibrillation. METHODS In an acute chest pain cohort (N=1673), mean age 61.4±13.6 (34% female), we measured hsTnI and 13 established and novel biomarkers reflecting ischaemia, necrosis, inflammation, myocardial stress, angiogenesis on admission and after three hours in order to investigate their diagnostic accuracy for NSTEMI. RESULTS In atrial fibrillation patients (N=299) hsTnI on admission had the best discriminatory ability for NSTEMI (area under the curve 0.97) with only two novel biomarkers, copeptin and heart-type fatty acid binding protein, having area under the curve >0.70. Measured biomarkers showed comparable discriminatory ability in atrial fibrillation and non-atrial fibrillation patients. The combination of hsTnI on admission with additional biomarkers did not clinically significantly improve diagnostic performance. In atrial fibrillation patients, hsTnI concentrations ⩽21.7 ng/L (99th percentile in a healthy German cohort) on admission gave a negative predictive value of ~100% (95% confidence interval 97-100%). The combination of hsTnI on admission and absolute change of hsTnI concentration after three hours of ⩾40 ng/L resulted in a positive predictive value of 81.2% and sensitivity of 88.6%. Diagnostic accuracy was validated in an independent cohort (N=1076). CONCLUSION The diagnostic accuracy of hsTnI in patients with acute chest pain and atrial fibrillation is high and comparable to those without atrial fibrillation. Absolute change in hsTnI concentration enhanced diagnostic performance. No clinically relevant improvement was achieved by adding other biomarkers.
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Affiliation(s)
- Nils A Sörensen
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Anoop Sv Shah
- BHF/University Centre for Cardiovascular Science, UK
| | - Francisco M Ojeda
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Philipp Peitsmeyer
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center, Germany German Center for Cardiovascular research (DZHK), Partner Site Hamburg, Germany
| | - Till Keller
- Department of Cardiology, University Hospital Frankfurt, Germany German Center for Cardiovascular research (DZHK), Partner Site Rhein/Main, Germany
| | - Silke S Johannsen
- Department of General and Interventional Cardiology, University Heart Center, Germany German Center for Cardiovascular research (DZHK), Partner Site Hamburg, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | | | - Thomas Münzel
- German Center for Cardiovascular research (DZHK), Partner Site Rhein/Main, Germany Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | | | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center, Germany German Center for Cardiovascular research (DZHK), Partner Site Hamburg, Germany
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart Center, Germany German Center for Cardiovascular research (DZHK), Partner Site Hamburg, Germany
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Calmarza P, Lapresta C, García-Castañón S, López-Perales C, Pérez-Guerrero A, Portolés A. [Usefulness of copeptin in the diagnosis of acute coronary syndrome in the emergency department of a tertiary hospital]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28:209-215. [PMID: 27650658 DOI: 10.1016/j.arteri.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/27/2016] [Accepted: 07/03/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study was conducted in order to evaluate the usefulness of copeptin (a stable fragment of the precursor of arginine vasopressin) in the differential diagnosis of acute chest pain of probable coronary origin. MATERIAL AND METHODS The study includes 82 patients who were initially evaluated according to the protocol of a patient with suspected acute coronary syndrome (ACS) in our Emergency Department, including the determination of troponin and copeptin with specimens taken on admission (time 0) and at 6h. RESULTS Statistically significant differences were observed in copeptin concentrations at time 0 among patients diagnosed with non-ST-segment elevation (NTEACS): 42.1±38.7pmol/L and non-NSTEACS patients: 15.6±21.2pmol/L (P<. 01). However, the differences did not reach statistical significance at 6h (P=.093). The analysis of the area under the ROC curve for Copeptin in NSTEACS patients at time 0 was 0.713, with a confidence interval of 95% from 0.592 to 0.834 and a significance level of P=.001. CONCLUSIONS The concentration of copeptin represents an additional value in the differentiation between NSTEACS patients and non-NSTEACS patients, as well as between ACS patients and patients with stable angina. The cut-off point of 10pmol/L provides the best values for sensitivity, negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) in the diagnosis of NSTEACS patients.
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Affiliation(s)
- Pilar Calmarza
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - Carlos Lapresta
- Servicio de Medicina Preventiva, Hospital de Barbastro, Zaragoza, España
| | | | | | | | - Ana Portolés
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, España
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118
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Lüscher TF. Troponin: the basis of decision-making in suspected acute coronary syndromes and beyond. Eur Heart J 2016; 37:2385-7. [DOI: 10.1093/eurheartj/ehw329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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119
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Spencer TR, Sidhu MS, Bisaillon J, Christopher King C. Novel Cardiac Biomarkers for Emergency Department Evaluation of Acute Coronary Syndrome: The Recent Evidence on Non-troponin Biomarkers and Their Limitations. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40138-016-0104-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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120
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Mueller C, Giannitsis E, Möckel M, Huber K, Mair J, Plebani M, Thygesen K, Jaffe AS, Lindahl B. Rapid rule out of acute myocardial infarction: novel biomarker-based strategies. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:218-222. [DOI: 10.1177/2048872616653229] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | | | - Martin Möckel
- Division of Emergency Medicine and Department of Cardiology, Charite, Universitätsmedizin Berlin, Germany
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Austria
| | - Johannes Mair
- Department of Internal Medicine III – Cardiology and Angiology, Innsbruck Medical University, Austria
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital Padova, Italy
| | | | | | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University and Uppsala Clinical Research Center, Sweden
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121
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Management of Patients With NSTE-ACS. J Am Coll Cardiol 2016; 68:313-321. [DOI: 10.1016/j.jacc.2016.03.599] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/25/2016] [Accepted: 03/01/2016] [Indexed: 11/24/2022]
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122
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Mueller C, Giannitsis E, Christ M, Ordóñez-Llanos J, deFilippi C, McCord J, Body R, Panteghini M, Jernberg T, Plebani M, Verschuren F, French J, Christenson R, Weiser S, Bendig G, Dilba P, Lindahl B, Twerenbold R, Katus HA, Popp S, Santalo-Bel M, Nowak RM, Horner D, Dolci A, Zaninotto M, Manara A, Menassanch-Volker S, Jarausch J, Zaugg C. Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T. Ann Emerg Med 2016; 68:76-87.e4. [DOI: 10.1016/j.annemergmed.2015.11.013] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/22/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
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123
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Montecucco F, Carbone F, Schindler TH. Pathophysiology of ST-segment elevation myocardial infarction: novel mechanisms and treatments. Eur Heart J 2016; 37:1268-1283. [PMID: 26543047 DOI: 10.1093/eurheartj/ehv592] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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124
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Ahlin F, Arfvidsson J, Vargas KG, Stojkovic S, Huber K, Wojta J. MicroRNAs as circulating biomarkers in acute coronary syndromes: A review. Vascul Pharmacol 2016; 81:15-21. [PMID: 27084396 DOI: 10.1016/j.vph.2016.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/02/2016] [Accepted: 04/03/2016] [Indexed: 12/15/2022]
Abstract
Coronary artery disease (CAD) and its complications remain the most common cause of death worldwide. Cardiac troponins (cTn) are standard biomarkers used today for diagnosis and risk stratification of myocardial infarction (MI). Increasing efforts are made to develop additional, new biomarkers for more effective and safe rule-in and rule-out of MI patients at the emergency department. During the past decade, microRNAs (miRNAs) have emerged as new, potential diagnostic biomarkers in several diseases, including MI. In this review, we aimed to summarize some of the prominent studies in the field, and discuss the potential value of miRNAs in the diagnosis of MI.
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Affiliation(s)
- Fredrik Ahlin
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen hospital, Vienna, Austria; Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - John Arfvidsson
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen hospital, Vienna, Austria; Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Kris G Vargas
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen hospital, Vienna, Austria
| | - Stefan Stojkovic
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen hospital, Vienna, Austria; Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria; Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Johann Wojta
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria; Core Facilities, Medical University of Vienna, Vienna, Austria.
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125
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Neumann JT, Sörensen NA, Westermann D. Biomarkers in the triage of chest pain: are we making progress? Biomark Med 2016; 10:345-7. [DOI: 10.2217/bmm.16.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Nils Arne Sörensen
- General & Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Dirk Westermann
- General & Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
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126
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Fox WR, Diercks DB. Troponin assay use in the emergency department for management of patients with potential acute coronary syndrome: current use and future directions. Clin Exp Emerg Med 2016; 3:1-8. [PMID: 27752608 PMCID: PMC5051615 DOI: 10.15441/ceem.16.120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 01/01/2023] Open
Abstract
Troponins are proteins commonly found in cardiac tissue that are released during myocardial ischemia or necrosis. These troponins can be detected by assays that can then be used to guide clinical decision-making and disposition, especially if the suspected insult is related to acute coronary syndrome. Timing of troponin measurement can be important as elevations may not be detectible immediately after an insult. New assays have been designed to detect troponin con-centrations previously too low to be detected by conventional assays. These tests are known as high-sensitivity cardiac troponin assays. Current research is aimed at evaluating the clinical sig-nificance of troponin elevations detected by these new assays especially in management of pa-tients with suspected acute coronary syndrome. A number of risk-stratification scores exist to assist physicians with evaluating chest pain in the emergency department in the context of de-tection (or absence) of troponins in systemic circulation. Additionally, investigators are working to integrate data generated by hs-cTn measurements into existing and new risk-stratification scores.
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Affiliation(s)
- William R Fox
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX , USA
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX , USA
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127
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Stallone F, Schoenenberger AW, Puelacher C, Rubini Gimenez M, Walz B, Naduvilekoot Devasia A, Bergner M, Twerenbold R, Wildi K, Reichlin T, Hillinger P, Erne P, Mueller C. Incremental value of copeptin in suspected acute myocardial infarction very early after symptom onset. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:407-15. [PMID: 27013743 DOI: 10.1177/2048872616641289] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 03/04/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Patients presenting very early after chest pain onset may provide a diagnostic challenge even when using a high-sensitivity cardiac troponin (hs-cTnT). We hypothesized that in these patients the incremental value of copeptin in the early diagnosis of acute myocardial infarction (AMI) may be substantial. METHODS We aimed to investigate the incremental value of copeptin in a pre-specified subgroup analysis of patients presenting with suspected AMI to the emergency department within 2 hours of symptom onset in a multicenter study. Copeptin was measured in a blinded fashion. Two independent cardiologists adjudicated the final diagnosis using all available clinical informations, including high-sensitivity cardiac troponin T (hs-cTnT). RESULTS Overall, 2000 patients were enrolled, of whom 519 (26%) arrived within 2 hours of symptom onset. Of these, 102 patients (20%) had an AMI. The additional use of copeptin did not increase diagnostic accuracy as quantified by the area under the receiver-operating characteristic curve (AUC) of hs-cTnT (0.87 (95% confidence interval (CI): 0.83-0.90) for hs-cTnT alone to 0.86 (95% CI: 0.82-0.90) for the combination; p = NS). Copeptin (using 9 pmol/L as a cut-off) increased the negative predictive value (NPV) of hs-cTnT (using 14 ng/L as a cut-off) alone from 93% (95% CI: 90-95%) to 96% (95% CI: 93-98%). The NPV for the combination of hs-cTnT and copeptin was lower in patients arriving in the first 2 hours than in those arriving after 2 hours: 96% (95% CI: 93-98%) versus 99% (95% CI: 99-100%), respectively. CONCLUSIONS The additional use of copeptin on top of hs-cTnT seems to lead to a small increase in NPV, but no increase in AUC. Routine use of copeptin in early presenters does not seem warranted.
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Affiliation(s)
- Fabio Stallone
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland Department of Internal Medicine, University Hospital Basel, Switzerland
| | - Andreas W Schoenenberger
- Division of Geriatrics, Department of General Internal Medicine, Inselspital, Bern University Hospital, Switzerland University of Bern, Switzerland
| | - Christian Puelacher
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland Department of Internal Medicine, University Hospital Basel, Switzerland
| | - Maria Rubini Gimenez
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland Department of Internal Medicine, University Hospital Basel, Switzerland
| | - Brigitte Walz
- Central Laboratory, Luzerner Kantonsspital, Switzerland
| | - Allwin Naduvilekoot Devasia
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland
| | - Michael Bergner
- Department of Intensive Care Medicine, University Hospital Basel, Switzerland
| | - Raphael Twerenbold
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland
| | - Karin Wildi
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland Department of Intensive Care Medicine, University Hospital Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland
| | - Petra Hillinger
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland Department of Internal Medicine, University Hospital Basel, Switzerland
| | - Paul Erne
- Department of Cardiology, Luzerner Kantonsspital, Switzerland
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland
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128
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Copeptin and high-sensitivity cardiac troponin to exclude severe coronary stenosis in patients with chest pain and coronary artery disease. Am J Emerg Med 2016; 34:493-8. [DOI: 10.1016/j.ajem.2015.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/08/2015] [Accepted: 12/10/2015] [Indexed: 11/22/2022] Open
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129
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Prognostic Value of Undetectable hs Troponin T in Suspected Acute Coronary Syndrome. Am J Med 2016; 129:274-82.e2. [PMID: 26524709 DOI: 10.1016/j.amjmed.2015.10.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND The search for improved strategies for safe and early discharge of patients with suspected acute coronary syndrome in emergency departments is ongoing. This Biomarkers in Cardiology (BIC)-8 biomarker substudy evaluated the usefulness of high-sensitivity troponin T (hsTnT) below or above the limit of detection (LoD) in low-to-intermediate-risk patients with suspected acute coronary syndrome in the emergency department. METHODS Patients were categorized into hsTnT ≥ the 99th percentile, between the 99th percentile and LoD, or undetectable hsTnT (<LoD). HsTnT and copeptin were measured at admission, using a copeptin cut-off of 10 pmol/L. The primary endpoint was death and myocardial infarction within 90 days after admission. RESULTS Of 882 patients with all biomarker results, 577 (65.4%) had detectable hsTnT levels (≥LoD). Among the 305 patients (34.6%) with undetectable hsTnT, no myocardial infarctions or deaths occurred within 90 days. In patients with detectable hsTnT at admission (≥LoD but ≤99th percentile), the combined endpoint occurred in 1.5% (6/410) of the copeptin-negative patients and in 6.3% (6/96) of copeptin-positive patients within 90 days (hazard ratio 4.39; 95% confidence interval, 1.42-13.61; P = .01). In patients with an initially elevated hsTnT (≥14 ng/L), 9.7% (3/31) of the copeptin-negative patients and 15.4% (4/26) of the copeptin-positive patients experienced the combined endpoint (hazard ratio 1.61; 95% confidence interval, 0.36-7.17; P = .536). CONCLUSIONS In low-to-intermediate-risk patients with suspected acute coronary syndrome, undetectable hsTnT values at admission allow a safe discharge without occurrence of death or myocardial infarction within 90 days.
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130
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Ozturk N, Baygutalp NK, Bayramoglu A, Polat H, Gul MA, Bakan E, Aslan S, Gunes ON. The Evaluation of Serum Copeptin Levels and Some Commonly Seen Thrombophilic Mutation Prevalence in Acute Pulmonary Embolism. Biochem Genet 2016; 54:306-312. [PMID: 26886096 DOI: 10.1007/s10528-016-9720-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 02/08/2016] [Indexed: 11/24/2022]
Abstract
Acute pulmonary embolism (PE) is a common, emergent condition and may affect a large number of patients. Copeptin has been indicated to be a sensitive biomarker of arginine vasopressin release, and has diagnostic and prognostic value in various clinical conditions. Genetic mutations are considerable components of thrombophilic diseases, and factor II gene G20210A, (FII20210A), factor V Leiden (FVL, G1691A) and methylenetetrahydrofolate reductase gene C677T (MTHFR677T) single nucleotide polymorphisms are the most common mutations of thrombophilic diseases. In this study, serum copeptin levels were determined in patients with PE and healthy controls, and the results were discussed. The prevalence of some commonly seen thrombophilic mutations was also evaluated in patients with PE. The study included 32 patients (18 male, 14 female) with PE and 24 (13 male, 11 female) age- and gender-matched healthy controls. A significant difference in serum copeptin levels was determined between the patient and control groups (8.58 ± 4.42 and 4.07 ± 1.02 pmol/L, respectively). Heterozygous mutant genotype for FII20210A and heterozygous mutant genotype for FVL were observed in 3.1 and 9.4% of patients, respectively. Mutant genotype of 49% was determined for MTHFR677T mutations. It was concluded that copeptin may have diagnostic value for PE.
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Affiliation(s)
- Nurinnisa Ozturk
- Department of Medical Biochemistry, Faculty of Medicine, Ataturk University Research Hospital, Ataturk University Medical School, Ataturk University, 25070, Erzurum, Turkey.
| | - Nurcan Kilic Baygutalp
- Department of Medical Biochemistry, Faculty of Medicine, Ataturk University Research Hospital, Ataturk University Medical School, Ataturk University, 25070, Erzurum, Turkey
| | - Atif Bayramoglu
- Department of Emergency, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Harun Polat
- Department of Medical Biochemistry, Faculty of Medicine, Ataturk University Research Hospital, Ataturk University Medical School, Ataturk University, 25070, Erzurum, Turkey
| | - Mehmet Ali Gul
- Department of Medical Biochemistry, Faculty of Medicine, Ataturk University Research Hospital, Ataturk University Medical School, Ataturk University, 25070, Erzurum, Turkey
| | - Ebubekir Bakan
- Department of Medical Biochemistry, Faculty of Medicine, Ataturk University Research Hospital, Ataturk University Medical School, Ataturk University, 25070, Erzurum, Turkey
| | - Sahin Aslan
- Department of Emergency, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Ozge Nur Gunes
- Department of Medical Biochemistry, Faculty of Medicine, Ataturk University Research Hospital, Ataturk University Medical School, Ataturk University, 25070, Erzurum, Turkey
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Abstract
Heart failure (HF) is one of the most common causes of hospitalization and mortality in the modern Western world and an increasing proportion of the population will be affected by HF in the future. Although HF management has improved quality of life and prognosis, mortality remains very high despite therapeutic options. Medical management consists of a neurohormonal blockade of an overly activated neurohormonal axis. No single marker has been able to predict or monitor HF with respect to disease progression, hospitalization, or mortality. New methods for diagnosis, monitoring therapy, and prognosis are warranted. Copeptin, a precursor of pre-provasopressin, is a new biomarker in HF with promising potential. Copeptin has been found to be elevated in both acute and chronic HF and is associated with prognosis. Copeptin, in combination with other biomarkers, could be a useful marker in the monitoring of disease severity and as a predictor of prognosis and survival in HF.
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Affiliation(s)
- Louise Balling
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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132
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Ricci F, Di Scala R, Massacesi C, Di Nicola M, Cremonese G, De Pace D, Rossi S, Griffo I, Cataldo I, Martinotti S, Rotondo D, Jaffe AS, Zimarino M, De Caterina R. Ultra-Sensitive Copeptin and Cardiac Troponin in Diagnosing Non-ST-Segment Elevation Acute Coronary Syndromes--The COPACS Study. Am J Med 2016; 129:105-14. [PMID: 26169889 DOI: 10.1016/j.amjmed.2015.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/13/2015] [Accepted: 06/15/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We tested the noninferiority of a fast-track rule-out protocol for the diagnosis of non-ST-segment elevation myocardial infarction vs noncoronary chest pain based on the single-sampling combined assessment of medium-sensitivity cardiac troponin I and ultra-sensitive copeptin compared with the serial assessment of medium-sensitivity cardiac troponin I. METHODS Ultra-sensitive copeptin and medium-sensitivity cardiac troponin I levels were measured at presentation in 196 consecutive patients admitted to the emergency department for acute nontraumatic chest pain within 6 hours from symptoms onset and without ST-segment elevation on a 12-lead electrocardiogram. The diagnostic performance for non-ST-segment elevation myocardial infarction diagnosis of the dual-marker single-sampling strategy with medium-sensitivity cardiac troponin I and ultra-sensitive copeptin on admission was compared with that of the serial 0- and 3-hour medium-sensitivity cardiac troponin I sampling in reference to the adjudicated postdischarge diagnosis, using both the comparison of area under the curve (AUC) receiver operating characteristic and the McNemar chi-square test. RESULTS The diagnosis of non-ST-segment elevation myocardial infarction was adjudicated in 29 patients (14.8%). The combination of medium-sensitivity cardiac troponin I and ultra-sensitive copeptin generated an AUC of 0.87 (95% confidence interval, 0.82-0.91), which was noninferior with respect to the 3-hour interval medium-sensitivity cardiac troponin I serial sampling (P = .194 for AUC difference). The combination of medium-sensitivity cardiac troponin I and ultra-sensitive copeptin also yielded a numerically higher diagnostic sensitivity (100% vs 89.7%; P = not significant). CONCLUSIONS A single-sampling strategy of combined ultra-sensitive copeptin and medium-sensitivity cardiac troponin I is noninferior to a 0- and 3-hour serial medium-sensitivity cardiac troponin I sampling in ruling out non-ST-segment elevation myocardial infarction and thus may allow an earlier discharge of patients who are ruled out for non-ST-segment elevation myocardial infarction (ClinicalTrials.gov Identifier NCT01962506).
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Affiliation(s)
- Fabrizio Ricci
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Rosa Di Scala
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Cristiano Massacesi
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Marta Di Nicola
- Laboratory of Biostatistics, Department of Experimental and Clinical Science, "G. d'Annunzio" University, Chieti, Italy
| | - Gianni Cremonese
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Doranna De Pace
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Serena Rossi
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Irma Griffo
- Department of Biomedical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Ivana Cataldo
- Department of Biomedical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Stefano Martinotti
- Department of Biomedical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Domenico Rotondo
- Emergency Department, Azienda Sanitaria Locale 2 Abruzzo Lanciano-Vasto-Chieti Hospitals, Chieti, Italy
| | | | - Marco Zimarino
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Raffaele De Caterina
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
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Desclefs JP, Martinez M, Cesareo E, Meininger C, Lefort H, Valdenaire G, Freund Y. Actualités en médecine d’urgence. ANNALES FRANCAISES DE MEDECINE D URGENCE 2015. [DOI: 10.1007/s13341-015-0592-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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134
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Hillinger P, Twerenbold R, Jaeger C, Wildi K, Reichlin T, Gimenez MR, Engels U, Miró O, Boeddinghaus J, Puelacher C, Nestelberger T, Röthlisberger M, Ernst S, Rentsch K, Mueller C. Optimizing Early Rule-Out Strategies for Acute Myocardial Infarction: Utility of 1-Hour Copeptin. Clin Chem 2015; 61:1466-74. [DOI: 10.1373/clinchem.2015.242743] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/06/2015] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Combined testing of high-sensitivity cardiac troponin T (hs-cTnT) and copeptin at presentation provides a very high—although still imperfect—negative predictive value (NPV) for the early rule-out of acute myocardial infarction (AMI). We hypothesized that a second copeptin measurement at 1 h might further increase the NPV.
METHODS
In a prospective diagnostic multicenter study, we measured hs-cTnT and copeptin concentrations at presentation and at 1 h in 1439 unselected patients presenting to the emergency department with suspected AMI. The final diagnosis was adjudicated by 2 independent cardiologists blinded to copeptin concentrations. We investigated the incremental value of 1-h copeptin in the rule-out setting (0-h hs-cTnT negative and 0-h copeptin negative) and the intermediate-risk setting (0-h hs-cTnT negative and 0-h copeptin positive).
RESULTS
The adjudicated diagnosis was AMI in 267 patients (18.6%). For measurements obtained at presentation, the NPV in the rule-out setting was 98.6% (95% CI, 97.4%–99.3%). Whereas 1-h copeptin did not increase the NPV significantly, 1-h hs-cTnT did, to 99.6% (95% CI, 98.7%–99.9%, P = 0.008). Similarly, in the intermediate-risk setting (NPV 92.8%, 95% CI, 88.7%–95.8%), 1-h copeptin did not significantly increase the NPV (P = 0.751), but 1-h hs-cTnT did, to 98.6 (95% CI, 96%–99.7%, P < 0.001).
CONCLUSIONS
One-hour copeptin increased neither the safety of the rule-out process nor the NPV in the intermediate-risk setting. In contrast, the incremental value of 1-h hs-cTnT was substantial in both settings. ClinicalTrials.gov/NCT00470587
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Affiliation(s)
- Petra Hillinger
- Department of Cardiology and Cardiovascular Research Institute Basel and
| | - Raphael Twerenbold
- Department of Cardiology and Cardiovascular Research Institute Basel and
| | - Cedric Jaeger
- Department of Cardiology and Cardiovascular Research Institute Basel and
| | - Karin Wildi
- Department of Cardiology and Cardiovascular Research Institute Basel and
| | - Tobias Reichlin
- Department of Cardiology and Cardiovascular Research Institute Basel and
| | - Maria Rubini Gimenez
- Department of Cardiology and Cardiovascular Research Institute Basel and
- Servicio de Urgencias, Hospital del Mar – Institut Municipal d'Investigació Mèdica, Barcelona, Spain
| | - Ulrike Engels
- Department of Cardiology and Cardiovascular Research Institute Basel and
| | - Oscar Miró
- Emergency Department, Hospital Clínic, Barcelona, Catalonia, Spain
- Research Group “Emergencies: Processes and Pathologies,” Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | | | | | | | | | - Susanne Ernst
- Department of Internal Medicine, Kantonsspital Olten, Switzerland
| | | | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel and
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Liebetrau C, Gaede L, Dörr O, Blumenstein J, Rosenburg S, Hoffmann J, Troidl C, Hamm CW, Nef HM, Möllmann H, Richards AM, Pemberton CJ. Reference Values and Release Kinetics of B-Type Natriuretic Peptide Signal Peptide in Patients with Acute Myocardial Infarction. Clin Chem 2015; 61:1532-9. [DOI: 10.1373/clinchem.2015.244327] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/22/2015] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
The signal peptide for human B-type natriuretic peptide preprohormone (BNPsp), which is released from cardiomyocytes, is increased in plasma of patients with acute myocardial infarction (AMI); however, its exact release kinetics have not been defined.
METHODS
We measured BNPsp and high-sensitivity cardiac troponin T (hs-cTnT) in a reference group of individuals without structural heart disease (n = 285) and determined the release kinetics of these biomarkers in patients (n = 29) with hypertrophic obstructive cardiomyopathy undergoing transcoronary ablation of septal hypertrophy (TASH), a procedure allowing exact timing of onset of iatrogenic AMI. Blood samples were collected before TASH and at numerous preselected time points after TASH.
RESULTS
The reference median BNPsp concentration was 53.4 pmol/L [interquartile range (IQR) 47.0–61.0; 95th percentile 85.9 pmol/L; 99th percentile 116.3 pmol/L]. Baseline concentrations in patients undergoing TASH were higher than in the reference group [91.9 pmol/L (IQR 62.9–116.4); P < 0.0001]. BNPsp increased significantly, peaking at 15 min after induction of AMI [149.6 pmol/L (109.5–204.9) vs baseline; P = 0.004] and declining slowly thereafter, falling below the preprocedural value after 8 h (P = 0.014). hs-cTnT increased significantly 15 min after induction of AMI [26 ng/L (19–39) vs 18 ng/L (11–29); P = 0.001] and remained high at all later time points.
CONCLUSIONS
BNPsp concentrations increased immediately after AMI induction, providing early evidence of myocardial injury. The release kinetics of BNPsp differed from those of hs-cTnT. These findings provide information that should help in establishing the diagnostic value of BNPsp in the setting of early AMI.
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Affiliation(s)
- Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
- DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany
| | - Luise Gaede
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
- DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany
| | - Oliver Dörr
- Department of Internal Medicine I, Division of Cardiology, University of Giessen, Giessen, Germany
| | - Johannes Blumenstein
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
- DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany
| | - Stefanie Rosenburg
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
- DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany
| | - Jedrzej Hoffmann
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
- DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany
| | - Christian Troidl
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
- DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
- DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany
- Department of Internal Medicine I, Division of Cardiology, University of Giessen, Giessen, Germany
| | - Holger M Nef
- Department of Internal Medicine I, Division of Cardiology, University of Giessen, Giessen, Germany
| | - Helge Möllmann
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
- DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany
| | - A Mark Richards
- Department of Medicine, Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
- Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Chris J Pemberton
- Department of Medicine, Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
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Current approaches for the diagnosis, risk stratification and interventional treatment of patients with acute coronary syndromes without st-segment elevation. КЛИНИЧЕСКАЯ ПРАКТИКА 2015. [DOI: 10.17816/clinpract83255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This article reviews current approaches to diagnosis and determination of the individual risk of patients with acute coronary syndrome without ST-segment elevation. Guidelines for determining the choice of treatment strategy and the time slots for its implementation are discussed. We describe the technical features of the implementation of interventional treatment in this group of patients; the choice of methods of myocardial revascularization is discussed.
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Vafaie M, Biener M, Mueller M, Abu Sharar H, Hartmann O, Hertel S, Katus HA, Giannitsis E. Addition of copeptin improves diagnostic performance of point-of-care testing (POCT) for cardiac troponin T in early rule-out of myocardial infarction — A pilot study. Int J Cardiol 2015; 198:26-30. [DOI: 10.1016/j.ijcard.2015.06.122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
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Slagman A, Searle J, Müller C, Möckel M. Temporal Release Pattern of Copeptin and Troponin T in Patients with Suspected Acute Coronary Syndrome and Spontaneous Acute Myocardial Infarction. Clin Chem 2015; 61:1273-82. [DOI: 10.1373/clinchem.2015.240580] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/10/2015] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
The release pattern of copeptin during the initial 36 h of spontaneous acute myocardial infarction (AMI) has received relatively little investigation but may provide important information on optimal timing of diagnostic measurements.
METHODS
We investigated the release pattern of copeptin and cardiac troponin T in patients with suspected acute coronary syndrome (ACS). Blood samples were collected in the ambulance, at admission, and after 2, 4, 6, and 12–36 h. Copeptin and high-sensitivity cardiac troponin T (hs-cTnT) were measured in heparin plasma samples.
RESULTS
Of 93 patients studied, 37 (39.8%) had ST-elevation myocardial infarction (STEMI), 20 (21.5%) non-STEMI, 20 (21.5%) unstable angina pectoris (UAP), and 16 (17.2%) non-ACS diagnoses. Peak copeptin concentrations were detected during ambulance transport for NSTEMI patients [median 94.0 pmol/L, interquartile range (IQR) 53.3–302.1 pmol/L] and at admission for patients with STEMI (70.0 pmol/L, 22.0–144.8 pmol/L). In patients with AMI, copeptin decreased significantly over time (P < 0.0001). This was true for patients with STEMI (P = 0.005) and non-STEMI (P = 0.021). The diagnostic performance during ambulance transport was similar for hs-cTnT (area under the ROC curve 0.75, 95% CI 0.62–0.88) and copeptin (0.81, 0.69–0.92). In early presenters (n = 52), no patient with AMI was initially (in ambulance or at admission) negative for copeptin, resulting in an area under the ROC curve of 0.963 for ambulance values and a negative predictive value of 100%. In late presenters, the negative predictive value of copeptin was 50% in ambulance and at admission.
CONCLUSIONS
Our analysis is the first to show a consistent early increase in copeptin at first medical contact in the ambulance and a decrease to routine values within 12–36 h in patients presenting early with spontaneous AMI.
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Affiliation(s)
| | | | - Christian Müller
- Department of Laboratory Medicine, Charité University Hospital, Berlin, Germany
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Łukaszyk E, Małyszko J. Copeptin: Pathophysiology and potential clinical impact. Adv Med Sci 2015; 60:335-41. [PMID: 26233637 DOI: 10.1016/j.advms.2015.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/29/2015] [Accepted: 07/02/2015] [Indexed: 12/24/2022]
Abstract
Copeptin, a C-terminal part of the precursor pre-provasopressin is a novel biomarker of arginine-vasopressin (AVP) system. Measurements of AVP concentration are not used in clinical practice because of technical difficulties. Copeptin is synthesized in stoichiometric ratio with AVP, hence it reflects vasopressin concentration in human plasma and serum. This review outlines current research concerning the role of copeptin as a prognostic marker in different diseases and its potential clinical value.
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141
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Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2015; 37:267-315. [PMID: 26320110 DOI: 10.1093/eurheartj/ehv320] [Citation(s) in RCA: 4257] [Impact Index Per Article: 473.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Wendt M, Ebinger M, Kunz A, Rozanski M, Waldschmidt C, Weber JE, Winter B, Koch PM, Nolte CH, Hertel S, Ziera T, Audebert HJ. Copeptin Levels in Patients With Acute Ischemic Stroke and Stroke Mimics. Stroke 2015; 46:2426-31. [PMID: 26251255 DOI: 10.1161/strokeaha.115.009877] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/07/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Copeptin levels are increased in patients diagnosed with stroke and other vascular diseases. Copeptin elevation is associated with adverse outcome, predicts re-events in patients with transient ischemic attack and is used in ruling-out acute myocardial infarction. We evaluated whether copeptin can also be used as a diagnostic marker in the prehospital stroke setting. METHODS We prospectively examined patients with suspected stroke on the Stroke Emergency Mobile-an ambulance that is equipped with computed tomography and point-of-care laboratory. A blood sample was taken from patients immediately after arrival. We analyzed copeptin levels in patients with final hospital-based diagnosis of stroke or stroke mimics as well as in vascular or nonvascular patients. In addition, we examined the associations of symptom onset with copeptin levels and the prognostic value of copeptin in patients with stroke. RESULTS Blood samples of 561 patients were analyzed. No significant differences were seen neither between cerebrovascular (n=383) and other neurological (stroke mimic; n=90) patients (P=0.15) nor between vascular (n=391) and nonvascular patients (n=170; P=0.57). We could not detect a relationship between copeptin levels and time from onset to blood draw. Three-month survival status was available in 159 patients with ischemic stroke. Copeptin levels in nonsurviving patients (n=8: median [interquartile range], 27.4 [20.2-54.7] pmol/L) were significantly higher than in surviving patients (n=151: median [interquartile range], 11.7 [5.2-30.9] pmol/L; P=0.024). CONCLUSIONS In the prehospital setting, copeptin is neither appropriate to discriminate between stroke and stroke mimic patients nor between vascular and nonvascular patients. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01382862. The Pre-Hospital Acute Neurological Therapy and Optimization of Medical Care in Stroke Patients study (PHANTOM-S) was registered (NCT01382862). This sub-study was observational and not registered separately, therefore.
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Affiliation(s)
- Matthias Wendt
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.).
| | - Martin Ebinger
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Alexander Kunz
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Michal Rozanski
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Carolin Waldschmidt
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Joachim E Weber
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Benjamin Winter
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Peter M Koch
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Christian H Nolte
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Sabine Hertel
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Tim Ziera
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Heinrich J Audebert
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
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Rubini Gimenez M, Twerenbold R, Jaeger C, Schindler C, Puelacher C, Wildi K, Reichlin T, Haaf P, Merk S, Honegger U, Wagener M, Druey S, Schumacher C, Krivoshei L, Hillinger P, Herrmann T, Campodarve I, Rentsch K, Bassetti S, Osswald S, Mueller C. One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I. Am J Med 2015; 128:861-870.e4. [PMID: 25840034 DOI: 10.1016/j.amjmed.2015.01.046] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 01/23/2015] [Accepted: 01/23/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We aimed to prospectively derive and validate a novel 1h-algorithm using high-sensitivity cardiac troponin I (hs-cTnI) for early rule-out and rule-in of acute myocardial infarction. METHODS We performed a prospective multicenter diagnostic study enrolling 1811 patients with suspected acute myocardial infarction. The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including coronary angiography, echocardiography, follow-up data, and serial measurements of hs-cTnT (but not hs-cTnI). The hs-cTnI 1h-algorithm, incorporating measurements performed at baseline and absolute changes within 1 hour, was derived in a randomly selected sample of 906 patients (derivation cohort), and then validated in the remaining 905 patients (validation cohort). RESULTS Acute myocardial infarction was the final diagnosis in 18% of patients. After applying the hs-cTnI 1h-algorithm developed in the derivation cohort to the validation cohort, 50.5% of patients could be classified as "rule-out," 19% as "rule-in," 30.5% as "observe." In the validation cohort, the negative predictive value for acute myocardial infarction in the "rule-out" zone was 99.6% (95% confidence interval, 98.4%-100%), and the positive predictive value for acute myocardial infarction in the "rule-in" zone was 73.9% (95% confidence interval, 66.7%-80.2%). Negative predictive value of the 1h-algorithm was higher compared with the classical dichotomous interpretation of hs-cTnI and to the standard of care combining hs-cTnI with the electrocardiogram (both P < .001). Positive predictive value also was higher compared with the standard of care (P < .001). CONCLUSION Using a simple algorithm incorporating baseline hs-cTnI values and the absolute change within the first hour allows safe rule-out as well as accurate rule-in of acute myocardial infarction in 70% of patients presenting with suspected acute myocardial infarction.
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Affiliation(s)
- Maria Rubini Gimenez
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain
| | - Raphael Twerenbold
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Cedric Jaeger
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Christian Schindler
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, University Basel, Switzerland
| | - Christian Puelacher
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Karin Wildi
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Philip Haaf
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Salome Merk
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Ursina Honegger
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Max Wagener
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Sophie Druey
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Carmela Schumacher
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Lian Krivoshei
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Petra Hillinger
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Thomas Herrmann
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Isabel Campodarve
- Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain
| | | | - Stefano Bassetti
- Department of Internal Medicine, University Hospital Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
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Poldervaart JM, Röttger E, Dekker MS, Zuithoff NPA, Verheggen PWHM, de Vrey EA, Wildbergh TX, van ‘t Hof AWJ, Mosterd A, Hoes AW. No Added Value of Novel Biomarkers in the Diagnostic Assessment of Patients Suspected of Acute Coronary Syndrome. PLoS One 2015; 10:e0132000. [PMID: 26177390 PMCID: PMC4503345 DOI: 10.1371/journal.pone.0132000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 06/09/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Despite the availability of high-sensitive troponin (hs-cTnT), there is still room for improvement in the diagnostic assessment of patients suspected of acute coronary syndrome (ACS). Apart from serial biomarker testing, which is time-consuming, novel biomarkers like copeptin have been proposed to expedite the early diagnosis of suspected ACS in addition to hs-cTnT. We determined whether placenta derived growth factor (PlGF), soluble Fms-like tyrosine kinase 1 (sFlt-1), myoglobin, N-terminal prohormone B-type Natriuretic Peptide (NT-proBNP), growth-differentiation factor 15 (GDF-15) and copeptin improved early assessment of chest pain patients. METHODS This prospective, single centre diagnostic FAME-ER study included patients presenting to the ED with symptoms suggestive of ACS. Blood was collected to measure biomarkers, notably, hs-cTnT was retrospectively assessed. Added value of markers was judged by increase in AUC using multivariable logistic regression. RESULTS Of 453 patients enrolled, 149 (33%) received a final diagnosis of ACS. Hs-cTnT had the highest diagnostic value in both univariable and multivariable analysis. PPVs of the biomarkers ranged from 23.5% (PlGF) to 77.9% (hs-cTnT), NPVs from 67.0% (PlGF) to 86.4% (hs-cTnT). Only myoglobin yielded diagnostic value in addition to clinical symptoms and electrocardiography (ECG) (AUC of clinical model 0.80) with AUC of 0.84 (p<0.001). However, addition of hs-cTnT was superior (AUC 0.89, p<0.001). Addition of the biomarkers to our clinical model and hs-cTnT did not or only marginally (GDF-15) improved diagnostic performance. CONCLUSION When assessing patients suspected of ACS, only myoglobin had added diagnostic value beyond clinical symptoms and ECG. However, when combined with hs-cTnT, it yields no additional diagnostic value. PlGF, sFlt-1, NT-proBNP, GDF-15 and copeptin had no added value to the clinical model or hs-cTnT.
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Affiliation(s)
- Judith M. Poldervaart
- Julius Center for Health Sciences and Primary Care, University Medical Center, Universiteitsweg 100, 3584 CG, Utrecht, the Netherlands
- * E-mail:
| | - Emma Röttger
- Faculty of Medicine, Utrecht University, Universiteitsweg 98, 3584 CG, Utrecht, the Netherlands
| | - Marieke S. Dekker
- Department of Cardiology, Isala Clinics, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands
- Department of Cardiology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands
| | - Nicolaas P. A. Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center, Universiteitsweg 100, 3584 CG, Utrecht, the Netherlands
| | - Peter W. H. M. Verheggen
- Department of Cardiology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands
| | - Evelyn A. de Vrey
- Department of Cardiology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands
| | - Thierry X. Wildbergh
- Department of Cardiology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands
| | - Arnoud W. J. van ‘t Hof
- Department of Cardiology, Isala Clinics, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands
| | - Arend Mosterd
- Department of Cardiology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands
| | - Arno W. Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center, Universiteitsweg 100, 3584 CG, Utrecht, the Netherlands
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145
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Post F, Gori T, Giannitsis E, Darius H, Baldus S, Hamm C, Hambrecht R, Hofmeister HM, Katus H, Perings S, Senges J, Münzel T. Criteria of the German Society of Cardiology for the establishment of chest pain units: update 2014. Clin Res Cardiol 2015; 104:918-28. [PMID: 26150114 PMCID: PMC4623090 DOI: 10.1007/s00392-015-0888-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 06/23/2015] [Indexed: 12/22/2022]
Abstract
Since 2008, the German Cardiac Society (DGK) has been establishing a network of certified chest pain units (CPUs). The goal of CPUs was and is to carry out differential diagnostics of acute or newly occurring chest pain of undetermined origin in a rapid and goal-oriented manner and to take immediate therapeutic measures. The basis for the previous certification process was criteria that have been established and published by the task force on CPUs. These criteria regulate the spatial and technical requirements and determine diagnostic and therapeutic strategies in patients with chest pain. Furthermore, the requirements for the organization of CPUs and the training requirements for the staff of a CPU are defined. The certification process is carried out by the DGK; currently, 225 CPUs are certified and 139 CPUs have been recertified after running for a period of 3 years. The certification criteria have now been revised and updated according to new guidelines.
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Affiliation(s)
- Felix Post
- Katholisches Klinikum Koblenz Montabaur, Koblenz, Germany
| | - Tommaso Gori
- II. Medizinische Klinik und Poliklinik für Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | | | - Harald Darius
- Department für Kardiologie, Innere Medizin und Intensivmedizin, Vivantes-Klinikum Neukölln, Berlin, Germany
| | - Stephan Baldus
- Klinikum III für Innere Medizin Uniklinik Köln, Cologne, Germany
| | | | - Rainer Hambrecht
- Klinik für Kardiologie und Angiologie, Herzzentrum Bremen, Bremen, Germany
| | | | - Hugo Katus
- Klinik für KardiologieAngiologie und Pneumonologie, Heidelberg, Germany
| | | | - Jochen Senges
- Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Thomas Münzel
- II. Medizinische Klinik und Poliklinik für Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
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146
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Marston NA, Shah KS, Mueller C, Neath SX, Christenson RH, McCord J, Nowak RM, Daniels LB, Hollander JE, Apple F, Nagurney J, Schreiber D, deFilippi C, Diercks D, Limkakeng A, Anand IS, Wu AHB, Jaffe AS, Peacock WF, Maisel AS. Serial sampling of copeptin levels improves diagnosis and risk stratification in patients presenting with chest pain: results from the CHOPIN trial. Emerg Med J 2015; 33:23-9. [DOI: 10.1136/emermed-2015-204692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/27/2015] [Indexed: 11/04/2022]
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147
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Vorlat A, Van Hoof VO, Hammami R, van Kerckhoven S, Van der Heijden CM, Coenen D, Bosmans JM, Haine S, Vandendriessche TR, Vrints CJ, Claeys MJ. Usefulness of early rule-in and rule-out biomarker protocols to estimate ischemia-induced myocardial injury in early chest pain presenters. Am J Cardiol 2015; 115:1667-71. [PMID: 25929579 DOI: 10.1016/j.amjcard.2015.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/01/2015] [Accepted: 03/01/2015] [Indexed: 01/09/2023]
Abstract
Protocols to minimize the time between 2 measurements of troponin or a combination with copeptin have been developed to rapidly rule-in or rule-out myocardial injury (MI) in patients with chest pain. These fast track protocols to rule-in and rule-out MI are not sufficiently validated for early chest pain presenters. The "early presenter" model was tested in 107 stable patients after a short period of myocardial ischemia, induced by stenting of a significant coronary artery stenosis. High-sensitivity troponin T (hsTnT), high-sensitivity troponin I (hsTnI), and copeptin were measured at the start and 90, 180, and 360 minutes after stent implantation. MI was defined as a troponin level more than the upper limit of normal (ULN) and an absolute increase of >50% ULN on the 360-minute sample. A single combined measurement of troponin and copeptin 90 minutes after the onset of ischemia has a low diagnostic value. This increases when serial measurements with 90-minute intervals are included. For ruling in MI, the highest positive predictive value (with a 95% confidence interval [CI]) can be obtained when focusing only on the increase in troponin level, with a positive predictive value of 86% (70, 93) and 80% (67, 90) for hsTnT and hsTnI, respectively. For ruling out MI, a combined absence of any troponin more than the ULN and any significant increase in troponin level perform best with a negative predictive value of 75% (55, 89) and 75% (55, 89) for hsTnT and hsTnI, respectively. In conclusion, in early presenters, rapid biomarker protocols underestimate MI. A standard biomarker assessment after 3 hours is required to adequately rule-in or rule-out myonecrosis.
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148
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Schurtz G, Lamblin N, Bauters C, Goldstein P, Lemesle G. Copeptin in acute coronary syndromes and heart failure management: State of the art and future directions. Arch Cardiovasc Dis 2015; 108:398-407. [PMID: 26071835 DOI: 10.1016/j.acvd.2015.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/02/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
Abstract
Over the past two decades, the use of multiple biomarkers has changed cardiovascular disease management. Recently, several trials have assessed the diagnostic and prognostic performances of copeptin, especially in patients with heart failure or acute coronary syndromes. Primary results are interesting, with copeptin looking promising for: the management of patients who present at emergency departments early after chest pain onset and the risk stratification of patients with heart failure. The purpose of this article is to review the data on the place of copeptin in the management of patients with chest pain or heart failure.
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Affiliation(s)
- Guillaume Schurtz
- Hôpital cardiologique, centre hospitalier régional et universitaire de Lille, 59037 Lille cedex, France; Faculté de médecine de Lille, 59037 Lille cedex, France
| | - Nicolas Lamblin
- Hôpital cardiologique, centre hospitalier régional et universitaire de Lille, 59037 Lille cedex, France; Faculté de médecine de Lille, 59037 Lille cedex, France; Inserm UMR744, Institut Pasteur de Lille, 59037 Lille cedex, France
| | - Christophe Bauters
- Hôpital cardiologique, centre hospitalier régional et universitaire de Lille, 59037 Lille cedex, France; Faculté de médecine de Lille, 59037 Lille cedex, France; Inserm UMR744, Institut Pasteur de Lille, 59037 Lille cedex, France
| | - Patrick Goldstein
- Emergency Department and SAMU, Lille University Hospital, 59037 Lille cedex, France
| | - Gilles Lemesle
- Hôpital cardiologique, centre hospitalier régional et universitaire de Lille, 59037 Lille cedex, France; Faculté de médecine de Lille, 59037 Lille cedex, France; Inserm UMR744, Institut Pasteur de Lille, 59037 Lille cedex, France.
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149
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Maznyczka A, Kaier T, Marber M. Troponins and other biomarkers in the early diagnosis of acute myocardial infarction. Postgrad Med J 2015; 91:322-30. [DOI: 10.1136/postgradmedj-2014-133129] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 05/08/2015] [Indexed: 12/24/2022]
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150
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Copeptin testing in acute myocardial infarction: ready for routine use? DISEASE MARKERS 2015; 2015:614145. [PMID: 25960596 PMCID: PMC4415476 DOI: 10.1155/2015/614145] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/12/2015] [Indexed: 01/11/2023]
Abstract
Suspected acute myocardial infarction is one of the leading causes of admission to emergency departments. In the last decade, biomarkers revolutionized the management of patients with suspected acute coronary syndromes. Besides their pivotal assistance in timely diagnosis, biomarkers provide additional information for risk stratification. Cardiac troponins I and T are the most sensitive and specific markers of acute myocardial injury. Nonetheless, in order to overcome the remaining limitations of these markers, novel candidate biomarkers sensitive to early stage of disease are being extensively investigated. Among them, copeptin, a stable peptide derived from the precursor of vasopressin, emerged as a promising biomarker for the evaluation of suspected acute myocardial infarction. In this review, we summarize the currently available evidence for the usefulness of copeptin in the diagnosis and risk stratification of patients with suspected acute myocardial infarction in comparison with routine biomarkers.
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