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Chouihed T, Bassand A, Duarte K, Jaeger D, Roth Y, Giacomin G, Delaruelle A, Duchanois C, Bannay A, Kobayashi M, Rossignol P, Girerd N. Head-to-head comparison of diagnostic scores for acute heart failure in the emergency department: results from the PARADISE cohort. Intern Emerg Med 2022; 17:1155-1163. [PMID: 34787803 DOI: 10.1007/s11739-021-02879-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/24/2021] [Indexed: 11/29/2022]
Abstract
BREST and PREDICA scores have recently emerged for the diagnosis of acute heart failure (AHF) in the emergency department (ED). This study aimed to perform a head-to-head comparison in a large contemporary cohort. BREST and PREDICA scores were calculated from, respectively, 11 and 8 routine clinical variables recorded in the ED in 1386 patients from the PArADIsE cohort. The diagnostic performance of the scores for adjudicated AHF diagnosis was assessed by the area under the ROC curve (AUC). Acute HF diagnosis was adjudicated according to the European Society of Cardiology criteria and BNP levels. A BREST score ≤ 3 or PREDICA score ≤ 1 was associated with low probabilities of AHF (5.7% and 2.6%, respectively). Conversely, a BREST score ≥ 9 or PREDICA score ≥ 5 was associated with a high risk of AHF diagnosis (77.3% and 66.9%, respectively) although more than half of the population was within the "gray zone" (4-8 and 2-4 for the BREST and PREDICA scores, respectively). Diagnostic performances of both scores were good (AUC 79.1%, [66.1-82.1] for the BREST score and 82.4%, [79.8-85.0] for the PREDICA score). PREDICA score had significantly higher diagnostic performance than BREST score (increase in AUC 3.3 [0.8-5.8], p = 0.009). Our study emphasizes the good diagnostic performance of both BREST and PREDICA scores, albeit with a significantly higher diagnostic performance of the PREDICA score. Yet, more than half of the population was classified within the "gray zone" by these scores; additional diagnostic tools are needed to ascertain AHF diagnosis in the ED in a majority of patients. Clinical trial registration: NCT02800122.
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Affiliation(s)
- Tahar Chouihed
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques - 1433, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
- Emergency Department, University Hospital of Nancy, Vanvoeuvre-Les-Nancy, Nancy, France
| | - Adrien Bassand
- Emergency Department, University Hospital of Nancy, Vanvoeuvre-Les-Nancy, Nancy, France
| | - Kevin Duarte
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques - 1433, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Déborah Jaeger
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques - 1433, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
- Emergency Department, University Hospital of Nancy, Vanvoeuvre-Les-Nancy, Nancy, France
| | - Yann Roth
- Emergency Department, University Hospital of Nancy, Vanvoeuvre-Les-Nancy, Nancy, France
| | - Gaetan Giacomin
- Emergency Department, University Hospital of Nancy, Vanvoeuvre-Les-Nancy, Nancy, France
| | - Anne Delaruelle
- Emergency Department, University Hospital of Nancy, Vanvoeuvre-Les-Nancy, Nancy, France
| | - Charlène Duchanois
- Emergency Department, University Hospital of Nancy, Vanvoeuvre-Les-Nancy, Nancy, France
| | - Aurélie Bannay
- Université de Lorraine, CHRU-Nancy, Medical Information Department, CNRS, Inria, LORIA, 54000, Nancy, France
| | - Masatake Kobayashi
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques - 1433, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Patrick Rossignol
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques - 1433, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Nicolas Girerd
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques - 1433, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France.
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Neurohumoral, cardiac and inflammatory markers in the evaluation of heart failure severity and progression. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:47-66. [PMID: 33613659 PMCID: PMC7868913 DOI: 10.11909/j.issn.1671-5411.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Heart failure is common in adult population, accounting for substantial morbidity and mortality worldwide. The main risk factors for heart failure are coronary artery disease, hypertension, obesity, diabetes mellitus, chronic pulmonary diseases, family history of cardiovascular diseases, cardiotoxic therapy. The main factor associated with poor outcome of these patients is constant progression of heart failure. In the current review we present evidence on the role of established and candidate neurohumoral biomarkers for heart failure progression management and diagnostics. A growing number of biomarkers have been proposed as potentially useful in heart failure patients, but not one of them still resembles the characteristics of the “ideal biomarker.” A single marker will hardly perform well for screening, diagnostic, prognostic, and therapeutic management purposes. Moreover, the pathophysiological and clinical significance of biomarkers may depend on the presentation, stage, and severity of the disease. The authors cover main classification of heart failure phenotypes, based on the measurement of left ventricular ejection fraction, including heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, and the recently proposed category heart failure with mid-range ejection fraction. One could envisage specific sets of biomarker with different performances in heart failure progression with different left ventricular ejection fraction especially as concerns prediction of the future course of the disease and of left ventricular adverse/reverse remodeling. This article is intended to provide an overview of basic and additional mechanisms of heart failure progression will contribute to a more comprehensive knowledge of the disease pathogenesis.
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Duyan M, Ünal AY, Özturan İU, Günsoy E. Contribution of caval index and ejection fraction estimated by e-point septal separation measured by emergency physicians in the clinical diagnosis of acute heart failure. Turk J Emerg Med 2020; 20:105-110. [PMID: 32832729 PMCID: PMC7416849 DOI: 10.4103/2452-2473.290065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/19/2020] [Accepted: 05/20/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Although the reliability of e-point septal separation (EPSS) and caval index (CI) is proven in the diagnosis of acute heart failure (AHF), how much they contribute to the initial clinical impression is unclear. This study aimed to determine the diagnostic contribution of EPSS and CI to the initial clinical impression of AHF. METHODS This is a prospective observational study conducted in an academic emergency department (ED). The patients admitted to the ED with acute undifferentiated dyspnea were included. Primary diagnosis was made after an initial clinical evaluation, and a secondary diagnosis was made after EPSS and CI measurements. Independent cardiologists made the final diagnosis. The primary outcome was the diagnostic contribution of EPSS and CI to the primary diagnosis. RESULTS A total of 182 patients were included in the study. The primary diagnosis was found with a sensitivity of 0.55 and specificity of 0.84 and the secondary diagnosis was determined with a sensitivity of 0.78 and specificity of 0.83 in predicting the final diagnosis. The agreement coefficient between the primary and final diagnosis was 0.44 and between the secondary diagnosis and the final diagnosis was 0.61. When the primary diagnosis was coherent with secondary diagnosis, sensitivity and specificity were found to be 0.74 and 0.90, respectively. CONCLUSION Although a detailed history and physical examination are the essential factors in shaping clinical perception, CI and EPSS combined significantly contribute to the initial clinical impression.
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Affiliation(s)
- Murat Duyan
- Department of Emergency Medicine, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | | | | | - Ertuğ Günsoy
- Department of Emergency Medicine, Sivas Numune Hospital, Sivas, Turkey
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Möckel M, Boer RA, Slagman AC, Haehling S, Schou M, Vollert JO, Wiemer JC, Ebmeyer S, Martín‐Sánchez FJ, Maisel AS, Giannitsis E. Improve Management of acute heart failure with ProcAlCiTonin in EUrope: results of the randomized clinical trial IMPACT EU Biomarkers in Cardiology (BIC) 18. Eur J Heart Fail 2020; 22:267-275. [DOI: 10.1002/ejhf.1667] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/05/2019] [Accepted: 10/11/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Martin Möckel
- Department of Cardiology, Division of Emergency and Acute Medicine Campus Charité Mitte and Virchow‐KlinikumCharité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Rudolf A. Boer
- Department of CardiologyUniversity Medical Center Groningen, University of Groningen Groningen The Netherlands
| | - Anna Christine Slagman
- Department of Cardiology, Division of Emergency and Acute Medicine Campus Charité Mitte and Virchow‐KlinikumCharité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Stephan Haehling
- Department of Cardiology and PneumologyUniversity of Goettingen Medical Center, Goettingen, Germany and German Center for Cardiovascular Research (DZHK), partner site Goettingen Germany
| | - Morten Schou
- Department of CardiologyHerlev and Gentofte Hospital, University of Copenhagen Herlev Denmark
| | - Jörn Ole Vollert
- Clinical DiagnosticsThermo Fisher Scientific Hennigsdorf Germany
| | - Jan C. Wiemer
- Clinical DiagnosticsThermo Fisher Scientific Hennigsdorf Germany
| | - Stefan Ebmeyer
- Clinical DiagnosticsThermo Fisher Scientific Hennigsdorf Germany
| | - F. Javier Martín‐Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC)Universidad Complutense de Madrid Madrid Spain
| | | | - Evangelos Giannitsis
- Abteilung Innere Medizin III Kardiologie, Angiologie und PneumologieMedizinische Universitätsklinik Heidelberg Heidelberg Germany
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Möckel M, von Haehling S, Vollert JO, Wiemer JC, Anker SD, Maisel A. Early identification of acute heart failure at the time of presentation: do natriuretic peptides make the difference? ESC Heart Fail 2018; 5:309-315. [PMID: 29667356 PMCID: PMC5933954 DOI: 10.1002/ehf2.12290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 03/21/2018] [Accepted: 03/23/2018] [Indexed: 11/21/2022] Open
Abstract
Background The early identification of patients with acute heart failure (AHF) is challenging as many other diseases lead to a clinical presentation with dyspnea. Aim The aim of the study was to evaluate the impact of natriuretic peptides at common HF study cut‐offs on the diagnosis of patients with dyspnea at admission. Methods and results For this post hoc analysis, we analysed n = 726 European Union (EU) patients from the prospective BACH (Biomarkers in Acute Heart Failure) study. Cut‐offs were 350 ng/L (BNP), 300 pmol/L [pro‐atrial natriuretic peptide (proANP)], and 1800 ng/L (NT‐proBNP). These cut‐offs had equivalent 90 days' mortality in the EU cohort of BACH. We analysed the effect of selection using these cut‐offs on the prevalence of the gold standard diagnoses made in the BACH study and the respective mortality. The prevalence of AHF is increased from 47.5 to 75.6% (NT‐proBNP criteria) up to 79.7% (BNP criteria). With the use of the proANP criteria, 90 days' mortality of patients with AHF rose from 14 to 17% (P = 0.029). In the group with no‐AHF diagnoses, mortality rose from 10 to 25% (P < 0.001). Conclusions The prevalence of patients with the gold standard diagnoses of AHF among those presenting with dyspnea to the emergency department is significantly increased by the use of natriuretic peptides with common cut‐offs used in prospective HF studies. Nevertheless, in the selected groups, patients with no AHF diagnosis have the highest mortality, and therefore, the addition of a natriuretic peptide alone is insufficient to start specific therapies.
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Affiliation(s)
- Martin Möckel
- Division of Emergency and Acute Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Jan C Wiemer
- BRAHMS, Thermo Fisher Scientific, Hennigsdorf, Germany
| | - Stefan D Anker
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (Campus Virchow-Klinikum), Berlin-Brandenburg Center for Regenerative Therapies (BCRT) and German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Alan Maisel
- University of California, San Diego and Veterans Affairs Medical Center, San Diego, CA, USA
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