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Braumann S, Faber-Zameitat C, Macherey-Meyer S, Tichelbäcker T, Meertens M, Heyne S, Nießen F, Julius Nies R, Nettersheim F, Reuter H, Pfister R, Hellmich M, Burst V, Baldus S, Lee* S, Adler* C. Acute Chest Pain—Diagnostic Accuracy and Pre-Hospital Use of Anticoagulants and Platelet Aggregation Inhibitors. Dtsch Arztebl Int 2023; 120:317-323. [PMID: 36942800 PMCID: PMC10398374 DOI: 10.3238/arztebl.m2023.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 09/20/2022] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Acute chest pain (aCP) can be a symptom of life-threatening diseases such as acute coronary or aortic syndrome, but often has a non-cardiac cause. The recommendations regarding pre-hospital drug treatment of patients with aCP are ambiguous. METHODS A retrospective cohort study was conducted of 822 patients with aCP who were attended by emergency physicians. The cause of aCP was classified as follows: acute coronary syndrome without ST-segment elevation (NSTE-ACS), acute aortic syndrome, hypertensive crisis, cardiac arrhythmias, musculoskeletal, or other. The suspected and discharge diagnoses were compared, and the pre-hospital administration of acetylsalicylic acid (ASA) and unfractionated heparin (UFH) was analyzed. Furthermore, the parameters that improved diagnostic accuracy were investigated. RESULTS The positive predictive value of the diagnosis assigned by the emergency physician (EP diagnosis) was 39.7%. NSTEACS was the most commonly suspected cause of aCP (74.7%), but was confirmed after hospital admission in only 26.3% of patients. ASA was administered in 51%, UFH in 55%, and both substances in 46.4% of cases. A large proportion of patients received anticoagulants in the pre-hospital setting although the discharge diagnosis was not NSTE-ACS: ASA 62.9%, UFH 66.0%, both substances 56.5%. CONCLUSION ASA and UFH are often given to EP-accompanied patients with aCP despite the low accuracy of diagnosis in the pre-hospital setting. Pre-hospital measurement of high-sensitivity troponin T (hs Trop-T) might improve discrimination between NSTE-ACS and other causes of aCP. This is important, as the current guidelines contain no clear recommendations for prehospital drug treatment in NSTE-ACS.
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Affiliation(s)
- Simon Braumann
- Medical Faculty, University of Cologne, and Department of Internal Medicine III, Cologne University Hospital
| | - Christian Faber-Zameitat
- Medical Faculty, University of Cologne, and Department of Internal Medicine III, Cologne University Hospital
| | - Sascha Macherey-Meyer
- Medical Faculty, University of Cologne, and Department of Internal Medicine III, Cologne University Hospital
| | - Tobias Tichelbäcker
- Medical Faculty, University of Cologne, and Department of Internal Medicine III, Cologne University Hospital
| | - Max Meertens
- Medical Faculty, University of Cologne, and Department of Internal Medicine III, Cologne University Hospital
| | - Sebastian Heyne
- Medical Faculty, University of Cologne, and Department of Internal Medicine III, Cologne University Hospital
| | - Franz Nießen
- Medical Faculty, University of Cologne, and Department of Internal Medicine III, Cologne University Hospital
| | - Richard Julius Nies
- Medical Faculty, University of Cologne, and Department of Internal Medicine III, Cologne University Hospital
| | - Felix Nettersheim
- Medical Faculty, University of Cologne, and Department of Internal Medicine III, Cologne University Hospital
| | - Hannes Reuter
- Medical Faculty, University of Cologne, and Department of Internal Medicine III, Cologne University Hospital
- Department of Internal Medicine, Evangelical Hospital Cologne-Weyertal
| | - Roman Pfister
- Medical Faculty, University of Cologne, and Department of Internal Medicine III, Cologne University Hospital
| | - Martin Hellmich
- Medical Faculty, University of Cologne, and Department of Internal Medicine III, Cologne University Hospital
- Medical Faculty, University of Cologne, and Institute for Medical Statistics, Cologne University Hospital
| | - Volker Burst
- Medical Faculty, University of Cologne, and Department of Internal Medicine III, Cologne University Hospital
- Medical Faculty, University of Cologne, and Clinical Acute and Emergency Medicine Team, Cologne University Hospital
- Medical Faculty, University of Cologne, and Department of Internal Medicine II, Cologne University Hospital
| | - Stephan Baldus
- Medical Faculty, University of Cologne, and Department of Internal Medicine III, Cologne University Hospital
| | - Samuel Lee*
- * Joint last authors
- Medical Faculty, University of Cologne, and Department of Internal Medicine III, Cologne University Hospital
| | - Christoph Adler*
- * Joint last authors
- Medical Faculty, University of Cologne, and Department of Internal Medicine III, Cologne University Hospital
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Braumann S, Schumacher W, Im NG, Nettersheim FS, Mehrkens D, Bokredenghel S, Hof A, Nies RJ, Adler C, Winkels H, Knöll R, Freeman BA, Rudolph V, Klinke A, Adam M, Baldus S, Mollenhauer M, Geißen S. Nitro-Oleic Acid (NO 2-OA) Improves Systolic Function in Dilated Cardiomyopathy by Attenuating Myocardial Fibrosis. Int J Mol Sci 2021; 22:9052. [PMID: 34445757 PMCID: PMC8396484 DOI: 10.3390/ijms22169052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/12/2022] Open
Abstract
Nitro-oleic acid (NO2-OA), a nitric oxide (NO)- and nitrite (NO2-)-derived electrophilic fatty acid metabolite, displays anti-inflammatory and anti-fibrotic signaling actions and therapeutic benefit in murine models of ischemia-reperfusion, atrial fibrillation, and pulmonary hypertension. Muscle LIM protein-deficient mice (Mlp-/-) develop dilated cardiomyopathy (DCM), characterized by impaired left ventricular function and increased ventricular fibrosis at the age of 8 weeks. This study investigated the effects of NO2-OA on cardiac function in Mlp-/- mice both in vivo and in vitro. Mlp-/- mice were treated with NO2-OA or vehicle for 4 weeks via subcutaneous osmotic minipumps. Wildtype (WT) littermates treated with vehicle served as controls. Mlp-/- mice exhibited enhanced TGFβ signalling, fibrosis and severely reduced left ventricular systolic function. NO2-OA treatment attenuated interstitial myocardial fibrosis and substantially improved left ventricular systolic function in Mlp-/- mice. In vitro studies of TGFβ-stimulated primary cardiac fibroblasts further revealed that the anti-fibrotic effects of NO2-OA rely on its capability to attenuate fibroblast to myofibroblast transdifferentiation by inhibiting phosphorylation of TGFβ downstream targets. In conclusion, we demonstrate a substantial therapeutic benefit of NO2-OA in a murine model of DCM, mediated by interfering with endogenously activated TGFβ signaling.
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Affiliation(s)
- Simon Braumann
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (F.S.N.); (D.M.); (S.B.); (A.H.); (R.J.N.); (C.A.); (H.W.); (M.A.); (S.B.); (M.M.); (S.G.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany; (W.S.); (N.G.I.)
| | - Wibke Schumacher
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany; (W.S.); (N.G.I.)
- Cologne Cardiovascular Research Center (CCRC), Faculty of Medicine, University of Cologne, 50937 Cologne, Germany;
| | - Nam Gyu Im
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany; (W.S.); (N.G.I.)
| | - Felix Sebastian Nettersheim
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (F.S.N.); (D.M.); (S.B.); (A.H.); (R.J.N.); (C.A.); (H.W.); (M.A.); (S.B.); (M.M.); (S.G.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany; (W.S.); (N.G.I.)
| | - Dennis Mehrkens
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (F.S.N.); (D.M.); (S.B.); (A.H.); (R.J.N.); (C.A.); (H.W.); (M.A.); (S.B.); (M.M.); (S.G.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany; (W.S.); (N.G.I.)
- Cologne Cardiovascular Research Center (CCRC), Faculty of Medicine, University of Cologne, 50937 Cologne, Germany;
| | - Senai Bokredenghel
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (F.S.N.); (D.M.); (S.B.); (A.H.); (R.J.N.); (C.A.); (H.W.); (M.A.); (S.B.); (M.M.); (S.G.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany; (W.S.); (N.G.I.)
| | - Alexander Hof
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (F.S.N.); (D.M.); (S.B.); (A.H.); (R.J.N.); (C.A.); (H.W.); (M.A.); (S.B.); (M.M.); (S.G.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany; (W.S.); (N.G.I.)
| | - Richard Julius Nies
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (F.S.N.); (D.M.); (S.B.); (A.H.); (R.J.N.); (C.A.); (H.W.); (M.A.); (S.B.); (M.M.); (S.G.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany; (W.S.); (N.G.I.)
| | - Christoph Adler
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (F.S.N.); (D.M.); (S.B.); (A.H.); (R.J.N.); (C.A.); (H.W.); (M.A.); (S.B.); (M.M.); (S.G.)
| | - Holger Winkels
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (F.S.N.); (D.M.); (S.B.); (A.H.); (R.J.N.); (C.A.); (H.W.); (M.A.); (S.B.); (M.M.); (S.G.)
| | - Ralph Knöll
- Department of Medicine, Integrated Cardio Metabolic Centre (ICMC), Heart and Vascular Theme, Karolinska Institute, 17177 Stockholm, Sweden;
- Bioscience, Cardiovascular, Renal & Metabolism, BioPharmaceuticals R&D, AstraZeneca, 43150 Mölndal, Sweden
| | - Bruce A. Freeman
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Volker Rudolph
- Cologne Cardiovascular Research Center (CCRC), Faculty of Medicine, University of Cologne, 50937 Cologne, Germany;
- Agnes Wittenborg Institute for Translational Cardiovascular Research, Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, University Hospital of the Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany;
| | - Anna Klinke
- Agnes Wittenborg Institute for Translational Cardiovascular Research, Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, University Hospital of the Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany;
| | - Matti Adam
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (F.S.N.); (D.M.); (S.B.); (A.H.); (R.J.N.); (C.A.); (H.W.); (M.A.); (S.B.); (M.M.); (S.G.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany; (W.S.); (N.G.I.)
| | - Stephan Baldus
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (F.S.N.); (D.M.); (S.B.); (A.H.); (R.J.N.); (C.A.); (H.W.); (M.A.); (S.B.); (M.M.); (S.G.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany; (W.S.); (N.G.I.)
- Cologne Cardiovascular Research Center (CCRC), Faculty of Medicine, University of Cologne, 50937 Cologne, Germany;
| | - Martin Mollenhauer
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (F.S.N.); (D.M.); (S.B.); (A.H.); (R.J.N.); (C.A.); (H.W.); (M.A.); (S.B.); (M.M.); (S.G.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany; (W.S.); (N.G.I.)
| | - Simon Geißen
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (F.S.N.); (D.M.); (S.B.); (A.H.); (R.J.N.); (C.A.); (H.W.); (M.A.); (S.B.); (M.M.); (S.G.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany; (W.S.); (N.G.I.)
- Cologne Cardiovascular Research Center (CCRC), Faculty of Medicine, University of Cologne, 50937 Cologne, Germany;
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