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Cardiac rule out

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https://www.readbyqxmd.com/read/28418520/rapid-rule-out-of-acute-myocardial-infarction-with-a-single-high-sensitivity-cardiac-troponin-t-measurement-below-the-limit-of-detection-a-collaborative-meta-analysis
#1
John W Pickering, Martin P Than, Louise Cullen, Sally Aldous, Ewoud Ter Avest, Richard Body, Edward W Carlton, Paul Collinson, Anne Marie Dupuy, Ulf Ekelund, Kai M Eggers, Christopher M Florkowski, Yonathan Freund, Peter George, Steve Goodacre, Jaimi H Greenslade, Allan S Jaffe, Sarah J Lord, Arash Mokhtari, Christian Mueller, Andrew Munro, Sebbane Mustapha, William Parsonage, W Frank Peacock, Christopher Pemberton, A Mark Richards, Juan Sanchis, Lukas P Staub, Richard Troughton, Raphael Twerenbold, Karin Wildi, Joanna Young
Background: High-sensitivity assays for cardiac troponin T (hs-cTnT) are sometimes used to rapidly rule out acute myocardial infarction (AMI). Purpose: To estimate the ability of a single hs-cTnT concentration below the limit of detection (<0.005 µg/L) and a nonischemic electrocardiogram (ECG) to rule out AMI in adults presenting to the emergency department (ED) with chest pain. Data Sources: EMBASE and MEDLINE without language restrictions (1 January 2008 to 14 December 2016)...
April 18, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28414663/not-another-acs-rule-out
#2
S Preston, R Nelson, M Watts, D Smith, T Dewenter, D Spruill
CASE: A 50 year old African-American woman with diabetes, hypertension, and hyperlipidemia presented with progressively worsening retro-sternal chest pain, exacerbated by activity and relieved by rest. She also endorsed a thirty-pound unintentional weight loss, and dysphagia. She was dysarthric with left-sided Bell's Palsy and a palpable left axillary lymph node. She had been evaluated at several hospitals in the previous months for similar typical chest pain. Her troponin values were normal, and an EKG showed T-wave inversions in leads I and aVL...
March 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/28394783/cardiac-computed-tomography-for-planning-revascularization-procedures
#3
Maksymilian P Opolski
Coronary computed tomography angiography (coronary CTA) is being increasingly used to detect and rule out coronary artery stenoses. Beyond stenosis detection, the abundance of anatomic, morphologic, and physiological information incorporated from a single one-stop-shop CT study has generated considerable interest in the context of preprocedural planning for coronary revascularization. Specifically, preprocedural CTA data sets can assist interventional cardiologists with selective catheter placement, appropriate guidewire choice, accurate stent size selection, and, most importantly, development of a stepwise revascularization strategy plan...
April 7, 2017: Journal of Thoracic Imaging
https://www.readbyqxmd.com/read/28377413/quantifying-the-release-of-biomarkers-of-myocardial-necrosis-from-cardiac-myocytes-and-intact-myocardium
#4
Jack Marjot, Thomas E Kaier, Eva D Martin, Shiney S Reji, O'Neal Copeland, Mohammed Iqbal, Bob Goodson, Sarah Hamren, Sian E Harding, Michael S Marber
BACKGROUND: Myocardial infarction is diagnosed when biomarkers of cardiac necrosis exceed the 99th centile, although guidelines advocate even lower concentrations for early rule-out. We examined how many myocytes and how much myocardium these concentrations represent. We also examined if dietary troponin can confound the rule-out algorithm. METHODS: Individual rat cardiac myocytes, rat myocardium, ovine myocardium, or human myocardium were spiked into 400-μ L aliquots of human serum...
April 4, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28361346/redesigning-the-diagnostic-pathway-for-chest-pain-patients-in-emergency-departments
#5
Sebastian Rachuba, Andrew Salmon, Zhivko Zhelev, Martin Pitt
Patients presenting with chest pain at an emergency department in the United Kingdom receive troponin tests to assess the likelihood of an acute myocardial infarction (AMI). Until recently, serial testing with two blood samples separated by at least six hours was necessary in order to analyse the change in troponin levels over time. New high-sensitivity troponin tests, however, allow the inter-test time to be shortened from six to three hours. Recent evidence also suggests that the new generation of troponin tests can be used to rule out AMI on the basis of a single test if patients at low risk of AMI present with very low cardiac troponin levels more than three hours after onset of worst pain...
March 30, 2017: Health Care Management Science
https://www.readbyqxmd.com/read/28347675/equal-clinical-performance-of-a-novel-point-of-care-cardiac-troponin-i-ctni-assay-with-a-commonly-used-high-sensitivity-ctni-assay
#6
Per Venge, Lian van Lippen, Sabine Blaschke, Michael Christ, Felicitas Geier, Evangelos Giannitsis, Emil Hagström, Pierre Hausfater, Mehdi Khellaf, Johannes Mair, David Pariente, Volkher Scharnhorst, Veronique Semjonow
BACKGROUND: Efficient rule-out of acute myocardial infarction (MI) facilitates early disposition of chest pain patients in emergency departments (ED). Point-of-care (POC) cardiac troponin (cTn) may improve patient throughput. We compared the diagnostic accuracy of a novel cTnI test (Minicare cTnI, Philips), with current POC cTnI (I-Stat, Abbott) and high-sensitivity central laboratory cTnI (hs-cTnI; Architect, Abbott) assays. METHODS: The clinical performance of the assays were compared in samples from 450 patients from a previous clinical evaluation of Minicare cTnI...
March 25, 2017: Clinica Chimica Acta; International Journal of Clinical Chemistry
https://www.readbyqxmd.com/read/28345068/how-much-risk-are-emergency-department-patients-willing-to-accept-to-avoid-diagnostic-testing
#7
Jeremy Padalecki, K Tom Xu, Cynthia Smith, Lynn Carrasco, Justin Hensley, Peter B Richman
OBJECTIVES: There is a paucity of research evaluating the risk tolerance of Emergency Department (ED) patients. We hypothesized that a significant percentage of ED patients surveyed would be comfortable with ≥5% risk of adverse outcome if they avoided testing in several hypothetical scenarios. MATERIALS AND METHODS: This was a cross-sectional study of a convenience sample of stable inner-city ED patients. Patients completed a written survey and were asked four closed-answer questions regarding risk tolerance/willingness to refuse a test/procedure, including the following scenarios: #1: LP following CT head; #2 overnight serial troponins for rule out myocardial infarction; #3 CT for possible appendicitis, #4 parent deciding whether child should undergo head CT for low risk head injury...
March 2017: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28344141/single-high-sensitivity-cardiac-troponin-i-to-rule-out-acute-myocardial-infarction
#8
Yader Sandoval, Stephen W Smith, Sara A Love, Anne Sexter, Karen Schulz, Fred S Apple
PURPOSE: Examine the performance of single high-sensitivity cardiac troponin I (hs-cTnI) measurement strategies to rule-out acute myocardial infarction. METHODS: Prospective, observational study of consecutive patients presenting to the emergency department (n=1,631) in whom cTnI measurements where obtained using an investigational hs-cTnI assay. Negative predictive value (NPV) and sensitivity for the a) diagnosis of acute myocardial infarction, type 1 myocardial infarction, and type 2 myocardial infarction and b) safety outcome of acute myocardial infarction or cardiac death at 30 days using hs-cTnI less than the limit of detection (LoD) (<1...
March 23, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28343173/fast-track-protocols-using-highly-sensitive-troponin-assays-for-ruling-out-and-ruling-in-non-st-elevation-acute-coronary-syndrome
#9
Simona Ferraro, Alberto Dolci, Mauro Panteghini
The introduction of "highly sensitive" cardiac troponin assays (hsTn) has reinforced the evidence that only serial testing incorporated in running algorithms allows a more accurate diagnosis of acute myocardial infarction. In this report, we consider the available evidence supporting the use of fast track protocols for ruling out and ruling in non-ST elevation myocardial infarction (NSTEMI) and compare it with the content of recently released guideline by the European Society of Cardiology, noting some uncomfortable aspects that need urgent clarification and/or revision...
March 27, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28342713/a-laboratory-score-at-presentation-to-rule-out-serious-cardiac-outcomes-or-death-in-patients-presenting-with-symptoms-suggestive-of-acute-coronary-syndrome
#10
Peter A Kavsak, Colleen Shortt, Jinhui Ma, Natasha Clayton, Jonathan Sherbino, Stephen A Hill, Matthew McQueen, Shamir R Mehta, P J Devereaux, Andrew Worster
BACKGROUND: We evaluated whether a low high-sensitivity cardiac troponin (hs-cTn) cutoff combined with glucose, red cell distribution width (RDW), and the estimated glomerular filtration rate (eGFR) can be used to rule-out a serious cardiac outcome or death in patients presenting with symptoms suggestive of acute coronary syndrome (ACS). METHODS: This was a prospective observational emergency department (ED) study enrolling consecutive patients presenting with symptoms suggestive of ACS (ClinicalTrials...
March 23, 2017: Clinica Chimica Acta; International Journal of Clinical Chemistry
https://www.readbyqxmd.com/read/28338472/robust-cardiac-motion-estimation-using-ultrafast-ultrasound-data-a-low-rank-topology-preserving-approach
#11
Angelica I Aviles, Thomas Widlak, Alicia Casals, Maartje Nillesen, Habib Ammari
Cardiac motion estimation is an important diagnostic tool to detect heart diseases and it has been explored with modalities such as MRI and conventional ultrasound (US) sequences. US cardiac motion estimation still presents challenges because of the complex motion patterns and the presence of noise. In this work, we propose a novel approach to estimate the cardiac motion using ultrafast ultrasound data. -- Our solution is based on a variational formulation characterized by the L2-regularized class. The displacement is represented by a lattice of b-splines and we ensure robustness by applying a maximum likelihood type estimator...
March 24, 2017: Physics in Medicine and Biology
https://www.readbyqxmd.com/read/28324186/association-of-evening-smartphone-use-with-cardiac-autonomic-nervous-activity-after-awakening-in-adolescents-living-in-high-school-dormitories
#12
Yoko Nose, Rina Fujinaga, Maki Suzuki, Ikuyo Hayashi, Toshio Moritani, Kazuhiko Kotani, Narumi Nagai
PURPOSE: Smartphones are prevalently used among adolescents; however, nighttime exposure to blue-enriched light, through electric devices, is known to induce delays of the circadian rhythm phases and poor morning somatic conditions. We therefore investigated whether evening smartphone use may affect sleep-wake cycle and cardiac autonomic nervous system (ANS) activity after awaking in dormitory students. METHODS: The participants were high school students, living under dormitory rules regarding the curfew, study, meals, lights-out, and wake-up times...
April 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28316101/n-terminal-pro-b-type-natriuretic-peptide-and-phonocardiography-in-differentiating-innocent-cardiac-murmurs-from-congenital-cardiac-anomalies-in-asymptomatic-puppies
#13
S M Marinus, H van Engelen, V Szatmári
BACKGROUND: Differentiating innocent cardiac murmurs from murmurs caused by congenital cardiac anomalies can be challenging with auscultation alone in asymptomatic puppies. HYPOTHESIS: Plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations and phonocardiograms recorded by an electronic stethoscope can differentiate innocent from pathologic cardiac murmurs. ANIMALS: A total of 186 client-owned asymptomatic dogs: 135 Cairn Terriers (age: 45-124 days), 20 adult Cairn Terriers (age: 7...
March 18, 2017: Journal of Veterinary Internal Medicine
https://www.readbyqxmd.com/read/28306671/noninvasive-monitoring-of-acute-and-chronic-rejection-in-heart-transplantation
#14
Maria G Crespo-Leiro, Gonzalo Barge-Caballero, David Couto-Mallon
PURPOSE OF REVIEW: Recent years have seen advances in the early detection of cardiac graft rejection. RECENT FINDINGS: We review the possibilities offered by tissue Doppler imaging and speckle tracking echocardiography, cardiac magnetic resonance, cardiac computed tomography, single positron emission tomography, gene expression profiling, and quantitation of donor-derived cell-free DNA, and microRNAs. SUMMARY: Noninvasive monitoring of acute and chronic rejection after cardiac transplantation is an unmet need and remains a challenge...
March 16, 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/28302424/external-validation-of-the-universal-termination-of-resuscitation-rule-for-out-of-hospital-cardiac-arrest-in-british-columbia
#15
Brian Grunau, John Taylor, Frank X Scheuermeyer, Robert Stenstrom, William Dick, Takahisa Kawano, David Barbic, Ian Drennan, Jim Christenson
STUDY OBJECTIVE: The Universal Termination of Resuscitation Rule (TOR Rule) was developed to identify out-of-hospital cardiac arrests eligible for field termination of resuscitation, avoiding futile transportation to the hospital. The validity of the rule in emergency medical services (EMS) systems that do not routinely transport out-of-hospital cardiac arrest patients to the hospital is unknown. We seek to validate the TOR Rule in British Columbia. METHODS: This study included consecutive, nontraumatic, adult, out-of-hospital cardiac arrests treated by EMS in British Columbia from April 2011 to September 2015...
March 14, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28299809/bedside-screening-with-the-use-of-pocket-size-imaging-device-can-be-useful-for-ruling-out-carotid-artery-stenosis-in-patients-scheduled-for-cardiac-surgery
#16
Dominika Filipiak-Strzecka, Jarosław D Kasprzak, Ewa Szymczyk, Paulina Wejner-Mik, Piotr Lipiec
BACKGROUND: Patients (pts) scheduled for coronary artery bypass grafting, burdened with high risk of carotid stenosis, are recommended to undergo duplex ultrasonography (DUS) of carotid arteries. PURPOSE: To validate pocket-size imaging device (PSID) equipped with linear probe as an easily accessible tool enabling bedside screening for carotid artery stenosis (CAS). METHODS: A total of 100 pts (60 men, mean age 69±11 years) with multivessel coronary artery disease underwent bedside DUS of carotid arteries with the use of PSID performed by a cardiology resident trained in DUS...
March 16, 2017: Echocardiography
https://www.readbyqxmd.com/read/28298946/tissue-doppler-imaging-in-the-evaluation-of-abdominal-aortic-pulsatility-a-useful-tool-for-the-neonatologist
#17
Enrico Valerio, Alessandra Grison, Anna Capretta, Rosanna Golin, Paola Ferrarese, Massimo Bellettato
Sonographic cardiac evaluation of newborns with suspected aortic coarctation (AoC) should tend to demonstrate a good phasic and pulsatile flow and the absence of pressure gradient along a normally conformed aortic arch from the modified left parasternal and suprasternal echocardiographic views; these findings, however, may not necessarily rule out a more distal coarctation in the descending aorta. For this reason, the sonographic exam of newborns with suspected AoC should always include a Doppler evaluation of abdominal aortic blood flow from the subcostal view...
March 2017: Journal of Ultrasound
https://www.readbyqxmd.com/read/28283497/direct-comparison-of-four-very-early-rule-out-strategies-for-acute-myocardial-infarction-using-high-sensitivity-cardiac-troponin-i
#18
Jasper Boeddinghaus, Thomas Nestelberger, Raphael Twerenbold, Karin Wildi, Patrick Badertscher, Janosch Cupa, Tobias Bürge, Patrick Mächler, Sydney Corbière, Karin Grimm, Maria Rubini Giménez, Christian Puelacher, Samyut Shrestha, Dayana Flores Widmer, Jakob Fuhrmann, Petra Hillinger, Zaid Sabti, Ursina Honegger, Nicolas Schaerli, Nikola Kozhuharov, Katharina Rentsch, Òscar Miró, Beatriz López Barbeito, F Javier Martin-Sanchez, Esther Rodriguez-Adrada, Beata Morawiec, Damian Kawecki, Eva Ganovská, Jiri Parenica, Jens Lohrmann, Wanda Kloos, Andreas Buser, Nicolas Geigy, Dagmar I Keller, Stefan Osswald, Tobias Reichlin, Christian Müller
Background -Four strategies for very early rule-out of acute myocardial infarction (AMI) using high-sensitivity cardiac troponin I (hs-cTnI) have been identified. It remains unclear which strategy is most attractive for clinical application. Methods -We prospectively enrolled unselected patients presenting to the emergency department (ED) with symptoms suggestive of AMI. The final diagnosis was adjudicated by two independent cardiologists. Hs-cTnI levels were measured at presentation and after 1h in a blinded fashion...
March 10, 2017: Circulation
https://www.readbyqxmd.com/read/28282354/diagnostic-evaluation-of-nontraumatic-chest-pain-in-athletes
#19
Byron Moran, Sean Bryan, Ted Farrar, Chris Salud, Gary Visser, Raymond Decuba, Deborah Renelus, Tyler Buckley, Michael Dressing, Nicholas Peterkin, Eric Coris
This article is a clinically relevant review of the existing medical literature relating to the assessment and diagnostic evaluation for athletes complaining of nontraumatic chest pain. The literature was searched using the following databases for the years 1975 forward: Cochrane Database of Systematic Reviews; CINAHL; PubMed (MEDLINE); and SportDiscus. The general search used the keywords chest pain and athletes. The search was revised to include subject headings and subheadings, including chest pain and prevalence and athletes...
March 2017: Current Sports Medicine Reports
https://www.readbyqxmd.com/read/28281270/liposome-enhanced-lateral-flow-assays-for-clinical-analyses
#20
Katie A Edwards, Ricki Korff, Antje J Baeumner
Clinical and environmental analyses frequently necessitate rapid, simple, and inexpensive point-of-care or field tests. These semiquantitative tests may be later followed up by confirmatory laboratory-based assays, but provide an initial scenario assessment important for resource mobilization and threat confinement. Lateral-flow assays (LFAs) and dip-stick assays, which are typically antibody-based and yield a visually detectable signal, provide an assay format suiting these applications extremely well. Signal generation is commonly obtained through the use of colloidal gold or latex beads, which yield a colored band either directly proportional or inversely proportional to the concentration of the analyte of interest...
2017: Methods in Molecular Biology
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