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https://www.readbyqxmd.com/read/28742643/sensitive-troponin-i-and-stress-testing-in-the-emergency-department-for-the-early-management-of-chest-pain-using-2-hour-protocol
#1
Shahriar Dadkhah, Zakaria Almuwaqqat, Samian Sulaiman, Husein Husein, Quang Nguyen, Saad Ali, Tuncay Taskesen
BACKGROUND: Despite improvements in identifying high-risk patients with non-ST segment ACS (acute coronary syndrome), low risk patients presenting with atypical chest pain and non-diagnostic Electrocardiogram (ECG) continued to undergo unnecessary admissions and testing. Since 1992, our chest pain protocol included using 4-hour serial biomarkers from ED admission in combination with stress testing to evaluate these patients. Our study aimed at determining whether a new accelerated diagnostic protocol using sensitive cardiac troponin I (cTnI) 2 hours after admission to the ED followed by stress testing is safe and effective in emergency settings, allowing for appropriate triage, earlier discharge and reducing costs...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28742306/identifying-emergency-department-patients-with-chest-pain-who-are-at-low-risk-for-acute-coronary-syndromes-digest
#2
David Markel, Jeremy Kim
Though a minority of patients presenting to the emergency department with chest pain have acute coronary syndromes,identifying the patients who may be safely discharged and determining whether further testing is needed remains challenging. From the prehospital care setting to disposition and follow-up, this systematic review addresses the fundamentals of the emergency department evaluation of patients determined to be at low risk for acute coronary syndromes or adverse outcomes. Clinical risk scores are discussed, as well as the evidence and indications for confirmatory testing...
July 21, 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28739197/type-1-and-2-myocardial-infarction-and-myocardial-injury-clinical-transition-to-high-sensitivity-cardiac-troponin-i
#3
Yader Sandoval, Stephen W Smith, Anne Sexter, Sarah E Thordsen, Charles A Bruen, Michelle D Carlson, Kenneth W Dodd, Brian E Driver, Yan Hu, Katherine Jacoby, Benjamin K Johnson, Sara A Love, Johanna C Moore, Karen Schulz, Nathaniel L Scott, Fred S Apple
BACKGROUND: Studies addressing patients with type 2 myocardial infarction and myocardial injury, including the impact of using high-sensitivity (hs) cardiac troponin (cTn) assays on their incidence are needed. METHODS: Prospective, observational US cohort study. Consecutive emergency department patients with serial cTnI measurements. Outcomes included 180-day mortality and major adverse cardiac events, including 2-year follow-up for those with myonecrosis. RESULTS: Among 1,640 patients, using a contemporary cTnI assay, 30% (n=497) had ≥1 cTnI >99(th) percentile; with 4...
July 21, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28735759/associations-between-tooth-loss-and-prognostic-biomarkers-and-the-risk-for-cardiovascular-events-in-patients-with-stable-coronary-heart-disease
#4
Ola Vedin, Emil Hagström, Ollie Östlund, Alvaro Avezum, Andrzej Budaj, Marcus D Flather, Robert A Harrington, Wolfgang Koenig, Joseph Soffer, Agneta Siegbahn, Philippe Gabriel Steg, Ralph A H Stewart, Lars Wallentin, Harvey D White, Claes Held
BACKGROUND: Underlying mechanisms behind the hypothesized relationship between periodontal disease (PD) and coronary heart disease (CHD) have been insufficiently explored. We evaluated associations between self-reported tooth loss- a marker of PD- and prognostic biomarkers in 15,456 (97%) patients with stable CHD in the global STABILITY trial. METHODS AND RESULTS: Baseline blood samples were obtained and patients reported their number of teeth according to the following tooth loss levels: "26-32 (All)" [lowest level], "20-25", "15-19", "1-14", and "No Teeth" [highest level]...
July 17, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28735291/subclinical-atherosclerosis-cardiac-and-kidney-function-heart-failure-and-dementia-in-the-very-elderly
#5
Lewis H Kuller, Oscar L Lopez, John S Gottdiener, Dalane W Kitzman, James T Becker, Yuefang Chang, Anne B Newman
BACKGROUND: Heart failure (HF) and dementia are major causes of disability and death among older individuals. Risk factors and biomarkers of HF may be determinants of dementia in the elderly. We evaluated the relationship between biomarkers of cardiovascular disease and HF and risk of dementia and death. Three hypotheses were tested: (1) higher levels of high-sensitivity cardiac troponin T, N-terminal of prohormone brain natriuretic peptide, and cystatin C predict risk of death, cardiovascular disease, HF, and dementia; (2) higher levels of cardiovascular disease biomarkers are associated with increased risk of HF and then secondary increased risk of dementia; and (3) risk of dementia is lower among participants with a combination of lower coronary artery calcium, atherosclerosis, and lower high-sensitivity cardiac troponin T (myocardial injury)...
July 22, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28729407/long-term-stroke-risk-prediction-in-patients-with-atrial-fibrillation-comparison-of-the-abc-stroke-and-cha2ds2-vasc-scores
#6
José Miguel Rivera-Caravaca, Vanessa Roldán, María Asunción Esteve-Pastor, Mariano Valdés, Vicente Vicente, Gregory Y H Lip, Francisco Marín
BACKGROUND: The ABC-stroke score (age, biomarkers [N-terminal fragment B-type natriuretic peptide, high-sensitivity troponin], and clinical history [prior stroke/transient ischemic attack]) was proposed to predict stroke in atrial fibrillation (AF). This score was derived/validated in 2 clinical trial cohorts in which patients with AF were highly selected and carefully followed-up. However, the median follow-up was 1.9 years in the trial cohort; therefore, its long-term predictive performance remains uncertain...
July 20, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28728851/predictors-of-incident-heart-failure-in-patients-after-an-acute-coronary-syndrome-the-lipid-heart-failure-risk-prediction-model
#7
Andrea Driscoll, Elizabeth H Barnes, Stefan Blankenberg, David M Colquhoun, David Hunt, Paul J Nestel, Ralph A Stewart, Malcolm J West, Harvey D White, John Simes, Andrew Tonkin
BACKGROUND: Coronary heart disease is a major cause of heart failure. Availability of risk-prediction models that include both clinical parameters and biomarkers is limited. We aimed to develop such a model for prediction of incident heart failure. METHODS: A multivariable risk-factor model was developed for prediction of first occurrence of heart failure death or hospitalization. A simplified risk score was derived that enabled subjects to be grouped into categories of 5-year risk varying from <5% to >20%...
June 30, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28728608/influence-of-apelin-12-on-troponin-levels-and-the-rate-of-mace-in-stemi-patients
#8
Xhevdet Krasniqi, Blerim Berisha, Masar Gashi, Dardan Koçinaj, Fisnik Jashari, Josip Vincelj
BACKGROUND: During acute myocardial infarction, phosphorylated TnI levels, Ca(2+) sensitivity and ATPase activity are decreased in the myocardium, and the subsequent elevation in Ca(2+) levels activates protease I (caplain I), leading to the proteolytic degradation of troponins. Concurrently, the levels of apelin and APJ expression are increased by limiting myocardial injury. METHODS: In this prospective observational study, 100 consecutive patients with ST-elevation acute myocardial infarction were included...
July 20, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28724951/n-terminal-pro-brain-natriuretic-peptide-and-associated-factors-in-the-general-working-population-a-baseline-survey-of-the-uranosaki-cohort-study
#9
Atsushi Tanaka, Hisako Yoshida, Atsushi Kawaguchi, Jun-Ichi Oyama, Norihiko Kotooka, Shigeru Toyoda, Teruo Inoue, Masafumi Natsuaki, Koichi Node
Few data on clinical characteristics associated with N-terminal pro-brain natriuretic peptide (NT-proBNP) or the clinical value of measuring NT-proBNP in the working population are available. The aim of the present study was to investigate the levels of NT-proBNP and their association with clinical variables in the Japanese general working population by using baseline data from the Uranosaki cohort study. In the study, the plasma concentration of NT-proBNP and some biomarkers were measured in addition to the standard health checkups at the workplace...
July 19, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28719430/high-sensitivity-cardiac-troponin-t-improves-the-diagnosis-of-perioperative-mi
#10
Jamie C Brown, Eslam Samaha, Srikar Rao, Mohammad A Helwani, Andreas Duma, Frank Brown, Brian F Gage, J Philip Miller, Allan S Jaffe, Fred S Apple, Mitchell G Scott, Peter Nagele
BACKGROUND: The diagnosis of myocardial infarction (MI) after noncardiac surgery has traditionally relied on using relatively insensitive contemporary cardiac troponin (cTn) assays. We hypothesized that using a recently introduced novel high-sensitivity cTnT (hscTnT) assay would increase the detection rate of perioperative MI. METHODS: In this ancillary study of the Vitamins in Nitrous Oxide trial, readjudicated incidence rates of myocardial injury (new isolated cTn elevation) and MI were compared when diagnosed by contemporary cTnI versus hscTnT...
July 14, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28716801/diabetes-mellitus-microalbuminuria-and-subclinical-cardiac-disease-identification-and-monitoring-of-individuals-at-risk-of-heart-failure
#11
Peter P Swoboda, Adam K McDiarmid, Bara Erhayiem, David P Ripley, Laura E Dobson, Pankaj Garg, Tarique A Musa, Klaus K Witte, Mark T Kearney, Julian H Barth, Ramzi Ajjan, John P Greenwood, Sven Plein
BACKGROUND: Patients with type 2 diabetes mellitus and elevated urinary albumin:creatinine ratio (ACR) have increased risk of heart failure. We hypothesized this was because of cardiac tissue changes rather than silent coronary artery disease. METHODS AND RESULTS: In a case-controlled observational study 130 subjects including 50 ACR+ve diabetes mellitus patients with persistent microalbuminuria (ACR >2.5 mg/mol in males and >3.5 mg/mol in females, ≥2 measurements, no previous renin-angiotensin-aldosterone therapy, 50 ACR-ve diabetes mellitus patients and 30 controls underwent cardiovascular magnetic resonance for investigation of myocardial fibrosis, ischemia and infarction, and echocardiography...
July 17, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28715149/welcome-to-the-real-world-do-the-conditions-of-fda-approval-devalue-high-sensitivity-troponin
#12
Richard Body, Simon Mahler
In January 2017 the Food and Drug Administration (FDA) approved the first high sensitivity cardiac troponin (hs-cTn) assay for use in the United States: the 5(th) generation hs-cTnT assay manufactured by Roche Diagnostics. This landmark decision finally enables Americans to benefit from the same improvements in diagnostic technology that the rest of the world has utilized for some six years. This article is protected by copyright. All rights reserved.
July 17, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28714526/different-postconditioning-cycles-affect-prognosis-of-aged-patients-undergoing-primary-percutaneous-coronary-intervention
#13
Jie Zhang, Xin Zhang, Yuqi Cui, Misbahul Ferdous, Lianqun Cui, Peng Zhao
BACKGROUND: Postconditioning can affect the infarct size in acute myocardial infarction (AMI). However, few studies show an effect of different postconditioning cycles on AMI aged patients. This study sought to assess the effect of different postconditioning cycles on prognosis in aged patients with AMI who underwent primary percutaneous coronary intervention (PCI). METHODS: 74 aged patients were randomly assigned to three groups. Control group; PC-1 group accepted postconditioning 4 cycles of 30 s inflation and 30 s deflation; PC-2 group accepted postconditioning 4 cycles of 60 s...
July 17, 2017: Cardiology Journal
https://www.readbyqxmd.com/read/28712855/plasma-high-sensitivity-troponin-t-predicts-end-stage-renal-disease-and-cardiovascular-and-all-cause-mortality-in-patients-with-type-1-diabetes-and-diabetic-nephropathy
#14
Julie Galsgaard, Frederik Persson, Tine Willum Hansen, Anders Jorsal, Lise Tarnow, Hans-Henrik Parving, Peter Rossing
High-sensitivity troponin T (hsTnT) is a marker of cardiovascular disease (CVD) and in type 2 diabetes also a marker of renal events, but has not been evaluated in type 1 diabetics. We therefore reviewed a type 1 diabetes cohort of 442 without and 458 with diabetic nephropathy. Baseline samples were analyzed for hsTnT levels. Cox regression analyses assessed predictive value in relation to the development of end-stage renal disease (ESRD) in 99 patients, all-cause mortality in 178, and CVD events in 134 after up to 12 years of follow-up...
July 13, 2017: Kidney International
https://www.readbyqxmd.com/read/28712187/utility-of-heart-type-fatty-acid-binding-protein-h-fabp-point-of-care-test-in-the-early-hours-of-stemi-compared-with-troponin-i-in-pakistani-population
#15
Walid Ahmad Abbasi, Muhammad Saleem, Shahid Rasheed, Azhar Mahmood Kiyani
BACKGROUND: Acute coronary syndrome remains a dominant cause of high morbidity and mortality despite advancements in treatment This study was conducted to examine the utility of point-of-care test of heart-type fatty-acid binding protein (h-FABP) and compare it with the point-of-care test of cardiac troponin I (cTnI) in the first 06 hours of STEMI. METHODS: This cross-sectional, comparative study which was conducted in Rawalpindi institute of cardiology, Rawalpindi, Pakistan, from January to June 2015...
January 2017: Journal of Ayub Medical College, Abbottabad: JAMC
https://www.readbyqxmd.com/read/28704807/high-sensitivity-troponin-t-and-nt-probnp-kinetics-in-breast-cancer-chemotherapy
#16
Pooja Advani, Jonathan Hoyne, Alvaro Moreno-Aspita, Marcia Dubin, Shelly Brock, Caroline Harlow, Saranya Chumsri, Thomas Suter, Joseph L Blackshear
BACKGROUND/AIMS: Doxorubicin (DOX) and trastuzumab (TRA) are associated with cardiac dysfunction. METHOD: High-sensitivity troponin T (hs-TnT) and brain natriuretic peptide attached to the amino acid N-terminal fragment in the prohormone (NT-proBNP) were measured before and on days +1, +2, +3, and +7 during cycles 1 and 2 of therapy with DOX or TRA in breast cancer patients. RESULTS: Five of eleven DOX-treated women, compared with 2/11 TRA-treated women, had undetectable baseline hs-TnT...
July 14, 2017: Chemotherapy
https://www.readbyqxmd.com/read/28704179/analytical-evaluation-of-the-new-beckman-coulter-access-high-sensitivity-cardiac-troponin-i-immunoassay
#17
Giuseppe Lippi, Anna Ferrari, Giorgio Gandini, Matteo Gelati, Claudia Lo Cascio, Gian Luca Salvagno
BACKGROUND: This study was aimed to evaluate the analytical performance of the novel chemiluminescent and fully-automated Beckman Coulter Access hsTnI high-sensitivity immunoassay for measurement of cardiac troponin I (cTnI). METHODS: The study, using lithium heparin samples, included assessment of limit of blank (LOB), limit of detection (LOD), functional sensitivity, linearity, imprecision (within run, between-run and total), calculation of 99th percentile upper reference limit (URL) in 175 healthy blood donors (mean age, 36±12 years; 47% women) and comparison with two other commercial cTnI immunoassays...
July 12, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28701316/diagnostic-performance-of-high-sensitivity-compared-with-contemporary-cardiac-troponin-i-for-the-diagnosis-of-acute-myocardial-infarction
#18
Yader Sandoval, Stephen W Smith, Sarah E Thordsen, Charles A Bruen, Michelle D Carlson, Kenneth W Dodd, Brian E Driver, Katherine Jacoby, Benjamin K Johnson, Sara A Love, Johanna C Moore, Anne Sexter, Karen Schulz, Nathaniel L Scott, Jennifer Nicholson, Fred S Apple
BACKGROUND: We examined the diagnostic performance of high-sensitivity cardiac troponin I (hs-cTnI) vs contemporary cTnI with use of the 99th percentile alone and with a normal electrocardiogram (ECG) to rule out acute myocardial infarction (MI) and serial changes (deltas) to rule in MI. METHODS: We included consecutive patients presenting to a US emergency department with serial cTnI on clinical indication (NCT02060760). Diagnostic performance for acute MI, including MI subtypes, and 30-day outcomes were examined...
July 12, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28698323/performance-of-highly-sensitive-cardiac-troponin-t-assay-to-detect-ischaemia-at-pet-ct-in-low-risk-patients-with-acute-coronary-syndrome-a-prospective-observational-study
#19
Beata Morawiec, Stephane Fournier, Maxime Tapponnier, John O Prior, Pierre Monney, Vincent Dunet, Nathalie Lauriers, Frederique Recordon, Catalina Trana, Juan-Fernando Iglesias, Damian Kawecki, Olivier Boulat, Daniel Bardy, Sabine Lamsidri, Eric Eeckhout, Olivier Hugli, Olivier Muller
BACKGROUND: Highly sensitive troponin T (hs-TnT) assay has improved clinical decision-making for patients admitted with chest pain. However, this assay's performance in detecting myocardial ischaemia in a lowrisk population has been poorly documented. PURPOSE: To assess hs-TnT assay's performance to detect myocardial ischaemia at positron emission tomography/CT (PET-CT) in low-risk patients admitted with chest pain. METHODS: Patients admitted for chest pain with a nonconclusive ECG and negative standard cardiac troponin T results at admission and after 6 hours were prospectively enrolled...
July 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28695975/decreased-admissions-and-hospital-costs-with-a-neutral-effect-on-mortality-following-lowering-of-the-troponin-t-cutoff-point-to-the-99th-percentile
#20
Christian Bjurman, Matteus Zywczyk, Bertil Lindahl, Tobias Carlsson, Per Johanson, Max Petzold, Martin Holzmann, Michael Lx Fu, Ola Hammarsten
BACKGROUND: The implementation of high-sensitivity cardiac troponin T (hs-cTnT) assays and a cutoff based on the 99th cTnT percentile in the evaluation of patients with suspected acute coronary syndrome has not been uniform due to uncertain effects on health benefits and utilization of limited resources. METHODS: Clinical and laboratory data from patients with chest pain or dyspnea at the emergency department (ED) were evaluated before (n = 20516) and after (n = 18485) the lowering of the hs-cTnT cutoff point from 40 ng/L to the 99th hs-cTnT percentile of 14 ng/L in February 2012...
July 11, 2017: Cardiology Journal
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