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  • 1
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    Online Resource
    Copeptin to rule out myocardial infarction in Blacks versus Caucasians
    Oxford University Press (OUP) ; 2019
    In:  European Heart Journal: Acute Cardiovascular Care Vol. 8, No. 5 ( 2019-08), p. 395-403
    Details
    In: European Heart Journal: Acute Cardiovascular Care, Oxford University Press (OUP), Vol. 8, No. 5 ( 2019-08), p. 395-403
    Abstract: Copeptin in combination with troponin has been shown to have incremental value for the early rule-out of myocardial infarction, but its performance in Black patients specifically has never been examined. In light of a potential for wider use, data on copeptin in different relevant cohorts are needed. This is the first study to determine whether copeptin is equally effective at ruling out myocardial infarction in Black and Caucasian races. Methods: This analysis of the CHOPIN trial included 792 Black and 1075 Caucasian patients who presented to the emergency department with chest pain and had troponin-I and copeptin levels drawn. Results: One hundred and forty-nine patients were diagnosed with myocardial infarction (54 Black and 95 Caucasian). The negative predictive value of copeptin at a cut-off of 14 pmol/l (as in the CHOPIN study) for myocardial infarction was higher in Blacks (98.0%, 95% confidence interval (CI) 96.2–99.1%) than Caucasians (94.1%, 95% CI 92.1–95.7%). The sensitivity at 14 pmol/l was higher in Blacks (83.3%, 95% CI 70.7–92.1%) than Caucasians (53.7%, 95% CI 43.2–64.0%). After controlling for age, hypertension, heart failure, chronic kidney disease and body mass index in a logistic regression model, the interaction term had a P value of 0.03. A cut-off of 6 pmol/l showed similar sensitivity in Caucasians as 14 pmol/l in Blacks. Conclusions: This is the first study to identify a difference in the performance of copeptin to rule out myocardial infarction between Blacks and Caucasians, with increased negative predictive value and sensitivity in the Black population at a cut-off of 14 pmol/l. This also holds true for non-ST-segment elevation myocardial infarction and, although numbers were small, similar trends exist in the normal troponin population. This may have significant implications for early rule-out strategies using copeptin.
    Type of Medium: Online Resource
    ISSN: 2048-8726 , 2048-8734
    URL: Article
    DOI: 10.1177/2048872618772500
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
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  • 2
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    Online Resource
    Lack of Diagnostic and Prognostic Utility of Circulating Plasma Myeloperoxidase Concentrations in Patients Presenting with Dyspnea
    Oxford University Press (OUP) ; 2009
    In:  Clinical Chemistry Vol. 55, No. 1 ( 2009-01-01), p. 59-67
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    In: Clinical Chemistry, Oxford University Press (OUP), Vol. 55, No. 1 ( 2009-01-01), p. 59-67
    Abstract: Background: Plasma myeloperoxidase (MPO), an inflammatory biomarker, is associated with increased mortality in patients with acute coronary syndrome or chronic left ventricular systolic dysfunction. We sought to assess the diagnostic accuracy of MPO for acute decompensated heart failure (ADHF) and its prognostic value for patients with acute dyspnea. Methods: In a prospective, observational study conducted in 5 US centers, 412 patients [mean (SD) age, 58 (14) years; 39% women] presenting with dyspnea to the emergency department were enrolled and followed for 1 year. Clinical, serum/plasma biomarker [MPO, B-type natriuretic peptide (BNP), N-terminal proBNP (NT-proBNP)] , and transthoracic echocardiographic data were obtained. Results: We observed no differences in MPO concentration (P = 0.07) between patients with ADHF [n = 147; median, 553 pmol/L; interquartile range (IQR), 415–738 pmol/L] and those without ADHF (n = 265; median, 576 pmol/L; IQR, 413–884 pmol/L). The diagnostic accuracy for ADHF was excellent for BNP [area under the ROC curve (AUC), 0.90; P & lt; 0.001] and NT-proBNP (AUC, 0.90; P & lt; 0.001) but poor for MPO (AUC, 0.46; P = 0.18). MPO appeared uncorrelated with echocardiographic measures of cardiac structure or function. The observed 1-year mortality rate was 12%. MPO concentration also appeared unrelated to mortality [hazard ratio, 1.25 (above vs below the median); 95% CI, 0.71–2.18], whereas BNP (P = 0.001) and NT-proBNP (P & lt; 0.001) were significant predictors of mortality. MPO concentration provided no prognostic information in addition to that of BNP or NT-proBNP concentration. Conclusions: Unlike natriuretic peptides, MPO concentration was not predictive of ADHF diagnosis or 1-year mortality in a heterogeneous sample of emergency department patients with acute dyspnea.
    Type of Medium: Online Resource
    ISSN: 0009-9147 , 1530-8561
    URL: Article
    DOI: 10.1373/clinchem.2008.108159
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2009
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  • 3
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    Online Resource
    Prognostic Utility of ST2 in Patients with Acute Dyspnea and Preserved Left Ventricular Ejection Fraction
    Oxford University Press (OUP) ; 2011
    In:  Clinical Chemistry Vol. 57, No. 6 ( 2011-06-01), p. 874-882
    Details
    In: Clinical Chemistry, Oxford University Press (OUP), Vol. 57, No. 6 ( 2011-06-01), p. 874-882
    Abstract: Soluble ST2 (sST2), an interleukin-1 receptor family member, is an emerging risk indicator for patients with cardiovascular disease. We evaluated the prognostic role of sST2 for patients presenting to the emergency department with acute dyspnea, with a focus on those with preserved left ventricular ejection fraction (LVEF ≥50%), as risk stratification is often most complex in this subgroup. METHODS We conducted a post hoc analysis of 387 patients [39% female, mean (SD) age 57.6 (14.5) years] presenting to the emergency department with dyspnea and followed for 1 year (97% complete follow-up). We examined clinical data, concentrations of serum biomarkers [sST2, amino-terminal pro–B-type natriuretic peptide (NT-proBNP)] , and transthoracic echocardiography. RESULTS Patients had a median sST2 concentration of 38.4 U/mL [interquartile range (IQR) 25.5–64 U/mL]. Forty-six patients (12%) died during follow-up. Log sST2 [hazard ratio (HR) (95% CI) 2.85 (2.04–3.99), P & lt; 0.001rsqb] and log NT-proBNP [1.28 (1.13–1.45), P & lt; 0.001] concentrations were significant predictors of mortality at 1 year. After multivariate adjustment, only sST2 remained predictive of mortality [per log: 2.14 (1.37–3.38), P = 0.001] . In the subpopulation of individuals with normal systolic function (n = 200), only sST2 continued to predict mortality after multivariate adjustment [per log: 2.57 (1.12–5.91), P = 0.03]. Only NT-proBNP, but not sST2, concentrations correlated with multiple echocardiographic indices of left ventricular diastolic function. CONCLUSIONS sST2 is a strong predictor of mortality in patients presenting with acute dyspnea, particularly those with preserved LVEF, and may be useful for triage and risk stratification of this challenging group.
    Type of Medium: Online Resource
    ISSN: 0009-9147 , 1530-8561
    URL: Article
    DOI: 10.1373/clinchem.2010.159277
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2011
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  • 4
    Online Resource
    Online Resource
    Editor’s Choice-The role of the emergency department in the management of acute heart failure: An international perspective on education and research
    Oxford University Press (OUP) ; 2017
    In:  European Heart Journal: Acute Cardiovascular Care Vol. 6, No. 5 ( 2017-08), p. 421-429
    Details
    In: European Heart Journal: Acute Cardiovascular Care, Oxford University Press (OUP), Vol. 6, No. 5 ( 2017-08), p. 421-429
    Type of Medium: Online Resource
    ISSN: 2048-8726 , 2048-8734
    URL: Article
    DOI: 10.1177/2048872615600096
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2017
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  • 5
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    Online Resource
    The obesity paradox, extreme obesity, and long-term outcomes in older adults with ST-segment elevation myocardial infarction: results from the NCDR
    Oxford University Press (OUP) ; 2017
    In:  European Heart Journal - Quality of Care and Clinical Outcomes Vol. 3, No. 3 ( 2017-07-01), p. 183-191
    Details
    In: European Heart Journal - Quality of Care and Clinical Outcomes, Oxford University Press (OUP), Vol. 3, No. 3 ( 2017-07-01), p. 183-191
    Abstract: To investigate the obesity paradox and association of extreme obesity with long-term outcomes among older ST-segment elevation myocardial infarction (STEMI) patients. Methods and results Nineteen thousand four hundred and ninety-nine patients ≥65 years with STEMI surviving to hospital discharge in NCDR ACTION Registry-GWTG linked to Centers for Medicare and Medicaid Services outcomes between 2007 and 2012 were stratified by body mass index (BMI) (kg/m2) into normal weight (18.5–24.9), overweight (25–29.9), class I (30–34.9), class II (35–39.9), and class III/extreme obese (≥40) categories. Multivariable-adjusted associations were evaluated between BMI categories and mortality by Cox proportional hazards models, and days alive and out of hospital (DAOH) by generalized estimating equations, within 3 years after discharge. Seventy percent of patients were overweight/obese and 3% extremely obese. Normal weight patients were older and more likely to smoke; while extremely obese patients were younger and more likely to be female and black, with lower socioeconomic status and more comorbidity (P ≤ 0.001). A U-shaped association was observed between BMI categories and mortality: patients with class I obesity were at lowest risk, while normal weight [hazard ratio (HR) 1.30, 95% confidence interval (CI) 1.15–1.47] and extremely obese patients (HR 1.33, 95% CI 1.02–1.74) had higher mortality. Normal weight [odds ratio (OR) 0.79, 95% CI 0.68–0.90] and extremely obese (OR 0.73, 95% CI 0.54–0.99) individuals also had lower odds of DAOH. Conclusion Mild obesity is associated with lower long-term risk in older STEMI patients, while normal weight and extreme obesity are associated with worse outcomes. These findings highlight hazards faced by an increasing number of older individuals with normal weight or extreme obesity and cardiovascular disease.
    Type of Medium: Online Resource
    ISSN: 2058-5225 , 2058-1742
    URL: Article
    DOI: 10.1093/ehjqcco/qcx010
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2017
    detail.hit.zdb_id: 2823451-0
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