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2. Clinical effect of renal dysfunction on diagnostic and prognostic accuracy of B-type Natriuretic Peptide and N-terminal Pro-B-type Natriuretic Peptide for acute heart failure

Author

Wussler, D, primary, Balkin, M, additional, Michou, E, additional, Sabti, Z, additional, Kozhuharov, N, additional, Strebel, I, additional, Nowak, A, additional, Von Eckardstein, A, additional, Pfister, O, additional, Breidthardt, T, additional, and Mueller, C, additional

Published
2023
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6. External validation of the Antwerp score: a novel score for predicting responders to catheter ablation of atrial fibrillation in patients with depressed left ventricular function

Author

Serban, T, primary, Du Fay De Lavallaz, J, additional, Barker, C D, additional, Knecht, S, additional, Strebel, I, additional, Krisai, P, additional, Voellmin, G, additional, Osswald, S, additional, Sticherling, C, additional, Kuehne, M, additional, and Badertscher, P, additional

Published
2023
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7. Differences in circulating cardiac troponin I and T in acute and chronic cardiac disease

Author

Zimmermann, T, primary, Koechlin, L, additional, Walter, J, additional, Kimenai, D, additional, Nestelberger, T, additional, Boeddinghaus, J, additional, Lopez-Ayala, P, additional, Puelacher, C, additional, Gualandro, D, additional, Strebel, I, additional, Diebold, M, additional, Twerenbold, R, additional, Hammarsten, O, additional, Meex, S, additional, and Mueller, C, additional

Published
2022
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8. Renal failure: a non-cardiac source of high sensitivity cardiac troponin T

Author

Papachristou, A, primary, Puelacher, C, additional, Glarner, N, additional, Strebel, I, additional, Steiger, J, additional, Diebold, M, additional, Lurati Buse, G, additional, Bolliger, D, additional, Steiner, L A, additional, Gurke, L, additional, Wolff, T, additional, Mujagic, E, additional, Gualandro, D M, additional, Mueller, C, additional, and Breidthardt, T, additional

Published
2022
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9. Performance of high-sensitivity cardiac troponin T versus I for the early diagnosis of myocardial infarction

Author

Koechlin, L, primary, Boeddinghaus, J, additional, Lopez-Ayala, P, additional, Nestelberger, T, additional, Miro, O, additional, Wussler, D, additional, Zimmermann, T, additional, Strebel, I, additional, Christ, M, additional, Wildi, K, additional, Rubini Gimenez, M, additional, Martin-Sanchez, J, additional, Keller, D, additional, Twerenbold, R, additional, and Mueller, C, additional

Published
2022
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12. Using high-sensitivity cardiac troponin for the exclusion of inducible myocardial ischemia in patients without previously known coronary artery disease

Author

Schaefer, I, primary, Lopez-Ayala, P, additional, Walter, J, additional, Rumora, K, additional, Amrein, M, additional, Zimmermann, T, additional, Boeddinghaus, J, additional, Koechlin, L, additional, Strebel, I, additional, Nestelberger, T, additional, Wussler, D, additional, Puelacher, C, additional, Kaiser, C, additional, Zellweger, M, additional, and Mueller, C, additional

Published
2022
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13. Development and validation of a decision support tool for the diagnosis of acute heart failure: systematic review, meta-analysis, and modelling study

Author

Lee, K.K., Doudesis, D., Anwar, M., Astengo, F., Chenevier-Gobeaux, C., Claessens, Y.E., Wussler, D., Kozhuharov, N., Strebel, I., Sabti, Z., deFilippi, C., Seliger, S., Moe, G., Fernando, C., Bayes-Genis, A., Kimmenade, R.R.J. van, Pinto, Yigal, Gaggin, H.K., Wiemer, J.C., Möckel, M., Rutten, J.H.W., Meiracker, A.H. van den, Gargani, L., Pugliese, N.R., Pemberton, C., Ibrahim, I., Gegenhuber, A., Mueller, T., Neumaier, M., Behnes, M., Akin, I., Bombelli, M., Grassi, G., Nazerian, P., Albano, G., Bahrmann, P., Newby, D.E., Japp, A.G., Tsanas, A., Shah, A.S.V., Richards, A.M.S., McMurray, J.J., Mueller, C., Januzzi, J.L., Jr., Mills, N.L., Lee, K.K., Doudesis, D., Anwar, M., Astengo, F., Chenevier-Gobeaux, C., Claessens, Y.E., Wussler, D., Kozhuharov, N., Strebel, I., Sabti, Z., deFilippi, C., Seliger, S., Moe, G., Fernando, C., Bayes-Genis, A., Kimmenade, R.R.J. van, Pinto, Yigal, Gaggin, H.K., Wiemer, J.C., Möckel, M., Rutten, J.H.W., Meiracker, A.H. van den, Gargani, L., Pugliese, N.R., Pemberton, C., Ibrahim, I., Gegenhuber, A., Mueller, T., Neumaier, M., Behnes, M., Akin, I., Bombelli, M., Grassi, G., Nazerian, P., Albano, G., Bahrmann, P., Newby, D.E., Japp, A.G., Tsanas, A., Shah, A.S.V., Richards, A.M.S., McMurray, J.J., Mueller, C., Januzzi, J.L., Jr., and Mills, N.L.

Abstract

Item does not contain fulltext, OBJECTIVES: To evaluate the diagnostic performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds for acute heart failure and to develop and validate a decision support tool that combines NT-proBNP concentrations with clinical characteristics. DESIGN: Individual patient level data meta-analysis and modelling study. SETTING: Fourteen studies from 13 countries, including randomised controlled trials and prospective observational studies. PARTICIPANTS: Individual patient level data for 10 369 patients with suspected acute heart failure were pooled for the meta-analysis to evaluate NT-proBNP thresholds. A decision support tool (Collaboration for the Diagnosis and Evaluation of Heart Failure (CoDE-HF)) that combines NT-proBNP with clinical variables to report the probability of acute heart failure for an individual patient was developed and validated. MAIN OUTCOME MEASURE: Adjudicated diagnosis of acute heart failure. RESULTS: Overall, 43.9% (4549/10 369) of patients had an adjudicated diagnosis of acute heart failure (73.3% (2286/3119) and 29.0% (1802/6208) in those with and without previous heart failure, respectively). The negative predictive value of the guideline recommended rule-out threshold of 300 pg/mL was 94.6% (95% confidence interval 91.9% to 96.4%); despite use of age specific rule-in thresholds, the positive predictive value varied at 61.0% (55.3% to 66.4%), 73.5% (62.3% to 82.3%), and 80.2% (70.9% to 87.1%), in patients aged <50 years, 50-75 years, and >75 years, respectively. Performance varied in most subgroups, particularly patients with obesity, renal impairment, or previous heart failure. CoDE-HF was well calibrated, with excellent discrimination in patients with and without previous heart failure (area under the receiver operator curve 0.846 (0.830 to 0.862) and 0.925 (0.919 to 0.932) and Brier scores of 0.130 and 0.099, respectively). In patients without previous heart failure, the diagnostic performance was consistent across al

Published
2022

14. Development and validation of a decision support tool for the diagnosis of acute heart failure: Systematic review, meta-analysis, and modelling study

Author

Lee, K, Doudesis, D, Anwar, M, Astengo, F, Chenevier-Gobeaux, C, Claessens, Y, Wussler, D, Kozhuharov, N, Strebel, I, Sabti, Z, Defilippi, C, Seliger, S, Moe, G, Fernando, C, Bayes-Genis, A, van Kimmenade, R, Pinto, Y, Gaggin, H, Wiemer, J, Möckel, M, Rutten, J, van den Meiracker, A, Gargani, L, Pugliese, N, Pemberton, C, Ibrahim, I, Gegenhuber, A, Mueller, T, Neumaier, M, Behnes, M, Akin, I, Bombelli, M, Grassi, G, Nazerian, P, Albano, G, Bahrmann, P, Newby, D, Japp, A, Tsanas, A, Shah, A, Richards, A, Mcmurray, J, Mueller, C, Januzzi, J, Mills, N, Lee, Kuan Ken, Doudesis, Dimitrios, Anwar, Mohamed, Astengo, Federica, Chenevier-Gobeaux, Camille, Claessens, Yann-Erick, Wussler, Desiree, Kozhuharov, Nikola, Strebel, Ivo, Sabti, Zaid, deFilippi, Christopher, Seliger, Stephen, Moe, Gordon, Fernando, Carlos, Bayes-Genis, Antoni, van Kimmenade, Roland R J, Pinto, Yigal, Gaggin, Hanna K, Wiemer, Jan C, Möckel, Martin, Rutten, Joost H W, van den Meiracker, Anton H, Gargani, Luna, Pugliese, Nicola R, Pemberton, Christopher, Ibrahim, Irwani, Gegenhuber, Alfons, Mueller, Thomas, Neumaier, Michael, Behnes, Michael, Akin, Ibrahim, Bombelli, Michele, Grassi, Guido, Nazerian, Peiman, Albano, Giovanni, Bahrmann, Philipp, Newby, David E, Japp, Alan G, Tsanas, Athanasios, Shah, Anoop S V, Richards, A Mark, McMurray, John J V, Mueller, Christian, Januzzi, James L, Mills, Nicholas L, Lee, K, Doudesis, D, Anwar, M, Astengo, F, Chenevier-Gobeaux, C, Claessens, Y, Wussler, D, Kozhuharov, N, Strebel, I, Sabti, Z, Defilippi, C, Seliger, S, Moe, G, Fernando, C, Bayes-Genis, A, van Kimmenade, R, Pinto, Y, Gaggin, H, Wiemer, J, Möckel, M, Rutten, J, van den Meiracker, A, Gargani, L, Pugliese, N, Pemberton, C, Ibrahim, I, Gegenhuber, A, Mueller, T, Neumaier, M, Behnes, M, Akin, I, Bombelli, M, Grassi, G, Nazerian, P, Albano, G, Bahrmann, P, Newby, D, Japp, A, Tsanas, A, Shah, A, Richards, A, Mcmurray, J, Mueller, C, Januzzi, J, Mills, N, Lee, Kuan Ken, Doudesis, Dimitrios, Anwar, Mohamed, Astengo, Federica, Chenevier-Gobeaux, Camille, Claessens, Yann-Erick, Wussler, Desiree, Kozhuharov, Nikola, Strebel, Ivo, Sabti, Zaid, deFilippi, Christopher, Seliger, Stephen, Moe, Gordon, Fernando, Carlos, Bayes-Genis, Antoni, van Kimmenade, Roland R J, Pinto, Yigal, Gaggin, Hanna K, Wiemer, Jan C, Möckel, Martin, Rutten, Joost H W, van den Meiracker, Anton H, Gargani, Luna, Pugliese, Nicola R, Pemberton, Christopher, Ibrahim, Irwani, Gegenhuber, Alfons, Mueller, Thomas, Neumaier, Michael, Behnes, Michael, Akin, Ibrahim, Bombelli, Michele, Grassi, Guido, Nazerian, Peiman, Albano, Giovanni, Bahrmann, Philipp, Newby, David E, Japp, Alan G, Tsanas, Athanasios, Shah, Anoop S V, Richards, A Mark, McMurray, John J V, Mueller, Christian, Januzzi, James L, and Mills, Nicholas L

Abstract

Objectives: To evaluate the diagnostic performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds for acute heart failure and to develop and validate a decision support tool that combines NT-proBNP concentrations with clinical characteristics. Design: Individual patient level data meta-analysis and modelling study. Setting: Fourteen studies from 13 countries, including randomised controlled trials and prospective observational studies. Participants: Individual patient level data for 10 369 patients with suspected acute heart failure were pooled for the meta-analysis to evaluate NT-proBNP thresholds. A decision support tool (Collaboration for the Diagnosis and Evaluation of Heart Failure (CoDE-HF)) that combines NT-proBNP with clinical variables to report the probability of acute heart failure for an individual patient was developed and validated. Main outcome measure: Adjudicated diagnosis of acute heart failure. Results: Overall, 43.9% (4549/10 369) of patients had an adjudicated diagnosis of acute heart failure (73.3% (2286/3119) and 29.0% (1802/6208) in those with and without previous heart failure, respectively). The negative predictive value of the guideline recommended rule-out threshold of 300 pg/mL was 94.6% (95% confidence interval 91.9% to 96.4%); despite use of age specific rule-in thresholds, the positive predictive value varied at 61.0% (55.3% to 66.4%), 73.5% (62.3% to 82.3%), and 80.2% (70.9% to 87.1%), in patients aged [removed]75 years, respectively. Performance varied in most subgroups, particularly patients with obesity, renal impairment, or previous heart failure. CoDE-HF was well calibrated, with excellent discrimination in patients with and without previous heart failure (area under the receiver operator curve 0.846 (0.830 to 0.862) and 0.925 (0.919 to 0.932) and Brier scores of 0.130 and 0.099, respectively). In patients without previous heart failure, the diagnostic performance was consistent across all subgroups

Published
2022

15. Ambient temperature and atmospheric pressure at discharge as precipitating factors in immediate adverse events in patients treated for decompensated heart failure

Author

Benito-Lozano, M, Lopez-Ayala, P, Rodriguez, S, Gil, V, Llorens, P, Yufera, A, Jacob, J, Traveria-Becker, L, Strebel, I, Lucas-Imbernon, FJ, Tost, J, Lopez-Hernandez, A, Rodriguez, B, Fuentes, M, Sanchez-Ramon, S, Herrera-Mateo, S, Aguirre, A, Alonso, MI, Pavon, J, Lopez-Grima, ML, Espinosa, B, Mueller, C, Burillo-Putze, G, Miro, O, Instituto de Salud Carlos III, Ministerio de Sanidad (España), European Commission, Novartis, and Orion Pharma

Subjects
acute heart failure, Climate, Emergency Departments, Temperature, temperature, Acute heart failure, Prognosis, mortality, emergency departments, atmospheric pressure, Emergency Medicine, Internal Medicine, Atmospheric pressure, prognosis, Mortality
Abstract

To investigate the relationship of ambient temperature and atmospheric pressure (AP) at patient discharge after an episode of acute heart failure (AHF) with very early post-discharge adverse outcomes. We analyzed 14,656 patients discharged after an AHF episode from 26 hospitals in 16 Spanish cities. The primary outcome was the 7-day post-discharge combined adverse event (emergency department –ED- revisit or hospitalization due to AHF, or all-cause death), and secondary outcomes were these three adverse events considered individually. Associations (adjusted for patient and demographic conditions, and length of stay -LOS- during the AHF index episode) of temperature and AP with the primary and secondary outcomes were investigated. We used restricted cubic splines to model the continuous non-linear association of temperature and AP with each endpoint. Some sensitivity analyses were performed. Patients were discharged after a median LOS of 5 days (IQR = 1–10). The highest temperature at discharge ranged from − 2 to 41.6 °C, and AP was from 892 to 1037 hPa. The 7-day post-discharge combined event occurred in 1242 patients (8.4%), with percentages of 7-day ED-revisit, hospitalization and death of 7.8%, 5.1% and 0.9%, respectively. We found no association between the maximal temperature and AP on the day of discharge and the primary or secondary outcomes. Similarly, there were no significant associations when the analyses were restricted to hospitalized patients (median LOS = 7 days, IQR = 4–11) during the index event, or when lag-1, lag-2 or the mean of the 3 post-discharge days (instead of point estimation) of ambient temperature and AP were considered. Temperature and AP on the day of patient discharge are not independently associated with the risk of very early adverse events during the vulnerable post-discharge period in patients discharged after an AHF episode., This study was partially supported by competitive grants from the Instituto de Salud Carlos III supported by funds from the Spanish Ministry of Health and FEDER (PI18/00393). The ICA-Research Group has received unrestricted funding from Novartis and Orion Pharma. We appreciate the high professionalism of Alicia Díaz in the data management of the EAHFE Registry. The design of the study, patient inclusion, data analysis, discussion, and final conclusions were exclusively carried out by the authors with no participation of the granters.

Published
2022

16. Development and validation of a decision support tool for the diagnosis of acute heart failure: systematic review, meta- analysis, and modelling study

Author

Lee, KK, Doudesis, D, Anwar, M, Astengo, F, Chenevier-Gobeaux, C, Claessens, YE, Wussler, D, Kozhuharov, N, Strebel, I, Sabti, Z, deFilippi, C, Seliger, S, Moe, G, Fernando, C, Bayes-Genis, A, van Kimmenade, RRJ, Pinto, Y, Gaggin, HK, Wiemer, JC, Mockel, M, Rutten, JHW, van den Meiracker, AH, Gargani, L, Pugliese, NR, Pemberton, C, Ibrahim, I, Gegenhuber, A, Mueller, T, Neumaier, M, Behnes, M, Akin, I, Bombelli, M, Grassi, G, Nazerian, P, Albano, G, Bahrmann, P, Newby, DE, Japp, AG, Tsanas, A, Shah, ASV, Richards, AM, McMurray, JJV, Mueller, C, Januzzi, JL, and Mills, NL

Abstract

OBJECTIVES To evaluate the diagnostic performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds for acute heart failure and to develop and validate a decision support tool that combines NT-proBNP concentrations with clinical characteristics. DESIGN Individual patient level data meta-analysis and modelling study. SETTING Fourteen studies from 13 countries, including randomised controlled trials and prospective observational studies. PARTICIPANTS Individual patient level data for 10 369 patients with suspected acute heart failure were pooled for the meta-analysis to evaluate NT-proBNP thresholds. A decision support tool (Collaboration for the Diagnosis and Evaluation of Heart Failure (CoDE-HF)) that combines NT-proBNP with clinical variables to report the probability of acute heart failure for an individual patient was developed and validated. MAIN OUTCOME MEASURE Adjudicated diagnosis of acute heart failure. RESULTS Overall, 43.9% (4549/10 369) of patients had an adjudicated diagnosis of acute heart failure (73.3% (2286/3119) and 29.0% (1802/6208) in those with and without previous heart failure, respectively). The negative predictive value of the guideline recommended rule-out threshold of 300 pg/mL was 94.6% (95% confidence interval 91.9% to 96.4%); despite use of age specific rule-in thresholds, the positive predictive value varied at 61.0% (55.3% to 66.4%), 73.5% (62.3% to 82.3%), and 80.2% (70.9% to 87.1%), in patients aged 75 years, respectively. Performance varied in most subgroups, particularly patients with obesity, renal impairment, or previous heart failure. CoDE-HF was well calibrated, with excellent discrimination in patients with and without previous heart failure (area under the receiver operator curve 0.846 (0.830 to 0.862) and 0.925 (0.919 to 0.932) and Brier scores of 0.130 and 0.099, respectively). In patients without previous heart failure, the diagnostic performance was consistent across all subgroups, with 40.3% (2502/6208) identified at low probability (negative predictive value of 98.6%, 97.8% to 99.1%) and 28.0% (1737/6208) at high probability (positive predictive value of 75.0%, 65.7% to 82.5%) of having acute heart failure. CONCLUSIONS In an international, collaborative evaluation of the diagnostic performance of NT-proBNP, guideline recommended thresholds to diagnose acute heart failure varied substantially in important patient subgroups. The CoDE-HF decision support tool incorporating NT-proBNP as a continuous measure and other clinical variables provides a more consistent, accurate, and individualised approach. STUDY REGISTRATION PROSPERO CRD42019159407.

Published
2022

17. Derivation and validation of a novel 3-hour pathway for the observe-zone of the ESC 0/1h-algorithm

Author

Lopez Ayala, P, primary, Nestelberger, T, additional, Boeddinghaus, J, additional, Koechlin, L, additional, Strebel, I, additional, Walter, J, additional, Rubini Gimenez, M, additional, Miro, O, additional, Martin-Sanchez, F J, additional, Keller, D, additional, Twerenbold, R, additional, Giannitsis, E, additional, Lindahl, B, additional, and Mueller, C, additional

Published
2021
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18. Early standardized clinical judgement for syncope diagnosis in the emergency department

Author

du Fay de Lavallaz, J., Badertscher, P., Zimmermann, T., Nestelberger, T., Walter, J., Strebel, I., Coelho, C., Miró, Salgado, E., Christ, M., Geigy, N., Cullen, L., Than, M., Javier Martin-Sanchez, F., Di Somma, S., Frank Peacock, W., Morawiec, B., Wussler, D., Keller, D. I., Gualandro, D., Michou, E., Kühne, M., Lohrmann, J., Reichlin, T., Mueller, C., Flores, Dayana, Widmer, Velina, Breidthardt, Tobias, Bustamante Mandrión, José, Poepping, Imke, Kawecki, Damian, Muzyk, Piotr, Belkin, Maria, Puelacher, Christian, Lopez Ayala, Pedro, Freese, Michael, Boeddinghaus, Jasper, Diebold, Matthias, Koechlin, Luca, Greenslade, Jaimi, Hawkins, Tracey, Rentsch, Katharina, von Eckardstein, Arnold, Buser, Andreas, Campodarve, Isabel, Gea, Joachim, Cruz, Helena Mañé, Calderon, Sofìa, Fuenzalida Inostroza, Carolina Isabel, Briñón, Miguel Angel García, Suárez Cadenas, María, Bingisser, Roland, Osswald, Stefan, other, and, du Fay de Lavallaz, J., Badertscher, P., Zimmermann, T., Nestelberger, T., Walter, J., Strebel, I., Coelho, C., Miró, Salgado, E., Christ, M., Geigy, N., Cullen, L., Than, M., Javier Martin-Sanchez, F., Di Somma, S., Frank Peacock, W., Morawiec, B., Wussler, D., Keller, D. I., Gualandro, D., Michou, E., Kühne, M., Lohrmann, J., Reichlin, T., Mueller, C., Flores, Dayana, Widmer, Velina, Breidthardt, Tobias, Bustamante Mandrión, José, Poepping, Imke, Kawecki, Damian, Muzyk, Piotr, Belkin, Maria, Puelacher, Christian, Lopez Ayala, Pedro, Freese, Michael, Boeddinghaus, Jasper, Diebold, Matthias, Koechlin, Luca, Greenslade, Jaimi, Hawkins, Tracey, Rentsch, Katharina, von Eckardstein, Arnold, Buser, Andreas, Campodarve, Isabel, Gea, Joachim, Cruz, Helena Mañé, Calderon, Sofìa, Fuenzalida Inostroza, Carolina Isabel, Briñón, Miguel Angel García, Suárez Cadenas, María, Bingisser, Roland, Osswald, Stefan, and other, and

Abstract

Background: The diagnosis of cardiac syncope remains a challenge in the emergency department (ED). Objective: Assessing the diagnostic accuracy of the early standardized clinical judgement (ESCJ) including a standardized syncope-specific case report form (CRF) in comparison with a recommended multivariable diagnostic score. Methods: In a prospective international observational multicentre study, diagnostic accuracy for cardiac syncope of ESCJ by the ED physician amongst patients ≥ 40 years presenting with syncope to the ED was directly compared with that of the Evaluation of Guidelines in Syncope Study (EGSYS) diagnostic score. Cardiac syncope was centrally adjudicated independently of the ESCJ or conducted workup by two ED specialists based on all information available up to 1-year follow-up. Secondary aims included direct comparison with high-sensitivity cardiac troponin I (hs-cTnI) and B-type natriuretic peptide (BNP) concentrations and a Lasso regression to identify variables contributing most to ESCJ. Results: Cardiac syncope was adjudicated in 252/1494 patients (15.2%). The diagnostic accuracy of ESCJ for cardiac syncope as quantified by the area under the curve (AUC) was 0.87 (95% CI: 0.84–0.89), and higher compared with the EGSYS diagnostic score (0.73 (95% CI: 0.70–0.76)), hs-cTnI (0.77 (95% CI: 0.73–0.80)) and BNP (0.77 (95% CI: 0.74–0.80)), all P < 0.001. Both biomarkers (alone or in combination) on top of the ESCJ significantly improved diagnostic accuracy. Conclusion: ESCJ including a standardized syncope-specific CRF has very high diagnostic accuracy and outperforms the EGSYS score, hs-cTnI and BNP.

Published
2021

19. External validation of a clinical decision rule to identify patients at low risk for acute coronary syndrome who do not need objective coronary artery disease testing

Author

Ratmann, P.D, primary, Boeddinghaus, J, additional, Lopez Ayala, P, additional, Strebel, I, additional, Koechlin, L, additional, Nestelberger, T, additional, Miro, O, additional, Martin-Sanchez, F.J, additional, Wussler, D, additional, Rubini Gimenez, M, additional, Prepoudis, A, additional, Gualandro, D.M, additional, Keller, D, additional, Twerenbold, R, additional, and Mueller, C, additional

Published
2020
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20. Prognostic value of health-related quality of life in patients with acute dyspnea

Author

Belkin, M, primary, Wussler, D, additional, Strebel, I, additional, Michou, E, additional, Kozhuharov, N, additional, Sabti, Z, additional, Nowak, A, additional, Flores, D, additional, Nestelberger, T, additional, Walter, J, additional, Boeddinghaus, J, additional, Zimmermann, T, additional, Koechlin, L, additional, Breidthardt, T, additional, and Mueller, C, additional

Published
2020
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22. Development and validation of an ECG-based cardiac syncope risk calculator

Author

Zimmermann, T, primary, Du Fay De Lavallaz, J, additional, Nestelberger, T, additional, Gualandro, D, additional, Strebel, I, additional, Lopez-Ayala, P, additional, Florez, D, additional, Koechlin, L, additional, Walter, J, additional, Diebold, M, additional, Wussler, D, additional, Belkin, M, additional, Kuehne, M, additional, Sun, B, additional, and Mueller, C, additional

Published
2020
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23. External validation of a suggested extension of the ESC 0/1h-algorithm for early rule out of myocardial infarction

Author

Lopez Ayala, P, primary, Nestelberger, T, additional, Strebel, I, additional, Ratmann, P.D, additional, Boeddinghaus, J, additional, Koechlin, L, additional, Wussler, D, additional, Walter, J, additional, Rubini Gimenez, M, additional, Miro, O, additional, Martin-Sanchez, F.J, additional, Keller, D, additional, Twerenbold, R, additional, and Mueller, C, additional

Published
2020
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25. Application of the ESC and AHA guidelines for admission of syncope patients presenting to the ED

Author

Du Fay De Lavallaz, J, primary, Zimmermann, T, additional, Badertscher, P, additional, Flores, D, additional, Widmer, V, additional, Walter, J, additional, Strebel, I, additional, Lopez-Ayala, P, additional, Wussler, D, additional, Koechlin, L, additional, Di Somma, S, additional, Keller, D, additional, Kuehne, M, additional, and Mueller, C, additional

Published
2020
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26. Incidence, characteristics and prognosis of different cardiac etiologies underlying cardiac syncope

Author

Lopez Ayala, P, primary, Flores, D, additional, Zimmermann, T, additional, Du Fay De Lavallaz, J, additional, Nestelberger, T, additional, Strebel, I, additional, Gualandro, D.M, additional, Badertscher, P, additional, Miro, O, additional, Martin-Sanchez, F.J, additional, Geigy, N, additional, Christ, M, additional, Keller, D, additional, Than, M, additional, and Mueller, C, additional

Published
2020
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27. Early diagnosis of acute myocardial infarction in patients with a history of percutaneous coronary intervention

Author

Lopez Ayala, P, primary, Koechlin, L, additional, Boeddinghaus, J, additional, Strebel, I, additional, Nestelberger, T, additional, Ratmann, P.D, additional, Wussler, D, additional, Walter, J, additional, Rubini Gimenez, M, additional, Miro, O, additional, Martin Sanchez, F.J, additional, Kawecki, D, additional, Keller, D, additional, Twerenbold, R, additional, and Mueller, C, additional

Published
2020
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28. Effect of a Strategy of Comprehensive Vasodilation vs Usual Care on Mortality and Heart Failure Rehospitalization Among Patients With Acute Heart Failure The GALACTIC Randomized Clinical Trial

Author

Kozhuharov, N, Goudev, A, Flores, D, Maeder, MT, Walter, J, Shrestha, S, Gualandro, DM, de Oliveira, MT, Sabti, Z, Muller, B, Noveanu, M, Socrates, T, Ziller, R, Bayes-Genis, A, Sionis, A, Simon, P, Michou, E, Gujer, S, Gori, T, Wenzel, P, Pfister, O, Conen, D, Kapos, I, Kobza, R, Rickli, H, Breidthardt, T, Munzel, T, Erne, P, Mueller, C, Dimov, B, Herr, N, Isenrich, R, Mosimann, T, Twerenbold, R, Boeddinghaus, J, Nestelberger, T, Puelacher, C, Freese, M, Vogele, J, Meissner, K, Martin, J, Strebel, I, Wussler, D, Schumacher, C, Osswald, S, Vogt, F, Hilti, J, Schwarz, J, Fitze, B, Hartwiger, S, Arenja, N, Glatz, B, Rentsch, K, Bossa, A, Jallad, S, Soeiro, A, Jansen, T, Gebel, G, Bossard, M, and Christ, M

Abstract

IMPORTANCE Short-term infusions of single vasodilators, usually given in a fixed dose, have not improved outcomes in patients with acute heart failure (AHF). OBJECTIVE To evaluate the effect of a strategy that emphasized early intensive and sustained vasodilation using individualized up-titrated doses of established vasodilators in patients with AHF. DESIGN, SETTING, AND PARTICIPANTS Randomized, open-label blinded-end-point trial enrolling 788 patients hospitalized for AHF with dyspnea, increased plasma concentrations of natriuretic peptides, systolic blood pressure of at least 100mmHg, and plan for treatment in a general ward in 10 tertiary and secondary hospitals in Switzerland, Bulgaria, Germany, Brazil, and Spain. Enrollment began in December 2007 and follow-up was completed in February 2019. INTERVENTIONS Patients were randomized 1:1 to a strategy of early intensive and sustained vasodilation throughout the hospitalization (n = 386) or usual care (n = 402). Early intensive and sustained vasodilation was a comprehensive pragmatic approach of maximal and sustained vasodilation combining individualized doses of sublingual and transdermal nitrates, low-dose oral hydralazine for 48 hours, and rapid up-titration of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or sacubitril-valsartan. MAIN OUTCOMES AND MEASURES The primary end pointwas a composite of all-cause mortality or rehospitalization for AHF at 180 days. RESULTS Among 788 patients randomized, 781 (99.1%; median age, 78 years; 36.9% women) completed the trial and were eligible for primary end point analysis. Follow-up at 180 days was completed for 779 patients (99.7%). The primary end point, a composite of all-cause mortality or rehospitalization for AHF at 180 days, occurred in 117 patients (30.6%) in the intervention group (including 55 deaths [14.4%]) and in 111 patients (27.8%) in the usual care group (including 61 deaths [15.3%]) (absolute difference for the primary end point, 2.8% [95% CI, -3.7% to 9.3%]; adjusted hazard ratio, 1.07 [95% CI, 0.83-1.39]; P =.59). The most common clinically significant adverse events with early intensive and sustained vasodilation vs usual care were hypokalemia (23% vs 25%), worsening renal function (21% vs 20%), headache (26% vs 10%), dizziness (15% vs 10%), and hypotension (8% vs 2%). CONCLUSIONS AND RELEVANCE Among patients with AHF, a strategy of early intensive and sustained vasodilation, compared with usual care, did not significantly improve a composite outcome of all-cause mortality and AHF rehospitalization at 180 days.

Published
2019

31. P6570Performance of the early clinical judgement for the diagnosis of syncope on the emergency department

Author

Du Fay De Lavallaz, J, primary, Badertscher, P B, additional, Zimmermann, T Z, additional, Nestelberger, T N, additional, Walter, J W, additional, Strebel, I S, additional, Lohrmann, J S, additional, Boeddinghaus, J B, additional, Miro, O M, additional, Than, M T, additional, Martin-Sanchez, J M S, additional, Cullen, L C, additional, Kuehne, M K, additional, Reichlin, T, additional, and Mueller, C M, additional

Published
2019
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32. P1765Hyperacute T-wave in the early diagnosis of acute myocardial infarction

Author

Koechlin, L, primary, Strebel, I, additional, Boeddinghaus, J, additional, Nestelberger, T, additional, Wussler, D, additional, Walter, J, additional, Zimmermann, T, additional, Badertscher, P, additional, Wildi, K, additional, Puelacher, C, additional, Du Fay De Lavallaz, J, additional, Rubini Gimenez, M, additional, Reichlin, T, additional, Twerenbold, R, additional, and Mueller, C, additional

Published
2019
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33. P1656Incremental value of interleukin-6 and C-reactive protein to the MEESSI acute heart failure risk score

Author

Wussler, D N, primary, Kozhuharov, N, additional, Sabti, Z, additional, Walter, J, additional, Strebel, I, additional, Miro, O, additional, Rossello, X, additional, Martin-Sanchez, F J, additional, Pocock, S, additional, Nowak, A, additional, Twerenbold, R, additional, Flores, D, additional, Pfister, O, additional, Breidthardt, T, additional, and Mueller, C, additional

Published
2019
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35. 2409ALERT-CS - Development of an ECG-based cardiac syncope risk calculator

Author

Zimmermann, T, primary, Du Fay De Lavallaz, J, additional, Walter, J E, additional, Strebel, I, additional, Nestelberger, T, additional, Badertscher, P, additional, Boeddinghaus, J, additional, Twerenbold, R, additional, Koechlin, L, additional, Lohrmann, J, additional, Steude, J S, additional, Gualandro, D M, additional, Kuehne, M, additional, Reichlin, T, additional, and Mueller, C, additional

Published
2019
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36. P5674Direct comparison of three high-sensitivity cardiac troponins in syncope

Author

Du Fay De Lavallaz, J, primary, Badertscher, P B, additional, Zimmermann, T Z, additional, Walter, J W, additional, Strebel, I S, additional, Puelacher, C P, additional, Peacock, F P, additional, Boeddinghaus, J B, additional, Nestelberger, T N, additional, Geigy, N G, additional, Miro, O M, additional, Kuehne, M K, additional, Reichlin, T R, additional, and Mueller, C M, additional

Published
2019
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37. P4849Man vs. machine: comparison of manual vs. automated 12-lead ECG prediction of the origin of idiopathic ventricular arrhythmias to guide catheter ablation

Author

Ebrahimi, R, primary, Strebel, I, additional, Van Dam, P M, additional, Kuehne, M, additional, Knecht, S, additional, Spies, F, additional, Abaecherli, R, additional, Badertscher, P, additional, Kozhuharov, N, additional, Zeljkovic, I, additional, Schaer, B, additional, Osswald, S, additional, Sticherling, C, additional, and Reichlin, T, additional

Published
2018
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38. P6458Extending the use of high-sensitivity cardiac troponin to patients with suspected stable coronary artery disease: insights from two large diagnostic studies

Author

Walter, J E, primary, Du Fay De Lavallaz, J, additional, Strebel, I, additional, Boeddinghaus, J, additional, Twerenbold, R, additional, Puelacher, C, additional, Rubini Gimenez, M, additional, Jeger, R, additional, Kaiser, C, additional, Nestelberger, T, additional, Wussler, D, additional, Badertscher, P, additional, Reichlin, T, additional, and Mueller, C, additional

Published
2018
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40. P1705Use of high-sensitivity cardiac troponin in patients with known coronary artery disease: insights from two large diagnostic studies

Author

Walter, J E, primary, Du Fay De Lavallaz, J, additional, Strebel, I, additional, Boeddinghaus, J, additional, Twerenbold, R, additional, Puelacher, C, additional, Rubini Gimenez, M, additional, Jeger, R, additional, Kaiser, C, additional, Nestelberger, T, additional, Wussler, D, additional, Badertscher, P, additional, Reichlin, T, additional, and Mueller, C, additional

Published
2018
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42. P2457Automated ECG quantification of myocardial scar in patients with and without conduction defects: correlation with myocardial perfusion imaging and clinical outcome in acute heart failure patients

Author

Badertscher, P., primary, Strebel, I., additional, Honegger, U., additional, Schaerli, N., additional, Puelacher, C., additional, Sabti, Z., additional, Osswald, S., additional, Zellweger, M.J., additional, Mueller, C., additional, and Reichlin, T., additional

Published
2017
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43. P6373Incremental diagnostic value of high-frequency QRS analysis for the detection of exercise induced myocardial ischemia

Author

Schaerli, N., primary, Honegger, U., additional, Abaecherli, R., additional, Rinderknecht, T., additional, Mueller, D., additional, Twerenbold, R., additional, Pretre, G., additional, Wagener, M., additional, Puelacher, C., additional, Strebel, I., additional, Leber, R., additional, Osswald, S., additional, Zellweger, M., additional, Mueller, C., additional, and Reichlin, T., additional

Published
2017
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44. The building process as a chain of displacements - Following a construction project from strategic planning through an architectural competition to the building permit

Author

Silberberger, J. (author), Strebel, I. (author), Tränkle, P. (author), Silberberger, J. (author), Strebel, I. (author), and Tränkle, P. (author)

Abstract

While research on architectural competitions can be considered a well-established field nowadays, research on the transition between the competition procedure and the subsequent project phase remains fragmentary. The paper at hand aims at addressing this gap. Standing in the tradition of actor-network theory (Callon 1986; Law and John 2004; Latour 2005) the paper is attentive to the various displacements that shape a construction project from strategic planning and preliminary studies to the end of the competition procedure and then through the subsequent project phase. In this way, the paper embeds the architectural competition into the building process and elaborates a perspective on the latter as a set of intertwining procedures that constantly assess and re-define the construction project

Published
2014

45. Development and validation of a decision support tool for the diagnosis of acute heart failure: systematic review, meta-analysis, and modelling study

Author

Lee, Kuan Ken, Doudesis, Dimitrios, Anwar, Mohamed, Astengo, Federica, Chenevier-Gobeaux, Camille, Claessens, Yann-Erick, Wussler, Desiree, Kozhuharov, Nikola, Strebel, Ivo, Sabti, Zaid, deFilippi, Christopher, Seliger, Stephen, Moe, Gordon, Fernando, Carlos, Bayes-Genis, Antoni, van Kimmenade, Roland R. J., Pinto, Yigal, Gaggin, Hanna K., Wiemer, Jan C., Möckel, Martin, Rutten, Joost H. W., van den Meiracker, Anton H., Gargani, Luna, Pugliese, Nicola R., Pemberton, Christopher, Ibrahim, Irwani, Gegenhuber, Alfons, Mueller, Thomas, Neumaier, Michael, Behnes, Michael, Akin, Ibrahim, Bombelli, Michele, Grassi, Guido, Nazerian, Peiman, Albano, Giovanni, Bahrmann, Philipp, Newby, David E., Japp, Alan G., Tsanas, Athanasios, Shah, Anoop S. V., Richards, A. Mark, McMurray, John J. V., Mueller, Christian, Januzzi, James L., Mills, Nicholas L., on behalf of the CoDE-HF investigators, Cardiology, ACS - Heart failure & arrhythmias, Internal Medicine, Lee, K, Doudesis, D, Anwar, M, Astengo, F, Chenevier-Gobeaux, C, Claessens, Y, Wussler, D, Kozhuharov, N, Strebel, I, Sabti, Z, Defilippi, C, Seliger, S, Moe, G, Fernando, C, Bayes-Genis, A, van Kimmenade, R, Pinto, Y, Gaggin, H, Wiemer, J, Möckel, M, Rutten, J, van den Meiracker, A, Gargani, L, Pugliese, N, Pemberton, C, Ibrahim, I, Gegenhuber, A, Mueller, T, Neumaier, M, Behnes, M, Akin, I, Bombelli, M, Grassi, G, Nazerian, P, Albano, G, Bahrmann, P, Newby, D, Japp, A, Tsanas, A, Shah, A, Richards, A, Mcmurray, J, Mueller, C, Januzzi, J, and Mills, N

Subjects
Heart Failure, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Predictive Value of Test, General Medicine, Biomarker, Peptide Fragments, Diagnosis, Differential, Prospective Studie, Observational Studies as Topic, Peptide Fragment, SDG 3 - Good Health and Well-being, Predictive Value of Tests, Natriuretic Peptide, Brain, Humans, Prospective Studies, Biomarkers, Human
Abstract

ObjectivesTo evaluate the diagnostic performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds for acute heart failure and to develop and validate a decision support tool that combines NT-proBNP concentrations with clinical characteristics.DesignIndividual patient level data meta-analysis and modelling study.SettingFourteen studies from 13 countries, including randomised controlled trials and prospective observational studies.ParticipantsIndividual patient level data for 10 369 patients with suspected acute heart failure were pooled for the meta-analysis to evaluate NT-proBNP thresholds. A decision support tool (Collaboration for the Diagnosis and Evaluation of Heart Failure (CoDE-HF)) that combines NT-proBNP with clinical variables to report the probability of acute heart failure for an individual patient was developed and validated.Main outcome measureAdjudicated diagnosis of acute heart failure.ResultsOverall, 43.9% (4549/10 369) of patients had an adjudicated diagnosis of acute heart failure (73.3% (2286/3119) and 29.0% (1802/6208) in those with and without previous heart failure, respectively). The negative predictive value of the guideline recommended rule-out threshold of 300 pg/mL was 94.6% (95% confidence interval 91.9% to 96.4%); despite use of age specific rule-in thresholds, the positive predictive value varied at 61.0% (55.3% to 66.4%), 73.5% (62.3% to 82.3%), and 80.2% (70.9% to 87.1%), in patients aged 75 years, respectively. Performance varied in most subgroups, particularly patients with obesity, renal impairment, or previous heart failure. CoDE-HF was well calibrated, with excellent discrimination in patients with and without previous heart failure (area under the receiver operator curve 0.846 (0.830 to 0.862) and 0.925 (0.919 to 0.932) and Brier scores of 0.130 and 0.099, respectively). In patients without previous heart failure, the diagnostic performance was consistent across all subgroups, with 40.3% (2502/6208) identified at low probability (negative predictive value of 98.6%, 97.8% to 99.1%) and 28.0% (1737/6208) at high probability (positive predictive value of 75.0%, 65.7% to 82.5%) of having acute heart failure.ConclusionsIn an international, collaborative evaluation of the diagnostic performance of NT-proBNP, guideline recommended thresholds to diagnose acute heart failure varied substantially in important patient subgroups. The CoDE-HF decision support tool incorporating NT-proBNP as a continuous measure and other clinical variables provides a more consistent, accurate, and individualised approach.Study registrationPROSPERO CRD42019159407.

Published
2022

46. Noninvasive Assessment of Cardiopulmonary Hemodynamics Using Cardiovascular Magnetic Resonance Pulmonary Transit Time.

Author

Segeroth M, Winkel DJ, Kaufmann BA, Strebel I, Yang S, Cyriac J, Wasserthal J, Bach M, Lopez-Ayala P, Sauter A, Mueller C, Bremerich J, Zellweger M, and Haaf P

Abstract

Introduction: Pulmonary transit time (PTT) is the time it takes blood to pass from the right ventricle to the left ventricle via the pulmonary circulation, making it a potentially useful marker for heart failure. We assessed the association of PTT with diastolic dysfunction (DD) and mitral valve regurgitation (MVR). Methods: We evaluated routine stress perfusion cardiovascular magnetic resonance (CMR) scans in 83 patients including assessment of PTT with simultaneously available echocardiographic assessment. Relevant DD and MVR were defined as exceeding Grade I (impaired relaxation and mild regurgitation). PTT was determined from CMR rest perfusion scans. Normalized PTT (nPTT), adjusted for heart rate, was calculated using Bazett's formula. Results: Higher PTT and nPTT values were associated with higher grade DD and MVR. The diagnostic accuracy for the prediction of DD as quantified by the area under the ROC curve (AUC) was 0.73 (CI 0.61-0.85; p = 0.001) for PTT and 0.81 (CI 0.71-0.89; p < 0.001) for nPTT. For MVR, the diagnostic performance amounted to an AUC of 0.80 (CI 0.68-0.92; p < 0.001) for PTT and 0.78 (CI 0.65-0.90; p < 0.001) for nPTT. PTT values < 8 s rule out the presence of DD and MVR with a probability of 70% (negative predictive value 78%). Conclusion: CMR-derived PTT is a readily obtainable hemodynamic parameter. It is elevated in patients with DD and moderate to severe MVR. Low PTT values make the presence of DD and MVR-as assessed by echocardiography-unlikely., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Martin Segeroth et al.)

Published
2024
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47. Combining anatomical and biochemical markers in the detection and risk stratification of coronary artery disease.

Author

Albus M, Zimmermann T, Median D, Rumora K, Isayeva G, Amrein M, Schaefer I, Walter J, Michel E, Huré G, Strebel I, Caobelli F, Haaf P, Frey SM, Mueller C, and Zellweger MJ

Subjects
Humans, Male, Female, Risk Assessment, Middle Aged, Aged, Prognosis, Myocardial Perfusion Imaging methods, Cohort Studies, Prospective Studies, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease blood, Biomarkers blood, Troponin T blood, Coronary Angiography methods, Tomography, Emission-Computed, Single-Photon
Abstract

Aims: We aimed to test the hypothesis if combining coronary artery calcium score (Ca-score) as a quantitative anatomical marker of coronary atherosclerosis with high-sensitivity cardiac troponin as a quantitative biochemical marker of myocardial injury provided incremental value in the detection of functionally relevant coronary artery disease (fCAD) and risk stratification., Methods and Results: Consecutive patients undergoing myocardial perfusion single-photon emission computed tomography (MPS) without prior CAD were enrolled. The diagnosis of fCAD was based on the presence of ischaemia on MPS and coronary angiography; fCAD was centrally adjudicated in the diagnostic and prognostic domain. Diagnostic accuracy was evaluated using the area under the receiver-operating characteristic curve (AUC). The composite of cardiovascular death and non-fatal acute myocardial infarction (AMI) within 730 days was the primary prognostic endpoint. Among 1715 patients eligible for the diagnostic analysis, 399 patients had fCAD. The combination of Ca-score and high-sensitivity cardiac troponin T (hs-cTnT) had good diagnostic accuracy for the diagnosis of fCAD (AUC 0.79, 95% confidence interval (CI) 0.77-0.81), but no incremental value compared with the Ca-score alone (AUC 0.79, 95% CI 0.77-0.81, P = 0.965). Similar results were observed using high-sensitivity cardiac troponin I (AUC 0.80, 95% CI 0.77-0.82) instead of hs-cTnT. Among 1709 patients (99.7%) with available follow-up, 59 patients (3.5%) suffered the composite primary prognostic endpoint (non-fatal AMI, n = 34; CV death, n = 28). Both Ca-score and hs-cTnT had independent prognostic value. Increased risk was restricted to patients with elevation in both markers., Conclusion: The combination of the Ca-score with hs-cTnT increases the prognostic accuracy for future events but does not provide incremental value vs. the Ca-score alone for the diagnosis of fCAD., Study Registration: Clinical trial registration: NCT00470587., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Published
2024
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48. Incremental value of C-reactive protein to the MEESSI acute heart failure risk score.

Author

Wussler D, Belkin M, Shrestha S, Wernicke H, Papachristou A, Nowak A, Aliyeva F, Mork C, Strebel I, Huré GVF, Weil D, Michou E, Kozhuharov N, Gualandro DM, Puelacher C, Miró O, Rossello X, Martín-Sánchez FJ, Pocock SJ, Goudev A, Breidthardt T, and Mueller C

Subjects
Humans, Male, Female, Risk Assessment methods, Aged, Prospective Studies, Acute Disease, Prognosis, Biomarkers blood, Risk Factors, Middle Aged, Emergency Service, Hospital, Retrospective Studies, Aged, 80 and over, C-Reactive Protein metabolism, Heart Failure blood, Heart Failure mortality
Abstract

Aims: We hypothesized that the current gold standard for risk stratification of patients with acute heart failure (AHF), the Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF (MEESSI-AHF) risk score, can be further improved by adding systemic inflammation as quantified by C-reactive protein (CRP)., Methods and Results: In a prospective multicentre diagnostic study (BASEL V), AHF was centrally adjudicated by two independent cardiologists. The MEESSI-AHF risk score was calculated using an established reduced and recalibrated model containing 12 independent risk factors. Model extension was performed by refitting and adding CRP in the logistic regression model with 30-day mortality as binary outcome. Discrimination, calibration and clinical usefulness were used to assess the performance of the extended Multiple Estimation of risk based on the Emergency department Spanish Score In patients (MEESSI) model. Validation was performed in an independent, retrospective and single-centre AHF cohort. Among 1208 AHF patients with complete data allowing calculation of the recalibrated MEESSI and the extended MEESSI models, the prognostic accuracy for 30-day mortality of the extended MEESSI model (c-statistic 0.83, 95% confidence interval [CI] 0.79-0.87) was significantly higher compared to the recalibrated model (c-statistic 0.79, 95% CI 0.75-0.83, p = 0.013). The extended model allowed to stratify a higher percentage of patients into the lowest risk group compared to the recalibrated model (33.1% vs. 20.3%). Demonstrating a calibration plot's slope of 1.00 (95% CI 0.81-1.19) and an intercept of 0.0 (95% CI -0.22 to 0.22), the extended MEESSI model achieved excellent and improved calibration. Results were confirmed in the independent validation cohort (n = 575)., Conclusions: Quantifying inflammation using CRP concentration provided incremental value in AHF risk stratification using the established MEESSI model., (© 2024 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Published
2024
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49. Enhancing the diagnosis of functionally relevant coronary artery disease with machine learning.

Author

Bock C, Walter JE, Rieck B, Strebel I, Rumora K, Schaefer I, Zellweger MJ, Borgwardt K, and Müller C

Subjects
Humans, Male, Female, Middle Aged, Aged, Area Under Curve, Logistic Models, Coronary Artery Disease diagnosis, Coronary Artery Disease diagnostic imaging, Machine Learning, ROC Curve, Electrocardiography, Exercise Test methods
Abstract

Functionally relevant coronary artery disease (fCAD) can result in premature death or nonfatal acute myocardial infarction. Its early detection is a fundamentally important task in medicine. Classical detection approaches suffer from limited diagnostic accuracy or expose patients to possibly harmful radiation. Here we show how machine learning (ML) can outperform cardiologists in predicting the presence of stress-induced fCAD in terms of area under the receiver operating characteristic (AUROC: 0.71 vs. 0.64, p = 4.0E-13). We present two ML approaches, the first using eight static clinical variables, whereas the second leverages electrocardiogram signals from exercise stress testing. At a target post-test probability for fCAD of <15%, ML facilitates a potential reduction of imaging procedures by 15-17% compared to the cardiologist's judgement. Predictive performance is validated on an internal temporal data split as well as externally. We also show that combining clinical judgement with conventional ML and deep learning using logistic regression results in a mean AUROC of 0.74., (© 2024. The Author(s).)

Published
2024
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50. Quantifying Hemodynamic Cardiac Stress and Cardiomyocyte Injury in Normotensive and Hypertensive Acute Heart Failure.

Author

Kozhuharov N, Michou E, Wussler D, Belkin M, Heinisch C, Lassus J, Siirilä-Waris K, Veli-Pekka H, Arenja N, Socrates T, Nowak A, Shrestha S, Willi JV, Strebel I, Gualandro DM, Rentsch K, Maeder MT, Münzel T, Tavares de Oliveira Junior M, von Eckardstein A, Breidthardt T, and Mueller C

Abstract

Background: The characterization of the different pathophysiological mechanisms involved in normotensive versus hypertensive acute heart failure (AHF) might help to develop individualized treatments., Methods: The extent of hemodynamic cardiac stress and cardiomyocyte injury was quantified by measuring the B-type natriuretic peptide (BNP), N-terminal proBNP (NT-proBNP), and high-sensitivity cardiac troponin T (hs-cTnT) concentrations in 1152 patients presenting with centrally adjudicated AHF to the emergency department (ED) (derivation cohort). AHF was classified as normotensive with a systolic blood pressure (SBP) of 90-140 mmHg and hypertensive with SBP > 140 mmHg at presentation to the ED. Findings were externally validated in an independent AHF cohort (n = 324)., Results: In the derivation cohort, with a median age of 79 years, 43% being women, 667 (58%) patients had normotensive and 485 (42%) patients hypertensive AHF. Hemodynamic cardiac stress, as quantified by the BNP and NT-proBNP, was significantly higher in normotensive as compared to hypertensive AHF [1105 (611-1956) versus 827 (448-1419) pg/mL, and 5890 (2959-12,162) versus 4068 (1986-8118) pg/mL, both p < 0.001, respectively]. Similarly, the extent of cardiomyocyte injury, as quantified by hs-cTnT, was significantly higher in normotensive AHF as compared to hypertensive AHF [41 (24-71) versus 33 (19-59) ng/L, p < 0.001]. A total of 313 (28%) patients died during 360 days of follow-up. All-cause mortality was higher in patients with normotensive AHF vs. patients with hypertensive AHF (hazard ratio 1.66, 95%CI 1.31-2.10; p < 0.001). Normotensive patients with a high BNP, NT-proBNP, or hs-cTnT had the highest mortality. The findings were confirmed in the validation cohort., Conclusion: Biomarker profiling revealed a higher extent of hemodynamic stress and cardiomyocyte injury in patients with normotensive versus hypertensive AHF.

Published
2024
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