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101. Early Diagnosis of Myocardial Infarction With Point-of-Care High-Sensitivity Cardiac Troponin I

Author

Boeddinghaus, Jasper, primary, Nestelberger, Thomas, additional, Koechlin, Luca, additional, Wussler, Desiree, additional, Lopez-Ayala, Pedro, additional, Walter, Joan Elias, additional, Troester, Valentina, additional, Ratmann, Paul David, additional, Seidel, Funda, additional, Zimmermann, Tobias, additional, Badertscher, Patrick, additional, Wildi, Karin, additional, Rubini Giménez, Maria, additional, Potlukova, Eliska, additional, Strebel, Ivo, additional, Freese, Michael, additional, Miró, Òscar, additional, Martin-Sanchez, F. Javier, additional, Kawecki, Damian, additional, Keller, Dagmar I., additional, Gualandro, Danielle M., additional, Christ, Michael, additional, Twerenbold, Raphael, additional, Mueller, Christian, additional, Meier, Mario, additional, Puelacher, Christian, additional, du Fay de Lavallaz, Jeanne, additional, Kozhuharov, Nikola, additional, Rentsch, Katharina, additional, Stelzig, Claudia, additional, Meissner, Kathrin, additional, Kulangara, Caroline, additional, Hillinger, Petra, additional, Michou, Eleni, additional, Flores, Dayana, additional, Reichlin, Tobias, additional, López, Beatriz, additional, Fuenzalida, Carolina, additional, Adrada, Esther Rodriguez, additional, Ganovská, Eva, additional, Lohrmann, Jens, additional, Huber, Jeffrey, additional, Steude, Jana, additional, Buser, Andreas, additional, von Eckardstein, Arnold, additional, Morawiec, Beata, additional, Nowalany-Kozielska, Ewa, additional, Muzyk, Piotr, additional, Bürgler, Franz, additional, and Geigy, Nicolas, additional

Published
2020
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102. Using High-Sensitivity Cardiac Troponin for the Exclusion of Inducible Myocardial Ischemia in Symptomatic Patients

Author

Walter, Joan, primary, du Fay de Lavallaz, Jeanne, additional, Koechlin, Luca, additional, Zimmermann, Tobias, additional, Boeddinghaus, Jasper, additional, Honegger, Ursina, additional, Strebel, Ivo, additional, Twerenbold, Raphael, additional, Amrein, Melissa, additional, Nestelberger, Thomas, additional, Wussler, Desiree, additional, Puelacher, Christian, additional, Badertscher, Patrick, additional, Zellweger, Michael, additional, Fahrni, Gregor, additional, Jeger, Raban, additional, Kaiser, Christoph, additional, Reichlin, Tobias, additional, and Mueller, Christian, additional

Published
2020
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103. Clinical Utility of Procalcitonin in the Diagnosis of Pneumonia

Author

Wussler, Desiree, Kozhuharov, Nikola, Tavares Oliveira, Mucio, Bossa, Aline, Sabti, Zaid, Nowak, Albina, Murray, Karsten, du Fay de Lavallaz, Jeanne, Badertscher, Patrick, Twerenbold, Raphael, Shrestha, Samyut, Flores, Dayana, Nestelberger, Thomas, Walter, Joan, Boeddinghaus, Jasper, Zimmermann, Tobias, Koechlin, Luca, von Eckardstein, Arnold, Breidthardt, Tobias, Mueller, Christian, University of Zurich, and Mueller, Christian

Subjects
10265 Clinic for Endocrinology and Diabetology, 610 Medicine & health, 1308 Clinical Biochemistry, 2704 Biochemistry (medical), 10038 Institute of Clinical Chemistry
Published
2019
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104. Growth differentiation factor-15 and all-cause mortality in patients with suspected myocardial infarction

Author

Walter, Joan, Nestelberger, Thomas, Boeddinghaus, Jasper, Twerenbold, Raphael, Croton, Lukas, Badertscher, Patrick, Wildi, Karin, Wussler, Desiree, du Fay de Lavallaz, Jeanne, Mueller, Christian, APACE investigators, University of Zurich, and Mueller, Christian

Subjects
540 Chemistry, 610 Medicine & health, 2705 Cardiology and Cardiovascular Medicine, 10038 Institute of Clinical Chemistry
Published
2019
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105. Prevalence of pulmonary embolism in patients with syncope

Author

Badertscher, Patrick, du Fay de Lavallaz, Jeanne, Hammerer-Lercher, Angelika, Nestelberger, Thomas, Zimmermann, Tobias, Geiger, Marc, Imahorn, Orell, Miró, Òscar, Salgado, Emilio, Christ, Michael, Cullen, Louise, Than, Martin, Martin-Sanchez, F Javier, Di Somma, Salvatore, Peacock, W Frank, Keller, Dagmar I, Costabel, Juan Pablo, Walter, Joan, Boeddinghaus, Jasper, Twerenbold, Raphael, Méndez, Adriana, Gospodinov, Boris, Puelacher, Christian, Wussler, Desiree, Koechlin, Luca, Kawecki, Damian, Geigy, Nicolas, Strebel, Ivo, Lohrmann, Jens, Kühne, Michael, et al, and University of Zurich

Subjects
540 Chemistry, 610 Medicine & health, 2705 Cardiology and Cardiovascular Medicine, 10038 Institute of Clinical Chemistry
Published
2019

106. Comparison of fourteen rule-out strategies for acute myocardial infarction

Author

Wildi, Karin, Boeddinghaus, Jasper, Nestelberger, Thomas, Twerenbold, Raphael, Badertscher, Patrick, Wussler, Desiree, Giménez, Maria Rubini, Puelacher, Christian, Du Fay De Lavallaz, Jeanne, Dietsche, Sebastian, Walter, Joan, Kozhuharov, Nikola, Morawiec, Beata, Miró, Òscar, Javier Martin-Sanchez, F, Subramaniam, Sinthuri, Geigy, Nicolas, Keller, Dagmar I, Reichlin, Tobias Roman, Mueller, Christian, University of Zurich, and Mueller, Christian

Subjects
540 Chemistry, 610 Medicine & health, health care economics and organizations, 2705 Cardiology and Cardiovascular Medicine, 10038 Institute of Clinical Chemistry
Abstract

BACKGROUND The clinical availability of high-sensitivity cardiac troponin (hs-cTn) has enabled the development of several innovative strategies for the rapid rule-out of acute myocardial infarction (AMI). Due to the lack of direct comparisons, selection of the best strategy for clinical practice is challenging. METHODS In a prospective international multicenter diagnostic study enrolling 3696 patients presenting with suspected AMI to the emergency department, we compared the safety and efficacy of 14 different hs-cTn-based strategies: hs-cTn concentrations below the limit of detection (LoD), dual-marker combining hs-cTn with copeptin, ESC 0 h/1 h-algorithm, 0 h/2 h-algorithm, 2 h-ADP-algorithm, NICE-algorithm, and ESC 0 h/3 h-algorithm, each using either hs-cTnT or hs-cTnI. The final diagnosis of AMI was adjudicated by two independent cardiologists using all available clinical information including cardiac imaging and serial hs-cTn concentrations. RESULTS AMI was the final diagnosis in 16% of patients. Using hs-cTnT, safety quantified by the negative predictive value (NPV) and sensitivity was very high (99.8-100% and 99.5-100%) and comparable for all strategies, except the dual-marker approach (NPV 98.7%, sensitivity 96.7%). Similarly, using hs-cTnI, safety quantified by the NPV and sensitivity was very high (99.7-100% and 98.9-100%) and comparable for all strategies, except the dual-marker approach (NPV 96.9%, sensitivity 90.4%) and the NICE-algorithm (NPV 99.1%, sensitivity 94.7%). Efficacy, quantified by the percentage of patients eligible for rule-out, differed markedly, and was lowest for LoD-algorithm (15.7-26.8%). CONCLUSION All rapid rule-out algorithms, except the dual-marker strategy and the NICE-algorithm using hs-cTnI, favorably combine safety and efficacy, and can be considered for routine clinical practice. CLINICAL TRIAL REGISTRATION NCT00470587, http://clinicaltrials.gov/show/NCT00470587.

Published
2019
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107. Circadian, weekly, seasonal, and temperature-dependent patterns of syncope aetiology in patients at increased risk of cardiac syncope

Author

du Fay de Lavallaz, Jeanne, Badertscher, Patrick, Nestelberger, Thomas, Flores, Dayana, Miró, Òscar, Salgado, Emilio, Geigy, Nicolas, Christ, Michael, Cullen, Louise, Than, Martin, Martin-Sanchez, F Javier, Rodriguez-Adrada, Esther, Di Somma, Salvatore, Peacock, W Frank, Kawecki, Damian, Boeddinghaus, Jasper, Twerenbold, Raphael, Puelacher, Christian, Wussler, Desiree, Strebel, Ivo, Keller, Dagmar I, Poepping, Imke, Kühne, Michael, Reichlin, Tobias, Mueller, Christian, BASEL IX Investigators, University of Zurich, and Mueller, Christian

Subjects
2737 Physiology (medical), 540 Chemistry, 610 Medicine & health, 2705 Cardiology and Cardiovascular Medicine, 10038 Institute of Clinical Chemistry
Published
2019

108. Prospective validation of N-terminal pro B-type natriuretic peptide cut-off concentrations for the diagnosis of acute heart failure

Author

Kozhuharov, Nikola, Sabti, Zaid, Wussler, Desiree, Nowak, Albina, Badertscher, Patrick, Twerenbold, Raphael, Wildi, Karin, Stallone, Fabio, Vogt, Fabian, Hilti, Jonas, Puelacher, Christian, Du Fay De Lavallaz, Jeanne, Shrestha, Samyut, Flores, Dayana, Nestelberger, Thomas, Koechlin, Luca, Boeddinghaus, Jasper, Zimmermann, Tobias, Walter, Joan, Schumacher, Carmela, Rentsch, Katharina, Von Eckardstein, Arnold, Keller, Dagmar I, Goudev, Assen, Pfister, Otmar, Breidthardt, Tobias, and Mueller, Christian

Published
2019
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109. Clinical utility of circulating interleukin-6 concentrations in the detection of functionally relevant coronary artery disease

Author

Walter, Joan, Tanglay, Yunus, Du Fay De Lavallaz, Jeanne, Strebel, Ivo, Boeddinghaus, Jasper, Twerenbold, Raphael, Doerflinger, Stephanie, Puelacher, Christian, Nestelberger, Thomas, Wussler, Desiree, Amrein, Melissa, Badertscher, Patrick, Todd, John, Rentsch, Katharina, Fahrni, Gregor, Jeger, Raban, Kaiser, Christoph, Reichlin, Tobias Roman, and Mueller, Christian

Subjects
610 Medicine & health
Abstract

BACKGROUND Inflammation plays a major role in the pathogenesis of coronary artery disease (CAD). METHODS We hypothesized, that quantifying inflammation by measuring circulating interleukin-6 concentrations help in the diagnosis and/or prediction of functionally relevant CAD. Among consecutive patients with symptoms suggestive of CAD, functionally relevant CAD was adjudicated in two domains: first, diagnosis according to myocardial perfusion single photon emission tomography (MPI-SPECT) and coronary angiography; second, cardiovascular death and all-cause death during 2-years follow-up. Adjudication was done blinded to the interleukin-6 concentrations. RESULTS Among 1553 patients, symptoms were adjudicated to be causally related to CAD in 43% (665/1553). Interleukin-6 concentrations were higher in patients with functionally relevant CAD as compared to those without (1.56 pg/mL versus 1.30 pg/mL, p

Published
2019
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110. Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome

Author

du Fay de Lavallaz, Jeanne, Puelacher, Christian, Lurati Buse, Giovanna, Bolliger, Daniel, Germanier, Dominic, Hidvegi, Reka, Walter, Joan Elias, Twerenbold, Raphael, Strebel, Ivo, Badertscher, Patrick, Sazgary, Lorraine, Lampart, Andreas, Espinola, Jaqueline, Kindler, Christoph, Hammerer-Lercher, Angelika, Thambipillai, Saranya, Guerke, Lorenz, Rentsch, Katharina, Buser, Andreas, Gualandro, Danielle, Jakob, Marcel, Mueller, Christian, and Basel-PMI Investigators

Subjects
Male, medicine.medical_specialty, Myocardial Infarction, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Troponin T, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Myocardial infarction, Propensity Score, Aged, Morning, business.industry, Incidence, Incidence (epidemiology), Perioperative, Prognosis, medicine.disease, Circadian Rhythm, Cardiac surgery, C-Reactive Protein, Surgical Procedures, Operative, Anesthesia, Preoperative Period, Cohort, Propensity score matching, Female, Cardiology and Cardiovascular Medicine, business, Biomarkers, Switzerland, Follow-Up Studies
Abstract

ObjectiveRecently, daytime variation in perioperative myocardial injury (PMI) has been observed in patients undergoing cardiac surgery. We aim at investigating whether daytime variation also occurs in patients undergoing non-cardiac surgery.MethodsIn a prospective diagnostic study, we evaluated the presence of daytime variation in PMI in patients at increased cardiovascular risk undergoing non-cardiac surgery, as well as its possible impact on the incidence of acute myocardial infarction (AMI), and death during 1-year follow-up in a propensity score–matched cohort. PMI was defined as an absolute increase in high-sensitivity cardiac troponin T (hs-cTnT) concentration of ≥14 ng/L from preoperative to postoperative measurements.ResultsOf 1641 patients, propensity score matching defined 630 with similar baseline characteristics, half undergoing non-cardiac surgery in the morning (starting from 8:00 to 11:00) and half in the afternoon (starting from 14:00 to 17:00). There was no difference in PMI incidence between both groups (morning: 50, 15.8% (95% CI 12.3 to 20.3); afternoon: 52, 16.4% (95% CI 12.7 to 20.9), p=0.94), nor if analysing hs-cTnT release as a quantitative variable (median morning group: 3 ng/L (95% CI 1 to 7 ng/L); median afternoon group: 2 ng/L (95% CI 0 to 7 ng/L; p=0.16). During 1-year follow-up, the incidence of AMI was 1.2% (95% CI 0.4% to 3.2%) among morning surgeries versus 4.1% (95% CI 2.3% to 6.9%) among the afternoon surgeries (corrected HR for afternoon surgery 3.44, bootstrapped 95% CI 1.33 to 10.49, p log-rank=0.03), whereas no difference in mortality emerged (p=0.70).ConclusionsAlthough there is no daytime variation in PMI in patients undergoing non-cardiac surgery, the incidence of AMI during follow-up is increased in afternoon surgeries and requires further study.Clinical trial registrationNCT02573532;Results.

Published
2019
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111. Early diagnosis and risk stratification of patients with syncope

Author

Du Fay de Lavallaz, Jeanne, Müller, Christian, Christ-Crain, Mirjam, and Hullin, Roger

Abstract

Background: Syncope is a common and challenging problem in the Emergency Department (ED), representing about 1-2% of patients visits. Early detection of the underlying cause is critical as it defines treatment and prognosis. Cardiac syncope is associated with the highest mortality of all syncope etiologies and requires specific interventions such as implantation of a pacemaker or defibrillator. ED clinicians struggle to rapidly identify the underlying cause and the threat of a possible serious cardiac origin which leads to numerous diagnostics and high hospitalisation rates. In an attempt to improve diagnosis and risk-stratification in syncope patients in the ED, several rules and scores were derived, mostly of mono-centric and rather small studies. Additionally, their external validity has never been assessed and their complexity represent a problem for a rapid and efficient implementation in the ED. Similarly, the diagnostic and prognostic value of some readily available cardiac biomarkers (such as cardiac troponins or B-type Natriuretic peptides) has been investigated in some pilot studies but the small number of patients assessed and the use of poorly sensitive assays resulted in varying results and did not allow for any definitive conclusions. Aim and Hypothesis: The aim of this thesis is to assess the accuracy of diagnostic and prognostic accuracy of scores and biomarkers in a large international cohort of syncope patients presenting to the ED. First, the accuracy of existing syncope-specific diagnostic and risk-stratification rules will be compared and their complexity put in perspective through a comparison with the CHADS2 score. Second, the diagnostic and prognostic performance of cardiac troponins, as assessed by three different assays, and BNP will be investigated. We hypothesize that complex syncope-specific scores might not reliably diagnose or risk-stratify syncope patients and that both assessed biomarkers, at least in certain subgroups of patients for which the determination of a precise etiology appears particularly difficult, could be of specific interest to improve the diagnosis and risk stratification of patients presenting with syncope to the ED. Patients and Methods: BASEL IX is an ongoing prospective international multicenter diagnostic cohort study coordinated by the University Hospital Basel. Patients >40y presenting to the ED with a syncope within the 12 last hours are enrolled and blood is drawn for the blinded analysis of the investigational biomarkers. All patients underwent clinical assessment that included standardized and detailed assessment of predefined details of the medical history and syncopal event. The adjudication of the final diagnosis is performed by two independent cardiologists based on all available information after diagnostic work-up of patients as well as the clinical follow-up at 12 months. Patients are followed up to 5 years. The diagnostic endpoint is the diagnostic accuracy for cardiac syncope, the prognostic endpoints are the accuracy to predict death or major cardiovascular events (MACE). Results: Syncope diagnostic and risk stratification rules showed a moderate accuracy in patients presenting with syncope to the ED (with Area Under The Receiver Operating Curve (AUC) between 0.67 and 0.75 for diagnostic endpoints and between 0.57 and 0.79 for prognostic endpoints) and most of them were, not superior to a readily calculable CHADS2 score. Both assessed biomarkers performed with a moderate-to-good accuracy for the diagnosis and risk stratification of the overall cohort (AUC for diagnostic endpoints between 0.76 and 0.77, AUC for prognostic endpoints between 0.73 and 0.8 depending on the chosen time-point). When assessed in patients for whom the diagnosis stayed unclear despite initial ED evaluation, these biomarkers could provide guidance to the ED physician regarding his decision for hospitalization and further testing. Conclusion: Diagnosis and risk-stratification of patients with syncope is a challenging task and currently available structured clinical assessments scores do not sufficiently help with initial ED evaluation. Common and readily available cardiac biomarkers seem to represent a valuable tool, especially in patients for whom a first evaluation did not lead to a satisfactory diagnosis.

Published
2019
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112. Two-hour algorithm for rapid triage of suspected acute myocardial infarction using a high-sensitivity cardiac troponin I assay

Author

Nestelberger, Thomas, Boeddinghaus, Jasper, Greenslade, Jaimi, Parsonage, William A., Than, Martin, Wussler, Desiree, Lopez-Ayala, Pedro, Zimmermann, Tobias, Meier, Mario, Troester, Valentina, Badertscher, Patrick, Koechlin, Luca, Wildi, Karin, Anwar, Mahnoor, Freese, Michael, Keller, Dagmar I., Reichlin, Tobias, Twerenbold, Raphael, Cullen, Louise, Mueller, Christian, Puelacher, Christian, Du Fay De Lavallaz, Jeanne, Giménez, Maria Rubini, Strebel, Ivo, Walter, Joan, Huber, Jeffrey, Christ, Michael, Kozhuharov, Nikola, Gualandro, Danielle M., Potlukova, Eliska, Baumgartner, Benjamin, Hafner, Benjamin, Rent-Sch, Katharina, Miró, Òscar, Fuenzalida, Carolina, Gil, Beatriz, Javier Martin-Sanchez, F., Kawecki, Damian, Geigy, Nicolas, Meissner, Kathrin, Kulangara, Caroline, López, Beatriz, Adrada, Esther Rodriguez, Ganovská, Eva, Lohrmann, Jens, Kloos, Wanda, Steude, Jana, Buser, Andreas, Von Eckardstein, Arnold, Nowalany-Kozielska, Ewa, Muzyk, Piotr, Nestelberger, Thomas, Boeddinghaus, Jasper, Greenslade, Jaimi, Parsonage, William A., Than, Martin, Wussler, Desiree, Lopez-Ayala, Pedro, Zimmermann, Tobias, Meier, Mario, Troester, Valentina, Badertscher, Patrick, Koechlin, Luca, Wildi, Karin, Anwar, Mahnoor, Freese, Michael, Keller, Dagmar I., Reichlin, Tobias, Twerenbold, Raphael, Cullen, Louise, Mueller, Christian, Puelacher, Christian, Du Fay De Lavallaz, Jeanne, Giménez, Maria Rubini, Strebel, Ivo, Walter, Joan, Huber, Jeffrey, Christ, Michael, Kozhuharov, Nikola, Gualandro, Danielle M., Potlukova, Eliska, Baumgartner, Benjamin, Hafner, Benjamin, Rent-Sch, Katharina, Miró, Òscar, Fuenzalida, Carolina, Gil, Beatriz, Javier Martin-Sanchez, F., Kawecki, Damian, Geigy, Nicolas, Meissner, Kathrin, Kulangara, Caroline, López, Beatriz, Adrada, Esther Rodriguez, Ganovská, Eva, Lohrmann, Jens, Kloos, Wanda, Steude, Jana, Buser, Andreas, Von Eckardstein, Arnold, Nowalany-Kozielska, Ewa, and Muzyk, Piotr

Abstract

BACKGROUND We aimed to derive and externally validate a 0/2-h algorithm using the high-sensitivity cardiac troponin I (hs-cTnI)-Access assay. METHODS We enrolled patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction (AMI) in 2 prospective diagnostic studies using central adjudication. Two independent cardiologists adjudicated the final diagnosis, including all available medical information including cardiac imaging. hs-cTnI-Access concentrations were measured at presentation and after 2 h in a blinded fashion. RESULTS AMI was the adjudicated final diagnosis in 164 of 1131 (14.5%) patients in the derivation cohort. Rule-out by the hs-cTnI-Access 0/2-h algorithm was defined as 0-h hs-cTnI-Access concentration <4 ng/L in patients with an onset of chest pain >3 h (direct rule-out) or a 0-h hs-cTnI-Access concentration <5 ng/L and an absolute change within 2 h <5 ng/L in all other patients. Derived thresholds for rule-in were a 0-h hs-cTnI-Access concentration ≥50 ng/L (direct rule-in) or an absolute change within 2 h ≥20 ng/L. In the derivation cohort, these cutoffs ruled out 55% of patients with a negative predictive value (NPV) of 99.8% (95% CI, 99.3–100) and sensitivity of 99.4% (95% CI, 96.5–99.9), and ruled in 30% of patients with a positive predictive value (PPV) of 73% (95% CI, 66.1–79). In the validation cohort, AMI was the adjudicated final diagnosis in 88 of 1280 (6.9%) patients. These cutoffs ruled out 77.9% of patients with an NPV of 99.8% (95% CI, 99.3–100) and sensitivity of 97.7% (95% CI, 92.0–99.7), and ruled in 5.8% of patients with a PPV of 77% (95% CI, 65.8–86) in the validation cohort. CONCLUSIONS Safety and efficacy of the l hs-cTnI-Access 0/2-h algorithm for triage toward rule-out or rule-in of AMI are very high.

Published
2019

113. Predicting acute myocardial infarction with a single blood draw

Author

Boeddinghaus, Jasper, Nestelberger, Thomas, Badertscher, Patrick, Twerenbold, Raphael, Fitze, Brigitte, Wussler, Desiree, Strebel, Ivo, Rubini Giménez, Maria, Wildi, Karin, Puelacher, Christian, du Fay de Lavallaz, Jeanne, Oehen, Loris, Walter, Joan, Miró, Òscar, Martin-Sanchez, F Javier, Morawiec, Beata, Potlukova, Eliska, Keller, Dagmar I, Reichlin, Tobias, Mueller, Christian, APACE Investigators, Boeddinghaus, Jasper, Nestelberger, Thomas, Badertscher, Patrick, Twerenbold, Raphael, Fitze, Brigitte, Wussler, Desiree, Strebel, Ivo, Rubini Giménez, Maria, Wildi, Karin, Puelacher, Christian, du Fay de Lavallaz, Jeanne, Oehen, Loris, Walter, Joan, Miró, Òscar, Martin-Sanchez, F Javier, Morawiec, Beata, Potlukova, Eliska, Keller, Dagmar I, Reichlin, Tobias, Mueller, Christian, and APACE Investigators

Abstract

BACKGROUND: We desired to determine cardiac troponin (cTn) concentrations necessary to achieve a positive predictive value (PPV) of ≥75% for acute myocardial infarction (AMI) to justify immediate admission of patients to a monitored unit and, in general, early coronary angiography. METHODS: In a prospective multicenter diagnostic study enrolling patients presenting to the emergency department with symptoms suggestive of AMI, final diagnoses were adjudicated by 2 independent cardiologists based on clinical information including cardiac imaging. cTn concentrations were measured using 5 different sensitive and high-sensitivity cTn (hs-cTn) assays in a blinded fashion at presentation and serially thereafter. The diagnostic end point was PPV for rule-in of AMI of initial cTn concentrations alone and in combination with early changes. RESULTS: Among 3828 patients, 616 (16%) had an AMI. At presentation, 7% to 14% of patients had cTnT/I concentrations associated with a PPV of ≥75%. Adding absolute or relative changes did not significantly further increase the PPV. PPVs increased from 46.5% (95% CI, 43.6-49.4) for hs-cTnT at presentation >14 ng/L to 78.9% (95% CI, 74.7-82.5) for >52 ng/L (P < 0.001), whereas PPVs in higher hs-cTnT strata remained largely unchanged [e.g., 82.4% (95% CI, 77.5-86.7) for >80 ng/L vs 83.9% (95% CI, 76.0-90.1) for >200 ng/L (P = 0.72)]. The addition of early changes in hs-cTnT further increased the PPV up to 60 ng/L, but not for higher concentrations. CONCLUSIONS: Serial sampling does not seem necessary for predicting AMI and concurrent decision-making in about 10% of patients, as it only marginally increases the PPV for AMI and not in a statistically or clinically significant way. CLINICALTRIALSGOV IDENTIFIER: NCT00470587.

Published
2019

114. Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction

Author

Boeddinghaus, Jasper, Nestelberger, Thomas, Twerenbold, Raphael, et al, Badertscher, Patrick, Jann, Janina E, Wussler, Desiree, Puelacher, Christian, Rubini Giménez, Maria, Wildi, Karin, Strebel, Ivo, Du Fay de Lavallaz, Jeanne, Selman, Farah, Sabti, Zaid, Kozhuharov, Nikola, Potlukova, Eliska, Rentsch, Katharina, Lohrmann, Jens, Kloos, Wanda, Buser, Andreas, Geigy, Nicolas, Keller, Dagmar I, Osswald, Stefan, Reichlin, T, Mueller, Christian, University of Zurich, and Mueller, Christian

Subjects
540 Chemistry, 610 Medicine & health, 2705 Cardiology and Cardiovascular Medicine, 10038 Institute of Clinical Chemistry
Published
2018

116. Direct Comparison of Cardiac Troponin T and I Using a Uniform and a Sex-Specific Approach in the Detection of Functionally Relevant Coronary Artery Disease

Author

Mueller, Deborah, Puelacher, Christian, Honegger, Ursina, Walter, Joan E, Badertscher, Patrick, Schaerli, Nicolas, Strebel, Ivo, Twerenbold, Raphael, Boeddinghaus, Jasper, Nestelberger, Thomas, Hollenstein, Christina, Du Fay De Lavallaz, Jeanne, Jeger, Raban, Kaiser, Christoph, Wild, Damian, Rentsch, Katharina, Buser, Andreas, Zellweger, Michael, Reichlin, Tobias Roman, and Mueller, Christian

Subjects
610 Medicine & health
Abstract

BACKGROUND We aimed to directly compare high-sensitivity cardiac troponin I (hs-cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) in the detection of functionally relevant coronary artery disease (fCAD). METHODS Consecutive patients referred with clinical suspicion of fCAD and no structural heart disease other than coronary artery disease were included. The presence of fCAD was based on rest/stress myocardial perfusion single-photon emission computed tomography/computed tomography and coronary angiography. hs-cTnI and hs-cTnT concentrations were measured in a blinded fashion. Diagnostic accuracy was quantified using the area under the ROC curve (AUC) and evaluated both for uniform use in all patients and for sex-specific use in women and men separately. The prognostic end point was major adverse cardiac events (MACEs; cardiovascular death or myocardial infarction) within 2 years. For the prognostic performance, we used a multivariable model comparison with the Akaike information criterion (AIC). RESULTS fCAD was detected in 613 of 2062 patients (29.7%) overall, 112 of 664 of women (16.9%), and 501 of 1398 of men (35.8%). hs-cTnI and hs-cTnT had comparable diagnostic accuracy when assessed for uniform use in all patients (AUC, 0.68 vs 0.66; = 0.107) and separately in women (AUC, 0.68 vs 0.63; = 0.068) and men (AUC, 0.65 vs 0.64; = 0.475). However, women required lower rule-out cutoffs to achieve high sensitivity, and men needed higher rule-in cutoffs to achieve high specificity. hs-cTnI and hs-cTnT were strongly and independently associated with MACE within 2 years ( < 0.001), with comparable prognostic accuracies by the AIC. CONCLUSIONS hs-cTnI and hs-cTnT provide moderate and comparable diagnostic accuracy. Sex-specific cutoffs may be preferred. The prognostic utility of both troponins is comparable.

Published
2018
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117. Clinical Validation of a Novel High-Sensitivity Cardiac Troponin I Assay for Early Diagnosis of Acute Myocardial Infarction

Author

Boeddinghaus, Jasper, Twerenbold, Raphael, Nestelberger, Thomas, Badertscher, Patrick, Wildi, Karin, Puelacher, Christian, Du Fay De Lavallaz, Jeanne, Keser, Elif, Rubini Giménez, Maria, Wussler, Desiree, Kozhuharov, Nikola, Rentsch, Katharina, Miró, Òscar, Martin-Sanchez, F Javier, Morawiec, Beata, Stefanelli, Sabrina, Geigy, Nicolas, Keller, Dagmar I, Reichlin, Tobias Roman, and Mueller, Christian

Subjects
610 Medicine & health
Abstract

BACKGROUND Clinical performance of the novel high-sensitivity cardiac troponin I (Siemens-hs-cTnI-Centaur) assay is unknown. We aimed to clinically validate the Siemens-hs-cTnI-Centaur assay and develop 0/1-h and 0/2-h algorithms. METHODS We enrolled patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction (AMI). Final diagnoses were centrally adjudicated by 2 independent cardiologists including all clinical information twice: first, using serial hs-cTnT (Roche-Elecsys, primary analysis); second, using hs-cTnI (Abbott-Architect, secondary analysis) measurements in addition to the clinically applied (hs)-cTn. Siemens-hs-cTnI-Centaur was measured at presentation, 1 h, and 2 h. The primary objective was a direct comparison of diagnostic accuracy, quantified by the area under the ROC curve (AUC), of Siemens-hs-cTnI-Centaur vs the 2 established hs-cTn assays (Roche-hs-cTnT-Elecsys, Abbott-hs-cTnI-Architect). Secondary objectives included the development of Siemens-hs-cTnI-Centaur-specific 0/1-h and 0/2-h algorithms. RESULTS AMI was the final diagnosis in 318 of 1755 (18%) patients (using Roche-hs-cTnT-Elecsys for adjudication). The AUC at presentation for Siemens-hs-cTnI-Centaur was 0.94 (95% CI, 0.92-0.96) and comparable with 0.95 (95% CI, 0.93-0.97) for Roche-hs-cTnT-Elecsys and 0.93 (95% CI, 0.90-0.96) for Abbott-hs-cTnI-Architect. Applying the derived Siemens-hs-cTnI-Centaur 0/1-h algorithm to the validation cohort, 46% of patients were ruled out (sensitivity, 99.1%; 95% CI, 95.3-100), and 18% of patients were ruled in (specificity, 94.1%; 95% CI, 91.8-95.9). The Siemens-hs-cTnI-Centaur 0/2-h algorithm ruled out 55% of patients (sensitivity, 100%; 95% CI, 94.1-100), and ruled in 18% of patients (specificity, 96.0%; 95% CI, 93.1-97.9). Findings were confirmed in the secondary analyses using serial measurements of Abbott-hs-cTnI-Architect for adjudication. CONCLUSIONS Diagnostic accuracy and clinical utility of the novel Siemens-hs-cTnI-Centaur assay are high and comparable with the established hs-cTn assays. ClinicalTrials.gov Identifier: NCT00470587.

Published
2018
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118. Clinical Utility of Procalcitonin in the Diagnosis of Pneumonia

Author

Wussler, Desiree, primary, Kozhuharov, Nikola, primary, Tavares Oliveira, Mucio, primary, Bossa, Aline, primary, Sabti, Zaid, primary, Nowak, Albina, primary, Murray, Karsten, primary, du Fay de Lavallaz, Jeanne, primary, Badertscher, Patrick, primary, Twerenbold, Raphael, primary, Shrestha, Samyut, primary, Flores, Dayana, primary, Nestelberger, Thomas, primary, Walter, Joan, primary, Boeddinghaus, Jasper, primary, Zimmermann, Tobias, primary, Koechlin, Luca, primary, von Eckardstein, Arnold, primary, Breidthardt, Tobias, primary, Mueller, Christian, primary, Soeiro, Alexandre, primary, Goldstein, Priscila, primary, Strabelli, Tânia, primary, Strunz, Célia, primary, Wildi, Karin, primary, Puelacher, Christian, primary, Rentsch, Katharina, primary, and Goudev, Assen, primary

Published
2019
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119. Reply

Author

Badertscher, Patrick, primary, du Fay de Lavallaz, Jeanne, additional, and Müller, Christian, additional

Published
2019
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120. Two-Hour Algorithm for Rapid Triage of Suspected Acute Myocardial Infarction Using a High-Sensitivity Cardiac Troponin I Assay

Author

Nestelberger, Thomas, primary, Boeddinghaus, Jasper, additional, Greenslade, Jaimi, additional, Parsonage, William A, additional, Than, Martin, additional, Wussler, Desiree, additional, Lopez-Ayala, Pedro, additional, Zimmermann, Tobias, additional, Meier, Mario, additional, Troester, Valentina, additional, Badertscher, Patrick, additional, Koechlin, Luca, additional, Wildi, Karin, additional, Anwar, Mahnoor, additional, Freese, Michael, additional, Keller, Dagmar I, additional, Reichlin, Tobias, additional, Twerenbold, Raphael, additional, Cullen, Louise, additional, Mueller, Christian, additional, Puelacher, Christian, additional, du Fay de Lavallaz, Jeanne, additional, Rubini Giménez, Maria, additional, Strebel, Ivo, additional, Walter, Joan, additional, Huber, Jeffrey, additional, Christ, Michael, additional, Kozhuharov, Nikola, additional, Gualandro, Danielle M, additional, Potlukova, Eliska, additional, Baumgartner, Benjamin, additional, Hafner, Benjamin, additional, Rentsch, Katharina, additional, Miró, Òscar, additional, Fuenzalida, Carolina, additional, Gil, Beatriz, additional, Martin-Sanchez, F Javier, additional, Kawecki, Damian, additional, Geigy, Nicolas, additional, Meissner, Kathrin, additional, Kulangara, Caroline, additional, López, Beatriz, additional, Rodriguez Adrada, Esther, additional, Ganovská, Eva, additional, Lohrmann, Jens, additional, Kloos, Wanda, additional, Steude, Jana, additional, Buser, Andreas, additional, von Eckardstein, Arnold, additional, Nowalany-Kozielska, Ewa, additional, and Muzyk, Piotr, additional

Published
2019
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121. Clinical Use of a New High-Sensitivity Cardiac Troponin I Assay in Patients with Suspected Myocardial Infarction

Author

Boeddinghaus, Jasper, primary, Twerenbold, Raphael, additional, Nestelberger, Thomas, additional, Koechlin, Luca, additional, Wussler, Desiree, additional, Meier, Mario, additional, Troester, Valentina, additional, Zimmermann, Tobias, additional, Badertscher, Patrick, additional, Wildi, Karin, additional, Rubini Giménez, Maria, additional, Lopez-Ayala, Pedro, additional, Potlukova, Eliska, additional, Miró, Òscar, additional, Martin-Sanchez, F Javier, additional, Kawecki, Damian, additional, Geigy, Nicolas, additional, Keller, Dagmar I, additional, Reichlin, Tobias, additional, Mueller, Christian, additional, du Fay de Lavallaz, Jeanne, additional, Walter, Joan Elias, additional, Freese, Michael, additional, Puelacher, Christian, additional, Hafner, Benjamin, additional, Strebel, Ivo, additional, Kozhuharov, Nikola, additional, Rentsch, Katharina, additional, Gualandro, Danielle M, additional, Schaerli, Nicolas, additional, Stelzig, Claudia, additional, Meissner, Kathrin, additional, Kulangara, Caroline, additional, Hillinger, Petra, additional, Grimm, Karin, additional, Michou, Eleni, additional, Flores, Dayana, additional, Czmok, Rafael, additional, Osswald, Stefan, additional, López, Beatriz, additional, Fuenzalida, Carolina, additional, Rodriguez Adrada, Esther, additional, Ganovská, Eva, additional, Lohrmann, Jens, additional, Kloos, Wanda, additional, Christ, Michael, additional, Steude, Jana, additional, Fahrni, Gregor, additional, Buser, Andreas, additional, von Eckardstein, Arnold, additional, Morawiec, Beata, additional, Nowalany-Kozielska, Ewa, additional, and Muzyk, Piotr, additional

Published
2019
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122. Growth differentiation factor-15 and all-cause mortality in patients with suspected myocardial infarction

Author

Walter, Joan, primary, Nestelberger, Thomas, additional, Boeddinghaus, Jasper, additional, Twerenbold, Raphael, additional, Croton, Lukas, additional, Badertscher, Patrick, additional, Wildi, Karin, additional, Wussler, Desiree, additional, du Fay de Lavallaz, Jeanne, additional, Mueller, Christian, additional, Giménez, Maria Rubini, additional, Puelacher, Christian, additional, Kozhuharov, Nikola, additional, Morawiec, Beata, additional, Rentsch, Katharina, additional, Miró, Òscar, additional, Martin-Sanchez, F. Javier, additional, Muzyk, Piotr, additional, Geigy, Nicolas, additional, Keller, Dagmar I., additional, Reichlin, Tobias, additional, Lohrmann, Jens, additional, Biskup, Ewalina, additional, Kloos, Wanda, additional, López, Beatriz, additional, Inostroza, Carolina Fuenzalida, additional, Adrada, Esther Rodriguez, additional, Kawecki, Damian, additional, Nowalany-Kozielska, Ewa, additional, Parenica, Jiri, additional, Meissner, Kathrin, additional, Kulangara, Caroline, additional, Mahfouz, Riham, additional, and von Eckardstein, Arnold, additional

Published
2019
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123. Prospective validation of current quantitative electrocardiographic criteria for ST-elevation myocardial infarction

Author

Hillinger, Petra, primary, Strebel, Ivo, additional, Abächerli, Roger, additional, Twerenbold, Raphael, additional, Wildi, Karin, additional, Bernhard, Denise, additional, Nestelberger, Thomas, additional, Boeddinghaus, Jasper, additional, Badertscher, Patrick, additional, Wussler, Desiree, additional, Koechlin, Luca, additional, Zimmermann, Tobias, additional, Puelacher, Christian, additional, Rubini Gimenez, Maria, additional, du Fay de Lavallaz, Jeanne, additional, Walter, Joan, additional, Geigy, Nicolas, additional, Keller, Dagmar I., additional, Reichlin, Tobias, additional, and Mueller, Christian, additional

Published
2019
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124. Predicting Major Adverse Events in Patients With Acute Myocardial Infarction

Author

Nestelberger, Thomas, primary, Boeddinghaus, Jasper, additional, Wussler, Desiree, additional, Twerenbold, Raphael, additional, Badertscher, Patrick, additional, Wildi, Karin, additional, Miró, Òscar, additional, López, Beatriz, additional, Martin-Sanchez, F. Javier, additional, Muzyk, Piotr, additional, Koechlin, Luca, additional, Baumgartner, Benjamin, additional, Meier, Mario, additional, Troester, Valentina, additional, Rubini Giménez, Maria, additional, Puelacher, Christian, additional, du Fay de Lavallaz, Jeanne, additional, Walter, Joan, additional, Kozhuharov, Nikola, additional, Zimmermann, Tobias, additional, Gualandro, Danielle M., additional, Michou, Eleni, additional, Potlukova, Eliska, additional, Geigy, Nicolas, additional, Keller, Dagmar I., additional, Reichlin, Tobias, additional, Mueller, Christian, additional, Hafner, Benjamin, additional, Flores, Dayana, additional, Meissner, Kathrin, additional, Kulangara, Caroline, additional, Freese, Michael, additional, Osswald, Stefan, additional, Stelzig, Claudia, additional, Bingisser, Roland, additional, Fuenzalida Inostroza, Carolina Isabel, additional, Rodríguez Adrada, Esther, additional, Nowalany-Kozielska, Ewa, additional, Kawecki, Damian, additional, Parenica, Jiri, additional, Ganovská, Eva, additional, Lohrmann, Jens, additional, Amrein, Melissa, additional, Steude, Jana, additional, Buser, Andreas, additional, Grimm, Karin, additional, Hartmann, Beate, additional, Morawiec, Beata, additional, Rentsch, Katharina, additional, von Eckardstein, Arnold, additional, Biskup, Ewalina, additional, Campodarve, Isabel, additional, and Gea, Joachim, additional

Published
2019
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125. Prevalence of Pulmonary Embolism in Patients With Syncope

Author

Badertscher, Patrick, primary, du Fay de Lavallaz, Jeanne, additional, Hammerer-Lercher, Angelika, additional, Nestelberger, Thomas, additional, Zimmermann, Tobias, additional, Geiger, Marc, additional, Imahorn, Orell, additional, Miró, Òscar, additional, Salgado, Emilio, additional, Christ, Michael, additional, Cullen, Louise, additional, Than, Martin, additional, Martin-Sanchez, F. Javier, additional, Di Somma, Salvatore, additional, Peacock, W. Frank, additional, Keller, Dagmar I., additional, Costabel, Juan Pablo, additional, Walter, Joan, additional, Boeddinghaus, Jasper, additional, Twerenbold, Raphael, additional, Méndez, Adriana, additional, Gospodinov, Boris, additional, Puelacher, Christian, additional, Wussler, Desiree, additional, Koechlin, Luca, additional, Kawecki, Damian, additional, Geigy, Nicolas, additional, Strebel, Ivo, additional, Lohrmann, Jens, additional, Kühne, Michael, additional, Reichlin, Tobias, additional, Mueller, Christian, additional, Rubini Giménez, Maria, additional, Kozhuharov, Nikola, additional, Shrestha, Samyut, additional, Sazgary, Lorraine, additional, Morawiec, Beata, additional, Muzyk, Piotr, additional, Nowalany-Kozielska, Ewa, additional, Bustamante Mandrión, José, additional, Poepping, Imke, additional, Freese, Michael, additional, Meissner, Kathrin, additional, Kulangara, Caroline, additional, Fuenzalida Inostroza, Carolina Isabel, additional, Greenslade, Jaimi, additional, Hawkins, Tracey, additional, Rentsch, Katharina, additional, von Eckardstein, Arnold, additional, Buser, Andreas, additional, Kloos, Wanda, additional, Steude, Jana, additional, and Osswald, Stefan, additional

Published
2019
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127. Relative hypochromia and mortality in acute heart failure

Author

Kleber, Martina, primary, Kozhuharov, Nikola, additional, Sabti, Zaid, additional, Glatz, Bettina, additional, Isenreich, Rahel, additional, Wussler, Desiree, additional, Nowak, Albina, additional, Twerenbold, Raphael, additional, Badertscher, Patrick, additional, Puelacher, Christian, additional, du Fay de Lavallaz, Jeanne, additional, Nestelberger, Thomas, additional, Boeddinghaus, Jasper, additional, Wildi, Karin, additional, Flores, Dayana, additional, Walter, Joan, additional, Rentsch, Katharina, additional, von Eckardstein, Arnold, additional, Goudev, Assen, additional, Breidthardt, Tobias, additional, and Mueller, Christian, additional

Published
2019
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128. Early Diagnosis of Myocardial Infarction in Patients With a History of Coronary Artery Bypass Grafting

Author

Koechlin, Luca, primary, Boeddinghaus, Jasper, additional, Nestelberger, Thomas, additional, Wussler, Desiree, additional, Walter, Joan, additional, Martin-Sanchez, F. Javier, additional, Geigy, Nicolas, additional, Keller, Dagmar I., additional, Twerenbold, Raphael, additional, Mueller, Christian, additional, Reichlin, Tobias, additional, Zimmermann, Tobias, additional, Meier, Mario, additional, Troester, Valentina, additional, Huber, Jeffrey, additional, Christ, Michael, additional, Badertscher, Patrick, additional, Wildi, Karin, additional, Puelacher, Christian, additional, du Fay de Lavallaz, Jeanne, additional, Giménez, Maria Rubini, additional, Strebel, Ivo, additional, Kozhuharov, Nikola, additional, Gualandro, Danielle M., additional, Potlukova, Eliska, additional, Rentsch, Katharina, additional, Miró, Òscar, additional, Fuenzalida, Carolina, additional, Shrestha, Samyut, additional, Kawecki, Damian, additional, Morawiec, Beata, additional, Munzk, Piotr, additional, Breidthardt, Tobias, additional, Flores, Dayana, additional, Freese, Michael, additional, Stelzig, Claudia, additional, Kulangara, Caroline, additional, Meissner, Kathrin, additional, Fahrni, Gregor, additional, Michou, Eleni, additional, Osswald, Stefan, additional, Jeger, Raban, additional, Kaiser, Christoph, additional, López, Beatriz, additional, Calderón, Sofia, additional, Adrada, Esther Rodriguez, additional, Ganovská, Eva, additional, Parenica, Jiri, additional, von Eckardstein, Arnold, additional, Campodarve, Isabel, additional, Gea, Joachim, additional, Reuthebuch, Oliver, additional, Grapow, Martin, additional, and Eckstein, Friedrich, additional

Published
2019
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129. High-Sensitivity Cardiac Troponin I Assay for Early Diagnosis of Acute Myocardial Infarction

Author

Boeddinghaus, Jasper, primary, Nestelberger, Thomas, primary, Twerenbold, Raphael, primary, Koechlin, Luca, primary, Meier, Mario, primary, Troester, Valentina, primary, Wussler, Desiree, primary, Badertscher, Patrick, primary, Wildi, Karin, primary, Puelacher, Christian, primary, du Fay de Lavallaz, Jeanne, primary, Rubini Giménez, Maria, primary, Zimmermann, Tobias, primary, Hafner, Benjamin, primary, Potlukova, Eliska, primary, Miró, Òscar, primary, Martin-Sanchez, F Javier, primary, Keller, Dagmar I, primary, Reichlin, Tobias, primary, Mueller, Christian, primary, Walter, Joan Elias, additional, Strebel, Ivo, additional, Kozhuharov, Nikola, additional, Freese, Michael, additional, Fuenzalida, Carolina, additional, Stelzig, Claudia, additional, Gualandro, Danielle M, additional, Michou, Eleni, additional, Meissner, Kathrin, additional, Kulangara, Caroline, additional, Shrestha, Samyut, additional, Fahrni, Gregor, additional, Osswald, Stefan, additional, López, Beatriz, additional, Adrada, Esther Rodriguez, additional, Ganovská, Eva, additional, Lohrmann, Jens, additional, Kloos, Wanda, additional, Steude, Jana, additional, Buser, Andreas, additional, von Eckardstein, Arnold, additional, Morawiec, Beata, additional, Kawecki, Damian, additional, Nowalany-Kozielska, Ewa, additional, Muzyk, Piotr, additional, Geigy, Nicolas, additional, and Rentsch, Katharina, additional

Published
2019
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130. Prevalence and determinants of exercise‐induced left ventricular dysfunction in patients with coronary artery disease

Author

Honegger, Ursina, primary, Walter, Joan E., additional, Mueller, Deborah, additional, Puelacher, Christian, additional, Schaerli, Nicolas, additional, Twerenbold, Raphael, additional, Badertscher, Patrick, additional, Boeddinghaus, Jasper, additional, Nestelberger, Thomas, additional, du Fay de Lavallaz, Jeanne, additional, Wussler, Desiree, additional, Pfister, Otmar, additional, Jeger, Raban, additional, Kaiser, Christoph, additional, Wild, Damian, additional, Schmidt‐Trucksäss, Arno, additional, Reichlin, Tobias, additional, and Mueller, Christian, additional

Published
2019
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132. Comparison of fourteen rule-out strategies for acute myocardial infarction

Author

Wildi, Karin, primary, Boeddinghaus, Jasper, additional, Nestelberger, Thomas, additional, Twerenbold, Raphael, additional, Badertscher, Patrick, additional, Wussler, Desiree, additional, Giménez, Maria Rubini, additional, Puelacher, Christian, additional, du Fay de Lavallaz, Jeanne, additional, Dietsche, Sebastian, additional, Walter, Joan, additional, Kozhuharov, Nikola, additional, Morawiec, Beata, additional, Miró, Òscar, additional, Javier Martin-Sanchez, F., additional, Subramaniam, Sinthuri, additional, Geigy, Nicolas, additional, Keller, Dagmar I., additional, Reichlin, Tobias, additional, Mueller, Christian, additional, Mueller, Deborah, additional, Sazgary, Lorraine, additional, Marbot, Stella, additional, Sabti, Zaid, additional, Flores, Dayana, additional, Meissner, Kathrin, additional, Kulangara, Caroline, additional, Freese, Michael, additional, Osswald, Stefan, additional, Stelzig, Claudia, additional, Bingisser, Roland, additional, López, Beatriz, additional, Agüero, María Martínez, additional, Nowalany-Kozielska, Ewa, additional, Kawecki, Damian, additional, Parenica, Jiri, additional, Ganovská, Eva, additional, Lohrmann, Jens, additional, Buser, Andreas, additional, Grimm, Karin, additional, Hartmann, Beate, additional, Muzyk, Piotr, additional, Rentsch, Katharina, additional, and von Eckardstein, Arnold, additional

Published
2019
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133. Incidence and outcomes of unstable angina compared with non-ST-elevation myocardial infarction

Author

Puelacher, Christian, primary, Gugala, Mathias, additional, Adamson, Philip D, additional, Shah, Anoop, additional, Chapman, Andrew R, additional, Anand, Atul, additional, Sabti, Zaid, additional, Boeddinghaus, Jasper, additional, Nestelberger, Thomas, additional, Twerenbold, Raphael, additional, Wildi, Karin, additional, Badertscher, Patrick, additional, Rubini Gimenez, Maria, additional, Shrestha, Samyut, additional, Sazgary, Lorraine, additional, Mueller, Deborah, additional, Schumacher, Lukas, additional, Kozhuharov, Nikola, additional, Flores, Dayana, additional, du Fay de Lavallaz, Jeanne, additional, Miro, Oscar, additional, Martín-Sánchez, Francisco Javier, additional, Morawiec, Beata, additional, Fahrni, Gregor, additional, Osswald, Stefan, additional, Reichlin, Tobias, additional, Mills, Nicholas L, additional, and Mueller, Christian, additional

Published
2019
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134. Incremental diagnostic and prognostic value of the QRS-T angle, a 12-lead ECG marker quantifying heterogeneity of depolarization and repolarization, in patients with suspected non-ST-elevation myocardial infarction

Author

Strebel, Ivo, primary, Twerenbold, Raphael, additional, Wussler, Desiree, additional, Boeddinghaus, Jasper, additional, Nestelberger, Thomas, additional, du Fay de Lavallaz, Jeanne, additional, Abächerli, Roger, additional, Maechler, Patrick, additional, Mannhart, Diego, additional, Kozhuharov, Nikola, additional, Rubini Giménez, Maria, additional, Wildi, Karin, additional, Sazgary, Lorraine, additional, Sabti, Zaid, additional, Puelacher, Christian, additional, Badertscher, Patrick, additional, Keller, Dagmar I., additional, Miró, Òscar, additional, Fuenzalida, Carolina, additional, Calderón, Sofia, additional, Martin-Sanchez, F. Javier, additional, Iglesias, Sergio Lopez, additional, Osswald, Stefan, additional, Mueller, Christian, additional, and Reichlin, Tobias, additional

Published
2019
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135. External Validation of the MEESSI Acute Heart Failure Risk Score

Author

Wussler, Desiree, primary, Kozhuharov, Nikola, additional, Sabti, Zaid, additional, Walter, Joan, additional, Strebel, Ivo, additional, Scholl, Letizia, additional, Miró, Oscar, additional, Rossello, Xavier, additional, Martín-Sánchez, Francisco Javier, additional, Pocock, Stuart J., additional, Nowak, Albina, additional, Badertscher, Patrick, additional, Twerenbold, Raphael, additional, Wildi, Karin, additional, Puelacher, Christian, additional, du Fay de Lavallaz, Jeanne, additional, Shrestha, Samyut, additional, Strauch, Olivia, additional, Flores, Dayana, additional, Nestelberger, Thomas, additional, Boeddinghaus, Jasper, additional, Schumacher, Carmela, additional, Goudev, Assen, additional, Pfister, Otmar, additional, Breidthardt, Tobias, additional, and Mueller, Christian, additional

Published
2019
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136. Clinical utility of circulating interleukin-6 concentrations in the detection of functionally relevant coronary artery disease

Author

Walter, Joan, primary, Tanglay, Yunus, additional, du Fay de Lavallaz, Jeanne, additional, Strebel, Ivo, additional, Boeddinghaus, Jasper, additional, Twerenbold, Raphael, additional, Doerflinger, Stephanie, additional, Puelacher, Christian, additional, Nestelberger, Thomas, additional, Wussler, Desiree, additional, Amrein, Melissa, additional, Badertscher, Patrick, additional, Todd, John, additional, Rentsch, Katharina, additional, Fahrni, Gregor, additional, Jeger, Raban, additional, Kaiser, Christoph, additional, Reichlin, Tobias, additional, and Mueller, Christian, additional

Published
2019
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137. Sex Differences in COVID-19 Hospitalization and Mortality.

Author

Gomez, Joanne Michelle D., Du-Fay-de-Lavallaz, Jeanne M., Fugar, Setri, Sarau, Alexandra, Simmons, J. Alan, Clark, Brian, Sanghani, Rupa M., Aggarwal, Neelum T., Williams, Kim A., Doukky, Rami, and Volgman, Annabelle Santos

Subjects
*EVALUATION of medical care, *RESEARCH, *INTENSIVE care units, *VASOCONSTRICTORS, *COVID-19, *CONFIDENCE intervals, *MEDICAL cooperation, *RETROSPECTIVE studies, *PATIENTS, *SEX distribution, *HOSPITAL admission & discharge, *HOSPITAL care, *DESCRIPTIVE statistics, *ODDS ratio, *TRACHEA intubation
Abstract

Background: To investigate sex differences in coronavirus disease 2019 (COVID-19) outcomes in a large Illinois-based cohort. Methods: A multicenter retrospective cohort study compared males versus females with COVID-19 infections from March 1, 2020, to June 21, 2020, in the Rush University System. We analyzed sex differences in rates of hospitalization, intensive care unit (ICU) admission, vasopressor use, endotracheal intubation, and death in this cohort. A multivariable model correcting for age and sum of comorbidities was used to explore associations between sex and COVID-19-related outcomes. Results: There were 8108 positive COVID-19 patients—4300 (53.0%) females and 3808 (47.0%) males. Males had higher rates of hospitalization (19% vs. 13%; p < 0.001), ICU transfer (8% vs. 4%; p < 0.001), vasopressor support (4% vs. 2%; p < 0.001), and endotracheal intubation (5% vs. 2%; p < 0.001). Of those who died, 92 were males and 64 were females (2% vs. 1%; p = 0.003). A multivariable model correcting for age and sum of comorbidities showed a significant association between male sex and mortality in the total cohort (odds ratio, 1.96; 95% confidence interval, 1.34–2.90; p = 0.001). Conclusion: Male sex was independently associated with death, hospitalization, ICU admissions, and need for vasopressors or endotracheal intubation, after correction for important covariates. [ABSTRACT FROM AUTHOR]

Published
2021
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138. Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction.

Author

UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (SLuc) Service des urgences, Boeddinghaus, Jasper, Nestelberger, Thomas, Twerenbold, Raphael, Neumann, Johannes Tobias, Lindahl, Bertil, Giannitsis, Evangelos, Sörensen, Nils Arne, Badertscher, Patrick, Jann, Janina E, Wussler, Desiree, Puelacher, Christian, Rubini Giménez, Maria, Wildi, Karin, Strebel, Ivo, Du Fay de Lavallaz, Jeanne, Selman, Farah, Sabti, Zaid, Kozhuharov, Nikola, Potlukova, Eliska, Rentsch, Katharina, Miró, Òscar, Martin-Sanchez, F Javier, Morawiec, Beata, Parenica, Jiri, Lohrmann, Jens, Kloos, Wanda, Buser, Andreas, Geigy, Nicolas, Keller, Dagmar I, Osswald, Stefan, Reichlin, Tobias, Westermann, Dirk, Blankenberg, Stefan, Mueller, Christian, APACE, BACC, and TRAPID-AMI Investigators, Verschuren, Franck, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (SLuc) Service des urgences, Boeddinghaus, Jasper, Nestelberger, Thomas, Twerenbold, Raphael, Neumann, Johannes Tobias, Lindahl, Bertil, Giannitsis, Evangelos, Sörensen, Nils Arne, Badertscher, Patrick, Jann, Janina E, Wussler, Desiree, Puelacher, Christian, Rubini Giménez, Maria, Wildi, Karin, Strebel, Ivo, Du Fay de Lavallaz, Jeanne, Selman, Farah, Sabti, Zaid, Kozhuharov, Nikola, Potlukova, Eliska, Rentsch, Katharina, Miró, Òscar, Martin-Sanchez, F Javier, Morawiec, Beata, Parenica, Jiri, Lohrmann, Jens, Kloos, Wanda, Buser, Andreas, Geigy, Nicolas, Keller, Dagmar I, Osswald, Stefan, Reichlin, Tobias, Westermann, Dirk, Blankenberg, Stefan, Mueller, Christian, APACE, BACC, and TRAPID-AMI Investigators, and Verschuren, Franck

Abstract

AIMS: We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1h-algorithms and to derive and externally validate alternative cut-offs specific to older patients. METHODS AND RESULTS: We prospectively enrolled patients presenting to the emergency department (ED) with symptoms suggestive of acute myocardial infarction in three large diagnostic studies. Final diagnoses were adjudicated by two independent cardiologists. High-sensitivity cardiac troponin (hs-cTn) T and I concentrations were measured at presentation and after 1 h. Patients were stratified according to age [<55 years (young), ≥55 to <70 years (middle-age), ≥70 years (old)]. Rule-out safety of the ESC hs-cTnT 0/1h-algorithm was very high in all age-strata: sensitivity 100% [95% confidence interval (95% CI) 94.9-100] in young, 99.3% (95% CI 96.0-99.9) in middle-age, and 99.3% (95% CI 97.5-99.8) in old patients. Accuracy of rule-in decreased with age: specificity 97.0% (95% CI 95.8-97.9) in young, 96.1% (95% CI 94.5-97.2) in middle-age, and 92.7% (95% CI 90.7-94.3) in older patients. Triage efficacy decreased with increasing age (young 93%, middle-age 80%, old 55%, P < 0.001). Similar results were found for the ESC hs-cTnT 0/1h-algorithm. Alternative, slightly higher cut-off concentrations optimized for older patients maintained very high safety of rule-out, increased specificity of rule-in (P < 0.01), reduced overall efficacy for hs-cTnT (P < 0.01), while maintaining efficacy for hs-cTnI. Findings were confirmed in two validation cohorts (n = 2767). CONCLUSION: While safety of the ESC 0/1h-algorithms remained very high, increasing age significantly reduced overall efficacy and the accuracy of rule-in. Alternative slightly higher cut-off concentrations may be considered for older patients, particularly if using hs-cTnI. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT00470587, number NCT00470587 and NCT02355457 (BACC).

Published
2018

139. Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome

Author

du Fay de Lavallaz, Jeanne, primary, Puelacher, Christian, additional, Lurati Buse, Giovanna, additional, Bolliger, Daniel, additional, Germanier, Dominic, additional, Hidvegi, Reka, additional, Walter, Joan Elias, additional, Twerenbold, Raphael, additional, Strebel, Ivo, additional, Badertscher, Patrick, additional, Sazgary, Lorraine, additional, Lampart, Andreas, additional, Espinola, Jaqueline, additional, Kindler, Christoph, additional, Hammerer-Lercher, Angelika, additional, Thambipillai, Saranya, additional, Guerke, Lorenz, additional, Rentsch, Katharina, additional, Buser, Andreas, additional, Gualandro, Danielle, additional, Jakob, Marcel, additional, and Mueller, Christian, additional

Published
2018
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140. Rhabdomyolysis

Author

du Fay de Lavallaz, Jeanne, primary, Zehntner, Tibor, additional, Puelacher, Christian, additional, Walter, Joan, additional, Strebel, Ivo, additional, Rentsch, Katharina, additional, Boeddinghaus, Jasper, additional, Nestelberger, Thomas, additional, Twerenbold, Raphael, additional, and Mueller, Christian, additional

Published
2018
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141. Direct Comparison of Cardiac Troponin T and I Using a Uniform and a Sex-Specific Approach in the Detection of Functionally Relevant Coronary Artery Disease

Author

Mueller, Deborah, primary, Puelacher, Christian, primary, Honegger, Ursina, primary, Walter, Joan E, primary, Badertscher, Patrick, primary, Schaerli, Nicolas, primary, Strebel, Ivo, primary, Twerenbold, Raphael, primary, Boeddinghaus, Jasper, primary, Nestelberger, Thomas, primary, Hollenstein, Christina, primary, du Fay de Lavallaz, Jeanne, primary, Jeger, Raban, primary, Kaiser, Christoph, primary, Wild, Damian, primary, Rentsch, Katharina, primary, Buser, Andreas, primary, Zellweger, Michael, primary, Reichlin, Tobias, primary, and Mueller, Christian, primary

Published
2018
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142. Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected myocardial infarction

Author

Cupa, Janosch, primary, Strebel, Ivo, additional, Badertscher, Patrick, additional, Abächerli, Roger, additional, Twerenbold, Raphael, additional, Schumacher, Lukas, additional, Boeddinghaus, Jasper, additional, Nestelberger, Thomas, additional, Maechler, Patrick, additional, Kozhuharov, Nikola, additional, Giménez, Maria Rubini, additional, Wildi, Karin, additional, Du Fay de Lavallaz, Jeanne, additional, Sabti, Zaid, additional, Sazgary, Lorraine, additional, Puelacher, Christian, additional, Mueller, Deborah, additional, Bianci, Chiara, additional, Miró, Òscar, additional, Fuenzalida, Carolina, additional, Calderón, Sofia, additional, Martín-Sánchez, F. Javier, additional, Iglesias, Sergio Lopez, additional, Morawiec, Beata, additional, Kawecki, Damian, additional, Parenica, Jiri, additional, Keller, Dagmar I., additional, Geigy, Nicolas, additional, Osswald, Stefan, additional, Mueller, Christian, additional, and Reichlin, Tobias, additional

Published
2018
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143. Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery

Author

Gualandro, Danielle M, primary, Puelacher, Christian, additional, LuratiBuse, Giovanna, additional, Lampart, Andreas, additional, Strunz, Celia, additional, Cardozo, Francisco A, additional, Yu, Pai C, additional, Jaffe, Allan S, additional, Barac, Sanela, additional, Bock, Lukas, additional, Badertscher, Patrick, additional, du Fay de Lavallaz, Jeanne, additional, Marbot, Stella, additional, Sazgary, Lorraine, additional, Bolliger, Daniel, additional, Rentsch, Katharina, additional, Twerenbold, Raphael, additional, Hammerer-Lercher, Angelika, additional, Melo, Edielle S, additional, Calderaro, Daniela, additional, Duarte, Alberto JS, additional, de Luccia, Nelson, additional, Caramelli, Bruno, additional, and Mueller, Christian, additional

Published
2018
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145. Automatically computed ECG algorithm for the quantification of myocardial scar and the prediction of mortality

Author

Badertscher, Patrick, primary, Strebel, Ivo, additional, Honegger, Ursina, additional, Schaerli, Nicolas, additional, Mueller, Deborah, additional, Puelacher, Christian, additional, Wagener, Max, additional, Abächerli, Roger, additional, Walter, Joan, additional, Sabti, Zaid, additional, Sazgary, Lorraine, additional, Marbot, Stella, additional, du Fay de Lavallaz, Jeanne, additional, Twerenbold, Raphael, additional, Boeddinghaus, Jasper, additional, Nestelberger, Thomas, additional, Kozhuharov, Nikola, additional, Breidthardt, Tobias, additional, Shrestha, Samyut, additional, Flores, Dayana, additional, Schumacher, Carmela, additional, Wild, Damian, additional, Osswald, Stefan, additional, Zellweger, Michael J., additional, Mueller, Christian, additional, and Reichlin, Tobias, additional

Published
2018
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146. Diagnostic value of the cardiac electrical biomarker, a novel ECG marker indicating myocardial injury, in patients with symptoms suggestive of non-ST-elevation myocardial infarction

Author

Strebel, Ivo, primary, Twerenbold, Raphael, additional, Boeddinghaus, Jasper, additional, Abächerli, Roger, additional, Rubini Giménez, Maria, additional, Wildi, Karin, additional, Grimm, Karin, additional, Puelacher, Christian, additional, Badertscher, Patrick, additional, Sabti, Zaid, additional, Breitenbücher, Dominik, additional, Jann, Janina, additional, Selman, Farah, additional, du Fay de Lavallaz, Jeanne, additional, Schaerli, Nicolas, additional, Nestelberger, Thomas, additional, Stelzig, Claudia, additional, Freese, Michael, additional, Schumacher, Lukas, additional, Osswald, Stefan, additional, Mueller, Christian, additional, and Reichlin, Tobias, additional

Published
2018
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147. Combining high-sensitivity cardiac troponin and B-type natriuretic peptide in the detection of inducible myocardial ischemia

Author

Puelacher, Christian, primary, Wagener, Max, additional, Honegger, Ursina, additional, Assadian, Mustafa, additional, Schaerli, Nicolas, additional, Mueller, Deborah, additional, Strebel, Ivo, additional, Twerenbold, Raphael, additional, Boeddinghaus, Jasper, additional, Nestelberger, Thomas, additional, Wildi, Karin, additional, Sabti, Zaid, additional, Sazgary, Lorraine, additional, Badertscher, Patrick, additional, du Fay de Lavallaz, Jeanne, additional, Marbot, Stella, additional, Kaiser, Christoph, additional, Wild, Damian, additional, Zellweger, Michael J., additional, Reichlin, Tobias, additional, and Mueller, Christian, additional

Published
2018
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148. Prospective Validation of a Biomarker-Based Rule Out Strategy for Functionally Relevant Coronary Artery Disease

Author

Walter, Joan E, primary, Honegger, Ursina, primary, Puelacher, Christian, primary, Mueller, Deborah, primary, Wagener, Max, primary, Schaerli, Nicolas, primary, Strebel, Ivo, primary, Twerenbold, Raphael, primary, Boeddinghaus, Jasper, primary, Nestelberger, Thomas, primary, Sazgary, Lorraine, primary, Marbot, Stella, primary, du Fay de Lavallaz, Jeanne, primary, Kaiser, Christoph, primary, Osswald, Stefan, primary, Wild, Damian, primary, Rentsch, Katharina, primary, Zellweger, Michael, primary, Reichlin, Tobias, primary, and Mueller, Christian, primary

Published
2018
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149. Cinética temprana de troponina en pacientes con sospecha de infarto agudo de miocardio

Author

Rubini Giménez, María, Wildi, Karin, Wussler, Desiree, Koechlin, Luca, Boeddinghaus, Jasper, Nestelberger, Thomas, Badertscher, Patrick, Sedlmayer, Raphael, Puelacher, Christian, Zimmermann, Tobias, du Fay de Lavallaz, Jeanne, Lopez-Ayala, Pedro, Leu, Kathrin, Rentsch, Katharina, Miró, Òscar, López, Beatriz, Martín-Sánchez, F. Javier, Bustamante, José, Kawecki, Damian, Parenica, Jiri, Lohrmann, Jens, Kloos, Wanda, Buser, Andreas, Keller, Dagmar I., Reichlin, Tobias, Twerenbold, Raphael, and Mueller, Christian

Abstract

La cinética de liberación de troponinas cardiacas ultrasensibles (Tnc-us) T e I en pacientes con sospecha de infarto agudo de miocardio (IAM) se desconoce completamente a día de hoy. Nuestro objetivo fue evaluar si la liberación de Tnc-us T/I en las fases iniciales del IAM sigue un patrón linear.

Published
2021
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150. Contributors

Author

Albakri, Aref, AlMahameed, Soufian T., Andršová, Irena, Asirvatham, Samuel J., Avari Silva, Jennifer N., Bacharova, Ljuba, Bagliani, Giuseppe, Barakat, Rody, Barakat, Michel M., Barletta, Valentina, Barthel, Petra, Bébarová, Markéta, Beck, Hiroko, Belhassen, Bernard, Bende, Girish, Berkefeld, Anna, Birgersdotter-Green, Ulrika, Blinova, Ksenia, Blomström-Lundqvist, Carina, Bongiorni, Maria Grazia, Brand, Thomas, Bugiardini, Raffaele, Bunch, T. Jared, Castiglione, Alessandro, Cenko, Edina, Chatzidou, Sofia, Chee, Jennifer, Chelu, Mihail G., Chen, Shih Ann, Ciconte, Giuseppe, Curtis, Anne B., Curtis, Stephanie, Cygankiewicz, Iwona, Dalal, Aarti S., Day, John D., Della Tommasina, Veronica, Deshmukh, Abhishek J., Dilaveris, Polychronis, Di Summa, Roberto, Dogan, Mehmet, Dong, Jun, du Fay de Lavallaz, Jeanne, Eckhardt, Lee L., Efimova, Elena, Ernst, Sabine, Fawzy, Ameenathul M., Gaita, Fiorenzo, Garber, Libet, Garnett, Christine, Georgiopoulos, Georgios, Gillis, Anne M., Giustetto, Carla, Gonzalez Corcia, M. Cecilia, Haim, Moti, Halliday, Brian P., Hamdan, Mohamed H., Hammersley, Daniel J., Hartikainen, Juha E.K., Haugaa, Kristina H., Haukilahti, M. Anette E., Hautala, Arto J., Helánová, Kateřina, Hnatkova, Katerina, Hu, Yu-Feng, Hu, Xiao, Hurley, David, Iwai, Sei, Jacobs, Victoria, Jacobson, Jason T., James, Cynthia A., Jiang, Hongying, Jones, Camelle, Jones, Richard E., Junttila, M. Juhani, Kadish, Alan H., Karavirta, Laura, Karim, Saima, Karnad, Dilip, Karunatilleke, Anne, Kaufman, Elizabeth S., Kenttä, Tuomas V., Kezerle, Louise, Khalil, Fouad M., Klingenheben, Thomas, Kloosterman, M., Kontogiannis, Christos, Kowlgi, Gurukripa N., Kroman, Anne M., Kutyifa, Valentina, Lampert, Rachel, Laukkanen, Jari, Lee, Hyon Jae, Leinveber, Pavel, Leren, Ida S., Lima, Fabio V., Linde, Cecilia, Locati, Emanuela T., Macfarlane, Peter W., Maclachlan, Hamish, Mäkikallio, Timo H., Malik, Marek, Manfrini, Olivia, Marashly, Qussay, Margioula, Eleni, McCaffrey, James A., Mehra, Nandini S., Milman, Anat, Moharem-Elgamal, Sarah, Mujović, Nebojša, Nagarajan, Darbhamulla V., Nemec, Petr, Novotný, Tomáš, O'Neill, Louisa, Odening, Katja E., Panicker, Gopi Krishna, Pappone, Carlo, Patton, Kristen K., Pelter, Michele M., Peyracchia, Mattia, Potpara, Tratjana, Powell, Benjamin E., Preben, Bjerregaard, Sarkozy, Andrea, Schneider, Birke, Segreti, Luca, Selzman, Kimberly A., Sharma, Sanjay, Šišáková, Martina, Spears, D.A., Spera, Francesco Raffaele, Špinarová, Lenka, Stein, Phyllis K., Stergiopoulos, Kathleen, Sticherling, Christian, Stuart, Graham, Sugrue, Alan M., Svennberg, Emma, Tada, Hiroshi, Tampakis, Konstantinos, Tereshchenko, Larisa G., Terho, Henri, te Riele, Anneline S.J.M., Tikkanen, Jani T., Toman, Ondřej, Toso, Elisabetta, Tracy, Cynthia M., Trifunovic, Danijela, Turner, James M.A., Vaidya, Vaibhav R., Van Gelder, Isabelle C., Vasavan, Tharni, Verrier, Richard L., Veseli, Granit, Vicente, Jose, Williamson, Catherine, Wu, Wendy W., YH. Lip, Gregory, Younis, Arwa, Zabel, Markus, Zathar, Zafraan, Zegre-Hemsey, Jessica K., Zheng, Nan, and Zucchelli, Giulio

Published
2020
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