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2. GRACE scores or high-sensitivity troponin for timing of coronary angiography in non-ST-elevation acute coronary syndromes

Author

Jobs, Alexander, Boeddinghaus, Jasper, Neumann, Johannes Tobias, Goßling, Alina, Sörensen, Nils A., Twerenbold, Raphael, Nestelberger, Thomas, Lopez-Ayala, Pedro, Gimenez, Maria Rubini, Miro, Oscar, Koechlin, Luca, Buergin, Natacha, Feistritzer, Hans-Josef, Collet, Jean-Philippe, Bhatt, Deepak L., Granger, Christopher B., Blankenberg, Stefan, Desch, Steffen, Mueller, Christian, Westermann, Dirk, and Thiele, Holger

Published
2024
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3. Personalized diagnosis in suspected myocardial infarction

Author

Neumann, Johannes Tobias, Twerenbold, Raphael, Ojeda, Francisco, Aldous, Sally J., Allen, Brandon R., Apple, Fred S., Babel, Hugo, Christenson, Robert H., Cullen, Louise, Di Carluccio, Eleonora, Doudesis, Dimitrios, Ekelund, Ulf, Giannitsis, Evangelos, Greenslade, Jaimi, Inoue, Kenji, Jernberg, Tomas, Kavsak, Peter, Keller, Till, Lee, Kuan Ken, Lindahl, Bertil, Lorenz, Thiess, Mahler, Simon A., Mills, Nicholas L., Mokhtari, Arash, Parsonage, William, Pickering, John W., Pemberton, Christopher J., Reich, Christoph, Richards, A. Mark, Sandoval, Yader, Than, Martin P., Toprak, Betül, Troughton, Richard W., Worster, Andrew, Zeller, Tanja, Ziegler, Andreas, and Blankenberg, Stefan

Published
2023
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6. Prognostic Value of Cardiovascular Biomarkers in the Population.

Author

Neumann, Johannes Tobias, Twerenbold, Raphael, Weimann, Jessica, Ballantyne, Christie M., Benjamin, Emelia J., Costanzo, Simona, de Lemos, James A., deFilippi, Christopher R., Di Castelnuovo, Augusto, Donfrancesco, Chiara, Dörr, Marcus, Eggers, Kai M., Engström, Gunnar, Felix, Stephan B., Ferrario, Marco M., Gansevoort, Ron T., Giampaoli, Simona, Giedraitis, Vilmantas, Hedberg, Pär, and Iacoviello, Licia

Subjects
*BRAIN natriuretic factor, *CARDIOVASCULAR diseases, *MYOCARDIAL infarction, *TROPONIN I, *PROGNOSIS, *BIOMARKERS, *PEPTIDES
Abstract

Key Points: Question: What is the value of cardiovascular biomarkers when added to established risk factors to predict incident cardiovascular events in the population? Findings: In this large, individual-level data analysis from 28 general population–based cohorts from 12 countries, high-sensitivity cardiac troponins I and T, B-type natriuretic peptide, and high-sensitivity C-reactive protein were associated with fatal and nonfatal events. Meaning: The addition of biomarkers to established risk factors leads to only a small improvement in risk prediction metrics for atherosclerotic cardiovascular disease, but was more favorable for heart failure and mortality. Importance: Identification of individuals at high risk for atherosclerotic cardiovascular disease within the population is important to inform primary prevention strategies. Objective: To evaluate the prognostic value of routinely available cardiovascular biomarkers when added to established risk factors. Design, Setting, and Participants: Individual-level analysis including data on cardiovascular biomarkers from 28 general population–based cohorts from 12 countries and 4 continents with assessments by participant age. The median follow-up was 11.8 years. Exposure: Measurement of high-sensitivity cardiac troponin I, high-sensitivity cardiac troponin T, N-terminal pro-B-type natriuretic peptide, B-type natriuretic peptide, or high-sensitivity C-reactive protein. Main Outcomes and Measures: The primary outcome was incident atherosclerotic cardiovascular disease, which included all fatal and nonfatal events. The secondary outcomes were all-cause mortality, heart failure, ischemic stroke, and myocardial infarction. Subdistribution hazard ratios (HRs) for the association of biomarkers and outcomes were calculated after adjustment for established risk factors. The additional predictive value of the biomarkers was assessed using the C statistic and reclassification analyses. Results: The analyses included 164 054 individuals (median age, 53.1 years [IQR, 42.7-62.9 years] and 52.4% were women). There were 17 211 incident atherosclerotic cardiovascular disease events. All biomarkers were significantly associated with incident atherosclerotic cardiovascular disease (subdistribution HR per 1-SD change, 1.13 [95% CI, 1.11-1.16] for high-sensitivity cardiac troponin I; 1.18 [95% CI, 1.12-1.23] for high-sensitivity cardiac troponin T; 1.21 [95% CI, 1.18-1.24] for N-terminal pro-B-type natriuretic peptide; 1.14 [95% CI, 1.08-1.22] for B-type natriuretic peptide; and 1.14 [95% CI, 1.12-1.16] for high-sensitivity C-reactive protein) and all secondary outcomes. The addition of each single biomarker to a model that included established risk factors improved the C statistic. For 10-year incident atherosclerotic cardiovascular disease in younger people (aged <65 years), the combination of high-sensitivity cardiac troponin I, N-terminal pro-B-type natriuretic peptide, and high-sensitivity C-reactive protein resulted in a C statistic improvement from 0.812 (95% CI, 0.8021-0.8208) to 0.8194 (95% CI, 0.8089-0.8277). The combination of these biomarkers also improved reclassification compared with the conventional model. Improvements in risk prediction were most pronounced for the secondary outcomes of heart failure and all-cause mortality. The incremental value of biomarkers was greater in people aged 65 years or older vs younger people. Conclusions and Relevance: Cardiovascular biomarkers were strongly associated with fatal and nonfatal cardiovascular events and mortality. The addition of biomarkers to established risk factors led to only a small improvement in risk prediction metrics for atherosclerotic cardiovascular disease, but was more favorable for heart failure and mortality. This study evaluates the prognostic value of routinely available cardiovascular biomarkers when added to established risk factors in the identification of individuals at high risk for atherosclerotic cardiovascular disease. [ABSTRACT FROM AUTHOR]

Published
2024
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7. Diagnostic and prognostic value of the sex-specific 99th percentile of four high-sensitivity cardiac troponin assays in patients with suspected myocardial infarction

Author

Lehmacher, Jonas, primary, Sörensen, Nils Arne, additional, Twerenbold, Raphael, additional, Goßling, Alina, additional, Haller, Paul Michael, additional, Hartikainen, Tau Sarra, additional, Schock, Alina, additional, Toprak, Betül, additional, Zeller, Tanja, additional, Westermann, Dirk, additional, and Neumann, Johannes Tobias, additional

Published
2023
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9. GRACE scores or high-sensitivity troponin for timing of coronary angiography in non-ST-elevation acute coronary syndromes

Author

Jobs, Alexander, primary, Boeddinghaus, Jasper, additional, Neumann, Johannes Tobias, additional, Goßling, Alina, additional, Sörensen, Nils A., additional, Twerenbold, Raphael, additional, Nestelberger, Thomas, additional, Lopez-Ayala, Pedro, additional, Gimenez, Maria Rubini, additional, Miro, Oscar, additional, Koechlin, Luca, additional, Buergin, Natacha, additional, Feistritzer, Hans-Josef, additional, Collet, Jean-Philippe, additional, Bhatt, Deepak L., additional, Granger, Christopher B., additional, Blankenberg, Stefan, additional, Desch, Steffen, additional, Mueller, Christian, additional, Westermann, Dirk, additional, and Thiele, Holger, additional

Published
2023
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12. Validation of a 0/1 h Algorithm for Rapid Diagnosis of Myocardial Infarction Using a High-Sensitivity Troponin I Assay

Author

Lehmacher, Jonas, primary, Toprak, Betül, additional, Sörensen, Nils Arne, additional, Bei der Kellen, Ramona, additional, Goßling, Alina, additional, Hartikainen, Tau Sarra, additional, Haller, Paul Michael, additional, Schock, Alina, additional, Twerenbold, Raphael, additional, Zeller, Tanja, additional, Blankenberg, Stefan, additional, Westermann, Dirk, additional, and Neumann, Johannes Tobias, additional

Published
2023
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14. Association of late gadolinium enhancement with biomarkers in patients with myocardial infarction

Author

Schneider, Jan Niklas, primary, Neumann, Johannes Tobias, additional, Bohnen, Sebastian, additional, Sörensen, Nils Arne, additional, Cavus, Ersin, additional, Schäfer, Sarina, additional, Hartikainen, Tau Sarra, additional, Goßling, Alina, additional, Tahir, Enver, additional, Lund, Gunnar K., additional, Adam, Gerhard, additional, Blankenberg, Stefan, additional, Muellerleile, Kai, additional, Westermann, Dirk, additional, and Radunski, Ulf Konrad, additional

Published
2021
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20. VALIDATION OF A NOVEL MULTI-BIOMARKER PANEL FOR ACCURATE PREDICTION OF INCIDENT CARDIOVASCULAR EVENTS IN PATIENTS WITH SUSPECTED MYOCARDIAL INFARCTION

Author

Neumann, Johannes Tobias, primary, Sörensen, Nils, additional, Zeller, Tanja, additional, Magaret, Craig, additional, Rhyne, Rhonda, additional, Barnes, Grady, additional, Peters, Celine, additional, Hartikainen, Tau, additional, Schäfer, Sarina, additional, Januzzi, James, additional, Blankenberg, Stefan, additional, and Westermann, Dirk, additional

Published
2019
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21. 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, Neumann, Johannes Tobias, Lindahl, Berta, Giannitsis, Evangelos, Soerensen, Nils Arne, Badertscher, Patrick, Jann, Janina E., Wussler, Desiree, Puelacher, Christian, Gimenez, Maria Rubini, Wildi, Karin, Strebel, Ivo, de Lavallaz, Jeanne Du Fay, Selman, Farah, Sabti, Zaid, Kozhuharov, Nikola, Potlukova, Eliska, Rentsch, Katharina, Miro, Oscar, 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, Boeddinghaus, Jasper, Nestelberger, Thomas, Twerenbold, Raphael, Neumann, Johannes Tobias, Lindahl, Berta, Giannitsis, Evangelos, Soerensen, Nils Arne, Badertscher, Patrick, Jann, Janina E., Wussler, Desiree, Puelacher, Christian, Gimenez, Maria Rubini, Wildi, Karin, Strebel, Ivo, de Lavallaz, Jeanne Du Fay, Selman, Farah, Sabti, Zaid, Kozhuharov, Nikola, Potlukova, Eliska, Rentsch, Katharina, Miro, Oscar, 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, and Mueller, Christian

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 and results 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 97.599.8) 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-cTnl. 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-cTnl.

Published
2018
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22. 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

25. Reply

Author

Twerenbold, Raphael, primary, Neumann, Johannes Tobias, additional, Blankenberg, Stefan, additional, Westermann, Dirk, additional, and Mueller, Christian, additional

Published
2018
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28. Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction

Author

Twerenbold, Raphael, primary, Neumann, Johannes Tobias, additional, Sörensen, Nils Arne, additional, Ojeda, Francisco, additional, Karakas, Mahir, additional, Boeddinghaus, Jasper, additional, Nestelberger, Thomas, additional, Badertscher, Patrick, additional, Rubini Giménez, Maria, additional, Puelacher, Christian, additional, Wildi, Karin, additional, Kozhuharov, Nikola, additional, Breitenbuecher, Dominik, additional, Biskup, Ewelina, additional, du Fay de Lavallaz, Jeanne, additional, Flores, Dayana, additional, Wussler, Desiree, additional, Miró, Òscar, additional, Martín Sánchez, F. Javier, additional, Morawiec, Beata, additional, Parenica, Jiri, additional, Geigy, Nicolas, additional, Keller, Dagmar I., additional, Zeller, Tanja, additional, Reichlin, Tobias, additional, Blankenberg, Stefan, additional, Westermann, Dirk, additional, and Mueller, Christian, additional

Published
2018
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29. Relations of Sex to Diagnosis and Outcomes in Acute Coronary Syndrome

Author

Sörensen, Nils Arne, primary, Neumann, Johannes Tobias, additional, Ojeda, Francisco, additional, Schäfer, Sarina, additional, Magnussen, Christina, additional, Keller, Till, additional, Lackner, Karl J., additional, Zeller, Tanja, additional, Karakas, Mahir, additional, Münzel, Thomas, additional, Blankenberg, Stefan, additional, Westermann, Dirk, additional, and Schnabel, Renate B., additional

Published
2018
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30. Immediate rule-out of acute myocardial infarction using electrocardiogram and baseline high-sensitivity troponin I

Author

Neumann, Johannes Tobias, Sörensen, Nils Arne, Ojeda, Francisco, Schwemer, Tjark, Lehmacher, Jonas, Gönner, Saskia, Jarsetz, Nikolas, Keller, Till, Schaefer, Sarina, Renné, Thomas, Landmesser, Ulf, Clemmensen, Peter, Makarova, Nataliya, Schnabel, Renate B., Zeller, Tanja, Karakas, Mahir, Pickering, John W., Than, Martin, Parsonage, William, Greenslade, Jaimi, Cullen, Louise, Westermann, Dirk, Blankenberg, Stefan, Neumann, Johannes Tobias, Sörensen, Nils Arne, Ojeda, Francisco, Schwemer, Tjark, Lehmacher, Jonas, Gönner, Saskia, Jarsetz, Nikolas, Keller, Till, Schaefer, Sarina, Renné, Thomas, Landmesser, Ulf, Clemmensen, Peter, Makarova, Nataliya, Schnabel, Renate B., Zeller, Tanja, Karakas, Mahir, Pickering, John W., Than, Martin, Parsonage, William, Greenslade, Jaimi, Cullen, Louise, Westermann, Dirk, and Blankenberg, Stefan

Abstract

AIMS: Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile. Here, we evaluated the performance of a single admission troponin with a lower cutoff combined with a low risk electrocardiogram (ECG) to rule out AMI. METHODS: Troponin I measured with a high-sensitivity assay (hs-TnI) was determined at admission in 1040 patients presenting with suspected AMI (BACC study). To rule out AMI we calculated the negative predictive value (NPV) utilizing the optimal hs-TnI cutoff combined with a low risk ECG. The results were validated in 3566 patients with suspected AMI [2-h Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker (ADAPT) studies]. Patients were followed for 6 or 12 months. RESULTS: 184 of all patients were diagnosed with AMI. An hs-TnI cutoff of 3 ng/L resulted in a NPV of 99.3% (CI 97.3-100.0), ruling out 35% of all non-AMI patients. Adding the information of a low riskECGresulted in a 100% (CI 97.5-100.0) NPV (28% ruled out). The 2 validation cohorts replicated the high NPV of this approach. The follow-up mortality in the ruled out population was low (0 deaths in BACC and Stenocardia, 1 death in ADAPT). CONCLUSIONS: A single hs-TnI measurement on admission combined with a low risk ECG appears to rule out AMI safely without need for serial troponin testing. Trial Registration: www.clinicaltrials.gov (NCT02355457).

Published
2017

32. Discrimination of patients with type 2 myocardial infarction

Author

Neumann, Johannes Tobias, primary, Sörensen, Nils Arne, additional, Rübsamen, Nicole, additional, Ojeda, Francisco, additional, Renné, Thomas, additional, Qaderi, Vazhma, additional, Teltrop, Elena, additional, Kramer, Solveig, additional, Quantius, Laura, additional, Zeller, Tanja, additional, Karakas, Mahir, additional, Blankenberg, Stefan, additional, and Westermann, Dirk, additional

Published
2017
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35. Immediate Rule-Out of Acute Myocardial Infarction Using Electrocardiogram and Baseline High-Sensitivity Troponin I

Author

Neumann, Johannes Tobias, primary, Sörensen, Nils Arne, primary, Ojeda, Francisco, primary, Schwemer, Tjark, primary, Lehmacher, Jonas, primary, Gönner, Saskia, primary, Jarsetz, Nikolas, primary, Keller, Till, primary, Schaefer, Sarina, primary, Renné, Thomas, primary, Landmesser, Ulf, primary, Clemmensen, Peter, primary, Makarova, Nataliya, primary, Schnabel, Renate B, primary, Zeller, Tanja, primary, Karakas, Mahir, primary, Pickering, John W, primary, Than, Martin, primary, Parsonage, William, primary, Greenslade, Jaimi, primary, Cullen, Louise, primary, Westermann, Dirk, primary, and Blankenberg, Stefan, primary

Published
2017
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36. Differences in measurement of high-sensitivity troponin in an on-demand and batch-wise setting

Author

Sörensen, Nils Arne, Neumann, Johannes Tobias, Ojeda, Francisco, Renné, Thomas, Karakas, Mahir, Blankenberg, Stefan, Westermann, Dirk, and Zeller, Tanja

Abstract

Background Most studies assessing the diagnostic value of high-sensitivity troponin in the diagnosis of myocardial infarction used batch-wise analyses of frozen samples for high-sensitivity troponin measurements. Whether the accuracy of these batch-wise high-sensitivity troponin measurements described in diagnostic studies is comparable to clinical routine is unknown.Methods We enrolled 937 patients presenting with suspected myocardial infarction in this prospective cohort study. Measurements of high-sensitivity troponin I (Abbott Architect) and high-sensitivity troponin T (Roche) were performed in two settings: (a) on-demand in clinical routine using fresh blood samples; and (b) in batches using frozen blood samples from the same individuals at three timepoints (0 hours, 1 hour and 3 hours after presentation).Results Median troponin levels were not different between on-demand and batch-wise measurements. Troponin levels in the range of 0 to 40 ng/L showed a very high correlation between the on-demand and batch setting (Pearson correlation coefficient (r) was 0.92–0.95 for high-sensitivity troponin I and 0.96 for high-sensitivity troponin T). However, at very low troponin levels (0 to 10 ng/L) correlation between the two settings was moderate (rfor high-sensitivity troponin I 0.59–0.66 and 0.65–0.69 for high-sensitivity troponin T). Application of guideline-recommended rapid diagnostic algorithms showed similar diagnostic performance with both methods.Conclusions Overall on-demand and batch-wise measurements of high-sensitivity troponin provided similar results, but their correlation was moderate, when focusing on very low troponin levels. The application of rapid diagnostic algorithms was safe in both settings. Trial Registration:www.clinicaltrials.gov(NCT02355457)

Published
2024
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37. Diagnosis of myocardial infarction using a high-sensitivity Troponin I 1-hour algorithm

Author

Neumann, Johannes Tobias, Sörensen, Nils Arne, Schwemer, Tjark, Ojeda, Francisco, Bourry, Rafael, Sciacca, Vanessa, Schaefer, Sarina, Waldeyer, Christoph, Sinning, Christoph, Renné, Thomas, Than, Martin, Parsonage, William, Wildi, Karin, Makarova, Nataliya, Schnabel, Renate B., Landmesser, Ulf, Mueller, Christian, Cullen, Louise, Greenslade, Jaimi, Zeller, Tanja, Blankenberg, Stefan, Karakas, Mahir, Westermann, Dirk, Neumann, Johannes Tobias, Sörensen, Nils Arne, Schwemer, Tjark, Ojeda, Francisco, Bourry, Rafael, Sciacca, Vanessa, Schaefer, Sarina, Waldeyer, Christoph, Sinning, Christoph, Renné, Thomas, Than, Martin, Parsonage, William, Wildi, Karin, Makarova, Nataliya, Schnabel, Renate B., Landmesser, Ulf, Mueller, Christian, Cullen, Louise, Greenslade, Jaimi, Zeller, Tanja, Blankenberg, Stefan, Karakas, Mahir, and Westermann, Dirk

Abstract

Importance Rapid and accurate diagnosis of acute myocardial infarction (AMI) currently constitutes an unmet need.Objective To test a 1-hour diagnostic algorithm to diagnose AMI using a high-sensitivity troponin I assay with a new cutoff level of 6 ng/L.Design, Setting, and Participants The Biomarkers in Acute Cardiac Care study is a prospective study that investigated the application of the troponin I assay for the diagnosis of AMI in 1040 patients presenting to the emergency department with acute chest pain from July 19, 2013, to December 31, 2014. Results were validated in 2 independent cohorts of 4009 patients. Final follow-up was completed on July 1, 2015, and data were assessed from July 2 to December 15, 2015.Exposure Acute chest pain suggestive of AMI.Main Outcomes and Measures Accurate diagnosis or exclusion of AMI and 12-month mortality in patients with acute chest pain.Results Of the 1040 patients included from the study cohort, 673 (64.7%) were male and had a median age of 65 (interquartile range, 52-75) years. With application of a low troponin I cutoff value of 6 ng/L, the rule-out algorithm showed a high negative predictive value of 99.8% (95% CI, 98.6%-100.0%) after 1 hour for non–ST-segment elevation MI type 1. The 1-hour approach was comparable to a 3-hour approach. Similarly, a rule-in algorithm based on troponin I levels provided a high positive predictive value with 82.8% (95% CI, 73.2%-90.0%). Moreover, application of the cutoff of 6 ng/L resulted in lower follow-up mortality (1.0%) compared with the routinely used 99th percentile (3.7%) for this assay. Two independent cohorts further validated the performance of this algorithm with high negative and positive predictive values.Conclusions and Relevance Patients with possible AMI can be triaged within 1 hour after admission with

Published
2016

38. Effects of renal denervation on heart failure biomarkers and blood pressure in patients with resistant hypertension

Author

Neumann, Johannes Tobias, primary, Ewen, Sebastian, additional, Mortensen, Kai, additional, Nef, Holger, additional, Zeller, Tanja, additional, Ojeda, Francisco, additional, Sydow, Karsten, additional, Mahfoud, Felix, additional, Böhm, Michael, additional, Hamm, Christian, additional, Dörr, Oliver, additional, and Blankenberg, Stefan, additional

Published
2016
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39. Diagnosis of Myocardial Infarction Using a High-Sensitivity Troponin I 1-Hour Algorithm

Author

Neumann, Johannes Tobias, primary, Sörensen, Nils Arne, additional, Schwemer, Tjark, additional, Ojeda, Francisco, additional, Bourry, Rafael, additional, Sciacca, Vanessa, additional, Schaefer, Sarina, additional, Waldeyer, Christoph, additional, Sinning, Christoph, additional, Renné, Thomas, additional, Than, Martin, additional, Parsonage, William, additional, Wildi, Karin, additional, Makarova, Nataliya, additional, Schnabel, Renate B., additional, Landmesser, Ulf, additional, Mueller, Christian, additional, Cullen, Louise, additional, Greenslade, Jaimi, additional, Zeller, Tanja, additional, Blankenberg, Stefan, additional, Karakas, Mahir, additional, and Westermann, Dirk, additional

Published
2016
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41. Biomarker response and therapy prediction in renal denervation therapy – the role of MR-proadrenomedullin in a multicenter approach

Author

Neumann, Johannes Tobias, primary, Schwerg, Marius, additional, Dörr, Oliver, additional, Mortensen, Kai, additional, Franzen, Klaas, additional, Zeller, Tanja, additional, Ojeda, Francisco, additional, Blankenberg, Stefan, additional, Hamm, Christian, additional, Nef, Holger, additional, Stangl, Verena, additional, Möckel, Martin, additional, and Sydow, Karsten, additional

Published
2016
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43. Right bundle branch block in patients with suspected myocardial infarction

Author

Neumann, Johannes Tobias, Sörensen, Nils Arne, Rübsamen, Nicole, Ojeda, Francisco, Schäfer, Sarina, Keller, Till, Blankenberg, Stefan, Clemmensen, Peter, and Westermann, Dirk

Abstract

Aims: The new European Society of Cardiology guideline for ST-segment elevation myocardial infarction recommends that left and right bundle branch block should be considered equal for recommending urgent angiography in patients with suspected myocardial infarction. We aimed to evaluate this novel recommendation in two prospective studies of patients with suspected myocardial infarction.Methods and results: We included 4067 patients presenting to the emergency department with suspected myocardial infarction. All patients had an ECG recorded immediately upon admission. Patients were classified as having right bundle branch block (RBBB), left bundle branch block (LBBB), bifascicular block (BFB) or no bundle branch block. All patients were followed for up to two years to assess mortality. In the overall population 125 (3.1%) patients had RBBB, 281 (6.9%) LBBB and 60 (1.5%) BFB. The final diagnosis of myocardial infarction was adjudicated in 20.8% (RBBB), 28.5% (LBBB), 23.3% (BFB) and 21.6% (no complete block) of patients. The mortality rate after one year was 10.7% (RBBB), 7% (LBBB), 17.5% (BFB) and 3.2% (no complete block). The adjusted hazard ratios were 1.29 (95% confidence interval (CI) 0.71–2.34; P=0.40) for RBBB, 1.71 (95% CI 1.17–2.50; P=0.006) for LBBB and 2.27 (95% CI 1.28–4.05; P=0.005) for BFB.Conclusion: Our results support the new European Society of Cardiology ST-segment elevation myocardial infarction guideline describing RBBB as a high risk for mortality in patients with suspected myocardial infarction. However, the data challenge the concept of RBBB as a trigger of acute angiography because the likelihood of myocardial infarction in a chest pain unit setting is equally frequent in patients without bundle branch block.

Published
2019
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44. Biomarker response and therapy prediction in renal denervation therapy – the role of MR-proadrenomedullin in a multicenter approach.

Author

Neumann, Johannes Tobias, Schwerg, Marius, Dörr, Oliver, Mortensen, Kai, Franzen, Klaas, Zeller, Tanja, Ojeda, Francisco, Blankenberg, Stefan, Hamm, Christian, Nef, Holger, Stangl, Verena, Möckel, Martin, and Sydow, Karsten

Subjects
*DENERVATION, *HYPERTENSION, *PATIENTS, *BIOMARKERS, *KIDNEY diseases, *NATRIURETIC peptides
Abstract

Background:Renal denervation has been proposed as a therapeutic option in patients with resistant hypertension. Circulating blood borne biomarkers might be helpful to identify individuals responding to RDN therapy. MR-proADM is a strong prognostic marker in patients with cardiovascular disease. The aim of this multicenter study was to evaluate the effect of RDN on MR-proADM concentrations. Methods and results:We measured MR-proADM, BNP, and MR-proANP in 110 patients before and after RDN in a multicenter setting. All patients were followed up after 1 and 6 months by office and ambulatory blood pressure (BP) measurements. The mean office BP decreased from 165/89 to 152/87 mmHg 6 months after RDN (systolic:p < 0.001; diastolic: ns), the responder-rate was 74%. Intriguingly MR-proADM concentrations increased from 0.66 to 0.69 nmol/L (p < 0.001) and were significantly associated with reduction of systolic office BP after 6 months in multivariate analyses (coefficient −0.0018,p < 0.001). In therapy-responders MR-proADM concentrations showed a significantly higher increase over time (coefficient 0.0105,p < 0.05), as compared to non-responders. There were no significant differences in BP change for individuals with low and high baseline MR-proADM (BP-Delta low MR-proADM −23/−4 mmHg vs. high MR-proADM −24/−5 mmHg). The natriuretic biomarkers BNP and MR-proANP did not change significantly after 6 months. Biomarkers at baseline were not able to predict for therapy-responder. Conclusion:In patients undergoing RDN, baseline measurements of various biomarkers had no prognostic use for therapy success in this short time follow-up period in a multicenter approach. Intriguingly, MR-proADM showed a significant association with BP reduction after 6 months. [ABSTRACT FROM AUTHOR]

Published
2017
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49. Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction

Author

Twerenbold, Raphael, Neumann, Johannes Tobias, Sörensen, Nils Arne, Ojeda, Francisco, Karakas, Mahir, Boeddinghaus, Jasper, Nestelberger, Thomas, Badertscher, Patrick, Rubini Giménez, Maria, Puelacher, Christian, Wildi, Karin, Kozhuharov, Nikola, Breitenbuecher, Dominik, Biskup, Ewelina, Du Fay De Lavallaz, Jeanne, Flores, Dayana, Wussler, Desiree, Miró, Òscar, Martín Sánchez, F Javier, Morawiec, Beata, Parenica, Jiri, Geigy, Nicolas, Keller, Dagmar I, Zeller, Tanja, Reichlin, Tobias Roman, Blankenberg, Stefan, Westermann, Dirk, and Mueller, Christian

Subjects
610 Medicine & health, 3. Good health
Abstract

BACKGROUND The safety of the European Society of Cardiology (ESC) 0/1-h algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin (hs-cTn) has been questioned. OBJECTIVES This study aimed to validate the diagnostic performance of the 0/1-h algorithm in a large multicenter study. METHODS The authors prospectively enrolled unselected patients in 6 countries presenting to the emergency department with symptoms suggestive of NSTEMI. Final diagnosis was centrally adjudicated by 2 independent cardiologists. Hs-cTnT and hs-cTnI blood concentrations were measured at presentation and after 1 h. Safety of rule-out was quantified by the negative predictive value (NPV) for NSTEMI, accuracy of rule-in by the positive predictive value (PPV), and overall efficacy by the proportion of patients triaged towards rule-out or rule-in within 1 h. RESULTS Prevalence of NSTEMI was 17%. Among 4,368 patients with serial hs-cTnT measurements available, safety of rule-out (NPV 99.8%, 2,488 of 2,493), accuracy of rule-in (PPV 74.5%, 572 of 768), and overall efficacy were high by assigning three-fourths of patients either to rule-out (57%, 2,493 to 4,368) or rule-in (18%, 768 to 4,368). Similarly, among 3,500 patients with serial hs-cTnI measurements, safety of rule-out (NPV 99.7%, 1,528 of 1,533), accuracy of rule-in (PPV 62.3%, 498 of 800), and overall efficacy were high by assigning more than two-thirds of patients either to rule-out (44%, 1,533 of 3,500) or rule-in (23%, 800 of 3,500). Excellent safety was confirmed in multiple subgroup analyses including patients presenting early (≤3 h) after chest pain onset. CONCLUSIONS The ESC 0/1-h algorithm using hs-cTnT and hs-cTnI is very safe and effective in triaging patients with suspected NSTEMI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE]; NCT00470587; and Biomarkers in Acute Cardiac Care [BACC]; NCT02355457).

50. Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction

Author

Twerenbold, Raphael, Neumann, Johannes Tobias, Sörensen, Nils Arne, Ojeda, Francisco, Karakas, Mahir, Boeddinghaus, Jasper, Nestelberger, Thomas, Badertscher, Patrick, Rubini Giménez, Maria, Puelacher, Christian, Wildi, Karin, Kozhuharov, Nikola, Breitenbuecher, Dominik, Biskup, Ewelina, du Fay de Lavallaz, Jeanne, Flores, Dayana, Wussler, Desiree, Miró, Òscar, Martín Sánchez, F. Javier, Morawiec, Beata, Parenica, Jiri, Geigy, Nicolas, Keller, Dagmar I., Zeller, Tanja, Reichlin, Tobias, Blankenberg, Stefan, Westermann, Dirk, and Mueller, Christian

Subjects
3. Good health

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