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1. Prediction of mortality using quantification of renal function in acute heart failure

Author

Weidmann, Zoraida Moreno, Breidthardt, Tobias, Twerenbold, Raphael, Züsli, Christina, Nowak, Albina, von Eckardstein, Arnold, Erne, Paul, Rentsch, Katharina, de Oliveira, Mucio T., Jr., Gualandro, Danielle, Maeder, Micha T., Gimenez, Maria Rubini, Pershyna, Kateryna, Stallone, Fabio, Haas, Laurent, Jaeger, Cedric, Wildi, Karin, Puelacher, Christian, Honegger, Ursina, Wagener, Max, Wittmer, Severin, Schumacher, Carmela, Krivoshei, Lian, Hillinger, Petra, Osswald, Stefan, and Mueller, Christian

Published
2015
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2. Incremental Value of a Single High-sensitivity Cardiac Troponin I Measurement to Rule Out Myocardial Ischemia

Author

Tanglay, Yunus, Twerenbold, Raphael, Lee, Gino, Wagener, Max, Honegger, Ursina, Puelacher, Christian, Reichlin, Tobias, Sou, Seoung Mann, Druey, Sophie, Hochgruber, Thomas, Zürcher, Stephan, Radosavac, Milos, Kreutzinger, Philipp, Pretre, Gilles, Stallone, Fabio, Hillinger, Petra, Jaeger, Cedric, Rubini Gimenez, Maria, Freese, Michael, Wild, Damian, Rentsch, Katharina, Osswald, Stefan, Zellweger, Michael J., and Mueller, Christian

Published
2015
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3. Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients

Author

Meller, Bernadette, Cullen, Louise, Parsonage, William A., Greenslade, Jaimi H., Aldous, Sally, Reichlin, Tobias, Wildi, Karin, Twerenbold, Raphael, Jaeger, Cedric, Hillinger, Petra, Haaf, Philip, Puelacher, Christian, Kern, Vera, Rentsch, Katharina, Stallone, Fabio, Rubini Gimenez, Maria, Ballarino, Paola, Bassetti, Stefano, Walukiewicz, Astrid, Troughton, Richard, Pemberton, Christopher J., Richards, A. Mark, Chu, Kevin, Reid, Christopher M., Than, Martin, and Mueller, Christian

Published
2015
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4. Gender-specific uncertainties in the diagnosis of acute coronary syndrome

Author

Hillinger, Petra, Twerenbold, Raphael, Wildi, Karin, Rubini Gimenez, Maria, Jaeger, Cedric, Boeddinghaus, Jasper, Nestelberger, Thomas, Grimm, Karin, Reichlin, Tobias, Stallone, Fabio, Puelacher, Christian, Sabti, Zaid, Kozhuharov, Nikola, Honegger, Ursina, Ballarino, Paola, Miro, Oscar, Denhaerynck, Kris, Ekrem, Temizel, Kohler, Claudia, Bingisser, Roland, Osswald, Stefan, and Mueller, Christian

Published
2017
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5. Serial changes in high-sensitivity cardiac troponin I in the early diagnosis of acute myocardial infarction

Author

Wildi, Karin, Reichlin, Tobias, Twerenbold, Raphael, Mäder, Fabienne, Zellweger, Christa, Moehring, Berit, Stallone, Fabio, Minners, Jan, Rubini Gimenez, Maria, Hoeller, Rebeca, Murray, Karsten, Sou, Seoung Mann, Mueller, Mira, Denhaerynck, Kris, Mosimann, Tamina, Reiter, Miriam, Haaf, Philip, Meller, Bernadette, Freidank, Heike, Osswald, Stefan, and Mueller, Christian

Published
2013
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6. Impact of haemoconcentration during acute heart failure therapy on mortality and its relationship with worsening renal function

Author

Breidthardt, Tobias, Weidmann, Zoraida Moreno, Twerenbold, Raphael, Gantenbein, Claudine, Stallone, Fabio, Rentsch, Katharina, Rubini Gimenez, Maria, Kozhuharov, Nikola, Sabti, Zaid, Breitenbücher, Dominik, Wildi, Karin, Puelacher, Christian, Honegger, Ursina, Wagener, Max, Schumacher, Carmela, Hillinger, Petra, Osswald, Stefan, and Mueller, Christian

Published
2017
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7. Clinical benefit of high-sensitivity cardiac troponin I in the detection of exercise-induced myocardial ischemia

Author

Lee, Gino, Twerenbold, Raphael, Tanglay, Yunus, Reichlin, Tobias, Honegger, Ursina, Wagener, Max, Jaeger, Cedric, Rubini Gimenez, Maria, Hochgruber, Thomas, Puelacher, Christian, Radosavac, Milos, Kreutzinger, Philipp, Stallone, Fabio, Hillinger, Petra, Krivoshei, Lian, Herrmann, Thomas, Mayr, Romy, Freese, Michael, Wild, Damian, Rentsch, Katharina M., Todd, John, Osswald, Stefan, Zellweger, Michael J., and Mueller, Christian

Published
2016
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8. Delayed release of brain natriuretic peptide to identify myocardial ischaemia

Author

Zürcher, Stephan, Honegger, Ursina, Wagener, Max, Lee, Gino, Stallone, Fabio, Marxer, Tanja, Puelacher, Christian, Schumacher, Carmela, Sou, Seoung Mann, Twerenbold, Raphael, Reichlin, Tobias, Hochgruber, Thomas, Tanglay, Yunus, Freese, Michael, Wild, Damian, Rentsch, Katharina, Osswald, Stefan, Zellweger, Michael, and Mueller, Christian

Published
2015
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10. Prevalence, characteristics and outcome of non-cardiac chest pain and elevated copeptin levels

Author

Stallone, Fabio, Twerenbold, Raphael, Wildi, Karin, Reichlin, Tobias, Rubini Gimenez, Maria, Haaf, Philip, Fuechslin, Nicole, Hillinger, Petra, Jaeger, Cedric, Kreutzinger, Philipp, Puelacher, Christian, Radosavac, Milos, Moreno Weidmann, Zoraida, Moehring, Berit, Honegger, Ursina, Schumacher, Carmela, Denhaerynck, Kris, Arnold, Christiane, Bingisser, Roland, Vollert, Jörn Ole, Osswald, Stefan, and Mueller, Christian

Published
2014
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11. Direct comparison of high-sensitivity-cardiac troponin I vs. T for the early diagnosis of acute myocardial infarction

Author

Rubini Gimenez, Maria, Twerenbold, Raphael, Reichlin, Tobias, Wildi, Karin, Haaf, Philip, Schaefer, Miriam, Zellweger, Christa, Moehring, Berit, Stallone, Fabio, Sou, Seoung Mann, Mueller, Mira, Denhaerynck, Kris, Mosimann, Tamina, Reiter, Miriam, Meller, Bernadette, Freese, Michael, Stelzig, Claudia, Klimmeck, Irina, Voegele, Janine, Hartmann, Beate, Rentsch, Katharina, Osswald, Stefan, and Mueller, Christian

Published
2014
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12. Sex-Specific Chest Pain Characteristics in the Early Diagnosis of Acute Myocardial Infarction

Author

Gimenez, Maria Rubini, Reiter, Miriam, Twerenbold, Raphael, Reichlin, Tobias, Wildi, Karin, Haaf, Philip, Wicki, Katharina, Zellweger, Christa, Hoeller, Rebeca, Moehring, Berit, Sou, Seoung Mann, Mueller, Mira, Denhaerynck, Kris, Meller, Bernadette, Stallone, Fabio, Henseler, Sarah, Bassetti, Stefano, Geigy, Nicolas, Osswald, Stefan, and Mueller, Christian

Published
2014
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13. 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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14. Diagnosis of acute myocardial infarction in the presence of left bundle branch block

Author

Nestelberger, Thomas, Cullen, Louise, Lindahl, Bertil, Reichlin, Tobias, Greenslade, Jaimi H., Giannitsis, Evangelos, Christ, Michael, Morawiec, Beata, Miro, Oscar, Martín-Sánchez, Francisco Javier, Wussler, Desiree Nadine, Koechlin, Luca, Twerenbold, Raphael, Parsonage, William, Boeddinghaus, Jasper, Rubini Gimenez, Maria, Puelacher, Christian, Wildi, Karin, Buerge, Tobias, Badertscher, Patrick, DuFaydeLavallaz, Jeanne, Strebel, Ivo, Croton, Lukas, Bendig, Garnet, Osswald, Stefan, Pickering, John William, Than, Martin, Mueller, Christian, Hillinger, Petra, Grimm, Karin, Honegger, Ursina, Schaerli, Nicolas, Kozhuharov, Nikola, Stelzig, Claudia, Freese, Michael, Sabti, Zaid, Walter, Joan, Sazgary, Lorraine, Kulangara, Caroline, Meissner, Kathrin, Mueller, Deborah, Lopez, Beatriz, Salgado, Emilio, Adrada, Esther Rodríguez, Kawecki, Damian, Parenica, Jiri, Ganovska, Eva, Rentsch, Katharina, Buser, Andreas, Lohrmann, Jens, Bingisser, Roland, Shrestha, Samyut, Stallone, Fabio, Abaecherli, Roger, McCord, James, Nowak, Richard, Body, Richard, DeFilippi, Christopher R., Christenson, Robert H., Panteghini, Mauro, Plebani, Mario, Verschuren, Franck, French, John, Weiser, Silvia, Dinkel, Carina, Keller, Dagmar I., Geigy, Nicolas, Nestelberger, Thomas, Cullen, Louise, Lindahl, Bertil, Reichlin, Tobias, Greenslade, Jaimi H., Giannitsis, Evangelos, Christ, Michael, Morawiec, Beata, Miro, Oscar, Martín-Sánchez, Francisco Javier, Wussler, Desiree Nadine, Koechlin, Luca, Twerenbold, Raphael, Parsonage, William, Boeddinghaus, Jasper, Rubini Gimenez, Maria, Puelacher, Christian, Wildi, Karin, Buerge, Tobias, Badertscher, Patrick, DuFaydeLavallaz, Jeanne, Strebel, Ivo, Croton, Lukas, Bendig, Garnet, Osswald, Stefan, Pickering, John William, Than, Martin, Mueller, Christian, Hillinger, Petra, Grimm, Karin, Honegger, Ursina, Schaerli, Nicolas, Kozhuharov, Nikola, Stelzig, Claudia, Freese, Michael, Sabti, Zaid, Walter, Joan, Sazgary, Lorraine, Kulangara, Caroline, Meissner, Kathrin, Mueller, Deborah, Lopez, Beatriz, Salgado, Emilio, Adrada, Esther Rodríguez, Kawecki, Damian, Parenica, Jiri, Ganovska, Eva, Rentsch, Katharina, Buser, Andreas, Lohrmann, Jens, Bingisser, Roland, Shrestha, Samyut, Stallone, Fabio, Abaecherli, Roger, McCord, James, Nowak, Richard, Body, Richard, DeFilippi, Christopher R., Christenson, Robert H., Panteghini, Mauro, Plebani, Mario, Verschuren, Franck, French, John, Weiser, Silvia, Dinkel, Carina, Keller, Dagmar I., and Geigy, Nicolas

Abstract

Objective Patients with suspected acute myocardial infarction (AMI) in the setting of left bundle branch block (LBBB) present an important diagnostic and therapeutic challenge to the clinician. Methods We prospectively evaluated the incidence of AMI and diagnostic performance of specific ECG and high-sensitivity cardiac troponin (hs-cTn) criteria in patients presenting with chest discomfort to 26 emergency departments in three international, prospective, diagnostic studies. The final diagnosis of AMI was centrally adjudicated by two independent cardiologists according to the universal definition of myocardial infarction. Results Among 8830 patients, LBBB was present in 247 (2.8%). AMI was the final diagnosis in 30% of patients with LBBB, with similar incidence in those with known LBBB versus those with presumably new LBBB (29% vs 35%, p=0.42). ECG criteria had low sensitivity (1%-12%) but high specificity (95%-100%) for AMI. The diagnostic accuracy as quantified by the receiver operating characteristics (ROC) curve of hs-cTnT and hs-cTnI concentrations at presentation (area under the ROC curve (AUC) 0.91, 95% CI 0.85 to 0.96 and AUC 0.89, 95% CI 0.83 to 0.95), as well as that of their 0/1-hour and 0/2-hour changes, was very high. A diagnostic algorithm combining ECG criteria with hs-cTnT/I concentrations and their absolute changes at 1 hour or 2 hours derived in cohort 1 (45 of 45(100%) patients with AMI correctly identified) showed high efficacy and accuracy when externally validated in cohorts 2 and 3 (28 of 29 patients, 97%). Conclusion Most patients presenting with suspected AMI and LBBB will be found to have diagnoses other than AMI. Combining ECG criteria with hs-cTnT/I testing at 0/1 hour or 0/2 hours allows early and accurate diagnosis of AMI in LBBB. Trial registration number APACE: NCT00470587; ADAPT: ACTRN12611001069943; TRAPID-AMI: RD001107;Results.

Published
2019

15. How accurate is clinical assessment of neck veins in the estimation of central venous pressure in acute heart failure? Insights from a prospective study

Author

Breidthardt, Tobias, Moreno-Weidmann, Zoraida, Uthoff, Heiko, Sabti, Zaid, Aeppli, Sven, Puelacher, Christian, Stallone, Fabio, Twerenbold, Raphael, Wildi, Karin, Kozhuharov, Nikola, Wussler, Desiree, Flores, Dayana, Shrestha, Samyut, Badertscher, Patrick, Boeddinghaus, Jasper, Nestelberger, Thomas, Gimenez, Maria Rubini, Staub, Daniel, Aschwanden, Markus, Lohrmann, Jens, Pfister, Otmar, Osswald, Stefan, and Mueller, Christian

Subjects
Heart Failure, Male, Central Venous Pressure, Acute Disease, Humans, Reproducibility of Results, Blood Pressure Determination, Female, Jugular Veins
Published
2017

16. How accurate is clinical assessment of neck veins in the estimation of central venous pressure in acute heart failure? Insights from a prospective study

Author

Breidthardt, Tobias, primary, Moreno-Weidmann, Zoraida, additional, Uthoff, Heiko, additional, Sabti, Zaid, additional, Aeppli, Sven, additional, Puelacher, Christian, additional, Stallone, Fabio, additional, Twerenbold, Raphael, additional, Wildi, Karin, additional, Kozhuharov, Nikola, additional, Wussler, Desiree, additional, Flores, Dayana, additional, Shrestha, Samyut, additional, Badertscher, Patrick, additional, Boeddinghaus, Jasper, additional, Nestelberger, Thomas, additional, Gimenez, Maria Rubini, additional, Staub, Daniel, additional, Aschwanden, Markus, additional, Lohrmann, Jens, additional, Pfister, Otmar, additional, Osswald, Stefan, additional, and Mueller, Christian, additional

Published
2018
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17. Complement activation products in acute heart failure: Potential role in pathophysiology, responses to treatment and impacts on long-term survival

Author

Trendelenburg, Marten, primary, Stallone, Fabio, additional, Pershyna, Kateryna, additional, Eisenhut, Timo, additional, Twerenbold, Raphael, additional, Wildi, Karin, additional, Dubler, Denise, additional, Schirmbeck, Lucia, additional, Puelacher, Christian, additional, Rubini Gimenez, Maria, additional, Sabti, Zaid, additional, Osswald, Luca, additional, Breidthardt, Tobias, additional, and Müller, Christian, additional

Published
2017
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18. Safety and efficacy of the 0 h/3 h protocol for rapid rule out of myocardial infarction

Author

Wildi, Karin, primary, Nelles, Berit, additional, Twerenbold, Raphael, additional, Rubini Giménez, Maria, additional, Reichlin, Tobias, additional, Singeisen, Hélène, additional, Druey, Sophie, additional, Haaf, Philip, additional, Sabti, Zaid, additional, Hillinger, Petra, additional, Jaeger, Cedric, additional, Campodarve, Isabel, additional, Kreutzinger, Philip, additional, Puelacher, Christian, additional, Moreno Weidmann, Zoraida, additional, Gugala, Mathias, additional, Pretre, Gilles, additional, Doerflinger, Stephanie, additional, Wagener, Max, additional, Stallone, Fabio, additional, Freese, Michael, additional, Stelzig, Claudia, additional, Rentsch, Katharina, additional, Bassetti, Stefano, additional, Bingisser, Roland, additional, Osswald, Stefan, additional, and Mueller, Christian, additional

Published
2016
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19. Impact of haemoconcentration during acute heart failure therapy on mortality and its relationship with worsening renal function

Author

Breidthardt, Tobias, primary, Weidmann, Zoraida Moreno, additional, Twerenbold, Raphael, additional, Gantenbein, Claudine, additional, Stallone, Fabio, additional, Rentsch, Katharina, additional, Rubini Gimenez, Maria, additional, Kozhuharov, Nikola, additional, Sabti, Zaid, additional, Breitenbücher, Dominik, additional, Wildi, Karin, additional, Puelacher, Christian, additional, Honegger, Ursina, additional, Wagener, Max, additional, Schumacher, Carmela, additional, Hillinger, Petra, additional, Osswald, Stefan, additional, and Mueller, Christian, additional

Published
2016
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20. Gender-specific uncertainties in the diagnosis of acute coronary syndrome

Author

Hillinger, Petra, primary, Twerenbold, Raphael, additional, Wildi, Karin, additional, Rubini Gimenez, Maria, additional, Jaeger, Cedric, additional, Boeddinghaus, Jasper, additional, Nestelberger, Thomas, additional, Grimm, Karin, additional, Reichlin, Tobias, additional, Stallone, Fabio, additional, Puelacher, Christian, additional, Sabti, Zaid, additional, Kozhuharov, Nikola, additional, Honegger, Ursina, additional, Ballarino, Paola, additional, Miro, Oscar, additional, Denhaerynck, Kris, additional, Ekrem, Temizel, additional, Kohler, Claudia, additional, Bingisser, Roland, additional, Osswald, Stefan, additional, and Mueller, Christian, additional

Published
2016
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21. Incremental value of copeptin in suspected acute myocardial infarction very early after symptom onset

Author

Stallone, Fabio, primary, Schoenenberger, Andreas W, additional, Puelacher, Christian, additional, Rubini Gimenez, Maria, additional, Walz, Brigitte, additional, Naduvilekoot Devasia, Allwin, additional, Bergner, Michael, additional, Twerenbold, Raphael, additional, Wildi, Karin, additional, Reichlin, Tobias, additional, Hillinger, Petra, additional, Erne, Paul, additional, and Mueller, Christian, additional

Published
2016
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23. Sex-Specific Chest Pain Characteristics in the Early Diagnosis of Acute Myocardial Infarction

Author

Rubini Gimenez, Maria, primary, Reiter, Miriam, additional, Twerenbold, Raphael, additional, Reichlin, Tobias, additional, Wildi, Karin, additional, Haaf, Philip, additional, Wicki, Katharina, additional, Zellweger, Christa, additional, Hoeller, Rebeca, additional, Moehring, Berit, additional, Sou, Seoung Mann, additional, Mueller, Mira, additional, Denhaerynck, Kris, additional, Meller, Bernadette, additional, Stallone, Fabio, additional, Henseler, Sarah, additional, Bassetti, Stefano, additional, Geigy, Nicolas, additional, Osswald, Stefan, additional, and Mueller, Christian, additional

Published
2014
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24. Complement activation products in acute heart failure: Potential role in pathophysiology, responses to treatment and impacts on long-term survival

Author

Trendelenburg, Marten, Stallone, Fabio, Pershyna, Kateryna, Eisenhut, Timo, Twerenbold, Raphael, Wildi, Karin, Dubler, Denise, Schirmbeck, Lucia, Puelacher, Christian, Rubini Gimenez, Maria, Sabti, Zaid, Osswald, Luca, Breidthardt, Tobias, and Müller, Christian

Abstract

Background: Previous studies have indicated a correlation between heart failure, inflammation and poorer outcome. However, the pathogenesis and role of inflammation in acute heart failure (AHF) is incompletely studied and understood. The aim of our study was to explore the potential role of innate immunity – quantified by complement activation products (CAPs) – in pathophysiology, responses to treatment and impacts on long-term survival in AHF.Methods: In a prospective study enrolling 179 unselected patients with AHF, plasma concentrations of C4d, C3a and sC5b-9 were measured in a blinded fashion on the first day of hospitalisation and prior to discharge. The final diagnosis, including the AHF phenotype, was adjudicated by two independent cardiologists. Long-term follow-up was obtained. Findings in AHF were compared to that obtained in 75 healthy blood donors (control group).Results: Overall, concentrations of all three CAPs were significantly higher in patients with AHF than in healthy controls (all p< 0.001). In an age-adjusted subgroup analysis, significant differences could be confirmed for concentrations of C4d and sC5b-9, and these parameters further increased after 6 days of in-hospital treatment (p< 0.001). In contrast, C3a levels in AHF patients did not differ from those of the control group in the age-adjusted subgroup analysis and remained constant during hospitalisation. Concentrations of C4d, C3a and sC5b-9 were significantly higher when AHF was triggered by an infection as compared to other triggers (p< 0.001). In addition, CAP levels significantly correlated with each other (r= 0.64–0.76), but did not predict death within 2 years.Conclusions: Activation of complement with increased plasma levels of C4d and sC5b-9 at admission and increasing levels during AHF treatment seems to be associated with AHF, particularly when AHF was triggered by an infection. However, CAPs do not have a prognostic value in AHF.

Published
2018
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25. Incremental value of heart-type fatty acid-binding protein in suspected acute myocardial infarction early after symptom onset

Author

Schoenenberger, Andreas W, Stallone, Fabio, Walz, Brigitte, Bergner, Michael, Twerenbold, Raphael, Reichlin, Tobias, Zogg, Bernhard, Jaeger, Cedric, Erne, Paul, and Mueller, Christian

Abstract

Background: The early diagnosis of acute myocardial infarction (AMI) very soon after symptom onset remains a major clinical challenge, even when using high-sensitivity cardiac troponin (hs-cTnT).Methods and results: We investigated the incremental value of heart-type fatty acid-binding protein (hFABP) in a pre-specified subgroup analysis of patients presenting with suspected AMI within 1?h of symptom onset to the emergency department (ED) in a multicentre study. HFABP was measured in a blinded fashion. Two independent cardiologists using all available clinical information, including hs-cTnT, adjudicated the final diagnosis. Overall, 1411 patients were enrolled, of whom 105 patients presented within 1?h of symptom onset. Of these, 34 patients (32.4%) had AMI. The diagnostic accuracy as quantified by the area under the receiver-operating characteristics curve (AUC) of hFABP was high (0.84 (95% CI 0.74–0.94)). However, the additional use of hFABP only marginally increased the diagnostic accuracy of hs-cTnT (AUC 0.88 (95% CI 0.81–0.94) for hs-cTnT alone to 0.90 (95% CI 0.83–0.98) for the combination; p=ns). After the exclusion of 18 AMI patients with ST-segment elevation, similar results were obtained. Among the 16 AMI patients without ST-segment elevation, six had normal hs-cTnT at presentation. Of these, hFABP was elevated in two (33.3%) patients.Conclusions: hFABP does not seem to significantly improve the early diagnostic accuracy of hs-cTnT in the important subgroup of patients with suspected AMI presenting to the ED very early after symptom onset.

Published
2016
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26. Prospective validation of N-terminal pro B-type natriuretic peptide cut-off concentrations for the diagnosis of acute heart failure.

Author

Kozhuharov N, Sabti Z, Wussler D, Nowak A, Badertscher P, Twerenbold R, Wildi K, Stallone F, Vogt F, Hilti J, Puelacher C, du Fay de Lavallaz J, Shrestha S, Flores D, Nestelberger T, Koechlin L, Boeddinghaus J, Zimmermann T, Walter J, Schumacher C, Rentsch K, von Eckardstein A, Keller DI, Goudev A, Pfister O, Breidthardt T, and Mueller C

Subjects
Acute Disease, Adult, Aged, Biomarkers blood, Female, Heart Failure blood, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Protein Precursors, ROC Curve, Heart Failure diagnosis, Natriuretic Peptide, Brain blood, Peptide Fragments blood
Published
2019
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27. Complement activation products in acute heart failure: Potential role in pathophysiology, responses to treatment and impacts on long-term survival.

Author

Trendelenburg M, Stallone F, Pershyna K, Eisenhut T, Twerenbold R, Wildi K, Dubler D, Schirmbeck L, Puelacher C, Rubini Gimenez M, Sabti Z, Osswald L, Breidthardt T, and Müller C

Subjects
Acute Disease, Aged, Aged, 80 and over, Biomarkers blood, Cause of Death trends, Complement C4b, Electrocardiography, Female, Follow-Up Studies, Heart Failure mortality, Heart Failure therapy, Hospital Mortality trends, Humans, Male, Oximetry, Prognosis, Prospective Studies, Survival Rate trends, Switzerland epidemiology, Time Factors, Complement Activation physiology, Complement C3a metabolism, Complement Membrane Attack Complex metabolism, Heart Failure blood, Hospitalization trends, Peptide Fragments blood
Abstract

Background: Previous studies have indicated a correlation between heart failure, inflammation and poorer outcome. However, the pathogenesis and role of inflammation in acute heart failure (AHF) is incompletely studied and understood. The aim of our study was to explore the potential role of innate immunity - quantified by complement activation products (CAPs) - in pathophysiology, responses to treatment and impacts on long-term survival in AHF., Methods: In a prospective study enrolling 179 unselected patients with AHF, plasma concentrations of C4d, C3a and sC5b-9 were measured in a blinded fashion on the first day of hospitalisation and prior to discharge. The final diagnosis, including the AHF phenotype, was adjudicated by two independent cardiologists. Long-term follow-up was obtained. Findings in AHF were compared to that obtained in 75 healthy blood donors (control group)., Results: Overall, concentrations of all three CAPs were significantly higher in patients with AHF than in healthy controls (all p < 0.001). In an age-adjusted subgroup analysis, significant differences could be confirmed for concentrations of C4d and sC5b-9, and these parameters further increased after 6 days of in-hospital treatment ( p < 0.001). In contrast, C3a levels in AHF patients did not differ from those of the control group in the age-adjusted subgroup analysis and remained constant during hospitalisation. Concentrations of C4d, C3a and sC5b-9 were significantly higher when AHF was triggered by an infection as compared to other triggers ( p < 0.001). In addition, CAP levels significantly correlated with each other ( r = 0.64-0.76), but did not predict death within 2 years., Conclusions: Activation of complement with increased plasma levels of C4d and sC5b-9 at admission and increasing levels during AHF treatment seems to be associated with AHF, particularly when AHF was triggered by an infection. However, CAPs do not have a prognostic value in AHF.

Published
2018
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28. Incremental value of heart-type fatty acid-binding protein in suspected acute myocardial infarction early after symptom onset.

Author

Schoenenberger AW, Stallone F, Walz B, Bergner M, Twerenbold R, Reichlin T, Zogg B, Jaeger C, Erne P, and Mueller C

Subjects
Adult, Aged, Aged, 80 and over, Early Diagnosis, Emergency Service, Hospital, Fatty Acid Binding Protein 3, Female, Humans, Male, Middle Aged, Myocardial Infarction diagnosis, Prospective Studies, ROC Curve, Troponin T metabolism, Young Adult, Fatty Acid-Binding Proteins metabolism, Myocardial Infarction metabolism
Abstract

Background: The early diagnosis of acute myocardial infarction (AMI) very soon after symptom onset remains a major clinical challenge, even when using high-sensitivity cardiac troponin (hs-cTnT)., Methods and Results: We investigated the incremental value of heart-type fatty acid-binding protein (hFABP) in a pre-specified subgroup analysis of patients presenting with suspected AMI within 1 h of symptom onset to the emergency department (ED) in a multicentre study. HFABP was measured in a blinded fashion. Two independent cardiologists using all available clinical information, including hs-cTnT, adjudicated the final diagnosis. Overall, 1411 patients were enrolled, of whom 105 patients presented within 1 h of symptom onset. Of these, 34 patients (32.4%) had AMI. The diagnostic accuracy as quantified by the area under the receiver-operating characteristics curve (AUC) of hFABP was high (0.84 (95% CI 0.74-0.94)). However, the additional use of hFABP only marginally increased the diagnostic accuracy of hs-cTnT (AUC 0.88 (95% CI 0.81-0.94) for hs-cTnT alone to 0.90 (95% CI 0.83-0.98) for the combination; p=ns). After the exclusion of 18 AMI patients with ST-segment elevation, similar results were obtained. Among the 16 AMI patients without ST-segment elevation, six had normal hs-cTnT at presentation. Of these, hFABP was elevated in two (33.3%) patients., Conclusions: hFABP does not seem to significantly improve the early diagnostic accuracy of hs-cTnT in the important subgroup of patients with suspected AMI presenting to the ED very early after symptom onset., (© The European Society of Cardiology 2015.)

Published
2016
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