Abstract:
BACKGROUND:Although high-sensitivity cardiac troponin (hs-cTn) substantially improves the early detection of myocardial injury, it lacks specificity for acute myocardial infarction (MI). In suspected non-ST-elevation MI, invasive coronary angiography (ICA) remains necessary to distinguish between acute MI and noncoronary myocardial disease (eg, myocarditis), unnecessarily subjecting the latter to ICA and associated complications. This trial investigates whether implementing cardiovascular magnetic resonance (CMR) or computed tomography angiography (CTA) early in the diagnostic process may help to differentiate between coronary and noncoronary myocardial disease, thereby preventing unnecessary ICA. STUDY DESIGN:In this prospective, single-center, randomized controlled clinical trial, 321 consecutive patients with acute chest pain, elevated hs-cTnT, and nondiagnostic electrocardiogram are randomized to 1 of 3 strategies: (1) CMR, or (2) CTA early in the diagnostic process, or (3) routine clinical management. In the 2 investigational arms of the study, results of CMR or CTA will guide further clinical management. It is expected that noncoronary myocardial disease is detected more frequently after early noninvasive imaging as compared with routine clinical management, and unnecessary ICA will be prevented. The primary end point is the total number of patients undergoing ICA during initial admission. Secondary end points are 30-day and 1-year clinical outcome (major adverse cardiac events and major procedure-related complications), time to final diagnosis, quality of life, and cost-effectiveness. CONCLUSION:The CARMENTA trial investigates whether implementing CTA or CMR early in the diagnostic process in suspected non-ST-elevation MI based on elevated hs-cTnT can prevent unnecessary ICA as compared with routine clinical management, with no detrimental effect on clinical outcome.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Smulders MW,Kietselaer BL,Das M,Wildberger JE,Crijns HJ,Veenstra LF,Brunner-La Rocca HP,van Dieijen-Visser MP,Mingels AM,Dagnelie PC,Post MJ,Gorgels AP,van Asselt AD,Vogel G,Schalla S,Kim RJ,Bekkers SCdoi
10.1016/j.ahj.2013.09.012subject
Has Abstractpub_date
2013-12-01 00:00:00pages
968-75issue
6eissn
0002-8703issn
1097-6744pii
S0002-8703(13)00657-1journal_volume
166pub_type
杂志文章,随机对照试验abstract::In vitro studies have established that intravascular ultrasound is a reliable technique for accurate assessment of vascular anatomic structure and disease conditions before and after intervention. In addition, quantitative data from intravascular ultrasound studies correspond well with histologic findings, which serve...
journal_title:American heart journal
pub_type: 社论,评审
doi:10.1016/s0002-8703(96)90263-x
更新日期:1996-09-01 00:00:00
abstract::We tested whether overload of the two ventricles may be associated with a preponderance of interventricular septum in patients with high blood pressure. The rationale is that the septum is shared by the greater and lesser circulation and that in hypertension the latter shows the same qualitative hemodynamic alteration...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(88)90626-6
更新日期:1988-08-01 00:00:00
abstract:BACKGROUND:Diastolic dysfunction induced by ischemia may alter transmitral blood flow, but this reflects global ventricular function, and pseudonormalization may occur with increased preload. Tissue Doppler may assess regional diastolic function and is relatively load-independent, but limited data exist regarding its a...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2002.123836
更新日期:2002-09-01 00:00:00
abstract::Programmed ventricular stimulation with a standard protocol that used up to three extrastimuli was compared prospectively with a short-to-long protocol and a two-site protocol in 77 consecutive patients undergoing electrophysiologic study in an attempt to increase the yield of ventricular tachycardia (VT) induction. T...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(91)90957-j
更新日期:1991-01-01 00:00:00
abstract::Intracoronary stents may potentially alleviate some of the problems associated with coronary angioplasty. Since the anatomy and physiology of swine coronary arteries closely resemble those of humans, the response to implantation of the Glanturco-Roubin, balloon-expandable, flexible stent was studied in this model. Add...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)90506-d
更新日期:1991-09-01 00:00:00
abstract::Guidelines published in 2001 recommended 1 regional adult congenital heart disease (ACHD) center per 3 to 10 million population. Our objective was to determine if published guidelines on the numbers of regional ACHD centers are sufficient to meet the needs of adults with congenital heart disease in the general populat...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2008.08.029
更新日期:2009-01-01 00:00:00
abstract::Three patients with subpulmonic ventricular septal defect and pulmonary valve fluttering by echocardiography are presented. The echographic changes appear identical to that reported with infundibular pulmonic stenosis and the mechanism causing this fluttering is probably similar. ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(77)80336-0
更新日期:1977-07-01 00:00:00
abstract::In January 1997, experts from the United States, Europe, and Japan gathered at Stanford University to review their collective experience with intracoronary and noncoronary stenting and to identify and prioritize issues requiring further clinical investigation. This report summarizes the discussions that took place dur...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/s0002-8703(98)70004-3
更新日期:1998-10-01 00:00:00
abstract:BACKGROUND:Cardiac pacing can be challenging after a Fontan operation, and limited data exist regarding pacing in adult Fontan patients. The objectives of our study were to determine risk factors for pacing and occurrence of device-related complications (DRCs) and pacemaker reinterventions. METHODS:We performed a retr...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2017.08.019
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:The prognostic significance of ventricular flutter (VFL) induced during programmed electrical stimulation (PES) is currently unknown. METHODS:This study examined patients who had PES-induced VFL and assessed their long-term prognosis compared with patients who had inducible sustained monomorphic ventricular...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2003.11.012
更新日期:2004-04-01 00:00:00
abstract:BACKGROUND:Cohort studies have suggested little effect of coffee consumption on risk of acute myocardial infarction. The effect of coffee consumption on prognosis after myocardial infarction is uncertain. METHODS:In a population-based inception cohort study, we followed 1,369 patients hospitalized with a confirmed fir...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2008.11.009
更新日期:2009-03-01 00:00:00
abstract::During the last few decades, acute ST-elevation on an electrocardiogram (ECG) in the proper clinical context has been a reliable surrogate marker of acute coronary occlusion requiring primary percutaneous coronary intervention (PPCI). In 2004, the American College of Cardiology/American Heart Association ST-elevation ...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2010.08.011
更新日期:2010-12-01 00:00:00
abstract:BACKGROUND:Low heart rate recovery (HRR) at exercise test and the metabolic syndrome (MetS) are both predictors of cardiovascular morbidity and mortality. We studied in 75-year-old women and men, representative of the general population, the relationship between (1) HRR and the MetS, (2) HRR and the individual componen...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2007.06.025
更新日期:2007-09-01 00:00:00
abstract:BACKGROUND:The latest cholesterol guidelines have shifted focus from achieving low-density lipoprotein cholesterol (LDL-C) targets toward statin use and intensity guided by atherosclerotic cardiovascular disease (ASCVD) risk. METHODS:Statin use and intensity were evaluated in 5,905 statin-eligible primary or secondary...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2017.08.005
更新日期:2017-11-01 00:00:00
abstract::Adenosine infusion is accompanied by increases in coronary blood flow and myocardial blood volume. Myocardial blood volume may produce changes in diastolic left ventricular (LV) performance by increasing myocardial turgor. Diastolic dysfunction may also be the result of myocardial ischemia. The relation between change...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(95)90318-6
更新日期:1995-04-01 00:00:00
abstract::We have explored the systolic time intervals of 52 patients with angina pectoris at the time of their hospitalization in our wards. Our results are in close agreement with published data, essentially indicating prolongation of the preejection time and shortening of the ejection time. These alterations of systolic time...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(83)90237-5
更新日期:1983-05-01 00:00:00
abstract::Pulmonary function was measured serially in two separate randomized trials of pindolol in the treatment of essential hypertension. Patients with overt obstructive airways disease were excluded. In study 1, 131 hypertensive patients were randomized to placebo (31) and 15 mg (33), 30 mg (33), and 60 mg (34) of pindolol....
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(82)90135-1
更新日期:1982-08-01 00:00:00
abstract:BACKGROUND:Patients with non-ST-elevation myocardial infarction (NSTEMI) and three-vessel or left main coronary disease (3VD/LMD) have a high risk of long-term mortality when treated with a medical management strategy (MMS) compared with revascularization. METHODS:We evaluated patterns of use and patient features acro...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2013.12.004
更新日期:2014-03-01 00:00:00
abstract::Major cardiovascular risk factors, such as hypertension, hyperlipidemia, and diabetes, often cluster in the same individuals. It has been claimed that obesity, hyperinsulinemia, insulin resistance, and a deranged intracellular handling of ions have pathogenetic importance in the development of this metabolic syndrome....
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(93)90446-g
更新日期:1993-05-01 00:00:00
abstract:BACKGROUND:Ibutilide is indicated for the acute termination of atrial fibrillation and atrial flutter. Recent work concludes that ibutilide activates a late inward sodium current that is blocked by nifedipine. Because calcium channel blockers are commonly used in patients with atrial fibrillation, it is important to ex...
journal_title:American heart journal
pub_type: 杂志文章,meta分析
doi:10.1067/mhj.2002.120156
更新日期:2002-01-01 00:00:00
abstract::To assess the role of oxidative stress in exercise intolerance in patients with heart failure, a symptom-limited exercise test was performed with a bicycle ergometer in 12 patients with heart failure and in 7 members of a healthy control group. Level of plasma malondialdehyde, a marker of lipid peroxidation, at rest w...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(98)70351-5
更新日期:1998-01-01 00:00:00
abstract:BACKGROUND:The timely and accurate identification of symptoms of acute coronary syndrome (ACS) is a challenge for patients and clinicians. It is unknown whether response times and clinical outcomes differ with specific symptoms. We sought to identify which ACS symptoms are related-symptom clusters-and to determine if s...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2010.01.003
更新日期:2010-03-01 00:00:00
abstract:BACKGROUND:The rise in cardiac troponin I after ST-elevation myocardial infarction treated by primary percutaneous coronary interventions (PCIs) is predictive of infarct size and left ventricular ejection fraction (LVEF). However, the comparative value of C-reactive protein (CRP) and troponin I for infarct size evaluat...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2006.07.016
更新日期:2006-12-01 00:00:00
abstract::Plasma cholesterol levels were measured in 15,892 participants of a cholesterol screening in Hartford, Connecticut. The screenees were typically health conscious as evidenced by the low prevalence of current cigarette smoking (12%). However, more than 25% of the men and 35% of the women over the age of 50 years had ch...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90741-2
更新日期:1989-03-01 00:00:00
abstract::Salient clinical, hemodynamic, angiocardiographic, and pathologic findings are presented in 100 patients with truncus arteriosus communis, 79 of whom were studied at autopsy. In this study of typical truncus, all had a ventricular septal defect (type A). Truncus with a partially formed aorticopulmonary septum (type A1...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(76)80400-0
更新日期:1976-07-01 00:00:00
abstract:BACKGROUND:The long-term effects of smoking and smoking cessation on markers of cardiovascular disease (CVD) prognosis obtained during treadmill stress testing (TST) are unknown. The purpose of this study was to evaluate the long-term effects of smoking cessation and continued smoking on TST parameters that predict CVD...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2011.06.023
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:31-Phosphorus-magnetic resonance spectroscopy may provide pathophysiological insights into the high-energy phosphate metabolism of the myocardium as measured by phosphocreatine to adenosine triphosphate (PCr/ATP) ratio. Aim of the present study was to determine in vivo the relation between cardiac PCr/ATP ra...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2011.04.012
更新日期:2011-07-01 00:00:00
abstract::We assessed the relationship between echocardiographic and hemodynamic parameters in 28 patients with documented acute myocardial infarction (AMI), who underwent M-mode echocardiography and Swan-Ganz catheterization during the same hospitalization. Patients with valvular heart disease were excluded from the study. On ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90542-8
更新日期:1984-07-01 00:00:00
abstract::Quinidine serum levels and pharmacokinetic data were assessed during steady state therapy with oral quinidine sulfate in 19 hospitalized patients who were being treated for ventricular arrhythmias. A new high performance liquid chromatography assay was employed. Four patients were studied both after the first dose of ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(79)90467-8
更新日期:1979-12-01 00:00:00
abstract:BACKGROUND:Women with X-chromosome monosomy or Turner syndrome (TS) are at increased risk for aortic dilation and dissection. To better understand the pathology and develop tools to monitor the risk of aortic disease, we investigated N-terminal pro-brain natriuretic peptide (BNP) (NT-proBNP) levels in women with TS and...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2012.06.021
更新日期:2012-09-01 00:00:00