Abstract:
BACKGROUND:Combining 2 signals of cardiomyocyte injury, cardiac troponin I (cTnI) and T (cTnT), might overcome some individual pathophysiological and analytical limitations and thereby increase diagnostic accuracy for acute myocardial infarction with a single blood draw. We aimed to evaluate the diagnostic performance of combinations of high-sensitivity (hs) cTnI and hs-cTnT for the early diagnosis of acute myocardial infarction. METHODS:The diagnostic performance of combining hs-cTnI (Architect, Abbott) and hs-cTnT (Elecsys, Roche) concentrations (sum, product, ratio, and a combination algorithm) obtained at the time of presentation was evaluated in a large multicenter diagnostic study of patients with suspected acute myocardial infarction. The optimal rule-out and rule-in thresholds were externally validated in a second large multicenter diagnostic study. The proportion of patients eligible for early rule-out was compared with the European Society of Cardiology 0/1 and 0/3 hour algorithms. RESULTS:Combining hs-cTnI and hs-cTnT concentrations did not consistently increase overall diagnostic accuracy as compared with the individual isoforms. However, the combination improved the proportion of patients meeting criteria for very early rule-out. With the European Society of Cardiology 2015 guideline recommended algorithms and cut-offs, the proportion meeting rule-out criteria after the baseline blood sampling was limited (6% to 24%) and assay dependent. Application of optimized cut-off values using the sum (9 ng/L) and product (18 ng2/L2) of hs-cTnI and hs-cTnT concentrations led to an increase in the proportion ruled-out after a single blood draw to 34% to 41% in the original (sum: negative predictive value [NPV] 100% [95% confidence interval (CI), 99.5% to 100%]; product: NPV 100% [95% CI, 99.5% to 100%]) and in the validation cohort (sum: NPV 99.6% [95% CI, 99.0-99.9%]; product: NPV 99.4% [95% CI, 98.8-99.8%]). The use of a combination algorithm (hs-cTnI <4 ng/L and hs-cTnT <9 ng/L) showed comparable results for rule-out (40% to 43% ruled out; NPV original cohort 99.9% [95% CI, 99.2-100%]; NPV validation cohort 99.5% [95% CI, 98.9-99.8%]) and rule-in (positive predictive value [PPV] original cohort 74.4% [95% Cl, 69.6-78.8%]; PPV validation cohort 84.0% [95% Cl, 79.7-87.6%]). CONCLUSIONS:New strategies combining hs-cTnI and hs-cTnT concentrations may significantly increase the number of patients eligible for very early and safe rule-out, but do not seem helpful for the rule-in of acute myocardial infarction. CLINICAL TRIAL REGISTRATION:URL (APACE): https://www.clinicaltrial.gov . Unique identifier: NCT00470587. URL (ADAPT): www.anzctr.org.au . Unique identifier: ACTRN12611001069943.
journal_name
Circulationjournal_title
Circulationauthors
van der Linden N,Wildi K,Twerenbold R,Pickering JW,Than M,Cullen L,Greenslade J,Parsonage W,Nestelberger T,Boeddinghaus J,Badertscher P,Rubini Giménez M,Klinkenberg LJJ,Bekers O,Schöni A,Keller DI,Sabti Z,Puelacher C,doi
10.1161/CIRCULATIONAHA.117.032003subject
Has Abstractpub_date
2018-09-04 00:00:00pages
989-999issue
10eissn
0009-7322issn
1524-4539pii
CIRCULATIONAHA.117.032003journal_volume
138pub_type
杂志文章,多中心研究相关文献
CIRCULATION文献大全abstract:BACKGROUND:Sirt7, 1 of the 7 members of the mammalian sirtuin family, promotes oncogenic transformation. Tumor growth and metastasis require fibrotic and angiogenic responses. Here, we investigated the role of Sirt7 in cardiovascular tissue repair process. METHODS AND RESULTS:In wild-type mice, Sirt7 expression increa...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.114.014821
更新日期:2015-09-22 00:00:00
abstract::Our experimental studies since 1972 show that the heart is preserved best during cardiopulmonary bypass when it is in the beating, nonworking state. Results after mitral valve replacement (MVR) from 1968 to 1974 using various techniques of cardiac preservation were compared. In group I were 47 patients (1968 to 1972) ...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1975-08-01 00:00:00
abstract::The purpose of this study was to assess the sensitivity and specificity of two-dimensional echocardiography in detecting ischemia-induced transient myocardial dyskinesis. We prepared an open-chest dog model of severe coronary stenosis (90% reduction of circumflex coronary artery diameter) and induced ischemia by acute...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.66.3.597
更新日期:1982-09-01 00:00:00
abstract:BACKGROUND:Recent advances in surgical techniques for the repair of left ventricular aneurysms (LVAs) include the use of an endoventricular patch to exclude the aneurysm cavity. This technique has replaced conventional linear plication of the aneurysm. The endoventricular patch technique remodels the left ventricular c...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.92.9.98
更新日期:1995-11-01 00:00:00
abstract::A 10 mg bolus of the angiotensin blocker saralasin was injected 113 times in 68 subjects with essential or renovascular hypertension. Ninety percent of injections caused a transient increase in blood pressure, which correlated with plasma renin activity (PRA) (r = -0.54); Mean increase at 2 minutes was 21/13.4 mm Hg (...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.57.6.1165
更新日期:1978-06-01 00:00:00
abstract::Carotid artery stenting, compared with carotid endarterectomy, is emerging as an effective and less invasive method of revascularization for extracranial carotid artery stenosis. Carotid stenting is established as the treatment of choice for certain high-risk patient subsets, and ongoing clinical trials are evaluating...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.105.595512
更新日期:2006-04-25 00:00:00
abstract:BACKGROUND:Guidelines have proposed that atrial fibrillation (AF) can occur as an isolated event, particularly when precipitated by a secondary, or reversible, condition. However, knowledge of long-term AF outcomes after diagnosis during a secondary precipitant is limited. METHODS AND RESULTS:In 1409 Framingham Heart ...
journal_title:Circulation
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCULATIONAHA.114.014058
更新日期:2015-05-12 00:00:00
abstract:BACKGROUND:We examined the associations of a range of parental and early life characteristics with systolic blood pressure at 5 years of age. METHODS AND RESULTS:Information from 3864 children who were followed up prospectively from their mother's first antenatal clinic assessment was used. Maternal age, body mass ind...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000145165.80130.B5
更新日期:2004-10-19 00:00:00
abstract:BACKGROUND:Myocardial necrosis can occur during percutaneous coronary intervention (PCI) despite optimal adjunctive pharmacology and careful technique. We investigated the mechanisms of procedural infarction using angiographic analysis, intravascular ultrasound, and delayed-enhancement magnetic resonance imaging. METH...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/CIRCULATIONAHA.105.593210
更新日期:2006-08-15 00:00:00
abstract:BACKGROUND:Increased consumption of sugar-sweetened beverages (SSBs) has been associated with an elevated risk of obesity, metabolic syndrome, and type II diabetes mellitus. However, the effects of SSB consumption on blood pressure (BP) are uncertain. The objective of this study was to determine the relationship betwee...
journal_title:Circulation
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1161/CIRCULATIONAHA.109.911164
更新日期:2010-06-08 00:00:00
abstract:BACKGROUND:This experiment sought to determine the effects of fish oil on superoxide anion production in the myocardium and coronary arteries of atherosclerotic monkeys. Recent evidence indicates that dietary supplementation with fish oil preserves normal vasomotion of atherosclerotic coronary arteries and reduces dama...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.91.4.1123
更新日期:1995-02-15 00:00:00
abstract:BACKGROUND:Endocardial mapping using standard electrode catheters is often technically limited in ventricular tachycardia and constitutes a major obstacle to successful ablation. We wished to examine the utility of a basket-shaped multielectrode mapping catheter (MMC) in the mapping and ablation of ventricular tachycar...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.96.7.2430
更新日期:1997-10-07 00:00:00
abstract::Nineteen patients with chronic low output cardiac failure were studied before, during and after infusion of phentolamine in doses of 10, 20, 30 and 40 microgram/kg/min. Significant reduction of left- and right-sided pressures and increases in cardiac index and heart rate (HR) were present within 15 minutes of starting...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.58.1.157
更新日期:1978-07-01 00:00:00
abstract::Frank lead vectorcardiograms (VCG) from four carefully selected patient subgroups (226 patients) were analyzed to develop optimal criteria for the diagnosis of anterior myocardial infarction. Specificity was evaluated using 100 healthy volunteers under age 30 and 80 patients with normal left ventriculogram and normal ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.53.2.229
更新日期:1976-02-01 00:00:00
abstract::Nonoperative therapy includes conservative noninterventional modalities and the endovascular interventional modalities of percutaneous transluminal angioplasty and a variety of laser systems and atherectomy devices. The role and impact of all nonoperative treatments are considered in the perspectives of the natural hi...
journal_title:Circulation
pub_type: 杂志文章,评审
doi:
更新日期:1991-02-01 00:00:00
abstract:BACKGROUND:Leptin has been implicated in cardiovascular disease. A diet rich in fish has been associated with decreased cardiac and vascular risk. METHODS AND RESULTS:We examined the relationship between diet and leptin in 2 related homogeneous African tribal populations of Tanzania. One tribe consumes freshwater fish...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.0000025241.01418.4d
更新日期:2002-07-16 00:00:00
abstract:BACKGROUND:It is not known whether progression of aortic arch (AA) atheroma is associated with vascular events in patients with stroke or transient ischemic attack (TIA). METHODS AND RESULTS:AA atheroma was detected on baseline transesophageal echocardiogram in 167 consecutive patients who had prevalent stroke or TIA....
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.106.671727
更新日期:2007-08-21 00:00:00
abstract:BACKGROUND:The accumulation of macrophage-derived foam cells in atherosclerotic lesions correlates with increased local release of matrix-degrading metalloproteinases (MMPs) and a thin fibrous cap. The activity of these enzymes is controlled by specific tissue inhibitors of metalloproteinases (TIMPs). METHODS AND RESU...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.99.3.420
更新日期:1999-01-26 00:00:00
abstract:BACKGROUND:Regression of left ventricular hypertrophy (LVH) after surgical correction for aortic stenosis is not fully understood on the molecular level. The aim of this study was to examine whether there is an association between LVH regression and extracellular matrix (ECM) gene expression. METHODS AND RESULTS:A sta...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/hc37t1.094777
更新日期:2001-09-18 00:00:00
abstract:BACKGROUND:The role of infections and inflammation in the pathophysiology of coronary heart disease is emerging. We studied the independent and joint effects of these 2 components on coronary risk. METHODS AND RESULTS:We measured baseline levels of C-reactive protein (CRP) and antibodies to adenovirus, enterovirus, cy...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.101.3.252
更新日期:2000-01-25 00:00:00
abstract:BACKGROUND:Congestive heart failure (CHF) is characterized by enhanced immune activation, and immune-mediated mechanisms may play a pathogenic role in this disorder. Based on the immunomodulatory effects of intravenous immunoglobulin (IVIG), we hypothesized that IVIG could downregulate inflammatory responses in CHF pat...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.103.2.220
更新日期:2001-01-16 00:00:00
abstract::Studies of the correlation of aortic valve gradient determined by continuous-wave Doppler echocardiography and that determined at catheterization have, to date, involved young patients and nonsimultaneous measurements. We therefore obtained simultaneous Doppler echocardiographic and catheter measurements of pressure g...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.71.6.1162
更新日期:1985-06-01 00:00:00
abstract:BACKGROUND:Familial hypercholesterolemia (FH), an autosomal codominant disease, is characterized by high levels of LDL cholesterol and a high incidence of coronary artery disease (CAD). To date, genetic heterogeneity has hindered the proper assessment of the relation between risk factors and CAD in FH patients. METHOD...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/01.cir.92.3.290
更新日期:1995-08-01 00:00:00
abstract:BACKGROUND:Various measures of arterial stiffness and wave reflection have been proposed as cardiovascular risk markers. Prior studies have not assessed relations of a comprehensive panel of stiffness measures to prognosis in the community. METHODS AND RESULTS:We used proportional hazards models to analyze first-onset...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.109.886655
更新日期:2010-02-02 00:00:00
abstract:BACKGROUND:Brain natriuretic peptide (BNP) levels are used in the evaluation of patients with heart disease, yet there is little understanding of the effect of hypoxia on natriuretic peptide secretion. Furthermore, recent data suggest that oxytocin may mediate stretch-induced atrial natriuretic peptide (ANP) secretion....
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000129305.25115.80
更新日期:2004-06-15 00:00:00
abstract:BACKGROUND:Ibutilide is an action potential-prolonging antiarrhythmic currently in clinical trials. The drug shares structural similarities with E-4031 and dofetilide, specific blockers of the rapidly activating delayed rectifier K+ current (IKr). However, previous in vitro studies in guinea pig myocytes have indicated...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.91.6.1799
更新日期:1995-03-15 00:00:00
abstract:BACKGROUND:The physiological effects of ACE inhibitors may act in part through a kinin-dependent mechanism. We investigated the effect of chronic ACE-inhibitor treatment on functional kinin B(1)- and B(2)-receptor expression, which are the molecular entities responsible for the biological effects of kinins. METHODS AN...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/hc0502.102965
更新日期:2002-02-05 00:00:00
abstract:BACKGROUND:The sarcomeric protein titin is a molecular spring responsible for passive tension and restoring forces of cardiomyocytes. Extension of titin as a function of sarcomere length (SL) has been studied in rodents, which predominantly express the smaller, stiffer N2B titin isoform. Large mammals coexpress roughly...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.109.918151
更新日期:2010-02-16 00:00:00
abstract::Audible atrial sounds were noted in a patient with congestive cardiomyopathy and atrial fibrillation with slow ventricular rate. Oscillatory motion of similar periodicity as fibrillation waves in the ECG and the sounds in the phonocardiogram was demonstrated in aortic and left ventricular walls, mitral, tricuspid and ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.53.3.569
更新日期:1976-03-01 00:00:00
abstract::Noninvasive gated cardiac blood pool imaging with technetium-99m autologous erythrocytes was employed to differentiate reversible verus irreversible abnormal ventricular segmental contraction by regional wall and pump responses to sublingual nitroglycerin in 25 patients with chronic coronary heart disease. In 12 patie...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.53.6.975
更新日期:1976-06-01 00:00:00