Abstract:
OBJECTIVES:The purpose of this study was to examine the relationships among B-type natriuretic peptide (BNP) levels within the diagnostic range, perceived congestive heart failure (CHF) severity, clinical decision making, and outcomes of the CHF patients presenting to emergency department (ED). BACKGROUND:Since BNP correlates with the presence of CHF, disease severity, and prognosis, we hypothesized that BNP levels in the diagnostic range offer value independent of physician decision making with regard to critical outcomes in emergency medicine. METHODS:The Rapid Emergency Department Heart failure Outpatient Trial (REDHOT) study was a 10-center trial in which patients seen in the ED with shortness of breath were consented to have BNP levels drawn on arrival. Entrance criteria included a BNP level >100 pg/ml. Physicians were blinded to the actual BNP level and subsequent BNP measurements. Patients were followed up for 90 days after discharge. RESULTS:Of the 464 patients, 90% were hospitalized. Two-thirds of patients were perceived to be New York Heart Association (NYHA) functional class III or IV. The BNP levels did not differ significantly between patients who were discharged home from the ED and those admitted (976 vs. 766, p = 0.6). Using logistic regression analysis, an ED doctor's intention to admit or discharge a patient had no influence on 90-day outcomes, while the BNP level was a strong predictor of 90-day outcome. Of admitted patients, 11% had BNP levels <200 pg/ml (66% of which were perceived NYHA functional class III or IV). The 90-day combined event rate (CHF visits or admissions and mortality) in the group of patients admitted with BNP <200 pg/ml and >200 pg/ml was 9% and 29%, respectively (p = 0.006). CONCLUSIONS:In patients presenting to the ED with heart failure, there is a disconnect between the perceived severity of CHF by ED physicians and severity as determined by BNP levels. The BNP levels can predict future outcomes and thus may aid physicians in making triage decisions about whether to admit or discharge patients. Emerging clinical data will help further refine biomarker-guided outpatient therapeutic and monitoring strategies involving BNP.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Maisel A,Hollander JE,Guss D,McCullough P,Nowak R,Green G,Saltzberg M,Ellison SR,Bhalla MA,Bhalla V,Clopton P,Jesse R,Rapid Emergency Department Heart Failure Outpatient Trial investigators.doi
10.1016/j.jacc.2004.06.015subject
Has Abstractpub_date
2004-09-15 00:00:00pages
1328-33issue
6eissn
0735-1097issn
1558-3597pii
S0735109704011489journal_volume
44pub_type
临床试验,杂志文章,多中心研究abstract:OBJECTIVES:The aim of this study was to evaluate low-level exercise echocardiography (LLEE) in detecting contractile reserve and predicting functional improvement of akinetic myocardium early after acute myocardial infarction (AMI). BACKGROUND:Experimental and clinical studies have shown that low-dose dobutamine enhan...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0735-1097(99)00340-x
更新日期:1999-10-01 00:00:00
abstract:OBJECTIVES:We investigated the value of reactive hyperemia peripheral arterial tonometry (RH-PAT) as a noninvasive tool to identify individuals with coronary microvascular endothelial dysfunction. BACKGROUND:Coronary endothelial dysfunction, a systemic disorder, represents an early stage of atherosclerosis; RH-PAT is ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2004.08.062
更新日期:2004-12-07 00:00:00
abstract:BACKGROUND:The current U.S. priority ranking for heart candidates is based on treatment intensity, not objective markers of severity of illness. This system may encourage centers to overtreat candidates. OBJECTIVES:This study sought to describe national variation in the intensity of treatment of adult heart transplant...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2018.02.030
更新日期:2018-04-24 00:00:00
abstract:OBJECTIVES:We examined the possible effect of neuropeptide Y in modulating central sympathetic activity after myocardial infarction in rats. BACKGROUND:Previous studies have shown the coexistence of neuropeptide Y and norepinephrine in the brain and a possible functional interaction between the two. Neuropeptide Y inh...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(96)00063-0
更新日期:1996-06-01 00:00:00
abstract::Among 3,548 patients undergoing a percutaneous transluminal coronary angioplasty procedure, 714 had multilesion angioplasty (1,550 lesions) in a single session. Acute occlusion occurred in 22 patients (3.1%) and 29 lesions (1.9%). The patients were classified into a group undergoing multivessel angioplasty (348 patien...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(89)90499-3
更新日期:1989-02-01 00:00:00
abstract:OBJECTIVES:A subgroup analysis of the Valsartan Heart Failure Trial (Val-HeFT) was performed to evaluate the effects of the angiotensin II receptor blocker, valsartan, in the patients with chronic heart failure (HF) not receiving angiotensin-converting enzyme (ACE) inhibitors. BACKGROUND:The ACE inhibitors reduce mort...
journal_title:Journal of the American College of Cardiology
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doi:10.1016/s0735-1097(02)02304-5
更新日期:2002-10-16 00:00:00
abstract:OBJECTIVES:A randomized trial was done to compare single-chamber atrial (AAI) and dual-chamber (DDD) pacing in patients with sick sinus syndrome (SSS). Primary end points were changes in left atrial (LA) size and left ventricular (LV) size and function as measured by M-mode echocardiography. BACKGROUND:In patients wit...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0735-1097(03)00757-5
更新日期:2003-08-20 00:00:00
abstract::Compared with recent advances in treatment of serious cardiovascular diseases, such as myocardial infarction and stroke, the treatment and outcome of acute pulmonary embolism (PE) have remained relatively unchanged over the last few decades. This has prompted several experts to call for the formation of multidisciplin...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
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更新日期:2016-03-01 00:00:00
abstract:OBJECTIVES:We sought to evaluate whether prolonged exercise in ultramarathon runners results in left ventricular (LV) damage. BACKGROUND:Strenuous exercise has been reported to cause LV damage. METHODS:Fourteen runners who completed an ultramarathon at high altitude underwent echocardiography, finger-tip oximetry and...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(97)00179-4
更新日期:1997-08-01 00:00:00
abstract:OBJECTIVES:The purpose of the present study was to compare the use of a mechanical transmyocardial implant (TMI) device with transmyocardial laser revascularization (TMR) for induction of therapeutic angiogenesis and arteriogenesis in the chronically ischemic heart. BACKGROUND:Prior experimental studies have demonstra...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(02)01734-5
更新日期:2002-04-03 00:00:00
abstract:OBJECTIVES:The aim of the study was to evaluate whether left ventricular (LV) mechanics are better under LV-based pacing than under right ventricular (RV) apical pacing in patients with permanent atrial fibrillation (AF) after atrioventricular junction (AVJ) ablation. BACKGROUND:"Ablate and pace" is an acceptable ther...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2003.10.038
更新日期:2004-03-17 00:00:00
abstract:OBJECTIVES:This study was designed to test the feasibility of high-resolution phased-array intracardiac imaging. BACKGROUND:Intracardiac echocardiographic imaging of the heart during interventional electrophysiologic (EP) procedures has been limited by inadequate ultrasound penetration and absence of Doppler hemodynam...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章
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更新日期:2002-02-06 00:00:00
abstract::To investigate the relation between basal coronary artery diameter and development of coronary artery spasm, the diameters of the proximal, middle and distal segments of the three major coronary artery branches, together with that of the left main trunk, were measured on a control angiogram and after ergonovine and ni...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(89)90100-9
更新日期:1989-09-01 00:00:00
abstract:OBJECTIVES:To obtain information on the long-term effects of dynamic cardiomyoplasty on hemodynamics and muscle histology, this surgical method was evaluated in goats. BACKGROUND:Dynamic cardiomyoplasty has been introduced as a new method to treat patients with severe cardiac failure. METHODS:In 24 goats, the left la...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(93)90188-7
更新日期:1993-09-01 00:00:00
abstract:BACKGROUND:A recent meta-analysis demonstrated a survival benefit in post-infarction patients whose ventricular tachycardia (VT) was rendered noninducible by catheter ablation. Furthermore, patients with noninducible VT had a lower VT recurrence rate than did patients whose VT remained inducible after ablation. OBJECT...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jacc.2015.02.058
更新日期:2015-05-12 00:00:00
abstract::Fine particulate matter <2.5 μm (PM2.5) air pollution is the most important environmental risk factor contributing to global cardiovascular (CV) mortality and disability. Short-term elevations in PM2.5 increase the relative risk of acute CV events by 1% to 3% within a few days. Longer-term exposures over several years...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
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更新日期:2018-10-23 00:00:00
abstract:OBJECTIVES:The purpose of this study was to better understand the effects of long-term right ventricular pacing on left ventricular perfusion, innervation, function and histology. BACKGROUND:Long-term right ventricular apical pacing is associated with increased congestive heart failure and mortality compared with atri...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(94)90567-3
更新日期:1994-07-01 00:00:00
abstract::The immediate result of percutaneous transluminal coronary angioplasty is influenced by both plastic and elastic changes of the vessel wall. To evaluate the amount of elastic recoil after coronary balloon angioplasty, the minimal luminal cross-sectional area of the largest balloon used at highest inflation pressure wa...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(91)90936-4
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abstract:OBJECTIVES:This study aimed to determine whether angiographically visualized collateral vessels in patients with chronic coronary artery disease imply the presence of viable myocardium in asynergic regions subtended by completely occluded coronary arteries. BACKGROUND:Patients with chronic coronary artery disease who ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(94)90630-0
更新日期:1994-03-15 00:00:00
abstract:OBJECTIVES:This study was undertaken to assess the hematologic, clinical, and biochemical response to intravenous iron in patients with chronic heart failure (CHF) and anemia. BACKGROUND:Anemia is common in patients with CHF and is associated with higher morbidity and mortality. The combination of erythropoietin (EPO)...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章
doi:10.1016/j.jacc.2006.07.015
更新日期:2006-09-19 00:00:00
abstract::The safety and efficacy of a new clinical synchronized diastolic retroperfusion mechanical pump and autoinflatable balloon catheter was studied in 10 dogs during and after 6 hours of left anterior descending coronary artery occlusion. Eight other dogs served as the untreated control group. Infarct size measured by tri...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(85)80168-6
更新日期:1985-08-01 00:00:00
abstract:OBJECTIVES:This study sought to assess the usefulness and accuracy of artificial neural networks in the prognosis of 1-year mortality in patients with heart failure. BACKGROUND:Artificial neural networks is a computational technique used to represent and process information by means of networks of interconnected proce...
journal_title:Journal of the American College of Cardiology
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doi:10.1016/0735-1097(95)00385-1
更新日期:1995-12-01 00:00:00
abstract::Recent trials have shown that recombinant tissue plasminogen activator (rt-PA) is an effective thrombolytic agent in patients with acute myocardial infarction. Because rt-PA converts plasminogen to plasmin, which is known to activate complement in vitro, we tested the hypothesis that rt-PA can induce in vivo activatio...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(87)80206-1
更新日期:1987-09-01 00:00:00
abstract::High-sensitivity cardiac troponin (hs-cTn) assays have been used clinically by thousands of physicians in many countries throughout the world since their clinical introduction 7 years ago. In the early diagnosis of myocardial infarction (MI), beyond doubt, the most important indication of hs-cTn assays, these simple, ...
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pub_type: 杂志文章,评审
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更新日期:2017-08-22 00:00:00
abstract:BACKGROUND:It is not known whether high-risk plaque, as detected by coronary computed tomography angiography (CTA), permits improved early diagnosis of acute coronary syndromes (ACS) independently to the presence of significant coronary artery disease (CAD) in patients with acute chest pain. OBJECTIVES:The primary aim...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jacc.2014.05.039
更新日期:2014-08-19 00:00:00
abstract::It has been 40 years since the first human-to-human heart transplant performed in South Africa by Christiaan Barnard in December 1967. This achievement did not come as a surprise to the medical community but was the result of many years of early pioneering experimental work by Alexis Carrel, Frank Mann, Norman Shumway...
journal_title:Journal of the American College of Cardiology
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doi:10.1016/j.jacc.2008.05.020
更新日期:2008-08-19 00:00:00
abstract:OBJECTIVES:The purpose of this research was to find out whether, in humans, dobutamine-induced hemodynamic effects and increase in plasma-renin activity (PRA) might be beta1-adrenoceptor (beta1AR) genotype-dependent. BACKGROUND:In vitro Arg389Gly-beta1AR polymorphism exhibits decreased receptor signaling. METHODS:We ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2005.08.041
更新日期:2005-12-06 00:00:00
abstract::Diabetes mellitus is one of the most common chronic medical conditions, and is a risk factor for the development of atrial fibrillation (AF). The presence of diabetes in patients with AF is associated with increased symptom burden and increased cardiovascular and cerebrovascular mortality. The pathophysiology of diabe...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2019.07.020
更新日期:2019-08-27 00:00:00
abstract:BACKGROUND:Proprotein convertase subtilisin/kexin type 9 (PCSK9) binds low-density lipoprotein receptor (LDLR), preventing its recycling. PCSK9 is a risk predictor and a biotarget in atherosclerosis progression. OBJECTIVES:The aim of this study was to determine whether the PCSK9-LDLR axis could predict risk in patient...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jacc.2017.08.057
更新日期:2017-10-24 00:00:00
abstract:OBJECTIVES:An initial crossover study comparing dual- and single-site right atrial pacing was performed followed by a long-term efficacy and safety evaluation of dual-site right atrial pacing in patients with drug-refractory atrial fibrillation (AF). Also examined was the efficacy of two single-site right atrial pacing...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章
doi:10.1016/s0735-1097(98)00489-6
更新日期:1998-12-01 00:00:00