Abstract:
BACKGROUND:Ruling out acute myocardial infarction (AMI) on the basis of rapid assays for cardiac markers will allow early triage of patients and cost-effective use of available coronary care facilities. METHODS AND RESULTS:We studied the value of myoglobin, creatine kinase (CK)-MBmass, and troponin T in ruling out an AMI in the emergency room in 309 consecutive patients presenting with chest pain. The gold standard for AMI was the combination of history, ECG, and a typical curve of the CK-MB activity (CK-MBact). Myoglobin was the earliest marker, and its negative predictive value (NPV) was significantly higher than for CK-MBmass and troponin T from 3 to 6 hours after the onset of symptoms (myoglobin versus CK-MBmass, P < .03; myoglobin versus troponin T, P < .01). The NPV of myoglobin reached 89% 4 hours after the onset of symptoms. The NPV of CK-MBmass reached 95% 7 hours after the onset of symptoms. Troponin T was not an early marker for ruling out AMI, and NPV changed over time, together with CK-MBact. The early NPV was higher in a subgroup of patients with a low probability of the presence of AMI for the three markers. Cardiac markers rise earlier in patients with large infarcts than in patients with small infarcts as indicated by the cumulative proportion of the marker above the upper reference limit at each time point (myoglobin, P = .04; CK-MBmass, P = .013; troponin T, P = .016). CONCLUSIONS:For ruling out AMI in the emergency room, myoglobin is a better marker than CK-MBmass or troponin T from 3 until 6 hours after the onset of symptoms, but the maximal NPV reaches only 89%. At 7 hours, the NPV of CK-MBmass is 95%. The test characteristics are influenced by the probability of the presence of AMI in the patients studied and by the size of their AMI. Infarct size of AMI patients should be reported in studies evaluating cardiac markers.
journal_name
Circulationjournal_title
Circulationauthors
de Winter RJ,Koster RW,Sturk A,Sanders GTdoi
10.1161/01.cir.92.12.3401subject
Has Abstractpub_date
1995-12-15 00:00:00pages
3401-7issue
12eissn
0009-7322issn
1524-4539journal_volume
92pub_type
杂志文章相关文献
CIRCULATION文献大全abstract:BACKGROUND:Extracorporeal membrane oxygenation (ECMO) is considered when respiratory failure (RF) persists despite increasing conventional mechanical ventilation (CMV). High-frequency jet ventilation (HFJV) can improve ventilation with comparable mean airway pressure (PAW) to that found on CMV. This study was undertake...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1992-11-01 00:00:00
abstract::The directions and magnitudes of time-normalized P, QRS, and ST vectors, and other ECG parameters were analyzed during and after multistage exercise in 56 ostensibly healthy men aged 23 to 62. By selective averaging with a digital computer system a single representative beat was obtained from each stage. Measurements ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.52.4.570
更新日期:1975-10-01 00:00:00
abstract::The role of right ventricular (RV) fibrosis in pulmonary hypertension (PH) remains a subject of ongoing discussion. Alterations of the collagen network of the extracellular matrix may help prevent ventricular dilatation in the pressure-overloaded RV. At the same time, fibrosis impairs cardiac function, and a growing b...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.118.035326
更新日期:2019-01-08 00:00:00
abstract:BACKGROUND:Tumor necrosis factor-alpha (TNF-alpha) has been implicated in the pathogenesis of dilated cardiomyopathy (DCM). TNF-alpha-converting enzyme (TACE) has recently been purified and its complementary DNA cloned. The expression of TACE results in the production of a functional enzyme that has precursor TNF-alpha...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.99.25.3260
更新日期:1999-06-29 00:00:00
abstract::Normal right ventricular muscles and similar preparations obtained from cats with signs of subacute right ventricular failure (RVF) (3 to 14 days after pressure overload induced by pulmonary artery coarctation) were studied during stimulation (at 0.5 Hz) and exposure to high-K+ Tyrode's solution. Twitch force, rate of...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1986-03-01 00:00:00
abstract::To define the factors influencing the success of emergency ventricular defibrillation, we identified 52 patients defibrillated at the University of Iowa Hospital during 1974--1976. Thirty-eight patients were successfully defibrillated at least once; 14 could not be defibrillated, despite multiple attempts. Comparisons...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.60.2.226
更新日期:1979-08-01 00:00:00
abstract:BACKGROUND:Fetal tachycardia may cause hydrops fetalis and lead to fetal death. No unanimity of opinion exists regarding the optimum treatment. This study evaluates our experience with transplacental sotalol therapy to treat fetal tachycardias in terms of safety and efficacy. METHODS AND RESULTS:The charts of 21 patie...
journal_title:Circulation
pub_type: 杂志文章,多中心研究
doi:10.1161/01.cir.101.23.2721
更新日期:2000-06-13 00:00:00
abstract:BACKGROUND:Hypercholesterolemia is associated with endothelial dysfunction. On the basis of the hypothesis that high plasma cholesterol per se may be a sufficient stimulus to upregulate endothelial adhesiveness and that this phenomenon might be reversible, soluble endothelial leukocyte adhesion molecules (sELAMs) were ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.96.5.1381
更新日期:1997-09-02 00:00:00
abstract:BACKGROUND:Clinical studies have implicated preinfarct angina (brief antecedent ischemia/reperfusion [I/R]) as a predictor of more rapid thrombolysis and lower rates of reocclusion. However, the effects of antecedent ischemia on the efficacy of thrombolysis have not been rigorously assessed. Using a canine model of cor...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.102.1.88
更新日期:2000-07-04 00:00:00
abstract::In previous studies from this laboratory, we found that approximately 30% of women with chest pain and normal coronary arteries demonstrated either a decrease in or a failure to increase radionuclide ejection fraction during exercise. To examine the hypothesis that this apparent abnormality in left ventricular functio...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.70.3.357
更新日期:1984-09-01 00:00:00
abstract::The human aorta and its terminal branches were investigated in normal subjects during elective cardiac catheterization to evaluate regional wave travel and arterial wave reflections. A specially designed catheter with six micromanometers equally spaced at 10 cm intervals was positioned with the tip sensor in the dista...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.72.6.1257
更新日期:1985-12-01 00:00:00
abstract:BACKGROUND:The combination of statin therapy and PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibition markedly lowers low-density lipoprotein cholesterol (LDL-C) and reduces cardiovascular event rates. Whether residual inflammatory risk as measured by on-treatment high sensitivity C-reactive protein (hsCRP)...
journal_title:Circulation
pub_type: 杂志文章,随机对照试验
doi:10.1161/CIRCULATIONAHA.118.034645
更新日期:2018-07-10 00:00:00
abstract:BACKGROUND:Systemic delivery of bone marrow-derived mesenchymal stem cells (BM-MSCs) is an attractive approach for myocardial repair. We aimed to test this strategy in a rat model after myocardial infarction (MI). METHODS AND RESULTS:BM-MSCs were obtained from rat bone marrow, expanded in vitro to a purity of >50%, an...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000084828.50310.6A
更新日期:2003-08-19 00:00:00
abstract::Many basic concepts of cardiac output and arterial pressure control have changed considerably in the past few years. In general, each tissue controls its own local resistance and blood flow regardless of the level of arterial pressure; the sum of the local flows then determines the venous return and cardiac output. Ho...
journal_title:Circulation
pub_type: 杂志文章,评审
doi:10.1161/01.cir.64.6.1079
更新日期:1981-12-01 00:00:00
abstract:BACKGROUND:Pulmonary hypertension induced by chronic hypoxia is characterized by thickening of pulmonary artery walls, elevated pulmonary vascular resistance, and right-heart failure. Prostacyclin analogues reduce pulmonary pressures in this condition; raising the possibility that cycloxygenase-2 (COX-2) modulates the ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000145613.01188.0B
更新日期:2004-10-26 00:00:00
abstract::We have applied the new technique of dual echocardiography to determine the sequence of atrial contraction as reflected in the simultaneously recorded movements of the tricuspid and mitral valves. The study group included 29 normal subjects and 23 patients with either atrial flutter, coarse atrial fibrillation or atri...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.58.2.314
更新日期:1978-08-01 00:00:00
abstract:BACKGROUND:Patients with congenital heart disease (CHD) and heterotaxy show high postsurgical morbidity/mortality, with some developing respiratory complications. Although this finding is often attributed to the CHD, airway clearance and left-right patterning both require motile cilia function. Thus, airway ciliary dys...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.111.079780
更新日期:2012-05-08 00:00:00
abstract::The 21-amino acid peptide endothelin-1 (ET-1) is the predominant isoform of the endothelin peptide family, which includes ET-2, ET-3, and ET-4. It exerts various biological effects, including vasoconstriction and the stimulation of cell proliferation in tissues both within and outside of the cardiovascular system. ET-...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.102.19.2434
更新日期:2000-11-07 00:00:00
abstract::The patterns of aortic and tricuspid valve motion in 50 patients with mitral valve prolapse were analyzed by wide-angle, phased-array, two-dimensional echocardiography. Twelve patients (24%) had redundant aortic leaflets bulging into the left ventricular outflow tract during diastole. Eight of 12 patients had aortic r...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.65.1.174
更新日期:1982-01-01 00:00:00
abstract:BACKGROUND:Residual mural thrombus on severely damaged arterial wall is very thrombogenic. We tested the hypothesis that direct thrombin inhibition will block thrombus growth on fresh thrombus better than indirect thrombin inhibition, cyclooxygenase inhibition, or both. METHODS AND RESULTS:A fresh mural thrombus was f...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.90.5.2432
更新日期:1994-11-01 00:00:00
abstract:BACKGROUND:Reducing sympathetic output to the heart from the neuraxis can protect against ventricular arrhythmias. The purpose of this study was to assess the value of thoracic epidural anesthesia (TEA) and left cardiac sympathetic denervation (LCSD) in the management of ventricular arrhythmias in patients with structu...
journal_title:Circulation
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCULATIONAHA.109.929703
更新日期:2010-06-01 00:00:00
abstract:BACKGROUND:Differences in vascular reactivity to phenylephrine (PE) responsiveness have been largely evidenced in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Because nitric oxide (NO) strongly affects modulation of the vascular tone in response to vasopressor agents, we hypothesized that the ...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/01.cir.99.24.3096
更新日期:1999-06-22 00:00:00
abstract:BACKGROUND:C-reactive protein (CRP) may have proatherogenic but also vasoprotective properties. We tested the hypothesis that the configuration of CRP (pentameric, or native [nCRP], versus monomeric, or modified [mCRP]) determines these different characteristics in an in vivo model. METHODS AND RESULTS:We investigated...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.105.556530
更新日期:2005-08-16 00:00:00
abstract:BACKGROUND:Low-density lipoprotein (LDL) impairs endothelial cell function by uncoupling endothelial nitric oxide synthase (eNOS) activity, which allows superoxide anion (O2*-)) to be generated rather than nitric oxide (*NO). Recent reports indicate that apolipoprotein (apo) A-1 mimetics inhibit the development of athe...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.0000061949.17174.b6
更新日期:2003-03-25 00:00:00
abstract:BACKGROUND:Coronary calcification detected by electron beam tomography may improve cardiovascular risk prediction. The technique is particularly promising in the elderly because the predictive power of cardiovascular risk factors weakens with age. We investigated the prognostic value of coronary calcification for cardi...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.104.488916
更新日期:2005-07-26 00:00:00
abstract::This study analyzes the response to overdrive suppression of junctional pacemakers (JP) and correlates it with symptoms in 21 patients. Junctional rhythm (JR) was seen in 5 patients with intact A-V conduction, and in 16 with complete heart block, the JPs were located proximal to or within the His bundle (BH). Junction...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.57.5.880
更新日期:1978-05-01 00:00:00
abstract:BACKGROUND:The safety and efficacy of percutaneous coronary intervention of de novo lesions in unprotected left main coronary arteries remains an unresolved issue. METHODS AND RESULTS:We analyzed 67 consecutive patients treated with the following devices: 39 with stents, 12 with rotational atherectomy plus stents, 13 ...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/01.cir.0000024983.34728.5d
更新日期:2002-08-06 00:00:00
abstract:BACKGROUND:Coronary blood flow occurs mainly during the diastolic phase of each cardiac cycle and is mainly dependent on diastolic driving pressure, especially in the left anterior descending coronary artery (LAD). We hypothesized that calculation of the ratio of the diastolic driving pressure of a stenotic LAD to its ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.102.19.2365
更新日期:2000-11-07 00:00:00
abstract:BACKGROUND:In the past few years, although significant efforts have been made to assess flow distribution during retrograde cerebral perfusion with microspheres, dye, or hydrogen clearance, flow distribution in real time is still undefined. We used MR perfusion imaging to monitor flow distribution in the brain during a...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1998-11-10 00:00:00
abstract::The effects of therapeutic levels of quinidine were studied in an ischemic gap preparation of reflected reentry. The preparation consisted of a Purkinje fiber mounted in a three-compartment chamber. A narrow central compartment was perfused with a solution prepared to mimic the extracellular milieu at a site of ischem...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.73.6.1342
更新日期:1986-06-01 00:00:00