European heart journal. Acute cardiovascular care
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Eur Heart J Acute Cardiovasc Care · Sep 2013
Multicenter StudyManagement of acute heart failure and the effect of systolic blood pressure on the use of intravenous therapies.
To examine the use of the treatments for acute heart failure (AHF) recommended by ESC guidelines in different clinical presentations and blood pressure groups. ⋯ The management of AHF differs between ESC clinical classes and the use of i.v. vasoactive therapies is related to the initial SBP. However, there seems to be room for improvement in administration of vasodilators and NIV.
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Eur Heart J Acute Cardiovasc Care · Sep 2013
Evaluation of the diagnostic performance of current and next-generation assays for cardiac troponin I in the BWH-TIMI ED Chest Pain Study.
Rapid diagnosis of acute coronary syndrome is a clinical and operational priority in busy emergency departments (ED). We examined the performance of an investigational troponin I (TnI) assay with 10-100-times greater sensitivity than current commercial assays. ⋯ Current and investigational Tn assays substantially increased clinical sensitivity and improved diagnostic accuracy for MI, despite a decline in specificity. A contemporary sensitive assay delivered similar overall accuracy to the investigational test, suggesting that we have reached a point of maximum diagnostic return with increasing analytical sensitivity.
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Eur Heart J Acute Cardiovasc Care · Sep 2013
The role of myeloperoxidase (MPO) for prognostic evaluation in sensitive cardiac troponin I negative chest pain patients in the emergency department.
The diagnostic work-up of patients with acute chest pain in the emergency department (ED) is a challenging task. Serial troponin testing is required to rule-out acute myocardial infarction. ⋯ MPO has an independent prognostic value overall and most notably in patients tested negative with a higher sensitive cardiac troponin I assay. MPO could be a promising biomarker for the initial evaluation of patients in chest pain units and is worth further investigation.
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Eur Heart J Acute Cardiovasc Care · Sep 2013
Observational StudyFGF-23 is associated with increased disease severity and early mortality in cardiogenic shock.
Despite the increased use of percutaneous interventions, infarction-related cardiogenic shock (CS) is still associated with high mortality. Biomarkers might be helpful to identify patients at risk, and point towards novel therapeutic strategies in CS. The phosphaturic hormone fibroblast growth factor 23 (FGF-23) has recently been introduced as a predictor for mortality in patients with chronic systolic heart failure. However, its predictive role in CS has not been investigated so far. ⋯ In CS, a tremendous increase in FGF-23 occurs, and high levels of FGF-23 are associated with poor outcome.
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Eur Heart J Acute Cardiovasc Care · Sep 2013
Randomized Controlled Trial Multicenter StudySafety of intravenous ivabradine in acute ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention: a randomized, placebo-controlled, double-blind, pilot study.
Rapid heart rate lowering may be attractive in acute ST-segment elevation myocardial infarction (STEMI). Accordingly we studied the effect of intravenous ivabradine on heart rate in this setting. ⋯ This pilot study shows that intravenous ivabradine may be used safely to slow the heart rate in STEMI. Further studies are needed to characterize its effect on infarct size, left ventricular function and clinical outcomes in this population.