European heart journal. Acute cardiovascular care
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Eur Heart J Acute Cardiovasc Care · Oct 2015
High sensitivity-troponin elevation secondary to non-coronary diagnoses and death and recurrent myocardial infarction: An examination against criteria of causality.
Myonecrosis provoked by illness unrelated to unstable coronary plaque is common, but uncertainty about a cause-effect relationship with future events challenges the appropriateness of initiating therapies known to be effective in cardiac conditions. We examined the causal relationship between troponin elevation in non-coronary diagnoses and late cardiac events using the Bradford Hills criteria for causality. ⋯ Consistency with causal criteria between secondary myonecrosis and cardiac events suggest the potential benefit for extending cardiac specific interventions to this population if supported in trials appropriately designed to address competing risks. Troponin elevation precipitated by non-coronary events is common and demonstrates an associations with late mortality that are analogous to spontaneous MI resulting from unstable coronary plaque. These observations help inform the design of randomized clinical trials exploring the benefits and risk of therapies with established benefits in other cardiac conditions. Such studies will need to appropriately account for competing risks in this population of patients.
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Eur Heart J Acute Cardiovasc Care · Oct 2015
Case ReportsFirst case of atypical takotsubo cardiomyopathy in a bilateral lung-transplanted patient due to acute respiratory failure.
Takotsubo cardiomyopathy which is characterised by a transient left ventricular wall motion abnormality was first described in 1990. The disease is still not well known, and as such it is suggested that an emotional trigger is mandatory in this disease. ⋯ Little is known about the association of hypoxia and takotsubo cardiomyopathy which can elicit a life-threatening condition requiring acute intensive care. Therefore, experimental studies are needed to investigate the role of hypoxia in takotsubo cardiomyopathy.
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Eur Heart J Acute Cardiovasc Care · Oct 2015
Observational StudyEarly rule-out of acute coronary syndrome using undetectable levels of high sensitivity troponin T.
To examine whether undetectable high sensitivity troponin T (hsTnT) can be used to safely rule out non-ST-elevation acute coronary syndrome (NSTE-ACS) (using the limit of detection (LOD) as the cut-off) and to compare this strategy to serial hsTnT and the use of combined hsTnT and copeptin. ⋯ A single hsTnT test at presentation, using the LOD as the cut-off, appears to be a safe and time-saving strategy to rule out NSTE-ACS. Further, undetectable levels of hsTnT were associated with an excellent prognosis and none of the patients with undetectable hsTnT were diagnosed with NSTEMI. Together with ECG and clinical assessment this biomarker strategy might permit outpatient treatment of almost one third of the patients we currently admit for observation.