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Milne B, John M, Evans R, Robertson S, Ó Scanaill P, Murphy GJ, Landoni G, Marber M, Clayton T, Kunst G. Comparison between propofol and total inhalational anaesthesia on cardiovascular outcomes following on-pump cardiac surgery in higher-risk patients: a randomised controlled pilot and feasibility study. Open Heart 2024; 11:e002630. [PMID: 38724266 PMCID: PMC11086547 DOI: 10.1136/openhrt-2024-002630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/14/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES Myocardial revascularisation and cardiopulmonary bypass (CPB) can cause ischaemia-reperfusion injury, leading to myocardial and other end-organ damage. Volatile anaesthetics protect the myocardium in experimental studies. However, there is uncertainty about whether this translates into clinical benefits because of the coadministration of propofol and its detrimental effects, restricting myocardial protective processes. METHODS In this single-blinded, parallel-group randomised controlled feasibility trial, higher-risk patients undergoing elective coronary artery bypass graft (CABG) surgery with an additive European System for Cardiac Operative Risk Evaluation ≥5 were randomised to receive either propofol or total inhalational anaesthesia as single agents for maintenance of anaesthesia. The primary outcome was the feasibility of recruiting and randomising 50 patients across two cardiac surgical centres, and secondary outcomes included the feasibility of collecting the planned perioperative data, clinically relevant outcomes and assessments of effective patient identification, screening and recruitment. RESULTS All 50 patients were recruited within 11 months in two centres, allowing for a 13-month hiatus in recruitment due to the COVID-19 pandemic. Overall, 50/108 (46%) of eligible patients were recruited. One patient withdrew before surgery and one patient did not undergo surgery. All but one completed in-hospital and 30-day follow-up. CONCLUSIONS It is feasible to recruit and randomise higher-risk patients undergoing CABG surgery to a study comparing total inhalational and propofol anaesthesia in a timely manner and with high acceptance and completion rates. TRIAL REGISTRATION NUMBER NCT04039854.
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Affiliation(s)
- Benjamin Milne
- Department of Anaesthetics and Pain Therapy, King's College Hospital NHS Foundation Trust, London, UK
| | - Martin John
- Department of Anaesthesia, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Richard Evans
- London School of Hygiene and Tropical Medicine, Medical Statistics, 1 Keppel Street, London WC1E 7HT, UK
| | - Steven Robertson
- London School of Hygiene and Tropical Medicine, Medical Statistics, 1 Keppel Street, London WC1E 7HT, UK
| | - Pádraig Ó Scanaill
- Department of Anaesthetics and Pain Therapy, King's College Hospital NHS Foundation Trust, London, UK
| | - Gavin J Murphy
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michael Marber
- School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK
| | - Tim Clayton
- London School of Hygiene and Tropical Medicine, Medical Statistics, 1 Keppel Street, London WC1E 7HT, UK
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Therapy, King's College Hospital NHS Foundation Trust, London, UK
- School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK
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Couch LS, Garrard JW, Henry JA, Kotronias RA, Alaour B, De Maria GL, Channon KM, Banning AP, Lyon AR, Marber M, Kaier TE. Comparison of troponin and natriuretic peptides in Takotsubo syndrome and acute coronary syndrome: a meta-analysis. Open Heart 2024; 11:e002607. [PMID: 38508657 PMCID: PMC10952941 DOI: 10.1136/openhrt-2024-002607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/16/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE Takotsubo syndrome (TTS) is an acute heart failure syndrome which resembles acute coronary syndrome (ACS) at presentation. Differentiation requires coronary angiography, but where this does not occur immediately, cardiac biomarkers may provide additional utility. We performed a meta-analysis to compare troponin and natriuretic peptides (NPs) in TTS and ACS to determine if differences in biomarker profile can aid diagnosis. METHODS We searched five literature databases for studies reporting NPs (Brain NP (BNP)/NT-pro-BNP) or troponin I/T in TTS and ACS, identifying 28 studies for troponin/NPs (5618 and 1145 patients, respectively). RESULTS Troponin was significantly lower in TTS than ACS (standardised mean difference (SMD) -0.86; 95% CI, -1.08 to -0.64; p<0.00001), with an absolute difference of 75 times the upper limit of normal (×ULN) higher in ACS than TTS. Conversely, NPs were significantly higher in TTS (SMD 0.62; 95% CI, 0.44 to 0.80; p<0.00001) and 5.8×ULN greater absolutely. Area under the curve (AUC) for troponin in ACS versus TTS was 0.82 (95% CI, 0.70 to 0.93), and 0.92 (95% CI, 0.80 to 1.00) for ST-segment elevation myocardial infarction versus TTS. For NPs, AUC was 0.69 (95% CI, 0.48 to 0.89). Combination of troponin and NPs with logistic regression did not improve AUC. Recursive Partitioning and Regression Tree analysis calculated a troponin threshold ≥26×ULN that identified 95% cases as ACS where and specificity for ACS were 85.71% and 53.57%, respectively, with 94.32% positive predictive value and 29.40% negative predictive value. CONCLUSIONS Troponin is lower and NPs higher in TTS versus ACS. Troponin had greater power than NPs at discriminating TTS and ACS, and with troponin ≥26×ULN patients are far more likely to have ACS.
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Affiliation(s)
- Liam Steven Couch
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - James W Garrard
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - John A Henry
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Rafail A Kotronias
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Bashir Alaour
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Giovanni Luigi De Maria
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Adrian P Banning
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | | | - Michael Marber
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Thomas Edward Kaier
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
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Hasselbalch RB, Alaour B, Kristensen JH, Couch LS, Kaier TE, Nielsen TL, Plesner LL, Strandkjær N, Schou M, Rydahl C, Goetze JP, Bundgaard H, Marber M, Iversen KK. Hemodialysis and biomarkers of myocardial infarction - a cohort study. Clin Chem Lab Med 2024; 62:361-370. [PMID: 37556843 DOI: 10.1515/cclm-2023-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVES End-stage renal disease is associated with a high risk of cardiovascular disease. We compared the concentration and prognostic ability of high sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) and cardiac myosin-binding protein C (cMyC) among stable hemodialysis patients. METHODS Patients were sampled before and after hemodialysis. We measured hs-cTnI, hs-cTnT and cMyC and used Cox regressions to assess the association between quartiles of concentrations and all-cause mortality and a combination of cardiovascular events and all-cause mortality during follow-up. RESULTS A total of 307 patients were included, 204 males, mean age 66 years (SD 14). Before dialysis, 299 (99 %) had a hs-cTnT concentration above the 99th percentile, compared to 188 (66 %) for cMyC and 35 (11 %) for hs-cTnI. Hs-cTnT (23 %, p<0.001) and hs-cTnI (15 %, p=0.049) but not cMyC (4 %, p=0.256) decreased during dialysis. Follow-up was a median of 924 days (492-957 days); patients in the 3rd and 4th quartiles of hs-cTnT (3rd:HR 3.0, 95 % CI 1.5-5.8, 4th:5.2, 2.7-9.8) and the 4th quartile of hs-cTnI (HR 3.8, 2.2-6.8) had an increased risk of mortality. Both were associated with an increased risk of the combined endpoint for patients in the 3rd and 4th quartiles. cMyC concentrations were not associated with risk of mortality or cardiovascular event. CONCLUSIONS Hs-cTnT was above the 99th percentile in almost all patients. This was less frequent for hs-cTnI and cMyC. High cTn levels were associated with a 3-5-fold higher mortality. This association was not present for cMyC. These findings are important for management of hemodialysis patients.
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Affiliation(s)
- Rasmus Bo Hasselbalch
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Bashir Alaour
- King's College London British Heart Foundation Centre, Rayne Institute, St Thomas' Hospital, London, UK
| | - Jonas Henrik Kristensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Liam S Couch
- King's College London British Heart Foundation Centre, Rayne Institute, St Thomas' Hospital, London, UK
| | - Thomas E Kaier
- King's College London British Heart Foundation Centre, Rayne Institute, St Thomas' Hospital, London, UK
| | - Ture Lange Nielsen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Louis Lind Plesner
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Nina Strandkjær
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Casper Rydahl
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Michael Marber
- King's College London British Heart Foundation Centre, Rayne Institute, St Thomas' Hospital, London, UK
| | - Kasper Karmark Iversen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Guldhaug NA, Røys EÅ, Viste K, Thorsby PM, Sylte MS, Torsvik J, Strand H, Alaour B, Marber M, Omland T, Aakre KM. Week-to-week within-subject and between-subject biological variation of copeptin. Clin Chem Lab Med 2024; 62:e29-e33. [PMID: 37533276 PMCID: PMC10725185 DOI: 10.1515/cclm-2023-0673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/23/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Nora Alicia Guldhaug
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Eirik Åsen Røys
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Kristin Viste
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Per Medbøe Thorsby
- Hormone Laboratory, Department of Medical Biochemistry and Biochemical Endocrinology and Metabolism Research Group, Oslo University Hospital, Aker, Oslo, Norway
- Institute of Clinical Medicine and University of Oslo, Oslo, Norway
| | | | - Janniche Torsvik
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Heidi Strand
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
| | - Bashir Alaour
- King’s BHF Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, London, UK
| | - Michael Marber
- Institute of Clinical Medicine and University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Institute of Clinical Medicine and University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Kristin Moberg Aakre
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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5
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Sinha A, Dutta U, Demir OM, De Silva K, Ellis H, Belford S, Ogden M, Li Kam Wa M, Morgan HP, Shah AM, Chiribiri A, Webb AJ, Marber M, Rahman H, Perera D. Rethinking False Positive Exercise Electrocardiographic Stress Tests by Assessing Coronary Microvascular Function. J Am Coll Cardiol 2024; 83:291-299. [PMID: 38199706 PMCID: PMC10790243 DOI: 10.1016/j.jacc.2023.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Exercise electrocardiographic stress testing (EST) has historically been validated against the demonstration of obstructive coronary artery disease. However, myocardial ischemia can occur because of coronary microvascular dysfunction (CMD) in the absence of obstructive coronary artery disease. OBJECTIVES The aim of this study was to assess the specificity of EST to detect an ischemic substrate against the reference standard of coronary endothelium-independent and endothelium-dependent microvascular function in patients with angina with nonobstructive coronary arteries (ANOCA). METHODS Patients with ANOCA underwent invasive coronary physiological assessment using adenosine and acetylcholine. CMD was defined as impaired endothelium-independent and/or endothelium-dependent function. EST was performed using a standard Bruce treadmill protocol, with ischemia defined as the appearance of ≥0.1-mV ST-segment depression 80 ms from the J-point on electrocardiography. The study was powered to detect specificity of ≥91%. RESULTS A total of 102 patients were enrolled (65% women, mean age 60 ± 8 years). Thirty-two patients developed ischemia (ischemic group) during EST, whereas 70 patients did not (nonischemic group); both groups were phenotypically similar. Ischemia during EST was 100% specific for CMD. Acetylcholine flow reserve was the strongest predictor of ischemia during exercise. Using endothelium-independent and endothelium-dependent microvascular dysfunction as the reference standard, the false positive rate of EST dropped to 0%. CONCLUSIONS In patients with ANOCA, ischemia on EST was highly specific of an underlying ischemic substrate. These findings challenge the traditional belief that EST has a high false positive rate.
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Affiliation(s)
- Aish Sinha
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom. https://twitter.com/AishSinha1
| | - Utkarsh Dutta
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Ozan M Demir
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Kalpa De Silva
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Howard Ellis
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Samuel Belford
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Mark Ogden
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Matthew Li Kam Wa
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Holly P Morgan
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Ajay M Shah
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Amedeo Chiribiri
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Andrew J Webb
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Michael Marber
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Haseeb Rahman
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom.
| | - Divaka Perera
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom. https://twitter.com/divaka_perera
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Sinha A, Rahman H, Douiri A, Demir OM, De Silva K, Clapp B, Webb I, Gulati A, Pinho P, Dutta U, Ellis H, Shah AM, Chiribiri A, Marber M, Webb AJ, Perera D. ChaMP-CMD: A Phenotype-Blinded, Randomized Controlled, Cross-Over Trial. Circulation 2024; 149:36-47. [PMID: 37905403 PMCID: PMC10752262 DOI: 10.1161/circulationaha.123.066680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/09/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Angina with nonobstructive coronary arteries is a common condition for which no effective treatment has been established. We hypothesized that the measurement of coronary flow reserve (CFR) allows identification of patients with angina with nonobstructive coronary arteries who would benefit from anti-ischemic therapy. METHODS Patients with angina with nonobstructive coronary arteries underwent blinded invasive CFR measurement and were randomly assigned to receive 4 weeks of amlodipine or ranolazine. After a 1-week washout, they crossed over to the other drug for 4 weeks; final assessment was after the cessation of study medication for another 4 weeks. The primary outcome was change in treadmill exercise time, and the secondary outcome was change in Seattle Angina Questionnaire summary score in response to anti-ischemic therapy. Analysis was on a per protocol basis according to the following classification: coronary microvascular disease (CMD group) if CFR<2.5 and reference group if CFR≥2.5. The study protocol was registered before the first patient was enrolled (International Standard Randomised Controlled Trial Number: ISRCTN94728379). RESULTS Eighty-seven patients (61±8 years of age; 62% women) underwent random assignment (57 CMD group and 30 reference group). Baseline exercise time and Seattle Angina Questionnaire summary scores were similar between groups. The CMD group had a greater increment (delta) in exercise time than the reference group in response to both amlodipine (difference in delta, 82 s [95% CI, 37-126 s]; P<0.001) and ranolazine (difference in delta, 68 s [95% CI, 21-115 s]; P=0.005). The CMD group reported a greater increment (delta) in Seattle Angina Questionnaire summary score than the reference group in response to ranolazine (difference in delta, 7 points [95% CI, 0-15]; P=0.048), but not to amlodipine (difference in delta, 2 points [95% CI, -5 to 8]; P=0.549). CONCLUSIONS Among phenotypically similar patients with angina with nonobstructive coronary arteries, only those with an impaired CFR derive benefit from anti-ischemic therapy. These findings support measurement of CFR to diagnose and guide management of this otherwise heterogeneous patient group.
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Affiliation(s)
- Aish Sinha
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
| | - Haseeb Rahman
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
| | - Abdel Douiri
- Department of Medical Statistics, School of Life Course & Population Sciences (A.D.), King’s College London, UK
| | - Ozan M. Demir
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
| | - Kalpa De Silva
- Guys’ and St. Thomas’ NHS Foundation Trust, London, UK (K.D.S., B.C., I.W., A.G., P.P., A.J.W., D.P.)
| | - Brian Clapp
- Guys’ and St. Thomas’ NHS Foundation Trust, London, UK (K.D.S., B.C., I.W., A.G., P.P., A.J.W., D.P.)
| | - Ian Webb
- Guys’ and St. Thomas’ NHS Foundation Trust, London, UK (K.D.S., B.C., I.W., A.G., P.P., A.J.W., D.P.)
- King’s College Hospital NHS Foundation Trust, London. UK (I.W., A.M.S.)
| | - Ankur Gulati
- Guys’ and St. Thomas’ NHS Foundation Trust, London, UK (K.D.S., B.C., I.W., A.G., P.P., A.J.W., D.P.)
| | - Pedro Pinho
- Guys’ and St. Thomas’ NHS Foundation Trust, London, UK (K.D.S., B.C., I.W., A.G., P.P., A.J.W., D.P.)
| | - Utkarsh Dutta
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
| | - Howard Ellis
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
| | - Ajay M. Shah
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
- King’s College Hospital NHS Foundation Trust, London. UK (I.W., A.M.S.)
| | - Amedeo Chiribiri
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
| | - Michael Marber
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
| | - Andrew J. Webb
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
- Guys’ and St. Thomas’ NHS Foundation Trust, London, UK (K.D.S., B.C., I.W., A.G., P.P., A.J.W., D.P.)
| | - Divaka Perera
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
- Guys’ and St. Thomas’ NHS Foundation Trust, London, UK (K.D.S., B.C., I.W., A.G., P.P., A.J.W., D.P.)
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Sinha A, Rahman H, Rajani R, Demir OM, Li KamWa M, Morgan H, Ezad SM, Ellis H, Hogan D, Gulati A, Shah AM, Chiribiri A, Webb AJ, Marber M, Perera D. Characterizing Mechanisms of Ischemia in Patients With Myocardial Bridges. Circ Cardiovasc Interv 2024; 17:e013657. [PMID: 37929596 PMCID: PMC10782941 DOI: 10.1161/circinterventions.123.013657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Myocardial bridges (MBs) are prevalent and can be associated with acute and chronic ischemic syndromes. We sought to determine the substrates for ischemia in patients with angina with nonobstructive coronary arteries and a MB in the left anterior descending artery. METHODS Patients with angina with nonobstructive coronary arteries underwent the acquisition of intracoronary pressure and flow during rest, supine bicycle exercise, and adenosine infusion. Coronary wave intensity analysis was performed, with perfusion efficiency defined as accelerating wave energy/total wave energy (%). Epicardial endothelial dysfunction was defined as a reduction in epicardial vessel diameter ≥20% in response to intracoronary acetylcholine infusion. Patients with angina with nonobstructive coronary arteries and a MB were compared with 2 angina with nonobstructive coronary arteries groups with no MB: 1 with coronary microvascular disease (CMD: coronary flow reserve, <2.5) and 1 with normal coronary flow reserve (reference: coronary flow reserve, ≥2.5). RESULTS Ninety-two patients were enrolled in the study (30 MB, 33 CMD, and 29 reference). Fractional flow reserve in these 3 groups was 0.86±0.05, 0.92±0.04, and 0.94±0.05; coronary flow reserve was 2.5±0.5, 2.0±0.3, and 3.2±0.6. Perfusion efficiency increased numerically during exercise in the reference group (65±9%-69±13%; P=0.063) but decreased in the CMD (68±10%-50±10%; P<0.001) and MB (66±9%-55±9%; P<0.001) groups. The reduction in perfusion efficiency had distinct causes: in CMD, this was driven by microcirculation-derived energy in early diastole, whereas in MB, this was driven by diminished accelerating wave energy, due to the upstream bridge, in early systole. Epicardial endothelial dysfunction was more common in the MB group (54% versus 29% reference and 38% CMD). Overall, 93% of patients with a MB had an identifiable ischemic substrate. CONCLUSIONS MBs led to impaired coronary perfusion efficiency during exercise, which was due to diminished accelerating wave energy in early systole compared with the reference group. Additionally, there was a high prevalence of endothelial and microvascular dysfunction. These ischemic mechanisms may represent distinct treatment targets.
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Affiliation(s)
- Aish Sinha
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Haseeb Rahman
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Ronak Rajani
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom (R.R., D.H., A.G., D.P.)
| | - Ozan M. Demir
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Matthew Li KamWa
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Holly Morgan
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Saad M. Ezad
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Howard Ellis
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Dexter Hogan
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom (R.R., D.H., A.G., D.P.)
| | - Ankur Gulati
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom (R.R., D.H., A.G., D.P.)
| | - Ajay M. Shah
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Amedeo Chiribiri
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Andrew J. Webb
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Michael Marber
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Divaka Perera
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom (R.R., D.H., A.G., D.P.)
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8
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Alaour B, Kaier TE, Hasselbalch RB, van Doorn W, Meex S, Marber M. Direct Comparison of the Circadian Rhythm of Cardiac Myosin-Binding Protein C (cMyC) and Cardiac Troponin. J Appl Lab Med 2023:7179258. [PMID: 37226050 DOI: 10.1093/jalm/jfad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Bashir Alaour
- King's College London British Heart Foundation Centre of Clinical Excellence, London, United Kingdom
| | - Thomas E Kaier
- King's College London British Heart Foundation Centre of Clinical Excellence, London, United Kingdom
| | - Rasmus Bo Hasselbalch
- King's College London British Heart Foundation Centre of Clinical Excellence, London, United Kingdom
| | - William van Doorn
- Department of Clinical Chemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Steven Meex
- Department of Clinical Chemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michael Marber
- King's College London British Heart Foundation Centre of Clinical Excellence, London, United Kingdom
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9
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Røys EÅ, Guldhaug NA, Viste K, Jones GD, Alaour B, Sylte MS, Torsvik J, Kellmann R, Strand H, Theodorsson E, Marber M, Omland T, Aakre KM. Sex Hormones and Adrenal Steroids: Biological Variation Estimated Using Direct and Indirect Methods. Clin Chem 2023; 69:100-109. [PMID: 36373220 DOI: 10.1093/clinchem/hvac175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Biological variation (BV) data may be used to develop analytical performance specifications (APS), reference change values (RCV), and support the applicability of population reference intervals. This study estimates within-subject BV (CVI) for several endocrine biomarkers using 3 different methodological approaches. METHODS For the direct method, 30 healthy volunteers were sampled weekly for 10 consecutive weeks. Samples were analyzed in duplicate for 17-hydroxyprogesterone (17-OHP), androstenedione, cortisol, cortisone, estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), sex hormone-binding globulin (SHBG), and testosterone. A CV-ANOVA with outlier removal and a Bayesian model were applied to derive the CVI. For estradiol, FSH and LH, only the male subgroup was included. In the indirect method, using the same analytes and groups, pairs of sequential results were extracted from the laboratory information system. The total result variation for individual pairs was determined by identifying a central gaussian distribution in the ratios of the result pairs. The CVI was then estimated by removing the effect of analytical variation. RESULTS The estimated CVI from the Bayesian model (μCVP(i)) in the total cohort was: 17-OHP, 23%; androstenedione, 20%; cortisol, 18%; cortisone, 11%; SHBG, 7.4%; testosterone, 16%; and for the sex hormones in men: estradiol, 14%; FSH, 8%; and LH, 26%. CVI-heterogeneity was present for most endocrine markers. Similar CVI data were estimated using the CV-ANOVA and the indirect method. CONCLUSIONS Similar CVI data were obtained using 2 different direct and one indirect method. The indirect approach is a low-cost alternative ensuring implementation of CVI data applicable for local conditions.
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Affiliation(s)
- Eirik Åsen Røys
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Nora Alicia Guldhaug
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Kristin Viste
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Graham Dallas Jones
- Department of Chemical Pathology, SydPath, St. Vincent's Hospital, Sydney, Darlinghurst, NSW, Australia.,Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Bashir Alaour
- King's BHF Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | | | - Janniche Torsvik
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Ralf Kellmann
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Heidi Strand
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
| | - Elvar Theodorsson
- Department of Clinical Chemistry, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Michael Marber
- King's BHF Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Torbjørn Omland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Kristin Moberg Aakre
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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10
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Ryan M, De Silva K, Morgan H, O’Gallagher K, Demir OM, Rahman H, Ellis H, Dancy L, Sado D, Strange J, Melikian N, Marber M, Shah AM, Chiribiri A, Perera D. Coronary Wave Intensity Analysis as an Invasive and Vessel-Specific Index of Myocardial Viability. Circ Cardiovasc Interv 2022; 15:e012394. [PMID: 36538582 PMCID: PMC9760472 DOI: 10.1161/circinterventions.122.012394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/28/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Coronary angiography and viability testing are the cornerstones of diagnosing and managing ischemic cardiomyopathy. At present, no single test serves both needs. Coronary wave intensity analysis interrogates both contractility and microvascular physiology of the subtended myocardium and therefore has the potential to fulfil the goal of completely assessing coronary physiology and myocardial viability in a single procedure. We hypothesized that coronary wave intensity analysis measured during coronary angiography would predict viability with a similar accuracy to late-gadolinium-enhanced cardiac magnetic resonance imaging. METHODS Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. Coronary wave intensity analysis was assessed during cardiac catheterization at rest, during adenosine-induced hyperemia, and during low-dose dobutamine stress using a dual pressure-Doppler sensing coronary guidewire. Scar burden was assessed with cardiac magnetic resonance imaging. Regional left ventricular function was assessed at baseline and 6-month follow-up after optimization of medical-therapy±revascularization, using transthoracic echocardiography. The primary outcome was myocardial viability, determined by the retrospective observation of functional recovery. RESULTS Forty participants underwent baseline physiology, cardiac magnetic resonance imaging, and echocardiography, and 30 had echocardiography at 6 months; 21/42 territories were viable on follow-up echocardiography. Resting backward compression wave energy was significantly greater in viable than in nonviable territories (-5240±3772 versus -1873±1605 W m-2 s-1, P<0.001), and had comparable accuracy to cardiac magnetic resonance imaging for predicting viability (area under the curve 0.812 versus 0.757, P=0.649); a threshold of -2500 W m-2 s-1 had 86% sensitivity and 76% specificity. CONCLUSIONS Backward compression wave energy has accuracy similar to that of late-gadolinium-enhanced cardiac magnetic resonance imaging in the prediction of viability. Coronary wave intensity analysis has the potential to streamline the management of ischemic cardiomyopathy, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.
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Affiliation(s)
- Matthew Ryan
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Kalpa De Silva
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Holly Morgan
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Kevin O’Gallagher
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Ozan M. Demir
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Haseeb Rahman
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Howard Ellis
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Luke Dancy
- Cardiology Department, King’s College Hospital, London, UK (L.D., D.S., N.M.)
| | - Daniel Sado
- Cardiology Department, King’s College Hospital, London, UK (L.D., D.S., N.M.)
| | | | | | - Michael Marber
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Ajay M. Shah
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Amedeo Chiribiri
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
- Imaging Sciences Division, King’s College London, UK (A.C.)
| | - Divaka Perera
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
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11
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Aziz W, Morgan H, Demir OM, Sinha A, Rua T, Rajani R, Chang AL, Woo E, Mak SM, Benedetti G, Villa A, Preston R, Navin R, O'Kane K, Hunter L, Ismail T, Carr-White G, Beckley-Hoelscher N, Peacock J, Marber M, Razavi R, Perera D. Prospective RandOmised Trial of Emergency Cardiac Computerised Tomography (PROTECCT). Heart 2022; 108:1972-1978. [PMID: 36288924 PMCID: PMC9726962 DOI: 10.1136/heartjnl-2022-320990] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/10/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Many patients presenting with suspected acute coronary syndrome (ACS) have high-sensitivity cardiac troponin (hs-cTn) concentrations between rule-in and rule-out thresholds and hence need serial testing, which is time consuming. The Prospective RandOmised Trial of Emergency Cardiac Computerised Tomography (PROTECCT) assessed the utility of coronary CT angiography (CCTA) in patients with suspected ACS, non-ischaemic ECG and intermediate initial hs-cTn concentration. METHODS Patients were randomised to CCTA-guided management versus standard of care (SOC). The primary outcome was hospital length of stay (LOS). Secondary outcomes included cost of in-hospital stay and major adverse cardiac events (MACE) at 12 months of follow-up. Data are mean (SD); for LOS harmonic means, IQRs are shown. RESULTS 250 (aged 55 (14) years, 25% women) patients were randomised. Harmonic mean (IQR) LOS was 7.53 (6.0-9.6) hours in the CCTA arm and 8.14 (6.3-9.8) hours in the SOC arm (p=0.13). Inpatient cost was £1285 (£2216) and £1108 (£3573), respectively, p=0.68. LOS was shorter in the CCTA group in patients with <25% stenosis, compared with SOC; 6.6 (5.6-7.8) hours vs 7.5 (6.1-9.4) hours, respectively; p=0.021. More referrals for cardiology outpatient clinic review and cardiac CT-related outpatient referrals occurred in the SOC arm (p=0.01). 12-month MACE rates were similar between the two arms (7 (5.6%) in the CCTA arm and 8 (6.5%) in the SOC arm-log-rank p=0.78). CONCLUSIONS CCTA did not lead to reduced hospital LOS or cost, largely because these outcomes were influenced by the detection of ≥25% grade stenosis in a proportion of patients. TRIAL REGISTRATION NUMBER NCT03583320.
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Affiliation(s)
- Waqar Aziz
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Holly Morgan
- British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Ozan M Demir
- British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Aish Sinha
- British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Tiago Rua
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Ai-Lee Chang
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Eric Woo
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Sze Mun Mak
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | - Adriana Villa
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Rebecca Preston
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Roshan Navin
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Kevin O'Kane
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Laura Hunter
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Tevfik Ismail
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | | | - Janet Peacock
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA
| | - Michael Marber
- British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Divaka Perera
- British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
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12
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Ryan M, Morgan H, O'Gallagher K, Demir O, Rahman H, Ellis H, Dancy L, Sado D, Strange J, Melikian N, Marber M, Shah A, De Silva K, Chiribiri A, Perera D. Coronary wave energy to predict functional recovery in patients with ischemic left ventricular dysfunction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Invasive coronary angiography and non-invasive viability testing are the cornerstones of diagnosing and managing ischemic left ventricular dysfunction. At present there is no single test which serves both needs but, if developed, could revolutionise investigation of this condition. Coronary wave intensity analysis (cWIA) interrogates both contractility and microvascular physiology of the subtended myocardium [1,2] and therefore has the potential to fulfil this goal.
Objectives
We hypothesized that cWIA measured during coronary angiography would predict functional recovery with a similar accuracy to late gadolinium enhanced cardiac magnetic resonance imaging (LGE-CMR).
Methods
Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. cWIA, fractional flow reserve and microvascular resistance were assessed with a simultaneous coronary Doppler and pressure-sensing guidewire during cardiac catheterization at rest, during hyperaemia and during low-dose dobutamine stress. Viability was assessed using LGE-CMR. Regional left ventricular function was assessed at baseline and 6-month follow up after optimization of medical therapy +/− revascularization, using transthoracic echocardiography. The primary outcome was regional functional recovery.
Results
Forty participants underwent baseline physiology, LGE-CMR and thirty had echocardiography at baseline and 6 months; 21/42 territories demonstrated functional recovery. Resting backward compression wave energy was significantly greater in recovering than non-recovering territories (−5240±3772 vs. −1873±1605 W m–2 s–1, p=0.099, Figure 1), and had comparable diagnostic accuracy to CMR (area under the curve 0.812 vs. 0.757, p=0.649, Figure 2); a threshold of −2500 W mm–2 s–1 had 86% sensitivity and 76% specificity at predicting recovery. Backward expansion wave energy did not predict recovery. FFR was numerically higher in recovering territories (0.81±0.17 vs. 0.71±0.16, p=0.058), whilst hyperaemic microvascular resistance did not differentiate recovering from non-recovering territories (1.97±0.73 vs. 2.29±1.00, p=0.287). The likelihood of functional recovery was similar in revascularised and non-revascularised territories (15/29 vs. 6/13 respectively, p=0.739). Low-dose dobutamine stress increased the energy of all waves, but did not improve the accuracy of cWIA in predicting recovery. In a regression model, resting backward compression wave energy and optimization of medical therapy predicted functional recovery; fractional flow reserve and hyperemic microvascular resistance did not.
Conclusions
Backward compression wave energy has similar accuracy to LGE-CMR in the prediction of functional recovery. cWIA has the potential to revolutionise the management of ischaemic left ventricular dysfunction, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The British Heart Foundation Clinical Research Training Fellowship
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Affiliation(s)
- M Ryan
- King's College London , London , United Kingdom
| | - H Morgan
- King's College London , London , United Kingdom
| | | | - O Demir
- King's College London , London , United Kingdom
| | - H Rahman
- King's College London , London , United Kingdom
| | - H Ellis
- King's College London , London , United Kingdom
| | - L Dancy
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - D Sado
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - J Strange
- Bristol Heart Institute , Bristol , United Kingdom
| | - N Melikian
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - M Marber
- King's College London , London , United Kingdom
| | - A Shah
- King's College London , London , United Kingdom
| | - K De Silva
- King's College London , London , United Kingdom
| | - A Chiribiri
- King's College London , London , United Kingdom
| | - D Perera
- King's College London , London , United Kingdom
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13
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Lecour S, Du Pré BC, Bøtker HE, Brundel BJJM, Daiber A, Davidson SM, Ferdinandy P, Girao H, Gollmann-Tepeköylü C, Gyöngyösi M, Hausenloy DJ, Madonna R, Marber M, Perrino C, Pesce M, Schulz R, Sluijter JPG, Steffens S, Van Linthout S, Young ME, Van Laake LW. Circadian rhythms in ischaemic heart disease: key aspects for preclinical and translational research: position paper of the ESC working group on cellular biology of the heart. Cardiovasc Res 2022; 118:2566-2581. [PMID: 34505881 DOI: 10.1093/cvr/cvab293] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/04/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022] Open
Abstract
Circadian rhythms are internal regulatory processes controlled by molecular clocks present in essentially every mammalian organ that temporally regulate major physiological functions. In the cardiovascular system, the circadian clock governs heart rate, blood pressure, cardiac metabolism, contractility, and coagulation. Recent experimental and clinical studies highlight the possible importance of circadian rhythms in the pathophysiology, outcome, or treatment success of cardiovascular disease, including ischaemic heart disease. Disturbances in circadian rhythms are associated with increased cardiovascular risk and worsen outcome. Therefore, it is important to consider circadian rhythms as a key research parameter to better understand cardiac physiology/pathology, and to improve the chances of translation and efficacy of cardiac therapies, including those for ischaemic heart disease. The aim of this Position Paper by the European Society of Cardiology Working Group Cellular Biology of the Heart is to highlight key aspects of circadian rhythms to consider for improvement of preclinical and translational studies related to ischaemic heart disease and cardioprotection. Applying these considerations to future studies may increase the potential for better translation of new treatments into successful clinical outcomes.
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Affiliation(s)
- Sandrine Lecour
- Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Bastiaan C Du Pré
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bianca J J M Brundel
- Department of Physiology, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Andreas Daiber
- Department of Cardiology, Molecular Cardiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Peter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Pharmahungary Group, Szeged, Hungary
| | - Henrique Girao
- Faculty of Medicine, Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Center for Innovative Biomedicine and Biotechnology (CIBB), Clinical Academic Centre of Coimbra (CACC), Coimbra, Portugal
| | | | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Derek J Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
- The Hatter Cardiovascular Institute, University College London, London, UK
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung City, Taiwan
| | - Rosalinda Madonna
- Institute of Cardiology, University of Pisa, Pisa, Italy
- Department of Internal Medicine, University of Texas Medical School in Houston, Houston, TX, USA
| | - Michael Marber
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Cinzia Perrino
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maurizio Pesce
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Rainer Schulz
- Institute of Physiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Joost P G Sluijter
- Department of Cardiology, Experimental Cardiology Laboratory, Regenerative Medicine Center, Circulatory Health Laboratory, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sabine Steffens
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-University, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Sophie Van Linthout
- Berlin Institute of Health Center for Regenerative Therapies & Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, Berlin 10178, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Martin E Young
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Linda W Van Laake
- Cardiology and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands
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14
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Kaier TE, Twerenbold R, Lopez-Ayala P, Nestelberger T, Boeddinghaus J, Alaour B, Huber IM, Zhi Y, Koechlin L, Wussler D, Wildi K, Shrestha S, Strebel I, Miro O, Martín-Sánchez JF, Christ M, Kawecki D, Keller DI, Rubini Gimenez M, Marber M, Mueller C. A 0/1h-algorithm using cardiac myosin-binding protein C for early diagnosis of myocardial infarction. Eur Heart J Acute Cardiovasc Care 2022; 11:325-335. [PMID: 35149868 PMCID: PMC9173679 DOI: 10.1093/ehjacc/zuac007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 11/13/2022]
Abstract
AIMS Cardiac myosin-binding protein C (cMyC) demonstrated high diagnostic accuracy for the early detection of non-ST-elevation myocardial infarction (NSTEMI). Its dynamic release kinetics may enable a 0/1h-decision algorithm that is even more effective than the ESC hs-cTnT/I 0/1 h rule-in/rule-out algorithm. METHODS AND RESULTS In a prospective international diagnostic study enrolling patients presenting with suspected NSTEMI to the emergency department, cMyC was measured at presentation and after 1 h in a blinded fashion. Modelled on the ESC hs-cTnT/I 0/1h-algorithms, we derived a 0/1h-cMyC-algorithm. Final diagnosis of NSTEMI was centrally adjudicated according to the 4th Universal Definition of Myocardial Infarction. Among 1495 patients, the prevalence of NSTEMI was 17%. The optimal derived 0/1h-algorithm ruled-out NSTEMI with cMyC 0 h concentration below 10 ng/L (irrespective of chest pain onset) or 0 h cMyC concentrations below 18 ng/L and 0/1 h increase <4 ng/L. Rule-in occurred with 0 h cMyC concentrations of at least 140 ng/L or 0/1 h increase ≥15 ng/L. In the validation cohort (n = 663), the 0/1h-cMyC-algorithm classified 347 patients (52.3%) as 'rule-out', 122 (18.4%) as 'rule-in', and 194 (29.3%) as 'observe'. Negative predictive value for NSTEMI was 99.6% [95% confidence interval (CI) 98.9-100%]; positive predictive value 71.1% (95% CI 63.1-79%). Direct comparison with the ESC hs-cTnT/I 0/1h-algorithms demonstrated comparable safety and even higher triage efficacy using the 0h-sample alone (48.1% vs. 21.2% for ESC hs-cTnT-0/1 h and 29.9% for ESC hs-cTnI-0/1 h; P < 0.001). CONCLUSION The cMyC 0/1h-algorithm provided excellent safety and identified a greater proportion of patients suitable for direct rule-out or rule-in based on a single measurement than the ESC 0/1h-algorithm using hs-cTnT/I. TRIAL REGISTRATION ClinicalTrials.gov number, NCT00470587.
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Grants
- FS/15/13/31320 British Heart Foundation
- G1000737 Medical Research Council
- Swiss National Science Foundation
- TG/15/1/31518, FS/15/13/31320 British Heart Foundation
- European Union
- Swiss Heart Foundation
- University of Basel
- University Hospital Basel, Abbott, Brahms, Beckman Coulter, Quidel, Ortho Clinical Diagnostics, Roche, Singulex, and Siemens
- Medical Research Council (London, UK)
- Guy's and St Thomas' Charity
- UK Department of Health through the National Institute for Health Research Biomedical Research Centre
- Guy’s & St Thomas’ National Health Service Foundation Trust
- NIHR clinical lectureship
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Affiliation(s)
- Thomas E Kaier
- King’s College London BHF Centre, The Rayne Institute, St Thomas’ Hospital, London, UK
| | - Raphael Twerenbold
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT Network
- University Center of Cardiovascular Science and Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Pedro Lopez-Ayala
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT Network
| | - Thomas Nestelberger
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT Network
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasper Boeddinghaus
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT Network
| | - Bashir Alaour
- King’s College London BHF Centre, The Rayne Institute, St Thomas’ Hospital, London, UK
| | - Iris-Martina Huber
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT Network
| | - Yuan Zhi
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT Network
| | - Luca Koechlin
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT Network
- Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Desiree Wussler
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT Network
| | - Karin Wildi
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT Network
- Critical Care Research Institute, The Prince Charles Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Samyut Shrestha
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT Network
| | - Ivo Strebel
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT Network
| | - Oscar Miro
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT Network
- Emergency Department, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Javier F Martín-Sánchez
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT Network
- Emergency Department, Hospital Clinico San Carlos, Madrid, Spain
| | - Michael Christ
- GREAT Network
- Department of Emergency Medicine, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Damien Kawecki
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT Network
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - Maria Rubini Gimenez
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT Network
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig Heart Institute, 04289 Leipzig, Germany
| | - Michael Marber
- King’s College London BHF Centre, The Rayne Institute, St Thomas’ Hospital, London, UK
| | - Christian Mueller
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT Network
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15
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Hasselbalch RB, Kristensen JH, Jørgensen N, Strandkjær N, Alaour B, Afzal S, Marber M, Bundgaard H, Iversen KK. High incidence of discrepancies in new Siemens assay - A comparison of cardiac troponin I assays. Clin Chem Lab Med 2022; 60:921-929. [PMID: 35411761 DOI: 10.1515/cclm-2022-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/28/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiac Troponin (cTn) is the biochemical gold standard for diagnosing myocardial infarction (MI). We compared the Siemens ADVIA Centaur high-sensitivity (hs-cTnI) assay with the Siemens Ultra assay (cTnI-U). METHODS Over 3 months cTnI-U and hs-cTnI were measured simultaneously at Herlev-Gentofte Hospital. Acute myocardial injury was diagnosed using the 4th universal definition. Disputed cases were adjudicated using clinical data. We compared diagnostic accuracy using area under the curve (AUC) of the receiver operating characteristic. Outliers in between-assay differences were defined as a factor-5 difference and ≥1 measurement >40 ng/L. Patients with outlier differences were invited for re-sampling and tested with serial dilution and heterophilic blocking tubes. RESULTS From the 18th January to the 20th April 2019, 4,369 samples on 2,658 patients were included. cTnI-U measured higher concentrations than hs-cTnI (mean 23%, -52-213%), resulting in a higher frequency of acute myocardial injury, 255 (9.6%) vs 203 (7.6%), p<0.001. This remained significant after adjudication, 212 vs 197, p<0.001. AUC for the prediction of MI for was 0.963 for cTnI-U and 0.959 for hs-cTnI, p=0.001. Outlier differences were seen in 35 (1.2%) patients, primarily with elevated hs-cTnI (n=33, 94%). On two re-samplings (median 144 and 297 days since inclusion), 16 of 20 (80%) and 11 of 11 had sustained elevation of hs-cTnI. The samples showed no signs of heterophilic antibodies. CONCLUSIONS Using hs-cTnI resulted in a subset of patients with large, discrepant elevations in concentration. These patients still had elevated hs-cTnI 6-10 months post admission but no heterophilic antibodies.
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Affiliation(s)
- Rasmus Bo Hasselbalch
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Cardiology Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Jonas Henrik Kristensen
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Cardiology Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Nicoline Jørgensen
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Cardiology Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Nina Strandkjær
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Cardiology Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Bashir Alaour
- King's College London British Heart Foundation Centre, Rayne Institute, St Thomas' Hospital, London, UK
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Michael Marber
- King's College London British Heart Foundation Centre, Rayne Institute, St Thomas' Hospital, London, UK
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Cardiology Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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16
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Alaour B, Omland T, Torsvik J, Kaier TE, Sylte MS, Strand H, Quraishi J, McGrath S, Williams L, Meex S, Redwood S, Marber M, Aakre KM. Biological variation of cardiac myosin-binding protein C in healthy individuals. Clin Chem Lab Med 2022; 60:576-583. [PMID: 34162037 DOI: 10.1515/cclm-2021-0306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/10/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Cardiac myosin-binding protein C (cMyC) is a novel biomarker of myocardial injury, with a promising role in the triage and risk stratification of patients presenting with acute cardiac disease. In this study, we assess the weekly biological variation of cMyC, to examine its potential in monitoring chronic myocardial injury, and to suggest analytical quality specification for routine use of the test in clinical practice. METHODS Thirty healthy volunteers were included. Non-fasting samples were obtained once a week for ten consecutive weeks. Samples were tested in duplicate on the Erenna® platform by EMD Millipore Corporation. Outlying measurements and subjects were identified and excluded systematically, and homogeneity of analytical and within-subject variances was achieved before calculating the biological variability (CVI and CVG), reference change values (RCV) and index of individuality (II). RESULTS Mean age was 38 (range, 21-64) years, and 16 participants were women (53%). The biological variation, RCV and II with 95% confidence interval (CI) were: CVA (%) 19.5 (17.8-21.6), CVI (%) 17.8 (14.8-21.0), CVG (%) 66.9 (50.4-109.9), RCV (%) 106.7 (96.6-120.1)/-51.6 (-54.6 to -49.1) and II 0.42 (0.29-0.56). There was a trend for women to have lower CVG. The calculated RCVs were comparable between genders. CONCLUSIONS cMyC exhibits acceptable RCV and low II suggesting that it could be suitable for disease monitoring, risk stratification and prognostication if measured serially. Analytical quality specifications based on biological variation are similar to those for cardiac troponin and should be achievable at clinically relevant concentrations.
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Affiliation(s)
- Bashir Alaour
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Torbjørn Omland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Janniche Torsvik
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Thomas E Kaier
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Marit S Sylte
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Heidi Strand
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
| | - Jasmine Quraishi
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | | | | | - Steven Meex
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - Simon Redwood
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Michael Marber
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Kristin M Aakre
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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17
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Aakre KM, Ottesen AH, Strand H, Faaren AL, Alaour B, Torsvik J, Sylte MS, Marber M, Christensen G, Røsjø H, Omland T. Biological variation of secretoneurin; a novel cardiovascular biomarker implicated in arrhythmogenesis. Clin Biochem 2021; 98:74-77. [PMID: 34624255 DOI: 10.1016/j.clinbiochem.2021.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/24/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Secretoneurin is a novel prognostic biomarker that may predict mortality in heart failure and the occurrence of ventricular arrhythmias. This study reports the within subject variation (CVI), between subject variation (CVG), reference change values (RCV) and index of individuality (II) of secretoneurin. METHODS Thirty healthy volunteers were included. Non-fasting samples were obtained between 8 and 10 am once a week for ten weeks. Secretoneurin was analyzed in duplicate using ELISA. No outliers were present according to Burnett and Reeds' criteria. Simple linear regression did not identify significant trends. Variance homogeneity in the analytical variance and CVI were tested using Cochrane's and Bartlett's tests and four participants were excluded. Calculation of CVI, CVG and RCV were done on ln transformed data as described by Fokkema, the II was calculated using retransformed data. RESULTS The median age of the participants was 36 years and 53% were female. Non-fasting glucose, eGFR(CKD-EPI), cTnT and NT-proBNP concentrations were within the normal range. Median secretoneurin concentrations were 38 pmol/L (women) and 33 pmol/L (men), p-value < 0.001. CVI and CVG were 9.8% (CI 8.7% to 11.0%) and 20.0 (CI 15.4% to 28.0%), respectively. RCV were 38.7% (CI 35.5% to 42.7%) and -27.9 (CI -29.9 to -26.2) and the II were 0.60 (CI 0.42-0.78). No gender differences were present. CONCLUSION Secretoneurin has a fairly low CVI, CVG, RCV and II, indicating that it could be suitable as a diagnostic or prognostic biomarker and that delta values in serial samplings may be preferable for identifying clinical changes.
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Affiliation(s)
- Kristin M Aakre
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Anett H Ottesen
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Heidi Strand
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
| | | | - Bashir Alaour
- School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
| | - Janniche Torsvik
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Marit S Sylte
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Michael Marber
- School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
| | - Geir Christensen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Institute for Experimental Medical Research, Oslo University Hospital, Oslo, Norway
| | - Helge Røsjø
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
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18
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Sithiravel C, Røysland R, Alaour B, Sylte MS, Torsvik J, Strand H, Marber M, Omland T, Aakre KM. Biological variation, reference change values and index of individuality of GDF-15. Clin Chem Lab Med 2021; 60:593-596. [PMID: 34644816 PMCID: PMC8997700 DOI: 10.1515/cclm-2021-0769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/21/2021] [Indexed: 01/11/2023]
Affiliation(s)
- Cindhya Sithiravel
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
| | - Ragnhild Røysland
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bashir Alaour
- School of Cardiovascular Medicine and Sciences, King’s College London, London, UK
| | | | - Janniche Torsvik
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Heidi Strand
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
| | - Michael Marber
- School of Cardiovascular Medicine and Sciences, King’s College London, London, UK
| | - Torbjørn Omland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Kristin Moberg Aakre
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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19
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Riveland E, Valborgland T, Ushakova A, Karlsen T, Delagardelle C, Van Cranenbroeck E, Linke A, Prescott E, Halle M, Stoylen A, Dalen H, Omland T, Marber M, Ellingsen Ø, Larsen A. Increased VO2 peak after a structured exercise-training program is associated with reduced levels of cardiac myosin binding protein C in patients with symptomatic chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac myosin-binding protein C (cMyC), a cardiac contractile protein, is a novel biomarker of myocardial injury, rising earlier and disappearing faster than cardiac troponins. It is a promising biomarker for use in triage of patients with chest pain presenting in the emergency department. It also has prognostic significance in patients with heart failure. However, the effects of systematic exercise training on plasma levels of cMyC has previously not been evaluated.
Purpose
The aim of this study was to assess the effect of a 12-week exercise training program on changes in plasma levels of cMyC in patients with chronic symptomatic heart failure with reduced ejection fraction (HFrEF). The changes in plasma levels of cMyC in an intervention group, performing structured exercise programs, were compared to those in a control group, instructed to perform regular recommended exercise (RRE) according to current guidelines.
Methods
This was a post hoc analysis of the SMARTEX-HF trial in 215 patients with symptomatic HF with Left Ventricular Ejection Fraction (LVEF) <35% and NYHA II-III. The patients were randomly assigned to High Intensity Interval Training (HIIT, n=77), Moderate Continuous Training (MCT, n=65) or RRE, (n=73) for 12 weeks. HIIT and MCT groups constituted the intervention group (IG). Measurements and clinical data were acquired before and after the 12-week intervention.
Statistical analysis
We divided the patients in two groups with Δ VO2Peak above and below the median of the sample. The absolute changes of cMyC were then compared between the two groups.
Mann-Whitney U test was used to compare continuous variables between the groups. Chi-squared test and Fisher exact test were used to compare categorical variables, as appropriate. A two-tailed p<0.05 was considered significant.
Results
There were no differences in changes of cMyC plasma levels, measured at baseline and after the intervention, between patients in the IG and RRE-group (p=0.580).
When dividing the entire study population according to Δ VO2Peak higher or lower than median value 0.48 ml/kg/min, we found a statistically significant greater reduction of cMyC values after 12 weeks of exercise training for those with higher than median Delta VO2Peak values compared to those with lower values (p=0.012). This finding was even stronger for the percentage change in cMyC levels (p=0.004 between groups).
Conclusion
In patients with symptomatic chronic HFrEF performing a structured 12-week exercise training program, a greater increase in Δ VO2Peak is significantly associated with a reduction in cMyC, suggesting cMyC may provide a dynamic measure of cardiorespiratory state.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Central Norwegian Health authority,Norwegian University of Science and Technology Baseline characteristicsBoxplot cMyC vs peak VO2
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Affiliation(s)
- E.A Riveland
- Stavanger University Hospital, Department of Cardiology, Department of Clinical science, University of Bergen, Stavanger, Norway
| | - T Valborgland
- University of Bergen, Department of clinical science, Bergen, Norway
| | - A Ushakova
- Stavanger University Hospital, Department of Research, Section of Biostatistics, Stavanger, Norway
| | - T Karlsen
- Nord University, Faculty of Nursing and Health Sciences, Bodø, Norway
| | - C Delagardelle
- Hospital Center of Luxembourg, Department of Cardiology, Luxembourg, Luxembourg
| | | | - A Linke
- Heart Center - University Hospital Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
| | - E Prescott
- Bispebjerg University Hospital, Department of Clinical Medicine, Copenhagen, Denmark
| | - M Halle
- Clinic rechts der Isar of the University of Technology, Department of Prevention, Rehabilitation and Sports Medicine, Munich, Germany
| | - A Stoylen
- Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Trondheim, Norway
| | - H Dalen
- Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Trondheim, Norway
| | - T Omland
- Akershus University Hospital, Department of Cardiology, Institute of Clinical Medicine University of Oslo, Oslo, Norway
| | - M Marber
- King's College London, School of Cardiovascular Medicine and Sciences, London, United Kingdom
| | - Ø Ellingsen
- Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Trondheim, Norway
| | - A.I Larsen
- Stavanger University Hospital, Department of Cardiology, Department of Clinical science, University of Bergen, Stavanger, Norway
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20
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Puntmann V, Carr-White G, Rolf A, Zainal H, Vasquez M, Zhou H, Arcari L, Valbuena S, Hinojar R, Vidalakis E, Kolentinis M, Martin S, Zeiher A, Marber M, Nagel E. Clinical risk score for individualized risk stratification of patients with clinically suspected myocardial inflammation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
To develop a clinical risk score for individualized risk stratification of patients with clinically suspected myocardial inflammation.
Background
Myocardial inflammation is a prominent cause of non-ischaemic dilated cardiomyopathy, heart failure (HF) and sudden cardiac death.
Methods
This is a prospective multicentre longitudinal study of consecutive patients referred to cardiac magnetic resonance (CMR) with clinically suspected myocardial inflammation between October 2011 and December 2019 as a part of standard diagnostic pathway. Patients were followed up from the date of CMR. The outcome endpoints included major adverse cardiovascular event (MACE, cardiovascular mortality, sudden cardiac death, appropriate device discharge); or death or hospitalisation due to HF). A prognostic model was developed using Cox proportional hazards analysis and validated internally and externally.
Results
The final dataset included 722 subjects (50 years (40–61); males 422 (58%)). During a follow-up period of median 19 (15–23) months, there were 64 (9%) MACE and 130 (18%) HF events. Ten predictor variables qualified for entry into the prognostic model: age, sex, hematocrit, C-reactive protein, high-sensitive troponin-T (TNT), left and right ventricular ejection fraction, native T1 and T2, and late gadolinium enhancement (LGE). The final multivariable Cox regression model included native T2 (Figure 1A), TNT and LGE (Figure 1B) for the primary (Chi-square: 102.0, p<0.001) and secondary endpoint (Chi-square: 166.9, p<0.001), respectively. Cross-validation as well as external validation of the secondary models revealed good performance and no healthcare system effect. Based on the MyoRISK Score, patients were classified into three risk groups with respective event rates for MACE of 0%, 6.3% and 25.1%, and HF endpoint of 1.8%, 17.3% and 44.2%. TNT≥7 pg/ml allowed to efficiently preselect patients prior to CMR.
Conclusions
This is the first systematic assessment of outcomes in patients with clinically suspected myocardial inflammation, providing a non-invasive estimation of the probability of adverse events based on a score using readily available clinical parameters.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): DZHK
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Affiliation(s)
- V Puntmann
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | | | - A Rolf
- Kerckhoff Heart and Thorax Center, Cardiology, Bad Nauheim, Germany
| | - H Zainal
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - M Vasquez
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - H Zhou
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - L Arcari
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - S Valbuena
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - R Hinojar
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - E Vidalakis
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - M Kolentinis
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - S Martin
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - A Zeiher
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - M Marber
- King's College Hospital, London, United Kingdom
| | - E Nagel
- Wolfgang Goethe University, Frankfurt am Main, Germany
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21
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Alaour B, Kaier TE, Demir Z, Van Doorn W, Kimenai DM, Zar A, Van Der Linden N, Marber M, Meex SJR. Physiological circadian rhythm of cardiac myosin-binding protein C (cMyC) and cardiac troponin. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Cardiac myosin-binding protein C (cMyC) is a novel protein biomarker of myocardial injury, with a promising role in the triage and risk stratification of patients with cardiac disease. Understanding the physiological diurnal oscillation of cMyC and cardiac troponin is important for the interpretation of single and serial measurements within the biomarker-assisted triage and risk stratification algorithms.
Purpose
In this study, we aim to assess and compare the physiological diurnal oscillation of cMyC and cardiac troponin cTnT and cTnI.
Method
Twenty-six consecutive hourly blood samples were drawn between 08.30 am and 09.30 am (+1 day) from normotensive 24 individuals without a recent history of acute myocardial infarction, for the measurement of cMyC, cardiac troponin T (Roche hs-cTnT) and I (Abbott hs-cTnI).
Fitted cosinor sine regression model (with R, version 3.6.1) was used to assess the presence and significance of circadian oscillation of the biomarker, and to estimate the respective amplitude and acrophase (the time of peak activity).
Amplitude and acrophase were compared across the biomarkers that exhibited significant circadian rhythm.
Results
Mean age was 72±7. 79% of participants (n=19) were men. All participants were free from renal disease.
On population-mean cosinor analysis, hs-cTnI exhibited random diurnal oscillation, whereas significant circadian rhythm was detected for cMyC and hs-cTnT (p=0.015 and <0.001, respectively) (Figure 1).
The circadian rhythm of cMyC is characterised by gradually increasing concentrations from early afternoon until early morning (acrophase 03:03 am, 95% CI 01:54–04:26 am) compared to hs-cTnT concentrations which exhibits delayed increase and a later peak (acrophase, 08:01, 95% CI 07:10–08:51 am), p=0.028 for acrophase difference (Figure 1).
Diurnal rhythm remained significant after correction for possible posture-induced changes in plasma volume.
To allow direct comparison between amplitudes, the measurements of cMyC and hs-TnT were normalised to the respective 08:30 am value, re-fitted cosinor model did not show significant difference between the amplitudes (amplitude ng/L, 0.12, 95% CI 0.07–0.15 vs 0.11, 95% CI 0.08–0.12, for normalised cMyC vs hs-cTnT, respectively; p=0.67).
Conclusion
Significant circadian rhythm exists for cMyC and hs-cTnT, with 5-hours phase difference between the two biomarkers (cMyC ahead of hs-cTnT). The cause of this rhythmic variation is unknown, but the phase difference is consistent with the previously described disparity in the release of cMyC and cTnT after iatrogenic myocardial injury, raising the possibility of an underlying diurnal variation in myocardial vulnerability. Studies are required to assess the impact of this physiological phenomenon on the performance of the biomarkers within unadjused diagnostic algorithms
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): British Heart FoundationStichting de Weijerhorst
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Affiliation(s)
- B Alaour
- King's College London, London, United Kingdom
| | - T E Kaier
- King's College London, London, United Kingdom
| | - Z Demir
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - W Van Doorn
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - D M Kimenai
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - A Zar
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - N Van Der Linden
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - M Marber
- King's College London, London, United Kingdom
| | - S J R Meex
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
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22
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Bulluck H, Paradies V, Barbato E, Baumbach A, Bøtker HE, Capodanno D, De Caterina R, Cavallini C, Davidson SM, Feldman DN, Ferdinandy P, Gili S, Gyöngyösi M, Kunadian V, Ooi SY, Madonna R, Marber M, Mehran R, Ndrepepa G, Perrino C, Schüpke S, Silvain J, Sluijter JPG, Tarantini G, Toth GG, Van Laake LW, von Birgelen C, Zeitouni M, Jaffe AS, Thygesen K, Hausenloy DJ. Prognostically relevant periprocedural myocardial injury and infarction associated with percutaneous coronary interventions: a Consensus Document of the ESC Working Group on Cellular Biology of the Heart and European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2021; 42:2630-2642. [PMID: 34059914 PMCID: PMC8282317 DOI: 10.1093/eurheartj/ehab271] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/19/2020] [Accepted: 04/26/2021] [Indexed: 12/17/2022] Open
Abstract
A substantial number of chronic coronary syndrome (CCS) patients undergoing percutaneous coronary intervention (PCI) experience periprocedural myocardial injury or infarction. Accurate diagnosis of these PCI-related complications is required to guide further management given that their occurrence may be associated with increased risk of major adverse cardiac events (MACE). Due to lack of scientific data, the cut-off thresholds of post-PCI cardiac troponin (cTn) elevation used for defining periprocedural myocardial injury and infarction, have been selected based on expert consensus opinions, and their prognostic relevance remains unclear. In this Consensus Document from the ESC Working Group on Cellular Biology of the Heart and European Association of Percutaneous Cardiovascular Interventions (EAPCI), we recommend, whenever possible, the measurement of baseline (pre-PCI) cTn and post-PCI cTn values in all CCS patients undergoing PCI. We confirm the prognostic relevance of the post-PCI cTn elevation >5× 99th percentile URL threshold used to define type 4a myocardial infarction (MI). In the absence of periprocedural angiographic flow-limiting complications or electrocardiogram (ECG) and imaging evidence of new myocardial ischaemia, we propose the same post-PCI cTn cut-off threshold (>5× 99th percentile URL) be used to define prognostically relevant ‘major’ periprocedural myocardial injury. As both type 4a MI and major periprocedural myocardial injury are strong independent predictors of all-cause mortality at 1 year post-PCI, they may be used as quality metrics and surrogate endpoints for clinical trials. Further research is needed to evaluate treatment strategies for reducing the risk of major periprocedural myocardial injury, type 4a MI, and MACE in CCS patients undergoing PCI.
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Affiliation(s)
- Heerajnarain Bulluck
- Department of Cardiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.,Norwich Medical School, Bob Champion Research and Educational Building, Rosalind Franklin Road, University of East Anglia, Norwich Research Park. Norwich, Norfolk, NR4 7UQ, United Kingdom
| | - Valeria Paradies
- Cardiology Department, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, Federico II University, Via Pansini 5, 8013, Naples, Italy.,Cardiovascular Center Aalst OLV Hospital, Moorselbaan n. 164, 9300 Aalst, Belgium
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, Barts Heart Centre, Charterhouse Square, London, EC1M 6BQ, UK.,Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Via Santa Sofia 78, 95100 Catania, Italy
| | - Raffaele De Caterina
- Department of Pathology, Cardiology Division, University of Pisa, Lungarno Antonio Pacinotti, 43, 56124 Pisa, Italy.,University of Pisa, and Cardiology Division, Pisa University Hospital AND Fondazione VillaSerena per la Ricerca, Città Sant'Angelo, Pescara, Italy
| | - Claudio Cavallini
- Department of Cardiology, Santa Maria della Misericordia Hospital, Piazzale Giorgio Menghini, 1, 06129 Perugia, Italy
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews London, WC1E 6HX, UK
| | - Dmitriy N Feldman
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, 1414 York Ave, New York, NY 10021, USA
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Nagyvarad tér 4, Budapest, 1089 Hungary.,Pharmahungary Group, Hajnóczy u. 6, Szeged, 6722 Hungary
| | - Sebastiano Gili
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Carlo Parea, 4, 20138 Milano MI, Italy
| | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, M4:146 4th Floor William Leech Building, Newcastle University Medical School, Newcastle upon Tyne, NE2 4HH, UK.,Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cardiothoracic centre, High Heaton, Newcastle upon Tyne, NE7 7DN, UK
| | - Sze-Yuan Ooi
- Eastern Heart Clinic, Prince of Wales Hospital, Barker St, Randwick NSW 2031, Australia
| | - Rosalinda Madonna
- Department of Pathology, Cardiology Division, University of Pisa, Lungarno Antonio Pacinotti, 43, 56124 Pisa, Italy.,Department of Internal Medicine, University of Texas Medical School, Houston, 77060 Houston, TX, USA
| | - Michael Marber
- School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, St. Thomas' Hospital Campus, King's College London, Westminster Bridge Rd, London SE1 7EH, UK
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA.,Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
| | - Gjin Ndrepepa
- Deutsches Herzzentrum München, Technische Universität, Lazarettstraße 36, 80636 München, Germany
| | - Cinzia Perrino
- Department of Advanced Biomedical Sciences, Federico II University, Via Pansini 5, 8013, Naples, Italy
| | - Stefanie Schüpke
- Deutsches Herzzentrum München, Lazarettstr. 36, 80636 Munich, Germany
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS, Paris 1166, France
| | - Joost P G Sluijter
- Laboratory of Experimental Cardiology, Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Regenerative Medicine Center Utrecht, Circulatory Health Laboratory, University Utrecht, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Giuseppe Tarantini
- Interventional Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2 - 35128 Padova, Italy
| | - Gabor G Toth
- University Heart Center Graz, Division of Cardiology, Department of Medicine, Medical University Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Linda W Van Laake
- Division Heart and Lungs, Department of Cardiology and Regenerative Medicine Center, University Medical Center Utrecht, Heidelberglaan 100, 3574 CX Utrecht, The Netherlands
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectum Twente, Koningstraat 1, 7512 KZ Enschede, The Netherlands.,Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Hallenweg 5, 7522 NH Enschede, The Netherlands
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS, Paris 1166, France
| | - Allan S Jaffe
- Departments of Cardiology and Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews London, WC1E 6HX, UK.,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, 8 College Road, Singapore 169857, Singapore.,National Heart Research Institute Singapore, National Heart Centre, 5 Hospital Drive, Singapore 169609, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore.,Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, 500, Lioufeng Rd., Wufeng, Taichung 41354, Taiwan
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23
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Nestelberger T, Boeddinghaus J, Lopez-Ayala P, Kaier TE, Marber M, Gysin V, Koechlin L, Sanchez AY, Giménez MR, Wussler D, Walter JE, Strebel I, Zimmermann T, Glarner N, Miró Ò, Martin-Sanchez FJ, Zehnder T, Twerenbold R, Keller DI, Mueller C. Cardiovascular Biomarkers in the Early Discrimination of Type 2 Myocardial Infarction. JAMA Cardiol 2021; 6:771-780. [PMID: 33881449 DOI: 10.1001/jamacardio.2021.0669] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Rapid and accurate noninvasive discrimination of type 2 myocardial infarction (T2MI), which is because of a supply-demand mismatch, from type 1 myocardial infarction (T1MI), which arises via plaque rupture, is essential, because treatment differs substantially. Unfortunately, this is a major unmet clinical need, because even high-sensitivity cardiac troponin (hs-cTn) measurement provides only modest accuracy. Objective To test the hypothesis that novel cardiovascular biomarkers quantifying different pathophysiological pathways involved in T2MI and/or T1MI may aid physicians in the rapid discrimination of T2MI vs T1MI. Design, Setting, and Participants This international, multicenter prospective diagnostic study was conducted in 12 emergency departments in 5 countries (Switzerland, Spain, Italy, Poland, and the Czech Republic) with patients presenting with acute chest discomfort to the emergency departments. The study quantified the discrimination of hs-cTn T, hs-cTn I, and 17 novel cardiovascular biomarkers measured in subsets of consecutively enrolled patients against a reference standard (final diagnosis), centrally adjudicated by 2 independent cardiologists according to the fourth universal definition of MI, using all information, including cardiac imaging and serial measurements of hs-cTnT or hs-cTnI. Results Among 5887 patients, 1106 (18.8%) had an adjudicated final diagnosis of MI; of these, 860 patients (77.8%) had T1MI, and 246 patients (22.2%) had T2MI. Patients with T2MI vs those with T1MI had lower concentrations of biomarkers quantifying cardiomyocyte injury hs-cTnT (median [interquartile range (IQR)], 30 (17-55) ng/L vs 58 (28-150) ng/L), hs-cTnI (median [IQR], 23 [10-83] ng/L vs 115 [28-576] ng/L; P < .001), and cardiac myosin-binding protein C (at presentation: median [IQR], 76 [38-189] ng/L vs 257 [75-876] ng/L; P < .001) but higher concentrations of biomarkers quantifying endothelial dysfunction, microvascular dysfunction, and/or hemodynamic stress (median [IQR] values: C-terminal proendothelin 1, 97 [75-134] pmol/L vs 68 [55-91] pmol/L; midregional proadrenomedullin, 0.97 [0.67-1.51] pmol/L vs 0.72 [0.53-0.99] pmol/L; midregional pro-A-type natriuretic peptide, 378 [207-491] pmol/L vs 152 [90-247] pmol/L; and growth differentiation factor 15, 2.26 [1.44-4.35] vs 1.56 [1.02-2.19] ng/L; all P < .001). Discrimination for these biomarkers, as quantified by the area under the receiver operating characteristics curve, was modest (hs-cTnT, 0.67 [95% CI, 0.64-0.71]; hs-cTn I, 0.71 [95% CI, 0.67-0.74]; cardiac myosin-binding protein C, 0.67 [95% CI, 0.61-0.73]; C-terminal proendothelin 1, 0.73 [95% CI, 0.63-0.83]; midregional proadrenomedullin, 0.66 [95% CI, 0.60-0.73]; midregional pro-A-type natriuretic peptide, 0.77 [95% CI, 0.68-0.87]; and growth differentiation factor 15, 0.68 [95% CI, 0.58-0.79]). Conclusions and Relevance In this study, biomarkers quantifying myocardial injury, endothelial dysfunction, microvascular dysfunction, and/or hemodynamic stress provided modest discrimination in early, noninvasive diagnosis of T2MI.
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Affiliation(s)
- Thomas Nestelberger
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT Network, Rome, Italy.,Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Pedro Lopez-Ayala
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Thomas E Kaier
- King's College London British Heart Foundation Centre, Rayne Institute, St Thomas' Hospital, London, United Kingdom
| | - Michael Marber
- King's College London British Heart Foundation Centre, Rayne Institute, St Thomas' Hospital, London, United Kingdom
| | - Vincent Gysin
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Luca Koechlin
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT Network, Rome, Italy.,Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ana Yufera Sanchez
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Maria Rubini Giménez
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT Network, Rome, Italy.,Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - Desiree Wussler
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Joan Elias Walter
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Ivo Strebel
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Tobias Zimmermann
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Noemi Glarner
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Òscar Miró
- GREAT Network, Rome, Italy.,Emergency Department, Hospital Clinic, Barcelona, Catalonia, Spain
| | - F Javier Martin-Sanchez
- GREAT Network, Rome, Italy.,Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain
| | - Tatjana Zehnder
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT Network, Rome, Italy
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24
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Aengevaeren VL, van Kimmenade RRJ, Ordóñez‐Llanos J, García‐Osuna Á, Kaier TE, Marber M, Froeling M, van den Berg‐Faay S, Hooijmans MT, Monte JR, Hopman MTE, Strijkers GJ, Nederveen AJ, Bakermans AJ, Eijsvogels TMH. Cardiac Biomarker Kinetics and Their Association With Magnetic Resonance Measures of Cardiomyocyte Integrity Following a Marathon Run: Implications for Postexercise Biomarker Testing. J Am Heart Assoc 2021; 10:e020039. [PMID: 34180243 PMCID: PMC8403309 DOI: 10.1161/jaha.120.020039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vincent L. Aengevaeren
- Department of PhysiologyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
- Department of CardiologyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Roland R. J. van Kimmenade
- Department of CardiologyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | | | | | - Thomas E. Kaier
- The Rayne InstituteSt Thomas' HospitalKing's College London British Heart Foundation CentreLondonUnited Kingdom
| | - Michael Marber
- The Rayne InstituteSt Thomas' HospitalKing's College London British Heart Foundation CentreLondonUnited Kingdom
| | - Martijn Froeling
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Sandra van den Berg‐Faay
- Department of Radiology and Nuclear MedicineAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Melissa T. Hooijmans
- Biomedical Engineering and PhysicsAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jithsa R. Monte
- Department of Radiology and Nuclear MedicineAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Maria T. E. Hopman
- Department of PhysiologyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and PhysicsAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear MedicineAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Adrianus J. Bakermans
- Department of Radiology and Nuclear MedicineAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Thijs M. H. Eijsvogels
- Department of PhysiologyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
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25
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Demir OM, Ryan M, Cirillo C, Desai N, Pericao A, Sinclair H, Stylianidis V, Victor K, Alaour B, Jones A, Pavlidis AN, Retter A, Carr-White G, Camporota L, Barrett N, Marber M, Perera D. Impact and Determinants of High-Sensitivity Cardiac Troponin-T Concentration in Patients With COVID-19 Admitted to Critical Care. Am J Cardiol 2021; 147:129-136. [PMID: 33617816 PMCID: PMC7895690 DOI: 10.1016/j.amjcard.2021.01.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 12/25/2022]
Abstract
Cardiac Troponin (hs-TnT) elevation has been reported in unselected patients hospitalized with COVID-19 however the mechanism and relationship with mortality remain unclear. Consecutive patients admitted to a high-volume intensive care unit (ICU) in London with severe COVID-19 pneumonitis were included if hs-TnT concentration at admission was known. Kaplan-Meier survival analysis performed, with cohorts classified a priori by multiples of the upper limit of normal (ULN). 277 patients were admitted during a 7-week period in 2020; 176 were included (90% received invasive ventilation). hs-TnT at admission was 16.5 (9.0 to 49.3) ng/L, 56% had concentrations >ULN. 56 patients (31.8%) died during the index admission. Admission hs-TnT level was lower in survivors (12.0 (8.0-27.8) vs 28.5 (14.0 to 81.0) ng/L, p = 0.001). Univariate predictors of mortality were age, APACHE-II Score and admission hs-TnT (HR 1.73, p = 0.007). By multivariate regression, only age (HR 1.33, CI: 1.16.to 1.51, p < 0.01) and admission hs-TnT (HR 1.94, CI: 1.22 to 3.10, p = 0.006) remained predictive. Survival was significantly lower when admission hs-TnT was >ULN (log-rank p-value<0.001). Peak hs-TnT was higher in those who died but was not predictive of death after adjustment for other factors. In conclusion, in critically ill patients with COVID-19 pneumonitis, the hs-TnT level at admission is a powerful independent predictor of the likelihood of surviving to discharge from ICU. In most cases, hs-TnT elevation does not represent major myocardial injury but acts as a sensitive integrated biomarker of global stress. Whether stratification based on admission Troponin level could be used to guide prognostication and management warrants further evaluation.
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26
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Hammond-Haley M, Allen C, Han J, Patterson T, Marber M, Redwood S. Utility of wearable physical activity monitors in cardiovascular disease: a systematic review of 11 464 patients and recommendations for optimal use. Eur Heart J Digit Health 2021; 2:231-243. [PMID: 36712392 PMCID: PMC9707885 DOI: 10.1093/ehjdh/ztab035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/22/2021] [Indexed: 02/01/2023]
Abstract
Aims Physical activity (PA) plays an important role in primary and secondary prevention of cardiovascular disease (CVD), functioning as a marker of disease progression and response to therapy. Real-world measurement of habitual PA is now possible through wearable activity monitors, however, their use in cardiovascular patients is not well described. Methods and results We performed a systematic review to summarize how wearable activity monitors have been used to measure PA in patients with CVD, with 11 464 patients included across 108 studies. Activity monitors were primarily used in the setting of cardiac rehabilitation (46, 43%). Most often, triaxial accelerometers (70, 65%) were instructed to be worn at the hip (58, 54%) for 7 days (n = 54, 50%). Thirty-nine different activity monitors were used, with a range of accelerometer specific settings for collection and reporting of activity data. Activity was reported most commonly as time spent in metabolic equivalent-defined activity levels (49, 45%), while non-wear time was defined in just 16 (15%) studies. Conclusion The collecting, processing, and reporting of accelerometer-related outcomes were highly heterogeneous. Most validation studies are limited to healthy young adults, while the paucity of methodological information disclosed renders interpretation of results and cross-study comparison challenging. While accelerometers are promising tools to measure real-world PA, we highlight current challenges facing their use in elderly multimorbid cardiology patients. We suggest recommendations to guide investigators using these devices in cardiovascular research. Future work is required to determine optimal methodology and consensus-based development of meaningful outcomes using raw acceleration data.
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Affiliation(s)
- Matthew Hammond-Haley
- British Heart Foundation Centre of Research Excellence, King's College London, Rayne Institute, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EP, UK,Department of Cardiology, Guys’ and St Thomas NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Christopher Allen
- British Heart Foundation Centre of Research Excellence, King's College London, Rayne Institute, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EP, UK,Department of Cardiology, Guys’ and St Thomas NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Jennie Han
- Royal Lancaster Infirmary, Ashton Road Lancaster, LA1 4RP, UK
| | - Tiffany Patterson
- British Heart Foundation Centre of Research Excellence, King's College London, Rayne Institute, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EP, UK,Department of Cardiology, Guys’ and St Thomas NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Michael Marber
- British Heart Foundation Centre of Research Excellence, King's College London, Rayne Institute, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EP, UK,Department of Cardiology, Guys’ and St Thomas NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Simon Redwood
- British Heart Foundation Centre of Research Excellence, King's College London, Rayne Institute, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EP, UK,Department of Cardiology, Guys’ and St Thomas NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, UK,Corresponding author. Tel: +44 207188 9359,
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27
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Kozhuharov N, Wussler D, Kaier T, Strebel I, Shrestha S, Flores D, Nowak A, Sabti Z, Nestelberger T, Zimmermann T, Walter J, Belkin M, Michou E, Lopez Ayala P, Gualandro DM, Keller DI, Goudev A, Breidthardt T, Mueller C, Marber M. Cardiac myosin-binding protein C in the diagnosis and risk stratification of acute heart failure. Eur J Heart Fail 2021; 23:716-725. [PMID: 33421273 DOI: 10.1002/ejhf.2094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 12/09/2020] [Accepted: 01/02/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Cardiac myosin-binding protein C (cMyC) seems to be even more sensitive in the quantification of cardiomyocyte injury vs. high-sensitivity cardiac troponin, and may therefore have diagnostic and prognostic utility. METHODS AND RESULTS In a prospective multicentre diagnostic study, cMyC, high-sensitivity cardiac troponin T (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) plasma concentrations were measured in blinded fashion in patients presenting to the emergency department with acute dyspnoea. Two independent cardiologists centrally adjudicated the final diagnosis. Diagnostic accuracy for acute heart failure (AHF) was quantified by the area under the receiver operating characteristic curve (AUC). All-cause mortality within 360 days was the prognostic endpoint. Among 1083 patients eligible for diagnostic analysis, 51% had AHF. cMyC concentrations at presentation were higher among AHF patients vs. patients with other final diagnoses [72 (interquartile range, IQR 39-156) vs. 22 ng/L (IQR 12-42), P < 0.001)]. cMyC's AUC was high [0.81, 95% confidence interval (CI) 0.78-0.83], higher than hs-cTnT's (0.79, 95% CI 0.76-0.82, P = 0.081) and lower than NT-proBNP's (0.91, 95% CI 0.89-0.93, P < 0.001). Among 794 AHF patients eligible for prognostic analysis, 28% died within 360 days; cMyC plasma concentrations above the median indicated increased risk of death (hazard ratio 2.19, 95% CI 1.66-2.89; P < 0.001). cMyC's prognostic accuracy was comparable with NT-proBNP's and hs-cTnT's. cMyC did not independently predict all-cause mortality when used in validated multivariable regression models. In novel multivariable regression models including medication, age, left ventricular ejection fraction, and discharge creatinine, cMyC remained an independent predictor of death and had no interactions with medical therapies at discharge. CONCLUSION Cardiac myosin-binding protein C may aid physicians in the rapid triage of patients with suspected AHF.
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Affiliation(s)
- Nikola Kozhuharov
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.,Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Desiree Wussler
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Thomas Kaier
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Ivo Strebel
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Samyut Shrestha
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Dayana Flores
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
| | - Zaid Sabti
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Thomas Nestelberger
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Tobias Zimmermann
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Joan Walter
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Maria Belkin
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Eleni Michou
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Pedro Lopez Ayala
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Danielle M Gualandro
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Dagmar I Keller
- Institute for Emergency Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Assen Goudev
- Department of Cardiology, Queen Ioanna University Hospital Sofia, Medical University of Sofia, Sofia, Bulgaria
| | - Tobias Breidthardt
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Michael Marber
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
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28
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Abstract
The 4th Universal Definition of Myocardial Infarction has stimulated considerable debate since its publication in 2018. The intention was to define the types of myocardial injury through the lens of their underpinning pathophysiology. In this review, we discuss how the 4th Universal Definition of Myocardial Infarction defines infarction and injury and the necessary pragmatic adjustments that appear in clinical guidelines to maximize triage of real-world patients.
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Affiliation(s)
- Thomas E Kaier
- King's College London BHF Centre, The Rayne Institute, 4th Floor, Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Bashir Alaour
- King's College London BHF Centre, The Rayne Institute, 4th Floor, Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Michael Marber
- King's College London BHF Centre, The Rayne Institute, 4th Floor, Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
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29
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Allen CJ, Joseph J, Patterson T, Hammond-Haley M, McConkey HZR, Prendergast BD, Marber M, Redwood SR. Baseline NT-proBNP Accurately Predicts Symptom Response to Transcatheter Aortic Valve Implantation. J Am Heart Assoc 2020; 9:e017574. [PMID: 33241754 PMCID: PMC7763793 DOI: 10.1161/jaha.120.017574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Up to 30% of patients undergoing transcatheter aortic valve implantation (TAVI) experience minimal symptomatic benefit or die within 1 year, indicating an urgent need for enhanced patient selection. Previous analyses of baseline NT‐proBNP (N‐terminal pro‐brain natriuretic peptide) and TAVI outcomes have assumed a linear relationship, yielding conflicting results. We reexamined the relationship between baseline NT‐proBNP and symptomatic improvement after TAVI. Methods and Results Symptom status, clinical and echocardiographic data, and baseline NT‐proBNP were reviewed from 144 consecutive patients undergoing TAVI for severe symptomatic aortic stenosis. The primary end point was change in New York Heart Association functional class at 1 year. There was a nonlinear, inverted‐U relationship between log‐baseline NT‐proBNP and post‐TAVI change in NYHA class (R2=0.4559). NT‐proBNP thresholds of <800 and >10 000 ng/L accurately predicted no symptomatic improvement at 1 year (sensitivity 88%, specificity 83%, positive predictive value 72%, negative predictive value 93%). In adjusted analyses, baseline NT‐proBNP outside this “sweet‐spot” range was the only factor independently associated with poor functional outcome (high: NT‐proBNP >10 000 ng/L, odds ratio [OR], 65; 95% CI, 6–664; low: NT‐proBNP <800 ng/L, OR, 73; 95% CI, 7–738). Conclusions Baseline NT‐proBNP is a useful prognostic marker to predict poor symptom relief after TAVI and may indicate when intervention is likely to be futile. Both low (<800 ng/L) and very high (>10 000 ng/L) levels are strongly associated with poor functional outcome, suggesting an alternative cause for symptoms in the former scenario and an irrevocably diseased left ventricle in the latter. Further evaluation of this relationship is warranted.
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Affiliation(s)
- Christopher J Allen
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Jubin Joseph
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Tiffany Patterson
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Matthew Hammond-Haley
- Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Hannah Z R McConkey
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Bernard D Prendergast
- Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Michael Marber
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Simon R Redwood
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
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30
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Perrino C, Ferdinandy P, Bøtker HE, Brundel BJJM, Collins P, Davidson SM, den Ruijter HM, Engel FB, Gerdts E, Girao H, Gyöngyösi M, Hausenloy DJ, Lecour S, Madonna R, Marber M, Murphy E, Pesce M, Regitz-Zagrosek V, Sluijter JPG, Steffens S, Gollmann-Tepeköylü C, Van Laake LW, Van Linthout S, Schulz R, Ytrehus K. Improving translational research in sex-specific effects of comorbidities and risk factors in ischaemic heart disease and cardioprotection: position paper and recommendations of the ESC Working Group on Cellular Biology of the Heart. Cardiovasc Res 2020; 117:367-385. [PMID: 32484892 DOI: 10.1093/cvr/cvaa155] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/29/2020] [Accepted: 05/27/2020] [Indexed: 12/17/2022] Open
Abstract
Ischaemic heart disease (IHD) is a complex disorder and a leading cause of death and morbidity in both men and women. Sex, however, affects several aspects of IHD, including pathophysiology, incidence, clinical presentation, diagnosis as well as treatment and outcome. Several diseases or risk factors frequently associated with IHD can modify cellular signalling cascades, thus affecting ischaemia/reperfusion injury as well as responses to cardioprotective interventions. Importantly, the prevalence and impact of risk factors and several comorbidities differ between males and females, and their effects on IHD development and prognosis might differ according to sex. The cellular and molecular mechanisms underlying these differences are still poorly understood, and their identification might have important translational implications in the prediction or prevention of risk of IHD in men and women. Despite this, most experimental studies on IHD are still undertaken in animal models in the absence of risk factors and comorbidities, and assessment of potential sex-specific differences are largely missing. This ESC WG Position Paper will discuss: (i) the importance of sex as a biological variable in cardiovascular research, (ii) major biological mechanisms underlying sex-related differences relevant to IHD risk factors and comorbidities, (iii) prospects and pitfalls of preclinical models to investigate these associations, and finally (iv) will provide recommendations to guide future research. Although gender differences also affect IHD risk in the clinical setting, they will not be discussed in detail here.
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Affiliation(s)
- Cinzia Perrino
- Department of Advanced Biomedical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Nagyvárad tér 4, 1089 Budapest, Hungary.,Pharmahungary Group, Hajnoczy str. 6., H-6722 Szeged, Hungary
| | - Hans E Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Bianca J J M Brundel
- Department of Physiology, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, Amsterdam, 1108 HV, the Netherlands
| | - Peter Collins
- Imperial College, Faculty of Medicine, National Heart & Lung Institute, South Kensington Campus, London SW7 2AZ, UK.,Royal Brompton Hospital, Sydney St, Chelsea, London SW3 6NP, UK
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, WC1E 6HX London, UK
| | - Hester M den Ruijter
- Experimental Cardiology Laboratory, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Felix B Engel
- Experimental Renal and Cardiovascular Research, Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Muscle Research Center Erlangen (MURCE), Schwabachanlage 12, 91054 Erlangen, Germany
| | - Eva Gerdts
- Department for Clinical Science, University of Bergen, PO Box 7804, 5020 Bergen, Norway
| | - Henrique Girao
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Azinhaga Santa Comba, Celas, 3000-548 Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, and Clinical Academic Centre of Coimbra (CACC), 3000-548 Coimbra, Portugal
| | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Derek J Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, 8 College Road, 169857, Singapore.,National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228, Singapore.,The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK.,Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, 500, Lioufeng Rd., Wufeng, Taichung 41354, Taiwan
| | - Sandrine Lecour
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, Chris Barnard Building, University of Cape Town, Private Bag X3 7935 Observatory, Cape Town, South Africa
| | - Rosalinda Madonna
- Institute of Cardiology, University of Pisa, Lungarno Antonio Pacinotti 43, 56126 Pisa, Italy.,Department of Internal Medicine, University of Texas Medical School in Houston, 6410 Fannin St #1014, Houston, TX 77030, USA
| | - Michael Marber
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Elizabeth Murphy
- Laboratory of Cardiac Physiology, Cardiovascular Branch, NHLBI, NIH, 10 Center Drive, Bethesda, MD 20892, USA
| | - Maurizio Pesce
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS Via Parea, 4, I-20138 Milan, Italy
| | - Vera Regitz-Zagrosek
- Berlin Institute of Gender in Medicine, Center for Cardiovascular Research, DZHK, partner site Berlin, Geschäftsstelle Potsdamer Str. 58, 10785 Berlin, Germany.,University of Zürich, Rämistrasse 71, 8006 Zürich, Germany
| | - Joost P G Sluijter
- Experimental Cardiology Laboratory, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 8, 3584 CS Utrecht, the Netherlands.,Circulatory Health Laboratory, Regenerative Medicine Center, University Medical Center Utrecht, Utrecht University, Heidelberglaan 8, 3584 CS Utrecht, the Netherlands
| | - Sabine Steffens
- Institute for Cardiovascular Prevention and German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Pettenkoferstr. 9, Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Can Gollmann-Tepeköylü
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstr.35, A - 6020 Innsbruck, Austria
| | - Linda W Van Laake
- Cardiology and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Sophie Van Linthout
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, 10178 Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, 10178 Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Rainer Schulz
- Institute of Physiology, Justus-Liebig University Giessen, Ludwigstraße 23, 35390 Giessen, Germany
| | - Kirsti Ytrehus
- Department of Medical Biology, UiT The Arctic University of Norway, Hansine Hansens veg 18, 9037 Tromsø, Norway
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31
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Abstract
Chest pain is responsible for 6-10% of all presentations to acute healthcare providers. Triage is inherently difficult and heavily reliant on the quantification of cardiac Troponin (cTn), as a minority of patients with an ultimate diagnosis of acute myocardial infarction (AMI) present with clear diagnostic features such as ST-elevation on the electrocardiogram. Owing to slow release and disappearance of cTn, many patients require repeat blood testing or present with stable but elevated concentrations of the best available biomarker and are thus caught at the interplay of sensitivity and specificity.We identified cardiac myosin-binding protein C (cMyC) in coronary venous effluent and developed a high-sensitivity assay by producing an array of monoclonal antibodies and choosing an ideal pair based on affinity and epitope maps. Compared to high-sensitivity cardiac Troponin (hs-cTn), we demonstrated that cMyC appears earlier and rises faster following myocardial necrosis. In this review, we discuss discovery and structure of cMyC, as well as the migration from a comparably insensitive to a high-sensitivity assay facilitating first clinical studies. This assay was subsequently used to describe relative abundance of the protein, compare sensitivity to two high-sensitivity cTn assays and test diagnostic performance in over 1900 patients presenting with chest pain and suspected AMI. A standout feature was cMyC's ability to more effectively triage patients. This distinction is likely related to the documented greater abundance and more rapid release profile, which could significantly improve the early triage of patients with suspected AMI.
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Affiliation(s)
- Thomas E Kaier
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, 4th Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Bashir Alaour
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, 4th Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH, UK
| | - Michael Marber
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, 4th Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH, UK
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32
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Chehab O, Roberts-Thomson R, Ng Yin Ling C, Marber M, Prendergast BD, Rajani R, Redwood SR. Secondary mitral regurgitation: pathophysiology, proportionality and prognosis. Heart 2020; 106:716-723. [DOI: 10.1136/heartjnl-2019-316238] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 01/17/2023] Open
Abstract
Secondary mitral regurgitation (SMR) occurs as a result of multifactorial left atrioventricular dysfunction and maleficent remodelling. It is the most common and undertreated form of mitral regurgitation (MR) and is associated with a very poor prognosis. Whether SMR is a bystander reflecting the severity of the cardiomyopathy disease process has long been the subject of debate. Studies suggest that SMR is an independent driver of prognosis in patients with an intermediate heart failure (HF) phenotype and not those with advanced HF. There is also no universal agreement regarding the quantitative thresholds defining severe SMR and indeed there are challenges with echocardiographic quantification. Until recently, no surgical or transcatheter intervention for SMR had demonstrated prognostic benefit, in contrast with HF medical therapy and cardiac resynchronisation therapy. In 2018, the first two randomised controlled trials (RCTs) of edge-to-edge transcatheter mitral valve repair versus guideline-directed medical therapy in HF (Percutaneous Repair with the MitraClip Device for Severe (MITRA-FR), Transcather mitral valve repair in patients with heart failure (COAPT)) reported contrasting yet complimentary results. Unlike in MITRA-FR, COAPT demonstrated significant prognostic benefit, largely attributed to the selection of patients with disproportionately severe MR relative to their HF phenotype. Consequently, quantifying the degree of SMR in relation to left ventricular volume may be a useful discriminator in predicting the success of transcatheter intervention. The challenge going forward is the identification and validation of such parameters while in parallel maintaining a heart-team guided holistic approach.
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Kaier TE, Chapman AR, Perera D, Marber M, Mills NL. Regarding Periprocedural PCI Myocardial Biomarker Elevation and Mortality. JACC Cardiovasc Interv 2020; 13:265. [PMID: 31973799 DOI: 10.1016/j.jcin.2019.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
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Rahman H, Ryan M, Lumley M, Modi B, McConkey H, Ellis H, Scannell C, Clapp B, Marber M, Webb A, Chiribiri A, Perera D. Coronary Microvascular Dysfunction Is Associated With Myocardial Ischemia and Abnormal Coronary Perfusion During Exercise. Circulation 2019; 140:1805-1816. [PMID: 31707835 PMCID: PMC6882540 DOI: 10.1161/circulationaha.119.041595] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 10/15/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Coronary microvascular dysfunction (MVD) is defined by impaired flow augmentation in response to a pharmacological vasodilator in the presence of nonobstructive coronary artery disease. It is unknown whether diminished coronary vasodilator response correlates with abnormal exercise physiology or inducible myocardial ischemia. METHODS Patients with angina and nonobstructive coronary artery disease had simultaneous coronary pressure and flow velocity measured using a dual sensor-tipped guidewire during rest, supine bicycle exercise, and adenosine-mediated hyperemia. Microvascular resistance (MR) was calculated as coronary pressure divided by flow velocity. Wave intensity analysis quantified the proportion of accelerating wave energy (perfusion efficiency). Global myocardial blood flow and subendocardial:subepicardial perfusion ratio were quantified using 3-Tesla cardiac magnetic resonance imaging during hyperemia and rest; inducible ischemia was defined as hyperemic subendocardial:subepicardial perfusion ratio <1.0. Patients were classified as having MVD if coronary flow reserve <2.5 and controls if coronary flow reserve ≥2.5, with researchers blinded to the classification. RESULTS Eighty-five patients were enrolled (78% female, 57±10 years), 45 (53%) were classified as having MVD. Of the MVD group, 82% had inducible ischemia compared with 22% of controls (P<0.001); global myocardial perfusion reserve was 2.01±0.41 and 2.68±0.49 (P<0.001). In controls, coronary perfusion efficiency improved from rest to exercise and was unchanged during hyperemia (59±11% vs 65±14% vs 57±18%; P=0.02 and P=0.14). In contrast, perfusion efficiency decreased during both forms of stress in MVD (61±12 vs 44±10 vs 42±11%; both P<0.001). Among patients with a coronary flow reserve <2.5, 62% had functional MVD, with normal minimal MR (hyperemic MR<2.5 mmHg/cm/s), and 38% had structural MVD with elevated hyperemic MR. Resting MR was lower in those with functional MVD (4.2±1.0 mmHg/cm/s) than in those with structural MVD (6.9±1.7 mmHg/cm/s) or controls (7.3±2.2 mmHg/cm/s; both P<0.001). During exercise, the structural group had a higher systolic blood pressure (188±25 mmHg) than did those with functional MVD (161±27 mmHg; P=0.004) and controls (156±30 mmHg; P<0.001). Functional and structural MVD had similar stress myocardial perfusion and exercise perfusion efficiency values. CONCLUSION In patients with angina and nonobstructive coronary artery disease, diminished coronary flow reserve characterizes a cohort with inducible ischemia and a maladaptive physiological response to exercise. We have identified 2 endotypes of MVD with distinctive systemic vascular responses to exercise; whether endotypes have a different prognosis or require different treatments merits further investigation.
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Affiliation(s)
- Haseeb Rahman
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Matthew Ryan
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Matthew Lumley
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Bhavik Modi
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Hannah McConkey
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Howard Ellis
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Cian Scannell
- Biomedical Engineering & Imaging Sciences (A.C., C.S.), King’s College London, United Kingdom
| | - Brian Clapp
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Michael Marber
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Andrew Webb
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Amedeo Chiribiri
- Biomedical Engineering & Imaging Sciences (A.C., C.S.), King’s College London, United Kingdom
| | - Divaka Perera
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
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Kozhuharov N, Wussler D, Kaier T, Walter J, Strebel I, Twerenbold R, Marber M, Breidthardt T, Mueller C. P792Cardiac myosin-binding protein C for the diagnosis and long-term prognosis of acute heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac myosin-binding protein C (cMyC) is a novel biomarker quantifying cardiac injury. Its utility for the diagnosis, prognosis, and therapy guidance in acute heart failure (AHF) is unclear.
Methods
In a prospective diagnostic multicentre study, unselected patients presenting with acute dyspnoea to the emergency department were enrolled. cMyC, high-sensitive cardiac troponin T (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) plasma concentrations were measured. Two independent cardiologists/internists centrally adjudicated the final diagnosis using all individual patient's information. Co-primary outcome measures were cMyC's: diagnostic safety and efficacy; prognostic accuracy.
Results
Among 1,330 recruited patients, 247 from an AHF substudy were not included in the diagnostic analysis. Accordingly, 548 patients (51%) in this analysis had an adjudicated diagnosis of AHF. For the rapid rule-out of AHF, the cMyC cut-off concentration at 16 ng/L achieved a sensitivity of 95% (95% CI, 93–97%), a negative predictive value of 88% (95% CI, 84–92%), and allowed to rule-out 21% of the patients. Correspondingly, cMyC's efficacy and safety in the triage of AHF were slightly lower than NT-proBNP's. Of the 790 AHF patients in the prognostic analysis, 222 (28%) died during the 360 days' follow-up. Patients with cMyC plasma concentrations above the median had significantly shorter mean time to death (274 versus 320 days, p=0.001). Compared to hs-cTnT and discharge NT-proBNP, cMyC showed non-inferior prognostic accuracy. No significant interactions between cMyC and cardiac medical therapies at discharge in predicting 360 days survival were present.
Conclusion
cMyC performs well in the rapid triage and prognosis of AHF.
Acknowledgement/Funding
European Union, Swiss National Science Foundation, Swiss Heart Foundation, Cardiovascular Research Foundation Basel, University Hospital of Basel
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Affiliation(s)
- N Kozhuharov
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, Basel, Switzerland
| | - D Wussler
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, Basel, Switzerland
| | - T Kaier
- King's College London, London, United Kingdom
| | - J Walter
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, Basel, Switzerland
| | - I Strebel
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, Basel, Switzerland
| | - R Twerenbold
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, Basel, Switzerland
| | - M Marber
- King's College London, London, United Kingdom
| | - T Breidthardt
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, Basel, Switzerland
| | - C Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, Basel, Switzerland
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Rahman H, Ryan M, Lumley M, McConkey H, Khan F, Ellis H, Clapp B, Marber M, Chiribiri A, Webb A, Perera D. 2380Mechanisms of myocardial ischemia during exercise in microvascular angina. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Coronary microvascular dysfunction (MVD) is defined by impaired flow augmentation in response to a vasodilator, the pathophysiological basis of which is unclear. This study sought to address two major gaps in our understanding of MVD: firstly, whether diminished flow reserve is due to structural changes within the microvasculature or potentially reversible dysfunction and secondly to unravel the mechanism of exercise-induced ischemia in the absence of obstructive disease.
Methods
Simultaneous intracoronary pressure and flow velocity recordings were made in the left anterior descending artery of patients with angina and no obstructive epicardial disease (Fractional Flow Reserve >0.80). Measurements were made at rest, during adenosine-mediated hyperaemia and supine bicycle exercise. Wave intensity analysis was used to quantify waves that accelerate and decelerate coronary blood flow, coronary perfusion efficiency being defined as the proportion of total wave energy that accelerates blood flow. Patients were prospectively classified into MVD (coronary flow reserve <2.5) and controls with researchers blinded to the classification throughout the protocol. Myocardial perfusion and vascular function were assessed by 3T cardiac MRI and venous occlusion plethysmography with forearm blood flow (FBF) assessment during serial infusions of acetylcholine, adenosine and the nitric oxide synthase inhibitor NG-monomethyl-L-arginine (L-NMMA).
Results
78 patients were enrolled (42 patients had MVD and 36 were controls), with no differences in cardiovascular risk factors between groups. The MVD group had elevated coronary blood flow (21.3±6.4 vs. 15.1±4.5cm s–1; p<0.001) and global myocardial perfusion (1.36±0.37 vs. 1.13±0.22ml/min/g; p=0.01) at rest. Maximum coronary and myocardial blood flow during hyperaemia was similar in both groups. During exercise, MVD patients achieved similar peak flow (30.5±10.0 vs. 26.3±7.7cm s–1; p=0.07) despite a higher rate-pressure product (20777±5205 vs. 17450±4710bpm.mmHg; p=0.01). Coronary perfusion efficiency, decreased with exercise in the MVD group (61±11% vs. 44±10% p<0.001) but was unchanged in controls. On MRI, MVD had lower hyperaemic endo-epicardial perfusion ratio than controls (0.94±0.08 vs. 1.04±0.13; p=0.001). Augmentation of FBF with acetylcholine was attenuated in MVD patients compared to controls (p=0.02) but the response to adenosine was similar (p=0.13). Infusion of L-NMMA caused a significantly greater reduction in FBF in MVD patients compared to controls (p<0.001).
Exercise Physiology in MVD
Conclusion
Impaired flow reserve in MVD represents a dysfunctional state, characterised by inappropriately elevated resting flow due to increased nitric-oxide synthase mediated vasodilatation. There is abnormal flow distribution in the myocardium predisposing to subendocardial ischaemia, associated with and exacerbated by impaired cardiac-coronary coupling during exercise. These novel findings may represent distinct therapeutic targets.
Acknowledgement/Funding
British Heart Foundation
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Affiliation(s)
- H Rahman
- King's College London, British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas Hospital, London, United Kingdom
| | - M Ryan
- King's College London, British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas Hospital, London, United Kingdom
| | - M Lumley
- King's College London, British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas Hospital, London, United Kingdom
| | - H McConkey
- King's College London, British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas Hospital, London, United Kingdom
| | - F Khan
- King's College London, British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas Hospital, London, United Kingdom
| | - H Ellis
- King's College London, British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas Hospital, London, United Kingdom
| | - B Clapp
- King's College London, British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas Hospital, London, United Kingdom
| | - M Marber
- King's College London, British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas Hospital, London, United Kingdom
| | - A Chiribiri
- King's College London, British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas Hospital, London, United Kingdom
| | - A Webb
- King's College London, British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas Hospital, London, United Kingdom
| | - D Perera
- King's College London, British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas Hospital, London, United Kingdom
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McConkey HZR, Marber M, Lee J, Ellis H, Joseph J, Allen C, Rahman H, Patterson T, Scannell C, Pibarot P, Chiribiri A, Redwood S, Prendergast BD. P6484Invasive and non-invasive characterisation of low gradient aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Low gradient severe aortic stenosis (LGAS) is associated with unfavourable outcomes when compared to high gradient aortic stenosis (HGAS), yet the contributing pathophysiology is poorly understood.
Methods
Symptomatic LGAS and HGAS patients undergoing trans-catheter aortic valve implantation (TAVI) underwent 3T stress perfusion cardiac magnetic resonance imaging (CMR) pre-(within 24 hours) and post-(4–6 months) TAVI. Left ventricular (LV) contractility and coronary flow/pressure were measured during hyperaemia and rapid pacing, immediately before and after TAVI, using a conductance LV catheter and dual-pressure and Doppler sensor–tipped guidewire in the mid-left anterior descending coronary artery.
Results
24 patients were recruited resulting in 19 suitable datasets (LGAS N=9, HGAS N=10, equally matched for comorbidities and B-natriuretic peptide level). LGAS patients had a smaller LV end diastolic volume index (p=0.035) and lower LV mass index (LVMI) (p=0.037). Pre-TAVI stress global endocardium-epicardium gradient was 0.88±0.09 and global myocardial perfusion reserve (MPR) 2.0±0.48 in 14 patients (6 LGAS and 8 HGAS patients, no difference between groups). Pre-TAVI, baseline coronary data demonstrated lower augmentation pressure (AP, p=0.035) and augmentation index (AIx, p=0.02) in the LGAS group. LGAS patients also exhibited a shorter ejection time (p=0.015), larger forward compression waves during rest, hyperaemia and rapid pacing, and smaller backward expansion waves (BEW) (p=0.001). Lower baseline end systolic pressure (p=0.004), inotropy (dP/dt+, p=0.045), lusitropy (dP/dt-, p=0.069), and stroke work (p=0.019) were observed in the LGAS group. Whilst LV size was smaller the LGAS group, rapid pacing induced a more significant drop in end systolic volume (p=0.045) and ejection fraction (p=0.015) in patients with HGAS. Post-TAVI, the hyperaemic BEW fell sharply (p<0.001), along with coronary VTI (p=0.02), and average pulse velocity (p=0.028), and AP and AIx remained lower (p=0.034 and p=0.031, respectively). The forward expansion wave was reduced in LGAS during rapid pacing. The HGAS group displayed a more profound drop in dP/dt+ (p=0.011) and dP/dt- p=0.014) at rest following intervention. Repeat CMR demonstrated statistically significant reduction in LV size and LVMI (p=0.012 and p<0.001, respectively) with significant increase in 3D global peak radial, circumferential and longitudinal strain (p=0.004, p=0.001 and p=0.018, respectively). Post-TAVI stress global endocardium-epicardium gradient was 0.88±0.13 and MPR 2.46±0.59 (improved from pre-TAVI, p=0.05). There was no difference in remodelling patterns or perfusion between the two groups.
Conclusion
This is the first study detailing the combined invasive and CMR pathophysiological changes in LGAS. Despite invasive parameters indicating a disease of less severe AS, the level of perfusion abnormality is disproportionate which may in part, relate to their adverse prognosis.
Acknowledgement/Funding
This research is funded by a Clinical Research Training Fellowship grant from the British Heart Foundation (FS/16/51/32365).
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Affiliation(s)
- H Z R McConkey
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - M Marber
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - J Lee
- Kings College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom
| | - H Ellis
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - J Joseph
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - C Allen
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - H Rahman
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - T Patterson
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - C Scannell
- Kings College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom
| | - P Pibarot
- Centre de Recherche de lInstitut Universitaire de Cardiologie et de Pneumologie de Quebec, Department of Medicine, Laval University, Quebec, Canada
| | - A Chiribiri
- Kings College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom
| | - S Redwood
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - B D Prendergast
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
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Abstract
Aortic stenosis is a heterogeneous disorder. Variations in the pathological and physiological responses to pressure overload are incompletely understood and generate a range of flow and pressure gradient patterns, which ultimately cause varying microvascular effects. The impact of cardiac-coronary coupling depends on these pressure and flow effects. In this article, we explore important concepts concerning cardiac physiology and the coronary microcirculation in aortic stenosis and their impact on myocardial remodeling, aortic valve flow patterns, and clinical progression.
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Affiliation(s)
- Hannah Z.R. McConkey
- Cardiovascular Division, King’s College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas’ Hospital Campus, London, United Kingdom (H.Z.R.M., M.M., A.C., S.R.R., B.D.P.)
| | - Michael Marber
- Cardiovascular Division, King’s College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas’ Hospital Campus, London, United Kingdom (H.Z.R.M., M.M., A.C., S.R.R., B.D.P.)
| | - Amedeo Chiribiri
- Cardiovascular Division, King’s College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas’ Hospital Campus, London, United Kingdom (H.Z.R.M., M.M., A.C., S.R.R., B.D.P.)
| | - Philippe Pibarot
- Department of Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec, Canada (P.P.)
| | - Simon R. Redwood
- Cardiovascular Division, King’s College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas’ Hospital Campus, London, United Kingdom (H.Z.R.M., M.M., A.C., S.R.R., B.D.P.)
| | - Bernard D. Prendergast
- Cardiovascular Division, King’s College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas’ Hospital Campus, London, United Kingdom (H.Z.R.M., M.M., A.C., S.R.R., B.D.P.)
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Kaier TE, Stengaard C, Marjot J, Sørensen JT, Alaour B, Stavropoulou-Tatla S, Terkelsen CJ, Williams L, Thygesen K, Weber E, Marber M, Bøtker HE. Cardiac Myosin-Binding Protein C to Diagnose Acute Myocardial Infarction in the Pre-Hospital Setting. J Am Heart Assoc 2019; 8:e013152. [PMID: 31345102 PMCID: PMC6761674 DOI: 10.1161/jaha.119.013152] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Early triage is essential to improve outcomes in patients with suspected acute myocardial infarction (AMI). This study investigated whether cMyC (cardiac myosin-binding protein), a novel biomarker of myocardial necrosis, can aid early diagnosis of AMI and risk stratification. Methods and Results cMyC and high-sensitivity cardiac troponin T were retrospectively quantified in blood samples obtained by ambulance-based paramedics in a prospective, diagnostic cohort study. Patients with ongoing or prolonged periods of chest discomfort, acute dyspnoea in the absence of known pulmonary disease, or clinical suspicion of AMI were recruited. Discrimination power was evaluated by calculating the area under the receiver operating characteristics curve; diagnostic performance was assessed at predefined thresholds. Diagnostic nomograms were derived and validated using bootstrap resampling in logistic regression models. Seven hundred seventy-six patients with median age 68 [58;78] were recruited. AMI was the final adjudicated diagnosis in 22%. Median symptom to sampling time was 70 minutes. cMyC concentration in patients with AMI was significantly higher than with other diagnoses: 98 [43;855] versus 17 [9;42] ng/L. Discrimination power for AMI was better with cMyC than with high-sensitivity cardiac troponin T (area under the curve, 0.839 versus 0.813; P=0.005). At a previously published rule-out threshold (10 ng/L), cMyC reaches 100% sensitivity and negative predictive value in patients after 2 hours of symptoms. In logistic regression analysis, cMyC is superior to high-sensitivity cardiac troponin T and was used to derive diagnostic and prognostic nomograms to evaluate risk of AMI and death. Conclusions In patients undergoing blood draws very early after symptom onset, cMyC demonstrates improved diagnostic discrimination of AMI and could significantly improve the early triage of patients with suspected AMI.
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Affiliation(s)
- Thomas E Kaier
- King's College London BHF Centre The Rayne Institute St Thomas' Hospital London United Kingdom
| | | | - Jack Marjot
- King's College London BHF Centre The Rayne Institute St Thomas' Hospital London United Kingdom
| | | | - Bashir Alaour
- King's College London BHF Centre The Rayne Institute St Thomas' Hospital London United Kingdom
| | | | | | - Luke Williams
- King's College London BHF Centre The Rayne Institute St Thomas' Hospital London United Kingdom
| | | | - Ekkehard Weber
- Institute of Physiological Chemistry Martin Luther University Halle-Wittenberg Halle Germany
| | - Michael Marber
- King's College London BHF Centre The Rayne Institute St Thomas' Hospital London United Kingdom
| | - Hans Erik Bøtker
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
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Nagel E, Greenwood JP, McCann GP, Bettencourt N, Shah AM, Hussain ST, Perera D, Plein S, Bucciarelli-Ducci C, Paul M, Westwood MA, Marber M, Richter WS, Puntmann VO, Schwenke C, Schulz-Menger J, Das R, Wong J, Hausenloy DJ, Steen H, Berry C. Magnetic Resonance Perfusion or Fractional Flow Reserve in Coronary Disease. N Engl J Med 2019; 380:2418-2428. [PMID: 31216398 DOI: 10.1056/nejmoa1716734] [Citation(s) in RCA: 287] [Impact Index Per Article: 57.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND In patients with stable angina, two strategies are often used to guide revascularization: one involves myocardial-perfusion cardiovascular magnetic resonance imaging (MRI), and the other involves invasive angiography and measurement of fractional flow reserve (FFR). Whether a cardiovascular MRI-based strategy is noninferior to an FFR-based strategy with respect to major adverse cardiac events has not been established. METHODS We performed an unblinded, multicenter, clinical-effectiveness trial by randomly assigning 918 patients with typical angina and either two or more cardiovascular risk factors or a positive exercise treadmill test to a cardiovascular MRI-based strategy or an FFR-based strategy. Revascularization was recommended for patients in the cardiovascular-MRI group with ischemia in at least 6% of the myocardium or in the FFR group with an FFR of 0.8 or less. The composite primary outcome was death, nonfatal myocardial infarction, or target-vessel revascularization within 1 year. The noninferiority margin was a risk difference of 6 percentage points. RESULTS A total of 184 of 454 patients (40.5%) in the cardiovascular-MRI group and 213 of 464 patients (45.9%) in the FFR group met criteria to recommend revascularization (P = 0.11). Fewer patients in the cardiovascular-MRI group than in the FFR group underwent index revascularization (162 [35.7%] vs. 209 [45.0%], P = 0.005). The primary outcome occurred in 15 of 421 patients (3.6%) in the cardiovascular-MRI group and 16 of 430 patients (3.7%) in the FFR group (risk difference, -0.2 percentage points; 95% confidence interval, -2.7 to 2.4), findings that met the noninferiority threshold. The percentage of patients free from angina at 12 months did not differ significantly between the two groups (49.2% in the cardiovascular-MRI group and 43.8% in the FFR group, P = 0.21). CONCLUSIONS Among patients with stable angina and risk factors for coronary artery disease, myocardial-perfusion cardiovascular MRI was associated with a lower incidence of coronary revascularization than FFR and was noninferior to FFR with respect to major adverse cardiac events. (Funded by the Guy's and St. Thomas' Biomedical Research Centre of the National Institute for Health Research and others; MR-INFORM ClinicalTrials.gov number, NCT01236807.).
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Affiliation(s)
- Eike Nagel
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - John P Greenwood
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Gerry P McCann
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Nuno Bettencourt
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Ajay M Shah
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Shazia T Hussain
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Divaka Perera
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Sven Plein
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Chiara Bucciarelli-Ducci
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Matthias Paul
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Mark A Westwood
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Michael Marber
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Wolf-Stefan Richter
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Valentina O Puntmann
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Carsten Schwenke
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Jeanette Schulz-Menger
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Rajiv Das
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Joyce Wong
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Derek J Hausenloy
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Henning Steen
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
| | - Colin Berry
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Center for Cardiovascular Research) Center for Cardiovascular Imaging, Goethe University, and the Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main (E.N., V.O.P.), Pharmtrace (W.-S.R.), Schwenke Consulting (C.S.), and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, DZHK, and Helios Kliniken Berlin-Buch (J.S.-M.), Berlin, and the Clinic for Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg (H.S.) - all in Germany; the Division of Biomedical Engineering and Imaging Sciences (E.N., S.T.H., S.P., M.P.) and British Heart Foundation Centre (A.M.S., D.P., M.M.), King's College London, Barts Heart Centre, St. Bartholomew's Hospital (M.A.W.), the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London (D.J.H.), and the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (D.J.H.), London, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (J.P.G., S.P.), the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital (G.P.M.), and the Department of Cardiology, Glenfield Hospital (S.T.H.), Leicester, Bristol Heart Institute, University of Bristol and Bristol NIHR Biomedical Research Centre, Bristol (C.B.-D.), the Faculty of Health and Life Sciences, Northumbria University, and Freeman Hospital, Newcastle-upon-Tyne (R.D.), the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Uxbridge (J.W.), and the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (C.B.) - all in the United Kingdom; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (N.B.); Kardiologie, Herzzentrum Luzern, Luzerner Kantonsspital, Lucerne, Switzerland (M.P.); and the Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, and the National Heart Research Institute Singapore, National Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.J.H.)
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Schulte C, Barwari T, Joshi A, Theofilatos K, Zampetaki A, Barallobre-Barreiro J, Singh B, Sörensen NA, Neumann JT, Zeller T, Westermann D, Blankenberg S, Marber M, Liebetrau C, Mayr M. Comparative Analysis of Circulating Noncoding RNAs Versus Protein Biomarkers in the Detection of Myocardial Injury. Circ Res 2019; 125:328-340. [PMID: 31159652 PMCID: PMC6641471 DOI: 10.1161/circresaha.119.314937] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
RATIONALE Noncoding RNAs (ncRNAs), including microRNAs (miRNAs), circular RNAs (circRNAs), and long noncoding RNAs (lncRNAs), are proposed novel biomarkers of myocardial injury. Their release kinetics have not been explored without confounding by heparin nor has their relationship to myocardial protein biomarkers. OBJECTIVE To compare ncRNA types in heparinase-treated samples with established and emerging protein biomarkers for myocardial injury. METHODS AND RESULTS Screening of 158 circRNAs and 21 lncRNAs in human cardiac tissue identified 12 circRNAs and 11 lncRNAs as potential biomarkers with cardiac origin. Eleven miRNAs were included. At low spike-in concentrations of myocardial tissue, significantly higher regression coefficients were observed across ncRNA types compared with cardiac troponins and cMyBP-C (cardiac myosin-binding protein C). Heparinase treatment of serial plasma and serum samples of patients undergoing transcoronary ablation of septal hypertrophy removed spurious correlations between miRNAs in non-heparinase-treated samples. After transcoronary ablation of septal hypertrophy, muscle-enriched miRNAs (miR-1 and miR-133a) showed a steeper and earlier increase than cardiac-enriched miRNAs (miR-499 and miR-208b). Putative cardiac lncRNAs, including LIPCAR (long intergenic noncoding RNA predicting cardiac remodeling and survival), did not rise, refuting a predominant cardiac origin. Cardiac circRNAs remained largely undetectable. In a validation cohort of acute myocardial infarction, receiver operating characteristic curve analysis revealed noninferiority of cardiac-enriched miRNAs, but miRNAs failed to identify cases presenting with low troponin values. cMyBP-C was validated as a biomarker with highly sensitive properties, and the combination of muscle-enriched miRNAs with high-sensitive cardiac troponin T and cMyBP-C returned the highest area under the curve values. CONCLUSIONS In a comparative assessment of ncRNAs and protein biomarkers for myocardial injury, cMyBP-C showed properties as the most sensitive cardiac biomarker while miRNAs emerged as promising candidates to integrate ncRNAs with protein biomarkers. Sensitivity of current miRNA detection is inferior to cardiac proteins but a multibiomarker combination of muscle-enriched miRNAs with cMyBP-C and cardiac troponins could open a new path of integrating complementary characteristics of different biomarker types.
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Affiliation(s)
- Christian Schulte
- From the King's British Heart Foundation Centre, King's College London, United Kingdom (C.S., T.B., A.J., K.T., A.Z., J.B.-B., B.S., M. Mayr).,Department of General and Interventional Cardiology, University Heart Centre Hamburg Eppendorf, Germany (C.S., N.A.S., J.T.N., T.Z., D.W., S.B.).,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg, Luebeck, Kiel, Germany (C.S., N.A.S., J.T.N., T.Z., D.W., S.B.)
| | - Temo Barwari
- From the King's British Heart Foundation Centre, King's College London, United Kingdom (C.S., T.B., A.J., K.T., A.Z., J.B.-B., B.S., M. Mayr)
| | - Abhishek Joshi
- From the King's British Heart Foundation Centre, King's College London, United Kingdom (C.S., T.B., A.J., K.T., A.Z., J.B.-B., B.S., M. Mayr).,Bart's Heart Centre, St. Bartholomew's Hospital, West Smithfield, London (A.J.)
| | - Konstantinos Theofilatos
- From the King's British Heart Foundation Centre, King's College London, United Kingdom (C.S., T.B., A.J., K.T., A.Z., J.B.-B., B.S., M. Mayr)
| | - Anna Zampetaki
- From the King's British Heart Foundation Centre, King's College London, United Kingdom (C.S., T.B., A.J., K.T., A.Z., J.B.-B., B.S., M. Mayr)
| | - Javier Barallobre-Barreiro
- From the King's British Heart Foundation Centre, King's College London, United Kingdom (C.S., T.B., A.J., K.T., A.Z., J.B.-B., B.S., M. Mayr)
| | - Bhawana Singh
- From the King's British Heart Foundation Centre, King's College London, United Kingdom (C.S., T.B., A.J., K.T., A.Z., J.B.-B., B.S., M. Mayr)
| | - Nils A Sörensen
- Department of General and Interventional Cardiology, University Heart Centre Hamburg Eppendorf, Germany (C.S., N.A.S., J.T.N., T.Z., D.W., S.B.).,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg, Luebeck, Kiel, Germany (C.S., N.A.S., J.T.N., T.Z., D.W., S.B.)
| | - Johannes T Neumann
- Department of General and Interventional Cardiology, University Heart Centre Hamburg Eppendorf, Germany (C.S., N.A.S., J.T.N., T.Z., D.W., S.B.).,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg, Luebeck, Kiel, Germany (C.S., N.A.S., J.T.N., T.Z., D.W., S.B.)
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Centre Hamburg Eppendorf, Germany (C.S., N.A.S., J.T.N., T.Z., D.W., S.B.).,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg, Luebeck, Kiel, Germany (C.S., N.A.S., J.T.N., T.Z., D.W., S.B.)
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart Centre Hamburg Eppendorf, Germany (C.S., N.A.S., J.T.N., T.Z., D.W., S.B.).,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg, Luebeck, Kiel, Germany (C.S., N.A.S., J.T.N., T.Z., D.W., S.B.)
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Centre Hamburg Eppendorf, Germany (C.S., N.A.S., J.T.N., T.Z., D.W., S.B.).,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg, Luebeck, Kiel, Germany (C.S., N.A.S., J.T.N., T.Z., D.W., S.B.)
| | - Michael Marber
- King's British Heart Foundation Centre, King's College London, Guy's and St Thomas' Hospitals, United Kingdom (M. Marber)
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany and German Centre of Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany (C.L.)
| | - Manuel Mayr
- From the King's British Heart Foundation Centre, King's College London, United Kingdom (C.S., T.B., A.J., K.T., A.Z., J.B.-B., B.S., M. Mayr)
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Kaier TE, Twerenbold R, Alaour B, Badertscher P, Puelacher C, Marjot J, Boeddinghaus J, Nestelberger T, Wildi K, Wussler D, Rubini-Gimenez M, Reichlin T, Marber M, Mueller C. 1086Derivation and validation of a 0/1h-algorithm to diagnose myocardial infarction using cardiac myosin-binding protein c - direct comparison to hs-cTnI. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T E Kaier
- King's College London, The Rayne Institute, St Thomas' Hospital, London, United Kingdom
| | | | - B Alaour
- King's College London, The Rayne Institute, St Thomas' Hospital, London, United Kingdom
| | | | - C Puelacher
- University Hospital Basel, Basel, Switzerland
| | - J Marjot
- King's College London, The Rayne Institute, St Thomas' Hospital, London, United Kingdom
| | | | | | - K Wildi
- University Hospital Basel, Basel, Switzerland
| | - D Wussler
- University Hospital Basel, Basel, Switzerland
| | | | - T Reichlin
- University Hospital Basel, Basel, Switzerland
| | - M Marber
- King's College London, The Rayne Institute, St Thomas' Hospital, London, United Kingdom
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
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Affiliation(s)
- Thomas E Kaier
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Bashir Alaour
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Michael Marber
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
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Perera D, Clayton T, Petrie MC, Greenwood JP, O'Kane PD, Evans R, Sculpher M, Mcdonagh T, Gershlick A, de Belder M, Redwood S, Carr-White G, Marber M. Percutaneous Revascularization for Ischemic Ventricular Dysfunction: Rationale and Design of the REVIVED-BCIS2 Trial: Percutaneous Coronary Intervention for Ischemic Cardiomyopathy. JACC Heart Fail 2018; 6:517-526. [PMID: 29852933 DOI: 10.1016/j.jchf.2018.01.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 01/23/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Evaluate whether PCI in combination with optimal medical therapy (OMT) will reduce all-cause death and hospitalization for HF compared to a strategy of OMT alone. BACKGROUND Ischemic cardiomyopathy (ICM) is the most common cause of heart failure (HF) and is associated with significant mortality and morbidity. Surgical revascularization has been shown to improve long-term outcomes in some patients, but surgery itself carries a major early hazard. Percutaneous coronary intervention (PCI) may allow a better balance between risk and benefit. METHODS REVIVED-BCIS2 is a prospective, multi-center, open-label, randomized controlled trial, funded by the National Institute for Health Research in the United Kingdom. Follow-up will be for at least 2 years from randomization. Secondary outcomes include left ventricular ejection fraction (LVEF), quality of life scores, appropriate implantable cardioverter defibrillator therapy and acute myocardial infarction. Patients with LVEF ≤35%, extensive coronary disease and demonstrable myocardial viability are eligible for inclusion and those with a myocardial infarction within 4 weeks, decompensated HF or sustained ventricular arrhythmias within 72 h are excluded. A trial of 700 patients has more than 85% power to detect a 30% relative reduction in hazard. RESULTS A total of 400 patients have been enrolled to date. CONCLUSIONS International guidelines do not provide firm recommendations on the role of PCI in managing severe ICM, because of a lack of robust evidence. REVIVED-BCIS2 will provide the first randomized data on the efficacy and safety of PCI in ICM and has the potential to inform guidelines pertaining to both revascularization and HF. (Study of Efficacy and Safety of Percutaneous Coronary Intervention to Improve Survival in Heart Failure [REVIVED-BCIS2]; NCT01920048) (REVascularisation for Ischaemic VEntricular Dysfunction; ISRCTN45979711).
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Affiliation(s)
- Divaka Perera
- National Institute for Health Research Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom.
| | - Tim Clayton
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Peter D O'Kane
- Royal Bournemouth and Christchurch Hospital, United Kingdom
| | - Richard Evans
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Sculpher
- Centre for Health Economics, University of York, United Kingdom
| | | | - Anthony Gershlick
- Biomedical Research Unit, University Hospitals of Leicester, Leicester, United Kingdom
| | | | - Simon Redwood
- National Institute for Health Research Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Gerald Carr-White
- National Institute for Health Research Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Michael Marber
- National Institute for Health Research Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
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Affiliation(s)
- Michael Marber
- The Rayne Institute, St Thomas' Hospital, 4th Floor Lambeth Wing, Westminster Bridge Road, London SE1 7EH, UK
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Kaier TE, Stengaard C, Marjot J, Sorensen J, Stavropoulou-Tatla S, Terkelsen C, Williams L, Thygesen K, Botker H, Marber M. FROM BENCH TO IMPROVED PRE-HOSPITAL DIAGNOSIS OF VERY EARLY AMI: CARDIAC MYOSIN-BINDING PROTEIN C. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)33200-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kravic B, Harbauer AB, Romanello V, Simeone L, Vögtle FN, Kaiser T, Straubinger M, Huraskin D, Böttcher M, Cerqua C, Martin ED, Poveda-Huertes D, Buttgereit A, Rabalski AJ, Heuss D, Rudolf R, Friedrich O, Litchfield D, Marber M, Salviati L, Mougiakakos D, Neuhuber W, Sandri M, Meisinger C, Hashemolhosseini S. In mammalian skeletal muscle, phosphorylation of TOMM22 by protein kinase CSNK2/CK2 controls mitophagy. Autophagy 2018; 14:311-335. [PMID: 29165030 DOI: 10.1080/15548627.2017.1403716] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In yeast, Tom22, the central component of the TOMM (translocase of outer mitochondrial membrane) receptor complex, is responsible for the recognition and translocation of synthesized mitochondrial precursor proteins, and its protein kinase CK2-dependent phosphorylation is mandatory for TOMM complex biogenesis and proper mitochondrial protein import. In mammals, the biological function of protein kinase CSNK2/CK2 remains vastly elusive and it is unknown whether CSNK2-dependent phosphorylation of TOMM protein subunits has a similar role as that in yeast. To address this issue, we used a skeletal muscle-specific Csnk2b/Ck2β-conditional knockout (cKO) mouse model. Phenotypically, these skeletal muscle Csnk2b cKO mice showed reduced muscle strength and abnormal metabolic activity of mainly oxidative muscle fibers, which point towards mitochondrial dysfunction. Enzymatically, active muscle lysates from skeletal muscle Csnk2b cKO mice phosphorylate murine TOMM22, the mammalian ortholog of yeast Tom22, to a lower extent than lysates prepared from controls. Mechanistically, CSNK2-mediated phosphorylation of TOMM22 changes its binding affinity for mitochondrial precursor proteins. However, in contrast to yeast, mitochondrial protein import seems not to be affected in vitro using mitochondria isolated from muscles of skeletal muscle Csnk2b cKO mice. PINK1, a mitochondrial health sensor that undergoes constitutive import under physiological conditions, accumulates within skeletal muscle Csnk2b cKO fibers and labels abnormal mitochondria for removal by mitophagy as demonstrated by the appearance of mitochondria-containing autophagosomes through electron microscopy. Mitophagy can be normalized by either introduction of a phosphomimetic TOMM22 mutant in cultured myotubes, or by in vivo electroporation of phosphomimetic Tomm22 into muscles of mice. Importantly, transfection of the phosphomimetic Tomm22 mutant in muscle cells with ablated Csnk2b restored their oxygen consumption rate comparable to wild-type levels. In sum, our data show that mammalian CSNK2-dependent phosphorylation of TOMM22 is a critical switch for mitophagy and reveal CSNK2-dependent physiological implications on metabolism, muscle integrity and behavior.
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Affiliation(s)
- Bojana Kravic
- a Institute of Biochemistry, Medical Faculty , Friedrich-Alexander-University of Erlangen-Nürnberg , Erlangen , Germany
| | - Angelika B Harbauer
- b Institute of Biochemistry and Molecular Biology, ZBMZ, Faculty of Biology , University of Freiburg , Germany
| | - Vanina Romanello
- c Department of Biomedical Science , University of Padova , Padova , Italy
| | - Luca Simeone
- a Institute of Biochemistry, Medical Faculty , Friedrich-Alexander-University of Erlangen-Nürnberg , Erlangen , Germany
| | - F-Nora Vögtle
- l Institute of Biochemistry and Molecular Biology, ZBMZ, BIOSS (Centre for Biological Signalling Studies), Faculty of Medicine , University of Freiburg , Germany
| | - Tobias Kaiser
- a Institute of Biochemistry, Medical Faculty , Friedrich-Alexander-University of Erlangen-Nürnberg , Erlangen , Germany
| | - Marion Straubinger
- a Institute of Biochemistry, Medical Faculty , Friedrich-Alexander-University of Erlangen-Nürnberg , Erlangen , Germany
| | - Danyil Huraskin
- a Institute of Biochemistry, Medical Faculty , Friedrich-Alexander-University of Erlangen-Nürnberg , Erlangen , Germany
| | - Martin Böttcher
- d Department of Internal Medicine, Hematology and Oncology, Medical Faculty , Friedrich-Alexander-University of Erlangen-Nürnberg , Erlangen , Germany
| | - Cristina Cerqua
- e Clinical Genetics Unit, Department of Woman and Child Health , University of Padova, IRP Città della Speranza , Padova , Italy
| | - Eva Denise Martin
- f King's College London BHF Centre of Research Excellence, The Rayne Institute , St Thomas' Hospital , London , United Kingdom
| | - Daniel Poveda-Huertes
- b Institute of Biochemistry and Molecular Biology, ZBMZ, Faculty of Biology , University of Freiburg , Germany
| | - Andreas Buttgereit
- g Institute of Medical Biotechnology , Friedrich-Alexander-University of Erlangen-Nürnberg , Erlangen , Germany
| | | | - Dieter Heuss
- i Department of Neurology , University Hospital of Erlangen, Medical Faculty, Friedrich-Alexander-University of Erlangen-Nürnberg , Erlangen , Germany
| | - Rüdiger Rudolf
- j University of Applied Sciences Mannheim , Mannheim , Germany
| | - Oliver Friedrich
- g Institute of Medical Biotechnology , Friedrich-Alexander-University of Erlangen-Nürnberg , Erlangen , Germany
| | | | - Michael Marber
- f King's College London BHF Centre of Research Excellence, The Rayne Institute , St Thomas' Hospital , London , United Kingdom
| | - Leonardo Salviati
- e Clinical Genetics Unit, Department of Woman and Child Health , University of Padova, IRP Città della Speranza , Padova , Italy
| | - Dimitrios Mougiakakos
- d Department of Internal Medicine, Hematology and Oncology, Medical Faculty , Friedrich-Alexander-University of Erlangen-Nürnberg , Erlangen , Germany
| | - Winfried Neuhuber
- k Institute of Anatomy, Medical Faculty , Friedrich-Alexander-University of Erlangen-Nürnberg , Erlangen , Germany
| | - Marco Sandri
- c Department of Biomedical Science , University of Padova , Padova , Italy
| | - Chris Meisinger
- l Institute of Biochemistry and Molecular Biology, ZBMZ, BIOSS (Centre for Biological Signalling Studies), Faculty of Medicine , University of Freiburg , Germany
| | - Said Hashemolhosseini
- a Institute of Biochemistry, Medical Faculty , Friedrich-Alexander-University of Erlangen-Nürnberg , Erlangen , Germany
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Williams RP, de Waard GA, De Silva K, Lumley M, Asrress K, Arri S, Ellis H, Mir A, Clapp B, Chiribiri A, Plein S, Teunissen PF, Hollander MR, Marber M, Redwood S, van Royen N, Perera D. Doppler Versus Thermodilution-Derived Coronary Microvascular Resistance to Predict Coronary Microvascular Dysfunction in Patients With Acute Myocardial Infarction or Stable Angina Pectoris. Am J Cardiol 2018; 121:1-8. [PMID: 29132649 PMCID: PMC5746201 DOI: 10.1016/j.amjcard.2017.09.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/07/2017] [Accepted: 09/07/2017] [Indexed: 01/02/2023]
Abstract
Coronary microvascular resistance is increasingly measured as a predictor of clinical outcomes, but there is no accepted gold-standard measurement. We compared the diagnostic accuracy of 2 invasive indices of microvascular resistance, Doppler-derived hyperemic microvascular resistance (hMR) and thermodilution-derived index of microcirculatory resistance (IMR), at predicting microvascular dysfunction. A total of 54 patients (61 ± 10 years) who underwent cardiac catheterization for stable coronary artery disease (n = 10) or acute myocardial infarction (n = 44) had simultaneous intracoronary pressure, Doppler flow velocity and thermodilution flow data acquired from 74 unobstructed vessels, at rest and during hyperemia. Three independent measurements of microvascular function were assessed, using predefined dichotomous thresholds: (1) coronary flow reserve (CFR), the average value of Doppler- and thermodilution-derived CFR; (2) cardiovascular magnetic resonance (CMR) derived myocardial perfusion reserve index; and (3) CMR-derived microvascular obstruction. hMR correlated with IMR (rho = 0.41, p <0.0001). hMR had better diagnostic accuracy than IMR to predict CFR (area under curve [AUC] 0.82 vs 0.58, p <0.001, sensitivity and specificity 77% and 77% vs 51% and 71%) and myocardial perfusion reserve index (AUC 0.85 vs 0.72, p = 0.19, sensitivity and specificity 82% and 80% vs 64% and 75%). In patients with acute myocardial infarction, the AUCs of hMR and IMR at predicting extensive microvascular obstruction were 0.83 and 0.72, respectively (p = 0.22, sensitivity and specificity 78% and 74% vs 44% and 91%). We conclude that these 2 invasive indices of coronary microvascular resistance only correlate modestly and so cannot be considered equivalent. In our study, the correlation between independent invasive and noninvasive measurements of microvascular function was better with hMR than with IMR.
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Affiliation(s)
- Rupert P Williams
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Guus A de Waard
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Kalpa De Silva
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Matthew Lumley
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Kaleab Asrress
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Satpal Arri
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Howard Ellis
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Awais Mir
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Brian Clapp
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Amedeo Chiribiri
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Paul F Teunissen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Maurits R Hollander
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Michael Marber
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Simon Redwood
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Divaka Perera
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom.
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49
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Sammut EC, Villa ADM, Di Giovine G, Dancy L, Bosio F, Gibbs T, Jeyabraba S, Schwenke S, Williams SE, Marber M, Alfakih K, Ismail TF, Razavi R, Chiribiri A. Prognostic Value of Quantitative Stress Perfusion Cardiac Magnetic Resonance. JACC Cardiovasc Imaging 2017; 11:686-694. [PMID: 29153572 PMCID: PMC5952817 DOI: 10.1016/j.jcmg.2017.07.022] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/15/2017] [Accepted: 07/20/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study sought to evaluate the prognostic usefulness of visual and quantitative perfusion cardiac magnetic resonance (CMR) ischemic burden in an unselected group of patients and to assess the validity of consensus-based ischemic burden thresholds extrapolated from nuclear studies. BACKGROUND There are limited data on the prognostic value of assessing myocardial ischemic burden by CMR, and there are none using quantitative perfusion analysis. METHODS Patients with suspected coronary artery disease referred for adenosine-stress perfusion CMR were included (n = 395; 70% male; age 58 ± 13 years). The primary endpoint was a composite of cardiovascular death, nonfatal myocardial infarction, aborted sudden death, and revascularization after 90 days. Perfusion scans were assessed visually and with quantitative analysis. Cross-validated Cox regression analysis and net reclassification improvement were used to assess the incremental prognostic value of visual or quantitative perfusion analysis over a baseline clinical model, initially as continuous covariates, then using accepted thresholds of ≥2 segments or ≥10% myocardium. RESULTS After a median 460 days (interquartile range: 190 to 869 days) follow-up, 52 patients reached the primary endpoint. At 2 years, the addition of ischemic burden was found to increase prognostic value over a baseline model of age, sex, and late gadolinium enhancement (baseline model area under the curve [AUC]: 0.75; visual AUC: 0.84; quantitative AUC: 0.85). Dichotomized quantitative ischemic burden performed better than visual assessment (net reclassification improvement 0.043 vs. 0.003 against baseline model). CONCLUSIONS This study was the first to address the prognostic benefit of quantitative analysis of perfusion CMR and to support the use of consensus-based ischemic burden thresholds by perfusion CMR for prognostic evaluation of patients with suspected coronary artery disease. Quantitative analysis provided incremental prognostic value to visual assessment and established risk factors, potentially representing an important step forward in the translation of quantitative CMR perfusion analysis to the clinical setting.
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Affiliation(s)
- Eva C Sammut
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Bristol Heart Institute, Bristol, United Kingdom
| | - Adriana D M Villa
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Gabriella Di Giovine
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Luke Dancy
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Filippo Bosio
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Thomas Gibbs
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Swarna Jeyabraba
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | | | - Steven E Williams
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Michael Marber
- Cardiovascular Division, King's College London, London, United Kingdom
| | - Khaled Alfakih
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Tevfik F Ismail
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
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50
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Kaier TE, Twerenbold R, Puelacher C, Marjot J, Imambaccus N, Boeddinghaus J, Nestelberger T, Badertscher P, Sabti Z, Giménez MR, Wildi K, Hillinger P, Grimm K, Loeffel S, Shrestha S, Widmer DF, Cupa J, Kozhuharov N, Miró Ò, Martín-Sánchez FJ, Morawiec B, Rentsch K, Lohrmann J, Kloos W, Osswald S, Reichlin T, Weber E, Marber M, Mueller C. Direct Comparison of Cardiac Myosin-Binding Protein C With Cardiac Troponins for the Early Diagnosis of Acute Myocardial Infarction. Circulation 2017; 136:1495-1508. [PMID: 28972002 PMCID: PMC5642333 DOI: 10.1161/circulationaha.117.028084] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 08/10/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cardiac myosin-binding protein C (cMyC) is a cardiac-restricted protein that is more abundant than cardiac troponins (cTn) and is released more rapidly after acute myocardial infarction (AMI). We evaluated cMyC as an adjunct or alternative to cTn in the early diagnosis of AMI. METHODS Unselected patients (N=1954) presenting to the emergency department with symptoms suggestive of AMI, concentrations of cMyC, and high-sensitivity (hs) and standard-sensitivity cTn were measured at presentation. The final diagnosis of AMI was independently adjudicated using all available clinical and biochemical information without knowledge of cMyC. The prognostic end point was long-term mortality. RESULTS Final diagnosis was AMI in 340 patients (17%). Concentrations of cMyC at presentation were significantly higher in those with versus without AMI (median, 237 ng/L versus 13 ng/L, P<0.001). Discriminatory power for AMI, as quantified by the area under the receiver-operating characteristic curve (AUC), was comparable for cMyC (AUC, 0.924), hs-cTnT (AUC, 0.927), and hs-cTnI (AUC, 0.922) and superior to cTnI measured by a contemporary sensitivity assay (AUC, 0.909). The combination of cMyC with hs-cTnT or standard-sensitivity cTnI (but not hs-cTnI) led to an increase in AUC to 0.931 (P<0.0001) and 0.926 (P=0.003), respectively. Use of cMyC more accurately classified patients with a single blood test into rule-out or rule-in categories: Net Reclassification Improvement +0.149 versus hs-cTnT, +0.235 versus hs-cTnI (P<0.001). In early presenters (chest pain <3 h), the improvement in rule-in/rule-out classification with cMyC was larger compared with hs-cTnT (Net Reclassification Improvement +0.256) and hs-cTnI (Net Reclassification Improvement +0.308; both P<0.001). Comparing the C statistics, cMyC was superior to hs-cTnI and standard sensitivity cTnI (P<0.05 for both) and similar to hs-cTnT at predicting death at 3 years. CONCLUSIONS cMyC at presentation provides discriminatory power comparable to hs-cTnT and hs-cTnI in the diagnosis of AMI and may perform favorably in patients presenting early after symptom onset. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00470587.
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Affiliation(s)
- Thomas E Kaier
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Raphael Twerenbold
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Christian Puelacher
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Jack Marjot
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Nazia Imambaccus
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Jasper Boeddinghaus
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Thomas Nestelberger
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Patrick Badertscher
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Zaid Sabti
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Maria Rubini Giménez
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Karin Wildi
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Petra Hillinger
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Karin Grimm
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Sarah Loeffel
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Samyut Shrestha
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Dayana Flores Widmer
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Janosch Cupa
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Nikola Kozhuharov
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Òscar Miró
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - F Javier Martín-Sánchez
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Beata Morawiec
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Katharina Rentsch
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Jens Lohrmann
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Wanda Kloos
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Stefan Osswald
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Tobias Reichlin
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Ekkehard Weber
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Michael Marber
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.).
| | - Christian Mueller
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
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