European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"Comparison of cardiac troponin assays reveals assay-specific sensitivities in a clinical model of very acute myocardial injury.","authors":"Julius Obergassel, Marc D Lemoine, Laura C Sommerfeld, Jan L Rieß, Salah Al-Aqili, Sandro J Jäckle, Laura Rottner, Andreas Rillig, Andreas Metzner, Nils A Sörensen, Larissa Fabritz, Thomas Renné, Raphael Twerenbold, Stefan Blankenberg, Tanja Zeller, Paulus Kirchhof, Johannes T Neumann","doi":"10.1093/ehjacc/zuaf064","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf064","url":null,"abstract":"<p><strong>Background: </strong>High-sensitivity cardiac troponin (hs-cTn) assays indicating myocardial injury are critical for the diagnosis of acute myocardial infarction (AMI), but their use to differentiate between acute and chronic myocardial injury is limited. This study aimed to assess the differential utility of three hs-cTn assays, targeting different troponin epitopes (proximal and/or central), to detect myocardial injury in a clinical model of acute myocardial injury by left-atrial ablation.</p><p><strong>Methods: </strong>First, pre- and post-procedural serum samples were prospectively collected from 158 patients undergoing pulmonary vein isolation in a standardised setting. cTn-concentrations were measured using the high-sensitive Architect-cTnI-, Atellica-IM-cTnI-, and Elecsys-cTnT-assays. cTnI/T-concentrations and -ratios were compared, also to established AMI rule-in-thresholds. Second, 48 patients in which hs-cTn measurements were performed in clinical routine after ablation with a clinical indication were assessed for correlations between hs-cTn-levels, symptoms and electrocardiogram changes.</p><p><strong>Results: </strong>The Atellica-assessed cTnI showed a doubled relative pre-to-post-procedural concentration-increase compared to Architect-cTnI (39.6-fold versus 20.5-fold; p=0.0036). The Atellica-hs-cTnI/T-ratio had a 2.5 [95%-CI 1.1,5.2] relative increase, while the Architect-cTnI-to-Elecsys-cTnT-ratio showed a 6.9 [95%-CI 2.3,11.8] relative increase (p<0.0001). In 78% of patients, at least one post-procedural cTn-concentration exceeded AMI rule-in-thresholds. Chronic kidney disease predicted higher pre-to-post-increases. In retrospectively analyzed routine cTn-assessments after ablation, cTn-levels after ablation did not correlate with neither symptoms, electrocardiogram changes nor angiography findings.</p><p><strong>Conclusions: </strong>The Atellica-assay demonstrated enhanced sensitivity for very acute myocardial injury, likely via its additional recognition of the proximally located cTnI epitope. This suggests its potential to improve differentiation of acute from chronic myocardial injury, warranting further investigation to confirm its clinical utility in that setting.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid Response Letter.","authors":"Colin Berry, Richard Good","doi":"10.1093/ehjacc/zuaf061","DOIUrl":"10.1093/ehjacc/zuaf061","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor related to \"An uncommon electrocardiogram pattern in a case of acute chest pain\" by Gulbadin Mufti, Shahid H. Shali, and A. Shaheer Ahmed.","authors":"Gheorghe-Andrei Dan","doi":"10.1093/ehjacc/zuaf050","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf050","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Cardiovascular Disease Journals in Reporting Sex and Gender in Research.","authors":"C Noel Bairey Merz, Robert O Bonow, Mercedes Carnethon, Filippo Crea, Joseph A Hill, Harlan M Krumholz, Roxana Mehran, Erica S Spatz","doi":"10.1093/ehjacc/zuaf041","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf041","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The legacy of extracorporeal cardiopulmonary resuscitation-bridging the past, shaping the present, defining the future.","authors":"Tharusan Thevathasan, Christian Hassager, Jason Bartos, Marcel van de Poll, Janine Pöss","doi":"10.1093/ehjacc/zuaf012","DOIUrl":"10.1093/ehjacc/zuaf012","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"195-197"},"PeriodicalIF":3.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antithrombotic therapy in patients with chronic coronary syndrome: a focus on the 2024 European Society of Cardiology guidelines.","authors":"Antonio Landi, Marco Valgimigli","doi":"10.1093/ehjacc/zuae134","DOIUrl":"10.1093/ehjacc/zuae134","url":null,"abstract":"<p><p>Antithrombotic therapy represents the mainstay of the pharmacological treatment in patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI). The optimal choice, combination, and duration of antithrombotic therapy represent still a clinical conundrum requiring a critical assessment of patient comorbidities, clinical presentation, and PCI features. The 2024 European Society of Cardiology (ESC) guidelines for the management of patients with CCS have been recently published encompassing new and revised recommendations on antithrombotic therapy. The scope of this manuscript is to provide a focus on the key recommendations on antithrombotic therapy of the 2024 ESC guidelines. Furthermore, we will provide an overview of differences and similarities between the latest ESC recommendations and statements on oral antithrombotic regimens in CCS patients from a recent European expert consensus document.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"178-182"},"PeriodicalIF":3.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical derivation and data simulated validation of rule-out and rule-in algorithms for the Siemens Atellica IM high-sensitivity cardiac troponin I assay.","authors":"Ingar Ziad Restan, Ole-Thomas Steiro, John W Pickering, Hilde L Tjora, Jørund Langørgen, Torbjørn Omland, Paul Collinson, Rune Bjørneklett, Kjell Vikenes, Trude Steinsvik, Øyvind Skadberg, Øistein R Mjelva, Alf Inge Larsen, Vernon V S Bonarjee, Kristin M Aakre","doi":"10.1093/ehjacc/zuaf017","DOIUrl":"10.1093/ehjacc/zuaf017","url":null,"abstract":"<p><strong>Aims: </strong>This prospective, two-centre study derived and validated predictive algorithms for the Siemens Atellica IM high-sensitivity cardiac troponin I (hs-cTnI) assay in the emergency department (ED).</p><p><strong>Methods and results: </strong>Algorithms for predicting 30-day myocardial infarction (MI) Types 1 and 2 and death or non-ST-elevation MI (NSTEMI, Types 1 and 2) at index admission were developed from a derivation cohort of 1896 patients and validated using a synthetic data set with nearly 1 million patient cases. Performance was compared with the European Society of Cardiology algorithms for hs-cTnT (Roche Diagnostics) and hs-cTnI (Abbott Diagnostics). An admission hs-cTnI concentration < 5 ng/L had a negative predictive value (NPV) and sensitivity for 30-day MI or death of 99.5-99.7% and 98.1-98.8%, respectively, in the derivation cohort and validation data set. The NPV and sensitivity were ≥99.7% and ≥98.8% for ruling out index NSTEMI. A 0- to 1-h algorithm with baseline hs-cTnI concentration < 10 ng/L and Δ change < 3 ng/L had NPV of ≥99.5% and sensitivity ≥ 97.3% for predicting 30-day MI or death and a ≥99.5% sensitivity and NPV for index NSTEMI. Rule-in algorithms of either 0-h hs-cTnI ≥ 120 ng/L or 0- to 1-h Δ change ≥ 12 ng/L had positive predictive value ≥ 73% and specificity > 96% for 30-day MI or death and index NSTEMI. The results were comparable with established hs-cTn algorithms.</p><p><strong>Conclusion: </strong>This study presents Siemens Atellica hs-cTnI algorithms for diagnosis and risk prediction in the ED with performance comparable with established hs-cTnT (Roche) and hs-cTnI (Abbott) algorithms.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"155-168"},"PeriodicalIF":3.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischaemia with non-obstructive coronary arteries in the 2024 European Society of Cardiology guidelines for the management of chronic coronary syndromes.","authors":"Harmony R Reynolds, Nathaniel R Smilowitz","doi":"10.1093/ehjacc/zuaf005","DOIUrl":"10.1093/ehjacc/zuaf005","url":null,"abstract":"<p><strong>Aims: </strong>Chronic coronary syndromes (CCS) occur commonly in the absence of flow-limiting epicardial coronary stenosis. Ischaemia or angina with non-obstructive coronary arteries (INOCA/ANOCA) may be caused by coronary microvascular disease, coronary artery spasm, myocardial bridging, diffuse atherosclerosis, or a combination of disorders.</p><p><strong>Methods and results: </strong>We highlight the new recommendations in the 2024 European Society of Cardiology (ESC) guidelines on CCS relevant to the diagnosis and management of INOCA/ANOCA. The guidelines place a new emphasis on consideration of INOCA/ANOCA early during cardiovascular risk stratification and the initial diagnostic workup for chest pain. There is a new Class I recommendation for the availability of invasive coronary function testing (CFT) at the time of initial coronary angiography, when the mechanisms of chest pain are uncertain after non-invasive testing, and in patients with established INOCA/ANOCA who have persistent symptoms and poor quality of life despite medical therapy. Once underlying disorders have been identified based on the results of invasive CFT, the ESC guidelines emphasize a patient-centred, mechanism-based approach to medical treatment of INOCA/ANOCA to improve the symptoms and quality of life.</p><p><strong>Conclusion: </strong>The 2024 ESC CCS guidelines provide a new vision for the diagnosis and management of ANOCA/INOCA, with an expanded role for invasive CFT and targeted medical therapy to improve symptoms and quality of life in patients with angina.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"173-177"},"PeriodicalIF":3.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of a new clinical classification of acute myocardial infarction.","authors":"Jasper Boeddinghaus, Anda Bularga, Caelan Taggart, Ryan Wereski, Michael McDermott, Alexander J F Thurston, Amy V Ferry, Michelle C Williams, Andrew H Baker, Marc R Dweck, David E Newby, Andrew R Chapman, Bertil Lindahl, Nicholas L Mills","doi":"10.1093/ehjacc/zuaf002","DOIUrl":"10.1093/ehjacc/zuaf002","url":null,"abstract":"<p><strong>Aims: </strong>The diagnostic criteria for Type 2 myocardial infarction identify a heterogeneous group of patients with variable outcomes and no clear treatment implications. We aimed to determine the implications of a new clinical classification for myocardial infarction with more objective diagnostic criteria using cardiac imaging.</p><p><strong>Methods and results: </strong>In a prospective cohort study, patients with Type 2 myocardial infarction underwent coronary angiography and cardiac magnetic resonance imaging or echocardiography. The new classification was applied to identify (i) spontaneous myocardial infarction due to acute coronary pathology, (ii) secondary myocardial infarction precipitated by acute illness in the presence of obstructive coronary artery disease, a new regional wall motion abnormality, or infarct-pattern scarring, and (iii) no myocardial infarction in the absence of obstructive disease or new myocardial abnormality. In 100 patients (65 years, 43% women) with Type 2 myocardial infarction, the new classification identified 25 and 31 patients with spontaneous and secondary myocardial infarction, respectively, and 44 without myocardial infarction. Compared with patients without myocardial infarction, those with secondary myocardial infarction were older, had more risk factors, and had higher troponin concentrations (P < 0.05 for all). During a median follow-up of 4.4 years, death, myocardial infarction, or heart failure hospitalization was more common in secondary myocardial infarction compared with those without myocardial infarction [55% (17/31) vs. 16% (7/44), P < 0.001].</p><p><strong>Conclusion: </strong>A new clinical classification of myocardial infarction informed by cardiac imaging would reduce the diagnosis of myocardial infarction in acute illness and identify those patients at highest risk who are most likely to benefit from treatment.</p><p><strong>Clinical trial registration: </strong>https://clinicaltrials.gov/ct2/show/NCT03338504.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"131-141"},"PeriodicalIF":4.6,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"This month: from groundbreaking insights to global conversations-we are just one step away from Florence! Join the leading edge of Acute Cardiovascular Care!","authors":"Pascal Vranckx, David Morrow, Sean van Diepen, Frederik H Verbrugge","doi":"10.1093/ehjacc/zuaf021","DOIUrl":"10.1093/ehjacc/zuaf021","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"129-130"},"PeriodicalIF":3.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}