R M Nowak

Henry Ford Health System, Detroit, Michigan, United States

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Publications (202)865.78 Total impact

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    ABSTRACT: Non-invasive, continuous hemodynamic monitoring is entering the clinical arena. The primary objective of this study was to test the feasibility of such monitoring in a pilot sample of Emergency Department (ED) stroke patients. Secondary objectives included analysis of hemodynamic variability and correlation of continuous blood pressure measurements with standard measurements.
    The western journal of emergency medicine 07/2014; 15(4):345-50.
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    ABSTRACT: Background Dyspnea is the most common symptom in acute heart failure (AHF), yet how to best measure it has not been well defined. Prior studies demonstrate differences in dyspnea improvement across various measurement scales, yet these studies typically enroll patients well after the emergency department (ED) phase of management.Objectives The aim of this study was to determine predictors of early dyspnea improvement for three different, commonly used dyspnea scales (i.e., five-point absolute Likert scale, 10-cm visual analog scale [VAS], or seven-point relative Likert scale).Methods This was a post hoc analysis of URGENT Dyspnea, an observational study of 776 patients in 17 countries enrolled within 1 hour of first physician encounter. Inclusion criteria were broad to reflect real-world clinical practice. Prior literature informed the a priori definition of clinically significant dyspnea improvement. Resampling-based multivariable models were created to determine patient characteristics significantly associated with dyspnea improvement.ResultsOf the 524 AHF patients, approximately 40% of patients did not report substantial dyspnea improvement within the first 6 hours. Baseline characteristics were similar between those who did or did not improve, although there were differences in history of heart failure, coronary artery disease, and initial systolic blood pressure. For those who did improve, patient characteristics differed across all three scales, with the exception of baseline dyspnea severity for the VAS and five-point Likert scale (c-index ranged from 0.708 to 0.831 for each scale).Conclusions Predictors of early dyspnea improvement differ from scale to scale, with the exception of baseline dyspnea. Attempts to use one scale to capture the entirety of the dyspnea symptom may be insufficient.ResumenAntecedentesLa disnea es el síntoma más frecuente en la insuficiencia cardiaca aguda (ICA), sin embargo no ha sido bien definida la mejor manera de medirla. Estudios previos demuestran diferencias en la mejoría de la disnea a través de varias escalas de medida, sin embargo estos estudios suelen reclutar pacientes bastante después de la fase de manejo en el SU.ObjetivosEl objetivo de este estudio fue determinar los predictores precoces de mejoría de la disnea para tres escalas de disnea diferentes frecuentemente utilizadas (escala Likert absoluta de 5 puntos, escala visual analógica [EVA] de 10 cm o escala Likert relativa de 7 puntos).MétodosSe trata de un análisis post hoc del estudio observacional Disnea URGENTE, que reclutó 776 pacientes dentro de la primera hora tras la primera valoración médica en 17 países. Los criterios de inclusión fueron amplios para reflejar la práctica clínica en el mundo real. La literatura previa documentó la definición a priori de la mejoría significativa de disnea. Se crearon modelos multivariables basados en el remuestreo para determinar las características de los pacientes significativamente asociadas con la mejoría de la disnea.ResultadosDe los 524 pacientes con ICA, aproximadamente un 40% de los pacientes no documentaron una mejoría sustancial de la disnea en las 6 primeras horas. Las características basales fueron similares entre los que mejoraron y los que no, aunque hubo diferencias en la historia de insuficiencia cardiaca, enfermedad coronaria y presión arterial sistólica inicial. Para aquéllos que mejoraron, las características del paciente difirieron en las tres escalas, con la excepción de la gravedad de la disnea basal para la EVA y en la escala Likert de 5 puntos (el índice-c varió desde 0,708 hasta 0,831 para cada escala).ConclusionesLos predictores de la mejoría precoz de disnea difieren dependiendo de la escala, con la excepción de la disnea basal. Los intentos para utilizar una sola escala para categorizar la totalidad del síntoma disnea pueden ser insuficientes.
    Academic Emergency Medicine 06/2014; 21(6). · 1.76 Impact Factor
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    ABSTRACT: Elevated blood pressure is present in more than 60% of patients with acute stroke. Moderate to severe hypertension affects stroke outcomes, yet the optimal management has been a gray area in the care of such patients. Although new data are changing the approach, particularly for hemorrhagic events, significant questions remain. This article presents the latest evidence on hypertension in the setting of ischemic and hemorrhagic stroke and highlights management considerations that are relevant to emergency medicine.
    Annals of emergency medicine 04/2014; · 4.23 Impact Factor
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    ABSTRACT: Despite its relatively common occurrence and life-threatening potential, the management of angioedema in the emergency department (ED) is lacking in terms of a structured approach. It is paramount to distinguish the different etiologies of angioedema from one another and more specifically differentiate histaminergic-mediated angioedema from bradykinin-mediated angioedema, especially in lieu of the more novel treatments that have recently become available for bradykinin-mediated angioedema. With this background in mind, this consensus parameter for the evaluation and management of angioedema attempts to provide a working framework for emergency physicians (EPs) in approaching the patient with angioedema in terms of diagnosis and management in the ED. This consensus parameter was developed from a collaborative effort among a group of EPs and leading allergists with expertise in angioedema. After rigorous debate, review of the literature, and expert opinion, the following consensus guideline document was created. The document has been endorsed by the American College of Allergy, Asthma & Immunology (ACAAI) and the Society for Academic Emergency Medicine (SAEM).ResumenA pesar de su ocurrencia relativamente común y su potencial riesgo vital, el manejo del paciente con angioedema en el servicio de urgencias está falto de una aproximación estructurada. Es primordial distinguir las diferentes etiologías del angioedema y más específicamente diferenciar el angioedema mediado por histamina del mediado por bradicinina, especialmente en relación con los tratamientos que recientemente están disponibles para el angioedema mediado por bradicinina. Con este escenario en mente, este parámetro consenso para la evaluación y el manejo del angiodema intenta proporcionar un marco de trabajo para los urgenciólogos en la aproximación del paciente con angiodema en términos de diagnóstico y tratamiento en el servicio de urgencias. Este esquema consenso fue desarrollado a través de un esfuerzo de colaboración entre un grupo de urgenciólogos y alergólogos expertos líderes en angiodema. Tras un riguroso debate, una revisión de la literatura y la opinión de los expertos, se creó el siguiente documento de guía clínica de consenso. En reconocimiento a la importancia de este tema, este documento de consenso ha sido respaldado por el American College of Allergy, Asthma, and Immunology (ACAAI) y la Society for Academic Emergency Medicine (SAEM).
    Academic Emergency Medicine 04/2014; 21(4). · 1.76 Impact Factor
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    Journal of the American College of Cardiology 04/2014; 63(12 S). · 14.09 Impact Factor
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    Journal of the American College of Cardiology 04/2014; 63(12 S). · 14.09 Impact Factor
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    Journal of the American College of Cardiology 04/2014; 63(12 S). · 14.09 Impact Factor
  • Christine B. Davis, Richard M. Nowak
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    ABSTRACT: Clinical problem This a case of non-traumatic shoulder pain initially diagnosed on x-ray as an anterior dislocation. The patient was on anticoagulants and in actuality had severe hemarthrosis that caused the subluxation. Attempts to reduce the dislocation in this situation might have resulted in worsening of the intra-articular bleed. Analysis of literature review There has been only one similar reported case in the European Journal of Emergency Medicine in 2013 of a 53-year-old woman who was thought to have a nontraumatic anterior shoulder dislocation and attempts were unsuccessful at reduction. Definitive therapy involved hemarthrosis aspiration. Others have reported spontaneous hemarthrosis due to anticoagulants, however, only one has reported an initial mistaken joint dislocation diagnosis. Summary Non-traumatic hemarthrosis do occur in patients on anticoagulant therapy and it is important to recognize that this can be misdiagnosed as a joint dislocation requiring reduction. In a patient who is on anticoagulants presenting with nontraumatic joint pain and anterior shoulder or possibly other dislocations on plain radiographs, it is pertinent to consider hemarthrosis.
    The American Journal of Emergency Medicine. 01/2014;
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    ABSTRACT: Eight to ten million individuals are evaluated for chest pain (CP) in Emergency Departments (ED) in the United States each year. CP characteristics are an important factor used to help determine a diagnosis. We studied the relationship between the duration of CP and the diagnosis of acute myocardial infarction (AMI) in patients evaluated in the ED. The study population consisted of a sub-group analysis of a previously published study. The survey population consisted of 1024 consecutive encounters of patients who were evaluated for possible ACS in the ED of Henry Ford Hospital between January and May of 1999, CP duration could be obtained in 426 who were included in this analysis. Of the 426 patients included in the study, 38 (8.9%) had a final diagnosis of AMI, with a median CP duration of 120 minutes (interquartile range, 30-240 minutes), compared with 40 minutes (interquartile range, 6-180 minutes) in patients without AMI (p =0.003). In patients with CP duration less than 5 minutes, there were no AMIs and no deaths at 30 days. There were 10 patients dead at 30 days, with a median CP duration of 180 minutes (interquartile range, 120-1440 minutes) compared to 40 minutes (interquartile range, 10-180 minutes) in patients alive at 30 days (p = 0.011). A longer CP duration and ST depression of 1 mm of less were independently associated with a final diagnosis of AMI. Patients with AMI have longer duration of CP than those without AMI; patients with CP of short duration, less than 5 minutes, are unlikely to have AMI and have a good prognosis at 30 days.
    Critical pathways in cardiology 09/2013; 12(3):150-3.
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    ABSTRACT: The purpose of this study was to assess the impact of atrial fibrillation (AF) on the performance of mid-region amino terminal pro-atrial natriuretic peptide (MR-proANP) in comparison with the B-type peptides (BNP and NT-proBNP) for diagnosis of acute heart failure (HF) in dyspneic patients. The effects of AF on the diagnostic and prognostic performance of MR-proANP in comparison with the B type natriuretic peptides have not been previously reported. A total of 1,445 patients attending the emergency department with acute dyspnea had measurements taken of MR-proANP, BNP, and NT-proBNP values on enrollment to the BACH trial and were grouped according to presence or absence of AF and HF. AF was present in 242 patients. Plasma concentrations of all three peptides were lowest in those with neither AF nor HF and AF without HF was associated with markedly increased levels (p < 0.00001). HF with or without AF was associated with a significant further increment (p < 0.00001 for all three markers). Areas under receiver operator characteristic curves (AUCs) for discrimination of acute HF were similar and powerful for all peptides without AF (0.893 to 0.912; all p < 0.001) with substantial and similar reductions (0.701 to 0.757) in the presence of AF. All 3 peptides were independently prognostic but there was no interaction between any peptide and AF for prediction of all-cause mortality. AF is associated with increased plasma natriuretic peptide (MR-proANP, BNP and NT-proBNP) levels in the absence of HF. The diagnostic performance of all three peptides is impaired by AF. This warrants consideration of adjusted peptide thresholds for diagnostic use in AF and mandates the continued search for markers free of confounding by AF.
    JACC. Heart failure. 06/2013; 1(3):192-9.
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    ABSTRACT: BACKGROUND: Most episodes of anaphylaxis are managed in emergency medical settings, where the cardinal signs and symptoms often differ from those observed in the allergy clinic. Data suggest that low recognition of anaphylaxis in the emergency setting may relate to inaccurate coding and lack of a standard, practical definition. OBJECTIVE: Develop a simple, consistent definition of anaphylaxis for emergency medicine providers, supported by clinically relevant consensus statements. DISCUSSION: Definitions of anaphylaxis and criteria for diagnosis from current anaphylaxis guidelines were reviewed with regard to their utilization in emergency medical settings. The agreed-upon working definition is: Anaphylaxis is a serious reaction causing a combination of characteristic findings, and which is rapid in onset and may cause death. It is usually due to an allergic reaction but can be non-allergic. The definition is supported by Consensus Statements, each with referenced discussion. For a positive outcome, quick diagnosis and treatment of anaphylaxis are critical. However, even in the emergency setting, the patient may not present with life-threatening symptoms. Because mild initial symptoms can quickly progress to a severe, even fatal, reaction, the first-line treatment for any anaphylaxis episode-regardless of severity-is intramuscular injection of epinephrine into the anterolateral thigh; delaying its administration increases the potential for morbidity and mortality. When a reaction appears as "possible anaphylaxis," it is generally better to err on the side of caution and administer epinephrine. CONCLUSION: We believe that this working definition and the supporting Consensus Statements are a first step to better management of anaphylaxis in the emergency medical setting.
    Journal of Emergency Medicine 04/2013; · 1.33 Impact Factor
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    ABSTRACT: OBJECTIVES: Demonstrate that copeptin level <14 pmol/L allows ruling out AMI when used in combination with cardiac troponin I (cTnI) <99(th) percentile and a non-diagnostic ECG at the time of presentation to the emergency department (ED). BACKGROUND: Copeptin is secreted from the pituitary early in the course of acute myocardial infarction (AMI). METHODS: This was a 16-site study in 1967 chest pain patients presenting to an ED within 6 hours of the onset of chest pain. Baseline demographics and clinical data were collected prospectively. Copeptin and a contemporary sensitive cTnI (99th percentile 40 ng/L; 10% coefficient of variation (CV) 0.03 μg/L) were measured in a core laboratory. Patients were followed for 180 days. The primary outcome was diagnosis of AMI. Final diagnoses were adjudicated by two independent cardiologists blinded to copeptin results. RESULTS: AMI was the final diagnosis in 156 patients (7.9%). A negative copeptin and cTnI at baseline ruled out AMI for 58% of patients, with a NPV of 99.2% (95% CI 98.5-99.6). AMIs not detected by the initial cTnI alone were picked up with copeptin >14 pmol/L in 23/32 patients (72%). NSTEMIs undetected by cTnI at 0h were detected with Copeptin >14 pmol/L in 10/19 patients (53%). Projected average time-to-decision could be reduced by 43% (from 3.0 hours to 1.8 hours) by the early rule out of 58% of patients. Both abnormal copeptin and cTnI were predictors of death at 180 days (p<0.0001 for both, c index 0.784 and 0.800, respectively). Both were independent of age and each other and provided additional predictive value (all p<0.0001). CONCLUSION: Adding copeptin to cTnI allowed safe rule out of AMI with a NPV >99% in patients presenting with suspected ACS. It has the potential to rule out AMI in 58% of patients without serial blood draws. CLINICAL TRIAL: CHOPIN; NCT00952744.
    Journal of the American College of Cardiology 04/2013; 62(2):150-160. · 14.09 Impact Factor
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    ABSTRACT: OBJECTIVE: To compare the efficacy of Food and Drug Administration recommended dosing of nicardipine versus labetalol for the management of hypertensive patients with signs and/or symptoms (S/S) suggestive of end-organ damage (EOD). DESIGN: Secondary analysis of the multicentre prospective, randomised CLUE trial. SETTING: 13 academic emergency departments in the USA. PARTICIPANTS: Eligible patients had two systolic blood pressure (SBP) measures ≥180 mm Hg at least 10 min apart, no contraindications to nicardipine or labetalol and predefined S/S suggestive of EOD on arrival. INTERVENTIONS: Medications were administered by continuous infusion (nicardipine) or repeat intravenous bolus (labetalol) for a study period of 30 min or until a specified target SBP ±20 mm Hg was achieved. PRIMARY OUTCOME MEASURE: Percentage of participants achieving a predefined target SBP range (TR) defined as an SBP within ±20 mm Hg as established by the treating physician. RESULTS: Of the 141 eligible patients, 49.6% received nicardipine, 51.7% were women and 81.6% were black. Mean age was 52.2±13.9 years. Median initial SBP did not differ in the nicardipine (210.5 (IQR 197-226) mm Hg) and labetalol (210 (200-226) mm Hg) groups (p=0.862). Nicardipine patients were more likely to have a history of diabetes (41.4% vs 25.7%, p=0.05) but there were no other historical, demographic or laboratory differences between groups. Within 30 min, nicardipine patients more often reached the target SBP range than those receiving labetalol (91.4% vs 76.1%, difference=15.3% (95% CI 3.5% to 27.3%); p=0.01). On multivariable modelling with adjustment for gender and clinical site, nicardipine patients were more likely to be in TR by 30 min than patients receiving labetalol (OR 3.65, 95% CI 1.31 to 10.18, C statistic=0.72). CONCLUSIONS: In the setting of hypertension with suspected EOD, patients treated with nicardipine are more likely to reach prespecified SBP targets within 30 min than patients receiving labetalol. CLINICAL TRIAL REGISTRATION: NCT00765648, clinicaltrials.gov.
    BMJ Open 03/2013; 3(3). · 1.58 Impact Factor
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    ABSTRACT: BACKGROUND: The HEART score and North American Chest Pain Rule (NACPR) are decision rules designed to identify acute chest pain patients for early discharge without stress testing or cardiac imaging. This study compares the clinical utility of these decision rules combined with serial troponin determinations. METHODS AND RESULTS: A secondary analysis was conducted of 1005 participants in the Myeloperoxidase In the Diagnosis of Acute coronary syndromes Study (MIDAS). MIDAS is a prospective observational cohort of Emergency Department (ED) patients enrolled from 18 US sites with symptoms suggestive of acute coronary syndrome (ACS). The ability to identify participants for early discharge and the sensitivity for ACS at 30days were compared among an unstructured assessment, NACPR, and HEART score, each combined with troponin measures at 0 and 3h. ACS, defined as cardiac death, acute myocardial infarction, or unstable angina, occurred in 22% of the cohort. The unstructured assessment identified 13.5% (95% CI 11.5-16%) of participants for early discharge with 98% (95% CI 95-99%) sensitivity for ACS. The NACPR identified 4.4% (95% CI 3-6%) for early discharge with 100% (95% CI 98-100%) sensitivity for ACS. The HEART score identified 20% (95% CI 18-23%) for early discharge with 99% (95% CI 97-100%) sensitivity for ACS. The HEART score had a net reclassification improvement of 10% (95% CI 8-12%) versus unstructured assessment and 19% (95% CI 17-21%) versus NACPR. CONCLUSIONS: The HEART score with 0 and 3hour serial troponin measures identifies a substantial number of patients for early discharge while maintaining high sensitivity for ACS.
    International journal of cardiology 10/2012; · 6.18 Impact Factor
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    ABSTRACT: The electrocardiogram's (ECG) ability to aid in the diagnosis and risk stratification of patients with acute coronary syndromes is well established. We sought to investigate the prognostic significance of ECG abnormalities in patients with noncardiac conditions in the emergency department. Patients presenting to the emergency department who were evaluated for possible acute coronary syndrome were consecutively enrolled and an initial ECG was obtained (n = 1024). Only patients with noncardiac diagnoses were reviewed in this analysis (n=493) and 30-month follow-up was obtained. Sinus tachycardia, atrial fibrillation/flutter, ST depression, and left bundle branch block were associated with increased 30-month mortality. After controlling for history of coronary artery disease, age, sex, diabetes mellitus, hypertension, and renal insufficiency, sinus tachycardia and ST-segment depression ≥1 mm were independent predictors of 30-month mortality with a hazard ratio of 2.33 (95% confidence interval, 1.36-4.00; P = 0.002) and 2.49 (95% confidence interval, 1.10-5.67; P = 0.029), respectively. In conclusion, ST-segment depression and sinus tachycardia in patients presenting to the hospital with noncardiac conditions are independently associated with increased 30-month mortality.
    Critical pathways in cardiology 09/2012; 11(3):147-51.
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    ABSTRACT: Heart failure requiring urgent therapy represents a burgeoning health care burden. Although acute heart failure syndromes are commonly defined as a change in chronic heart failure signs and symptoms requiring urgent therapy, the presentation, development, and response to treatment is highly dependent on individual patient characteristics. This heterogeneity has led to challenges in interpreting widely differing study methods, including eligibility requirements and outcome measures. To improve interpretation of results and translate such information to better patient care, it is essential to present an accurate description of the patient population and study design. Based on existing recommendations and expert consensus, the authors present standardized reporting criteria to improve interpretability of research in this challenging cohort.
    Journal of the American College of Cardiology 08/2012; 60(9):822-32. · 14.09 Impact Factor
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    ABSTRACT: Serum mid-regional pro-atrial natriuretic peptide (MR-proANP) and pro-adrenomedullin (MR-proADM) are novel biomarkers for acute heart failure (AHF). Like other AFH biomarkers, the performance of these tests are affected by the presence of clinical variables such as renal failure and obesity. In a substudy of the Biomarkers from Acute Heart Failure Study, we show that diabetes did not influence the performance of these markers with regards to AHF diagnosis or 90-day all cause death. However, in patients without AHF, increased MR-proADM alone was associated with the presence of diabetes.
    Biomarkers 05/2012; 17(6):490-7. · 1.88 Impact Factor
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    ABSTRACT: Biomarkers have proven their ability in the evaluation of cardiopulmonary diseases. We investigated the utility of concentrations of the biomarker procalcitonin (PCT) alone and with clinical variables for the diagnosis of pneumonia in patients presenting to emergency departments (EDs) with a chief complaint of shortness of breath. The BACH trial was a prospective, international, study of 1641 patients presenting to EDs with dyspnoea. Blood samples were analysed for PCT and other biomarkers. Relevant clinical data were also captured. Patient outcomes were assessed at 90 days. The diagnosis of pneumonia was made using strictly validated guidelines. A model using PCT was more accurate [area under the curve (AUC) 72.3%] than any other individual clinical variable for the diagnosis of pneumonia in all patients, in those with obstructive lung disease, and in those with acute heart failure (AHF). Combining physician estimates of the probability of pneumonia with PCT values increased the accuracy to >86% for the diagnosis of pneumonia in all patients. Patients with a diagnosis of AHF and an elevated PCT concentration (>0.21 ng/mL) had a worse outcome if not treated with antibiotics (P = 0.046), while patients with low PCT values (<0.05 ng/mL) had a better outcome if they did not receive antibiotic therapy (P = 0.049). Procalcitonin may aid in the diagnosis of pneumonia, particularly in cases with high diagnostic uncertainty. Importantly, PCT may aid in the decision to administer antibiotic therapy to patients presenting with AHF in which clinical uncertainty exists regarding a superimposed bacterial infection.
    European Journal of Heart Failure 03/2012; 14(3):278-86. · 5.25 Impact Factor
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    ABSTRACT: Midregional pro atrial natriuretic peptide (MR-proANP) is useful for diagnosing acute heart failure (HF) in patients presenting to the Emergency Department with dyspnoea. Optimal interpretation of MR-proANP requires understanding of how various demographic variables influence its levels and performance as a diagnostic marker. We sought to determine how age, race, sex, and body mass index (BMI) affect the levels and interpretation of MR-proANP for the diagnosis of acute HF. The Biomarkers in Acute Heart Failure (BACH) study was an international 15-centre study of 1641 patients presenting to the Emergency Department with acute dyspnoea. Of these, 1352 had complete information on age, race, sex, and BMI. MR-proANP levels increased with age and were higher in men and in patients with lower BMI. MR-proANP performed better as a diagnostic marker in younger individuals and in blacks compared with whites. Despite this, MR-proANP at the recommended cut-off point of 120 pmol/L was >90 % sensitive in ruling out the diagnosis of acute HF in all subgroups of patients except white subjects <50 years old. Age, race, sex, and BMI affect MR-proANP levels to various degrees. However, the diagnostic performance of the recommended cut-off point of 120 pmol/L to rule out acute HF was robust across most subgroups. Although both sex and BMI affected MR-proANP levels, they did not alter its overall diagnostic performance. Lower cut-off points for MR-proANP could be considered in younger patients and in patients with a higher BMI, to optimize diagnostic sensitivity.
    European Journal of Heart Failure 12/2011; 14(1):22-31. · 5.25 Impact Factor
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    ABSTRACT: Myeloperoxidase (MPO) is proposed for risk stratification in patients with suspected acute coronary syndromes (ACSs). We determined if MPO has diagnostic value in patients being evaluated for ACS. MIDAS was an 18-center prospective study enrolling suspected ACS emergency department patients who presented <8 hours after symptom onset and in whom serial cardiac markers and objective cardiac perfusion testing were planned. Blinded MPO (Biosite, Inc, San Diego, CA) and troponin I (Triage Cardio 3; Biosite, Inc) were drawn at arrival, and Troponin I (TnI) was measured at 90, 180, and 360 minutes. Final diagnoses were adjudicated by the local investigator blinded to study assay. Of 1,018 patients, 54% were male, 26% black, with a mean age of 58 ± 13 years. Diagnoses were ACS in 288 (23%) and noncardiac chest pain (NCCP) in 788 (77%). Of patients with ACS, 94 (9.2%) had a myocardial infarction (MI) at presentation (69 non-ST-elevation MI, 25 ST-elevation MI), and 136 had unstable angina. Using a cutpoint of 210 ng/mL to provide 90% specificity, MPO had a sensitivity of 0.18; negative predictive value, 0.69; positive predictive value, 0.47; negative likelihood ratio, 0.91; and a positive likelihood ratio of 1.83 to differentiate ACS and NCCP. Because of the large overlap of quartiles, MPO was not clinically useful to predict serial TnI changes. The C statistics ± 95% CI for MPO differentiating ACS from NCCP and for AMI versus NCCP were 0.629 ± 0.04 and 0.666 ± 0.06, respectively. Myeloperoxidase has insufficient accuracy for decision making in patients with suspected ACS.
    American heart journal 11/2011; 162(5):893-9. · 4.65 Impact Factor

Publication Stats

5k Citations
865.78 Total Impact Points

Institutions

  • 1992–2014
    • Henry Ford Health System
      • Department of Emergency Medicine
      Detroit, Michigan, United States
    • State University of New York Downstate Medical Center
      • Department of Emergency Medicine
      Brooklyn, NY, United States
  • 1977–2014
    • Henry Ford Hospital
      • • Department of Emergency Medicine
      • • Department of Internal Medicine
      Detroit, Michigan, United States
  • 2013
    • Kansas City University of Medicine and Biosciences
      Kansas City, Missouri, United States
  • 2002–2013
    • University of California, San Diego
      • Division of Cardiology
      San Diego, California, United States
    • Wayne State University
      • Department of Emergency Medicine
      Detroit, Michigan, United States
  • 2012
    • Wake Forest School of Medicine
      Winston-Salem, North Carolina, United States
    • University of California, San Francisco
      San Francisco, California, United States
  • 2010–2012
    • VA San Diego Healthcare System
      San Diego, California, United States
    • Virginia Commonwealth University
      Richmond, Virginia, United States
  • 2011
    • University of California, Davis
      • Department of Emergency Medicine
      Davis, CA, United States
  • 2009–2010
    • University of Cincinnati
      • Department of Emergency Medicine
      Cincinnati, OH, United States
    • Akershus universitetssykehus
      Kristiania (historical), Oslo County, Norway
  • 2008–2010
    • New York Methodist Hospital
      New York City, New York, United States
    • Northwestern University
      • Department of Emergency Medicine
      Evanston, IL, United States
  • 2006
    • CSU Mentor
      Long Beach, California, United States
    • Hennepin County Medical Center
      Minneapolis, Minnesota, United States
  • 2005
    • San Francisco VA Medical Center
      San Francisco, California, United States
  • 2004–2005
    • Oslo University Hospital
      • Department of Cardiology
      Kristiania (historical), Oslo County, Norway
    • University of Texas Southwestern Medical Center
      Dallas, Texas, United States
  • 1991–2004
    • Hartford Hospital
      • • Department of Pathology and Laboratory Medicine
      • • Department of Emergency Medicine
      Hartford, CT, United States
  • 2003
    • William Beaumont Army Medical Center
      El Paso, Texas, United States
  • 2002–2003
    • University of Missouri - Kansas City
      • Department of Basic Med Sciences
      Kansas City, MO, United States