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Publications (3)8.73 Total impact

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    ABSTRACT: Objectives Heart‐type fatty acid–binding protein (h‐FABP), sensitive troponins, natriuretic peptides, and clinical scores such as the Pulmonary Embolism Severity Index (PESI) are candidates for risk stratification of patients with acute pulmonary embolism (PE). The aim was to compare their respective prognostic values to predict an adverse outcome at 1 month.Methods The authors prospectively included 132 consecutive patients with confirmed acute PE. On admission to the emergency department (ED), plasma concentrations of h‐FABP, sensitive cardiac troponin I‐Ultra (cTnI‐Ultra), and brain natriuretic peptide (BNP) were measured and the PESI calculated in all patients. The combined 30‐day outcomes of interest were death, cardiac arrest, mechanical ventilation, use of catecholamines, and recurrence of acute PE.ResultsDuring the first 30 days, 14 (10.6%) patients suffered complications. Among the biomarkers, h‐FABP above 6 μg/L was a stronger predictor of an unfavorable outcome (odds ratio [OR] = 17.5, 95% confidence interval [CI] = 4.2 to 73.3) than BNP > 100 pg/mL (OR = 5.7, 95% CI = 1.6 to 20.4) or cTnI‐Ultra > 0.05 μg/L (OR = 3.4, 95% CI = 1.1 to 10.9). The PESI classified 83 of 118 patients (70.3%) with favorable outcomes and only one of 14 (7%) with adverse outcomes in low class I or II (OR = 30.8, 95% CI = 3.2 to 299.7). The areas under the receiver operating characteristic (ROC) curves (AUCs) were 0.90 (95% CI = 0.81 to 0.98) for h‐FABP, 0.89 (95% CI = 0.82 to 0.96) for PESI, 0.79 (95% CI = 0.67 to 0.90) for BNP, and 0.76 (95% CI = 0.64 to 0.87) for cTnI‐Ultra. The combination of h‐FABP with PESI was a particularly useful prognostic indicator because none of the 79 patients (59.8%) with h‐FABP < 6 ng/mL and PESI class < III had an adverse outcome.Conclusionsh‐FABP and the PESI are superior to BNP and cTnI‐Ultra as markers for risk stratification of patients with acute PE. The high sensitivity of their combination identified a large number of low‐risk patients in the ED.ResumenObjetivosLa proteína transportadora de ácidos grasos del miocardio (h‐FABP), las troponinas sensibles, los péptidos natriuréticos y las escalas clínicas como el Pulmonary Embolism Severity Index (PESI) son candidatos para la estratificación del riesgo de los pacientes con embolismo pulmonar (EP) agudo. El objetivo fue comparar sus valores pronóstico respectivos para predecir un evento adverso al mes.MetodologíaSe incluyó prospectivamente a 132 pacientes de forma consecutiva con EP agudo confirmado. Se midieron al ingreso en el servicio de urgencias (SU) las concentraciones plasmáticas de h‐FABP, troponina sensible (cTnI‐Ultra) y péptido natriurético tipo B (BNP) y se calculó la PESI en todos los pacientes. Los resultados combinados a 30 días de interés fueron muerte, parada cardiaca, ventilación mecánica, uso de catecolaminas y recurrencia del EP agudo.ResultadosDurante los primeros 30 días, 14 (10,6%) pacientes sufrieron complicaciones. Entre los biomarcoadres, la h‐FABP por encima de 6 μg/L tuvo mayor capacidad predictora de un resultado desfavorable (*odds ratio* [OR] 17,5, intervalo de confianza [IC] 95% = 4,2 a 73,3) que el BNP > 100 pg/mL (OR 5,7, IC 95% = 1,6 a 20,4) o la cTnI‐Ultra > 0,05 μg/L (OR 3,4, IC 95% = 1,1 a 10,9). El PESI clasificó 83 de 118 pacientes (70,3%) con un resultado favorable, y sólo uno de 14 (7%) en clase baja I o II tuvo un resultado adverso (OR 30,8, IC 95% = 3,2 a 299,7). Las áreas bajo la curva ROC fueron 0,90 (IC 95% = 0,81 a 0,98) para h‐FABP, 0,89 (IC 95% = 0,82 a 0,96) para PESI, 0,79 (IC 95% = 0,67 a 0,90) para BNP y 0,76 (IC 95% = 0,64 a 0,87) para cTnI‐Ultra. La combinación de la h‐FABP con la PESI fue un indicador pronóstico particularmente útil porque ninguno de los 79 pacientes (59,8%) con la h‐FABP < 6 ng/mL y clase PESI < III tuvieron un resultado adverso.ConclusionesLa H‐FABP y el PESI son superiores al BNP y la cTnI‐Ultra como marcadores para la estratificación del riesgo de pacientes con EP agudo. La alta sensibilidad de su combinación identificó un gran número de pacientes de bajo riesgo en el SU.
    Academic Emergency Medicine 10/2014; 21(10). · 2.20 Impact Factor
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    ABSTRACT: STUDY OBJECTIVE: We assess the performance of a single multimarker strategy, using a combination of sensitive troponin I-Ultra and copeptin assays to rule out non-ST-elevation myocardial infarction (NSTEMI) at presentation to an emergency department (ED). METHODS: A secondary analysis was carried out on 587 consecutive patients with chest pain who presented to the ED without ST elevation on ECG and were included in a single-site, prospective observational study. Samples for copeptin and combination of sensitive troponin I-Ultra assays were collected at presentation. The performance of the combination of copeptin and combination of sensitive troponin I-Ultra for NSTEMI was calculated in the whole cohort and after stratification by thrombosis in myocardial infarction (TIMI) risk score. RESULTS: NSTEMI was diagnosed in 87 patients (14.8%). The sensitivity and the negative predictive value of the combination of copeptin and combination of sensitive troponin I-Ultra were 96.6% (95% confidence interval [CI] 90.3% to 99.3%) and 99.1% (95% CI 97.4% to 99.8%), respectively, for a cutoff level of copeptin less than 12 pmol/L. Among the 243 patients with a low TIMI score, all 8 who had an NSTEMI were detected with the combination (sensitivity 100%; 95% CI 63.1% to 100%), and 158 were a combination of sensitive troponin I-Ultra and copeptin negative and had no NSTEMI (negative predictive value 100%; 95% CI 97.7% to 100%). CONCLUSION: In this study, the combination of sensitive troponin and copeptin measurements had a high sensitivity and negative predictive value for NSTEMI diagnosis, especially among subjects with a low TIMI risk score. However, the sensitivity was too low to rule out NSTEMI with a single-draw strategy at ED presentation. Future studies are needed on the low-risk TIMI group to further investigate this preliminary finding.
    Annals of emergency medicine 03/2013; · 4.33 Impact Factor
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    ABSTRACT: The aim of this study was to analyze the diagnostic accuracy and the clinical usefulness of the combination of troponin I (cTnI) and copeptin measured at presentation with an automated assay to rapidly rule out non-ST elevation myocardial infarction (NSTEMI) in patients with suspected cardiac chest pain presenting to an emergency department (ED). This study was an ancillary analysis of a prospective observational study. Copeptin and cTnI levels were sampled at presentation in 641 consecutive patients admitted to the ED for chest pain with onset within the last 12 hours and without ST elevation on a 12-lead electrocardiogram (ECG). Copeptin was measured with an automated assay and troponin with conventional assay. The performance of a combination of cTnI and copeptin for NSTEMI diagnosis was studied, the clinical utility was assessed by multivariate analysis, and an area under the curve (AUC) calculation was used to determine accuracy. NSTEMI was diagnosed in 95 patients (15%). The sensitivity and negative predictive value (NPV) of the combination of copeptin and cTnI measures were 90.4% (95% confidence interval [CI] = 88.2% to 92.7%) and 97.6% (95% CI = 96.4% to 98.7%) versus 55.3% (95% CI = 51.5% to 59.2%) and 92.8% (95% CI = 90.8% to 94.8%) with cTnI alone. The AUC of the combination of copeptin and cTnI was 0.89 (95% CI = 0.85% to 0.92%) and was significantly higher than the AUC of cTnI alone (0.77, 95% CI = 0.72% to 0.82%, p < 0.05). The patient classification was slightly improved when copeptin was added to the usual diagnostic tools used for NSTEMI management. In this study, determination of copeptin, in addition to cTnI, improves early diagnostic accuracy of NSTEMI. However, the sensitivity of this combination even using a conventional troponin assay remains insufficient to safely rule out NSTEMI at the time of presentation.
    Academic Emergency Medicine 05/2012; 19(5):517-24. · 2.20 Impact Factor