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1.
J Am Coll Cardiol ; 74(4): 483-494, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31345421

RESUMO

BACKGROUND: The European Society of Cardiology (ESC) recommends the 0/1-h algorithm for rapid triage of patients with suspected non-ST-segment elevation myocardial infarction (MI). However, its impact on patient management and safety when routinely applied is unknown. OBJECTIVES: This study sought to determine these important real-world outcome data. METHODS: In a prospective international study enrolling patients presenting with acute chest discomfort to the emergency department (ED), the authors assessed the real-world performance of the ESC 0/1-h algorithm using high-sensitivity cardiac troponin T embedded in routine clinical care and its associated 30-day rates of major adverse cardiac events (MACE) (the composite of cardiovascular death and MI). RESULTS: Among 2,296 patients, non-ST-segment elevation MI prevalence was 9.8%. In median, 1-h blood samples were collected 65 min after the 0-h blood draw. Overall, 94% of patients were managed without protocol violations, and 98% of patients triaged toward rule-out did not require additional cardiac investigations including high-sensitivity cardiac troponin T measurements at later time points or coronary computed tomography angiography in the ED. Median ED stay was 2 h and 30 min. The ESC 0/1-h algorithm triaged 62% of patients toward rule-out, and 71% of all patients underwent outpatient management. Proportion of patients with 30-day MACE were 0.2% (95% confidence interval: 03% to 0.5%) in the rule-out group and 0.1% (95% confidence interval: 0% to 0.2%) in outpatients. Very low MACE rates were confirmed in multiple subgroups, including early presenters. CONCLUSIONS: These real-world data document the excellent applicability, short time to ED discharge, and low rate of 30-day MACE associated with the routine clinical use of the ESC 0/1-h algorithm for the management of patients presenting with acute chest discomfort to the ED.

3.
Clin Chem ; 65(7): 893-904, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30988172

RESUMO

BACKGROUND: The aim of this study was to validate the clinical performance of the Beckman Access high-sensitivity cardiac troponin I (hs-cTnI) assay. METHODS: We enrolled patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction (AMI). Final diagnoses were centrally adjudicated by 2 independent cardiologists with all clinical information including cardiac imaging twice: first, using serial hs-cTnT (Elecsys, primary analysis), and second, using hs-cTnI (Architect, secondary analysis) measurements in addition to the clinically used hs-cTn. hs-cTnI Access was measured at presentation and at 1 h. The primary objective was a direct comparison of diagnostic accuracy as quantified by the area under the ROC curve (AUC) of hs-cTnI Access vs the hs-cTnT Elecsys and hs-cTnI Architect assays. Secondary objectives included the derivation and validation of an hs-cTnI Access-specific 0/1-h algorithm. RESULTS: AMI was the adjudicated final diagnosis in 243 of 1579 (15.4%) patients. The AUC at presentation for hs-cTnI Access was 0.95 (95% CI, 0.94-0.96), higher than hs-cTnI Architect [0.92 (95% CI, 0.91-0.94; P < 0.001)] and comparable to hs-cTnT Elecsys [0.94 (95% CI, 0.93-0.95; P = 0.12)]. Applying the derived hs-cTnI Access 0/1-h algorithm (derivation cohort n = 686) to the validation cohort (n = 680), 60% of patients were ruled out [sensitivity, 98.9% (95% CI, 94.3-99.8)], and 15% of patients were ruled in [specificity, 95.9% (95% CI, 94.0-97.2)]. Patients ruled out by the 0/1-h algorithm had a survival rate of 100% at 30 days. Findings were confirmed in the secondary analyses by the adjudication including serial measurements of Architect hs-cTnI. CONCLUSIONS: Diagnostic accuracy and clinical utility of the Beckman hs-cTnI Access assay are very high and at least comparable to Roche hs-cTnT and Abbott hs-cTnI assays. ClinicalTrials.gov Identifier: NCT00470587.

4.
Microvasc Res ; 120: 36-40, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29883621

RESUMO

OBJECTIVE: We aimed to investigate the association of retinal microvascular health with cardiorespiratory fitness (VO2peak) and cardiovascular risk factors. METHODS: In a population of 260 obesity-enriched participants we investigated the association of retinal vessel diameters with cardiorespiratory fitness (CRF), body mass index (BMI) and blood pressure (BP). Retinal vessel imaging was performed by use of a fundus camera and a semi-automated processing software, calculating the central retinal arteriolar (CRAE) and venular equivalent (CRVE) as well as the arteriolar-to-venular diameter ratio (AVR). RESULTS: Participants had a mean age of 45.8 ±â€¯12.5 years and a BMI of 35.8 ±â€¯6.8 kg/m2. 45% of patients were diagnosed with hypertension, 26% with diabetes and 30% with dyslipidemia. Increasing VO2peak was independently associated with lower CRVE (ß = -0.600; CI -1.141, -0.060; p = 0.030). Higher BMI and mean arterial pressure were independently associated with narrower CRAE (ß = -0.492; CI -0.909, -0.076; p = 0.021 and ß = -0.268; CI -0.471, -0.066; p = 0.009, respectively) and lower AVR (ß = -0.002; CI -0.003, -0.000; p = 0.026 and ß = -0.001; CI -0.002, -0.000; p = 0.001, respectively). CONCLUSIONS: Higher cardiorespiratory fitness is associated with beneficial retinal microvascular health. Higher BMI and BP were associated with an impairment of retinal microvascular health. Exercise is known for its potential to improve body composition and reduce BP but may also prove to be an efficient therapy to counteract small vessel disease in cardiometabolic disease.


Assuntos
Arteríolas/fisiopatologia , Aptidão Cardiorrespiratória , Doenças Cardiovasculares/etiologia , Microcirculação , Obesidade/complicações , Vasos Retinianos/fisiopatologia , Vênulas/fisiopatologia , Adulto , Arteríolas/diagnóstico por imagem , Pressão Sanguínea , Índice de Massa Corporal , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico por imagem , Obesidade/fisiopatologia , Obesidade/terapia , Consumo de Oxigênio , Vasos Retinianos/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Vênulas/diagnóstico por imagem
5.
Atherosclerosis ; 272: 21-26, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29544085

RESUMO

BACKGROUND AND AIMS: Higher cardiorespiratory fitness is associated with lower pulse wave velocity and arterial stiffness in normal weight individuals, and this has not been examined in obese individuals. It is unclear whether an altered body composition acts as a modifier of the association between cardiorespiratory fitness and arterial stiffness. We examined the association between peak oxygen uptake and brachial-ankle pulse wave velocity and analysed whether body composition attenuates this association in obese middle-aged individuals. METHODS: Bio-impedance analysis-derived body composition assessment in 212 healthy and sedentary either overweight or obese individuals was followed by measurement of brachial-ankle pulse wave velocity and spiroergometric peak oxygen uptake. Multivariate analysis was performed to analyse the association between peak oxygen uptake and brachial-ankle pulse wave velocity and to assess the moderating effect of several body composition-related interaction terms (BMI, total body mass, body fat mass, waist circumference, waist-to-height ratio) on this association. RESULTS: Peak oxygen uptake was inversely associated with brachial-ankle pulse wave velocity (ß = -0.059, 95% CI = -0.099; -0.018, p = 0.005). Testing for the impact of different body composition-related interaction terms on this association showed no significance, 95% CI lateralized towards positivity. CONCLUSIONS: This study shows an inverse association between cardiorespiratory fitness and arterial stiffness in middle-aged obese individuals. We also found a tendency towards an attenuating impact of an obese body composition on this association. Physical fitness seems to be a stronger modulator of cardiovascular risk than body composition but the success of training efforts may be compromised by obesity.


Assuntos
Aptidão Cardiorrespiratória , Doenças Cardiovasculares/prevenção & controle , Obesidade/complicações , Obesidade/fisiopatologia , Índice Tornozelo-Braço , Composição Corporal , Índice de Massa Corporal , Impedância Elétrica , Ergometria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pacientes Ambulatoriais , Sobrepeso , Oxigênio/química , Análise de Onda de Pulso , Fatores de Risco , Comportamento Sedentário , Rigidez Vascular , Circunferência da Cintura , Razão Cintura-Estatura
6.
Obesity (Silver Spring) ; 26(2): 291-298, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29230967

RESUMO

OBJECTIVE: Cardiopulmonary exercise testing is clinically used to estimate cardiorespiratory fitness (CRF). The relation to total body mass (TBM) leads to an underestimation of CRF in people with obesity and to inappropriate prognostic and therapeutic decisions. This study aimed to determine body composition-derived bias in the estimation of CRF in people with obesity. METHODS: Two hundred eleven participants (58.8% women; mean BMI 35.7 kg/m2 [± 6.94; 20.7-58.6]) were clinically examined, and body composition (InBody720; InBody Co., Ltd., Seoul, South Korea) and spiroergometrical peak oxygen consumption (VO2 peak) were assessed. The impacts of TBM, lean body mass (LBM), and skeletal muscle mass (SMM) on CRF estimates were analyzed by the application of respective weight models. Linear regression and plotting of residuals against BMI were performed on the whole study population and two subgroups (BMI < 30 kg/m2 and BMI ≥ 30 kg/m2 ). RESULTS: For every weight model, Δmean VO2 peak (expected - measured) was positive. LBM and SMM had a considerable impact on VO2 peak demand (P = 0.001; ΔR2 = 2.3%; adjusted R2 = 56% and P = 0.001; ΔR2 = 2.7%; adjusted R2 = 56%), whereas TBM did not. Confounding of body composition on VO2 peak did not differ in LBM and SMM. CONCLUSIONS: TBM-adjusted overestimation of relative VO2 demand is much higher in people with obesity than in those without. LBM or SMM adjustment may be superior alternatives, although small residual body composition-derived bias remains.


Assuntos
Aptidão Cardiorrespiratória/fisiologia , Teste de Esforço/métodos , Obesidade/terapia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
Tree Physiol ; 37(7): 950-960, 2017 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-28541559

RESUMO

Hydraulic redistribution (HR) of soil water through plant roots is a crucial phenomenon improving the water balance of plants and ecosystems. It is mostly described under severe drought, and not yet studied under moderate drought. We tested the potential of HR under moderate drought, hypothesizing that (H1) tree species redistribute soil water in their roots even under moderate drought and that (H2) neighboring plants are supported with water provided by redistributing plants. Trees were planted in split-root systems with one individual (i.e., split-root plant, SRP) having its roots divided between two pots with one additional tree each. Species were 2- to  4-year-old English oak (Quercus robur L.), European beech (Fagus sylvatica L.) and Norway spruce (Picea abies (L.) Karst). A gradient in soil water potential (ψsoil) was established between the two pots (-0.55 ± 0.02 MPa and -0.29 ± 0.03 MPa), and HR was observed by labeling with deuterium-enriched water. Irrespective of species identity, 93% of the SRPs redistributed deuterium enriched water from the moist to the drier side, supporting H1. Eighty-eight percent of the plants in the drier pots were deuterium enriched in their roots, with 61 ± 6% of the root water originating from SRP roots. Differences in HR among species were related to their root anatomy with diffuse-porous xylem structure in both beech and-opposing the stem structure-oak roots. In spruce, we found exclusively tracheids. We conclude that water can be redistributed within roots of different tree species along a moderate ψsoil gradient, accentuating HR as an important water source for drought-stressed plants, with potential implications for ecohydrological and plant physiological sciences. It remains to be shown to what extent HR occurs under field conditions in Central Europe.


Assuntos
Secas , Fagus/fisiologia , Picea/fisiologia , Quercus/fisiologia , Água/fisiologia , Deutério , Europa (Continente) , Marcação por Isótopo , Raízes de Plantas/fisiologia , Árvores/fisiologia
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