Acute heart failure in elderly patients admitted to the emergency department with acute dyspnea : a multimarker approach diagnostic study
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc..
BACKGROUND AND IMPORTANCE: Diagnosing acute heart failure (AHF) is difficult in elderly patients presenting with acute dyspnea to the emergency department.
OBJECTIVES: To assess the diagnostic accuracy of NT-proBNP, high-sensitivity cardiac troponin-I (Hs-cTnI), soluble ST2 (ST2), galectin-3 and CD146 alone and in combination for diagnosing AHF in elderly patients presenting with acute dyspnea to the emergency department.
DESIGN, SETTINGS AND PARTICIPANTS: This was a prospective, multicenter study performed between September 2016 and January 2020, including elderly patients presenting with acute dyspnea to the emergency department of 6 French hospitals.
INTERVENTION: Measurement of NT-proBNP, hs-cTnI, ST2, galectin-3 and CD146.
OUTCOME MEASURE AND ANALYSIS: The reference standard, AHF, was adjudicated by two independent physicians based on ED and hospitalization clinical, biological (excluding biomarkers), radiological and echocardiography data (performed by a cardiologist in the cardiology department specifically for this study). Three exploratory methods (two using a cross-sectional approach with logistic regression and counting all biomarker combinations, and one using a sequential approach with gray zone optimizations) were applied to create comprehensive combinations of the 5 biomarkers for measuring diagnostic accuracy.
MAIN RESULTS: Two hundred thirty-eight patients (median age of 85 years, IQR = 8) were analyzed, and 110 (46%) were diagnosed with AHF. The accuracies of NT-proBNP, CD146, hs-cTnI, galectin-3, and ST2 were 0.72 [95% confidence interval (CI) 0.66-0.77], 0.63 (95% CI 0.57-0.69), 0.59 (95% CI 0.53-0.65), 0.55 (95% CI 0.49-0.61) and 0.51 (95% CI 0.45-0.57), respectively. Regardless of the approach used or how the 5 biomarkers were combined, the best accuracy for diagnosing AHF (0.73, 95% CI 0.67-0.78) did not differ from that of NT-proBNP alone.
CONCLUSION: In this study, NT-proBNP alone exhibited the best diagnostic accuracy for diagnosing AHF in elderly patients presenting with acute dyspnea to the emergency departments. None of the other biomarkers alone or combined improved the accuracy compared to NT-proBNP, which is the only biomarker to use in this setting.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:30 |
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| Enthalten in: |
European journal of emergency medicine : official journal of the European Society for Emergency Medicine - 30(2023), 5 vom: 01. Okt., Seite 347-355 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Taheri, Omide [VerfasserIn] |
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| Links: |
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| Themen: |
CD146 Antigen |
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| Anmerkungen: |
Date Completed 01.09.2023 Date Revised 01.09.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1097/MEJ.0000000000001053 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM360971369 |
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| 245 | 1 | 0 | |a Acute heart failure in elderly patients admitted to the emergency department with acute dyspnea |b a multimarker approach diagnostic study |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 01.09.2023 | ||
| 500 | |a Date Revised 01.09.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. | ||
| 520 | |a BACKGROUND AND IMPORTANCE: Diagnosing acute heart failure (AHF) is difficult in elderly patients presenting with acute dyspnea to the emergency department | ||
| 520 | |a OBJECTIVES: To assess the diagnostic accuracy of NT-proBNP, high-sensitivity cardiac troponin-I (Hs-cTnI), soluble ST2 (ST2), galectin-3 and CD146 alone and in combination for diagnosing AHF in elderly patients presenting with acute dyspnea to the emergency department | ||
| 520 | |a DESIGN, SETTINGS AND PARTICIPANTS: This was a prospective, multicenter study performed between September 2016 and January 2020, including elderly patients presenting with acute dyspnea to the emergency department of 6 French hospitals | ||
| 520 | |a INTERVENTION: Measurement of NT-proBNP, hs-cTnI, ST2, galectin-3 and CD146 | ||
| 520 | |a OUTCOME MEASURE AND ANALYSIS: The reference standard, AHF, was adjudicated by two independent physicians based on ED and hospitalization clinical, biological (excluding biomarkers), radiological and echocardiography data (performed by a cardiologist in the cardiology department specifically for this study). Three exploratory methods (two using a cross-sectional approach with logistic regression and counting all biomarker combinations, and one using a sequential approach with gray zone optimizations) were applied to create comprehensive combinations of the 5 biomarkers for measuring diagnostic accuracy | ||
| 520 | |a MAIN RESULTS: Two hundred thirty-eight patients (median age of 85 years, IQR = 8) were analyzed, and 110 (46%) were diagnosed with AHF. The accuracies of NT-proBNP, CD146, hs-cTnI, galectin-3, and ST2 were 0.72 [95% confidence interval (CI) 0.66-0.77], 0.63 (95% CI 0.57-0.69), 0.59 (95% CI 0.53-0.65), 0.55 (95% CI 0.49-0.61) and 0.51 (95% CI 0.45-0.57), respectively. Regardless of the approach used or how the 5 biomarkers were combined, the best accuracy for diagnosing AHF (0.73, 95% CI 0.67-0.78) did not differ from that of NT-proBNP alone | ||
| 520 | |a CONCLUSION: In this study, NT-proBNP alone exhibited the best diagnostic accuracy for diagnosing AHF in elderly patients presenting with acute dyspnea to the emergency departments. None of the other biomarkers alone or combined improved the accuracy compared to NT-proBNP, which is the only biomarker to use in this setting | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a Galectin 3 |2 NLM | |
| 650 | 7 | |a CD146 Antigen |2 NLM | |
| 650 | 7 | |a Interleukin-1 Receptor-Like 1 Protein |2 NLM | |
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| 700 | 1 | |a Ray, Patrick |e verfasserin |4 aut | |
| 700 | 1 | |a Puyraveau, Marc |e verfasserin |4 aut | |
| 700 | 1 | |a Dubart, Alain-Eric |e verfasserin |4 aut | |
| 700 | 1 | |a Chenevier-Gobeaux, Camille |e verfasserin |4 aut | |
| 700 | 1 | |a Seronde, Marie-France |e verfasserin |4 aut | |
| 700 | 1 | |a Mebazaa, Alexandre |e verfasserin |4 aut | |
| 700 | 1 | |a Martin, Bérenger |e verfasserin |4 aut | |
| 700 | 1 | |a Pretalli, Jean-Baptiste |e verfasserin |4 aut | |
| 700 | 1 | |a Desmettre, Thibaut |e verfasserin |4 aut | |
| 700 | 0 | |a READ Study group |e verfasserin |4 aut | |
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