title: Quantifying cardiac hemodynamic stress and cardiomyocyte damage in ischemic and nonischemic acute heart failure.
abstract: BACKGROUND
  The early and noninvasive differentiation of ischemic and nonischemic acute heart failure (AHF) in the emergency department (ED) is an unmet clinical need.
  
  
  RESULTS
  We quantified cardiac hemodynamic stress using B-type natriuretic peptide (BNP) and cardiomyocyte damage using 2 different cardiac troponin assays in 718 consecutive patients presenting to the ED with AHF (derivation cohort). The diagnosis of ischemic AHF was adjudicated using all information, including coronary angiography. Findings were validated in a second independent multicenter cohort (326 AHF patients). Among the 718 patients, 400 (56%) were adjudicated to have ischemic AHF. BNP levels were significantly higher in ischemic compared with nonischemic AHF (1097 [604-1525] pg/mL versus 800 [427-1317] pg/mL; P<0.001). Cardiac troponin T (cTnT) and sensitive cardiac troponin I (s-cTnI) were also significantly higher in ischemic compared with nonischemic AHF patients (0.040 [0.010-0.306] μg/L versus 0.018 [0.010-0.060] μg/L [P<0.001]; 0.024 [0.008-0.106] μg/L versus 0.016 [0.004-0.044 ] μg/L [P=0.002]). The diagnostic accuracy of BNP, cTnT, and s-cTnI for the diagnosis of ischemic AHF, as quantified by the area under the receiver-operating characteristic curve, was low (0.58 [95% CI, 0.54-0.63], 0.61 [95% CI, 0.57-0.66], and 0.59 [95% CI,0.54-0.65], respectively). These findings were confirmed in the validation cohort.
  
  
  CONCLUSIONS
  At presentation to the ED, patients with ischemic AHF exhibit more extensive hemodynamic cardiac stress and cardiomyocyte damage than patients with nonischemic AHF. However, the overlap is substantial, resulting in poor diagnostic accuracy.
authors: Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors: Beatrice
authors: B
authors: Drexler
authors: Corinna
authors: C
authors: Heinisch
authors: Cathrin
authors: C
authors: Balmelli
authors: Johan
authors: J
authors: Lassus
authors: Krista
authors: K
authors: Siirilä-Waris
authors: Nisha
authors: N
authors: Arenja
authors: Thenral
authors: T
authors: Socrates
authors: Markus
authors: M
authors: Noveanu
authors: Mihael
authors: M
authors: Potocki
authors: Christophe
authors: C
authors: Meune
authors: Philip
authors: P
authors: Haaf
authors: Christian
authors: C
authors: Degen
authors: Tobias
authors: T
authors: Breidthardt
authors: Tobias
authors: T
authors: Reichlin
authors: Markku S
authors: MS
authors: Nieminen
authors: Harjola
authors: H
authors: Veli-Pekka
authors: Stefan
authors: S
authors: Osswald
authors: Christian
authors: C
authors: Mueller
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology; D032383:Myocytes, Cardiac / Q000473:pathology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D012189:Retrospective Studies; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020107:Troponin T; D020097:Natriuretic Peptide, Brain