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Prohormones in the early diagnosis of cardiac syncope
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نویسنده
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badertscher p. ,nestelberger t. ,de lavallaz j.f. ,than m. ,morawiec b. ,kawecki d. ,miró o. ,lópez b. ,javier martin-sanchez f. ,bustamante j. ,geigy n. ,christ m. ,di somma s. ,frank peacock w. ,cullen l. ,sarasin f. ,flores d. ,tschuck m. ,boeddinghaus j. ,twerenbold r. ,wildi k. ,sabti z. ,puelacher c. ,giménez m.r. ,kozhuharov n. ,shrestha s. ,strebel i. ,rentsch k. ,keller d.i. ,poepping i. ,buser a. ,kloos w. ,lohrmann j. ,kuehne m. ,osswald s. ,reichlin t. ,mueller c.
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منبع
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journal of the american heart association - 2017 - دوره : 6 - شماره : 12
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چکیده
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Background--the early detection of cardiac syncope is challenging. we aimed to evaluate the diagnostic value of 4 novel prohormones,quantifying different neurohumoral pathways,possibly involved in the pathophysiological features of cardiac syncope: midregional-pro-a-type natriuretic peptide (mrproanp),c-terminal proendothelin 1,copeptin,and midregionalproadrenomedullin. methods and results--we prospectively enrolled unselected patients presenting with syncope to the emergency department (ed) in a diagnostic multicenter study. ed probability of cardiac syncope was quantified by the treating ed physician using a visual analogue scale. prohormones were measured in a blinded manner. two independent cardiologists adjudicated the final diagnosis on the basis of all clinical information,including 1-year follow-up. among 689 patients,cardiac syncope was the adjudicated final diagnosis in 125 (18%). plasma concentrations of mrproanp,c-terminal proendothelin 1,copeptin,and midregional-proadrenomedullin were all significantly higher in patients with cardiac syncope compared with patients with other causes (p < 0.001). the diagnostic accuracies for cardiac syncope,as quantified by the area under the curve,were 0.80 (95% confidence interval [ci],0.76-0.84),0.69 (95% ci,0.64-0.74),0.58 (95% ci,0.52-0.63),and 0.68 (95% ci,0.63-0.73),respectively. in conjunction with the ed probability (0.86; 95% ci,0.82-0.90),mrproanp,but not the other prohormone,improved the area under the curve to 0.90 (95% ci,0.87-0.93),which was significantly higher than for the ed probability alone (p=0.003). an algorithm to rule out cardiac syncope combining an mrproanp level of < 77 pmol/l and an ed probability of < 20% had a sensitivity and a negative predictive value of 99%. conclusions--the use of mrproanp significantly improves the early detection of cardiac syncope among unselected patients presenting to the ed with syncope. © 2017 the authors.
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کلیدواژه
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Arrhythmia; Biomarker; Diagnosis; Syncope (fainting)
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آدرس
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cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel,switzerland,great network,rome, Italy, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel,switzerland,department of internal medicine,university hospital basel,university of basel,switzerland,great network,rome, Italy, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel,switzerland,great network,rome, Italy, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel,switzerland,great network,rome, Italy, great network,rome,italy,2nd department of cardiology,medical university of silesia,zabrze, Poland, great network,rome,italy,2nd department of cardiology,medical university of silesia,zabrze,poland,emergency department,university hospital zurich,zurich, Switzerland, great network,rome,italy,emergency department,hospital clinic,barcelona,catalonia, Spain, great network,rome,italy,emergency department,hospital clinic,barcelona,catalonia, Spain, great network,rome,italy,emergency department,hospital clínico san carlos,madrid, Spain, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel,switzerland,department of internal medicine,university hospital basel,university of basel,switzerland,great network,rome,italy,emergency department,hospital clínico san carlos,madrid, Spain, department of emergency medicine,hospital of liestal, Switzerland, great network,rome,italy,department of emergency care,lucerne general hospital,lucerne, Switzerland, great network,rome,italy,emergency medicine,department of medical-surgery sciences and translational medicine,sant'andrea hospital,university sapienza rome,rome, Italy, great network,rome,italy,department of emergency medicine,baylor college of medicine,houston,tx, Australia, great network,rome,italy,royal brisbane and women's hospital,herston, Australia, emergency department,hôpitaux universitaires de genève, Switzerland, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel,switzerland,great network,rome, Italy, great network,rome,italy,christchurch hospital,christchurch, New Zealand, great network,rome, Italy, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel,switzerland,great network,rome,italy,department of general and interventional cardiology,hamburg university heart center,hamburg, Germany, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel,switzerland,great network,rome, Italy, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel,switzerland,great network,rome, Italy, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel,switzerland,great network,rome, Italy, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel,switzerland,great network,rome, Italy, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel,switzerland,great network,rome, Italy, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel,switzerland,great network,rome, Italy, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel,switzerland,great network,rome, Italy, laboratory medicine,university hospital basel,university of basel, Switzerland, blood transfusion centre,swiss red cross,basel, Switzerland, department of internal medicine,hospital of lachen, Switzerland, department of hematology,university hospital basel,university of basel,switzerland,blood transfusion centre,swiss red cross,basel, Switzerland, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel, Switzerland, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel, Switzerland, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel, Switzerland, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel, Switzerland, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel,switzerland,great network,rome, Italy, cardiovascular research institute basel and department of cardiology,university hospital basel,university of basel,switzerland,great network,rome, Italy
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