Publications by authors named "Maria Belkin"

Background And Aim: The possible clinical utility of Bone Morphogenetic Protein 10 (BMP10), a novel atrial-specific biomarker, is incompletely understood. We aimed to test the hypothesis that BMP10 has high diagnostic and prognostic accuracy in patients presenting with acute dyspnea.

Methods And Results: In a multicenter diagnostic study, BMP10, high-sensitivity cardiac troponin T (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations were determined in patients presenting with acute dyspnea to the emergency department.

View Article and Find Full Text PDF

Aims: We hypothesized that the current gold standard for risk stratification of patients with acute heart failure (AHF), the Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF (MEESSI-AHF) risk score, can be further improved by adding systemic inflammation as quantified by C-reactive protein (CRP).

Methods And Results: In a prospective multicentre diagnostic study (BASEL V), AHF was centrally adjudicated by two independent cardiologists. The MEESSI-AHF risk score was calculated using an established reduced and recalibrated model containing 12 independent risk factors.

View Article and Find Full Text PDF
Article Synopsis
  • * Among 1,152 patients studied, those with normotensive acute heart failure exhibited significantly higher levels of hemodynamic stress and heart cell injury markers compared to those who were hypertensive.
  • * The findings indicated that normotensive patients had a higher risk of mortality, particularly if their biomarker levels were elevated, which was confirmed in a separate cohort of 324 patients.
View Article and Find Full Text PDF
Article Synopsis
  • There are significant sex-specific differences in acute heart failure (AHF), indicating a need for separate evaluation of treatments for men and women.
  • In a multicenter trial of 781 AHF patients, women were older, less weighted, and had lower kidney function compared to men, with a notable difference in treatment outcomes.
  • The study found that the rapid increase of RAAS inhibitors was less effective in women, which may contribute to their higher rates of mortality and rehospitalization due to AHF.
View Article and Find Full Text PDF

Background: Self-reported exercise capacity is a well-established prognostic measure in stable ambulatory patients with cardiac and pulmonary disease.

Objectives: The authors aimed to directly compare the prognostic accuracy of quantified self-reported exercise capacity using the Duke Activity Status Index (DASI) with the established objective disease-severity marker B-type natriuretic peptide (BNP) in patients presenting with acute dyspnea to the emergency department.

Methods: The DASI was obtained in a prospective multicenter diagnostic study recruiting unselected patients presenting with acute dyspnea to the emergency department.

View Article and Find Full Text PDF

Aims: Systemic inflammation may be central in the pathophysiology of acute heart failure (AHF). We aimed to assess the possible role of systemic inflammation in the pathophysiology, phenotyping, and risk stratification of patients with AHF.

Methods And Results: Using a novel Interleukin-6 immunoassay with unprecedented sensitivity (limit of detection 0.

View Article and Find Full Text PDF

Aims: Obese patients have lower natriuretic peptide concentrations. We hypothesized that adjusting the concentration of N-terminal pro-B-type natriuretic peptide (NT-proBNP) for obesity could further increase its clinical utility in the early diagnosis of acute heart failure (AHF).

Methods And Results: This hypothesis was tested in a prospective diagnostic study enrolling unselected patients presenting to the emergency department with acute dyspnoea.

View Article and Find Full Text PDF
Article Synopsis
  • Current guidelines for interpreting natriuretic peptide concentrations in emergency settings do not account for the time of day when patients present.
  • A study comparing diagnostic accuracy for acute heart failure in daytime versus evening/nighttime patients found significant diurnal variations in BNP and NT-proBNP levels, with lower concentrations at night affecting accuracy of diagnosis.
  • Results show that BNP and NT-proBNP have a distinct diurnal rhythm, which could lead to misdiagnosis if not considered, while MR-proANP levels remained consistent regardless of the time of day.
View Article and Find Full Text PDF
Article Synopsis
  • The Canadian Syncope Risk Score (CSRS) was tested in an international study to predict serious outcomes within 30 days for patients over 40 who experience syncope and seek emergency care.
  • Among 2,283 participants, the CSRS outperformed the OESIL score in predicting adverse outcomes, with a better area under the curve (AUC) for both primary and secondary outcomes.
  • A simplified version of the CSRS that uses just the clinician's classification of syncope also showed strong predictive ability, raising questions about the necessity of the full score components.
View Article and Find Full Text PDF

Objectives: To determine the prevalence, characteristics and association with prognosis of left bundle branch block (LBBB) in 3 different cohorts of patients with acute heart failure (AHF).

Methods And Results: We retrospectively analyzed 12,950 patients with AHF who were included in the EAHFE (Epidemiology Acute Heart Failure Emergency), RICA (National Heart Failure Registry of the Spanish Internal Medicine Society), and BASEL-V (Basics in Acute Shortness of Breath Evaluation of Switzerland) registries. We independently analyzed the relationship between baseline and clinical characteristics and the presence of LBBB and the potential association of LBBB with 1-year all-cause mortality and a 90-day postdischarge combined endpoint (Emergency Department reconsultation, hospitalization or death).

View Article and Find Full Text PDF

Aims: We aimed to assess the long-term effect of a strategy of comprehensive vasodilation versus usual care on health-related quality of life (HRQL) among patients with acute heart failure (AHF).

Methods And Results: Health-related quality of life was prospectively assessed by the generic 3-levelled EQ-5D and the disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ) among adult AHF patients enrolled in an international, multicentre, randomised, open-label blinded-end-point trial of a strategy that emphasized early intensive and sustained vasodilation using maximally tolerated doses of established oral and transdermal vasodilators according to systolic blood pressure. Changes in EQ-5D and KCCQ from admission to 180 day follow-up were individually compared between the intensive vasodilatation and the usual care group.

View Article and Find Full Text PDF

Background: Quantifying the activity of the adrenomedullin system might help to monitor and guide treatment in acute heart failure (AHF) patients. The aims were to (1) identify AHF patients with marked benefit or harm from specific treatments at hospital discharge and (2) predict mortality by quantifying the adrenomedullin system activity.

Methods: This was a prospective multicentre study.

View Article and Find Full Text PDF

Aims: Cardiac myosin-binding protein C (cMyC) seems to be even more sensitive in the quantification of cardiomyocyte injury vs. high-sensitivity cardiac troponin, and may therefore have diagnostic and prognostic utility.

Methods And Results: In a prospective multicentre diagnostic study, cMyC, high-sensitivity cardiac troponin T (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) plasma concentrations were measured in blinded fashion in patients presenting to the emergency department with acute dyspnoea.

View Article and Find Full Text PDF

Acute heart failure (AHF) is a complex and heterogeneous syndrome not only associated with a concerning rise in incidence, but also with still unacceptably high rates of mortality and morbidity. As this dismal outcome is at least in part due to a mismatch between the severity of AHF and the intensity of its management, both in-hospital and immediately after discharge, early and accurate risk prediction could contribute to more effective, risk-adjusted management. Biomarkers are noninvasive and highly reproducible quantitative tools that have improved the understanding of AHF pathophysiology.

View Article and Find Full Text PDF