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Objective:To explore the risk stratification value of HEART score combined with cardiac troponin (cTn) in emergency patients with chest pain.Methods:A total of 11 583 patients with chest pain who visited the Emergency Department of Zhongshan Hospital Affiliated to Fudan University from January to December 2019 were retrospectively collected. Patients who unfinished 0 h high-sensitivity cardiac troponin T (hs-cTnT) or electrocardiogram diagnosed ST-segment elevation myocardial infarction (STEMI) or lost to follow-up were excluded, and 7 057 patients were finally included. The final diagnosis of chest pain and the occurrence of major adverse cardiovascular events within 6 mon (6 m MACEs) were followed up by telephone and medical history. The HEART score of each patient was calculated by two attending physicians, and the patients were divided into the low-risk group (0-3 points), intermediate-risk group (4-6 points) and high-risk group (7-10 points) according to the final score. The risk stratification performance and safety of HEART score were observed and analyzed. A total of 1 884 patients who completed serial hs-cTnT tests were divided into groups according to HEART score (≤3 as low-risk group) and HEART score combined with serial hs-cTnT pathway (HEART score ≤3 and two hs-cTnT measurements <0.03 ng/mL as the low-risk group). The sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of each diagnostic method were calculated to compare the diagnostic performance of the two predictive values.Results:The patients were divided into 3 groups by HEART score : 2 765 (39.2%) patients in the low-risk group, 3 438 (48.7%) in the intermediate-risk group, and 854 (12.1%) in the high-risk group. The incidence of 6 m MACEs in each group was 1.2%, 18% and 55.3%, respectively. When the low-risk threshold was 2, 23.1% of patients entered the low-risk group and the incidence of 6 m MACEs was 0.9%. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive performance of the HEART score for 6 m MACEs, and the final AUC was 0.831 ( P=0.006, 95% CI: 0.819-0.843). Regarding the occurrence of NSTEMI at the time of this visit, 4 (0.8%) patients were misdiagnosed by using the HEART score alone. Combined with serial troponin detection, the diagnostic SE and NPV were both 100%; at the same time, the diagnostic SE and NPV of 6 m MACEs in patients increased from 98.1% (95% CI: 96.9%-99.1%), 97.9% (95% CI: 96.2%-99%) to 99.1% (95% CI: 97.9%-99.7%) and 98.9% (95% CI: 97.4%-99.6%), the diagnosis SE and NPV of 6 m myocardial infarction and cardiac death in patients increased from 98% (95% CI: 96%-99.2%), 98.6% (95% CI: 97%-99.4%) to 99.2% (95% CI: 97.6%-99.8%) and 99.3% (95% CI: 98.1%-99.9%). Conclusions:The HEART score can be used for risk assessment in emergency patients with chest pain, and a threshold of 2 is recommended for the low-risk group. The diagnostic performance of HEART score combined with serial cTn is better than that of HEART score alone.
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Objective:To explore the value of HEART score combined with three bedside tests of myocardial infarction in the diagnosis of emergency chest pain patients.Methods:310 patients with emergency chest pain treated in Langfang People's Hospital from January 2018 to December 2018 were retrospectively selected. The HEART score was evaluated at admission, and the levels of serum creatine kinase isoenzyme (CK-MB), myoglobin (Myo) and troponin I (cTnI) were detected.Results:Among 310 patients, 232 cases were diagnosed as cardiogenic chest pain, 78 cases were non cardiogenic chest pain; In cardiogenic chest pain, 151 cases were acute coronary syndrome and 81 cases were stable angina pectoris; The HEART score, CK-MB, Myo and cTnI in patients with cardiogenic chest pain were (5.00±1.01)points, (14.45±3.11)ng/ml, (60.20±11.34)ng/ml and (2.30±0.89)ng/ml, respectively, which were significantly higher than those in patients with non cardiogenic chest pain ( P<0.05); The HEART score, CK-MB, myo and cTnI in patients with acute coronary syndrome were (5.83±1.12), (16.02±2.88)ng/ml, (64.49±12.01)ng/ml and (2.54±0.91)ng/ml, which were significantly higher than those in patients with stable angina pectoris ( P<0.05); The area under receiver operating characteristic (ROC) curve of HEART score combined with myocardial infarction in the diagnosis of cardiogenic chest pain was 0.811 ( P<0.05), which was higher than single diagnosis of other indexes; the sensitivity and specificity were 85.28% and 82.50% respectively; The area under ROC curve of HEART score combined with myocardial infarction in the diagnosis of acute coronary syndrome was 0.901 ( P<0.05), which was higher than single diagnosis of other indexes; the sensitivity and specificity were 90.00% and 85.00% respectively; The HEART score of patients with acute coronary death was (6.88±1.02), which was significantly higher than that of patients with survival ( P<0.05); The area under ROC curve predicted by HEART score was 0.674 ( P<0.05). When the cut-off value was 6, the sensitivity and specificity were 78.00% and 70.00%, respectively; the CK-MB, Myo and cTnI increased with the risk of cardiogenic chest pain ( P<0.05). Conclusions:HEART score combined with three bedside tests of myocardial infarction has a good application value in the emergency chest pain, which is worthy of clinical use.
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Background: To compare TIMI & HEART SCORE for their risk stratification in Acute Myocardial Infarction Patients, prognostic accuracy and Arrhythmia incidence.Methods: This observational study is conducted in a Tertiary care hospital over a period of 2 years from August 2017 to July 2019. A total of 100 patients presented to ER with Chest Pain are selected for study. Patients were monitored for a period of one month in ICCU.Results: In present study out of 61 cases with TIMI score ≥5, mortality of 11.5%(7 cases, p value 0.028). Heart score more than 6 constitutes high risk group, out of which mortality was observed in 7.45% cases (p=0.48). Most of the arrhythmias (70.49%) in present study observed in patients with TIMI score ≥5 (High risk group) which is statistically significant with p value 0.002. Most of the arrhythmias in present study observed in patients with HS ≥8 which is not statistically significant with p value 0.135.Conclusions: In present study, overall mortality rate was 7% and these patients who died constitutes to high risk group with TIMI. HEART SCORE identified more patients as low risk compared to TIMI SCORE. TIMI SCORE is a good predictor of arrhythmia incidence.
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OBJECTIVE: To rapidly and safely identify the risk of developing acute coronary syndrome in patients with chest pain who present to the emergency department, the clinical use of the History, Electrocardiogram, Age, Risk Factors, and Troponin (HEART) scoring has recently been proposed. This study aimed to assess the inter-rater reliability of the HEART score calculated by a large number of Italian emergency physicians.METHODS: The study was conducted in three academic emergency departments using clinical scenarios obtained from medical records of patients with chest pain. Twenty physicians, who took the HEART score course, independently assigned a score to different clinical scenarios, which were randomly administered to the participants, and data were collected and recorded in a spreadsheet by an independent investigator who was blinded to the study’s aim.RESULTS: After applying the exclusion criteria, 53 scenarios were finally included in the analysis. The general inter-rater reliability was good (kappa statistics [κ], 0.63; 95% confidence interval, 0.57 to 0.70), and a good inter-rater agreement for the high- and low-risk classes (HEART score, 7 to 10 and 0 to 3, respectively; κ, 0.60 to 0.73) was observed, whereas a moderate agreement was found for the intermediate-risk class (HEART score, 4 to 6; κ, 0.51). Among the different items of the HEART score, history and electrocardiogram had the worse agreement (κ, 0.37 and 0.42, respectively).CONCLUSION: The HEART score had good inter-rater reliability, particularly among the high- and low-risk classes. The modest agreement for history suggests that major improvements are needed for objectively assessing this component.
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Humans , Acute Coronary Syndrome , Chest Pain , Electrocardiography , Emergencies , Emergency Service, Hospital , Heart , Medical Records , Observational Study , Research Personnel , Risk Factors , TroponinABSTRACT
Resumen Objetivo: El dolor torácico es un importante motivo de atención en salas de urgencia a nivel mundial. Se evaluó la relación entre el score HEART modificado y la presencia de eventos cardiacos mayores a los 30 días. Métodos: Estudio retrospectivo, observacional en un solo centro hospitalario. En pacientes mayores de 18 años atendidos en urgencias por dolor torácico, en los cuales se aplicó el score HEART modificado al ingreso y se relacionó con la presencia de eventos cardiacos mayores (infarto de miocardio, muerte, re hospitalización por causa cardiaca y revascularización coronaria percutánea o quirúrgica) a los 30 días de seguimiento. Resultados: De 158 pacientes analizados, 17 eventos adversos (10.8%) se encontraron al mes de seguimiento. El score HEART modificado pudo predecir eventos adversos en el 4; 21,4 y 100% de pacientes con scores 0-3, 4-6 y 7-10 respectivamente (p = 0.0001). Un score HEART modificado mayor o igual a 4 se relacionó con más eventos adversos (OR: 4.52; IC: 2.76-7.39) con una sensibilidad del 70% y una especificidad del 84%. Conclusiones: La aplicación del score HEART modificado estratifica a los pacientes con dolor torácico en urgencias de manera adecuada en bajo, moderado y alto riesgo de complicaciones cardiovasculares, lo cual permite que las unidades de urgencia mejoren sus protocolos de triaje y diagnóstico de los síndromes coronarios agudos.
Abstract Objective: Chest pain is a major reason for emergency room care worldwide. The relationship between the Modified Heart Score and the presence of major cardiac events at 30 days after emergency admission was evaluated. Methods: Retrospective, observational study in a single centre on patients older than 18 years, who were treated for chest pain. The Modified HEART Score was applied at admission and related to the presence of major cardiac events (myocardial infarction, death, hospital re-admission due to cardiac causes, and percutaneous or surgical coronary revascularisation) at 30 days of follow-up. Results: Of 158 patients analysed, 17 (10.8%) adverse events were found at follow-up. The modified HEART score could predict adverse events in 4%; 21.4%, and 100% of patients with scores 0-3; 4-6, and 7-10, respectively (P = .0001). A modified HEART score greater than or equal to 4 was associated with more adverse events (OR: 4.52; 95% CI 2.76-7.39) with a sensitivity of 70% and specificity of 84%. Conclusions: The application of the modified HEART score is useful for stratifying patients with chest pain into low, moderate, and high risk of cardiovascular complications, which should help the emergency units to improve their protocols for triage and diagnosis of acute coronary syndromes.
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Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Chest Pain/etiology , Triage/methods , Emergency Service, Hospital , Acute Coronary Syndrome/diagnosis , Patient Readmission/statistics & numerical data , Cardiovascular Diseases/epidemiology , Retrospective Studies , Follow-Up Studies , Sensitivity and Specificity , Acute Coronary Syndrome/physiopathology , Myocardial Infarction/epidemiologyABSTRACT
The objective of this research was to evaluate the electrocardiogram (ECG) of horses used for wagon traction and to compare the results with the parameters obtained from inactive horses or horses submitted to a training routine. Fifty-six 3-15-year-old healthy horses (22 females and 34 males) were divided into three groups: control (without a work routine; N=21), wagon traction (N=25) and athlete (N=10) and submitted to physical examination and ECG (at rest). The rhythm, heart rate (HR), amplitude and duration of ECG waveforms and intervals were obtained from the frontal plane and base-apex leads. Heart score (HS) was calculated using the arithmetic mean of QRS duration in LI, LII and LIII. Measurements of ECG waves were smaller in control group, in comparison with wagon traction and athlete groups, suggesting that exercise can change ECG. Similar results were observed in the wagon traction and athlete groups, but the electrophysiological adjustments to exercise were not the same for these groups.(AU)
O objetivo deste trabalho foi avaliar o eletrocardiograma (ECG) de cavalos que tracionavam carroças (carroceiros; N=25), comparando os resultados com os parâmetros de cavalos que não realizavam essa atividade (controles; N=21), ou que apresentavam uma rotina de treinamento (atletas; N=10). O ECG foi precedido pelo exame físico do animal e, a partir das derivações no plano frontal e na base-ápice, determinou-se o ritmo, a frequência cardíaca, a amplitude e a duração das ondas e dos intervalos, em repouso. O escore cardíaco foi calculado pela média aritmética da duração do complexo QRS em DI, DII e DIII. O grupo controle apresentou menores valores de amplitude e duração das ondas do ECG, em comparação aos grupos carroceiro e atleta, sugerindo que o exercício pode alterar o ECG. Resultados semelhantes foram observados nos grupos carroceiro e atleta; contudo, os ajustes eletrofisiológicos ao exercício não foram os mesmos para esses dois grupos.(AU)
Subject(s)
Animals , Heart Rate , Horses , Physical Examination/veterinary , Physical Exertion , Electrocardiography/veterinaryABSTRACT
Small-breed dogs (n = 168; weight < 15 kg) diagnosed with myxomatous mitral valve degeneration based on a routine clinical examination, radiology, electrocardiography, and echocardiography at the Seoul National University Veterinary Medical Teaching Hospital were included in this study. Survival periods were determined, and there were significant differences in survival rates among the three International Small Animal Cardiac Health Council classes. The mean follow-up period was 14.3 ± 12.1 months. Univariate analysis revealed that dyspnea, pulmonary edema, and vertebral heart score were significantly associated with survival time (p < 0.05). Additionally, age, left atrial-to-aortic root ratio, ejection fraction, and left ventricular end diastolic volume were associated with an increased risk of death (p < 0.1), while body weight, body condition score, systolic blood pressure, arrhythmia, syncope, fractional shortening, and end systolic volume were not associated with an increased risk of death. These results suggest that among the assessed variables dyspnea, pulmonary edema, and vertebral heart score could be useful prognostic factors for providing patient information to owners.
Subject(s)
Animals , Dogs , Humans , Arrhythmias, Cardiac , Blood Pressure , Body Weight , Dyspnea , Echocardiography , Electrocardiography , Follow-Up Studies , Heart , Heart Failure , Hospitals, Teaching , Mitral Valve , Prognosis , Pulmonary Edema , Retrospective Studies , Seoul , Stroke Volume , Survival Rate , SyncopeABSTRACT
Objective To investigate the value of detecting HEART score and HEARTS3 score in risk stratification and prognosis of acute coronary syndrome (ACS) in patients with non-ST segment elevation chest pain in emergency department (ED).Methods Clinical data of case-control retrospective study of 775 patients with non-ST segment elevation chest pain in ED were collected from July 2011 to March 2015.The patients were estimated and risk stratification was made with HEART score and HEARTS3 score.After follow-up visiting by telephone for 30 days,outcomes were found to be ACS and myocardial infarction (MI).And the patients were categorized with score into low,intermediate and high risk groups.The correlation between the ACS and risk score in three groups was analyzed.Comparison of capability of performance in predicting 30-day ACS between the HEART score and HEARTS3 risk score.Statistical analyses were performed using SPSS13.0.Enumeration variables were expressed as percentage.For comparison of predictive value of the two sets of scores,area under the receiver operating curve (auROC) was calculated and compared by Z test.Results There were 92 cases with 30-day ACS.The rate of ACS had a trend of increase with increase in HEART score and HEARTS3 score.The patients with higher scores of HEART and HEARTS3,higher incidence of ACS in 30 days.Especially,the high-risk patients with score≥7 of HEART score and≥8 of HEARTS3 score had higher rate of ACS.And there was significant difference in predicting high-risk patients between two sets of scoring (P ＜ 0.05).The HEARTS3 score outperformed the HEART score as determined by comparison of areas under the ROC curve for MI (0.952 vs 0.813;P =0.028),30-day ACS (0.913 vs.0.815;P =0.034).Conclusions HEART score and HEARTS3 score both can be used to evaluate and perform risk stratification for non-ST segment elevation chest pain patients in ED.But HEARTS3 score can more precisely stratify high-risk patients with chest pain for 30-day ACS.
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Objective To study the value of HEART scores in predicting the risk of getting acute coronary syndrome in patients with chest pain and assessing the prognosis in order to elucidate the validity of the HEART scores.Methods A total of 1 200 patients with chest pain were continuously observed and followed up,and their HEART scores were calculated.The survival rates were calculated with Kaplan-Meier method and AUROC (area under ROC curve) was used to determine the accuracy of this methods.The HEART scores were compared with TIMI and GRACE scores.Results Low HEART scores (0-3) were found in 34.5％ of the patients and MACE (major adverse cardiac event) occurred in 1.4％ of them.The patients with intermediate HEART scores (4-6) accounted for 50.7％ patients,and MACE was diagnosed in 22.2％ of them.High HEART scores (7-10) were found in 14.85％ patients,and MACE occurred in 60.7％ of them.There was significant difference among these three groups (Log rank P ＜ 0.01).The AUROC of HEART score was 0.83 (95％ CI:0.80-0.85,P ＜0.01),being significantly higher than the GRACE scores (0.76) and TIMI scores (0.72).Conclusions The HEART score is applicable for predicting the risk of getting acute coronary syndrome of chest pain patients in emergency department and the prognosis.
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Avaliou-se o eletrocardiograma de 100 equinos sadios praticantes de hipismo clássico modalidade salto, com idades entre 4 e 19 anos, sendo 61 machos e 39 fêmeas, com média de 516,3 kg. Observou-se frequência cardíaca média de 40,20 ±13,33 bpm, sendo o ritmo cardíaco mais freqüente o sinusal (56 por cento). As alterações de ritmo cardíaco estiveram presentes em 38 por cento dos animais estudados, sendo a mais presente o marcapasso migratório (22 por cento), seguido de bloqueio atrioventricular de 2º grau (4 por cento), bloqueio atrioventricular de 1º grau (3 por cento), contração ventricular prematura (2 por cento), contração atrial prematura (1 por cento). Não se observou correlação entre as variáveis estudadas (freqüência cardíaca, ritmo e arritmias) e a capacidade atlética, a idade e o sexo. O escore cardíaco após analise estatística não diferiu entre os grupos quanto ao desempenho atlético, a faixa etária e o sexo. O escore cardíaco, nesta amostra, não se mostrou um parâmetro confiável para se predizer o futuro atlético ou o nível de treinamento do eqüino.
The electrocardiographic study was made in 100 healthy showjumping horses, with ages between 4 and 19 year-old, being 61 males and 39 females, with mean bodyweight of 516.3 kg. A mean heart rate of 40.20 ± 13.33 bpm was observed, and the most common cardiac rhythm was sinus rhythm (56 percent). Alterations in cardiac rhythm were observed in 38 percent of the animals, as wandering pacemaker (22 percent), second degree atrioventricular block (4 percent), first degree atrioventricular block (3 percent), ventricular premature contraction (2 percent), atrial premature contraction (1 percent). There was no relationship between the variables (heart rate, rhythm and arrhythmias) and the athletic performance, age and sex. The heart score data obtained after statistical analysis were not different concerning the athletic performance, age or sex. Therefore, heart score, in this sample, did not appear to be a confident parameter to predict the athletic future or the training level of the individual horse.
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Animals , Heart Rate/physiology , Tachycardia, Sinus/diagnosis , Tachycardia, Sinus/veterinaryABSTRACT
Prediction of potential performance is one of the goals of exercise physiology investigations. When Selecting a horse for competition, one of the main objectives is to choose the one that predictably will reveal a competitive aptitude above the average. The horses used in this study underwent a two-dimensional echocardiography study and a conventional 3 leads electrocardiogram. The results show that heart score is not an appropriate index to evaluate the heart size in the horse. On the other hand, there are currently more suitable and accurate procedures such as echocardiography that allow performing a clear anatomical evaluation and accurate measurement in order to calculate LVMM and to predict performance.