Acute Heart Failure Clinical Trial
Official title:
Multimarker Approach for Acute Dyspnea in Elderly Patients Admitted in the Emergency Department
Elderly people constitute the largest proportion of emergency department (ED) patients,
representing 12% of all ED admissions. The need for diagnostic tests or therapeutic
interventions is much greater in this patient population. Cardiovascular diseases and
symptoms represent 12% of the causes for ED admission, and patients suffering from
cardiovascular disease are those whose ED visit lasts longest.
The diagnostic approach in the ED in elderly patients admitted for acute dypsnoea is complex,
and early identification of acute left-sided heart failure (ALSHF) is vital as it has an
impact on prognosis. The clinical signs are difficult to interpret, and are non-specific,
particularly at the acute phase and in elderly or obese patients. Indeed, some authors have
reported up to 50% of diagnostic errors in elderly patients.
Measure of the blood concentration of a natriuretic peptide allows a quick diagnosis.
However, peptides alone suffer from several limitations, particularly in situations that are
often encountered in elderly patients, such as sepsis, renal failure, acute coronary
syndrome, pulmonary embolism, chronic respiratory failure, atrial fibrillation and high body
mass index. Diagnostic performance deteriorates with increasing age, and there is a
significant increase in this grey-zone in patients aged ≥75 years. In critical situations in
elderly patients, assessment of natriuretic peptides serve mainly to rule out a diagnosis of
left heart failure.
Some authors have studied other biomarkers showing their performance in the diagnosis of
ALSHF. These are biomarkers involved in remodeling and myocardial fibrosis (ST2, Galectin-3)
or involved in myocardial injury (High-sensitivity Troponin-I).
Therefore, a combined "multimarker" approach could improve the diagnostic performance of
ALSHF.
READ (NCT02531542) is a diagnostic study including patients over the age of 75 admitted to
acute dyspnea in the ED, to demonstrate the superiority of an ultrasound protocol (the READ
protocol) on NT-proBNP in the ALSHF diagnosis.
The hypothesis is that the diagnostic accuracy of a multimarker diagnostic approach, namely
the READ-MA method, combining NT-proBNP, High-sensitivity Troponin-I, ST2 and Galectin-3
would be superior to that of NT-proBNP assessment for the diagnosis of ALSHF in elderly
patients (≥75 years) admitted to the ED.
n/a
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