BACKGROUND: Acute heart failure negatively affects short-term outcomes of patients with acute coronary syndrome (ACS). Therefore, reliable and non-invasive assessment of pulmonary congestion is needed to select patients requiring more intensive monitoring and therapy. Since plasma levels of natriuretic peptides are influenced by myocardial ischemia, they might not reliably reflect congestion in the context of ACS. The novel endothelial biomarker, soluble CD146 (sCD146), presents discriminative power for detecting the cardiac origin of acute dyspnea similar to that of natriuretic peptides and is associated with systemic congestion. We evaluated the performance of sCD146 for the assessment of pulmonary congestion in the early phase of ACS. METHODS: One thousand twenty-one consecutive patients with ACS were prospectively enrolled. Plasma levels of sCD146, brain natriuretic peptide (BNP), and high-sensitive troponin T were measured within 24 hr after the onset of chest pain. Pulmonary congestion on chest radiography was determined and classified in three groups according to the degree of congestion. RESULTS: Nine hundred twenty-seven patients with ACS were analyzed. Ninety-two (10%) patients showed signs of pulmonary edema on chest radiography. Plasma levels of sCD146 reflected the radiological severity of pulmonary congestion. Higher plasma levels of sCD146 were associated with the worse degree of pulmonary congestion. In contrast to BNP, sCD146 levels were not affected by the level of troponin T. CONCLUSIONS: The novel endothelial biomarker, sCD146, correlates with radiological severity of pulmonary congestion in the early phase of ACS and, in contrast to BNP, is not affected by the amount of myocardial cell necrosis.
Acute Coronary Syndrome/*diagnosis/diagnostic imaging ; Aged ; Antigens, CD146/blood ; Biomarkers/blood ; Chest Pain/diagnostic imaging/*pathology ; Electrocardiography ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnosis ; Natriuretic Peptide, Brain/*blood ; Severity of Illness Index ; Troponin T/blood

OBJECTIVETo investigate the value of an early diagnosis grading model derived from the clinical manifestation, laboratory and imaging data for the diagnosis of aortic dissection (AD).

METHODSAn early diagnosis grading model was established based on the clinical manifestation, laboratory and imaging data from 182 AD patients who admitted to our department during the last 3 years, 184 patients with chest and back pain served as controls.

RESULTSThe sensitivity and specificity of diagnosing AD with the score of 5 is 96.7% and 81.0%, respectively.

CONCLUSIONThe emergency diagnose of AD could be improved based on the established early grading model based on the stabbing and severe pain, rapid blood pressure increase, asymmetry of the blood pressure and/or the pulse, widened aortic knob, mediastinum or descending aorta on X-ray, and significantly increased D-dimmer level.

Adult ; Aged ; Aged, 80 and over ; Aneurysm, Dissecting ; diagnosis ; Aorta, Thoracic ; pathology ; Aortic Aneurysm ; diagnosis ; Back Pain ; Chest Pain ; Diagnostic Imaging ; Early Diagnosis ; Female ; Humans ; Male ; Middle Aged ; Sensitivity and Specificity