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Article ; Online: Bleeding After Transcatheter Aortic Valve Replacement: The Pebble and the Ripple.

Stortecky, Stefan / Alaour, Bashir

2023 Volume 16, Issue 24, Page(s) 2963–2966

MeSH term(s)	Humans ; Transcatheter Aortic Valve Replacement/adverse effects ; Treatment Outcome ; Hemorrhage/diagnostic imaging ; Hemorrhage/etiology ; Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Aortic Valve Stenosis/diagnostic imaging ; Aortic Valve Stenosis/surgery ; Risk Factors
Language	English
Publishing date	2023-12-27
Publishing country	United States
Document type	Editorial
ZDB-ID	2452157-7
ISSN	1876-7605 ; 1936-8798
ISSN (online)	1876-7605
ISSN	1936-8798
DOI	10.1016/j.jcin.2023.10.060
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Article ; Online: Combined Significant Aortic Stenosis and Mitral Regurgitation: Challenges in Timing and Type of Intervention.

Alaour, Bashir / Nakase, Masaaki / Pilgrim, Thomas

The Canadian journal of cardiology

2023 Volume 40, Issue 2, Page(s) 235–249

Abstract: In this narrative review, we aim to summarize the literature surrounding the assessment and management of the common, yet understudied combination of aortic stenosis (AS) and mitral regurgitation (MR), the components of which are complexly inter-related ... ...

Abstract	In this narrative review, we aim to summarize the literature surrounding the assessment and management of the common, yet understudied combination of aortic stenosis (AS) and mitral regurgitation (MR), the components of which are complexly inter-related and interdependent from diagnostic, prognostic, and therapeutic perspectives. The hemodynamic interdependency of AS and MR confounds the assessment of the severity of each valve disease, thus underscoring the importance of a multimodal approach integrating valvular and extravalvular indicators of severity. A large body of literature suggests that baseline MR is associated with reduced survival post aortic valve (AV) intervention and that regression of MR post-AV intervention confers a mortality benefit. Functional MR is more likely to regress after AV intervention than primary MR. The respective natural courses of the 2 valve diseases are not synchronized; therefore, significant AS and MR at or above the respective threshold for intervention might not coincide. Surgery is primarily a 1-stop-shop procedure because of a considerable perioperative risk of repeat interventions, whereas transcatheter treatment modalities allow for a more tailored timing of intervention with reassessment of concomitant MR after AV replacement and a potential staged intervention in the absence of MR regression. In summary, AS and MR, when combined, are interlaced into a complex hemodynamic, diagnostic, and prognostic synergy, with important therapeutic implications. Contemporary approaches should consider stepwise intervention by exploiting the advantage of transcatheter options. However, evidence is needed to demonstrate the efficacy of different timing and therapeutic options.
MeSH term(s)	Humans ; Mitral Valve Insufficiency/diagnosis ; Mitral Valve Insufficiency/etiology ; Mitral Valve Insufficiency/surgery ; Treatment Outcome ; Aortic Valve Stenosis/complications ; Aortic Valve Stenosis/diagnosis ; Aortic Valve Stenosis/surgery ; Aortic Valve/surgery ; Transcatheter Aortic Valve Replacement/methods ; Severity of Illness Index
Language	English
Publishing date	2023-11-04
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	632813-1
ISSN	1916-7075 ; 0828-282X
ISSN (online)	1916-7075
ISSN	0828-282X
DOI	10.1016/j.cjca.2023.11.003
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Article: Direct Comparison of the Circadian Rhythm of Cardiac Myosin-Binding Protein C (cMyC) and Cardiac Troponin.

Alaour, Bashir / Kaier, Thomas E / Hasselbalch, Rasmus Bo / van Doorn, William / Meex, Steven / Marber, Michael

The journal of applied laboratory medicine

2023 Volume 8, Issue 4, Page(s) 831–834

MeSH term(s)	Humans ; Carrier Proteins ; Circadian Rhythm ; Myocardial Infarction ; Troponin
Chemical Substances	Carrier Proteins ; myosin-binding protein C ; Troponin
Language	English
Publishing date	2023-05-24
Publishing country	England
Document type	Comparative Study ; Letter ; Research Support, Non-U.S. Gov't
ISSN	2576-9456
ISSN	2576-9456
DOI	10.1093/jalm/jfad025
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Article ; Online: Cardiac troponin and defining myocardial infarction.

Kaier, Thomas E / Alaour, Bashir / Marber, Michael

Cardiovascular research

2021 Volume 117, Issue 10, Page(s) 2203–2215

Abstract: The 4th Universal Definition of Myocardial Infarction has stimulated considerable debate since its publication in 2018. The intention was to define the types of myocardial injury through the lens of their underpinning pathophysiology. In this review, we ... ...

Abstract	The 4th Universal Definition of Myocardial Infarction has stimulated considerable debate since its publication in 2018. The intention was to define the types of myocardial injury through the lens of their underpinning pathophysiology. In this review, we discuss how the 4th Universal Definition of Myocardial Infarction defines infarction and injury and the necessary pragmatic adjustments that appear in clinical guidelines to maximize triage of real-world patients.
MeSH term(s)	Biomarkers/blood ; Consensus ; Decision Support Techniques ; Humans ; Myocardial Infarction/blood ; Myocardial Infarction/classification ; Myocardial Infarction/diagnosis ; Myocardial Infarction/therapy ; Practice Guidelines as Topic ; Predictive Value of Tests ; Prognosis ; Terminology as Topic ; Troponin/blood
Chemical Substances	Biomarkers ; Troponin
Language	English
Publishing date	2021-01-16
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	80340-6
ISSN	1755-3245 ; 0008-6363
ISSN (online)	1755-3245
ISSN	0008-6363
DOI	10.1093/cvr/cvaa331
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Article ; Online: Prognostic impact of cardiac damage staging classification in each aortic stenosis subtype undergoing TAVI.

Nakase, Masaaki / Okuno, Taishi / Tomii, Daijiro / Alaour, Bashir / Praz, Fabien / Stortecky, Stefan / Lanz, Jonas / Reineke, David / Windecker, Stephan / Pilgrim, Thomas

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology

2023 Volume 19, Issue 10, Page(s) e865–e874

Abstract: Background: The prognostic value of cardiac damage staging classifications across the haemodynamic spectrum of severe aortic stenosis (AS) remains unknown.: Aims: We aimed to investigate the prognostic impact of cardiac damage staging classifications ...

Abstract	Background: The prognostic value of cardiac damage staging classifications across the haemodynamic spectrum of severe aortic stenosis (AS) remains unknown. Aims: We aimed to investigate the prognostic impact of cardiac damage staging classifications in patients with high-gradient AS (HG-AS) and low-gradient AS (LG-AS) undergoing transcatheter aortic valve implantation (TAVI). Methods: In a prospective TAVI registry, five-year mortality was evaluated for early stages of cardiac damage (stage 0, 1, or 2) and advanced stages of cardiac damage (stage 3 or 4) in patients with HG-AS, classical low-flow (LF) LG-AS, LF LG-AS with preserved ejection fraction (pEF), and normal-flow (NF) LG-AS. Results: Among 2,090 patients undergoing TAVI, 1,045 patients had HG-AS, 337 patients had classical LF LG-AS, 394 patients had LF LG-AS with pEF, and 314 patients had NF LG-AS. The majority of patients with classical LF LG-AS exhibited advanced cardiac damage (73.6%), followed by LF LG-AS with pEF (55.6%), NF LG-AS (51.6%), and HG-AS (50.6%). Patients with advanced stage cardiac damage had significantly higher mortality after TAVI than those with early stage cardiac damage in all subtypes of AS (adjusted hazard ratio [HR Conclusions: Cardiac damage staging classifications stratified mortality after TAVI irrespective of AS subtype.
MeSH term(s)	Humans ; Transcatheter Aortic Valve Replacement/adverse effects ; Prognosis ; Prospective Studies ; Stroke Volume ; Treatment Outcome ; Aortic Valve Stenosis/surgery ; Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Severity of Illness Index ; Ventricular Function, Left
Language	English
Publishing date	2023-12-04
Publishing country	France
Document type	Journal Article
ZDB-ID	2457174-X
ISSN	1969-6213 ; 1774-024X
ISSN (online)	1969-6213
ISSN	1774-024X
DOI	10.4244/EIJ-D-23-00590
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Zs.A 6680: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
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Article: Comparison of troponin and natriuretic peptides in Takotsubo syndrome and acute coronary syndrome: a meta-analysis.

Couch, Liam Steven / Garrard, James W / Henry, John A / Kotronias, Rafail A / Alaour, Bashir / De Maria, Giovanni Luigi / Channon, Keith M / Banning, Adrian P / Lyon, Alexander Richard / Marber, Michael / Kaier, Thomas Edward

Open heart

2024 Volume 11, Issue 1

Abstract: Objective: Takotsubo syndrome (TTS) is an acute heart failure syndrome which resembles acute coronary syndrome (ACS) at presentation. Differentiation requires coronary angiography, but where this does not occur immediately, cardiac biomarkers may ... ...

Abstract	Objective: Takotsubo syndrome (TTS) is an acute heart failure syndrome which resembles acute coronary syndrome (ACS) at presentation. Differentiation requires coronary angiography, but where this does not occur immediately, cardiac biomarkers may provide additional utility. We performed a meta-analysis to compare troponin and natriuretic peptides (NPs) in TTS and ACS to determine if differences in biomarker profile can aid diagnosis. Methods: We searched five literature databases for studies reporting NPs (Brain NP (BNP)/NT-pro-BNP) or troponin I/T in TTS and ACS, identifying 28 studies for troponin/NPs (5618 and 1145 patients, respectively). Results: Troponin was significantly lower in TTS than ACS (standardised mean difference (SMD) -0.86; 95% CI, -1.08 to -0.64; p<0.00001), with an absolute difference of 75 times the upper limit of normal (×ULN) higher in ACS than TTS. Conversely, NPs were significantly higher in TTS (SMD 0.62; 95% CI, 0.44 to 0.80; p<0.00001) and 5.8×ULN greater absolutely. Area under the curve (AUC) for troponin in ACS versus TTS was 0.82 (95% CI, 0.70 to 0.93), and 0.92 (95% CI, 0.80 to 1.00) for ST-segment elevation myocardial infarction versus TTS. For NPs, AUC was 0.69 (95% CI, 0.48 to 0.89). Combination of troponin and NPs with logistic regression did not improve AUC. Recursive Partitioning and Regression Tree analysis calculated a troponin threshold ≥26×ULN that identified 95% cases as ACS where and specificity for ACS were 85.71% and 53.57%, respectively, with 94.32% positive predictive value and 29.40% negative predictive value. Conclusions: Troponin is lower and NPs higher in TTS versus ACS. Troponin had greater power than NPs at discriminating TTS and ACS, and with troponin ≥26×ULN patients are far more likely to have ACS.
MeSH term(s)	Humans ; Acute Coronary Syndrome/diagnosis ; Troponin ; Takotsubo Cardiomyopathy/diagnosis ; Natriuretic Peptides ; Biomarkers ; Troponin T
Chemical Substances	Troponin ; Natriuretic Peptides ; Biomarkers ; Troponin T
Language	English
Publishing date	2024-03-19
Publishing country	England
Document type	Meta-Analysis ; Journal Article
ZDB-ID	2747269-3
ISSN	2053-3624
ISSN	2053-3624
DOI	10.1136/openhrt-2024-002607
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Article ; Online: Cardiac Myosin-Binding Protein C-From Bench to Improved Diagnosis of Acute Myocardial Infarction.

Kaier, Thomas E / Alaour, Bashir / Marber, Michael

Cardiovascular drugs and therapy

2019 Volume 33, Issue 2, Page(s) 221–230

Abstract: Chest pain is responsible for 6-10% of all presentations to acute healthcare providers. Triage is inherently difficult and heavily reliant on the quantification of cardiac Troponin (cTn), as a minority of patients with an ultimate diagnosis of acute ... ...

Abstract	Chest pain is responsible for 6-10% of all presentations to acute healthcare providers. Triage is inherently difficult and heavily reliant on the quantification of cardiac Troponin (cTn), as a minority of patients with an ultimate diagnosis of acute myocardial infarction (AMI) present with clear diagnostic features such as ST-elevation on the electrocardiogram. Owing to slow release and disappearance of cTn, many patients require repeat blood testing or present with stable but elevated concentrations of the best available biomarker and are thus caught at the interplay of sensitivity and specificity.We identified cardiac myosin-binding protein C (cMyC) in coronary venous effluent and developed a high-sensitivity assay by producing an array of monoclonal antibodies and choosing an ideal pair based on affinity and epitope maps. Compared to high-sensitivity cardiac Troponin (hs-cTn), we demonstrated that cMyC appears earlier and rises faster following myocardial necrosis. In this review, we discuss discovery and structure of cMyC, as well as the migration from a comparably insensitive to a high-sensitivity assay facilitating first clinical studies. This assay was subsequently used to describe relative abundance of the protein, compare sensitivity to two high-sensitivity cTn assays and test diagnostic performance in over 1900 patients presenting with chest pain and suspected AMI. A standout feature was cMyC's ability to more effectively triage patients. This distinction is likely related to the documented greater abundance and more rapid release profile, which could significantly improve the early triage of patients with suspected AMI.
MeSH term(s)	Animals ; Biomarkers/blood ; Carrier Proteins/blood ; Clinical Decision-Making ; Humans ; Myocardial Infarction/blood ; Myocardial Infarction/diagnosis ; Myocardial Infarction/therapy ; Myocardium/metabolism ; Myocardium/pathology ; Necrosis ; Predictive Value of Tests ; Prognosis ; Time Factors ; Triage ; Up-Regulation
Chemical Substances	Biomarkers ; Carrier Proteins ; myosin-binding protein C
Language	English
Publishing date	2019-01-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	639068-7
ISSN	1573-7241 ; 0920-3206
ISSN (online)	1573-7241
ISSN	0920-3206
DOI	10.1007/s10557-018-6845-3
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Article: Clinical and echocardiographic follow-up of patients following surgical heart valve repair or replacement: a tertiary centre experience.

Alaour, Bashir / Menexi, Christina / Shah, Benoy N

Echo research and practice

2018 Volume 5, Issue 3, Page(s) 113–119

Abstract: International best practice guidelines recommend lifelong follow-up of patients that have undergone valve repair or replacement surgery and provide recommendations on the utilization of echocardiography during follow-up. However, such follow-up regimes ... ...

Abstract	International best practice guidelines recommend lifelong follow-up of patients that have undergone valve repair or replacement surgery and provide recommendations on the utilization of echocardiography during follow-up. However, such follow-up regimes can vary significantly between different centres and sometimes within the same centre. We undertook this study to determine the patterns of clinical follow-up and use of transthoracic echocardiography (TTE) amongst cardiologists in a large UK tertiary centre. In this retrospective study, we identified patients that underwent heart valve repair or replacement surgery in 2008. We used local postal codes to identify patients within our hospital's follow-up catchment area. We determined the frequency of clinical follow-up and use of transthoracic echocardiography (TTE) during the 9-year follow-up period (2009-2016 inclusive). Of 552 patients that underwent heart valve surgery, 93 (17%) were eligible for local follow-up. Of these, the majority (61/93, 66%) were discharged after their 6-week post-operative check-up with no further follow-up. Of the remaining 32 patients, there was remarkable heterogeneity in follow-up regimes and use of TTE. This variation did not correlate with the prosthesis type. In summary, the frequency of clinical follow-up and use of echocardiography is highly variable in contemporary practice. Many patients are inappropriately discharged back to their family doctor with no plans for hospital follow-up. These data further support the creation of dedicated specialist heart valve clinics to optimize patient care, ensure rational use of TTE and optimize adherence with best practice guidelines.
Language	English
Publishing date	2018-07-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2777997-X
ISSN	2055-0464
ISSN	2055-0464
DOI	10.1530/ERP-18-0035
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Article ; Online: Cardiac Troponin - diagnostic problems and impact on cardiovascular disease.

Alaour, Bashir / Liew, Felicity / Kaier, Thomas E

Annals of medicine

2018 Volume 50, Issue 8, Page(s) 655–665

Abstract: The definition of a high-sensitivity cardiac Troponin (cTn) assay describes the ability to quantify a cardiac biomarker level in at least 50% of healthy individuals. This advance in analytic sensitivity has come with a perceived loss of specificity in ... ...

Abstract	The definition of a high-sensitivity cardiac Troponin (cTn) assay describes the ability to quantify a cardiac biomarker level in at least 50% of healthy individuals. This advance in analytic sensitivity has come with a perceived loss of specificity in the most classic application - chest pain triage and the diagnosis of acute myocardial infarction (AMI). As cardiac Troponin can no longer be used as a dichotomous test, the medical field is increasingly moving towards a more granular interpretation. However, rapid rule-out/rule-in algorithms for AMI still rely on concrete thresholds for efficient triage, irrespective of the patient's comorbidities. Owing to a slightly elevated cTn value, evermore patients appear to fall into an indeterminate risk zone of diagnostic uncertainty. The reasons are manifold, spanning biological variation, analytical issues, increased plasma membrane permeability and the potential cytosolic release of cTn. This review provides a contemporary overview of the literature concerning the use of cardiac Troponin in chronic and acute cardiovascular care. Key messages High-sensitivity cardiac Troponin assays have transformed the assessment of cardiovascular disease. Rapid rule-out algorithms for chest pain triage have become increasingly complicated, but enable safe rule-out. Cardiac Troponin tracks mid- to long-term risk in patients with hyperlipidaemia, heart failure and renal dysfunction.
MeSH term(s)	Biomarkers/blood ; Chest Pain/blood ; Chest Pain/diagnosis ; Humans ; Myocardial Infarction/blood ; Myocardial Infarction/diagnosis ; Sensitivity and Specificity ; Time Factors ; Triage/methods ; Troponin I/blood ; Troponin T/blood
Chemical Substances	Biomarkers ; Troponin I ; Troponin T
Language	English
Publishing date	2018-11-21
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1004226-x
ISSN	1365-2060 ; 1651-2219 ; 0785-3890 ; 1743-1387
ISSN (online)	1365-2060 ; 1651-2219
ISSN	0785-3890 ; 1743-1387
DOI	10.1080/07853890.2018.1530450
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Article ; Online: Cardiac myosin-binding protein C: how a novel biomarker could transform chest pain triage.

Kaier, Thomas E / Alaour, Bashir / Marber, Michael

Biomarkers in medicine

2018 Volume 12, Issue 8, Page(s) 823–826

MeSH term(s)	Acute Coronary Syndrome/blood ; Biomarkers/blood ; Carrier Proteins/blood ; Chest Pain/blood ; Female ; Humans ; Male ; Non-ST Elevated Myocardial Infarction/blood ; Triage
Chemical Substances	Biomarkers ; Carrier Proteins ; myosin-binding protein C
Language	English
Publishing date	2018-07-18
Publishing country	England
Document type	Editorial ; Research Support, Non-U.S. Gov't
ZDB-ID	2481014-9
ISSN	1752-0371 ; 1752-0363
ISSN (online)	1752-0371
ISSN	1752-0363
DOI	10.2217/bmm-2018-0176
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