Thomas Nestelberger
A5055939495- Acute Myocardial Infarction Research
- Cardiac Imaging and Diagnostics
- Atrial Fibrillation Management and Outcomes
- Coronary Interventions and Diagnostics
- Cardiac Valve Diseases and Treatments
- Cardiac electrophysiology and arrhythmias
- Heart Failure Treatment and Management
- Cardiovascular Syncope and Autonomic Disorders
- Cardiac, Anesthesia and Surgical Outcomes
- Cardiac Arrhythmias and Treatments
- Venous Thromboembolism Diagnosis and Management
- Infective Endocarditis Diagnosis and Management
- Cardiac pacing and defibrillation studies
- Cardiovascular Function and Risk Factors
- Blood Pressure and Hypertension Studies
- Cardiovascular Effects of Exercise
- ECG Monitoring and Analysis
- Cardiovascular Issues in Pregnancy
- Emergency and Acute Care Studies
- Aortic aneurysm repair treatments
- Cardiac Health and Mental Health
- Sepsis Diagnosis and Treatment
- Aortic Disease and Treatment Approaches
- Cardiac Structural Anomalies and Repair
- Antiplatelet Therapy and Cardiovascular Diseases
University of Basel
2016-2025
University Hospital of Basel
2016-2025
Cardiovascular Institute Hospital
2016-2025
Vancouver General Hospital
2020-2023
University of British Columbia
2020-2023
British Heart Foundation
2016-2023
University of Edinburgh
2023
St. Paul's Hospital
2022-2023
St. Paul's Hospital
2022-2023
INCLIVA Health Research Institute
2023
Perioperative myocardial injury (PMI) seems to be a contributor mortality after noncardiac surgery. Because the vast majority of PMIs are asymptomatic, PMI usually is missed in absence systematic screening. We performed prospective diagnostic study enrolling consecutive patients undergoing surgery who had planned postoperative stay ≥24 hours and were considered at increased cardiovascular risk. All received screening using serial measurements high-sensitivity cardiac troponin T clinical...
Data regarding high-sensitivity troponin concentrations in patients presenting to the emergency department with symptoms suggestive of myocardial infarction may be useful determining probability and subsequent 30-day outcomes.
Acute aortic syndromes (AASs) are rare and severe cardiovascular emergencies with unspecific symptoms. For AASs, both misdiagnosis overtesting key concerns, standardized diagnostic strategies may help physicians to balance these risks. D-dimer (DD) is highly sensitive for AAS but inadequate as a stand-alone test. Integration of pretest probability assessment DD testing feasible, the safety efficiency such strategy currently unknown.In multicenter prospective observational study involving 6...
Variations in cardiac troponin concentrations by age, sex, and time between samples patients with suspected myocardial infarction are not currently accounted for diagnostic approaches. We aimed to combine these variables through machine learning improve the assessment of risk individual patients.A algorithm (myocardial-ischemic-injury-index [MI3]) incorporating paired high-sensitivity I concentrations, was trained on 3013 tested 7998 infarction. MI3 uses gradient boosting compute a value...
Background: High-sensitivity cardiac troponin assays enable myocardial infarction to be ruled out earlier, but the optimal approach is uncertain. We compared European Society of Cardiology rule-out pathway with a that incorporates lower concentrations risk stratify patients. Methods: Patients suspected acute coronary syndrome (n=1218) underwent high-sensitivity I measurement at presentation and 3 6 or 12 hours. (<99th centile hours if symptoms <6 hours) developed in High-STEACS study...
Abstract Although guidelines recommend fixed cardiac troponin thresholds for the diagnosis of myocardial infarction, concentrations are influenced by age, sex, comorbidities and time from symptom onset. To improve diagnosis, we developed machine learning models that integrate at presentation or on serial testing with clinical features compute Collaboration Diagnosis Evaluation Acute Coronary Syndrome (CoDE-ACS) score (0–100) corresponds to an individual’s probability infarction. The were...
High-sensitivity cardiac troponin (hs-cTn) assays provide higher diagnostic accuracy for acute myocardial infarction (AMI) when compared with conventional assays, but may result in increased use of unnecessary coronary angiographies due to their detection cardiomyocyte injury conditions other than AMI.We evaluated the impact clinical introduction high-sensitivity T (hs-cTnT) on angiography, stress testing, and time discharge 2544 patients presenting symptoms suggestive AMI emergency...
Background: Four strategies for very early rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I (hs-cTnI) have been identified. It remains unclear which strategy is most attractive clinical application. Methods: We prospectively enrolled unselected patients presenting to the emergency department with symptoms suggestive infarction. The final diagnosis was adjudicated by 2 independent cardiologists. Hs-cTnI levels were measured at presentation and after 1 hour in...
The European Society of Cardiology recommends a 0/1-hour algorithm for rapid rule-out and rule-in non-ST-segment elevation myocardial infarction using high-sensitivity cardiac troponin (hs-cTn) concentrations irrespective renal function. Because patients with dysfunction (RD) frequently present increased hs-cTn even in the absence infarction, concern has been raised regarding performance RD. In prospective multicenter diagnostic study enrolling unselected presenting suspected to emergency...
Abstract BACKGROUND Clinical performance of the novel high-sensitivity cardiac troponin I (Siemens-hs-cTnI-Centaur) assay is unknown. We aimed to clinically validate Siemens-hs-cTnI-Centaur and develop 0/1-h 0/2-h algorithms. METHODS enrolled patients presenting emergency department with symptoms suggestive acute myocardial infarction (AMI). Final diagnoses were centrally adjudicated by 2 independent cardiologists including all clinical information twice: first, using serial hs-cTnT...
Until now, high-sensitivity cardiac troponin (hs-cTn) assays were mainly developed for large central laboratory platforms. This study aimed to assess the clinical performance of a point-of-care (POC)-hs-cTnI assay in patients with suspected myocardial infarction (MI). enrolled presenting emergency department symptoms suggestive MI. Two cardiologists centrally adjudicated final diagnosis using all data including imaging. The primary objective was directly compare diagnostic accuracy...
Abstract BACKGROUND The early triage of patients toward rule-out and rule-in acute myocardial infarction (AMI) is challenging. Therefore, we aimed to develop a 2-h algorithm that uses high-sensitivity cardiac troponin I (hs-cTnI). METHODS We prospectively enrolled 1435 (derivation cohort) 1194 (external validation presenting with suspected AMI the emergency department. final diagnosis was adjudicated by 2 independent cardiologists. hs-cTnI measured at presentation after h in blinded fashion....
We aimed to evaluate the impact of age on performance European Society Cardiology (ESC) 0/1h-algorithms and derive externally validate alternative cut-offs specific older patients.We prospectively enrolled patients presenting emergency department (ED) with symptoms suggestive acute myocardial infarction in three large diagnostic studies. Final diagnoses were adjudicated by two independent cardiologists. High-sensitivity cardiac troponin (hs-cTn) T I concentrations measured at presentation...
It is currently unknown whether the uniform (universal clinical practice for more than 2 decades) or sex-specific cutoff levels are preferable when using high-sensitivity cardiac troponin T (hs-cTnT) in diagnosis of acute myocardial infarction (AMI).To improve management suspected AMI women by exploring vs hs-cTnT.In an ongoing prospective, diagnostic, multicenter study conducted at 9 emergency departments, present evaluated patients enrolled from April 21, 2006, through June 5, 2013. The...
The aim of this study was to validate the clinical performance Beckman Access high-sensitivity cardiac troponin I (hs-cTnI) assay.We enrolled patients presenting emergency department with symptoms suggestive acute myocardial infarction (AMI). Final diagnoses were centrally adjudicated by 2 independent cardiologists all information including imaging twice: first, using serial hs-cTnT (Elecsys, primary analysis), and second, hs-cTnI (Architect, secondary analysis) measurements in addition...
Cardiac troponin (cTn) T and cTnI are considered cardiac specific equivalent in the diagnosis of acute myocardial infarction. Previous studies suggested rare skeletal myopathies as a noncardiac source cTnT. We aimed to confirm reliability/cardiac specificity cTnT patients with various muscle disorders (SMDs).We prospectively enrolled presenting muscular complaints (≥2 weeks) for elective evaluation 4 hospitals 2 countries. After workup, were adjudicated into 3 predefined disease categories....
Collaboration for the Diagnosis and Evaluation of Acute Coronary Syndrome (CoDE-ACS) is a validated clinical decision support tool that uses machine learning with or without serial cardiac troponin measurements at flexible time point to calculate probability myocardial infarction (MI). How CoDE-ACS performs different points measurement compares guideline-recommended diagnostic pathways rely on fixed thresholds uncertain.
Abstract BACKGROUND Interpretation of serial high-sensitivity cardiac troponin (hs-cTn) measurements for the diagnosis acute myocardial infarction (AMI) assumes random fluctuation hs-cTn around an individual's homeostatic set point. The aim this study was to challenge diagnostic concept. METHODS Study 1 examined presence a diurnal rhythm by hourly blood sampling, day and night, in 24 individuals without recent history AMI. 2 assessed morning vs evening accuracy hs-cTnT hs-cTnI prospective...
Background: Combining 2 signals of cardiomyocyte injury, cardiac troponin I (cTnI) and T (cTnT), might overcome some individual pathophysiological analytical limitations thereby increase diagnostic accuracy for acute myocardial infarction with a single blood draw. We aimed to evaluate the performance combinations high-sensitivity (hs) cTnI hs-cTnT early diagnosis infarction. Methods: The combining hs-cTnI (Architect, Abbott) (Elecsys, Roche) concentrations (sum, product, ratio, combination...