High-sensitivity troponin and novel biomarkers for the early diagnosis of non-ST-segment elevation myocardial infarction in patients with atrial fibrillation

Sörensen, Nils Arne; Shah, Anoop; Ojeda, Francisco; Peitsmeyer, Philipp; Zeller, Tanja; Keller, Till; Johannsen, Silke S; Lackner, Karl J.; Griffiths, Megan; Münzel, Thomas; Mills, Nicholas L; Blankenberg, Stefan; Schnabel, Renate B.

doi:10.1177/2048872615611108

Cited by 14 publications

(11 citation statements)

References 37 publications

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“…[15–18] We hypothesised that plasma cardiac troponin I (cTnI) levels may be elevated and act as a biomarker of cardiac involvement in DM1, and thus could prove a useful tool for risk stratification in this group.…”

Section: Introductionmentioning

confidence: 99%

Elevated plasma levels of cardiac troponin-I predict left ventricular systolic dysfunction in patients with myotonic dystrophy type 1: A multicentre cohort follow-up study

et al. 2017

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ObjectiveHigh sensitivity plasma cardiac troponin-I (cTnI) is emerging as a strong predictor of cardiac events in a variety of settings. We have explored its utility in patients with myotonic dystrophy type 1 (DM1).Methods117 patients with DM1 were recruited from routine outpatient clinics across three health boards. A single measurement of cTnI was made using the ARCHITECT STAT Troponin I assay. Demographic, ECG, echocardiographic and other clinical data were obtained from electronic medical records. Follow up was for a mean of 23 months.ResultsFifty five females and 62 males (mean age 47.7 years) were included. Complete data were available for ECG in 107, echocardiography in 53. Muscle Impairment Rating Scale score was recorded for all patients. A highly significant excess (p = 0.0007) of DM1 patients presented with cTnI levels greater than the 99th centile of the range usually observed in the general population (9 patients; 7.6%). Three patients with elevated troponin were found to have left ventricular systolic dysfunction (LVSD), compared with four of those with normal range cTnI (33.3% versus 3.7%; p = 0.001). Sixty two patients had a cTnI level < 5ng/L, of whom only one had documented evidence of LVSD. Elevated cTnI was not predictive of severe conduction abnormalities on ECG, or presence of a cardiac device, nor did cTnI level correlate with muscle strength expressed by Muscle Impairment Rating Scale score.ConclusionsPlasma cTnI is highly elevated in some ambulatory patients with DM1 and shows promise as a tool to aid cardiac risk stratification, possibly by detecting myocardial involvement. Further studies with larger patient numbers are warranted to assess its utility in this setting.

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Section: Introductionmentioning

confidence: 99%

Elevated plasma levels of cardiac troponin-I predict left ventricular systolic dysfunction in patients with myotonic dystrophy type 1: A multicentre cohort follow-up study

et al. 2017

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“…Similarly, the median times between the fi rst and second test following the initial elevation, as well as the second and third test following the initial elevation, did not diff er ( P = 0.95 and 0.37, respectively). Th e median number of troponin tests performed per patient until the fi rst elevation occurred was 1 for both AMI and non-AMI patients; however, the median total number of tests performed for AMI patients was 4 [3,5], compared to 3 [2,4] for non-AMI patients ( P = 0.01). Of the 124 patients who had at least one elevated troponin, 114 (91.9%) had at least one subsequent test performed.…”

Section: Resultsmentioning

confidence: 89%

Interpretation of Positive Troponin Results Among Patients with and Without Myocardial Infarction

Tecson

Arnold

Barrett

et al. 2017

Baylor University Medical Center Proceedings

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Measuring cardiac troponins is integral to diagnosing acute myocardial infarction (AMI); however, troponins may be elevated without AMI, and the use of multiple different assays confounds comparisons. We considered characteristics and serial troponin values in emergency department chest pain patients with and without AMI to interpret troponin excursions. We compared serial troponin in 124 AMI and non-AMI patients from the observational Performance of Triage Cardiac Markers in the Clinical Setting (PEARL) study who presented with chest pain and had at least one troponin value exceeding the 99th percentile of normal. Because 8 assays were used during data collection, we employed a method of scaling the troponin value to the corresponding assay's 99th percentile upper reference limit to standardize the results. In 81 AMI patients, 96% had elevated troponin at the first test following initial elevation, compared to 73% of the 43 non-AMI patients ( P < 0.001). Scaling troponin to the 99th percentile of normal yielded a median value that was 4.8 [2.2, 14.1] times higher than the 99th percentile cutpoint among AMI patients, compared to 2.3 [1.5, 6.5] times higher among non-AMI patients ( P = 0.04). The rise in serial scaled troponin values distinguished the AMI patients. Scaling to the 99th percentile was useful for comparing troponin when different assays were utilized. H igh-sensitivity troponin I testing has been shown to improve the early diagnosis of acute myocardial infarction (AMI) and aid with risk stratifi cation ( 1 -3 ). Investigators using a registry in Australia and New Zealand determined that high-sensitivity troponin I testing was associated with fewer in-hospital adverse events for patients hospitalized with possible acute coronary syndrome ( 4 ). Th ere are multiple non-AMI clinical scenarios, however, where troponin may exceed the 99th percentile, including renal failure, stroke, heart failure, pulmonary embolism, sepsis, and hypertension ( 5 ). We capitalized on a data set of chest pain patients who had serial troponin assays performed, had at least one positive value, and had central adjudication of the outcome of AMI. We compared the characteristics, as well as the dynamic rise and fall of troponin, in this group of patients to better understand how to quantitatively evaluate the excursion of troponin and relate it to the confi rmed diagnosis of AMI.

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“…Coronary artery disease is more common in men. 9 Patients presenting with suspected ACS to the emergency department are almost twice as likely to be men [10][11][12] and women are underrepresented in these studies. In addition, while cardiovascular mortality is declining in Western countries because of improved diagnostics and therapies, women do not profit to the same extend.…”

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confidence: 99%

Relations of Sex to Diagnosis and Outcomes in Acute Coronary Syndrome

Sörensen

Neumann

Ojeda³

et al. 2018

JAHA

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BackgroundThe atypical presentation of women with acute coronary syndrome (ACS) has been related to delayed diagnosis and treatment, which may explain worse outcome compared with men.Methods and ResultsWe analyzed pooled data of 2520 patients of 2 prospective cohorts in terms of differences in presentation and management of women and men suggestive of ACS. Using logistic regression, we established 2 diagnostic models and tested their diagnostic performance in both sexes separately. Sex‐specific differences in management of patients with ACS were ascertained and a 2‐year follow‐up was performed. Women were older than men (median 67 versus 61 years, P=0.001), had more often dyspnea (22% versus 18%, P=0.024), nausea or vomiting (26% versus 16%, P=0.001) and radiating chest pain (47% versus 40%, P=0.001). Classical risk factors (smoking, diabetes mellitus, dyslipidemia or known coronary artery disease) were less frequent in women. Diagnostic models showed no significant sex‐related differences in diagnostic performance in a “first contact” setting (medical history and symptoms) or after “complete triage” (including ECG and biomarkers). Women with ACS underwent coronary angiography (73.8% versus 84.3%, P<0.001) and revascularization (53.8% versus 70.1%, P<0.001) less frequently. Two‐year incidence of myocardial infarction and death was similar in both sexes, but revascularization and cardiac rehospitalization were more frequent in men.ConclusionsIn a large cohort of patients with suspected ACS, sex differences in clinical presentation did not impair diagnostic accuracy. Two‐year outcomes were comparable. Our findings suggest a benefit of chest pain units to minimize sex differences in ACS management and prognosis.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifiers: NCT02355457 (BACC), NCT03227159 (stenoCardia).

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High-sensitivity troponin and novel biomarkers for the early diagnosis of non-ST-segment elevation myocardial infarction in patients with atrial fibrillation

Cited by 14 publications

References 37 publications

Elevated plasma levels of cardiac troponin-I predict left ventricular systolic dysfunction in patients with myotonic dystrophy type 1: A multicentre cohort follow-up study

Elevated plasma levels of cardiac troponin-I predict left ventricular systolic dysfunction in patients with myotonic dystrophy type 1: A multicentre cohort follow-up study

Interpretation of Positive Troponin Results Among Patients with and Without Myocardial Infarction

Relations of Sex to Diagnosis and Outcomes in Acute Coronary Syndrome

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