THE RATIO OF N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE TO HIGH SENSITIVITY CARDIAC TROPONIN TO DISTINGUISH TYPE 1 FROM TYPE 2 ACUTE MYOCARDIAL INFARCTION

AbstractBackground:The distinction of type 1 and type 2 myocardial infarction (MI) is of major clinical importance. Our aim was to evaluate the diagnostic ability of absolute and relative conventional cardiac troponin I (cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) in the distinction between type 1 and type 2 MI in patients presenting at the emergency department with non-ST-segment elevation acute chest pain within the first 12 h.Methods:We measured cTnI (Dimension Vista) and hs-cTnT (Cobas e601) concentrations at presentation and after 4 h in 200 patients presenting with suspected acute MI. The final diagnosis, based on standard criteria, was adjudicated by two independent cardiologists.Results:One hundred and twenty-five patients (62.5%)were classified as type 1 MI and 75 (37.5%) were type 2 MI. In a multivariable setting, age (relative risk [RR]=1.43, p=0.040), male gender (RR=2.22, p=0.040), T-wave inversion (RR=8.51, p<0.001), ST-segment depression (RR=8.71, p<0.001) and absolute delta hs-cTnT (RR=2.10, p=0.022) were independently associated with type 1 MI. In a receiver operating characteristic curve analysis, the discriminatory power of absolute delta cTnI and hs-cTnT was significantly higher compared to relative c-TnI and hs-cTnT changes. The additive information provided by cTnI and hs-cTnT over and above the information provided by the “clinical” model was only marginal.Conclusions:The diagnostic information provided by serial measurements of conventional or hs-cTnT is not better than that yielded by a simple clinical scoring model. Absolute changes are more informative than relative troponin changes.

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Rapid rule out of acute myocardial infarction in the observe zone using a combination of presentation N-terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin I

Clinical Biochemistry ◽

10.1016/j.clinbiochem.2019.06.002 ◽

2019 ◽

Vol 70 ◽

pp. 34-38 ◽

Cited By ~ 3

Author(s):

Yao Wang ◽

Lihua Dai ◽

Ning Wang ◽

Yingying Zhu ◽

Miao Chen ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Natriuretic Peptide ◽

Cardiac Troponin ◽

Troponin I ◽

High Sensitivity ◽

Cardiac Troponin I ◽

Rule Out

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High-Sensitivity Cardiac Troponin-T and N-Terminal Prohormone of B-Type Natriuretic Peptide in Relation to Cardiovascular Outcomes in Type 1 Diabetes

10.2337/figshare.12298754.v2 ◽

2020 ◽

Author(s):

Tina Costacou ◽

Amy K. Saenger ◽

Trevor J. Orchard

Keyword(s):

Myocardial Infarction ◽

Type 1 Diabetes ◽

Natriuretic Peptide ◽

Cardiac Troponin ◽

Troponin T ◽

Coronary Revascularization ◽

High Sensitivity ◽

Cardiac Troponin T ◽

Cox Models

Objective: High-sensitivity cardiac Troponin-T (hs-cTnT) and N-terminal pro B-Type natriuretic peptide (NT-proBNP), biomarkers of cardiovascular disease (CVD) and heart failure, respectively, have not been widely studied in type 1 diabetes (T1D). We evaluated whether their assessment in T1D enhances the prediction of CVD and major atherosclerotic cardiovascular events (MACE). Research Design and Methods: hs-cTnT and NT-proBNP were analyzed on the Roche Cobas E601 utilizing the first available stored specimen (n=581; mean age 29 and duration 21 years). CVD was defined as CVD death, myocardial infarction, coronary revascularization, angina, ischemia, or stroke and MACE as CVD death, myocardial infarction, or stroke. Results: Median hs-cTnT (5.0 ng/L, IQR: <3.0, 10.0) was higher among men (p<0.0001), whereas median NT-proBNP (22.0 ng/L; 7.0, 61.0) did not differ by sex. In Cox models, log hs-cTnT (HR=1.38, p=0.0006) and log NT-proBNP (HR=1.24, p=0.0001) independently predicted CVD during 21 years of follow-up. However, their addition to models either singly or together did not significantly improve CVD prediction. Furthermore, a marginally significant sex interaction was observed (p=0.06), indicating that hs-cTnT’s prediction was limited to men. hs-cTnT and NT-proBNP also predicted MACE, although only NT-proBNP remained significant (HR=1.27, p=0.0009) when the biomarkers were included in a model simultaneously. Nonetheless, their addition to multivariable models did not enhance MACE prediction. Conclusions: Sex differences were observed in the concentration and predictive ability of hs-cTnT and NT-proBNP in T1D. Overall, their addition to traditional risk factor models increased the area under the curve for neither CVD nor MACE.

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Diagnosis of Type 1 and Type 2 Myocardial Infarction Using a High-Sensitivity Cardiac Troponin I Assay with Sex-Specific 99th Percentiles Based on the Third Universal Definition of Myocardial Infarction Classification System

Clinical Chemistry ◽

10.1373/clinchem.2014.236638 ◽

2015 ◽

Vol 61 (4) ◽

pp. 657-663 ◽

Cited By ~ 45

Author(s):

Yader Sandoval ◽

Stephen W Smith ◽

Karen M Schulz ◽

MaryAnn M Murakami ◽

Sara A Love ◽

...

Keyword(s):

Myocardial Infarction ◽

Classification System ◽

Cardiac Troponin ◽

Troponin I ◽

High Sensitivity ◽

The Third ◽

Universal Definition ◽

Definition Of

Abstract BACKGROUND The frequency and characteristics of myocardial infarction (MI) subtypes per the Third Universal Definition of MI (TUDMI) classification system using high-sensitivity (hs) cardiac troponin assays with sex-specific cutoffs is not well known. We sought to describe the diagnostic characteristics of type 1 (T1MI) and type 2 (T2MI) MI using an hs–cardiac troponin I (hs-cTnI) assay with sex-specific cutoffs. METHODS A total of 310 consecutive patients with serial cTnI measurements obtained on clinical indication were studied with contemporary and hs-cTnI assays. Ninety-ninth percentile sex-specific upper reference limits (URLs) for the hs-cTnI assay were 16 ng/L for females and 34 ng/L for males. The TUDMI consensus recommendations were used to define and adjudicate MI based on each URL. RESULTS A total of 127 (41%) patients had at least 1 hs-cTnI exceeding the sex-specific 99th percentiles, whereas 183 (59%) had hs-cTnI within the reference interval. Females had more myocardial injury related to supply/demand ischemia than males (39% vs 18%, P = 0.01), whereas males had more multifactorial or indeterminate injury (52% vs 33%, P = 0.05). By hs-cTnI, there were 32 (10%) acute MIs, among which 10 (3%) were T1MI and 22 (7%) were T2MI. T2MI represented 69% (22 out of 32) of all acute MIs, whereas T1MI represented 31% (10 out of 32). Ninety-five patients (31%) had an increased hs-cTnI above the 99th percentile but did not meet criteria for acute MI. The most common triggers for T2MI were tachyarrhythmias, hypotension/shock, and hypertension. By contemporary cTnI, more MIs (14 T1MI and 29 T2MI) were diagnosed. By contemporary cTnI, there were 43 MIs, 14 T1MI, and 29 T2MI. CONCLUSIONS Fewer MI diagnoses were found with the hs-cTnI assay, contrary to the commonly accepted idea that hs-cTnI will lead to excessive false-positive diagnoses.

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P1578Outcomes in patients with renal impairment and myocardial injury or infarction identified by high-sensitivity cardiac troponin testing: a secondary analysis of the High-STEACS trial

European Heart Journal ◽

10.1093/eurheartj/ehz748.0338 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P J Gallacher ◽

E Miller-Hodges ◽

A Shah ◽

A Anand ◽

K K Lee ◽

...

Keyword(s):

Myocardial Infarction ◽

Renal Function ◽

Renal Impairment ◽

Cardiac Troponin ◽

Myocardial Injury ◽

Primary Outcome ◽

Secondary Analysis ◽

High Sensitivity

Abstract Background Patients with renal impairment are at increased risk of myocardial infarction (MI), but the interpretation of cardiac troponin is challenging in this setting. The use of high-sensitivity cardiac troponin (hs-cTn) assays increases the detection of myocardial injury, yet may contribute to uncertainty in the diagnosis of MI in those with renal impairment. Purpose To describe the diagnosis and outcomes of patients with myocardial injury or infarction identified using a hs-cTnI assay, stratified by renal function. Methods In a pre-specified secondary analysis of a stepped-wedge cluster-randomised controlled trial, we identified consecutive patients with a hs-cTnI concentration greater than the sex-specific 99th centile between June 2013 and March 2016. The diagnoses of type 1 or type 2 MI were adjudicated and classified according to the 4th Universal Definition of Myocardial Infarction. Renal impairment was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73m2.The primary outcome of type 1 or type 4b MI or cardiovascular death was compared in patients with and without renal impairment at 1 year. Results A measure of renal function was available in 47,334 (98.0%) patients, of whom 7,933 (16.8%) had renal impairment (mean age 76±12 years; 54% female). Plasma hs-cTnI concentrations were >99th centile in 47.9% (3,800/7,933) of patients with renal impairment and 16.3% (6,439/39,401) of patients with normal renal function. In those with and without renal impairment, the adjudicated diagnosis was type 1 MI in 35.2% (1,336/3,800) and 55.8% (3,596/6,439) of patients, and type 2 MI in 12.6% (480/3,800) and 9.7% (626/6,439) of patients, respectively (P<0.001 for both). In patients with hs-cTnI concentrations >99th centile, the primary outcome occurred in 24.9% (945/3,800) of patients with renal impairment, compared to 12.1% (779/6,439) of patients with normal renal function (P<0.001). In patients with type 1 MI, the primary outcome occurred in 32.6% (436/1,336) of those with renal impairment and 11.7% (419/3,596) of those without (P<0.001). In patients with type 2 MI, the primary outcome occurred in 20.4% (98/480) and 9.9% (62/626) of patients with and without renal impairment, respectively (P<0.001). Conclusion Almost half of all patients with suspected acute coronary syndrome and renal impairment have hs-cTnI concentrations greater than the sex-specific 99th centile. Whilst only one in three had a diagnosis of type 1 MI, an elevated troponin concentration was associated with a poorer prognosis in those with concomitant renal impairment compared to those without, irrespective of the index diagnosis. Acknowledgement/Funding British Heart Foundation

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High-Sensitivity Cardiac Troponin-T and N-Terminal Prohormone of B-Type Natriuretic Peptide in Relation to Cardiovascular Outcomes in Type 1 Diabetes

10.2337/figshare.12298754 ◽

2020 ◽

Author(s):

Tina Costacou ◽

Amy K. Saenger ◽

Trevor J. Orchard

Keyword(s):

Myocardial Infarction ◽

Type 1 Diabetes ◽

Natriuretic Peptide ◽

Cardiac Troponin ◽

Troponin T ◽

Coronary Revascularization ◽

High Sensitivity ◽

Cardiac Troponin T ◽

Cox Models

Objective: High-sensitivity cardiac Troponin-T (hs-cTnT) and N-terminal pro B-Type natriuretic peptide (NT-proBNP), biomarkers of cardiovascular disease (CVD) and heart failure, respectively, have not been widely studied in type 1 diabetes (T1D). We evaluated whether their assessment in T1D enhances the prediction of CVD and major atherosclerotic cardiovascular events (MACE). Research Design and Methods: hs-cTnT and NT-proBNP were analyzed on the Roche Cobas E601 utilizing the first available stored specimen (n=581; mean age 29 and duration 21 years). CVD was defined as CVD death, myocardial infarction, coronary revascularization, angina, ischemia, or stroke and MACE as CVD death, myocardial infarction, or stroke. Results: Median hs-cTnT (5.0 ng/L, IQR: <3.0, 10.0) was higher among men (p<0.0001), whereas median NT-proBNP (22.0 ng/L; 7.0, 61.0) did not differ by sex. In Cox models, log hs-cTnT (HR=1.38, p=0.0006) and log NT-proBNP (HR=1.24, p=0.0001) independently predicted CVD during 21 years of follow-up. However, their addition to models either singly or together did not significantly improve CVD prediction. Furthermore, a marginally significant sex interaction was observed (p=0.06), indicating that hs-cTnT’s prediction was limited to men. hs-cTnT and NT-proBNP also predicted MACE, although only NT-proBNP remained significant (HR=1.27, p=0.0009) when the biomarkers were included in a model simultaneously. Nonetheless, their addition to multivariable models did not enhance MACE prediction. Conclusions: Sex differences were observed in the concentration and predictive ability of hs-cTnT and NT-proBNP in T1D. Overall, their addition to traditional risk factor models increased the area under the curve for neither CVD nor MACE.

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High-sensitivity cardiac Troponin-T and N-terminal pro B-Type Natriuretic Peptide in relation to cardiovascular outcomes in type 1 diabetes

10.2337/figshare.12298754.v1 ◽

2020 ◽

Author(s):

Tina Costacou ◽

Amy K. Saenger ◽

Trevor J. Orchard

Keyword(s):

Myocardial Infarction ◽

Type 1 Diabetes ◽

Natriuretic Peptide ◽

Cardiac Troponin ◽

Troponin T ◽

Coronary Revascularization ◽

High Sensitivity ◽

Cardiac Troponin T ◽

Cox Models

Objective: High-sensitivity cardiac Troponin-T (hs-cTnT) and N-terminal pro B-Type natriuretic peptide (NT-proBNP), biomarkers of cardiovascular disease (CVD) and heart failure, respectively, have not been widely studied in type 1 diabetes (T1D). We evaluated whether their assessment in T1D enhances the prediction of CVD and major atherosclerotic cardiovascular events (MACE). Research Design and Methods: hs-cTnT and NT-proBNP were analyzed on the Roche Cobas E601 utilizing the first available stored specimen (n=581; mean age 29 and duration 21 years). CVD was defined as CVD death, myocardial infarction, coronary revascularization, angina, ischemia, or stroke and MACE as CVD death, myocardial infarction, or stroke. Results: Median hs-cTnT (5.0 ng/L, IQR: <3.0, 10.0) was higher among men (p<0.0001), whereas median NT-proBNP (22.0 ng/L; 7.0, 61.0) did not differ by sex. In Cox models, log hs-cTnT (HR=1.38, p=0.0006) and log NT-proBNP (HR=1.24, p=0.0001) independently predicted CVD during 21 years of follow-up. However, their addition to models either singly or together did not significantly improve CVD prediction. Furthermore, a marginally significant sex interaction was observed (p=0.06), indicating that hs-cTnT’s prediction was limited to men. hs-cTnT and NT-proBNP also predicted MACE, although only NT-proBNP remained significant (HR=1.27, p=0.0009) when the biomarkers were included in a model simultaneously. Nonetheless, their addition to multivariable models did not enhance MACE prediction. Conclusions: Sex differences were observed in the concentration and predictive ability of hs-cTnT and NT-proBNP in T1D. Overall, their addition to traditional risk factor models increased the area under the curve for neither CVD nor MACE.

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