Value Of hs-cTnT Research Articles

High-sensitive cardiac troponin T in patients with idiopathic inflammatory myopathies

Abstract Introduction Patients with idiopathic inflammatory myopathies (IIM) may have positive blood tests of cardiac troponin in absence of clinically detected cardiac disease. This situation is more common using high-sensitive cardiac troponin T (hs-cTnT) but there is limited information of the expected results according to type of IIM and prognostic value of this test in this group of patients. Methods Prospective study with 32 healthy controls and 61 patients with IIM without known cardiac condition. These patients with IIM were followed for 25 months. High-sensitive cardiac troponin T (Roche Elecsys hs-cTnT) was measured at baseline in both groups and a value of 14 pg/ml was the percentile 99th and considered the upper limit of normality (ULN). Results The median value of hs-cTnT was higher in patients with myopathies [12.0 (5.0; 35.0) vs. 5.0 (4.0; 6.2) P< 0.001] and the frequency of abnormal values were also more common in patients with IIM compared to controls (45.9% vs 6.2%, p<0.001). The frequency varied according to the type of myositis: Inclusion Body Myosytis (75%), Polymyositis (66.7%) , Dermatomyositis (42.1%) and Antisynthetase syndrome (38.5%). In terms of magnitude, 57% had mild elevations (1 to 3 x ULN) while 11% had levels 3 to 5 times ULN and 32% had troponin values > 5x ULN (Figure 1). Among patients with IIM, elevated levels of hs-cTnT were not associated with left ventricle global longitudinal strain < 18% or lower ejection fraction and was not associated with cardiovascular events during 25 months of follow-up (Figure 2). Conclusion Abnormal values of high-sensitive cardiac troponin T are common in patients with idiopathic inflammatory myopathies including levels similar to myocardial infaction. This elevation was not associated with echocardiographic abnormalities or cardiovascular events in patients with IIM.Figure 1Figure 2

Prediction of scar and microvascular obstruction after myocardial infarction

Abstract Background Myocardial scar, demonstrated by late gadolinium enhancement (LGE), and microvascular obstruction (MVO) at cardiac magnetic resonance imaging (CMR) are well described risk factors for cardiac events after myocardial infarction (MI). Purpose This study aimed to evaluate the prediction of myocardial scar and MVO based on cardiac biomarker levels. Methods We evaluated 631 patients with CMR 3 days [interquartile range 2-4 days] after myocardial infarction (420 with ST-segment elevation and 211 with non-ST-segment elevation myocardial infarction). Cardiac biomarker levels were measured at admission as well as 8, 16, 24 and 48 hours after percutaneous coronary intervention (PCI). Results A myocardial scar was detectable in 586 patients (92.9%), microvascular obstruction in 170 patients (29.3%). Patients with LGE showed significantly higher peak hs-cTnT levels than those without (3908.2±4374.0 ng/l vs 416.8±426.8 ng/l, p<0.001). A cut-off value of hs-cTnT >688.5 ng/l was a predictor for scar with a sensitivity of 81.7% and a specificity of 84.4%. Patients with MVO showed significantly higher peak hs-cTnT levels than those without (6909.8±5525.1 ng/l vs 2467.1±2993.0 ng/l, p<0.001). A cut-off value of hs-cTnT >1500.0 ng/l was a predictor for MVO with a sensitivity of 92.9% and a specificity of 43.4%. Conclusions Higher peak hs-cTnT levels are strong predictors for the occurrence of myocardial scar and MVO at CMR after MI as risk factors for future myocardial events. We propose the new cut-off value of hs-cTnT of >688.5 ng/l within 48 hours after PCI for prediction of myocardial scar and hs-cTnT of >1500.0 ng/l for prediction of MVO. This could be used as a screening tool for post-myocardial infarction patients, who may benefit from further evaluation using CMR.

Prognostic Value and Determinants of High-Sensitivity Cardiac Troponin T in Patients With a Systemic Right Ventricle: Insights From the SERVE Trial.

The determinants and prognostic value of high-sensitivity cardiac troponin T (hs-cTnT) among patients with a systemic right ventricle are largely unknown. Ninety-eight patients from the randomized controlled SERVE (Effect of Phosphodiesterase-5 Inhibition With Tadalafil on Systemic Right Ventricular Size and Function) trial were included. The correlation between baseline hs-cTnT concentrations and biventricular volumes and function quantified by cardiac magnetic resonance or cardiac multirow detector computed tomography was assessed by adjusted linear regression models. The prognostic value of hs-cTnT was assessed by adjusted Cox proportional hazards models, survival analysis, and concordance statistics. The primary outcome was time to the composite of clinically relevant arrhythmia, hospitalization for heart failure, or all-cause death. Median age was 39 (interquartile range, 32-48) years, and 32% were women. Median hs-cTnT concentration was 7 (interquartile range, 4-11) ng/L. Coefficients of determination for the relationship between hs-cTnT concentrations and right ventricular end-systolic volume index and right ventricular ejection fraction (RVEF) were +0.368 (P=0.046) and -0.381 (P=0.018), respectively. The sex- and age-adjusted hazard ratio for the primary outcome of hs-cTnT at 2 and 4 times the reference level (5 ng/L) were 2.89 (95% CI, 1.14-7.29) and 4.42 (95% CI, 1.21-16.15), respectively. The prognostic performance quantified by the concordance statistics for age- and sex-adjusted models based on hs-cTnT, right ventricular ejection fraction, and peak oxygen uptake predicted were comparable: 0.71% (95% CI, 0.61-0.82), 0.72% (95% CI, 0.59-0.84), and 0.71% (95% CI, 0.59-0.83), respectively. Hs-cTnT concentration was significantly correlated with right ventricular ejection fraction and right ventricular end-systolic volume index in patients with a systemic right ventricle. The prognostic accuracy of hs-cTnT was comparable to that of right ventricular ejection fraction and peak oxygen uptake predicted. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03049540.

High-Sensitivity Cardiac Troponin and the Management of Congenital Heart Disease in Newborns and Infants.

Early cardiac interventions in newborns and infants suspected for congenital heart disease (CHD) decrease morbidity and mortality. After updating current evidence on the use of cardiac troponins (cTn) in the context of CHD for risk stratification at early ages, we discuss relevant issues, starting from the evidence that only the measurement of the cTnT form is useful in this population. In newborns/infants with CHD, the cTnT concentration increase is correlated with: (a) cardiac stress and hemodynamic parameters, but not with the type of CHD; (b) volume overload/right ventricular pressure overload; (c) postoperative hypoperfusion injury and mortality; and (d) effects of cardioprotective strategies. For infants with CHD, high-sensitivity cTnT (hs-cTnT) concentrations >25 ng/L are an independent predictor of poor outcomes. Transitioning from cTnT to hs-cTnT in newborns/infants improves the identification of: (a) physiopathological mechanisms and factors that increased hs-cTnT early after birth; (b) myocardial injury, even when subclinical; (c) identification of patients requiring immediate therapeutic interventions; and (d) 99th percentile upper reference limits (URLs). However, no reliable URLs are currently available to allow the detection of myocardial injury associated with CHD in newborns/infants. Additional data evaluating the clinical value of hs-cTnT in the risk stratification of newborns/infants with CHD who may suffer myocardial injury is needed. Validating the measurement, possibly in amniotic fluid samples, and improving the interpretation of hs-cTnT concentrations in the prenatal period, at birth and within 1 year of age are crucial to change CHD mortality/morbidity trends in the pediatric population.

Diagnostic value of high sensitivity cardiac troponin T (hs-cTnT) in dialysis patients with myocardial infarction.

As a sensitive diagnostic marker for myocardial infarction (MI) in people with normal renal function, elevated high sensitivity cardiac troponin T (hs-cTnT) was often found in chronic kidney disease (CKD) patients requiring dialysis. However, the accuracy of baseline hs-cTnT in the diagnosis of MI (including Type 1 MI (T1MI) and Type 2 MI (T2MI)) in dialysis patients is still controversial. The aim of this study was to retrospectively explore whether there were any clinical indices that could increase the predictive value of hs-cTnT on admission for MI occurrence in dialysis patients. Here, 136 patients with uremia who underwent regular dialysis with coronary angiography in the First Affiliated Hospital of Nanjing Medical University from August 2017 to October 2021 were enrolled. According to the coronary angiography results and the presence of clinical symptoms, the patients were divided into: (1). AMI group (n = 69; angiography positive) and Control group (n = 67; angiography negative); (2). T1MI group (n = 69; angiography positive), T2MI group (n = 7; angiography negative & symptomatic), and Control group (n = 60; angiography negative & asymptomatic). Here, we found the mean hs-cTnT on admission in the Control group was much lower than that in the AMI group. Hs-cTnT alone had a mediocre predictive performance, with an AUROC of 0.7958 (95% CI: 0.7220, 0.8696). Moreover, the ROC curve of hs-cTnT combined with the Triglyceride (TG), Time of dialysis, and Albumin (Alb) showed a higher sensitivity area [0.9343 (95% CI: 0.8901, 0.9786)] than that of single hs-cTnT. Next, hs-cTnT combined with the TG, Time of dialysis, and Alb also presented a better performance in predicting T1MI [0.9150 (95% CI: 0.8678, 0.9621)] or T2MI (0.9167 [0.9167 (95% CI: 0.8427, 0.9906)] occurrences. Last, these combined variables could better distinguish patient between T1MI and T2MI group than hs-cTnT alone. On admission, a combination of hs-cTnT, TG, Time of dialysis, and Alb presented a higher sensitivity than hs-cTnT alone in predicting MI occurrence in dialysis patients, suggesting a better diagnostic approach for future clinical applications.

Prognostic value and determinants of high sensitive cardiac Troponin levels in patients with a systemic right ventricle: insights from the SERVE-Trial

Abstract Background The prognostic value of high-sensitivity cardiac Troponin T (hs-cTnT) in patients with a systemic left ventricle is well-established. However, the determinants and prognostic value of hs-cTnT among patients with a systemic right ventricle (sRV) are largely unknown. Purpose We aimed to assessed the determinants and prognostic value of hs-cTnT among patients with sRV. Methods Ninety-eight patients from the randomized-controlled SERVE-trial were included. The correlation between baseline hs-cTnT concentrations and bi-ventricular volumes and function quantified by cardiac magnetic resonance was assessed by adjusted linear regression models. The prognostic value of hs-cTnT and other established prognostic markers were assessed by adjusted cox proportional hazards models, survival analysis and c-statistics. The primary outcome was the composite of clinically relevant arrhythmia, hospitalization for heart failure or all-cause death. Results Median age [interquartile range, IQR] was 39 [32, 48] years and 32% were female. Median hs-cTnT concentration was 7 [IQR, 4-11] ng/L. Coefficients of determination for the relationship between hs-cTnT concentrations and right ventricular end-systolic volume index, (RVESVi) and ejection fraction (RVEF) were +0.368, p=0.046; and -0.381, p=0.018, respectively. The sex and aged adjusted hazard ratio [95%, confidence interval, CI] of hs-cTnT at 2- and 4-times the reference level (5 ng/l) for the primary outcome were 2.89 [1.14-7.29] and 4.42 [1.21-16.15], respectively (Figure 1). Patients with hs-cTnT concentrations ≤7 ng/L (median) had better event-free survival (89% vs. 67%, p=0.004). The prognostic performance quantified by the C-statistics [95%, CI] for age and sex adjusted models based on hs-cTnT, RVEF, and peak VO2 predicted (%) were comparable: 0.71 [0.61-0.82], 0.72 [0.59-0.84], and 0.71 [0.59-0.83], respectively (Figure 2). Conclusion Hs-cTnT concentration was significantly correlated with RVEF and RVESVi in patients with a sRV. The prognostic accuracy of this biomarker was comparable to that of the current gold standards (RVEF and peak VO2 predicted).Figure 1Figure 2

Abstract 16287: Predictive Value of High Sensitivity Troponin T for Patients With Suspected Acute Coronary Syndromes Undergoing Invasive Coronary Angiography

Introduction: High sensitivity troponin T (hs-cTnT) assays are used to risk stratify patients with suspected acute coronary syndromes(ACS), but the predictive value of hs-cTnT in patients undergoing invasive coronary angiography (ICA) has not been well described. Hypothesis: Hs-cTnT levels at baseline and the delta change with serial sampling will correlate with the findings of ICA, and the diagnostic performance of hs-cTnT may be affected by patient specific variables. Methods: This is a retrospective study of 1,037 patients that presented to the emergency department with suspected ACS who had hs-cTnT measured and underwent ICA. We collected patient demographics, medical history and results of cardiac testing. Our primary endpoint was a diagnosis of obstructive coronary artery disease (CAD) defined as a stenosis > 70% or > 50% in the left main. We excluded cases of arrhythmias, cardiac arrests, or STEMI. Data analyzed using multivariate regression models. Results: We analyzed data from 728 patients with a mean age of 68 years old, 62.5% were male and 37.5% female. 312 patients were diagnosed with no obstructive CAD and 413 with obstructive CAD, of which 286 underwent PCI, 43 underwent CABG and 84 were medically managed. There were significant (p<0.001) differences in average baseline hs-cTnT levels between no obstructive CAD (78.8 ng/L) and obstructive CAD (201.1 ng/L) patients, but no significant difference in the 1 hour hs-cTnT delta (30.4 ng/L vs 33.3ng/L) or the 3 hour delta (56.4ng/L vs 66.6ng/L). Being male, White race, or having diabetes were independent predictors of obstructive CAD with odd ratios of 2.42 (95% CI 1.75-3.34), 1.64 (95% CI 1.12-2.41), and 1.47 (95% CI 1.05-2.06) respectively. Conclusion: In this study, elevated baseline hs-cTnT was predictive of obstructive CAD but trending hs-cTnT had no additionalpredictive value. Average baseline hs-cTnT for no obstructive CAD was higher than the manufacture suggested cutoff (52 ng/L) to identify myocardial injury. Baseline variables of sex, race and history of diabetes were predictive of obstructive CAD regardless of the hs-cTnT. Future analysis will determine whether specific hs-cTnT thresholds in these populations could improve hs-cTnT performance for the identification of obstructive CAD.

The use of high-sensitivity cardiac troponin T and creatinine kinase-MB as a prognostic markers in patients with acute myocardial infarction and chronic kidney disease

Background High-sensitivity cardiac troponin T (hs-cTnT) and creatine kinase (CK)-MB are the most commonly used biomarkers for the diagnosis and prognosis of acute myocardial infarction (AMI). Chronic kidney disease (CKD) often leads to elevated hs-cTnT levels in non-AMI patients. However, studies comparing the prognostic value of both hs-cTnT and CK-MB in patients with AMI and CKD are lacking. Methods We conducted a retrospective study on AMI patients diagnosed between January 2015 and October 2020. Patients were categorized based on renal function as normal or CKD. Peak hs-cTnT and CK-MB levels during hospitalization were collected, and their diagnostic value was evaluated using receiver operating characteristic (ROC) curves. The impact on in-hospital mortality was analyzed using multivariate logistic regression. The relationship between the hs-cTnT/CK-MB ratio and in-hospital death was examined using a restricted cubic spline (RCS) curve. Results The study included 5022 AMI patients, of whom 797 (15.9%) had CKD. The AUCs of Hs-cTnT and CK-MB were higher in the CKD group [0.842 (95% CI: 0.789–0.894) and 0.821 (95% CI: 0.760–0.882)] than in the normal renal function group [0.695 (95% CI: 0.604-0.790) and 0.708 (95% CI: 0.624-0.793)]. After full adjustment for all risk factors, hs-cTnT (OR, 2.82; 95% CI, 1.03–9.86; p = 0.038) and CK-MB (OR, 4.91; 95% CI, 1.54–14.68; p = 0.007) above the cutoff values were independent predictors of in-hospital mortality in patients with CKD. However, in patients with normal renal function, only CK-MB above the cutoff (OR, 2.45; 95% CI, 1.02–8.24; p = 0.046) was a predictor of in-hospital mortality, whereas hs-cTnT was not. There was an inverted V-shaped relationship between the hs-cTnT/CK-MB ratio and in-hospital mortality, with an inflection point of 19.61. The ratio within the second quartile (9.63-19.6) was an independent predictor of in-hospital mortality in patients with CKD (OR 5.3, 95% CI 1.66–16.86, p = 0.005). Conclusions Hs-cTnT independently predicted in-hospital mortality in AMI patients with CKD, whereas its predictive value was not observed in patients with normal renal function. CK-MB was an independent predictor of in-hospital mortality regardless of renal function. Moreover, the hs-cTnT/CK-MB ratio may aid in risk stratification of AMI patients with CKD.

Early diagnostic value of high-sensitivity cardiac troponin T for cancer treatment-related cardiac dysfunction: a meta-analysis.

Early diagnosis of cancer treatment-related cardiac dysfunction (CTRCD) is important as cancer therapy increases the risk of cardiac dysfunction. High-sensitivity cardiac troponin T (hs-cTnT) is a highly specific marker of myocardial injury. However, its diagnostic value for CTRCD has not been systematically evaluated. This meta-analysis aimed to evaluate whether hs-cTnT could be used as an early diagnostic biomarker for CTRCD. We systematically surveyed PubMed, Embase, Cochrane Library, and Web of Science databases for studies of hs-cTnT for the diagnosis of CTRCD before 1 April 2022. Patients of all ages and all cancer types who underwent echocardiographic left ventricular ejection fraction assessment and blood hs-cTnT and received anticancer therapy (including chemotherapy, radiotherapy, targeted therapy, immune checkpoint inhibitors, and other treatments) were included in this study, resulting in a total of eight studies with 1294 patients. The occurrence of CTRCD was associated with elevated hs-cTnT [sensitivity: 0.78, 95% confidence interval (CI): 0.64-0.88; specificity: 0.75, 95% CI: 0.59-0.86; area under the curve (AUC): 0.83, 95% CI: 0.80-0.86]. We further performed subgroup analysis and found that the AUC of hs-cTnT elevation for the diagnosis of CTRCD increased from 0.83 to 0.90 (95% CI: 0.87-0.92) at 3-6months, suggesting a higher early diagnostic value of hs-cTnT compared with echocardiography for CTRCD. In terms of clinical applicability, the Fagan plot showed pre-test and post-test probabilities of 51% and 9%, respectively, indicating that hs-cTnT testing can improve the accuracy of clinical diagnosis of CTRCD. However, it was not possible to determine the optimal cut-off value for early diagnosis of CTRCD with hs-cTnT. The Deeks funnel plot was largely symmetrical (P=0.74); hence, publication bias was not observed. Hs-cTnT allowed early CTRCD diagnosis at 3-6months. However, further high-quality research is needed to determine the optimal cut-off value for early CTRCD diagnosis with this biomarker.

The Role of Cardiac Biomarkers in the Diagnosis of Hypertensive Emergency.

There is a growing interest in the role of biomarkers in differentiating hypertensive emergency from hypertensive urgency. This study aimed to determine the diagnostic utility of lactate dehydrogenase (LDH), high-sensitivity cardiac troponin T (hscTnT), and N-terminal prohormone of brain-type natriuretic peptide (NT-proBNP) for identifying hypertensive emergency. A diagnosis of hypertensive emergency was made based on a systolic blood pressure of ≥180 mmHg and/or a diastolic blood pressure of ≥110 mmHg with acute hypertension-mediated organ damage. The predictive value of LDH, hscTnT, NT-proBNP, and models of these biomarkers for hypertensive emergency was determined using the area under the receiver operator characteristic curve (AUC). There were 66 patients (66.7% male) with a hypertensive emergency and 16 (31.3% male) with hypertensive urgency. LDH, NT-proBNP, and hscTnT were significantly higher in hypertensive emergency. Serum LDH > 190 U/L and high creatinine were associated with hypertensive emergency. LDH had an AUC ranging from 0.87 to 0.92 for the spectrum of hypertensive emergencies, while hscTnT had an AUC of 0.82 to 0.92, except for neurological emergencies, in which the AUC was 0.72. NT-proBNP was only useful in predicting acute pulmonary edema (AUC of 0.89). A model incorporating LDH with hscTnT had an AUC of 0.92 to 0.97 for the spectrum of hypertensive emergencies. LDH in isolation or combined with hscTnT correctly identified hypertensive emergency in patients presenting with hypertensive crisis. The routine assessment of these biomarkers has the potential to facilitate the timely identification of hypertensive emergencies, especially in patients with subtle and subclinical target organ injury.

Normal high-sensitivity cardiac troponin for ruling-out inpatient mortality in acute COVID-19.

Assessment of inpatient mortality risk in COVID-19 patients is important for guiding clinical decision-making. High sensitivity cardiac troponin T (hs-cTnT) is a biomarker of cardiac injury associated with a worse prognosis in COVID-19. We explored how hs-cTnT could potentially be used in clinical practice for ruling in and ruling out mortality in COVID-19. We tested the diagnostic value of hs-cTnT in laboratory-confirmed COVID-19 patients (≥18 years old) admitted to the Royal Berkshire Hospital (UK) between 1st March and 10th May 2020. A normal hs-cTnT was defined as a value within the 99th percentile of healthy individuals (≤14 ng/L), and an elevated hs-cTnT was defined as >14 ng/L. Adverse clinical outcome was defined as inpatient mortality related to COVID-19. A total of 191 COVID-19 patients (62% male; age 66±16 years) had hs-cTnT measured on admission. Of these patients, 124 (65%) had elevated hs-cTnT and 67 (35%) had normal hs-cTnT. On a group level, patients with elevated hs-cTnT had worse inpatient survival (p = 0.0014; Kaplan-Meier analysis) and higher risk of inpatient mortality (HR 5.84 [95% CI 1.29-26.4]; p = 0.02; Cox multivariate regression) compared to patients with normal hs-cTnT. On a per-patient level, a normal hs-cTnT had a negative predictive value of 94% (95% CI: 85-98%) for ruling out mortality, whilst an elevated hs-cTnT had a low positive predictive value of 38% (95% CI: 39-47%) for ruling in mortality. In this study cohort of COVID-19 patients, the potential clinical utility of hs-cTnT appears to rest in ruling out inpatient mortality. This finding, if prospectively validated in a larger study, may allow hs-cTnT to become an important biomarker to facilitate admission-avoidance and early safe discharge.

Suspected Non-ST-elevation acute coronary syndrome meeting rapid rule-out criteria: resource utilization, diagnostic yield, and clinical outcomes of hospital admission.

Many patients with suspected non-ST-elevation (NSTE) acute coronary syndromes (ACS) are admitted, even those with initial high-sensitivity cardiac troponins (hs-cTn) values who meet rapid rule-out criteria for myocardial infarction (MI). We examined the clinical outcomes, resource utilization, and diagnostic yield of suspected NSTE-ACS patients, who presented with hs-cTnT values meeting these criteria but were nevertheless hospitalized. Applying the 2020 European Society of Cardiology (ESC) rapid rule-out MI criteria, we identified consecutive patients with an initial value of hs-cTnT <5ng/L or an initial value of ≥5ng/L but <14ng/L (99th percentile) and a small increment in a subsequent test, who were nevertheless admitted. The majority (85.4%) of patients presented to the emergency department (ED) with suspected NSTE-ACS had an initial hs-cTnT <99th percentile. We examined 3775 admitted patients out of 11 477 patients who were triaged and met MI rule-out criteria. Only 0.32% (12 patients) of admitted patients experienced index MI or overall death within 30 days. Resource utilization in terms of ED stay, hospital stay, noninvasive and invasive tests was substantial, yet revascularization was uncommon (2.5%). Multivariate adjustment for age, gender, and baseline cardiovascular risk factors demonstrates similar survival of admitted vs. discharged patients (P=0.88). Initial hs-cTnT even below the 99th percentile provided a prognostic stratification for long term mortality. Our findings support a policy of ED discharge of suspected NSTE-ACS patients meeting rapid MI rule-out criteria and subsequent ambulatory evaluation, sparing resource-consuming admissions. In-hospital and ensuing prognosis were better with lower initial hs-cTnT values.

Retracted: The Diagnostic Value of Serum GDF15 and hs-CTnT in Elderly Patients with Acute Myocardial Infarction.

[This retracts the article DOI: 10.1155/2022/9281636.].

Predictive value of high-sensitivity troponin for significant coronary artery disease in new-onset atrial fibrillation with rapid ventricular response.

High-sensitivity troponin-T (HS-cTnT) levels are often measured in patients presenting with atrial fibrillation (AF), with many subjected to unnecessary invasive assessments. The significance of a normal or mildly raised HS-cTnT in this context is poorly understood. This study aimed to determine the predictive value of HS-cTnT for significant coronary artery disease (CAD) in new AF with rapid ventricular response. We also compared the discriminative ability of HS-cTnT to suspected angina for significant CAD. We examined patients presenting with new AF to two tertiary Irish centers in a defined period. Those included had HS-cTnT taken at presentation and subsequent ischemic evaluation. Of 5350 cases screened for inclusion, 281 were deemed eligible. Of these, 148 and 133 patients had a positive and negative index HS-cTnT, respectively. Of those with negative HS-cTnT, 13 (9.8%) had significant CAD versus 51 (34.5%) with positive HS-cTnT (P < 0.001). Positive Hs-cTnT status remained significant upon multivariate analysis (OR, 2.9; 95% CI, 1.37-6.14; P = 0.005). A similar model where HS-cTnT was replaced with suspected angina produced an OR of 1.64 (95% CI, 0.75-3.59; P = 0.213). A logistic model determined optimal cutoff value for HS-cTnT to be less than 30 ng/l, producing a negative predictive value of 91.8% and area under the receiver operative curve of 83.36. HS-cTnT exhibits potential as an effective screening biomarker to predict nonsignificant CAD in new rapid AF, allowing more targeted and rationalized ischemic testing. HS-cTnT may also be a more accurate predictor of significant CAD than clinically suspected stable angina.Graphical abstract: http://links.lww.com/MCA/A540.

The difference in prognostic value between high-sensitive cardiac troponin T and I for long-term major adverse cardiovascular events in hemodialysis patients

Abstract Background Previous studies using conventional cardiac troponin (cTn) assays have shown conflicting results in the predictability of major adverse cardiovascular events (MACEs) in hemodialysis patients. Objective We aimed to evaluate the prognostic values of high-sensitivity cTnT (hs-cTnT) and hs-cTnI assays for long-term MACEs in asymptomatic chronic hemodialysis patients. Methods A total of 198 asymptomatic patients undergoing regular hemodialysis (mean age 62.4±14.8 years) were enrolled in this study. Pre-dialysis hs-cTnT and hs-cTnI levels were measured at the time of study entry. The primary outcome was the prognostic value of hs-cTnT and hs-cTnI for all-cause mortality. Results At baseline, the median values of hs-cTnT and hs-cTnI were 61.1 ng/L (IQR 36.6–102.0 ng/L) and 18.4 ng/L (IQR 9.5–36.6 ng/L), respectively. During a median follow-up period of 408 days (IQR 343–415 days), 35 (17.7%) patients developed MACEs, and 20 (10.1%) patients died. The patients with hs-cTnT level above the highest quartile (&amp;gt;102 ng/L) had an increased risk of all-cause mortality (HR 3.34; 95% CI 1.39–8.04, P=0.007) and MACEs (HR 1.99; 95% CI 1.00–3.96, P=0.049), compared to those with lower hs-cTnT level. The association between hs-cTnT and all-cause mortality remained significant after adjustment for age, gender, and comorbidities. On the contrary, hs-cTnI level was not associated with long-term all-cause mortality and MACEs. Conclusions We demonstrated that level of hs-cTnT, but not hs-cTnI, was associated with higher risk of long-term mortality and MACEs. As a result, hs-cTnT may be a better prognostic factor than hs-cTnI in this population. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Faculty of Medicine Endowment Fund for medical research

The Diagnostic Value of Serum GDF15 and hs-CTnT in Elderly Patients with Acute Myocardial Infarction.

Objective To analyze the diagnostic value of serum growth differentiation factor 15 (GDFl5) and high-sensitivity troponin T (hs-cTnT) in elderly acute myocardial infarction (AMI). Methods A retrospective analysis of 165 patients with acute chest pain admitted to the Department of Cardiology in our hospital from January to December 2020, Among them, 76 AMI patients (AMI group), 89 non-AMI patients (non-AMI group), and 80 healthy people were selected as the control group during the same period. Compare the three groups of serum GDF15, hs-CTnT levels, and left ventricular ejection fraction (LVEF) parallel correlation analysis, and draw the receiver operating curve (ROC) of serum GDF15 and hs-CTnT levels to diagnose AMI. Results The serum GDF15 and hs-CTnT levels of the AMI group were significantly higher than those of the non-AMI group and the control group, and the difference was statistically significant (p < 0.01). The LVEF was significantly lower than the non-AMI group and the control group, whose difference was statistically significant (p < 0.01). Among them, the indicators of the non-AMI group were both higher and lower than the control group, and the difference was statistically significant (p < 0.01). Serum GDF15 and hs-CTnT levels of AMI patients increased with the increase of NYHA grade, among which grade IV group was significantly higher than grade I∼II group and grade III group (P < 0.01), and grade III group was significantly higher than grade I∼II Group (p < 0.01). Pearson correlation analysis showed that GDF15 and hs-CTnT levels of AMI patients were significantly negatively correlated with LVEF (r = −0.584, −0.612, − < 0.01). The ROC curve showed that GDF15 had a high specificity (93.75%) and hs-CTnT has a high sensitivity (90.67%). The area under the curve for diagnosing AMI is > 0.7 (0.895, 0.948). The sensitivity of the combined detection and the specificity are higher than that of individual detection. Conclusion Serum GDF15 and hs-CTnT are highly expressed in elderly patients with AMI. The combined detection of the two can improve the efficiency of AMI diagnosis. GDF15 can be used as a new biomarker for AMI diagnosis and disease monitoring.

Prognostic Implications of a Second Peak of High-Sensitivity Troponin T After Myocardial Infarction.

BackgroundAfter an acute myocardial infarction (MI), repeated measurement of cardiac biomarkers is commonly performed, although not recommended in current guidelines. There is only limited data on the kinetics of troponin in this phase. For high-sensitivity cardiac troponin T (hs-cTnT), but not high-sensitivity cardiac troponin I (hs-cTnI), late increases in terms of a second peak have been described. Their impact on the prognosis of patients with MI remains unclear.MethodsWe included 2,305 patients presenting to the emergency department with symptoms suggestive of MI. Five hundred and seven were diagnosed with MI. Hs-cTnT, creatine kinase (CK) and the MB fraction of CK (CK-MB) were measured at admission, after 1 and 3 h and thereafter as indicated by the treating physician. A mixed-model approach was applied for modeling the biomarker kinetics. All patients were followed up to assess a composite endpoint of mortality, recurrent MI, revascularization and rehospitalization and to investigate the effect of a second hs-cTnT peak on prognosis.ResultsOut of 507 patients with MI, 192 had a sufficient amount of hs-cTnT measurements after the index MI. In 111 (57.8%) patients a second hs-cTnT peak was found after 4.48 days. For CK and CK-MB a second peak could not be identified. Regarding the composite endpoint there was no significant difference between patients with and without a second hs-cTnT peak.ConclusionIn our analyses, a second peak of hs-cTnT after an acute MI was common, but not associated with poorer outcome. Thus, the clinical value of hs-cTnT for monitoring myocardial ischemia might be limited in this phase and other biomarkers might be more suitable.Trial Registration: www.ClinicalTrials.gov, identifier: NCT02355457, Date of registration: February 4, 2015.

High-sensitivity troponins for outcome prediction in the general population: a systematic review and meta-analysis

BackgroundHigh-sensitivity (hs) assays allow to measure cardiac troponin T and I (cTnT/I) even in healthy individuals. The higher hs-cTn values, the higher the ongoing cardiomyocyte damage, and then reasonably the risk of developing symptomatic cardiac disease. MethodsWe retrieved all studies evaluating the prognostic value of hs-cTnT or I in the general population. We calculated pooled hazard ratio (HR) values for all-cause and cardiovascular death, cardiovascular events and heart failure (HF) hospitalization. ResultsWe included 24 studies for a total of 203,202 subjects; 11 studies assessed hs-cTnT and 14 hs-cTnI. One standard deviation (SD) increase in baseline hs-cTn was associated with a 23% higher risk of all-cause death (HR 1.226, 95% CI 1.083-1.388, p<0.001, I2=88.5%); all these studies measured hs-cTnI. In an exploratory analysis on 3 studies with 25,760 subjects, hs-cTn predicted cardiovascular death (HR 1.822, 95% CI 1.241-2.674, p=0.002, I2=87.2%). After synthesizing 9 studies with 58,565 subjects, hs-cTn predicted cardiovascular events (HR 1.328, 95% CI 1.167-1.513, p<0.001, I2=93.8%). Both hs-cTnT (HR 1.627, 95% CI 1.145-2.311, p<0.001) and hs-cTnI (HR 1.260, 95% CI 1.115-1.423, p<0.001; p for interaction <0.001). Furthermore, in 10 studies with 61,467 subjects, hs-cTn predicted HF hospitalization (HR 1.493, 95% CI 1.368-1.630, p<0.001, I2=76.6%). Both hs-cTnT (HR 1.566, 95% CI 1.303-1.883, p<0.001) and hs-cTnI (HR 1.467, 95% CI 1.321-1.628, p<0.001) were associated with HF hospitalization (p for interaction <0.001). Conclusionshs-cTn values hold strong prognostic value in subjects from the general population, predicting the risk of all-cause and cardiovascular mortality, cardiovascular events, and HF hospitalization.

419 High-sensitivity troponins for outcome prediction in the general population: a systematic review and meta-analysis

Abstract Aims High-sensitivity (hs) assays allow to measure cardiac troponin T and I (cTnT/I) even in healthy individuals. The higher hs-cTn values, the higher the ongoing cardiomyocyte damage, and then reasonably the risk of developing symptomatic cardiac disease. Methods and results We retrieved all studies evaluating the prognostic value of hs-cTnT or I in the general population. We calculated pooled hazard ratio (HR) values for all-cause and cardiovascular death, cardiovascular events and heart failure (HF) hospitalization. We included 24 studies for a total of 203 202 subjects; 11 studies assessed hs-cTnT and 14 hs-cTnI. One standard deviation (SD) increase in baseline hs-cTn was associated with a 23% higher risk of all-cause death (HR: 1.226, 95% CI: 1.083–1.388, P &amp;lt; 0.001, I2 = 88.5%); all these studies dosed hs-cTnI. In an exploratory analysis on three studies with 25 760 subjects, hs-cTn predicted cardiovascular death (HR: 1.822, 95% CI: 1.241–2.674, P = 0.002, I2 = 87.2%). After synthesizing nine studies with 58 565 subjects, hs-cTn predicted cardiovascular events (HR: 1.328, 95% CI: 1.167–1.513, P &amp;lt; 0.001, I2 = 93.8%). Both hs-cTnT (HR: 1.627, 95% CI: 1.145–2.311, P &amp;lt; 0.001) and hs-cTnI (HR: 1.260, 95% CI: 1.115–1.423, P &amp;lt; 0.001; p for interaction &amp;lt;0.001). Furthermore, in 10 studies with 61 467 subjects, hs-cTn predicted HF hospitalization (HR: 1.493, 95% CI: 1.368–1.630, P &amp;lt; 0.001, I2 = 76.6%). Both hs-cTnT (HR: 1.566, 95% CI: 1.303–1.883, P &amp;lt; 0.001) and hs-cTnI (HR: 1.467, 95% CI: 1.321–1.628, P &amp;lt; 0.001) were associated with HF ho (p for interaction &amp;lt;0.001). Conclusions hs-cTn values hold strong prognostic value in subjects from the general population, predicting the risk of all-cause and cardiovascular mortality, cardiovascular events, and HF hospitalization.

Expression of F0 ATP synthase C subunit in serum of patients with ischemic heart disease and its clinical implications

To investigate the expression and clinical significance of F0 ATP synthase C subunit (Csub) in patients with ischemic heart disease (IHD). The 101 patients with chest pain admitted to the department of emergency of the People's Hospital of Yuhuan from May 2019 to December 2020 were enrolled, including 59 patients with acute myocardial infarction (AMI) and 42 patients with unstable angina pectoris (UAP). At the same time, 50 age-matched healthy subjects in the health examination center were selected as the healthy control (HC). All patients had completed blood sampling before the intervention of drugs or other intervention measures in the emergency room. The content of serum Csub was detected by enzyme linked immunosorbent assay (ELISA), and the relationship between Csub and clinical characteristics was analyzed. At the same time, the contents of hypersensitivity cardiac troponin T (hs-cTnT) and MB isoenzyme of creatine kinase (CK-MB) in blood were detected by electrochemical luminescence. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the value of Csub, hs-cTnT, and CK-MB in the early diagnosis of IHD. The baseline data such as age, gender, and history of the three groups were balanced. There were significant differences in low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), CK-MB, hs-cTnT and B-type natriuretic peptide (BNP), but there were no significant differences in other biochemical indexes. The Csub content in the AMI group and the UAP group were significantly higher than those in the HC group [8.96% (6.37%, 11.53%), 4.27% (3.23%, 6.49%) vs. 1.56% (1.07%, 2.33%), both P < 0.01]. Moreover, the Csub in the AMI group with more severe myocardial ischemia was higher than UAP group [8.96% (6.37%, 11.53%) vs. 4.27% (3.23%, 6.49%), P < 0.01]. A total of 59 patients with AMI were treated with percutaneous coronary intervention (PCI). According to the median of Csub, AMI patients were subdivided into above-median group (29 cases) and below-median group (30 cases). The results showed that there were no significant differences in the number of coronary artery lesion branches, the number of stent implantation and postoperative medication between the two groups. ROC curve analysis showed that the area under the curve (AUC) and 95% confidence interval (95%CI) of Csub, hs-cTnT and CK-MB in the diagnosis of IHD were 0.98 (0.95-1.00), 0.99 (0.99-1.00), 0.94 (0.89-0.99), respectively. The diagnostic efficacy of Csub was slightly lower than that of hs-cTnT but higher than that of CK-MB. When the cut-off value of Csub was 4.74%, the sensitivity and specificity for the diagnosis of IHD were 100% and 87.0%, respectively. Csub increased significantly in the serum of IHD patients, and further increased with the severity of ischemia. It can be used as a new diagnostic biomarker for the diagnosis and evaluation of the development of myocardial ischemia.