Troponin T measurements by high-sensitivity vs conventional assays for risk stratification in acute dyspnea
Sandra van Wijk1, Leo Jacobs, Luc W Eurlings
1Department of Cardiology, Maastricht University Medical Center, CARIM, Maastricht, the Netherlands. sandra.van.wijk@mumc.nl
Insights
High-sensitivity cardiac troponin T (hs-cTnT) improves risk assessment in patients with acute dyspnea. Elevated hs-cTnT levels identify higher mortality risk, even when conventional troponin is undetectable.
Area of Science:
- Cardiology
- Biomarkers
- Emergency Medicine
Background:
- High-sensitivity cardiac troponin T (hs-cTnT) has demonstrated prognostic value in various patient populations.
- The hs-cTnT assay shows potential for enhancing risk stratification in individuals presenting with acute dyspnea.
Purpose of the Study:
- To prospectively evaluate the prognostic significance of hs-cTnT in patients with acute dyspnea.
- To compare the prognostic utility of hs-cTnT with conventional cardiac troponin T (cTnT) and N-terminal pro-brain-type natriuretic peptide (NT-proBNP).
Main Methods:
- A prospective study of 678 consecutive patients with acute dyspnea in the emergency department.
- Patients were categorized based on cTnT and hs-cTnT levels: neither elevated, only hs-cTnT elevated, or both elevated.
- hs-cTnT's prognostic value was specifically assessed in patients with undetectable cTnT.
Main Results:
- Mortality rates significantly increased across the three troponin categories (90-day: 2%, 10%, 26%; 1-year: 9%, 21%, 39%).
- In patients with undetectable cTnT (51% of cohort), elevated hs-cTnT was linked to worse outcomes (90-day OR 4.26, 1-year HR 2.27).
- N-terminal pro-brain-type natriuretic peptide (NT-proBNP) did not predict short-term outcomes in this cohort.
Conclusions:
- hs-cTnT is a significant predictor of mortality in patients presenting with acute dyspnea.
- hs-cTnT provides additional prognostic information beyond cTnT and NT-proBNP, particularly in patients with low or undetectable cTnT.
- An hs-cTnT cutoff of 0.016 μg/L effectively identifies low-risk patients.
Background:
Cardiac troponin T measured by a high-sensitivity assay (hs-cTnT) recently proved to be of prognostic value in several populations. The hs-cTnT assay may also improve risk stratification in acute dyspnea.
Methods:
We prospectively studied the prognostic value of hs-cTnT in 678 consecutive patients presenting to the emergency department with acute dyspnea. On the basis of conventional cardiac troponin T assay (cTnT) and hs-cTnT assay measurements, patients were divided into 3 categories: (1) neither assay increased (cTnT<0.03 μg/L, hs-cTnT<0.016 μg/L), (2) only hs-cTnT increased≥0.016 μg/L (cTnT<0.03 μg/L), and (3) both assays increased (cTnT≥0.03 μg/L, hs-cTnT≥0.016 μg/L). Moreover, the prognostic value of hs-cTnT was investigated if cTnT was not detectable (<0.01).
Results:
One hundred seventy-two patients were in the lowest, 282 patients in the middle, and 223 patients in the highest troponin category. Patients in the second and third categories had significantly higher mortality compared to those in the first category (90-day mortality rate 2%, 10%, and 26% in groups 1, 2, and 3, respectively, P<0.001; 1-year mortality rate 9%, 21%, and 39%, P<0.001). Importantly, in patients with undetectable cTnT (n=347, 51%), increased hs-cTnT indicated worse outcome [90-day mortality, odds ratio 4.26 (95% CI 1.19-15.21); 1-year mortality, hazard ratio 2.27 (1.19-4.36), P=0.013], whereas N-terminal pro-brain-type natriuretic peptide (NT-proBNP) was not predictive of short-term outcome.
Conclusions:
hs-cTnT is associated with mortality in patients presenting with acute dyspnea. hs-cTnT concentrations provide additional prognostic information to cTnT and NT-proBNP testing in patients with cTnT concentrations below the detection limit. In particular, the hs-cTnT cutoff of 0.016 μg/L enables identification of low-risk patients.
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