High-Sensitivity Troponin I Assay for Differential Diagnosis of New-Onset Myocardial Infarction in Patients with
Joo Hong Han1, Sung Oh Hwang1, Kyoung Chul Cha1
1Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Insights
Diagnosing non-ST elevation myocardial infarction (NSTEMI) in acute decompensated heart failure (ADHF) patients is crucial. Initial high-sensitivity troponin I (hS-TnI) levels are effective for NSTEMI diagnosis in ADHF, outperforming delta hS-TnI.
Area of Science:
- Cardiology
- Emergency Medicine
- Biomarker Analysis
Background:
- Acute decompensated heart failure (ADHF) from ischemic heart disease carries high mortality.
- Prompt diagnosis of non-ST elevation myocardial infarction (NSTEMI) is essential in ADHF patients.
- High-sensitivity cardiac troponin assays offer novel diagnostic approaches.
Purpose of the Study:
- To compare the diagnostic utility of high-sensitivity troponin I (hS-TnI), delta troponin I, and traditional methods for NSTEMI in ADHF patients.
- To evaluate the clinical performance of hS-TnI in the emergency department setting for NSTEMI diagnosis.
Main Methods:
- Retrospective cross-sectional study of 524 ADHF patients.
- Analysis of patients undergoing a 0-2 hour hS-TnI protocol.
- Grouping patients based on NSTEMI diagnosis and comparing biomarker levels and electrocardiographic findings.
Main Results:
- Initial hS-TnI (2.44±5.60 ng/mL) and delta hS-TnI (1.55) were significant predictors of NSTEMI in ADHF.
- hS-TnI (OR: 2.18) and delta hS-TnI (OR: 1.55) showed significant predictive value.
- Areas under the ROC curve for initial hS-TnI (0.802) and delta hS-TnI (0.773) indicated diagnostic capability.
Conclusions:
- Initial hS-TnI assay demonstrates strong predictive value for NSTEMI in ADHF patients.
- The diagnostic performance of initial hS-TnI is comparable to electrocardiogram ischemic changes.
- Initial hS-TnI is superior to delta hS-TnI for NSTEMI diagnosis in this ADHF cohort.
Purpose:
Acute decompensated heart failure (ADHF) caused by ischemic heart disease is associated with higher mortality and requires immediate diagnosis. Recently, novel methods to diagnose non-ST elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin have been applied. We compared the clinical utility of high-sensitivity troponin I (hS-TnI), delta troponin I, and other traditional methods to diagnose NSTEMI in patients with ADHF.
Materials And Methods:
This retrospective cross-sectional study was conducted to analyze patients with ADHF who underwent hS-TnI evaluation of 0-2-h protocol in our emergency department. Patients were grouped according to a diagnosis of NSTEMI.
Results:
A total of 524 ADHF [ADHF with NSTEMI, n=109 (20.8%)] patients were enrolled in this analysis. The mean values of hS-TnI (ng/mL) in the ADHF with and without NSTEMI groups were 2.44±5.60 and 0.25±0.91, respectively. Multivariable analysis revealed that regional wall-motion abnormality, T-wave inversion/hyperacute T wave, and initial and delta hS-TnI were predictive factors for NSTEMI. Laboratory values related to cardiac biomarkers, including hS-TnI [odds ratio (OR) (95% confidence interval, CI): 2.18], and the delta hS-TnI [OR (95% CI): 1.55] were significant predictors of NSTEMI. Moreover, receiver operating characteristic analysis showed that the areas under receiver operating characteristic curves for electrocardiographic abnormalities, initial hS-TnI, and delta hS-TnI were 0.794, 0.802, and 0.773, respectively.
Conclusion:
For diagnosis of suspected NSTEMI in patients with ADHF, initial hS-TnI assay has similar predictive value as ischemic changes on electrocardiogram and superior predictive value than delta hS-TnI calculated by the 0-2-h protocol.
More Related Videos
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
09:23Using Extraordinary Optical Transmission to Quantify Cardiac Biomarkers in Human Serum
Published on: December 13, 2017
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:27Myocarditis II: Clinical Features and Diagnostic Tests
01:28Acute Coronary Syndrome IV: Interprofessional Care