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The diagnostic value of tenascin-C in acute aortic syndrome
Ming Ma1,2, Wei Chen3, Hai-Long Cao1,2
1Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
Insights
Tenascin-C (TN-C) shows significantly elevated levels in patients with acute aortic syndrome (AAS), outperforming other biomarkers. This finding suggests TN-C is a promising new biomarker for distinguishing AAS in its early stages.
Area of Science:
- Cardiovascular Medicine
- Biomarker Discovery
- Emergency Medicine
Background:
- Acute aortic syndrome (AAS) diagnosis is critical due to high mortality.
- Tenascin-C (TN-C), an extracellular matrix glycoprotein, is linked to cardiovascular injury.
- The diagnostic utility of TN-C for AAS in Chinese patients with acute chest pain is not well-established.
Purpose of the Study:
- To investigate the plasma concentration of TN-C in patients presenting with chest or back pain.
- To evaluate TN-C's ability to discriminate between AAS and acute coronary syndrome (ACS).
- To assess TN-C as a potential early-stage biomarker for AAS.
Main Methods:
- Plasma TN-C levels were measured using ELISA in 376 patients with chest or back pain.
- Patients were categorized into AAS, ACS, and no cardiovascular disease (NCV) groups.
- Diagnostic performance metrics, including sensitivity, specificity, and ROC analysis, were calculated for TN-C.
Main Results:
- TN-C was significantly elevated in AAS (18.18 ng/mL) compared to ACS (7.51 ng/mL) and NCV (3.68 ng/mL) (P < 0.001).
- TN-C levels peaked in the acute stage of AAS.
- TN-C demonstrated high diagnostic accuracy (82.0%) with a sensitivity of 76.0% and specificity of 85.5% for AAS detection, outperforming D-dimer and hs-cTnT.
Conclusions:
- Serum TN-C concentrations are significantly higher in AAS patients compared to ACS and NCV groups.
- TN-C shows potential as a novel biomarker for early-stage differentiation of AAS from other pain-causing conditions.
- The study highlights TN-C's superior diagnostic performance in identifying AAS.
Objectives:
Misdiagnosis of acute aortic syndrome (AAS) significantly increases mortality. Tenascin-C (TN-C) is an extracellular matrix glycoprotein related to cardiovascular injury. The elevation of TN-C in AAS and whether it can discriminate sudden-onset of acute chest pain in Chinese remains unclear.
Methods:
We measured the plasma concentration of TN-C by ELISA in a cohort of 376 patients with chest or back pain. Measures to discriminate AAS from acute coronary syndrome (ACS) were compared and calculated.
Results:
From October 2016 to September 2021, 376 undiagnosed patients with chest or back pain were enrolled. 166 of them were finally diagnosed as AAS, 100 were ACS and 110 without cardiovascular diseases (NCV). TN-C was significantly elevated in AAS at 18.18 ng/mL (IQR: 13.10-27.68) compared with 7.51 ng/mL (IQR: 5.67-11.38) in ACS (P < 0.001) and 3.68 ng/mL (IQR: 2.50-5.29) in NCV (P < 0.001). There was no significant difference in TN-C level among the subtypes of AAS. Of the 166 AAS patients, the peaked level of TN-C was at acute stage (P = 0.012), then a slight of decrease was observed at subacute stage. The area under receiver operating characteristic curve for AAS patients versus NCV was 0.979 (95% CI: 0.964-0.994) for TN-C. At a cutoff level of 11.474 ng/mL, TN-C has a sensitivity of 76.0%, specificity of 85.5%, accuracy of 82.0%, positive predictive value (PPV) of 76.0%, negative predictive value (NPV) of 85.5%. Diagnostic performance of TN-C was superior to D-dimer and hs-cTnT.
Conclusions:
The concentration of serum TN-C in AAS patients was significantly higher than that in ACS patients and NCV. TN-C could be a new biomarker to distinguish AAS patients in the early stage after symptoms onset from other pain diseases.
