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Optimal Cutoff Values and Utility of High-Sensitivity Troponin T and NT-proBNP for the Risk Stratification of
Timothy M Matthews1, Gregory A Peters1,2,3, Grace Wang1
1Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States.
Insights
This study identified optimal cutoffs for high-sensitivity troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in pulmonary embolism (PE) risk stratification. However, their low to moderate performance suggests reconsideration for clinical use in stable PE patients.
Area of Science:
- Cardiology
- Biomarker Research
- Pulmonary Medicine
Background:
- Current guidelines recommend high-sensitivity troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for risk stratification in hemodynamically stable acute pulmonary embolism (PE) patients.
- However, evidence-based cutoff values for this specific clinical application are lacking.
Purpose of the Study:
- To determine optimal cutoff values for hsTnT and NT-proBNP in risk stratifying hemodynamically stable patients with acute pulmonary embolism (PE).
- To evaluate the performance of these biomarkers in predicting adverse outcomes within 7 days.
Main Methods:
- A retrospective cohort study included 234 patients for hsTnT and 727 for NT-proBNP analysis, all with imaging-confirmed PE.
- Patients were hemodynamically stable, and hsTnT/NT-proBNP levels were measured within 24 hours of PE Response Team (PERT) activation.
- Area under the receiver operating curve (AUC) was calculated to determine optimal cutoffs for hsTnT (46 ng/L) and NT-proBNP (1092 pg/mL).
Main Results:
- The optimal hsTnT cutoff of 46 ng/L yielded an AUC of 0.64 (sensitivity 59%, specificity 61%).
- The optimal NT-proBNP cutoff of 1092 pg/mL yielded an AUC of 0.56 (sensitivity 53%, specificity 59%).
- Both biomarkers demonstrated low to moderate performance in risk stratification for initially stable PERT patients.
Conclusions:
- Optimal cutoffs were identified as 46 ng/L for hsTnT and 1092 pg/mL for NT-proBNP.
- The low to moderate AUC values suggest that the use of these biomarkers for risk stratification in PE may need reevaluation.
- Further research may be required to refine the role of hsTnT and NT-proBNP in managing hemodynamically stable PE patients.
Background:
Guidelines recommend using high-sensitivity troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) to risk stratify hemodynamically stable patients with acute pulmonary embolism (PE). However, there are no evidence-based cutoff values defined for this clinical application.
Methods:
We performed a single-center, retrospective cohort study of patients with imaging-confirmed PE and hsTnT and/or NT-proBNP (ElecsysTM, Roche) measured 12 h before or 24 h after PE Response Team (PERT) activation. We excluded hypotensive patients. Our primary outcome was a composite of adverse outcomes or critical interventions within 7 days. We calculated the area under the receiver operating curve (AUC, ROC) for hsTnT and NT-proBNP and determined the optimal cutoffs using the distance from (0,1). We performed a subgroup analysis on patients with PE and right ventricular dysfunction on imaging.
Results:
Two hundred thirty-four patients were included in the hsTnT analysis, and 727 in the NT-proBNP analysis. Mean age was 62 years (SD = 17) and 47% were female. The AUC for hsTnT was 0.64 (95% CI, 0.56-0.71) with an optimal cutoff of 46 ng/L, corresponding to a sensitivity of 59% (95% CI, 49-69) and a specificity of 61% (95% CI, 53-69). The AUC for NT-proBNP was 0.56 (95% CI, 0.51-0.61) with an optimal cutoff of 1092 pg/mL, corresponding to a sensitivity of 53% (95% CI, 45-61) and a specificity of 59% (95% CI, 55-63).
Conclusion:
We identified an optimal cutoff of 46 ng/L for hsTnT and 1092 pg/mL for NT-proBNP, though the AUC for both markers suggests low to moderate performance for the risk stratification of initially hemodynamically stable PERT patients. Use of these biomarkers to risk stratify PE may require reconsideration.
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