急性胸痛患者の高感度トロポニンT濃度は,心筋コンピュータトモグラフィで評価された
James L Januzzi1, Fabian Bamberg, Hang Lee
1Massachusetts General Hospital, Boston, MA 02114, USA.
Circulation
|March 3, 2010
まとめ
高感度トロポニンT (hsTnT) アッセイは,胸痛患者の急性冠動脈症候群 (ACS) の検出を改善します. hsTnT値の上昇は,正式なACS診断がない場合でも,心筋梗塞の損傷と重大な心疾患を示す.
科学分野:
- 心臓病学 心臓病学
- バイオマーカーの発見
- 緊急医療 緊急医療
背景:
- 現在のガイドラインでは,急性冠動脈症候群 (ACS) の評価のための99パーセントの心臓トロポニン検査を推奨しています.
- 従来のトロポニン測定は,これらの低い診断レベルでは,しばしば必要な精度が欠けている.
研究 の 目的:
- 胸痛を呈する患者の高感度トロポニンT (hsTnT) アッセイのパフォーマンスを評価する.
- ACS検出のための従来のトロポニンT法とhsTnTを比較する.
- hsTnTレベルと心臓の構造/機能の関係を探求する.
主な方法:
- 横断的な研究では,胸痛と低〜中程度のACSの可能性のある377人の患者が登録されました.
- 血液サンプルは,商業化前のhsTnTアッセイと従来のトロポニンT法を使用して分析されました.
- 患者はまた,心臓の評価のために冠動脈コンピュータトモグラフィー血管図 (CCTA) を受けました.
主要な成果:
- hsTnTアッセイは,99thパーセンチルの切断点 (13pg/mL) でACSに対して62%の感度と89%の特異性を示した.
- hsTnTは,従来の方法 (P=.001) よりも27%多くのACS症例を検出しました.
- hsTnTの上昇はACS (OR 9.0) を強く予測し,冠動脈疾患の重症度および左心室異常と相関していた.
結論:
- hsTnTアッセイは,胸痛の患者でACSを診断するための良好な感度と特異性を提供します.
- hsTnT値の上昇は,ACSの診断に関係なく,心筋梗塞の損傷および重要な構造性心疾患の兆候です.
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