年龄对心肌梗塞诊断的影响
Matthew T H Lowry1, Dimitrios Doudesis1,2, Ryan Wereski1
1BHF Centre for Cardiovascular Science (M.T.H.L., D.D., R.W., D.M.K., C.T., A.V.F., A.B., C.T., K.K.L., A.R.C., D.E.N., N.L.M., A.A.), University of Edinburgh, UK.
Circulation
|September 15, 2022
概括
在老年人中,心肌梗塞的心脏素测试精度下降. 标准值显示老年患者的特异性降低和积极的预测价值,需要个性化诊断策略.
科学领域:
- 心脏病学
- 医疗诊断
- 老年医学
背景情况:
- 心脏素是诊断心肌梗塞 (MI) 的关键生物标志物.
- 标准的诊断值是基于健康人群的99分位数.
- 患者年龄显著影响托波宁度,影响诊断的准确性.
研究的目的:
- 在怀疑心肌梗塞的老年人中评估心脏素测试的诊断性能.
- 评估年龄对心脏素测试的敏感性和特异性的影响.
- 将指导方针推的临界值与不同年龄组的MI诊断临界值进行比较.
主要方法:
- 涉及疑似心肌梗塞患者的多中心试验的二次分析.
- 在三个年龄组中评估高灵敏性心脏素I诊断准确性:< 50,50-74岁和≥75岁.
- 使用指南推的性别和年龄调整的第99百分点值进行分析.
主要成果:
- 在46435名患者中,心脏病发病率为11%.
- 使用指导值,对心脏病发作的敏感性在各年龄段 (79. 2% 至 81. 6%) 均相似.
- 随着年龄的增长,特异性显著下降,从50岁以下的98. 3%降至75岁以上的82. 6%.
结论:
- 年龄显著影响心脏热的诊断性能,降低了老年患者的特异性和积极预测值.
- 无论是指导方针推的还是年龄调整的门,都无法完全克服与年龄相关的诊断精度下降.
- 在老年人群中需要个性化诊断方法,而不是仅仅调整二元值.
相关概念视频
Acute Coronary Syndrome III: Diagnostic Studies
21
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
21
Myocarditis II: Clinical Features and Diagnostic Tests
19
Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
19
Myocarditis I: Introduction
23
Myocarditis is inflammation of the myocardium, which is the muscular layer of the heart.EtiologyMyocarditis has a diverse etiology, including a wide range of infectious and non-infectious causes:Infectious CausesViral: Common viruses include Coxsackie A and B, adenovirus, parvovirus B19, enteroviruses, and influenza A.Bacterial: Examples include infections caused by Streptococcus, Staphylococcus, and Mycoplasma species.Rickettsial: Infections like Rocky Mountain spotted fever can result in...
23
Ischemic Heart Disease: Overview
1.4K
Ischemic heart disease occurs when the heart's blood supply dwindles, causing an ominous lack of oxygen and nutrients. This deficiency, stemming from reduced or obstructed blood flow, spells danger, leading to heart muscle damage and dysfunction.
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
1.4K
Coronary Artery Disease I: Introduction
47
Coronary Artery Disease (CAD): An Overview with Scientific InsightsCoronary Artery Disease (CAD), often referred to as C-A-D, is a prevalent blood vessel disorder classified under the broader category of atherosclerosis. Atherosclerosis is a pathological process characterized by the hardening and narrowing of arteries due to the accumulation of atherosclerotic plaques. These plaques are composed of cholesterol, fatty substances, inflammatory cells, calcium, and fibrin, reducing blood flow to...
47
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
36
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
36


