Higher sensitivity troponin levels in the community: what do they mean and how will the diagnosis of myocardial infarction be made?

نویسنده

  • Harvey D White
چکیده

Troponins are the preferred markers for risk stratification of patients with acute coronary syndromes and for making the diagnosis of myocardial infarction (MI). They guide the selection of antithrombotic therapy and selection of an invasive strategy. They are also indicative of myocyte necrosis in a number of other clinical situations such as pulmonary embolism, myopericarditis, heart failure, and renal failure. In this issue of the Journal (Am Heart J 2010;159:9728), Otsuka et al report the first study evaluating high-sensitivity (hs) troponins in a healthy population and correlate levels with cardiovascular disease (CVD) risk factors and the Framingham risk score. The hsTroponin T levels were measured in 1,072 middle-aged (aged between 35 and 63, mean age 44 years) Japanese men working at a company making precision instruments. Individuals with a history or presence of CVD were excluded, as was a patient who had received hemodialysis. Detectable levels, using a lower limit of detection of hsTroponin T of 0.002 ng/mL, were found in 80.9% of participants. It is noted that a recent analytical validation article has defined the detection limit as a 0.003 ng/mL. Also, it is better to use whole numbers to avoid errors, due to possible confusion of decimal places, and to use SI units. Therefore, the lower limit of detection used in this study should be 2 ng/L. A hsTroponin level of 20 ng/L was the highest value measured. As hsTroponin T measures 23 ng/L higher than the contemporary fourth-generation troponin T test the comparative cutpoint of 0.03 μg/L for the diagnosis of MI with the fourth-generation troponin T based on the 99th percentile becomes 0.053 μg/L or 53 ng/L. In this study this level was not found with the contemporary fourth-generation troponin T assay in any participant. The hsTroponin T levels were associated with several CVD risk factors including age, blood pressure, estimated glomerular filtration rate, current smoking, left ventricular hypertrophy, and C-reactive protein (CRP) levels.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

The most sensitive double-marker method of cardiac isoenzymes of creatinine kinase, troponin I, and myoglobin in different time periods for diagnosing acute myocardial infarction

  Purpose: Myocardial infarction is among the most common diagnoses in patients admitted   to hospitals in western countries, and its rapid diagnosis is of utmost importance. This study   was conducted to determine the most sensitive double-marker cardiac isoenzyme of creatinine   kinase, troponin I, and myoglobin for diagnosing acute myocardial infarction.   Materials and Methods: This was an ...

متن کامل

An Aptamer-based Biosensor for Troponin I Detection in Diagnosis of Myocardial Infarction

Background: Acute myocardial infarction (MI) accounts for one third of deaths. Cardiac troponin I (TnI) is a reliable biomarker of cardiac muscle tissue injury and is employed in the early diagnosis of MI.Objectives: In this study, a molecular method is introduced to early diagnosis of MI by rapid detection of TnI.Materials and Methods: The detection method was based on electrochemical aptasens...

متن کامل

study of platelet parameters in the patients with acute myocardial infarction referred to Ali Shariati Hospital in 2018

Introdution: The rapid and accurate diagnosis of acute myocardial infarction is essential for effective treatment. Recently, troponin has been introduced as a biochemical marker for early diagnosis of acute myocardial infarction. Platelet parameters (P-LCR, MPV, PDW) play a key role in the pathophysiology of acute coronary syndrome. The aim of this study was to evaluate platelet indexes in the ...

متن کامل

Comparison of pregnancy-associated plasma protein-A, troponin and creatine kinase-MB levels in acute coronary syndrome

Background: Early diagnosis and proper treatment of patient with acute coronary syndrome (ACS) and ischemic heart disease are important in determining prognosis, preventing adverse effects, and may even save lives. In this study, the level of pregnancy-associated plasma protein-A (PAPP-A) in ACS patients was compared with the control group, in addition to cardiac Troponin (cTn) and creatine kin...

متن کامل

Cardiac enzyme in emergency medicine

Objective: Acute chest pain is an important and frequently occurring symptom in patients. Chest pain is often a sign of ischemic heart disease. Chest pain due to suspected Acute Coronary Syndrome (ACS) is responsible for a large and ijncreasing number of hospital attendances and admissions. Current practice for suspected ACS involves troponin testing 10–12 hours after symptom o...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • American heart journal

دوره 159 6  شماره 

صفحات  -

تاریخ انتشار 2010