Higher sensitivity troponin levels in the community: what do they mean and how will the diagnosis of myocardial infarction be made?
نویسنده
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.
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ورودعنوان ژورنال:
- American heart journal
دوره 159 6 شماره
صفحات -
تاریخ انتشار 2010