High sensitive troponin T in individuals with chest pain of presumed ischemic origin (original) (raw)
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Journal of Evidence Based Medicine and Healthcare, 2016
INTRODUCTION Myocardial infarction is a common and severe manifestation of ischaemic heart disease (IHD). Acute myocardial infarction (AMI) is the result of death of heart muscle cells following either from a prolonged or severe ischaemia. The World Health Organisation emphasises IHD as our "Modern Epidemic" and AMI as common cause of sudden death. AIM The present study has been undertaken with the aim to assess the role of cardiac Troponin-T in early diagnosis of AMI and to evaluate its positive roles over CK-MB and LDH enzyme assays. The study also aims to find out the role of cardiac Troponin-T test, where ECG changes are nondiagnostic and inconclusive for AMI. MATERIAL & METHOD One hundred cases of provisionally diagnosed AMI, who were admitted during June 2012 to July 2015 in ICC Unit of TMC & Dr. BRAM Teaching Hospital, formed the subjects for the study. Those patients reported 2 to 10 hours after onset of chest pain were included in this study. Patients reported beyond 10 hours after onset of chest pain of AMI cases and patients having chest pain of non-AMI causes are excluded from the study. The provisional diagnosis of AMI was done on the basis of the history, chest pain, clinical findings and ECG changes. Trop-T test (Troponin-T sensitive rapid test by Muller Bardoff, et al, 1991) as well as CK-MB (creatine kinase-MB isoenzymeassays were performed immediately for each and every patient. Trop-T test was repeated in some selective cases where the early changes were insignificant and the results were compared with those of CK-MB, at different period of the disease onset. RESULTS The rapid cardiac Troponin-T test (CTn-T) has 100% specificity for AMI whereas CK-MB and LDH have specificities of 80% and 60% respectively. The CTn-T has diagnostic efficiency of 92% for AMI but ECG has only 69% sensitivity and 80% specificity. The overall diagnostic efficacy of cardiac Troponin-T is higher than that of CK-MB, LDH and ECG (94% versus 92%, 91 % and 72% respectively). So, cardiac Troponin-T test done between 4 to 10 hours following onset of the disease is an excellent marker for evaluating chest pain of AMI or ACS. CONCLUSION It is therefore, concluded that cardiac Troponin-T test done between 4 to 10 hours following onset of the disease is an excellent marker for evaluating chest pain of AMI or ACS.
Early Diagnostic Efficiency of Cardiac Troponin I and Troponin T for Acute Myocardial Infarction
Academic Emergency Medicine, 1997
Objective: To compare the early diagnostic efficiency of the cardiac troponin I (cTn-I) level with that of the cardiac troponin T (cTn-T) level, as well as the creatine kinase (CK), CK-MB, and myoglobin levels, for acute myocardial infarction (AMI) in patients without an initially diagnostic ECG presenting to the ED within 24 hours of the onset of their symptoms. Methods: A prospective, observational, cohort study was performed involving chest pain patients admitted to a large urban community hospital. Participants were consecutive consenting ED chest pain patients 230 years of age. Exclusions included duration of symptoms >24 hours, inability to complete data collection, receipt of CPR, and ST-segment elevation on the initial ECG. Measurements included levels of cTn-I, cTn-T, CK, CK-MB, and myoglobin at the time of presentation and 1, 2, 6, and 12-24 hours after presentation as well as presenting ECG and clinical follow-up. Confirmation of the diagnosis of AM1 was based on World Health Organization criteria. Results: Of the 177 patients included in the study, 27 (15%) were diagnosed as having AMIs. The sensitivities of all 5 biochemical markers for AM1 were poor at the time of ED presentation (3.7-33.3%) but rose significantly over the study period. The sensitivity of cTn-T was significantly better than that of cTn-I over the initial 2 hours, but both markers' sensitivities were low (<60%) during this time frame. The cTn-I was significantly more specific for AM1 than was the cTn-T, but not significantly better than CK-MB or myoglobin. Likelihood ratio analysis showed that the biochemical markers with the highest positive likelihood ratios for AM1 during the first 2 hours following ED presentation were myoglobin and CK-MB. From 6 through 24 hours, the positive likelihood ratios for cTn-I, CK-MB, and myoglobin were superior to those of CK and cTn-T. Conclusions: cTn-I, CK-MB, and myoglobin are significantly more specific for AM1 than are CK and cTn-T. Myoglobin is the biochemical marker having the highest combination of sensitivity, specificity, and negative predictive value for AM1 within 2 hours of ED presentation. Neither cTn-I nor cTn-T offers significant advantages over myoglobin and CK-MB in the early (1 2 hours) initial screening for AMI. The cardiac troponins are of benefit in identifying AM1 2 6 hours after presentation.
Diagnostic Efficiency and Prognostic Value of Troponin T Measurement in Acute Myocardial Infarction
2014
The diagnosis and prognosis of patients hospitalized with acute myocardial ischemia is quite variable. We examined the value of serum levels of cardiac Troponin T, serum CK-MB levels for detection of ischemic myocardial injury and risk stratification within 40 days in patients with acute myocardial ischemia with one specimen taken 2-8 hours of the onset of symptoms. Methods We studied 141 patients with a diagnosis of acute ischemic myocardial injury. The concentration of TnT and CK-MB is made on Coobas 6000 by a electrochemioluminescence and turbidometric methods. Results The median duration of the ischemic episodes qualifying the patients for the study was 4 hours. Chest pain was continuous in 51.8% and intermittent in 48.2%. Troponin T levels were elevated in 47 % of the patients whose ischemic symptoms had lasted more than seven hours (p= 0.06). 33% of the patients had the elevated troponin T level but CK-MB level was normal. Mortality within 40 days was significantly higher in t...
The American Journal of Cardiology, 2013
Improvement of prehospital triage is essential to ensure rapid management of patients with acute myocardial infarction (AMI). This study evaluates the feasibility of prehospital quantitative point-of-care cardiac troponin T (POC-cTnT) analysis, its ability to identify patients with AMI, and its capacity to predict mortality. The study was performed in the Central Denmark Region from May 2010 to May 2011. As a supplement to electrocardiography, a prehospital POC-cTnT measurement was performed by a paramedic in patients with suspected AMI. AMI was diagnosed according to the universal definition of myocardial infarction using the ninety-ninth percentile upper reference level as diagnostic cut point. The paramedics performed POC-cTnT measurements in 985 subjects with a symptom duration of 70 minutes (95% CI, 35 to 180); of whom, 200 (20%) had an AMI. The prehospital sample was obtained 88 minutes (range, 58 to 131) before the sample made on admission to the hospital. The sensitivity for detection of patients with an AMI was 39% (95% CI, 32% to 46%) and the diagnostic accuracy of the POC-cTnT values was 0.67 (95% CI, 0.64 to 0.71). Adjusted survival analysis showed a strong significant association between elevated prehospital POC-cTnT level above the detection level of 50 ng/L and mortality in patients with a suspected AMI irrespective of whether an AMI was diagnosed.
Cardiac troponin I: the gold standard in acute myocardial infarction diagnosis
Bosnian journal of basic medical sciences / Udruženje basičnih mediciniskih znanosti = Association of Basic Medical Sciences, 2003
Cardiovascular diseases are leading cause of morbidity in the world. Measurement of the level of biochemical markers in the serum is one of World Health Organisation (WHO) criteria in diagnosing acute myocardial infarction (AMI). Non-specific clinical state of patients and insufficiently sensitive electrocardiographic (ECG) diagnostics, at patient's hospital admission time, point out the importance of biochemical markers in acute myocardial infarction diagnosis. Technology development and new diagnostic methods lead to the invention of highly sensitive and specific marker as myocardial damage evidence. Cardiac Troponin I (cTnI) is specific marker for myocardial damage1. Its elevation in the serum within myocardial ischemia symptomatology is important in diagnosis of myocardial infarction.
Myocardial Infarction Diagnosis and Cardiac Troponins
TURKISH MEDICAL STUDENT JOURNAL, 2020
Acute myocardial infarction is a condition that develops due to the blockage of blood flow to the heart. Serial electrocardiography follow-up should be performed in patients with suspected acute myocardial infarction, serum cardiac troponin levels should be measured, and this measurement should be repeated at regular intervals. Cardiac troponins are the main markers for the diagnosis of acute myocardial infarction, as they are sensitive and specific biochemical markers of myocardial cell necrosis. Elevated levels of cardiac troponins indicate cardiac damage, but it does not explain the cause of the damage. Increases in cardiac troponin levels can be observed in many different disease states and do not necessarily indicate acute myocardial infarction. It is necessary to check cardiac troponin levels in a patient admitted to the hospital in order to exclude other diseases before establishing the diagnosis of myocardial infarction. The one-hour "rule-in" and "rule-out" algorithms are used in the tests performed on patients who come to the emergency department with non-ST elevation myocardial infarction. In addition, there are point-of-care cardiac troponin tests that can be used in emergency services and ambulances. However, while using point-of-care cardiac troponin tests for the diagnosis of myocardial infarction, it should be kept in mind that these tests are less sensitive and more costly than tests performed in central laboratories.
Sensitivity and specificity of cardiac troponin-T in diagnosis of acute myocardial infarction
International Journal of Advances in Medicine, 2017
Background: Myocardial Infarction is the irreversible necrosis of the heart muscle secondary to prolong lack of oxygen supply. Troponin T is a structurally bound protein found in striated muscle cells. They have rapidly attained central role in diagnosis, prognostication and planning of therapeutic strategies in MI patients. The objective of this study was to evaluate the status of Troponin T in MI patients and its role in diagnosis compare to normal subjects.Methods: The study was conducted at M. L .N. Medical College, Allahabad, Uttar Pradesh India. A total of 136 cases were included in our study. Out of these, 86 were patients of AMI and 50 were healthy controls. They were evaluated by measurement of various parameters including enzymatic markers such as CPK-MB, SGOT, LDH1, and LDH2 and non-enzymatic markers such as troponin-T and myoglobin. Apart from these, LDL, VLDL and HDL levels were also kept under evaluation.Results: Troponin-T test was better than CPK-MB or SGOT in diagno...
CLINICAL USE OF ULTRA-SENSITIVE TROPONINS IN THE DIFFERENTIAL DIAGNOSIS OF ACUTE MYOCARDIAL INFARCTION (Atena Editora), 2023
Acute Myocardial Infarction (AMI) is when myocardial necrosis occurs through acute obstruction of a coronary artery. Its main symptom is chest pain, which is a sudden constant and constricting pain that can radiate to different parts of the body. It is usually intense and prolonged accompanied by a feeling of heaviness or tightness over the chest. However, other symptoms may occur, such as: dyspnea, nausea and/or diaphoresis. AMI can have major mechanical complications, for example, mitral valve regurgitation with or without papillary muscle rupture; ventricular septal rupture; rupture of the free wall of the ventricle; and left ventricular aneurysm. In order to have the diagnosis of AMI, there is a need to perform an ECG and verify the existence or absence of biomarkers. These biomarkers have the role of reducing the time between the onset of the heart attack and the restoration of myocardial perfusion, thus, they help in the diagnosis of AMI, risk stratification, choice of adequate treatment and prediction of events after Acute Coronary Syndrome (SCA). Among these biomarkers, we can mention the ultrasensitive troponin, which can significantly increase the diagnostic sensitivity when there is a very early phase of myocardial ischemic injury. It is also effective for detecting the risk of mortality and cardiac events in patients with unstable angina, for knowing the size of the infarction after reperfusion and because it is a specific biomarker of cardiac injury when coronary artery bypass grafting is performed.