Combining high-sensitivity cardiac troponin and B-type natriuretic peptide in the detection of inducible myocardial ischemia

被引：14

作者：

Puelacher, Christian ^{[1
]}

Wagener, Max ^{[1
,2
]}

Honegger, Ursina ^{[1
]}

Assadian, Mustafa ^{[1
]}

Schaerli, Nicolas ^{[1
,2
]}

Mueller, Deborah ^{[1
]}

Strebel, Ivo ^{[1
]}

Twerenbold, Raphael ^{[1
,3
]}

Boeddinghaus, Jasper ^{[1
]}

Nestelberger, Thomas ^{[1
]}

Wildi, Karin ^{[1
,3
]}

Sabti, Zaid ^{[1
]}

Sazgary, Lorraine ^{[1
]}

Badertscher, Patrick ^{[1
]}

de Lavallaz, Jeanne du Fay ^{[1
]}

Marbot, Stella ^{[1
]}

Kaiser, Christoph ^{[1
]}

Wild, Damian ^{[4
]}

Zellweger, Michael J. ^{[1
]}

Reichlin, Tobias ^{[1
]}

Mueller, Christian ^{[1
]}

机构：

[1] Univ Basel, Univ Hosp Basel, Dept Cardiol, CRIB, Basel, Switzerland

[2] Univ Basel, Univ Hosp Basel, Dept Internal Med, Basel, Switzerland

[3] Univ Heart Ctr Hamburg, Dept Gen & Intervent Cardiol, Hamburg, Germany

[4] Univ Basel, Univ Hosp Basel, Div Nucl Med, Basel, Switzerland

来源：

CLINICAL BIOCHEMISTRY | 2018年 / 52卷

基金：

瑞士国家科学基金会;

关键词：

Myocardial ischemia; High-sensitivity cardiac troponin; B-type natriuretic peptide; Sensitivity and specificity; TASK-FORCE; DIAGNOSIS; STRESS; MANAGEMENT; GUIDELINE; DISEASE; ASSAY; RISK;

D O I：

10.1016/j.clinbiochem.2017.10.014

中图分类号：

R446 [实验室诊断]; R-33 [实验医学、医学实验];

学科分类号：

1001 ;

摘要：

Background: Single biomarker approaches provide only moderate accuracy in the non-invasive detection of exercise-induced myocardial ischemia. We therefore assessed the combination of the two most promising single biomarkers: high-sensitivity cardiac troponin I (hs-cTnI) and B-type natriuretic peptide (BNP). Methods: Consecutive patients with suspected myocardial ischemia referred to stress myocardial perfusion single-photon emission tomography imaging (MPI) were enrolled. Clinical judgment (CJ) of the treating cardiologist regarding myocardial ischemia, quantified using a visual analogue scale, and blood concentrations of hs-cTnI and BNP were determined before and after stress. The presence of myocardial ischemia was adjudicated by independent cardiologists using MPI, blinded to biomarker measurements. Death and acute myocardial infarction (AMI) during follow-up were the prognostic endpoints. Results: Among 1142 consecutive patients inducible myocardial ischemia was found in 456 (40%) of all patients. For the detection of inducible myocardial ischemia, CJ before exercise stress testing (CJb) showed an area under the receiver-operating-characteristics curve (AUC) of 0.66 (95% CI 0.63-0.69), hs-cTnI 0.70 (95% CI 0.67-0.73, p = 0.07 vs CJb), and BNP 0.66 (95% CI 0.62-0.69, p = 0.98). The use of a dual-biomarker strategy combining hs-cTnI and BNP with CJb did not provide a significant advantage over the combination of hs-cTnI alone and CJb (AUC 0.74, 95% CI 0.72-0.77 vs AUC 0.74, 95% CI 0.71-0.77, p = 0.16). Hs-cTnI showed good prognostic value for AMI (HR 1.6, 95% CI 1.3-1.9), and BNP for death (HR 1.6, 95% CI 1.3-2.1). Conclusion: A dual-biomarker strategy combing BNP and hs-cTnI does not further increase diagnostic accuracy on top of clinical judgment and hs-cTnI alone. Summary and highlights: We included 1142 consecutive patients with suspected inducible ischemia, and evaluated the added value of the biomarkers high-sensitivity cardiac troponin (hs-cTn) and B-type natriuretic peptide (BNP), alone and in combination, on top of clinical judgment.

引用

页码：33 / 40

页数：8

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