Troponin T Measurements by High-Sensitivity vs Conventional Assays for Risk Stratification in Acute Dyspnea

被引：23

作者：

van Wijk, Sandra ^{[1
]}

Jacobs, Leo ^{[2
]}

Eurlings, Luc W. ^{[1
]}

van Kimmenade, Roland ^{[1
]}

Lemmers, Roosmarijn ^{[1
]}

Broos, Pieter ^{[1
]}

Bekers, Otto ^{[2
]}

Prins, Martin H. ^{[3
]}

Crijns, Harry J. ^{[1
]}

Pinto, Yigal M. ^{[4
]}

van Dieijen-Visser, Marja P. ^{[2
]}

Brunner-La Rocca, Hans-Peter ^{[1
]}

机构：

[1] Maastricht Univ, Med Ctr, CARIM, Dept Cardiol, P Debeyelaan 25,POB 5800, NL-6202 AZ Maastricht, Netherlands

[2] Maastricht Univ, Med Ctr, CARIM, Dept Clin Chem, NL-6202 AZ Maastricht, Netherlands

[3] Maastricht Univ, Med Ctr, CARIM, Dept Epidemiol, NL-6202 AZ Maastricht, Netherlands

[4] Univ Amsterdam, Acad Med Ctr, Heart Failure Res Ctr, NL-1105 AZ Amsterdam, Netherlands

来源：

CLINICAL CHEMISTRY | 2012年 / 58卷 / 01期

关键词：

CARDIAC TROPONIN; NATRIURETIC PEPTIDE; PROGNOSTIC VALUE; HEART-FAILURE; MORTALITY; ASSOCIATION; ELEVATIONS; DIAGNOSIS; DISEASE; PATIENT;

D O I：

10.1373/clinchem.2011.175976

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: Cardiac troponin T measured by a high-sensitivity assay (hs-cTnT) recently proved to be of prognostic value in several populations. The hs-cTnT assay may also improve risk stratification in acute dyspnea. METHODS: We prospectively studied the prognostic value of hs-cTnT in 678 consecutive patients presenting to the emergency department with acute dyspnea. On the basis of conventional cardiac troponin T assay (cTnT) and hs-cTnT assay measurements, patients were divided into 3 categories: (1) neither assay increased (cTnT < 0.03 mu g/L, hs-cTnT < 0.016 mu g/L), (2) only hs-cTnT increased < 0.016 mu g/L (cTnT < 0.03 mu g/L), and (3) both assays increased (cTnT < 0.03 mu g/L, hs-cTnT < 0.016 mu g/L). Moreover, the prognostic value of hs-cTnT was investigated if cTnT was not detectable (< 0.01). RESULTS: One hundred seventy-two patients were in the lowest, 282 patients in the middle, and 223 patients in the highest troponin category. Patients in the second and third categories had significantly higher mortality compared to those in the first category (90-day mortality rate 2%, 10%, and 26% in groups 1, 2, and 3, respectively, P < 0.001; 1-year mortality rate 9%, 21%, and 39%, P < 0.001). Importantly, in patients with undetectable cTnT (n = 347, 51%), increased hs-cTnT indicated worse outcome [ 90-day mortality, odds ratio 4.26 (95% CI 1.19-15.21); 1-year mortality, hazard ratio 2.27 (1.19-4.36), P = 0.013], whereas N-terminal pro-brain-type natriuretic peptide (NT-proBNP) was not predictive of short-term outcome. CONCLUSIONS: hs-cTnT is associated with mortality in patients presenting with acute dyspnea. hs-cTnT concentrations provide additional prognostic information to cTnT and NT-proBNP testing in patients with cTnT concentrations below the detection limit. In particular, the hs-cTnT cutoff of 0.016 mu g/L enables identification of low-risk patients. (C) 2011 American Association for Clinical Chemistry

引用

页码：284 / 292

页数：9

共 30 条

[1] Long-term prognostic value of B-type natriuretic peptide in cardiac and non-cardiac causes of acute dyspnoea [J].