Significance of emergency observation time of measurement with high-sensitive troponin T in patients with chest pain / 实用医学杂志

Objective To investigate the value of emergency observation time of chest pain patients for ruling-out myocardial infarction by using high-sensitive troponin T. Method Total 1 687 patients with chest pain from December 2015 to August 2016 visiting Sichuan University Huaxi Hospital emergency department were en-rolled.We included 1082 patients who diagnose with AMI finally.We define the time from the start of the chest pain to visiting the emergency as the onset time.We analyzed the level of high-sensitive troponin T of AMI patients at dif-ferent onset time and calculated the rate of patients with hs-cTnT level lower than the conventional hs-cTnT thresh-old of 14 ng/L. Result Among 1082 cases of AMI patients,32 patients with hs-cTnT level below threshold(14 ng/L).The for whose The onset time over 5h was observed in AMI patients with hs-cTnT level over 14 ng/L.Con-clusion AMI can not be excluded in chest pain patients whose hs-cTnT levels below the conventional threshold value of 14 ng/L,and these people should be dynamically monitored for 5h in emergency department.The patients can exclude AMI if the hs-cTnT levels are below 14 ng/L after 5 hours.

Clinical Evaluation of High-Sensitive Troponin T in Acute Myocardial Infarction / 实用医学杂志

Objective To investigate the diagnostic value of High-Sensitive Troponin T(hs-TnT)in acute myocardial infarction(AMI). Methods One hundred and sixty nine patients with serum hs-TnT concentration≥0.014 μg/L in early hospitalization were enrolled in this study.The ROC curve was used to compare the concentra-tion of hs-TnT with four heart enzyme(CK,CK-MB,LDH,AST)on the diagnostic efficacy to AMI. The differ-ence of hs-TnT in different clinical data groups were investigated using Mann-Whitney U rank test.Then the correla-tion between hs-TnT and Gensini score of Coronary angiography was investigated using the Spearman rank correla-tion test.Results The concentration of hs-TnT in patients with chest pain was significantly higher than that in non-AMI group(P<0.05).The AUC of each ROC curve was hs-TnT(0.806)>CK-MB(0.792)>CK(0.780)>AST (0.704)> LDH(0.684). The optimal diagnostic point of hs-TnT was 0.152 ug/L(sensitivity 0.659,specificity 0.894,Yuden index 0.553).There was a positive correlation between hs-TnT and Gensini scores in men,age>65 years old and the chest tightness group(P < 0.05). Conclusion The hs-TnT is better than four heart enzyme in early diagnosis of AMI and benefit early treatment of AMI.

The significance of detection of high sensitive troponin T and creatine kinase isoenzyme in diagnosis of pediatric myocarditis / 中国基层医药

Objective To learn the significance of detection of high sensitive troponin T and creatine kinase isoenzyme in diagnosis of pediatric myocarditis.To provide reliable laboratory diagnosis method for the disease.Methods 23 cases of pediatric myocarditis,28 cases of viral myocarditis with capillary bronchitis and 61.cases of myocarditis with neonatal pneumonia were selected as the research objects;and 48 cases of healthy control group,55 cases of capillary bronchitis and 49 cases of neonatal pneumonia were also selected.Blood samples were collected from all the patients and healthy controls,and the levels of high sensitive serum troponin T and creatine kinase isoenzyme were also measured.Results There was no significant difference in the detection results of high sensitive troponin T and creatine kinase isoenzyme between the healthy control group,children with capillary bronchitis and neonatal pneumonia (all P ＞ 0.05);high sensitive troponin T and creatine kinase isoenzyme detection results of myocarditis,myocarditis complicated with bronchiolitis,myocarditis complicated with neonatal pneumonia were higher than those in healthy control group,the differences were statistically significant (t =13.723,6.628,10.079,9.475,17.650,15.364,all P ＜ 0.05).The abnormal rates of combined detection of children with myocarditis,myocarditis combined with capillary bronchitis,myocarditis combined with neonatal pneumonia were higher than those of single detection of high sensitive troponin T and single detection of creatine kinase isoenzyme (x2 =7.426,6.310,6.720,4.308,4.381,6.900,all P ＜0.05).The high sensitive troponin T and creatine kinase isoenzyme in the children with the age of 1-12 months and 1-3 were lower than those with the age of ＜ 1 month,the differences were statistically significant (t =3.498,4.043,4.202,4.132,all P ＜ 0.05).Conclusion The simultaneous detection of high sensitive troponin T and creatine kinase isoenzyme can be used in the diagnosis of pediatric myocarditis,with good clinical application value.

Evaluación de un nuevo algoritmo diagnóstico para el síndrome coronario agudo con determinación de troponina T de alta sensibilidad / Evaluation of a New Diagnostic Algorithm for Acute Coronary Syndrome Using High-Sensitivity Troponin T Assay

Introducción El dolor precordial representa el 5% al 10% de las consultas anuales en los departamentos de emergencias; su diagnóstico suele ser dificultoso y a ello se le suma el problema que implican la externación de pacientes con patología coronaria aguda o las internaciones innecesarias. Esto ha llevado al desarrollo de diferentes sistemáticas para la evaluación de estos pacientes. Objetivo Validar en términos de seguridad y tiempos de estadía hospitalaria un nuevo algoritmo incorporado en nuestro centro que incluye la medición de troponina T de alta sensibilidad en pacientes con sospecha de síndrome coronario agudo. Material y métodos Se incluyeron 528 pacientes que consultaron en el servicio de emergencias con sospecha de síndrome coronario agudo y se les realizó el protocolo de unidad de dolor. Se analizaron variables clínicas, de laboratorio y el resultado de las pruebas funcionales efectuadas. En todos los pacientes se efectuó seguimiento a los 30 días. Resultados El 90,7% de los pacientes fueron externados luego de la observación y al seguimiento el 1,25% había presentado un evento cardíaco, representado por angioplastia coronaria e internación por síndrome coronario agudo; la especificidad del algoritmo global para el diagnóstico de síndrome coronario agudo fue del 97% y el valor predictivo negativo fue del 99%. El tiempo de estadía en el servicio de emergencias del total de los pacientes fue de 4,5 ± 2,5 horas. Conclusión El nuevo algoritmo incorporado en nuestro centro con determinación de troponina T de alta sensibilidad en pacientes con sospecha de síndrome coronario agudo demostró que es seguro al evitar la externación de pacientes que cursaban un síndrome coronario agudo y, a la vez, requiere una corta estadía hospitalaria en el servicio de emergencias.

Introduction Chest pain represents 5 to 10% of annual visits to emergency departments. Its diagnosis is sometimes difficult, with the added problem of inappropriate discharge of patients with acute coronary syndrome or unnecessary hospitalizations. This has led to the development of different algorithms for the evaluation of these patients. Objective The aim of this study was to validate, in terms of safety and length of hospital stay, a novel algorithm incorporated in our center, which includes measurement of high-sensitivity troponin T in patients with suspected acute coronary syndrome. Methods The study included 528 consecutive patients attending the emergency department with suspected acute coronary syndrome and evaluated according to the chest pain unit protocol. Clinical and laboratory variables and functional tests were analyzed. Follow-up at 30 days was performed in all the patients. Results After observation, 90.7% of the patients were discharged and 1.25% presented a cardiovascular event during follow-up, represented by percutaneous coronary intervention and hospitalization due to acute coronary syndrome. The specificity of the global algorithm for the diagnosis of acute coronary syndrome was 97% with a negative predictive value of 99%. Emergency department length of stay was 4.5 ± 2.5 hours for all the patients. Conclusion The novel algorithm incorporated in our center with measurement of high-sensitivity troponin T in patients with suspected acute coronary syndrome has proved to be safe, as it prevents the discharge of patients with acute coronary syndrome and at the same time reduces emergency department length of stay.

Valor en la práctica diaria de la troponina T ultrasensible para el diagnóstico de infarto de miocardio / The value in daily practice of high sensitive troponin T for myocardial infarction diagnosi / Valor na prática diária da troponina T ultra-sensível para o diagnóstico de infarto do miocárdio

Introducción. La troponina T ultrasensible (TnTus) es un biomarcador útil para la valoración del dolor precordial. Sin embargo, es frecuente su incremento en pacientes sin diagnóstico de síndrome coronario agudo. El objetivo de este trabajo fue evaluar la utilidad de diferentes estrategias de uso de TnTus para el diagnóstico de infarto agudo de miocardio (IAM). Material y método. Estudio retrospectivo que incluyó 99 pacientes consecutivos con sospecha de IAM ingresados a la unidad coronaria, con al menos una determinación de TnTus dentro de las 4-6 horas del inicio del dolor o admisión. El diagnóstico final de IAM fue realizado por dos médicos expertos que analizaron los datos clínicos, laboratorio e imágenes. Resultados. La edad media fue de 64 años y el 75% fueron varones. De acuerdo al diagnóstico final se clasificaron como IAM: el 58%. La TnTus basal mostró un área bajo la curva COR de 0,86 y el punto de corte de 30 ng/L tuvo sensibilidad del 86% y especificidad del 71% para diagnóstico de IAM, mientras que para el valor >14 ng/L, la sensibilidad y especificidad fueron del 93 y 34%, respectivamente. Las áreas bajo la curva para la variación absoluta y porcentual de TnTus (basal y segunda determinación) fueron 0,69 y 0,68, identificándose puntos de corte de 10 ng/L y 15%, respectivamente (sensibilidad 60 y 63%, especificidad del 74 y 74%). Conclusiones. La medición temprana de TnTus>14ng/L muestra la mejor sensibilidad para el diagnóstico de IAM, mientras que un valor >30ng/L fue más específico. La medición repetida del biomarcador mostró menor utilidad.

Background. High-sensitive troponin T (hs-TnT) is a useful biomarker in the assessment of chest pain. However, it could be frequently elevated in patients without acute coronary syndrome. We sought to evaluate the usefulness of different strategies using hs-TnT for diagnosis of acute myocardial infarction (AMI). Material and method. Retrospective study including 99 consecutive patients with suspected AMI admitted to the coronary care unit with at least one determination of hs-TnT within 4-6 hours of onset of pain or admission. The final diagnosis of AMI was made by two medical experts who analyzed the clinical, laboratory and imaging. Results. The mean age was 64 years and 75% were male. According to the final diagnosis were classified as AMI 58%. The basal hs-TnT showed an area under the ROC curve of 0.86 and the cut-off of 30 ng/L had a sensitivity of 86% and specificity of 71% for diagnosis of AMI, whereas the value >14 ng/L had a sensitivity and specificity of 93 and 34%, respectively. The areas under the curve for the absolute and percentage changes of hs-TnT (basal and second determination) were 0.69 and 0.68, identifying cut-offs of 10 ng/L and 15%, respectively (sensitivity 60 and 63%, specificity of 74 and 74%). Conclusions. Early measurement hs-TnT>14ng/L shows the best sensitivity for the diagnosis of AMI, while a value >30ng/L was more specific. Repeated measurements of biomarker showed less useful.

Introdução. A troponina ultra-sensível (TnTus) é um biomarcador útil na avaliação de dor de peito. Além disso, seu crescimento é comum em pacientes sem diagnóstico da síndrome coronariana aguda. O objeto desta investigação foi avaliação da utilidade de diferentes estratégias de TnTus empregadas para o diagnóstico do infarto agudo do miocárdio (IAM). Material e método. Foi realizado um estudo retrospectivo incluindo 99 pacientes consecutivos com suspeita de IAM admitidos na unidade coronariana com pelo menos uma determinação TnTus dentro de 4-6 horas após o início da dor ou da admissão. O diagnóstico final de IAM foi conferido por dois médicos especialistas que analisaram o quadro clínico, laboratorial e de imagem. Resultados. A idade média foi de 64 anos, e 75% foram de sexo masculino. Cinqüenta e oito porcento dos IAM diagnosticado a traveis da TnTus foram conferidos pelos especialistas. A TnTus basal mostrou área embaixo da curva ROC de 0,86 e o corte de 30 ng/L com uma sensibilidade de 86% e especificidade de 71% para o diagnóstico de IAM, mas também o valor >14ng/L teve uma sensibilidade e especificidade de 93 e 34% respectivamente. As áreas sob a curva para o percentual absoluto e de mudança de TnTus (basal e segunda determinação) foram 0,69 e 0,68 com uma sensibilidade de 60 e 63% e especificidade de 74 e 74% respectivamente. Não só, os pontos de inflexão foram de 10 ng/L e 15%, respectivamente (sensibilidade de 60 e 63%, especificidade 74 e 74%). Conclusões. A medição precoce de TnTus >14ng/L mostrou a melhor sensibilidade para o diagnóstico de IAM, mais também um valor >30 ng/L teve mais especificidade em nossa série. As determinações repetidas não melhoraram a utilidade do biomarcador.