[Relation between intermediate troponin T values and diagnosis of cardiac disease]. / Relación de los valores intermedios de troponina T con el diagnóstico de enfermedad cardíaca.

BACKGROUND AND OBJECTIVE: Troponins are useful tools in management of patients with acute coronary syndrome (ACS). Small increases do not guarantee a desirable precision (CV < 10%) and there is a "grey zone" between 99 percentile and clinical cut off. Our objective was to evaluate if "grey zone" troponin values reflect heart damage or they are only "analyzer noise". PATIENTS AND METHOD: Final diagnoses of patients with "grey zone" values attended during 2001 and 2002 were reviewed (group Tn). Control group (Cn): patients with negative values (four months randomly chosen during the same period). Admitted patients were classified in: A, ACS; B, non ischemic heart disease, and C, non heart disease. RESULTS: Tn group (n = 521): admitted, 330 (63.3%); A (53.9%), B (30.9%), C (15.2%). Cn group (n = 652): admitted, 156 (23.9%); A (41%), B (24.4%), C (34.6%). Odds ratio for admittance (Tn vs Cn) was 4.82 (95% CI, 3.68-6.31); OR for diagnosis A, B and C (Tn vs Cn) were: A (1.56) (95% CI, 1.04-2.34), B (1.43) (95% CI, 0.90-2.25), C (0.38) (95% CI, 0.24-0.6). CONCLUSIONS: Intermediate troponin values are associated with diagnosis of heart disease, especially ACS.

Relación de los valores intermedios de troponina T con el diagnóstico de enfermedad cardíaca / Relation between intermediate troponin T values and diagnosis of cardiac disease

FUNDAMENTO Y OBJETIVO: Las troponinas son útiles en el diagnóstico del síndrome coronario agudo (SCA). Pequeños incrementos no garantizan la imprecisión recomendable (CV < 10%).Así, existe una «zona gris» de valores intermedios entre el valor superior de la normalidad yel punto de corte de decisión clínica. Evaluamos si estos valores de cTnT reflejan lesión miocárdica o son «ruido» del analizador. PACIENTES Y MÉTODO: Estudiamos a pacientes de urgencias con valores intermedios de cTnT durante 2001-2002 (grupo Tn). Grupo control (Cn): muestra de pacientes del mismo período con cTnT negativa. Grupos diagnósticos finales: A, relacionados con SCA; B, relacionados con patología cardíaca no isquémica; C, enfermedades no cardíacas. RESULTADOS: Grupo Tn (n = 521): ingresos, 330(63,3%); A (53,9%), B (30,9%), C (15,2%).Grupo Cn (n = 652): ingresos, 156 (23,9%); A(41%), B (24,4%), C (34,6%). Odds ratio para ingresos en grupo Tn frente al Cn, 4,82 (IC del95%, 3,68-6,31); para los diagnósticos: A 1,56(IC del 95%, 1,04-2,34), B 1,43 (IC del 95%,0,90-2,25), C 0,38 (IC del 95%, 0,24-0,6).CONCLUSIONES: Los valores intermedios de cTnT se asocian con patología cardíaca, especialmente SCA

BACKGROUND AND OBJECTIVE: Troponins are useful tools in management of patients with acute coronary syndrome (ACS). Small increases do not guarantee a desirable precision (CV < 10%) and there is a «grey zone» between 99 percentile and clinical cut off. Our objective was to evaluate if «grey zone» troponin values reflect heart damage or they are only «analyzer noise». PATIENTS AND METHOD: Final diagnoses of patients with «grey zone» values attended during2001 and 2002 were reviewed (group Tn).Control group (Cn): patients with negative values(four months randomly chosen during the same period). Admitted patients were classifiedin: A, ACS; B, non ischemic heart disease, and C, non heart disease. RESULTS: Tn group (n = 521): admitted, 330(63.3%); A (53.9%), B (30.9%), C (15.2%).Cn group (n = 652): admitted, 156 (23.9%);A (41%), B (24.4%), C (34.6%). Odds ratio for admittance (Tn vs Cn) was 4.82 (95% CI,3.68-6.31); OR for diagnosis A, B and C (Tnvs Cn) were: A (1.56) (95% CI, 1.04-2.34), B(1.43) (95% CI, 0.90-2.25), C (0.38) (95%CI, 0.24-0.6).CONCLUSIONS: Intermediate troponin values are associated with diagnosis of heart disease, especially ACS