Single resting hsTnT level predicts abnormal myocardial stress test in acute chest pain patients with normal initial standard troponin.

Abstract

OBJECTIVES:

The goal of this study was to determine the ability of a single, resting high-sensitivity troponin T (hsTnT) measurement to predict abnormal myocardial perfusion imaging (MPI) in patients presenting with acute chest pain to the emergency department (ED).

BACKGROUND:

HsTnT assays precisely detect very low levels of troponin T, which may be a surrogate for the presence and extent of myocardial ischemia.

METHODS:

We included all patients from the ROMICAT I (Rule Out Myocardial Infarction Using Computer Assisted Tomography) trial, an observational cohort study, who underwent both single-photon emission computed tomography (SPECT)-MPI stress testing and 64-slice computed tomography angiography (CTA) and in whom hsTnT measurements were available. We assessed the discriminatory value of hsTnT for abnormal SPECT-MPI and the association of reversible myocardial ischemia by SPECT-MPI and the extent of coronary atherosclerosis by CTA to hsTnT levels.

RESULTS:

Of the 138 patients (mean age 54 ± 11 years, 46% male), 19 (13.7%) had abnormal SPECT-MPI. Median hsTnT levels were significantly different between patients with normal and abnormal SPECT-MPI (9.41 pg/ml [interquartile range (IQR): 5.73 to 19.20 pg/ml] vs. 4.89 pg/ml [IQR: 2.34 to 7.68 pg/ml], p = 0.001). Sensitivity of 80% and 90% to detect abnormal SPECT-MPI was reached at hsTnT levels as low as 5.73 and 4.26 pg/ml, respectively. Corresponding specificity was 62% and 46%, and negative predictive value was 96% and 96%, respectively. HsTnT levels had good discriminatory ability for prediction of abnormal SPECT-MPI (area under the curve: 0.739, 95% confidence interval: 0.609 to 0.868). Both reversible myocardial ischemia and the extent of coronary atherosclerosis (combined model r(2) = 0.19 with partial of r(2) = 0.12 and r(2) = 0.05, respectively) independently and incrementally predicted the measured hsTnT levels.

CONCLUSIONS:

In patients with acute chest pain, myocardial perfusion abnormalities and coronary artery disease are predicted by resting hsTnT levels. Prospective evaluations are warranted to confirm whether resting hsTnT could serve as a powerful triage tool in chest pain patients in the ED before diagnostic testing and improve the effectiveness of patient management.

• Authors: Waleed Ahmed, Christopher L Schlett, Shanmugam Uthamalingam, Quynh A Truong, Wolfgang Koenig, Ian S Rogers, Ron Blankstein, John T Nagurney, Ahmed Tawakol, James L Januzzi, Udo Hoffmann
• Journal: JACC. Cardiovascular imaging (JACC Cardiovasc Imaging) Vol. 6 Issue 1 Pg. 72-82 (Jan 2013) ISSN: 1876-7591 [Electronic] United States
• PMID: 23328564 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Troponin T

Topics

• Acute Disease
• Adult
• Aged
• Angina Pectoris (blood, diagnosis, physiopathology)
• Biomarkers (blood)
• Coronary Angiography (methods)
• Coronary Artery Disease (blood, diagnosis, physiopathology)
• Cross-Sectional Studies
• Discriminant Analysis
• Emergency Service, Hospital
• Female
• Humans
• Linear Models
• Logistic Models
• Male
• Middle Aged
• Multidetector Computed Tomography
• Multivariate Analysis
• Myocardial Ischemia (blood, diagnosis, physiopathology)
• Myocardial Perfusion Imaging (methods)
• Predictive Value of Tests
• Sensitivity and Specificity
• Tomography, Emission-Computed, Single-Photon
• Troponin T (blood)