PMID- 35065860
OWN - NLM
STAT- MEDLINE
DCOM- 20220422
LR  - 20220422
IS  - 0736-4679 (Print)
IS  - 0736-4679 (Linking)
VI  - 62
IP  - 3
DP  - 2022 Mar
TI  - Diagnostic Accuracy of High-Sensitive Troponin for the Identification of 
      Myocardial Infarction in Patients Presenting with Acute Heart Failure.
PG  - 359-367
LID - S0736-4679(21)00918-5 [pii]
LID - 10.1016/j.jemermed.2021.11.013 [doi]
AB  - BACKGROUND: The differentiation of myocardial infarction (MI) in the setting of 
      acute heart failure (AHF) can be challenging because the majority of patients 
      presenting with AHF show elevations of high-sensitive troponin (hs-Tn). Fast 
      identification of MI is crucial to perform timely coronary angiography and to 
      improve clinical outcome. OBJECTIVES: The aim of the present study was to assess 
      the diagnostic accuracy of different levels of hs-Tn for the identification of 
      type 1 MI in patients with AHF. METHODS: This was a retrospective single-center 
      analysis of admitted AHF patients with documentation of high-sensitive troponin T 
      (hs-TnT). RESULTS: A total of 649 patients were enrolled into the present study. 
      Of them, 18% had type 1 MI, 7% had type 2 MI, 69% had myocardial injury, and 6% 
      had no myocardial injury. The area under the curve of hs-TnT for the prediction 
      of type 1 MI was 0.70. Sensitivity and specificity of the hs-TnT 99(th) 
      percentile upper reference limit (URL) for type 1 MI was 100% and 8%, 
      respectively. The Youden index derived cut-off of hs-TnT was 50 ng/L, showing a 
      sensitivity and specificity for type 1 MI of 63% and 68%, respectively. No 
      significant difference regarding 30-day mortality was found depending on the 
      presence of type 1 MI (odds ratio 1.86; 95% confidence interval 0.91-3.81). 
      CONCLUSIONS: Hs-TnT-based identification of type 1 MI in patients with AHF 
      requires higher cut-offs compared with the 99(th) percentile URL used in overall 
      acute coronary syndrome populations. However, the adjusted cut-off provided only 
      moderate sensitivity and specificity.
CI  - Copyright (c) 2021. Published by Elsevier Inc.
FAU - Ledwoch, Jakob
AU  - Ledwoch J
AD  - Klinik fur Kardiologie, Pneumologie und Internistische Intensivmedizin, Munchen 
      Klinik Neuperlach, Munich, Germany.
FAU - Schneider, Alisa
AU  - Schneider A
AD  - Klinik und Poliklinik fur Innere Medizin I, Klinikum rechts der Isar, Technical 
      University of Munich, Munich, Germany; DZHK (German Center for Cardiovascular 
      Research), Partner Site Munich Heart Alliance, Munich, Germany.
FAU - Leidgschwendner, Katharina
AU  - Leidgschwendner K
AD  - Klinik und Poliklinik fur Innere Medizin I, Klinikum rechts der Isar, Technical 
      University of Munich, Munich, Germany; DZHK (German Center for Cardiovascular 
      Research), Partner Site Munich Heart Alliance, Munich, Germany.
FAU - Kraxenberger, Jana
AU  - Kraxenberger J
AD  - Klinik und Poliklinik fur Innere Medizin I, Klinikum rechts der Isar, Technical 
      University of Munich, Munich, Germany; DZHK (German Center for Cardiovascular 
      Research), Partner Site Munich Heart Alliance, Munich, Germany.
FAU - Krauth, Anna
AU  - Krauth A
AD  - Klinik und Poliklinik fur Innere Medizin I, Klinikum rechts der Isar, Technical 
      University of Munich, Munich, Germany; DZHK (German Center for Cardiovascular 
      Research), Partner Site Munich Heart Alliance, Munich, Germany.
FAU - Schneider, Vera
AU  - Schneider V
AD  - Klinik und Poliklinik fur Innere Medizin I, Klinikum rechts der Isar, Technical 
      University of Munich, Munich, Germany; DZHK (German Center for Cardiovascular 
      Research), Partner Site Munich Heart Alliance, Munich, Germany.
FAU - Martens, Eimo
AU  - Martens E
AD  - Klinik und Poliklinik fur Innere Medizin I, Klinikum rechts der Isar, Technical 
      University of Munich, Munich, Germany; DZHK (German Center for Cardiovascular 
      Research), Partner Site Munich Heart Alliance, Munich, Germany.
FAU - Muller, Alexander
AU  - Muller A
AD  - Klinik und Poliklinik fur Innere Medizin I, Klinikum rechts der Isar, Technical 
      University of Munich, Munich, Germany; DZHK (German Center for Cardiovascular 
      Research), Partner Site Munich Heart Alliance, Munich, Germany.
FAU - Laugwitz, Karl-Ludwig
AU  - Laugwitz KL
AD  - Klinik und Poliklinik fur Innere Medizin I, Klinikum rechts der Isar, Technical 
      University of Munich, Munich, Germany; DZHK (German Center for Cardiovascular 
      Research), Partner Site Munich Heart Alliance, Munich, Germany.
FAU - Kupatt, Christian
AU  - Kupatt C
AD  - Klinik und Poliklinik fur Innere Medizin I, Klinikum rechts der Isar, Technical 
      University of Munich, Munich, Germany; DZHK (German Center for Cardiovascular 
      Research), Partner Site Munich Heart Alliance, Munich, Germany.
LA  - eng
PT  - Journal Article
DEP - 20220120
PL  - United States
TA  - J Emerg Med
JT  - The Journal of emergency medicine
JID - 8412174
RN  - 0 (Biomarkers)
RN  - 0 (Troponin)
RN  - 0 (Troponin T)
SB  - IM
MH  - Biomarkers
MH  - *Heart Failure/complications/diagnosis
MH  - Humans
MH  - *Myocardial Infarction/complications/diagnosis
MH  - Retrospective Studies
MH  - Troponin
MH  - Troponin T
OTO - NOTNLM
OT  - Acute coronary syndrome
OT  - Acute heart failure
OT  - Myocardial infarction
OT  - Troponin
EDAT- 2022/01/24 06:00
MHDA- 2022/04/23 06:00
CRDT- 2022/01/23 20:28
PHST- 2021/07/20 00:00 [received]
PHST- 2021/10/27 00:00 [revised]
PHST- 2021/11/27 00:00 [accepted]
PHST- 2022/01/24 06:00 [pubmed]
PHST- 2022/04/23 06:00 [medline]
PHST- 2022/01/23 20:28 [entrez]
AID - S0736-4679(21)00918-5 [pii]
AID - 10.1016/j.jemermed.2021.11.013 [doi]
PST - ppublish
SO  - J Emerg Med. 2022 Mar;62(3):359-367. doi: 10.1016/j.jemermed.2021.11.013. Epub 
      2022 Jan 20.