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Troponin Sensitive Diagnosis

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https://www.readbyqxmd.com/read/28545635/outcomes-in-patients-with-chest-pain-discharged-after%C3%A2-evaluation-using-a-high-sensitivity-troponin-t-assay
#1
Atosa Nejatian, Åsa Omstedt, Jonas Höijer, L O Hansson, Therese Djärv, Kai M Eggers, Per Svensson
BACKGROUND: Most patients with chest pain are discharged from the emergency department (ED) with the diagnosis "unspecified chest pain." It is unknown if evaluation with a high-sensitivity troponin T (hsTnT) assay affects prognosis in this large population. OBJECTIVES: The aim was to investigate whether the introduction of an hsTnT assay is associated with reduced incidence of major adverse cardiac events (MACEs) and cardiovascular (CV) risk profile in patients with chest pain discharged from the ED...
May 30, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28532247/high-sensitivity-cardiac-troponin-t-in-patients-not-having-an-acute-coronary-syndrome-results-from-the-trapid-ami-study
#2
Richard Nowak, Christian Müller, E Giannitsis, Michael Christ, Jordi Ordonez-Llanos, Christopher DeFilippi, James McCord, Richard Body, Mauro Panteghini, Tomas Jernberg, Mario Plebani, Franck Verschuren, John K French, Robert Christenson, Gordon Jacobsen, Carina Dinkel, Bertil Lindahl
PURPOSE: To describe the baseline, 1 hour and delta high sensitivity cardiac troponin (hs-cTnT) values in patients with suspected acute myocardial infarction (AMI) but without a final acute coronary syndrome (ACS) diagnosis. MATERIALS AND METHODS: TRAPID-AMI was a prospective diagnostic (hs-cTnT) trial that enrolled Emergency Department (ED) patients with suspected AMI. Final patient diagnoses were adjudicated by a clinical events committee and subjects placed in different clinical groups: AMI, unstable angina, non-ACS cardiac, non-cardiac and unknown origin...
May 23, 2017: Biomarkers: Biochemical Indicators of Exposure, Response, and Susceptibility to Chemicals
https://www.readbyqxmd.com/read/28515106/direct-comparison-of-2-rule-out-strategies-for-acute-myocardial-infarction-2-h-accelerated-diagnostic-protocol-vs-2-h-algorithm
#3
Karin Wildi, Louise Cullen, Raphael Twerenbold, Jaimi H Greenslade, William Parsonage, Jasper Boeddinghaus, Thomas Nestelberger, Zaid Sabti, Maria Rubini-Giménez, Christian Puelacher, Janosch Cupa, Lukas Schumacher, Patrick Badertscher, Karin Grimm, Nikola Kozhuharov, Claudia Stelzig, Michael Freese, Katharina Rentsch, Jens Lohrmann, Wanda Kloos, Andreas Buser, Tobias Reichlin, John Pickering, Martin Than, Christian Mueller
BACKGROUND: We compared 2 high-sensitivity cardiac troponin (hs-cTn)-based 2-h strategies in patients presenting with suspected acute myocardial infarction (AMI) to the emergency department (ED): the 2-h accelerated diagnostic protocol (2h-ADP) combining hs-cTn, electrocardiogram, and a risk score, and the 2-h algorithm exclusively based on hs-cTn concentrations and their absolute changes. METHODS: Analyses were performed in 2 independent diagnostic cohorts [European Advantageous Predictors of Acute Coronary Syndrome Evaluation (APACE) study, Australian-New Zealand 2-h Accelerated Diagnostic Protocol to Assess patients with chest Pain symptoms using contemporary Troponins as the only biomarker (ADAPT) study] employing hs-cTnT (Elecsys) and hs-cTnI (Architect)...
May 17, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28466882/asia-pacific-consensus-statement-on-the-optimal-use-of-high-sensitivity-troponin-assays-in-acute-coronary-syndromes-diagnosis-focus-on-hs-tni
#4
COMMENT
Jack Wei Chieh Tan, Carolyn S P Lam, Sazzli Shahlan Kasim, Tar Choon Aw, Joel M Abanilla, Wei-Ting Chang, Van Phuoc Dang, Maria Iboleon-Dy, Sari Sri Mumpuni, Arintaya Phommintikul, Manh Cuong Ta, Punkiat Topipat, Kai Hang Yiu, Louise Cullen
OBJECTIVE: High-sensitivity troponin (hs-Tn) assays need to be applied appropriately to improve diagnosis and patient outcomes in acute coronary syndromes (ACS). METHODS: Experts from Asia Pacific convened in 2015 to provide data-driven consensus-based, region-specific recommendations and develop an algorithm for the appropriate incorporation of this assay into the ACS assessment and treatment pathway. RESULTS: Nine recommendations were developed by the expert panel: (1) troponin is the preferred cardiac biomarker for diagnostic assessment of ACS and is indicated for patients with symptoms of possible ACS; (2) hs-Tn assays are recommended; (3) serial testing is required for all patients; (4) testing should be performed at presentation and 3 hours later; (5) gender-specific cut-off values should be used for hs-Tn I assays; (6) hs-Tn I level >10 times the upper limit of normal should be considered to 'rule in' a diagnosis of ACS; (7) dynamic change >50% in hs-Tn I level from presentation to 3-hour retest identifies patients at high risk for ACS; (8) where only point-of-care testing is available, patients with elevated readings should be considered at high risk, while patients with low/undetectable readings should be retested after 6 hours or sent for laboratory testing and (9) regular education on the appropriate use of troponin tests is essential...
2017: Heart Asia
https://www.readbyqxmd.com/read/28462952/high-sensitivity-cardiac-troponin-i-assays-in-the-diagnosis-of-acute-myocardial-infarction
#5
EDITORIAL
Andrew R Chapman, David E Newby, Nicholas L Mills
No abstract text is available yet for this article.
2017: Heart Asia
https://www.readbyqxmd.com/read/28460039/prognostic-value-of-elevated-high-sensitivity-cardiac-troponin-t-in-patients-admitted-to-an-emergency-department-with-atrial-fibrillation
#6
Kiril M Stoyanov, Evangelos Giannitsis, Moritz Biener, Matthias Mueller-Hennessen, Katharina Arens, Hugo A Katus, Mehrshad Vafaie
Aims: Elevated levels of high-sensitivity cardiac troponin T (hsTnT) indicate underlying heart disease and are known to predict adverse outcomes in various patient populations. Their role in atrial fibrillation (AF) is still under debate. Methods and results: This retrospective study included 2898 consecutive patients presenting with AF to the emergency department of the Department of Cardiology, Heidelberg University Hospital. Multivariable Cox regression was used to assess associations between hsTnT and mortality...
April 27, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28459901/overuse-of-troponin-a-comprehensive-evaluation-of-testing-in-a-large-hospital-system
#7
Gibbs Wilson, Kyler Barkley, Kipp Slicker, Robert Kowal, Brandon Pope, Jeffrey Michel
Troponin assays are integral to the diagnosis of acute myocardial infarction (AMI), but there is concern that testing is over utilized and may not conform to published guidelines. We reviewed all testing performed at 14 hospitals over 12 months and associated troponin values with the primary and secondary diagnoses for each visit. Troponin was determined to be negative, indeterminate or elevated based on reference ranges. The majority of troponin measurements were single, not serial (64%). The rate of AMI was low, with only 3...
May 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28457177/high-sensitivity-cardiac-troponin-assays-from-improved-analytical-performance-to-enhanced-risk-stratification
#8
Marek Kozinski, Magdalena Krintus, Jacek Kubica, Grazyna Sypniewska
Implementation of cardiac troponin (cTn) assays has revolutionized the diagnosis, risk stratification, triage and management of patients with suspected myocardial infarction (MI). The Universal Definition of MI brought about a shift in the diagnostics of MI, from an approach primarily based on electrocardiography (ECG) to one primarily based on biomarkers. Currently, detection of a rise and/or fall in concentration or activity of myocardial necrosis biomarkers, preferentially cTns, with at least one value above the 99th percentile upper reference limit (URL), is the essential component for the diagnosis of MI...
May 2017: Critical Reviews in Clinical Laboratory Sciences
https://www.readbyqxmd.com/read/28446515/role-of-biomarkers-for-the-prevention-assessment-and-management-of-heart-failure-a-scientific-statement-from-the-american-heart-association
#9
REVIEW
Sheryl L Chow, Alan S Maisel, Inder Anand, Biykem Bozkurt, Rudolf A de Boer, G Michael Felker, Gregg C Fonarow, Barry Greenberg, James L Januzzi, Michael S Kiernan, Peter P Liu, Thomas J Wang, Clyde W Yancy, Michael R Zile
BACKGROUND AND PURPOSE: Natriuretic peptides have led the way as a diagnostic and prognostic tool for the diagnosis and management of heart failure (HF). More recent evidence suggests that natriuretic peptides along with the next generation of biomarkers may provide added value to medical management, which could potentially lower risk of mortality and readmissions. The purpose of this scientific statement is to summarize the existing literature and to provide guidance for the utility of currently available biomarkers...
April 26, 2017: Circulation
https://www.readbyqxmd.com/read/28429348/diagnostic-value-of-copeptin-in-acute-myocardial-infarction
#10
M O Ay, A K Erenler, T Dogan, M Yetim
OBJECTIVE: The aim of this study was to investigate the effectiveness of copeptin in the early diagnosis of acute myocardial infarction (AMI), and to compare the diagnostic efficacy of copeptin with other cardiac markers. PATIENTS AND METHODS: A total of 160 cases were enrolled in the study. All were over 18 years of age, and consisted of 54 non-ST elevation MI (NSTEMI), 54 ST segment elevation MI (STEMI), and 52 healthy subjects (controls). Serum troponin-I, CK-MB mass, copeptin and CRP levels were measured in each of the cases, and were compared between the three groups for statistical differences...
April 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28416358/non-gated-high-pitch-computed-tomography-aortic-angiography-myocardial-perfusion-defects-in-patients-with-suspected-aortic-dissection
#11
Li-Ting Huang, Shih-Hung Chan, Chia-Chang Chuang, Yi-Shan Tsai
OBJECTIVES: To investigate the diagnostic value of first-pass myocardial perfusion defects visualised in non-gated high-pitch computed tomography angiography (CTA) in patients admitted to the emergency department (ED) for suspected aortic dissection. METHODS: We recruited 174 ED patients who underwent high-pitch CTA of the aorta because of suspected aortic dissection. We divided these patients into two groups (diseased and control groups) based on whether their clinical data fulfilled the third universal definition of acute myocardial infarction (AMI), specifically an increase in cardiac troponin (cTn) with at least one of the following: (a) symptoms of ischemia; (b) new ST-segment-T wave (ST-T) changes or new left bundle branch block (LBBB); (c) development of pathological Q wave; (d) new loss of viable myocardium or new regional wall motion abnormality; or (e) identification of an intracoronary thrombus by angiography or autopsy...
April 12, 2017: Journal of Cardiovascular Computed Tomography
https://www.readbyqxmd.com/read/28391559/cardiac-biomarkers-and-the-diagnosis-of-myocardial-infarction-in-women
#12
REVIEW
Anoop S V Shah, Amy V Ferry, Nicholas L Mills
PURPOSE OF REVIEW: Women with suspected acute coronary syndrome are less likely to undergo investigation or receive treatment than men, and women consistently have poorer outcomes. This review summarises how the latest development in cardiac biomarkers could improve both diagnosis and outcomes in women. RECENT FINDINGS: Novel high-sensitivity cardiac troponin assays have identified differences in the reference range and therefore diagnostic threshold for myocardial infarction in men and women...
May 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/28383401/establishment-of-a-reference-interval-for-high-sensitivity-cardiac-troponin-i-in-healthy-adults-from-the-sichuan-area
#13
Shunjun Li, Yue Zuo, Wenfang Huang
High-sensitivity cardiac troponin I (hs-cTnI) has been used in the diagnosis and risk stratification of acute myocardial infarction. However, there is no common consensus on an hs-cTnI reference interval for the Chinese population. The aim of this study was to describe the distribution of hs-TnI and establish the 99th percentile reference interval for hs-cTnI in healthy adults from the Sichuan area.Serum specimens were collected from 1485 healthy adults (731 men and 754 women ranging in age from 18 to 85 years) in Sichuan Provincial People's Hospital...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28383022/high-sensitivity-assays-for-troponin-in-patients-with-cardiac-disease
#14
REVIEW
Dirk Westermann, Johannes Tobias Neumann, Nils Arne Sörensen, Stefan Blankenberg
Troponin is a widely used biomarker in patients with cardiac disease. The use of troponin is well established in patients with suspected acute myocardial infarction (AMI), but troponin measurement is also used in other acute and nonacute settings. In patients with suspected AMI, early decision-making is crucial to allow rapid treatment and further diagnostic evaluation. Current guidelines recommend serial measurements of troponin with a cut-off concentration at the 99th percentile to triage patients in the emergency department...
April 6, 2017: Nature Reviews. Cardiology
https://www.readbyqxmd.com/read/28377153/clinical-performance-of-cardiac-troponin-i-a-comparison-between-the-poct-aqt90-flex-and-the-dimension-vista-analyzer-in-an-emergency-setting
#15
Monica Maria Mion, Giada Bragato, Alessandra Casarotti, Chiara Cosma, Stefania Vigolo, Gianna Vettore, Franco Tosato, Martina Zaninotto, Mario Plebani
BACKGROUND: Cardiac troponin [cTn (I or T)] is the preferred biomarker for the diagnosis of myocardial infarction (MI). AIM: We studied the analytical performance of the POCT AQT90 FLEX cTnI assay and its diagnostic accuracy, in comparison to the Dimension Vista cTnI method, in patients presenting to the Emergency Department (ED) with suspect of acute coronary syndrome (ACS). METHODS: 786 consecutive patients were enrolled. cTnI was measured at admission to the ED and about 3 and 6 hours later...
April 1, 2017: Clinical Biochemistry
https://www.readbyqxmd.com/read/28363994/validating-the-manchester-acute-coronary-syndromes-macs-and-troponin-only-manchester-acute-coronary-syndromes-t-macs-rules-for-the-prediction-of-acute-myocardial-infarction-in-patients-presenting-to-the-emergency-department-with-chest-pain
#16
Jaimi H Greenslade, Robert Nayer, William Parsonage, Shaela Doig, Joanna Young, John W Pickering, Martin Than, Christopher Hammett, Louise Cullen
BACKGROUND: The Manchester Acute Coronary Syndromes (MACS) rule and the Troponin-only MACS (T-MACS) rule risk stratify patients with suspected acute coronary syndrome (ACS). This observational study sought to validate and compare the MACS and T-MACS rules for assessment of acute myocardial infarction (AMI). METHODS: Prospectively collected data from twoEDs in Australia and New Zealand were analysed. Patients were assigned a probability of ACS based on the MACS and T-MACS rules, incorporating high-sensitivity troponin T, heart-type fatty acid-binding protein, ECG results and clinical symptoms...
March 31, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28344141/single-high-sensitivity-cardiac-troponin-i-to-rule-out-acute-myocardial-infarction
#17
Yader Sandoval, Stephen W Smith, Sara A Love, Anne Sexter, Karen Schulz, Fred S Apple
PURPOSE: Examine the performance of single high-sensitivity cardiac troponin I (hs-cTnI) measurement strategies to rule-out acute myocardial infarction. METHODS: Prospective, observational study of consecutive patients presenting to the emergency department (n=1,631) in whom cTnI measurements where obtained using an investigational hs-cTnI assay. Negative predictive value (NPV) and sensitivity for the a) diagnosis of acute myocardial infarction, type 1 myocardial infarction, and type 2 myocardial infarction and b) safety outcome of acute myocardial infarction or cardiac death at 30 days using hs-cTnI less than the limit of detection (LoD) (<1...
March 23, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28343173/fast-track-protocols-using-highly-sensitive-troponin-assays-for-ruling-out-and-ruling-in-non-st-elevation-acute-coronary-syndrome
#18
Simona Ferraro, Alberto Dolci, Mauro Panteghini
The introduction of "highly sensitive" cardiac troponin assays (hsTn) has reinforced the evidence that only serial testing incorporated in running algorithms allows a more accurate diagnosis of acute myocardial infarction. In this report, we consider the available evidence supporting the use of fast track protocols for ruling out and ruling in non-ST elevation myocardial infarction (NSTEMI) and compare it with the content of recently released guideline by the European Society of Cardiology, noting some uncomfortable aspects that need urgent clarification and/or revision...
March 27, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28338188/implication-of-peripheral-blood-mirna-124-in-predicting-acute-myocardial-infarction
#19
M-L Guo, L-L Guo, Y-Q Weng
OBJECTIVE: This study aimed to determine the expression of miR-124 in the patients with acute myocardial infarction (AMI) and elucidated the role of miR-124 on early diagnosis of AMI. PATIENTS AND METHODS: A total of 90 AMI patients were recruited, along with 45 healthy individuals as the control group. Blood samples were collected at different time points (0 h at admission, 6 h, 12 h and 24 h of disease onset). Real-time PCR was used to test miRNA-124 level. ELISA was used to test serum troponin (cTnI) and creatine kinase-MB isoenzyme (CK-MB) levels...
March 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28333976/early-diagnosis-of-acute-myocardial-infarction-using-high-sensitivity-troponin-i
#20
Johannes Tobias Neumann, Nils Arne Sörensen, Francisco Ojeda, Thomas Renné, Renate B Schnabel, Tanja Zeller, Mahir Karakas, Stefan Blankenberg, Dirk Westermann
OBJECTIVE: There is a clinical need for early and accurate diagnosis of acute myocardial infarction (AMI). Current European Society of Cardiology (ESC) guidelines recommend diagnosis of non-ST-elevation AMI based on serial troponin measurements. We aimed to challenge the ESC guidelines using 1) a high-sensitivity troponin I (hs-TnI) baseline cutoff, 2) an absolute hs-TnI change after 1 hour and 3) additional application of an ischemic ECG. METHODS: 1,516 patients with suspected AMI presenting to the emergency department were included...
2017: PloS One
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