Refereed journal article or data article (A1)

Cardiac troponin T and NT-proBNP for detecting myocardial ischemia in suspected chronic coronary syndrome




List of Authors: Myhre Peder L., Røsjø Helge, Sarvari Sebastian I., Ukkonen Heikki, Rademakers Frank, Engvall Jan E., Hagve Tor-Arne, Nagel Eike, Sicari Rosa, Zamorano Jose L., Monaghan Mark, D'hooge Jan, Edvardsen Thor, Omland Torbjørn

Publisher: Elsevier Ireland Ltd

Publication year: 2022

Journal: International Journal of Cardiology

Journal name in source: International Journal of Cardiology

Volume number: 361

eISSN: 1874-1754

DOI: http://dx.doi.org/10.1016/j.ijcard.2022.05.027

URL: https://doi.org/10.1016/j.ijcard.2022.05.027

Self-archived copy’s web address: https://research.utu.fi/converis/portal/175573403


Abstract

Background
Elevated N-terminal pro-B-type natriuretic peptides (NT-proBNP) and cardiac troponin T (cTnT) are associated with poor outcome in patients with chronic coronary syndrome (CCS). The performance of these biomarkers in diagnosing ischemia, and their association with myocardial hypoperfusion and hypokinesis is unclear.

Methods
Patients with suspected CCS (history of angina, estimated cardiovascular risk >15% or a positive stress test) were included in the prospective, multi-center DOPPLER-CIP study. Patients underwent Single Positron Emission Computed Tomography for assessment of ischemia and NT-proBNP and cTnT were measured in venous blood samples.

Results
We included 430 patients (25% female) aged 64 ± 8 years. Reversible hypoperfusion and hypokinesis were present in 139 (32%) and 89 (21%), respectively. Concentrations of NT-proBNP and cTnT correlated moderately (rho = 0.50, p < 0.001). NT-proBNP and cTnT concentrations (median [IQR]) were higher in patients with versus without reversible ischemia: 150 (73–294) versus 87 (44–192) ng/L and 10 (6–13) versus 7 (4–11) ng/L, respectively (p < 0.001 for both), and the associations persisted after adjusting for possible confounders. The C-statistics to discriminate ischemia ranged from 63%–73%, were comparable for cTnT and NT-proBNP, and higher for hypokinesis than hypoperfusion, and both were superior to exercise electrocardiography and stress echocardiography. Very low concentrations (≤5 ng/L cTnT and ≤ 60 ng/L NT-proBNP) ruled out reversible hypokinesis with negative predictive value >90%.

Conclusion
cTnT and NT-proBNP are associated with irreversible and reversible ischemia in patients with suspected CCS, particularly hypokinesis. The diagnostic performance was comparable between the biomarkers, and very low concentrations may reliably rule out ischemia.


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Last updated on 2022-01-07 at 14:40