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Adjusted Troponin I for Improved Evaluation of Patients with Chest Pain
Goethe Univ Frankfurt, Univ Hosp, Dept Internal Med 3, Cardiol, Frankfurt, Germany;German Ctr Cardiovasc Dis DZHK, Berlin, Germany;Goethe Univ Frankfurt, Ctr Mol Med, Inst Cardiovasc Regenerat, Frankfurt, Germany;Univ Hosp Leipzig, Dept Internal Med, Cardiol, Leipzig, Germany.
Goethe Univ Frankfurt, Univ Hosp, Dept Internal Med 3, Cardiol, Frankfurt, Germany.
Tech Univ Dresden, Clin Psychol & Psychotherapy, Dresden, Germany.
German Ctr Cardiovasc Dis DZHK, Berlin, Germany;Univ Heart Ctr Hamburg, Clin Gen & Intervent Cardiol, Hamburg, Germany.
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2018 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 8087Article in journal (Refereed) Published
Abstract [en]

The use of cardiac troponins (cTn) is the gold standard for diagnosing myocardial infarction. Independent of myocardial infarction (MI), however, sex, age and kidney function affect cTn levels. Here we developed a method to adjust cTnI levels for age, sex, and renal function, maintaining a unified cut-off value such as the 99th percentile. A total of 4587 individuals enrolled in a prospective longitudinal study were used to develop a model for adjustment of cTn. cTnI levels correlated with age and estimated glomerular filtration rate (eGFR) in males/females with r(age) = 0.436/0.518 and with (r)(eGFR) = -0.142/-0.207. For adjustment, these variables served as covariates in a linear regression model with cTnl as dependent variable. This adjustment model was then applied to a real-world cohort of 1789 patients with suspected acute MI (AMI) (N = 407). Adjusting cTnI showed no relevant loss of diagnostic information, as evidenced by comparable areas under the receiver operator characteristic curves, to identify AMI in males and females for adjusted and unadjusted cTnI. In specific patients groups such as in elderly females, adjusting cTnI improved specificity for AMI compared with unadjusted cTnI. Specificity was also improved in patients with renal dysfunction by using the adjusted cTnI values. Thus, the adjustments improved the diagnostic ability of cTnI to identify AMI in elderly patients and in patients with renal dysfunction. Interpretation of cTnI values in complex emergency cases is facilitated by our method, which maintains a single diagnostic cut-off value in all patients.

Place, publisher, year, edition, pages
NATURE PUBLISHING GROUP , 2018. Vol. 8, article id 8087
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Cardiac and Cardiovascular Systems
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URN: urn:nbn:se:uu:diva-357270DOI: 10.1038/s41598-018-26120-lISI: 000432928200012PubMedID: 29799020OAI: oai:DiVA.org:uu-357270DiVA, id: diva2:1239735
Available from: 2018-08-17 Created: 2018-08-17 Last updated: 2018-08-17Bibliographically approved

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