Diagnostic accuracy of baseline troponin and troponin change for the diagnosis of myocardial infarction complicated with heart failure
Background The diagnosis of myocardial infarction (MI) in the presence of heart failure (HF) presents a clinical problem. While diagnostic algorithms using high-sensitivity cardiac troponin have been established for suspected MI, their accuracy in patients with HF remains uncertain. This study aims...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2024-03-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/11/1/e002538.full |
| _version_ | 1797261894901301248 |
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| author | Matteo Serenelli Gianluca Campo Simone Biscaglia Roberta Campana Valentino Santori Beatrice Dal Passo Paolo Tolomeo Luca Di Ienno Anna Cantone Federico Sanguettoli Federico Marchini Matteo Arzenton Daniele Maio |
| author_facet | Matteo Serenelli Gianluca Campo Simone Biscaglia Roberta Campana Valentino Santori Beatrice Dal Passo Paolo Tolomeo Luca Di Ienno Anna Cantone Federico Sanguettoli Federico Marchini Matteo Arzenton Daniele Maio |
| author_sort | Matteo Serenelli |
| collection | DOAJ |
| description | Background The diagnosis of myocardial infarction (MI) in the presence of heart failure (HF) presents a clinical problem. While diagnostic algorithms using high-sensitivity cardiac troponin have been established for suspected MI, their accuracy in patients with HF remains uncertain. This study aims to assess the diagnostic accuracy of high-sensitivity troponin I (TnI) levels in identifying acute MI among patients with HF, focusing on baseline, absolute and relative TnI changes.Methods Data from 562 individuals admitted to the emergency department with suspected MI were retrospectively analysed. Two-point TnI and baseline brain natriuretic peptide (BNP) test results were available. HF status was determined based on clinical, laboratory and instrumental criteria.Results Among the 562 patients, 299 (53.2%) were confirmed having MI. Baseline TnI demonstrated predictive capability for MI in the overall population (area under the curve (AUC) 0.63), while TnI relative change exhibited superior performance (AUC 0.83). Baseline TnI accuracy varied significantly by group, notably decreasing in the third group (severe HF) (AUC 0.54) compared with the first and second groups (AUC 0.67 and AUC 0.71, respectively). TnI relative change demonstrated consistent accuracy across all groups, with AUCs of 0.79, 0.79 and 0.89 for the first, second and third groups, respectively, even after adjustment for age, sex and glomerular filtration rate.Discussion Troponin relative change is a reliable predictor of MI, even in patients with acute HF. Baseline TnI accuracy is influenced by HF severity. It is essential to consider HF status and BNP levels when employing high-sensitivity cardiac troponin testing to rule out suspected MIs. |
| first_indexed | 2024-04-24T23:48:29Z |
| format | Article |
| id | doaj.art-3202a781e61d45fcacd9e6687041b738 |
| institution | Directory Open Access Journal |
| issn | 2053-3624 |
| language | English |
| last_indexed | 2024-04-24T23:48:29Z |
| publishDate | 2024-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj.art-3202a781e61d45fcacd9e6687041b7382024-03-15T01:10:08ZengBMJ Publishing GroupOpen Heart2053-36242024-03-0111110.1136/openhrt-2023-002538Diagnostic accuracy of baseline troponin and troponin change for the diagnosis of myocardial infarction complicated with heart failureMatteo Serenelli0Gianluca Campo1Simone Biscaglia2Roberta Campana3Valentino Santori4Beatrice Dal Passo5Paolo Tolomeo6Luca Di Ienno7Anna Cantone8Federico Sanguettoli9Federico Marchini10Matteo Arzenton11Daniele Maio121 Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant`Anna, Cona, Emilia-Romagna, Italy1Department of Medical Sciences, Cardiovascular Institute, Azienda Ospedaliero-Universitaria S.Anna, Cona, Ferrara, ItalyDepartment of Cardiology, University Hospital Arcispedale Sant`Anna of Ferrara, Ferrara, Italy1 Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, ItalyDepartment of Statistics, Informatics, Applications `Giuseppe Parenti` (DISIA), University of Florence Unit of Methodological and Statistical Support to Clinical Research, AOU of Modena, Modena, ItalyDepartment of Cardiology, University Hospital Arcispedale Sant`Anna of Ferrara, Ferrara, ItalyDepartment of Cardiology, University Hospital Arcispedale Sant`Anna of Ferrara, Ferrara, ItalyDepartment of Cardiology, University Hospital Arcispedale Sant`Anna of Ferrara, Ferrara, ItalyDepartment of Cardiology, University Hospital Arcispedale Sant`Anna of Ferrara, Ferrara, ItalyDepartment of Cardiology, University Hospital Arcispedale Sant`Anna of Ferrara, Ferrara, ItalyDepartment of Cardiology, University Hospital Arcispedale Sant`Anna of Ferrara, Ferrara, ItalyDepartment of Cardiology, University Hospital Arcispedale Sant`Anna of Ferrara, Ferrara, ItalyDepartment of Cardiology, University Hospital Arcispedale Sant`Anna of Ferrara, Ferrara, ItalyBackground The diagnosis of myocardial infarction (MI) in the presence of heart failure (HF) presents a clinical problem. While diagnostic algorithms using high-sensitivity cardiac troponin have been established for suspected MI, their accuracy in patients with HF remains uncertain. This study aims to assess the diagnostic accuracy of high-sensitivity troponin I (TnI) levels in identifying acute MI among patients with HF, focusing on baseline, absolute and relative TnI changes.Methods Data from 562 individuals admitted to the emergency department with suspected MI were retrospectively analysed. Two-point TnI and baseline brain natriuretic peptide (BNP) test results were available. HF status was determined based on clinical, laboratory and instrumental criteria.Results Among the 562 patients, 299 (53.2%) were confirmed having MI. Baseline TnI demonstrated predictive capability for MI in the overall population (area under the curve (AUC) 0.63), while TnI relative change exhibited superior performance (AUC 0.83). Baseline TnI accuracy varied significantly by group, notably decreasing in the third group (severe HF) (AUC 0.54) compared with the first and second groups (AUC 0.67 and AUC 0.71, respectively). TnI relative change demonstrated consistent accuracy across all groups, with AUCs of 0.79, 0.79 and 0.89 for the first, second and third groups, respectively, even after adjustment for age, sex and glomerular filtration rate.Discussion Troponin relative change is a reliable predictor of MI, even in patients with acute HF. Baseline TnI accuracy is influenced by HF severity. It is essential to consider HF status and BNP levels when employing high-sensitivity cardiac troponin testing to rule out suspected MIs.https://openheart.bmj.com/content/11/1/e002538.full |
| spellingShingle | Matteo Serenelli Gianluca Campo Simone Biscaglia Roberta Campana Valentino Santori Beatrice Dal Passo Paolo Tolomeo Luca Di Ienno Anna Cantone Federico Sanguettoli Federico Marchini Matteo Arzenton Daniele Maio Diagnostic accuracy of baseline troponin and troponin change for the diagnosis of myocardial infarction complicated with heart failure Open Heart |
| title | Diagnostic accuracy of baseline troponin and troponin change for the diagnosis of myocardial infarction complicated with heart failure |
| title_full | Diagnostic accuracy of baseline troponin and troponin change for the diagnosis of myocardial infarction complicated with heart failure |
| title_fullStr | Diagnostic accuracy of baseline troponin and troponin change for the diagnosis of myocardial infarction complicated with heart failure |
| title_full_unstemmed | Diagnostic accuracy of baseline troponin and troponin change for the diagnosis of myocardial infarction complicated with heart failure |
| title_short | Diagnostic accuracy of baseline troponin and troponin change for the diagnosis of myocardial infarction complicated with heart failure |
| title_sort | diagnostic accuracy of baseline troponin and troponin change for the diagnosis of myocardial infarction complicated with heart failure |
| url | https://openheart.bmj.com/content/11/1/e002538.full |
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