13 Jan Highly Sensitive Troponins Improve ER Diagnosis of Heart Disease
MedicalResearch.com Interview with:
James Louis Januzzi, Jr, MD, FACC, FESC
Director, Cardiac Intensive Care Unit
Director, Dennis and Marilyn Barry Fellowship in Cardiology Research
Massachusetts General Hospital Boston, MA, 02114.
Medical Research: What is the background for this study? What are the main findings?
Dr. Januzzi: Evaluation for suspected or proven acute coronary syndrome is one of the most common reasons patients present to the emergency department setting. The standard means by which patients are evaluated is through serial sampling of blood for troponin, a structural protein from the heart muscle. When troponin is abnormal, it indicates heart injury, and in the appropriate clinical context, this may indicate a heart attack. Recent refinement in troponin assays has led to the development of ‘highly sensitive’ troponin methods, which may offer considerable advantages over conventional assays, in that they allow for more rapid diagnosis or exclusion of acute coronary syndrome.
In this study of 322 patients with chest discomfort, we evaluated the diagnostic accuracy of two more sensitive troponin assays compared to conventional troponin methods. We found the first draw sensitivity of the more sensitive troponins was considerably higher, and allowed for immediate “rule out” of acute coronary syndrome, if below the level of detection for the sensitive assays. The more sensitive methods reclassified 30% of patients previously thought not to have heart injury to myocardial infarction, and also allowed for an interesting detection of underlying structural heart disease: in those with very low highly sensitive troponin methods, on CT angiography, none had any significant coronary artery disease, while in those with higher values, we detected a substantial amount of coronary disease, even in those without an acute coronary syndrome.
Medical Research: What should clinicians and patients take away from your report?
Dr. Januzzi: Clinicians should be aware that highly sensitive troponins will increase the speed of diagnosis and allow for more confident identification or exclusion of acute coronary syndrome. Additionally, abnormal values of the test—even in the absence of acute coronary syndrome—identify patients with underlying structural heart disease and higher risk.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Januzzi: Randomized trials evaluating the methods for how to use highly sensitive troponin not only to assist in diagnosis but also to improve the medical therapy of patients are needed now.
James L. Januzzi, MD Umesh Sharma, MD Pearl Zakroysky, MS Quynh A. Truong, MD Pamela K. Woodard, MD J. Hector Pope, MD Thomas Hauser, MD Thomas Mayrhofer, MD J. Toby Nagurney, MD David Schoenfeld, PhD W.Frank Peacock, MD,Jerome L. Fleg, MDi Stephen Wiviott, MDj Peter S. Pang, MD James Udelson, MD Udo Hoffmann, MD
American Heart Journal Available online 9 January 2015 in press