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ISSN 0188-2198 (Print)

2003, Number 3

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Rev Mex Cardiol 2003; 14 (3)

Cardiac troponin T test in the early diagnosis of acute myocardial infarction

Ramos CMA, Sánchez BJJ, Basave RMN, Rangel AA, Medécigo MMJ, Rodríguez SS, Cordero PLJ, Cárdenas MMG, Ramos GMA, Frati MAC

Language: Spanish
References: 21
Page: 81-85
PDF size: 74.24 Kb.


ABSTRACT

The necessity of a reliable and accessible test to early confirm or discard the acute myocardial infarction (AMI) has lead to develop the determination of cardiac T troponin (cTnT) in blood, a qualitative test for diagnosis of AMI. The purpose of this study was to determinate the sensitivity, specificity, and positive and negative predictive values of the cTnT test, during the first 6 hour of evolution of AMI. We consider the curve of the MB fraction of creatine kinase (CPK-MB) as the gold-standard to compare cTnT. We studied 55 patients with suspicion of AMI. We observed that, in those patients in whom AMI was confirmed, the sensitivity of cTnT at sixth hour of evolution of AMI was 86% (IC95% 84-87); specificity at second hour was 88% (IC95% 72-100); positive predictive value at fourth hour was 83%, and negative predictive value at fifth hour was 100%. We conclude that cTnT test is specific for diagnosis of AMI at second hour after symptoms beginning, is significantly sensitive at sixth hour, and can discard it if results negative at fifth hour.


REFERENCES

  1. Pasternak RC, Braunwald E, Sobel BE. Acute myocardial infarction. In: Braunwald E, editor. Heart disease: a textbook of cardiovascular medicine. Filadelfia: Saunders, 1992: 1200-1292.

  2. Working Group on the Establishment of Ischaemic Heart Disease Registers: Report of the Fifth Working Group. Eur 8201 (5). Copenhague: OMS 1971.

  3. Jaffe AS. More rapid biochemical diagnosis of myocardial infarction: Necessary? Prudent? Clin Chem 1993; 39: 1567.

  4. Adams JE, Abendschein DR, Jaffe AS. Biochemical markers of myocardial injury: Is MB creatine kinase the choice for the 1990s? Circulation 1993; 88: 750-63.

  5. Katus HA, Remppis A, Neumann FJ, Scheffold T, Diederich KW, Vinar G et al. Diagnostic effciency of troponin T measurements in acute myocardial infarction. Circulation 1991; 83: 902-912.

  6. Gerhardt W, Katus H, Ravkilde J, Hamm C, Jorgensen PJ, Peheim E et al. Troponin T suspected ischemic myocardial injury compared with mass and catalytic concentrations is of S-creatine kinase isoenzyme MB. Clin Chem 1991; 37: 1405-1411.

  7. Katus HA, Yasuda T, Gold HK, Leinbach RC, Strauss HW, Waksmonski C et al: Diagnosis of acute myocardial infarction by detection of circulating cardiac myosin light chains. Am J Cardiol 1984; 54: 964-970.

  8. Wang J, Shi Q, Wu T-W, Jacckwski G, Mickle DAG. The quantification of human ventricular myosin light chain 1 in serum after myocardial necrosis and infarction. Clin Chim Acta 1989; 181: 325-336.

  9. Ravkilde J, Botker HE, Sogaard P, Selmer J, Rej R, Jorgensen PJ et al. Human ventricular myosin light chains isotype 1 as a marker of myocardial injury. Cardiology 1994; 84: 135-144.

  10. Chan DW, Taylor E, Frye R, Blitzer RL. Immunoenzimatic assay for creatine kinase MB with subunit specific monoclonal entibodies compared with an immunochemical method and electrophoresis. Clin Chem 1985; 31: 465-469.

  11. Jorgensen PJ, Horder M, Selmer J, Botker HE. Analytical evaluation of a sensitive enzyme immunoassay for determinations of creatine kinase isoenzyme MB. Clin Chem 1990; 36: 1502-1505.

  12. Adams JE, Bodor GS, Davila-Roman VG, Delmez JA, Apple FS, Ladenson JH et al. Cardiac troponin I. A marker with high specifity for cardiac injury. Circulation 1993; 88: 101-106.

  13. Bodor GS, Porter S, Landt Y, Ladenson JH. The development of monoclonal antibodies and assay for cardiac troponin-I with preliminary results in suspected myocardial infarction. Clin Chem 1992; 11: 2203-2214.

  14. Katus HA, Looser S, Hallermayer K, Remppis A, Scheffold T, Borgya A et al. Development and in vitro characterization of a new immunoassay of cardiac troponin T. Clin Chem 1992; 38: 386-393.

  15. Juárez HU, Lasses OL, Rosas PM, Luna GJ, López RM, Chuquiure VE et al. The utility of rapid qualitative determination of troponin T, the MB fraction of creatine phosphokinase and myoglobin in acute ischemic coronary syndromes. Arch Inst Cardiol Mex 1998; 68: 473-481.

  16. Baaker AJ, Georgels JPMC, Van Vlies B. The mass concentrations of serum troponin T and creatine kinase-MB are elevated before creatine kinase and creatine kinase-MB activities in acute myocardial infarction. Eur J Clin Chem Clin Biochem 1993; 31: 715-721.

  17. Collinson PO, Thomas S, Siu L, Vasudeva P, Stubbs PJ, Canepa-Anson. Rapid troponin T measurement in whole blood for detection of myocardial damage. Ann Clin Biochem 1995; 32: 454-458.

  18. Antman EM, Grudzien C, Sacks DB. Evaluation of a rapid bedside assay for detection of serum cardiac troponin T. JAMA 1995; 273: 1279-1282.

  19. Investigators Study Group. Evaluation of a beside whole-blood rapid troponin T assay in the emergency department. Rapid evaluation by assay of cardiac Troponin T (REACTT). Acad Emerg Med 1997; 11: 1018-1024.

  20. Hirschl MM, Lechleitner P, Friedrich G, Sint G, Sterz F, Binder M et al. Uselfulness of a new rapid bedside troponin T assay in patients with chest pain. Resuscitation 1996; 32: 193-198.

  21. Gerhardt W, Ljungdahl L. Troponin T: a sensitive and specific diagnostic and prognostic marker of myocardial damage. Clin Chem Acta 1998; 272: 47-57.




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