Single-point cardiac troponin T at coronary care unit discharge after myocardial infarction correlates with infarct size and ejection fraction.
BACKGROUND
One of the major concerns in replacing creatine kinase MB (CK-MB) with cardiac troponins is the lack of evidence of the ability of troponins to estimate the size of acute myocardial infarction (AMI). We investigated the ability of a single measurement of cardiac troponin T (cTnT) at coronary care unit (CCU) discharge to estimate infarct size and assess left ventricular (LV) function in AMI patients.


METHODS
We studied 65 AMI patients in whom infarct size was estimated by CK-MB peak concentrations and gated single-photon emission computed tomography (SPECT) myocardial perfusion using technetium-99m sestamibi and LV function by SPECT imaging. Measurements of cTnT and SPECT were performed 72 h (median) after admission (range, 40-160 h). SPECT was also repeated 3 months later.


RESULTS
We found a significant correlation between cTnT and both the peak CK-MB concentrations (r = 0.76; P <0.001) and the perfusion defect size at SPECT (r = 0.62; P <0.001). cTnT was inversely related to LV ejection fraction (LVEF) assessed both early (r = -0.56; P <0.001) and 3 months after AMI (r = -0.70; P <0.001). cTnT >2.98 micro g/L predicted a LVEF <40% at 3 months with a sensitivity of 86.7%, specificity of 81.4%, and a likelihood ratio for a positive test of 4.7 (95% confidence interval, 4.0-5.4).


CONCLUSIONS
A single cTnT measurement at CCU discharge after AMI is useful as a noninvasive estimate of infarct size and for the assessment of LV function in routine clinical setting.
Laboratorio Analisi Chimico Cliniche 1, Azienda Ospedaliera Spedali Civili, Piazza Spedali Civili 1, 25125 Brescia, Italy. panteghi@bshosp.osp.unibs.it
Mauro
M
Panteghini
Claudio
C
Cuccia
Graziella
G
Bonetti
Raffaele
R
Giubbini
Franca
F
Pagani
Elena
E
Bonini
D000328:Adult; D000368:Aged; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D005260:Female; D006748:Hospital Departments; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon; D020107:Troponin T / Q000097:blood*
D007527:Isoenzymes; D020107:Troponin T; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form