title: High-sensitivity troponin T and C-reactive protein to identify patients without cardiac structural and functional abnormalities as assessed by cardiac CT and SPECT imaging: can biomarkers predict cardiac health?
abstract: While high-sensitivity troponin-T (hsTnT) and C-reactive protein (hsCRP) are associated with structural heart disease, we thought to determine whether biomarkers can predict which heart is healthy based on multimodality imaging. Patients from the emergency department with acute chest pain suggestive of acute coronary syndrome undergoing contrast enhanced cardiac CT and stress single photon emission computed tomography (SPECT) myocardial perfusion imaging were included. HsTnT and hsCRP were assessed at time of CT. Imaging data were assessed for coronary atherosclerosis, left ventricular hypertrophy/dysfunction and myocardial perfusion abnormalities. Patients were stratified into those with or without any cardiac findings, who were considered as cardiac healthy. For biomarkers, low cut-off corresponding to good specificity and high cut-off corresponding to good sensitivity for cardiac health were derived. Among 117 patients (52 years, 55 % male), 42 (36 %) were cardiac healthy based on cardiac CT and SPECT imaging. These patients had significantly lower hsTnT and hsCRP levels as compared to those with functional or structural abnormalities (3.58 vs. 5.63 ng/L, p = 0.002; 0.82 vs. 1.93 mg/L, p = 0.0005; respectively). Patients with both low hsTnT (<3.00 ng/L) and hsCRP (<0.45 mg/L) had a probability of 85 % for being cardiac healthy. In contrast, patients with high hsTnT (>7.00 ng/L) and hsCRP (>2.00 mg/L) had 8 % probability for being cardiac healthy. Discriminative capacity of a dual-biomarker strategy was significantly improved as compared to hsTnT or hsCRP alone or to Framingham Risk score (AUC: 0.781 vs. 0.691; vs. 0.678; vs. 0.649; all p ≤ 0.02, respectively). A dual-biomarker strategy of hsTnT and hsCRP is highly discriminative for patients with normal cardiac structure and function and provides incremental value beyond the Framingham risk score.
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA. cschlett@partners.org
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Schlett
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
authors.forename: Waleed
authors.initials: W
authors.lastname: Ahmed
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.forename: Maros
authors.initials: M
authors.lastname: Ferencik
authors.forename: Shanmugam
authors.initials: S
authors.lastname: Uthamalingam
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Koenig
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
mesh_terms: D015415:Biomarkers / Q000097:blood; D001900:Boston; D002097:C-Reactive Protein / Q000032:analysis*; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D064847:Multimodal Imaging; D015999:Multivariate Analysis; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T; D002097:C-Reactive Protein