title: Diagnosis of Acute Myocardial Infarction in Hemodialysis Patients With High-Sensitivity Cardiac Troponin T Assay.
abstract: BACKGROUND
  Cardiac troponins have become the gold standard for diagnosing acute myocardial infarction (AMI) in the general population; however, their diagnostic accuracy for hemodialysis (HD) patients presenting with chest pain or dyspnea is uncertain.
  
  
  OBJECTIVE
  To examine the diagnostic accuracy of high-sensitivity cardiac troponin T (hs-cTnT) assay for AMI in HD patients.
  
  
  METHODS
  In this prospective study, we enrolled 670 consecutive stable HD patients presenting with chest pain or dyspnea on routine predialysis therapy in the nephrology department. Receiver operating characteristic (ROC) curves were used to examine the diagnostic accuracy of hs-cTnT levels at enrollment in HD patients presenting with chest pain or dyspnea, and the dynamic change in these levels after 3 hours.
  
  
  RESULTS
  Acute myocardial infarction was the adjudicated final diagnosis in 12% of HD patients. Among patients with a final diagnosis other than AMI, 97% had a plasma hs-cTnT concentration above the 99th percentile. At the time of enrollment, the area under the ROC curve of hs-cTnT levels for diagnosis of AMI was 0.68 (95% confidence interval [CI], 0.62-0.74; P < .001) with a cutoff value of 107.7 ng/L; the relative change after 3 hours was 0.90 (95% CI, 0.82-0.96, P < .001) with a cutoff value of 24%, and the absolute change was 0.88 (95% CI, 0.82-0.94, P < .001) with a cutoff value of 32.6 ng/L. The prognostic value for 40-day mortality varied with the magnitude of elevation in hs-cTnT levels.
  
  
  CONCLUSIONS
  Tracking the dynamic change in hs-cTnT levels during the short term significantly increased this measure's diagnostic accuracy for AMI in HD patients.
authors.affiliation: From the Departments of Laboratory Medicine (Drs Li and Wang L-L; Mss Huang, Wang W-Q, Nie, He, and Song; and Messrs Zhu and Miao) and Nephrology (Drs Shi and Fu), West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Hua-Lan
authors.initials: HL
authors.lastname: Huang
authors.forename: Shuai
authors.initials: S
authors.lastname: Zhu
authors.forename: Wei-Qing
authors.initials: WQ
authors.lastname: Wang
authors.forename: Xin
authors.initials: X
authors.lastname: Nie
authors.forename: Ying-Ying
authors.initials: YY
authors.lastname: Shi
authors.forename: Yong
authors.initials: Y
authors.lastname: He
authors.forename: Hao-Lan
authors.initials: HL
authors.lastname: Song
authors.forename: Qiang
authors.initials: Q
authors.lastname: Miao
authors.forename: Ping
authors.initials: P
authors.lastname: Fu
authors.forename: Lan-Lan
authors.initials: LL
authors.lastname: Wang
authors.forename: Gui-Xing
authors.initials: GX
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008163:Luminescent Measurements / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D011446:Prospective Studies; D012372:ROC Curve; D006435:Renal Dialysis / Q000009:adverse effects*; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T