title: High-sensitivity cardiac troponin T: A biomarker for the early risk stratification of type-A acute aortic dissection?
abstract: BACKGROUND
  High-sensitivity cardiac troponin is the most specific and sensitive biomarker of myocardial injury. However, no study has investigated whether the early concentration of high-sensitivity cardiac troponin is increased or is of value in predicting short-term prognosis in patients with type-A acute aortic dissection (AAD) in the emergency department.
  
  
  OBJECTIVE
  To measure the high-sensitivity cardiac troponin T (hs-TnT) concentration in patients with type-A AAD upon hospital admission, and to assess its value in predicting short-term prognosis.
  
  
  METHODS
  We enrolled consecutive patients with type-A AAD. Blood samples were collected on admission; hs-TnT concentrations were measured on the Elecsys 2010 system. High-sensitivity C-reactive protein (hs-CRP), D-dimer and other biochemical indicators were measured. Patients were divided into two groups according to hs-TnT concentration on admission (< or ≥0.014ng/mL).
  
  
  RESULTS
  More than half (61.2%) of the 103 included patients had an hs-TnT concentration ≥0.014ng/mL. hs-TnT concentrations were significantly higher in those who died compared with survivors (0.292±0.516 vs. 0.069±0.154ng/mL; P=0.003). Multivariable Cox regression analysis suggested that hs-TnT is an independent factor for predicting in-hospital mortality risk (odds ratio: 2.202, 95% confidence interval: 1.111-4.367; P=0.024). Kaplan-Meier curves revealed a significant increase in hospital mortality in the hs-TnT(+) group compared with the hs-TnT(-) group (P=0.021). When hs-TnT was ≥0.042ng/mL, the sensitivity and specificity in predicting hospital short-term mortality were 70.8% and 76.4%, respectively.
  
  
  CONCLUSIONS
  Our study suggests that hs-TnT concentration could be used as an early biomarker for the risk stratification of patients with type-A AAD in the emergency department; the relationship between hs-TnT concentration and long-term prognosis needs further investigation.
authors.affiliation: Laboratory of Cardiovascular Immunology, Institute of Cardiology, Union Hospital, Huazhong University of Science and Technology, 430022 Wuhan, China; Emergency Department, Wuhan General Hospital of Guangzhou Military Command, Wuhan, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Li
authors.affiliation: Department of Thoracic Surgery, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Xiao-Wei
authors.initials: XW
authors.lastname: Wu
authors.affiliation: Emergency Department, Wuhan General Hospital of Guangzhou Military Command, Wuhan, China.
authors.forename: Wei-Hua
authors.initials: WH
authors.lastname: Lu
authors.affiliation: Emergency Department, Wuhan General Hospital of Guangzhou Military Command, Wuhan, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Department of Cardiology, Pu'ai Hospital, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Xin-Ying
authors.initials: XY
authors.lastname: Wu
authors.affiliation: College of Foreign Language, Huazhong Agriculture University, Wuhan, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Ai
authors.affiliation: Laboratory of Cardiovascular Immunology, Institute of Cardiology, Union Hospital, Huazhong University of Science and Technology, 430022 Wuhan, China.
authors.forename: Zi-Hua
authors.initials: ZH
authors.lastname: Zhou
authors.affiliation: Emergency Department, Wuhan General Hospital of Guangzhou Military Command, Wuhan, China.
authors.forename: Zhong-Zhi
authors.initials: ZZ
authors.lastname: Tang
authors.affiliation: Laboratory of Cardiovascular Immunology, Institute of Cardiology, Union Hospital, Huazhong University of Science and Technology, 430022 Wuhan, China. Electronic address: liaoyh27@163.com.
authors.forename: Yu-Hua
authors.initials: YH
authors.lastname: Liao
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D001014:Aortic Aneurysm / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D015415:Biomarkers / Q000097:blood*; D016009:Chi-Square Distribution; D002681:China; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D020107:Troponin T / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C545568:TNNT2 protein, human; D020107:Troponin T
keywords: Acute aortic dissection; Dissection aortique aiguë; High-sensitivity cardiac troponin T; In-hospital mortality; Mortalité hospitalière; Prognosis; Pronostic; Troponine T cardiaque hypersensible