高敏肌钙蛋白T检测在低风险急性冠状动脉综合征患者PET-CT检查中检测缺血情况的性能：一项前瞻性观察研究。
Performance of highly sensitive cardiac troponin T assay to detect ischaemia at PET-CT in low-risk patients with acute coronary syndrome: a prospective observational study.
作者信息
Morawiec Beata, Fournier Stephane, Tapponnier Maxime, Prior John O, Monney Pierre, Dunet Vincent, Lauriers Nathalie, Recordon Frederique, Trana Catalina, Iglesias Juan-Fernando, Kawecki Damian, Boulat Olivier, Bardy Daniel, Lamsidri Sabine, Eeckhout Eric, Hugli Olivier, Muller Olivier
机构信息
Department of Cardiology, University Hospital, Lausanne, Switzerland.
2 Department of Cardiology, School of Medicine with the Division of Dentistry, Zabrze, Medical University of Silesia, Katowice, Poland.
出版信息
BMJ Open. 2017 Jul 10;7(7):e014655. doi: 10.1136/bmjopen-2016-014655.
BACKGROUND
Highly sensitive troponin T (hs-TnT) assay has improved clinical decision-making for patients admitted with chest pain. However, this assay's performance in detecting myocardial ischaemia in a lowrisk population has been poorly documented.
PURPOSE
To assess hs-TnT assay's performance to detect myocardial ischaemia at positron emission tomography/CT (PET-CT) in low-risk patients admitted with chest pain.
METHODS
Patients admitted for chest pain with a nonconclusive ECG and negative standard cardiac troponin T results at admission and after 6 hours were prospectively enrolled. Their hs-TnT samples were at T0, T2 and T6. Physicians were blinded to hs-TnT results. All patients underwent a PET-CT at rest and during adenosine-induced stress. All patients with a positive PET-CT result underwent a coronary angiography.
RESULTS
Forty-eight patients were included. Six had ischaemia at PET-CT. All of them had ≥1 significant stenosis at coronary angiography. Areas under the curve (95% CI) for predicting significant ischaemia at PET-CT using hs-TnT were 0.764 (0.515 to 1.000) at T0, 0.812(0.616 to 1.000) at T2 and 0.813(0.638 to 0.989) at T6. The receiver operating characteristicbased optimal cut-off value for hs-TnT at T0, T2 and T6 needed to exclude significant ischaemia at PET-CT was <4 ng/L. Using this value, sensitivity, specificity, positive and negative predictive values of hs-TnT to predict significant ischaemia were 83%/38%/16%/94% at T0, 100%/40%/19%/100% at T2 and 100%/43%/20%/100% at T6, respectively.
CONCLUSIONS
Our findings suggest that in low-risk patients, using the hs-TnT assay with a cut-off value of 4 ng/L demonstrates excellent negative predictive value to exclude myocardial ischaemia detection at PET-CT, at the expense of weak specificity and positive predictive value.
TRIAL REGISTRATION NUMBER
ClinicalTrials.gov Identifier: NCT01374607.
背景
高敏肌钙蛋白T（hs-TnT）检测改善了胸痛入院患者的临床决策。然而，该检测在低风险人群中检测心肌缺血的性能鲜有文献记载。
目的
评估hs-TnT检测在胸痛入院的低风险患者中通过正电子发射断层扫描/计算机断层扫描（PET-CT）检测心肌缺血的性能。
方法
前瞻性纳入因胸痛入院、心电图无定论且入院时及6小时后标准心肌肌钙蛋白T结果为阴性的患者。他们的hs-TnT样本分别在T0、T2和T6采集。医生对hs-TnT结果不知情。所有患者均接受静息及腺苷诱发应激状态下的PET-CT检查。所有PET-CT结果阳性的患者均接受冠状动脉造影。
结果
纳入48例患者。6例在PET-CT检查时有心肌缺血。他们在冠状动脉造影时均有≥1处严重狭窄。使用hs-TnT预测PET-CT检查时严重心肌缺血的曲线下面积（95%CI）在T0时为0.764（0.515至1.000），T2时为0.812（0.616至1.000），T6时为0.813（0.638至0.989）。为排除PET-CT检查时的严重心肌缺血，hs-TnT在T0、T2和T6时基于受试者工作特征曲线的最佳截断值<4 ng/L。采用该值时，hs-TnT预测严重心肌缺血的敏感性、特异性、阳性预测值和阴性预测值在T0时分别为83%/38%/16%/94%，T2时分别为100%/40%/19%/100%，T6时分别为100%/43%/20%/100%。
结论
我们的研究结果表明，在低风险患者中，使用截断值为4 ng/L的hs-TnT检测对排除PET-CT检查时的心肌缺血检测具有出色的阴性预测值，但特异性和阳性预测值较弱。
试验注册号
ClinicalTrials.gov标识符：NCT01374607。
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