Puelacher Christian, Wagener Max, Honegger Ursina, Assadian Mustafa, Schaerli Nicolas, Mueller Deborah, Strebel Ivo, Twerenbold Raphael, Boeddinghaus Jasper, Nestelberger Thomas, Wildi Karin, Sabti Zaid, Sazgary Lorraine, Badertscher Patrick, du Fay de Lavallaz Jeanne, Marbot Stella, Kaiser Christoph, Wild Damian, Zellweger Michael J, Reichlin Tobias, Mueller Christian
Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland.
Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University Basel, Switzerland.
Clin Biochem. 2018 Feb;52:33-40. doi: 10.1016/j.clinbiochem.2017.10.014. Epub 2017 Nov 8.
Single biomarker approaches provide only moderate accuracy in the non-invasive detection of exercise-induced myocardial ischemia. We therefore assessed the combination of the two most promising single biomarkers: high-sensitivity cardiac troponin I (hs-cTnI) and B-type natriuretic peptide (BNP).
Consecutive patients with suspected myocardial ischemia referred to stress myocardial perfusion single-photon emission tomography imaging (MPI) were enrolled. Clinical judgment (CJ) of the treating cardiologist regarding myocardial ischemia, quantified using a visual analogue scale, and blood concentrations of hs-cTnI and BNP were determined before and after stress. The presence of myocardial ischemia was adjudicated by independent cardiologists using MPI, blinded to biomarker measurements. Death and acute myocardial infarction (AMI) during follow-up were the prognostic endpoints.
Among 1142 consecutive patients inducible myocardial ischemia was found in 456 (40%) of all patients. For the detection of inducible myocardial ischemia, CJ before exercise stress testing (CJb) showed an area under the receiver-operating-characteristics curve (AUC) of 0.66 (95%CI 0.63-0.69), hs-cTnI 0.70 (95%CI 0.67-0.73, p=0.07 vs CJb), and BNP 0.66 (95%CI 0.62-0.69, p=0.98). The use of a dual-biomarker strategy combining hs-cTnI and BNP with CJb did not provide a significant advantage over the combination of hs-cTnI alone and CJb (AUC 0.74, 95%CI 0.72-0.77 vs AUC 0.74, 95%CI 0.71-0.77, p=0.16). Hs-cTnI showed good prognostic value for AMI (HR 1.6, 95%CI 1.3-1.9), and BNP for death (HR 1.6, 95%CI 1.3-2.1).
A dual-biomarker strategy combing BNP and hs-cTnI does not further increase diagnostic accuracy on top of clinical judgment and hs-cTnI alone.
We included 1142 consecutive patients with suspected inducible ischemia, and evaluated the added value of the biomarkers high-sensitivity cardiac troponin (hs-cTn) and B-type natriuretic peptide (BNP), alone and in combination, on top of clinical judgment.
Biochemical and Electrocardiographic Signatures in the Detection of Exercise-induced Myocardial Ischemia (BASEL VIII), NCT01838148, https://clinicaltrials.gov/ct2/show/NCT01838148.
单一生物标志物方法在运动诱发心肌缺血的无创检测中准确性仅为中等。因此，我们评估了两种最具前景的单一生物标志物的组合：高敏心肌肌钙蛋白I（hs-cTnI）和B型利钠肽（BNP）。
纳入连续的疑似心肌缺血患者，这些患者接受了负荷心肌灌注单光子发射断层扫描成像（MPI）。治疗心脏病专家关于心肌缺血的临床判断（CJ），使用视觉模拟量表进行量化，并在负荷前后测定hs-cTnI和BNP的血浓度。心肌缺血的存在由独立心脏病专家使用MPI判定，他们对生物标志物测量结果不知情。随访期间的死亡和急性心肌梗死（AMI）为预后终点。
在1142例连续患者中，456例（40%）存在可诱导性心肌缺血。对于可诱导性心肌缺血的检测，运动负荷试验前的CJ（CJb）的受试者操作特征曲线下面积（AUC）为0.66（95%CI 0.63 - 0.69），hs-cTnI为0.70（95%CI 0.67 - 0.73，与CJb相比p = 0.07），BNP为0.66（95%CI 0.62 - 0.69，与CJb相比p = 0.98）。将hs-cTnI和BNP与CJb结合的双生物标志物策略与单独使用hs-cTnI和CJb的组合相比，没有显著优势（AUC 0.74，95%CI 0.72 - 0.77 对比 AUC 0.74，95%CI 0.71 - 0.77，p = 0.
