Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Center of Biomedical Data Science, Yonsei University Wonju College of Medicine, Wonju, Korea.
Yonsei Med J. 2021 Feb;62(2):129-136. doi: 10.3349/ymj.2021.62.2.129.
Acute decompensated heart failure (ADHF) caused by ischemic heart disease is associated with higher mortality and requires immediate diagnosis. Recently, novel methods to diagnose non-ST elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin have been applied. We compared the clinical utility of high-sensitivity troponin I (hS-TnI), delta troponin I, and other traditional methods to diagnose NSTEMI in patients with ADHF.
This retrospective cross-sectional study was conducted to analyze patients with ADHF who underwent hS-TnI evaluation of 0-2-h protocol in our emergency department. Patients were grouped according to a diagnosis of NSTEMI.
A total of 524 ADHF [ADHF with NSTEMI, n=109 (20.8%)] patients were enrolled in this analysis. The mean values of hS-TnI (ng/mL) in the ADHF with and without NSTEMI groups were 2.44±5.60 and 0.25±0.91, respectively. Multivariable analysis revealed that regional wall-motion abnormality, T-wave inversion/hyperacute T wave, and initial and delta hS-TnI were predictive factors for NSTEMI. Laboratory values related to cardiac biomarkers, including hS-TnI [odds ratio (OR) (95% confidence interval, CI): 2.18], and the delta hS-TnI [OR (95% CI): 1.55] were significant predictors of NSTEMI. Moreover, receiver operating characteristic analysis showed that the areas under receiver operating characteristic curves for electrocardiographic abnormalities, initial hS-TnI, and delta hS-TnI were 0.794, 0.802, and 0.773, respectively.
For diagnosis of suspected NSTEMI in patients with ADHF, initial hS-TnI assay has similar predictive value as ischemic changes on electrocardiogram and superior predictive value than delta hS-TnI calculated by the 0-2-h protocol.
由缺血性心脏病引起的急性失代偿性心力衰竭（ADHF）与更高的死亡率相关，需要立即诊断。最近，使用高敏心肌肌钙蛋白诊断非 ST 段抬高型心肌梗死（NSTEMI）的新方法已经得到应用。我们比较了高敏肌钙蛋白 I（hS-TnI）、肌钙蛋白 I 差值和其他传统方法在诊断 ADHF 患者 NSTEMI 中的临床效用。
本回顾性横断面研究分析了在我院急诊科接受 hS-TnI 0-2-h 方案评估的 ADHF 患者。根据 NSTEMI 的诊断将患者分组。
共纳入 524 例 ADHF[ADHF 合并 NSTEMI，n=109（20.8%）]患者。ADHF 合并和不合并 NSTEMI 组 hS-TnI（ng/mL）的平均值分别为 2.44±5.60 和 0.25±0.91。多变量分析显示，区域性壁运动异常、T 波倒置/超急性 T 波和初始及肌钙蛋白 I 差值是 NSTEMI 的预测因素。与心脏生物标志物相关的实验室值，包括 hS-TnI[比值比（OR）（95%置信区间，CI）：2.18]和肌钙蛋白 I 差值[OR（95%CI）：1.55]，是 NSTEMI 的显著预测因素。此外，受试者工作特征曲线分析显示，心电图异常、初始 hS-TnI 和肌钙蛋白 I 差值的受试者工作特征曲线下面积分别为 0.794、0.802 和 0.773。
对于疑似 ADHF 患者 NSTEMI 的诊断，初始 hS-TnI 检测与心电图上的缺血性改变具有相似的预测价值，优于 0-2-h 方案计算的肌钙蛋白 I 差值。
