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Combining high-sensitivity cardiac troponin and B-type natriuretic peptide in the detection of inducible myocardial ischemia

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Combining high-sensitivity cardiac troponin and B-type natriuretic peptide in the detection of inducible myocardial ischemia. / 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.

In: CLIN BIOCHEM, Vol. 52, 02.2018, p. 33-40.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Puelacher, C, Wagener, M, Honegger, U, Assadian, M, Schaerli, N, Mueller, D, Strebel, I, Twerenbold, R, Boeddinghaus, J, Nestelberger, T, Wildi, K, Sabti, Z, Sazgary, L, Badertscher, P, du Fay de Lavallaz, J, Marbot, S, Kaiser, C, Wild, D, Zellweger, MJ, Reichlin, T & Mueller, C 2018, 'Combining high-sensitivity cardiac troponin and B-type natriuretic peptide in the detection of inducible myocardial ischemia', CLIN BIOCHEM, vol. 52, pp. 33-40. https://doi.org/10.1016/j.clinbiochem.2017.10.014

APA

Puelacher, C., Wagener, M., Honegger, U., Assadian, M., Schaerli, N., Mueller, D., Strebel, I., Twerenbold, R., Boeddinghaus, J., Nestelberger, T., Wildi, K., Sabti, Z., Sazgary, L., Badertscher, P., du Fay de Lavallaz, J., Marbot, S., Kaiser, C., Wild, D., Zellweger, M. J., ... Mueller, C. (2018). Combining high-sensitivity cardiac troponin and B-type natriuretic peptide in the detection of inducible myocardial ischemia. CLIN BIOCHEM, 52, 33-40. https://doi.org/10.1016/j.clinbiochem.2017.10.014

Vancouver

Puelacher C, Wagener M, Honegger U, Assadian M, Schaerli N, Mueller D et al. Combining high-sensitivity cardiac troponin and B-type natriuretic peptide in the detection of inducible myocardial ischemia. CLIN BIOCHEM. 2018 Feb;52:33-40. https://doi.org/10.1016/j.clinbiochem.2017.10.014

Bibtex

@article{e1e0c217fc7342669a2b6005b1c2a9a2,
title = "Combining high-sensitivity cardiac troponin and B-type natriuretic peptide in the detection of inducible myocardial ischemia",
abstract = "BACKGROUND: 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).METHODS: 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.RESULTS: 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).CONCLUSION: A dual-biomarker strategy combing BNP and hs-cTnI does not further increase diagnostic accuracy on top of clinical judgment and hs-cTnI alone.SUMMARY AND HIGHLIGHTS: 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.CLINICAL TRIAL REGISTRATION: Biochemical and Electrocardiographic Signatures in the Detection of Exercise-induced Myocardial Ischemia (BASEL VIII), NCT01838148, https://clinicaltrials.gov/ct2/show/NCT01838148.",
keywords = "Aged, Area Under Curve, Biomarkers/blood, Coronary Artery Disease/blood, Electrocardiography, Exercise, Exercise Test/methods, Female, Humans, Male, Middle Aged, Myocardial Infarction/blood, Myocardial Ischemia/blood, Natriuretic Peptide, Brain/analysis, Prognosis, ROC Curve, Tomography, Emission-Computed, Single-Photon, Troponin I/analysis",
author = "Christian Puelacher and Max Wagener and Ursina Honegger and Mustafa Assadian and Nicolas Schaerli and Deborah Mueller and Ivo Strebel and Raphael Twerenbold and Jasper Boeddinghaus and Thomas Nestelberger and Karin Wildi and Zaid Sabti and Lorraine Sazgary and Patrick Badertscher and {du Fay de Lavallaz}, Jeanne and Stella Marbot and Christoph Kaiser and Damian Wild and Zellweger, {Michael J} and Tobias Reichlin and Christian Mueller",
note = "Copyright {\textcopyright} 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.",
year = "2018",
month = feb,
doi = "10.1016/j.clinbiochem.2017.10.014",
language = "English",
volume = "52",
pages = "33--40",
journal = "CLIN BIOCHEM",
issn = "0009-9120",
publisher = "Elsevier Inc.",

}

RIS

TY - JOUR

T1 - Combining high-sensitivity cardiac troponin and B-type natriuretic peptide in the detection of inducible myocardial ischemia

AU - Puelacher, Christian

AU - Wagener, Max

AU - Honegger, Ursina

AU - Assadian, Mustafa

AU - Schaerli, Nicolas

AU - Mueller, Deborah

AU - Strebel, Ivo

AU - Twerenbold, Raphael

AU - Boeddinghaus, Jasper

AU - Nestelberger, Thomas

AU - Wildi, Karin

AU - Sabti, Zaid

AU - Sazgary, Lorraine

AU - Badertscher, Patrick

AU - du Fay de Lavallaz, Jeanne

AU - Marbot, Stella

AU - Kaiser, Christoph

AU - Wild, Damian

AU - Zellweger, Michael J

AU - Reichlin, Tobias

AU - Mueller, Christian

N1 - Copyright © 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

PY - 2018/2

Y1 - 2018/2

N2 - BACKGROUND: 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).METHODS: 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.RESULTS: 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).CONCLUSION: A dual-biomarker strategy combing BNP and hs-cTnI does not further increase diagnostic accuracy on top of clinical judgment and hs-cTnI alone.SUMMARY AND HIGHLIGHTS: 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.CLINICAL TRIAL REGISTRATION: Biochemical and Electrocardiographic Signatures in the Detection of Exercise-induced Myocardial Ischemia (BASEL VIII), NCT01838148, https://clinicaltrials.gov/ct2/show/NCT01838148.

AB - BACKGROUND: 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).METHODS: 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.RESULTS: 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).CONCLUSION: A dual-biomarker strategy combing BNP and hs-cTnI does not further increase diagnostic accuracy on top of clinical judgment and hs-cTnI alone.SUMMARY AND HIGHLIGHTS: 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.CLINICAL TRIAL REGISTRATION: Biochemical and Electrocardiographic Signatures in the Detection of Exercise-induced Myocardial Ischemia (BASEL VIII), NCT01838148, https://clinicaltrials.gov/ct2/show/NCT01838148.

KW - Aged

KW - Area Under Curve

KW - Biomarkers/blood

KW - Coronary Artery Disease/blood

KW - Electrocardiography

KW - Exercise

KW - Exercise Test/methods

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/blood

KW - Myocardial Ischemia/blood

KW - Natriuretic Peptide, Brain/analysis

KW - Prognosis

KW - ROC Curve

KW - Tomography, Emission-Computed, Single-Photon

KW - Troponin I/analysis

U2 - 10.1016/j.clinbiochem.2017.10.014

DO - 10.1016/j.clinbiochem.2017.10.014

M3 - SCORING: Journal article

C2 - 29107010

VL - 52

SP - 33

EP - 40

JO - CLIN BIOCHEM

JF - CLIN BIOCHEM

SN - 0009-9120

ER -