A-028心肌肌钙蛋白I-T-C复合物与cTnI和cTnT在鉴别心肌梗死表现中的比较

IF 6.3 2区医学 Q1 MEDICAL LABORATORY TECHNOLOGY

Clinical chemistry Pub Date : 2025-10-02 DOI:10.1093/clinchem/hvaf086.028

Yi Zhang

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Major cTn forms in the circulation were quantified using hs-cTnI, hs-cTnT, and ITC complex assays including long-cTnT ITC complex assay and hs-total ITC complex assay. We compared the performance of the ITC complex assays with hs-cTnI and hs-cTnT based on the 99th percentile upper reference limits (URLs), evaluated their area under the receiver operating characteristic curve (AUC), and assessed their ability to differentiate MI patients using established cut-off values. Results Among the study cohort, 138 (11.4%) patients were diagnosed with MI. The concentration of all cTn forms were significant higher in MI patients compared to non-MI patients. 86% patients had long-cTnT ITC complex concentration below the 99th percentile URLs, with the sensitivity 0.818 (95%CI: 0.746–0.874), specificity 0.943 (95%CI: 0.927–0.955), NPV 0.975 (95%CI: 0.964–0.983) and PPV 0.649 (95%CI: 0.575–0.716). Diagnostic accuracy, quantified by AUC values, was 0.959 (95% CI: 0.942–0.975) for the long-cTnT ITC complex, comparable to hs-cTnI (0.953, 95% CI: 0.934–0.971) and superior to both the hs-total ITC complex (0.889, 95% CI: 0.858–0.920, P &lt; 0.001) and hs-cTnT (0.927, 95% CI: 0.904–0.948, P &lt; 0.001). Using established cut-off values, the long-cTnT ITC complex assay classified 10% of patients as rule-in and 52% as rule-out, with a sensitivity of 0.993 (95% CI: 0.960–0.998), NPV of 0.998 (95% CI: 0.991–0.999), specificity of 0.972 (95% CI: 0.960–0.980), and PPV of 0.760 (95% CI: 0.678–0.826), which was comparable to hs-cTnI and better than hs-total ITC complex and hs-cTnT. In patients with a short chest pain onset time, the long-cTnT ITC complex assay demonstrated improved discrimination and enhanced diagnostic performance, as reflected by higher AUC values and more effective patient classification based on the 99th percentile URLs and established cut-off values. Conclusion The long-cTnT ITC complex assay demonstrated performance comparable to hs-cTnI and superior to both the hs-total ITC complex and hs-cTnT in distinguishing MI at presentation. 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Using established cut-off values, the long-cTnT ITC complex assay classified 10% of patients as rule-in and 52% as rule-out, with a sensitivity of 0.993 (95% CI: 0.960–0.998), NPV of 0.998 (95% CI: 0.991–0.999), specificity of 0.972 (95% CI: 0.960–0.980), and PPV of 0.760 (95% CI: 0.678–0.826), which was comparable to hs-cTnI and better than hs-total ITC complex and hs-cTnT. In patients with a short chest pain onset time, the long-cTnT ITC complex assay demonstrated improved discrimination and enhanced diagnostic performance, as reflected by higher AUC values and more effective patient classification based on the 99th percentile URLs and established cut-off values. Conclusion The long-cTnT ITC complex assay demonstrated performance comparable to hs-cTnI and superior to both the hs-total ITC complex and hs-cTnT in distinguishing MI at presentation. 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引用次数: 0

摘要

心肌肌钙蛋白（cTn）片段组成与心肌损伤病因之间的潜在关系表明，cTn组成特征或靶向特定cTn片段可能提供超越总cTn水平的诊断见解，并改善心肌梗死（MI）的诊断。我们分析了循环中的三元cTnI -cTnT - tnc复合物（ITC）、总cTnI和总cTnT，并将新型ITC复合物测定法与广泛使用的高灵敏度(hs)-cTnI和hs-cTnT在诊断MI患者时的表现进行了比较。方法收集急诊1210例有心肌梗死症状的患者的血浆样本，根据所有临床记录进行最终诊断。使用hs-cTnI、hs-cTnT和ITC复合物测定法定量循环中的主要cTn形式，包括长ctnt ITC复合物测定法和hs-总ITC复合物测定法。我们基于99百分位参考上限（url）比较了ITC复合检测与hs-cTnI和hs-cTnT的性能，评估了它们在受试者工作特征曲线（AUC）下的面积，并使用既定的临界值评估了它们区分心肌梗死患者的能力。结果在研究队列中，138例（11.4%）患者被诊断为心肌梗死。与非心肌梗死患者相比，心肌梗死患者中所有cTn形式的浓度均显著升高。86%的患者长ctnt ITC复合体浓度低于第99百分位url，敏感性0.818 (95%CI: 0.746 ~ 0.874)，特异性0.943 (95%CI: 0.927 ~ 0.955), NPV 0.975 (95%CI: 0.964 ~ 0.983), PPV 0.649 （95%CI: 0.575 ~ 0.716）。通过AUC值量化，长ctnt ITC复合物的诊断准确率为0.959 (95% CI: 0.942-0.975)，与hs-cTnI （0.953, 95% CI: 0.934-0.971）相当，优于hs-total ITC复合物（0.889,95% CI: 0.858-0.920, P < 0.001）和hs-cTnT （0.927, 95% CI: 0.904-0.948, P < 0.001）。使用已建立的临界值，长ctnt ITC复合物测定将10%的患者分类为正常患者，52%为排除患者，灵敏度为0.993 (95% CI: 0.960-0.998)， NPV为0.998 (95% CI: 0.991-0.999)，特异性为0.972 (95% CI: 0.960-0.980)， PPV为0.760 (95% CI: 0.678-0.826)，与hs-cTnI相当，优于hs-total ITC复合物和hs-cTnT。在胸痛发作时间较短的患者中，长ctnt ITC复合分析显示出更好的鉴别和增强的诊断性能，这反映在更高的AUC值和基于第99百分位url和建立的截止值的更有效的患者分类上。结论长ctnt ITC复合物测定与hs-cTnI相当，优于hs-total ITC复合物和hs-cTnT。值得注意的是，其诊断优势在症状发作后早期出现的患者中更为明显，突出了其在优化急诊科快速分诊策略方面的潜在效用。

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A-028 Comparison of the Cardiac Troponin I-T-C complex and cTnI and cTnT in Distinguishing Myocardial Infraction at Presentation

Background The potential relationship between cardiac troponin (cTn) fragment composition and the etiologies of myocardial injury indicate that characterization of cTn composition or targeting specific cTn fragments may provide diagnostic insights beyond total cTn levels and improve the diagnosis of myocardial infarction (MI). We analyzed the ternary cTnI–cTnT–TnC complexes (ITC), total cTnI and total cTnT in the circulation and compared the performance of the novel ITC complex assays with the widely used high-sensitivity (hs)-cTnI and hs-cTnT in differentiating MI patients at presentation. Methods Plasma samples were collected from 1210 patients presenting to the emergency department (ED) with symptoms suggestive of MI. The final diagnosis was adjudicated based on all available clinical records. Major cTn forms in the circulation were quantified using hs-cTnI, hs-cTnT, and ITC complex assays including long-cTnT ITC complex assay and hs-total ITC complex assay. We compared the performance of the ITC complex assays with hs-cTnI and hs-cTnT based on the 99th percentile upper reference limits (URLs), evaluated their area under the receiver operating characteristic curve (AUC), and assessed their ability to differentiate MI patients using established cut-off values. Results Among the study cohort, 138 (11.4%) patients were diagnosed with MI. The concentration of all cTn forms were significant higher in MI patients compared to non-MI patients. 86% patients had long-cTnT ITC complex concentration below the 99th percentile URLs, with the sensitivity 0.818 (95%CI: 0.746–0.874), specificity 0.943 (95%CI: 0.927–0.955), NPV 0.975 (95%CI: 0.964–0.983) and PPV 0.649 (95%CI: 0.575–0.716). Diagnostic accuracy, quantified by AUC values, was 0.959 (95% CI: 0.942–0.975) for the long-cTnT ITC complex, comparable to hs-cTnI (0.953, 95% CI: 0.934–0.971) and superior to both the hs-total ITC complex (0.889, 95% CI: 0.858–0.920, P < 0.001) and hs-cTnT (0.927, 95% CI: 0.904–0.948, P < 0.001). Using established cut-off values, the long-cTnT ITC complex assay classified 10% of patients as rule-in and 52% as rule-out, with a sensitivity of 0.993 (95% CI: 0.960–0.998), NPV of 0.998 (95% CI: 0.991–0.999), specificity of 0.972 (95% CI: 0.960–0.980), and PPV of 0.760 (95% CI: 0.678–0.826), which was comparable to hs-cTnI and better than hs-total ITC complex and hs-cTnT. In patients with a short chest pain onset time, the long-cTnT ITC complex assay demonstrated improved discrimination and enhanced diagnostic performance, as reflected by higher AUC values and more effective patient classification based on the 99th percentile URLs and established cut-off values. Conclusion The long-cTnT ITC complex assay demonstrated performance comparable to hs-cTnI and superior to both the hs-total ITC complex and hs-cTnT in distinguishing MI at presentation. Notably, its diagnostic advantages were more pronounced in patients at early presentation after symptom onset, highlighting its potential utility in optimizing rapid triage strategies in the ED.

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来源期刊

Clinical chemistry 医学-医学实验技术

CiteScore

11.30

自引率

4.30%

发文量

212

审稿时长

1.7 months

期刊介绍： Clinical Chemistry is a peer-reviewed scientific journal that is the premier publication for the science and practice of clinical laboratory medicine. It was established in 1955 and is associated with the Association for Diagnostics & Laboratory Medicine (ADLM). The journal focuses on laboratory diagnosis and management of patients, and has expanded to include other clinical laboratory disciplines such as genomics, hematology, microbiology, and toxicology. It also publishes articles relevant to clinical specialties including cardiology, endocrinology, gastroenterology, genetics, immunology, infectious diseases, maternal-fetal medicine, neurology, nutrition, oncology, and pediatrics. In addition to original research, editorials, and reviews, Clinical Chemistry features recurring sections such as clinical case studies, perspectives, podcasts, and Q&A articles. It has the highest impact factor among journals of clinical chemistry, laboratory medicine, pathology, analytical chemistry, transfusion medicine, and clinical microbiology. The journal is indexed in databases such as MEDLINE and Web of Science.