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1 Laboratorio Analisi Chimico Cliniche 1,
2 Divisione di Cardiologia, and
3 Servizio di Medicina Nucleare, Azienda Ospedaliera ‘Spedali Civili’, 25125 Brescia, Italy.
aAddress correspondence to this author at: Laboratorio Analisi Chimico Cliniche 1, Azienda Ospedaliera ‘Spedali Civili’, Piazza Spedali Civili 1, 25125 Brescia, Italy. Fax 39-030-3995369; e-mail panteghi{at}bshosp.osp.unibs.it.
Background: One of the major concerns in replacing creatine kinase MB (CK-MB) with cardiac troponins is the lack of evidence of the ability of troponins to estimate the size of acute myocardial infarction (AMI). We investigated the ability of a single measurement of cardiac troponin T (cTnT) at coronary care unit (CCU) discharge to estimate infarct size and assess left ventricular (LV) function in AMI patients.
Methods: We studied 65 AMI patients in whom infarct size was estimated by CK-MB peak concentrations and gated single-photon emission computed tomography (SPECT) myocardial perfusion using technetium-99m sestamibi and LV function by SPECT imaging. Measurements of cTnT and SPECT were performed 72 h (median) after admission (range, 40–160 h). SPECT was also repeated 3 months later.
Results: We found a significant correlation between cTnT and both the peak CK-MB concentrations (r = 0.76; P <0.001) and the perfusion defect size at SPECT (r = 0.62; P <0.001). cTnT was inversely related to LV ejection fraction (LVEF) assessed both early (r = -0.56; P <0.001) and 3 months after AMI (r = -0.70; P <0.001). cTnT >2.98 µg/L predicted a LVEF <40% at 3 months with a sensitivity of 86.7%, specificity of 81.4%, and a likelihood ratio for a positive test of 4.7 (95% confidence interval, 4.0–5.4).
Conclusions: A single cTnT measurement at CCU discharge after AMI is useful as a noninvasive estimate of infarct size and for the assessment of LV function in routine clinical setting.
The following articles in journals at HighWire Press have cited this article:
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  A. K. Saenger and A. S. Jaffe Requiem for a Heavyweight: The Demise of Creatine Kinase-MB Circulation, November 18, 2008; 118(21): 2200 - 2206. [Full Text] [PDF]
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 V. C. Vasile, L. Babuin, E. Giannitsis, H. A. Katus, and A. S. Jaffe Relationship of MRI-Determined Infarct Size and cTnI Measurements in Patients with ST-Elevation Myocardial Infarction Clin. Chem., March 1, 2008; 54(3): 617 - 619. [Full Text] [PDF]
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 E. Giannitsis, H. Steen, K. Kurz, B. Ivandic, A. C. Simon, S. Futterer, C. Schild, P. Isfort, A. S. Jaffe, and H. A. Katus Cardiac Magnetic Resonance Imaging Study for Quantification of Infarct Size Comparing Directly Serial Versus Single Time-Point Measurements of Cardiac Troponin T J. Am. Coll. Cardiol., January 22, 2008; 51(3): 307 - 314. [Abstract] [Full Text] [PDF]
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 J. F Younger, S. Plein, J. Barth, J. P Ridgway, S. G Ball, and J. P Greenwood Troponin-I concentration 72 h after myocardial infarction correlates with infarct size and presence of microvascular obstruction Heart, December 1, 2007; 93(12): 1547 - 1551. [Abstract] [Full Text] [PDF]
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K. Thygesen, J. S. Alpert, H. D. White, and on behalf of the Joint ESC/ACCF/AHA/WHF Task Force Universal Definition of Myocardial Infarction J. Am. Coll. Cardiol., November 27, 2007; 50(22): 2173 - 2195. [Full Text] [PDF]
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K. Thygesen, J. S. Alpert, H. D. White, on behalf of the Joint ESC/ACCF/AHA/WHF Task Force, TASK FORCE MEMBERS: Chairpersons: Kristian Thygese, Biomarker Group: Allan S. Jaffe, Coordinator (USA), ECG Group: Bernard Chaitman, Co-ordinator (USA), P, Imaging Group: Richard Underwood, Coordinator (UK), Intervention Group: Jean-Pierre Bassand, Co-ordina, Clinical Investigation Group: Paul W. Armstrong, C, et al. Universal Definition of Myocardial Infarction Circulation, November 27, 2007; 116(22): 2634 - 2653. [Full Text] [PDF]
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S. A. Mollema, S. S. Liem, M. S. Suffoletto, G. B. Bleeker, B. L. van der Hoeven, N. R. van de Veire, E. Boersma, E. R. Holman, E. E. van der Wall, M. J. Schalij, et al. Left Ventricular Dyssynchrony Acutely After Myocardial Infarction Predicts Left Ventricular Remodeling J. Am. Coll. Cardiol., October 16, 2007; 50(16): 1532 - 1540. [Abstract] [Full Text] [PDF]
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 Task Force Members, K. Thygesen, J. S. Alpert, H. D. White, Biomarker Group, A. S. Jaffe, F. S. Apple, M. Galvani, H. A. Katus, L. K. Newby, et al. Universal definition of myocardial infarction: Kristian Thygesen, Joseph S. Alpert and Harvey D. White on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction Eur. Heart J., October 2, 2007; 28(20): 2525 - 2538. [Full Text] [PDF]
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D. E. Cutlip, S. Windecker, R. Mehran, A. Boam, D. J. Cohen, G.-A. van Es, P. Gabriel Steg, M.-a. Morel, L. Mauri, P. Vranckx, et al. Clinical End Points in Coronary Stent Trials: A Case for Standardized Definitions Circulation, May 1, 2007; 115(17): 2344 - 2351. [Abstract] [Full Text] [PDF]
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A. S. Jaffe, L. Babuin, and F. S. Apple Biomarkers in Acute Cardiac Disease: The Present and the Future J. Am. Coll. Cardiol., July 4, 2006; 48(1): 1 - 11. [Abstract] [Full Text] [PDF]
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 L. Babuin and A. S. Jaffe Troponin: the biomarker of choice for the detection of cardiac injury Can. Med. Assoc. J., November 8, 2005; 173(10): 1191 - 1202. [Abstract] [Full Text] [PDF]
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W. P. Ingkanisorn, K. L. Rhoads, A. H. Aletras, P. Kellman, and A. E. Arai Gadolinium delayed enhancement cardiovascular magnetic resonance correlates with clinical measures of myocardial infarction J. Am. Coll. Cardiol., June 16, 2004; 43(12): 2253 - 2259. [Abstract] [Full Text] [PDF]
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B. Lumbreras-Lacarra, J. M. Ramos-Rincon, and I. Hernandez-Aguado Methodology in Diagnostic Laboratory Test Research in Clinical Chemistry and Clinical Chemistry and Laboratory Medicine Clin. Chem., March 1, 2004; 50(3): 530 - 536. [Abstract] [Full Text] [PDF]
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