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Study on Clinical Value of High-sensitivity Cardiac Troponin T Assay in Myocardial Infarction

Author: YuXiaoLi
Tutor: LiYuZhong
School: Dalian Medical University
Course: Clinical Laboratory Science
Keywords: Acute myocardial infarction (AMI) High - sensitivity troponin T (hs-cTnT) Myoglobin (Myo) Creatine kinase MB mass (CK-MBmass) Cardiac troponin T ( cTnT)
CLC: R542.22
Type: Master's thesis
Year: 2011
Downloads: 13
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Objective:Through assaying the indicators , such as high-sensitivity cardiac troponin T (hs-cTnT), creatine kinase MB mass (CK-MB mass), Myoglobin(Myo)and traditional cardiac troponin T (cTnT) for patients with acute Myocardial infarction,to observe the variation features of hs-cTnT , CK-MB mass , Myo and cTnT in the course of disease attack and development , compare their sensitivities and specificities and positie predictie and negative predictive in the diagnosis of acute Myocardial infarction., explore and discuss the clinical value of hs-cTnT assay in diagnosing Myocardial infarction.Methods:100 patients at the average age of 67.5±4.4 with Myocardial infarction (55males and 45 females) were selected.The inclusion criteria is testing medical application guidelines of biomakers of acute coronary syndrome and heart failure that was determined by National Academy of Clinical Biochemistry of American in 2007 . The following patients were excluded: (1) with trauma (including contusions, ablation , pacing , burns caused by implantable cardioverter defibrillator incloulding atrial defibrillator,endocardial biopsy, cardiac surgery and after interventional therapy for closed atrial septal defects ) ,(2)with Acute or chronic congestive heart failure,(3) with Arterial valve disease and hypertrophic obstructive cardiomyopath with left ventricular hypertrophy,obviously,(4)with hypertension,(5)with the hypotension, usua- lly associated with arrhythmia,(6) the postoperative patients of noncardiac surgery with apparent normal ,(7)with renal failure,(8)with severe illness, especially complications of diabetes,respiratory failure,gastrointestinal bleeding and septemia,(9)with the side effects of drugs, such as doxorubicin, 5-fluorouracil and, HER2 protein monoclonal antibody, snake venom, carbon monoxide poisoning,(10)with hypothyroidism,(11) with coronary artery dilation and contraction abnormalities, including coronary artery spasm,(12) with cardiac apex saccule syndrome,(13)with inflammatory diseases, such as myocarditis, tiny virus B10 infection, kawasaki disease, sarcoidosis, inflammation of smallpox vaccination,or myocardial expansion caused by bacterial endocarditis,(14) with the patients of no postoperative complications by Percutaneous coronary interention(PCI),(15)with pulmonary embolism,severe pulmonary arterial hypertension, (16) with septicopyemia,(17)with burns, especially the burn area>30% of the area of the body,(18) with exudative diseases including amyloidosis,hemachromatosis, sarcoidosis and scleroderma etc,(19) with acute diseases of the nervous system,including cerebrovascular accident, subarachnoid hemorrhage,(20) with rhabdomyolysis casued cardiac trauma,(21)with vascular lesions related to transplant,(22)with Life-threatening depleting diseases.In normal controls there’re 68 cases at the average age of 55.3±4.6 ( 30 males and 38 females) who are healthy persons with normal results of physical examination by our hospital .Venous blood was drawn from patients at the 0 th, 4th and 12th hour of admission for chest pain,and from the normal controls in the morning. The contents of Hs-cTnT、cTnT CKMB and Myo in their blood were determined by chemiluminescence immunoassay and enzyme-linked immunosorbent analysis. Their positive rates, sensibilities and specificities to AMI diagnosis at different time were compared after chest pain onset. SPSS10.0 software was used to conduct the statistics. The measurement data is mean±standard deviation(X±S). P<0.05 was considered having statistical significance.Results:1、The determination value of Myo increased after the patients of AMI ware admitted to the hospital , the positive rate of Myo reached 70 percent, the level of Myo was the highest at 4 h, the positive rate reached 75 percent, Myo had showed a drop tendency at 12 h;Meanwhile the determination value of CK-MB and cTnT went up too,the positive rates of CKMB and cTnT reached 75 percent and 81 percent respectively and the level of CKMB and cTnT still showed uptrend at 12h ,the positive rates ware 94 percent and 99 percent respectively, and the determination value of hs-TnT was increased significantly from AMI admission to hospital, the positive rate was 91%,the level of hs-TnT continued to rise after 4 hours,the positive rate already peaked 100% and the determination value of hs-TnT stillshowed uptrend.at 12h.Comparative the AMI group with the control group,the determination values of hs - cTnT, CK - MB, cTnT and Myo of the AMI group were higher than that of the control group at different time,there is significant difference in bothgroups.(p < 0.05). 2、After the patients of AMI were admitted to hospital , the levels of hs-TnT of 91 patients exceeded the limitted value > 0.014 ng/ml ,taked up 91% in AMI patients (sensitiity);, the levels of hs-TnT of 57 people In the control group were lower than 0.014ng/ml ,taked up 83%(specificity); the positie predictie of hs TnT was 89% (91/102), the negatie predictie of hs–TnT was 86% (57/66). Compared to CKMBmass cTnT and Myo ,the sensitivity and negatie predictie of hs -TnT were the best ,91% and 86%, respectively. the positie predicties of hs - cTnT and TnT were same as 89% ; the specificity of Myo combined cTnT and Myo were the best ,85%.Conclusions:1、high-sensitivity cardiac troponin has the best sensitivity and negatie predictive,and has better organization spe-cificity and the positie predictie,and has a wider diagnostic time window, so it is the ideal myocardial injury markers.2、After the body happens AMI , hs-cTnT is one of myocardial markers which appear the earliest in the blood .If the level of hs-cTnT increases lightly, the patients may happen to AMI,which is benefit for early diagnosis and treatment of AMI.3、In no detection to hs -TnT case,cTnT and Myo united detection also can be considered to use for clinical diagnosis and treatment of AMI.4、Myo has high sensitivity, but specific characteristics is poor relatively and diagnosis window is too narrow ,so It is difficult to rely solely on Myo for AMI diagnosis, and Myo is not recommended for conventional detection .

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Myocardial diseases > Myocardial infarction
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