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Risk classification of highly sensitive troponin I predict presence of vulnerable plaque assessed by dual source coronary computed tomography angiography.
Int J Cardiovasc Imaging. 2017 Nov; 33(11):1831-1839.IJ

Abstract

Patients presenting to the emergency department with acute chest pain, negative conventional troponin and electrocardiogram require serial testing to rule out acute coronary syndrome (ACS). We studied the association of highly sensitive troponin (hsTn) I with vulnerable plaque features as detected by coronary dual source computed tomography angiography (DSCTA) and determined whether hsTn I at the time of presentation combined with early DSCTA could improve classification of patients as high-risk or low risk for ACS. We included 220 patients with acute chest pain, negative electrocardiogram and conventional troponin who underwent DSCTA and had hsTn I measured at the time of presentation. The patients were categorized as having hsTn I below the limit of detection (low risk), intermediate and above the 99th percentile (high risk). Readers assessed DSCTA qualitatively for the presence of significant CAD (≥50% stenosis), calcified and non-calcified coronary plaque, and vulnerable plaque features (positive remodeling, low CT attenuation plaque, napkin-ring sign, spotty calcium). The mean age of the population was 50.3 ± 8.2 years (43% women). ACS during the index hospitalization occurred in 36 (16.3%) patients (myocardial infarction n = 8, unstable angina pectoris n = 28). HsTn I was below the limit of detection, intermediate, and above 99th percentile in 39 (17.7%), 139 (86.9%), and 42 (19.1%) patients, respectively. Across the categories of low risk, intermediate and high risk of hsTn I, there was increase in prevalence of ≥50% stenosis (0, 11.5, and 61.9% of patients; p < 0.001), any plaque (35.9, 51.1, and 85.7% of patients; p < 0.001) and high-risk plaque (0, 36.0, and 85.7% of patients; p < 0.001). None of the patients in low risk HsTn I group had ACS. ACS occurred in 10.1% of the intermediate hsTn I group and in 52.3% of the patients with high risk hsTnI group. Severity of stenosis and presence of vunerable plaque as detected by DSCTA are associated with increasing levels of hsTn I. DSCTA at the time of presentation with the assessment for both stenosis and high-risk plaque improved the diagnostic accuracy for ACS in the intermediate hsTn I group patients.

Authors+Show Affiliations

Department of Radiology, The First Affiliated Hospital of China Medical University, 155 Nanjing Bei St, Heping District, Shenyang, China.Department of Radiology, The First Affiliated Hospital of China Medical University, 155 Nanjing Bei St, Heping District, Shenyang, China.Department of Radiology, The First Affiliated Hospital of China Medical University, 155 Nanjing Bei St, Heping District, Shenyang, China.Department of Radiology, The First Affiliated Hospital of China Medical University, 155 Nanjing Bei St, Heping District, Shenyang, China. daixu821117@126.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28528430

Citation

Liu, Ting, et al. "Risk Classification of Highly Sensitive Troponin I Predict Presence of Vulnerable Plaque Assessed By Dual Source Coronary Computed Tomography Angiography." The International Journal of Cardiovascular Imaging, vol. 33, no. 11, 2017, pp. 1831-1839.
Liu T, Wang G, Li P, et al. Risk classification of highly sensitive troponin I predict presence of vulnerable plaque assessed by dual source coronary computed tomography angiography. Int J Cardiovasc Imaging. 2017;33(11):1831-1839.
Liu, T., Wang, G., Li, P., & Dai, X. (2017). Risk classification of highly sensitive troponin I predict presence of vulnerable plaque assessed by dual source coronary computed tomography angiography. The International Journal of Cardiovascular Imaging, 33(11), 1831-1839. https://doi.org/10.1007/s10554-017-1174-3
Liu T, et al. Risk Classification of Highly Sensitive Troponin I Predict Presence of Vulnerable Plaque Assessed By Dual Source Coronary Computed Tomography Angiography. Int J Cardiovasc Imaging. 2017;33(11):1831-1839. PubMed PMID: 28528430.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk classification of highly sensitive troponin I predict presence of vulnerable plaque assessed by dual source coronary computed tomography angiography. AU - Liu,Ting, AU - Wang,Guan, AU - Li,Peiling, AU - Dai,Xu, Y1 - 2017/05/20/ PY - 2017/01/24/received PY - 2017/05/17/accepted PY - 2017/5/22/pubmed PY - 2018/1/6/medline PY - 2017/5/22/entrez KW - Coronary computed tomography KW - High risk plaque KW - Highly sensitive troponin SP - 1831 EP - 1839 JF - The international journal of cardiovascular imaging JO - Int J Cardiovasc Imaging VL - 33 IS - 11 N2 - Patients presenting to the emergency department with acute chest pain, negative conventional troponin and electrocardiogram require serial testing to rule out acute coronary syndrome (ACS). We studied the association of highly sensitive troponin (hsTn) I with vulnerable plaque features as detected by coronary dual source computed tomography angiography (DSCTA) and determined whether hsTn I at the time of presentation combined with early DSCTA could improve classification of patients as high-risk or low risk for ACS. We included 220 patients with acute chest pain, negative electrocardiogram and conventional troponin who underwent DSCTA and had hsTn I measured at the time of presentation. The patients were categorized as having hsTn I below the limit of detection (low risk), intermediate and above the 99th percentile (high risk). Readers assessed DSCTA qualitatively for the presence of significant CAD (≥50% stenosis), calcified and non-calcified coronary plaque, and vulnerable plaque features (positive remodeling, low CT attenuation plaque, napkin-ring sign, spotty calcium). The mean age of the population was 50.3 ± 8.2 years (43% women). ACS during the index hospitalization occurred in 36 (16.3%) patients (myocardial infarction n = 8, unstable angina pectoris n = 28). HsTn I was below the limit of detection, intermediate, and above 99th percentile in 39 (17.7%), 139 (86.9%), and 42 (19.1%) patients, respectively. Across the categories of low risk, intermediate and high risk of hsTn I, there was increase in prevalence of ≥50% stenosis (0, 11.5, and 61.9% of patients; p < 0.001), any plaque (35.9, 51.1, and 85.7% of patients; p < 0.001) and high-risk plaque (0, 36.0, and 85.7% of patients; p < 0.001). None of the patients in low risk HsTn I group had ACS. ACS occurred in 10.1% of the intermediate hsTn I group and in 52.3% of the patients with high risk hsTnI group. Severity of stenosis and presence of vunerable plaque as detected by DSCTA are associated with increasing levels of hsTn I. DSCTA at the time of presentation with the assessment for both stenosis and high-risk plaque improved the diagnostic accuracy for ACS in the intermediate hsTn I group patients. SN - 1875-8312 UR - https://www.unboundmedicine.com/medline/citation/28528430/Risk_classification_of_highly_sensitive_troponin_I_predict_presence_of_vulnerable_plaque_assessed_by_dual_source_coronary_computed_tomography_angiography_ L2 - https://doi.org/10.1007/s10554-017-1174-3 DB - PRIME DP - Unbound Medicine ER -