Presentation on theme: "Early assessment of myocardial injury by joint measurement of TnT-hs and Copeptin (1) J. Teixeira, (2) P. Wotquenne, (2) V. D’Orio, (3) D. Gruson, (1)"— Presentation transcript:
Early assessment of myocardial injury by joint measurement of TnT-hs and Copeptin (1) J. Teixeira, (2) P. Wotquenne, (2) V. D’Orio, (3) D. Gruson, (1) J.P. Chapelle (1)University of Liège, Department of Clinical Chemistry, University Hospital, Liège, Belgium (2)University of Liège, Department of Emergency, University Hospital, Liège, Belgium (3)Catholic University of Louvain, Department of Endocrinology, St Luc, Brussels, Belgium Background The ability to rapidly determine the presence of myocardial ischemia is crucial for the management of patients presenting with suspected acute coronary syndrome (ACS). Since the redefinition of the diagnostic criteria of myocardial Infarction (MI) in 2000, the cardiac troponins (cTnT or cTnI) have been established as a critical component for the diagnosis of MI. Aim of the study High sensitivity cardiac troponin T (hs cTnT) and troponin I (hs cTnI) have increased sensitivity as compared to conventional assays. Copeptin, the C-terminal fragment of the vasopressin prohormone, is a marker of stress. The aim of the study was to examine whether the association of the two markers (Copeptin and hs cTnT or cTnI) could be useful to rule out myocardial damage and to help identify patients with acute MI within 3 to 4 hours (or even before) after the attack. Between June 2010 and March 2011, 145 patients with suspicion of ACS presenting at the University Hospital of Liège were enrolled in this study. Copeptin, cTnT (conventional), hs cTnT, hs cTnI, myoglobin, creatine kinase-myocardial band (CKMB), total creatine kinase and N-terminal pro-brain natriuretic peptide (NTproBNP) were determined at admission and after 4, 8 and 12 hrs. Each patient involvement in the study lasted for at least 12 hours. This period of the patient observation is based on the AHA guidelines for non ST segment elevation MI recommending to collect the first draw for biomarker measurement at admission and 6h after, and if hs cTnT test is negative, to repeat hs cTnT measurement 8 to 12 hrs after the onset of symptoms to rule out MI. Plasma samples were collected in Li-heparin tubes. The samples were centrifuged and measured immediately after centrifugation or within 24 hrs, stored at 2 – 8° C. Preliminary results indicate that, in ACS patients, hs cTnT and hs cTnI increase in the plasma earlier than standard troponin T. The predictive value of a negative result was also increased as compared to the standard assay. In case of acute event, copeptin levels rise very rapidly above the upper limit of reference values. The evolution of the investigated biomarkers in two ACS patients admitted to the hospital within 2 hours following onset of symptoms is illustrated in Fig 1 and 2. Preliminary results indicate early appearance of hs cardiac troponins and copeptin after ACS. The potential interest of the joint appreciation of these early markers has to be confirmed. Methods Results Conclusion Fig. 1 Patient DG (F) 70 years Diagnosis: Unstable angina Admission delay: < 2h Fig. 2 Patient KH (M) 63 years Diagnosis: myocardial infarction Admission delay: < 2h
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