TY - JOUR
T1 - Acute chest pain in the high-sensitivity cardiac troponin era: A changing role for noninvasive imaging?
AU - Smulders, Martijn W.
AU - Kietselaer, Bas L. J. H.
AU - Schalla, Simon
AU - Bucerius, Jan
AU - Jaarsma, Caroline
AU - van Dieijen-Visser, Marja P.
AU - Mingels, Alma M. A.
AU - Brunner-La Rocca, Hanspeter
AU - Post, Mark
AU - Das, Marco
AU - Crijns, Harry J. G. M.
AU - Wildberger, Joachim E.
AU - Bekkers, Bas
PY - 2016/7
Y1 - 2016/7
N2 - Management of patients with acute chest pain remains challenging. Cardiac biomarker testing reduces the likelihood of erroneously discharging patients with acute myocardial infarction (AMI). Despite normal contemporary troponins, physicians have still been reluctant to discharge patients without additional testing. Nowadays, the extremely high negative predictive value of current high-sensitivity cardiac troponin (hs-cTn) assays challenges this need. However, the decreased specificity of hs-cTn assays to diagnose AMI poses a new problem as noncoronary diseases (eg, pulmonary embolism, myocarditis, cardiomyopathies, hypertension, renal failure, etc) may also cause elevated hs-cTn levels. Subjecting patients with noncoronary diseases to unnecessary pharmacological therapy or invasive procedures must be prevented. Attempts to improve the positive predictive value to diagnose AMI by defining higher initial cutoff values or dynamic changes over time inherently lower the sensitivity of troponin assays. In this review, we anticipate a potential changing role of noninvasive imaging from ruling out myocardial disease when troponin values are normal toward characterizing myocardial disease when hs-cTn values are (mildly) abnormal.
AB - Management of patients with acute chest pain remains challenging. Cardiac biomarker testing reduces the likelihood of erroneously discharging patients with acute myocardial infarction (AMI). Despite normal contemporary troponins, physicians have still been reluctant to discharge patients without additional testing. Nowadays, the extremely high negative predictive value of current high-sensitivity cardiac troponin (hs-cTn) assays challenges this need. However, the decreased specificity of hs-cTn assays to diagnose AMI poses a new problem as noncoronary diseases (eg, pulmonary embolism, myocarditis, cardiomyopathies, hypertension, renal failure, etc) may also cause elevated hs-cTn levels. Subjecting patients with noncoronary diseases to unnecessary pharmacological therapy or invasive procedures must be prevented. Attempts to improve the positive predictive value to diagnose AMI by defining higher initial cutoff values or dynamic changes over time inherently lower the sensitivity of troponin assays. In this review, we anticipate a potential changing role of noninvasive imaging from ruling out myocardial disease when troponin values are normal toward characterizing myocardial disease when hs-cTn values are (mildly) abnormal.
U2 - 10.1016/j.ahj.2016.03.025
DO - 10.1016/j.ahj.2016.03.025
M3 - Article
C2 - 27297855
SN - 0002-8703
VL - 177
SP - 102
EP - 111
JO - American Heart Journal
JF - American Heart Journal
ER -