CV biomarkers may help noninvasively diagnose type 2 MI
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CV biomarkers that quantify myocardial injury, endothelial dysfunction, microvascular dysfunction and/or hemodynamic stress successfully provided modest discrimination in a noninvasive diagnosis of type 2 MI, researchers reported.

“Because treatments differ substantially, the early and accurate discrimination of type 2 MI is a major yet largely unmet clinical need,” researchers wrote in JAMA Cardiology. “Unfortunately, established biomarkers of cardiomyocyte injury, including high-sensitivity cardiac troponin T and I levels, have only modest diagnostic discrimination.”

The international, multicenter prospective diagnostic study included 5,887 patients (mean age, 61 years; 34% women) who presented with acute chest discomfort in 12 EDs in Switzerland, Spain, Italy, Poland and the Czech Republic. Researchers quantified discrimination of 17 novel CV biomarkers and high-sensitivity cardiac troponin T and I levels and measured these results against a final diagnosis.

In the cohort, 18.8% of patients had an adjudicated final MI diagnosis and, of these, 77.8% had type 1 MI and 22.2% had type 2 MI.

Compared with patients with type 1 MI, those with type 2 MI had lower biomarker concentrations quantifying cardiomyocyte injury: high-sensitivity cardiac troponin T (30 ng/L vs. 58 ng/L), high-sensitivity cardiac troponin I (23 ng/L vs. 115 ng/L) and cardiac myosin-binding protein C (76 ng/L vs. 257 ng/L). However, patients with type 2 MI had higher biomarker concentrations quantifying endothelial dysfunction, microvascular dysfunction and/or hemodynamic stress, including C-terminal proendothelin 1 (97 pmol/L vs. 68 pmol/L), midregional proadrenomedullin (0.97 pmol/L vs. 0.72 pmol/L), midregional pro-A-type natriuretic peptide (378 pmol/L vs. 152 pmol/L) and growth differentiation factor 15 (2.26 ng/L vs. 1.56 ng/L).

The researchers wrote that the following biomarkers provided modest discrimination: high-sensitivity cardiac troponin T, high-sensitivity cardiac troponin I, cardiac myosin-binding protein C, C-terminal proendothelin 1, midregional proadrenomedullin, midregional pro-A-type natriuretic peptide and growth differentiation factor 15.

“Given the suggestive findings observed for midregional pro-A-type natriuretic peptide, future studies are warranted to develop diagnostic models combining routinely available information such as high-sensitivity cardiac troponin-T or high-sensitivity cardiac troponin-I, medical history and the 12-lead ECG with selected biomarkers,” the researchers wrote. “Until these tools are derived and externally validated, however, most patients will still require coronary angiography and/or noninvasive functional or anatomic testing to achieve a high level of diagnostic discrimination.”

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Dr. K●●●●●r     R. G●●●i
Dr. K●●●●●r R. G●●●i Internal Medicine
May 3, 2021Like