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Sengupta S, Biswal S, Titus J, Burman A, Reddy K, Fulwani MC, Khan A, Deshpande N, Shrivastava S, Yanamala N, Sengupta PP. A novel breakthrough in wrist-worn transdermal troponin-I-sensor assessment for acute myocardial infarction. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:145-154. [PMID: 37265867 PMCID: PMC10232240 DOI: 10.1093/ehjdh/ztad015] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/14/2023] [Indexed: 06/03/2023]
Abstract
Aims Clinical differentiation of acute myocardial infarction (MI) from unstable angina and other presentations mimicking acute coronary syndromes (ACS) is critical for implementing time-sensitive interventions and optimizing outcomes. However, the diagnostic steps are dependent on blood draws and laboratory turnaround times. We tested the clinical feasibility of a wrist-worn transdermal infrared spectrophotometric sensor (transdermal-ISS) in clinical practice and assessed the performance of a machine learning algorithm for identifying elevated high-sensitivity cardiac troponin-I (hs-cTnI) levels in patients hospitalized with ACS. Methods and results We enrolled 238 patients hospitalized with ACS at five sites. The final diagnosis of MI (with or without ST elevation) and unstable angina was adjudicated using electrocardiography (ECG), cardiac troponin (cTn) test, echocardiography (regional wall motion abnormality), or coronary angiography. A transdermal-ISS-derived deep learning model was trained (three sites) and externally validated with hs-cTnI (one site) and echocardiography and angiography (two sites), respectively. The transdermal-ISS model predicted elevated hs-cTnI levels with areas under the receiver operator characteristics of 0.90 [95% confidence interval (CI), 0.84-0.94; sensitivity, 0.86; and specificity, 0.82] and 0.92 (95% CI, 0.80-0.98; sensitivity, 0.94; and specificity, 0.64), for internal and external validation cohorts, respectively. In addition, the model predictions were associated with regional wall motion abnormalities [odds ratio (OR), 3.37; CI, 1.02-11.15; P = 0.046] and significant coronary stenosis (OR, 4.69; CI, 1.27-17.26; P = 0.019). Conclusion A wrist-worn transdermal-ISS is clinically feasible for rapid, bloodless prediction of elevated hs-cTnI levels in real-world settings. It may have a role in establishing a point-of-care biomarker diagnosis of MI and impact triaging patients with suspected ACS.
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Affiliation(s)
- Shantanu Sengupta
- Sengupta Hospital and Research Institute, Nagpur- 440033, Vidarbha (Dist), India
| | | | - Jitto Titus
- RCE Technologies, 2292 Faraday Avenue, Carlsbad, CA 92008, USA
| | - Atandra Burman
- RCE Technologies, 2292 Faraday Avenue, Carlsbad, CA 92008, USA
| | - Keshav Reddy
- Division of Cardiovascular Disease and Hypertension, Rutgers RobertWood Johnson Medical School, 125 Patterson St, New Brunswick, NJ 08901, USA
| | - Mahesh C Fulwani
- Shrikrishna Hrudayalay and Critical Care Center, Department of Cardiology, Dhantoli, Nagpur - 440010, Vidarbha (Dist), India
| | - Aziz Khan
- Department of Cardiology, Crescent Hospital and Heart Center, Dhantoli, Nagpur- 440010, Vidarbha (Dist), India
| | - Niteen Deshpande
- Department of Cardiology, Spandan Heart Institute and Research Center, Dhantoli, Nagpur- 440010, Vidarbha (Dist), India
| | - Smit Shrivastava
- Department of Cardiology, Advanced Cardiac Institute Pt JNM Medical College, Raipur- 492009, Chattisgarh, India
| | - Naveena Yanamala
- Division of Cardiovascular Disease and Hypertension, Rutgers RobertWood Johnson Medical School, 125 Patterson St, New Brunswick, NJ 08901, USA
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Kristensen AMD, Pareek M, Kragholm KH, Sehested TSG, Olsen MH, Prescott EB. Unstable Angina as a Component of Primary Composite Endpoints in Clinical Cardiovascular Trials: Pros and Cons. Cardiology 2022; 147:235-247. [PMID: 35537418 PMCID: PMC9393841 DOI: 10.1159/000524948] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/29/2022] [Indexed: 11/19/2022]
Abstract
Background Unstable angina (UA) is a component of acute coronary syndrome that is only occasionally included in primary composite endpoints in clinical cardiovascular trials. The aim of this paper is to elucidate the potential benefits and disadvantages of including UA in such contexts. Summary UA comprises <10% of patients with acute coronary syndromes in contemporary settings. Based on the pathophysiological similarities, it is ideal as a part of a composite endpoint along with myocardial infarction (MI). By adding UA as a component of a primary composite endpoint, the number of events and feasibility of the trial should increase, thus decreasing size and costs of trials. Furthermore, UA has both economic and quality of life implications on a societal and an individual level. However, there are important challenges associated with the use of UA as an endpoint. With the introduction of high-sensitivity troponins, the number of individuals diagnosed with UA has decreased to rather low levels, with a reciprocal increase in the number of MI. In addition, UA is particularly challenging to define given the subjective assessment of the index symptoms, rendering a high risk of bias. To minimize bias, strict criteria are warranted, and events should be adjudicated by a blinded endpoint adjudication committee. Key messages UA should only be chosen as a component of a primary composite endpoint in cardiovascular trials after thoroughly evaluating the pros and cons. If it is chosen to include UA, appropriate precautions should be taken to minimize possible bias.
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Affiliation(s)
- Anna Meta Dyrvig Kristensen
- Department of Cardiology, Copenhagen University Hospital − Bispebjerg and Frederiksberg, Copenhagen, Denmark
- *Anna Meta Dyrvig Kristensen,
| | - Manan Pareek
- Department of Cardiology, Copenhagen University Hospital − Herlev and Gentofte, Copenhagen, Denmark
| | | | - Thomas Steen Gyldenstierne Sehested
- Department of Cardiology, Copenhagen University Hospital − Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Michael Hecht Olsen
- Division of Cardiology, Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Eva Bossano Prescott
- Department of Cardiology, Copenhagen University Hospital − Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Liang Q, Lei X, Huang X, Fan L, Yu H. Elevated Lipoprotein-Associated Phospholipase A2 is Valuable in Prediction of Coronary Slow Flow in Non-ST-Segment Elevation Myocardial Infarction Patients. Curr Probl Cardiol 2020; 46:100596. [PMID: 32444159 DOI: 10.1016/j.cpcardiol.2020.100596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/06/2020] [Indexed: 12/19/2022]
Abstract
Background Coronary flow is a determinative factor of non-ST-segment elevation myocardial infarction (NSTEMI) patients. Lipoprotein-Associated Phospholipase A2(Lp-PLA2) as a vascular specific inflammatory cytokine might relate to coronary slow flow in these patients. Methods 105 NSTEMI patients and 83 UAP patients were enrolled. Another group division was made by Lp-PLA2 tertile data. Corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) was adopted to represent coronary flow condition. Correlation analysis was made between CTFC and other clinical indicators. Multivariable regression analysis was used to identify the influential factors of coronary flow in NSTEMI patients. ROC curve was used to determine the diagnostic value of Lp-PLA2 with coronary slow flow (CSF). Results High sensitive C reactive protein (hsCRP, P < 0.01), Lp-PLA2(P < 0.01), N-terminal pro-brain natriuretic peptide (NT-proBNP, P < 0.05), mean platelet volume (MPV, P<0.05), CTFC(P < 0.05) was higher in NSTEMI than UAP patients. hsCRP(P < 0.01), MPV(P < 0.01), NT-proBNP(P < 0.01) CTFC(P < 0.01) was higher in high-Lp-PLA2 group. Lp-PLA2 and hsCRP (r = 0.22, P < 0.01), MPV (r = 0.21, P < 0.05), CTFC (r = 0.69, P < 0.01) had a positive correlation in NSTEMI group. Multivariable regression analysis showed that Lp-PLA2 could explain most part changes of CTFC in NSTEMI patients, CTFC = 0.55*Lp-PLA2+0.03*hsCRP+0.005*NT-proBNP+15.843. Lp-PLA2 was specific and sensitive in diagnosis of CSF in NSTEMI group, AUC = 0.851(95% confidence interval (CI): 0.771-0.924, P < 0.01), Cutoff=196.96ng/ml, sensitivity = 84%, specificity = 81%. Conclusions Lp-PLA2 is closely correlated with coronary flow in NSTEMI patients. Lp-PLA2 over 196.96ng/ml could be used to predict CSF in NSTEMI patients.
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