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BMJ (Clinical Research Ed.) Jan 2015To obtain summary estimates of the accuracy of a single baseline measurement of the Elecsys Troponin T high-sensitive assay (Roche Diagnostics) for the diagnosis of... (Meta-Analysis)
Meta-Analysis Review
Diagnostic accuracy of single baseline measurement of Elecsys Troponin T high-sensitive assay for diagnosis of acute myocardial infarction in emergency department: systematic review and meta-analysis.
OBJECTIVE
To obtain summary estimates of the accuracy of a single baseline measurement of the Elecsys Troponin T high-sensitive assay (Roche Diagnostics) for the diagnosis of acute myocardial infarction in patients presenting to the emergency department.
DESIGN
Systematic review and meta-analysis of diagnostic test accuracy studies.
DATA SOURCES
Medline, Embase, and other relevant electronic databases were searched for papers published between January 2006 and December 2013.
STUDY SELECTION
Studies were included if they evaluated the diagnostic accuracy of a single baseline measurement of Elecsys Troponin T high-sensitive assay for the diagnosis of acute myocardial infarction in patients presenting to the emergency department with suspected acute coronary syndrome.
STUDY APPRAISAL AND DATA SYNTHESIS
The first author screened all titles and abstracts identified through the searches and selected all potentially relevant papers. The screening of the full texts, the data extraction, and the methodological quality assessment, using the adapted QUADAS-2 tool, were conducted independently by two reviewers with disagreements being resolved through discussion or arbitration. If appropriate, meta-analysis was conducted using the hierarchical bivariate model.
RESULTS
Twenty three studies reported the performance of the evaluated assay at presentation. The results for 14 ng/L and 3-5 ng/L cut-off values were pooled separately. At 14 ng/L (20 papers), the summary sensitivity was 89.5% (95% confidence interval 86.3% to 92.1%) and the summary specificity was 77.1% (68.7% to 83.7%). At 3-5 ng/L (six papers), the summary sensitivity was 97.4% (94.9% to 98.7%) and the summary specificity was 42.4% (31.2% to 54.5%). This means that if 21 of 100 consecutive patients have the target condition (21%, the median prevalence across the studies), 2 (95% confidence interval 2 to 3) of 21 patients with acute myocardial infarction will be missed (false negatives) if 14 ng/L is used as a cut-off value and 18 (13 to 25) of 79 patients without acute myocardial infarction will test positive (false positives). If the 3-5 ng/L cut-off value is used, <1 (0 to 1) patient with acute myocardial infarction will be missed and 46 (36 to 54) patients without acute myocardial infarction will test positive.
CONCLUSIONS
The results indicate that a single baseline measurement of the Elecsys Troponin T high-sensitive assay could be used to rule out acute myocardial infarction if lower cut-off values such as 3 ng/L or 5 ng/L are used. However, this method should be part of a comprehensive triage strategy and may not be appropriate for patients who present less than three hours after symptom onset. Care must also be exercised because of the higher imprecision of the evaluated assay and the greater effect of lot-to-lot reagent variation at low troponin concentrations.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration number CRD42013003926.
Topics: Biomarkers; Emergency Service, Hospital; Humans; Myocardial Infarction; Predictive Value of Tests; Sensitivity and Specificity; Troponin T
PubMed: 25646632
DOI: 10.1136/bmj.h15 -
Medical Sciences (Basel, Switzerland) May 2021The optimal timing of aortic valve replacement (AVR) remains controversial. Several biomarkers reflect the underlying pathophysiological processes in aortic stenosis... (Meta-Analysis)
Meta-Analysis
The optimal timing of aortic valve replacement (AVR) remains controversial. Several biomarkers reflect the underlying pathophysiological processes in aortic stenosis (AS) and may be of use as mortality predictors. The aim of this systematic review and meta-analysis is to evaluate the blood biomarkers utilised in AS and assess whether they associate with mortality. PubMed and Embase were searched for studies reporting baseline biomarker level and mortality outcomes in patients with AS. A total of 83 studies met the inclusion criteria and were systematically reviewed. Of these, 21 reporting brain natriuretic peptide (BNP), N-terminal pro B-type natriuretic peptide (NT-proBNP), Troponin and Galectin-3 were meta-analysed. Pooled analysis demonstrated that all-cause mortality was significantly associated with elevated baseline levels of BNP (HR 2.59; 95% CI 1.95-3.44; < 0.00001), NT-proBNP (HR 1.73; 95% CI 1.45-2.06; = 0.00001), Troponin (HR 1.65; 95% CI 1.31-2.07; < 0.0001) and Galectin-3 (HR 1.82; 95% CI 1.27-2.61; < 0.001) compared to lower baseline biomarker levels. Elevated levels of baseline BNP, NT-proBNP, Troponin and Galectin-3 were associated with increased all-cause mortality in a population of patients with AS. Therefore, a change in biomarker level could be considered to refine optimal timing of intervention. The results of this meta-analysis highlight the importance of biomarkers in risk stratification of AS, regardless of symptom status.
Topics: Aortic Valve; Aortic Valve Stenosis; Biomarkers; Galectin 3; Humans; Natriuretic Peptide, Brain; Troponin
PubMed: 34067808
DOI: 10.3390/medsci9020029 -
Biomarkers : Biochemical Indicators of... Dec 2017Cardiac-specific troponin T (cTnT) and troponin I (cTnI) are considered diagnostically equal in patients with acute coronary syndrome (ACS). The aim of this systematic... (Comparative Study)
Comparative Study Review
BACKGROUND
Cardiac-specific troponin T (cTnT) and troponin I (cTnI) are considered diagnostically equal in patients with acute coronary syndrome (ACS). The aim of this systematic review was to compare the prevalence and prognostic strength of elevations of cTnT and cTnI in patients with other conditions than ACS.
METHODS
A systemic review was conducted in concordance with the PRISMA guidelines. The studies were identified by searching PubMed, EMBASE and Cochrane Central Register, from May to August 2016. Studies measuring both cTnT and cTnI in populations without ACS were eligible.
RESULTS
Twenty-nine studies were included (n = 25,859). Seventeen studies reported on prognostic information with follow-up time ranging for 30 d-5 years. Elevation above the 99th percentile (reference value for a healthy population) in non-ACS population was reported to be 0-39% for cTnI and 40-100% for cTnT. Elevation of cTnT tends to be a superior predictor for all-cause mortality and elevation of cTnI tends to be a superior predictor for cardiovascular related mortality.
DISCUSSION
In the absence of ACS, elevation of cTnT is more frequent than elevation of cTnI.
CONCLUSION
Both cTnT and cTnI elevations have important prognostic information regarding morbidity, cardiac mortality and all-cause mortality.
Topics: Acute Coronary Syndrome; Biomarkers; Kidney Failure, Chronic; Myocardium; Prognosis; Reference Values; Sensitivity and Specificity; Troponin I; Troponin T
PubMed: 28545334
DOI: 10.1080/1354750X.2017.1335779 -
Chest Oct 2009Controversy exists regarding the usefulness of troponin testing for the risk stratification of patients with acute pulmonary embolism (PE). We conducted an updated... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Controversy exists regarding the usefulness of troponin testing for the risk stratification of patients with acute pulmonary embolism (PE). We conducted an updated systematic review and a metaanalysis of troponin-based risk stratification of normotensive patients with acute symptomatic PE. The sources of our data were publications listed in Medline and Embase from 1980 through April 2008 and a review of cited references in those publications.
METHODS
We included all studies that estimated the relation between troponin levels and the incidence of all-cause mortality in normotensive patients with acute symptomatic PE. Two reviewers independently abstracted data and assessed study quality. From the literature search, 596 publications were screened. Nine studies that consisted of 1,366 normotensive patients with acute symptomatic PE were deemed eligible. Pooled results showed that elevated troponin levels were associated with a 4.26-fold increased odds of overall mortality (95% CI, 2.13 to 8.50; heterogeneity chi(2) = 12.64; degrees of freedom = 8; p = 0.125). Summary receiver operating characteristic curve analysis showed a relationship between the sensitivity and specificity of troponin levels to predict overall mortality (Spearman rank correlation coefficient = 0.68; p = 0.046). Pooled likelihood ratios (LRs) were not extreme (negative LR, 0.59 [95% CI, 0.39 to 0.88]; positive LR, 2.26 [95% CI, 1.66 to 3.07]). The Begg rank correlation method did not detect evidence of publication bias.
CONCLUSIONS
The results of this metaanalysis indicate that elevated troponin levels do not adequately discern normotensive patients with acute symptomatic PE who are at high risk for death from those who are at low risk for death.
Topics: Humans; Pulmonary Embolism; Risk Assessment; Sensitivity and Specificity; Troponin
PubMed: 19465511
DOI: 10.1378/chest.09-0608 -
Cardiology 2015Coronary artery bypass grafting (CABG) is a key and effective surgical treatment modality for coronary artery disease. Unfortunately, ischemia-reperfusion injury during... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Coronary artery bypass grafting (CABG) is a key and effective surgical treatment modality for coronary artery disease. Unfortunately, ischemia-reperfusion injury during and after CABG can lead to reversible and irreversible myocardial damage. Trimetazidine [1-(2,3,4-trimethoxybenzyl)piperazine dihydrochloride] is a metabolic anti-ischemic agent with demonstrated cardioprotective effects; however, its effects with respect to myocardial preservation in CABG patients remain unclear.
METHODS
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to investigate the effectiveness of myocardial preservation of preoperative trimetazidine therapy in CABG patients by assessing the postoperative levels of several blood-based biochemical markers of myocardial injury, including creatine kinase (CK), creatine kinase-muscle and brain (CK-MB), creatine phosphokinase (CPK), troponin T (TnT) and troponin I (TnI). The RCTs were classified into two subgroup analyses by the timing of sample collection (either ≤12 or >12 h after CABG).
RESULTS
Six RCTs were finally included in the meta-analysis. The pooled effect sizes showed significantly lower postoperative levels of CK, CK-MB, TnT and TnI in the trimetazidine-treated CABG patients relative to control CABG patients. However, there were no significant differences in the postoperative CPK levels between trimetazidine-treated CABG patients relative to control CABG patients. In both the ≤12 and >12 h post-CABG subgroup analyses, significant differences in CK, CK-MB, TnT and TnI were detected between the trimetazidine-treated CABG patients relative to control CABG patients.
CONCLUSIONS
Preoperative trimetazidine therapy appears to have a positive effect on myocardial preservation in CABG patients.
Topics: Biomarkers; Cardiotonic Agents; Coronary Artery Bypass; Creatine Kinase, MB Form; Humans; Myocardial Reperfusion Injury; Postoperative Complications; Preoperative Care; Randomized Controlled Trials as Topic; Trimetazidine; Troponin; Vasodilator Agents
PubMed: 25871315
DOI: 10.1159/000375289 -
Journal of Cardiology Sep 2021Elevation of high-sensitivity troponin-T (hs-TnT) is linked to cardiovascular morbidity and mortality. However, its prognostic value for survival and cardiovascular... (Review)
Review
BACKGROUND
Elevation of high-sensitivity troponin-T (hs-TnT) is linked to cardiovascular morbidity and mortality. However, its prognostic value for survival and cardiovascular events and its relation to clinical characteristics and cardiac function parameters in clinically asymptomatic adults with congenital heart disease (ACHD) needs further exploration.
METHODS
A systematic literature search was performed in PubMed and Cochrane from 2010 to May 2020 for hs-TnT as a prognostic marker in ACHD. Three independent reviewers evaluated the articles according to the Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Heart, Lung, and Blood Institute. Overall, eight studies with a total of 2162 ACHD patients (18-63 years) were included.
RESULTS
Hs-TnT level was elevated in 8-26% of asymptomatic ACHD. The follow-up for all-cause mortality and cardiovascular events ranged from 3.0 to 5.6 years and in 8-38% of the participants cardiac endpoints were reached. Throughout the included studies, elevated hs-TnT was found to be an independent predictor for survival and heart failure in stable ACHD. Serial hs-TnT measurement was found to be beneficial over single measurement. Hs-TnT levels were correlated with male sex, higher age, and higher New York Heart Association class and associated with several cardiac dysfunction parameters.
CONCLUSION
More scientific research investigating the prognostic value of hs-TnT in stable ACHD is needed and the clinical relevance to guide aftercare has still to be determined.
Topics: Adult; Biomarkers; Cross-Sectional Studies; Heart Defects, Congenital; Humans; Male; Prognosis; Troponin T
PubMed: 33678488
DOI: 10.1016/j.jjcc.2021.02.008 -
Journal of Oral Pathology & Medicine :... May 2018To perform a meta-analysis to assess whether the presence of cancer-associated fibroblasts (CAF) is a prognostic marker of oral squamous cell carcinomas (OSCC). (Meta-Analysis)
Meta-Analysis Review
AIM
To perform a meta-analysis to assess whether the presence of cancer-associated fibroblasts (CAF) is a prognostic marker of oral squamous cell carcinomas (OSCC).
METHODS
Immunohistochemical studies assessing the prognostic relevance of CAF (alpha smooth muscle actin (α-SMA)-positive fibroblasts) in patients with OSCC were systematically reviewed using Cochrane, Lilacs, PubMed, Scopus, and Web of Science databases. The outcomes assessed were overall survival (OS) and disease-free survival (DFS). The meta-analysis was performed using the random- and fixed-effects model with adjusted hazard ratio (HR) and 95% confidence intervals (95% CI) as effect measures. The methodological quality of the included studies was assessed using the Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) tool, and the evidence quality was assessed by the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) system.
RESULTS
The presence of high levels of CAF in the stroma of OSCC predicted shortened time to DFS (HR = 3.32, 95% CI: 2.09-5.26, P < .00001) and an overall decrease in survival (HR: 2.16, 95% CI: 1.60-2.92, P < .00001). Moreover, high presence of CAF was frequently reported in association with parameters that worsen the prognosis in OSCC, including advanced disease stage (TNM classification), recurrence, tumor grade, depth of invasion, vascular, lymphatic and neural invasion, and extranodal metastatic spread.
CONCLUSION
The presence of CAF, as assessed by α-SMA-positive fibroblasts in the stroma, indicates poor prognosis in patients with OSCC.
Topics: Actins; Biomarkers, Tumor; Carcinoma, Squamous Cell; Databases, Bibliographic; Disease-Free Survival; Fibroblasts; Humans; Immunohistochemistry; Mouth Neoplasms; Prognosis; Survival
PubMed: 28782893
DOI: 10.1111/jop.12623 -
Heart & Lung : the Journal of Critical... 2015The objective of our meta-analysis is to update the evidence on the prognostic value of elevated troponin levels in patient with acute normotensive pulmonary embolism... (Meta-Analysis)
Meta-Analysis Review
The objective of our meta-analysis is to update the evidence on the prognostic value of elevated troponin levels in patient with acute normotensive pulmonary embolism (PE). We did a systematic literature review of database, including Pubmed, EMBASE, and Cochrane. Studies were included if those were done on normotensive patients with acute PE and serum troponin assay was done. The primary end point was short term all cause mortality. The secondary end points were short term PE related mortality and serious adverse events. Elevated troponin levels were significantly associated with the increased risk for short term mortality (odds ratio [OR], 4.80; 95% CI, 3.25-7.08, I(2) = 54%), PE related mortality (OR, 3.80; 95% CI, 2.74-5.27, I(2) = 0%) and serious adverse events (OR, 3.65; 95% CI, 2.41-5.53, I(2) = 47%). Our study suggests that elevated levels of troponin identify a subgroup of patients with increased risk for short term mortality and serious adverse events.
Topics: Acute Disease; Aged; Biomarkers; Blood Pressure; Female; Humans; Male; Middle Aged; Odds Ratio; Prognosis; Pulmonary Embolism; Troponin
PubMed: 25976228
DOI: 10.1016/j.hrtlng.2015.03.007 -
Internal and Emergency Medicine Dec 2015The role of cardiac biomarkers in risk stratification of syncope is unclear. We undertook a systematic review to assess their predictive value for short-term major... (Review)
Review
The role of cardiac biomarkers in risk stratification of syncope is unclear. We undertook a systematic review to assess their predictive value for short-term major adverse cardiovascular events (MACE). We conducted a systematic review using MEDLINE, EMBASE, DARE and Cochrane databases from inception to July 2014. We included studies involving adult syncope patients that evaluated cardiac biomarker levels for risk stratification during acute management and excluded case reports, reviews and studies involving children. Primary outcome (MACE) included death, cardiopulmonary resuscitation, myocardial infarction (MI), structural heart disease, pulmonary embolism, significant hemorrhage or cardiac procedural interventions. Secondary outcome analysis assessed for prediction of MI, cardiac syncope and death. Two reviewers extracted patient-level data based on the cut-off reported. Pooled sensitivities and specificities were calculated using patient-level data. A total of 1862 articles were identified, and 11 studies with 4246 patients were included. Studies evaluated 3 biomarkers: contemporary troponin (2693 patients), natriuretic peptides (1353 patients) and high-sensitive troponin (819 patients). The pooled sensitivities and specificities for MACE were: contemporary troponin 0.29 (95 % CI 0.24, 0.34) and 0.88 (95 % CI 0.86, 0.89); natriuretic peptides 0.77 (95 % CI 0.69, 0.85) and 0.73 (95 % CI 0.70, 0.76); high-sensitive troponin 0.74 (95 % CI 0.65, 0.83) and 0.65 (95 % CI 0.62, 0.69), respectively. Natriuretic peptides and high-sensitive troponin showed good diagnostic characteristics for both primary and secondary outcomes. Natriuretic peptides and high-sensitive troponin might be useful in risk stratification.
Topics: Biomarkers; Cardiopulmonary Resuscitation; Humans; Myocardial Infarction; Natriuretic Peptide, Brain; Prognosis; Risk Assessment; Syncope; Troponin
PubMed: 26498335
DOI: 10.1007/s11739-015-1318-1 -
Journal of the American Heart... Mar 2019Background The recent introduction of high-sensitivity cardiac troponin (hs-cTn) assays has allowed clinicians to measure hs-cTn before and after cardiac stress testing,... (Meta-Analysis)
Meta-Analysis
Background The recent introduction of high-sensitivity cardiac troponin (hs-cTn) assays has allowed clinicians to measure hs-cTn before and after cardiac stress testing, but the hs-cTn release pattern and potential utility in identifying inducible myocardial ischemia are unclear. We thus conducted a systematic review and meta-analysis to improve our understanding of hs-cTn release associated with exercise and pharmacological stress testing. Methods and Results Studies published between January 2008 and July 2016 that reported hs-cTn change values (high-sensitivity cardiac troponin T [hs-cTnT] or high-sensitivity cardiac troponin I [hs-cTnI]) in relation to cardiac stress testing were searched and reviewed by 2 independent screeners. Primary outcomes were pooled estimates of absolute and relative hs-cTn changes after cardiac stress test, stratified by the presence of inducible myocardial ischemia. This meta-analysis included 11 studies (n=2432 patients). After exercise stress testing, hs-cTnT increased by 0.5 ng/L or 11% (6 studies, n=406) and hs-cTnI by 2.4 ng/L or 41% (4 studies, n=365) in patients with inducible myocardial ischemia versus hs-cTnT by 1.1 ng/L or 18% (8 studies, n=629; P=0.29) and hs-cTnI by 1.8 ng/L or 72% (4 studies, n=831; P=0.61) in patients who did not develop inducible myocardial ischemia. After pharmacological stress test, hs-cTnT changed by -0.1 ng/L or -0.4% (6 studies, n=251) and hs-cTnI by 2.4 ng/L or 32% (2 studies, n=108) in patients with inducible myocardial ischemia versus hs-cTnT by 0.7 ng/L or 11% (5 studies, n=443, P=0.44) and hs-cTnI by 1.7 ng/L or 38% (2 studies, n=116; P=0.62) in patients who did not develop inducible myocardial ischemia. Conclusions hs-cTn rising patterns after exercise and pharmacological stress testing appear inconsistent and comparably small, and do not appear to be correlated with inducible myocardial ischemia.
Topics: Biomarkers; Electrocardiography; Exercise Test; Humans; Myocardial Ischemia; Reproducibility of Results; Troponin
PubMed: 30871395
DOI: 10.1161/JAHA.118.008626