Author + information
- Received January 9, 2011
- Revision received March 9, 2011
- Revision received March 10, 2011
- Published online May 1, 2011.
- Adelaide M. Arruda-Olson, MD, PhD⁎,†,
- Véronique L. Roger, MD, MPH⁎,†,
- Allan S. Jaffe, MD⁎,
- David O. Hodge, MS†,
- Raymond J. Gibbons, MD⁎ and
- Todd D. Miller, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Todd D. Miller, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota 55905
Objectives To evaluate the relationship between serial cardiac troponin T (cTnT) levels with infarct size and left ventricular ejection fraction by gated single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in patients with acute myocardial infarction (AMI).
Background Current guidelines recommend the use of cTnT as the biomarker of choice for the diagnosis of AMI. Data relating cTnT to SPECT-MPI in patients with AMI are limited.
Methods A subset of patients with their first AMI participating in a community-based cohort of AMI in Olmsted County, Minnesota, were prospectively studied. Serial cTnT levels were evaluated at presentation, <12 h and 1, 2, and 3 days after onset of pain. Peak cTnT was defined as the maximum cTnT value.
Results A total of 121 patients (age, 61 ± 13 years; 31% women) with AMI underwent gated SPECT-MPI at a median (25th percentile, 75th percentile) of 10 (5, 15) days post-AMI. The type of infarct was non–ST-segment elevation myocardial infarction in 61%, and 13% were anterior in location. The median infarct size was 1% (0%, 11%) and the median gated left ventricular ejection fraction was 54% (47%, 60%). Fifty-nine patients (49% of the population) had no measurable infarction by SPECT-MPI. Independent predictors of measurable SPECT-MPI infarct size included cTnT at days 1, 2, and 3 and peak cTnT, but not at presentation or <12 h. In receiver-operator characteristic analysis, the area under the curve was highest at day 3. Receiver-operator characteristic analysis demonstrated a cutoff of 1.5 ng/ml for peak cTnT for the detection of measurable infarct size.
Conclusions In a community-based cohort of patients with their first AMI, independent predictors of measurable SPECT-MPI infarct size included cTnT at days 1, 2, and 3 and peak cTnT. In contrast, cTnT level at presentation and <12 h was not an independent predictor of myocardial infarction size as assessed by SPECT-MPI. Receiver-operator characteristic analysis demonstrated a cutoff value peak cTnT of 1.5 ng/ml for the detection of measurable infarct.
This study was supported by a Clinician Investigator Fellowship Award from the Mayo Clinic, grants from the Public Health Service and the National Institutes of Health (AR30582, R01 HL 59205, R01 HL 72435, and R03 AG031347-01) and by a research grant from Xantheus Medical Imaging. Dr. Roger is an Established Investigator of the American Heart Association. Dr. Jaffe has consulting arrangements with Beckman, Inverness, Amten, and Pfizer and during the past year has received financial compensation to participate in symposia sponsored by Roche and Abbott. Dr. Gibbons has a research grant with Ikaria Corporation. Dr. Miller has a consulting arrangement with Astellas Pharma. All other authors report that they have no relationships to disclose.
- Received January 9, 2011.
- Revision received March 9, 2011.
- Revision received March 10, 2011.
- American College of Cardiology Foundation