Home/고감도 심장 트로포닌 수치에 영향을 미치는 요인

고감도 심장 트로포닌 수치에 영향을 미치는 요인

ESC 2020
최신 관점
Dr Evangelos Giannitsis Cardiologist, Medical Director of Chest Pain Unit, University Hospital of Heidelberg, Germany
30 October 2020

Key Takeaways

  • 임상 변수는 심근 경색 유무 외에도 hs-cTn 농도에 영향을 미칩니다.
  • ESC는 이제 동반이환 또는 성별 관련 판정기준치를 무시하고 일반적인 판정기준치를 권장합니다.
  • 임상 변수에 대한 새로운 ESC 권장사항은 동반이환이 있는 환자들에서 베이스라인 값보다 농도 변화가 더 중요함을 시사합니다.

고감도 심장 트로포닌 수치에 영향을 미치는 임상 변수에 대한 최신 ESC 권장사항은 무엇입니까?

트로포닌 수치의 일부 교란인자로 인한 어려움이 항상 있습니다. 이러한 교란인자는 동반이환으로 인한 트로포닌 상승에 영향을 미칩니다. 이러한 동반이환에는 고령, 기저 구조적 심장 질환 존재, 만성 신장 질환, 성별이 있습니다.

예를 들어 베이스라인 트로포닌 농도에는 성별 차이가 있습니다. 성별에 따라 심장이 다르고, 심장 질량이 다르며, 기능적으로 차이가 있고, 남성보다 여성에서 99번째 백분위수 값이 더 낮습니다. 그러나 성별뿐만 아니라 모든 교란 변수에 따라 이러한 베이스라인 차이를 보정하려 하는 경우, 매우 복잡한 알고리즘을 얻게 되고 응급실 담당 의사들이 이를 관리하는 것은 무리입니다. 따라서 제가 감히 생각하기에 ESC는 이러한 이유로 동반이환 또는 성별 관련 판정기준치를 무시하고, 공통적인 일반 판정기준치를 채택하기로 결정한 것 같습니다.  이는 좋은 아이디어라고 생각합니다. 이는 보편적 심근경색 정의 및 IFCC(국제임상화학실험실의학연맹)의 권장사항과는 다소 상반되고, 일부 트로포닌 I 제품 설명서 정보와 트로포닌 T 미국 제품 설명서 정보와도 약간 차이가 있습니다. 그러나 많은 복잡성을 해결하며, 저는 동반이환이 있는 이 환자들의 농도 변화가 베이스라인 값보다 더 중요하다고 생각합니다.

Home/Sex Differences in Troponin Levels – affecting high-sensitivity cardiac troponin (hs-cTn) levels

Sex Differences in Troponin Levels – affecting high-sensitivity cardiac troponin (hs-cTn) levels

Latest Perspectives
ESC 2020
Dr Evangelos Giannitsis Cardiologist, Medical Director of Chest Pain Unit, University Hospital of Heidelberg, Germany
30 October 2020

Key Takeaways

  • Beyond the presence or absence of MI, clinical variables affect hs-cTn concentrations
  • The ESC now disregards comorbidity or gender related cut-offs and recommends general cut-offs
  • The new ESC recommendation for clinical variables demonstrates the importance of concentration changes in patients with comorbidities than the baseline values

What are the latest ESC recommendations for the clinical variables that affect the high sensitivity cardiac troponin levels?

We always are troubled by some confounders of troponin levels. These confounders have an effect on the troponin elevated due to comorbidities. These comorbidities are older age, the presence of underlying structural heart disease, chronic kidney disease, and gender.

Learn More – How High-Sensitivity Cardiac Troponin Results Influenced By Age

What are the sex differences in troponin levels?

So, there are sex differences in the baseline troponin concentrations. The genders have different hearts, they have different cardiac masses, they are functionally different, and the 99th percentile value is lower in female than men. But if you try to adjust for this baseline differences depending not only on sex but on all confounding variables, then you end up with a very complicated algorithm, and that cannot be managed by a physician who is in charge of an emergency department. The ESC has decided, I think bravely, to disregard comorbidity or sex-related cut-offs, and to go for a common, general cut-off.  I think this is an excellent idea. It is a little bit contrary to recommendations from the universal myocardial infarction definition and the IFCC (International Federation of Clinical Chemistry and Laboratory Medicine), and it is also a little bit different from the information that we have in some package inserts from some troponin I, and from the US package insert from troponin T.

But now it simplifies things a lot and another thing is, I think that the concentration changes in these patients with comorbidities are more important than the baseline values. So, if you have to decide whether a patient with end-stage renal disease or severe chronic kidney disease has suffered an infarct or maybe and unstable angina or non-cardiac chest pain, you have to look at the delta change and not at the baseline value. That is really important, and here, of course, the omittance of specific baseline cut-offs emphasises the role for delta changes.

Learn more for other Factors For Increased Troponin Levels

Home/高感度心筋トロポニン値に影響を及ぼす因子

高感度心筋トロポニン値に影響を及ぼす因子

Latest Perspectives
ESC 2020
Dr Evangelos Giannitsis Cardiologist, Medical Director of Chest Pain Unit, University Hospital of Heidelberg, Germany
30 October 2020

Key Takeaways

  • 心筋梗塞の有無にかかわらず、高感度心筋トロポニン（hs-cTn）濃度は臨床変数による影響を受けます。
  • ESCでは現在、併存疾患または性別に関連するカットオフを除外し、総合的なカットオフを推奨しています。
  • 臨床変数に関するESCの新たな推奨では、併存疾患を有する患者においては、ベースライン値よりも濃度変化の方が重要であることが示されています。

What are the latest ESC recommendations for the clinical variables that affect the high sensitivity cardiac troponin levels?

私たちにとって、トロポニン濃度の交絡因子はいつも悩みの種となっています。こうした交絡因子は、併存疾患によるトロポニン濃度の上昇に影響します。こうした併存疾患（や影響を及ぼす因子）には、高齢、基礎疾患としての構造的心疾患、慢性腎臓病および性別があります。

Learn More – How High-Sensitivity Cardiac Troponin Results Influenced By Age

What are the sex differences in troponin levels?

So, there are sex differences in the baseline troponin concentrations. The genders have different hearts, they have different cardiac masses, they are functionally different, and the 99th percentile value is lower in female than men. But if you try to adjust for this baseline differences depending not only on sex but on all confounding variables, then you end up with a very complicated algorithm, and that cannot be managed by a physician who is in charge of an emergency department. The ESC has decided, I think bravely, to disregard comorbidity or sex-related cut-offs, and to go for a common, general cut-off.  I think this is an excellent idea. It is a little bit contrary to recommendations from the universal myocardial infarction definition and the IFCC (International Federation of Clinical Chemistry and Laboratory Medicine), and it is also a little bit different from the information that we have in some package inserts from some troponin I, and from the US package insert from troponin T.

But now it simplifies things a lot and another thing is, I think that the concentration changes in these patients with comorbidities are more important than the baseline values. So, if you have to decide whether a patient with end-stage renal disease or severe chronic kidney disease has suffered an infarct or maybe and unstable angina or non-cardiac chest pain, you have to look at the delta change and not at the baseline value. That is really important, and here, of course, the omittance of specific baseline cut-offs emphasises the role for delta changes.

Learn more for other Factors For Increased Troponin Levels

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