Cardiac Biomarkers and the Diagnosis of Myocardial Infarction in Women

Overview

Journal Curr Cardiol Rep

Publisher Current Science

Specialty Cardiology & Vascular Diseases

Date 2017 Apr 10

PMID 28391559

Citations 13

Authors

Anoop S V Shah

Amy V Ferry

Nicholas L Mills

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: Women with suspected acute coronary syndrome are less likely to undergo investigation or receive treatment than men, and women consistently have poorer outcomes. This review summarises how the latest development in cardiac biomarkers could improve both diagnosis and outcomes in women.

Recent Findings: Novel high-sensitivity cardiac troponin assays have identified differences in the reference range and therefore diagnostic threshold for myocardial infarction in men and women. These differences are present across multiple populations with different ethnic backgrounds and for a range of assays. The use of a uniform threshold for cardiac troponin does not provide equivalent prediction in men and women, with lower thresholds needed for women to provide comparable risk stratification. Sex differences in cardiac troponin concentrations are not widely recognised in clinical practice and may be contributing to the under-diagnosis of myocardial infarction in women and discrepancies in patient care and outcomes.

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References

Koerbin G, Tate J, Potter J, Cavanaugh J, Glasgow N, Hickman P . Characterisation of a highly sensitive troponin I assay and its application to a cardio-healthy population. Clin Chem Lab Med. 2012; 50(5):871-8. DOI: 10.1515/cclm-2011-0540. View

Mueller-Hennessen M, Lindahl B, Giannitsis E, Biener M, Vafaie M, deFilippi C . Diagnostic and prognostic implications using age- and gender-specific cut-offs for high-sensitivity cardiac troponin T - Sub-analysis from the TRAPID-AMI study. Int J Cardiol. 2016; 209:26-33. DOI: 10.1016/j.ijcard.2016.01.213. View

Thygesen K, Alpert J, Jaffe A, Chaitman B, White H, Katus H . Third universal definition of myocardial infarction. Circulation. 2012; 126(16):2020-35. DOI: 10.1161/CIR.0b013e31826e1058. View

Katus H, Looser S, Hallermayer K, Remppis A, Scheffold T, Borgya A . Development and in vitro characterization of a new immunoassay of cardiac troponin T. Clin Chem. 1992; 38(3):386-93. View

Wildi K, Gimenez M, Twerenbold R, Reichlin T, Jaeger C, Heinzelmann A . Misdiagnosis of Myocardial Infarction Related to Limitations of the Current Regulatory Approach to Define Clinical Decision Values for Cardiac Troponin. Circulation. 2015; 131(23):2032-40. PMC: 4456170. DOI: 10.1161/CIRCULATIONAHA.114.014129. View

Motiwala S, Sarma A, Januzzi J, ODonoghue M . Biomarkers in ACS and heart failure: should men and women be interpreted differently?. Clin Chem. 2013; 60(1):35-43. DOI: 10.1373/clinchem.2013.202531. View

De Simone G, Devereux R, Daniels S, Meyer R . Gender differences in left ventricular growth. Hypertension. 1995; 26(6 Pt 1):979-83. DOI: 10.1161/01.hyp.26.6.979. View

Schofer N, Brunner F, Schluter M, Ojeda F, Zeller T, Baldus S . Gender-specific diagnostic performance of a new high-sensitivity cardiac troponin I assay for detection of acute myocardial infarction. Eur Heart J Acute Cardiovasc Care. 2016; 6(1):60-68. DOI: 10.1177/2048872615626660. View

Shah A, Griffiths M, Lee K, McAllister D, Hunter A, Ferry A . High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study. BMJ. 2015; 350:g7873. PMC: 4301191. DOI: 10.1136/bmj.g7873. View

10.

Donaldson C, Eder S, Baker C, Aronovitz M, Weiss A, Hall-Porter M . Estrogen attenuates left ventricular and cardiomyocyte hypertrophy by an estrogen receptor-dependent pathway that increases calcineurin degradation. Circ Res. 2008; 104(2):265-75, 11p following 275. PMC: 4427027. DOI: 10.1161/CIRCRESAHA.108.190397. View

11.

Omland T, de Lemos J, Holmen O, Dalen H, Saltyte Benth J, Nygard S . Impact of sex on the prognostic value of high-sensitivity cardiac troponin I in the general population: the HUNT study. Clin Chem. 2015; 61(4):646-56. DOI: 10.1373/clinchem.2014.234369. View

12.

Woodfield S, Lundergan C, Reiner J, Thompson M, Rohrbeck S, Deychak Y . Gender and acute myocardial infarction: is there a different response to thrombolysis?. J Am Coll Cardiol. 1997; 29(1):35-42. DOI: 10.1016/s0735-1097(96)00449-4. View

13.

White H . Pathobiology of troponin elevations: do elevations occur with myocardial ischemia as well as necrosis?. J Am Coll Cardiol. 2011; 57(24):2406-8. DOI: 10.1016/j.jacc.2011.01.029. View

14.

Mills N, Churchhouse A, Lee K, Anand A, Gamble D, Shah A . Implementation of a sensitive troponin I assay and risk of recurrent myocardial infarction and death in patients with suspected acute coronary syndrome. JAMA. 2011; 305(12):1210-6. DOI: 10.1001/jama.2011.338. View

15.

Gimenez M, Twerenbold R, Boeddinghaus J, Nestelberger T, Puelacher C, Hillinger P . Clinical Effect of Sex-Specific Cutoff Values of High-Sensitivity Cardiac Troponin T in Suspected Myocardial Infarction. JAMA Cardiol. 2016; 1(8):912-920. DOI: 10.1001/jamacardio.2016.2882. View

16.

Dallmeier D, Denkinger M, Peter R, Rapp K, Jaffe A, Koenig W . Sex-specific associations of established and emerging cardiac biomarkers with all-cause mortality in older adults: the ActiFE study. Clin Chem. 2014; 61(2):389-99. DOI: 10.1373/clinchem.2014.230839. View

17.

Saaby L, Poulsen T, Diederichsen A, Hosbond S, Larsen T, Schmidt H . Mortality rate in type 2 myocardial infarction: observations from an unselected hospital cohort. Am J Med. 2014; 127(4):295-302. DOI: 10.1016/j.amjmed.2013.12.020. View

18.

Alpert J, Thygesen K, Jaffe A, White H . The universal definition of myocardial infarction: a consensus document: ischaemic heart disease. Heart. 2008; 94(10):1335-41. DOI: 10.1136/hrt.2008.151233. View

19.

Hamm C, Ravkilde J, Gerhardt W, Jorgensen P, Peheim E, Ljungdahl L . The prognostic value of serum troponin T in unstable angina. N Engl J Med. 1992; 327(3):146-50. DOI: 10.1056/NEJM199207163270302. View

20.

de Lemos J, Drazner M, Omland T, Ayers C, Khera A, Rohatgi A . Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population. JAMA. 2010; 304(22):2503-12. PMC: 5621378. DOI: 10.1001/jama.2010.1768. View