High-Sensitivity Cardiac Troponin for the Exclusion of Inducible Myocardial Ischemia in Symptomatic Patients

Letters7 July 2020High-Sensitivity Cardiac Troponin for the Exclusion of Inducible Myocardial Ischemia in Symptomatic PatientsJeong Hwan Kim, MD, Muhammad Hammadah, MD, Viola Vaccarino, MD, PhD, and Arshed A. Quyyumi, MDJeong Hwan Kim, MDEmory University School of Medicine, Atlanta, Georgia (J.H.K., M.H., A.A.Q.)Search for more papers by this author, Muhammad Hammadah, MDEmory University School of Medicine, Atlanta, Georgia (J.H.K., M.H., A.A.Q.)Search for more papers by this author, Viola Vaccarino, MD, PhDEmory University Rollins School of Public Health, Atlanta, Georgia (V.V.)Search for more papers by this author, and Arshed A. Quyyumi, MDEmory University School of Medicine, Atlanta, Georgia (J.H.K., M.H., A.A.Q.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-0260 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Walter and colleagues (1) reported that a high-sensitivity cardiac troponin I (hs-cTnI) cutoff value of 2.5 ng/L failed to accurately exclude inducible myocardial ischemia in a cohort of “symptomatic” patients with known coronary artery disease (CAD). This differs from the findings in our recent publication, which derived and validated this value for exclusion of inducible myocardial ischemia in 2 independent cohorts of “asymptomatic” patients with stable CAD (2). Here, we explain why our findings differed.First, the nature of the 2 cohorts differed. Walter and colleagues' cohort had a higher pretest probability of ischemia than ours (46% ...References1. Walter J, du Fay de Lavallaz J, Koechlin L, et al. Using high-sensitivity cardiac troponin for the exclusion of inducible myocardial ischemia in symptomatic patients. A cohort study. Ann Intern Med. 2020;172:175-185. [PMID: 31905377]. doi:10.7326/M19-0080 LinkGoogle Scholar2. Hammadah M, Kim JH, Tahhan AS, et al. Use of high-sensitivity cardiac troponin for the exclusion of inducible myocardial ischemia. A cohort study. Ann Intern Med. 2018;169:751-760. [PMID: 30398528]. doi:10.7326/M18-0670 LinkGoogle Scholar3. Hammadah M, Al Mheid I, Wilmot K, et al. Association between high-sensitivity cardiac troponin levels and myocardial ischemia during mental stress and conventional stress. JACC Cardiovasc Imaging. 2018;11:603-611. [PMID: 28330661] doi:10.1016/j.jcmg.2016.11.021 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Emory University School of Medicine, Atlanta, Georgia (J.H.K., M.H., A.A.Q.)Emory University Rollins School of Public Health, Atlanta, Georgia (V.V.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-0260. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoUsing High-Sensitivity Cardiac Troponin for the Exclusion of Inducible Myocardial Ischemia in Symptomatic Patients Joan Walter , Jeanne du Fay de Lavallaz , Luca Koechlin , Tobias Zimmermann , Jasper Boeddinghaus , Ursina Honegger , Ivo Strebel , Raphael Twerenbold , Melissa Amrein , Thomas Nestelberger , Desiree Wussler , Christian Puelacher , Patrick Badertscher , Michael Zellweger , Gregor Fahrni , Raban Jeger , Christoph Kaiser , Tobias Reichlin , and Christian Mueller High-Sensitivity Cardiac Troponin for the Exclusion of Inducible Myocardial Ischemia in Symptomatic Patients Joan Walter and Christian Mueller Metrics 7 July 2020Volume 173, Issue 1Page: 76-77KeywordsConflicts of interestDisclosureHigh sensitivity cardiac troponinIschemiaMyocardial infarctionMyocardiumNegative predictive valueScarsStable coronary artery disease ePublished: 7 July 2020 Issue Published: 7 July 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...