Clinical implications of sex-specific upper reference limits for high-sensitivity cardiac troponin I in myocardial infarction diagnosis.

Introduction And Objectives: It is unclear whether applying sex-specific rather than uniform upper reference limits (URLs) for high-sensitivity cardiac troponin I (hs-cTnI) improves diagnostic equity between women and men with suspected myocardial infarction (MI). We compared the diagnostic performance of these 2 approaches.

Methods: In an international, prospective, multicenter study of patients presenting with suspected MI, the final diagnosis was centrally adjudicated twice by 2 independent cardiologists using all available information, including serial measurements of hs-cTnI-Architect, once using the uniform URL (26.

Evaluation of three diagnostic algorithms to reduce normal scan rates, radiation exposure and costs in patients with suspected chronic coronary syndrome referred for 82Rb-Positron Emission Tomography (Rb-PET).

Background: The majority of functional ischemia tests in patients with suspected chronic coronary syndromes (CCS) yield normal results. Implementing gatekeepers for patient preselection, such as pretest probability (PTP) and/or coronary artery calcium score (CACS), could reduce the number of normal scan results, radiation exposure and costs. However, the efficacy and safety of these approaches remain unclear.

Diagnostic utility of coronary artery calcium score percentiles and categories to exclude abnormal scans and relevant ischemia in rubidium positron emission tomography.

Background: Despite clinical suspicion, most non-invasive ischemia tests for coronary artery disease (CAD) reveal unremarkable results. Patients with a coronary artery calcium score (CACS) of zero rarely have an abnormal positron emission tomography (PET) and could be deferred from further testing. However, most patients have some extent of coronary calcification.

Enhancing the diagnosis of functionally relevant coronary artery disease with machine learning.

Functionally relevant coronary artery disease (fCAD) can result in premature death or nonfatal acute myocardial infarction. Its early detection is a fundamentally important task in medicine. Classical detection approaches suffer from limited diagnostic accuracy or expose patients to possibly harmful radiation.

Diagnostic and prognostic value of mannan-binding lectin associated protein (MAp19) for functionally relevant coronary artery disease.

Background: This study aimed to evaluate the diagnostic and prognostic potential of MAp19, a regulating component of the lectin pathway of the complement system, in patients with suspected functionally relevant coronary artery disease (fCAD) as well as the determinants of MAp19 levels.

Methods: The presence of fCAD was adjudicated using myocardial perfusion imaging with single-photon emission tomography and, where available, coronary angiography. MAp19 levels were measured in participants at rest, at peak stress tests, and two hours after the stress.

Combining anatomical and biochemical markers in the detection and risk stratification of coronary artery disease.

Aims: We aimed to test the hypothesis if combining coronary artery calcium score (Ca-score) as a quantitative anatomical marker of coronary atherosclerosis with high-sensitivity cardiac troponin as a quantitative biochemical marker of myocardial injury provided incremental value in the detection of functionally relevant coronary artery disease (fCAD) and risk stratification.

Methods And Results: Consecutive patients undergoing myocardial perfusion single-photon emission computed tomography (MPS) without prior CAD were enrolled. The diagnosis of fCAD was based on the presence of ischaemia on MPS and coronary angiography; fCAD was centrally adjudicated in the diagnostic and prognostic domain.

Artificial intelligence to improve ischemia prediction in Rubidium Positron Emission Tomography-a validation study.

Background: Patients are referred to functional coronary artery disease (CAD) testing based on their pre-test probability (PTP) to search for myocardial ischemia. The recommended prediction tools incorporate three variables (symptoms, age, sex) and are easy to use, but have a limited diagnostic accuracy. Hence, a substantial proportion of non-invasive functional tests reveal no myocardial ischemia, leading to unnecessary radiation exposure and costs.

Diagnostic and prognostic value of H-ficolin for functionally relevant coronary artery disease.

Background: We aimed to test the diagnostic and prognostic ability of H-ficolin, an initiator of the lectin pathway of the complement system, for functionally relevant coronary artery disease (fCAD), and explore its determinants.

Methods: The presence of fCAD was adjudicated using myocardial perfusion imaging single-photon emission tomography and coronary angiography. H-ficolin levels were measured by a sandwich-type immunoassay at rest, peak stress-test, and 2 h after stress-test.

Sex-specific differences in myocardial injury incidence after COVID-19 mRNA-1273 booster vaccination.

Aims: To explore the incidence and potential mechanisms of oligosymptomatic myocardial injury following COVID-19 mRNA booster vaccination.

Methods And Results: Hospital employees scheduled to undergo mRNA-1273 booster vaccination were assessed for mRNA-1273 vaccination-associated myocardial injury, defined as acute dynamic increase in high-sensitivity cardiac troponin T (hs-cTnT) concentration above the sex-specific upper limit of normal on day 3 (48-96 h) after vaccination without evidence of an alternative cause. To explore possible mechanisms, antibodies against interleukin-1 receptor antagonist (IL-1RA), the SARS-CoV-2-nucleoprotein (NP) and -spike (S1) proteins and an array of 14 inflammatory cytokines were quantified.