Clinical Cases: Diagnostic relevance of elevated hs-cTnT

Case   69-year old man

Key signs and symptoms Acute left-sided chest tightness/discomfort at rest for the past 8 hours, duration 30 – 40 minutes, brief symptom-free phases Exertional dyspnoea for several months

Medical history/ Clinical examination Peripheral arterial occlusive disease (PAOD) IIa bilateral, walking distance 270 m, active smoker, arterial hypertension, hypercholesterolaemia

Laboratory test results Result   Reference range CRP 9 mg/dL   < 5 mg/dL GFR 55 mL/min/1.73 m2   >90 mL/min/1.73 m2 Leukocytes 9.2/nL   4.4 – 11.3/nL D-dimer 1.3 mg/dL   < 0.5 mg/dL NT-proBNP 250 ng/L   < 300 ng/L to rule-out acute heart failure (AHF) and >900 ng/L heart failure (HF) likely if 50–75 year-old (confirmation with imaging)

ECG Characteristic ECG with ST segment depression in the lateral leads.

Troponin kinetic profile

Coronary angiography

 

Diagnosis

Acute myocardial infarction/NSTEMI

According to the universal definition, the diagnosis of AMI is confirmed:

• The cTnT-hs concentration within 24 hours of the index event was above the 99th percentile cut-off value (14 ng/L) on at least one occasion

• A typical rise and fall in the cTnT-hs levels was also observed

• The clinical criterion for myocardial ischemia is fulfilled by the typical angina pectoris symptoms and ECG changes

• Coronary angiography shows high grade stenosis of the ramus interventricularis anterior / Ieft anterior descending artery (RIVA / LAD)

Conclusion

All three criteria for an acute myocardial infarction are satisfied: elevated cTnT-hs level, typical kinetic of cTnT-hs release and clinical presentation with ECG changes.