Using Sex-specific Cutoffs for High-sensitivity Cardiac Troponin T to Diagnose Acute Myocardial Infarction.
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2020-07-29
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Abstract
High-sensitivity cardiac troponin (hs-cTn) assays facilitate early decision-making in acute myocardial infarction (AMI).1 The accuracy of these assays now allow sex-specific differences in levels to be detected within healthy populations. It is thought that differences in plasma levels of cardiac troponin (cTn) are due to sex-specific variations in body composition and cardiac physiology,2 and that estrogen may also play a part.3 However, the clinical relevance of this remains unclear.4 Women presenting with suspected acute coronary syndrome (ACS) are less frequently diagnosed, have poorer outcomes,5 and are more likely to have atypical symptoms than men.6 The requirement for sex-specific cutoffs may vary depending on the troponin assay, intended use, AMI type, and clinical performance estimate being assessed. Previously proposed sex-specific hs-cTnT assay cutoffs (females, 14 ng/L; males, 22 ng/L) did not alter sensitivity for AMI versus the overall cutoff (19 ng/L), but resulted in slightly lower specificity for AMI in females and higher specificity in males.4 However, it is uncertain whether sex-specific cutoffs improve hs-cTnT assay diagnostic performance.
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Peacock, W Frank, Brigitte M Baumann, E Joy Rivers, Thomas E Davis, Beverly Handy, Christopher W Jones, Judd E Hollander, Alexander T Limkakeng, et al. (2020). Using Sex-specific Cutoffs for High-sensitivity Cardiac Troponin T to Diagnose Acute Myocardial Infarction. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 10.1111/acem.14098 Retrieved from https://hdl.handle.net/10161/21355.
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Alexander Tan Limkakeng
Dr. Alexander T. Limkakeng, Jr., MD, MHSc, FACEP is a Professor of Emergency Medicine, Vice Chair of Clinical Research, Director of the Acute Care Research Team, and Director of the Resident Research Fellowship for the Department of Emergency Medicine in the Duke University School of Medicine in Durham, North Carolina.
Dr. Limkakeng has served as chair of the American College of Emergency Physicians (ACEP) Research Committee, and been the Course Director of the ACEP Research Forum from 2016-2018, the largest emergency medical research platform in the nation. He is also the Assistant Director of ACEP’s Emergency Medicine Basic Research Skills course. He was elected to the Nominating Committee of the Society of Academic Emergency Medicine.
As a researcher, Dr. Limkakeng has led multiple clinical trials and interdepartmental sponsored projects and is author on over 100 peer-reviewed manuscripts. These include studies in emergency conditions such as COVID-19, traumatic brain injury, hypertension, heart failure, thrombosis, stroke, envenomations, and septic shock. His research has been funded by grants and contracts totaling over $9 million dollars. He has lectured internationally on acute coronary syndrome, responsible conduct of research, design of clinical trials, and precision medicine in emergency care. He has led Duke’s involvement in NIH-funded research networks and in industry-funded work that led to FDA approval for multiple high-sensitivity cardiac troponin assays and point-of-care COVID-19 diagnostic tests. He has servesd as Co-PI for the Duke U24 Hub in the NIH Early Phase Pain Investigation Clinical Network (EPPIC-Net) (1U24NS114416) and now serves as a co-PI on the Duke U24 Hub award (1U24NS129498) in the NIH Strategies to Innovate Emergency Care Clinical Trials (SIREN) Network and in the NIH NINDS Strokenet network (1U24NS135250)
His personal research interest is finding new ways to diagnose acute coronary syndrome. In particular, he is interested in novel biomarkers and precision medicine approaches to this problem. The common element throughout this work is a focus on time-sensitive health conditions.
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