William Franklin Peacock, Karina Melissa Soto-Ruiz, Allan S. Jaffe, Brian R. Tiffany, Simon A. Mahler, Brian W. Patterson, Alan H. B. Wu, Robert Christenson
Clin Exp Emerg Med 2025;12(3):251-258. Published online September 6, 2024
Objective Chest pain, a common emergency department presentation, requires rapid evaluation. The current gold standard of care is serial troponin measurements from blood draws along with an electrocardiogram and clinical presentation. However, an optical technology-based noninvasive wearable device, the Infrasensor, which can rapidly and transcutaneously assesses cardiac troponin I (cTnI), was recently developed. We aimed to perform a pilot study to evaluate the performance of the Infrasensor in cTnI defined cohorts.
Methods This was a 10-hospital prospective observational study in healthy US subjects with a normal cTnI level and in patients with an elevated local cTnI level. Healthy subjects as determined by a negative questionnaire and bloodwork underwent 3-minute Infrasensor measurement and levels of high-sensitivity cTnI (hs-cTnI), n-terminal pro-B-type natriuretic peptide (NTproBNP), creatinine, and glycosylated hemoglobin (HbA1c) were evaluated from blood. Patients with elevated cTnI had the same Infrasensor and blood sample measurements. Using a fivefold cross-validation technique, cTnI-based binary classification models that did and did not include age were trained on 80% and validated on 20% of the dataset (n=168; elevated hs-cTnI equally partitioned into five nearly equally-sized subsets ).
Results Of 840 patients, 727 (87.5%) had normal (nonelevated) cTnI levels while the remaining 113 had elevated cTnI. Median age was 61 years (interquartile range, 52–71 years) for the elevated cohort and 48 years (interquartile range, 32–57 years) for the nonelevated. Overall, 416 (50.5%) were female, with 33 of 113 (29.2%) in the elevated cohort and 383 of 727 (52.7%) in the nonelevated cohort. Overall, the sensitivity, specificity, negative and positive predictive values of the Infrasensor for identifying elevated cTnI were 0.90, 0.70, 0.98 and 0.48, respectively, with a C-statistic of 0.90 (95% confidence interval, 0.89–0.99).
Conclusion The Infrasensor accurately identifies elevated cTnI within 3 minutes of application.
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The diagnosis or exclusion of pulmonary embolism (PE) remains challenging for emergency physicians. Symptoms can be vague or non-existent, and the clinical presentation shares features with many other common diagnoses. Diagnostic testing is complicated, as biomarkers, like the D-dimer, are frequently false positive, and imaging, like computed tomography pulmonary angiography, carries risks of radiation and contrast dye exposure. It is therefore incumbent on emergency physicians to be both vigilant and thoughtful about this diagnosis. In recent years, several advances in treatment have also emerged. Novel, direct-acting oral anticoagulants make the outpatient treatment of low risk PE easier than before. However, the spectrum of PE severity varies widely, so emergency physicians must be able to risk-stratify patients to ensure the appropriate disposition. Finally, PE response teams have been developed to facilitate rapid access to advanced therapies (e.g., catheter directed thrombolysis) for patients with high-risk PE. This review will discuss the clinical challenges of PE diagnosis, risk stratification and treatment that emergency physicians face every day.
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Troponins are proteins commonly found in cardiac tissue that are released during myocardial ischemia or necrosis. These troponins can be detected by assays that can then be used to guide clinical decision-making and disposition, especially if the suspected insult is related to acute coronary syndrome. Timing of troponin measurement can be important as elevations may not be detectible immediately after an insult. New assays have been designed to detect troponin con-centrations previously too low to be detected by conventional assays. These tests are known as high-sensitivity cardiac troponin assays. Current research is aimed at evaluating the clinical sig-nificance of troponin elevations detected by these new assays especially in management of pa-tients with suspected acute coronary syndrome. A number of risk-stratification scores exist to assist physicians with evaluating chest pain in the emergency department in the context of de-tection (or absence) of troponins in systemic circulation. Additionally, investigators are working to integrate data generated by hs-cTn measurements into existing and new risk-stratification scores.
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