Objective To obtain summary estimates of the accuracy of a single baseline measurement of the Elecsys Troponin T high-sensitive assay (Roche Diagnostics) for the diagnosis of acute myocardial infarction in patients presenting to the emergency department.Design Systematic review and meta-analysis of diagnostic test accuracy studies.Data sources Medline, Embase, and other relevant electronic databases were searched for papers published between January 2006 and December 2013.Study selection Studies were included if they evaluated the diagnostic accuracy of a single baseline measurement of Elecsys Troponin T high-sensitive assay for the diagnosis of acute myocardial infarction in patients presenting to the emergency department with suspected acute coronary syndrome. Study appraisal and data synthesisThe first author screened all titles and abstracts identified through the searches and selected all potentially relevant papers. The screening of the full texts, the data extraction, and the methodological quality assessment, using the adapted QUADAS-2 tool, were conducted independently by two reviewers with disagreements being resolved through discussion or arbitration. If appropriate, meta-analysis was conducted using the hierarchical bivariate model. ResultsTwenty three studies reported the performance of the evaluated assay at presentation. The results for 14 ng/L and 3-5 ng/L cut-off values were pooled separately. At 14 ng/L (20 papers), the summary sensitivity was 89.5% (95% confidence interval 86.3% to 92.1%) and the summary specificity was 77.1% (68.7% to 83.7%). At 3-5 ng/L (six papers), the summary sensitivity was 97.4% (94.9% to 98.7%) and the summary specificity was 42.4% (31.2% to 54.5%). This means that if 21 of 100 consecutive patients have the target condition (21%, the median prevalence across the studies), 2 (95% confidence interval 2 to 3) of 21 patients with acute myocardial infarction will be missed (false negatives) if 14 ng/L is used as a cut-off value and 18 (13 to 25) of 79 patients without acute myocardial infarction will test positive (false positives). If the 3-5 ng/L cut-off value is used, <1 (0 to 1) patient with acute myocardial infarction will be missed and 46 (36 to 54) patients without acute myocardial infarction will test positive. ConclusionsThe results indicate that a single baseline measurement of the Elecsys Troponin T high-sensitive assay could be used to rule out acute myocardial infarction if lower cut-off values such as 3 ng/L or 5 ng/L are used. However, this method should be part of a comprehensive triage strategy and may not be appropriate for patients who present less than three hours after symptom onset. Care must also be exercised because of the higher imprecision of the evaluated assay and the greater effect of lot-to-lot reagent variation at low troponin concentrations.Systematic review registration PROSPERO registration number CRD42013003926.
This study examined the effects of ALTI-VIT supplementation on exercise performance and Acute Mountain Sickness (AMS) at altitude. Seven healthy males with no experience of exercise at altitude completed two 16 km cycle time-trials at a simulated altitude of 2400 m in an altitude chamber. Using a single-blind, randomised, crossover design, participants consumed 2 capsules (270 mg) of ALTI-VIT (A) or a placebo (Pl) 24-hours prior to testing and 2 capsules on the morning of testing. Time-trial completion was faster in the A condition (30.04±4.39 min) than the Pl condition (31.02±5.22 min) (P=0.05). RER was lower in the A condition (A: 1.03±0.11 vs. Pl: 1.13±0.12; P=0.044) and the incidence of AMS (A: 0.4±0.5 vs. Pl: 3±1; P=0.002) and severity of symptoms were reduced (P<0.05). No differences were found between conditions for HR, RPE, VO 2 , VE, VO 2 max , speed, power output and RPM (P>0.05). These results demonstrated that 24-hour supplementation of ALTI-VIT enhanced exercise performance at altitude and reduced the incidence and severity of AMS.Br J Sports Med 2013;47:e4 7 of 17
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