Wrist-worn transdermal sensor for troponin measurement can help early diagnosis of heart attacks

The device used infrared light to detect the concentration and presence of cardiac troponin-I in the blood through the skin and predicted the levels with 90% accuracy within 5 minutes. The study's findings were presented at the ACC (American College of Cardiology) Scientific Session/World Congress of Cardiology (WCC) 2023 by Partho P. Sengupta, a cardiology professor at Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey.

"There's still a lot of work to be done, but this approach could potentially address prioritization and access issues, for example, by shortening the time to triage or being used by emergency responders to plan the patient's journey before they arrived at the hospital," Dr Sengupta said in his presentation.

Clinical differentiation of acute MI from unstable angina and other presentations mimicking ACS (acute coronary syndromes) is critical for implementing time-sensitive interventions and optimizing outcomes. However, the diagnostic steps depend on laboratory turnaround times, and blood draws.

Dr Sengupta and colleagues assessed the performance of a machine learning algorithm for identifying elevated high-sensitivity cardiac troponin-I (hs-cTnI) levels in patients hospitalized with ACS.

For this purpose, the researchers enrolled 238 patients hospitalized with ACS at five sites. The final MI diagnosis (with or without ST elevation) and unstable angina were adjudicated using ECG (electrocardiography), cardiac troponin test, echocardiography, or coronary angiography. A transdermal-ISS–derived deep learning model was trained and validated externally with hs-cTnI (one site) and echocardiography and angiography (two sites), respectively.

The study revealed the following findings:

• The transdermal-ISS model predicted elevated hs-cTnI levels with areas under the receiver operator characteristics of 0.90 [sensitivity, 0.86; and specificity, 0.82] and 0.92 (sensitivity, 0.94; and specificity, 0.64) for internal and external validation cohorts, respectively.
• In addition, the model predictions were associated with regional wall motion abnormalities [odds ratio (OR), 3.37] and significant coronary stenosis (OR, 4.69).

To conclude, a transdermal ISS for rapid bloodless estimation of hs-cTnI levels is feasible in real-world settings and may help establish a point-of-care (POC) biomarker diagnosis of acute myocardial infarction in patients with acute coronary syndrome.

"Future larger studies and pragmatic clinical trials would require to investigate the impact of transdermal-ISS on early, pre-hospital infarct diagnosis, triage, and therapy in emergency settings, including its use in chest pain clinics, emergency rooms, and implementation in ambulances and its utilization by trained paramedics," the researchers wrote.

The study, however, was preliminary that involved a relatively small number of patients, and additional refinements of the technology would be required.

Reference:

Shantanu Sengupta, Siddharth Biswal, Jitto Titus, Atandra Burman, Keshav Reddy, Mahesh C Fulwani, Aziz Khan, Niteen Deshpande, Smit Shrivastava, Naveena Yanamala, Partho P Sengupta, A novel breakthrough in wrist-worn transdermal troponin-I-sensor assessment for acute myocardial infarction, European Heart Journal - Digital Health, 2023;, ztad015,https://doi.org/10.1093/ehjdh/ztad015