Diagnostic Performance of Troponin I and BNP in MyocardialInfarction and Heart Failure

Diagnostic Performance of Troponin I and BNP in MyocardialInfarction and Heart Failure | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Diagnostic Performance of Troponin I and BNP in MyocardialInfarction and Heart Failure Nataly BARAKAT, Sidi Mohamed Mohamed Mahmoud, Brahim Hamadi N’GAIDÉ, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9040293/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Cardiovascular diseases are a leading cause of morbidity and mortality in sub-Saharan Africa. Differentiatingmyocardialinfarction (MI) fromheartfailure (HF) isdiagnosticallychallenging, particularly in resource-limited settings withrestrictedaccess to advanced diagnostic modalities. Cardiactroponin I (cTnI) and B-type natriuretic peptide (BNP) are key biomarkerswhoseinterpretationmaybeinfluenced by comorbidities, lifestyle behaviors, and social determinants. Objectives: To evaluate the individual and combined diagnostic value of cTnI and BNP in differentiating MI from HF, and to assess the influence of clinical, behavioral, and social factorsamonghospitalized patients in Mauritania. Methods: A cross-sectional comparative studywasconducted at the National Cardiology Center of Nouakchott. Serum cTnI and BNP levelsweremeasuredin 1,246 hospitalized patients withsuspected or confirmedcardiovasculardisease. A subsample of 101 patients completed an epidemiologicalsurveyadaptedfrom the WHO STEPS framework. Statistical analyses includedintergroupcomparisons, multivariable logisticregression, and receiver operating characteristic (ROC) curveanalysis. Results: cTnIelevationwasobservedin 95.6% of patients with MI comparedwith 4.6% of patients withisolated HF (p < 0.0001). BNP levelswereelevatedin 82.0% of patients withisolated HF and 33.3% of thosewithisolated MI (p < 0.0001). Elevated BNP levelsweresignificantlyassociatedwithdiabetes, hypertension, renaldysfunction, smoking, high saltintake, and consumption of sugar-sweetenedbeverages. Social factors, includingeducationlevel, residential setting, and occupationalstatus, alsoinfluencedbiomarker profiles. Conclusions: cTnI and BNP are complementarybiomarkers for differentiating MI from HF. Theirinterpretationshouldincorporatecomorbidities, lifestyle behaviors, and social determinants to optimizecardiovascular care in resource-limited settings. CardiactroponinI B-type natriureticpeptide Myocardialinfarction Heart failure Biomarkers Mauritania Figures Figure 1 Introduction Cardiovascular diseases (CVDs) remain the leading cause of deathworldwide, accounting for nearly one-third of global mortality (World Health Organization, 2023 ). Amongthem, myocardialinfarction (MI) and heartfailure (HF) are major causes of hospitalization and mortality, particularly in low- and middle-income countries undergoingrapidepidemiological transition (Roth et al., 2020 ). Because MI and HF sharecommonclinical manifestations such as chest pain and dyspnea, distinguishingbetweenthese conditions basedsolely on clinicalexamination and electrocardiographymaybechallenging. Cardiacbiomarkersthereforeplaya key role in diagnostic assessment. Cardiactroponin I (cTnI) is the referencebiomarker for myocardialinjury, while B-type natriuretic peptide (BNP) reflectsventricularwall stress and iswidelyused in HF diagnosis (Thygesen et al., 2018 ). This studyaimed to evaluate the combined diagnostic performance of cTnI and BNP for differentiating MI from HF in hospitalized patients in Nouakchott, Mauritania. Materials and Methods Study Design and Setting Weconducted a cross-sectional comparative study at the National Cardiology Center (NCC) in Nouakchott, Mauritania. The studyconsisted of twocomplementarycomponents: (i) a clinical and biologicalassessment of serumcTnI and BNP concentrations according to cardiovascular diagnoses, and (ii) an epidemiologicalsurveyevaluating lifestyle behaviors and social determinants of cardiovascularhealth. Study Population The clinical and biological component included 1,246 adult patients hospitalized for suspected or confirmedcardiovasculardisease. A subsample of 101 patients participated in the epidemiologicalsurveyafter confirmation of eligibilitycriteria and obtainingwritteninformed consent. Diagnostic Criteria Acute Coronary Syndrome (ACS) wasdiagnosedaccording to the Universal Definition of MyocardialInfarction, based on suggestive clinicalsigns, compatible electrocardiographicabnormalities, and cardiacbiomarkerkinetics, particularlycTnI. Heart failure (HF) diagnosisfollowed the recommendations of the European Society of Cardiology (ESC), incorporatingclinicalfindings and echocardiographic data whenavailable. BiomarkerAssessment Serum cTnI and BNP weremeasuredusingstandardizedimmunologicalassays: Tosoh AIA-360 (cTnI, immunometricassay) AFIAS-10 (cTnI, immunofluorescence assay) Mini-VIDAS (BNP and high-sensitivitytroponin, ELFA assay) Reference rangeswere as follows: cTnI (Tosoh/AFIAS) < 0.03 ng/mL; high-sensitivity VIDAS troponin 100 pg/mL . Pre-analyticalnormalizationprocedureswereimplemented to minimizeanalyticalvariability. Epidemiological Data Sociodemographiccharacteristics, dietary habits, smoking status, physicalactivity, and medicalhistorywerecollectedusing a structured questionnaire. The questionnaire used in thisstudywasdevelopedbased on the standardized instrument of the WHO STEPwiseapproach to NCD risk factor surveillance (STEPS) program developed by the World Health Organization. This toolprovides an internationallyrecognizedmethodologicalframework for collecting comparable data on the major riskfactors for non-communicable diseases. The STEPS instrument includes modules addressingsociodemographiccharacteristics, health-relatedbehaviors (such as tobacco use, dietary habits, and physicalactivity), and medical and family histories associatedwithmetabolicdisordersincluding hypertension and diabetes. In the presentstudy, some questions wereadapted to the local context in order to betterreflect the dietary habits and lifestyle patterns of the study population, whilemaintaining the structure and methodologicalrecommendations of the STEPS protocol. This approachensuredcomparability of the resultswith international data whileaccounting for the cultural and nutritionalspecificities of the population studied (World Health Organization, 2017). StatisticalAnalysis Data analysiswasperformedusing SPSS software. Intergroupcomparisonswereconductedusing Student’s t-test , Mann–Whitney U test , or Chi-square test , as appropriate. Multivariable logisticregressionmodelswereused to identifyindependentpredictors of elevatedcTnI and BNP levels, adjusting for potentialconfoundersincludingage and renalfunction. Receiver operating characteristic ( ROC ) curveanalysiswasperformed to evaluate diagnostic performance. Statisticalsignificancewasdefined as p < 0.05 . EthicalConsiderations The studyprotocolwasapproved by the ResearchEthicsCommittee of the University of Nouakchott . Writteninformed consent wasobtainedfrom all participants prior to inclusion in the study. Results: c’est long, desorganisé, serait bien de contacter un biostaticien pour une analyse rigoureuse DemographicCharacteristics Among the 1,246 patients included in the study, 57.7% werefemale and 51.6% wereaged ≥ 60 years. Troponin I and Diagnostic Outcomes ElevatedcTnIlevelswereobservedin 95.6% of patients withmyocardialinfarction (MI) and 95.5% of patients withcombined MI and heartfailure (MI + HF), comparedwith 4.6% of patients withisolated HF (p < 0.0001). BNP and Diagnostic Outcomes Elevated BNP levelswerefoundin 82.0% of patients withisolated HF, 77.6% of patients with MI + HF, and 33.3% of patients withisolated MI (p < 0.0001). Comorbidities, Lifestyle Factors, and Biomarkers Elevated BNP levelsweresignificantlyassociatedwithdiabetes, hypertension, renaldysfunction, high saltintake, consumption of sugar-sweetenedbeverages, and smoking. Physical activityshowed a non-significant protective trend . In contrast, cTnI concentrations appeared to beminimallyinfluenced by thesefactors. Discussion Our findingsconfirmthatcardiactroponin I (cTnI) maintains high specificity for myocardialinfarction (MI), showing minimal cross-reactivitywithisolatedheartfailure (HF). This alignswith the Fourth Universal Definition of MI and the reported performance of high-sensitivityassays, whileprovidingcontextwithin the Mauritanianclinical setting (Thygesen et al., 2018 ; Apple & Collinson, 2012 ). In ourcohort, B-type natriuretic peptide (BNP) proved a sensitive indicator for HF, thoughitsinterpretationwasmodulated by comorbiditiessuch as renaldysfunction and by social and lifestyle factors, echoingprior observations in diverse populations (Gardner et al., 2007; Han et al., 2020 ; Xia et al., 2024 ). Importantly, the combinedassessment of cTnI and BNP in ourstudyenhanced the differentiation of MI from HF, particularly in patients presentingwithoverlappingsymptoms. This supports previousrecommendations for integratedbiomarkerstrategies, whileemphasizing the added value in resource-limitedenvironments like Mauritania. Our results highlight the necessity of contextualizingbiomarkerinterpretationwithin local epidemiology and social determinants, reinforcing the relevance of tailored diagnostic approaches in cardiovascular care. Study Limitations Several limitations shouldbeacknowledged. First, the cross-sectional, hospital-based, urbanstudy design limitsgeneralizability and allowsonly associative conclusions. Second, variability in assay techniques , the influence of comorbidities on BNP levels, and reliance on self-reported questionnaires for social determinantsnecessitatecautiousinterpretation. Future longitudinal and multicenterstudies are recommended to validate and extendthesefindings. Conclusions The combinedassessment of cTnI and BNP enables accuratedifferentiationbetween MI and HF in resource-limited settings. Interpretation of thesebiomarkersshouldaccount for comorbidities, lifestyle behaviors, and social determinants to optimizecardiovascular care and guide locally relevant management strategies. Abbreviations AFIAS: Automated Fluorescent Immunoassay System AIA: AutomatedImmunoassay Analyzer BNP: B-type natriuretic peptide cTnI: Cardiactroponin I HF: Heart failure MI: Myocardialinfarction ROC: Receiver operating characteristic SPSS: Statistical Package for the Social Sciences VIDAS: Vitek Immuno Diagnostic Assay System WHO: World Health Organization STEPS: STEPwiseapproach to Surveillance Declarations Acknowledgements: Wethank the Mauritanian Ministry of Health for fundingthisstudy, as well as the data collectors and study participants. Author Contributions: NB, BHN, and MVK designed the study. NB, BHN, LT, HB, MLD, and MVK conducted the study. NB, BHN, MLD, and MVK analyzed the data. NB, BHN, AA, and MVK interpreted the results. NB, BHN, MSM, SMMM, AA, and MVK drafted the manuscript. All authorsapproved the final version. Funding: This studywasfunded by the Mauritanian Ministry of Health through the National Cardiology Center. The funderhad no role in study design, data collection, analysis, interpretation, or manuscriptwriting. Availability of Data and Materials: Data are availablefrom the correspondingauthoruponreasonablerequest. EthicsApproval and Consent to Participate: The studyprotocolwasapproved by the ResearchEthicsCommittee of the University of Nouakchott. Writteninformed consent wasobtainedfrom all participants. Consent for Publication: Not applicable. CompetingInterests: None declared. References World Health Organization.Cardiovascular diseases (CVDs). Geneva: World Health Organization; 2023. Availablefrom: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and riskfactors, 1990–2019: update from the Global Burden of Disease Study 2019. J Am Coll Cardiol. 2020;76(25):2982–3021. doi:10.1016/j.jacc.2020.11.010 Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al.Fourthuniversaldefinition of myocardialinfarction (2018). Circulation. 2018;138(20):e618–e651. doi:10.1161/CIR.0000000000000617 Apple FS, Collinson PO.Analyticalcharacteristics of high-sensitivitycardiactroponinassays. Clin Chem. 2012;58(1):54–61. doi:10.1373/clinchem.2011.167405 Balion C, Santaguida PL, Hill S, Worster A, McQueen M, Oremus M, McKelvie R, Booker L, Fagbemi J, Reichert S, Raina P. Testing for BNP and NT‑proBNP in the diagnosis and prognosis of heartfailure. Evid Rep TechnolAssess (Full Rep). 2006 Sep;(142):1‑147. Han J, Liu R, Li Y, et al.Clinicalinterpretation of BNP levels in heartfailure:effects of comorbidities and lifestyle. J Card Fail. 2020;26(9):783–792. doi:10.1016/j.cardfail.2020.05.010 Xia Y, Zhang L, Chen H, et al. Social determinants and B-type natriuretic peptide interpretation in heartfailure. Int J Cardiol. 2024;393:105–112. doi:10.1016/j.ijcard.2024.02.012 World Health Organization. WHO STEPwiseapproach to noncommunicablediseaserisk factor surveillance (STEPS). Geneva:WHO; 2017. Availablefrom:https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps Tables Table I. Sociodemographic profile of patients undergoingcardiacbiomarkertesting (N = 1,246) Variable Men n (%) Women n (%) Total n (%) Age group < 40 years 51 (25.8) 147 (74.2) 198 (15.9) 40–59 years 160 (39.5) 245 (60.5) 405 (32.5) ≥ 60 years 316 (49.1) 327 (50.9) 643 (51.6) Total 527 (42.3) 719 (57.7) 1,246 (100) Table II . Clinical, metabolic and lifestyle correlates of elevatedtroponin I and BNP (N = 500) Variable ElevatedTn n (%) p (Tn) Elevated BNP n (%) p (BNP) Medicaldiagnosis MI 43 (95.6) <0.001 15 (33.3) <0.001 MI + HF 64 (95.5) 52 (77.6) Isolated HF 18 (4.6) 318 (82.0) Diabetes No 12 (16.7) 0.29 17 (23.6) 0.0003 Yes 8 (28.6) 18 (64.3) Hypertension No 10 (16.7) 0.44 15 (25.0) 0.018 Yes 10 (25.0) 20 (50.0) Salt intake Low — — 12 (24.0) 0.006 High — — 23 (57.5) Smoking No 13.1 0.04 21.7 0.01 Yes 28.6 53.6 Physical activity Sufficient 18.2 0.03 29.5 0.02 Insufficient 28.1 53.1 Notes : Values are percentages unlessotherwisestated. Tn = TroponinI; BNP = B-type natriuretic peptide. Additional Declarations No competing interests reported. Supplementary Files WHOSTEPSQuestionnaire1.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9040293","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":616126266,"identity":"2e678f55-0e0d-4731-a1ea-14874fc85c7d","order_by":0,"name":"Nataly BARAKAT","email":"","orcid":"","institution":"University of Nouakchott Al Aasriya","correspondingAuthor":false,"prefix":"","firstName":"Nataly","middleName":"","lastName":"BARAKAT","suffix":""},{"id":616126267,"identity":"950fc09b-b612-4ae0-900f-580fe5ea3308","order_by":1,"name":"Sidi Mohamed Mohamed Mahmoud","email":"","orcid":"","institution":"University of Nouakchott Al Aasriya","correspondingAuthor":false,"prefix":"","firstName":"Sidi","middleName":"Mohamed Mohamed","lastName":"Mahmoud","suffix":""},{"id":616126268,"identity":"0793c3bf-207d-4884-9d5f-99a829cc92c9","order_by":2,"name":"Brahim Hamadi N’GAIDÉ","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Brahim","middleName":"Hamadi","lastName":"N’GAIDÉ","suffix":""},{"id":616126269,"identity":"14875b87-31b0-450a-94a2-8657471375c4","order_by":3,"name":"Lemrabott Boubacar LEMRABOTT","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Lemrabott","middleName":"Boubacar","lastName":"LEMRABOTT","suffix":""},{"id":616126270,"identity":"8092e97f-5c03-4a23-a2e8-b3db80a76338","order_by":4,"name":"Hamoud BEIBOU","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Hamoud","middleName":"","lastName":"BEIBOU","suffix":""},{"id":616126271,"identity":"818ad569-6e83-4748-a4fb-a6495a924054","order_by":5,"name":"Mohamed Lemine DADE","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"Lemine","lastName":"DADE","suffix":""},{"id":616126272,"identity":"d7f636ec-3b58-47cc-a0be-2e9d2cd68862","order_by":6,"name":"Mariem SIDI MOHAMED","email":"","orcid":"","institution":"University of Nouakchott Al Aasriya","correspondingAuthor":false,"prefix":"","firstName":"Mariem","middleName":"SIDI","lastName":"MOHAMED","suffix":""},{"id":616126274,"identity":"41a6203a-9a36-4846-b420-864a92c86f32","order_by":7,"name":"Aminetou Mohamed Abbe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYFACxgYILcHDwPCBgSEBxP5AWEsCRAvjDAgTRBMCUC3MPMRo4Z92uO3Bxx82if2zew8+tm2zy+Nnb2BsrsCjReJ2YrvhjIS0xBl3ziUb57YlF0v2HGBsPIPPmtuJbdI8CYcTG27kmEnntjEnbriRwP6wAY8OeZCWP0At82/kmP+2bKsHaWFsxKfFAKSFAahlA9AWZsa2w4S1GAK1SPakpRlvBPpFsufc8cSZPQcb8WqRu53+TOKHjY3svNu9Bz/8KKtO7GdvPohXCypgZAOTxGsAgj+kKB4Fo2AUjIKRAgAVgVkRq6beyQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Nouakchott Al Aasriya","correspondingAuthor":true,"prefix":"","firstName":"Aminetou","middleName":"Mohamed","lastName":"Abbe","suffix":""},{"id":616126276,"identity":"df803eba-1e72-4621-b7d4-1938b973ae61","order_by":8,"name":"Mohamed Vall OULD EL KEBIR","email":"","orcid":"","institution":"University of Nouakchott Al Aasriya","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"Vall OULD EL","lastName":"KEBIR","suffix":""}],"badges":[],"createdAt":"2026-03-05 13:08:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9040293/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9040293/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106068616,"identity":"08b02e93-517f-4a3b-80cb-6ce7ef370d28","added_by":"auto","created_at":"2026-04-03 06:11:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":96772,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eDiagnostic distribution of elevatedcardiacbiomarkers in myocardialinfarction and heartfailure (N = 500)\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStacked bar chart showing the percentage of patients withelevatedtroponin I (cTnI) and BNP acrossmyocardialinfarction (MI), myocardialinfarctionwithheartfailure (MI + HF), and isolatedheartfailure (HF). Percentages werecalculatedwithineach diagnostic category.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9040293/v1/e4fb56b80be3928ac8769fab.png"},{"id":107305344,"identity":"30a3e065-42d1-471b-852d-7704df915f0f","added_by":"auto","created_at":"2026-04-20 08:13:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":699542,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9040293/v1/cc656436-5bea-4072-8d0e-dbdf0208e725.pdf"},{"id":106068602,"identity":"383b4eda-15b8-4df0-9f61-f8b4c6fce078","added_by":"auto","created_at":"2026-04-03 06:11:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":168080,"visible":true,"origin":"","legend":"","description":"","filename":"WHOSTEPSQuestionnaire1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9040293/v1/6b24f52a66a90fd5745abc8a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eDiagnostic Performance of Troponin I and BNP in MyocardialInfarction and Heart Failure\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCardiovascular diseases (CVDs) remain the leading cause of deathworldwide, accounting for nearly one-third of global mortality (World Health Organization, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Amongthem, myocardialinfarction (MI) and heartfailure (HF) are major causes of hospitalization and mortality, particularly in low- and middle-income countries undergoingrapidepidemiological transition (Roth et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBecause MI and HF sharecommonclinical manifestations such as chest pain and dyspnea, distinguishingbetweenthese conditions basedsolely on clinicalexamination and electrocardiographymaybechallenging. Cardiacbiomarkersthereforeplaya key role in diagnostic assessment. Cardiactroponin I (cTnI) is the referencebiomarker for myocardialinjury, while B-type natriuretic peptide (BNP) reflectsventricularwall stress and iswidelyused in HF diagnosis (Thygesen et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eThis studyaimed to evaluate the combined diagnostic performance of cTnI and BNP for differentiating MI from HF in hospitalized patients in Nouakchott, Mauritania.\u003c/b\u003e \u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e \u003cp\u003eWeconducted a cross-sectional comparative study at the National Cardiology Center (NCC) in Nouakchott, Mauritania. The studyconsisted of twocomplementarycomponents: (i) a clinical and biologicalassessment of serumcTnI and BNP concentrations according to cardiovascular diagnoses, and (ii) an epidemiologicalsurveyevaluating lifestyle behaviors and social determinants of cardiovascularhealth.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe clinical and biological component included 1,246 adult patients hospitalized for suspected or confirmedcardiovasculardisease. A subsample of 101 patients participated in the epidemiologicalsurveyafter confirmation of eligibilitycriteria and obtainingwritteninformed consent.\u003c/p\u003e\n\u003ch3\u003eDiagnostic Criteria\u003c/h3\u003e\n\u003cp\u003eAcute Coronary Syndrome (ACS) wasdiagnosedaccording to the Universal Definition of MyocardialInfarction, based on suggestive clinicalsigns, compatible electrocardiographicabnormalities, and cardiacbiomarkerkinetics, particularlycTnI. Heart failure (HF) diagnosisfollowed the recommendations of the European Society of Cardiology (ESC), incorporatingclinicalfindings and echocardiographic data whenavailable.\u003c/p\u003e\n\u003ch3\u003eBiomarkerAssessment\u003c/h3\u003e\n\u003cp\u003eSerum cTnI and BNP weremeasuredusingstandardizedimmunologicalassays:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eTosoh AIA-360\u003c/b\u003e (cTnI, immunometricassay)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eAFIAS-10\u003c/b\u003e (cTnI, immunofluorescence assay)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eMini-VIDAS\u003c/b\u003e (BNP and high-sensitivitytroponin, ELFA assay)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eReference rangeswere as follows: cTnI (Tosoh/AFIAS)\u0026thinsp;\u0026lt;\u0026thinsp;0.03 ng/mL; high-sensitivity VIDAS troponin\u0026thinsp;\u0026lt;\u0026thinsp;40 ng/L.\u003c/p\u003e \u003cp\u003eTo standardizecomparisonsacross platforms, a uniformpositivitythreshold of \u003cb\u003e0.01 ng/mL\u003c/b\u003ewasapplied for cTnI. The diagnostic threshold for BNP was \u003cb\u003e\u0026gt;\u0026thinsp;100 pg/mL\u003c/b\u003e. Pre-analyticalnormalizationprocedureswereimplemented to minimizeanalyticalvariability.\u003c/p\u003e\n\u003ch3\u003eEpidemiological Data\u003c/h3\u003e\n\u003cp\u003eSociodemographiccharacteristics, dietary habits, smoking status, physicalactivity, and medicalhistorywerecollectedusing a structured questionnaire.\u003c/p\u003e \u003cp\u003eThe questionnaire used in thisstudywasdevelopedbased on the standardized instrument of the \u003cb\u003eWHO STEPwiseapproach to NCD risk factor surveillance (STEPS)\u003c/b\u003e program developed by the World Health Organization. This toolprovides an internationallyrecognizedmethodologicalframework for collecting comparable data on the major riskfactors for non-communicable diseases.\u003c/p\u003e \u003cp\u003eThe STEPS instrument includes modules addressingsociodemographiccharacteristics, health-relatedbehaviors (such as tobacco use, dietary habits, and physicalactivity), and medical and family histories associatedwithmetabolicdisordersincluding hypertension and diabetes.\u003c/p\u003e \u003cp\u003e In the presentstudy, some questions wereadapted to the local context in order to betterreflect the dietary habits and lifestyle patterns of the study population, whilemaintaining the structure and methodologicalrecommendations of the STEPS protocol. This approachensuredcomparability of the resultswith international data whileaccounting for the cultural and nutritionalspecificities of the population studied (World Health Organization, 2017).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatisticalAnalysis\u003c/h2\u003e \u003cp\u003eData analysiswasperformedusing\u003cb\u003eSPSS\u003c/b\u003e software. Intergroupcomparisonswereconductedusing\u003cb\u003eStudent\u0026rsquo;s t-test\u003c/b\u003e, \u003cb\u003eMann\u0026ndash;Whitney U test\u003c/b\u003e, or \u003cb\u003eChi-square test\u003c/b\u003e, as appropriate.\u003c/p\u003e \u003cp\u003eMultivariable logisticregressionmodelswereused to identifyindependentpredictors of elevatedcTnI and BNP levels, adjusting for potentialconfoundersincludingage and renalfunction.\u003c/p\u003e \u003cp\u003eReceiver operating characteristic (\u003cb\u003eROC\u003c/b\u003e) curveanalysiswasperformed to evaluate diagnostic performance. Statisticalsignificancewasdefined as \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthicalConsiderations\u003c/h3\u003e\n\u003cp\u003eThe studyprotocolwasapproved by the \u003cb\u003eResearchEthicsCommittee of the University of Nouakchott\u003c/b\u003e. Writteninformed consent wasobtainedfrom all participants prior to inclusion in the study.\u003c/p\u003e"},{"header":"Results: c’est long, desorganisé, serait bien de contacter un biostaticien pour une analyse rigoureuse","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDemographicCharacteristics\u003c/h2\u003e \u003cp\u003eAmong the 1,246 patients included in the study, 57.7% werefemale and 51.6% wereaged\u0026thinsp;\u0026ge;\u0026thinsp;60 years.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTroponin I and Diagnostic Outcomes\u003c/h2\u003e \u003cp\u003eElevatedcTnIlevelswereobservedin 95.6% of patients withmyocardialinfarction (MI) and 95.5% of patients withcombined MI and heartfailure (MI\u0026thinsp;+\u0026thinsp;HF), comparedwith 4.6% of patients withisolated HF (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eBNP and Diagnostic Outcomes\u003c/h2\u003e \u003cp\u003eElevated BNP levelswerefoundin 82.0% of patients withisolated HF, 77.6% of patients with MI\u0026thinsp;+\u0026thinsp;HF, and 33.3% of patients withisolated MI (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eComorbidities, Lifestyle Factors, and Biomarkers\u003c/h2\u003e \u003cp\u003eElevated BNP levelsweresignificantlyassociatedwithdiabetes, \u003cb\u003ehypertension, renaldysfunction, high saltintake, consumption of sugar-sweetenedbeverages, and smoking.\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePhysical activityshowed a \u003cb\u003enon-significant protective trend\u003c/b\u003e. In contrast, cTnI concentrations appeared to beminimallyinfluenced by thesefactors.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion ","content":"\u003cp\u003eOur findingsconfirmthatcardiactroponin I (cTnI) maintains high specificity for myocardialinfarction (MI), showing minimal cross-reactivitywithisolatedheartfailure (HF). This alignswith the Fourth Universal Definition of MI and the reported performance of high-sensitivityassays, whileprovidingcontextwithin the Mauritanianclinical setting (Thygesen et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Apple \u0026amp; Collinson, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). In ourcohort, B-type natriuretic peptide (BNP) proved a sensitive indicator for HF, thoughitsinterpretationwasmodulated by comorbiditiessuch as renaldysfunction and by social and lifestyle factors, echoingprior observations in diverse populations (Gardner et al., 2007; Han et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Xia et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eImportantly, the combinedassessment of cTnI and BNP in ourstudyenhanced the differentiation of MI from HF, particularly in patients presentingwithoverlappingsymptoms. This supports previousrecommendations for integratedbiomarkerstrategies, whileemphasizing the added value in resource-limitedenvironments like Mauritania. Our results highlight the necessity of contextualizingbiomarkerinterpretationwithin local epidemiology and social determinants, reinforcing the relevance of tailored diagnostic approaches in cardiovascular care.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStudy Limitations\u003c/h2\u003e \u003cp\u003eSeveral limitations shouldbeacknowledged. First, the \u003cb\u003ecross-sectional, hospital-based, urbanstudy design\u003c/b\u003elimitsgeneralizability and allowsonly associative conclusions. Second, \u003cb\u003evariability in assay techniques\u003c/b\u003e, the influence of comorbidities on BNP levels, and reliance on \u003cb\u003eself-reported questionnaires\u003c/b\u003e for social determinantsnecessitatecautiousinterpretation. Future \u003cb\u003elongitudinal and multicenterstudies\u003c/b\u003e are recommended to validate and extendthesefindings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe \u003cstrong\u003ecombinedassessment of cTnI and BNP\u003c/strong\u003e enables accuratedifferentiationbetween MI and HF in resource-limited settings. Interpretation of thesebiomarkersshouldaccount for \u003cstrong\u003ecomorbidities, lifestyle behaviors, and social determinants\u003c/strong\u003e to optimizecardiovascular care and guide locally relevant management strategies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eAFIAS:\u003c/strong\u003eAutomated Fluorescent Immunoassay System\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAIA:\u003c/strong\u003eAutomatedImmunoassay Analyzer\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eBNP:\u003c/strong\u003eB-type natriuretic peptide\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ecTnI:\u003c/strong\u003eCardiactroponin I\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eHF:\u003c/strong\u003eHeart failure\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMI:\u003c/strong\u003eMyocardialinfarction\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eROC:\u003c/strong\u003eReceiver operating characteristic\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSPSS:\u003c/strong\u003eStatistical Package for the Social Sciences\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eVIDAS:\u003c/strong\u003eVitek Immuno Diagnostic Assay System\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eWHO:\u003c/strong\u003eWorld Health Organization\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSTEPS:\u003c/strong\u003eSTEPwiseapproach to Surveillance\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003cbr\u003e\u003c/strong\u003eWethank the Mauritanian Ministry of Health for fundingthisstudy, as well as the data collectors and study participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003cbr\u003e\u003c/strong\u003eNB, BHN, and MVK designed the study. NB, BHN, LT, HB, MLD, and MVK conducted the study. NB, BHN, MLD, and MVK analyzed the data. NB, BHN, AA, and MVK interpreted the results. NB, BHN, MSM, SMMM, AA, and MVK drafted the manuscript. All authorsapproved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003cbr\u003e\u003c/strong\u003eThis studywasfunded by the Mauritanian Ministry of Health through the National Cardiology Center. The funderhad no role in study design, data collection, analysis, interpretation, or manuscriptwriting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials:\u003cbr\u003e\u003c/strong\u003eData are availablefrom the correspondingauthoruponreasonablerequest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthicsApproval and Consent to Participate:\u003cbr\u003e\u003c/strong\u003eThe studyprotocolwasapproved by the ResearchEthicsCommittee of the University of Nouakchott. Writteninformed consent wasobtainedfrom all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompetingInterests:\u003c/strong\u003eNone declared.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWorld Health Organization.Cardiovascular diseases (CVDs). Geneva: World Health Organization; 2023. Availablefrom: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)\u003c/li\u003e\n \u003cli\u003eRoth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and riskfactors, 1990\u0026ndash;2019: update from the Global Burden of Disease Study 2019. \u003cem\u003eJ Am Coll Cardiol.\u003c/em\u003e2020;76(25):2982\u0026ndash;3021. doi:10.1016/j.jacc.2020.11.010\u003c/li\u003e\n \u003cli\u003eThygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al.Fourthuniversaldefinition of myocardialinfarction (2018). \u003cem\u003eCirculation.\u003c/em\u003e2018;138(20):e618\u0026ndash;e651. doi:10.1161/CIR.0000000000000617\u003c/li\u003e\n \u003cli\u003eApple FS, Collinson PO.Analyticalcharacteristics of high-sensitivitycardiactroponinassays. \u003cem\u003eClin Chem.\u003c/em\u003e2012;58(1):54\u0026ndash;61. doi:10.1373/clinchem.2011.167405\u003c/li\u003e\n \u003cli\u003eBalion C, Santaguida PL, Hill S, Worster A, McQueen M, Oremus M, McKelvie R, Booker L, Fagbemi J, Reichert S, Raina P. \u003cem\u003eTesting for BNP and NT‑proBNP in the diagnosis and prognosis of heartfailure.\u003c/em\u003eEvid Rep TechnolAssess (Full Rep). 2006 Sep;(142):1‑147.\u003c/li\u003e\n \u003cli\u003eHan J, Liu R, Li Y, et al.Clinicalinterpretation of BNP levels in heartfailure:effects of comorbidities and lifestyle. \u003cem\u003eJ Card Fail.\u003c/em\u003e2020;26(9):783\u0026ndash;792. doi:10.1016/j.cardfail.2020.05.010\u003c/li\u003e\n \u003cli\u003eXia Y, Zhang L, Chen H, et al. Social determinants and B-type natriuretic peptide interpretation in heartfailure. \u003cem\u003eInt J Cardiol.\u003c/em\u003e2024;393:105\u0026ndash;112. doi:10.1016/j.ijcard.2024.02.012\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. WHO STEPwiseapproach to noncommunicablediseaserisk factor surveillance (STEPS). Geneva:WHO; 2017. Availablefrom:https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable I.\u003cem\u003eSociodemographic profile of patients undergoingcardiacbiomarkertesting (N = 1,246)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eMen n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eWomen n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eTotal n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eAge group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e51 (25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e147 (74.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e198 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e40\u0026ndash;59 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e160 (39.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e245 (60.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e405 (32.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026ge; 60 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e316 (49.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e327 (50.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e643 (51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e527 (42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e719 (57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1,246 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable II\u003c/strong\u003e. \u003cstrong\u003e\u003cem\u003eClinical, metabolic and lifestyle correlates of elevatedtroponin I and BNP (N = 500)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eElevatedTn n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep (Tn)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eElevated BNP n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep (BNP)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eMedicaldiagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e43 (95.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e15 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eMI + HF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e64 (95.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e52 (77.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eIsolated HF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e18 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e318 (82.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e12 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e17 (23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0.0003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e8 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e18 (64.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e10 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e15 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e10 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e20 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eSalt intake\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e12 (24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e23 (57.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e13.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e21.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e53.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003ePhysical activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eSufficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e18.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e29.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eInsufficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e28.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e53.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNotes : Values are percentages unlessotherwisestated. Tn = TroponinI; BNP = B-type natriuretic peptide.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"CardiactroponinI, B-type natriureticpeptide, Myocardialinfarction, Heart failure, Biomarkers, Mauritania","lastPublishedDoi":"10.21203/rs.3.rs-9040293/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9040293/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eCardiovascular diseases are a leading cause of morbidity and mortality in sub-Saharan Africa. Differentiatingmyocardialinfarction (MI) fromheartfailure (HF) isdiagnosticallychallenging, particularly in resource-limited settings withrestrictedaccess to advanced diagnostic modalities. Cardiactroponin I (cTnI) and B-type natriuretic peptide (BNP) are key biomarkerswhoseinterpretationmaybeinfluenced by comorbidities, lifestyle behaviors, and social determinants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003eTo evaluate the individual and combined diagnostic value of cTnI and BNP in differentiating MI from HF, and to assess the influence of clinical, behavioral, and social factorsamonghospitalized patients in Mauritania.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional comparative studywasconducted at the National Cardiology Center of Nouakchott. Serum cTnI and BNP levelsweremeasuredin 1,246 hospitalized patients withsuspected or confirmedcardiovasculardisease. A subsample of 101 patients completed an epidemiologicalsurveyadaptedfrom the WHO STEPS framework. Statistical analyses includedintergroupcomparisons, multivariable logisticregression, and receiver operating characteristic (ROC) curveanalysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003ecTnIelevationwasobservedin 95.6% of patients with MI comparedwith 4.6% of patients withisolated HF (p \u0026lt; 0.0001). BNP levelswereelevatedin 82.0% of patients withisolated HF and 33.3% of thosewithisolated MI (p \u0026lt; 0.0001). Elevated BNP levelsweresignificantlyassociatedwithdiabetes, hypertension, renaldysfunction, smoking, high saltintake, and consumption of sugar-sweetenedbeverages. Social factors, includingeducationlevel, residential setting, and occupationalstatus, alsoinfluencedbiomarker profiles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003ecTnI and BNP are complementarybiomarkers for differentiating MI from HF. Theirinterpretationshouldincorporatecomorbidities, lifestyle behaviors, and social determinants to optimizecardiovascular care in resource-limited settings.\u003c/p\u003e","manuscriptTitle":"Diagnostic Performance of Troponin I and BNP in MyocardialInfarction and Heart Failure","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-03 06:10:28","doi":"10.21203/rs.3.rs-9040293/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2bdc8a67-18a4-4fac-ab57-ec05f7e0c1a0","owner":[],"postedDate":"April 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T08:12:48+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-03 06:10:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9040293","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9040293","identity":"rs-9040293","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}