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Effect of combined testing of ceramides with high-sensitive troponin T on the detection of acute coronary syndrome in patients with chest pain in China: a prospective observational study
  1. Kang Yao1,2,
  2. Yanzhong Wang3,
  3. Demin Xu4,5,
  4. Xuebo Liu6,
  5. Chengxing Shen7,
  6. Wei Hu8,
  7. Zhe Wang1,
  8. Runda Wu1,
  9. Xianglin Tang1,
  10. Aijun Sun1,9,
  11. Yunzeng Zou1,
  12. Juying Qian1,
  13. Guangyu Wu10,
  14. Xin Guo10,
  15. Xiaoliang Cheng10,
  16. Junbo Ge1
  1. 1 Department of Cardiology, Zhongshan Hospital, Fudan University. Shanghai Institute of Cardiovascular Diseases, Shanghai, China
  2. 2 Department of Cardiology, Xiamen Branch, Zhongshan Hospital Fudan University, China
  3. 3 School of Population Health and Environmental Sciences, Kings College London, London, UK
  4. 4 Department of Cardiac Surgey, Zhongshan Hospital, Fudan University, Shanghai, ​China
  5. 5 Department of Cardiac Surgey, Xiamen Branch, Zhongshan HospitalFudan University, Shanghai, China
  6. 6 Department of Cardiology, Tongji Hospital, Tongji University, Shanghai, China
  7. 7 Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
  8. 8 Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
  9. 9 Shanghai Institute of Biomedical Science, Fudan University, Shanghai, China
  10. 10 Qlife Lab Co., Ltd., Shanghai, China
  1. Correspondence to Dr Junbo Ge; ge.junbo2{at}


Objective Ceramides are associated with coronary plaque vulnerability. We aim to investigate the potential diagnostic value of ceramides for acute coronary syndrome (ACS) in Chinese patients with chest pain.

Design Prospective observational survey.

Setting Shanghai, China, 2016–2017.

Participants A total of 2773 patients with chest pain from four hospitals in Shanghai, China, between August 2016 and October 2017.

Main outcome measures Performance of metabolites model in detection of ACS cases including ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina.

Results Plasma levels of 12 ceramide molecules and corresponding ratios were compared between patients diagnosed with ACS and those without. Cer(d18:1/24:1(15Z))/Cer(d18:1/24:0) ratio, Cer(d18:1/14:0) and Cer(d18:1/22:0) were independent predictors of ACS after adjustment of traditional risk factors and high-sensitivecardiac troponin T. Receiver operating characteristic curve analysis showed a significant improvement in detecting ACS in the multivariable model with ceramides compared with that without (0.865 (0.840 to 0.889) vs 0.808 (0.776 to 0.841), p<0.001).

Conclusion Distinct plasma ceramides are independent diagnostic predictors of ACS among patients with chest pain. Ceramides together with high-sensitive troponin and traditional factors showed great potential in identifying ACS among patients with chest pain.

  • cardiac epidemiology
  • cardiology
  • lipid disorders

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  • KY, YW and DX contributed equally.

  • Contributors JG, KY, YW and DX contributed to study concept and design. KY, XL, CS, WH, ZW, RW, XT, AS, YZ and JQ contributed to recruitment of patients and acquisition of samples. YW, GW, XG and XC contributed to analysis and interpretation of data. GW and YW drafted the first version of the manuscript. All authors contributed to critical revision of the manuscript and approval of final version.

  • Funding This work was supported by National Key Research and Development Programme (No. 2016YFC1301200) and National Natural Science Foundation of China (No. 81470386).

  • Competing interests Q-life lab holds patents for the diagnostic use of ceramides for cardiovascular risk determination in China. WG, GX and CX work for Q-life and GX and CX are also shareholders.

  • Ethics approval This study was approved by the Ethics Committee of Zhongshan Hospital, the Ethics Committee of Tongji Hospital, the Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital and the Ethics Committee of Minhang Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available with the corresponding author and will be available on request.

  • Patient consent for publication Obtained.

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