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

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.