Cardiac troponin-T and CK-MB (mass) levels in cardiac and non cardiac disease

Evaluation of novel biomarkers for early diagnosis of bisphenol A-induced coronary artery disease

Introduction

Bisphenol A (BPA), a ubiquitous synthetic monomer primarily used in the manufacture of polycarbonate plastic and epoxy resins and as a non-polymer additive to other plastics, can leach into the food and water supply and has been linked to cardiovascular disease (CVD). This study aimed to analyze BPA levels in patients with varying numbers of coronary artery stenosis and evaluate the prognostic value of new biomarkers cluster of differentiation 36 (CD36) and heart-type fatty acid-binding protein (H-FABP), compared to troponin I and creatine kinase (CK) MB, for detecting myocardial injury.

Method

Eighty nine patients undergoing angiography at Urmia Hospital from March 2019 to 2020 were included. Serum levels of BPA, CD36, H-FABP, troponin I, and CK-M were measured.

Results

When comparing CD36 and H-FABP with troponin I and CK-MB across coronary occlusion classes, receiver operating characteristic curves indicated CD36 and H-FABP had higher accuracy than troponin I and CK-MB for detecting stenosis stages. In patients with occlusion, significant alterations were detected in age, sex, BMI, hypertension, diabetes, dyslipidemia, and smoking. BPA serum concentration significantly increased compared to normal subjects.

Conclusions

Our study revealed that serum biomarkers were valuable for prognosticating myocardial injury. Among these, CD36 and H-FABP were more accurate. BPA concentration correlated with myocardial necrosis, underlying disease, and occlusion stage, suggesting BPA's harmful effects.

5-Hydroxymethylcytosine signatures in circulating cell-free DNA as diagnostic and predictive biomarkers for coronary artery disease

Background

The 5-hydroxymethylcytosine (5hmC) DNA modification is an epigenetic marker involved in a range of biological processes. Its function has been studied extensively in tumors, neurodegenerative diseases, and atherosclerosis. Studies have reported that 5hmC modification is closely related to the phenotype transformation of vascular smooth muscle cells and endothelial dysfunction. However, its role in coronary artery disease (CAD) has not been fully studied.

Results

To investigate whether 5hmC modification correlates with CAD pathogenesis and whether 5hmC can be used as a biomarker, we used a low-input whole-genome sequencing technology based on selective chemical capture (hmC-Seal) to firstly generate the 5hmC profiles in the circulating cell-free DNA(cfDNA) of CAD patients, including stable coronary artery disease (sCAD) patients and acute myocardial infarction (AMI) patients. We detected a significant difference of 5hmC enrichment in gene bodies from CAD patients compared with normal coronary artery (NCA) individuals. Our results showed that CAD patients can be well separated from NCA individuals by 5hmC markers. The prediction performance of the model established by differentially regulated 5hmc modified genes were superior to common clinical indicators for the diagnosis of CAD (AUC = 0.93) and sCAD (AUC = 0.93). Specially, we found that 5hmC markers in cfDNA showed prediction potential for AMI (AUC = 0.95), which was superior to that of cardiac troponin I, muscle/brain creatine kinase, and myoglobin.

Conclusions

Our results suggest that 5hmC markers derived from cfDNA can serve as effective epigenetic biomarkers for minimally noninvasive diagnosis and prediction of CAD.

Elevated cardiac troponin I, creatine kinase and myoglobin and their relationship with cardiovascular risk factors in patients with type 2 diabetes

BACKGROUND

Elevated cardiac troponin I, Creatine kinase (CK-MB) and Myoglobin levels are observed in the setting of acute myocardial damage. However sub-clinical elevations occur in patients with diabetes mellitus. This study was carried out to determine the relationship between the presence of multiple cardiovascular risk factors and the metabolic syndrome and elevations in cardiac markers in patients with type2 diabetes mellitus.

SUBJECTS AND METHODS

Consecutive stable out-patients with type2 diabetes mellitus at the University of Port Harcourt Teaching Hospital, Nigeria were recruited. Non-diabetic individuals such as hospital staff and the general public acted as controls. Baseline demographic data collection was done and waist circumference, weight, height and blood pressure were measured. Venous samples were assayed for CTnI, CK-MB and Myoglobin levels using ELISA. Data was analysed using SPSS v 20.

RESULTS

There were 188 DM patients, who were older than the 200 control subjects (56.1 ± 13.1 years and 42.7 ± 5.7 years, p < 0.001). Mean duration of diabetes was 7.1(5.7) years. Hypertension was present in 59%, 84.6% had dyslipidaemia, while 76.1% had metabolic syndrome. All the cardiac markers were significantly higher in DM patients than controls. The presence of hypertension or dyslipidaemia was not significantly associated with the cardiac markers (p > 0.05 for all), however the DM patients with metabolic syndrome had higher levels of CK-MB and myoglobin but not CTnI than those without.

CONCLUSION

Diabetes mellitus is associated with chronic sub-clinical elevation of cardiac markers and this is more in those with multiple cardiovascular risk factors and/or the metabolic syndrome.

Surface plasmon resonance aided electrochemical immunosensor for CK-MB determination in undiluted serum samples

This article presents a simple chronoamperometric immunosensor for the quantitative assessment of creatine kinase MB (CK-MB) in 50 microL undiluted serum samples. The immunosensor consists of gold working and counter electrodes patterned onto a glass chip by thin-film photolithography and an external Ag|AgCl reference electrode. The detection limit (DL) of the chronoamperometric method is 13 ng mL(-1) (DL = 2xRMSD/S, where RMSD is the residual mean standard deviation of the measured points around a calibration curve with a slope of S). In spiked serum samples, the response was linear up to 300 ng mL(-1) of CK-MB. A surface plasmon resonance (SPR) system with simultaneous electrochemical detection (EC-SPR) aided the development of the sandwich immunoassay. Real-time monitoring of the SPR signal was used to optimize the capture antibody immobilization, CK-MB and detection antibody binding, as well as to minimize the nonspecific adsorption of serum proteins to the sensor surface. The detection antibody has been labeled with alkaline phosphatase (ALP) enzyme for sensitive electrochemical detection. ALP catalyzes the hydrolysis of ascorbic acid phosphate and generates ascorbic acid, which is measured chronoamperometrically. The electrochemical immunoassay for CK-MB was less sensitive to nonspecific adsorption related interferences, had a better detection limit, and required a lower volume of sample than the SPR method.

Perioperative control of hypertension: when will it adversely affect perioperative outcome?

Much has been published about the impact of treatment on adverse outcomes in patients with cardiovascular diseases. Hypertension is an extremely common condition affecting a significant percentage of the world population. Although care guidelines exist for the medical patient with raised blood pressure, there are no accepted guidelines for the preoperative evaluation and perioperative care of the patient with hypertension who undergoes noncardiac surgery. Of particular importance are defining at-risk groups of patients, and the indications for cancellation to treat and hence reduce this risk. This review examines the interactions between hypertension, drug therapies, anesthesia, and adverse outcomes in these patients. Recommendations for identifying patients at greatest risk of adverse cardiovascular events and cardiac mortality have been developed through evaluation of available data. Based on these findings, the only patients in whom cancellation may be justified and the level of hypertension treated prior to surgery are those with stage 2 hypertension and accompanying target-organ damage, or stage 3 hypertension (blood pressure > 180/> 110 mm Hg).

Diagnosis of acute myocardial infarction: CK-MB versus cTn-T in Indian patients

The comparative diagnostic efficacy of two cardiac markers: CK-MB and cTn-T, has scarcely been investigated in Indian patients of acute myocardial infarction. The present study was conducted for the same objective. The present study comprised of 59 patients. Males were 44 (75%) and females were 15 (25 %). The age of patients ranged from 32-84 years with mean age of 62.8 yrs. The mean age of males and females were 60 and 63 yrs respectively. All patients presented with history of chest pain with a 12 leads ECG proven MI (ST Elevation, discordant T-waves). CK-MB was estimated in peripheral blood samples at 0,24,48 and 72 hours by an autoanalyzer. Following 12 hours of admission bed side Troponin-T test was done employing cTn-T marker kit. Initially (0 hr), in 50% patients CK-MB was elevated. By end of 24 hours all the patients were CKMB positive and peak level was attained at 24 hrs. Then it tended to decline over next 48 hrs. There were no false positive or negative results. The cTn-T test was positive only in 22 % of ECG positive infarctions. However, the cTn-T positive cases were always accompanied by a higher CK-MB levels. A significantly lower cTn-T positive cases in Indian patients can only be attributed to some difference in amino acid sequence of Indian cTn-T and occidental cTn-T. A larger study from other Indian cardiac centers can either substantiate or contradict our results.

A serial follow up study of cardiac marker enzymes during the week after acute myocardial infarction

Laboratory infarction diagnostics are based on the detection of elevated serum activities of creatine kinase (CK) Creatine kinase Isoenzyme MB (CKMB) and Transaminases. Determination of these cardiac marker enzymes permits the diagnosis of transmural myocardial infarction. However in such patients the diagnosis of acute myocardial infarction can be confirmed by the clinical symptoms and changes in the ECG, in addition to the enzyme assays. The 50 AMI patients selected in the present study were those admitted to the ICCU of Shri Krishna Hospital, Karamsad. The blood samples were taken at Zero hours (i.e. at the time of admission of the patient). Within 6 hrs of the starting of chest pain, 1.5 million units of streptokinase were mixed with 100 to 150ml of normal saline and administered by infusion over a period of one hour. The blood samples were further collected at intervals of 6 hrs, 14hrs, 32hrs, 48hrs, 5(th) day and 7(th) day. The blood samples were analyzed for CK, CKMB, SGOT, α HBDH and Cardiac specific Troponin T. By 6hrs the CK and CKMB values had started rising, the rise continuing at 14hrs with peak values at 32hrs. The CK showed a slight decrease by 48 hrs. The cardiac Troponin T showed wide time window from 4 hrs to 7(th) day for detecting myocardial damage. The maximum cardiac Troponin T values were during the first 24hrs. Cardiac Troponin T in serum appears to be a more sensitive and early indicator of myocardial cell injury in comparison to CKMB.