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Ahn SH, Kim YH, Lee JS, Han JH, Kim SY, Kang DW, Kim JS, Kwon SU. Troponin I Levels and Long-Term Outcomes in Acute Ischemic Stroke Patients. J Am Coll Cardiol 2019; 73:525-526. [PMID: 30704584 DOI: 10.1016/j.jacc.2018.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
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Mass Spectrometry Based Comparative Proteomics Using One Dimensional and Two Dimensional SDS-PAGE of Rat Atria Induced with Obstructive Sleep Apnea. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1140:541-561. [DOI: 10.1007/978-3-030-15950-4_32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ahn SH, Lee JS, Kim YH, Kim BJ, Kim YJ, Kang DW, Kim JS, Kwon SU. Prognostic Significance of Troponin Elevation for Long-Term Mortality after Ischemic Stroke. J Stroke 2017; 19:312-322. [PMID: 28877565 PMCID: PMC5647632 DOI: 10.5853/jos.2016.01942] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/12/2017] [Accepted: 05/03/2017] [Indexed: 11/11/2022] Open
Abstract
Background and Purpose Troponin, a marker of myocardial injury, frequently increases and is related with poor outcome in ischemic stroke patients. However, the long-term outcome of this elevation remains uncertain. We, therefore, investigated the prognostic significance of troponin elevation for long-term mortality, and explored factors affecting troponin elevation after ischemic stroke. Methods We retrospectively analyzed the medical data of stroke patients who were admitted within 24 hours of symptom onset and underwent a serum cardiac troponin I test at admission during a five-year period. Information on mortality as the outcome was obtained from the National Death Certificate system. Results A total of 1,692 patients were eligible for inclusion with 33 months of median follow-up. Troponin elevation that exceeded the 99th percentile (>0.04 ng/mL) of values was detected in 166 patients (9.8%). After adjusting for baseline characteristics, troponin elevation was associated with previous ischemic heart disease and congestive heart failure, comorbid atrial fibrillation and active cancer, and increased National Institutes of Health Stroke Scale score. Patients with troponin elevation had a high risk of overall death (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.40–2.40), including stroke-related (HR 1.71, 95% CI 1.14–2.55), cardiac-related (HR 3.17, 95% CI 1.49–6.74), and cancer-related (HR 1.98, 95% CI 1.14–3.45) death than those without troponin elevation. Conclusions Troponin elevation in the acute stage of ischemic stroke was associated with long-term mortality, mainly due to increased stroke- and cancer-related death in the first year and cardiacrelated death in the later period.
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Affiliation(s)
- Sung-Ho Ahn
- Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.,Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Ji-Sung Lee
- Clinical Research Center, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Young-Hak Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yeon-Jung Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
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Vilela EM, Bettencourt-Silva R, da Costa JT, Barbosa AR, Silva MP, Teixeira M, Primo J, Gama Ribeiro V, Nunes JPL. Anti-cardiac troponin antibodies in clinical human disease: a systematic review. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:307. [PMID: 28856147 DOI: 10.21037/atm.2017.07.40] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Anti-cardiac troponin antibodies have been studied in different types of clinical diseases and in healthy populations. A systematic review of published data on anti-troponin antibodies was carried out (search performed on PubMed, ISI Web of Knowledge and Scopus databases). From title and abstract analysis, thirty-three articles were included that met the pre-specified criteria; after full-text analysis, nine articles were excluded. Most studies assessed anti-troponin I antibodies. The prevalence of anti-cardiac troponin antibodies in healthy individuals ranged from 0.0% to 20.0%. The prevalence of anti-troponin I autoantibodies in dilated cardiomyopathy (DCM) ranged from 7.0% to 22.2%. Other conditions under study were myocardial infarction, ischemic cardiomyopathy (ICM), peripartum cardiomyopathy (PPCM), Chagas disease, Emery-Dreifuss muscular dystrophy (EDMD) and renal transplantation. In the different patient populations studied, anti-cardiac troponin antibodies have been shown to be either positively or negatively associated with prognostic and clinical features. In what concerns a possible value as biomarkers, these assays have not emerged up to the present moment as important aids for practical clinical decisions in cardiac or other types of patients. In what concerns pathophysiology, anti-cardiac troponin autoantibodies may play a role in different diseases. It can be speculated that these antibodies could be involved in perpetuating some degree of cardiac injury after an event, such as myocardial infarction or PPCM.
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Affiliation(s)
- Eduardo M Vilela
- Department of Cardiology, Centro Hospitalar V.N. Gaia/Espinho, Gaia, Portugal
| | | | - J Torres da Costa
- Centro Hospitalar São João, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Ana Raquel Barbosa
- Department of Cardiology, Centro Hospitalar V.N. Gaia/Espinho, Gaia, Portugal
| | - Marisa P Silva
- Department of Cardiology, Centro Hospitalar V.N. Gaia/Espinho, Gaia, Portugal
| | - Madalena Teixeira
- Department of Cardiology, Centro Hospitalar V.N. Gaia/Espinho, Gaia, Portugal
| | - João Primo
- Department of Cardiology, Centro Hospitalar V.N. Gaia/Espinho, Gaia, Portugal
| | - Vasco Gama Ribeiro
- Department of Cardiology, Centro Hospitalar V.N. Gaia/Espinho, Gaia, Portugal
| | - José Pedro L Nunes
- Centro Hospitalar São João, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Torre M, Jarolim P. Cardiac troponin assays in the management of heart failure. Clin Chim Acta 2014; 441:92-8. [PMID: 25545229 DOI: 10.1016/j.cca.2014.12.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 01/18/2023]
Abstract
Cardiac troponins I and T are established biomarkers of cardiac injury. Testing for either of these two cardiac troponins has long been an essential component of the diagnosis of acute myocardial infarction. In addition, cardiac troponin concentrations after acute myocardial infarction predict future adverse events including development of ischemic heart failure and chronic elevations of cardiac troponin correlate with heart failure severity. These predictions and correlations are particularly obvious when cardiac troponin concentrations are measured using the new high sensitivity cardiac troponin assays. Thus, a growing body of literature suggests that cardiac troponin testing may have important clinical implications for heart failure patients with reduced or preserved ejection fraction. In this review, we explore the prognostic utility of measuring cardiac troponin concentrations in patients with acute or chronic heart failure and in populations at risk of developing heart failure and the relationship between cardiac troponin levels and disease severity. We also summarize the ongoing debates and research on whether serial monitoring of cardiac troponin levels may become a useful tool for guiding therapeutic interventions in patients with heart failure.
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Affiliation(s)
| | - Petr Jarolim
- Harvard Medical School, Boston, MA, USA; Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
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Korley FK, Schulman SP, Sokoll LJ, DeFilippis AP, Stolbach AI, Bayram JD, Saheed MO, Omron R, Fernandez C, Lwin A, Cai SS, Post WS, Jaffe AS. Troponin elevations only detected with a high-sensitivity assay: clinical correlations and prognostic significance. Acad Emerg Med 2014; 21:727-35. [PMID: 25112512 DOI: 10.1111/acem.12417] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 01/29/2014] [Accepted: 02/08/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVES With clinical use of high-sensitivity troponin I (hsTnI), more frequent troponin elevations will occur. However, the burden and implications of these elevations are not well understood. The authors quantified the prevalence of elevated hsTnI in patients presenting with possible acute coronary syndrome (ACS) who do not have elevated troponin with a current generation assay (cardiac troponin I [cTnI]) and determined the association of these newly detected elevations with a composite of all-cause mortality and subsequent cardiac hospitalization. METHODS This was a prospective observational study of 808 subjects evaluated for possible ACS and followed for up to 1 year. Troponin values were measured with hsTnI (Abbott Laboratories) and cTnI (Abbott and Beckman Coulter). Cardiac hospitalization was defined as hospitalization for ACS, revascularization, acute heart failure (AHF), or tachy/brady arrhythmia that occurred after the index emergency department (ED) visit or hospital discharge. RESULTS Forty subjects (5%) were diagnosed with ACS (26 myocardial infarction and 14 unstable angina). On the initial sample, the prevalence of elevated hsTnI among subjects with nonelevated cTnI was 9.2% using a gender-neutral cutoff (95% confidence interval [CI] = 7.1% to 11.4%) and 11.1% using a gender-specific cutoff (95% CI = 8.8% to 13.4%). Adjudicated diagnoses for subjects whose initial samples had elevated hsTnI but nonelevated cTnI (gender-neutral cutoff) were as follows: three (4.6%) ACS, 15 (23.1%) AHF, three (4.6%) volume overload etiology unclear/noncardiac, three (4.6%) cardiac (non-ACS), and 41 (63.1%) other. Of the 65 patients whose initial samples had hsTnI but nonelevated cTnI, eight developed cTnI elevation on subsequent serial sampling. After traditional cardiovascular risk factors and renal function were adjusted for, subjects with elevated initial hsTnI but nonelevated cTnI (initial and serial sampling) had a higher risk of all-cause mortality and subsequent cardiac hospitalization than subjects with both nonelevated hsTnI and nonelevated cTnI (hazard ratio [HR] = 1.91, 95% CI = 1.14 to 3.19). CONCLUSIONS On the initial sample, 9% to 11% of subjects without cTnI elevation had hsTnI elevation. Although the majority of the patients with these newly detected hsTnI elevations did not have ACS, they had a higher risk for all-cause mortality and subsequent cardiac hospitalization.
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Affiliation(s)
| | | | - Lori J. Sokoll
- The Department of Medicine; Division of Clinical Chemistry; Department of Pathology; Baltimore MD
| | | | | | | | | | - Rodney Omron
- The Department of Emergency Medicine; Baltimore MD
| | | | - Albert Lwin
- Johns Hopkins University School of Medicine; Baltimore MD
| | - Stephen S. Cai
- The University of Maryland School of Medicine; Baltimore Maryland
| | | | - Allan S. Jaffe
- The Cardiovascular Division and Departments of Medicine and Laboratory Medicine and Pathology; Mayo Clinic and Medical School; Rochester MN
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Usefulness of high-sensitivity cardiac troponin T and brain natriuretic peptide as biomarkers of myocardial fibrosis in patients with hypertrophic cardiomyopathy. Am J Cardiol 2013; 112:867-72. [PMID: 23746480 DOI: 10.1016/j.amjcard.2013.04.060] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 04/25/2013] [Accepted: 04/25/2013] [Indexed: 01/20/2023]
Abstract
Myocardial fibrosis assessed by late gadolinium enhancement cardiac magnetic resonance imaging is associated with cardiovascular events in patients with hypertrophic cardiomyopathy (HC), but few data are available regarding the utility of biomarkers for detecting late gadolinium enhancement. The aim of this study was to examine serum levels of myoglobin, cardiac myosin light chain I, high-sensitivity cardiac troponin T (hs-cTnT), and creatine kinase-MB isoenzyme and plasma levels of brain natriuretic peptide (BNP) in relation to late gadolinium enhancement in 53 patients with HC. Levels of hs-cTnT and BNP were higher in 23 patients with late gadolinium enhancement than in 30 patients without it (p <0.01 for both). An hs-cTnT level ≥0.007 ng/ml or a BNP level ≥70 pg/ml had good diagnostic value for detecting late gadolinium enhancement, with sensitivity of 96% or specificity of 90% with the combination of these 2 biomarkers. The extent of late gadolinium enhancement was correlated with BNP level (p <0.01) but not with hs-cTnT level in 23 patients with HC with late gadolinium enhancement. The increase in the extent of late gadolinium enhancement was related to hs-cTnT level in 8 patients during 22 months of follow-up (p = 0.02). In conclusion, the combination of hs-cTnT and BNP is useful in detecting myocardial fibrosis in patients with HC. The findings of this study indicate that hs-cTnT is a direct marker of ongoing myocardial fibrosis and that BNP is a marker of left ventricular overload partially associated with myocardial fibrosis.
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Lippi G, Cervellin G. Choosing Troponin Immunoassays in a World of Limited Resources. J Am Coll Cardiol 2013; 62:647-8. [DOI: 10.1016/j.jacc.2013.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
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Peng Y, Chen M, Chai H, Yan SD, Huang DJ. Cardiac Troponin. J Am Coll Cardiol 2013; 61:2571-2. [DOI: 10.1016/j.jacc.2013.02.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 02/26/2013] [Indexed: 11/25/2022]
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Reply. J Am Coll Cardiol 2013; 61:2572. [DOI: 10.1016/j.jacc.2013.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 03/12/2013] [Indexed: 11/22/2022]
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