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Sourour N, Riveland E, Næsgaard P, Kjekshus H, Larsen AI, Røsjø H, Omland T, Myhre PL. Associations Between Biomarkers of Myocardial Injury and Systemic Inflammation and Risk of Incident Ventricular Arrhythmia. JACC Clin Electrophysiol 2024:S2405-500X(24)00295-0. [PMID: 38904572 DOI: 10.1016/j.jacep.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Cardiac troponins (cTns) and biomarkers of inflammation are elevated in heart failure (HF) and predict cardiovascular risk. Whether these biomarkers associate with risk of ventricular arrhythmias (VAs) is unclear. OBJECTIVES This study sought to assess whether cTnT, growth differentiation factor 15 (GDF-15), interleukin-6 (IL-6), and C-reactive protein (CRP) concentrations are associated with incident VA. METHODS In a prospective, observational study of patients treated with implantable cardioverter-defibrillator, cTnT, GDF-15, IL-6, and CRP were measured at baseline and after 1.4 ± 0.5 years and were associated with implantable cardioverter-defibrillator-detected incident VA, HF hospitalizations, and mortality. RESULTS This study included 489 patients aged 66 ± 12 years and 83% were men. Median concentrations of cTnT were 15 (Q1-Q3: 9-25) ng/L at inclusion, and higher concentrations were associated with higher age, male sex, diabetes mellitus, coronary artery disease, and HF. During 3.1 ± 0.7 years of follow-up, 137 patients (28%) had ≥1 VA. cTnT concentrations were associated with an increased VA risk (per log-unit, HR: 1.63; 95% CI: 1.31-2.01; P < 0.001), also after adjustment for age, sex, body mass index, coronary artery disease, HF, renal function, and left ventricular ejection fraction (P < 0.001). GDF-15, IL-6, and CRP concentrations were not associated with incident VA, but all (including cTnT) were associated with HF hospitalization and mortality. Changes in cTnT, GDF-15, IL-6, and CRP from baseline to 1.4 years were not associated with subsequent VA. CONCLUSIONS Higher concentrations of cTnT, GDF-15, IL-6, and CRP associate with HF hospitalization and death, but only cTnT predict incident VA. These findings suggest that myocardial injury rather than inflammation may play a pathophysiological role in VA and sudden cardiac death.
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Affiliation(s)
- Nur Sourour
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Egil Riveland
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway; Institute of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Patrycja Næsgaard
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Harald Kjekshus
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway; Institute of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Helge Røsjø
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division for Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peder L Myhre
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Bockus LB, Jensen PN, Fretts AM, Hoofnagle AN, McKnight B, Sitlani CM, Siscovick DS, King IB, Psaty BM, Sotoodehnia N, Lemaitre RN. Plasma Ceramides and Sphingomyelins and Sudden Cardiac Death in the Cardiovascular Health Study. JAMA Netw Open 2023; 6:e2343854. [PMID: 37976059 PMCID: PMC10656644 DOI: 10.1001/jamanetworkopen.2023.43854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Sphingolipids, including ceramides and sphingomyelins, may influence the pathophysiology and risk of sudden cardiac death (SCD) through multiple biological activities. Whether the length of the fatty acid acylated to plasma sphingolipid species is associated with SCD risk is not known. Objective To determine whether the saturated fatty acid length of plasma ceramides and sphingomyelins influences the association with SCD risk. Design, Setting, and Participants In this cohort study, multivariable Cox proportional hazards regression models were used to examine the association of sphingolipid species with SCD risk. The study population included 4612 participants in the Cardiovascular Health Study followed up prospectively for a median of 10.2 (IQR, 5.5-11.6) years. Baseline data were collected from January 1992 to December 1995 during annual examinations. Data were analyzed from February 11, 2020, to September 9, 2023. Exposures Eight plasma sphingolipid species (4 ceramides and 4 sphingomyelins) with saturated fatty acids of 16, 20, 22, and 24 carbons. Main Outcome and Measure Association of plasma ceramides and sphingomyelins with saturated fatty acids of different lengths with SCD risk. Results Among the 4612 CHS participants included in the analysis (mean [SD] age, 77 [5] years; 2724 [59.1%] women; 6 [0.1%] American Indian; 4 [0.1%] Asian; 718 [15.6%] Black; 3869 [83.9%] White, and 15 [0.3%] Other), 215 SCD cases were identified. In adjusted Cox proportional hazards regression analyses, plasma ceramides and sphingomyelins with palmitic acid (Cer-16 and SM-16) were associated with higher SCD risk per higher SD of log sphingolipid levels (hazard ratio [HR] for Cer-16, 1.34 [95% CI, 1.12-1.59]; HR for SM-16, 1.37 [95% CI, 1.12-1.67]). Associations did not differ by baseline age, sex, race, or body mass index. No significant association of SCD with sphingolipids with very-long-chain saturated fatty acids was observed after correction for multiple testing (HR for ceramide with arachidic acid, 1.06 [95% CI, 0.90-1.24]; HR for ceramide with behenic acid, 0.92 [95% CI, 0.77-1.10]; HR for ceramide with lignoceric acid, 0.92 [95% CI, 0.77-1.09]; HR for sphingomyelin with arachidic acid, 0.83 [95% CI, 0.71-0.98]; HR for sphingomyelin with behenic acid, 0.84 [95% CI, 0.70-1.00]; HR for sphingomyelin with lignoceric acid, 0.86 [95% CI, 0.72-1.03]). Conclusions and Relevance The findings of this large, population-based cohort study of SCD identified that higher plasma levels of Cer-16 and SM-16 were associated with higher risk of SCD. Future studies are needed to examine the underlying mechanism of these associations.
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Affiliation(s)
- Lee B Bockus
- Department of Medicine, University of Washington, Seattle
| | - Paul N Jensen
- Department of Medicine, University of Washington, Seattle
| | - Amanda M Fretts
- Department of Epidemiology, University of Washington, Seattle
| | - Andrew N Hoofnagle
- Departments of Laboratory Medicine and Pathology, University of Washington, Seattle
| | | | | | | | - Irena B King
- Department of Internal Medicine, University of New Mexico, Albuquerque
| | - Bruce M Psaty
- Department of Medicine, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
- Department of Health Systems and Population Health, University of Washington, Seattle
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Leukotriene A4 Hydrolase and Hepatocyte Growth Factor Are Risk Factors of Sudden Cardiac Death Due to First-Ever Myocardial Infarction. Int J Mol Sci 2022; 23:ijms231810251. [PMID: 36142157 PMCID: PMC9499415 DOI: 10.3390/ijms231810251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
Patients at a high risk for sudden cardiac death (SCD) without previous history of cardiovascular disease remain a challenge to identify. Atherosclerosis and prothrombotic states involve inflammation and non-cardiac tissue damage that may play active roles in SCD development. Therefore, we hypothesized that circulating proteins implicated in inflammation and tissue damage are linked to the future risk of SCD. We conducted a prospective nested case–control study of SCD cases with verified myocardial infarction (N = 224) and matched controls without myocardial infarction (N = 224), aged 60 ± 10 years time and median time to event was 8 years. Protein concentrations (N = 122) were measured using a proximity extension immunoassay. The analyses revealed 14 proteins significantly associated with an increased risk of SCD, from which two remained significant after adjusting for smoking status, systolic blood pressure, BMI, cholesterol, and glucose levels. We identified leukotriene A4 hydrolase (LTA4H, odds ratio 1.80, corrected confidence interval (CIcorr) 1.02–3.17) and hepatocyte growth factor (HGF; odds ratio 1.81, CIcorr 1.06–3.11) as independent risk markers of SCD. Elevated LTA4H may reflect increased systemic and pulmonary neutrophilic inflammatory processes that can contribute to atherosclerotic plaque instability. Increased HGF levels are linked to obesity-related metabolic disturbances that are more prevalent in SCD cases than the controls.
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Prognostic Value of Cardiac Troponin I in Patients with Ventricular Tachyarrhythmias. J Clin Med 2022; 11:jcm11112987. [PMID: 35683378 PMCID: PMC9181556 DOI: 10.3390/jcm11112987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 01/07/2023] Open
Abstract
Besides the diagnostic role in acute myocardial infarction, cardiac troponin I levels (cTNI) may be increased in various other clinical conditions, including heart failure, valvular heart disease and sepsis. However, limited data are available regarding the prognostic role of cTNI in the setting of ventricular tachyarrhythmias. Therefore, the present study sought to assess the prognostic impact of cTNI in patients with ventricular tachyarrhythmias (i.e., ventricular tachycardia (VT) and fibrillation (VF)) on admission. A large retrospective registry was used, including all consecutive patients presenting with ventricular tachyarrhythmias from 2002 to 2015. The prognostic impact of elevated cTNI levels was investigated for 30-day all-cause mortality (i.e., primary endpoint) using Kaplan–Meier, receiver operating characteristic (ROC), multivariable Cox regression analyses and propensity score matching. From a total of 1104 patients with ventricular tachyarrhythmias and available cTNI levels on admission, 46% were admitted with VT and 54% with VF. At 30 days, high cTNI was associated with the primary endpoint (40% vs. 22%; log rank p = 0.001; HR = 2.004; 95% CI 1.603–2.505; p = 0.001), which was still evident after multivariable adjustment and propensity score matching (30% vs. 18%; log rank p = 0.003; HR = 1.729; 95% CI 1.184–2.525; p = 0.005). Significant discrimination of the primary endpoint was especially evident in VT patients (area under the curve (AUC) 0.734; 95% CI 0.645–0.823; p = 0.001). In contrast, secondary endpoints, including all-cause mortality at 30 months and a composite arrhythmic endpoint, were not affected by cTNI levels. The risk of cardiac rehospitalization was lower in patients with high cTNI, which was no longer observed after propensity score matching. In conclusion, high cTNI levels were associated with increased risk of all-cause mortality at 30 days in patients presenting with ventricular tachyarrhythmias.
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Singh KB, Nnadozie MC, Abdal M, Shrestha N, Abe RAM, Masroor A, Khorochkov A, Prieto J, Mohammed L. Type 2 Diabetes and Causes of Sudden Cardiac Death: A Systematic Review. Cureus 2021; 13:e18145. [PMID: 34692349 PMCID: PMC8525691 DOI: 10.7759/cureus.18145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/20/2021] [Indexed: 12/14/2022] Open
Abstract
Type 2 diabetes mellitus has been on the rise in recent years. A major cause of death in the United States is myocardial infarction with underlying coronary artery disease. Impairment of tissue insulin sensitivity in type 2 diabetes is a significant factor for sudden cardiac death. The complex pathophysiology stems from coexisting cardiovascular disease and complications of impaired tissue sensitivity to insulin. Long-term diabetics with underlying kidney disease and those requiring dialysis have systemic inflammation that adds to an increased risk of death. During times of pathological stress, myocardial tissue will express substrates and growth factors that cause conduction disequilibrium and predispose to sudden cardiac death. Diabetes is a modifiable risk factor in the prevention of sudden cardiac arrest. Specific prevention measures aimed towards lifestyle modification and medications are important to prevent diabetes and decrease mortality of future cardiac death. In recent times, drugs that compete with glucose in the proximal convoluted tubule of the nephron have clinical significance in lowering the risk of sudden cardiac arrest.
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Affiliation(s)
- Karan B Singh
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Maduka C Nnadozie
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Muhammad Abdal
- Emergency Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Niki Shrestha
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rose Anne M Abe
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Anum Masroor
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Psychiatry, Psychiatric Care Associates, Englewood, USA
- Medicine, Khyber Medical College, Peshawar, PAK
| | - Arseni Khorochkov
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Jose Prieto
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Perrone MA, Storti S, Salvadori S, Pecori A, Bernardini S, Romeo F, Guccione P, Clerico A. Cardiac troponins: are there any differences between T and I? J Cardiovasc Med (Hagerstown) 2021; 22:797-805. [PMID: 33399346 DOI: 10.2459/jcm.0000000000001155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The most recent international guidelines recommend the measurement of cardiac troponin I (cTnI) and cardiac troponin T (cTnT) using high-sensitivity methods (hs-cTn) for the detection of myocardial injury and the differential diagnosis of acute coronary syndromes. Myocardial injury is a prerequisite for the diagnosis of acute myocardial infarction, but also a distinct entity. The 2018 Fourth Universal Definition of Myocardial Infarction states that myocardial injury is detected when at least one value above the 99th percentile upper reference limit is measured in a patient with high-sensitivity methods for cTnI or cTnT. Not infrequently, increased hs-cTnT levels are reported in patients with congenital or chronic neuromuscular diseases, while the hs-cTnI values are often in the normal range. Furthermore, some discrepancies between the results of laboratory tests for the two troponins are occasionally found in individuals apparently free of cardiac diseases, and also in patients with cardiac diseases. In this review article, authors discuss the biochemical, pathophysiological and analytical mechanisms which may cause discrepancies between hs-cTnI and hs-cTnT test results.
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Affiliation(s)
- Marco A Perrone
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS Division of Cardiology, University of Rome Tor Vergata, Rome CNR-Regione Toscana G. Monasterio Foundation, Heart Hospital, Massa, and Scuola Superiore Sant'Anna CNR Institute of Clinical Physiology, Pisa Division of Clinical Biochemistry and Clinical Molecular Biology, University of Rome Tor Vergata, Rome, Italy
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Everett BM, Moorthy MV, Tikkanen JT, Cook NR, Albert CM. Markers of Myocardial Stress, Myocardial Injury, and Subclinical Inflammation and the Risk of Sudden Death. Circulation 2020; 142:1148-1158. [PMID: 32700639 DOI: 10.1161/circulationaha.120.046947] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The majority of sudden cardiac deaths (SCDs) occur in low-risk populations often as the first manifestation of cardiovascular disease (CVD). Biomarkers are screening tools that may identify subclinical cardiovascular disease and those at elevated risk for SCD. We aimed to determine whether the total to high-density lipoprotein cholesterol ratio, high-sensitivity cardiac troponin I, NT-proBNP (N-terminal pro-B-type natriuretic peptide), or high-sensitivity C-reactive protein individually or in combination could identify individuals at higher SCD risk in large, free-living populations with and without cardiovascular disease. METHODS We performed a nested case-control study within 6 prospective cohort studies using 565 SCD cases matched to 1090 controls (1:2) by age, sex, ethnicity, smoking status, and presence of cardiovascular disease. RESULTS The median study follow-up time until SCD was 11.3 years. When examined as quartiles or continuous variables in conditional logistic regression models, each of the biomarkers was significantly and independently associated with SCD risk after mutually controlling for cardiac risk factors and other biomarkers. The mutually adjusted odds ratios for the top compared with the bottom quartile were 1.90 (95% CI, 1.30-2.76) for total to high-density lipoprotein cholesterol ratio, 2.59 (95% CI, 1.76-3.83) for high-sensitivity cardiac troponin I, 1.65 (95% CI, 1.12-2.44) for NT-proBNP, and 1.65 (95% CI, 1.13-2.41) for high-sensitivity C-reactive protein. A biomarker score that awarded 1 point when the concentration of any of those 4 biomarkers was in the top quartile (score range, 0-4) was strongly associated with SCD, with an adjusted odds ratio of 1.56 (95% CI, 1.37-1.77) per 1-unit increase in the score. CONCLUSIONS Widely available measures of lipids, subclinical myocardial injury, myocardial strain, and vascular inflammation show significant independent associations with SCD risk in apparently low-risk populations. In combination, these measures may have utility to identify individuals at risk for SCD.
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Affiliation(s)
- Brendan M Everett
- Divisions of Preventive Medicine (B.M.E., M.V.M., J.T.T., N.R.C., C.M.A.), Department of Medicine, Brigham and Women's Hospital, Boston, MA.,Cardiovascular Medicine (B.M.E.), Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - M V Moorthy
- Divisions of Preventive Medicine (B.M.E., M.V.M., J.T.T., N.R.C., C.M.A.), Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Jani T Tikkanen
- Divisions of Preventive Medicine (B.M.E., M.V.M., J.T.T., N.R.C., C.M.A.), Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Nancy R Cook
- Divisions of Preventive Medicine (B.M.E., M.V.M., J.T.T., N.R.C., C.M.A.), Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Christine M Albert
- Divisions of Preventive Medicine (B.M.E., M.V.M., J.T.T., N.R.C., C.M.A.), Department of Medicine, Brigham and Women's Hospital, Boston, MA.,Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (C.M.A.)
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Evidence on clinical relevance of cardiovascular risk evaluation in the general population using cardio-specific biomarkers. ACTA ACUST UNITED AC 2020; 59:79-90. [DOI: 10.1515/cclm-2020-0310] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/22/2020] [Indexed: 12/25/2022]
Abstract
Abstract
In recent years, the formulation of some immunoassays with high-sensitivity analytical performance allowed the accurate measurement of cardiac troponin I (cTnI) and T (cTnT) levels in reference subjects. Several studies have demonstrated the association between the risk of major cardiovascular events and cardiac troponin concentrations even for biomarker values within the reference intervals. High-sensitivity cTnI and cTnT methods (hs-cTn) enable to monitor myocardial renewal and remodelling, and to promptly identify patients at highest risk ofheart failure. An early and effective treatment of individuals at higher cardiovascular risk may revert the initial myocardial remodelling and slow down heart failure progression. Specific clinical trials should be carried out to demonstrate the efficacy and efficiency of the general population screening by means of cost-benefit analysis, in order to better identify individuals at higher risk for heart failure (HF) progression with hs-cTn methods.
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Classic and Novel Biomarkers as Potential Predictors of Ventricular Arrhythmias and Sudden Cardiac Death. J Clin Med 2020; 9:jcm9020578. [PMID: 32093244 PMCID: PMC7074455 DOI: 10.3390/jcm9020578] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 02/07/2023] Open
Abstract
Sudden cardiac death (SCD), most often induced by ventricular arrhythmias, is one of the main reasons for cardiovascular-related mortality. While coronary artery disease remains the leading cause of SCD, other pathologies like cardiomyopathies and, especially in the younger population, genetic disorders, are linked to arrhythmia-related mortality. Despite many efforts to enhance the efficiency of risk-stratification strategies, effective tools for risk assessment are still missing. Biomarkers have a major impact on clinical practice in various cardiac pathologies. While classic biomarkers like brain natriuretic peptide (BNP) and troponins are integrated into daily clinical practice, inflammatory biomarkers may also be helpful for risk assessment. Indeed, several trials investigated their application for the prediction of arrhythmic events indicating promising results. Furthermore, in recent years, active research efforts have brought forward an increasingly large number of “novel and alternative” candidate markers of various pathophysiological origins. Investigations of these promising biological compounds have revealed encouraging results when evaluating the prediction of arrhythmic events. To elucidate this issue, we review current literature dealing with this topic. We highlight the potential of “classic” but also “novel” biomarkers as promising tools for arrhythmia prediction, which in the future might be integrated into clinical practice.
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Passino C, Aimo A, Masotti S, Musetti V, Prontera C, Emdin M, Clerico A. Cardiac troponins as biomarkers for cardiac disease. Biomark Med 2019; 13:325-330. [DOI: 10.2217/bmm-2019-0039] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Claudio Passino
- Fondazione CNR Regione Toscana G Monasterio & Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alberto Aimo
- Fondazione CNR Regione Toscana G Monasterio & Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvia Masotti
- Fondazione CNR Regione Toscana G Monasterio & Scuola Superiore Sant'Anna, Pisa, Italy
| | - Veronica Musetti
- Fondazione CNR Regione Toscana G Monasterio & Scuola Superiore Sant'Anna, Pisa, Italy
| | - Concetta Prontera
- Fondazione CNR Regione Toscana G Monasterio & Scuola Superiore Sant'Anna, Pisa, Italy
| | - Michele Emdin
- Fondazione CNR Regione Toscana G Monasterio & Scuola Superiore Sant'Anna, Pisa, Italy
| | - Aldo Clerico
- Fondazione CNR Regione Toscana G Monasterio & Scuola Superiore Sant'Anna, Pisa, Italy
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Clerico A, Zaninotto M, Padoan A, Masotti S, Musetti V, Prontera C, Ndreu R, Zucchelli G, Passino C, Migliardi M, Plebani M. Evaluation of analytical performance of immunoassay methods for cTnI and cTnT: From theory to practice. Adv Clin Chem 2019; 93:239-262. [PMID: 31655731 DOI: 10.1016/bs.acc.2019.07.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Current guidelines worldwide recommend cardiac troponins I (cTnI) and T (cTnT) as the biomarkers of choice for the differential diagnosis of acute coronary syndrome (ACS), and the measurement of the 99th upper reference population limit (URL) value for cardiac troponins, with an imprecision of ≤10 CV%. Measuring the 99th URL of cTnI and cTnT is a challenging analytical task due to low biomarker concentrations present in healthy subjects. Therefore, since the year 2006, several manufacturers have established new generation cTnI and cTnT immunoassays with an improved analytical sensitivity in accordance with the quality specifications described in international guidelines, the more recent of which state that only immunoassays that meet the required quality specifications should be considered "high-sensitivity" methods. For the early diagnosis of ACS, and for the stratification of cardiovascular risk in cardiac patients and the general population, high-sensitivity methods should be employed. It is therefore important for laboratory professionals and clinicians to gain a thorough understanding of the analytical performances of immunoassay methods for cTnI and cTnT, especially at low to normal concentration ranges. The aim of the present study was to analyze critical aspects related to definition, analytical performance, pathophysiological interpretations, and the clinical relevance of high-sensitivity cardiac troponin assays.
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Affiliation(s)
- Aldo Clerico
- Fondazione CNR, Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Martina Zaninotto
- Department of Laboratory Medicine, University Hospital, Padova, Italy
| | - Andrea Padoan
- Department of Laboratory Medicine, University Hospital, Padova, Italy
| | - Silvia Masotti
- Fondazione CNR, Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy
| | - Veronica Musetti
- Fondazione CNR, Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy
| | - Concetta Prontera
- Fondazione CNR, Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy
| | - Rudina Ndreu
- QualiMedLab and CNR Clinical Physiology Institute, Pisa, Italy
| | | | - Claudio Passino
- Fondazione CNR, Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy
| | - Marco Migliardi
- S.C. Laboratorio Analisi, A.O. Ordine Mauriziano di Torino, Torino, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital, Padova, Italy
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Lyngbakken MN, Myhre PL, Røsjø H, Omland T. Novel biomarkers of cardiovascular disease: Applications in clinical practice. Crit Rev Clin Lab Sci 2018; 56:33-60. [DOI: 10.1080/10408363.2018.1525335] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Magnus Nakrem Lyngbakken
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Peder Langeland Myhre
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
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2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm 2018; 15:e73-e189. [DOI: 10.1016/j.hrthm.2017.10.036] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 02/07/2023]
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14
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e272-e391. [PMID: 29084731 DOI: 10.1161/cir.0000000000000549] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018; 72:e91-e220. [PMID: 29097296 DOI: 10.1016/j.jacc.2017.10.054] [Citation(s) in RCA: 700] [Impact Index Per Article: 116.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Krzanowski M, Krzanowska K, Dumnicka P, Gajda M, Woziwodzka K, Fedak D, Grodzicki T, Litwin JA, Sułowicz W. Elevated Circulating Osteoprotegerin Levels in the Plasma of Hemodialyzed Patients With Severe Artery Calcification. Ther Apher Dial 2018; 22:519-529. [PMID: 29974642 DOI: 10.1111/1744-9987.12681] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/05/2018] [Accepted: 02/15/2018] [Indexed: 12/30/2022]
Abstract
We studied the correlations between circulating osteoprotegerin (OPG) level and radial artery calcification (RAC) assessed histologically and carotid artery intima-media thickness (CCA-IMT). Moreover, we studied the relationship between OPG levels and all-cause and cardiovascular (CV) mortality during a 5-year observation period. The study comprised 59 CKD patients (36 hemodialyzed (HD), 23 predialysis). The biochemical parameters included: creatinine, calcium, phosphate, intact parathormone, C-reactive protein, interleukin-6, tumor necrosis factor receptor II (TNFRII), transforming growth factor-β, hepatocyte growth factor, fibroblast growth factor 23, osteonectin (ON), osteopontin, osteoprotegerin, and osteocalcin. CCA-IMT and the presence of atherosclerotic plaques was assessed by ultrasound. Fragments of radial artery obtained during creation of HD access were prepared for microscopy and stained for calcifications with alizarin red. RAC was detected in 34 patients (58%). In multiple regression adjusted for dialysis status, TNFRII, ON and Framingham risk score (FRS) were identified as the independent predictors of OPG. Serum OPG above the median value of 7.55 pmol/L significantly predicted the presence of RAC in simple logistic regression (OR 5.33; 95%CI 1.39-20.4; P = 0.012) and in multiple logistic regression adjusted for FRS, dialysis status and CCA-IMT values (OR 6.56; 95%CI 1.06-40.6; P = 0.036). OPG levels above the median were associated with higher CCA-IMT values (1.02 ± 0.10 vs. 0.86 ± 0.13; P < 0.001) and predicted the presence of atherosclerotic plaques in carotid artery (OR 14.4; 95%CI 2.84-72.9; P < 0.001), independently of FRS, dialysis status and RAC. In this study, elevated serum OPG levels correlated with higher CCA-IMT, the presence of atherosclerotic plaques and the severity of the RAC independently of each other. During follow-up, 25 patients (42%) died, including 21 due to CV causes. In multiple Cox regression, OPG above the median predicted overall survival independently of dialysis status, Framingham risk score, CCA-IMT above the median value, and the presence of atherosclerotic plaques in CCA, but not independently of RAC. We postulate that circulating OPG may play a dual role as a marker for both medial arterial calcification and atherosclerosis, hence it seems to be a valuable tool for assessing CV risk in patients with CKD. OPG might be an early indicator of all-cause mortality in CKD patients with advanced medial arterial calcification.
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Affiliation(s)
- Marcin Krzanowski
- Department of Nephrology, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Krzanowska
- Department of Nephrology, Jagiellonian University Medical College, Krakow, Poland
| | - Paulina Dumnicka
- Department of Medical Diagnostics, Jagiellonian University Medical College, Krakow, Poland
| | - Mariusz Gajda
- Department of Histology, Jagiellonian University Medical College, Krakow, Poland
| | - Karolina Woziwodzka
- Department of Nephrology, Jagiellonian University Medical College, Krakow, Poland
| | - Danuta Fedak
- Department of Clinical Biochemistry, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Jan A Litwin
- Department of Histology, Jagiellonian University Medical College, Krakow, Poland
| | - Władysław Sułowicz
- Department of Nephrology, Jagiellonian University Medical College, Krakow, Poland
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17
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Monneret D, Mestari F, Djiavoudine S, Bachelot G, Cloison M, Imbert-Bismut F, Bernard M, Hausfater P, Lacorte JM, Bonnefont-Rousselot D. Wide-range CRP versus high-sensitivity CRP on Roche analyzers: focus on low-grade inflammation ranges and high-sensitivity cardiac troponin T levels. Scand J Clin Lab Invest 2018; 78:346-351. [PMID: 29764220 DOI: 10.1080/00365513.2018.1471618] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Wide-range C-reactive protein (wr-CRP) has been proposed as an economical alternative to high-sensitivity C-reactive protein (hs-CRP) for the evaluation of low-grade inflammation-associated cardiovascular risk (LGI-CVR). Concomitant values of serum hs-CRP and plasma wr-CRP ≤5 mg/L, and high-sensitivity cardiac troponin T (hs-cTnT), all assayed on Roche Diagnostics analyzers over a 1.8-year period, were extracted from a hospital laboratory database. Hs-CRP and wr-CRP values were compared (Bland-Altman method; Deming's correlation), then separately classified into low (<1 mg/L), moderate (1-3 mg/L) and high (>3 mg/L) LGI-CVR ranges for agreement test (κ), assessed before and after Deming's regression-based adjustment of wr-CRP (Adj-wr-CRP). Wr-CRP and hs-CRP values were strongly correlated, with linearity, whether below 5 mg/L (n = 744; τ = 0.933; p < .001) or below 1 mg/L (n = 283; τ = 0.823; p < .001). Overall, wr-CRP values were lower than hs-CRP (mean bias: -0.11 ± 0.17 mg/L). Agreement was good, with 8.1% of wr-CRP values misclassified compared to hs-CRP (κ: 0.874), and weakly improved after regression-based adjustment (7.7% reclassified values; κ: 0.881). Lowering the Adj-wr-CRP cutoff of the moderate LGI-CVR subrange from 1.0 to 0.9 mg/L resulted in an almost perfect agreement (3.2% reclassified data; κ: 0.950). Hs-cTnT concentration was positively associated with hs-CRP, wr-CRP, and Adj-wr-CRP (p < .001). Within each LGI-CVR subrange, hs-cTnT medians were similar regardless of the hs-CRP, wr-CRP or Adj-wr-CRP used for risk classification. Based on hs-cTnT, this study supports the use of wr-CRP as a low-cost alternative to hs-CRP for cardiovascular risk evaluation.
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Affiliation(s)
- Denis Monneret
- a Department of Metabolic Biochemistry , Pitié Salpêtrière-Charles Foix University Hospital (AP-HP) , Paris , France
| | - Fouzi Mestari
- a Department of Metabolic Biochemistry , Pitié Salpêtrière-Charles Foix University Hospital (AP-HP) , Paris , France
| | - Shaedah Djiavoudine
- a Department of Metabolic Biochemistry , Pitié Salpêtrière-Charles Foix University Hospital (AP-HP) , Paris , France
| | - Guillaume Bachelot
- a Department of Metabolic Biochemistry , Pitié Salpêtrière-Charles Foix University Hospital (AP-HP) , Paris , France
| | - Maxime Cloison
- a Department of Metabolic Biochemistry , Pitié Salpêtrière-Charles Foix University Hospital (AP-HP) , Paris , France
| | - Françoise Imbert-Bismut
- a Department of Metabolic Biochemistry , Pitié Salpêtrière-Charles Foix University Hospital (AP-HP) , Paris , France
| | - Maguy Bernard
- a Department of Metabolic Biochemistry , Pitié Salpêtrière-Charles Foix University Hospital (AP-HP) , Paris , France.,b Department of Oncology and Endocrine Biochemistry , Pitié Salpêtrière-Charles Foix University Hospital (AP-HP) , Paris , France
| | - Pierre Hausfater
- c Sorbonne Universités, UPMC-Univ Paris 06, GRC-14 BIOSFAST , Paris , France.,e Department of Emergency , Pitié Salpêtrière-Charles Foix University Hospital (AP-HP) , Paris , France
| | - Jean-Marc Lacorte
- b Department of Oncology and Endocrine Biochemistry , Pitié Salpêtrière-Charles Foix University Hospital (AP-HP) , Paris , France.,d Sorbonne Universités, UPMC Univ-Paris 06; INSERM, UMR_S 1166, Institute of Cardiometabolism and Nutrition, ICAN , Paris , France
| | - Dominique Bonnefont-Rousselot
- a Department of Metabolic Biochemistry , Pitié Salpêtrière-Charles Foix University Hospital (AP-HP) , Paris , France.,f Sorbonne Paris Cité, Paris Descartes University, CNRS UMR8258-INSERM U1022, Faculty of Pharmacy , Paris , France
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18
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Yang X, Yang R, Li X, Zheng X. Danshensu attenuates aldosterone-induced cardiomyocytes injury through interfering p53 pathway. Mol Med Rep 2017; 16:4994-5000. [PMID: 28765913 DOI: 10.3892/mmr.2017.7137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/11/2017] [Indexed: 11/05/2022] Open
Abstract
Heart failure, characterized by impaired systolic and/or diastolic function, is a common cardiovascular disease. The loss of cardiomyocytes due to various factors, including through necrosis or apoptosis can result in heart failure. Previous studies have indicated that excessive aldosterone (ALD) serves an essential role in the process of heart failure, and the heart is also one of the direct targets of ALD, which can provoke hypertrophy and the apoptosis of cardiomyocytes. The aim of the present study was to investigate the protective effect of danshensu (DSS) on ALD‑induced cardiomyocytes injury. The present results demonstrated that DSS increased cell viability and decreased the leakage of lactate dehydrogenase in cardiomyocytes exposed to ALD. In addition, DSS decreased the apoptotic rate of ALD‑stimulated cells. Further research indicated that DSS‑ and cellular tumor antigen p53 (p53)‑alone or combination treatment was able to decrease the expression levels of apoptosis regulator BAX and caspase‑3, and increase the expression of apoptosis regulator B‑cell lymphoma (Bcl)‑2 in ALD‑stimulated cardiomyocytes. Taken together, the results of the present study suggest that DSS inhibits the harmful effects of ALD on cardiomyocytes via interfering with the p53 signaling pathway. These results provide novel evidence for the potential protective effects of DSS.
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Affiliation(s)
- Xiaohong Yang
- Department of Cardiovascular, Anyang District Hospital, Anyang, Henan 455000, P.R. China
| | - Rui Yang
- Department of Cardiovascular, Anyang District Hospital, Anyang, Henan 455000, P.R. China
| | - Xianli Li
- Department of Cardiovascular, Anyang District Hospital, Anyang, Henan 455000, P.R. China
| | - Xiaohui Zheng
- Department of Cardiovascular, Anyang District Hospital, Anyang, Henan 455000, P.R. China
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Troponin I and T in relation to cardiac injury detected with electrocardiography in a population-based cohort - The Maastricht Study. Sci Rep 2017; 7:6610. [PMID: 28747765 PMCID: PMC5529453 DOI: 10.1038/s41598-017-06978-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/22/2017] [Indexed: 01/07/2023] Open
Abstract
Interest in high-sensitivity cardiac troponin I(hs-cTnI) and T(hs-cTnT) has expanded from acute cardiac care to cardiovascular disease(CVD) risk stratification. Whether hs-cTnI and hs-cTnT are interchangeable in the ambulant setting is largely unexplored. Cardiac injury is a mechanism that may underlie the associations between troponin levels and mortality in the general population. In the population-based Maastricht Study, we assessed the correlation and concordance between hs-cTnI and hs-cTnT. Multiple regression analyses were conducted to assess the association of hs-cTnI and hs-cTnT with electrocardiographic (ECG) changes indicative of cardiac abnormalities. In 3016 eligible individuals(mean age,60 ± 8years;50.6%,men) we found a modest correlation between hs-cTnI and hs-cTnT(r = 0.585). After multiple adjustment, the association with ECG changes indicative of cardiac abnormalities was similar for both hs-cTn assays(OR,hs-cTnI:1.72,95%CI:1.40-2.10;OR,hs-cTnT:1.60,95%CI:1.22–2.11). The concordance of dichotomized hs-cTnI and hs-cTnT was κ = 0.397(≥sex-specific 75th percentile). Isolated high levels of hs-cTnI were associated with ECG changes indicative of cardiac abnormalities(OR:1.93,95%CI:1.01–3.68), whereas isolated high levels of hs-cTnT were not(OR:1.07,95%CI:0.49–2.31). In conclusion, there is a moderate correlation and limited concordance between hs-cTnI and hs-cTnT under non-acute conditions. These data suggest that associations of hs-cTnI and hs-cTnT with cardiac injury detected by ECG are driven by different mechanisms. This information may benefit future development of CVD risk stratification algorithms.
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Xiao W, Cao R, Liu Y, Wang F, Bai Y, Wu H, Ye P. Association of high-sensitivity cardiac troponin T with mortality and cardiovascular events in a community-based prospective study in Beijing. BMJ Open 2017; 7:e013431. [PMID: 28652289 PMCID: PMC5541394 DOI: 10.1136/bmjopen-2016-013431] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The prognostic value of cardiac troponins in apparently healthy populations is not well established. The aim of this study was to investigate the prognostic properties of high-sensitivity cardiac troponin T (hs-cTnT) for long-term adverse outcomes. SETTING A community-dwelling prospective survey of residents from two communities in Beijing. PARTICIPANTS From September 2007 to January 2009, 1680 participants were initially enrolled. Of these, 1499 (870 females, mean age: 61.4 years) participants completed the survey and were followed up for a median of 4.8 years (IQR: 4.5-5.2). OUTCOME MEASURES The primary outcome was the occurrence of all-cause mortality and major cardiovascular events. RESULTS Overall, 820 individuals (54.7%) had detectable hs-cTnT levels. During the follow-up, 52 participants (3.5%) died, 154 (10.3%) had major cardiovascular events and 99 (6.6%) experienced new-onset coronary events. Compared with those with undetectable hs-cTnT levels, participants with hs-cTnT levels in the highest category (≥14 ng/L) had a significantly increased risk for all-cause mortality (adjusted HR (aHR): 2.07, 95% CI 1.05 to 3.01), major cardiovascular events (aHR: 3.27, 95% CI 1.88 to 5.70) and coronary events (aHR: 4.50, 95% CI 2.26 to 9.02) in covariate-adjusted analyses. No differences in stroke incidence were found (aHR: 1.27, 95% CI 0.69 to 2.62). Also, significant associations were presented when hs-cTnT levels were modelled as a continuous variable and when analysing changes in hs-cTnT levels over time with adverse outcomes. The addition of troponin T levels to clinical variables led to significant increases in risk prediction with a marked improvement in the C-statistics (p=0.003 or lower). CONCLUSIONS In this cohort of individuals from a community-based population, cTnT levels measured with a highly sensitive assay were associated with increases in the subsequent risk for all-cause mortality and major cardiovascular events. These results might support screening for at-risk individuals.
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Affiliation(s)
- Wenkai Xiao
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Ruihua Cao
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yuan Liu
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Fan Wang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yongyi Bai
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Hongmei Wu
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Ping Ye
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
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21
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High-Sensitivity Troponin as a Biomarker in Heart Rhythm Disease. Am J Cardiol 2017; 119:1407-1413. [PMID: 28256250 DOI: 10.1016/j.amjcard.2017.01.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 11/23/2022]
Abstract
Biomarkers are important prognostic tools in various cardiovascular conditions, including coronary artery disease and heart failure. Although their utility in cardiac electrophysiology (EP) is less established, biomarkers may guide EP clinical practice by identifying patients at risk for developing arrhythmias and their complications, in addition to augmenting therapeutic decisions by targeting appropriate pharmacologic and interventional therapies to patients who may benefit most. In this review, we focus on the prognostic role of high-sensitivity cardiac troponin (hs-cTn) assays-which detect subclinical cardiac myocyte damage-in cardiac arrhythmias and their sequelae. We review the current literature on hs-cTn and its impact on various arrhythmia disease states and also provide suggestions for future research in this field. In conclusion, although the utility of hs-cTn assays remains at an investigational stage in cardiac EP, studies to date have suggested value as a prognostic biomarker in atrial fibrillation and as a screening marker for patients at high risk of sudden cardiac death (both in the general population and among those with hypertrophic cardiomyopathy).
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22
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Roos A, Hellgren A, Rafatnia F, Hammarsten O, Ljung R, Carlsson AC, Holzmann MJ. Investigations, findings, and follow-up in patients with chest pain and elevated high-sensitivity cardiac troponin T levels but no myocardial infarction. Int J Cardiol 2017; 232:111-116. [DOI: 10.1016/j.ijcard.2017.01.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/12/2016] [Accepted: 01/04/2017] [Indexed: 12/31/2022]
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23
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Selvanayagam JB, Hartshorne T, Billot L, Grover S, Hillis GS, Jung W, Krum H, Prasad S, McGavigan AD. Cardiovascular magnetic resonance-GUIDEd management of mild to moderate left ventricular systolic dysfunction (CMR GUIDE): Study protocol for a randomized controlled trial. Ann Noninvasive Electrocardiol 2017; 22. [PMID: 28117536 DOI: 10.1111/anec.12420] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 10/04/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The majority of sudden cardiac death (SCD) in patients with heart failure occurs in those with mild-moderate left ventricular (LV) systolic dysfunction (LVEF 36-50%) who under current guidelines are ineligible for primary prevention implantable cardiac defibrillator (ICD) therapy. Recent data suggest that cardiac magnetic resonance (CMR) evidence of replacement fibrosis forms a substrate for malignant arrhythmia and therefore potentially identifies a subgroup at increased risk of SCD. Our hypothesis is that among patients with mild-moderate LV systolic dysfunction, a CMR-guided management strategy for ICD insertion based on the presence of scar or fibrosis is superior to a current strategy of standard care. METHODS/DESIGN CMR GUIDE is a prospective, multicenter randomized control trial enrolling patients with mild-moderate LV systolic dysfunction and CMR evidence of fibrosis on optimal heart failure therapy. Participants will be randomized to receive either a primary prevention ICD or an implantable loop recorder (ILR). The primary endpoint is the time to SCD or hemodynamically significant ventricular arrhythmia (VF or VT) during an average 4-year follow-up. Secondary endpoints include quality of life assessed by Minnesota Living with Heart Failure Questionnaire, heart failure related hospitalizations, and a cost-utility analysis. Clinical trials.gov identifier NCT01918215. DISCUSSION CMR GUIDE trial will add substantially to our understanding of the role of myocardial fibrosis and the risk of developing life-threatening ventricular arrhythmias. If the superiority of a CMR-guided approach over standard care is proven, it may change international clinical guidelines, with the potential to considerably increase survival in this growing patient population.
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Affiliation(s)
- Joseph B Selvanayagam
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA, Australia.,School of Medicine, Flinders University, Adelaide, SA, Australia.,Department of Heart Health, South Australian Health & Medical Research Institute, Adelaide, SA, Australia
| | - Trent Hartshorne
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA, Australia.,School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Laurent Billot
- The George Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Suchi Grover
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA, Australia.,School of Medicine, Flinders University, Adelaide, SA, Australia.,Department of Heart Health, South Australian Health & Medical Research Institute, Adelaide, SA, Australia
| | | | - Werner Jung
- Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany
| | - Henry Krum
- Faculty of Medicine, Monash University, Clayton, VIC, Australia
| | | | - Andrew D McGavigan
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA, Australia.,School of Medicine, Flinders University, Adelaide, SA, Australia
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Temporal Trends in Sudden Cardiac Death From 1997 to 2010: A Data Linkage Study. Heart Lung Circ 2017; 26:808-816. [PMID: 28190759 DOI: 10.1016/j.hlc.2016.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/21/2016] [Accepted: 11/29/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Community-wide trends data for sudden cardiac death (SCD) are scarce, unlike widely reported declines in cardiovascular disease (CVD) mortality. Using administrative data, we aimed to examine population-level trends in SCD, stratified by sex, age and prior CVD hospitalisation. METHODS Person-linked mortality and hospital morbidity data were used to identify SCD and determine hospitalisation and comorbidity using a 10-year hospitalisation lookback period. Log-linear Poisson regression was used to calculate annual rate changes and rate ratios. RESULTS In Western Australia, 7160 SCD cases were identified from 1997 to 2010 with males comprising 69%. Overall age-standardised SCD rates decreased by 17% in men and 31% in women from 1997-2001 to 2007-2010. The annual rate reduction was higher in women than men (-4.0%/year versus -2.3%/year; p=0.0039). Significant reductions were observed for 55-69 year-old and 70-84 year-old men and women but not for the 35-54 year-olds. The overall relative risk comparing men to women increased slightly from 2.4 in 1997 to 3.0 in 2010 (trend p=0.0039) but differed across age groups. The relative risk declined in 35-54 year-olds from 5.1 to 3.2 whereas it increased from 2.9 to 3.9 in 55-69 year-olds and 1.9 to 2.3 in 70-84 year-olds. Declining trends in SCD rates were observed in those with and without prior CVD and were similar to CVD mortality trends (-4.9%/year in men and -5.5%/year in women). CONCLUSIONS Trends in rates of SCD fell in middle to older aged men and women, with and without CVD, and mirrored the fall in fatal CVD. Limited improvement in 35-54 year-olds requires further investigation.
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Tereshchenko LG, Feeny A, Shelton E, Metkus T, Stolbach A, Mavunga E, Putman S, Korley FK. Dynamic Changes in High-Sensitivity Cardiac Troponin I Are Associated with Dynamic Changes in Sum Absolute QRST Integral on Surface Electrocardiogram in Acute Decompensated Heart Failure. Ann Noninvasive Electrocardiol 2017; 22:e12379. [PMID: 27265641 PMCID: PMC5140779 DOI: 10.1111/anec.12379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A three-dimensional electrocardiographic (ECG) metric, the sum absolute QRST integral (SAI QRST), predicts ventricular arrhythmias in heart failure (HF) patients with implantable cardioverter defibrillator and mechanical response to cardiac resynchronization therapy. We hypothesized that there is an association between patient-specific changes in SAI QRST and myocardial injury as measured by high-sensitivity troponin I (hsTnI). METHODS Sum absolute integral QRST on resting 12-lead ECG and hsTnI were measured simultaneously, every 3 hours, and during 12-hour observation period in a prospective cohort of emergency department patients (n = 398; mean age 57.8 ± 13.2 years; 54% female, 64% black), diagnosed with acute coronary syndrome (ACS, n = 28), acutely decompensated HF (acute decompensated heart failure, n = 35), cardiac non-ACS (n = 19), or noncardiac condition (n = 316). Random-effects linear regression analysis assessed the association of SAI QRST and myocardial injury, with adjustment for demographics (age, sex, race), prevalent cardiovascular disease (myocardial infarction, history of revascularization, stroke, and HF), risk factors (diabetes, smoking, hypercholesterolemia, hypertension, and cocaine use), and left bundle branch block. RESULTS Within the entire cohort, SAI QRST decreased by 3 (95%CI -5 to -1) mV*ms every 3 hours. A 10-fold increase in hsTnI was associated with a 7.7 (0.6-14.9) mV*ms increase in SAI QRST. In the subgroup of acutely decompensated HF patients (n = 35), a 10-fold increase in hsTnI was associated with a 61.0 (5.9-116.1) mV*ms increase in SAI QRST. CONCLUSION Patient-specific time-varying changes in the surface ECG scalar measure of global electrical heterogeneity, as measured by SAI QRST, and in myocardial injury as measured by hsTnI, are independently and directly associated with each other, likely reflecting a common underlying mechanism.
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Affiliation(s)
- Larisa G. Tereshchenko
- The Division of CardiologyDepartment of MedicineJohns Hopkins HospitalBaltimoreMDUSA
- Knight Cardiovascular InstituteOregon Health & Science UniversityPortlandORUSA
| | - Albert Feeny
- Whiting School of EngineeringThe Johns Hopkins UniversityBaltimoreMDUSA
| | - Erica Shelton
- The Emergency Medicine DepartmentJohns Hopkins HospitalBaltimoreMDUSA
| | - Thomas Metkus
- The Division of CardiologyDepartment of MedicineJohns Hopkins HospitalBaltimoreMDUSA
| | - Andrew Stolbach
- The Emergency Medicine DepartmentJohns Hopkins HospitalBaltimoreMDUSA
| | - Ernest Mavunga
- The Emergency Medicine DepartmentJohns Hopkins HospitalBaltimoreMDUSA
| | - Shannon Putman
- The Emergency Medicine DepartmentJohns Hopkins HospitalBaltimoreMDUSA
| | - Frederick K. Korley
- Department of Emergency MedicineUniversity of Michigan Health SystemsAnn ArborMIUSA
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van der Linden N, Klinkenberg LJJ, Bekers O, Loon LJCV, Dieijen-Visser MPV, Zeegers MP, Meex SJR. Prognostic value of basal high-sensitive cardiac troponin levels on mortality in the general population: A meta-analysis. Medicine (Baltimore) 2016; 95:e5703. [PMID: 28033267 PMCID: PMC5207563 DOI: 10.1097/md.0000000000005703] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Interest in the use of cardiac troponin T (cTnT) and cardiac troponin I (cTnI) has expanded from diagnosis of acute myocardial infarction to risk assessment for morbidity and mortality. Although cTnT and cTnI were shown to have equivalent diagnostic performance in the setting of suspected acute myocardial infarction, potential prognostic differences are largely unexplored.The aim of this study is to quantify and compare the relationship between cTnT and cTnI, and cardiovascular and all-cause mortality in the general population.Medline, Embase, and the Cochrane Library (from inception through October 2016) were searched for prospective observational cohort studies reporting on the prognostic value of basal high-sensitive cTnT and/or cTnI levels on cardiovascular and all-cause mortality in the general population. Data on study characteristics, participants' characteristics, outcome parameters, and quality [according to the Effective Public Health Practice Project (EPHPP) "Quality Assessment Tool For Quantitative Studies] were retrieved. Hazard ratios per standard deviation increase in basal cardiac troponin level (HR per 1-SD; retrieved from the included articles or estimated) were pooled using a random-effects model.On a total of 2585 reviewed citations, 11 studies, with data on 65,019 participants, were included in the meta-analysis. Random effects pooling showed significant associations between basal cardiac troponin levels and HR for cardiovascular and all-cause mortality [HR per 1-SD 1.29 (95% confidence interval, 95% CI, 1.20-1.38) and HR per 1-SD 1.18 (95% CI, 1.11-1.26), respectively]. Stratified analyses showed higher HRs for cTnT than cTnI [cardiovascular mortality: cTnT HR per 1-SD 1.37 (95% CI, 1.23-1.52); and cTnI HR per 1-SD 1.21 (95% CI, 1.16-1.26); all-cause mortality: cTnT HR per 1-SD 1.31 (955 CI, 1.13-1.53); and cTnI HR per 1-SD 1.14 (95% CI, 1.06-1.22)]. These differences were significant (P < 0.01) in meta-regression analyses for cardiovascular mortality but did not reach statistical significance for all-cause mortality.Elevated, basal cTnT, and cTnI show robust associations with an increased risk of cardiovascular and all-cause mortality during follow-up in the general population.Systematic review registration number PROSPERO CRD42014006964.
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Affiliation(s)
- Noreen van der Linden
- Department of Clinical Chemistry, Cardiovascular Research Institute Maastricht (CARIM) Department of Human Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism Department of Complex Genetics, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
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Vestergaard KR, Jespersen CB, Arnadottir A, Sölétormos G, Schou M, Steffensen R, Goetze JP, Kjøller E, Iversen KK. Prevalence and significance of troponin elevations in patients without acute coronary disease. Int J Cardiol 2016; 222:819-825. [DOI: 10.1016/j.ijcard.2016.07.166] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/27/2016] [Indexed: 11/30/2022]
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Deo R, Norby FL, Katz R, Sotoodehnia N, Adabag S, DeFilippi CR, Kestenbaum B, Chen LY, Heckbert SR, Folsom AR, Kronmal RA, Konety S, Patton KK, Siscovick D, Shlipak MG, Alonso A. Development and Validation of a Sudden Cardiac Death Prediction Model for the General Population. Circulation 2016; 134:806-16. [PMID: 27542394 PMCID: PMC5021600 DOI: 10.1161/circulationaha.116.023042] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 07/31/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Most sudden cardiac death (SCD) events occur in the general population among persons who do not have any prior history of clinical heart disease. We sought to develop a predictive model of SCD among US adults. METHODS We evaluated a series of demographic, clinical, laboratory, electrocardiographic, and echocardiographic measures in participants in the ARIC study (Atherosclerosis Risk in Communities) (n=13 677) and the CHS (Cardiovascular Health Study) (n=4207) who were free of baseline cardiovascular disease. Our initial objective was to derive a SCD prediction model using the ARIC cohort and validate it in CHS. Independent risk factors for SCD were first identified in the ARIC cohort to derive a 10-year risk model of SCD. We compared the prediction of SCD with non-SCD and all-cause mortality in both the derivation and validation cohorts. Furthermore, we evaluated whether the SCD prediction equation was better at predicting SCD than the 2013 American College of Cardiology/American Heart Association Cardiovascular Disease Pooled Cohort risk equation. RESULTS There were a total of 345 adjudicated SCD events in our analyses, and the 12 independent risk factors in the ARIC study included age, male sex, black race, current smoking, systolic blood pressure, use of antihypertensive medication, diabetes mellitus, serum potassium, serum albumin, high-density lipoprotein, estimated glomerular filtration rate, and QTc interval. During a 10-year follow-up period, a model combining these risk factors showed good to excellent discrimination for SCD risk (c-statistic 0.820 in ARIC and 0.745 in CHS). The SCD prediction model was slightly better in predicting SCD than the 2013 American College of Cardiology/American Heart Association Pooled Cohort risk equations (c-statistic 0.808 in ARIC and 0.743 in CHS). Only the SCD prediction model, however, demonstrated similar and accurate prediction for SCD using both the original, uncalibrated score and the recalibrated equation. Finally, in the echocardiographic subcohort, a left ventricular ejection fraction <50% was present in only 1.1% of participants and did not enhance SCD prediction. CONCLUSIONS Our study is the first to derive and validate a generalizable risk score that provides well-calibrated, absolute risk estimates across different risk strata in an adult population of white and black participants without a clinical diagnosis of cardiovascular disease.
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Affiliation(s)
- Rajat Deo
- From Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (R.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N., A.R.F.); Kidney Research Institute (R.K., B.K., R.A.K.), Division of Cardiology (N.S., K.K.P.), University of Washington, Seattle; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN (S.A.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (C.R.D.); Division of Nephrology, University of Washington, Seattle (B.K.); Division of Cardiology, University of Minnesota Medical School, Minneapolis (L.Y.C., S.K.); Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle (S.R.H.); Department of Biostatistics (R.A.K.), The New York Academy of Medicine, New York, NY (D.S.); General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA, Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.).
| | - Faye L Norby
- From Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (R.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N., A.R.F.); Kidney Research Institute (R.K., B.K., R.A.K.), Division of Cardiology (N.S., K.K.P.), University of Washington, Seattle; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN (S.A.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (C.R.D.); Division of Nephrology, University of Washington, Seattle (B.K.); Division of Cardiology, University of Minnesota Medical School, Minneapolis (L.Y.C., S.K.); Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle (S.R.H.); Department of Biostatistics (R.A.K.), The New York Academy of Medicine, New York, NY (D.S.); General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA, Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Ronit Katz
- From Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (R.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N., A.R.F.); Kidney Research Institute (R.K., B.K., R.A.K.), Division of Cardiology (N.S., K.K.P.), University of Washington, Seattle; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN (S.A.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (C.R.D.); Division of Nephrology, University of Washington, Seattle (B.K.); Division of Cardiology, University of Minnesota Medical School, Minneapolis (L.Y.C., S.K.); Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle (S.R.H.); Department of Biostatistics (R.A.K.), The New York Academy of Medicine, New York, NY (D.S.); General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA, Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Nona Sotoodehnia
- From Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (R.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N., A.R.F.); Kidney Research Institute (R.K., B.K., R.A.K.), Division of Cardiology (N.S., K.K.P.), University of Washington, Seattle; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN (S.A.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (C.R.D.); Division of Nephrology, University of Washington, Seattle (B.K.); Division of Cardiology, University of Minnesota Medical School, Minneapolis (L.Y.C., S.K.); Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle (S.R.H.); Department of Biostatistics (R.A.K.), The New York Academy of Medicine, New York, NY (D.S.); General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA, Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Selcuk Adabag
- From Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (R.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N., A.R.F.); Kidney Research Institute (R.K., B.K., R.A.K.), Division of Cardiology (N.S., K.K.P.), University of Washington, Seattle; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN (S.A.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (C.R.D.); Division of Nephrology, University of Washington, Seattle (B.K.); Division of Cardiology, University of Minnesota Medical School, Minneapolis (L.Y.C., S.K.); Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle (S.R.H.); Department of Biostatistics (R.A.K.), The New York Academy of Medicine, New York, NY (D.S.); General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA, Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Christopher R DeFilippi
- From Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (R.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N., A.R.F.); Kidney Research Institute (R.K., B.K., R.A.K.), Division of Cardiology (N.S., K.K.P.), University of Washington, Seattle; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN (S.A.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (C.R.D.); Division of Nephrology, University of Washington, Seattle (B.K.); Division of Cardiology, University of Minnesota Medical School, Minneapolis (L.Y.C., S.K.); Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle (S.R.H.); Department of Biostatistics (R.A.K.), The New York Academy of Medicine, New York, NY (D.S.); General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA, Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Bryan Kestenbaum
- From Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (R.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N., A.R.F.); Kidney Research Institute (R.K., B.K., R.A.K.), Division of Cardiology (N.S., K.K.P.), University of Washington, Seattle; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN (S.A.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (C.R.D.); Division of Nephrology, University of Washington, Seattle (B.K.); Division of Cardiology, University of Minnesota Medical School, Minneapolis (L.Y.C., S.K.); Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle (S.R.H.); Department of Biostatistics (R.A.K.), The New York Academy of Medicine, New York, NY (D.S.); General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA, Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Lin Y Chen
- From Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (R.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N., A.R.F.); Kidney Research Institute (R.K., B.K., R.A.K.), Division of Cardiology (N.S., K.K.P.), University of Washington, Seattle; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN (S.A.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (C.R.D.); Division of Nephrology, University of Washington, Seattle (B.K.); Division of Cardiology, University of Minnesota Medical School, Minneapolis (L.Y.C., S.K.); Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle (S.R.H.); Department of Biostatistics (R.A.K.), The New York Academy of Medicine, New York, NY (D.S.); General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA, Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Susan R Heckbert
- From Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (R.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N., A.R.F.); Kidney Research Institute (R.K., B.K., R.A.K.), Division of Cardiology (N.S., K.K.P.), University of Washington, Seattle; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN (S.A.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (C.R.D.); Division of Nephrology, University of Washington, Seattle (B.K.); Division of Cardiology, University of Minnesota Medical School, Minneapolis (L.Y.C., S.K.); Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle (S.R.H.); Department of Biostatistics (R.A.K.), The New York Academy of Medicine, New York, NY (D.S.); General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA, Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Aaron R Folsom
- From Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (R.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N., A.R.F.); Kidney Research Institute (R.K., B.K., R.A.K.), Division of Cardiology (N.S., K.K.P.), University of Washington, Seattle; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN (S.A.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (C.R.D.); Division of Nephrology, University of Washington, Seattle (B.K.); Division of Cardiology, University of Minnesota Medical School, Minneapolis (L.Y.C., S.K.); Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle (S.R.H.); Department of Biostatistics (R.A.K.), The New York Academy of Medicine, New York, NY (D.S.); General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA, Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Richard A Kronmal
- From Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (R.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N., A.R.F.); Kidney Research Institute (R.K., B.K., R.A.K.), Division of Cardiology (N.S., K.K.P.), University of Washington, Seattle; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN (S.A.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (C.R.D.); Division of Nephrology, University of Washington, Seattle (B.K.); Division of Cardiology, University of Minnesota Medical School, Minneapolis (L.Y.C., S.K.); Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle (S.R.H.); Department of Biostatistics (R.A.K.), The New York Academy of Medicine, New York, NY (D.S.); General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA, Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Suma Konety
- From Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (R.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N., A.R.F.); Kidney Research Institute (R.K., B.K., R.A.K.), Division of Cardiology (N.S., K.K.P.), University of Washington, Seattle; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN (S.A.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (C.R.D.); Division of Nephrology, University of Washington, Seattle (B.K.); Division of Cardiology, University of Minnesota Medical School, Minneapolis (L.Y.C., S.K.); Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle (S.R.H.); Department of Biostatistics (R.A.K.), The New York Academy of Medicine, New York, NY (D.S.); General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA, Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Kristen K Patton
- From Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (R.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N., A.R.F.); Kidney Research Institute (R.K., B.K., R.A.K.), Division of Cardiology (N.S., K.K.P.), University of Washington, Seattle; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN (S.A.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (C.R.D.); Division of Nephrology, University of Washington, Seattle (B.K.); Division of Cardiology, University of Minnesota Medical School, Minneapolis (L.Y.C., S.K.); Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle (S.R.H.); Department of Biostatistics (R.A.K.), The New York Academy of Medicine, New York, NY (D.S.); General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA, Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - David Siscovick
- From Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (R.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N., A.R.F.); Kidney Research Institute (R.K., B.K., R.A.K.), Division of Cardiology (N.S., K.K.P.), University of Washington, Seattle; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN (S.A.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (C.R.D.); Division of Nephrology, University of Washington, Seattle (B.K.); Division of Cardiology, University of Minnesota Medical School, Minneapolis (L.Y.C., S.K.); Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle (S.R.H.); Department of Biostatistics (R.A.K.), The New York Academy of Medicine, New York, NY (D.S.); General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA, Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Michael G Shlipak
- From Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (R.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N., A.R.F.); Kidney Research Institute (R.K., B.K., R.A.K.), Division of Cardiology (N.S., K.K.P.), University of Washington, Seattle; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN (S.A.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (C.R.D.); Division of Nephrology, University of Washington, Seattle (B.K.); Division of Cardiology, University of Minnesota Medical School, Minneapolis (L.Y.C., S.K.); Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle (S.R.H.); Department of Biostatistics (R.A.K.), The New York Academy of Medicine, New York, NY (D.S.); General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA, Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
| | - Alvaro Alonso
- From Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (R.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N., A.R.F.); Kidney Research Institute (R.K., B.K., R.A.K.), Division of Cardiology (N.S., K.K.P.), University of Washington, Seattle; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN (S.A.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (C.R.D.); Division of Nephrology, University of Washington, Seattle (B.K.); Division of Cardiology, University of Minnesota Medical School, Minneapolis (L.Y.C., S.K.); Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle (S.R.H.); Department of Biostatistics (R.A.K.), The New York Academy of Medicine, New York, NY (D.S.); General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA, Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.)
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Vamos M, Healey JS, Wang J, Duray GZ, Connolly SJ, van Erven L, Vinolas X, Neuzner J, Glikson M, Hohnloser SH. Troponin levels after ICD implantation with and without defibrillation testing and their predictive value for outcomes: Insights from the SIMPLE trial. Heart Rhythm 2015; 13:504-10. [PMID: 26569461 DOI: 10.1016/j.hrthm.2015.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Shockless IMPLant Evaluation trial randomized 2500 patients receiving a first implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy-defibrillator device to have either defibrillation testing (DT) or no DT. It demonstrated that DT did not improve shock efficacy or reduce mortality. OBJECTIVE This prospective substudy evaluated the effect of DT on postoperative troponin levels and their predictive value for total and arrhythmic mortality. METHODS Troponin levels were measured between 6 and 24 hours after ICD implantation in 2200 of 2500 patients. RESULTS A postoperative serum troponin level above the upper limit of normal (ULN) was more common in patients undergoing DT (n = 509 [46.4%]) than in those not subjected to DT (n = 456 [41.3%]; P = .02). After excluding patients with known preoperative troponin levels above the ULN, consistent findings were observed (42.1% vs 37.5%; P = .04). During a mean follow-up of 3.1 ± 1.0 years, the annual mortality rate was increased in patients with postoperative troponin levels above the ULN (adjusted hazard ratio [HR] 1.43; 95% confidence interval [CI] 1.15-1.76; P = .001) irrespective of DT or no DT. Likewise, patients with elevated troponin levels had a significantly higher risk of arrhythmic death (adjusted HR 1.80; 95% CI 1.23-2.63; P = .002). The rate of first appropriate ICD shock (adjusted HR 0.89; 95% CI 0.71-1.12; P = .32) or failed appropriate shock (adjusted HR 1.02; 95% CI 0.59-1.76; P = .95) was similar in patients with or without troponin elevation. CONCLUSION DT at the time of ICD implantation is associated with increased troponin levels, indicating subclinical myocardial injury caused by the procedure. Elevated troponin levels but not DT seem to predict clinical outcomes in ICD recipients.
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Affiliation(s)
- Mate Vamos
- Division of Clinical Electrophysiology, Department of Cardiology, J.W. Goethe University, Frankfurt Am Main, Germany
| | - Jeff S Healey
- McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada
| | - Jia Wang
- Population Health Research Institute, Hamilton, Canada
| | - Gabor Z Duray
- Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | | | | | | | | | | | - Stefan H Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, J.W. Goethe University, Frankfurt Am Main, Germany.
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30
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McEvoy JW, Chen Y, Nambi V, Ballantyne CM, Sharrett AR, Appel LJ, Post WS, Blumenthal RS, Matsushita K, Selvin E. High-Sensitivity Cardiac Troponin T and Risk of Hypertension. Circulation 2015; 132:825-33. [PMID: 26152706 DOI: 10.1161/circulationaha.114.014364] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 06/25/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND The diagnosis of hypertension is often preceded by cardiac structural abnormalities. Thus, we assessed whether high-sensitivity cardiac troponin T (hs-cTnT), a marker of subclinical myocardial damage, can identify individuals at risk for hypertension or left ventricular hypertrophy. METHODS AND RESULTS We studied 6516 Atherosclerosis Risk in Communities (ARIC) Study participants who were free of prevalent hypertension and cardiovascular disease at baseline (1990-1992). We examined the association of baseline hs-cTnT categories with incident diagnosed hypertension (defined by self-report of a diagnosis or medication use during a maximum of 19.9 years of follow-up) and with incident visit-based hypertension (defined by self-report, medication use, or measured blood pressure >140/90 mm Hg over 6 years). Relative to hs-cTnT <5 ng/L, adjusted hazard ratios for incident diagnosed hypertension were 1.16 (95% confidence interval, 1.08-1.25) for individuals with hs-cTnT of 5 to 8 ng/L, 1.29 (95% confidence interval, 1.14-1.47) for hs-cTnT of 9 to 13 ng/L, and 1.31 (95% confidence interval, 1.07-1.61) for hs-cTnT ≥14 ng/L (P for trend <0.001). Associations were stronger for incident visit-based hypertension. These associations were driven by higher relative hazard in normotensive people (compared with those with prehypertension; P for interaction=0.001). Baseline hs-cTnT was also strongly associated with incident left ventricular hypertrophy by electrocardiography over 6 years (eg, adjusted hazard ratio, 5.19 [95% confidence interval, 1.49-18.08] for hs-cTnT ≥14 versus <5 ng/L). Findings were not appreciably changed after accounting for competing deaths or adjusting for baseline blood pressure levels or N-terminal probrain natriuretic peptide. CONCLUSIONS In an ambulatory population with no history of cardiovascular disease, hs-cTnT was associated with incident hypertension and risk of left ventricular hypertrophy. Further research is needed to determine whether hs-cTnT can identify people who may benefit from ambulatory blood pressure monitoring or hypertension prevention lifestyle strategies.
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Affiliation(s)
- John W McEvoy
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - Yuan Chen
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - Vijay Nambi
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - Christie M Ballantyne
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - A Richey Sharrett
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - Lawrence J Appel
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - Wendy S Post
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - Roger S Blumenthal
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - Kunihiro Matsushita
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - Elizabeth Selvin
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.).
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Hussein AA, Bartz TM, Gottdiener JS, Sotoodehnia N, Heckbert SR, Lloyd-Jones D, Kizer JR, Christenson R, Wazni O, deFilippi C. Serial measures of cardiac troponin T levels by a highly sensitive assay and incident atrial fibrillation in a prospective cohort of ambulatory older adults. Heart Rhythm 2015; 12:879-85. [PMID: 25602173 PMCID: PMC4546831 DOI: 10.1016/j.hrthm.2015.01.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Various mechanisms in cardiac remodeling related to atrial fibrillation (AF) lead to elevated circulating cardiac troponin levels, but little is known about such elevations upstream to AF onset. OBJECTIVE The purpose of this study was to study the association between circulating troponin levels as assessed by a highly sensitive cardiac troponin T (hs-cTnT) assay and incident atrial fibrillation (AF). METHODS In a large prospective cohort of ambulatory older adults [the Cardiovascular Health Study (CHS)], hs-cTnT levels were measured in sera that were collected at enrollment from 4262 participants without AF (2871 with follow-up measurements). Incident AF was identified by electrocardiograms during CHS visits, hospital discharge diagnoses, and Medicare files, including outpatient and physician claims diagnoses. RESULTS Over median follow-up of 11.2 years (interquartile range 6.1-16.5), 1363 participants (32.0%) developed AF. Higher baseline levels of hs-cTnT were associated with incident AF in covariate-adjusted analyses accounting for demographics, traditional risk factors, and incident heart failure in time-dependent analyzes (hazard ratio for 3rd tertile vs undetectable 1.75, 95% confidence interval 1.48-2.08). This association was statistically significant in analyses that additionally adjusted for biomarkers of inflammation and hemodynamic strain (hazard ratio for 3rd tertile vs undetectable 1.38, 95% confidence interval 1.16-1.65). Significant associations were also found when hs-cTnT levels were treated as a continuous variable and when examining change from baseline of hs-cTnT levels and incident AF. CONCLUSION The findings show a significant association of circulating troponin levels in ambulatory older adults with incident AF beyond that of traditional risk factors, incident heart failure, and biomarkers of inflammation and hemodynamic strain.
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Affiliation(s)
| | | | | | | | | | | | - Jorge R Kizer
- Albert Einstein College of Medicine, Bronx, New York
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32
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McEvoy JW, Lazo M, Chen Y, Shen L, Nambi V, Hoogeveen RC, Ballantyne CM, Blumenthal RS, Coresh J, Selvin E. Patterns and determinants of temporal change in high-sensitivity cardiac troponin-T: The Atherosclerosis Risk in Communities Cohort Study. Int J Cardiol 2015; 187:651-7. [PMID: 25880403 DOI: 10.1016/j.ijcard.2015.03.436] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 02/15/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patterns and determinants of temporal change in highly-sensitivity troponin-T (hs-cTNT), a novel measure of subclinical myocardial injury, among asymptomatic persons have not been well characterized. METHODS We studied 8571 ARIC Study participants, free of cardiovascular disease, who had hs-cTNT measured at two time-points, 6 years apart (1990-1992 and 1996-1998). We examined the association of baseline 10-year atherosclerotic cardiovascular (ASCVD) risk-group (<5%, 5-7.4%, ≥ 7.5%) and individual cardiac risk-factors with change across hs-cTNT categories using Poisson and Multinomial Logistic regression and with mean continuous hs-cTNT change using linear regression. RESULTS Mean age was 57 years and 43% were male. Mean (SD) 6-year hs-cTNT change was higher across increasing ASCVD risk-groups; +1.2 (6.1) ng/L [<5%], +2.1 (5.4) ng/L [5-7.4%], and +2.8 (8.8) ng/L [≥ 7.5%]. Major baseline determinants of temporal hs-cTNT increases were: age, male gender, hypertension, diabetes, and obesity. In addition, the relative risk (RR) of incident elevated hs-cTNT (≥ 14 ng/L) was 1.46 (95% CI 1.1-2.0) for persons with sustained hypertension compared to those who remained normotensive. Results for sustained obesity (RR 1.65 [1.19-2.29]) and hyperglycemia (RR 1.76 [1.16-2.67]) were similar. These associations were generally stronger after accounting for survival bias. However, smoking, LDL-cholesterol and triglycerides were not associated with hs-cTNT change. HDL-cholesterol was associated with declining hs-cTNT. CONCLUSIONS Persons in higher ASCVD risk-groups were more likely to have increases in hs-cTNT over 6 years of follow-up. The modifiable risk-factors primarily driving this association were diabetes, hypertension, and obesity; particularly when they were persistently elevated over follow-up. Future studies are needed to determine whether modifying these risk factors can prevent progression of subclinical myocardial injury.
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Affiliation(s)
- John W McEvoy
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mariana Lazo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Yuan Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lu Shen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Vijay Nambi
- Michael E DeBakey Veterans Affairs Hospital, Houston, TX, United States
| | - Ron C Hoogeveen
- Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston TX, United States; Houston Methodist DeBakey Heart and Vascular Center, Houston TX, United States
| | - Christie M Ballantyne
- Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston TX, United States; Houston Methodist DeBakey Heart and Vascular Center, Houston TX, United States
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
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33
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Korley FK, Jaffe AS. High-sensitivity troponin: where are we now and where do we go from here? Biomark Med 2014; 8:1021-32. [DOI: 10.2217/bmm.14.54] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
High-sensitivity troponin (hsTn) assays are used clinically in most parts of the world and are expected to be approved by the US FDA for clinical use in the USA soon. Clinical use of hsTn leads to improvements in the detection of myocardial injury, shorter time to ruling out acute myocardial infarction, improved risk-stratification of patients with heart failure and atrial fibrillation among others. HsTn may also guide strategies for primary and secondary prevention of cardiovascular disease. However, unmet challenges remain, including distinguishing between acute and chronic hsTn elevations, distinguishing between type 1 and type 2 acute myocardial infarction and determining whether to use gender-neutral or gender-specific reference values.
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Affiliation(s)
- Frederick K Korley
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Davis Building, Suite 3220, 5801 Smith Avenue, Baltimore, MD 21209, USA
| | - Allan S Jaffe
- Cardiovascular Division & Division of Core Clinical Laboratory Services, Departments of Medicine & Laboratory Medicine and Pathology, Mayo Clinic and Medical School, Rochester, MN, USA
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34
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Ragupathi L, Pavri BB. Tools for risk stratification of sudden cardiac death: a review of the literature in different patient populations. Indian Heart J 2014; 66 Suppl 1:S71-81. [PMID: 24568833 DOI: 10.1016/j.ihj.2013.12.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/09/2013] [Accepted: 12/10/2013] [Indexed: 12/14/2022] Open
Abstract
While various modalities to determine risk of sudden cardiac death (SCD) have been reported in clinical studies, currently reduced left ventricular ejection fraction remains the cornerstone of SCD risk stratification. However, the absolute burden of SCD is greatest amongst populations without known cardiac disease. In this review, we summarize the evidence behind current guidelines for implantable cardioverter defibrillator (ICD) use for the prevention of SCD in patients with ischemic heart disease (IHD). We also evaluate the evidence for risk stratification tools beyond clinical guidelines in the general population, patients with IHD, and patients with other known or suspected medical conditions.
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Affiliation(s)
| | - Behzad B Pavri
- Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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35
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Kramer CM. Avoiding the imminent plague of troponinitis: the need for reference limits for high-sensitivity cardiac troponin T. J Am Coll Cardiol 2014; 63:1449-50. [PMID: 24530670 DOI: 10.1016/j.jacc.2013.12.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 12/06/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Christopher M Kramer
- Departments of Medicine and Radiology and the Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia.
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36
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Daimon M. [New era of laboratory testing. Topics: II. Particulars; 8. Recent development of laboratory test for circulatory system]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2013; 102:3160-3166. [PMID: 24605565 DOI: 10.2169/naika.102.3160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Masao Daimon
- Department of Clinical Laboratory, The Tokyo University Hospital, Japan
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37
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Wazni O, Baranowski B. Highly sensitive troponin assay and sudden cardiac death in the community: unlocking the pathophysiology of sudden cardiac death one biomarker at a time. J Am Coll Cardiol 2013; 62:2121-3. [PMID: 23973705 DOI: 10.1016/j.jacc.2013.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 07/29/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Oussama Wazni
- Out Patient Department, Section of Cardiac Electrophysiology, Cleveland Clinic, Cleveland, Ohio.
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