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Kumar S, Griffith N, Walter D, Swett M, Raman V, Vargas JD, Deb B, Chou J, Arafat A, Srichai MB. Characterization of Myocardial Injury With High-Sensitivity Troponin. Tex Heart Inst J 2023; 50:e238108. [PMID: 38115713 PMCID: PMC10751476 DOI: 10.14503/thij-23-8108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND High-sensitivity troponin I, cardiac form (hs-cTnI) accelerates the assessment of acute coronary syndrome. Little has been documented about its performance, how it relates to different types of myocardial injury, and its impact on morbidity and mortality. This study sought to expand understanding of hs-cTnI by characterizing types of myocardial injury, the impact of comorbidities, and 30-day outcomes. METHODS The study retrospectively evaluated 1,975 patients with hs-cTnI levels obtained in the emergency department or inpatient setting from June to September 2020. Troponin was considered elevated if it was higher than the 99th percentile for either sex. Charts were reviewed to determine the presence of myocardial injury. Troponin elevation was adjusted for demographics, comorbidities, and kidney dysfunction. Thirty-day mortality and readmission rates were calculated. RESULTS Of 1,975 patients, 468 (24%) had elevated hs-cTnI, and 330 (17%) had at least 1 type of myocardial injury, type 2 myocardial infarction being the most frequent. Sensitivity and specificity using the 99th percentile as a cutoff were 99% and 92%, respectively. The average maximum hs-cTnI level was significantly higher for type 1 myocardial infarction (P < .001). Being male, Black, non-Hispanic, and a hospital inpatient were all associated with higher initial and peak hs-cTnI levels (P < .001). Elevated hs-cTnI level, age, heart disease, kidney dysfunction, and inpatient status were predictive of 30-day mortality on multivariate analysis. CONCLUSION Elevated hs-cTnI levels in emergency department and inpatient settings occurs most commonly because of type 2 myocardial infarction. Maximum hs-cTnI level is associated with the patient's particular type of myocardial injury, certain demographics, and cardiovascular comorbidities, and it may be a predictor of 30-day outcomes.
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Affiliation(s)
- Sant Kumar
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Nayrana Griffith
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Dylan Walter
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Michael Swett
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Venkatesh Raman
- Department of Cardiology, US Department of Veterans Affair Medical Center, Washington, DC
| | - Jose D. Vargas
- Department of Cardiology, US Department of Veterans Affair Medical Center, Washington, DC
| | - Brototo Deb
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Jiling Chou
- MedStar Health Research Institute, Hyattsville, Maryland
| | - Ayah Arafat
- MedStar Health Research Institute, Hyattsville, Maryland
| | - Monvadi B. Srichai
- Department of Cardiology, MedStar Georgetown University Hospital, Washington, DC
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2
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Left Ventricular Hypertrophy and Ventricular Tachyarrhythmia: The Role of Biomarkers. Int J Mol Sci 2023; 24:ijms24043881. [PMID: 36835293 PMCID: PMC9958550 DOI: 10.3390/ijms24043881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
Left ventricular hypertrophy (LVH) refers to a complex rebuilding of the left ventricle that can gradually lead to serious complications-heart failure and life-threatening ventricular arrhythmias. LVH is defined as an increase in the size of the left ventricle (i.e., anatomically), therefore the basic diagnosis detecting the increase in the LV size is the domain of imaging methods such as echocardiography and cardiac magnetic resonance. However, to evaluate the functional status indicating the gradual deterioration of the left ventricular myocardium, additional methods are available approaching the complex process of hypertrophic remodeling. The novel molecular and genetic biomarkers provide insights on the underlying processes, representing a potential basis for targeted therapy. This review summarizes the spectrum of the main biomarkers employed in the LVH valuation.
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Rafaqat S, Afzal S, Rafaqat S, Khurshid H, Rafaqat S. Cardiac markers: Role in the pathogenesis of arterial hypertension. World J Hypertens 2022; 10:1-14. [DOI: 10.5494/wjh.v10.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/03/2022] [Accepted: 10/14/2022] [Indexed: 02/08/2023] Open
Abstract
Cardiac biomarkers may play unique roles in the prognostic evaluation of patients with hypertension, as many cardiac biomarker levels become abnormal long before the onset of obvious cardiovascular disease (CVD). There are numerous cardiac markers. However, this review article only reported the roles of creatinine kinase-MB, cardiac troponins, lipoprotein a, osteopontin, cardiac extracellular matrix, C-reactive protein, cardiac matrix metalloproteinases, cardiac natriuretic peptides, myoglobin, renin, and dynorphin in the pathogenesis of hypertension. This article explained recent major advances, as well as discoveries, significant gaps, and current debates and outlined possible directions for future research. Further studies are required to determine the association between myoglobin and other cardiac markers in hypertension. Moreover, therapeutic approaches are required to determine the early control of these cardiac markers, which ultimately reduce the prevalence of CVDs.
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Affiliation(s)
- Saira Rafaqat
- Department of Zoology, Lahore College for Women University, Lahore 5400, Pakistan
| | - Shaheed Afzal
- Emergency Department of Cardiology, Punjab Institute of Cardiology, Lahore 5400, Pakistan
| | - Sana Rafaqat
- Department of Biotechnology, Lahore College for Women University, Lahore 5400, Pakistan
| | - Huma Khurshid
- Department of Zoology, Lahore College for Women University, Lahore 5400, Pakistan
| | - Simon Rafaqat
- Department of Business, Forman Christian College, Lahore 5400, Pakistan
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4
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Jacobsen DP, Røysland R, Strand H, Moe K, Sugulle M, Omland T, Staff AC. Circulating cardiovascular biomarkers during and after preeclampsia: Crosstalk with placental function? Pregnancy Hypertens 2022; 30:103-109. [PMID: 36148698 DOI: 10.1016/j.preghy.2022.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/15/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in women, yet sex-specific risk factors remain understudied. Preeclampsia and other adverse pregnancy outcomes imply an increased maternal cardiovascular risk. We hypothesized that cardiac troponin T (cTnT), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) and growth differentiation factor 15 (GDF-15) are increased in such pregnancies and correlate with markers of placental dysfunction. We also investigated these cardiovascular biomarkers 1 or 3 years postpartum. Prior to delivery, we included serum from 417 pregnant women: 55 early-onset preeclampsia (EO-PE), 63 late-onset preeclampsia (LO-PE), 30 gestational hypertension (GH) and 269 healthy controls. Postpartum, we included 341 women 1 or 3 years after delivery: 26 EO-PE, 107 LO-PE, 61 GH, and 147 healthy pregnancies. Prior to delivery, median cTnT and NT-proBNP concentrations were higher in women with EO-PE, LO-PE, or GH than in controls. Median GDF-15 was higher in EO-PE and LO-PE compared to controls. Postpartum, GDF-15 was elevated in women with previous EO-PE. Markers of placental dysfunction correlated with CVD biomarkers in pregnancy, but not postpartum. Our findings underscore the cardiovascular burden of hypertensive disorders of pregnancy and the crosstalk with placental function. The upregulation of circulating GDF-15 following early-onset preeclampsia is in line with the epidemiological excessive risk of premature CVD in this group of women. GDF-15 may be explored for targeting postpartum women with most to gain from intensified preventive follow-up for CVD.
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Affiliation(s)
- Daniel P Jacobsen
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Norway.
| | - Ragnhild Røysland
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Heidi Strand
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
| | - Kjartan Moe
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Department of Obstetrics and Gynaecology, Bærum Hospital, Vestre Viken HF, Norway
| | - Meryam Sugulle
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Torbjørn Omland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Anne Cathrine Staff
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
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McHugh MC, Diercks DB. Interpreting High-Sensitive Troponins in Patients with Hypertension. Curr Hypertens Rep 2022; 24:349-352. [PMID: 35716248 DOI: 10.1007/s11906-022-01197-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW As the high-sensitivity cardiac troponin (hs-cTn) becomes more broadly used, physicians must understand the strengths and limitations of using the hs-cTn in the hypertensive population. RECENT FINDINGS The most common cause of hs-cTn elevation is cardiac myocyte injury and death; alternate mechanisms for hs-cTn elevation in the absence of cardiac myocyte death are not clearly understood. Hs-cTn elevation has been found in significant proportions of patients with asymptomatic hypertension, in patients with acute hypertensive crisis, and has even been used to predict patients who will go on to develop hypertension. While the mechanisms remain undefined, there is evidence that elevations in hs-cTn are associated with both short- and long-term morbidity and mortality. While ongoing research further defines the relationship between hypertension and hs-cTn, the emergency medicine physician must make clinical decisions today regarding the utility of this increasingly used biomarker. Given the current evidence, clinical context must be utilized including a complete clinical picture, EKGs findings, and importantly serial hs-cTn when needed to establish whether myocardial injury or myocardial infarction is occurring.
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Affiliation(s)
- Mary C McHugh
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard E4.300, Dallas, TX, 75390, USA.
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard E4.300, Dallas, TX, 75390, USA
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6
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Omran F, Kyrou I, Osman F, Lim VG, Randeva HS, Chatha K. Cardiovascular Biomarkers: Lessons of the Past and Prospects for the Future. Int J Mol Sci 2022; 23:ijms23105680. [PMID: 35628490 PMCID: PMC9143441 DOI: 10.3390/ijms23105680] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases (CVDs) are a major healthcare burden on the population worldwide. Early detection of this disease is important in prevention and treatment to minimise morbidity and mortality. Biomarkers are a critical tool to either diagnose, screen, or provide prognostic information for pathological conditions. This review discusses the historical cardiac biomarkers used to detect these conditions, discussing their application and their limitations. Identification of new biomarkers have since replaced these and are now in use in routine clinical practice, but still do not detect all disease. Future cardiac biomarkers are showing promise in early studies, but further studies are required to show their value in improving detection of CVD above the current biomarkers. Additionally, the analytical platforms that would allow them to be adopted in healthcare are yet to be established. There is also the need to identify whether these biomarkers can be used for diagnostic, prognostic, or screening purposes, which will impact their implementation in routine clinical practice.
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Affiliation(s)
- Farah Omran
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; (F.O.); (I.K.); (F.O.); (V.G.L.); (H.S.R.)
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, Coventry CV2 2DX, UK
| | - Ioannis Kyrou
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; (F.O.); (I.K.); (F.O.); (V.G.L.); (H.S.R.)
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Centre of Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry CV1 5FB, UK
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece
| | - Faizel Osman
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; (F.O.); (I.K.); (F.O.); (V.G.L.); (H.S.R.)
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Ven Gee Lim
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; (F.O.); (I.K.); (F.O.); (V.G.L.); (H.S.R.)
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Harpal Singh Randeva
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; (F.O.); (I.K.); (F.O.); (V.G.L.); (H.S.R.)
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, Coventry CV2 2DX, UK
| | - Kamaljit Chatha
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; (F.O.); (I.K.); (F.O.); (V.G.L.); (H.S.R.)
- Biochemistry and Immunology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Correspondence:
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7
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Privalova EA, Belenkov YN, Danilogorskaya YA, Zheleznykh EA, Kozhevnikova MV, Zektser VY, Lishuta AS, Ilgisonis IS. To study the dynamics of serum levels of vascular remodeling in patients with hypertension, including in combination with type 2 diabetes mellitus during 12‑month therapy with perindopril A. KARDIOLOGIIA 2022; 62:24-31. [PMID: 35168530 DOI: 10.18087/cardio.2022.1.n1890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/09/2021] [Indexed: 06/14/2023]
Abstract
Aim To study the dynamics of serum markers for vascular remodeling in patients with arterial hypertension (AH), including AH associated with type 2 diabetes mellitus (DM2) during the 12-month treatment with the angiotensin-converting enzyme (ACE) inhibitor, perindopril A.Material and methods The study included patients with grade 1-2 AH with or without type 2 DM (30 and 32, respectively). Perindopril A 10 mg/day was administered for the outpatient correction of previous, ineffective antihypertensive therapy. The following biomarkers were measured for all patients at baseline and at 12 months: matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), E-selectin, endothelin 1, transforming growth factor β-1 (TGF-β1), and von Willebrand factor (WF). Laboratory tests were performed with enzyme immunoassay.Results After 12 months of the perindopril A (perindopril arginine) 10 mg/day treatment, both groups achieved the goal blood pressure. Evaluation of biomarker dynamics during the perindopril A treatment showed significant decreases in MMP-9, TIMP-1, and endothelin 1 in the AH group; then the level of TIMP-1 returned to normal values (р<0.05). In the AH+DM2 group, the MMP-9 concentration was significantly decreased (р<0.05); the other values did not show any significant differences. In both groups, MMP-9 was significantly decreased (28.6 % (р=0.01) in group 1 and 33.2 % (р=0.00) in group 2. Notably, in none of these groups, did this index reach normal values. Also, there were no significant differences in this index between the groups (р=0.66). It should be noted that the decreases in TIMP-1 were significantly different between the groups (р=0.001). Thus, this biomarker did not significantly decrease in patients with AH and DM2 (р=0.26) whereas in group 1 (AH without DM2), the level of TIMP-1 decreased by 39.3 % and reached the normal range (р=0.005).Conclusion Concentrations of biomarkers were decreased in both groups. However, in the AH group, there were statistically significant decreases in the markers that reflect processes of fibrosis and vasoconstriction. At the same time in the AH+DM2 group, there was no significant dynamics of the biomarkers, which was most likely due to more pronounced damage of blood vessels. However, the decrease in MMP-9 may indicate an alleviation of fibrotic processes in arterial walls. These results allow a conclusion that the long-term treatment with the ACE inhibitor, perindopril A, may reverse remodeling of the vascular changes that are called "early vascular ageing".r aging".
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Affiliation(s)
- E A Privalova
- I.M. Sechenov First Moscow Medical University (Sechenov University), Moscow
| | - Yu N Belenkov
- I.M. Sechenov First Moscow Medical University (Sechenov University), Moscow
| | | | - E A Zheleznykh
- I.M. Sechenov First Moscow Medical University (Sechenov University), Moscow
| | - M V Kozhevnikova
- I.M. Sechenov First Moscow Medical University (Sechenov University), Moscow
| | - V Y Zektser
- I.M. Sechenov First Moscow Medical University (Sechenov University), Moscow
| | - A S Lishuta
- I.M. Sechenov First Moscow Medical University (Sechenov University), Moscow
| | - I S Ilgisonis
- I.M. Sechenov First Moscow Medical University (Sechenov University), Moscow
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8
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Muijsers HEC, Westermann D, Birukov A, van der Heijden OWH, Drost JT, Kräker K, Haase N, Müller DN, Herse F, Maas AHEM, Dechend R, Zeller T, Roeleveld N. High-sensitivity cardiac troponin I in women with a history of early-onset preeclampsia. J Hypertens 2020; 38:1948-1954. [PMID: 32890270 DOI: 10.1097/hjh.0000000000002497] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Preeclampsia is associated with an elevated risk of cardiovascular disease later in life. Women with a history of preeclampsia are at risk of developing hypertension as well as ischemic heart disease. Identification of women at the highest risk is important to initiate preventive strategies. We investigated whether high-sensitivity cardiac troponin I (hs-cTnI) levels are associated with a history of early-onset preeclampsia, and with hypertension in these high-risk women. METHODS Approximately 9-10 years after pregnancy, hs-cTnI levels were measured for 339 women of the Preeclampsia Risk Evaluation in FEMales cohort, consisting of 177 women with a history of early-onset preeclampsia and 162 women with a previous uncomplicated index pregnancy. Associations were analyzed using several statistical tests and linear regression analysis. RESULTS The median hs-cTnI levels (IQR) were 2.50 ng/l (2.30) in women with a history of early-onset preeclampsia and 2.35 ng/l (2.50) in women without a history of preeclampsia, P = 0.53. Among women with a history of early-onset preeclampsia, the hs-cTnI levels were higher in women who were hypertensive compared with their normotensive counterparts (medians 2.60 versus 2.30; P = 0.03). In addition, blood pressure levels increased with increasing hs-cTnI levels. CONCLUSION We did not find a difference in hs-cTnI levels between women with and without a history of early-onset preeclampsia. Nonetheless, hs-cTnI levels were statistically significantly higher in current hypertensive women with a history of preeclampsia compared with their normotensive counterparts. Therefore, hs-cTnI levels might improve risk prediction for women at the highest risk of cardiovascular disease.
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Affiliation(s)
- Hella E C Muijsers
- Radboud university medical center, Department of Cardiology, Nijmegen, The Netherlands
| | - Dirk Westermann
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Anna Birukov
- Experimental and Clinical Research Center, a Joint Cooperation Between Max-Delbrück-Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
- German Center for Cardiovascular Research (DZKH), Partner Site Berlin
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association
- Berlin Institute of Health (BIH), Berlin, Germany
| | | | - José T Drost
- Saxenburgh Group, Department of Cardiology, Hardenberg
| | - Kristin Kräker
- Experimental and Clinical Research Center, a Joint Cooperation Between Max-Delbrück-Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
- German Center for Cardiovascular Research (DZKH), Partner Site Berlin
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Nadine Haase
- Experimental and Clinical Research Center, a Joint Cooperation Between Max-Delbrück-Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
- German Center for Cardiovascular Research (DZKH), Partner Site Berlin
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Dominik N Müller
- Experimental and Clinical Research Center, a Joint Cooperation Between Max-Delbrück-Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
- German Center for Cardiovascular Research (DZKH), Partner Site Berlin
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Florian Herse
- Experimental and Clinical Research Center, a Joint Cooperation Between Max-Delbrück-Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Angela H E M Maas
- Radboud university medical center, Department of Cardiology, Nijmegen, The Netherlands
| | - Ralf Dechend
- Experimental and Clinical Research Center, a Joint Cooperation Between Max-Delbrück-Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
- German Center for Cardiovascular Research (DZKH), Partner Site Berlin
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association
- Berlin Institute of Health (BIH), Berlin, Germany
- HELIOS Klinikum Berlin, Department of Cardiology and Nephrology, Berlin, Germany
| | - Tanja Zeller
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Nel Roeleveld
- Radboud university medical center, Radboud Institute for Health Sciences, Department for Health Evidence, Nijmegen, The Netherlands
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9
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Clinical importance of high- sensitivity troponin T in patients without coronary artery disease. North Clin Istanb 2020; 7:305-310. [PMID: 32478307 PMCID: PMC7251271 DOI: 10.14744/nci.2019.71135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/13/2019] [Indexed: 11/20/2022] Open
Abstract
Cardiac troponin is the preferred biomarker for the diagnosis of the acute coronary syndrome (ACS), but many other diseases can be identified with elevated troponin levels in the absence of ACS. The recent development of a high-sensitive cardiac troponin T (hs-cTnT) assay permits the detection of very low levels of cTnT. The use of hs-cTnT assay has emerged as a tool for identifying high-risk individuals for primary preventive treatment and can detect subclinical injury in asymptomatic patients. Hs-cTnT analyses are generally related to ischemia in the literature. Thus, we made an evaluation of hs-cTnT analysis in non-coronary patients, which may contribute to the literature.
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10
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Jespersen MM, Munk Jensen SS, Harbak J, Jeppesen KF, Revsholm J, Nybo M. Can High-Sensitivity Troponins Predict Future Hypertension? A Systematic Literature Review. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 79:613-618. [PMID: 31651192 DOI: 10.1080/00365513.2019.1683765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Hypertension (HT) is associated with cardiovascular events and increased mortality, and identification of persons at risk in due time is therefore important. Finding a biomarker to identify those at risk will enable early preventive treatment, and high-sensitivity cardiac troponin (hs-cTn) seems to be a highly relevant candidate. To gather the existing knowledge on the association between hs-cTn and future HT, a systematic literature review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) reporting guidelines and using the PICOS system. Medline was searched until August 2018. Of 45 extracted papers, eleven papers were eligible for the study. None were randomized controlled trials. Three studies assessed hs-cTnI, eight studies assessed hs-cTnT. All studies found statistically significant associations between hs-cTn concentrations and future HT, but the studies included different types of blood pressure (diastolic, systolic, diurnal). Due to differences in troponin assay construction and test capability, a direct comparison of test performance in terms of specificity, sensitivity and predictive values was not possible, and a specific hs-cTn cutoff value for HT prediction could therefore not be defined. Furthermore, a number of conditions known to affect troponin concentrations (e.g. gender, renal function, and co-morbidities) were not sufficiently studied. All retrieved studies found significant associations between hs-cTn concentrations and future HT; although the findings are promising, the studies were too heterogeneous, and many conditions affecting troponin concentrations needs investigation at these low concentrations before hs-cTn can be considered a useful HT predictor.
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Affiliation(s)
- Mette M Jespersen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Simon S Munk Jensen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Jonathan Harbak
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Kristian F Jeppesen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Jesper Revsholm
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Mads Nybo
- Clinical Diagnostics Department, Hospital of Southwest Jutland, Odense University Hospital, Odense, Denmark
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Cohen N, Brzezinski RY, Ehrenwald M, Shapira I, Zeltser D, Berliner S, Shenhar-Tsarfaty S, Milwidsky A, Rogowski O. Familial history of heart disease and increased risk for elevated troponin in apparently healthy individuals. Clin Cardiol 2019; 42:760-767. [PMID: 31175686 PMCID: PMC6671830 DOI: 10.1002/clc.23214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/23/2019] [Accepted: 05/31/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Family history of heart disease (FH-HD) is associated with an increase drisk of subsequent HD. High sensitive cardiac troponin T (hs-cTnT) is arecognized biomarker of myocyte injury even in HD free patients. We examined the association between FH-HD and hs-cTnT in apparently healthy individuals. HYPOTHESIS FH-HD is associated with elevated hs-cTnT in apparently healthy individuals. METHODS In a cross sectional study we analyzed data of apparently healthy individuals (n=3,821) recruited for the Tel-Aviv Medical Center Inflammation Survey (TAMCIS). Blood samples were obtained for hs-cTnT and high sensitive CRP (hs-CRP) among other tests. FH-HD was defined as first degree family member with HD diagnosis and classified as premature if the diagnosis was done before the age of 55 for men or 65 for women. RESULTS Elevated hs-cTnT (>14 ng/L) was more common in FH-HD of any age, and in premature FH-HD (FH-P-HD) participants than in participants without FH-HD (4.4% vs 2.0%, p<0.001 and 4.3% vs 2.0%, p=0.001, respectively). Adjustmentfor potential risk factors with association to elevated hs-cTnT (age, sex, BMI, hypertension, diabetes, hs-CRP, smoking and physical activity), showed that FH-HD and FH-P-HD remained significantly associated with elevated hs-cTnT (OR=1.62, p=0.025 and OR=1.70, p=0.039, respectively). Furthermore, we found that a significant interaction between FH-HD or FH-P-HD and high levels ofhs-CRP (>3 mg/L) increased the risk for elevated hs-cTnT (OR=3.07, p=0.036 for FH-HD and OR=3.25, p=0.053 for FH-P-HD). CONCLUSIONS FH-HD and its interaction with elevated hs-CRP levels were significantly associated with elevated hs-cTnT in apparently healthy individuals suggesting that an inflammatory process may be involved in this association.
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Affiliation(s)
- Noa Cohen
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rafael Y Brzezinski
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Ehrenwald
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itzhak Shapira
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Zeltser
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Berliner
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shani Shenhar-Tsarfaty
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assi Milwidsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Rogowski
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Hitsumoto T. Clinical Impact of Hemorheology on Subclinical Myocardial Injury in Patients with Hypertension. J Clin Med Res 2018; 10:928-935. [PMID: 30425766 PMCID: PMC6225855 DOI: 10.14740/jocmr3652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/16/2018] [Indexed: 12/21/2022] Open
Abstract
Background The blood concentration of high-sensitivity cardiac troponin T (hs-cTnT) is a useful biomarker for myocardial injury or the pathogenesis of hypertension. Little is known about the relationship between hemorheology and myocardial injury in patients with hypertension. This cross-sectional study aimed to clarify the clinical impact of hemorheology on subclinical myocardial injury assessed with a microchannel array flow analyzer (MC-FAN) and its impact on hs-cTnT in patients with hypertension. Methods A total of 447 outpatients (men: 181; women: 266; mean age: 65 ± 13 years), with no history of cardiovascular disease, including admission for heart failure, who were undergoing treatment for hypertension, were enrolled. Whole blood passage time (WBPT) as a marker of hemorheology was measured with a MC-FAN, and the relationship between hs-cTnT levels and various clinical parameters, including WBPT, was examined. Results hs-cTnT levels were detected in 400 patients (89.5%). WBPT was significantly higher in patients with detectable hs-cTnT levels than in those with undetectable hs-cTnT levels (60.5 ± 16.8 s versus 50.2 ± 14.2 s, P < 0.001). In patients with detectable hs-cTnT levels, there was a significant positive correlation between WBPT and hs-cTnT level (r = 0.33; P < 0.001). Multiple regression analysis revealed that WBPT was an independent variable when hs-cTnT was a subordinate factor (β = 0.15; P < 0.01). Receiver-operating characteristic curve analysis indicated that a cutoff value for WBPT of 55.6 s yielded the largest area under the curve (0.744; P < 0.001) for discriminating high hs-cTnT levels as ≥ 0.014 ng/mL. Conclusion The results indicate that WBPT is independently associated with hs-cTnT in hypertensive patients with no history of cardiovascular events, suggesting that impairment of hemorheology in small cardiac vessels causes subclinical myocardial injury. In addition, the study suggests that progression of myocardial injury can be prevented by maintaining WBPT at approximately ≤ 55 s.
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13
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Milwidsky A, Fisher E, Brzezinski RY, Ehrenwald M, Shefer G, Stern N, Shapira I, Zeltser D, Rosenbaum Z, Greidinger D, Berliner S, Shenhar-Tsarfaty S, Rogowski O. Metabolic syndrome is associated to high-sensitivity cardiac troponin T elevation. Biomarkers 2018; 24:153-158. [DOI: 10.1080/1354750x.2018.1528630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Assi Milwidsky
- Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Department of Cardiology, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Fisher
- Department of Statistics, School of Mathematical Science, Tel Aviv University, Tel Aviv, Israel
| | - Rafael Y. Brzezinski
- Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Department of Internal Medicine “C”, “D” and “E”, Tel Aviv University, Tel Aviv, Israel
| | - Michal Ehrenwald
- Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Department of Internal Medicine “C”, “D” and “E”, Tel Aviv University, Tel Aviv, Israel
| | - Gabi Shefer
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Naftali Stern
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Itzhak Shapira
- The Institute for Special Medical Examinations (MALRAM), Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Zeltser
- Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Department of Internal Medicine “C”, “D” and “E”, Tel Aviv University, Tel Aviv, Israel
| | - Zach Rosenbaum
- Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Department of Cardiology, Tel Aviv University, Tel Aviv, Israel
| | - Dahlia Greidinger
- Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Department of Cardiology, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Berliner
- Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Department of Internal Medicine “C”, “D” and “E”, Tel Aviv University, Tel Aviv, Israel
| | - Shani Shenhar-Tsarfaty
- Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Department of Internal Medicine “C”, “D” and “E”, Tel Aviv University, Tel Aviv, Israel
| | - Ori Rogowski
- Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Department of Internal Medicine “C”, “D” and “E”, Tel Aviv University, Tel Aviv, Israel
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14
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Discerning the relationship between left ventricular geometry, high-sensitivity troponin T, and nondipper hypertension. Blood Press Monit 2018; 23:12-18. [PMID: 29278556 DOI: 10.1097/mbp.0000000000000297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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15
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Abiko M, Inai K, Shimada E, Asagai S, Nakanishi T. The prognostic value of high sensitivity cardiac troponin T in patients with congenital heart disease. J Cardiol 2017; 71:389-393. [PMID: 29108668 DOI: 10.1016/j.jjcc.2017.09.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/05/2017] [Accepted: 09/22/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac troponin T (cTnT) is a specific marker of myocardial injury that is elevated in patients with coronary artery disease or heart failure; it has been investigated as a prognostic marker. A highly sensitive, commercially available assay has been developed to detect cardiac troponin T (hs-cTnT). This study aimed to evaluate the clinical implications and prognostic value of hs-cTnT in patients with congenital heart disease (CHD). METHODS We evaluated 122 consecutive patients hospitalized at our institution because of heart failure or scheduled cardiac catheterization. We measured the serum concentration of hs-cTnT at the time of hospitalization, and we prospectively followed-up all patients for 3 years and monitored rates of cardiovascular events (e.g. cardiac death, readmission owing to worsening of heart failure or arrhythmia, and reintervention) as endpoints. RESULTS We classified the patients according to their hs-cTnT level into non-detectable (ND group, hs-cTnT <0.003ng/mL), detectable normal (DN group, 0.003ng/mL ≤hs-cTnT <0.014ng/mL), or elevated (EL group, 0.014ng/mL ≤hs-cTnT) group; 20 of 122 (16.4%) patients were in the EL group, in which 17 cardiovascular events occurred during follow-up. In the multivariate Cox proportional hazard analyses, the EL group [p=0.024, hazard ratio (HR) 2.7, 95% confidence interval (CI) 1.1-5.8] was an independent significant predictor of cardiovascular events. A Kaplan-Meier curve revealed a high incidence of cardiovascular events in the EL group (EL vs ND log rank p<0.0001, HR 7.6, 95% CI 3.2-20.0, EL vs DN log rank p<0.0001, HR 4.1, 95% CI 2.1-7.8). CONCLUSIONS Because the EL group is more likely to have an adverse outcome, elevated hs-cTnT level can be a prognostic marker in patients with CHD.
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Affiliation(s)
- Masayuki Abiko
- Department of Pediatric Cardiology, Division of Clinical Research for Adult Congenital Heart Disease, Tokyo Women's Medical University, Tokyo, Japan; Department of Pediatrics, Yamagata University, Yamagata, Japan
| | - Kei Inai
- Department of Pediatric Cardiology, Division of Clinical Research for Adult Congenital Heart Disease, Tokyo Women's Medical University, Tokyo, Japan.
| | - Eriko Shimada
- Department of Pediatric Cardiology, Division of Clinical Research for Adult Congenital Heart Disease, Tokyo Women's Medical University, Tokyo, Japan
| | - Seiji Asagai
- Department of Pediatric Cardiology, Division of Clinical Research for Adult Congenital Heart Disease, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Nakanishi
- Department of Pediatric Cardiology, Division of Clinical Research for Adult Congenital Heart Disease, Tokyo Women's Medical University, Tokyo, Japan
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16
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Hitsumoto T. Clinical impact of skin autofluorescence on high-sensitivity troponin T in hypertensive patients. Clin Hypertens 2017; 23:19. [PMID: 29026648 PMCID: PMC5627403 DOI: 10.1186/s40885-017-0076-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/12/2017] [Indexed: 11/30/2022] Open
Abstract
Background Recent studies have reported the importance of high-sensitivity troponin T (hs-cTnT) or skin autofluorescence (AF) as a cardiovascular risk factor. However, little is known about the relationship between these two markers. The aim of this study was to clarify the clinical impact of skin AF on hs-cTnT in hypertensive patients, from the perspective of primary prevention of cardiovascular events. Methods In total, 457 outpatients on treatment for hypertension [182 men and 275 women; mean (± SD) age, 67 ± 13 y] and with no history of cardiovascular events were enrolled. Hs-cTnT levels and skin AF were measured using commercial devices, and relationships between hs-cTnT levels and various clinical parameters including skin AF were examined. Results Hs-cTnT was detected in 405 (88.6%) patients. Skin AF was significantly higher in patients with detectable hs-cTnT than in those without detectable hs-cTnT [2.6 ± 0.5 arbitrary units (AU) vs. 2.2 ± 0.5 AU, respectively, p < 0.001]. In patients with detectable hs-cTnT, there was a significantly positive correlation between skin AF and Log-hs-cTnT (r = 0.41, p < 0.001). Furthermore, multiple regression analysis revealed that skin AF was the strongest variable associated with Log-hs-cTnT as a subordinate factor (β = 0.30, p < 0.001). Conclusions The results of this study indicate that skin AF is an important determining factor for hs-cTnT elevation in hypertensive patients with no history of cardiovascular events.
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Affiliation(s)
- Takashi Hitsumoto
- Hitsumoto Medical Clinic, 2-7-7, Takezakicyou, Shimonoseki City, Yamaguchi 750-0025 Japan
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17
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Askin L, Yesiltepe Y. High-Sensitivity Cardiac Troponin T levels in prehypertensive patients. Clin Exp Hypertens 2017; 40:332-336. [PMID: 28952796 DOI: 10.1080/10641963.2017.1377216] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND High-sensitivity cardiac troponin T (hs-cTNT) is an important non-invasive laboratory-based marker of subclinical myocardial injury. Prehypertension, which may be a precursor of hypertension, is a major public health issue. Our aim was to evaluate the importance of serum hs-cTnT as a marker predicting prehypertension. METHODS A total of 100 subjects (45 women and 55 men) consisting of 50 consecutive prehypertensive patients with blood pressures between 120/80 and 139/89 mmHg and 50 normotensive patients with blood pressures < 120/80 mmHg were enrolled prospectively. The hs-cTNT level was calculated and compared between the two groups. Echocardiographic examinations were performed in all patients. RESULTS The hs-cTnT level was significantly higher in the prehypertensive group (p < 0.001) and was positively correlated with prehypertension (r = 0.625, p < 0.001). Hs-cTnT was an independent predictor of prehypertension (odds ratio = 1.043, 95% confidence interval [CI] 1.019-1.067, p < 0.001). An Hs-cTnT level of 0.55 ng/L was predictive of prehypertension with a sensitivity of 86% and specificity of 60% (area under the curve = 0.861; 95% CI, 0.787-0.935; p < 0.001). CONCLUSION hs-cTnT may complement other diagnostic biomarkers in predicting prehypertension. Abbrevations: high-sensitivity cardiac troponin T, prehypertension, subclinical myocardial injury.
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Affiliation(s)
- Lutfu Askin
- a Department of cardiology , Palandoken State Hospital , Erzurum , Turkey
| | - Yener Yesiltepe
- b Department of biochemistry , Palandoken State Hospital , Erzurum , Turkey
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18
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Jagodzinski A, Neumann JT, Ojeda F, Sörensen NA, Wild P, Münzel T, Zeller T, Westermann D, Blankenberg S. Cardiovascular Biomarkers in Hypertensive Patients with Medical Treatment-Results from the Randomized TEAMSTA Protect I Trial. Clin Chem 2017; 63:1877-1885. [PMID: 28904053 DOI: 10.1373/clinchem.2017.275289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/03/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND High blood pressure (BP) is associated with an increased rate of cardiovascular events and mortality. Cardiovascular biomarkers are able to predict long-term risk in the general population, particularly in diseased cohorts. We undertook an investigation of the effect of 2 different antihypertensive treatments on cardiovascular biomarkers in a randomized trial. METHODS The TEAMSTA study included 481 hypertensive patients. They were randomized to either 80-mg telmisartan + 5-mg amlodipine (TA) or 40-mg olmesartan + 12.5-mg hydrochlorothiazide (OH). The trial was performed as a prospective, randomized, double-blinded, controlled, single-center study. We measured BP, high-sensitivity cardiac troponin I (hs-cTnI), high-sensitivity cardiac troponin T (hs-cTnT), B-type natriuretic peptide (BNP), and N-terminal-pro-BNP (NT-proBNP) before randomization and after 6 months. RESULTS Individuals were randomized into 2 groups: 230 individuals to the OH-group and 251 to the TA-group. After 6 months of treatment, a reduction in BP (systolic/diastolic) was seen, from 135.2/85.2 mmHg to 122.5/75.7 mmHg with similar effects in both groups. hs-cTnT concentrations were measureable in 26.2% of the study population, while hs-cTnI was detected in 98.3%. hs-cTnI concentrations were significantly reduced from 4.6 to 4.2 ng/L in the overall population, from 4.7 to 4.4 ng/L in the OH-group, and from 4.6 to 4.0 ng/L in the TA-group (all P < 0.001). No significant changes of hs-cTnT were observed. BNP and NT-proBNP concentrations decreased from 15.0 to 12.4 ng/L (P < 0.001) and from 64.8 to 53.3 ng/L (P < 0.001), respectively, after 6 months. CONCLUSIONS The reduction in BP was associated with a decrease of high-sensitivity troponin I, BNP, and NT-proBNP concentrations, which might represent a cardiovascular risk reduction. CLINICAL TRIAL REGISTRATION EudraCT 2009-017010-68.
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Affiliation(s)
- Annika Jagodzinski
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Johannes Tobias Neumann
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany; .,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Francisco Ojeda
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Nils Arne Sörensen
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Philipp Wild
- Department of Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany.,German Center for Cardiovascular Research, Partner Site RheinMain, Mainz, Germany.,Center for Translational Vascular Biology, University Medical Center Mainz, Germany
| | - Thomas Münzel
- German Center for Cardiovascular Research, Partner Site RheinMain, Mainz, Germany.,Center for Translational Vascular Biology, University Medical Center Mainz, Germany.,Center for Cardiology-Cardiology I, University Medical Center Mainz, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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19
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Ichise T, Tada H, Sakata K, Kawashiri MA, Yamagishi M, Hayashi K. Impact of Aging on High-sensitivity Cardiac Troponin T in Patients Suspected of Acute Myocardial Infarction. Intern Med 2017; 56:2097-2102. [PMID: 28781317 PMCID: PMC5596267 DOI: 10.2169/internalmedicine.8510-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective High-sensitivity cardiac troponin T (hs-cTnT) is widely used for the diagnosis of acute myocardial infarction (AMI). The current cut-off value of 0.014 ng/mL was determined based on the 99th percentile of a normal reference population; however, little data exist regarding the appropriate cut-off value in the elderly (≥75 years). Accordingly, we aimed to investigate the accuracy of the current cut-off value in an elderly population. Methods We assessed 355 consecutive patients (mean age =66.7±16.1 years, male =210) whose hs-cTnT levels were measured at Kanazawa University Hospital from January 2014 to July 2015. Twenty-six patients were eventually diagnosed with AMI. Hs-cTnT was measured during a visit to the emergency or outpatient department. Receiver operating characteristic (ROC) curves were assessed to determine the appropriate cut-off levels, yielding the maximum sensitivity and specificity while dividing the subjects into two groups according to ages (≥75 or ≤74 years). Results The appropriate overall cut-off value was 0.038, the sensitivity and specificity of which were 85% and 89%, respectively, with an area under the ROC curve (AUC) of 0.945 overall. The conventional cut-off value (99th percentile: 0.014 ng/mL) provided low specificity, particularly in the elderly or those with renal dysfunction. In contrast, a calculated appropriate cut-off provided higher sensitivity with significantly larger c-statistics in the elderly (0.940 vs. 0.629, p<0.001). Conclusion When measuring hs-cTnT, careful assessments are needed in elderly subjects.
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Affiliation(s)
- Taro Ichise
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Japan
| | - Hayato Tada
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Japan
| | - Kenji Sakata
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Japan
| | - Masa-Aki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Japan
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Japan
| | - Kenshi Hayashi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Japan
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20
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Hitsumoto T. Arterial Velocity Pulse Index as a Novel Marker of Atherosclerosis Using Pulse Wave Analysis on High Sensitivity Troponin T in Hypertensive Patients. Cardiol Res 2017; 8:36-43. [PMID: 28515820 PMCID: PMC5421484 DOI: 10.14740/cr545w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 01/29/2023] Open
Abstract
Background The arterial velocity pulse index (AVI) is explored as a novel marker of atherosclerosis using pulse wave analysis in clinical settings. Recent clinical studies have reported that the level of high-sensitivity troponin T (hs-cTnT) is an important biomarker in hypertensive patients. The aim of this study was to clarify the impact of AVI on hs-cTnT in these patients. Methods This study enrolled 455 hypertensive outpatients (181 males and 274 females; mean age, 65 ± 11 years (mean ± standard deviation)) without a history of cardiovascular events. AVI and hs-cTnT levels were measured using a commercial device, and relations among various clinical parameters, including AVI and hs-cTnT, were examined. Results Hs-cTnT was detected in 405 patients (89.0%). AVI was significantly higher in patients with detectable hs-cTnT than in those without (28 ± 7 vs. 24 ± 8, respectively, P < 0.001). In patients with detectable hs-cTnT, there was a significant positive correlation between AVI and hs-cTnT (r = 0.42, P < 0.001). Furthermore, multiple regression analyses revealed that AVI was an independent variable when hs-cTnT was used as a subordinate factor. On the other hand, hs-cTnT age, Cornell electrocardiographic voltage, height, urinary albumin excretion, pulse rate, and derivatives of reactive oxygen metabolites test were independent variables when AVI was used as a subordinate factor. Conclusion The results of this study indicate that AVI reflects features of arterial wave reflection and is an important factor for hs-cTnT elevation in hypertensive patients.
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Affiliation(s)
- Takashi Hitsumoto
- Hitsumoto Medical Clinic, 2-7-7, Takezakicyou, Shimonoseki City, Yamaguchi 750-0025, Japan.
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21
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Bijsmans ES, Jepson RE, Wheeler C, Syme HM, Elliott J. Plasma N-Terminal Probrain Natriuretic Peptide, Vascular Endothelial Growth Factor, and Cardiac Troponin I as Novel Biomarkers of Hypertensive Disease and Target Organ Damage in Cats. J Vet Intern Med 2017; 31:650-660. [PMID: 28387019 PMCID: PMC5435049 DOI: 10.1111/jvim.14655] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/06/2016] [Accepted: 12/12/2016] [Indexed: 12/22/2022] Open
Abstract
Background In the absence of ocular target organ damage (ocular‐TOD), diagnosis of hypertension is challenging in cats. Biomarkers would provide additional support for the diagnosis of hypertension. Hypothesis Vascular endothelial growth factor (VEGF), N‐terminal probrain natriuretic peptide (NT‐proBNP), cardiac troponin I (cTnI), and urine protein‐to‐creatinine ratio (UPC) are predictors of systemic hypertension, will be increased in cats with hypertension with or without ocular‐TOD, and will decrease with antihypertensive treatment. Methods Plasma VEGF, NT‐proBNP, and cTnI concentrations and UPC were determined in healthy geriatric cats, normotensive cats with chronic kidney disease (CKD), hypertensive cats with evidence of hypertensive retinopathy (HT‐ocular‐TOD), and hypertensive cats without hypertensive ocular‐TOD (HT‐noTOD). Comparisons among groups were performed. Multivariable binary logistic regression models were built to identify independent biomarkers of hypertension and ocular‐TOD. Receiver operator characteristic (ROC) curves were drawn to assess clinical use. Results Cats with HT‐ocular‐TOD had significantly higher VEGF than all other groups (P < .05) and significantly higher NT‐proBNP than healthy cats (P < .001). Healthy cats had significantly lower cTnI than all other groups (P < .05). No differences were found among groups for UPC (P = .08). Cardiac troponin I and VEGF were independent predictors of hypertension (P < .05), but none of the biomarkers were independent predictors of ocular‐TOD. N‐terminal probrain natriuretic peptide concentrations decreased with antihypertensive treatment (P < .001). The ROC curves indicated that none of the biomarkers met the criteria to function as diagnostic tests for the diagnosis of hypertension or associated ocular‐TOD. Conclusions and Clinical Significance Despite statistical significance and changes with ocular‐TOD, antihypertensive treatment, or both, VEGF, NT‐proBNP, and cTnI did not function as useful diagnostic tests for hypertension. Persistently increased systolic blood pressure (SBP) measurements in combination with fundoscopy remains the preferred method for diagnosis of feline hypertension.
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Affiliation(s)
- E S Bijsmans
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK
| | - R E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - C Wheeler
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK
| | - H M Syme
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - J Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK
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22
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Okuyama R, Ishii J, Takahashi H, Kawai H, Muramatsu T, Harada M, Yamada A, Motoyama S, Matsui S, Naruse H, Sarai M, Hasegawa M, Watanabe E, Suzuki A, Hayashi M, Izawa H, Yuzawa Y, Ozaki Y. Combination of high-sensitivity troponin I and N-terminal pro-B-type natriuretic peptide predicts future hospital admission for heart failure in high-risk hypertensive patients with preserved left ventricular ejection fraction. Heart Vessels 2017; 32:880-892. [PMID: 28154958 DOI: 10.1007/s00380-017-0948-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/13/2017] [Indexed: 01/20/2023]
Abstract
Additional risk stratification may provide more aggressive and focalized preventive treatment to high-risk hypertensive patients according to the Japanese hypertension guidelines. We prospectively investigated the predictive value of high-sensitivity troponin I (hsTnI), both independently and in combination with N-terminal pro-B-type natriuretic peptide (NT-proBNP), for incident heart failure (HF) in high-risk hypertensive patients with preserved left ventricular ejection fraction (LVEF). Baseline hsTnI and NT-proBNP levels and echocardiography data were obtained for 493 Japanese hypertensive outpatients (mean age, 68.5 years) with LVEF ≥ 50%, no symptomatic HF, and at least one of the following comorbidities: stage 3-4 chronic kidney disease, diabetes mellitus, and stable coronary artery disease. During a mean follow-up period of 86.1 months, 44 HF admissions occurred, including 31 for HF with preserved ejection fraction (HFpEF) and 13 for HF with reduced ejection fraction (HFrEF; LVEF <50%). Both hsTnI (p < 0.01) and NT-proBNP (p < 0.005) levels were significant independent predictors of HF admission. Furthermore, when the patients were stratified into 4 groups according to increased hsTnI (≥highest tertile value of 10.6 pg/ml) and/or increased NT-proBNP (≥highest tertile value of 239.7 pg/ml), the adjusted relative risks for patients with increased levels of both biomarkers versus neither biomarker were 13.5 for HF admission (p < 0.0001), 9.45 for HFpEF (p = 0.0009), and 23.2 for HFrEF (p = 0.003). Finally, the combined use of hsTnI and NT-proBNP enhanced the C-index (p < 0.05), net reclassification improvement (p = 0.0001), and integrated discrimination improvement (p < 0.05) to a greater extent than that of any single biomarker. The combination of hsTnI and NT-proBNP, which are individually independently predictive of HF admission, could improve predictions of incident HF in high-risk hypertensive patients but could not predict future HF phenotypes.
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Affiliation(s)
- Ryunosuke Okuyama
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Junnichi Ishii
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan.
| | - Hiroshi Takahashi
- Division of Statistics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hideki Kawai
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masahide Harada
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Akira Yamada
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Sadako Motoyama
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shigeru Matsui
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroyuki Naruse
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Midori Hasegawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Atsushi Suzuki
- Department of Endocrinology and Metabolism, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mutsuharu Hayashi
- Department of Cardiology, Banbuntane Houtokukai Hospital, Nagoya, Japan
| | - Hideo Izawa
- Department of Cardiology, Banbuntane Houtokukai Hospital, Nagoya, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
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23
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Kruger R, Schutte AE, Mels CMC, Smith W, van Rooyen JM, Kruger IM, Fourie CMT. Cardiac Troponin T as Early Marker of Subclinical Cardiovascular Deterioration in Black Hypertensive Women. Heart Lung Circ 2016; 26:825-832. [PMID: 28110852 DOI: 10.1016/j.hlc.2016.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 11/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hypertensive heart disease is a rising concern, especially among black South African women. As high sensitivity cardiac troponin T (cTnT) is a marker of cardiomyocyte damage, we determined the potential link of (i) systemic endothelial dysfunction (reflected by urinary albumin-to-creatinine ratio), (ii) large artery stiffness, (iii) cardiac volume load (estimated by the N-terminal prohormone B-type natriuretic peptide (Nt-proBNP)), and (iv) ECG left ventricular hypertrophy in post-menopausal black women. METHODS In 121 (50 normotensive and 71 hypertensive) black women (mean age: 60.6 years), basic cardiovascular assessments including blood pressure and ECG were performed, along with plasma and urinary biomarkers including cTnT. RESULTS The cTnT levels (p=0.049) along with Nt-proBNP (p=0.003), pulse pressure (p<0.0001) and the Cornell product (p=0.030) were higher in hypertensive than normotensive women. Only in hypertensive women, was cTnT independently associated with urinary albumin-to-creatinine ratio (β=0.25; p=0.019), pulse pressure (β=0.31; p=0.019), Nt-proBNP (β=0.47; p<0.0001) and Cornell product (β=0.31; p=0.018). An independent association between albumin-to-creatinine ratio and cTnT was also evident in normotensive women (β=0.34; p=0.037). CONCLUSION We found cTnT to be a useful marker in an elderly black population relating to several measures of cardiovascular deterioration - from subclinical endothelial dysfunction to left ventricular hypertrophy.
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Affiliation(s)
- R Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
| | - A E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; Medical Research Council: Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - C M C Mels
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - W Smith
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - J M van Rooyen
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - I M Kruger
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa
| | - C M T Fourie
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
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24
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Aloia E, Sciaccaluga C. Low acid uric in primary prophylaxis: worthy? Int J Cardiol 2016; 215:223-6. [DOI: 10.1016/j.ijcard.2016.04.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 04/11/2016] [Indexed: 12/22/2022]
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25
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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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Kaypakli O, Gür M, Gözükara MY, Uçar H, Kivrak A, Şeker T, Şahin DY, Elbasan Z, Türkoğlu C, Çayli M. Association between high-sensitivity troponin T, left ventricular hypertrophy, and myocardial performance index. Herz 2015; 40:1004-10. [DOI: 10.1007/s00059-015-4322-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/21/2015] [Accepted: 04/16/2015] [Indexed: 12/01/2022]
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Carda R, Aceña Á, Pello A, Cristóbal C, Tarín N, Huelmos A, Alonso J, Asensio D, Lorenzo Ó, Martín-Ventura JL, Blanco-Colio L, Farré J, López Bescós L, Egido J, Tuñón J. The Prognostic Value of High-Sensitive Troponin I in Stable Coronary Artery Disease Depends on Age and Other Clinical Variables. Cardiology 2015; 132:1-8. [DOI: 10.1159/000381259] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 02/25/2015] [Indexed: 11/19/2022]
Abstract
Objectives: To study the prognostic value of high-sensitive troponin (hs-cTn) I in stable coronary artery disease. Methods: In total, we studied 705 patients. Secondary outcomes were the incidence of: (1) acute ischemic events and (2) heart failure or death. The primary outcome was the composite of them. Results: Patients with hs-cTnI >0 ng/ml (62.1%) were older, had a lower estimated glomerular filtration rate, more frequent a history of hypertension, atrial fibrillation, ejection fraction <40%, and therapy with angiotensin-converting enzyme inhibitors, diuretics and acenocumarol. The follow-up period was 2.2 ± 0.99 years. Fifty-three patients suffered an acute ischemic event, 33 died or suffered heart failure and 78 developed the primary outcome. By univariate Cox's regression analysis, hs-cTnI >0 was associated with a higher risk of developing the primary outcome [relative risk = 2.360 (1.359-4.099); p = 0.001] and heart failure or death [relative risk = 5.932 (1.806-19.482); p < 0.001], but not with acute ischemic events. Statistical significance was lost after controlling for age. By logistic regression analysis, age [relative risk = 1.026 (1.009-1.044); p = 0.003], ejection fraction <40% [relative risk = 4.099 (2.043-8.224); p < 0.001], use of anticoagulants [relative risk = 2.785 (1.049-7.395); p = 0.040] and therapy with angiotensin-converting enzyme inhibitors [relative risk = 1.471 (1.064-2.034); p = 0.020], and estimated glomerular filtration rate [relative risk = 0.988 (0.977-0.999); p = 0.027] were associated with hs-cTnI >0. Conclusions: In stable coronary disease, hs-cTnI is associated with the incidence of heart failure or death, but this relationship depends on other variables.
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Eindhoven JA, Roos-Hesselink JW, van den Bosch AE, Kardys I, Cheng JM, Veenis JF, Cuypers JA, Witsenburg M, van Schaik RH, Boersma E. High-sensitive troponin-T in adult congenital heart disease. Int J Cardiol 2015; 184:405-411. [DOI: 10.1016/j.ijcard.2015.02.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/05/2015] [Accepted: 02/21/2015] [Indexed: 10/24/2022]
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Pokharel Y, Sun W, de Lemos JA, Taffet GE, Virani SS, Ndumele CE, Mosley TH, Hoogeveen RC, Coresh J, Wright JD, Heiss G, Boerwinkle EA, Bozkurt B, Solomon SD, Ballantyne CM, Nambi V. High-sensitivity troponin T and cardiovascular events in systolic blood pressure categories: atherosclerosis risk in communities study. Hypertension 2015; 65:78-84. [PMID: 25350984 PMCID: PMC4268376 DOI: 10.1161/hypertensionaha.114.04206] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Based on observational studies, there is a linear increase in cardiovascular risk with higher systolic blood pressure (SBP), yet clinical trials have not shown benefit across all SBP categories. We assessed whether troponin T measured using high-sensitivity assay was associated with cardiovascular disease within SBP categories in 11 191 Atherosclerosis Risk in Communities study participants. Rested sitting SBP by 10-mm Hg increments and troponin categories were identified. Incident heart failure hospitalization, coronary heart disease, and stroke were ascertained for a median of 12 years after excluding individuals with corresponding disease. Approximately 53% of each type of cardiovascular event occurred in individuals with SBP<140 mm Hg and troponin T ≥3 ng/L. Higher troponin T was associated with increasing cardiovascular events across most SBP categories. The association was strongest for heart failure and least strong for stroke. There was no similar association of SBP with cardiovascular events across troponin T categories. Individuals with troponin T ≥3 ng/L and SBP <140 mm Hg had higher cardiovascular risk compared with those with troponin T <3 ng/L and SBP 140 to 159 mm Hg. Higher troponin T levels within narrow SBP categories portend increased cardiovascular risk, particularly for heart failure. Individuals with lower SBP but measurable troponin T had greater cardiovascular risk compared with those with suboptimal SBP but undetectable troponin T. Future trials of systolic hypertension may benefit by using high-sensitivity troponin T to target high-risk patients.
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Affiliation(s)
- Yashashwi Pokharel
- From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.)
| | - Wensheng Sun
- From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.)
| | - James A de Lemos
- From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.)
| | - George E Taffet
- From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.)
| | - Salim S Virani
- From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.)
| | - Chiadi E Ndumele
- From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.)
| | - Thomas H Mosley
- From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.)
| | - Ron C Hoogeveen
- From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.)
| | - Josef Coresh
- From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.)
| | - Jacqueline D Wright
- From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.)
| | - Gerardo Heiss
- From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.)
| | - Eric A Boerwinkle
- From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.)
| | - Biykem Bozkurt
- From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.)
| | - Scott D Solomon
- From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.)
| | - Christie M Ballantyne
- From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.)
| | - Vijay Nambi
- From the Department of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (S.S.V., B.B., V.N.); Baylor College of Medicine, Houston, TX (Y.P., W.S., G.E.T., S.S.V., R.C.H., B.B., C.M.B., V.N.); Department of Medicine, Methodist DeBakey Heart Center, Houston, TX (Y.P., S.S.V., R.C.H., C.M.B., V.N.); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.); Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.S.V., B.B., C.M.B., V.N.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.D.W.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (G.H.); Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston (E.A.B.); and Department of Medicine, Harvard Medical School, Boston, MA (S.D.S.).
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Hitsumoto T, Shirai K. Factors affecting high-sensitivity cardiac troponin T elevation in Japanese metabolic syndrome patients. Diabetes Metab Syndr Obes 2015; 8:157-62. [PMID: 25792848 PMCID: PMC4362654 DOI: 10.2147/dmso.s80907] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The blood concentration of cardiac troponin T (ie, high-sensitivity cardiac troponin T [hs-cTnT]), measured using a highly sensitive assay, represents a useful biomarker for evaluating the pathogenesis of heart failure or predicting cardiovascular events. However, little is known about the clinical significance of hs-cTnT in metabolic syndrome. The aim of this study was to examine the factors affecting hs-cTnT elevation in Japanese metabolic syndrome patients. PATIENTS AND METHODS We enrolled 258 metabolic syndrome patients who were middle-aged males without a history of cardiovascular events. We examined relationships between hs-cTnT and various clinical parameters, including diagnostic parameters of metabolic syndrome. RESULTS There were no significant correlations between hs-cTnT and diagnostic parameters of metabolic syndrome. However, hs-cTnT was significantly correlated with age (P<0.01), blood concentrations of brain natriuretic peptide (P<0.01), reactive oxygen metabolites (markers of oxidative stress, P<0.001), and the cardio-ankle vascular index (marker of arterial function, P<0.01). Furthermore, multiple regression analysis revealed that these factors were independent variables for hs-cTnT as a subordinate factor. CONCLUSION The findings of this study indicate that in vivo oxidative stress and abnormality of arterial function are closely associated with an increase in hs-cTnT concentrations in Japanese metabolic syndrome patients.
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Affiliation(s)
- Takashi Hitsumoto
- Hitsumoto Medical Clinic, Yamaguchi, Japan
- Correspondence: Takashi Hitsumoto, Hitsumoto Medical Clinic, 2-7-7, Takezakicyou, Shimonoseki-City, Yamaguchi 750-0025, Japan, Tel +81 83 223 0657, Fax +81 83 233 0657, Email
| | - Kohji Shirai
- Department of Vascular Function (donated), Sakura Hospital, Toho University School of Medicine, Chiba, Japan
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Çaylı M, Gür M, Elbasan Z, Şeker T, Türkoğlu C, Kaypaklı O, Şahin DY, Uçar H, Kıvrak A, Koyunsever NY, Şen Ö. High-sensitivity cardiac troponin T predicts nondipper hypertension in newly diagnosed hypertensive patients. J Clin Hypertens (Greenwich) 2013; 15:731-6. [PMID: 24088281 PMCID: PMC8033873 DOI: 10.1111/jch.12176] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 06/29/2013] [Accepted: 07/07/2013] [Indexed: 11/28/2022]
Abstract
The increased prognostic accuracy of the high-sensitivity cardiac troponin T (hs-cTnT) assay vs the conventional cTnT assay has recently been reported in hypertensive patients. The authors aimed to investigate the significance of serum hs-cTnT marker for prediction of nondipper hypertension (HTN) in hypertensive patients. A total of 317 patients with newly diagnosed HTN were studied. The patients were divided into two groups: 198 dipper hypertensive patients (mean age, 51.7 ± 5.1 years) and 119 nondipper hypertensive patients (mean age, 53.4 ± 7.6 years). Hs-cTnT and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured in all patients. hs-cTnT and NT-proBNP were independent predictors for nondipper HTN (P<.05 for all). The cutoff value of hs-cTnT obtained by the receiver operator curve analysis was 7.55 ng/L for the prediction of nondipper HTN (sensitivity: 79%, specificity: 70%; 95% confidence interval, 0.769-0.860; P<.001). In patients with HTN, higher serum concentration of hs-cTnT even within normal range is an independent predictor of nondipper HTN.
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Affiliation(s)
- Murat Çaylı
- Department of CardiologyAdana Numune Training and Research HospitalAdanaTurkey
| | - Mustafa Gür
- Department of CardiologyAdana Numune Training and Research HospitalAdanaTurkey
| | - Zafer Elbasan
- Department of CardiologyAdana Numune Training and Research HospitalAdanaTurkey
| | - Taner Şeker
- Department of CardiologyAdana Numune Training and Research HospitalAdanaTurkey
| | - Caner Türkoğlu
- Department of CardiologyAdana Numune Training and Research HospitalAdanaTurkey
| | - Onur Kaypaklı
- Department of CardiologyAdana Numune Training and Research HospitalAdanaTurkey
| | - Durmuş Y. Şahin
- Department of CardiologyAdana Numune Training and Research HospitalAdanaTurkey
| | - Hakan Uçar
- Department of CardiologyAdana Numune Training and Research HospitalAdanaTurkey
| | - Ali Kıvrak
- Department of CardiologyAdana Numune Training and Research HospitalAdanaTurkey
| | | | - Ömer Şen
- Department of CardiologyAdana Numune Training and Research HospitalAdanaTurkey
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Uçar H, Gür M, Kivrak A, Koyunsever NY, Seker T, Akilli RE, Türkoğlu C, Kaypakli O, Sahin DY, Elbasan Z, Tanboğa Hİ, Cayli M. High-sensitivity cardiac troponin T levels in newly diagnosed hypertensive patients with different left ventricle geometry. Blood Press 2013; 23:240-7. [PMID: 24059745 DOI: 10.3109/08037051.2013.840429] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The high-sensitivity cardiac troponin T (hs-cTnT) assay provides important prognostic information on cardiovascular diseases. Although hs-cTnT is associated with left ventricle (LV) hypertrophy (LVH), it has not been investigated in different LV geometric patterns incorporating normal LV structure and concentric remodeling in addition to LVH. OBJECTIVES We aimed to investigate the possible association between hs-cTnT and LV geometric patterns in newly diagnosed hypertensive patients. METHODS We studied 306 patients with newly diagnosed hypertension (HT; mean age 51.7 ± 5.6 years) and 44 healthy control subjects (mean age 51.3 ± 4.7 years). Echocardiographic examination was performed in all subjects. Four different geometric patterns were determined in hypertensive patients according to LV mass index (LVMI) and relative wall thickness (RWth). hs-cTnT and other biochemical markers were measured in all participants. RESULTS The highest hs-cTnT values were observed in the concentric hypertrophy group compared with the control, normal geometry, concentric remodeling and eccentric hypertrophy groups (p < 0.05, for all). Also, hs-cTnT values of the eccentric hypertrophy group were higher than the control, normal geometry and concentric remodeling groups (p < 0.05, for all). Multivariate regression analysis showed that hs-cTnT was independently associated with LV geometry (β = 0.326, p = 0.001) as well as LVMI (β = 0.228, p = 0.010) and creatinine level β = 0.132, p = 0.012). CONCLUSION hs-cTnT level is related not only to LVH but also to LV geometry in hypertensive patients. hs-cTnT levels may mediate poorer LV geometric patterns in hypertensive patients.
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Affiliation(s)
- Hakan Uçar
- Adana Numune Training and Research Hospital, Department of Cardiology , Adana , Turkey
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Xu RY, Zhu XF, Yang Y, Ye P. High-sensitive cardiac troponin T. J Geriatr Cardiol 2013; 10:102-9. [PMID: 23610580 PMCID: PMC3627711 DOI: 10.3969/j.issn.1671-5411.2013.01.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 01/31/2013] [Accepted: 02/26/2013] [Indexed: 11/18/2022] Open
Abstract
Cardiac troponin is the preferred biomarker for the diagnosis of acute myocardial infarction (AMI). The recent development of a high-sensitive cardiac troponin T (hs-cTnT) assay permits detection of very low levels of cTnT. Using the hs-cTnT assay improves the overall diagnostic accuracy in patients with suspected AMI, while a negative result also has a high negative predictive value. The gain in sensitivity may be particularly important in patients with a short duration from symptom onset to admission. Measurement of cardiac troponin T with the hs-cTnT assay may provide strong prognostic information in patients with acute coronary syndromes, stable coronary artery disease, heart failure and even in the general population; however, increased sensitivity comes at a cost of decreased specificity. Serial testing, as well as clinical context and co-existing diseases, are likely to become increasingly important for the interpretation of hs-cTnT assay results.
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Affiliation(s)
- Ru-Yi Xu
- Department of Geriatric Cardiology, Navy General Hospital, No.6, Fucheng Road, Beijing 100048, China
| | - Xiao-Fa Zhu
- Department of Geriatric Cardiology, Navy General Hospital, No.6, Fucheng Road, Beijing 100048, China
| | - Ye Yang
- Department of Geriatric Cardiology, Navy General Hospital, No.6, Fucheng Road, Beijing 100048, China
| | - Ping Ye
- Department of Geriatric Cardiology, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing 100853, China
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Choi HS, Kim KH, Yoon HJ, Hong YJ, Kim JH, Ahn Y, Jeong MH, Cho JG, Park JC, Kang JC. Usefulness of cardiac biomarkers in the prediction of right ventricular dysfunction before echocardiography in acute pulmonary embolism. J Cardiol 2012; 60:508-13. [DOI: 10.1016/j.jjcc.2012.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 06/27/2012] [Accepted: 06/30/2012] [Indexed: 11/29/2022]
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Sato Y, Fujiwara H, Takatsu Y. Cardiac troponin and heart failure in the era of high-sensitivity assays. J Cardiol 2012; 60:160-7. [PMID: 22867801 DOI: 10.1016/j.jjcc.2012.06.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 06/06/2012] [Accepted: 06/06/2012] [Indexed: 10/28/2022]
Abstract
The Joint European Society of Cardiology-American College of Cardiology Foundation-American Heart Association-World Heart Federation Task Force for the Redefinition of Myocardial Infarction recommends cardiac troponin (cTn)-T as a first-line biomarker, and suggests the use of the 99th percentile of a reference population with acceptable precision (i.e. a coefficient of variance≤10%) as a cut-off for the diagnosis of acute myocardial infarction. Recently developed troponin assays fulfill this analytical precision. While conventional cTnT assays have often been used as a positive or negative categorical variable, stepwise rises in high sensitivity (Hs)-cTnT in patients presenting with chronic heart failure (HF) have been associated with a progressive increase in the incidence of cardiovascular events. Similar observations have been made in the general population. Hs-cTnT at baseline and during follow-up is a powerful predictor of cardiac events in patients with HF and in the general population. Whether it is the ideal biomarker remains to be confirmed, however. We review the potential contributions of TnT assays in the assessment of risk of HF, in HF, and in myocardial diseases that cause HF.
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Affiliation(s)
- Yukihito Sato
- Department of Cardiovascular Medicine, Hyogo Prefecture Amagasaki Hospital, Hyogo, Japan.
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Vasikaran SD, Macdonald SPJ, Sikaris KA. High-sensitivity cardiac troponin assays for risk stratification and for the diagnosis of acute myocardial infarction. Ann Clin Biochem 2012; 49:209-10. [DOI: 10.1258/acb.2012.012058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Samuel D Vasikaran
- Department of Core Clinical Pathology and Biochemistry, PathWest – Royal Perth Hospital, Perth, WA 6000
| | - Stephen P J Macdonald
- Emergency Medicine, University of Western Australia, Armadale Health Service, Armadale, WA 6112
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Relationships among hyperuricemia, endothelial dysfunction and cardiovascular disease: molecular mechanisms and clinical implications. J Cardiol 2012; 59:235-42. [PMID: 22398104 DOI: 10.1016/j.jjcc.2012.01.013] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 01/17/2012] [Accepted: 01/20/2012] [Indexed: 12/22/2022]
Abstract
Uric acid is the end product of purine metabolism. Its immediate precursor, xanthine, is converted to uric acid by an enzymatic reaction involving xanthine oxidoreductase. Uric acid has been formerly considered a major antioxidant in human plasma with possible beneficial anti-atherosclerotic effects. In contrast, studies in the past two decades have reported associations between elevated serum uric acid levels and cardiovascular events, suggesting a potential role for uric acid as a risk factor for atherosclerosis and related diseases. In this paper, the molecular pattern of uric acid formation, its possible deleterious effects, as well as the involvement of xanthine oxidoreductase in reactive oxygen species generation are critically discussed. Reactive oxygen species contribute to vascular oxidative stress and endothelial dysfunction, which are associated with the risk of atherosclerosis. Recent studies have renewed attention to the xanthine oxidoreductase system, since xanthine oxidoreductase inhibitors, such as allopurinol and oxypurinol, would be capable of preventing atherosclerosis progression by reducing endothelial dysfunction. Also, beneficial effects could be obtained in patients with congestive heart failure. The simultaneous reduction in uric acid levels might contribute to these effects, or be a mere epiphenomenon of the drug action. The molecular mechanisms involved are discussed.
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Highly sensitive cardiac troponin T in heart failure: Comparison with echocardiographic parameters and natriuretic peptides. J Cardiol 2012; 59:202-8. [DOI: 10.1016/j.jjcc.2011.11.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 11/23/2011] [Accepted: 11/30/2011] [Indexed: 11/20/2022]
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Sato Y, Fujiwara H, Takatsu Y. Biochemical markers in heart failure. J Cardiol 2012; 59:1-7. [DOI: 10.1016/j.jjcc.2011.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 11/14/2011] [Indexed: 12/31/2022]
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