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De Vita A, Bruno I, Baroni S, Moretti G, Tempestini F, Telesca A, Tremamunno S, Felici T, Verrillo A, Tempesta V, Feudo V, Lamendola P, Liuzzo G, Crea F, Giordano A, Lanza GA. Relation between high-sensitivity troponin I serum levels and myocardial ischemia in patients with suspected chronic coronary syndrome: The RESET-MI study. Eur J Intern Med 2024; 123:107-113. [PMID: 38000920 DOI: 10.1016/j.ejim.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Previous studies showed that exercise may increase cardiac troponin serum levels; whether the occurrence of myocardial ischemia influences the changes of exercise-induced troponin raise, however, remains debatable. METHODS We prospectively enrolled consecutive patients undergoing for the first time an elective stress myocardial perfusion scintigraphy (MPS) because of clinical suspicion of obstructive coronary artery disease (CAD). Patients were divided into 3 groups based on the evidence and degree of stress-induced myocardial ischemia at MPS: 1) group 1, no myocardial ischemia (≤4 %); 2) group 2, mild myocardial ischemia (5-10 %); 3) group 3, moderate-to-severe myocardial ischemia (≥10 %). High-sensitivity cardiac troponin I (cTnI) was measured immediately before (T0) and 1 hour (T1) and 4 h (T2) after the stress test. RESULTS One hundred-seven patients (71 males; age 65.6 ± 9.4 years) were enrolled in the study. Serum hs-cTnI concentrations (logarithmic values) significantly increased after MPS, compared to baseline, in the whole population, from 1.47±1.26 ng/L at T0, to 1.68±1.12 ng/L at T1 (p<0.001) and 2.15±1.02 ng/L at T2 (p<0.001 vs. both T0 and T1). The increase in hs-cTnI did not significantly differ between the 3 groups (p = 0.44). The heart rate achieved during the test was the strongest determinant of cTnI increase (p < 0.001) after the stress test. CONCLUSIONS In patients with suspected CAD, stress MPS induces an increase of cTnI that is independent of the induction and extension/severity of myocardial ischemia and is mainly related to myocardial work, as indicated by the heart rate achieved during the test.
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Affiliation(s)
- Antonio De Vita
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8 - 00168, Rome, Italy; Department of Cardiovascular and Pneumologic Sciences, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Isabella Bruno
- Department of diagnostic imaging, oncological radiotherapy and hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Baroni
- Department of laboratory and infectious disease, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Moretti
- Department of laboratory and infectious disease, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Tempestini
- Department of Cardiovascular and Pneumologic Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessandro Telesca
- Department of Cardiovascular and Pneumologic Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Saverio Tremamunno
- Department of Cardiovascular and Pneumologic Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Tamara Felici
- Department of Cardiovascular and Pneumologic Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alfonso Verrillo
- Department of diagnostic imaging, oncological radiotherapy and hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valeria Tempesta
- Department of diagnostic imaging, oncological radiotherapy and hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vanessa Feudo
- Department of diagnostic imaging, oncological radiotherapy and hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Priscilla Lamendola
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8 - 00168, Rome, Italy
| | - Giovanna Liuzzo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8 - 00168, Rome, Italy; Department of Cardiovascular and Pneumologic Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8 - 00168, Rome, Italy; Department of Cardiovascular and Pneumologic Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessandro Giordano
- Department of diagnostic imaging, oncological radiotherapy and hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of diagnostic imaging, oncological radiotherapy and hematology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gaetano Antonio Lanza
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8 - 00168, Rome, Italy; Department of Cardiovascular and Pneumologic Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
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Bollen Pinto B, Ackland GL. Pathophysiological mechanisms underlying increased circulating cardiac troponin in noncardiac surgery: a narrative review. Br J Anaesth 2024; 132:653-666. [PMID: 38262855 DOI: 10.1016/j.bja.2023.12.017] [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] [Received: 06/12/2023] [Revised: 11/23/2023] [Accepted: 12/15/2023] [Indexed: 01/25/2024] Open
Abstract
Assay-specific increases in circulating cardiac troponin are observed in 20-40% of patients after noncardiac surgery, depending on patient age, type of surgery, and comorbidities. Increased cardiac troponin is consistently associated with excess morbidity and mortality after noncardiac surgery. Despite these findings, the underlying mechanisms are unclear. The majority of interventional trials have been designed on the premise that ischaemic cardiac disease drives elevated perioperative cardiac troponin concentrations. We consider data showing that elevated circulating cardiac troponin after surgery could be a nonspecific marker of cardiomyocyte stress. Elevated concentrations of circulating cardiac troponin could reflect coordinated pathological processes underpinning organ injury that are not necessarily caused by ischaemia. Laboratory studies suggest that matching of coronary artery autoregulation and myocardial perfusion-contraction coupling limit the impact of systemic haemodynamic changes in the myocardium, and that type 2 ischaemia might not be the likeliest explanation for cardiac troponin elevation in noncardiac surgery. The perioperative period triggers multiple pathological mechanisms that might cause cardiac troponin to cross the sarcolemma. A two-hit model involving two or more triggers including systemic inflammation, haemodynamic strain, adrenergic stress, and autonomic dysfunction might exacerbate or initiate acute myocardial injury directly in the absence of cell death. Consideration of these diverse mechanisms is pivotal for the design and interpretation of interventional perioperative trials.
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Affiliation(s)
- Bernardo Bollen Pinto
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
| | - Gareth L Ackland
- Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK
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Abstract
Rapid and accurate triage of patients presenting with chest pain to an emergency department (ED) is critical to prevent ED overcrowding and unnecessary resource use in individuals at low risk of acute myocardial infarction (AMI) and to efficiently and effectively guide patients at high risk to definite therapy. The use of biomarkers for rule-out or rule-in of suspected AMI has evolved substantially over the last several decades. Previously well-established biomarkers have been replaced by cardiac troponin (cTn). High-sensitivity cTn (hs-cTn) assays represent the newest generation of cTn assays and offer tremendous advantages, including improved sensitivity and precision. Still, implementation of these assays in the United States lags behind several other areas of the world. Within this educational review, we discuss the evolution of biomarker testing for detection of myocardial injury, address the specifics of hs-cTn assays and their recommended use within triage algorithms, and highlight potential challenges in their use. Ultimately, we focus on implementation strategies for hs-cTn assays, as they are now clearly ready for prime time.
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Affiliation(s)
| | - L Kristin Newby
- Duke Clinical Research Institute, Durham, North Carolina, USA; ,
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Giers J, Bartel A, Kirsch K, Müller SF, Horstmann S, Gehlen H. Blood-Based Markers for Skeletal and Cardiac Muscle Function in Eventing Horses before and after Cross-Country Rides and How They Are Influenced by Plasma Volume Shift. Animals (Basel) 2023; 13:3110. [PMID: 37835716 PMCID: PMC10572052 DOI: 10.3390/ani13193110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Horses competing in cross-country tests are subjected to high physical demands. Within the scope of this prospective longitudinal study, blood values of 20 elite eventing horses were examined before and after two- to four-star cross-country rides. The aim was to find out whether blood-based markers for skeletal muscle and cardiac muscle function change after cross-country exercise. Parameters that provide information about fluid balance, muscle enzymes, metabolites and cardiac muscle-specific markers were investigated. We developed an approach to eliminate the concentration changes caused by reduced plasma volume. Parameters were measured pre, 10 and 30 min post exercise and the next morning and were evaluated using a mixed model. Thirty minutes after exercise, most parameter concentrations changed in an exercise-dependent manner. The next morning, most exercise-related markers recovered rapidly, while creatine kinase (CK) (26% increase; p = 0.008) and lactate dehydrogenase (LDH) (15% increase; p < 0.001) showed a declining but sustained increase. Cardiac troponin I (cTnI) increased above the reference range in 40 of the 55 rides (73%) and in 18 of 20 horses in the morning after exercise.
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Affiliation(s)
- Johanna Giers
- Equine Clinic, Internal Medicine, Freie Universität Berlin, Oertzenweg 19b, 14193 Berlin, Germany
| | - Alexander Bartel
- Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Königsweg 67, 14163 Berlin, Germany;
| | - Katharina Kirsch
- Department Sensors and Modeling, Leibniz Institute for Agricultural Engineering and Bioeconomy (ATB), Max-Eyth Allee 100, 14469 Potsdam, Germany;
| | - Simon Franz Müller
- Laboklin Veterinary Laboratory Diagnostics, Steubenstrasse 4, 97688 Bad Kissingen, Germany;
| | - Stephanie Horstmann
- German Olympic Committee for Equestrian Sports (DOKR), Freiherr-von-Langen-Straße 15, 48231 Warendorf, Germany;
| | - Heidrun Gehlen
- Equine Clinic, Internal Medicine, Freie Universität Berlin, Oertzenweg 19b, 14193 Berlin, Germany
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Selvin E, Wang D, Tang O, Fang M, Christenson RH, McEvoy JW. Elevated Cardiac Biomarkers, Erectile Dysfunction, and Mortality in U.S. Men: NHANES 2001 to 2004. JACC. ADVANCES 2023; 2:100380. [PMID: 37427147 PMCID: PMC10328217 DOI: 10.1016/j.jacadv.2023.100380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/17/2023] [Accepted: 03/06/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND The prevalence of elevated cardiac biomarkers and their link to mortality in men with erectile dysfunction in the U.S. population are unknown. OBJECTIVES The purpose of this study was to evaluate the prevalence of elevations in N-terminal prohormone B-type natriuretic peptide, high sensitivity troponin (hs-troponin) T, and 3 hs-troponin I assays and their associations with mortality in U.S. men with and without erectile dysfunction. METHODS We conducted cross-sectional analyses using logistic regression to examine associations of elevated cardiac biomarkers (>90th percentile) with erectile dysfunction in 2,971 male participants aged 20 years or older in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2004. We conducted prospective analyses using Cox regression to examine the mortality implications of elevations in cardiac biomarkers in the setting of erectile dysfunction. RESULTS Elevations in hs-troponin T and the 3 hs-troponin I assays were associated with erectile dysfunction, with the strongest association for hs-troponin T (adjusted OR: 2.01; 95% CI: 1.22-3.30). Elevated N-terminal prohormone B-type natriuretic peptide was not significantly associated with erectile dysfunction (OR: 1.22; 95% CI: 0.74-2.03). There were 673 deaths during a median of 16 years of follow-up. Men with erectile dysfunction were at an elevated risk of death (adjusted HR: 1.23; 95% CI: 1.04-1.46). Those men with elevated cardiac biomarkers in the setting of erectile dysfunction were at highest risk of all-cause and cardiovascular mortality (adjusted HRs ranging from ~1.5 to 2.4). CONCLUSIONS In this national study, the association of erectile dysfunction with elevated hs-troponin and excess mortality risk suggests that men with erectile dysfunction should be evaluated and targeted for intensive cardiovascular risk management.
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Affiliation(s)
- Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dan Wang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Olive Tang
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael Fang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert H. Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - John W. McEvoy
- Division of Cardiology & National Institute for Prevention & Cardiovascular Health, National University of Ireland, Galway, Ireland
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Elevated troponin I levels on admission predict long-term mortality in patients with acute cerebral infarction following thrombolysis. Neurol Sci 2022; 43:5431-5439. [PMID: 35579823 PMCID: PMC9385800 DOI: 10.1007/s10072-022-06116-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/30/2022] [Indexed: 11/27/2022]
Abstract
Background/objective Cardiac diseases are frequently accompanied by elevated levels of biomarkers, among which, troponin is commonly investigated. The levels of plasma cardiac troponin I (cTnI), which has been shown to predict short-term mortality, are elevated in patients with acute cerebral infarction (ACI). However, few studies have assessed the association between cTnI concentration and long-term mortality in patients with ACI following thrombolysis. Methods Patients with ACI admitted between January 1, 2014, and December 31, 2016, were registered. Data on demographics and outcomes with elevated cTnI levels were also collected. Results A total of 145 patients with ACI were recruited; 97 (66%), 30 (20%), and 18 (12%) patients had cTnI concentrations < 0.030 (group 1), 0.030–0.10 (group 2), and > 0.10 μg/L (group 3), respectively. cTnI elevation was associated with older age, atrial fibrillation, congestive heart failure, renal insufficiency, coronary artery disease, stroke severity (National Institutes of Health Stroke Scale score), and prior smoking history at admission. After adjusting for comorbidities and severity at 3 months after ACI, cTnI elevation on admission was significantly associated with ascending 5-year mortality (hazard ratio, 1.80; 95% confidence interval, 1.22–2.65). Conclusions Even after adjusting for several possible confounders, cTnI elevation in patients with ACI treated with rt-PA was associated with a 1.80-fold increased risk of 5-year mortality.
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Medilek K, Zaloudkova L, Borg A, Brozova L, Stasek J. Myocardial injury in stress echocardiography: Comparison of dobutamine, dipyridamole and dynamic stressors-single center study. Echocardiography 2022; 39:1171-1179. [PMID: 35950564 DOI: 10.1111/echo.15411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/18/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES In stress echocardiography (SE), dipyridamole (DIP) and dynamic stress (ExSE) are reported as being safer than dobutamine stress echocardiography (DSE). We investigated whether these commonly used stressors cause myocardial injury, measured by high sensitivity troponin T (hsTnT). METHODS One hundred and thirty five patients (DSE n = 46, ExsE n = 46, DIP n = 43) with negative result of SE were studied. The exclusion criteria were known ischaemic heart disease (IHD), baseline wall motion abnormalities, left ventricle systolic dysfunction/regional wall motion abnormalities, septum/posterior wall ≥13 mm, diabetes/pre-diabetes, baseline hsTnT level ≥14 ng/L, baseline blood pressure ≥160/100 mmHg, peak pulmonary pressure ≥45mmHg, eGFR <1ml/s/1.73m2 , more than mild to moderate valvular disease and dobutamine side effects. HsTnT was measured before and 180 minutes after the test. RESULTS All patients had low pre-test probabilities of having obstructive IHD. HsTnT increased in DSE, less so in ExSE, and was unchanged in the DIP group (∆hsTnT 9.4 [1.5-58.6], 1.1 [-0.9-15.7], -0.1 [-1.4-2.1] ng/L, respectively, p<0.001). In DSE, the ∆hsTnT was associated with peak dobutamine dose (r = 0.30, p = 0.045), test length (r = 0.43, p = 0.003) and atropine use (p<0.001). In ExSE, the hsTnT increase was more likely in females (p = 0.012) and the elderly (>65 years) (r = 0.32, p = 0.03); no association was found between atropine use (p = 0.786) or test length and ∆hsTnT (r = 0.10, p = 0.530). CONCLUSIONS DSE is associated with myocardial injury in patients with negative SE, no injury was observed in DIP and only mild case in ExSE. Whether myocardial injury is causative of the higher reported adverse event rates in DSE remains to be determined.
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Affiliation(s)
- Karel Medilek
- Department of Cardio-Angiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.,Faculty of Medicine Hradec Kralove, Charles University Prague, Hradec Kralove, Czech Republic
| | - Lenka Zaloudkova
- Department of Clinical Biochemistry, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Alexander Borg
- Department of Cardiology, Mater Dei Hospital, Triq Dun Karm, L-Imsida MSD, Malta.,University of Malta, Msida MSD, Malta
| | - Lucie Brozova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Josef Stasek
- Department of Cardio-Angiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.,Faculty of Medicine Hradec Kralove, Charles University Prague, Hradec Kralove, Czech Republic
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Lidgard B, Zelnick LR, Go A, O'Brien KD, Bansal N. Framingham and American College of Cardiology/American Heart Association Pooled Cohort Equations, High-Sensitivity Troponin T, and N-Terminal Pro-Brain-Type Natriuretic Peptide for Predicting Atherosclerotic Cardiovascular Events Across the Spectrum of Kidney Dysfunction. J Am Heart Assoc 2022; 11:e024913. [PMID: 35621223 PMCID: PMC9238746 DOI: 10.1161/jaha.121.024913] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Contemporary guidelines recommend using atherosclerotic cardiovascular disease screening tools to guide primary prevention. The performance of these scores is not well known in patients with moderate to advanced chronic kidney disease, particularly in combination with clinically available cardiac biomarkers including N‐terminal pro–brain‐type natriuretic peptide and high‐sensitivity troponin T (hsTnT). Methods and Results We studied 1027 participants from the Chronic Renal Insufficiency Cohort without self‐reported atherosclerotic cardiovascular disease who were not taking aspirin or statins at enrollment. Framingham Risk Score, Pooled Cohort Equation, N‐terminal pro–brain‐type natriuretic peptide, and hsTnT were measured at baseline. Outcomes included fatal and nonfatal myocardial infarction, stroke, and cardiac death. We calculated 10‐fold cross‐validated Harrell’s C‐indices for each risk score and cardiac biomarker alone and in combination. The C‐index (95% CI) for discrimination of atherosclerotic cardiovascular disease was 0.72 (0.67, 0.77) for the Framingham Risk Score, and 0.72 (0.67, 0.76) for the Pooled Cohort Equation. HsTnT had comparable discrimination to each risk score, and improved the discrimination of each (change in Framingham 0.029, 95% CI 0.003, 0.055; change in Pooled Cohort Equation 0.027, 95% CI 0.002, 0.052). N‐terminal pro–brain‐type natriuretic peptide had poorer discrimination than the risk scores and did not significantly improve their discrimination (change in Framingham 0.009, 95% CI −0.001, 0.018; change in Pooled Cohort Equation 0.011, 95% CI −0.001, 0.024). Conclusions The Framingham Risk Score and Pooled Cohort Equation demonstrated moderate discrimination for atherosclerotic cardiovascular disease in patients with chronic kidney disease. HsTnT, but not N‐terminal pro–brain‐type natriuretic peptide, improved their discrimination overall. Until chronic kidney disease–specific atherosclerotic cardiovascular disease risk scores can be developed, it may be worth considering how to incorporate hsTnT into existing clinical risk scores.
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Affiliation(s)
| | | | - Alan Go
- Kaiser Permanente Division of ResearchNorthern California Oakland CA
| | | | - Nisha Bansal
- Department of Medicine University of Washington Seattle WA
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Lidgard B, Zelnickv L, Anderson AH, Feldman H, Go A, He J, Kansal M, Mohanty MJ, Mehta R, Shlipak MG, Soliman E, Weir MR, Bansal N. Cardiac Biomarkers and Risk of Atherosclerotic Cardiovascular Disease in Patients with CKD. KIDNEY360 2022; 3:859-871. [PMID: 36128494 PMCID: PMC9438429 DOI: 10.34067/kid.0006222021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/01/2022] [Indexed: 01/12/2023]
Abstract
Background Several cardiac biomarkers of cardiac stress, inflammation, and fibrosis (N-terminal pro brain-type natriuretic peptide [NT-proBNP], high-sensitivity troponin T [hsTnT], growth differentiation factor 15 [GDF-15], and soluble ST2 [sST2]) have been associated with atherosclerotic disease in the general population. We hypothesized that these cardiac biomarkers may also be associated with the atherosclerotic cardiovascular disease in patients with CKD. Methods We analyzed levels of NT-proBNP, hsTnT, GDF-15, and sST2 in a cohort of 2732 participants with mild to moderate CKD from the Chronic Renal Insufficiency Cohort (CRIC) study. Outcomes included incident atherosclerotic disease, defined as the first instance of myocardial infarction, stroke, or peripheral vascular disease. We used Cox proportional hazard models to the test the association of each cardiac biomarker with risk of incident atherosclerotic disease, adjusting for multiple possible confounders. Results When modeled continuously (per SD increase in the log-transformed biomarker), NT-proBNP, hsTnT, GDF-15, and sST2 were significantly associated with incident atherosclerotic disease after adjustment for multiple potential confounders: (NT-proBNP HR, 1.51; 95% CI, 1.27 to 1.81; hsTnT HR, 1.61; 95% CI, 1.38 to 1.89; GDF-15 HR, 1.44; 95% CI, 1.19 to 1.73; and sST2 HR, 1.19; 95% CI, 1.04 to 1.36). Conclusions NT-proBNP, hsTnT, GDF-15, and sST2 were significantly associated with incident atherosclerotic cardiovascular disease in patients with CKD. These associations may highlight important mechanisms for the development of atherosclerotic disease in CKD.
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Affiliation(s)
- Benjamin Lidgard
- Division of Nephrology, University of Washington, Seattle, Washington
| | - Leila Zelnickv
- Division of Nephrology, University of Washington, Seattle, Washington
| | | | - Harold Feldman
- CRIC Scientific and Data Coordinating Center, University of PennsylvaniaPhiladelphia, Pennsylvania
| | - Alan Go
- Kaiser Permanente Division of Research, Northern California, Oakland, California
| | - Jiang He
- Department of Epidemiology, Tulane University, New Orleans, Louisiana
| | - Mayank Kansal
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | | | - Rupal Mehta
- Division of Nephrology, Northwestern University, Chicago, Illinois
| | - Michael G. Shlipak
- Division of Nephrology, University of California, San Francisco, San Francisco, California
| | - Elsayed Soliman
- Department of Medicine, Wake Health, Winston-Salem, North Carolina
| | - Matt R. Weir
- Division of Nephrology, University of Maryland, College Park, Maryland
| | - Nisha Bansal
- Division of Nephrology, University of Washington, Seattle, Washington
| | - the CRIC Study Investigators*
- Division of Nephrology, University of Washington, Seattle, Washington
- Department of Epidemiology, Tulane University, New Orleans, Louisiana
- CRIC Scientific and Data Coordinating Center, University of PennsylvaniaPhiladelphia, Pennsylvania
- Kaiser Permanente Division of Research, Northern California, Oakland, California
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
- Division of Nephrology, Wayne State University, Detroit, Michigan
- Division of Nephrology, Northwestern University, Chicago, Illinois
- Division of Nephrology, University of California, San Francisco, San Francisco, California
- Department of Medicine, Wake Health, Winston-Salem, North Carolina
- Division of Nephrology, University of Maryland, College Park, Maryland
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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: 18] [Impact Index Per Article: 9.0] [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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11
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Canty JM. Myocardial Injury, Troponin Release and Cardiomyocyte Death in Brief Ischemia, Failure and Ventricular Remodeling. Am J Physiol Heart Circ Physiol 2022; 323:H1-H15. [PMID: 35559722 DOI: 10.1152/ajpheart.00093.2022] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Troponin released from irreversibly injured myocytes is the gold standard biomarker for the rapid identification of an acute coronary syndrome. In acute myocardial infarction, necrotic cell death is characterized by sarcolemmal disruption in response to a critical level of energy depletion after more than 15-minutes of ischemia. While troponin I and T are highly specific for cardiomyocyte death, high-sensitivity assays have demonstrated that measurable circulating levels of troponin are present in the majority of normal subjects. In addition, transient as well as chronic elevations have been demonstrated in many disease states not clearly associated with myocardial ischemia. The latter observations have given rise to the clinical concept of myocardial injury. This review will summarize evidence supporting the notion that circulating troponin levels parallel the extent of myocyte apoptosis in normal ventricular remodeling and in pathophysiological conditions not associated with infarction or necrosis. It will review the evidence that myocyte apoptosis can be accelerated by both diastolic strain from elevated ventricular preload as well as systolic strain from dyskinesis after brief episodes of ischemia too short to cause a critical level of myocyte energy depletion. We then show how chronic, low rates of myocyte apoptosis from endogenous myocyte turnover, repetitive ischemia or repetitive elevations in LV diastolic pressure can lead to significant myocyte loss in the absence of neurohormonal stimulation. Finally, we posit that the differential response to strain-induced injury in heart failure may determine whether progressive myocyte loss and HFrEF or interstitial fibrosis and HFpEF become the heart failure phenotype.
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Affiliation(s)
- John M Canty
- VA WNY Health Care System, the Departments of Medicine, Physiology & Biophysics, Biomedical Engineering and The Clinical and Translational Research Center of the University at Buffalo, Buffalo, NY, United States
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12
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Tveit SH, Myhre PL, Hanssen TA, Forsdahl SH, Iqbal A, Omland T, Schirmer H. Cardiac troponin I and T for ruling out coronary artery disease in suspected chronic coronary syndrome. Sci Rep 2022; 12:945. [PMID: 35042885 PMCID: PMC8766564 DOI: 10.1038/s41598-022-04850-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/17/2021] [Indexed: 01/20/2023] Open
Abstract
To compare the performance of high-sensitivity cardiac troponin I and T (hs-cTnI; hs-cTnT) in diagnosing obstructive coronary artery disease (CAD50) in patients with suspected chronic coronary syndrome (CCS). A total of 706 patients with suspected CCS, referred for Coronary Computed Tomography Angiography, were included. cTn concentrations were measured using the Singulex hs-cTnI (limit of detection [LoD] 0.08 ng/L) and Roche hs-cTnT (LoD 3 ng/L) assays. Obstructive coronary artery disease (CAD50) was defined as ≥ 50% coronary stenosis. Cardiovascular risk was determined by the NORRISK2-score. Median age of the patients was 65 (range 28-87) years, 35% were women. All patients had hs-cTnI concentrations above the LoD (median 1.9 [Q1-3 1.2-3.6] ng/L), 72% had hs-cTnT above the LoD (median 5 [Q1-3 2-11] ng/L). There was a graded relationship between hs-cTn concentrations and coronary artery calcium. Only hs-cTnI remained associated with CAD50 in adjusted analyses (OR 1.20 95% Confidence Interval [1.05-1.38]), p = 0.009). The C-statistics for hs-cTnI and hs-cTnT were 0.65 (95% CI [0.60-0.69]) and 0.60 (0.56-0.64). The highest specificity and negative predictive values for CAD50 were in the lowest NORRISK2-tertile. hs-cTn concentrations provide diagnostic information in patients with suspected CCS, with superior performance of hs-cTnI compared to hs-cTnT in regard to CAD50. The diagnostic performance appeared best in those with low cardiovascular risk.
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Affiliation(s)
- Sjur H Tveit
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Peder L Myhre
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tove Aminda Hanssen
- Department of Health and Care Science, UiT - The Arctic University of Norway, Tromsø, Norway.,Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | | | - Amjid Iqbal
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Henrik Schirmer
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
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13
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Hansen CH, Cwikiel J, Bratseth V, Arnesen H, Flaa A, Seljeflot I. Effect of Revascularization on Exercise-Induced Changes in Cardiac and Prothrombotic Biomarkers in Patients with Coronary Artery Disease. Clin Appl Thromb Hemost 2022; 28:10760296221094029. [PMID: 35437054 PMCID: PMC9021467 DOI: 10.1177/10760296221094029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We examined whether resting levels and exercise-induced changes during exercise ECG stress test (EST) of cardiac Troponin T (cTnT), NT-proBNP and prothrombotic markers were affected by revascularization in patients with coronary artery disease (CAD). EST1 was performed before coronary angiography and revascularization, and patients (n = 20) with confirmed CAD, performed another EST (EST2) 9 weeks later. Blood samples were drawn at rest and within five min after termination of ESTs. cTnT and NT-proBNP increased during exercise at both ESTs (p < 0.001, all). Resting cTnT levels at EST2 versus EST1 were significantly higher (p = 0.02) whereas NT-proBNP did not differ. At both visits, increased D-dimer (p = 0.008 and <0.001), pro-thrombin fragment 1 + 2 (p = 0.009 and 0.001) and tissue factor pathway inhibitor (TFPI) (p < 0.001 and 0.001) during exercise were demonstrated. Resting levels of endogenous thrombin potential (ETP) and TFPI were reduced at EST2 versus EST1 (p < 0.01). Revascularization did not affect exercise-induced release of cardiac and prothrombotic biomarkers and did not reduce resting levels of cTnT or NT-proBNP, suggesting revascularization per se not to prevent secretion of biomarkers. The lower resting levels of ETP and TFPI after revascularization may however, be indicative of reduced thrombin generation and endothelial activation. Clinicaltrials.gov, CADENCE, NCT01495091 https://clinicaltrials.gov/ct2/show/NCT01495091?term = 01495091&draw = 2&rank = 1.
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Affiliation(s)
- C H Hansen
- Center for Clinical Heart Research, 60504Oslo University Hospital, Ullevaal, Norway.,Department of Cardiology, 155272Oslo University Hospital, Ullevaal, Norway
| | - J Cwikiel
- Center for Clinical Heart Research, 60504Oslo University Hospital, Ullevaal, Norway
| | - V Bratseth
- Center for Clinical Heart Research, 60504Oslo University Hospital, Ullevaal, Norway.,Department of Cardiology, 155272Oslo University Hospital, Ullevaal, Norway
| | - H Arnesen
- Center for Clinical Heart Research, 60504Oslo University Hospital, Ullevaal, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - A Flaa
- Department of Cardiology, 155272Oslo University Hospital, Ullevaal, Norway
| | - I Seljeflot
- Center for Clinical Heart Research, 60504Oslo University Hospital, Ullevaal, Norway.,Department of Cardiology, 155272Oslo University Hospital, Ullevaal, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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14
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Cullen L, Greenslade J, Parsonage W. Chest Pain Assessment: What Is Our Endgame? Clin Chem 2021; 68:261-263. [PMID: 34919650 DOI: 10.1093/clinchem/hvab246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Louise Cullen
- Royal Brisbane and Women's Hospital, Herston, Australia.,PROV-ED, Clinical Excellence Queensland, Queensland Health, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Jaimi Greenslade
- Royal Brisbane and Women's Hospital, Herston, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - William Parsonage
- Royal Brisbane and Women's Hospital, Herston, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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15
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Aengevaeren VL, Baggish AL, Chung EH, George K, Kleiven Ø, Mingels AMA, Ørn S, Shave RE, Thompson PD, Eijsvogels TMH. Exercise-Induced Cardiac Troponin Elevations: From Underlying Mechanisms to Clinical Relevance. Circulation 2021; 144:1955-1972. [PMID: 34898243 PMCID: PMC8663527 DOI: 10.1161/circulationaha.121.056208] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Serological assessment of cardiac troponins (cTn) is the gold standard to assess myocardial injury in clinical practice. A greater magnitude of acutely or chronically elevated cTn concentrations is associated with lower event-free survival in patients and the general population. Exercise training is known to improve cardiovascular function and promote longevity, but exercise can produce an acute rise in cTn concentrations, which may exceed the upper reference limit in a substantial number of individuals. Whether exercise-induced cTn elevations are attributable to a physiological or pathological response and if they are clinically relevant has been debated for decades. Thus far, exercise-induced cTn elevations have been viewed as the only benign form of cTn elevations. However, recent studies report intriguing findings that shed new light on the underlying mechanisms and clinical relevance of exercise-induced cTn elevations. We will review the biochemical characteristics of cTn assays, key factors determining the magnitude of postexercise cTn concentrations, the release kinetics, underlying mechanisms causing and contributing to exercise-induced cTn release, and the clinical relevance of exercise-induced cTn elevations. We will also explain the association with cardiac function, correlates with (subclinical) cardiovascular diseases and exercise-induced cTn elevations predictive value for future cardiovascular events. Last, we will provide recommendations for interpretation of these findings and provide direction for future research in this field.
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Affiliation(s)
- Vincent L Aengevaeren
- Radboud Institute for Health Sciences, Departments of Physiology (V.L.A., T.M.H.E.), Radboud University Medical Center, Nijmegen, The Netherlands.,Cardiology (V.L.A.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston (A.L.B.)
| | - Eugene H Chung
- Michigan Medicine, University of Michigan, Ann Arbor (E.H.C.)
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (K.G.)
| | - Øyunn Kleiven
- Cardiology Department, Stavanger University Hospital, Norway (Ø.K., S.Ø.)
| | - Alma M A Mingels
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center Maastricht, The Netherlands (A.M.A.M.)
| | - Stein Ørn
- Cardiology Department, Stavanger University Hospital, Norway (Ø.K., S.Ø.).,Department of Electrical Engineering and Computer Science, University of Stavanger, Norway (S.Ø.)
| | - Rob E Shave
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Vancouver, Canada (R.E.S.)
| | | | - Thijs M H Eijsvogels
- Radboud Institute for Health Sciences, Departments of Physiology (V.L.A., T.M.H.E.), Radboud University Medical Center, Nijmegen, The Netherlands
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16
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Muscente F, De Caterina R. New insights from the MESA study: increased high-sensitivity troponins as a cardiovascular risk factor. Eur Heart J Suppl 2021; 23:E68-E72. [PMID: 34650358 PMCID: PMC8503498 DOI: 10.1093/eurheartj/suab092] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The most recent high-sensitivity assays for troponins I and T (hs-TnI and hs-TnT) have made it possible to detect blood concentrations up to 10 times lower than previous assays, making troponins detectable even in asymptomatic subjects without manifest cardiovascular disease. For this reason, hs-Tn, initially introduced as markers of myocardial damage in an acute setting, have also become possible markers of subclinical myocardial damage in baseline conditions. In fact, recent evidence suggests that hs-TnT and hs-TnI predict the risk of future cardiovascular events also in the context of primary prevention, and offer incremental information when added to current risk stratification models. The different association highlighted with different outcome measures, such as coronary heart disease, atherosclerotic cardiovascular disease, heart failure, and death from all causes, seems to indicate that the risk observed in asymptomatic subjects with high levels of hs-Tn is an expression of subclinical damage secondary to multiple pathophysiological mechanisms, and not only to atherothrombosis. However, the ability of hs-TnT and hs-TnI (until now used interchangeably), to provide differential predictive information, and not redundant with respect to more traditional factors, remains to be definitively clarified, both for the purpose of predicting specific outcomes and for the implementation of specific preventive strategies. To date, evidences available allow us to hypothesize their role more as markers than as risk factors.
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Affiliation(s)
- Francesca Muscente
- Ospedale Floraspe-Renzetti, ASL Lanciano-Vasto-Chieti, Vasto, Italy.,Cattedra di Cardiologia, Università degli Studi di Pisa, C/o Azienda Ospedaliero-Universitaria Pisana, Ospedale di Cisanello, Via Paradisa, 2, 56124 Pisa, Italy
| | - Raffaele De Caterina
- Ospedale Floraspe-Renzetti, ASL Lanciano-Vasto-Chieti, Vasto, Italy.,Cattedra di Cardiologia, Università degli Studi di Pisa, C/o Azienda Ospedaliero-Universitaria Pisana, Ospedale di Cisanello, Via Paradisa, 2, 56124 Pisa, Italy
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17
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Elgebaly SA, Christenson RH, Kandil H, Ibrahim M, Rizk H, El-Khazragy N, Rashed L, Yacoub B, Eldeeb H, Ali MM, Kreutzer DL. Nourin-Dependent miR-137 and miR-106b: Novel Biomarkers for Early Diagnosis of Myocardial Ischemia in Coronary Artery Disease Patients. Diagnostics (Basel) 2021; 11:diagnostics11040703. [PMID: 33919942 PMCID: PMC8070915 DOI: 10.3390/diagnostics11040703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 02/08/2023] Open
Abstract
Background: Although cardiovascular imaging techniques are widely used to diagnose myocardial ischemia in patients with suspected stable coronary artery disease (CAD), they have limitations related to lack of specificity, sensitivity and “late” diagnosis. Additionally, the absence of a simple laboratory test that can detect myocardial ischemia in CAD patients, has led to many patients being first diagnosed at the time of the development of myocardial infarction. Nourin is an early blood-based biomarker rapidly released within five minutes by “reversible” ischemic myocardium before progressing to necrosis. Recently, we demonstrated that the Nourin-dependent miR-137 (marker of cell damage) and miR-106b-5p (marker of inflammation) can diagnose myocardial ischemia in patients with unstable angina (UA) and also stratify severity of ischemia, with higher expression in acute ST-segment elevation myocardial infarction (STEMI) patients compared to UA patients. Minimal baseline-gene expression levels of Nourin miRNAs were detected in healthy subjects. Objectives: To determine: (1) whether Nourin miRNAs are elevated in chest pain patients with myocardial ischemia suspected of CAD, who also underwent dobutamine stress echocardiography (DSE) or ECG/Treadmill stress test, and (2) whether the elevated levels of serum Nourin miRNAs correlate with results of ECHO/ECG stress test in diagnosing CAD patients. Methods: Serum gene expression levels of miR-137, miR-106b-5p and their corresponding molecular pathway network were measured blindly in 70 enrolled subjects using quantitative real time PCR (qPCR). Blood samples were collected from: (1) patients with chest pain suspected of myocardial ischemia (n = 38) both immediately “pre-stress test” and “post-stress test” 30 min. after test termination; (2) patients with acute STEMI (n = 16) functioned as our positive control; and (3) healthy volunteers (n = 16) who, also, exercised on ECG/Treadmill stress test for Nourin baseline-gene expression levels. Results: (1) strong correlation was observed between Nourin miRNAs serum expression levels and results obtained from ECHO/ECG stress test in diagnosing myocardial ischemia in CAD patients; (2) positive “post-stress test” patients with CAD diagnosis showed upregulation of miR-137 by 572-fold and miR-106b-5p by 122-fold, when compared to negative “post-stress test” patients (p < 0.001); (3) similarly, positive “pre-stress test” CAD patients showed upregulation of miR-137 by 1198-fold and miR-106b-5p by 114-fold, when compared to negative “pre-stress test” patients (p < 0.001); and (4) healthy subjects had minimal baseline-gene expressions of Nourin miRNAs. Conclusions: Nourin-dependent miR-137 and miR-106b-5p are promising novel blood-based biomarkers for early diagnosis of myocardial ischemia in chest pain patients suspected of CAD in outpatient clinics. Early identification of CAD patients, while patients are in the stable state before progressing to infarction, is key to providing crucial diagnostic steps and therapy to limit adverse cardiac events, improve patients’ health outcome and save lives.
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Affiliation(s)
- Salwa A. Elgebaly
- Research & Development, Nour Heart, Inc., Vienna, VA 22180, USA
- Department of Surgery, UConn Health, School of Medicine, Farmington, CT 06032, USA;
- Correspondence: ; Tel.: +1-860-680-8860
| | - Robert H. Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Hossam Kandil
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (M.I.); (H.R.); (B.Y.); (H.E.); (M.M.A.)
| | - Mohsen Ibrahim
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (M.I.); (H.R.); (B.Y.); (H.E.); (M.M.A.)
| | - Hussien Rizk
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (M.I.); (H.R.); (B.Y.); (H.E.); (M.M.A.)
| | - Nashwa El-Khazragy
- Department of Clinical Pathology-Hematology, Ain Shams Medical Research Institute (MASRI), Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
| | - Laila Rashed
- Department of Biochemistry and Molecular Biology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt;
| | - Beshoy Yacoub
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (M.I.); (H.R.); (B.Y.); (H.E.); (M.M.A.)
| | - Heba Eldeeb
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (M.I.); (H.R.); (B.Y.); (H.E.); (M.M.A.)
| | - Mahmoud M. Ali
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (M.I.); (H.R.); (B.Y.); (H.E.); (M.M.A.)
| | - Donald L. Kreutzer
- Department of Surgery, UConn Health, School of Medicine, Farmington, CT 06032, USA;
- Cell & Molecular Tissue Engineering, LLC, Farmington, CT 06032, USA
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18
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deFilippi CR, Mills NL. Rapid Cardiac Troponin Release After Transient Ischemia: Implications for the Diagnosis of Myocardial Infarction. Circulation 2021; 143:1105-1108. [PMID: 33720770 DOI: 10.1161/circulationaha.120.052649] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Nicholas L Mills
- British Heart Foundation Centre for Cardiovascular Science and Usher Institute, University of Edinburgh, United Kingdom (N.L.M.)
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19
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Rossi TM, Kavsak PA, Maxie MG, Pearl DL, Pyle WG, Physick-Sheard PW. Effect of racing on cardiac troponin I concentration and associations with cardiac rhythm disturbances in Standardbred racehorses. J Vet Cardiol 2021; 35:14-24. [PMID: 33789181 DOI: 10.1016/j.jvc.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/01/2021] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION/OBJECTIVES Accumulating evidence indicates intense exercise can be associated with myocardial damage. Investigating the impact of maximal effort on myocardium and exploring possible association of injury with rhythm disturbance requires a high-sensitivity cardiac troponin assay. The objectives of this study were: (1) to determine the effect of racing on serum cardiac troponin I (cTnI) in Standardbred horses using a high-sensitivity assay; (2) to determine the 99th percentile of cTnI in healthy horses and investigate the effect of demographic variables on cTnI prevailing pre-race in Standardbred horses using a validated high-sensitivity assay and a contemporary assay, and; (3) to explore associations between exercise-associated arrhythmia and cTnI concentration. ANIMALS Racehorses (n = 145). MATERIALS AND METHODS ≤ 2 h pre-race, cTnI concentrations were measured in 158 race starts. Electrocardiogram (ECG) monitoring was applied during racing and race recovery and screened for complex ventricular arrhythmia. Associations between cTnI prevailing before racing concentration, age, sex, and gait were investigated. Demographic and performance variables were evaluated for associations with cTnI concentration post-race and rhythm disturbance. RESULTS Incidence of arrhythmia was 11.6% (16 horses). A significant increase in median (interquartile range) cTnI concentration of 1.36 (0.49-2.81) ng/L was found post-race (p < 0.0001). Serum cardiac troponin I (cTnI) concentration prevailing pre-race was positively associated with increasing age, and gait. Serum cardiac troponin I prevailing post-race was positively associated with concentration prevailing pre-race. Interaction between arrhythmia and finishing distanced revealed horses finishing distanced and experiencing arrhythmia displayed higher cTnI release than with the presence of either alone. CONCLUSIONS Racing increased cTnI concentration. Horses finishing distanced and also exhibiting arrhythmia may be experiencing myocardial compromise.
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Affiliation(s)
- T M Rossi
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, 50 Stone Rd E, Ontario, N1G 2W1, Canada.
| | - P A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, 1280 Main Street West, HSC-2N16, Hamilton, ON, L8S 4K1, Canada
| | - M G Maxie
- Animal Health Laboratory, Laboratory Services Division, University of Guelph, Laboratory Services Division, Building 89, 419 Gordon St., Ontario, N1G 2W1, Canada
| | - D L Pearl
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, 50 Stone Rd E, Ontario, N1G 2W1, Canada
| | - W G Pyle
- Centre for Cardiovascular Research, Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, 50 Stone Rd E, Ontario, N1G 2W1, Canada
| | - P W Physick-Sheard
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, 50 Stone Rd E, Ontario, N1G 2W1, Canada
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20
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Benes J, Kotrc M, Jarolim P, Hoskova L, Hegarova M, Dorazilova Z, Podzimkova M, Binova J, Lukasova M, Malek I, Franekova J, Jabor A, Kautzner J, Melenovsky V. The effect of three major co-morbidities on quality of life and outcome of patients with heart failure with reduced ejection fraction. ESC Heart Fail 2021; 8:1417-1426. [PMID: 33512782 PMCID: PMC8006738 DOI: 10.1002/ehf2.13227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/28/2020] [Accepted: 01/13/2021] [Indexed: 12/18/2022] Open
Abstract
Aims Diabetes mellitus, chronic obstructive pulmonary disease, and chronic kidney disease are prevalent in patients with heart failure with reduced ejection fraction (HFrEF). We have analysed the impact of co‐morbidities on quality of life (QoL) and outcome. Methods and results A total of 397 patients (58.8 ± 11.0 years, 73.6% with New York Heart Association functional class ≥3) with stable advanced HFrEF were followed for a median of 1106 (inter‐quartile range 379–2606) days, and 68% of patients (270 patients) experienced an adverse outcome (death, urgent heart transplantation, and implantation of mechanical circulatory support). Chronic obstructive pulmonary disease was present in 16.4%, diabetes mellitus in 44.3%, and chronic kidney disease in 34.5% of patients; 33.5% of patients had none, 40.0% had one, 21.9% had two, and 3.8% of patient had three co‐morbidities. Patients with more co‐morbidities reported similar QoL (assessed by Minnesota Living with Heart Failure Questionnaire, 45.46 ± 22.21/49.07 ± 21.69/47.52 ± 23.54/46.77 ± 23.60 in patients with zero to three co‐morbidities, P for trend = 0.51). Multivariable regression analysis revealed that furosemide daily dose, systolic blood pressure, New York Heart Association functional class, and body mass index, but not the number of co‐morbidities, were significantly (P < 0.05) associated with QoL. Increasing co‐morbidity burden was associated with worse survival (P < 0.0001), lower degree of angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker treatment (P = 0.001), and increasing levels of BNP (mean of 685, 912, 1053, and 985 ng/L for patients with zero to three co‐morbidities, P for trend = 0.008) and cardiac troponin (sm‐cTnI, P for trend = 0.0496), which remained significant (P < 0.05) after the adjustment for left ventricular ejection fraction, left ventricular end‐diastolic diameter, right ventricular dysfunction grade, body mass index, and estimated glomerular filtration rate. Conclusions In stable advanced HFrEF patients, co‐morbidities are not associated with impaired QoL, but negatively affect the prognosis both directly and indirectly through lower level of HF pharmacotherapy and increased myocardial stress and injury.
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Affiliation(s)
- Jan Benes
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic.,Department of Internal Medicine, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Martin Kotrc
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Petr Jarolim
- 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lenka Hoskova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Marketa Hegarova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Zora Dorazilova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Mariana Podzimkova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Jana Binova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Marianna Lukasova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Ivan Malek
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Janka Franekova
- Department of Laboratory Methods, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic.,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Antonin Jabor
- Department of Laboratory Methods, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic.,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Vojtech Melenovsky
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
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21
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Dekker M, Waissi F, van Bennekom J, Silvis MJM, Timmerman N, Bank IEM, Walter JE, Mueller C, Schoneveld AH, Schiffelers RM, Pasterkamp G, Grobbee DE, de Winter RJ, Mosterd A, de Kleijn DPV, Timmers L. Plasma extracellular vesicle proteins are associated with stress-induced myocardial ischemia in women presenting with chest pain. Sci Rep 2020; 10:12257. [PMID: 32704130 PMCID: PMC7378184 DOI: 10.1038/s41598-020-69297-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/12/2020] [Indexed: 11/13/2022] Open
Abstract
Diagnosing stable ischemic heart disease (IHD) is challenging, especially in females. Currently, no blood test is available. Plasma extracellular vesicles (EV) are emerging as potential biomarker source. We therefore aimed to identify stress induced ischemia due to stable IHD with plasma extracellular vesicle protein levels in chest pain patients. We analyzed 450 patients suspected for stable IHD who were referred for 82Rb PET/CT in the outpatient clinic. Blood samples were collected before PET/CT and plasma EVs were isolated in 3 plasma subfractions named: TEX, HDL, LDL. In total 6 proteins were quantified in each of these subfractions using immuno-bead assays. CD14 and CystatinC protein levels were independent significant predictors of stress-induced ischemia in the LDL and the HDL subfraction and SerpinC1 and SerpinG1 protein levels in the HDL fraction. Subgroup-analysis on sex revealed that these associations were completely attributed to the associations in women. None of the significant EV proteins remained significant in men. Plasma EV proteins levels are associated with the presence of stable IHD in females presenting with chest pain. This finding, if confirmed in larger cohort studies could be a crucial step in improving diagnostic assessment of women with suspected IHD.
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Affiliation(s)
- Mirthe Dekker
- Department of Vascular Surgery, University Medical Centre, Utrecht, the Netherlands. .,Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands. .,Department of Cardiology, UMC Utrecht, Heidelberglaan 100, 3508GA, Utrecht, the Netherlands.
| | - Farahnaz Waissi
- Department of Vascular Surgery, University Medical Centre, Utrecht, the Netherlands.,Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Joelle van Bennekom
- Department of Vascular Surgery, University Medical Centre, Utrecht, the Netherlands
| | - Max J M Silvis
- Department of Cardiology, University Medical Centre, Utrecht, the Netherlands
| | - Nathalie Timmerman
- Department of Vascular Surgery, University Medical Centre, Utrecht, the Netherlands
| | - Ingrid E M Bank
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Joan E Walter
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - A H Schoneveld
- Department of Clinical Chemistry and Haematology, University Medical Centre, Utrecht, the Netherlands
| | - Raymond M Schiffelers
- Department of Clinical Chemistry and Haematology, University Medical Centre, Utrecht, the Netherlands
| | - Gerard Pasterkamp
- Department of Clinical Chemistry and Haematology, University Medical Centre, Utrecht, the Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands
| | - Robbert J de Winter
- Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
| | - A Mosterd
- Department of Cardiology, Meander Medical Centre, Amersfoort, the Netherlands
| | - Dominique P V de Kleijn
- Department of Vascular Surgery, University Medical Centre, Utrecht, the Netherlands.,Netherlands Heart Institute, Utrecht, the Netherlands
| | - Leo Timmers
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
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22
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Benes J, Kotrc M, Conrad MJ, Kautzner J, Melenovsky V, Jarolim P. Exercise dynamics of cardiac biomarkers and hemoconcentration in patients with chronic systolic heart failure. J Card Fail 2020; 26:1100-1105. [PMID: 32687881 DOI: 10.1016/j.cardfail.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 06/17/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Jan Benes
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic;; Department of Medicine, First Faculty of Medicine, Charles University and Military University Hospital Prague, Czech Republic
| | - Martin Kotrc
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Michael J Conrad
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Josef Kautzner
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Vojtech Melenovsky
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Jarolim
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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23
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Long B, Long DA, Tannenbaum L, Koyfman A. An emergency medicine approach to troponin elevation due to causes other than occlusion myocardial infarction. Am J Emerg Med 2020; 38:998-1006. [DOI: 10.1016/j.ajem.2019.12.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/18/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
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24
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Superiority of high sensitivity cardiac troponin T vs. I for long-term prognostic value in patients with chest pain; data from the Akershus cardiac Examination (ACE) 3 study. Clin Biochem 2020; 78:10-17. [DOI: 10.1016/j.clinbiochem.2019.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/05/2019] [Accepted: 12/27/2019] [Indexed: 12/18/2022]
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25
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Velilla Moliner J, Gros Bañeres B, Povar Marco J, Santaló Bel M, Ordoñez Llanos J, Martín Martín A, Temboury Ruiz F. Rendimiento diagnóstico de la troponina de alta sensibilidad en el síndrome coronario agudo sin elevación del segmento ST. Med Intensiva 2020; 44:88-95. [DOI: 10.1016/j.medin.2018.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/12/2018] [Accepted: 07/31/2018] [Indexed: 01/12/2023]
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26
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Hellings IR, Krontveit R, Øverlie M, Kallmyr A, Holm T, Fintl C. Pre- and post-race serum cardiac troponin T concentrations in Standardbred racehorses. Vet J 2020; 256:105433. [PMID: 32113587 DOI: 10.1016/j.tvjl.2020.105433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 10/25/2022]
Abstract
Elevated cardiac troponin T (cTnT) concentrations may provide evidence of myocardial injury but physiological post-exercise release also occurs. Reference intervals are not fully established in horses making interpretation difficult. The aims of this study were to establish an upper reference limit for serum cTnT, compare pre-and post-race serum cTnT concentrations, and to evaluate factors that may influence these in a population of healthy, race-fit Standardbred racehorses. Serum samples were collected pre- (n = 108) and 1-2 h post-racing (n = 101) and analysed using a high sensitivity-cTnT assay. Reference limits with 90% confidence intervals (CI) were calculated by non-parametric methods using the bootstrap method. Effects of sex, age, racing speed, distance, placings and track surface were assessed by fitting generalized linear models with an identity link function and inverse Gaussian distribution. The upper reference limit for serum cTnT concentration was 27.4 ng/L (90% CI 13.1-32.0). The median serum cTnT concentration was significantly higher 1-2 h post-racing compared to pre-racing (P < 0.001). Age and sex did not significantly affect serum cTnT concentrations pre-racing (P = 0.5 and P = 0.11). Cardiac troponin T concentrations were significantly higher post-racing in females (P = 0.018). Racing speed and placings had no effect on serum cTnT concentrations post-race (P = 0.71 and P = 0.66). The study contributed towards establishing an upper reference limit for serum cTnT concentrations in a population of race-fit Standardbreds and evaluated factors that may have influenced the results obtained.
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Affiliation(s)
- I R Hellings
- Norwegian University of Life Sciences, Faculty of Veterinary Medicine and Biosciences, Department of Companion Animal Clinical Sciences, Post Box 8146 Dep., 0033 Oslo, Norway.
| | - R Krontveit
- Norwegian Medicine Agency, Post Box 240 Skøyen, 0213 Oslo, Norway
| | - M Øverlie
- Rikstotoklinikken Bjerke, Post Box 194 Økern, 0510 Oslo, Norway
| | - A Kallmyr
- Rikstotoklinikken Bjerke, Post Box 194 Økern, 0510 Oslo, Norway
| | - T Holm
- Evidensia Lørenskog Dyreklinikk, Solheimveien 56, 1473 Lørenskog, Norway
| | - C Fintl
- Norwegian University of Life Sciences, Faculty of Veterinary Medicine and Biosciences, Department of Companion Animal Clinical Sciences, Post Box 8146 Dep., 0033 Oslo, Norway
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27
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Fitzgerald G, Kerley RN, Kiernan TJ. High-sensitivity troponin assays: development and utility in a modern health-care system. Expert Rev Cardiovasc Ther 2019; 17:763-770. [PMID: 31574239 DOI: 10.1080/14779072.2019.1675514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction: The introduction of cardiac troponin (cTn) assays have revolutionized the diagnosis and management of acute myocardial infarction in Emergency Departments worldwide. Its success has led to significant research and development investment in this area culminating in the development of newer high-sensitivity cardiac troponin assays (hs-cTn). While these newer assays allow for more rapid diagnosis by decreasing the time interval between serial data points, there is an inevitable trade off between increasing sensitivity and specificity. This review examines in detail the introduction and implementation of hs-cTN and its implications for clinical practice.Areas covered: This article reviews the history and development of high-sensitivity troponin assays and their application to clinical practice and current evidence base. It also discusses both the positive and negative aspects of the continuing increasing sensitivity of biochemical assays and the translation of this into clinical practice. Potential future developments are also discussed.Expert commentary: It is clear that there are many benefits to detecting extremely low concentration of cardiac troponin including the development of rapid rule out algorithms and the cost and time-saving advantages associated with the quicker movement of patients through the health-care system. It is important to note however that detecting troponin at very low concentrations also dramatically increases the false-positive rates and leads to a potentially large increase in invasive testing and diagnosis of myocardial infarction.
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Affiliation(s)
- Gerald Fitzgerald
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - R N Kerley
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Thomas J Kiernan
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
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28
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Marcassa C. The never-ending story of cardiac biomarkers: A further step toward a very early detection of ischemic patients? J Nucl Cardiol 2019; 26:1684-1687. [PMID: 29511929 DOI: 10.1007/s12350-018-1249-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Claudio Marcassa
- Maugeri Clinical and Scientific Institutes, IRCCS, Cardiology Department, Scientific Institute of Veruno (NO), Via Per Revislate 13, 28010, Veruno, Italy.
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29
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Pipikos T, Kapelouzou A, Tsilimigras DI, Fostinis Y, Pipikou M, Theodorakos A, Pavlidis AN, Kontogiannis C, Cokkinos DV, Koutelou M. Stronger correlation with myocardial ischemia of high-sensitivity troponin T than other biomarkers. J Nucl Cardiol 2019; 26:1674-1683. [PMID: 29380285 DOI: 10.1007/s12350-018-1199-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Acute myocardial infarction (AMI) is considered a major cause of death and disability. Myocardial perfusion scintigraphy (MPS) as a non-invasive diagnostic imaging procedure and certain biomarkers associated with myocardial ischemia (ISCH), such as ischemia-modified albumin (IMA), neuropeptide Y (NPY), N-terminal pro b-type natriuretic peptide (NT-proBNP), and high-sensitivity troponin T (hsTnT) could probably aid in the detection of myocardial infarction. METHODS Between December 2011 and June 2012, we prospectively analyzed patients who underwent a MPS study with the clinical question of myocardial ISCH. An exercise test was performed along with a MPS. Blood was drawn from the patients before exercise and the within 3 minutes from achieving maximum load and was analyzed for the aforementioned biomarkers. RESULTS A total of 71 patients (56 men and 15 women) were enrolled with a mean age of 61 ± 12 years. Twenty-six patients (36.6%) showed reduced uptake on stress MPS images that normalized at rest, a finding consistent with ISCH. Between ISCH and non-ISCH groups, only hsTnT levels showed a significant difference with the highest levels pertaining to the former group both before (0.0075 ng/ml vs 0.0050 ng/ml, P = 0.023) and after stress exercise (0.0085 vs 0.0050, P = 0.015). The most prominent differences were seen in higher stages of the Bruce protocol (stress duration > 9.05 minutes - P < 0.017). None of the IMA, NPY, and NP-pro BNP showed significant differences in time between the two groups. CONCLUSIONS Although IMA, NPY, and NT-pro BNP may not detect minor ischemic myocardial insults, serum hsTnT holds a greater ability of detecting not only myocardial infarction but also less severe ischemia. Further studies with larger cohorts of patients are warranted in order to better define the role of hsTnT as a screening tool for myocardial ischemia.
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Affiliation(s)
- Theodore Pipikos
- Nuclear Medicine Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Alkistis Kapelouzou
- Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 4 Soranou Efesiou Str., 11527, Athens, Greece.
| | | | - Yannis Fostinis
- Nuclear Medicine Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Marina Pipikou
- Nuclear Medicine Department, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Antonis N Pavlidis
- Department of Cardiology, Guy's and St. Thomas', NHS Foundation Trust, London, UK
| | | | - Dennis V Cokkinos
- Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 4 Soranou Efesiou Str., 11527, Athens, Greece
| | - Maria Koutelou
- Nuclear Medicine Department, Onassis Cardiac Surgery Center, Athens, Greece
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30
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Myhre PL, Lyngbakken MN, Tveit SH, Røsjø H, Omland T. Cardiac imaging and circulating biomarkers for primary prevention in the era of precision medicine. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2019. [DOI: 10.1080/23808993.2019.1660162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Peder Langeland Myhre
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Magnus Nakrem Lyngbakken
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Sjur Hansen Tveit
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
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31
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Felker GM, Fudim M. Unraveling the Mystery of Troponin Elevation in Heart Failure. J Am Coll Cardiol 2019; 71:2917-2918. [PMID: 29929615 DOI: 10.1016/j.jacc.2018.03.537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 03/26/2018] [Indexed: 11/26/2022]
Affiliation(s)
- G Michael Felker
- Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina.
| | - Marat Fudim
- Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina. https://twitter.com/FudimMarat
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32
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Cwikiel J, Seljeflot I, Fagerland MW, Wachtell K, Arnesen H, Berge E, Flaa A. High-sensitive cardiac Troponin T and exercise stress test for evaluation of angiographically significant coronary disease. Int J Cardiol 2019; 287:1-6. [PMID: 31006595 DOI: 10.1016/j.ijcard.2019.04.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exercise stress test (EST) has a moderate precision for diagnosis of CAD and could potentially obtain improved accuracy if adding a reliable cardiac biomarker to the test. OBJECTIVE We aimed to investigate resting levels and change in hs-cTnT during EST in patients with and without angiographically significant CAD. Moreover, we intended to explore the additive value of hs-cTnT to EST results in diagnosis of stable CAD. We hypothesized that hs-cTnT would be higher in CAD patients and increase diagnostic precision of EST. METHOD Patients presenting with symptoms of stable CAD, performed a maximal EST on a bicycle ergometer. Venous blood samples were taken at rest and within 5 min post-exercise. All patients underwent coronary angiography. Significant CAD was defined as having ≥75% stenosis in one or more segments of the coronary arteries. RESULTS Out of the 297 participants, significant CAD was found in 111 (37%) patients. Patients with significant CAD compared to without, had higher resting levels of hs-cTnT (median 8.1 vs 5.0 ng/L) and no significant difference in exercise-induced change (median 0.5 vs 0.3 ng/L), p < 0.001 and p = 0.086 respectively. Combined resting hs-cTnT with EST had higher predictive value for significant CAD than EST alone, AUC = 0.751 vs. AUC = 0.637. In an adjusted multivariable regression analysis, resting hs-cTnT >6.0 ng/L was predictive for having significant CAD, OR 2.55 (CI 95% 1.40, 4.65 p = 0.002). CONCLUSION In patients with suspected stable CAD, hs-cTnT has a predictive value alone, as well as added to a diagnostic EST for CAD.
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Affiliation(s)
- Joanna Cwikiel
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Norway; Faculty of Medicine, University of Oslo, Norway; Section of Cardiovascular and Renal Research Oslo University Hospital Ullevaal, Norway.
| | - Ingebjørg Seljeflot
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Norway; Department of Cardiology, Oslo University Hospital Ullevaal, Norway; Faculty of Medicine, University of Oslo, Norway.
| | - Morten W Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Service, Oslo University Hospital, Oslo, Norway.
| | - Kristian Wachtell
- Department of Cardiology, Section for Cardiology Intervention, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Norway.
| | - Harald Arnesen
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Norway; Faculty of Medicine, University of Oslo, Norway.
| | - Eivind Berge
- Department of Cardiology, Oslo University Hospital Ullevaal, Norway.
| | - Arnljot Flaa
- Department of Cardiology, Oslo University Hospital Ullevaal, Norway; Section of Cardiovascular and Renal Research Oslo University Hospital Ullevaal, Norway
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Droplet digital PCR of serum miR-499, miR-21 and miR-208a for the detection of functionally relevant coronary artery disease. Int J Cardiol 2019; 275:129-135. [DOI: 10.1016/j.ijcard.2018.08.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 01/16/2023]
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34
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High-sensitivity cardiac troponin T increases after stress echocardiography. Clin Biochem 2019; 63:18-23. [DOI: 10.1016/j.clinbiochem.2018.11.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/24/2018] [Accepted: 11/28/2018] [Indexed: 11/21/2022]
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35
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Kosowski M, Młynarska K, Chmura J, Kustrzycka-Kratochwil D, Sukiennik-Kujawa M, Todd JA, Jankowska EA, Banasiak W, Reczuch K, Ponikowski P. Cardiovascular stress biomarker assessment of middle-aged non-athlete marathon runners. Eur J Prev Cardiol 2018; 26:318-327. [DOI: 10.1177/2047487318819198] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Cardiovascular safety of marathon running in recreational runners remains unclear. We set up this study to comprehensively evaluate the effects of a marathon run on the profile of cardiovascular stress biomarkers in connection with transthoracic echocardiography. Design and methods Thirty-three healthy male amateur runners, aged ≥50 years (mean age 57 ± 7) were enrolled. Venous blood samples were obtained before the marathon, just after the race, 2–4 and seven days after the marathon. Using novel single molecule counting technology we measured: plasma concentrations of high-sensitivity cardiac troponin I (hs-cTnI) and endothelin-1. N-terminal pro B-type natriuretic peptide was measured using electrochemiluminescence. Each participant had transthoracic echocardiography before and immediately after the race. Results We observed a sharp rise in the levels of all biomarkers after the race (all p < 0.01), which subsequently normalized after 2–4 days and stayed within normal range after seven days. Runners with intensive training programmes (>169 km/month, a median for the studied group) had lower hs-cTnI leak after the race (median 15.11 ng/ml and 31.2 ng/ml, respectively; p < 0.05). Neither transthoracic echocardiography measures of ventricles nor strain rates changed after the run. We observed a decrease in the left atrial volume index and increase in the maximal right atrial volumes (all p < 0.05). Changes in Doppler indices of diastolic function suggestive of alteration in left ventricular relaxation were observed. Conclusions Marathon run is associated with sharp and significant rises in the biomarkers of cardiovascular stress. The profile of these changes, however, along with echocardiographic parameters, does not suggest irreversible myocardial damage.
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Affiliation(s)
- Michał Kosowski
- Department of Heart Diseases, Wroclaw Medical University, Poland
- Centre for Heart Diseases, 4th Military Hospital, Wroclaw, Poland
| | | | - Jan Chmura
- Department of Motor Ability and Sport Performance, University School of Physical Education, Wroclaw, Poland
| | | | | | | | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Poland
- Centre for Heart Diseases, 4th Military Hospital, Wroclaw, Poland
| | | | - Krzysztof Reczuch
- Department of Heart Diseases, Wroclaw Medical University, Poland
- Centre for Heart Diseases, 4th Military Hospital, Wroclaw, Poland
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Poland
- Centre for Heart Diseases, 4th Military Hospital, Wroclaw, Poland
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Hammadah M, Kim JH, Tahhan AS, Kindya B, Liu C, Ko YA, Al Mheid I, Wilmot K, Ramadan R, Alkhoder A, Choudhary F, Gafeer MM, Abdelhadi N, Pimple P, Sandesara P, Lima BB, Shah AJ, Ward L, Kutner M, Bremner JD, Sheps DS, Raggi P, Sperling LS, Vaccarino V, Quyyumi AA. Use of High-Sensitivity Cardiac Troponin for the Exclusion of Inducible Myocardial Ischemia: A Cohort Study. Ann Intern Med 2018; 169:751-760. [PMID: 30398528 PMCID: PMC6942174 DOI: 10.7326/m18-0670] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Many patients with coronary artery disease (CAD) are routinely referred for surveillance stress testing despite recommendations against it. OBJECTIVE To determine whether low levels of resting high-sensitivity cardiac troponin I (hs-cTnI) can identify persons without inducible myocardial ischemia. DESIGN Observational study. SETTING A university-affiliated hospital network. PATIENTS Persons with stable CAD: 589 in the derivation group and 118 in the validation cohort. MEASUREMENTS Presence of inducible myocardial ischemia was determined by myocardial perfusion imaging with technetium-99m single-photon emission computed tomography during either treadmill or pharmacologic stress testing. Resting plasma hs-cTnI was measured within 1 week of the stress test, and the negative predictive value (NPV) for inducible ischemia was calculated. The derivation cohort was followed for 3 years for incident cardiovascular death and myocardial infarction. RESULTS In the derivation cohort, 10 of 101 patients with an hs-cTnI level below 2.5 pg/mL had inducible myocardial ischemia (NPV, 90% [95% CI, 83% to 95%]) and 3 of 101 had inducible ischemia involving at least 10% of the myocardium (NPV, 97% [CI, 92% to 99%]). In the validation cohort, 4 of 32 patients with an hs-cTnI level below 2.5 pg/mL had inducible ischemia (NPV, 88% [CI, 71% to 96%]) and 2 of 32 had ischemia of 10% or greater (NPV, 94% [CI, 79% to 99%]). After a median follow-up of 3 years in the derivation cohort, no adverse events occurred in patients with an hs-cTnI level below 2.5 pg/mL, compared with 33 (7%) cardiovascular deaths or incident myocardial infarctions among those with an hs-cTnI level of 2.5 pg/mL or greater. LIMITATION The data may not be applicable to a population without known CAD or to persons with unstable angina, and the modest sample sizes warrant further validation in a larger cohort. CONCLUSION Very low hs-cTnI levels may be useful in excluding inducible myocardial ischemia in patients with stable CAD. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Muhammad Hammadah
- Emory University School of Medicine, Atlanta, Georgia (M.H., J.H.K., A.S.T., B.K., C.L., I.A., K.W., R.R., A.A., F.C., M.M.G., N.A., P.S., B.B.L., J.D.B., L.S.S., A.A.Q.)
| | - Jeong Hwan Kim
- Emory University School of Medicine, Atlanta, Georgia (M.H., J.H.K., A.S.T., B.K., C.L., I.A., K.W., R.R., A.A., F.C., M.M.G., N.A., P.S., B.B.L., J.D.B., L.S.S., A.A.Q.)
| | - Ayman Samman Tahhan
- Emory University School of Medicine, Atlanta, Georgia (M.H., J.H.K., A.S.T., B.K., C.L., I.A., K.W., R.R., A.A., F.C., M.M.G., N.A., P.S., B.B.L., J.D.B., L.S.S., A.A.Q.)
| | - Bryan Kindya
- Emory University School of Medicine, Atlanta, Georgia (M.H., J.H.K., A.S.T., B.K., C.L., I.A., K.W., R.R., A.A., F.C., M.M.G., N.A., P.S., B.B.L., J.D.B., L.S.S., A.A.Q.)
| | - Chang Liu
- Emory University School of Medicine, Atlanta, Georgia (M.H., J.H.K., A.S.T., B.K., C.L., I.A., K.W., R.R., A.A., F.C., M.M.G., N.A., P.S., B.B.L., J.D.B., L.S.S., A.A.Q.)
| | - Yi-An Ko
- Emory University, Atlanta, Georgia (Y.K., P.P., L.W., M.K.)
| | - Ibhar Al Mheid
- Emory University School of Medicine, Atlanta, Georgia (M.H., J.H.K., A.S.T., B.K., C.L., I.A., K.W., R.R., A.A., F.C., M.M.G., N.A., P.S., B.B.L., J.D.B., L.S.S., A.A.Q.)
| | - Kobina Wilmot
- Emory University School of Medicine, Atlanta, Georgia (M.H., J.H.K., A.S.T., B.K., C.L., I.A., K.W., R.R., A.A., F.C., M.M.G., N.A., P.S., B.B.L., J.D.B., L.S.S., A.A.Q.)
| | - Ronnie Ramadan
- Emory University School of Medicine, Atlanta, Georgia (M.H., J.H.K., A.S.T., B.K., C.L., I.A., K.W., R.R., A.A., F.C., M.M.G., N.A., P.S., B.B.L., J.D.B., L.S.S., A.A.Q.)
| | - Ayman Alkhoder
- Emory University School of Medicine, Atlanta, Georgia (M.H., J.H.K., A.S.T., B.K., C.L., I.A., K.W., R.R., A.A., F.C., M.M.G., N.A., P.S., B.B.L., J.D.B., L.S.S., A.A.Q.)
| | - Fahad Choudhary
- Emory University School of Medicine, Atlanta, Georgia (M.H., J.H.K., A.S.T., B.K., C.L., I.A., K.W., R.R., A.A., F.C., M.M.G., N.A., P.S., B.B.L., J.D.B., L.S.S., A.A.Q.)
| | - Mohamad Mazen Gafeer
- Emory University School of Medicine, Atlanta, Georgia (M.H., J.H.K., A.S.T., B.K., C.L., I.A., K.W., R.R., A.A., F.C., M.M.G., N.A., P.S., B.B.L., J.D.B., L.S.S., A.A.Q.)
| | - Naser Abdelhadi
- Emory University School of Medicine, Atlanta, Georgia (M.H., J.H.K., A.S.T., B.K., C.L., I.A., K.W., R.R., A.A., F.C., M.M.G., N.A., P.S., B.B.L., J.D.B., L.S.S., A.A.Q.)
| | - Pratik Pimple
- Emory University, Atlanta, Georgia (Y.K., P.P., L.W., M.K.)
| | - Pratik Sandesara
- Emory University School of Medicine, Atlanta, Georgia (M.H., J.H.K., A.S.T., B.K., C.L., I.A., K.W., R.R., A.A., F.C., M.M.G., N.A., P.S., B.B.L., J.D.B., L.S.S., A.A.Q.)
| | - Bruno B Lima
- Emory University School of Medicine, Atlanta, Georgia (M.H., J.H.K., A.S.T., B.K., C.L., I.A., K.W., R.R., A.A., F.C., M.M.G., N.A., P.S., B.B.L., J.D.B., L.S.S., A.A.Q.)
| | - Amit J Shah
- Emory University School of Medicine and Emory University, Atlanta, Georgia (A.J.S., V.V.)
| | - Laura Ward
- Emory University, Atlanta, Georgia (Y.K., P.P., L.W., M.K.)
| | - Michael Kutner
- Emory University, Atlanta, Georgia (Y.K., P.P., L.W., M.K.)
| | - J Douglas Bremner
- Emory University School of Medicine, Atlanta, Georgia (M.H., J.H.K., A.S.T., B.K., C.L., I.A., K.W., R.R., A.A., F.C., M.M.G., N.A., P.S., B.B.L., J.D.B., L.S.S., A.A.Q.)
| | - David S Sheps
- University of Florida, Gainesville, Florida (D.S.S.)
| | - Paolo Raggi
- University of Alberta, Edmonton, Alberta, Canada (P.R.)
| | - Laurence S Sperling
- Emory University School of Medicine, Atlanta, Georgia (M.H., J.H.K., A.S.T., B.K., C.L., I.A., K.W., R.R., A.A., F.C., M.M.G., N.A., P.S., B.B.L., J.D.B., L.S.S., A.A.Q.)
| | - Viola Vaccarino
- Emory University School of Medicine and Emory University, Atlanta, Georgia (A.J.S., V.V.)
| | - Arshed A Quyyumi
- Emory University School of Medicine, Atlanta, Georgia (M.H., J.H.K., A.S.T., B.K., C.L., I.A., K.W., R.R., A.A., F.C., M.M.G., N.A., P.S., B.B.L., J.D.B., L.S.S., A.A.Q.)
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Mueller D, Puelacher C, Honegger U, Walter JE, Badertscher P, Schaerli N, Strebel I, Twerenbold R, Boeddinghaus J, Nestelberger T, Hollenstein C, du Fay de Lavallaz J, Jeger R, Kaiser C, Wild D, Rentsch K, Buser A, Zellweger M, Reichlin T, Mueller C. Direct Comparison of Cardiac Troponin T and I Using a Uniform and a Sex-Specific Approach in the Detection of Functionally Relevant Coronary Artery Disease. Clin Chem 2018; 64:1596-1606. [DOI: 10.1373/clinchem.2018.286971] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/17/2018] [Indexed: 12/29/2022]
Abstract
Abstract
BACKGROUND
We aimed to directly compare high-sensitivity cardiac troponin I (hs-cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) in the detection of functionally relevant coronary artery disease (fCAD).
METHODS
Consecutive patients referred with clinical suspicion of fCAD and no structural heart disease other than coronary artery disease were included. The presence of fCAD was based on rest/stress myocardial perfusion single-photon emission computed tomography/computed tomography and coronary angiography. hs-cTnI and hs-cTnT concentrations were measured in a blinded fashion. Diagnostic accuracy was quantified using the area under the ROC curve (AUC) and evaluated both for uniform use in all patients and for sex-specific use in women and men separately. The prognostic end point was major adverse cardiac events (MACEs; cardiovascular death or myocardial infarction) within 2 years. For the prognostic performance, we used a multivariable model comparison with the Akaike information criterion (AIC).
RESULTS
fCAD was detected in 613 of 2062 patients (29.7%) overall, 112 of 664 of women (16.9%), and 501 of 1398 of men (35.8%). hs-cTnI and hs-cTnT had comparable diagnostic accuracy when assessed for uniform use in all patients (AUC, 0.68 vs 0.66; P = 0.107) and separately in women (AUC, 0.68 vs 0.63; P = 0.068) and men (AUC, 0.65 vs 0.64; P = 0.475). However, women required lower rule-out cutoffs to achieve high sensitivity, and men needed higher rule-in cutoffs to achieve high specificity. hs-cTnI and hs-cTnT were strongly and independently associated with MACE within 2 years (P < 0.001), with comparable prognostic accuracies by the AIC.
CONCLUSIONS
hs-cTnI and hs-cTnT provide moderate and comparable diagnostic accuracy. Sex-specific cutoffs may be preferred. The prognostic utility of both troponins is comparable.
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Affiliation(s)
- Deborah Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Puelacher
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ursina Honegger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Joan E Walter
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Badertscher
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nicolas Schaerli
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ivo Strebel
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of General and Interventional Cardiology, University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christina Hollenstein
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Raban Jeger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christoph Kaiser
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Damian Wild
- Division of Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Katharina Rentsch
- Department of Laboratory Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andreas Buser
- Department of Hematology and Blood Bank, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Zellweger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias Reichlin
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
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Myhre PL, Omland T, Sarvari SI, Ukkonen H, Rademakers F, Engvall JE, Hagve TA, Nagel E, Sicari R, Zamorano JL, Monaghan M, D'hooge J, Edvardsen T, Røsjø H. Cardiac Troponin T Concentrations, Reversible Myocardial Ischemia, and Indices of Left Ventricular Remodeling in Patients with Suspected Stable Angina Pectoris: a DOPPLER-CIP Substudy. Clin Chem 2018; 64:1370-1379. [DOI: 10.1373/clinchem.2018.288894] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/01/2018] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Cardiac troponin T concentrations measured with high-sensitivity assays (hs-cTnT) provide important prognostic information for patients with stable coronary artery disease (CAD). However, whether hs-cTnT concentrations mainly reflect left ventricular (LV) remodeling or recurrent myocardial ischemia in this population is not known.
METHODS
We measured hs-cTnT concentrations in 619 subjects with suspected stable CAD in a prospectively designed multicenter study. We identified associations with indices of LV remodeling, as assessed by cardiac MRI and echocardiography, and evidence of myocardial ischemia diagnosed by single positron emission computed tomography.
RESULTS
Median hs-cTnT concentration was 7.8 ng/L (interquartile range, 4.8–11.6 ng/L), and 111 patients (18%) had hs-cTnT concentrations above the upper reference limit (>14 ng/L). Patients with hs-cTnT >14 ng/L had increased LV mass (144 ± 40 g vs 116 ± 34 g; P < 0.001) and volume (179 ± 80 mL vs 158 ± 44 mL; P = 0.006), lower LV ejection fraction (LVEF) (59 ± 14 vs 62 ± 11; P = 0.006) and global longitudinal strain (14.1 ± 3.4% vs 16.9 ± 3.2%; P < 0.001), and more reversible perfusion defects (P = 0.001) and reversible wall motion abnormalities (P = 0.008). Age (P = 0.009), estimated glomerular filtration rate (P = 0.01), LV mass (P = 0.003), LVEF (P = 0.03), and evidence of reversible myocardial ischemia (P = 0.004 for perfusion defects and P = 0.02 for LV wall motion) were all associated with increasing hs-cTnT concentrations in multivariate analysis. We found analogous results when using the revised US upper reference limit of 19 ng/L.
CONCLUSIONS
hs-cTnT concentrations reflect both LV mass and reversible myocardial ischemia in patients with suspected stable CAD.
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Affiliation(s)
- Peder L Myhre
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research, University of Oslo, Oslo, Norway
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Sebastian I Sarvari
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Heikki Ukkonen
- Department of Medicine, Turku University Hospital, Turku, Finland
| | - Frank Rademakers
- Department of Cardiovascular Sciences, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Jan E Engvall
- Department of Clinical Physiology Linköping University, Linköping, Sweden and Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Tor-Arne Hagve
- Division of Diagnostics and Technology, Akershus University Hospital, Lørenskog and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eike Nagel
- Kings College Hospital, Department of Non-invasive Cardiology, Denmark Hill, London, UK
| | - Rosa Sicari
- CNR, Istituto di Fisiologia Clinica, Pisa, Italy
| | - Jose L Zamorano
- Hospital Universitario Ramón y Cajal, Cardiovascular Imaging Unit, Madrid, Spain
| | - Mark Monaghan
- Kings College Hospital, Department of Non-invasive Cardiology, Denmark Hill, London, UK
| | - Jan D'hooge
- Department of Cardiovascular Sciences, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research, University of Oslo, Oslo, Norway
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Affiliation(s)
- W A Parsonage
- Royal Brisbane & Women's Hospital, Brisbane, Qld, Australia
| | - L Ruane
- Royal Brisbane & Women's Hospital, Brisbane, Qld, Australia
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Brzezinski RY, Fisher E, Ehrenwald M, Shefer G, Stern N, Shapira I, Zeltser D, Berliner S, Shenhar-Tsarfaty S, Milwidsky A, Rogowski O. Elevated high-sensitive troponin T in negative stress test individuals. Eur J Clin Invest 2018; 48:e12930. [PMID: 29577259 DOI: 10.1111/eci.12930] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/19/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND The exercise ECG stress test (EST) is still the first step of work-up in intermediate risk patients in many clinical scenarios. High-sensitive cardiac troponin T (hs-cTnT) elevation is related to future cardiovascular events in the general population and in patients with ischaemic heart disease. The relation between these 2 tests is not well described. MATERIALS AND METHODS A total of 2780 participants from the Tel-Aviv Medical Center Inflammation Survey cohort (mean age 49 years, 79% men) were analysed. Multiple physiologic and metabolic parameters including hs-cTnT were collected. All participants completed an EST manually reviewed by a cardiologist. RESULTS A positive EST was documented in 224 subjects (8%). The majority (91%) of participants with hs-cTnT levels of 5-14 ng/L had a negative EST as well as 89.3% of subjects with levels >14 ng/L. The proportion of subjects with a positive EST and detectable hs-cTnT levels (>5 ng/L) was not significantly greater compared to those with a negative EST (53.1% vs 46.2%, respectively, P = .09). CONCLUSION Among subjects referred for EST as part of an annual health survey, we found no significant association between EST results to hs-cTnT detection.
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Affiliation(s)
- 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
| | - Eyal Fisher
- Department of Statistics, School of Mathematical Science, 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
| | - 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
- 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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The cardiac troponin response following physical exercise in relation to biomarker criteria for acute myocardial infarction; the North Sea Race Endurance Exercise Study (NEEDED) 2013. Clin Chim Acta 2018; 479:155-159. [DOI: 10.1016/j.cca.2018.01.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/19/2018] [Accepted: 01/19/2018] [Indexed: 11/22/2022]
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Samman Tahhan A, Sandesara P, Hayek SS, Hammadah M, Alkhoder A, Kelli HM, Topel M, O'Neal WT, Ghasemzadeh N, Ko YA, Gafeer MM, Abdelhadi N, Choudhary F, Patel K, Beshiri A, Murtagh G, Kim J, Wilson P, Shaw L, Vaccarino V, Epstein SE, Sperling L, Quyyumi AA. High-Sensitivity Troponin I Levels and Coronary Artery Disease Severity, Progression, and Long-Term Outcomes. J Am Heart Assoc 2018; 7:JAHA.117.007914. [PMID: 29467150 PMCID: PMC5866331 DOI: 10.1161/jaha.117.007914] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background The associations between high‐sensitivity troponin I (hsTnI) levels and coronary artery disease (CAD) severity and progression remain unclear. We investigated whether there is an association between hsTnI and angiographic severity and progression of CAD and whether the predictive value of hsTnI level for incident cardiovascular outcomes is independent of CAD severity. Methods and Results In 3087 patients (aged 63±12 years, 64% men) undergoing cardiac catheterization without evidence of acute myocardial infarction, the severity of CAD was calculated by the number of major coronary arteries with ≥50% stenosis and the Gensini score. CAD progression was assessed in a subset of 717 patients who had undergone ≥2 coronary angiograms >3 months before enrollment. Patients were followed up for incident all‐cause mortality and incident cardiovascular events. Of the total population, 11% had normal angiograms, 23% had nonobstructive CAD, 20% had 1‐vessel CAD, 20% had 2‐vessel CAD, and 26% had 3‐vessel CAD. After adjusting for age, sex, race, body mass index, smoking, hypertension, diabetes mellitus history, and renal function, hsTnI levels were independently associated with the severity of CAD measured by the Gensini score (log 2 ß=0.31; 95% confidence interval, 0.18–0.44; P<0.001) and with CAD progression (log 2 ß=0.36; 95% confidence interval, 0.14–0.58; P=0.001). hsTnI level was also a significant predictor of incident death, cardiovascular death, myocardial infarction, revascularization, and cardiac hospitalizations, independent of the aforementioned covariates and CAD severity. Conclusions Higher hsTnI levels are associated with the underlying burden of coronary atherosclerosis, more rapid progression of CAD, and higher risk of all‐cause mortality and incident cardiovascular events. Whether more aggressive treatment aimed at reducing hsTnI levels can modulate disease progression requires further investigation.
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Affiliation(s)
- Ayman Samman Tahhan
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Pratik Sandesara
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Salim S Hayek
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Muhammad Hammadah
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Ayman Alkhoder
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Heval M Kelli
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Matthew Topel
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Wesley T O'Neal
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Nima Ghasemzadeh
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Mohamad Mazen Gafeer
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Naser Abdelhadi
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Fahad Choudhary
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Keyur Patel
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Agim Beshiri
- Diagnostics Division, Abbott Laboratories, North Chicago, IL
| | - Gillian Murtagh
- Diagnostics Division, Abbott Laboratories, North Chicago, IL
| | - Jonathan Kim
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Peter Wilson
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Leslee Shaw
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA.,Department of Epidemiology and Rollins School of Public Health, Emory University, Atlanta, GA
| | - Stephen E Epstein
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | - Laurence Sperling
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Arshed A Quyyumi
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
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Walter JE, Honegger U, Puelacher C, Mueller D, Wagener M, Schaerli N, Strebel I, Twerenbold R, Boeddinghaus J, Nestelberger T, Sazgary L, Marbot S, du Fay de Lavallaz J, Kaiser C, Osswald S, Wild D, Rentsch K, Zellweger M, Reichlin T, Mueller C. Prospective Validation of a Biomarker-Based Rule Out Strategy for Functionally Relevant Coronary Artery Disease. Clin Chem 2018; 64:386-395. [DOI: 10.1373/clinchem.2017.277210] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/18/2017] [Indexed: 12/17/2022]
Abstract
Abstract
BACKGROUND
This study aimed to prospectively advance a rule-out strategy for functionally significant coronary artery disease (CAD) by use of high-sensitivity cardiac troponin I (hs-cTnI) from bench to bedside, by application of a 3-step approach: validation in serum, correlation in plasma, and application on a clinical platform.
METHODS
Patients without known CAD referred for rest/stress myocardial perfusion single-photon emission tomography/computer tomography (MPI-SPECT/CT) were assigned to 3 consecutive cohorts: validation, correlation, and application. Functionally relevant CAD was adjudicated with the use of expert interpretation of MPI-SPECT/CT and, if available, coronary angiography. In the validation cohort resting hs-cTnI was measured in serum before stress testing with the research Erenna system, in serum and plasma in the correlation cohort with the research Erenna system, and in plasma in the application cohort with the clinical Clarity system.
RESULTS
Overall, functionally relevant CAD was adjudicated in 21% (304/1478) of patients. In the validation cohort (n = 613), hs-cTnI concentrations were significantly higher in patients with functionally relevant CAD (median 2.8 ng/L vs 1.9 ng/L, P < 0.001) as compared to patients without functionally relevant CAD and allowed a rule out with 95% sensitivity in 14% of patients. In the correlation cohort (n = 606), hs-cTnI concentrations in serum and plasma strongly correlated (Spearman r = 0.921) and had similar diagnostic accuracy as quantified by the area under the receiver operating characteristic curve (0.686 vs 0.678, P = 0.425). In the application cohort (n = 555), very low hs-cTnI plasma concentrations (< 0.5 ng/L) ruled out functionally relevant CAD with 95% sensitivity in 10% of patients.
CONCLUSIONS
A single resting plasma hs-cTnI measurement can safely rule out functionally relevant CAD in around 10% of patients without known CAD.
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Affiliation(s)
- Joan E Walter
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Ursina Honegger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Christian Puelacher
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Deborah Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Max Wagener
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Nicolas Schaerli
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Ivo Strebel
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
- Department of General and Interventional Cardiology, University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Lorraine Sazgary
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Stella Marbot
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Christoph Kaiser
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Stefan Osswald
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Damian Wild
- Division of Nuclear Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Katharina Rentsch
- Department of Laboratory Medicine, University Hospital Basel University of Basel, Switzerland
| | - Michael Zellweger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Tobias Reichlin
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
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Mair J, Lindahl B, Hammarsten O, Müller C, Giannitsis E, Huber K, Möckel M, Plebani M, Thygesen K, Jaffe AS. How is cardiac troponin released from injured myocardium? EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 7:553-560. [PMID: 29278915 DOI: 10.1177/2048872617748553] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cardiac troponin I and cardiac troponin T are nowadays the criterion biomarkers for the laboratory diagnosis of acute myocardial infarction due to their very high sensitivities and specificities for myocardial injury. However, still many aspects of their degradation, tissue release and elimination from the human circulation are incompletely understood. Myocardial injury may be caused by a variety of different mechanisms, for example, myocardial ischaemia, inflammatory and immunological processes, trauma, drugs and toxins, and myocardial necrosis is preceded by a substantial reversible prelethal phase. Recent experimental data in a pig model of myocardial ischaemia demonstrated cardiac troponin release into the circulation from apoptotic cardiomyocytes as an alternative explanation for clinical situations with increased cardiac troponin without any other evidence for myocardial necrosis. However, the comparably lower sensitivities of all currently available imaging modalities, including cardiac magnetic resonance imaging for the detection of particularly non-focal myocardial necrosis in patients, has to be considered for cardiac troponin test result interpretation in clinical settings without any other evidence for myocardial necrosis apart from increased cardiac troponin concentrations as well.
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Affiliation(s)
- Johannes Mair
- 1 Department of Internal Medicine III - Cardiology and Angiology, Heart Centre, Medical University of Innsbruck, Austria
| | - Bertil Lindahl
- 2 Department of Medical Sciences, Uppsala University and Uppsala Clinical Research Centre, Uppsala University, Sweden
| | - Ola Hammarsten
- 3 Department of Clinical Chemistry and Transfusion Medicine, University of Gothenburg, Sweden
| | - Christian Müller
- 4 Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Evangelos Giannitsis
- 5 Medizinische Klinik III, Department of Cardiology, University of Heidelberg, Germany
| | - Kurt Huber
- 6 Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria.,7 Sigmund Freud University Medical School, Vienna, Austria
| | - Martin Möckel
- 8 Division of Emergency Medicine and Department of Cardiology, Charité-Universitätsmedizin Berlin, Germany
| | - Mario Plebani
- 9 Department of Laboratory Medicine, University Hospital Padova, Italy
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Mukherjee A, Dang T, Morrell H, Yerramilli R, Bishop JJ. Expanding the Utility of High-Sensitivity Dried Blood Spot Immunoassay Testing with Single Molecule Counting. ACTA ACUST UNITED AC 2017; 2:674-686. [DOI: 10.1373/jalm.2017.023911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/11/2017] [Indexed: 11/06/2022]
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Puelacher C, Wagener M, Honegger U, Assadian M, Schaerli N, Mueller D, Strebel I, Twerenbold R, Boeddinghaus J, Nestelberger T, Wildi K, Sabti Z, Sazgary L, Badertscher P, du Fay de Lavallaz J, Marbot S, Kaiser C, Wild D, Zellweger MJ, Reichlin T, Mueller C. Combining high-sensitivity cardiac troponin and B-type natriuretic peptide in the detection of inducible myocardial ischemia. Clin Biochem 2017; 52:33-40. [PMID: 29107010 DOI: 10.1016/j.clinbiochem.2017.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/21/2017] [Accepted: 10/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Single biomarker approaches provide only moderate accuracy in the non-invasive detection of exercise-induced myocardial ischemia. We therefore assessed the combination of the two most promising single biomarkers: high-sensitivity cardiac troponin I (hs-cTnI) and B-type natriuretic peptide (BNP). METHODS Consecutive patients with suspected myocardial ischemia referred to stress myocardial perfusion single-photon emission tomography imaging (MPI) were enrolled. Clinical judgment (CJ) of the treating cardiologist regarding myocardial ischemia, quantified using a visual analogue scale, and blood concentrations of hs-cTnI and BNP were determined before and after stress. The presence of myocardial ischemia was adjudicated by independent cardiologists using MPI, blinded to biomarker measurements. Death and acute myocardial infarction (AMI) during follow-up were the prognostic endpoints. RESULTS Among 1142 consecutive patients inducible myocardial ischemia was found in 456 (40%) of all patients. For the detection of inducible myocardial ischemia, CJ before exercise stress testing (CJb) showed an area under the receiver-operating-characteristics curve (AUC) of 0.66 (95%CI 0.63-0.69), hs-cTnI 0.70 (95%CI 0.67-0.73, p=0.07 vs CJb), and BNP 0.66 (95%CI 0.62-0.69, p=0.98). The use of a dual-biomarker strategy combining hs-cTnI and BNP with CJb did not provide a significant advantage over the combination of hs-cTnI alone and CJb (AUC 0.74, 95%CI 0.72-0.77 vs AUC 0.74, 95%CI 0.71-0.77, p=0.16). Hs-cTnI showed good prognostic value for AMI (HR 1.6, 95%CI 1.3-1.9), and BNP for death (HR 1.6, 95%CI 1.3-2.1). CONCLUSION A dual-biomarker strategy combing BNP and hs-cTnI does not further increase diagnostic accuracy on top of clinical judgment and hs-cTnI alone. SUMMARY AND HIGHLIGHTS We included 1142 consecutive patients with suspected inducible ischemia, and evaluated the added value of the biomarkers high-sensitivity cardiac troponin (hs-cTn) and B-type natriuretic peptide (BNP), alone and in combination, on top of clinical judgment. CLINICAL TRIAL REGISTRATION Biochemical and Electrocardiographic Signatures in the Detection of Exercise-induced Myocardial Ischemia (BASEL VIII), NCT01838148, https://clinicaltrials.gov/ct2/show/NCT01838148.
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Affiliation(s)
- Christian Puelacher
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland
| | - Max Wagener
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University Basel, Switzerland
| | - Ursina Honegger
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland
| | - Mustafa Assadian
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland
| | - Nicolas Schaerli
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University Basel, Switzerland
| | - Deborah Mueller
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland
| | - Ivo Strebel
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland
| | - Karin Wildi
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Zaid Sabti
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland
| | - Lorraine Sazgary
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland
| | - Patrick Badertscher
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland
| | - Stella Marbot
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland
| | - Christoph Kaiser
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland
| | - Damian Wild
- Division of Nuclear Medicine, University Hospital Basel, University Basel, Switzerland
| | - Michael J Zellweger
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland
| | - Tobias Reichlin
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University Basel, Switzerland.
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Ho JE, Shi L, Day SM, Colan SD, Russell MW, Towbin JA, Sherrid MV, Canter CE, Jefferies JL, Murphy A, Taylor M, Mestroni L, Cirino AL, Sleeper LA, Jarolim P, Lopez B, Gonzalez A, Diez J, Orav EJ, Ho CY. Biomarkers of cardiovascular stress and fibrosis in preclinical hypertrophic cardiomyopathy. Open Heart 2017; 4:e000615. [PMID: 29177058 PMCID: PMC5687543 DOI: 10.1136/openhrt-2017-000615] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/09/2017] [Accepted: 06/13/2017] [Indexed: 11/04/2022] Open
Abstract
Objective Sarcomeric gene mutation carriers without overt left ventricular hypertrophy (G+/LVH-) can harbour subclinical changes in cardiovascular structure and function that precede the development of hypertrophic cardiomyopathy (HCM). We sought to investigate if circulating biomarkers of cardiovascular stress and collagen metabolism among G+/LVH- individuals, measured at rest and following exercise provocation, yield further insights into the underlying biology of HCM. Methods We studied 76 individuals with overt HCM, 50 G+/LVH- individuals and 41 genotype-negative related controls enrolled in a cross-sectional, multicentre observational study (HCMNet). Biomarkers of cardiac stress (N-terminal pro-B-type natriuretic peptide, NT-proBNP; high-sensitivity troponin I, hsTnI; soluble ST2) and fibrosis (carboxy-terminal propeptide of procollagen type I; C-terminal telopeptide of type I collagen; galectin-3; periostin) were measured. Results Individuals with overt HCM had elevated NT-proBNP and hsTnI compared with G+/LVH- subjects and controls at rest, along with an exaggerated increase in NT-proBNP and hsTnI in response to exercise. We found no detectable differences in resting or exercise-provoked biomarker profiles of cardiovascular stress and fibrosis among G+/LVH- individuals compared with healthy controls despite subtle echocardiographic differences in cardiac structure and function. Conclusion Dynamic exercise testing exaggerated resting differences in natriuretic peptides and troponin elevations among individuals with overt HCM. In contrast, we found no differences in biomarker profiles of cardiovascular stress and fibrosis among G+/LVH- individuals compared with controls even after maximal exercise provocation. Our findings highlight the need for continued investigation into early phenotypes of sarcomeric gene mutations and the evolution of HCM.
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Affiliation(s)
- Jennifer E Ho
- Division of Cardiology, Department of Medicine, Cardiovascular Research Center, Massachusetts General Hospital, Ann Arbor, Michigan, USA
| | - Ling Shi
- New England Research Institutes, Watertown, Massachusetts, USA
| | - Sharlene M Day
- Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mark W Russell
- Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey A Towbin
- The Heart Institute and Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mark V Sherrid
- Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, New York, USA
| | - Charles E Canter
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - John Lynn Jefferies
- The Heart Institute and Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Anne Murphy
- Division of Pediatric Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew Taylor
- Department of Medicine, University of Colorado Denver CU-Cardiovascular Institute, Aurora, Colorado, USA
| | - Luisa Mestroni
- Department of Medicine, University of Colorado Denver CU-Cardiovascular Institute, Aurora, Colorado, USA
| | - Allison L Cirino
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lynn A Sleeper
- New England Research Institutes, Watertown, Massachusetts, USA
| | - Peter Jarolim
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Begoña Lopez
- Program of Cardiovascular Diseases, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Arantxa Gonzalez
- Program of Cardiovascular Diseases, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Javier Diez
- Program of Cardiovascular Diseases, Center for Applied Medical Research, University of Navarra, Pamplona, Spain.,Department for Cardiology and Cardiac Surgery, University Clinic, University of Navarra, Pamplona, Spain
| | - E John Orav
- Department of Biostatistics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Carolyn Y Ho
- Division of Cardiology, Department of Medicine, Cardiovascular Research Center, Massachusetts General Hospital, Ann Arbor, Michigan, USA
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Orsini E, Caravelli P, Dini FL, Marzilli M. High sensitivity cardiac troponins: Can they help in diagnosing myocardial ischaemia? EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2017; 7:544-552. [PMID: 29064277 DOI: 10.1177/2048872617700868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiac troponin is the most sensitive marker of myocardial injury, but controversy still exists about its role in detecting ischaemia. METHODS To investigate the role of troponin as a marker of stress-induced ischaemia, circulating high sensitivity cardiac troponin T (hs-cTnT) was measured and compared with the MB fraction of creatine kinase (CK-MB) in 125 patients undergoing a stress test (53 electrocardiogram/echo exercise, 42 echo dipyridamole and 30 echo dobutamine tests). RESULTS Plasma concentrations of hs-cTnT increased after the tests in 90/125 patients, while an increase of CK-MB was seen in 31/125 patients ( p<0.0001). Overall, hs-cTnT significantly increased from 17.5±16.9 ng/l to 25.5±27.9 ng/l ( p<0.0001), without significant changes of CK-MB. Significant increments in hs-cTnT were documented after exercise test (from 15.9±11.9 ng/l to 19.5±13.6 ng/l, p<0.0001) and dobutamine test (from 20.6±20.8 ng/l to 37.8±31.1 ng/l, p=0.0006), in absence of changes in CK-MB according to each stressor. Among the 125 tests, 84 were diagnosed as negative and 41 as positive for myocardial ischaemia. Significant increments in hs-cTnT were detected after both negative (from 18.6±19.2 ng/l to 27.1±32.1 ng/l, p=0.0018) and positive test (from 15.2±10.8 ng/l to 22.3±16.2 ng/l, p=0.0005), without significant changes of CK-MB according to the test result. Despite a positive correlation between stress-induced increase of hs-cTnT and obstructive coronary artery disease, the release of troponin was observed also in a significant proportion of patients without coronary stenoses. Left ventricular hypertrophy markedly enhanced myocardial release of troponin. CONCLUSIONS Circulating troponin increases in most patients undergoing a stress test, irrespective of the test result and of coronary artery disease. Plasma release of troponin depends on multiple pathogenetic mechanisms, making the biomarker a not reliable tool in detecting transient ischaemia.
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Affiliation(s)
- Enrico Orsini
- University Division of Cardiology, Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Paolo Caravelli
- University Division of Cardiology, Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Frank Lloyd Dini
- University Division of Cardiology, Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Mario Marzilli
- University Division of Cardiology, Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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Prevalence and Prognostic Association of Circulating Troponin in the Acute Respiratory Distress Syndrome. Crit Care Med 2017; 45:1709-1717. [PMID: 28777195 DOI: 10.1097/ccm.0000000000002641] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Circulating cardiac troponin has been associated with adverse prognosis in the acute respiratory distress syndrome in small and single-center studies; however, comprehensive studies of myocardial injury in acute respiratory distress syndrome using modern high-sensitivity troponin assays, which can detect troponin at much lower circulating concentrations, have not been performed. DESIGN We performed a prospective cohort study. SETTING We included patients enrolled in previously completed trials of acute respiratory distress syndrome. PATIENTS One thousand fifty-seven acute respiratory distress syndrome patients were included. INTERVENTIONS To determine the association of circulating high-sensitivity troponin I (Abbott ARCHITECT), with acute respiratory distress syndrome outcomes, we measured high-sensitivity troponin I within 24 hours of intubation. The primary outcome was 60-day mortality. MEASUREMENTS AND MAIN RESULTS Detectable high-sensitivity troponin I was present in 94% of patients; 38% of patients had detectable levels below the 99th percentile of a healthy reference population (26 ng/L), whereas 56% of patients had levels above the 99th percentile cut point. After multivariable adjustment, age, cause of acute respiratory distress syndrome, temperature, heart rate, vasopressor use, Sequential Organ Failure Assessment score, creatinine, and PCO2 were associated with higher high-sensitivity troponin I concentration. After adjustment for age, sex, and randomized trial assignment, the hazard ratio for 60-day mortality comparing the fifth to the first quintiles of high-sensitivity troponin I was 1.61 (95% CI, 1.11-2.32; p trend = 0.003). Adjusting for Sequential Organ Failure Assessment score suggested that this association was not independent of disease severity (hazard ratio, 0.95; 95% CI, 0.64-1.39; p = 0.93). CONCLUSIONS Circulating troponin is detectable in over 90% of patients with acute respiratory distress syndrome and is associated with degree of critical illness. The magnitude of myocardial injury correlated with mortality.
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Smith JG, Gerszten RE. Emerging Affinity-Based Proteomic Technologies for Large-Scale Plasma Profiling in Cardiovascular Disease. Circulation 2017; 135:1651-1664. [PMID: 28438806 DOI: 10.1161/circulationaha.116.025446] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Plasma biomarkers that reflect molecular states of the cardiovascular system are central for clinical decision making. Routinely used plasma biomarkers include troponins, natriuretic peptides, and lipoprotein particles, yet interrogate only a modest subset of pathways relevant to cardiovascular disease. Systematic profiling of a larger portion of circulating plasma proteins (the plasma proteome) will provide opportunities for unbiased discovery of novel markers to improve diagnostic or predictive accuracy. In addition, proteomic profiling may inform pathophysiological understanding and point to novel therapeutic targets. Obstacles for comprehensive proteomic profiling include the immense size and structural heterogeneity of the proteome, and the broad range of abundance levels, as well. Proteome-wide, untargeted profiling can be performed in tissues and cells with tandem mass spectrometry. However, applications to plasma are limited by the need for complex preanalytical sample preparation stages limiting sample throughput. Multiplexing of targeted methods based on capture and detection of specific proteins are therefore receiving increasing attention in plasma proteomics. Immunoaffinity assays are the workhorse for measuring individual proteins but have been limited for proteomic applications by long development times, cross-reactivity preventing multiplexing, specificity issues, and incomplete sensitivity to detect proteins in the lower range of the abundance spectrum (below picograms per milliliter). Emerging technologies to address these issues include nucleotide-labeled immunoassays and aptamer reagents that can be automated for efficient multiplexing of thousands of proteins at high sample throughput, coupling of affinity capture methods to mass spectrometry for improved specificity, and ultrasensitive detection systems to measure low-abundance proteins. In addition, proteomics can now be integrated with modern genomics tools to comprehensively relate proteomic profiles to genetic variants, which may both influence binding of affinity reagents and serve to validate the target specificity of affinity assays. The application of deep quantitative proteomic profiling to large cohorts has thus become increasingly feasible with emerging affinity methods. The aims of this article are to provide the broad readership of Circulation with a timely overview of emerging methods for affinity proteomics and recent progress in cardiovascular medicine based on such methods.
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Affiliation(s)
- J Gustav Smith
- From Molecular Epidemiology and Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Sweden (J.G.S.); Department of Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden (J.G.S.); Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (J.G.S., R.E.G.); and Cardiovascular Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.E.G.).
| | - Robert E Gerszten
- From Molecular Epidemiology and Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Sweden (J.G.S.); Department of Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden (J.G.S.); Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (J.G.S., R.E.G.); and Cardiovascular Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.E.G.).
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