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Falahati A, Arazi H. Cardiac biomarker responses following high-intensity interval and continuous exercise: the influence of ACE-I/D gene polymorphism and training status in men. Physiol Genomics 2024; 56:436-444. [PMID: 38586874 DOI: 10.1152/physiolgenomics.00129.2023] [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: 10/26/2023] [Revised: 03/03/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024] Open
Abstract
This study aimed to investigate the relationship between pre- and postexercise cardiac biomarker release according to athletic status (trained vs. untrained) and to establish whether the I/D polymorphism in the angiotensin-converting enzyme (ACE) gene had an influence on cardiac biomarkers release with specific regard on the influence of the training state. We determined cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in 29 trained and 27 untrained male soccer players before and after moderate-intensity continuous exercise (MICE) and high-intensity interval exercise (HIIE) running tests. Trained soccer players had higher pre (trained: 0.014 ± 0.007 ng/mL; untrained: 0.010 ± 0.005 ng/mL) and post HIIE (trained: 0.031 ± 0.008 ng/mL; untrained: 0.0179 ± 0.007) and MICE (trained: 0.030 ± 0.007 ng/mL; untrained: 0.018 ± 0.007) cTnI values than untrained subjects, but the change with exercise (ΔcTnI) was similar between groups. There was no significant difference in baseline and postexercise NT-proBNP between groups. NT-proBNP levels were elevated after both HIIE and MICE. Considering three ACE genotypes, the mean pre exercise cTnI values of the trained group (DD: 0.015 ± 0.008 ng/mL, ID: 0.015 ± 0.007 ng/mL, and II: 0.014 ± 0.008 ng/mL) and their untrained counterparts (DD: 0.010 ± 0.004 ng/mL, ID: 0.011 ± 0.004 ng/mL, and II: 0.010 ± 0.006 ng/mL) did not show any significant difference. To sum up, noticeable difference in baseline cTnI was observed, which was related to athletic status but not ACE genotypes. Neither athletic status nor ACE genotypes seemed to affect the changes in cardiac biomarkers in response to HIIE and MICE, indicating that the ACE gene does not play a significant role in the release of exercise-induced cardiac biomarkers indicative of cardiac damage in Iranian soccer players.NEW & NOTEWORTHY Our study investigated the impact of athletic status and angiotensin-converting enzyme (ACE) gene I/D polymorphism on cardiac biomarkers in soccer players. Trained players showed higher baseline cardiac troponin I (cTnI) levels, whereas postexercise ΔcTnI remained consistent across groups. N-terminal pro-brain natriuretic peptide increased after exercise in both groups, staying within normal limits. ACE genotypes did not significantly affect pre-exercise cTnI. Overall, athletic status influences baseline cTnI, but neither it nor ACE genotypes significantly impact exercise-induced cardiac biomarker responses in this population.
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Affiliation(s)
- Akram Falahati
- Department of Exercise Physiology, University Campus, University of Guilan, Rasht, Iran
| | - Hamid Arazi
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht, Iran
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de Bakker M, Scholte NTB, Oemrawsingh RM, Umans VA, Kietselaer B, Schotborgh C, Ronner E, Lenderink T, Aksoy I, van der Harst P, Asselbergs FW, Maas A, Oude Ophuis AJ, Krenning B, de Winter RJ, The SHK, Wardeh AJ, Hermans W, Cramer GE, van Schaik RH, de Rijke YB, Akkerhuis KM, Kardys I, Boersma E. Acute Coronary Syndrome Subphenotypes Based on Repeated Biomarker Measurements in Relation to Long-Term Mortality Risk. J Am Heart Assoc 2024; 13:e031646. [PMID: 38214281 PMCID: PMC10926784 DOI: 10.1161/jaha.123.031646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND We aimed to identify patients with subphenotypes of postacute coronary syndrome (ACS) using repeated measurements of high-sensitivity cardiac troponin T, N-terminal pro-B-type natriuretic peptide, high-sensitivity C-reactive protein, and growth differentiation factor 15 in the year after the index admission, and to investigate their association with long-term mortality risk. METHODS AND RESULTS BIOMArCS (BIOMarker Study to Identify the Acute Risk of a Coronary Syndrome) was an observational study of patients with ACS, who underwent high-frequency blood sampling for 1 year. Biomarkers were measured in a median of 16 repeated samples per individual. Cluster analysis was performed to identify biomarker-based subphenotypes in 723 patients without a repeat ACS in the first year. Patients with a repeat ACS (N=36) were considered a separate cluster. Differences in all-cause death were evaluated using accelerated failure time models (median follow-up, 9.1 years; 141 deaths). Three biomarker-based clusters were identified: cluster 1 showed low and stable biomarker concentrations, cluster 2 had elevated concentrations that subsequently decreased, and cluster 3 showed persistently elevated concentrations. The temporal biomarker patterns of patients in cluster 3 were similar to those with a repeat ACS during the first year. Clusters 1 and 2 had a similar and favorable long-term mortality risk. Cluster 3 had the highest mortality risk. The adjusted survival time ratio was 0.64 (95% CI, 0.44-0.93; P=0.018) compared with cluster 1, and 0.71 (95% CI, 0.39-1.32; P=0.281) compared with patients with a repeat ACS. CONCLUSIONS Patients with subphenotypes of post-ACS with different all-cause mortality risks during long-term follow-up can be identified on the basis of repeatedly measured cardiovascular biomarkers. Patients with persistently elevated biomarkers have the worst outcomes, regardless of whether they experienced a repeat ACS in the first year.
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Affiliation(s)
- Marie de Bakker
- Department of CardiologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Niels T. B. Scholte
- Department of CardiologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | | | - Victor A. Umans
- Department of CardiologyNoordwest ZiekenhuisgroepAlkmaarThe Netherlands
| | | | - Carl Schotborgh
- Department of CardiologyHagaZiekenhuisDen HaagThe Netherlands
| | - Eelko Ronner
- Department of CardiologyReinier de Graaf HospitalDelftThe Netherlands
| | - Timo Lenderink
- Department of CardiologyZuyderland HospitalHeerlenThe Netherlands
| | - Ismail Aksoy
- Department of CardiologyAdmiraal de Ruyter HospitalGoesThe Netherlands
| | - Pim van der Harst
- Department of CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Folkert W. Asselbergs
- Amsterdam University Medical Centers, Department of CardiologyUniversity of AmsterdamAmsterdamThe Netherlands
- Health Data Research UK and Institute of Health InformaticsUniversity College LondonLondonUnited Kingdom
| | - Arthur Maas
- Department of CardiologyGelre HospitalZutphenThe Netherlands
| | | | - Boudewijn Krenning
- Department of CardiologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
- Department of CardiologyFranciscus Gasthuis & VlietlandRotterdamThe Netherlands
| | - Robbert J. de Winter
- Amsterdam University Medical Centers, Department of CardiologyUniversity of AmsterdamAmsterdamThe Netherlands
| | - S. Hong Kie The
- Department of CardiologyTreant ZorggroepEmmenThe Netherlands
| | | | - Walter Hermans
- Department of CardiologyElizabeth‐Tweesteden HospitalTilburgThe Netherlands
| | - G. Etienne Cramer
- Department of CardiologyRadboud University Medical Center NijmegenNijmegenThe Netherlands
| | - Ron H. van Schaik
- Department of Clinical ChemistryErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Yolanda B. de Rijke
- Department of Clinical ChemistryErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - K. Martijn Akkerhuis
- Department of CardiologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Isabella Kardys
- Department of CardiologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Eric Boersma
- Department of CardiologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
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Morrow DA, Mills NL, Mueller C. High-sensitivity cardiac troponin in stable atherosclerotic vascular disease. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:396-398. [PMID: 37217982 DOI: 10.1093/ehjacc/zuad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/18/2023] [Indexed: 05/24/2023]
Affiliation(s)
- David A Morrow
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
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Patel SM, Qamar A, Giugliano RP, Jarolim P, Marston NA, Park JG, Blazing MA, Cannon CP, Braunwald E, Morrow DA. Association of Serial High-Sensitivity Cardiac Troponin T With Subsequent Cardiovascular Events in Patients Stabilized After Acute Coronary Syndrome: A Secondary Analysis From IMPROVE-IT. JAMA Cardiol 2022; 7:1199-1206. [PMID: 36260325 PMCID: PMC9582963 DOI: 10.1001/jamacardio.2022.3627] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/30/2022] [Indexed: 01/13/2023]
Abstract
Importance Studies have demonstrated an association between single measures of high-sensitivity troponin (hsTn) and future cardiovascular events in patients with chronic coronary syndromes. However, limited data exist regarding the association between changes in serial values of hsTn and subsequent cardiovascular events in this patient population. Objective To evaluate the association between changes in high-sensitivity troponin T (hsTnT) and subsequent cardiovascular events in patients stabilized after acute coronary syndrome (ACS). Design, Setting, and Participants This is a secondary analysis from the Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT), a randomized clinical trial of ezetimibe vs placebo on a background of simvastatin in 18 144 patients hospitalized for an ACS across 1147 sites in 39 countries. The current biomarker substudy includes the 6035 participants consenting to the biomarker substudy with available hsTnT at months 1 and 4. Data were collected from October 26, 2005, through July 8, 2010, with the database locked October 21, 2014. Data were analyzed from February 28, 2021, through August 14, 2022. Main Outcomes and Measures The outcomes of interest were cardiovascular death, myocardial infarction (MI), stroke, or hospitalization for heart failure (HHF). Associations of absolute and relative changes in hsTnT between month 1 and month 4 as a function of the starting month 1 hsTnT and the composite outcome were examined using landmark analyses. Results Of 6035 patients in this analysis (median [IQR] age, 64 [57-71]), 1486 (24.6%) were female; 361 (6.0%) were Asian; 121 were (2.0%) Black; 252 (4.2%) were Spanish descent; 4959 were (82.2%) White; and 342 (5.7%) reported another race (consolidated owing to small numbers), declined to respond, or were not asked to report race owing to regulatory prohibitions. Most patients (4114 [68.2%]) had stable hsTnT values (change <3 ng/L), with 1158 (19.2%) and 763 (12.6%) having changes of 3 to less than 7 ng/L and 7 ng/L or more, respectively. After adjustment for clinical risk factors and stratification by the starting month 1 hsTnT level, an absolute increase in hsTnT of 7 ng/L or more was associated with a more than 3-fold greater risk of the composite outcome (adjusted hazard ratio [aHR], 3.33; 95% CI, 1.99-5.57; P < .001), whereas decreases of 7 ng/L or more were associated with similar to lower risk (aHR, 0.51; 95% CI, 0.26-1.03; P = .06) compared with stable values. There was a stepwise association moving from larger absolute decreases (aHR, 0.51; 95% CI, 0.26-1.03) to larger absolute increases (aHR, 3.33; 95% CI, 1.99-5.57) in hsTnT with future risk of the composite outcome (P trend <.001). A similar association was observed when analyzed on the basis of relative percent and continuous change. Conclusions and Relevance Among stable patients post-ACS, changes in hsTnT were associated with a gradient of risk of subsequent cardiovascular events across the range of starting hsTnT values. Serial assessment of hsTnT may refine risk stratification with the potential to guide therapy decisions in this patient population. Trial Registration ClinicalTrials.gov Identifier: NCT00202878.
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Affiliation(s)
- Siddharth M. Patel
- Thrombolysis in Myocardial Infarction Clinical Trials (TIMI) Study Group, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Arman Qamar
- Section of Interventional Cardiology & Vascular Medicine, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston, Illinois
| | - Robert P. Giugliano
- Thrombolysis in Myocardial Infarction Clinical Trials (TIMI) Study Group, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Petr Jarolim
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicholas A. Marston
- Thrombolysis in Myocardial Infarction Clinical Trials (TIMI) Study Group, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeong-Gun Park
- Thrombolysis in Myocardial Infarction Clinical Trials (TIMI) Study Group, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael A. Blazing
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Christopher P. Cannon
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eugene Braunwald
- Thrombolysis in Myocardial Infarction Clinical Trials (TIMI) Study Group, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - David A. Morrow
- Thrombolysis in Myocardial Infarction Clinical Trials (TIMI) Study Group, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Zhu S, Yu C, Liu N, Zhao M, Chen Z, Liu J, Li G, Huang H, Guo H, Sun T, Chen J, Zhuang J, Zhu P. Injectable conductive gelatin methacrylate / oxidized dextran hydrogel encapsulating umbilical cord mesenchymal stem cells for myocardial infarction treatment. Bioact Mater 2022; 13:119-134. [PMID: 35224296 PMCID: PMC8844712 DOI: 10.1016/j.bioactmat.2021.11.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/04/2021] [Accepted: 11/07/2021] [Indexed: 02/03/2023] Open
Abstract
Umbilical cord mesenchymal stem cells (UCMSCs) transplantation has been proposed as a promising treatment modality for myocardial infarction (MI), but the low retention rate remains a considerable challenge. Injectable natural polymer hydrogels with conductivity ability are highly desirable as cell delivery vehicles to repair infarct myocardium and restore the cardiac function. In this work, we developed a hydrogel system based on gelatin methacrylate (GelMA) and oxidized dextran (ODEX) as cell delivery vehicles for MI. And dopamine could be used as a reductant of graphene oxide (GO) to form reductive GO (rGO). By adjusting the amount of rGO, the conductivity of hydrogels with 0.5 mg/mL rGO concentration (≈10−4 S/cm) was similar to that of natural heart tissue. In vitro cell experiments showed that the prepared hydrogels had excellent biocompatibility and cell delivery ability of UCMSCs. More importantly, GelMA-O5/rGO hydrogel could promote UCMSCs growth and proliferation, improve the myocardial differentiation ability of UCMSCs, and up-regulate the expression of cTnI and Cx43. Further in vivo experiments demonstrated that GelMA-O5/rGO/UCMSCs Hydrogel could significantly improve the ejection fraction (EF) of rats and significantly reduce myocardial infarct area compared to PBS group, promote the survival of UCMSCs, enhance the expression level of cTnI and Cx43, and decrease the expression level of caspase-3. The findings of this study suggested that the injectable conductive GelMA-O5/rGO hydrogel encapsulating UCMSCs could improve damaged myocardial tissue and reconstruct myocardial function, which will be a promising therapeutic strategy for cardiac repair. Conducting interpenetrating polymer network (IPN) hydrogels were synthesized for myocardial infarction treatment. The conductivity of hydrogel with 0.5 mg/mL rGO concentration (≈10−4 S/cm) was similar to that of natural heart tissue. The hydrogel could promote the growth and proliferation of UCMSCs, and improve the myocardial differentiation ability of UCMSCs. The hydrogel could reduce infarct size and cardiac fibrosis in the infarct zone, increase ventricular ejection fraction. The hydrogel could promote the survival of UCMSCs, up-regulate the expression level of cTnI and Cx43, down-regulate the expression level of caspase-3.
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Banaszkiewicz M, Gąsecka A, Darocha S, Florczyk M, Pietrasik A, Kędzierski P, Piłka M, Torbicki A, Kurzyna M. Circulating Blood-Based Biomarkers in Pulmonary Hypertension. J Clin Med 2022; 11:jcm11020383. [PMID: 35054082 PMCID: PMC8779219 DOI: 10.3390/jcm11020383] [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] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/01/2022] [Accepted: 01/09/2022] [Indexed: 12/23/2022] Open
Abstract
Pulmonary hypertension (PH) is a serious hemodynamic condition, characterized by increased pulmonary vascular resistance (PVR), leading to right heart failure (HF) and death when not properly treated. The prognosis of PH depends on etiology, hemodynamic and biochemical parameters, as well as on response to specific treatment. Biomarkers appear to be useful noninvasive tools, providing information about the disease severity, treatment response, and prognosis. However, given the complexity of PH, it is impossible for a single biomarker to be adequate for the broad assessment of patients with different types of PH. The search for novel emerging biomarkers is still ongoing, resulting in a few potential biomarkers mirroring numerous pathophysiological courses. In this review, markers related to HF, myocardial remodeling, inflammation, hypoxia and tissue damage, and endothelial and pulmonary smooth muscle cell dysfunction are discussed in terms of diagnosis and prognosis. Extracellular vesicles and other markers with complex backgrounds are also reviewed. In conclusion, although many promising biomarkers have been identified and studied in recent years, there are still insufficient data on the application of multimarker strategies for monitoring and risk stratification in PH patients.
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Affiliation(s)
- Marta Banaszkiewicz
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
- Correspondence:
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.G.); (A.P.)
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
| | - Michał Florczyk
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
| | - Arkadiusz Pietrasik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.G.); (A.P.)
| | - Piotr Kędzierski
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
| | - Michał Piłka
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
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Ke J, Chen Y, Wang X, Wu Z, Zhang Q, Lian Y, Chen F. Machine learning-based in-hospital mortality prediction models for patients with acute coronary syndrome. Am J Emerg Med 2022; 53:127-134. [PMID: 35033770 DOI: 10.1016/j.ajem.2021.12.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 12/13/2021] [Accepted: 12/31/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The purpose of this study is to identify the risk factors of in-hospital mortality in patients with acute coronary syndrome (ACS) and to evaluate the performance of traditional regression and machine learning prediction models. METHODS The data of ACS patients who entered the emergency department of Fujian Provincial Hospital from January 1, 2017 to March 31, 2020 for chest pain were retrospectively collected. The study used univariate and multivariate logistic regression analysis to identify risk factors for in-hospital mortality of ACS patients. The traditional regression and machine learning algorithms were used to develop predictive models, and the sensitivity, specificity, and receiver operating characteristic curve were used to evaluate the performance of each model. RESULTS A total of 6482 ACS patients were included in the study, and the in-hospital mortality rate was 1.88%. Multivariate logistic regression analysis found that age, NSTEMI, Killip III, Killip IV, and levels of D-dimer, cardiac troponin I, CK, N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-density lipoprotein (HDL) cholesterol, and Stains were independent predictors of in-hospital mortality. The study found that the area under the receiver operating characteristic curve of the models developed by logistic regression, gradient boosting decision tree (GBDT), random forest, and support vector machine (SVM) for predicting the risk of in-hospital mortality were 0.884, 0.918, 0.913, and 0.896, respectively. Feature importance evaluation found that NT-proBNP, D-dimer, and Killip were top three variables that contribute the most to the prediction performance of the GBDT model and random forest model. CONCLUSIONS The predictive model developed using logistic regression, GBDT, random forest, and SVM algorithms can be used to predict the risk of in-hospital death of ACS patients. Based on our findings, we recommend that clinicians focus on monitoring the changes of NT-proBNP, D-dimer, Killip, cTnI, and LDH as this may improve the clinical outcomes of ACS patients.
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Affiliation(s)
- Jun Ke
- Department of Emergency, Fujian Provincial Hospital, Fuzhou 350001, Provincial College of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China; Fujian Provincial Institute of Emergency Medicine, Fuzhou 350001, China; Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou 350001, China
| | - Yiwei Chen
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai 201203, China
| | - Xiaoping Wang
- Department of Emergency, Fujian Provincial Hospital, Fuzhou 350001, Provincial College of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China; Fujian Provincial Institute of Emergency Medicine, Fuzhou 350001, China; Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou 350001, China
| | - Zhiyong Wu
- Department of Cardiology, Fujian Provincial Hospital, Fuzhou 350001, Provincial College of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China
| | - Qiongyao Zhang
- Center for information management, Fujian Provincial Hospital, Fuzhou 350001, Fujian Provincial, China
| | - Yangpeng Lian
- Center for information management, Fujian Provincial Hospital, Fuzhou 350001, Fujian Provincial, China
| | - Feng Chen
- Department of Emergency, Fujian Provincial Hospital, Fuzhou 350001, Provincial College of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China; Fujian Provincial Institute of Emergency Medicine, Fuzhou 350001, China; Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou 350001, China.
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Moriarty ME, Miller MA, Murray MJ, Duignan PJ, Gunther-Harrington CT, Field CL, Adams LM, Schmitt TL, Johnson CK. Exploration of serum cardiac troponin I as a biomarker of cardiomyopathy in southern sea otters (Enhydra lutris nereis). Am J Vet Res 2021; 82:529-537. [PMID: 34166086 DOI: 10.2460/ajvr.82.7.529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare serum cardiac troponin I (cTnI) concentrations between sea otters with and without cardiomyopathy and describe 2 cases of cardiomyopathy with different etiologies. ANIMALS 25 free-ranging southern sea otters (Enhydra lutris nereis) with (n = 14; cases) and without (11; controls) cardiomyopathy and 17 healthy managed southern sea otters from aquariums or rehabilitation centers (controls). PROCEDURES Serum cTnI concentration was measured in live sea otters. Histopathologic and gross necropsy findings were used to classify cardiomyopathy status in free-ranging otters; physical examination and echocardiography were used to assess health status of managed otters. Two otters received extensive medical evaluations under managed care, including diagnostic imaging, serial cTnI concentration measurement, and necropsy. RESULTS A significant difference in cTnI concentrations was observed between cases and both control groups, with median values of 0.279 ng/mL for cases and < 0.006 ng/mL for free-ranging and managed controls. A cutoff value of ≥ 0.037 ng/mL yielded respective sensitivity and specificity estimates for detection of cardiomyopathy of 64.3% and 90.9% for free-ranging cases versus free-ranging controls and 64.3% and 94.1% for free-ranging cases versus managed controls. CONCLUSIONS AND CLINICAL RELEVANCE Cardiomyopathy is a common cause of sea otter death that has been associated with domoic acid exposure and protozoal infection. Antemortem diagnostic tests are needed to identify cardiac damage. Results suggested that serum cTnI concentration has promise as a biomarker for detection of cardiomyopathy in sea otters. Serial cTnI concentration measurements and diagnostic imaging are recommended to improve heart disease diagnosis in managed care settings.
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Affiliation(s)
- Megan E Moriarty
- From the Karen C. Drayer Wildlife Health Center and EpiCenter for Disease Dynamics, One Health Institute, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616
| | - Melissa A Miller
- From the Marine Wildlife Veterinary Care and Research Center, California Department of Fish and Wildlife, Santa Cruz, CA 95060
| | | | | | - Catherine T Gunther-Harrington
- From the Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616
| | - Cara L Field
- From the Marine Mammal Center, Sausalito, CA 94965
| | - Lance M Adams
- From the Aquarium of the Pacific, Long Beach, CA 90802
| | - Todd L Schmitt
- From the SeaWorld Animal Health and Rescue Center, San Diego, CA 92109
| | - Christine K Johnson
- From the Karen C. Drayer Wildlife Health Center and EpiCenter for Disease Dynamics, One Health Institute, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616
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9
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van den Berg VJ, Oemrawsingh RM, Umans VAWM, Kardys I, Asselbergs FW, van der Harst P, Hoefer IE, Kietselaer B, Lenderink T, Oude Ophuis AJ, van Schaik RH, de Winter RJ, Akkerhuis KM, Boersma E. Temporal Evolution of Serum Concentrations of High-Sensitivity Cardiac Troponin During 1 Year After Acute Coronary Syndrome Admission. J Am Heart Assoc 2021; 10:e017393. [PMID: 33325242 PMCID: PMC7955490 DOI: 10.1161/jaha.120.017393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 11/03/2020] [Indexed: 12/04/2022]
Abstract
Background Detailed insights in temporal evolution of high-sensitivity cardiac troponin following acute coronary syndrome (ACS) are currently missing. We aimed to describe and compare the post-ACS kinetics of high-sensitivity cardiac troponin I (hs-cTnI) and high-sensitivity cardiac troponin T (hs-cTnT), and to determine their intra- and interindividual variation in clinically stable patients. Methods and Results We determined hs-cTnI (Abbott) and hs-cTnT (Roche) in 1507 repeated blood samples, derived from 191 patients with ACS (median, 8/patient) who remained free from adverse cardiac events during 1-year follow-up. Post-ACS kinetics were studied by linear mixed-effect models. Using the samples collected in the 6- to 12-month post-ACS time frame, patients were then considered to have chronic coronary syndrome. We determined (differences between) the average hs-cTnI and average hs-cTnT concentration, and the intra- and interindividual variation for both biomarkers. Compared with hs-cTnT, hs-cTnI peaked higher (median 3506 ng/L versus 494 ng/L; P<0.001) and was quicker below the biomarker-specific upper reference limit (16 versus 19 days; P<0.001). In the post-6-month samples, hs-cTnI and hs-cTnT showed modest correlation (rspearman=0.60), whereas the average hs-cTnT concentration was 5 times more likely to be above the upper reference limit than hs-cTnI. The intraindividual variations of hs-cTnI and hs-cTnT were 14.0% and 18.1%, while the interindividual variations were 94.1% and 75.9%. Conclusions Hs-cTnI peaked higher after ACS and was quicker below the upper reference limit. In the post-6-month samples, hs-cTnI and hs-cTnT were clearly not interchangeable, and average hs-cTnT concentrations were much more often above the upper reference limit than hs-cTnI. For both markers, the within-patient variation fell largely below beween-patient variation. Registration URL: https://www.trialregister.nl; unique identifiers: NTR1698 and NTR1106.
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Affiliation(s)
- Victor J. van den Berg
- Netherlands Heart InstituteUtrechtThe Netherlands
- Northwest ClinicsAlkmaarThe Netherlands
- Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | | | | | - Isabella Kardys
- Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | | | | | - Imo E. Hoefer
- University Medical Center UtrechtUtrechtThe Netherlands
| | | | | | - Anton J. Oude Ophuis
- Canisius‐Wilhelmina ZiekenhuisNijmegenThe Netherlands
- Working Group on Cardiovascular Research the Netherlands (WCN)UtrechtThe Netherlands
| | - Ron H. van Schaik
- Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | | | | | - Eric Boersma
- Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
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10
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Redefining the Prognostic Value of High-Sensitivity Troponin in COVID-19 Patients: The Importance of Concomitant Coronary Artery Disease. J Clin Med 2020; 9:jcm9103263. [PMID: 33053826 PMCID: PMC7601151 DOI: 10.3390/jcm9103263] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Although studies assessing cardiovascular comorbidities and myocardial injury in Coronavirus disease 2019 (COVID-19) patients have been published, no reports focused on clinical outcomes of myocardial injury in patients with and without chronic coronary syndromes (CCS) are currently available. Methods: In this study, consecutive COVID-19 patients admitted to four different institutions were screened for enrolment. Patients were divided into two groups (CCS vs. no-CCS). Association with in-hospital mortality and related predictors represented the main study outcome; myocardial injury and its predictors were deemed secondary outcomes. Results: A total of 674 COVID-19 patients were enrolled, 112 (16.6%) with an established history of CCS. Myocardial injury occurred in 43.8% patients with CCS vs. 14.4% patients without CCS, as confirmed by high-sensitivity cardiac troponin (hs-cTn) elevation on admission or during hospitalization. The mortality rate in the CCS cohort was nearly three-fold higher. After adjusting for disease severity, myocardial injury resulted significantly associated with in-hospital mortality in the no-CCS group but not in CCS patients. Conclusions: Patients with CCS and COVID-19 showed high mortality rate. Myocardial injury may be a bystander in CCS patients and COVID-19, while in patients without known history of CCS, myocardial injury has a significant role in predicting poor outcomes.
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11
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Falahati A, Arazi H, Suzuki K. Acute Responses of Cardiac Biomarkers to Intermittent and Continuous Exercise Are Related to Age Difference but Not I/D Polymorphism in the ACE Gene. Front Physiol 2020; 11:665. [PMID: 32774305 PMCID: PMC7381388 DOI: 10.3389/fphys.2020.00665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 05/25/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose The purpose of this study was to determine the (i) cardiac biomarker (cTnI and NT-proBNP) responses to moderate-intensity continuous exercise (MICE) and high-intensity interval exercise (HIIE) in the middle-aged and young groups, (ii) relationship of post-exercise cardiac biomarker release between these two age groups, and (iii) investigate whether insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme (ACE) gene is associated with predisposition to cardiac damage after exercise in Iranian men. Methods We examined cTnI and NT-proBNP in 29 middle-aged (54.5 ± 4.6 years) and 28 young (22.7 ± 4.2 years) soccer players before and after HIIE and MICE running tests. Results The middle-aged soccer players had higher baseline cTnI (0.015 ± 0.007 ng/ml vs. 0.010 ± 0.006 ng/ml; P = 0.01) and NT-proBNP (30.7 ± 13.6 ng/L vs. 18.4 ± 8.3 ng/L; P < 0.001) values compared with the young group. The changes with exercise (ΔcTnI: 13 vs. 11 ng/ml and ΔNT-proBNP: 18 vs. 11 ng/L) were also higher in the middle-aged group. No subject exceeded the upper reference limit for cTnI and NT-proBNP. Considering three ACE genotypes, the mean cTnI and NT-proBNP values of middle-aged and young groups did not show any significant difference. Conclusion Marked differences in baseline and post-exercise cTnI and NT-proBNP values were observed, which were related to age differences but not to ACE genotypes.
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Affiliation(s)
- Akram Falahati
- Department of Exercise Physiology, University of Guilan, Rasht, Iran
| | - Hamid Arazi
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht, Iran
- *Correspondence: Hamid Arazi,
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12
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Waschki B, Alter P, Zeller T, Magnussen C, Neumann JT, Twerenbold R, Sinning C, Herr C, Kahnert K, Fähndrich S, Blankenberg S, Rabe KF, Welte T, Jörres RA, Vogelmeier CF, Bals R, Watz H. High-sensitivity troponin I and all-cause mortality in patients with stable COPD: an analysis of the COSYCONET study. Eur Respir J 2020; 55:13993003.01314-2019. [PMID: 31831579 DOI: 10.1183/13993003.01314-2019] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/11/2019] [Indexed: 11/05/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of death with a considerable part of the population dying from cardiovascular diseases. High-sensitivity troponin I (hs-TnI) might help to better identify COPD patients at high risk of mortality. We aimed to study the predictive value of hs-TnI for all-cause mortality beyond established COPD assessments, and after consideration of relevant cardiovascular risk factors and prevalent cardiovascular diseases, in a broad population with stable COPD.Circulating hs-TnI concentrations together with a wide range of respiratory and cardiovascular markers were evaluated in 2085 patients with stable COPD across all severity stages enrolled in the multicentre COSYCONET cohort study. The primary outcome was all-cause mortality over 3 years of follow-up.Hs-TnI was detectable in 2020 (96.9%) patients. The median hs-TnI concentration was 3.8 ng·L-1 (interquartile range 2.5-6.6 ng·L-1), with levels above the 99th percentile reference limit of 27 ng·L-1 observed in 1.8% of patients. In Cox regression analyses including adjustments for airflow limitation, dyspnoea grade, exercise capacity and history of severe exacerbations, as well as traditional cardiovascular risk factors, estimated glomerular filtration rate, ankle-brachial index, N-terminal pro-brain natriuretic peptides and prevalent cardiovascular diseases, hs-TnI was a significant predictor for all-cause mortality, both as a continuous variable (hazard ratio (HR) for log hs-TnI 1.28, 95% CI 1.01-1.62) and categorised according to the cut-off of 6 ng·L-1 (HR 1.63, 95% CI 1.10-2.42).In patients with stable COPD, hs-TnI is a strong predictor of all-cause mortality beyond established COPD mortality predictors, and independent of a broad range of cardiovascular risk factors and prevalent cardiovascular diseases. Hs-TnI concentrations well below the upper reference limit provide further prognostic value for all patients with COPD when added to established risk assessments.
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Affiliation(s)
- Benjamin Waschki
- Dept of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany .,LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Grosshansdorf, Germany.,German Center for Lung Research (DZL).,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck
| | - Peter Alter
- German Center for Lung Research (DZL).,Dept of Medicine, Pulmonary and Critical Care Medicine, Philipps-University of Marburg (UMR), Marburg, Germany
| | - Tanja Zeller
- Dept of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck
| | - Christina Magnussen
- Dept of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck
| | - Johannes T Neumann
- Dept of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Raphael Twerenbold
- Dept of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Christoph Sinning
- Dept of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Christian Herr
- Dept of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Kathrin Kahnert
- German Center for Lung Research (DZL).,Dept of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Munich, Germany
| | | | - Stefan Blankenberg
- Dept of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Grosshansdorf, Germany.,German Center for Lung Research (DZL)
| | - Tobias Welte
- German Center for Lung Research (DZL).,Dept of Respiratory Medicine, Hannover Medical School, Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Rudolf A Jörres
- German Center for Lung Research (DZL).,Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilians University (LMU) Munich, Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
| | - Claus F Vogelmeier
- German Center for Lung Research (DZL).,Dept of Medicine, Pulmonary and Critical Care Medicine, Philipps-University of Marburg (UMR), Marburg, Germany
| | - Robert Bals
- Dept of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany.,Both authors contributed equally
| | - Henrik Watz
- German Center for Lung Research (DZL).,Pulmonary Research Institute at LungenClinic Grosshansdorf, ARCN, Grosshansdorf, Germany.,Both authors contributed equally
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13
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Sörensen NA, Ludwig S, Makarova N, Neumann JT, Lehmacher J, Hartikainen TS, Haller PM, Keller T, Blankenberg S, Westermann D, Zeller T, Schofer N. Prognostic Value of a Novel and Established High-Sensitivity Troponin I Assay in Patients Presenting with Suspected Myocardial Infarction. Biomolecules 2019; 9:E469. [PMID: 31505902 PMCID: PMC6769518 DOI: 10.3390/biom9090469] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/26/2019] [Accepted: 09/05/2019] [Indexed: 12/31/2022] Open
Abstract
: High-sensitivity troponin has proven to be a promising biomarker for the prediction of future adverse cardiovascular events. We aimed to assess the prognostic value of high-sensitivity troponin I (hs-TnI) on admission in patients with suspected acute myocardial infarction (AMI) analyzed by a novel (Singulex Clarity cTnI) and established hs-TnI assay (ARCHITECT STAT hs-TnI, Abbott). Hs-TnI was measured in a total of 2332 patients from two prospective cohort studies presenting to the emergency department with suspected AMI. The prognostic impact for overall and cardiovascular mortality of both hs-TnI assays was assessed in the total patient cohort as well as in the subgroups of patients with AMI (n = 518) and without AMI (non-AMI) (n = 1814). Patients presenting with highest hs-TnI levels showed higher overall and cardiovascular mortality rates compared to those with lower troponin levels, irrespective of the assay used. Both hs-TnI assays indicated association with overall mortality according to adjusted hazard ratio (HR) among the entire study population (HR for Singulex assay: 1.16 (95% CI 1.08-1.24) and HR for Abbott assay: 1.17 (95% CI 1.09-1.25)). This finding was particularly pronounced in non-AMI patients, whereas no association between hs-TnI and overall mortality was found in AMI patients for either assay. In non-AMI patients, both assays equally improved risk prediction for cardiovascular mortality beyond conventional cardiovascular risk factors. Hs-TnI is independently predictive for adverse outcomes in patients with suspected AMI, especially in the subset of patients without confirmed AMI. There was no difference between the established and the novel assay in the prediction of mortality.
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Affiliation(s)
- Nils A Sörensen
- Department of General and Interventional Cardiology, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Sebastian Ludwig
- Department of General and Interventional Cardiology, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Nataliya Makarova
- Department of General and Interventional Cardiology, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Johannes T Neumann
- Department of General and Interventional Cardiology, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Jonas Lehmacher
- Department of General and Interventional Cardiology, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Tau S Hartikainen
- Department of General and Interventional Cardiology, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Paul M Haller
- Department of General and Interventional Cardiology, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Till Keller
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Benekestrasse 2-8, 61231 Bad Nauheim, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Benekestrasse 2-8, 61231 Bad Nauheim, Germany.
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Niklas Schofer
- Department of General and Interventional Cardiology, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany.
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14
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Performance of Coronary Risk Scores Among Patients With Chest Pain in the Emergency Department. J Am Coll Cardiol 2019; 71:606-616. [PMID: 29420956 DOI: 10.1016/j.jacc.2017.11.064] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/30/2017] [Accepted: 11/27/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Both the modified History, Electrocardiogram, Age, Risk factors and Troponin (HEART) score and the Emergency Department Assessment of Chest pain Score (EDACS) can identify patients with possible acute coronary syndrome (ACS) at low risk (<1%) for major adverse cardiac events (MACE). OBJECTIVES The authors sought to assess the comparative accuracy of the EDACS (original and simplified) and modified HEART risk scores when using cardiac troponin I (cTnI) cutoffs below the 99th percentile, and obtain precise MACE risk estimates. METHODS The authors conducted a retrospective study of adult emergency department (ED) patients evaluated for possible ACS in an integrated health care system between 2013 and 2015. Negative predictive values for MACE (composite of myocardial infarction, cardiogenic shock, cardiac arrest, and all-cause mortality) were determined at 60 days. Reclassification analyses were used to assess the comparative accuracy of risk scores and lower cTnI cutoffs. RESULTS A total of 118,822 patients with possible ACS were included. The 3 risk scores' accuracies were optimized using the lower limit of cTnI quantitation (<0.02 ng/ml) to define low risk for 60-day MACE, with reclassification yields ranging between 3.4% and 3.9%, while maintaining similar negative predictive values (range 99.49% to 99.55%; p = 0.27). The original EDACS identified the largest proportion of patients as low risk (60.6%; p < 0.0001). CONCLUSIONS Among ED patients with possible ACS, the modified HEART score, original EDACS, and simplified EDACS all predicted a low risk of 60-day MACE with improved accuracy using a cTnI cutoff below the 99th percentile. The original EDACS identified the most low-risk patients, and thus may be the preferred risk score.
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15
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Abstract
ST-segment elevation myocardial infarction (STEMI) is the most acute manifestation of coronary artery disease and is associated with great morbidity and mortality. A complete thrombotic occlusion developing from an atherosclerotic plaque in an epicardial coronary vessel is the cause of STEMI in the majority of cases. Early diagnosis and immediate reperfusion are the most effective ways to limit myocardial ischaemia and infarct size and thereby reduce the risk of post-STEMI complications and heart failure. Primary percutaneous coronary intervention (PCI) has become the preferred reperfusion strategy in patients with STEMI; if PCI cannot be performed within 120 minutes of STEMI diagnosis, fibrinolysis therapy should be administered to dissolve the occluding thrombus. The initiation of networks to provide around-the-clock cardiac catheterization availability and the generation of standard operating procedures within hospital systems have helped to reduce the time to reperfusion therapy. Together with new advances in antithrombotic therapy and preventive measures, these developments have resulted in a decrease in mortality from STEMI. However, a substantial amount of patients still experience recurrent cardiovascular events after STEMI. New insights have been gained regarding the pathophysiology of STEMI and feed into the development of new treatment strategies.
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16
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Li Y, Pei H, Zhou C. Cardiac troponins predict adverse clinical outcomes in stable coronary artery disease: a dose–response meta-analysis of prospective studies. Biomarkers 2019; 24:556-565. [PMID: 30974974 DOI: 10.1080/1354750x.2019.1606277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Yuehua Li
- Department of Cardiology State Key Laboratory of Cardiovascular Disease, Fuwai Hospital National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hanjun Pei
- Department of Cardiology, The First Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Chenghui Zhou
- Department of Anesthesiology State Key Laboratory of Cardiovascular Disease, Fuwai Hospital National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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17
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Castro LTD, Santos IDS, Goulart AC, Pereira ADC, Staniak HL, Bittencourt MS, Lotufo PA, Bensenor IM. Elevated High-Sensitivity Troponin I in the Stabilized Phase after an Acute Coronary Syndrome Predicts All-Cause and Cardiovascular Mortality in a Highly Admixed Population: A 7-Year Cohort. Arq Bras Cardiol 2019; 112:230-237. [PMID: 30916200 PMCID: PMC6424029 DOI: 10.5935/abc.20180268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/02/2018] [Indexed: 11/20/2022] Open
Abstract
Background High-sensitivity cardiac troponin I (hs-cTnI) has played an important role in
the risk stratification of patients during the in-hospital phase of acute
coronary syndrome (ACS), but few studies have determined its role as a
long-term prognostic marker in the outpatient setting. Objective To investigate the association between levels of hs-cTnI measured in the
subacute phase after an ACS event and long-term prognosis in a highly
admixed population. Methods We measured levels of hs-cTnI in 525 patients 25 to 90 days after admission
for an ACS event; these patients were then divided into tertiles according
to hs-cTnI levels and followed for up to 7 years. We compared all-cause and
cardiovascular mortality using Cox proportional hazards models and adopting
a significance level of 5%. Results After a median follow-up of 51 months, patients in the highest tertile had a
greater hazard ratio (HR) for all-cause mortality after adjustment for age,
sex, known cardiovascular risk factors, medication use, and demographic
factors (HR: 3.84, 95% CI: 1.92-8.12). These findings persisted after
further adjustment for estimated glomerular filtration rate < 60
ml/min/1.73 m2 and left ventricular ejection fraction < 0.40
(HR: 6.53, 95% CI: 2.12-20.14). Cardiovascular mortality was significantly
higher in the highest tertile after adjustment for age and sex (HR: 5.65,
95% CI: 1.94-16.47) and both in the first (HR: 4.90, 95% CI: 1.35-17.82) and
second models of multivariate adjustment (HR: 5.89, 95% CI: 1.08-32.27). Conclusions Elevated hs-cTnI levels measured in the stabilized phase after an ACS event
are independent predictors of all-cause and cardiovascular mortality in a
highly admixed population.
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Affiliation(s)
| | - Itamar de Souza Santos
- Centro de Pesquisa Clínica e Epidemiológica da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Alessandra C Goulart
- Centro de Pesquisa Clínica e Epidemiológica da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Alexandre da Costa Pereira
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Henrique Lane Staniak
- Centro de Pesquisa Clínica e Epidemiológica da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Marcio Sommer Bittencourt
- Centro de Pesquisa Clínica e Epidemiológica da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Paulo Andrade Lotufo
- Centro de Pesquisa Clínica e Epidemiológica da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Isabela Martins Bensenor
- Centro de Pesquisa Clínica e Epidemiológica da Universidade de São Paulo (USP), São Paulo, SP - Brazil
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18
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Cheng XY, Chen C, He SF, Huang CX, Zhang L, Chen ZW, Zhang Y. Spinal NGF induces anti-intrathecal opioid-initiated cardioprotective effect via regulation of TRPV1 expression. Eur J Pharmacol 2018; 844:145-155. [PMID: 30529472 DOI: 10.1016/j.ejphar.2018.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 11/26/2022]
Abstract
Evidences from previous studies confirmed that intrathecal morphine preconditioning (ITMP) reduces the cardiac injury of ischemia-reperfusion (IR) via the central nervous system. However, the molecular mechanism is not fully understood. The breath of central nerve growth factor (NGF) during nociceptive transmission has been well documented, and little is known about the significance of NGF in myocardial injury of IR and intrathecal morphine-induced cardioprotection. To address these questions, we over-expressed or silenced NGF in the spinal cord by using intrathecal injection of lentivirus-NGF or shRNA respectively, accompanied by ITMP in the IR rat model. The levels of NGF and tropomyosin receptor kinase A (Trka) as well as transient receptor potential vanilloid 1 (TRPV1) in the T2-6 spinal cord were evaluated. The results showed that cardiac damage indicators induced by IR, including the increased infarct size, arrhythmia score and serum troponin levels were attenuated after ITMP. However, overexpression of spinal NGF significantly reversed these decreases, as well as reduced the expression and phosphorylation of TRPV1 that was elicited by ITMP. Conversely, silencing of spinal NGF enhanced ITMP-induced cardioprotective effects. Phosphorylation and expression of TRPV1 in the spinal cord were significantly decreased after regional NGF silencing. These findings suggested that the cardioprotective effects of ITMP may implement by mediating through spinal NGF expression, wherein it involves the nociceptor TRPV1. NGF may act as a potential therapeutic target in the development of new agents for the treatment of cardiac injury induced by IR.
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Affiliation(s)
- Xue-Ying Cheng
- Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Chen Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Shu-Fang He
- Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Chun-Xia Huang
- Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Li Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Zhi-Wu Chen
- Department of Pharmacology, Anhui Medical University, Hefei, China.
| | - Ye Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China.
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Badertscher P, Boeddinghaus J, Nestelberger T, Twerenbold R, Wildi K, Sabti Z, Puelacher C, Rubini Giménez M, Pfäffli J, Flores D, du Fay de Lavallaz J, Miró Ò, Martin-Sanchez FJ, Morawiec B, Lohrmann J, Buser A, Keller DI, Geigy N, Reichlin T, Mueller C, Cupa J, Schumacher L, Grimm K, Kozhuharov N, Shrestha S, Rentsch K, López B, Yañez-Palma MC, Iglesias S, Kawecki D, Ganovská E, Osswald S. Effect of Acute Coronary Syndrome Probability on Diagnostic and Prognostic Performance of High-Sensitivity Cardiac Troponin. Clin Chem 2018; 64:515-525. [DOI: 10.1373/clinchem.2017.279513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 12/20/2017] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
There is concern that high-sensitivity cardiac troponin (hs-cTn) may have low diagnostic accuracy in patients with low acute coronary syndrome (ACS) probability.
METHODS
We prospectively stratified patients presenting with acute chest discomfort to the emergency department (ED) into 3 groups according to their probability for ACS as assessed by the treating ED physician using a visual analog scale: ≤10%, 11% to 79%, and ≥80%, reviewing all information available at 90 min. hs-cTnT and hs-cTnI concentrations were determined in a blinded fashion. Two independent cardiologists adjudicated the final diagnosis.
RESULTS
Among 3828 patients eligible for analysis, 1189 patients had low (≤10%) probability for ACS. The incidence of non-ST-segment elevation myocardial infarction (NSTEMI) increased from 1.3% to 12.2% and 54.8% in patients with low, intermediate, and high ACS probability, respectively. The positive predictive value of hs-cTnT and hs-cTnI was low in patients with low ACS probability and increased with the incidence of NSTEMI, whereas the diagnostic accuracy of hs-cTnT and hs-cTnI for NSTEMI as quantified by the area under the curve (AUC) was very high and comparable among all 3 strata, e.g., AUC hs-cTnI, 0.96 (95% CI, 0.94–0.97); 0.87 (95% CI, 0.85–0.89); and 0.89 (95% CI, 0.87–0.92), respectively. Findings were validated using bootstrap analysis as an alternative methodology to define ACS probability. Similarly, higher hs-cTnT/I concentrations independently predicted all-cause mortality within 2 years (e.g., hs-cTnT hazard ratio, 1.39; 95% CI, 1.27–1.52), irrespective of ACS probability.
CONCLUSIONS
Diagnostic and prognostic accuracy and utility of hs-cTnT and hs-cTnI remain high in patients with acute chest discomfort and low ACS probability.
ClinicalTrials.gov Identifier: NCT00470587.
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Affiliation(s)
- Patrick Badertscher
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Sao Paulo, Brazil
| | - 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
- GREAT network, Sao Paulo, Brazil
| | - 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
- GREAT network, Sao Paulo, Brazil
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Sao Paulo, Brazil
- Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany
| | - Karin Wildi
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Sao Paulo, Brazil
| | - Zaid Sabti
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Sao Paulo, Brazil
| | - Christian Puelacher
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Sao Paulo, Brazil
| | - Maria Rubini Giménez
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Sao Paulo, Brazil
| | - Julian Pfäffli
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Dayana Flores
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Sao Paulo, Brazil
| | - Jeanne du Fay de Lavallaz
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Sao Paulo, Brazil
| | - Òscar Miró
- GREAT network, Sao Paulo, Brazil
- Emergency Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Beata Morawiec
- GREAT network, Sao Paulo, Brazil
- 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Katowice, Katowice, Poland
| | - Jens Lohrmann
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andreas Buser
- Blood Transfusion Centre, Swiss Red Cross, and Department of Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - Nicolas Geigy
- Emergency Department, Kantonsspital, Liestal, Switzerland
| | - Tobias Reichlin
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Sao Paulo, Brazil
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Sao Paulo, Brazil
| | - Janosch Cupa
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network
| | - Lukas Schumacher
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network
| | - Karin Grimm
- 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 Basel, Basel, Switzerland
- GREAT network
| | - Nikola Kozhuharov
- 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 Basel, Basel, Switzerland
| | - Samyut Shrestha
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network
| | - Katharina Rentsch
- Laboratory Medicine, University Hospital Basel, University Basel, Basel, Switzerland
| | - Beatriz López
- GREAT network
- Emergency Department, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - M C Yañez-Palma
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain
| | - Sergio Iglesias
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Damian Kawecki
- GREAT network
- 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Katowice, Katowice, Poland
| | - Eva Ganovská
- GREAT network
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Stefan Osswald
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
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20
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Rusnak J, Behnes M, Henzler T, Reckord N, Vogler N, Meyer M, Hoffmann U, Natale M, Hoffmann J, Hamed S, Weidner K, Lang S, Mukherji A, Haubenreisser H, Schoenberg SO, Borggrefe M, Bertsch T, Akin I. Comparative analysis of high-sensitivity cardiac troponin I and T for their association with coronary computed tomography-assessed calcium scoring represented by the Agatston score. Eur J Med Res 2017; 22:47. [PMID: 29145895 PMCID: PMC5691858 DOI: 10.1186/s40001-017-0290-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/07/2017] [Indexed: 12/19/2022] Open
Abstract
Background This study evaluates the association between high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) and coronary calcium concentration (CAC) detected by coronary computed tomography (CCT) and evaluated with the Agatston score in patients with suspected coronary artery disease (CAD). Methods Patients undergoing CCT during routine clinical care were enrolled prospectively. CCT was indicated for patients with a low to intermediate pretest probability for CAD. Within 24 h of CCT examination, peripheral blood samples were taken to measure cardiac biomarkers hs-cTnI and hs-cTnT. Results A total of 76 patients were enrolled including 38% without detectable CAC, 36% with an Agatston score from 1 to 100, 17% from 101 to 400, and 9% with values ≥ 400. hs-cTnI was increasing alongside Agatston score and was able to differentiate between different groups of Agatston scores. Both hs-cTn discriminated values greater than 100 (hs-cTnI, AUC = 0.663; p = 0.032; hs-cTnT, AUC = 0.650; p = 0.048). In univariate and multivariate logistic regression models, hs-cTnT and hs-cTnI were significantly associated with increased Agatston scores. Patients with hs-cTnT ≥ 0.02 µg/l and hs-cTnI ≥ 5.5 ng/l were more likely to reveal values ≥ 400 (hs-cTnT; OR = 13.4; 95% CI 1.545–116.233; p = 0.019; hs-cTnI; OR = 8.8; 95% CI 1.183–65.475; p = 0.034). Conclusion The present study shows that the Agatston score was significantly correlated with hs cardiac troponins, both in univariable and multivariable linear regression models. Hs-cTnI is able to discriminate between different Agatston values. The present results might reveal potential cut-off values for hs cardiac troponins regarding different Agatston values. Trial registration Cardiovascular Imaging and Biomarker Analyses (CIBER), NCT03074253 https://clinicaltrials.gov/ct2/show/record/NCT03074253
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Affiliation(s)
- Jonas Rusnak
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. .,DZHK (German Center for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany.
| | - Michael Behnes
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nadine Reckord
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| | - Nils Vogler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mathias Meyer
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ursula Hoffmann
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| | - Michele Natale
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| | - Julia Hoffmann
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| | - Sonja Hamed
- Department of Internal Medicine III, University Hospital Heidelberg, Faculty of Medicine Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Kathrin Weidner
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| | - Agnibh Mukherji
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| | - Holger Haubenreisser
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
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21
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Roos A, Bandstein N, Lundbäck M, Hammarsten O, Ljung R, Holzmann MJ. Stable High-Sensitivity Cardiac Troponin T Levels and Outcomes in Patients With Chest Pain. J Am Coll Cardiol 2017; 70:2226-2236. [PMID: 29073949 DOI: 10.1016/j.jacc.2017.08.064] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 08/30/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is a paucity of data on the association between high-sensitivity cardiac troponin (hs-cTn) levels and outcomes in patients with chest pain but no myocardial infarction (MI), or any other condition that may lead to acutely elevated troponin levels. OBJECTIVES The authors hypothesized that any detectable high-sensitivity cardiac troponin T (hs-cTnT) level is associated with adverse outcomes. METHODS All patients (N = 22,589) >25 years of age with chest pain and hs-cTnT analyzed concurrently in the emergency department of Karolinska University Hospital, Stockholm, Sweden from 2011 to 2014 were eligible for inclusion. After excluding all patients with acute conditions that may have affected hs-cTnT, or MI associated with the visit, or insufficient information to determine whether troponin levels were stable, Cox regression was used to estimate risks for all-cause, cardiovascular, and noncardiovascular mortality, MI, and heart failure at different levels of troponins. RESULTS A total of 19,460 patients with a mean age of 54 ± 17 years were included. During a mean follow-up of 3.3 ± 1.2 years, 1,349 (6.9%) patients died. Adjusted hazard ratios (with 95% confidence intervals) for all-cause mortality were 2.00 (1.66 to 2.42), 2.92 (2.38 to 3.59), 4.07 (3.28 to 5.05), 6.77 (5.22 to 8.78), and 9.68 (7.18 to 13.00) in patients with hs-cTnT levels of 5 to 9, 10 to 14, 15 to 29, 30 to 49, and ≥50 ng/l, respectively, compared with patients with hs-cTnT levels <5 ng/l. There was a strong and graded association between all detectable levels of hs-cTnT and risk for MI, heart failure, and cardiovascular and noncardiovascular mortality. CONCLUSIONS Among patients with chest pain and stable troponin levels, any detectable level of hs-cTnT is associated with an increased risk of death and cardiovascular outcomes and should merit further attention.
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Affiliation(s)
- Andreas Roos
- Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden; Functional Area of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Nadia Bandstein
- Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden; Functional Area of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Magnus Lundbäck
- Department of Clinical Sciences, Karolinska Institutet, Solna, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Danderyd, Stockholm, Sweden
| | - Ola Hammarsten
- Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rickard Ljung
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Martin J Holzmann
- Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden; Functional Area of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
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22
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High Sensitivity Troponins Discriminate Different Morphologies of Coronary Artery Plaques Being Assessed by Coronary Computed Tomography Angiography. DISEASE MARKERS 2017; 2017:9306409. [PMID: 28804199 PMCID: PMC5540457 DOI: 10.1155/2017/9306409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/31/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study evaluates the association between high sensitivity troponin I (hsTnI) and T (hsTnT) and the morphology of coronary artery plaques detected by coronary computed tomography angiography (CCTA) in patients with suspected coronary artery disease (CAD). METHODS Patients undergoing CCTA were prospectively enrolled. CCTA was indicated by a low to intermediate pretest probability for CAD during routine clinical care. Within 24 hours of CCTA examination, peripheral blood samples were taken to measure hsTnI, hsTnT, and N-terminal probrain natriuretic peptide (NT-proBNP). RESULTS A total of 99 patients were enrolled with 43% without CAD, 9% with noncalcified plaques, 28% with calcified plaques, and 19% with mixed type plaque lesions. Both hsTnI and hsTnT levels were able to discriminate significantly between the groups, especially in the presence of mixed coronary plaques (AUC range: 0.741-0.752; p = 0.0001). In multivariate logistic regression models, hsTnT, but not hsTnI, was still significantly associated with mixed coronary plaque morphology (odds ratio = 8.968; 95% CI 1.999-40.241; p = 0.004). CONCLUSIONS Both hsTnI and hsTnT are able to discriminate between different coronary artery plaques morphologies, whereas hsTnT was significantly associated with mixed coronary plaques in patients with suspected CAD. This trial is registered with NCT03074253.
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23
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Hijazi Z, Lindahl B, Oldgren J, Andersson U, Lindbäck J, Granger CB, Alexander JH, Gersh BJ, Hanna M, Harjola VP, Hylek EM, Lopes RD, Siegbahn A, Wallentin L. Repeated Measurements of Cardiac Biomarkers in Atrial Fibrillation and Validation of the ABC Stroke Score Over Time. J Am Heart Assoc 2017; 6:e004851. [PMID: 28645934 PMCID: PMC5669148 DOI: 10.1161/jaha.116.004851] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 04/03/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cardiac biomarkers are independent risk markers in atrial fibrillation, and the novel biomarker-based ABC stroke score (age, biomarkers, and clinical history of prior stroke) was recently shown to improve the prediction of stroke risk in patients with atrial fibrillation. Our aim was to investigate the short-term variability of the cardiac biomarkers and evaluate whether the ABC stroke risk score provides a stable short-term risk estimate. METHODS AND RESULTS According to the study protocol, samples were obtained at entry and also at 2 months in 4796 patients with atrial fibrillation followed for a median of 1.8 years in the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial. Cardiac troponin I, cardiac troponin T, and N-terminal pro-B-type natriuretic peptide were measured with high-sensitivity immunoassays. Associations with outcomes were evaluated by Cox regression. C indices and calibration plots were used to evaluate the ABC stroke score at 2 months. The average changes in biomarker levels during 2 months were small (median change cardiac troponin T +2.8%, troponin I +2.0%, and N-terminal pro-B-type natriuretic peptide +13.5%) and within-subject correlation was high (all ≥0.82). Repeated measurement of cardiac biomarkers provided some incremental prognostic value for mortality but not for stroke when combined with clinical risk factors and baseline levels of the biomarkers. Based on 8702 person-years of follow-up and 96 stroke/systemic embolic events, the ABC stroke score at 2 months achieved a similar C index of 0.70 (95% CI, 0.65-0.76) as compared with 0.70 (95% CI, 0.65-0.75) at baseline. The ABC stroke score remained well calibrated using predefined risk classes. CONCLUSIONS In patients with stable atrial fibrillation, the variability of the cardiac biomarkers and the biomarker-based ABC stroke score during 2 months are small. The prognostic information by the ABC stroke score remains consistent and well calibrated with similar good predictive performance if patients are retested after 2 months. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984.
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Affiliation(s)
- Ziad Hijazi
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala Sweden
| | - Bertil Lindahl
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala Sweden
| | - Jonas Oldgren
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala Sweden
| | - Ulrika Andersson
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Johan Lindbäck
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | | | | | | | - Veli-Pekka Harjola
- Division of Emergency Care, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | | | | | - Agneta Siegbahn
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Lars Wallentin
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala Sweden
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24
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Vieira de Melo RM, Hueb W, Nomura CH, Ribeiro da Silva EE, Villa AV, Oikawa FTC, da Costa LMA, Rezende PC, Garzillo CL, Lima EG, Franchini Ramires JA, Kalil Filho R. Biomarker release after percutaneous coronary intervention in patients without established myocardial infarction as assessed by cardiac magnetic resonance with late gadolinium enhancement. Catheter Cardiovasc Interv 2017; 90:87-93. [DOI: 10.1002/ccd.27125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/05/2017] [Accepted: 04/23/2017] [Indexed: 12/24/2022]
Affiliation(s)
| | - Whady Hueb
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | - Cesar Higa Nomura
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | | | - Alexandre Volney Villa
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | | | | | - Paulo Cury Rezende
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | - Cibele Larrosa Garzillo
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | - Eduardo Gomes Lima
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | | | - Roberto Kalil Filho
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
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25
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Horjen AW, Ulimoen SR, Enger S, Norseth J, Seljeflot I, Arnesen H, Tveit A. Troponin I levels in permanent atrial fibrillation-impact of rate control and exercise testing. BMC Cardiovasc Disord 2016; 16:79. [PMID: 27142292 PMCID: PMC4855853 DOI: 10.1186/s12872-016-0255-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High-sensitivity troponin I (hs-TnI) and troponin T (hs-TnT) are moderately correlated and independently related to outcome in atrial fibrillation (AF). Rate controlling therapy has been shown to reduce hs-TnT, however the potential impact on hs-TnI levels, and whether this differs from the effects on hs-TnT, has not been investigated previously. METHODS Sixty patients with stable, permanent AF without heart failure or known ischemic heart disease were included in a randomised crossover study (mean age 71 ± 9 years, 18 women). Diltiazem 360 mg, verapamil 240 mg, metoprolol 100 mg, and carvedilol 25 mg were administered once daily for three weeks, in a randomised sequence. At baseline and on the last day of each treatment period, hs-TnI was measured at rest and after a maximal exercise test and compared to hs-TnT. RESULTS Hs-TnI and hs-TnT correlated moderately at baseline (rs = 0.582, p < 0.001). All drugs reduced both the resting and the peak exercise levels of hs-TnI compared with baseline (p < 0.001 for all). The decline in resting hs-TnI and hs-TnT values relative to baseline levels was similar for all drugs except for verapamil, which reduced hs-TnI more than hs-TnT (p = 0.017). Levels of hs-TnI increased significantly in response to exercise testing at baseline and at all treatment regimens (p < 0.001 for all). The relative exercise-induced increase in hs-TnI was significantly larger compared to hs-TnT at baseline (p < 0.001), on diltiazem (p < 0.001) and on verapamil (p = 0.001). CONCLUSIONS In our population of stable, permanent AF patients, all four rate control drug regimens reduced hs-TnI significantly, both at rest and during exercise. The decline in hs-TnI and hs-TnT levels associated with beta-blocker and calcium channel blocker treatment was similar, except for a larger relative decrease in hs-TnI levels following verapamil treatment. TRIAL REGISTRATION www.clinicaltrials.gov ( NCT00313157 ).
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Affiliation(s)
- Anja Wiedswang Horjen
- Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, N-3004, Drammen, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Sara Reinvik Ulimoen
- Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, N-3004, Drammen, Norway
| | - Steve Enger
- Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, N-3004, Drammen, Norway
| | - Jon Norseth
- Clinic for Medical Diagnostics, Vestre Viken Hospital Trust, Drammen, Norway
| | - Ingebjørg Seljeflot
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Harald Arnesen
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Arnljot Tveit
- Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, N-3004, Drammen, Norway
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Sinning JM, Hammerstingl C, Schueler R, Neugebauer A, Keul S, Ghanem A, Mellert F, Schiller W, Müller C, Vasa-Nicotera M, Zur B, Welz A, Grube E, Nickenig G, Werner N. The prognostic value of acute and chronic troponin elevation after transcatheter aortic valve implantation. EUROINTERVENTION 2016; 11:1522-9. [DOI: 10.4244/eijy15m02_02] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Nordenskjöld AM, Hammar P, Ahlström H, Bjerner T, Duvernoy O, Eggers KM, Fröbert O, Hadziosmanovic N, Lindahl B. Unrecognized myocardial infarctions detected by cardiac magnetic resonance imaging are associated with cardiac troponin I levels. Clin Chim Acta 2016; 455:189-94. [DOI: 10.1016/j.cca.2016.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 10/22/2022]
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Affiliation(s)
- James A de Lemos
- From Division of Cardiology, Department of Medicine (J.A.d.L., A.R.) and Department of Clinical Sciences (C.R.A.), University of Texas Southwestern Medical Center, Dallas.
| | - Anand Rohatgi
- From Division of Cardiology, Department of Medicine (J.A.d.L., A.R.) and Department of Clinical Sciences (C.R.A.), University of Texas Southwestern Medical Center, Dallas
| | - Colby R Ayers
- From Division of Cardiology, Department of Medicine (J.A.d.L., A.R.) and Department of Clinical Sciences (C.R.A.), University of Texas Southwestern Medical Center, Dallas
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Legaz-Arrese A, López-Laval I, George K, Puente-Lanzarote JJ, Moliner-Urdiales D, Ayala-Tajuelo VJ, Mayolas-Pi C, Reverter-Masià J. Individual variability in cardiac biomarker release after 30 min of high-intensity rowing in elite and amateur athletes. Appl Physiol Nutr Metab 2015; 40:951-8. [DOI: 10.1139/apnm-2015-0055] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This study had two objectives: (i) to examine individual variation in the pattern of cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) release in response to high-intensity rowing exercise, and (ii) to establish whether individual heterogeneity in biomarker appearance was influenced by athletic status (elite vs. amateur). We examined cTnI and NT-proBNP in 18 elite and 14 amateur rowers before and 5 min, 1, 3, 6, 12, and 24 h after a 30-min maximal rowing test. Compared with pre-exercise levels, peak postexercise cTnI (pre: 0.014 ± 0.030 μg·L–1; peak post: 0.058 ± 0.091 μg·L–1; p = 0.000) and NT-proBNP (pre: 15 ± 11 ng·L–1; peak post: 31 ± 19 ng·L–1; p = 0.000) were elevated. Substantial individual heterogeneity in peak and time-course data was noted for cTnI. Peak cTnI exceeded the upper reference limit (URL) in 9 elite and 3 amateur rowers. No rower exceeded the URL for NT-proBNP. Elite rowers had higher baseline (0.019 ± 0.038 vs. 0.008 ± 0.015 μg·L–1; p = 0.003) and peak postexercise cTnI (0.080 ± 0.115 vs. 0.030 ± 0.029 μg·L–1; p = 0.022) than amateur rowers, but the change with exercise was similar between groups. There were no significant differences in baseline and peak postexercise NT-proBNP between groups. In summary, marked individuality in the cTnI response to a short but high-intensity rowing bout was observed. Athletic status did not seem to affect the change in cardiac biomarkers in response to high-intensity exercise.
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Affiliation(s)
- Alejandro Legaz-Arrese
- Section of Physical Education and Sports, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Isaac López-Laval
- Section of Physical Education and Sports, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | | | - Diego Moliner-Urdiales
- Department of Education, University Jaume I, Avenida Sos Baynat s/n, 12071 Castellón, Spain
| | | | - Carmen Mayolas-Pi
- Section of Physical Education and Sports, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Joaquín Reverter-Masià
- Research Group Human Movement, University of Lleida, C/Partida Caparrella s/n, 25192 Lleida, Spain
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Saad YME, McEwan J, Shugman IM, Mussap C, Juergens CP, Ferguson I, French JK. Use of a high-sensitivity troponin T assay in the assessment and disposition of patients attending a tertiary Australian emergency department: A cross-sectional pilot study. Emerg Med Australas 2015; 27:405-11. [DOI: 10.1111/1742-6723.12430] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Yousef ME Saad
- Department of Cardiology; Liverpool Hospital; Sydney New South Wales Australia
- South Western Sydney Clinical School; The University of New South Wales; Sydney New South Wales Australia
| | - James McEwan
- South Western Sydney Clinical School; The University of New South Wales; Sydney New South Wales Australia
- Department of Emergency; Liverpool Hospital; Sydney New South Wales Australia
| | - Ibrahim M Shugman
- Department of Cardiology; Liverpool Hospital; Sydney New South Wales Australia
- South Western Sydney Clinical School; The University of New South Wales; Sydney New South Wales Australia
| | - Christian Mussap
- Department of Cardiology; Liverpool Hospital; Sydney New South Wales Australia
- South Western Sydney Clinical School; The University of New South Wales; Sydney New South Wales Australia
| | - Craig P Juergens
- Department of Cardiology; Liverpool Hospital; Sydney New South Wales Australia
- South Western Sydney Clinical School; The University of New South Wales; Sydney New South Wales Australia
| | - Ian Ferguson
- South Western Sydney Clinical School; The University of New South Wales; Sydney New South Wales Australia
- Department of Emergency; Liverpool Hospital; Sydney New South Wales Australia
| | - John K French
- Department of Cardiology; Liverpool Hospital; Sydney New South Wales Australia
- South Western Sydney Clinical School; The University of New South Wales; Sydney New South Wales Australia
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Maznyczka A, Kaier T, Marber M. Troponins and other biomarkers in the early diagnosis of acute myocardial infarction. Postgrad Med J 2015; 91:322-30. [DOI: 10.1136/postgradmedj-2014-133129] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 05/08/2015] [Indexed: 12/24/2022]
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Carda R, Aceña Á, Pello A, Cristóbal C, Tarín N, Huelmos A, Alonso J, Asensio D, Lorenzo Ó, Martín-Ventura JL, Blanco-Colio L, Farré J, López Bescós L, Egido J, Tuñón J. The Prognostic Value of High-Sensitive Troponin I in Stable Coronary Artery Disease Depends on Age and Other Clinical Variables. Cardiology 2015; 132:1-8. [DOI: 10.1159/000381259] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 02/25/2015] [Indexed: 11/19/2022]
Abstract
Objectives: To study the prognostic value of high-sensitive troponin (hs-cTn) I in stable coronary artery disease. Methods: In total, we studied 705 patients. Secondary outcomes were the incidence of: (1) acute ischemic events and (2) heart failure or death. The primary outcome was the composite of them. Results: Patients with hs-cTnI >0 ng/ml (62.1%) were older, had a lower estimated glomerular filtration rate, more frequent a history of hypertension, atrial fibrillation, ejection fraction <40%, and therapy with angiotensin-converting enzyme inhibitors, diuretics and acenocumarol. The follow-up period was 2.2 ± 0.99 years. Fifty-three patients suffered an acute ischemic event, 33 died or suffered heart failure and 78 developed the primary outcome. By univariate Cox's regression analysis, hs-cTnI >0 was associated with a higher risk of developing the primary outcome [relative risk = 2.360 (1.359-4.099); p = 0.001] and heart failure or death [relative risk = 5.932 (1.806-19.482); p < 0.001], but not with acute ischemic events. Statistical significance was lost after controlling for age. By logistic regression analysis, age [relative risk = 1.026 (1.009-1.044); p = 0.003], ejection fraction <40% [relative risk = 4.099 (2.043-8.224); p < 0.001], use of anticoagulants [relative risk = 2.785 (1.049-7.395); p = 0.040] and therapy with angiotensin-converting enzyme inhibitors [relative risk = 1.471 (1.064-2.034); p = 0.020], and estimated glomerular filtration rate [relative risk = 0.988 (0.977-0.999); p = 0.027] were associated with hs-cTnI >0. Conclusions: In stable coronary disease, hs-cTnI is associated with the incidence of heart failure or death, but this relationship depends on other variables.
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Twerenbold R, Wildi K, Jaeger C, Gimenez MR, Reiter M, Reichlin T, Walukiewicz A, Gugala M, Krivoshei L, Marti N, Moreno Weidmann Z, Hillinger P, Puelacher C, Rentsch K, Honegger U, Schumacher C, Zurbriggen F, Freese M, Stelzig C, Campodarve I, Bassetti S, Osswald S, Mueller C. Optimal Cutoff Levels of More Sensitive Cardiac Troponin Assays for the Early Diagnosis of Myocardial Infarction in Patients With Renal Dysfunction. Circulation 2015; 131:2041-50. [PMID: 25948542 PMCID: PMC4456169 DOI: 10.1161/circulationaha.114.014245] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/27/2015] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. Background— It is unknown whether more sensitive cardiac troponin (cTn) assays maintain their clinical utility in patients with renal dysfunction. Moreover, their optimal cutoff levels in this vulnerable patient population have not previously been defined. Methods and Results— In this multicenter study, we examined the clinical utility of 7 more sensitive cTn assays (3 sensitive and 4 high-sensitivity cTn assays) in patients presenting with symptoms suggestive of acute myocardial infarction. Among 2813 unselected patients, 447 (16%) had renal dysfunction (defined as Modification of Diet in Renal Disease–estimated glomerular filtration rate <60 mL·min−1·1.73 m−2). The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including coronary angiography and serial levels of high-sensitivity cTnT. Acute myocardial infarction was the final diagnosis in 36% of all patients with renal dysfunction. Among patients with renal dysfunction and elevated baseline cTn levels (≥99th percentile), acute myocardial infarction was the most common diagnosis for all assays (range, 45%–80%). In patients with renal dysfunction, diagnostic accuracy at presentation, quantified by the area under the receiver-operator characteristic curve, was 0.87 to 0.89 with no significant differences between the 7 more sensitive cTn assays and further increased to 0.91 to 0.95 at 3 hours. Overall, the area under the receiver-operator characteristic curve in patients with renal dysfunction was only slightly lower than in patients with normal renal function. The optimal receiver-operator characteristic curve–derived cTn cutoff levels in patients with renal dysfunction were significantly higher compared with those in patients with normal renal function (factor, 1.9–3.4). Conclusions— More sensitive cTn assays maintain high diagnostic accuracy in patients with renal dysfunction. To ensure the best possible clinical use, assay-specific optimal cutoff levels, which are higher in patients with renal dysfunction, should be considered. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00470587.
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Affiliation(s)
- Raphael Twerenbold
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Karin Wildi
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Cedric Jaeger
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Maria Rubini Gimenez
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Miriam Reiter
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Tobias Reichlin
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Astrid Walukiewicz
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Mathias Gugala
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Lian Krivoshei
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Nadine Marti
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Zoraida Moreno Weidmann
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Petra Hillinger
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Christian Puelacher
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Katharina Rentsch
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Ursina Honegger
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Carmela Schumacher
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Felicitas Zurbriggen
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Michael Freese
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Claudia Stelzig
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Isabel Campodarve
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Stefano Bassetti
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Stefan Osswald
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.)
| | - Christian Mueller
- From Department of Cardiology and Cardiovascular Research Institute Basel (R.T., K.W., C.J., M.R.G., M.R., T.R., A.W., M.G., L.K., N.M., Z.M.W., P.H., C.P., U.H., C.S., F.Z., M.F., C.S., S.O., C.M.), Department of Internal Medicine (K.W., C.J., M.R.G., P.H., S.B.), and Department of Laboratory Medicine (K.R.), University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain (M.R.G., I.C.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.R.).
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Biomarkers in Cardiology - Part 2: In Coronary Heart Disease, Valve Disease and Special Situations. Arq Bras Cardiol 2015; 104:337-46. [PMID: 26083777 PMCID: PMC4495448 DOI: 10.5935/abc.20150061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/01/2015] [Indexed: 01/25/2023] Open
Abstract
Cardiovascular diseases are the main causes of mortality and morbidity in Brazil.
Their primary and secondary preventions are a priority for the health system and
require multiple approaches for increased effectiveness. Biomarkers are tools used to
identify with greater accuracy high-risk individuals, establish a faster diagnosis,
guide treatment, and determine prognosis. This review aims to highlight the
importance of biomarkers in clinical cardiology practice and raise relevant points
regarding their application and perspectives for the next few years. This document
was divided into two parts. This second part addresses the application of biomarkers
in coronary heart disease, valvular diseases, cardio-oncology, pulmonary embolism,
and cardiorenal syndrome.
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Hall TS, Hallén J, Krucoff MW, Roe MT, Brennan DM, Agewall S, Atar D, Lincoff AM. Cardiac troponin I for prediction of clinical outcomes and cardiac function through 3-month follow-up after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Am Heart J 2015; 169:257-265.e1. [PMID: 25641535 DOI: 10.1016/j.ahj.2014.10.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Circulating levels of cardiac troponin I (cTnI) after ST-segment elevation myocardial infarction (STEMI) are associated with infarct size and chronic left ventricular dysfunction, but the relation to clinical end points and biochemical measures of global cardiac function remains less well defined. METHODS One thousand sixty-six patients receiving primary percutaneous coronary intervention (PCI) in the PROTECTION AMI trial were studied in a post hoc analysis. Cardiac troponin I was measured at several time points during the index hospitalization, and patients were followed up for 3 months before reassessment including N-terminal pro-B-type natriuretic peptide (NT-proBNP) and left ventricular ejection fraction (LVEF) measurements. RESULTS The median (quartile 1-3) cTnI levels were 0.4 (0.1-0.4) μg/L at admission, 33.1 (12.8-72.1) μg/L after 16 to 24 hours, and 9.1 (3.9-17.5) μg/L after 70 to 80 hours. In adjusted models, all post-PCI single points, peak, and area under curve were found to be independently associated with clinical events, NT-proBNP >118 pmol/L, or LVEF <40% (P for all <.001). When cTnI was added to a baseline risk model for prediction of clinical events, the C statistic improved from 0.779 to 0.846 (16-24 hours) and 0.859 (70-80 hours). Quantified by integrated discrimination improvement, the addition of cTnI significantly augmented prediction ability (relative integrated discrimination improvement 44%-154%; P for all ≤.001). Consistent improvements in discrimination of NT-proBNP >118 pmol/L and LVEF <40% were observed. CONCLUSIONS Cardiac troponin I measured after primary PCI for STEMI is independently associated with clinical outcomes and cardiac function through 3-month follow-up. These results suggest that cTnI levels are a useful risk stratification tool in STEMI patients.
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Study design of embracing high-sensitivity troponin effectively: The value of more information: A randomized comparison. Contemp Clin Trials 2014; 39:183-90. [DOI: 10.1016/j.cct.2014.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/23/2014] [Accepted: 08/29/2014] [Indexed: 11/21/2022]
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Cardiac troponin I levels in patients with non-ST-elevation acute coronary syndrome-the importance of gender. Am Heart J 2014; 168:317-324.e1. [PMID: 25173543 DOI: 10.1016/j.ahj.2014.06.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 06/02/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Measurement of high-sensitivity cardiac troponin levels is increasingly used in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, studies investigating the distribution and prognostic implications of high-sensitivity troponin levels in men and women separately are currently lacking. METHODS Cardiac troponin I (cTnI) levels were determined using a high-sensitivity assay (Abbott Laboratories, Abbott Park, IL) in 1,677 male and 1,073 female NSTE-ACS patients participating in the GUSTO IV study. The prognostic associations of cTnI to outcome (30-day composite end point of recurrent myocardial infarction and 1-year mortality) were assessed in multivariable models, using cTnI both as a continuous variable and dichotomized at different sets of single and gender-specific 99th percentiles. RESULTS Median cTnI levels were 947 and 175 ng/L in men and women, respectively (P < .001). The adjusted odds ratios for cTnI (ln) were similar in men and women. The adjusted odds ratios for cTnI above the tested 99th percentiles levels in contrast were twice as high in women compared with men. This was a consequence of differences in the cTnI distribution and risk gradients across cTnI levels, in particular due to lower event rates in women without cTnI elevation. Gender-specific cutoffs did not improve risk prediction. CONCLUSIONS Despite overall lower levels, cTnI above the tested 99th percentiles exhibited stronger prognostic information in women with NSTE-ACS compared with men. This likely reflects differences in the pathophysiology and the clinical presentation in NSTE-ACS. Our data, thus, emphasize that women with symptoms of unstable coronary artery disease encompass a broader risk panorama than men.
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Park K, Kim M, Cho YR, Park JS, Park TH, Kim MH, Kim YD. Association between Cardiac Troponin Level and Coronary Flow Reserve in Patients without Coronary Artery Disease: Insight from a Thermodilution Technique Using an Intracoronary Pressure Wire. Korean Circ J 2014; 44:141-7. [PMID: 24876854 PMCID: PMC4037635 DOI: 10.4070/kcj.2014.44.3.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/25/2014] [Accepted: 04/04/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cardiac troponins are associated with increased mortality, even among patients with no coronary artery disease. Elevated cardiac troponin levels are frequently observed in patients without significant coronary lesions, although the mechanism underlying this finding is unclear. The aim of our study was to evaluate the association between the levels of cardiac troponin and coronary flow reserve (CFR). SUBJECTS AND METHODS We evaluated serum cardiac troponin-I in 19 patients (9 female; age 61.9±10.9 year-old). All patients had an ejection fraction >40% and angiographically normal coronary arteries. Simultaneous measurements of fractional flow reserve (FFR), the index of microcirculatory resistance (IMR), and CFR measurements using an intracoronary temperature- and pressure-sensing guidewire under basal conditions and during maximal hyperemia were performed in three vessels: the left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA). RESULTS All patients were followed for a median of 13 months. FFR, IMR, and CFR measurements were performed successfully in all subjects. Mean CFRs of LAD, LCX, and RCA were 1.98±1.20, 2.75±2.11, and 4.44±2.51, respectively. Mean IMRs of LAD, LCX and RCA were 33.28±18.78, 29.11±26.70, and 30.55±23.65, respectively. There was a poor correlation between CFR and troponin-I values in each vessel. In selecting the lowest value of CFR in each patient as the corresponding value, the lowest CFR was not associated with troponin-I levels (r=-0.219, p=0.367). CONCLUSION In patients without significant coronary lesions, the correlation between CFR and troponin-I level was not significant using a thermodilution technique. Further study of a larger population with longer-term follow-up may be needed to more fully understand microvascular dysfunction.
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Affiliation(s)
- Kyungil Park
- Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea. ; Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Minkwan Kim
- Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Young-Rak Cho
- Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea. ; Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jong-Sung Park
- Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea. ; Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Tea-Ho Park
- Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea. ; Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Moo Hyun Kim
- Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea. ; Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Young-Dae Kim
- Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea. ; Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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Hijazi Z, Oldgren J, Andersson U, Connolly SJ, Ezekowitz MD, Hohnloser SH, Reilly PA, Siegbahn A, Yusuf S, Wallentin L. Importance of persistent elevation of cardiac biomarkers in atrial fibrillation: a RE-LY substudy. Heart 2014; 100:1193-200. [PMID: 24794140 DOI: 10.1136/heartjnl-2013-304872] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate the prognostic importance of transient or persistent elevations of cardiac troponin-I (cTnI) and N-terminal-B-type natriuretic peptide (NT-proBNP) in atrial fibrillation (AF). METHODS Plasma samples were obtained at randomisation and after 3 months in 2514 patients with AF in the RE-LY trial; median follow-up was 2.0 years. Patients were grouped based on levels at the two time points according to detectable cTnI levels (≥0.01 µg/L) or NT-proBNP levels above median (≥778 ng/L). These groups were related to occurrence of stroke or cardiovascular events evaluated with Cox models adjusting for established risk factors. RESULTS The proportion of patients with detectable cTnI levels at both time points was 48.5%, at one time point 28.5% and at neither time point 21.0%. Patients with detectable cTnI at both time points had substantially higher rates of stroke compared with those with transient elevations and those with no elevation at either time point (p<0.005, effect of cTnI). Persistent elevation of either or both cardiac biomarkers at baseline and 3 months was associated with a higher risk for cardiovascular events and mortality (p<0.0001). Prognostic prediction improved most with the use of repeated measurements of both cardiac biomarkers simultaneously (p<0.05) and achieved C-statistic 0.644 for stroke compared with 0.611 for CHADS2-score. CONCLUSIONS Persistent elevation of troponin and NT-proBNP indicates a worse prognosis than transient elevations or no elevations of either marker. Prognostication of stroke, death and thromboembolic events is improved by the use of repeated determinations of cardiac biomarkers. TRIAL REGISTRATION NUMBER http://www.clinicaltrials.gov, NCT00262600.
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Affiliation(s)
- Ziad Hijazi
- Department of Cardiology, Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jonas Oldgren
- Department of Cardiology, Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Ulrika Andersson
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | - Michael D Ezekowitz
- Thomas Jefferson Medical College and the Heart Center, Wynnewood, Pennsylvania, USA
| | | | - Paul A Reilly
- Boehringer Ingelheim Pharmaceuticals, Ridgefield, USA
| | - Agneta Siegbahn
- Department of Medical Sciences, Uppsala Clinical Research Center, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Salim Yusuf
- Population Health Research Institute, Hamilton, Canada
| | - Lars Wallentin
- Department of Cardiology, Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Percy AJ, Simon R, Chambers AG, Borchers CH. Enhanced sensitivity and multiplexing with 2D LC/MRM-MS and labeled standards for deeper and more comprehensive protein quantitation. J Proteomics 2014; 106:113-24. [PMID: 24769237 DOI: 10.1016/j.jprot.2014.04.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 04/10/2014] [Accepted: 04/14/2014] [Indexed: 01/04/2023]
Abstract
UNLABELLED Mass spectrometry (MS)-based protein quantitation is increasingly being employed to verify candidate protein biomarkers. Multiple or selected reaction monitoring-mass spectrometry (MRM-MS or SRM-MS) with isotopically labeled internal standards has proven to be a successful approach in that regard, but has yet to reach its full potential in terms of multiplexing and sensitivity. Here, we report the development of a new MRM method for the quantitation of 253 disease-associated proteins (represented by 625 interference-free peptides) in 13 LC fractions. This 2D RPLC/MRM-MS approach extends the depth and breadth of the assay by 2 orders of magnitude over pre-fractionation-free assays, with 31 proteins below 10 ng/mL and 41 proteins above 10 ng/mL now quantifiable. Standard flow rates are used in both chromatographic dimensions, and up-front depletion or antibody-based enrichment is not required. The LC separations utilize high and low pH conditions, with the former employing an ammonium hydroxide-based eluent, instead of the conventional ammonium formate, resulting in improved LC column lifetime and performance. The high sensitivity (determined concentration range: 15 mg/mL to 452 pg/mL) and robustness afforded by this method makes the full MRM panel, or subsets thereof, useful for the verification of disease-associated plasma protein biomarkers in patient samples. BIOLOGICAL SIGNIFICANCE The described research extends the breadth and depth of protein quantitation in undepleted and non-enriched human plasma by employing standard-flow 2D RPLC/MRM-MS in conjunction with a complex mixture of isotopically labeled peptide standards. The proteins quantified are mainly putative biomarkers of non-communicable (i.e., non-infectious) disease (e.g., cardiovascular or cancer), which require pre-clinical verification and validation before clinical implementation. Based on the enhanced sensitivity and multiplexing, this quantitative plasma proteomic method should prove useful in future candidate biomarker verification studies.
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Affiliation(s)
- Andrew J Percy
- University of Victoria-Genome British Columbia Proteomics Centre, Vancouver Island Technology Park, #3101-4464 Markham St., Victoria, BC V8Z 7X8, Canada
| | - Romain Simon
- University of Victoria-Genome British Columbia Proteomics Centre, Vancouver Island Technology Park, #3101-4464 Markham St., Victoria, BC V8Z 7X8, Canada
| | - Andrew G Chambers
- University of Victoria-Genome British Columbia Proteomics Centre, Vancouver Island Technology Park, #3101-4464 Markham St., Victoria, BC V8Z 7X8, Canada
| | - Christoph H Borchers
- University of Victoria-Genome British Columbia Proteomics Centre, Vancouver Island Technology Park, #3101-4464 Markham St., Victoria, BC V8Z 7X8, Canada; Department of Biochemistry and Microbiology, University of Victoria, Petch Building Room 207, 3800 Finnerty Rd., Victoria, BC V8P 5C2, Canada.
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Schreck DM, Fishberg RD. Diagnostic accuracy of a new cardiac electrical biomarker for detection of electrocardiogram changes suggestive of acute myocardial ischemic injury. Ann Noninvasive Electrocardiol 2014; 19:129-44. [PMID: 24118724 PMCID: PMC4034593 DOI: 10.1111/anec.12109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE A new cardiac "electrical" biomarker (CEB) for detection of 12-lead electrocardiogram (ECG) changes indicative of acute myocardial ischemic injury has been identified. Objective was to test CEB diagnostic accuracy. METHODS This is a blinded, observational retrospective case-control, noninferiority study. A total of 508 ECGs obtained from archived digital databases were interpreted by cardiologist and emergency physician (EP) blinded reference standards for presence of acute myocardial ischemic injury. CEB was constructed from three ECG cardiac monitoring leads using nonlinear modeling. Comparative active controls included ST voltage changes (J-point, ST area under curve) and a computerized ECG interpretive algorithm (ECGI). Training set of 141 ECGs identified CEB cutoffs by receiver-operating-characteristic (ROC) analysis. Test set of 367 ECGs was analyzed for validation. Poor-quality ECGs were excluded. Sensitivity, specificity, and negative and positive predictive values were calculated with 95% confidence intervals. Adjudication was performed by consensus. RESULTS CEB demonstrated noninferiority to all active controls by hypothesis testing. CEB adjudication demonstrated 85.3-94.4% sensitivity, 92.5-93.0% specificity, 93.8-98.6% negative predictive value, and 74.6-83.5% positive predictive value. CEB was superior against all active controls in EP analysis, and against ST area under curve and ECGI by cardiologist. CONCLUSION CEB detects acute myocardial ischemic injury with high diagnostic accuracy. CEB is instantly constructed from three ECG leads on the cardiac monitor and displayed instantly allowing immediate cost-effective identification of patients with acute ischemic injury during cardiac rhythm monitoring.
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Affiliation(s)
- David M. Schreck
- Departments of Emergency Medicine and Internal MedicineSummit Medical GroupBerkeley HeightsNJ
- Department of Medicine, Atlantic Health SystemOverlook Medical CenterSummitNJ
| | - Robert D. Fishberg
- Department of Medicine and Division of Cardiology, Atlantic Health SystemOverlook Medical CenterSummitNJ
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Hussein AA, Gottdiener JS, Bartz TM, Sotoodehnia N, DeFilippi C, Dickfeld T, Deo R, Siscovick D, Stein PK, Lloyd-Jones D. Cardiomyocyte injury assessed by a highly sensitive troponin assay and sudden cardiac death in the community: the Cardiovascular Health Study. J Am Coll Cardiol 2013; 62:2112-20. [PMID: 23973690 PMCID: PMC4157919 DOI: 10.1016/j.jacc.2013.07.049] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/27/2013] [Accepted: 07/12/2013] [Indexed: 01/02/2023]
Abstract
OBJECTIVES This study sought to determine the association between markers of cardiomyocyte injury in ambulatory subjects and sudden cardiac death (SCD). BACKGROUND The pathophysiology of SCD is complex but is believed to be associated with an abnormal cardiac substrate in most cases. The association between biomarkers of cardiomyocyte injury in ambulatory subjects and SCD has not been investigated. METHODS Levels of cardiac troponin T, a biomarker of cardiomyocyte injury, were measured by a highly sensitive assay (hsTnT) in 4,431 ambulatory participants in the Cardiovascular Health Study, a longitudinal community-based prospective cohort study. Serial measures were obtained in 3,089 subjects. All deaths, including SCD, were adjudicated by a central events committee. RESULTS Over a median follow-up of 13.1 years, 246 participants had SCD. Baseline levels of hsTnT were significantly associated with SCD (hazard ratio [HR] for +1 log(hsTnT): 2.04, 95% confidence interval [CI]: 1.78 to 2.34]. This association persisted in covariate-adjusted Cox analyses accounting for baseline risk factors (HR: 1.30, 95% CI: 1.05 to 1.62), as well as for incident heart failure and myocardial infarction (HR: 1.26, 95% CI: 1.01 to 1.57). The population was also categorized into 3 groups based on baseline hsTnT levels and SCD risk [fully adjusted HR: 1.89 vs. 1.55 vs. 1 (reference group) for hsTnT ≥12.10 vs. 5.01 to 12.09 vs. ≤ 5.00 pg/ml, respectively; p trend = 0.005]. On serial measurements, change in hsTnT levels was also associated with SCD risk (fully adjusted HR for +1 pg/ml per year increase from baseline: 1.03, 95% CI: 1.01 to 1.06). CONCLUSIONS The findings suggest an association between cardiomyocyte injury in ambulatory subjects and SCD risk beyond that of traditional risk factors.
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Affiliation(s)
| | | | | | | | | | | | - Rajat Deo
- University of Pennsylvania, Philadelphia, PA
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Illmann A, Riemer T, Erbel R, Giannitsis E, Hamm C, Haude M, Heusch G, Maier LS, Münzel T, Schmitt C, Schumacher B, Senges J, Voigtländer T, Mudra H. Disease distribution and outcome in troponin-positive patients with or without revascularization in a chest pain unit: results of the German CPU-Registry. Clin Res Cardiol 2013; 103:29-40. [DOI: 10.1007/s00392-013-0619-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
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Retracted article: Concomitant measurement of copeptin and high-sensitivity troponin for fast and reliable rule out of acute myocardial infarction. Intensive Care Med 2013; 38:732. [PMID: 22302027 DOI: 10.1007/s00134-012-2481-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 12/19/2011] [Indexed: 12/24/2022]
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Santaló M, Martin A, Velilla J, Povar J, Temboury F, Balaguer J, Muñoz M, Calmarza P, Ortiz C, Carratalá A, Gich I, Mercé J, Jaffe AS, Ordoñez-Llanos J. Using high-sensitivity troponin T: the importance of the proper gold standard. Am J Med 2013; 126:709-17. [PMID: 23764266 DOI: 10.1016/j.amjmed.2013.03.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 03/18/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The study objective was to determine how best to use high-sensitivity cardiac troponin T (hscTnT) to diagnose myocardial infarction. METHODS A total of 358 patients presenting with acute coronary syndromes sampled at admission and 2, 4, and 6 to 8 hours. Both contemporary cardiac troponin T (cTnT) and hscTnT were measured. Patients were classified with conventional cTnT values by independent investigators. Myocardial infarction required a cTnT value ≥99th reference percentile and a ≥20% change. RESULTS Seventy-nine patients had non-ST-segment elevation myocardial infarction, 105 patients had unstable angina, and 174 patients had nonacute coronary syndromes. A cTnT cutoff at the 10% coefficient of variation value missed 14.5% of infarctions. hscTnT had a sensitivity at admission of 89.9%, but specificity was only 75.1% because of elevations in 45.3% and 25.3% of those with unstable angina and nonacute coronary syndromes, respectively. The optimal value for myocardial infarction diagnosis with hscTnT was 25 ng/L at admission and 30 ng/L during serial sampling. All infarctions were diagnosed within 4 hours, with a time saving of 11 and 68 minutes compared with a cTnT value at the 99th reference percentile value and a cTnT value at a coefficient of variation of 10%. By using the 99th percentile of hsTnT plus a ≥20% change, 25 additional infarctions were identified. With these included, the optimal cutoff decreased to 12 ng/L at admission and 13 ng/L over time, but time to diagnosis increased. CONCLUSIONS The gold standard used to diagnose myocardial infarction makes a major difference in the results. When myocardial infarction is diagnosed using hscTnT 99th percentile values with a 20% change, more are identified, diagnosis is delayed, and the optimal value for use is reduced.
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de Lemos JA, Kumbhani DJ. Lessons from the heart: troponin elevations in patients with established peripheral artery disease. J Am Coll Cardiol 2013; 63:1539-41. [PMID: 23810876 DOI: 10.1016/j.jacc.2013.05.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 05/28/2013] [Indexed: 11/16/2022]
Affiliation(s)
- James A de Lemos
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Dharam J Kumbhani
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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Vélez-Martínez M, Ayers C, Mishkin JD, Bartolome SB, García CK, Torres F, Drazner MH, de Lemos JA, Turer AT, Chin KM. Association of cardiac troponin I with disease severity and outcomes in patients with pulmonary hypertension. Am J Cardiol 2013; 111:1812-7. [PMID: 23540547 DOI: 10.1016/j.amjcard.2013.02.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 02/17/2013] [Accepted: 02/17/2013] [Indexed: 10/27/2022]
Abstract
Previous studies have identified cardiac troponin I (cTnI) as an important marker in pulmonary hypertension (PH) prognosis. However, traditional assays are limited by poor sensitivity, even among patients at high risk. cTnI was measured in 255 PH patients using a new highly sensitive (hs) assay. Other measures included demographics, creatinine, 6-minute walk distance, hemodynamics, cardiac magnetic resonance imaging, and B-type natriuretic peptide level. The association between cTnI and survival was assessed using Kaplan-Meier analysis and Cox regression. cTnI was detectable with the hs assay in 95% of the patients with a median level of 6.9 pg/ml (IQR 2.7-12.6 pg/ml). Higher cTnI levels associated with higher levels of B-type natriuretic peptide, shorter 6-minute walk distance, and more severe hemodynamic and cardiac magnetic resonance imaging abnormalities. During a median follow-up of 3.5 years, 60 individuals died. Unadjusted event rates increased across higher cTnI quartiles (3, 5, 13, 17 events/100 person-years, respectively, p trend = 0.002). cTnI in the fourth (vs first) quartile remained associated with death in a final stepwise multivariable model that included clinical variables and hemodynamics (adjusted hazard ratio 5.3, 95% confidence interval 1.8-15.6). In conclusion, cTnI levels, detectable with a novel hs assay, identify patients with PH who have more severe hemodynamic and cardiac structural abnormalities and provide novel and independent prognostic information. This hs assay has the potential to detect more at-risk patients and improve current risk-stratification algorithms.
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Safford MM, Parmar G, Barasch CS, Halanych JH, Glasser SP, Goff DC, Prineas RJ, Brown TM. Hospital laboratory reporting may be a barrier to detection of 'microsize' myocardial infarction in the US: an observational study. BMC Health Serv Res 2013; 13:162. [PMID: 23635044 PMCID: PMC3648433 DOI: 10.1186/1472-6963-13-162] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 04/26/2013] [Indexed: 11/11/2022] Open
Abstract
Background International guidelines recommend that the decision threshold for troponin should be the 99th percentile of a normal population, or, if the laboratory assay is not sufficiently precise at this low level, the level at which the assay achieves a 10% or better coefficient of variation (CV). Our objectives were to examine US hospital laboratory troponin reports to determine whether either the 99th percentile or the 10% CV level were clearly indicated, and whether nonconcordance with these guidelines was a potential barrier to detecting clinically important microscopic or ‘microsize’ myocardial infarctions (MIs). To confirm past reports of the clinical importance of microsize MIs, we also contrasted in-hospital, 28-day and 1-year mortality among those with microsize and nonmicrosize MI. Methods In the REasons for Geographic And Racial Differences in Stroke national prospective cohort study (n=30,239), 1029 participants were hospitalized for acute coronary syndrome (ACS) between 2003–2009. For each case, we recorded all thresholds of abnormal troponin on the laboratory report and whether the 99th percentile or 10% CV value were clearly identified. All cases were expert adjudicated for presence of MI. Peak troponin values were used to classify MIs as microsize MI (< five times the lowest listed upper limit of normal) and nonmicrosize MI. Results Participants were hospitalized at 649 acute care US hospitals, only 2% of whose lab reports clearly identified the 99th percentile or the 10% CV level; 52% of reports indicated an indeterminate range, a practice that is no longer recommended. There were 183 microsize MIs and 353 nonmicrosize MIs. In-hospital mortality tended to be lower in the microsize than in the nonmicrosize MI group (1.1 vs. 3.6%, p = 0.09), but 28-day and 1-year mortality were similar (2.5% vs. 2.7% [p = 0.93] and 5.2% vs. 4.3% [p = 0.64], respectively). Conclusions Current practices in many US hospitals created barriers to the clinical recognition of microsize MI, which was common and clinically important in our study. Improved hospital troponin reporting is warranted.
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Affiliation(s)
- Monika M Safford
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Medical Towers 621, 1717 11th Avenue South, Birmingham, AL 35294-4410, USA.
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Venge P, Lindahl B. Cardiac troponin assay classification by both clinical and analytical performance characteristics: a study on outcome prediction. Clin Chem 2013; 59:976-81. [PMID: 23481696 DOI: 10.1373/clinchem.2012.194928] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cardiac troponin assays have been classified according to whether they measure the 99th percentile concentration of a healthy reference population with imprecision (expressed as CV) of ≤10%, between 10% and 20%, or >20%. Assays in these categories have been deemed "guideline acceptable," "clinically usable," or "not acceptable," respectively. We compared four widely used "clinically usable" cardiac troponin I (cTnI) assays with an assay designated "not acceptable" for accuracy in predicting the clinical outcome of death. METHODS Blood was collected from 259 men and 249 women, mean (SD) age 68.8 (17.8) and 70.2 (17.8) years, respectively, admitted to the emergency department for suspected myocardial infarction. We measured cTnI by the Access, Architect, i-Stat, Stratus CS, and VIDAS assays. Deaths in this population were recorded over a 31-month period. RESULTS We found VIDAS cTnI assay measurement CVs of 10% and 20% at concentrations of 0.04 and 0.02 μg/L, respectively. Comparing at the 10% CV cutoff concentration, VIDAS cTnI was less sensitive than the Access and Architect assays (P < 0.001) but more sensitive than i-Stat (P < 0.001) and Stratus CS (P < 0.001) in identifying patients with poor outcomes. At the 20% CV cutoff, the VIDAS assay was equivalent to the other assays in identifying patients with poor outcomes. CONCLUSIONS For outcome prediction, the VIDAS cTnI assay was clinically equivalent or superior to other cTnI assays judged to be acceptable from a pure analytical standpoint. Thus, comparison of cardiac troponin assays should consider not only analytical performance, but also clinical performance characteristics.
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Affiliation(s)
- Per Venge
- Department of Medical Sciences, Clinical Chemistry, University of Uppsala, Uppsala, Sweden.
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Eggers KM, Venge P, Lindahl B, Lind L. Cardiac troponin I levels measured with a high-sensitive assay increase over time and are strong predictors of mortality in an elderly population. J Am Coll Cardiol 2013; 61:1906-13. [PMID: 23500239 DOI: 10.1016/j.jacc.2012.12.048] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 12/03/2012] [Accepted: 12/09/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study sought to assess changes in troponin levels, underlying conditions, and the prognostic implications in elderly subjects from the community. BACKGROUND Cardiac troponin levels are often detectable in community dwellers when sensitive assays are applied. However, information on the course of troponin levels over time is limited. METHODS Cardiac troponin I (cTnI) was measured by using a novel, high-sensitive assay in community dwellers aged 70 years from the Prospective Investigation of the Vasculature in Uppsala Seniors study. Measurements were performed at baseline (n = 1,004) and after 5 years (n = 814). Total follow-up was 8.0 years. RESULTS cTnI levels were detectable in 968 (96.4%) subjects at baseline and independently predicted all-cause mortality (adjusted hazard ratio [HR]: 1.44 [95% confidence interval (CI): 1.18 to 1.77]) and cardiovascular mortality (adjusted HR: 1.66 [95% CI: 1.20 to 2.29]) when levels from baseline and 5-year follow-up were used as updated covariates. The integrated discrimination improvement of cTnI regarding all-cause mortality was 0.014 (p = 0.04), and the category-free net reclassification improvement was 0.231 (p = 0.02). Median cTnI levels increased by 45% between both measurements. The change in cTnI levels was significantly related to male sex (p = 0.02), body mass index (p = 0.01), high-density lipoprotein cholesterol (p = 0.005), N-terminal pro-B-type natriuretic peptide (p = 0.004), and left ventricular ejection fraction (p = 0.04), and it independently predicted all-cause mortality occurring after 5-year follow-up (adjusted HR: 1.97 [95% CI: 1.14 to 3.40]; p = 0.02). CONCLUSIONS Using a novel high-sensitive assay, cTnI levels could be determined in nearly all elderly study subjects. cTnI levels increased over time and were a strong marker of mortality risk. Our data suggest that cTnI might offer utility for clinical assessment of subjects in the general population.
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Affiliation(s)
- Kai M Eggers
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
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