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Salonen SM, Tuominen TJK, Raiko KIS, Vasankari T, Aalto R, Hellman TA, Lahtinen SE, Soukka T, Airaksinen KEJ, Wittfooth ST. Highly Sensitive Immunoassay for Long Forms of Cardiac Troponin T Using Upconversion Luminescence. Clin Chem 2024:hvae075. [PMID: 38888909 DOI: 10.1093/clinchem/hvae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/06/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Long cardiac troponin T (cTnT) has been proposed to be a promising and more specific biomarker of acute myocardial infarction (AMI). As it represents a subfraction of circulating cTnT, detection of very low concentrations is a requirement. The aim of this study was to develop a novel, highly sensitive immunoassay for long cTnT. METHODS A two-step sandwich-type immunoassay for long cTnT was developed, utilizing upconverting nanoparticles (UCNPs) as reporters. The limits of detection and quantitation were determined for the assay. Linearity and matrix effects were evaluated. Performance with clinical samples was assessed with samples from patients with non-ST elevation myocardial infarction (NSTEMI, n = 30) and end-stage renal disease (ESRD, n = 37) and compared to a previously developed time-resolved fluorescence (TRF)-based long cTnT assay and a commercial high-sensitivity cTnT assay. RESULTS The novel assay reached a 28-fold lower limit of detection (0.40 ng/L) and 14-fold lower limit of quantitation (1.79 ng/L) than the previously developed TRF long cTnT assay. Li-heparin and EDTA plasma, but not serum, were found to be suitable sample matrixes for the assay. In a receiver operating characteristics curve analysis, the troponin ratio (long/total cTnT) determined with the novel assay showed excellent discrimination between NSTEMI and ESRD with an area under the curve of 0.986 (95% CI, 0.967-1.000). CONCLUSIONS By utilizing upconversion luminescence technology, we developed a highly sensitive long cTnT assay. This novel assay can be a valuable tool for investigating the full potential of long cTnT as a biomarker for AMI. ClinicalTrials.gov Registration Number: NCT04465591.
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Affiliation(s)
- Selma M Salonen
- Biotechnology Unit, Department of Life Technologies, University of Turku, Turku, Finland
| | - Tuulia J K Tuominen
- Biotechnology Unit, Department of Life Technologies, University of Turku, Turku, Finland
| | - Kirsti I S Raiko
- Biotechnology Unit, Department of Life Technologies, University of Turku, Turku, Finland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Rami Aalto
- Biotechnology Unit, Department of Life Technologies, University of Turku, Turku, Finland
| | - Tapio A Hellman
- Kidney Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Satu E Lahtinen
- Biotechnology Unit, Department of Life Technologies, University of Turku, Turku, Finland
| | - Tero Soukka
- Biotechnology Unit, Department of Life Technologies, University of Turku, Turku, Finland
| | | | - Saara T Wittfooth
- Biotechnology Unit, Department of Life Technologies, University of Turku, Turku, Finland
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Zheng K, Bor WL, Kelder JC, Hackeng CM, Kropman RHJ, Ten Berg JM, Noordzij PG. Postoperative Myocardial Injury and Inflammatory Biomarkers in Patients Undergoing Vascular Surgery: A Subanalysis of the Platelet Reactivity and Postoperative Myocardial Injury after Major Vascular Surgery (PROMISE) Study. Ann Vasc Surg 2024; 102:202-208. [PMID: 37926141 DOI: 10.1016/j.avsg.2023.09.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/12/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Postoperative myocardial injury (PMI) is associated with morbidity and mortality, but the aetiology remains unclear. We studied whether PMI is associated with perioperative systemic inflammation. The objective is the examination of the relationship between inflammatory biomarkers (Interleukin 6[IL-6], C-reactive protein [CRP]) and PMI, detected by elevated cardiac troponin (cTn), in patients undergoing elective open abdominal aortic surgery. METHODS This prospective, single-center, observational cohort study included 54 patients undergoing elective open abdominal aortic surgery between March 2018 and April 2021. Patients were routinely treated with aspirin. IL-6 and CRP were measured preoperatively, directly after surgery, 24 hr and 48 hr postoperatively. The primary outcome was cTn release assessed by a fifth-generation high-sensitive cTn assay. Multivariable generalized linear regression models were used to evaluate the association between inflammatory biomarkers and cTn concentrations. RESULTS Fifteen patients (27.8%) developed PMI. IL-6 directly and 24 hr postoperatively was associated with elevated cTn concentrations (1.28 [1.07-1.54], P = 0.009) and 1.75 [1.18-2.59], P = 0.006, respectively). Also, CRP directly and 24 hr postoperatively was associated with elevated cTn concentrations (1.25 [1.06-1.47], P = 0.009) and 1.61 [1.1-2.33], P = 0.013, respectively). No association was found between IL-6 or CRP and cTn concentrations when measured at 48 hr postsurgery. CONCLUSIONS Biomarkers of inflammation are associated with elevated postoperative cTn concentrations in the early postoperative period in patients undergoing elective open abdominal aortic surgery.
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Affiliation(s)
- Kailiang Zheng
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Willem L Bor
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Johannes C Kelder
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Chris M Hackeng
- Department of Clinical Chemistry, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Rogier H J Kropman
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Jurrien M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands; University Medical Centre Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Peter G Noordzij
- Department of Anaesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Anaesthesiology, Intensive Care and Pain medicine, University Medical Centre, Utrecht, the Netherlands.
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3
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Hti Lar Seng NS, Zeratsion G, Pena Zapata OY, Tufail MU, Jim B. Utility of Cardiac Troponins in Patients With Chronic Kidney Disease. Cardiol Rev 2024; 32:62-70. [PMID: 35617248 DOI: 10.1097/crd.0000000000000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cardiovascular disease is a major cause of death worldwide especially in patients with chronic kidney disease (CKD). Troponin T and troponin I are cardiac biomarkers used not only to diagnose acute myocardial infarction (AMI) but also to prognosticate cardiovascular and all-cause mortality. The diagnosis of AMI in the CKD population is challenging because of their elevated troponins at baseline. The development of high-sensitivity cardiac troponins shortens the time needed to rule in and rule out AMI in patients with normal renal function. While the sensitivity of high-sensitivity cardiac troponins is preserved in the CKD population, the specificity of these tests is compromised. Hence, diagnosing AMI in CKD remains problematic even with the introduction of high-sensitivity assays. The prognostic significance of troponins did not differ whether it is detected with standard or high-sensitivity assays. The elevation of both troponin T and troponin I in CKD patients remains strongly correlated with adverse cardiovascular and all-cause mortality, and the prognosis becomes poorer with advanced CKD stages. Interestingly, the degree of troponin elevation appears to be predictive of the rate of renal decline via unclear mechanisms though activation of the renin-angiotensin and other hormonal/oxidative stress systems remain suspect. In this review, we present the latest evidence of the use of cardiac troponins in both the diagnosis of AMI and the prognosis of cardiovascular and all-cause mortality. We also suggest strategies to improve on the diagnostic capability of these troponins in the CKD/end-stage kidney disease population.
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Affiliation(s)
- Nang San Hti Lar Seng
- From the Division of Nephrology/Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine, Bronx, NY
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Claudel SE, Waikar SS, Gopal DM, Verma A. Association of cardiac biomarkers, kidney function, and mortality among adults with chronic kidney disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.12.23299886. [PMID: 38168327 PMCID: PMC10760296 DOI: 10.1101/2023.12.12.23299886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background and Aims The performance of high sensitivity troponin T (hs-cTnT), hs-cTnI, and N-terminal pro-hormone brain natriuretic peptide (NT-proBNP) in patients with chronic kidney disease (CKD) is poorly understood. Methods We included adults with CKD (eGFR<60 ml/min/1.73m2) in the 1999-2004 NHANES. We calculated the 99th percentile of hs-cTnT, hs-cTnI (Abbott, Ortho, and Siemens assays), and NT-proBNP, measured the association between eGFR and cardiac biomarker concentration, and used Cox regression models to assess the relationship between cardiac biomarkers and CVD mortality. Results Across 1,068 adults with CKD, the mean [SD] age was 71.9[12.7] years and 61.2% were female; 78.8% had elevated NT-proBNP and 42.6% had elevated hs-cTnT based on traditional clinical reference limits. The 99th percentile of hs-cTnT was 122 ng/L (95% confidence interval (CI) 101-143), hs-cTnIAbbott was 69 ng/L (95% CI 38-99), and NT-proBNP was 8952 pg/mL (95% CI 7506-10,399). A 10 ml/min decrease in eGFR was associated with greater increases in hs-cTnT and NT-proBNP than hs-cTnI (hs-cTnT: 27.5% increase (β=27.5, 95% CI 28.2-43.3)), NT-proBNP 46.0% increase (β=46.0, 95% CI 36.0-56.8), hs-cTnISiemens 17.9% (β=17.9, 95% CI 9.7-26.7). Each doubling of hs-cTnT, hs-cTnI, and NT-proBNP were associated with CVD mortality (hs-cTnT HR 1.62 [95% CI 1.32-1.98], p<0.0001; hs-cTnISiemens HR 1.40 [95% CI 1.26-1.55], p<0.0001; NT-proBNP HR 1.29 [95% CI 1.19-1.41], p<0.0001). Conclusions and Relevance Community dwelling adults with CKD have elevated concentrations of cardiac biomarkers, above established reference ranges. Of the troponin assays, hs-cTnI concentration appears to be most stable across eGFR categories and is associated with CVD mortality.
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Affiliation(s)
| | - Sushrut S. Waikar
- Department of Medicine, Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Deepa M. Gopal
- Department of Medicine, Section of Cardiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Amyloidosis Center, Boston Medical Center, Boston, MA, USA
| | - Ashish Verma
- Department of Medicine, Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Amyloidosis Center, Boston Medical Center, Boston, MA, USA
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5
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O'Lone E, Apple FS, Burton JO, Caskey FJ, Craig JC, de Filippi CR, Forfang D, Hicks KA, Jha V, Mahaffey KW, Mark PB, Rossignol P, Scholes-Robertson N, Jaure A, Viecelli AK, Wang AY, Wheeler DC, White D, Winkelmayer WC, Herzog CA. Defining Myocardial Infarction in trials of people receiving hemodialysis: consensus report from the SONG-HD MI Expert Working group. Kidney Int 2023; 103:1028-1037. [PMID: 37023851 DOI: 10.1016/j.kint.2023.02.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/22/2023] [Accepted: 02/15/2023] [Indexed: 04/08/2023]
Abstract
Cardiovascular disease is the leading cause of death in patients receiving hemodialysis. Currently there is no standardized definition of myocardial infarction (MI) for patients receiving hemodialysis. Through an international consensus process MI was established as the core CVD measure for this population in clinical trials. The Standardised Outcomes in Nephrology Group - Hemodialysis (SONG-HD) initiative convened a multidisciplinary, international working group to address the definition of MI in this population.Based on current evidence, the working group recommends using the 4th Universal Definition of MI with specific caveats with regard to the interpretation of "ischemic symptoms" and performing a baseline 12-lead electrocardiogram to facilitate interpretation of acute changes on subsequent tracings. The working group does not recommend obtaining baseline cardiac troponin values, though does recommend obtaining serial cardiac biomarkers in settings where ischemia is suspected. Application of an evidence-based uniform definition should increase the reliability and accuracy of trial results.
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Affiliation(s)
- E O'Lone
- The University of Sydney, Camperdown, Sydney, Australia.
| | - F S Apple
- Departments of Laboratory Medicine and Pathology, Hennepin Healthcare/Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota
| | - J O Burton
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital Leicester, Leicester, UK
| | - F J Caskey
- Population Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - J C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - C R de Filippi
- Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - D Forfang
- The National Forum of ESRD Networks, Kidney Patient Advisory Council (KPAC) WI USA
| | - K A Hicks
- Division of Cardiology and Nephrology, Office of Cardiology, Hematology, Endocrinology, and Nephrology, Center for Drug Evaluation and Research (CDER), United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - V Jha
- George Institute of Global Health, UNSW, New Delhi, India; School of Public Health, Imperial College, London, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - K W Mahaffey
- The Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - P B Mark
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - P Rossignol
- Université de Lorraine, Centre d'Investigation Clinique Plurithématique 1433 -INSERM- CHRU de Nancy, Inserm U1116 & FCRIN INI-CRCT (Cardiovascular and RenalClinical Trialists), Vandoeuvre-les-Nancy, France; Medical specialties and nephrology -hemodialysis departments, Princess Grace Hospital, and Monaco Private Hemodialysis Centre, Monaco, Monaco
| | - N Scholes-Robertson
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - A Jaure
- The University of Sydney, Camperdown, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - A K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - A Y Wang
- Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - D C Wheeler
- University College London, London, United Kingdom
| | - D White
- American Association of Kidney Patients, Tampa, Florida
| | - W C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - C A Herzog
- Chronic Disease Research Group, Hennepin Healthcare Research Institute,Minneapolis, Minnesota; Division of Cardiology, Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, Minnesota
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6
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Stengl H, Ganeshan R, Hellwig S, Klammer MG, von Rennenberg R, Böhme S, Audebert HJ, Nolte CH, Endres M, Scheitz JF. Frequency, associated variables, and outcomes of acute myocardial injury according to the fourth Universal Definition of Myocardial Infarction in patients with acute ischemic stroke. Eur Stroke J 2022; 7:413-420. [PMID: 36478763 PMCID: PMC9720848 DOI: 10.1177/23969873221120159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/30/2022] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Myocardial injury as indicated by elevation of cardiac troponin levels is common after acute ischemic stroke (AIS) and linked to poor outcomes. Previous studies rarely reported on serial hs-cTn measurements to distinguish whether myocardial injury is acute or chronic. Thus, little is known about frequency, associated variables, and outcome of acute myocardial injury in AIS. METHODS AND PATIENTS In this single-centered observational cohort study, from 01/2019 to 12/2020, consecutive patients with neuroimaging-confirmed AIS <48 h after symptom onset, and serial troponin measurements within the first 2 days after admission (Roche Elecsys®, hs-cardiac troponin T) were prospectively registered. Acute myocardial injury was defined according to the fourth Universal Definition of Myocardial Infarction (troponin above the upper reference limit and rise/fall>20%). Outcomes of interest were in-hospital mortality and unfavorable functional status at discharge (modified Rankin Scale >1). RESULTS Out of 1067 analyzed patients, 25.3% had acute myocardial injury, 40.4% had chronic myocardial injury and 34.3% had no myocardial injury. Older age, higher stroke severity, thrombolytic treatment, and impaired kidney function were independently associated with acute myocardial injury. In-hospital mortality was higher in patients with acute myocardial injury than in those without (13% vs 3%, adjusted OR, 2.9% [95% CI, 1.6-5.5]). Compared with no myocardial injury, both acute and chronic myocardial injury were associated with unfavorable functional status at discharge (adjusted OR, 1.6 [95% CI, 1.1-2.5] and OR, 1.7 [95% CI, 1.2-2.4], respectively). CONCLUSIONS A quarter of patients with AIS have evidence of acute myocardial injury according to the fourth Universal Definition of Myocardial Infarction. The strong association with in-hospital mortality highlights the need for clinical awareness and future studies on underlying mechanisms.
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Affiliation(s)
- Helena Stengl
- Department of Neurology, Charité –
Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin
(CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH) at
Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Ramanan Ganeshan
- Department of Neurology, Charité –
Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin
(CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH) at
Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Simon Hellwig
- Department of Neurology, Charité –
Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin
(CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH) at
Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Markus G Klammer
- Department of Neurology, Charité –
Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin
(CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
- Excellence Cluster NeuroCure, Charité –
Universitätsmedizin Berlin, Berlin, Germany
| | - Regina von Rennenberg
- Department of Neurology, Charité –
Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin
(CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative
Diseases (DZNE), Partner Site, Berlin, Germany
| | - Sophie Böhme
- Department of Neurology, Charité –
Universitätsmedizin Berlin, Berlin, Germany
| | - Heinrich J Audebert
- Department of Neurology, Charité –
Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin
(CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Christian H Nolte
- Department of Neurology, Charité –
Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin
(CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular
Research (DZHK), Partner Site, Berlin, Germany
- Berlin Institute of Health (BIH) at
Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Endres
- Department of Neurology, Charité –
Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin
(CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular
Research (DZHK), Partner Site, Berlin, Germany
- Berlin Institute of Health (BIH) at
Charité – Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative
Diseases (DZNE), Partner Site, Berlin, Germany
- Excellence Cluster NeuroCure, Charité –
Universitätsmedizin Berlin, Berlin, Germany
| | - Jan F Scheitz
- Department of Neurology, Charité –
Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin
(CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular
Research (DZHK), Partner Site, Berlin, Germany
- Berlin Institute of Health (BIH) at
Charité – Universitätsmedizin Berlin, Berlin, Germany
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Postoperative myocardial injury and platelet reactivity in patients undergoing vascular surgery: The platelet reactivity and postoperative myocardial injury after major vascular surgery (PROMISE) study. Thromb Res 2022; 218:177-185. [PMID: 36057168 DOI: 10.1016/j.thromres.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Postoperative myocardial injury (PMI) after major vascular surgery, detected by elevated cardiac troponin (cTn), has been associated with morbidity and mortality. It is unclear whether the pathophysiology of PMI is determined by increased platelet activity. OBJECTIVE To examine the relationship between platelet activation (P-selectin expression) and PMI in patients undergoing elective open abdominal aortic surgery. METHODS This prospective, single-centre, observational, cohort study included 33 patients undergoing elective open abdominal aortic surgery between March 2018 and April 2021. Patients were routinely treated with aspirin. Unstimulated platelet activation was measured by platelet bound P-selectin expression (range 0-100 %). Explorative coagulation measurements were: stimulated platelet aggregation measured with the VerifyNow® assay (aspirin cartridge), with the Multiplate® analyzer (ASPI, ADP and TRAP) and stimulated coagulation status evaluated by the TEG® Hemostasis Analyzer System (global hemostasis cartridge). The primary outcome was cTn release assessed by the fifth generation high-sensitive cTn assay. Multivariable generalized linear mixed models were used to evaluate the association between platelet function and cTn concentrations over time. RESULTS Ten patients (30.3 %) developed PMI. Increased P-selectin expression directly after surgery was associated with the cTn concentrations over 48 h (β = 1.39 (1.1-1.75), P = 0.0064). No association was found between P-selectin measured later after surgery (at 24 h or 48 h) and cTn concentrations. Furthermore, there was no association between the explorative coagulation parameters and cTn release. CONCLUSION Platelet reactivity, assessed by P-selectin expression measured directly after surgery is associated with PMI, assessed by elevated cTn concentrations in the early postoperative period in patients undergoing elective open abdominal aortic surgery.
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Owen A, Patel JM, Parekh D, Bangash MN. Mechanisms of Post-critical Illness Cardiovascular Disease. Front Cardiovasc Med 2022; 9:854421. [PMID: 35911546 PMCID: PMC9334745 DOI: 10.3389/fcvm.2022.854421] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Prolonged critical care stays commonly follow trauma, severe burn injury, sepsis, ARDS, and complications of major surgery. Although patients leave critical care following homeostatic recovery, significant additional diseases affect these patients during and beyond the convalescent phase. New cardiovascular and renal disease is commonly seen and roughly one third of all deaths in the year following discharge from critical care may come from this cluster of diseases. During prolonged critical care stays, the immunometabolic, inflammatory and neurohumoral response to severe illness in conjunction with resuscitative treatments primes the immune system and parenchymal tissues to develop a long-lived pro-inflammatory and immunosenescent state. This state is perpetuated by persistent Toll-like receptor signaling, free radical mediated isolevuglandin protein adduct formation and presentation by antigen presenting cells, abnormal circulating HDL and LDL isoforms, redox and metabolite mediated epigenetic reprogramming of the innate immune arm (trained immunity), and the development of immunosenescence through T-cell exhaustion/anergy through epigenetic modification of the T-cell genome. Under this state, tissue remodeling in the vascular, cardiac, and renal parenchymal beds occurs through the activation of pro-fibrotic cellular signaling pathways, causing vascular dysfunction and atherosclerosis, adverse cardiac remodeling and dysfunction, and proteinuria and accelerated chronic kidney disease.
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Affiliation(s)
- Andrew Owen
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Jaimin M. Patel
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Dhruv Parekh
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Mansoor N. Bangash
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Mansoor N. Bangash
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9
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Breidthardt T, van Doorn WPTM, van der Linden N, Diebold M, Wussler D, Danier I, Zimmermann T, Shrestha S, Kozhuharov N, Belkin M, Porta C, Strebel I, Michou E, Gualandro DM, Nowak A, Meex SJR, Mueller C. Diurnal Variations in Natriuretic Peptide Levels: Clinical Implications for the Diagnosis of Acute Heart Failure. Circ Heart Fail 2022; 15:e009165. [PMID: 35670217 PMCID: PMC10004748 DOI: 10.1161/circheartfailure.121.009165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current guidelines recommend interpreting concentrations of NPs (natriuretic peptides) irrespective of the time of presentation to the emergency department. We hypothesized that diurnal variations in NP concentration may affect their diagnostic accuracy for acute heart failure. METHODS In a secondary analysis of a multicenter diagnostic study enrolling patients presenting with acute dyspnea to the emergency department and using central adjudication of the final diagnosis by 2 independent cardiologists, the diagnostic accuracy for acute heart failure of BNP (B-type NP), NT-proBNP (N-terminal pro-B-type NP), and MR-proANP (midregional pro-atrial NP) was compared among 1577 daytime presenters versus 908 evening/nighttime presenters. In a validation study, the presence of a diurnal rhythm in BNP and NT-proBNP concentrations was examined by hourly measurements in 44 stable individuals. RESULTS Among patients adjudicated to have acute heart failure, BNP, NT-proBNP, and MR-proANP concentrations were comparable among daytime versus evening/nighttime presenters (all P=nonsignificant). Contrastingly, among patients adjudicated to have other causes of dyspnea, evening/nighttime presenters had lower BNP (median, 44 [18-110] versus 74 [27-168] ng/L; P<0.01) and NT-proBNP (median, 212 [72-581] versus 297 [102-902] ng/L; P<0.01) concentrations versus daytime presenters. This resulted in higher diagnostic accuracy as quantified by the area under the curve of BNP and NT-proBNP among evening/nighttime presenters (0.97 [95% CI, 0.95-0.98] and 0.95 [95% CI, 0.93-0.96] versus 0.94 [95% CI, 0.92-0.95] and 0.91 [95% CI, 0.90-0.93]) among daytime presenters (both P<0.01). These differences were not observed for MR-proANP. Diurnal variation of BNP and NT-proBNP with lower evening/nighttime concentration was confirmed in 44 stable individuals (P<0.01). CONCLUSIONS BNP and NT-proBNP, but not MR-proANP, exhibit a diurnal rhythm that results in even higher diagnostic accuracy among evening/nighttime presenters versus daytime presenters. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifiers: NCT01831115, NCT02091427, and NCT02210897.
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Affiliation(s)
- Tobias Breidthardt
- Divison of Internal Medicine (T.B., D.W., T.Z., S.S., M.B.), University Hospital Basel, Basel University, Switzerland.,Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - William P T M van Doorn
- General Clinical Chemistry and Hematology, Central Diagnostic Laboratory Maastricht University Medical Center, the Netherlands (W.P.T.M.v.D., N.v.d.L., S.J.R.M.)
| | - Noreen van der Linden
- General Clinical Chemistry and Hematology, Central Diagnostic Laboratory Maastricht University Medical Center, the Netherlands (W.P.T.M.v.D., N.v.d.L., S.J.R.M.)
| | - Matthias Diebold
- Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Desiree Wussler
- Divison of Internal Medicine (T.B., D.W., T.Z., S.S., M.B.), University Hospital Basel, Basel University, Switzerland
| | - Isabelle Danier
- Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Tobias Zimmermann
- Divison of Internal Medicine (T.B., D.W., T.Z., S.S., M.B.), University Hospital Basel, Basel University, Switzerland.,Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Samyut Shrestha
- Divison of Internal Medicine (T.B., D.W., T.Z., S.S., M.B.), University Hospital Basel, Basel University, Switzerland.,Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Nikola Kozhuharov
- Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland.,and Department of Cardiology (N.K., C.M.), University Hospital Basel, Basel University, Switzerland.,Liverpool Heart and Chest Hospital, United Kingdom (N.K.)
| | - Maria Belkin
- Divison of Internal Medicine (T.B., D.W., T.Z., S.S., M.B.), University Hospital Basel, Basel University, Switzerland.,Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Caroline Porta
- Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Ivo Strebel
- Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Eleni Michou
- Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Danielle M Gualandro
- Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Albina Nowak
- Division of Endocrinology, University Hospital Zurich, University of Zurich, Switzerland (A.N.)
| | - S J R Meex
- General Clinical Chemistry and Hematology, Central Diagnostic Laboratory Maastricht University Medical Center, the Netherlands (W.P.T.M.v.D., N.v.d.L., S.J.R.M.)
| | - Christian Mueller
- Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland.,and Department of Cardiology (N.K., C.M.), University Hospital Basel, Basel University, Switzerland
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10
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Stultiens JMG, Top WMC, Kimenai DM, Lehert P, Bekers O, Stehouwer CDA, Kooy A, Meex SJR. Metformin and high-sensitivity cardiac troponin I and T trajectories in type 2 diabetes patients: a post-hoc analysis of a randomized controlled trial. Cardiovasc Diabetol 2022; 21:49. [PMID: 35379238 PMCID: PMC8981770 DOI: 10.1186/s12933-022-01482-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metformin has favorable effects on cardiovascular outcomes in both newly onset and advanced type 2 diabetes, as previously reported findings from the UK Prospective Diabetes Study and the HOME trial have demonstrated. Patients with type 2 diabetes present with chronically elevated circulating cardiac troponin levels, an established predictor of cardiovascular endpoints and prognostic marker of subclinical myocardial injury. It is unknown whether metformin affects cardiac troponin levels. The study aimed to evaluate cardiac troponin I and T trajectories in patients with diabetes treated either with metformin or placebo. METHODS This study is a post-hoc analysis of a randomized controlled trial (HOME trial) that included 390 patients with advanced type 2 diabetes randomized to 850 mg metformin or placebo up to three times daily concomitant to continued insulin treatment. Cardiac troponin I and T concentrations were measured at baseline and after 4, 17, 30, 43 and 52 months. We evaluated cardiac troponin trajectories by linear mixed-effects modeling, correcting for age, sex, smoking status and history of cardiovascular disease. RESULTS This study enrolled 390 subjects, of which 196 received metformin and 194 received placebo. In the treatment and placebo groups, mean age was 64 and 59 years; with 50% and 58% of subjects of the female sex, respectively. Despite the previously reported reduction of macrovascular disease risk in this cohort by metformin, linear mixed-effects regression modelling did not reveal evidence for an effect on cardiac troponin I and cardiac troponin T levels [- 8.4% (- 18.6, 3.2), p = 0.150, and - 4.6% (- 12, 3.2), p = 0.242, respectively]. A statistically significant time-treatment interaction was found for troponin T [- 1.6% (- 2.9, - 0.2), p = 0.021] but not troponin I concentrations [- 1.5% (- 4.2, 1.2), p = 0.263]. CONCLUSIONS In this post-hoc analysis of a 4.3-year randomized controlled trial, metformin did not exert a clinically relevant effect on cardiac troponin I and cardiac troponin T levels when compared to placebo. Cardioprotective effects of the drug observed in clinical studies are not reflected by a reduction in these biomarkers of subclinical myocardial injury. Trial registration ClinicalTrials.gov identifier NCT00375388.
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Affiliation(s)
- Johanna M G Stultiens
- Central Diagnostic Laboratory, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Wiebe M C Top
- Department of Intensive Care, Care Group Treant, Emmen, The Netherlands.,Bethesda Diabetes Research Center, Hoogeveen, The Netherlands
| | - Dorien M Kimenai
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Philippe Lehert
- Department of Statistics, Faculty of Economics, Facultés Universitaires Catholiques de Mons, Louvain Academy, Mons, Belgium
| | - Otto Bekers
- Central Diagnostic Laboratory, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Adriaan Kooy
- Department of Intensive Care, Care Group Treant, Emmen, The Netherlands.,Bethesda Diabetes Research Center, Hoogeveen, The Netherlands.,Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Steven J R Meex
- Central Diagnostic Laboratory, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. .,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
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11
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Alushi B, Jost-Brinkmann F, Kastrati A, Cassese S, Fusaro M, Stangl K, Landmesser U, Thiele H, Lauten A. High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome. J Clin Med 2021; 10:4216. [PMID: 34575325 PMCID: PMC8471888 DOI: 10.3390/jcm10184216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Patients with severe chronic kidney disease (CKD G4-G5) often have chronically elevated high-sensitivity cardiac troponin T (hs-cTnT) values above the 99th percentile of the upper reference limit. In these patients, optimal cutoff levels for diagnosing non-ST-elevation acute coronary syndrome (NSTE-ACS) requiring revascularization remain undefined. (2) Methods: Of 11,912 patients undergoing coronary angiography from 2012 to 2017 for suspected NSTE-ACS, 325 (3%) had severe CKD. Of these, 290 with available serial hs-cTnT measurements were included, and 300 matched patients with normal renal function were selected as a control cohort. (3) Results: In the CKD cohort, 222 patients (76%) had NSTE-ACS with indication for coronary revascularization. Diagnostic performance was high at presentation and similar to that of the control population (AUC, 95% CI: 0.81, 0.75-0.87 versus 0.85, 0.80-0.89, p = 0.68), and the ROC-derived cutoff value was 4 times higher compared to the conventional 99th percentile. Combining the ROC-derived cutoff levels for hs-cTnT at presentation and absolute 3 h changes, sensitivity increased to 98%, and PPV and NPV improved up to 93% and 86%, respectively. (4) Conclusions: In patients with severe CKD and suspected ACS, the diagnostic accuracy of hs-cTnT for the diagnosis of NSTE-ACS requiring revascularization is improved by using higher assay-specific cutoff levels combined with early absolute changes.
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Affiliation(s)
- Brunilda Alushi
- Department of Cardiovascular Diseases, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; (F.J.-B.); (U.L.); (A.L.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany;
- Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Fabian Jost-Brinkmann
- Department of Cardiovascular Diseases, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; (F.J.-B.); (U.L.); (A.L.)
- Department of Hepatology and Gastroenterology, Campus Virchow Klinikum (CVK) and Campus Charité Mitte (CCM), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Adnan Kastrati
- German Heart Center Munich, Technische Universität München, Lazarettstraße 36, 80636 Munich, Germany; (A.K.); (S.C.); (M.F.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80336 Munich, Germany
| | - Salvatore Cassese
- German Heart Center Munich, Technische Universität München, Lazarettstraße 36, 80636 Munich, Germany; (A.K.); (S.C.); (M.F.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80336 Munich, Germany
| | - Massimiliano Fusaro
- German Heart Center Munich, Technische Universität München, Lazarettstraße 36, 80636 Munich, Germany; (A.K.); (S.C.); (M.F.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80336 Munich, Germany
| | - Karl Stangl
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany;
- Department of Cardiovascular Diseases, Campus Charité Mitte (CCM), Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiovascular Diseases, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; (F.J.-B.); (U.L.); (A.L.)
- Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany;
- Leipzig Heart Institute, Russenstraße 69a, 04289 Leipzig, Germany
| | - Alexander Lauten
- Department of Cardiovascular Diseases, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; (F.J.-B.); (U.L.); (A.L.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany;
- Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
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12
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Park JE, Song M, Kim T, Lee GT, Hwang SY, Yoon H, Cha WC, Shin TG, Sim MS, Jo IJ, Lee SH, Park HD, Choi JH. Cardiac troponin I and the risk of cardiovascular or non-cardiovascular death in patients visiting the emergency department. Sci Rep 2021; 11:17461. [PMID: 34465861 PMCID: PMC8408270 DOI: 10.1038/s41598-021-96951-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/19/2021] [Indexed: 11/09/2022] Open
Abstract
The prognostic implication of cardiac troponin I (cTnI) values for the determination of the magnitude or duration of cause-specific death risk is limited. We included consecutive patients with maximal cTnI values within 24 h of their emergency department visits. Multivariate analyses using variables selected by the Bayesian information criterion were performed to investigate the impact of cTnI on the event rate, time-dependent risk, and dose-dependent risk of cardiovascular or non-cardiovascular death within 360 days. There were 5472 (14.9%) all-cause deaths including 881 (2.4%) cardiovascular deaths and 4591 (12.5%) non-cardiovascular deaths. In patients with positive cTnI, defined as the ≥ 99th percentile of the upper normal limit, the cumulative risk of cardiac and non-cardiac death was 4.4- and 1.4-fold higher, respectively, than that of negative cTnI, respectively. In the competing risk analysis, positive cTnI was linked to 2.4- and 1.2-fold higher risks of cardiovascular and non-cardiovascular death, respectively. The cTnI value showed a positive relationship with the risk of both cardiovascular and non-cardiovascular deaths. In the time-dependent risk analysis, the excess risk of cardiovascular death was mostly evident in the first few weeks. Higher cTnI value was associated with an increased risk of both cardiovascular and non-cardiovascular death, especially which was in the early period.
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Affiliation(s)
- Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Minseok Song
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Gun Tak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Min Sub Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Seung-Hwa Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung-Doo Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Choi
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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13
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Arcari L, Engel J, Freiwald T, Zhou H, Zainal H, Gawor M, Buettner S, Geiger H, Hauser I, Nagel E, Puntmann VO. Cardiac biomarkers in chronic kidney disease are independently associated with myocardial edema and diffuse fibrosis by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2021; 23:71. [PMID: 34092229 PMCID: PMC8183054 DOI: 10.1186/s12968-021-00762-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 04/28/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND High sensitivity cardiac troponin T (hs-cTnT) and NT-pro-brain natriuretic peptide (NT-pro BNP) are often elevated in chronic kidney disease (CKD) and associated with both cardiovascular remodeling and outcome. Relationship between these biomarkers and quantitative imaging measures of myocardial fibrosis and edema by T1 and T2 mapping remains unknown. METHODS Consecutive patients with established CKD and estimated glomerular filtration rate (eGFR) < 59 ml/min/1.73 m2 (n = 276) were compared to age/sex matched patients with eGFR ≥ 60 ml/min/1.73 m2 (n = 242) and healthy controls (n = 38). Comprehensive cardiovascular magnetic resonance (CMR) with native T1 and T2 mapping, myocardial ischemia and scar imaging was performed with venous sampling immediately prior to CMR. RESULTS Patients with CKD showed significant cardiac remodeling in comparison with both healthy individuals and non-CKD patients, including a stepwise increase of native T1 and T2 (p < 0.001 between all CKD stages). Native T1 and T2 were the sole imaging markers independently associated with worsening CKD in patients [B = 0.125 (95% CI 0.022-0.235) and B = 0.272 (95% CI 0.164-0.374) with p = 0.019 and < 0.001 respectively]. At univariable analysis, both hs-cTnT and NT-pro BNP significantly correlated with native T1 and T2 in groups with eGFR 30-59 ml/min/1.73 m2 and eGFR < 29 ml/min/1.73 m2 groups, with associations being stronger at lower eGFR (NT-pro BNP (log transformed, lg10): native T1 r = 0.43 and r = 0.57, native T2 r = 0.39 and r = 0.48 respectively; log-transformed hs-cTnT(lg10): native T1 r = 0.23 and r = 0.43, native T2 r = 0.38 and r = 0.58 respectively, p < 0.001 for all, p < 0.05 for interaction). On multivariable analyses, we found independent associations of native T1 with NT-pro BNP [(B = 0.308 (95% CI 0.129-0.407), p < 0.001 and B = 0.334 (95% CI 0.154-0.660), p = 0.002 for eGFR 30-59 ml/min/1.73 m2 and eGFR < 29 ml/min/1.73 m2, respectively] and of T2 with hs-cTnT [B = 0.417 (95% CI 0.219-0.650), p < 0.001 for eGFR < 29 ml/min/1.73 m2]. CONCLUSIONS We demonstrate independent associations between cardiac biomarkers with imaging markers of interstitial expansion, which are CKD-group specific. Our findings indicate the role of diffuse non-ischemic tissue processes, including excess of myocardial fluid in addition to diffuse fibrosis in CKD-related adverse remodeling.
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Affiliation(s)
- Luca Arcari
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
- Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Juergen Engel
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Tilo Freiwald
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Hui Zhou
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
- Department of Radiology, XiangYa Hospital, Central South University, Changsha, Hunan, China
| | - Hafisyatul Zainal
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
- Department of Cardiology, Universiti Teknologi MARA (UiTM), Sg. Buloh, Malaysia
| | - Monika Gawor
- Department of Cardiology, University Hospital Warsaw, Warsaw, Poland
| | - Stefan Buettner
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Helmut Geiger
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ingeborg Hauser
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Eike Nagel
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Valentina O Puntmann
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany.
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14
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Chan K, Moe SM, Saran R, Libby P. The cardiovascular-dialysis nexus: the transition to dialysis is a treacherous time for the heart. Eur Heart J 2021; 42:1244-1253. [PMID: 33458768 DOI: 10.1093/eurheartj/ehaa1049] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 08/13/2020] [Accepted: 12/15/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic kidney disease (CKD) patients require dialysis to manage the progressive complications of uraemia. Yet, many physicians and patients do not recognize that dialysis initiation, although often necessary, subjects patients to substantial risk for cardiovascular (CV) death. While most recognize CV mortality risk approximately doubles with CKD the new data presented here show that this risk spikes to >20 times higher than the US population average at the initiation of chronic renal replacement therapy, and this elevated CV risk continues through the first 4 months of dialysis. Moreover, this peak reflects how dialysis itself changes the pathophysiology of CV disease and transforms its presentation, progression, and prognosis. This article reviews how dialysis initiation modifies the interpretation of circulating biomarkers, alters the accuracy of CV imaging, and worsens prognosis. We advocate a multidisciplinary approach and outline the issues practitioners should consider to optimize CV care for this unique and vulnerable population during a perilous passage.
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Affiliation(s)
- Kevin Chan
- National Institute of Diabetes and Digestive and Kidney Disease, Division of Kidney, Urology, and Hematology, 6707 Democracy Blvd, Bethesda, MD 20892-5458, USA
| | - Sharon M Moe
- Division of Nephrology, Indiana University School of Medicine, 950 W. Walnut Street R2-202, Indianapolis, IN 46202, USA
| | - Rajiv Saran
- Division of Nephrology, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr # 31, Ann Arbor, MI 48109, USA
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 77 Ave. Louis Pasteur, NRB-741-G, Boston, MA 02115, USA
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15
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de Boer D, Streng AS, van Doorn WPTM, Vroemen WHM, Bekers O, Wodzig WKWH, Mingels AMA. Cardiac Troponin T: The Impact of Posttranslational Modifications on Analytical Immunoreactivity in Blood up to the Excretion in Urine. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1306:41-59. [PMID: 33959905 DOI: 10.1007/978-3-030-63908-2_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Cardiac troponin T (cTnT) is a sensitive and specific biomarker for detecting cardiac muscle injury. Its concentration in blood can be significantly elevated outside the normal reference range under several pathophysiological conditions. The classical analytical method in routine clinical analysis to detect cTnT in serum or plasma is a single commercial immunoassay, which is designed to quantify the intact cTnT molecule. The targeted epitopes are located in the central region of the cTnT molecule. However, in blood cTnT exists in different biomolecular complexes and proteoforms: bound (to cardiac troponin subunits or to immunoglobulins) or unbound (as intact protein or as proteolytic proteoforms). While proteolysis is a principal posttranslational modification (PTM), other confirmed PTMs of the proteoforms include N-terminal initiator methionine removal, N-acetylation, O-phosphorylation, O-(N-acetyl)-glucosaminylation, N(ɛ)-(carboxymethyl)lysine modification and citrullination. The immunoassay probably detects several of those cTnT biomolecular complexes and proteoforms, as long as they have the centrally targeted epitopes in common. While analytical cTnT immunoreactivity has been studied predominantly in blood, it can also be detected in urine, although it is unclear in which proteoform cTnT immunoreactivity is present in urine. This review presents an overview of the current knowledge on the pathophysiological lifecycle of cTnT. It provides insight into the impact of PTMs, not only on the analytical immunoreactivity, but also on the excretion of cTnT in urine as one of the waste routes in that lifecycle. Accordingly, and after isolating the proteoforms from urine of patients suffering from proteinuria and acute myocardial infarction, the structures of some possible cTnT proteoforms are reconstructed using mass spectrometry and presented.
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Affiliation(s)
- Douwe de Boer
- Unit of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands.
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Medicine and Life Sciences (FHML) of Maastricht University (UM), Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Alexander S Streng
- Unit of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - William P T M van Doorn
- Unit of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wim H M Vroemen
- Unit of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Otto Bekers
- Unit of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM, School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences (FHML) of Maastricht University (UM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Will K W H Wodzig
- Unit of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Medicine and Life Sciences (FHML) of Maastricht University (UM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alma M A Mingels
- Unit of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM, School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences (FHML) of Maastricht University (UM), Maastricht University Medical Center, Maastricht, The Netherlands
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16
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Do age-adjusted sex-specific cut-off values improve the agreement between high sensitivity cardiac troponins I and T? A retrospective study. Clin Chim Acta 2021; 519:76-82. [PMID: 33865814 DOI: 10.1016/j.cca.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many reports noted a disagreement between High sensitivity cardiac Troponin (hs-cTn) assays on the diagnosis of Acute Coronary Syndrome (ACS). METHODS We conducted a retrospective study aiming to assess the agreement between hs-cTn T (Roche) and hs-cTn I (Abbott) in patients presenting with a suspected ACS to the emergency department at Hotel-Dieu hospital between September 2017 and October 2019 using overall, sex-specific, and age-adjusted sex-specific cut-off values. This was measured using Cohen's Kappa. We explored whether renal function, circadian rhythm, age and sex influenced the discordance. And we analyzed the trend of agreement between baseline and repeated measurements. RESULTS 4856 patients who had simultaneous hs-cTn I and T values were retained for the analysis. 53.5% had a hs-cTn T above the overall 99th percentile, compared to 19.9% for hs-cTn I. The numbers were significantly reduced when applying age-adjusted sex-specific 99th percentile. A disagreement was seen in 34% of cases using overall 99th percentile. Using sex-specific cut off values did not impact this discordance; however, age-adjusted sex-specific cut-off values reduced the percentage of discrepancies to 15.8%. The decreased renal function had a negative effect on the agreement while the circadian rhythm had minimal effect. This initial discordance was carried forward into repeated measurements. CONCLUSION The disagreement between hs-cTn T and I assays could be imputed to the choice of cut-off values. The use of age-adjusted sex specific 99th percentile reduced majorly these discordances. Further studies are needed in order to evaluate their clinical utility in patients presenting with ACS.
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17
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Neurological update: use of cardiac troponin in patients with stroke. J Neurol 2020; 268:2284-2292. [PMID: 33372247 PMCID: PMC8179917 DOI: 10.1007/s00415-020-10349-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
Cardiac troponin is a specific and sensitive biomarker to identify and quantify myocardial injury. Myocardial injury is frequently detected after acute ischemic stroke and strongly associated with unfavorable outcomes. Concomitant acute coronary syndrome is only one of several possible differential diagnoses that may cause elevation of cardiac troponin after stroke. As a result, there are uncertainties regarding the correct interpretation and optimal management of stroke patients with myocardial injury in clinical practice. Elevation of cardiac troponin may occur as part of a 'Stroke-Heart Syndrome'. The term 'Stroke-Heart Syndrome' subsumes a clinical spectrum of cardiac complications after stroke including cardiac injury, dysfunction, and arrhythmia which may relate to disturbances of autonomic function and the brain-heart axis. In this review, we provide an up-to-date overview about prognostic implications, mechanisms, and management of elevated cardiac troponin levels in patients with acute ischemic stroke.
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18
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Perrone MA, Passino C, Vassalle C, Masotti S, Romeo F, Guccione P, Bernardini S, Clerico A. Early evaluation of myocardial injury by means of high-sensitivity methods for cardiac troponins after strenuous and prolonged exercise. J Sports Med Phys Fitness 2020; 60:1297-1305. [PMID: 32720778 DOI: 10.23736/s0022-4707.20.11016-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
All the latest international guidelines recommend that cardiac troponin (cTn) I and T should be considered the preferred biomarkers for diagnosis of acute myocardial infarction. However, only in the last 5 years, a progressive improvement in analytical performance of immunometric assays has allowed the measurement of circulating levels of cTnI and cTnT in the large part of apparently healthy adult subjects. The routine use of these high-sensitivity methods for cardiac troponin (hs-cTn) assay has in a short time demonstrated that cardiac troponin concentrations frequently increase after strenuous prolonged exercise in healthy athletes. This acute response of hs-cTn assay following exercise was at first considered to be physiological and without long-term adverse consequences. More recent studies have suggested that exercise-induced increases in hs-cTn values may not be always a physiological response to exercise, but, conversely, it should sometimes be considered as an early cardiovascular risk marker. The aim of this review is to provide an overview of acute and chronic effects of strenuous physical exercise on hs-cTn circulating levels and also to discuss the potential pathophysiological and clinical implications of biomarker responses.
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Affiliation(s)
- Marco A Perrone
- Department of Cardiology, Tor Vergata University, Rome, Italy - .,Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy - .,University Sports Center, Tor Vergata University, Rome, Italy -
| | - Claudio Passino
- Fondazione Toscana G. Monasterio, Council of National Research, Pisa, Italy.,Scuola Superiore Sant'Anna, Pisa, Italy
| | - Cristina Vassalle
- Fondazione Toscana G. Monasterio, Council of National Research, Pisa, Italy.,Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvia Masotti
- Fondazione Toscana G. Monasterio, Council of National Research, Pisa, Italy.,Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesco Romeo
- Department of Cardiology, Tor Vergata University, Rome, Italy
| | - Paolo Guccione
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Sergio Bernardini
- University Sports Center, Tor Vergata University, Rome, Italy.,Department of Clinical Biochemistry and Clinical Molecular Biology, Tor Vergata University, Rome, Italy
| | - Aldo Clerico
- Fondazione Toscana G. Monasterio, Council of National Research, Pisa, Italy.,Scuola Superiore Sant'Anna, Pisa, Italy
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19
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Implications of the complex biology and micro-environment of cardiac sarcomeres in the use of high affinity troponin antibodies as serum biomarkers for cardiac disorders. J Mol Cell Cardiol 2020; 143:145-158. [PMID: 32442660 PMCID: PMC7235571 DOI: 10.1016/j.yjmcc.2020.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 02/06/2023]
Abstract
Cardiac troponin I (cTnI), the inhibitory-unit, and cardiac troponin T (cTnT), the tropomyosin-binding unit together with the Ca-binding unit (cTnC) of the hetero-trimeric troponin complex signal activation of the sarcomeres of the adult cardiac myocyte. The unique structure and heart myocyte restricted expression of cTnI and cTnT led to their worldwide use as biomarkers for acute myocardial infarction (AMI) beginning more than 30 years ago. Over these years, high sensitivity antibodies (hs-cTnI and hs-cTnT) have been developed. Together with careful determination of history, physical examination, and EKG, determination of serum levels using hs-cTnI and hs-cTnT permits risk stratification of patients presenting in the Emergency Department (ED) with chest pain. With the ability to determine serum levels of these troponins with high sensitivity came the question of whether such measurements may be of diagnostic and prognostic value in conditions beyond AMI. Moreover, the finding of elevated serum troponins in physiological states such as exercise and pathological states where cardiac myocytes may be affected requires understanding of how troponins may be released into the blood and whether such release may be benign. We consider these questions by relating membrane stability to the complex biology of troponin with emphasis on its sensitivity to the chemo-mechanical and micro-environment of the cardiac myocyte. We also consider the role determinations of serum troponins play in the precise phenotyping in personalized and precision medicine approaches to promote cardiac health. Serum levels of cardiac TnI and cardiac TnT permit stratification of patients with chest pain. Release of troponins into blood involves not only frank necrosis but also programmed necroptosis. Genome wide analysis of serum troponin levels in the general population may be prognostic about cardiovascular health. Significant levels of serum troponins with exhaustive exercise may not be benign. Troponin in serum can lead to important data related to personalized and precision medicine.
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20
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Nam K, Shin KW, Kim TK, Kim KH, Kim KB, Jeon Y, Cho YJ. Prognostic value of high-sensitivity troponin I after cardiac surgery according to preoperative renal function. Medicine (Baltimore) 2020; 99:e20040. [PMID: 32443309 PMCID: PMC7253774 DOI: 10.1097/md.0000000000020040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cardiac troponin levels can be elevated without myocardial injury in patients with renal impairment. However, the prognostic value of elevated troponin levels after cardiac surgery has not been well evaluated in patients with renal impairment. We evaluated the relationship between postoperative troponin levels and mortality following cardiac surgery according to preoperative renal function.Among 3661 patients underwent cardiac surgery between March 2005 and December 2015, 1909 patients were analyzed after excluding those with insufficient laboratory data, preoperative myocardial infarction, underwent Cox-Maze or redo surgery, or with a follow-up period <30 days. The primary outcome was risk of 30-day mortality according to elevated postoperative high-sensitivity cardiac troponin I (hs-cTnI) levels in varying degrees of renal function. Secondary outcomes included long-term cardiac-cause and all-cause mortality during the median follow-up of 52 months.After adjustment for risk factors, elevated peak postoperative hs-cTnI was associated with 30-day mortality [adjusted odds ratio 1.028, 95% confidence interval (CI) 1.013-1.043, P < .001], long-term cardiac-cause [adjusted hazard ratio (HR) 1.013, 95% CI 1.009-1.017, P < .001] and all-cause mortality (adjusted HR 1.013, 95% CI 1.009-1.016, P < .001), in patients with preoperative normal renal function [estimated glomerular filtration rate (eGFR) ≥60 ml/minute/1.73 m]. However, in patients with renal impairment (eGFR < 60 ml/minute/1.73 m), hs-cTnI levels were not associated with mortality following cardiac surgery.Elevated hs-cTnI levels following cardiac surgery did not predict short- and long-term mortality in patients with preoperative renal impairment.
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Affiliation(s)
- Karam Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine
| | - Kyung Won Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine
| | - Tae Kyong Kim
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Ki-Bong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Yunseok Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine
| | - Youn Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine
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21
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Bellia C, Lombardo M, Della-Morte D. Use of Troponin as a predictor for cardiovascular diseases in patients with type 2 Diabetes Mellitus. Clin Chim Acta 2020; 507:54-61. [PMID: 32302683 DOI: 10.1016/j.cca.2020.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
People with type 2 diabetes mellitus (T2DM) have two- to four-fold increased cardiovascular mortality in comparison to the general population. With the identification of new therapeutic targets and hypoglycemic drugs for T2DM, the need for a better stratification of CVD risk has emerged to select patients who may need intensive or specific treatment. At present, risk stratification is based on clinical, demographic, and biochemical factors. High sensitivity cardiac troponin (hs-cTn) increases after several ischemic and non-ischemic insults and it is considered a marker of myocardial injury. This review summarizes the main findings about hs-cTn utilization for risk stratification in people with T2DM and no clinical CVD. Several large observational studies have documented the association between hs-cTn and adverse cardiovascular outcomes in both the general population and in patients with T2DM. Lifestyle interventions, and particularly promotion of physical activity and adoption of healthy nutritional habits, have been associated to a significant benefit on hs-cTn release in the general population. Randomized controlled trials suggested that hypoglycemic, anti-hypertensive and lipid-lowering therapy may influence the degree of T2DM-induced cardiac injury. Besides these promising findings, the efficacy of an hs-cTn-based approach for CVD prevention in T2DM patients still requires more investigations.
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Affiliation(s)
- Chiara Bellia
- Department of Biomedicine, Neurosciences, and Advanced Diagnostics, University of Palermo, Italy.
| | - Mauro Lombardo
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Rome, Italy
| | - David Della-Morte
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy; Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
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22
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23
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Chesnaye NC, Szummer K, Bárány P, Heimbürger O, Magin H, Almquist T, Uhlin F, Dekker FW, Wanner C, Jager KJ, Evans M. Association Between Renal Function and Troponin T Over Time in Stable Chronic Kidney Disease Patients. J Am Heart Assoc 2019; 8:e013091. [PMID: 31662068 PMCID: PMC6898818 DOI: 10.1161/jaha.119.013091] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background People with reduced glomerular filtration rate (GFR) often have elevated cardiac troponin T (cTnT) levels. It remains unclear how cTnT levels develop over time in those with chronic kidney disease (CKD). The aim of this study was to prospectively study the association between cTnT and GFR over time in older advanced‐stage CKD patients not on dialysis. Methods and Results The EQUAL (European Quality Study) study is an observational prospective cohort study in stage 4 to 5 CKD patients aged ≥65 years not on dialysis (incident estimated GFR, <20 mL/min/1.73 m²). The EQUAL cohort used for the purpose of this study includes 171 patients followed in Sweden between April 2012 and December 2018. We used linear mixed models, adjusted for important groups of confounders, to investigate the effect of both measured GFR and estimated GFR on high‐sensitivity cTnT (hs‐cTnT) trajectory over 4 years. Almost all patients had at least 1 hs‐cTnT measurement elevated above the 99th percentile of the general reference population (≤14 ng/L). On average, hs‐cTnT increased by 16%/year (95% CI, 13–19; P<0.0001). Each 15 mL/min/1.73 m2 lower mean estimated GFR was associated with a 23% (95% CI, 14–31; P<0.0001) higher baseline hs‐cTnT and 9% (95% CI, 5–13%; P<0.0001) steeper increase in hs‐cTnT. The effect of estimated GFR on hs‐cTnT trajectory was somewhat lower than a previous myocardial infarction (15%), but higher than presence of diabetes mellitus (4%) and male sex (5%). Conclusions In CKD patients, hs‐cTnT increases over time as renal function decreases. Lower CKD stage (each 15 mL/min/1.73 m2 lower) is independently associated with a steeper hs‐cTnT increase over time in the same range as other established cardiovascular risk factors.
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Affiliation(s)
- Nicholas C Chesnaye
- Department of Medical Informatics Academic Medical Center University of Amsterdam Amsterdam Public Health Research Institute Amsterdam The Netherlands
| | - Karolina Szummer
- Department of Medicine Karolinska Institutet Stockholm Sweden.,Department of Cardiology Huddinge Karolinska University Hospital Stockholm Sweden
| | - Peter Bárány
- Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Olof Heimbürger
- Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Hasan Magin
- Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Tora Almquist
- Division of Nephrology Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital Stockholm Sweden
| | - Fredrik Uhlin
- Department of Nephrology Linköping University Linköping Sweden.,Department of Medical and Health Sciences Linköping University Linköping Sweden.,Centre of Biomedical Engineering Department of Health Technologies School of Informatics Tallinn University of Technology Tallinn Estonia
| | - Friedo W Dekker
- Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands
| | | | - Kitty J Jager
- Department of Medical Informatics Academic Medical Center University of Amsterdam Amsterdam Public Health Research Institute Amsterdam The Netherlands
| | - Marie Evans
- Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
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24
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Prud'homme M, Coutrot M, Michel T, Boutin L, Genest M, Poirier F, Launay JM, Kane B, Kinugasa S, Prakoura N, Vandermeersch S, Cohen-Solal A, Delcayre C, Samuel JL, Mehta R, Gayat E, Mebazaa A, Chadjichristos CE, Legrand M. Acute Kidney Injury Induces Remote Cardiac Damage and Dysfunction Through the Galectin-3 Pathway. JACC Basic Transl Sci 2019; 4:717-732. [PMID: 31709320 PMCID: PMC6834958 DOI: 10.1016/j.jacbts.2019.06.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/29/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022]
Abstract
In 2 different mouse models, AKI increased Gal-3 expression and induced cardiac dysfunction, cardiac and systemic inflammation, cardiac macrophage infiltration, and fibrosis. Cardiac consequences of AKI were dependent on the Gal-3 pathway and were prevented using Gal-3 knockout mice or modified citrus pectin as a pharmaceutical inhibitor. Cardiac Gal-3 expression resulted from bone marrow-derived immune cells recruitment after AKI. In critically ill patients, development of AKI is associated with increased plasma Gal-3 levels and increased biomarkers of cardiac injury and damage.
Acute kidney injury is associated with increased risk of heart failure and mortality. This study demonstrates that acute kidney injury induces remote cardiac dysfunction, damage, injury, and fibrosis via a galectin-3 (Gal-3) dependent pathway. Gal-3 originates from bone marrow-derived immune cells. Cardiac damage could be prevented by blocking this pathway.
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Key Words
- AKI, acute kidney injury
- BM, bone marrow
- BUN, blood urea nitrogen
- Cr, creatinine
- Gal-3, galectin-3
- ICAM, intercellular adhesion molecule
- ICU, intensive care unit
- IL, interleukin
- IR, ischemia-reperfusion
- KDIGO, Kidney Disease Improving Global Outcome
- KO, knock-out
- MCP, modified citrus pectin
- NT-proBNP, N-terminal-pro-brain natriuretic peptide
- TGF, transforming growth factor
- TNF, tumor necrosis factor
- UUO, unilateral ureteral obstruction
- WT, wild type
- eGFR, estimated glomerular filtration rate
- fibrosis
- heart failure
- inflammation
- macrophages
- renal failure
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Affiliation(s)
- Mathilde Prud'homme
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France
| | - Maxime Coutrot
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France.,AP-HP, St-Louis-Lariboisière Hospital, Department of Anesthesiology and Critical Care and Burn Unit, University Paris Diderot, Paris, France
| | - Thibault Michel
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France
| | - Louis Boutin
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France.,AP-HP, St-Louis-Lariboisière Hospital, Department of Anesthesiology and Critical Care and Burn Unit, University Paris Diderot, Paris, France
| | - Magali Genest
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France.,INSERM UMR-S 1155, Tenon Hospital, Paris, France
| | - Françoise Poirier
- Institut Jacques Monod, Team: Morphogenesis, Homeostasis and Pathologies, Paris, France
| | - Jean-Marie Launay
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France
| | - Bocar Kane
- UMS-28 Phénotypage du petit animal, Université Pierre et Marie Curie, Paris, France
| | | | | | | | - Alain Cohen-Solal
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France.,Cardiology Department, Lariboisière Hospital, Paris, France
| | - Claude Delcayre
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France
| | - Jane-Lise Samuel
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France
| | - Ravindra Mehta
- Department of Medicine, University of California-San Diego, San Diego, California
| | - Etienne Gayat
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France.,AP-HP, St-Louis-Lariboisière Hospital, Department of Anesthesiology and Critical Care and Burn Unit, University Paris Diderot, Paris, France
| | - Alexandre Mebazaa
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France.,AP-HP, St-Louis-Lariboisière Hospital, Department of Anesthesiology and Critical Care and Burn Unit, University Paris Diderot, Paris, France
| | | | - Matthieu Legrand
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France.,AP-HP, St-Louis-Lariboisière Hospital, Department of Anesthesiology and Critical Care and Burn Unit, University Paris Diderot, Paris, France.,Department of Anesthesiology and peri-operative Care, University of California San Francisco, United States
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25
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Vroemen WHM, Mezger STP, Masotti S, Clerico A, Bekers O, de Boer D, Mingels A. Cardiac Troponin T: Only Small Molecules in Recreational Runners After Marathon Completion. J Appl Lab Med 2019; 3:909-911. [DOI: 10.1373/jalm.2018.027144] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/07/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Wim H M Vroemen
- Central Diagnostic Laboratory Maastricht University Medical Center Maastricht, the Netherlands
| | - Stephanie T P Mezger
- Central Diagnostic Laboratory Maastricht University Medical Center Maastricht, the Netherlands
| | - Silvia Masotti
- Fondazione Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna Pisa, Italy
| | - Aldo Clerico
- Fondazione Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna Pisa, Italy
| | - Otto Bekers
- Central Diagnostic Laboratory Maastricht University Medical Center Maastricht, the Netherlands
| | - Douwe de Boer
- Central Diagnostic Laboratory Maastricht University Medical Center Maastricht, the Netherlands
| | - Alma Mingels
- Central Diagnostic Laboratory Maastricht University Medical Center Maastricht, the Netherlands
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Antukh DE, Shchekochikhin DY, Nesterov AP, Gilarov MY. Diagnosis and treatment of myocardial infarction in patient with end - stage renal disease on chronic hemodialysis. TERAPEVT ARKH 2019; 91:137-144. [DOI: 10.26442/00403660.2019.06.000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Indexed: 11/22/2022]
Abstract
This review represents different aspects of myocardial infarction in patient with end - stage renal disease on chronic hemodialysis. We discuss difficulties in diagnosis, optimal method of coronary revascularization, timing of hemodialysis session, medical therapy, as well as epidemiology and prognosis. There are no unambiguous answers to these problems because patients with end - stage renal disease were excluded from most of the studies.
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Szczykowska J, Hryszko T, Naumnik B. Cardiac troponins in chronic kidney disease patients with special emphasis on their importance in acute coronary syndrome. Adv Med Sci 2019; 64:131-136. [PMID: 30641274 DOI: 10.1016/j.advms.2018.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 06/04/2018] [Accepted: 08/31/2018] [Indexed: 11/27/2022]
Abstract
Troponin measurement is one of crucial assessments facilitating diagnosis of acute coronary syndrome. Patients with chronic kidney disease are decimated by cardiovascular disease. Unfortunately, elevated concentration of serum troponin is commonly faced in clinical practice creating a challenge to rule out acute cardiac ischaemia in this vulnerable population. This review presents current knowlegde on analytical differences in troponin T and I measurements, their prognostic significance and their application in diagnosing acute coronary syndrome in chronic kidney disease patients. It also points out poorly known aspects and suggests directions for future research.
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Affiliation(s)
- Joanna Szczykowska
- 1st Department of Nephrology and Transplantation with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland.
| | - Tomasz Hryszko
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | - Beata Naumnik
- 1st Department of Nephrology and Transplantation with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
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Gualandro DM, Puelacher C, LuratiBuse G, Lampart A, Strunz C, Cardozo FA, Yu PC, Jaffe AS, Barac S, Bock L, Badertscher P, du Fay de Lavallaz J, Marbot S, Sazgary L, Bolliger D, Rentsch K, Twerenbold R, Hammerer-Lercher A, Melo ES, Calderaro D, Duarte AJ, de Luccia N, Caramelli B, Mueller C. Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery. Am Heart J 2018; 203:67-73. [PMID: 30041065 DOI: 10.1016/j.ahj.2018.06.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/30/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND We aimed to directly compare preoperative high-sensitivity cardiac troponin (hs-cTn) I and T concentration for the prediction of major cardiac complications after non-cardiac surgery. METHODS We measured hs-cTnI and hs-cTnT preoperatively in a blinded fashion in 1022 patients undergoing non-cardiac surgery. The primary endpoint was a composite of major cardiac complications including cardiac death, cardiac arrest, myocardial infarction, clinically relevant arrhythmias, and acute heart failure within 30 days. We hypothesized that the type of surgery may impact on the predictive accuracy of hs-cTnI/T and stratified all analyses according to the type of surgery. RESULTS Major cardiac complications occurred in 108 (11%) patients, 58/243 (24%) patients undergoing vascular surgery and 50/779 (6%, P < .001) patients undergoing non-vascular surgery. Using regulatory-approved 99th percentile cut-off concentrations, preoperative hs-cTnI elevations were less than one-fifth as common as preoperative hs-cTnT elevations (P < .001). Among patients undergoing vascular surgery, preoperative hs-cTnI concentrations, but not hs-cTnT, was an independent predictor of cardiac complications (adjusted odds ratio (aOR) 1.5, 95% confidence interval (95% CI) 1.0-2.1). The area under the receiver-operating characteristics curve (AUC) was 0.67 (95% CI, 0.59-0.75) for hs-cTnI versus 0.59 (95% CI 0.51-0.67, P = .012) for hs-cTnT. In contrast, among patients undergoing non-vascular surgery both preoperative hs-cTnI and hs-cTnT were independent predictors of the primary endpoint (aOR 1.6, 95% CI 1.3-2.0, and aOR 3.0, 95% CI 2.0-4.6, respectively) and showed higher predictive accuracy (AUC 0.77, 95% CI, 0.71-0.83, and 0.79, 95% CI 0.73-0.85, P = ns). CONCLUSIONS Preoperative hs-cTnI and hs-cTnT concentrations predict major cardiac complications after non-vascular surgery, while, in patients undergoing vascular surgery, hs-cTnI may have better accuracy.
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Affiliation(s)
- Danielle M Gualandro
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil; Department of Cardiology, University Hospital Basel, University of Basel, Switzerland.
| | - Christian Puelacher
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Giovanna LuratiBuse
- Department of Anaesthesiology, University Hospital Düsseldorf, Germany; Department of Anaesthesiology, University Hospital Basel, University of Basel, Switzerland
| | - Andreas Lampart
- Department of Anaesthesiology, University Hospital Basel, University of Basel, Switzerland
| | - Celia Strunz
- Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Francisco A Cardozo
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Pai C Yu
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Allan S Jaffe
- Department of Cardiology and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | - Sanela Barac
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Lukas Bock
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | | | - Stella Marbot
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Lorraine Sazgary
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Daniel Bolliger
- Department of Anaesthesiology, University Hospital Basel, University of Basel, Switzerland
| | - Katharina Rentsch
- Department of Laboratory Medicine, University Hospital Basel, Switzerland
| | - Raphael Twerenbold
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland; Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany
| | | | - Edielle S Melo
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Daniela Calderaro
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Alberto Js Duarte
- Laboratory of Immunogenetics and Experimental Transplantation, University of Sao Paulo Medical School, Brazil
| | - Nelson de Luccia
- Vascular and Endovascular Surgery Clinic of the Clinics Hospital, University of São Paulo Medical School, Brazil
| | - Bruno Caramelli
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
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Affiliation(s)
- Germán Cediel
- Department of Medicine, Heart Institute, Hospital Universitari Germans Trias i Pujol, CIBERCV, Autonomous University of Barcelona, Carretera de Canyet s/n, Barcelona, Spain
| | - Evelyn Santiago-Vacas
- Department of Medicine, Heart Institute, Hospital Universitari Germans Trias i Pujol, CIBERCV, Autonomous University of Barcelona, Carretera de Canyet s/n, Barcelona, Spain
| | - Antoni Bayes-Genis
- Department of Medicine, Heart Institute, Hospital Universitari Germans Trias i Pujol, CIBERCV, Autonomous University of Barcelona, Carretera de Canyet s/n, Barcelona, Spain
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Mueller T, Egger M, Peer E, Dieplinger B. 5th generation cardiac troponin I and T assays in clinical routine - A head-to-head comparison with data from the Linz troponin (LITROP) study. Clin Chim Acta 2018; 485:195-204. [PMID: 29958891 DOI: 10.1016/j.cca.2018.06.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/13/2018] [Accepted: 06/21/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND In Europe, clinicians use so called high-sensitivity assays for the measurement of cardiac troponin I and T (i.e., hs-cTnI and hs-cTnT assays, also termed 5th generation assays) since several years. We aimed at performing a head-to-head comparison of two 5th generation assays in "real life use". METHODS We studied 3588 consecutive patients presenting to an emergency department. We used both, a hs-cTnI assay from Abbott and a hs-cTnT assay from Roche in clinical routine. We assessed (1) the capabilities of hs-cTnI and hs-cTnT for the prediction of 3.7 year all-cause mortality; (2) discordant diagnoses of myocardial injury by hs-cTnI and hs-cTnT according to the European gender-neutral 99th percentile upper reference limits (i.e., 26 ng/L and 14 ng/L, respectively); and (3) analyte kinetics in patient with serial troponin measurements. RESULTS With respect to prognosis of all-cause mortality, the AUC of hs-cTnI was 0.81 (95% CI, 0.80-0.82), and the AUC of hs-cTnT was 0.85 (95% CI, 0.84-0.86). With respect to discordant diagnoses, 21% of the 3588 patients were classified as having myocardial injury by hs-cTnT but not by hs-cTnI, and < 1% were classified as having myocardial injury by hs-cTnI but not by hs-cTnT. In the patients with serial blood sampling, the median delta values were 6.3 ng/L and 25% for hs-cTnI, and 4.2 ng/L and 16% for hs-cTnT. CONCLUSION We found different characteristics of the Abbott hs-cTnI and the Roche hs-cTnT assays, especially when using the European gender-neutral 99th percentile upper reference limits. Clinically, these different characteristics are related to discordant results in the diagnosis and prognosis of patients presenting to an emergency department.
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Affiliation(s)
- Thomas Mueller
- Department of Clinical Pathology, Hospital of Bolzano, Bolzano, Italy.
| | - Margot Egger
- Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Linz, Austria
| | - Evi Peer
- Department of Clinical Pathology, Hospital of Bolzano, Bolzano, Italy
| | - Benjamin Dieplinger
- Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Linz, Austria
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31
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Kavsak PA, Andruchow JE, McRae AD, Worster A. Profile of Roche’s Elecsys Troponin T Gen 5 STAT blood test (a high-sensitivity cardiac troponin assay) for diagnosing myocardial infarction in the emergency department. Expert Rev Mol Diagn 2018; 18:481-489. [DOI: 10.1080/14737159.2018.1476141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Peter A. Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - James E. Andruchow
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew D. McRae
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Worster
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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Streng AS, van der Linden N, Kocken JMM, Bekers O, Bouwman FG, Mariman ECM, Meex SJR, Wodzig WKWH, de Boer D. Mass Spectrometric Identification of Cardiac Troponin T in Urine of Patients Suffering from Acute Myocardial Infarction. J Appl Lab Med 2018; 2:857-867. [PMID: 33636816 DOI: 10.1373/jalm.2017.024224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/30/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Because of its high cardiospecificity, cardiac troponin T (cTnT) is one of the first-choice biomarkers to diagnose acute myocardial infarction (AMI). cTnT is extensively fragmented in serum of patients suffering from AMI. However, it is currently unknown whether all cTnT is completely degraded in the body or whether some cTnT fragments can leave the body via urine. The aim of the present study is to develop a method for the detection of cTnT in urine and to examine whether cTnT is detectable in patient urine. METHODS Proteins in urine samples of 20 patients were precipitated using a cTnT-specific immunoprecipitation technique and a nonspecific acetonitrile protein precipitation. After in-solution digestion of the precipitated proteins, the resulting peptides were separated and analyzed using HPLC and mass spectrometry with a targeted selected ion monitoring assay with data-dependent tandem mass spectrometry (t-SIM/dd-MS2). RESULTS The t-SIM/dd-MS2 assay was validated using a synthetic peptide standard containing 10 specific cTnT peptides of interest and with purified human intact cTnT spiked in urine from healthy individuals. Using this assay, 6 different cTnT-specific peptides were identified in urine samples from 3 different patients, all suffering from AMI. CONCLUSIONS We show here for the first time that cTnT can be present in the urine of AMI patients using a targeted LC-MS/MS assay. Whether the presence of cTnT in urine reflects a physiological or pathophysiological process still needs to be elucidated.
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Affiliation(s)
- Alexander S Streng
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Noreen van der Linden
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jordy M M Kocken
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Otto Bekers
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Freek G Bouwman
- Department of Human Biology, Maastricht University, Maastricht, the Netherlands
| | - Edwin C M Mariman
- Department of Human Biology, Maastricht University, Maastricht, the Netherlands
| | - Steven J R Meex
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Will K W H Wodzig
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Douwe de Boer
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
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33
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How to best use high-sensitivity cardiac troponin in patients with suspected myocardial infarction. Clin Biochem 2018; 53:143-155. [DOI: 10.1016/j.clinbiochem.2017.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/15/2017] [Indexed: 11/21/2022]
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34
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Hilderink JM, van der Linden N, Kimenai DM, Litjens EJR, Klinkenberg LJJ, Aref BM, Aziz F, Kooman JP, Rennenberg RJMW, Bekers O, Koopmans RP, Meex SJR. Biological Variation of Creatinine, Cystatin C, and eGFR over 24 Hours. Clin Chem 2018; 64:851-860. [PMID: 29483105 DOI: 10.1373/clinchem.2017.282517] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/07/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Estimated glomerular filtration rate (eGFR) is widely used in clinical practice. This study assessed the within-subject biological variation (CVI) of different eGFR equations in people with chronic kidney disease (CKD) and people without CKD. The aims of this study were (a) to determine the 24-h biological variation profiles of creatinine, cystatin C, and eGFR and (b) to determine whether CVI of creatinine, cystatin C, and eGFR changes on deterioration of glomerular filtration. METHODS Hourly blood samples were analyzed from 37 individuals (17 without CKD, 20 with CKD) during 24 h. Creatinine (enzymatic method) and cystatin C were measured using a Cobas 8000 (Roche Diagnostics). eGFR was estimated using the Modification of Diet in Renal Disease and the Chronic Kidney Disease Epidemiology Collaboration based on creatinine and/or cystatin C. Plasma samples were stored at -80 °C before analysis. Outlier and homogeneity analyses were checked before performing a nested ANOVA to determine biological variation. RESULTS CVI of creatinine was higher in people without CKD than in those with CKD (6.4% vs 2.5%) owing primarily to the more profound effect of meat consumption on creatinine variability in individuals with lower baseline creatinine concentrations. Unlike creatinine, cystatin C concentrations were unaffected by meat consumption. Cystatin C showed some diurnal rhythmic variation and less in people with CKD. Reference change values (RCVs) of all eGFR equations were within 13% to 20% in both study groups. CONCLUSIONS Despite differences in CVI of creatinine, the CVI and RCV of the eGFR equations were relatively similar for people with or without CKD.
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Affiliation(s)
- Judith M Hilderink
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Noreen van der Linden
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Dorien M Kimenai
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Elisabeth J R Litjens
- Department of Nephrology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Lieke J J Klinkenberg
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Breshna M Aref
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Fahra Aziz
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jeroen P Kooman
- Department of Nephrology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Roger J M W Rennenberg
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Otto Bekers
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Richard P Koopmans
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Steven J R Meex
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands;
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Kavsak PA, Worster A, Shortt C, Ma J, Clayton N, Sherbino J, Hill SA, McQueen M, Griffith LE, Mehta SR, McRae AD, Devereaux PJ. Performance of high-sensitivity cardiac troponin in the emergency department for myocardial infarction and a composite cardiac outcome across different estimated glomerular filtration rates. Clin Chim Acta 2018; 479:166-170. [PMID: 29366835 DOI: 10.1016/j.cca.2018.01.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/11/2018] [Accepted: 01/19/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Clinicians regularly observe increased high-sensitivity cardiac troponin (hs-cTn) concentrations in patients with low estimated glomerular filtration rate (eGFR). The challenge is to differentiate acute coronary syndrome (ACS) from increased hs-cTn results across a range of eGFR. The objective of this study was to determined the optimal hs-cTn concentrations for acute myocardial infarction (MI) and a composite cardiovascular outcome across different eGFR ranges and to assess the utility of a low hs-cTn cutoff to rule-out events. METHODS We undertook an observational study in the emergency department of patients (n = 1212) with symptoms suggestive of ACS who had an eGFR and at least one Roche hs-cTnT and one Abbott hs-cTnI result. The 7-day outcomes were MI or a composite of MI, unstable angina, congestive heart failure, serious ventricular cardiac arrhythmia, or death. The maximum hs-cTn concentration was assessed across different eGFR ranges (<30,30-59,60-89,≥90 ml/min/1.73m2) by spearman correlation, ROC-curve analyses, and sensitivity and negative predictive value (NPV) for the proposed rule-out hs-cTn cutoffs (hs-cTnI<5 ng/l and hs-cTnT<6 ng/l) for the outcomes. RESULTS Both hs-cTnI and hs-cTnT concentrations were negatively correlated with eGFR. The lower the eGFR, the lower the AUC and the higher the optimal hs-cTn cutoffs for both MI and the composite outcome. The highest combined sensitivity (100%), NPV (100%) and proportion of low-risk for MI (45% of group) was observed for patients with hs-cTnT<6 ng/l with an eGFR≥90. CONCLUSION The test performance for hs-cTn for diagnosing or ruling-out an acute cardiac event varies per the eGFR. Accurate risk stratification requires knowledge of the eGFR.
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Affiliation(s)
- Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
| | - Andrew Worster
- Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Colleen Shortt
- Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Natasha Clayton
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jonathan Sherbino
- Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Stephen A Hill
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Matthew McQueen
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Shamir R Mehta
- Division of Cardiology, and Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Andrew D McRae
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - P J Devereaux
- Division of Cardiology, and Population Health Research Institute, McMaster University, Hamilton, ON, Canada
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Twerenbold R, Badertscher P, Boeddinghaus J, Nestelberger T, Wildi K, Puelacher C, Sabti Z, Rubini Gimenez M, Tschirky S, du Fay de Lavallaz J, Kozhuharov N, Sazgary L, Mueller D, Breidthardt T, Strebel I, Flores Widmer D, Shrestha S, Miró Ò, Martín-Sánchez FJ, Morawiec B, Parenica J, Geigy N, Keller DI, Rentsch K, von Eckardstein A, Osswald S, Reichlin T, Mueller C. 0/1-Hour Triage Algorithm for Myocardial Infarction in Patients With Renal Dysfunction. Circulation 2018; 137:436-451. [PMID: 29101287 PMCID: PMC5794234 DOI: 10.1161/circulationaha.117.028901] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/19/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The European Society of Cardiology recommends a 0/1-hour algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardial infarction using high-sensitivity cardiac troponin (hs-cTn) concentrations irrespective of renal function. Because patients with renal dysfunction (RD) frequently present with increased hs-cTn concentrations even in the absence of non-ST-segment elevation myocardial infarction, concern has been raised regarding the performance of the 0/1-hour algorithm in RD. METHODS In a prospective multicenter diagnostic study enrolling unselected patients presenting with suspected non-ST-segment elevation myocardial infarction to the emergency department, we assessed the diagnostic performance of the European Society of Cardiology 0/1-hour algorithm using hs-cTnT and hs-cTnI in patients with RD, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2, and compared it to patients with normal renal function. The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including cardiac imaging. Safety was quantified as sensitivity in the rule-out zone, accuracy as the specificity in the rule-in zone, and efficacy as the proportion of the overall cohort assigned to either rule-out or rule-in based on the 0- and 1-hour sample. RESULTS Among 3254 patients, RD was present in 487 patients (15%). The prevalence of non-ST-segment elevation myocardial infarction was substantially higher in patients with RD compared with patients with normal renal function (31% versus 13%, P<0.001). Using hs-cTnT, patients with RD had comparable sensitivity of rule-out (100.0% [95% confidence interval {CI}, 97.6-100.0] versus 99.2% [95% CI, 97.6-99.8]; P=0.559), lower specificity of rule-in (88.7% [95% CI, 84.8-91.9] versus 96.5% [95% CI, 95.7-97.2]; P<0.001), and lower overall efficacy (51% versus 81%, P<0.001), mainly driven by a much lower percentage of patients eligible for rule-out (18% versus 68%, P<0.001) compared with patients with normal renal function. Using hs-cTnI, patients with RD had comparable sensitivity of rule-out (98.6% [95% CI, 95.0-99.8] versus 98.5% [95% CI, 96.5-99.5]; P=1.0), lower specificity of rule-in (84.4% [95% CI, 79.9-88.3] versus 91.7% [95% CI, 90.5-92.9]; P<0.001), and lower overall efficacy (54% versus 76%, P<0.001; proportion ruled out, 18% versus 58%, P<0.001) compared with patients with normal renal function. CONCLUSIONS In patients with RD, the safety of the European Society of Cardiology 0/1-hour algorithm is high, but specificity of rule-in and overall efficacy are decreased. Modifications of the rule-in and rule-out thresholds did not improve the safety or overall efficacy of the 0/1-hour algorithm. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00470587.
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Affiliation(s)
- Raphael Twerenbold
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
- Department of General and Interventional Cardiology, University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Germany (R.T.)
| | - Patrick Badertscher
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Karin Wildi
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Christian Puelacher
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Zaid Sabti
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Maria Rubini Gimenez
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Sandra Tschirky
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Jeanne du Fay de Lavallaz
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Nikola Kozhuharov
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Lorraine Sazgary
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Deborah Mueller
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Tobias Breidthardt
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Ivo Strebel
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Dayana Flores Widmer
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Samyut Shrestha
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Òscar Miró
- Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.)
| | | | - Beata Morawiec
- 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.)
| | - Jiri Parenica
- Department of Cardiology, University Hospital Brno, Czech Republic (J.P.)
- Medical Faculty, Masaryk University, Brno, Czech Republic (J.P.)
| | - Nicolas Geigy
- Emergency Department, Kantonsspital Liestal, Switzerland (N.G.)
| | - Dagmar I Keller
- Emergency Department, University Hospital Zürich, Switzerland (D.I.K.)
| | - Katharina Rentsch
- Department of Laboratory Medicine, University Hospital Basel, Switzerland (K.R.)
| | | | - Stefan Osswald
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Tobias Reichlin
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Christian Mueller
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
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Mariathas M, Olechowski B, Mahmoudi M, Curzen N. High sensitivity troponins in contemporary cardiology practice: are we turning a corner? Expert Rev Cardiovasc Ther 2017; 16:49-57. [PMID: 29260921 DOI: 10.1080/14779072.2018.1419063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Troponin is considered to be the gold standard biomarker for ruling out MI. There has been a drive to improve the diagnostic speed, and as such the high sensitivity cardiac troponin (hs-cTn) assays have been introduced into clinical practice and are now part of international guidelines. Their novel value in clinical practice more generally is becoming apparent. Areas covered: In this review we will evaluate the evidence for the use of hs-cTn assays in clinical practice, the issues with the assay and how the hs-cTn can be utilized in the future as a biomarker of cardiovascular risk. Expert commentary: The use of the hs-cTn assays as a 'rule out' test for MI is compelling, as a 'rule in' there are significant issues relating the specificity of the assay for MI. The future of the assay may lie in population screening and risk modeling.
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Affiliation(s)
- Mark Mariathas
- a Coronary Research Group , University Hospital Southampton NHS Foundation Trust , Southampton , UK.,b Faculty of Medicine , University of Southampton , Southampton , UK
| | - Bartosz Olechowski
- a Coronary Research Group , University Hospital Southampton NHS Foundation Trust , Southampton , UK.,b Faculty of Medicine , University of Southampton , Southampton , UK
| | - Michael Mahmoudi
- a Coronary Research Group , University Hospital Southampton NHS Foundation Trust , Southampton , UK.,b Faculty of Medicine , University of Southampton , Southampton , UK
| | - Nick Curzen
- a Coronary Research Group , University Hospital Southampton NHS Foundation Trust , Southampton , UK.,b Faculty of Medicine , University of Southampton , Southampton , UK
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Duma A, Wagner C, Titz M, Maleczek M, Hüpfl M, Weihs VB, Samaha E, Herkner H, Szekeres T, Mittlboeck M, Scott MG, Jaffe AS, Nagele P. High-sensitivity cardiac troponin T in young, healthy adults undergoing non-cardiac surgery. Br J Anaesth 2017; 120:291-298. [PMID: 29406178 DOI: 10.1016/j.bja.2017.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/18/2017] [Accepted: 09/24/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It is unclear if isolated postoperative cardiac-troponin elevation, often referred to as myocardial injury, represents a pathological event, as control studies in otherwise healthy adults are lacking. METHODS In this single-centre prospective observational cohort study, serial high-sensitivity cardiac troponin T (hscTnT) plasma concentrations were obtained from young, healthy adults undergoing elective orthopaedic surgery at three time points: before operation, 2-6 h, and 18-30 h after surgery. End points were hscTnT increases after surgery: ≥20% (exceeding analytical variability), ≥50% (exceeding short-term biological variability), and ≥85% (exceeding long-term biological variability). The secondary end point was myocardial injury, defined as new postoperative hscTnT elevation >99th % upper reference limit (URL) (women >10 ng litre-1; men >15 ng litre-1). RESULTS Amongst the study population (n=95), no hscTnT increase ≥20% was detected in 68 patients (73%). A hscTnT increase between 20% and 49% was observed in 17 patients (18%), 50-84% in seven patients (7%), and ≥85% in three patients (3%). Twenty patients (21%) had an absolute ΔhscTnT between 0 and 2 ng litre-1, 12 patients (13%) between 2 and 4 ng litre-1, three patients between 4 and 6 ng litre-1, and one patient (1%) between 6 and 8 ng litre-1. Myocardial injury (new hscTnT elevation >99th%) was diagnosed in one patient (1%). The median hscTnT concentrations did not increase after operation, and were 4 (3.9-5, inter-quartile range) ng litre-1 at baseline, 4 (3.9-5) ng litre-1 at 2-6 h after surgery, and 4 (3.9-5) ng litre-1 on postoperative day 1. CONCLUSIONS One in four young adult patients without known cardiovascular disease developed a postoperative hscTnT increase, but without exceeding the 99th% URL and without evidence of myocardial ischaemia. These results may have important ramifications for the concept of postoperative myocardial injury, as they suggest that, in some patients, postoperative cardiac-troponin increases may be the result of a normal physiological process in the surgical setting. CLINICAL TRIAL REGISTRATION NCT 02394288.
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Affiliation(s)
- A Duma
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - C Wagner
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - M Titz
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - M Maleczek
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - M Hüpfl
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - V B Weihs
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - E Samaha
- Department of Internal Medicine, Medical University of Vienna, Vienna, Austria; Department of Anesthesiology, Washington University in St Louis, St Louis, MO, USA
| | - H Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - T Szekeres
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - M Mittlboeck
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - M G Scott
- Department of Pathology and Immunology, Washington University in St Louis, St Louis, MO, USA
| | - A S Jaffe
- Cardiovascular Division, Department of Internal Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA; Division of Clinical Core Laboratory Services, Department of Laboratory Medicine and Pathology, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - P Nagele
- Department of Anesthesiology, Washington University in St Louis, St Louis, MO, USA.
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