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Wark TW, Lang WR, Cahill KE, Gardner RL. Management of Elevated Troponin I Levels in Adult Medical Inpatients. J Gen Intern Med 2021; 36:3264-3266. [PMID: 32757168 PMCID: PMC8481439 DOI: 10.1007/s11606-020-06074-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/16/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Tyler W Wark
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - William R Lang
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kate E Cahill
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rebekah L Gardner
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Cohn SL, Rohatgi N, Patel P, Whinney C. Clinical Progress Note: Myocardial Injury After Noncardiac Surgery. J Hosp Med 2020; 15:412-415. [PMID: 32584248 DOI: 10.12788/jhm.3448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/14/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Steven L Cohn
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Nidhi Rohatgi
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Preethi Patel
- Department of Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Christopher Whinney
- Department of Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
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Yan I, Börschel CS, Neumann JT, Sprünker NA, Makarova N, Kontto J, Kuulasmaa K, Salomaa V, Magnussen C, Iacoviello L, Di Castelnuovo A, Costanzo S, Linneberg A, Söderberg S, Zeller T, Ojeda-Echevarria FM, Blankenberg S, Westermann D. High-Sensitivity Cardiac Troponin I Levels and Prediction of Heart Failure: Results From the BiomarCaRE Consortium. JACC-HEART FAILURE 2020; 8:401-411. [PMID: 32171759 DOI: 10.1016/j.jchf.2019.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to characterize the association of high-sensitivity cardiac troponin I (hs-cTnI) with heart failure (HF), to determine its predictive value beyond classical cardiovascular risk factors (CVRFs) and N-terminal pro-B-type natriuretic peptide, and to derive a relevant cutoff for potential clinical application. BACKGROUND HF is an important contributor to the overall burden of cardiovascular disease. Early identification of individuals at risk could be beneficial for preventive therapies. METHODS Based on the Biomarker for Cardiovascular Risk Assessment in Europe consortium, we analyzed individual-level data from 4 prospective population-based cohort studies including 48,455 individuals. Participants with myocardial infarction, HF, and stroke at baseline were excluded. We investigated the value of adding hs-cTnI to CVRFs and N-terminal pro-B-type natriuretic peptide using Cox proportional hazards survival models and for prediction by calculating C-statistics and Brier score. RESULTS The median age of the study population was 51 years, and the median follow-up time for occurrence of HF was 6.61 years. Cox regression models adjusted for age, sex, and CVRFs revealed a significant association of hs-cTnI with incident HF (hazard ratio: 1.42 per log [ng/l] unit change [95% confidence interval: 1.31 to 1.53]). The best predictive value was achieved in the model with CVRFs (base model) and both biomarkers (C-index = 0.862; 95% confidence interval: 0.841 to 0.882). Optimal hs-cTnI cutoff values of 2.6 ng/l for women and 4.2 ng/l for men were derived for selecting individuals at risk. CONCLUSIONS In this large dataset from the general population, hs-cTnI could show its independence for the prognosis of HF.
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Affiliation(s)
- Isabell Yan
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Christin S Börschel
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Johannes T Neumann
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Ngoc A Sprünker
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Nataliya Makarova
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Jukka Kontto
- National Institute for Health and Welfare, Helsinki, Finland
| | - Kari Kuulasmaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Christina Magnussen
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy; Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Allan Linneberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tanja Zeller
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | | | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.
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