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von Rennenberg R, Herm J, Krause T, Hellwig S, Stengl H, Scheitz JF, Elgeti T, Nagel SN, Endres M, Haeusler KG, Nolte CH. Elevation of cardiac biomarkers in stroke is associated with pathological findings on cardiac MRI-results of the HEart and BRain interfaces in Acute Stroke study. Int J Stroke 2023; 18:180-186. [PMID: 35403503 DOI: 10.1177/17474930221095698] [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] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Cardiac biomarkers, such as high-sensitivity cardiac troponin T (hs-cTnT), are frequently elevated in ischemic stroke patients but the mechanisms underlying this elevation are insufficiently understood. We determined the presence of cardiac damage, assessed using cardiac magnetic resonance imaging (CMR), in stroke patients with elevated hs-cTnT and brain natriuretic peptide (BNP). METHODS This is a post hoc analysis of the prospective, investigator-initiated, cross-sectional HEart and BRain interfaces in Acute Stroke (HEBRAS) study. All patients underwent the measurement of hs-cTnT and BNP as well as gadolinium-enhanced CMR in the acute phase of ischemic stroke. We performed unadjusted and adjusted logistic regression models to assess the association between hs-cTnT and BNP elevation and the presence of pathological CMR findings. RESULTS Two hundred and thirty-three stroke patients (median age 67 years, 33% female) were included, of whom 43 (21%) had elevated hs-cTnT and 109 (47%) had elevated BNP. Hundred of the 233 (43%) patients had pathological findings on CMR had focal fibrosis as detected by late-gadolinium enhancement (LGE) in 51 (23%), left-ventricular hypertrophy (LVH) in 38 (16%), reduced LVEF in 32 (14%), and left-atrial dilatation in 34 (15%). After adjustment for potential confounders, both hs-cTnT (adjOR 5.0 (95%CI 2.1-11.7), p < 0.001) and BNP (adjOR 4.1 (95%CI 2.3-7.3), p < 0.001) were significantly associated with pathological findings on CMR. Hs-cTnT was associated with LGE, LVEF, and LVH, whereas BNP was associated with left-atrial dilatation and LVEF, LVH. CONCLUSION Elevated cardiac biomarkers in acute stroke including CMR are strongly associated with pathological findings on CMR. In acute stroke patients, the elevation of cardiac biomarkers may identify patients who require a more thorough cardiology work-up.
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Affiliation(s)
- Regina von Rennenberg
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Juliane Herm
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Berlin, Germany
| | - Thomas Krause
- Department of Neurology, Jüdisches Krankenhaus Berlin, Berlin, Germany
| | - Simon Hellwig
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Berlin, Germany
| | - Helena Stengl
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Berlin, Germany
| | - Jan F Scheitz
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site, Berlin, Germany
| | - Thomas Elgeti
- Departments of Radiology Pediatric Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian N Nagel
- Departments of Radiology Pediatric Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site, Berlin, Germany.,ExcellenceCluster NeuroCure, Berlin, Germany
| | | | - Christian H Nolte
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site, Berlin, Germany
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Leite L, Matos P, Leon-Justel A, Espírito-Santo C, Rodríguez-Padial L, Rodrigues F, Orozco D, Redon J. High sensitivity troponins: A potential biomarkers of cardiovascular risk for primary prevention. Front Cardiovasc Med 2022; 9:1054959. [PMID: 36531726 PMCID: PMC9748104 DOI: 10.3389/fcvm.2022.1054959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/14/2022] [Indexed: 03/07/2024] Open
Abstract
There have been several approaches to building charts for CV risk, all of which have both strengths and limitations. Identifying early organ damage provides relevant information and should be included in risk charts, although the direct relationship with risk is imprecise, variability between operators at the time to assess, and low availability in some healthcare systems, limits its use. Biomarkers, like troponin (cTns) isoforms cTnI and cTnT, a cardiac specific myocyte injury marker, have the great advantage of being relatively reproducible, more readily accessible, and applicable to different populations. New and improved troponin assays have good analytical performance, can measure very low levels of circulating troponin, and have low intra individual variation, below 10 %. Several studies have analyzed the blood levels in healthy subjects and their predictive value for cardiovascular events in observational, prospective and post-hoc studies. All of them offered relevant information and shown that high sensitivity hs-cTnI has a place as an additional clinical marker to add to current charts, and it also reflects sex- and age-dependent differences. Although few more questions need to be answered before recommend cTnI for assessing CV risk in primary prevention, seems to be a potential strong marker to complement CV risk charts.
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Affiliation(s)
- Luis Leite
- Cardiology Department, Coimbra University Hospital, University of Coimbra, Coimbra, Portugal
| | - Pedro Matos
- APDP e Hospital CUF Infante Santo, Lisbon, Portugal
| | - Antonio Leon-Justel
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | | | | | | | - Domingo Orozco
- Department of Clinical Medicine, Miguel Hernández University, Elche, Spain
| | - Josep Redon
- INCLIVA Research Institute, University of Valencia, Valencia, Spain
- CIBERObn Institute of Health Carlos III, Madrid, Spain
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High-sensitivity troponin I for cardiovascular risk stratification in the general asymptomatic population: Perspectives from Asia-Pacific. Int J Cardiol 2019; 282:93-98. [DOI: 10.1016/j.ijcard.2019.01.107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/22/2018] [Accepted: 01/14/2019] [Indexed: 11/15/2022]
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Karpouzas GA, Estis J, Rezaeian P, Todd J, Budoff MJ. High-sensitivity cardiac troponin I is a biomarker for occult coronary plaque burden and cardiovascular events in patients with rheumatoid arthritis. Rheumatology (Oxford) 2018; 57:1080-1088. [DOI: 10.1093/rheumatology/key057] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Indexed: 01/07/2023] Open
Affiliation(s)
- George A Karpouzas
- Division of Rheumatology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | - Panteha Rezaeian
- Division of Cardiology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | - Matthew J Budoff
- Division of Cardiology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
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Zhu X, Li H, Zhang C. Clinical effects of Ganglioside and fructose-1, 6-diphosphate on neonatal heart and brain injuries after Asphyxia. Pak J Med Sci 2017; 33:1199-1204. [PMID: 29142564 PMCID: PMC5673733 DOI: 10.12669/pjms.335.12830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To study the clinical effect of ganglioside (GM) and fructose-1, 6-diphosphate (FDP) on neonatal heart and brain injuries after asphyxia. Methods Ninety-one neonates with asphyxia neonatal heart and brain injuries were randomly divided into an observation group and a control group. Both groups were given symptomatic treatment as soon as possible. On this basis, the observation group was given 200 mL of 5% glucose injection and 20 mg of GM and 250 mg/kg·d FDP by intravenous infusion. The above two drugs were given once a day for 14 days. The control group was given 20 mL of 5% glucose injection, 2 mL of cerebrolysin and 250 mg/kg·d FDP by intravenous infusion, once a day for 14 days. Both groups were administered on the first day after admission, and the course of treatment was 14 days. The treatment outcomes of the two groups were compared by detecting the levels of glycogen phosphorylase isoenzyme BB (GPBB), cTn-I and CK-MB, MRI results and Neonatal Behavioral Neurological Assessment (NBNA) scores before and after treatment. Results The levels of GPBB, cTn-I and CK-MB in the observation group were significantly higher than those of normal neonates. After treatment, the levels of cTn-I and CK-MB in the observation group were closer to those of normal neonates compared with the control group, with significant differences (P<0.05). There was a significant difference in the brain MRI examination between the two groups (P<0.05). The NBNA scores of the two groups were significantly different before and after treatment (P<0.05). The total effective rate of the observation group was significantly higher than that of the control group (P<0.05). Conclusion Neonatal heart and brain injuries after asphyxia can be well treated by combining GM with FDP.
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Affiliation(s)
- Xiaojing Zhu
- Xiaojing Zhu, Department of Pediatrics, First Center Hospital of Baoding, Baoding 071000, Hebei Province, P. R. China
| | - Hongya Li
- Hongya Li, Department of Pediatrics, First Center Hospital of Baoding, Baoding 071000, Hebei Province, P. R. China
| | - Congmin Zhang
- Congmin Zhang, Department of Pediatrics, First Center Hospital of Baoding, Baoding 071000, Hebei Province, P. R. China
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Harada Y, Michel J, Koenig W, Rheude T, Colleran R, Giacoppo D, Kastrati A, Byrne RA. Prognostic Value of Cardiac Troponin T and Sex in Patients Undergoing Elective Percutaneous Coronary Intervention. J Am Heart Assoc 2016; 5:e004464. [PMID: 27895042 PMCID: PMC5210430 DOI: 10.1161/jaha.116.004464] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 11/03/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with stable coronary artery disease undergoing elective percutaneous coronary intervention, the prognostic value of high-sensitivity cardiac troponin T (hs-cTnT) and the influence of sex remain poorly defined. METHODS AND RESULTS Consecutive patients with stable coronary artery disease who underwent elective percutaneous coronary intervention were included. Primary endpoint was all-cause mortality. Unadjusted hazard ratio (HR) in overall and sex-specific population and multivariable adjusted HR were calculated by using Cox proportional hazard models. In a total of 5626 patients, elevated hs-cTnT levels, more than the sex-specific 99th percentile upper reference limit of normal (URL), were observed in 2221 patients (39%) at baseline. During follow-up (median, 14.5 months; 25th-75th percentiles, 6.4-27.2 months), 265 patients died. Mortality was higher in patients with the sex-specific 99th percentile URL compared to those with normal hs-cTnT (17.3% vs 3.4%; HR=6.10; 95% CI, 4.58-8.14; P<0.001). hs-cTnT was an independent predictor of mortality in multivariable adjusted models. The C-statistic was significantly increased by adding hs-cTnT to the basic prediction model for mortality (0.793-0.815; P<0.001). There was a significant interaction between hs-cTnT and sex on mortality. Differences in all-cause mortality between patients with more than the sex-specific 99th percentile URL and those with normal hs-cTnT were numerically larger in male than female patients (male, HR=6.45; 95% CI, 4.68-8.87, P<0.001; female, HR=4.29, 95% CI, 2.36-9.03; P<0.001). CONCLUSIONS In patients with stable coronary artery disease undergoing elective percutaneous coronary intervention, preprocedural hs-cTnT was a strong predictor of mortality in both men and women.
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Affiliation(s)
- Yukinori Harada
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Jonathan Michel
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Tobias Rheude
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Daniele Giacoppo
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Barbier CE, Themudo R, Bjerner T, Johansson L, Lind L, Ahlström H. Long-term prognosis of unrecognized myocardial infarction detected with cardiovascular magnetic resonance in an elderly population. J Cardiovasc Magn Reson 2016; 18:43. [PMID: 27430315 PMCID: PMC4950686 DOI: 10.1186/s12968-016-0264-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/30/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Individuals with unrecognized myocardial infarctions (UMIs) detected with cardiovascular magnetic resonance (CMR) constitute a recently defined group whose prognosis has not been fully evaluated. However, increasing evidence indicate that these individuals may be at considerable cardiovascular risk. The aim of the present study was to investigate the prognostic impact of CMR detected UMIs for major adverse cardiac events (MACE) in community living elderly individuals. METHODS Late gadolinium enhancement CMR was performed in 248 randomly chosen 70-year-olds. Individuals with myocardial infarction (MI) scars, with or without a hospital diagnosis of MI were classified as recognized MI (RMI) or UMI, respectively. Medical records and death certificates were scrutinized. MACE was defined as cardiac death, non-fatal MI, a new diagnosis of angina pectoris, or symptom-driven coronary artery revascularization. RESULTS During follow-up (mean 11 years) MACE occurred in 10 % (n = 18/182) of the individuals without MI scars, in 20 % (n = 11/55) of the individuals with UMI, and in 45 % (n = 5/11) of the individuals with RMI, with a significant difference between the UMI group and the group without MI scars (p = 0.045), and between the RMI group and the group without MI scars (p = 0.0004). Cardiac death and/or non-fatal MI occurred in 15, 5, and 3 of the individuals in the NoMI, UMI, and RMI group respectively. Hazards ratios for MACE adjusted for risk factors and sex were 2.55 (95 % CI 1.20-5.42; p = 0.015) for UMI and 3.28 (95 % CI1.16-9.22; p = 0.025) for RMI. CONCLUSIONS The presence of a CMR detected UMI entailed a more than double risk for MACE in community living 70-year-old individuals.
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Affiliation(s)
| | - Raquel Themudo
- />Department of Radiology, Uppsala University Hospital, Uppsala, 751 85 Sweden
| | - Tomas Bjerner
- />Department of Radiology, Uppsala University Hospital, Uppsala, 751 85 Sweden
| | - Lars Johansson
- />Department of Radiology, Uppsala University Hospital, Uppsala, 751 85 Sweden
| | - Lars Lind
- />Department of Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Håkan Ahlström
- />Department of Radiology, Uppsala University Hospital, Uppsala, 751 85 Sweden
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Nordenskjöld AM, Hammar P, Ahlström H, Bjerner T, Duvernoy O, Eggers KM, Fröbert O, Hadziosmanovic N, Lindahl B. Unrecognized myocardial infarctions detected by cardiac magnetic resonance imaging are associated with cardiac troponin I levels. Clin Chim Acta 2016; 455:189-94. [DOI: 10.1016/j.cca.2016.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 10/22/2022]
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Kotani K, Ishii J. High-sensitivity cardiac troponin I in the clinical setting: a rapidly developing field. Ann Clin Biochem 2015; 52:414. [PMID: 25762212 DOI: 10.1177/0004563215575036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kazuhiko Kotani
- Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi, Japan
| | - Junnichi Ishii
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Aichi, Japan
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