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Bakoš M, Dilber D, Jazbec A, Svaguša T, Potkonjak AM, Braovac D, Đurić Ž, Radeljak A, Lončar Vrančić A, Vraneš H, Galić S, Novak M, Prkacin I. Urine high-sensitive troponin I in children cannot offer an applicable alternative to serum. Front Cardiovasc Med 2024; 11:1391434. [PMID: 38836067 PMCID: PMC11149416 DOI: 10.3389/fcvm.2024.1391434] [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: 02/25/2024] [Accepted: 05/06/2024] [Indexed: 06/06/2024] Open
Abstract
Introduction In children, congenital heart defects represent the primary cause of increased serum troponin I. The elimination process of cardiac troponin I from the bloodstream and the factors influencing this process remain unknown. The objective of this study was to explore the role of troponin I as an indicator of cardiac damage in children both in serum and urine, a concept previously investigated in adults. Methods Our prospective study involved 70 children under 24 months of age. The first group underwent ventricular septal defect repair, while the second group involved children who had undergone partial cavopulmonary anastomosis. For these groups, urine and serum troponin I were assessed on four occasions. The third group, consisting of healthy children, underwent a single measurement of urine troponin I. Results Serum troponin I values exhibited an expected elevation in the early postoperative period, followed by a return to lower levels. Significantly higher concentrations of serum troponin I were observed in the first group of children (p < 0.05). A positive correlation was found between troponin I in the first three measurements and cardiopulmonary bypass and aortic cross-clamping time. There was no discernible increase in urine troponin I directly related to myocardial damage; troponin I couldn't be detected in most urine samples. Discussion The inability to detect troponin I in urine remains unexplained. Potential explanatory factors may include the isoelectric point of troponin I, elevated urinary concentrations of salts and urea, variations in urine acidity (different pH levels), and a relatively low protein concentration in urine.
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Affiliation(s)
- Matija Bakoš
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Daniel Dilber
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Anamarija Jazbec
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department for Forest Inventory, Management Planning and Remote Sensing, University of Zagreb Faculty of Forestry and Wood Technology, Zagreb, Croatia
| | - Tomo Svaguša
- Department of Cardiology, Dubrava University Hospital, Zagreb, Croatia
| | - Ana-Meyra Potkonjak
- Department of Gynecology and Obstetrics, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Duje Braovac
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Željko Đurić
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Andrea Radeljak
- Department of Medical Biochemistry and Laboratory Medicine, Merkur University Hospital, Zagreb, Croatia
| | - Ana Lončar Vrančić
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Hrvoje Vraneš
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Slobodan Galić
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Milivoj Novak
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ingrid Prkacin
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Internal Medicine, Merkur Clinical Hospital Zagreb, Zagreb, Croatia
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Svaguša T, Žarak M, Šušnjar D, Gjorgjievska S, Varvodić J, Slišković N, Šestan G, Kušurin M, Prkačin I, Rudež I. Low Level of First Morning Urine Cardiac Troponin I: A Specific Hallmark of Aortic Stenosis Severity. J Clin Med 2024; 13:2472. [PMID: 38731001 PMCID: PMC11084163 DOI: 10.3390/jcm13092472] [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: 03/30/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Background: It has recently been shown that cardiac-specific troponin I concentrations in first morning urine samples can be measured with commercially available tests. Due to their accumulation in the first morning urine, scientific papers indicate a potential predictive value for cardiovascular diseases. Therefore, the aim of this study was to compare the concentration of cardiac troponin I in the first morning urine in patients with severe aortic stenosis and the healthy population. Patients and Methods: Blood and first morning urine samples were collected from 34 healthy individuals (17 female) at University Hospital Merkur and 25 patients with severe aortic stenosis (14 female) before surgical treatment at University Hospital Dubrava. Cardiac troponin I and T values were determined using high-sensitivity assays using commercially available Abbott and Roche tests. Results: Patients with severe aortic stenosis had significantly lower troponin I concentrations in the first morning urine samples (0.3 ng/L (0.1-0.6)) as compared to the healthy population (15.2 ng/L (8.4-19.9)) (p < 0.001). There was no statistically significant difference in troponin T concentrations between healthy individuals and patients with severe aortic stenosis. In parallel, both I and T plasma troponin concentrations were significantly higher in patients with severe aortic stenosis. Conclusions: In patients with severe aortic stenosis, cardiac troponin I values in the first morning urine are significantly lower than in healthy subjects.
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Affiliation(s)
- Tomo Svaguša
- Department of Cardiovascular Disease, Dubrava University Hospital, 10000 Zagreb, Croatia
| | - Marko Žarak
- Clinical Department of Laboratory Diagnostics, Dubrava University Hospital, 10000 Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | - Dubravka Šušnjar
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10000 Zagreb, Croatia
| | - Savica Gjorgjievska
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10000 Zagreb, Croatia
| | - Josip Varvodić
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10000 Zagreb, Croatia
| | - Nikola Slišković
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10000 Zagreb, Croatia
| | - Gloria Šestan
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10000 Zagreb, Croatia
| | - Marko Kušurin
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10000 Zagreb, Croatia
| | - Ingrid Prkačin
- Department of Internal Medicine, Merkur University Hospital, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Igor Rudež
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Huang X, Bai S, Luo Y. Advances in research on biomarkers associated with acute myocardial infarction: A review. Medicine (Baltimore) 2024; 103:e37793. [PMID: 38608048 PMCID: PMC11018244 DOI: 10.1097/md.0000000000037793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/14/2024] [Indexed: 04/14/2024] Open
Abstract
Acute myocardial infarction (AMI), the most severe cardiovascular event in clinical settings, imposes a significant burden with its annual increase in morbidity and mortality rates. However, it is noteworthy that mortality due to AMI in developed countries has experienced a decline, largely attributable to the advancements in medical interventions such as percutaneous coronary intervention. This trend highlights the importance of accurate diagnosis and effective treatment to preserve the myocardium at risk and improve patient outcomes. Conventional biomarkers such as myoglobin, creatine kinase isoenzymes, and troponin have been instrumental in the diagnosis of AMI. However, recent years have witnessed the emergence of new biomarkers demonstrating the potential to further enhance the accuracy of AMI diagnosis. This literature review focuses on the recent advancements in biomarker research in the context of AMI diagnosis.
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Affiliation(s)
| | - Suwen Bai
- Central Laboratory, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People’s Hospital of Shenzhen, Shenzhen, China
| | - Yumei Luo
- Guangdong Medical University, Zhanjiang, China
- Cardiology Department of The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People’s Hospital of Shenzhen, Shenzhen, China
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4
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Chaulin AM. Cardiospecific Troponins as Laboratory Biomarkers of Myocardial Cell Injury in Hypertension: A Mini-Review. Curr Med Chem 2024; 31:1235-1250. [PMID: 36825699 DOI: 10.2174/0929867330666230220100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 02/22/2023]
Abstract
To date, it is well known that a significant number of diseases of cardiovascular genesis (coronary heart disease, myocardial infarction, cardiomyopathy, Takotsubo syndrome, heart failure, etc.) and extra-cardiac genesis (renal failure, chronic obstructive pulmonary disease, sepsis, diabetes mellitus, etc.) cause injury to contractile cells of the heart muscle (myocardial cells). The most sensitive and specific criteria for proving myocardial cell injury are cardiospecific troponins (CSTns) - CSTnI and CSTnT. According to the current clinical recommendations of the European, American, and Russian Cardiological Communities, CSTnI and CSTnT are the main biomarkers for early diagnosis of myocardial infarction. Hypertension is one of the most dangerous and common risk factors for the development of cardiovascular pathologies and is associated with a high risk of dangerous cardiovascular complications. Therefore, there is an urgent need to search for new biomarkers for the timely assessment of the prognosis of patients with hypertension. This mini-review aims to substantiate the possibilities of using the cardiomarkers (CSTnI and CSTnT) to assess the prognosis of patients suffering from hypertension and to discuss potential mechanisms that cause injury to myocardial cells and increase serum levels of CSTnI and CSTnT. This is a narrative mini-review, which was prepared using the following databases: Pubmed/Medline, PubMed Central, Embase, Scopus, and Web of Science. The following keywords were used in the literature search: "myocardial cells", "injury", "damage", and "hypertension" in combination with the terms "mechanisms of injury" "predictive significance", "cardiac troponins", or "cardiospecific troponins".
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Affiliation(s)
- Aleksey Michailovich Chaulin
- Department of Cardiology and Cardiovascular Surgery, Samara State Medical University, Samara, 443099, Russia
- Department of Histology and Embryology, Samara State Medical University, Samara, 443099, Russia
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Chaulin A. Modern View on the Role of Sex-Specific Levels of High-Sensitive Cardiospecific Troponins T and I in the Diagnosis of Myocardial Infarction. Cardiol Res 2023; 14:22-31. [PMID: 36896225 PMCID: PMC9990538 DOI: 10.14740/cr1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/13/2023] [Indexed: 02/27/2023] Open
Abstract
It is well known that the molecules of cardiospecific troponins T and I are localized in the troponin-tropomyosin complex of the cytoplasm of cardiac myocytes and, due to the specific localization, these cardiospecific troponins are widely used as diagnostic biomarkers of myocardial infarction. Cardiospecific troponins are released from the cytoplasm of cardiac myocytes as a result of irreversible cell damage (for example, ischemic necrosis of cardiomyocytes in myocardial infarction or apoptosis of cardiac myocytes in cardiomyopathies and heart failure) or reversible damage (for example, intense physical exertion, hypertension, the influence of stress factors, etc.). Current immunochemical methods for determining cardiospecific troponins T and I have extremely high sensitivity to subclinical (minor) damage to myocardial cells and, thanks to modern high-sensitive methods, it is possible to detect damage to cardiac myocytes in the early (subclinical) stages of a number of cardiovascular pathologies, including myocardial infarction. So, recently, leading cardiological communities (the European Society of Cardiology, the American Heart Association, the American College of Cardiology, etc.) have approved algorithms for early diagnosis of myocardial infarction based on the assessment of serum levels of cardiospecific troponins in the first 1 - 3 h after the onset of pain syndrome. An important factor that may affect early diagnostic algorithms of myocardial infarction are sex-specific features of serum levels of cardiospecific troponins T and I. This manuscript presents a modern view on the role of sex-specific serum levels of cardiospecific troponins T and I in the diagnosis of myocardial infarction and the mechanisms of formation of sex-specific serum levels of troponins.
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Affiliation(s)
- Aleksey Chaulin
- Department of Histology and Embryology, Department of Cardiology and Cardiovascular Surgery, Samara State Medical University, 443099 Samara, Samara Region, Russia.,Research Institute of Cardiology, Samara State Medical University, 443099 Samara, Samara Region, Russia
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Gender Specificities of Cardiac Troponin Serum Levels: From Formation Mechanisms to the Diagnostic Role in Case of Acute Coronary Syndrome. Life (Basel) 2023; 13:life13020267. [PMID: 36836623 PMCID: PMC9965547 DOI: 10.3390/life13020267] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 01/20/2023] Open
Abstract
Cardiac troponins T and I are the main (most sensitive and specific) laboratory indicators of myocardial cell damage. A combination of laboratory signs of myocardial cell damage (elevated levels of cardiac troponins T and I) with clinical (severe chest pain spreading to the left side of the human body) and functional (rise or depression of the ST segment, negative T wave or emergence of the Q wave according to electrocardiography and/or decrease in the contractility of myocardial areas exposed to ischemia according to echocardiography) signs of myocardial ischemia is indicative of the ischemic damage to cardiomyocytes, which is characteristic of the development of acute coronary syndrome (ACS). Today, with early diagnostic algorithms for ACS, doctors rely on the threshold levels of cardiac troponins (99th percentile) and on the dynamic changes in the serum levels over several hours (one, two, or three) from the moment of admission to the emergency department. That said, some recently approved highly sensitive methods for determining troponins T and I show variations in 99th percentile reference levels, depending on gender. To date, there are conflicting data on the role of gender specificities in the serum levels of cardiac troponins T and I in the diagnostics of ACS, and the specific mechanisms for the formation of gender differences in the serum levels of cardiac troponins T and I are unknown. The purpose of this article is to analyze the role of gender specificities in cardiac troponins T and I in the diagnostics of ACS, and to suggest the most likely mechanisms for the formation of differences in the serum levels of cardiac troponins in men and women.
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(Modern ideas about the mechanisms of cardiac troponin release and their diagnostic role). COR ET VASA 2022. [DOI: 10.33678/cor.2022.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Review of Recent Laboratory and Experimental Data on Cardiotoxicity of Statins. J Cardiovasc Dev Dis 2022; 9:jcdd9110403. [PMID: 36421938 PMCID: PMC9696927 DOI: 10.3390/jcdd9110403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/30/2022] [Accepted: 10/08/2022] [Indexed: 11/22/2022] Open
Abstract
Due to the fact that statins are among the most high-demand therapeutic agents used for the treatment and prevention of the most common cardiovascular diseases, a significant amount of research is focused on these drugs. As a result, the study and discovery of new effects in statin drugs continues. Research methods are constantly being improved in terms of their sensitivity and specificity, which leads to a change in ideas. In addition to the main lipid-lowering effect, statins have a number of additional effects, which can be conditionally divided into positive (pleiotropic) and negative (side effects). Moreover, information about many of the pleiotropic effects of statins is controversial and may subsequently change as new data become available. To a large extent, this is due to the introduction of new and the improvement of old methods of study: clinical, laboratory and morphological ones. Recent studies report the possibility of statins having potential cardiotoxic properties, which is expressed by an increase in the concentration of highly sensitive cardiac troponins, as well as various adverse changes in cardiac myocytes at the ultrastructural and molecular levels. This paper discusses possible mechanisms of statin cardiotoxicity. This narrative review is based on an analysis of publications in the Medline, PubMed, PubMed Central and Embase databases. The terms “statins”, “troponin”, “troponin I”, “troponin T” in combination with “cardiotoxicity”, “false positive”, “mechanisms of increase”, “pathophysiological mechanisms”, “oxidative stress” and “cardiomyocyte apoptosis” were used to search publications.
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Chaulin AM. Hypertension as One of the Main Non-Myocardial Infarction-Related Causes of Increased Cardiospecific Troponins: From Mechanisms to Significance in Current Medical Practice. J Clin Med Res 2022; 14:448-457. [PMID: 36578369 PMCID: PMC9765318 DOI: 10.14740/jocmr4796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/20/2022] [Indexed: 12/03/2022] Open
Abstract
It is well known that many pathological conditions of both cardiovascular diseases (CVDs) (coronary heart disease, myocardial infarction, arrhythmias, myocarditis, cardiomyopathy, etc.) and non-cardiac (sepsis, anemia, kidney diseases, diabetes mellitus, etc.) origin in the course of their development cause injury to contractile cardiac muscle cells - myocardial cells (MCs). One of the most sensitive and specific criteria for detecting MC injury are cardiospecific troponins (CTs), which are regulatory protein molecules that are released into the blood serum from MC upon their death or injury. Current methods for determining CTs are called high-sensitive ones, and their main advantage is a very low minimum detectable concentration (limit of detection) (average 1 - 10 ng/L or less), which allows early detection of minor MC injury at the earliest stages of CVDs, and therefore they can change the understanding of disease development mechanisms and open up new diagnostic possibilities. One of the most common and dangerous early diseases of the cardiovascular system is hypertension (HT). The novelty of this article lies in the discussion of a new diagnostic direction - predicting the risk of developing CVDs and their dangerous complications in patients with HT by determining the concentration of CTs. In addition, pathophysiological mechanisms underlying MC injury and the release of CTs into the bloodstream and the elimination of CTs into the urine are proposed. This information will contribute to additional fundamental and clinical research to verify the new diagnostic possibility of using CTs in clinical practice (for the management of patients with HT).
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Affiliation(s)
- Aleksey Michailovich Chaulin
- Department of Cardiology and Cardiovascular Surgery, Samara State Medical University, Samara 443099, Russia
- Department of Histology and Embryology, Samara State Medical University, Samara 443099, Russia
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Saviñon-Flores AI, Saviñon-Flores F, Trejo G, Méndez E, Ţălu Ş, González-Fuentes MA, Méndez-Albores A. A review of cardiac troponin I detection by surface enhanced Raman spectroscopy: Under the spotlight of point-of-care testing. Front Chem 2022; 10:1017305. [PMID: 36311415 PMCID: PMC9608872 DOI: 10.3389/fchem.2022.1017305] [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: 08/11/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022] Open
Abstract
Cardiac troponin I (cTnI) is a biomarker widely related to acute myocardial infarction (AMI), one of the leading causes of death around the world. Point-of-care testing (POCT) of cTnI not only demands a short turnaround time for its detection but the highest accuracy levels to set expeditious and adequate clinical decisions. The analytical technique Surface-enhanced Raman spectroscopy (SERS) possesses several properties that tailor to the POCT format, such as its flexibility to couple with rapid assay platforms like microfluidics and paper-based immunoassays. Here, we analyze the strategies used for the detection of cTnI by SERS considering POCT requirements. From the detection ranges reported in the reviewed literature, we suggest the diseases other than AMI that could be diagnosed with this technique. For this, a section with information about cardiac and non-cardiac diseases with cTnI release, including their release kinetics or cut-off values are presented. Likewise, POCT features, the use of SERS as a POCT technique, and the biochemistry of cTnI are discussed. The information provided in this review allowed the identification of strengths and lacks of the available SERS-based point-of-care tests for cTnI and the disclosing of requirements for future assays design.
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Affiliation(s)
- Anel I. Saviñon-Flores
- Centro de Química-ICUAP- Posgrado en Ciencias Ambientales, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | | | - G. Trejo
- Laboratory of Composite Materials and Functional Coatings, Center for Research and Technological Development in Electrochemistry (CIDETEQ), Querétaro, Mexico
| | - Erika Méndez
- Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Ştefan Ţălu
- Technical University of Cluj-Napoca, The Directorate of Research, Development and Innovation Management (DMCDI), Cluj-Napoca, Romania
| | - Miguel A. González-Fuentes
- Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
- *Correspondence: Miguel A. González-Fuentes, ; Alia Méndez-Albores,
| | - Alia Méndez-Albores
- Centro de Química-ICUAP- Posgrado en Ciencias Ambientales, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
- *Correspondence: Miguel A. González-Fuentes, ; Alia Méndez-Albores,
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Chaulin AM. Cardiac Troponins as Biomarkers of Cardiac Myocytes Damage in Case of Arterial Hypertension: From Pathological Mechanisms to Predictive Significance. Life (Basel) 2022; 12:life12091448. [PMID: 36143484 PMCID: PMC9505657 DOI: 10.3390/life12091448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/09/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background. Many pathological conditions of both cardiovascular and non-cardiac origin in the course of their development cause damage to contractile cardiac muscle cells—cardiac myocytes (CMCs). One of the most sensitive and specific criteria for detecting CMCs are cardiac troponins (CTs), which are regulatory protein molecules that are released into the blood serum from CMCs upon their death or damage. New (high-sensitive) methods for detecting CTs allow the detection of minor CMCs damages at the earliest stages of cardiovascular diseases and can therefore change the understanding of disease development mechanisms and open up new diagnostic possibilities. One of the most common and dangerous early diseases of the cardiovascular system is arterial hypertension. The purpose of this paper is to summarize the pathophysiological mechanisms underlying CMCs damage and CTs release into the bloodstream in the case of arterial hypertension and to state the clinical significance of increased CTs levels in patients with arterial hypertension. Materials and methods. This is a descriptive review, which was prepared using the following databases: Embase, Pubmed/Medline and Web of Science. The following key words were used in the literature search: “myocardial injury” and “arterial hypertension” in combination with the terms “cardiac troponins” and “mechanisms of increase”. Conclusions. According to a literature analysis, CMCs damage and CTs release in the case of arterial hypertension occur according to the following pathophysiological mechanisms: myocardial hypertrophy, CMCs apoptosis, damage to the CMC cell membrane and increase in its permeability for CTs molecules, as well as changes in the glomerular filtration rate. Most often, increased CTs serum levels in case of arterial hypertension indicate an unfavorable prognosis. Data on the CTs predictive significance in case of arterial hypertension open the prospects for the use of these biomarkers in the choice of patient management plans.
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Affiliation(s)
- Aleksey Michailovich Chaulin
- Department of Cardiology and Cardiovascular Surgery, Samara State Medical University, 443099 Samara, Russia; or ; Tel.: +7-(927)-770-25-87
- Department of Histology and Embryology, Samara State Medical University, 443099 Samara, Russia
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Chaulin AM. Metabolic Pathway of Cardiospecific Troponins: From Fundamental Aspects to Diagnostic Role (Comprehensive Review). Front Mol Biosci 2022; 9:841277. [PMID: 35517866 PMCID: PMC9062030 DOI: 10.3389/fmolb.2022.841277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/28/2022] [Indexed: 11/28/2022] Open
Abstract
Many molecules of the human body perform key regulatory functions and are widely used as targets for the development of therapeutic drugs or as specific diagnostic markers. These molecules undergo a significant metabolic pathway, during which they are influenced by a number of factors (biological characteristics, hormones, enzymes, etc.) that can affect molecular metabolism and, as a consequence, the serum concentration or activity of these molecules. Among the most important molecules in the field of cardiology are the molecules of cardiospecific troponins (Tns), which regulate the processes of myocardial contraction/relaxation and are used as markers for the early diagnosis of ischemic necrosis of cardiomyocytes (CMC) in myocardial infarction (MI). The diagnostic value and diagnostic capabilities of cardiospecific Tns have changed significantly after the advent of new (highly sensitive (HS)) detection methods. Thus, early diagnostic algorithms of MI were approved for clinical practice, thanks to which the possibility of rapid diagnosis and determination of optimal tactics for managing patients with MI was opened. Relatively recently, promising directions have also been opened for the use of cardiospecific Tns as prognostic markers both at the early stages of the development of cardiovascular diseases (CVD) (arterial hypertension (AH), heart failure (HF), coronary heart disease (CHD), etc.), and in non-ischemic extra-cardiac pathologies that can negatively affect CMC (for example, sepsis, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), etc.). Recent studies have also shown that cardiospecific Tns are present not only in blood serum, but also in other biological fluids (urine, oral fluid, pericardial fluid, amniotic fluid). Thus, cardiospecific Tns have additional diagnostic capabilities. However, the fundamental aspects of the metabolic pathway of cardiospecific Tns are definitively unknown, in particular, specific mechanisms of release of Tns from CMC in non-ischemic extra-cardiac pathologies, mechanisms of circulation and elimination of Tns from the human body, mechanisms of transport of Tns to other biological fluids and factors that may affect these processes have not been established. In this comprehensive manuscript, all stages of the metabolic pathway are consistently and in detail considered, starting from release from CMC and ending with excretion (removal) from the human body. In addition, the possible diagnostic role of individual stages and mechanisms, influencing factors is analyzed and directions for further research in this area are noted.
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Affiliation(s)
- Aleksey M Chaulin
- Department of Cardiology and Cardiovascular Surgery, Department of Clinical Chemistry, Samara State Medical University, Samara, Russia.,Samara Regional Clinical Cardiological Dispensary, Samara, Russia
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The Importance of Cardiac Troponin Metabolism in the Laboratory Diagnosis of Myocardial Infarction (Comprehensive Review). BIOMED RESEARCH INTERNATIONAL 2022; 2022:6454467. [PMID: 35402607 PMCID: PMC8986381 DOI: 10.1155/2022/6454467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 01/02/2023]
Abstract
The study of the metabolism of endogenous molecules is not only of great fundamental significance but also of high practical importance, since many molecules serve as drug targets and/or biomarkers for laboratory diagnostics of diseases. Thus, cardiac troponin molecules have long been used as the main biomarkers for confirmation of diagnosis of myocardial infarction, and with the introduction of high-sensitivity test methods, many of our ideas about metabolism of these cardiac markers have changed significantly. In clinical practice, there are opening new promising diagnostic capabilities of cardiac troponins, the understanding and justification of which are closely connected with the fundamental principles of the metabolism of these molecules. Our current knowledge about the metabolism of cardiac troponins is insufficient and extremely disconnected from various literary sources. Thus, many researchers do not sufficiently understand the potential importance of cardiac troponin metabolism in the laboratory diagnosis of myocardial infarction. The purpose of this comprehensive review is to systematize information about the metabolism of cardiac troponins and during the discussion to focus on the potential impact of cTns metabolism on the laboratory diagnosis of myocardial infarction. The format of this comprehensive review includes a sequential consideration and analysis of the stages of the metabolic pathway, starting from possible release mechanisms and ending with elimination mechanisms. This will allow doctors and researchers to understand the significant importance of cTns metabolism and its impact on the laboratory diagnosis of myocardial infarction.
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Features of the Metabolisms of Cardiac Troponin Molecules—Part 1: The Main Stages of Metabolism, Release Stage. Curr Issues Mol Biol 2022; 44:1376-1394. [PMID: 35723315 PMCID: PMC8947512 DOI: 10.3390/cimb44030092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Cardiac troponins (cTns) have long been the most valuable and specific biomarkers for detecting ischemic myocardial cells (MCs) injury, which is one of the key signs of myocardial infarction (MI). Modern methods (highly sensitive and ultra-sensitive immunoassays (hs-cTns)) of detection are an important and indispensable tool for the early diagnosis of MI and the choice of patient management protocols. Timely diagnosis of MI can significantly improve the prognosis of patients. However, in real clinical practice, doctors often face a significant problem when using cTns—the difficulty of differential diagnosis due to frequent and unexplained increases in the concentration of cTns in blood serum. In addition, there is conflicting information that may potentially affect the diagnostic capabilities and value of cTns: the influence of certain biological factors (diurnal rhythm, gender and age) on serum cTns levels; extra-cardiac expression of cTns; the possibilities of non-invasive diagnosis of MI; and other pathological conditions that cause non-ischemic injury to MCs. To solve these problems, it is necessary to concentrate on studying the metabolism of cTns. The review of our current knowledge about cTns metabolism consists of two parts. In this (first) part of the manuscript, the main stages of cTns metabolism are briefly described and the mechanisms of cTns release from MCs are considered in detail.
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Chaulin AM. Biology of Cardiac Troponins: Emphasis on Metabolism. BIOLOGY 2022; 11:biology11030429. [PMID: 35336802 PMCID: PMC8945489 DOI: 10.3390/biology11030429] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 02/07/2023]
Abstract
Simple Summary Cardiovascular diseases, including myocardial infarction, are among the most common diseases worldwide. Markers associated with the diagnosis of myocardial infarction have been in the spotlight for many years. The most commonly used markers of myocardial infarction are cardiac troponins. However, insufficient understanding of the biology and metabolism of cardiac troponins does not allow us to fully unlock the full diagnostic potential of these cardiomarkers. In this article, I summarized and discussed in detail the features of the metabolism of cardiac troponins. I conducted a comprehensive review of current literary sources and presented my point of view. The format of the manuscript includes a consistent description of the biology and stages of the metabolism of cardiac troponins, starting from the release and circulation, and ending with the features of elimination of cardiac troponins. The possible influence of the biology of cardiac troponins on the diagnostic value of cardiac troponins is analyzed. Based on the analysis of the literature, I found a close relationship between the diagnostic value of cardiac troponins and their biology/metabolism. Further research is needed to increase the diagnostic value of cardiac troponins, and to fully unlock their diagnostic potential. Abstract Understanding of the biology of endo- and exogenous molecules, in particular their metabolism, is not only of great theoretical importance, but also of high practical significance, since many molecules serve as drug targets or markers for the laboratory diagnostics of many human diseases. Thus, cardiac troponin (cTns) molecules have long been used as key markers for the confirmation of diagnosis of myocardial infarction (MI), and with the introduction of contemporary (high sensitivity) test methods, many of our concepts related to the biology of these cardiac markers have changed significantly. In current clinical practice, there are opening new promising diagnostic capabilities of cTns, the understanding and justification of which is closely connected with the theoretical principles of the metabolism of these molecules. However, today, the biology and metabolism of cTns have not been properly investigated; in particular, we do not know the precise mechanisms of release of these molecules from the myocardial cells (MCs) of healthy people and the mechanisms of circulation, and the elimination of cTns from the bloodstream. The main purpose of this manuscript is to systematize information about the biology of cTns, with an emphasis on the metabolism of cTns. The format of this paper, starting with the release of cTns in the blood and concluding with the metabolism/filtration of troponins, provides a comprehensive yet logically easy way for the readers to approach our current knowledge in the framework of understanding the basic mechanisms by which cTns are produced and processed. Conclusions. Based on the analysis of the current literature, the important role of biology and all stages of metabolism (release, circulation, removal) of cTns in laboratory diagnostics should be noted. It is necessary to continue studying the biology and metabolism of cTns, because this will improve the differential diagnosis of MI and i a new application of cTns immunoassays in current clinical practice.
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Affiliation(s)
- Aleksey M. Chaulin
- Department of Histology and Embryology, Samara State Medical University, 89 Chapaevskaya Street, Samara Region, 443099 Samara, Russia; ; Tel.: +7-(927)-770-25-87
- Department of Cardiology and Cardiovascular Surgery, Samara State Medical University, 89 Chapaevskaya Street, Samara Region, 443099 Samara, Russia
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16
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Chaulin A. Metabolic Pathway of Cardiac Troponins and Its Diagnostic Value. Vasc Health Risk Manag 2022. [DOI: 10.2147/vhrm.s335851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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17
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Chaulin AM, Duplyakov DV. [Mechanisms of increase and diagnostic role of highly sensitive troponins in arterial hypertension]. Ann Cardiol Angeiol (Paris) 2021; 71:99-106. [PMID: 34823814 DOI: 10.1016/j.ancard.2021.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 01/19/2023]
Abstract
Improvement in immunochemical methods for the determination of key biomarkers of acute myocardial infarction has led not only to an improvement in the early diagnosis of acute myocardial infarction, but also to a change in many of our ideas about the biology and diagnostic role of cardiac troponins. Modern (highly and ultrasensitive) laboratory methods for the determination of cardiac troponin molecules in human biological fluids are highly sensitive, which makes it possible to detect even the smallest damage to cardiomyocytes that occur at the early stages of many pathologies of cardiac (coronary heart disease, arterial hypertension, etc.) and extracardiac etiology (renal failure, sepsis, chronic obstructive pulmonary disease and others), as well as under the influence of a number of physiological conditions, including the influence of physical exercises, psychoemotional stress, gender characteristics (higher levels of cardiac troponins in men, compared with women), age characteristics (an increase in the concentration of cardiac troponins with age) and circadian characterisics (prevalence of morning values of cardiac troponins concentration over evening ones). In this regard, the diagnostic capabilities of the use of highly sensitive cardiac troponins have been significantly expanded. One of the promising areas for the use of highly sensitive cardiac troponins includes the assessment of the risk of adverse cardiovascular events both in healthy patients and in patients with various risk factors for their development, one of which can be considered arterial hypertension. This article systematizes the results of clinical studies evaluating the diagnostic role of highly sensitive cardiac troponins in biological fluids (blood serum and urine) in hypertension and discusses in detail the mechanisms of increasing the levels of highly sensitive troponins in this pathological condition.
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Affiliation(s)
- Aleksey M Chaulin
- Université médicale d'État de Samara, département de cardiologie et de chirurgie cardiovasculaire, 18 rue de Gagarine, Samara, Russie, 443079.
| | - Dmitry V Duplyakov
- Université médicale d'État de Samara, département de cardiologie et de chirurgie cardiovasculaire, 18 rue de Gagarine, Samara, Russie, 443079
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Chaulin AM. Elevation Mechanisms and Diagnostic Consideration of Cardiac Troponins under Conditions Not Associated with Myocardial Infarction. Part 2. Life (Basel) 2021; 11:life11111175. [PMID: 34833051 PMCID: PMC8619207 DOI: 10.3390/life11111175] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 01/19/2023] Open
Abstract
This article proceeds with a discussion of the causes and mechanisms of an elevation in cardiac troponins in pathological conditions not associated with acute myocardial infarction. The second part of the article discusses the causes and mechanisms of cardiac troponins elevation in diabetes mellitus, arterial hypertension, hereditary cardiomyopathies, cardiac arrhythmias (atrial fibrillation, supraventricular tachycardia), acute aortic dissection, and diseases of the central nervous system (strokes, subarachnoidal hemorrhage). The final chapter of this article discusses in detail the false-positive causes and mechanisms of elevated cardiac troponins.
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Affiliation(s)
- Aleksey M. Chaulin
- Department of Cardiology and Cardiovascular Surgery, Samara State Medical University, 443099 Samara, Russia; ; Tel.: +7-(927)-770-25-87
- Department of Histology and Embryology, Samara State Medical University, 443099 Samara, Russia
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19
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Cardiac Troponins Metabolism: From Biochemical Mechanisms to Clinical Practice (Literature Review). Int J Mol Sci 2021; 22:ijms222010928. [PMID: 34681585 PMCID: PMC8535601 DOI: 10.3390/ijms222010928] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 11/22/2022] Open
Abstract
The metabolic processes of endo- and exogenous compounds play an important role in diagnosing and treating patients since many metabolites are laboratory biomarkers and/or targets for therapeutic agents. Cardiac troponins are one of the most critical biomarkers to diagnose cardiovascular diseases, including acute myocardial infarction. The study of troponin metabolism is of great interest as it opens up new possibilities for optimizing laboratory diagnostics. This article discusses in detail the key stages of the cardiac troponins metabolism, in particular the mechanisms of release from a healthy myocardium, mechanisms of circulation in the bloodstream, possible mechanisms of troponin penetration into other biological fluids (oral fluid, cerebrospinal fluid, pericardial and amniotic fluids), mechanisms of elimination of cardiac troponins from the blood, and daily changes in the levels of troponins in the blood. Considering these aspects of cardiac troponin metabolism, attention is focused on the potential value for clinical practice.
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Chauin A. The Main Causes and Mechanisms of Increase in Cardiac Troponin Concentrations Other Than Acute Myocardial Infarction (Part 1): Physical Exertion, Inflammatory Heart Disease, Pulmonary Embolism, Renal Failure, Sepsis. Vasc Health Risk Manag 2021; 17:601-617. [PMID: 34584417 PMCID: PMC8464585 DOI: 10.2147/vhrm.s327661] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022] Open
Abstract
The causes and mechanisms of increased cardiac troponin T and I (cTnT and cTnI) concentrations are numerous and are not limited to acute myocardial infarction (AMI) (ischemic necrosis of cardiac myocytes). Any type of reversible or irreversible cardiomyocyte injury can result in elevated serum cTnT and cTnI levels. Researchers and practitioners involved in the diagnosis and treatment of cardiovascular disease, including AMI, should know the key causes and mechanisms of elevated serum cTnT and cTnI levels. This will allow to reduce or completely avoid diagnostic errors and help to choose the most correct tactics for further patient management. The purpose of this article is to discuss the main causes and mechanisms of increase in cardiac troponins concentrations in frequently occurring physiological (physical exertion, psycho-emotional stress) and pathological conditions (inflammatory heart disease, pulmonary embolism, chronic renal failure and sepsis (systemic inflammatory response)) not related to myocardial infarction.
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Affiliation(s)
- Aleksey Chauin
- Department of Cardiology and Cardiovascular Surgery, Samara State Medical University, Samara, 443099, Russia.,Department of Histology and Embryology, Samara State Medical University, Samara, 443099, Russia
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Chaulin AM. Elevation Mechanisms and Diagnostic Consideration of Cardiac Troponins under Conditions Not Associated with Myocardial Infarction. Part 1. Life (Basel) 2021; 11:life11090914. [PMID: 34575063 PMCID: PMC8471393 DOI: 10.3390/life11090914] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 12/31/2022] Open
Abstract
Although cardiac troponins are considered the most specific biomarkers for the diagnosis of acute myocardial infarction (AMI), their diagnostic consideration goes far beyond the detection of this dangerous disease. The mechanisms of cardiac troponin elevation are extremely numerous and not limited to ischemic necrosis of cardiac myocytes. Practitioners should be well aware of the underlying pathological and physiological conditions that can lead to elevated serum levels of cardiac troponins to avoid differential diagnostic errors, which will be greatly increased if clinicians rely on laboratory data alone. This article presents a classification of the main causes of an elevation in cardiac troponins and discusses in detail the mechanisms of such elevation and the diagnostic consideration of cardiac troponins in some conditions not associated with AMI, such as physical exertion, inflammatory heart diseases (myocarditis and endocarditis), pulmonary embolism (PE), renal failure, and systemic inflammation (sepsis).
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Affiliation(s)
- Aleksey M. Chaulin
- Department of Cardiology and Cardiovascular Surgery, Samara State Medical University, 443099 Samara, Russia; ; Tel.: +7-(927)-770-25-87
- Department of Histology and Embryology, Samara State Medical University, 443099 Samara, Russia
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22
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Bonet G, Carrasquer A, Peiró ÓM, Sanchez-Gimenez R, Lal-Trehan N, Del-Moral-Ronda V, Fort-Gallifa I, Bardají A. Clinical characteristics and prognostic implications of diabetes and myocardial injury in patients admitted to the emergency room. BMC Cardiovasc Disord 2021; 21:414. [PMID: 34461832 PMCID: PMC8404360 DOI: 10.1186/s12872-021-02220-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study aimed to investigate the clinical features and prognosis of diabetes and myocardial injury in patients admitted to the emergency department. METHODS We analyzed the clinical data of all consecutive patients admitted to the emergency department during the years 2012 and 2013 with at least 1 cardiac Troponin I (cTnI Ultra Siemens, Advia Centaur) determination, and were classified according to the status of diabetes mellitus (DM) and myocardial injury (MI). Clinical events were evaluated in a 4-year follow-up. RESULTS A total of 3622 patients were classified according to the presence of DM (n = 924 (25.55%)) and MI (n = 1049 (28.96%)). The proportion of MI in patients with DM was 40% and 25% in patients without DM. Mortality during follow-up was 10.9% in non-DM patients without MI, 21.3% in DM patients without MI, 40.1% in non-DM patients with MI, and 52.8% in DM patients with MI. A competitive risk model was used to obtain the Hazard Ratio (HR) for readmission for myocardial infarction or heart failure. There was a similar proportion of readmission for myocardial infarction and heart failure at a four-year follow-up in patients with DM or MI, which was much higher when DM was associated with MI, with respect to patients without DM or MI. The HR (95% Coefficient Interval) for myocardial infarction in the DM without MI, non-DM with MI, and DM with MI groups with respect to the non-DM without MI group was 2511 (1592-3960), 2682 (1739-4138), and 5036 (3221-7876), respectively. The HR (95% CI) for the risk of readmission for heart failure in the DM without MI, non-DM with MI, and DM with MI groups with respect to the non-DM without MI group was 2663 (1825-3886), 2562 (1753-3744) and 4292 (2936-6274), respectively. CONCLUSIONS The association of DM and MI in patients treated in an Emergency Service identifies patients at very high risk of mortality and cardiovascular events.
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Affiliation(s)
- Gil Bonet
- Department of Cardiology, Joan XXIII University Hospital, Calle Dr Mallafré Guash 4, 43005, Tarragona, Spain
- Pere Virgili Health Research Institute (IISPV), Tarragona, Spain
- Rovira I Virgili University, Tarragona, Spain
| | - Anna Carrasquer
- Department of Cardiology, Joan XXIII University Hospital, Calle Dr Mallafré Guash 4, 43005, Tarragona, Spain
- Pere Virgili Health Research Institute (IISPV), Tarragona, Spain
- Rovira I Virgili University, Tarragona, Spain
| | - Óscar M Peiró
- Department of Cardiology, Joan XXIII University Hospital, Calle Dr Mallafré Guash 4, 43005, Tarragona, Spain
- Pere Virgili Health Research Institute (IISPV), Tarragona, Spain
- Rovira I Virgili University, Tarragona, Spain
| | - Raul Sanchez-Gimenez
- Department of Cardiology, Joan XXIII University Hospital, Calle Dr Mallafré Guash 4, 43005, Tarragona, Spain
- Pere Virgili Health Research Institute (IISPV), Tarragona, Spain
- Rovira I Virgili University, Tarragona, Spain
| | - Nisha Lal-Trehan
- Department of Cardiology, Joan XXIII University Hospital, Calle Dr Mallafré Guash 4, 43005, Tarragona, Spain
- Pere Virgili Health Research Institute (IISPV), Tarragona, Spain
- Rovira I Virgili University, Tarragona, Spain
| | - Victor Del-Moral-Ronda
- Department of Cardiology, Joan XXIII University Hospital, Calle Dr Mallafré Guash 4, 43005, Tarragona, Spain
- Pere Virgili Health Research Institute (IISPV), Tarragona, Spain
- Rovira I Virgili University, Tarragona, Spain
| | - Isabel Fort-Gallifa
- Clinical Laboratory, Catalan Institute of Health, Camp de Tarragona-Terres de L'Ebre, Tarragona, Spain
| | - Alfredo Bardají
- Department of Cardiology, Joan XXIII University Hospital, Calle Dr Mallafré Guash 4, 43005, Tarragona, Spain.
- Pere Virgili Health Research Institute (IISPV), Tarragona, Spain.
- Rovira I Virgili University, Tarragona, Spain.
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Chaulin A. Clinical and Diagnostic Value of Highly Sensitive Cardiac Troponins in Arterial Hypertension. Vasc Health Risk Manag 2021; 17:431-443. [PMID: 34366667 PMCID: PMC8336985 DOI: 10.2147/vhrm.s315376] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/02/2021] [Indexed: 12/13/2022] Open
Abstract
In modern laboratory diagnostics of cardiovascular diseases (CVD), there is a clear tendency toward an increase in the sensitivity of methods for determining key CVD biomarkers, among which highly sensitive cardiac troponins (hs-Tn) deserve special attention. The introduction of the latter into clinical practice made it possible not only to improve the early diagnosis of acute myocardial infarction but also to open up a number of additional valuable opportunities for the use of hs-Tn, including the assessment of the risk of developing CVD in a healthy population, detection and monitoring of early myocardial injuries in the early stages of CVD development (for example, with ischemic heart disease and arterial hypertension), with noncardiac pathologies (for example, sepsis, chronic obstructive pulmonary disease, chronic renal failure, stroke, cancer, etc), and diagnostics of CVD by using biological fluids that can be obtained by noninvasive methods. This article discusses in detail the diagnostic value of hs-Tn in serum and urine in cases of arterial hypertension. Also, the paper pays considerable attention to the consideration of the mechanisms underlying the increase in hs-Tn in serum and urine in cases of arterial hypertension.
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Affiliation(s)
- Aleksey Chaulin
- Department of Cardiology and Cardiovascular Surgery, Samara State Medical University, Samara, 443099, Russia.,Department of Histology and Embryology, Samara State Medical University, Samara, 443099, Russia
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