1
|
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.
Collapse
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
| | | | | | | | | |
Collapse
|
2
|
Iribarren C, Chandra M, Lee C, Sanchez G, Sam DL, Azamian FF, Cho HM, Ding H, Wong ND, Molloi S. High-sensitivity troponin I is associated with cardiovascular outcomes but not with breast arterial calcification among postmenopausal women. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2022; 15:200157. [PMID: 36573194 PMCID: PMC9789357 DOI: 10.1016/j.ijcrp.2022.200157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
Background Prior studies support the utility of high sensitivity troponin I (hsTnI) for cardiovascular disease (CVD) risk stratification among asymptomatic populations; however, only two prior studies examined women separately. The association between hsTnI and breast arterial calcification is unknown. Methods Cohort study of 2896 women aged 60-79 years recruited after attending mammography screening between 10/2012 and 2/2015. BAC status (presence versus absence) and quantity (calcium mass mg) was determined using digital mammograms. Pre-specified endpoints were incident coronary heart disease (CHD), ischemic stroke, heart failure and its subtypes and all CVD. Results After 7.4 (SD = 1.7) years of follow-up, 51 CHD, 30 ischemic stroke and 46 heart failure events were ascertained. At a limit of detection of 1.6 ng/L, 98.3 of the cohort had measurable hsTnI concentration. HsTnI in the 4-10 ng/L range were independently associated of CHD (adjusted hazard ratio[aHR] = 2.78; 95% CI, 1.48-5.22; p = 0.002) and all CVD (aHR = 2.06; 95% CI, 1.37-3.09; p = 0.0005) and hsTnI over 10 ng/L was independently associated with CHD (aHR = 4.75; 95% CI, 1.83-12.3; p = 0.001), ischemic stroke (aHR = 3.81; 95% CI, 1.22-11.9; p = 0.02), heart failure (aHR = 3.29; 95% CI, 1.33-8.13; p = 0.01) and all CVD (aHR = 4.78; 95% CI, 2.66-8.59; p < 0.0001). No significant association was found between hsTnI and BAC. Adding hsTnI to a model containing the Pooled Cohorts Equation resulted in significant and clinical important improved calibration, discrimination (Δ Cindex = 6.5; p = 0.02) and reclassification (bias-corrected clinical NRI = 0.18; 95% CI, -0.13-0.49 after adding hsTnI categories). Conclusions Our results support the consideration of hsTnI as a risk enhancing factor for CVD in asymptomatic women that could drive preventive or therapeutic decisions.
Collapse
Affiliation(s)
- Carlos Iribarren
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, USA,Corresponding author. Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Malini Chandra
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, USA
| | - Catherine Lee
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, USA
| | - Gabriela Sanchez
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, USA
| | - Danny L. Sam
- Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, USA
| | - Farima Faith Azamian
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Hyo-Min Cho
- Medical Measurement Team, Korea Research Institute of Standards and Science, Daejeon, South Korea
| | - Huanjun Ding
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Nathan D. Wong
- Division of Cardiology, Department of Medicine and Department of Epidemiology, University of California Irvine, Irvine, CA, USA
| | - Sabee Molloi
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, CA, USA
| |
Collapse
|
3
|
High-Sensitivity Troponin: A Review on Characteristics, Assessment, and Clinical Implications. DISEASE MARKERS 2022; 2022:9713326. [PMID: 35371340 PMCID: PMC8965602 DOI: 10.1155/2022/9713326] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 12/12/2022]
Abstract
The use of high-sensitivity cardiac troponin (hs-cTn) assays has become part of the daily practice in most of the laboratories worldwide in the initial evaluation of the typical chest pain. Due to their early surge, the use of hs-cTn may reduce the time needed to recognise myocardial infarctions (MI), which is vital for the patients presenting in the emergency departments for chest pain. The latest European Society of Cardiology Guidelines did not only recognise their central role in the diagnosis algorithm but also recommended their use for rapid rule-in/rule-out of MI. High-sensitivity cardiac troponins are also powerful prognostic markers for long-term events and mortality, not only in a wide spectrum of other cardiovascular diseases (CVD) but also in several non-CVD pathologies. Moreover, these biomarkers became a powerful tool in special populations, such as paediatric patients and, most recently, COVID-19 patients. Although highly investigated, the assessment and interpretation of the hs-cTn changes are still challenging in the patients with basal elevation such as CKD or critically ill patients. Moreover, there are still various analytical characteristics not completely understood, such as circadian or sex variability, with major clinical implications. In this context, the present review focuses on summarizing the most recent research in the current use of hs-cTn, with a main consideration for its role in the diagnosis of MI but also its prognostic value. We have also carefully selected the most important studies regarding the challenges faced by clinicians from different specialties in the correct interpretation of this biomarker. Moreover, future perspectives have been proposed and analysed, as more research and cross-disciplinary collaboration are necessary to improve their performance.
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Hao C, Long G, Rong GZ, Li G, Yang Y, Li Z, Zhenhu W. Predictive value of high-sensitive cardiac troponin T (cTnT) for adverse cardiac events in patients undergoing primary total knee arthroplasty (TKA). J Orthop Sci 2020; 25:647-651. [PMID: 31575498 DOI: 10.1016/j.jos.2019.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/13/2019] [Accepted: 08/30/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Elevated high-sensitive cardiac troponin T (cTnT) is a well-known biomarker to predict cardiac events following non-cardiac surgery. However, further information regarding high-sensitive cTnT in orthopedic surgery, especially total knee arthroplasty (TKA), is not present yet. This study aims to gain further insight into the predictive value of high-sensitive cTnT in adverse cardiac events in patients accepting TKA. METHODS We performed a prospective study in our hospital with the aim to enrolling 789 consecutive patients. Included patients who underwent TKA had mean ages of 65 years, and 64.9% were female. High-sensitive cTnT measurements were performed for study purposes before operation and on 1st postoperative days respectively. Postoperative cardiac events (POCE) 2 months and 2 years postoperatively were used to be evaluated for present study and defined short-term and long-term POCE respectively. The cut-off value of high-sensitive cTnT predicting patients at increased risks of POCE was evaluated by the Receiver Operating Characteristic (ROC) curve analysis. RESULTS Mean preoperative, postoperative cTnT and difference value between preoperative and postoperative cTnT (D-cTnT) were 20, 32, 12 ng/L respectively. 2-month and 2-year cardiac event rate following TKA were 2.3% and 3.4%. Using difference value between preoperative and postoperative cTnT (D-cTnT) to predict short-term cardiac events, the best cut-off was 23 ng litre-1, with an AUC of 0.84 (95% CI: 0.79-0.89, p < 0.001), which was better in comparison to preoperative and postoperative cTnT. In contrast, using preoperative cTnT to predict long-term cardiac events, the best cut-off was 25 ng litre-1 with an AUC of 0.78 (95% CI: 0.73-0.83, p < 0.001), which was better in comparison to postoperative and D-cTnT. CONCLUSIONS D-cTnT best predicted short-term POCE in comparison to preoperative and postoperative cTnT, while preoperative cTnT level best predicted long-term POCE in comparison to postoperative cTnT and D-cTnT.
Collapse
Affiliation(s)
- Chen Hao
- Department of Cardiology, Men Tou Gou District Hospital, Beijing, 100000, China
| | - Gong Long
- Department of Orthopedic, China-Japan Friendship Hospital, Peking Union Medical College, Chinese Academy of Medical College, China.
| | - Guo Zhi Rong
- Department of Joint Surgery, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China
| | - Geng Li
- Department of Joint Surgery, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China
| | - Yu Yang
- Department of Joint Surgery, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China
| | - Zhao Li
- Department of Joint Surgery, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China.
| | - Wang Zhenhu
- Department of Joint Surgery, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China.
| |
Collapse
|
6
|
Chen XJ, Lerman A, Lerman LO. Cardiorenal biomarkers: one step closer. JOURNAL OF LABORATORY AND PRECISION MEDICINE 2017; 2:16. [PMID: 30148255 PMCID: PMC6107311 DOI: 10.21037/jlpm.2017.05.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Xiao-Jun Chen
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Lilach O. Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|