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Churchill RA, Gochanour BR, Scott CG, Vasile VC, Rodeheffer RJ, Meeusen JW, Jaffe AS. Association of cardiac biomarkers with long-term cardiovascular events in a community cohort. Biomarkers 2024; 29:161-170. [PMID: 38666319 DOI: 10.1080/1354750x.2024.2335245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/21/2024] [Indexed: 05/15/2024]
Abstract
MATERIALS AND METHODS The study assessed major adverse cardiac events (MACE) (myocardial infarction, coronary artery bypass graft, percutaneous intervention, stroke, and death. Cox proportional hazards models assessed apolipoprotein AI (ApoA1), apolipoprotein B (ApoB), ceramide score, cystatin C, galectin-3 (Gal3), LDL-C, Non-HDL-C, total cholesterol (TC), N-terminal B-type natriuretic peptide (NT proBNP), high-sensitivity cardiac troponin (HscTnI) and soluble interleukin 1 receptor-like 1. In adjusted models, Ceramide score was defined by from N-palmitoyl-sphingosine [Cer(16:0)], N-stearoyl-sphingosine [Cer(18:0)], N-nervonoyl-sphingosine [Cer(24:1)] and N-lignoceroyl-sphingosine [Cer(24:0)]. Multi-biomarker models were compared with C-statistics and Integrated Discrimination Index (IDI). RESULTS A total of 1131 patients were included. Adjusted NT proBNP per 1 SD resulted in a 31% increased risk of MACE/death (HR = 1.31) and a 31% increased risk for stroke/MI (HR = 1.31). Adjusted Ceramide per 1 SD showed a 13% increased risk of MACE/death (HR = 1.13) and a 29% increased risk for stroke/MI (HR = 1.29). These markers added to clinical factors for both MACE/death (p = 0.003) and stroke/MI (p = 0.034). HscTnI was not a predictor of outcomes when added to the models. DISCUSSION Ceramide score and NT proBNP improve the prediction of MACE and stroke/MI in a community primary prevention cohort.
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Affiliation(s)
| | | | | | - Vlad C Vasile
- Department of Cardiovascular Medicine, Wayne and Kathryn Preisel Professor of Cardiovascular Disease Research, Rochester, MN, USA
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Richard J Rodeheffer
- Department of Cardiovascular Medicine, Wayne and Kathryn Preisel Professor of Cardiovascular Disease Research, Rochester, MN, USA
| | | | - Allan S Jaffe
- Department of Cardiovascular Medicine, Wayne and Kathryn Preisel Professor of Cardiovascular Disease Research, Rochester, MN, USA
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Khan D, Elhadi M, Vasile VC. 59-Year-Old Woman With Episodic Chest Pain. Mayo Clin Proc 2024; 99:146-152. [PMID: 38176823 DOI: 10.1016/j.mayocp.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Daniel Khan
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Mohamed Elhadi
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Vlad C Vasile
- Advisor to Residents and Consultant in Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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Vasile VC, Jaffe AS. An enhanced ceramide-based approach for primary prevention of atherosclerotic events. European Heart Journal Open 2021; 1:oeab016. [PMID: 35923805 PMCID: PMC9242060 DOI: 10.1093/ehjopen/oeab016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 07/26/2021] [Indexed: 12/23/2022]
Affiliation(s)
- Vlad C Vasile
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine , 200 First Street SW, Rochester, MN 55905, USA
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine , 200 First Street SW, Rochester, MN 55905, USA
| | - Allan S Jaffe
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine , 200 First Street SW, Rochester, MN 55905, USA
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine , 200 First Street SW, Rochester, MN 55905, USA
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Sharain K, Vasile VC, Sandoval Y, Donato LJ, Clements CM, Newman JS, Karon BS, Jaffe AS. The Elevated High-Sensitivity Cardiac Troponin T Pilot: Diagnoses and Outcomes. Mayo Clin Proc 2021; 96:2366-2375. [PMID: 33992452 DOI: 10.1016/j.mayocp.2021.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/24/2020] [Accepted: 01/06/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To identify the diagnoses and outcomes associated with elevated high sensitivity cardiac troponin T (hs-cTnT) compared with the 4th-generation troponin T and to validate the Mayo Clinic hs-cTnT myocardial infarction algorithm cutoff values. PATIENTS AND METHODS Consecutive blood samples of patients presenting to the emergency department between July 2017 and August 2017, who had 4th-generation troponin T, were also analyzed using the hs-cTnT assay. Troponin T values, discharge diagnoses, comorbidities, and outcomes were assessed. In addition, analyses of sex-specific and hs-cTnT cutoff values were assessed. RESULTS Of 830 patients, 32% had an elevated 4th-generation troponin T, whereas 64% had elevated hs-cTnT. With serial sampling, 4th-generation troponin missed a chronic myocardial injury pattern and acute myocardial injury pattern in 64% and 16% of patients identified with hs-cTnT, respectively. Many of these "missed" patients had discharge diagnoses associated with cardiovascular disease, infection, or were postoperative. Five of the 6 patients with unstable angina ruled in for myocardial infarction. CONCLUSION There were many increases in hs-cTnT that were missed by the 4th-generation cTnT assay. Most new increases are not related to acute cardiac causes. They were more consistent with chronic myocardial injury. High-sensitivity cTnT did reclassify most patients with unstable angina as having non-ST-elevation myocardial infarction. Older age, more comorbidities, and lower hemoglobin were associated with elevated hs-cTnT. Our data also support the use of our sex-specific cutoff values.
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Affiliation(s)
- Korosh Sharain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Vlad C Vasile
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Yader Sandoval
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Leslie J Donato
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Casey M Clements
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - James S Newman
- Department of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - Brad S Karon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Allan S Jaffe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
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Vasile VC, Meeusen JW, Medina Inojosa JR, Donato LJ, Scott CG, Hyun MS, Vinciguerra M, Rodeheffer RR, Lopez-Jimenez F, Jaffe AS. Ceramide Scores Predict Cardiovascular Risk in the Community. Arterioscler Thromb Vasc Biol 2021; 41:1558-1569. [PMID: 33596665 DOI: 10.1161/atvbaha.120.315530] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Vlad C Vasile
- Department of Laboratory Medicine and Pathology (V.C.V., J.W.M., L.J.D., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN.,Department of Cardiovascular Diseases (V.C.V., J.R.M.J., R.R.R., F.L.-J., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology (V.C.V., J.W.M., L.J.D., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN
| | - Jose R Medina Inojosa
- Department of Cardiovascular Diseases (V.C.V., J.R.M.J., R.R.R., F.L.-J., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN
| | - Leslie J Donato
- Department of Laboratory Medicine and Pathology (V.C.V., J.W.M., L.J.D., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN
| | - Christopher G Scott
- Department of Biomedical Statistics and Informatics (C.G.S., M.S.H.), Mayo Clinic College of Medicine, Rochester, MN
| | - Meredith S Hyun
- Department of Biomedical Statistics and Informatics (C.G.S., M.S.H.), Mayo Clinic College of Medicine, Rochester, MN
| | - Manlio Vinciguerra
- International Clinical Research Center (ICRC [Human Bridge for Strengthening Integration of ICRC into European Research Area]), St. Anne's University Hospital, Brno, Czech Republic (M.V.)
| | - Richard R Rodeheffer
- Department of Cardiovascular Diseases (V.C.V., J.R.M.J., R.R.R., F.L.-J., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN
| | - Francisco Lopez-Jimenez
- Department of Cardiovascular Diseases (V.C.V., J.R.M.J., R.R.R., F.L.-J., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN
| | - Allan S Jaffe
- Department of Laboratory Medicine and Pathology (V.C.V., J.W.M., L.J.D., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN.,Department of Cardiovascular Diseases (V.C.V., J.R.M.J., R.R.R., F.L.-J., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN
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Meeusen JW, Donato LJ, Kopecky SL, Vasile VC, Jaffe AS, Laaksonen R. Ceramides improve atherosclerotic cardiovascular disease risk assessment beyond standard risk factors. Clin Chim Acta 2020; 511:138-142. [PMID: 33058843 DOI: 10.1016/j.cca.2020.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 12/26/2022]
Abstract
Ceramides are bioactive lipids that act as secondary messengers for both intra- and inter-cellular signaling. Elevated plasma concentrations of ceramides are associated with multiple risk factors of atherosclerotic cardiovascular diseases and comorbidities including obesity, insulin resistance and diabetes mellitus. Furthermore, atherosclerotic plaques have been shown to be highly enriched with ceramides. Increases in ceramide content may accelerate atherosclerosis development by promoting LDL infiltration to the endothelium and aggregation within the intima of artery walls. Thus, ceramides appear to play a key role in the development of cardiometabolic disease due to their central location in major metabolic pathways that intersect lipid and glucose metabolism. Recently published data have shown that ceramides are not only of scientific interest but may also have diagnostic value. Their independent prognostic value for future cardiovascular outcomes over and above LDL cholesterol and other traditional risk factors have consistently been shown in numerous clinical studies. Thus, ceramide testing with a mass spectrometer offers a simple, reproducible and cost-effective blood test for risk stratification in atherosclerotic cardiovascular diseases.
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Affiliation(s)
- Jeffrey W Meeusen
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, United States.
| | - Leslie J Donato
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, United States
| | | | - Vlad C Vasile
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, United States; Department of Cardiology, Mayo Clinic, Rochester, MN, United States
| | - Allan S Jaffe
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, United States; Department of Cardiology, Mayo Clinic, Rochester, MN, United States
| | - Reijo Laaksonen
- Zora Biosciences Oy, Espoo, Finland; Finnish Cardiovascular Research Center, Tampere University, Tampere, Finland
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Fatica EM, Meeusen JW, Vasile VC, Jaffe AS, Donato LJ. Measuring the contribution of Lp(a) cholesterol towards LDL-C interpretation. Clin Biochem 2020; 86:45-51. [PMID: 32997972 DOI: 10.1016/j.clinbiochem.2020.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lipoprotein(a) [Lp(a)] is a pro-atherogenic and pro-thrombotic LDL-like particle recognized as an independent risk factor for cardiovascular disease (CVD). The cholesterol within Lp(a) (Lp(a)-C) contributes to the reported LDL-cholesterol (LDL-C) concentration by nearly all available methods. Accurate LDL-C measurements are critical for identification of genetic dyslipidemias such as familial hypercholesterolemia (FH). FH diagnostic criteria, such as the Dutch Lipid Clinic Network (DLCN) criteria, utilize LDL-C concentration cut-offs to assess the likelihood of FH. Therefore, failure to adjust for Lp(a)-C can impact accurate FH diagnosis and classification, appropriate follow-up testing and treatments, and interpretation of cholesterol-lowering treatment efficacy. OBJECTIVE In this study, we use direct Lp(a)-C measurements to assess the potential misclassification of FH from contributions of Lp(a)-C to reported LDL-C in patient samples submitted for advanced lipoprotein profiling. METHODS A total of 31,215 samples submitted for lipoprotein profiling were included. LDL-C was measured by beta quantification or calculated by one of three equations. Lp(a)-C was measured by quantitative lipoprotein electrophoresis. DLCN LDL-C cut-offs were applied to LDL-C results before and after accounting for Lp(a)-C contribution. RESULTS Lp(a)-C was detected in 8665 (28%) samples. A total of 940 subjects were reclassified to a lower DLCN LDL-C categories; this represents 3% of the total patient series or 11% of subjects with measurable Lp(a)-C. CONCLUSION Lp(a)-C is present in a significant portion of samples submitted for advanced lipid testing and could cause patient misclassification when using FH diagnostic criteria. These misclassifications could trigger inappropriate follow-up, treatment, and cascade testing for suspected FH.
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Affiliation(s)
- Erica M Fatica
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Vlad C Vasile
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States; Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Allan S Jaffe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States; Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Leslie J Donato
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
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Hilvo M, Vasile VC, Donato LJ, Hurme R, Laaksonen R. Ceramides and Ceramide Scores: Clinical Applications for Cardiometabolic Risk Stratification. Front Endocrinol (Lausanne) 2020; 11:570628. [PMID: 33133018 PMCID: PMC7550651 DOI: 10.3389/fendo.2020.570628] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/27/2020] [Indexed: 01/10/2023] Open
Abstract
Ceramides are bioactive lipids that have an important role in many cellular functions such as apoptosis and inflammation. During the past decade emerging clinical data have shown that ceramides are not only of great biochemical interest but may also have diagnostic utility. Ceramides have shown independent predictive value for negative cardiovascular outcomes as well as for the onset of type 2 diabetes. Based on abundant published data, risk score using the concentrations of circulating ceramides have been developed and adapted for routine clinical practice. Currently serum ceramides are used clinically as efficient risk stratifiers for primary and secondary prevention of atherosclerotic cardiovascular disease (CVD). A direct cause-effect relationship between CVD and ceramide has not been established to date. As ceramide-specific medications are being developed, conventional strategies such as lipid lowering agents and lifestyle interventions can be used to reduce overall risk. Ceramides can identify a very high-risk coronary heart disease category of patients in need for more intense medical attention, specifically those patients at higher risk as highlighted in the 2019 European Society of Cardiology guidelines for stable chronic coronary syndrome patients. In addition, the ceramide risk score may be used as a decision-making tool in primary prevention patients with moderate CVD risk. Finally, the ceramide risk score may have a unique utility as a motivational tool to increase patient's adherence to medical therapy and lifestyle changes.
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Affiliation(s)
| | - Vlad C. Vasile
- Department of Laboratory Medicine and Pathology and Department of Cardiovascular Diseases Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Leslie J. Donato
- Department of Laboratory Medicine and Pathology and Department of Cardiovascular Diseases Mayo Clinic College of Medicine, Rochester, MN, United States
| | | | - Reijo Laaksonen
- Zora Biosciences Oy, Espoo, Finland
- Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
- *Correspondence: Reijo Laaksonen
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Abstract
BACKGROUND The natriuretic peptide system is an endocrine, autocrine and paracrine system that plays an important role in the maintenance of cardiovascular homeostasis. Biomarkers based on these peptides are important diagnostic and prognostic tools for myocardial function. CONTENT Although natriuretic peptides were discovered more than 2 decades ago, their intricate and complex biology is associated with important questions not yet elucidated. The diversity of circulating forms of natriuretic peptides, the distinct expression of these forms in particular patients, and the heterogeneity of heart failure forms, along with specific assay-related and preanalytic issues, cause assays to be poorly harmonized. SUMMARY This review presents the relevant issues related to the biology of natriuretic peptides and differences between assays with immediate implications for clinical practice.
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Affiliation(s)
- Vlad C Vasile
- Division of Cardiovascular Diseases, Department of Medicine, Rochester, MN
| | - Allan S Jaffe
- Division of Cardiovascular Diseases, Department of Medicine, Rochester, MN; .,Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN
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Sharain K, Vasile VC, Jaffe AS. Does cardiac rhythm monitoring in patients with elevated troponin levels lead to changes in management? Eur Heart J Acute Cardiovasc Care 2016; 6:545-552. [PMID: 26819344 DOI: 10.1177/2048872615627709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We sought to identify the frequency of arrhythmias in patients with elevated cardiac troponin levels and without ST-segment elevation myocardial infarction or a primary arrhythmia, and to determine whether detection of an arrhythmia leads to management changes. METHODS A review of 1381 consecutive patients admitted from the emergency department for rhythm monitoring with an elevated cardiac troponin T (cTnT) level was performed. Patients admitted to an intensive care unit and those with an initial primary arrhythmia were excluded. Troponin values were obtained on admission, at 3 hours and at 6 hours. Electronic medical records and all rhythm recordings were reviewed for documentation of an arrhythmia and any changes in management. RESULTS An arrhythmia was detected in 26% of the 330 patients who met the inclusion criteria. Those with arrhythmias had higher rates of coronary artery disease and prior percutaneous coronary intervention ( p = 0.02 and p = 0.01, respectively). Those with arrhythmias had higher mean cTnT values compared to those without arrhythmias ( p = 0.02 at 3 hours and p = 0.006 at 6 hours) even after controlling for a discharge diagnosis of acute coronary syndrome. Changes in management in response to the detection of arrhythmias were infrequent (6.3%) and usually included only changes in medication doses. CONCLUSIONS Patients admitted with an elevated cTnT level to a non-intensive care unit rhythm-monitored bed without ST-segment elevation myocardial infarction or primary arrhythmia have a high incidence of arrhythmias; however, changes in management are infrequent.
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Affiliation(s)
- Korosh Sharain
- 1 Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vlad C Vasile
- 1 Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Allan S Jaffe
- 2 Division of Cardiology, Department of Medicine and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Vasile VC, Chai HS, Abdeldayem D, Afessa B, Jaffe AS. Elevated cardiac troponin T levels in critically ill patients with sepsis. Am J Med 2013; 126:1114-21. [PMID: 24083646 DOI: 10.1016/j.amjmed.2013.06.029] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 06/21/2013] [Accepted: 06/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND It is known that troponin elevations have prognostic importance in critically ill patients. We examined whether cardiac troponin T elevations are independently associated with in-hospital, short-term (30 days), and long-term (3 years) mortality in intensive care unit (ICU) patients admitted with sepsis, severe sepsis, and septic shock after adjusting for the severity of disease with the Acute Physiology, Age and Chronic Health Evaluation III system. METHODS We studied the Mayo Clinic's Acute Physiology, Age and Chronic Health Evaluation III database and cardiac troponin T levels from patients admitted consecutively to the medical ICU. Between January 2001 and December 2006, 926 patients with sepsis had cardiac troponin T measured at ICU admission. In-hospital, short-term, and long-term all-cause mortality were determined. RESULTS Among study patients, 645 (69.7%) had elevated cardiac troponin T levels and 281 (30.3%) had undetectable cardiac troponin T. During hospitalization, 15% of the patients with troponin T <0.01 ng/mL died compared with 31.9% of those with troponin T ≥ 0.01 ng/mL (P < .0001). At 30 days, mortality was 31% and 17% in patients with and without elevations, respectively (P < .0001). The Kaplan-Meier probability of survival at 1-, 2-, and 3-year follow-ups was 68.1%, 56.3%, and 46.8% with troponin T ≥ 0.01 ng/mL, respectively, and 76.4%, 69.1%, and 62.0% with troponin T <0.01 μg/L, respectively (P < .0001). After adjustment for severity of disease and baseline characteristics, cardiac troponin T levels remained associated with in-hospital and short-term mortality but not with long-term mortality. CONCLUSIONS In patients with sepsis who are admitted to an ICU, cardiac troponin T elevations are independently associated with in-hospital and short-term mortality but not long-term mortality.
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Affiliation(s)
- Vlad C Vasile
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minn; Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minn
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Jaffe AS, Vasile VC, Milone M, Saenger AK, Olson KN, Apple FS. Diseased skeletal muscle: a noncardiac source of increased circulating concentrations of cardiac troponin T. J Am Coll Cardiol 2011; 58:1819-24. [PMID: 21962825 DOI: 10.1016/j.jacc.2011.08.026] [Citation(s) in RCA: 191] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 08/09/2011] [Accepted: 08/16/2011] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The purpose of this study was to determine whether there is immunoreactive cardiac troponin T (cTnT) expression in diseased skeletal muscle that might cause possible false-positive increases in cTnT. BACKGROUND Cardiac troponin (I or T) is the biomarker of choice for the diagnosis of cardiac injury. Recently, we were presented with a case that challenged the specificity of cTnT. METHODS Patients with myopathies seen in the Neuromuscular Clinic at the Mayo Clinic were screened for increases in cTnT. If present, an assay for cTnI was performed. If normal, skeletal biopsy tissue was obtained for Western blot analysis using the capture and detection antibodies from both the fourth-generation and high-sensitivity cTnT assays. Results were compared with findings in normal cardiac tissue. RESULTS Sixteen patients had increases in cTnT but not cTnI. All had a myopathy by clinical evaluation, clinical testing, and biopsy. Four residual biopsy samples were obtained. All 3 antibodies used in the cTnT (M11.7, M7) and high-sensitivity cTnT (5D8, M7) assays were immunoreactive with a 37- to 39-kDa protein in all 4 diseased skeletal muscle biopsy specimens and in cardiac tissue. A second immunoreactive isoform (34 to 36 kDa) was also found in 1 patient. None of the noncardiac control tissues expressed immunoreactive protein. CONCLUSIONS These results document that there are forms in diseased skeletal muscle that could cause increases in circulating levels of cTnT. These increases could reflect re-expressed isoforms. Clinicians need to be aware of the possibility that noncardiac increases in cTnT may occur and lead to a possible false-positive diagnosis of cardiac injury when skeletal muscle pathology is present.
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Affiliation(s)
- Allan S Jaffe
- Core Clinical Laboratory Services Division, Department of Laboratory Medicine and Pathology, Mayo Clinic and Medical School, Rochester, Minnesota 55905, USA.
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Vasile VC, Chai HS, Khambatta S, Afessa B, Jaffe AS. Significance of elevated cardiac troponin T levels in critically ill patients with acute respiratory disease. Am J Med 2010; 123:1049-58. [PMID: 21035593 DOI: 10.1016/j.amjmed.2010.06.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 06/19/2010] [Accepted: 06/19/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Elevations in cardiac troponin have prognostic importance in critically ill patients. However, there are no data addressing the independent association between troponin levels and mortality, adjusted for the severity of the underlying disease, in patients hospitalized for acute respiratory disorders. We investigated whether troponin T (cTnT) elevations are independently associated with in-hospital mortality in patients in the intensive care unit (ICU) admitted for severe and acute respiratory conditions. After adjusting for the severity of disease measured by the Acute Physiology, Age, and Chronic Health Evaluation (APACHE) III prognostic system, we evaluated short-term (30 days) and long-term (3 years) mortality. METHODS We studied the APACHE III database and cTnT levels from patients admitted consecutively to the ICU at Mayo Clinic, Rochester, Minnesota. Between January 2001 and December 2005, 2078 patients with respiratory conditions had cTnT measured at ICU admission. In-hospital, short-term (30 days) and long-term (3 years) all-cause mortality were determined. RESULTS Of the study patients, 878 (42.3%) had elevated cTnT and 1200 patients (57.7%) had undetectable cTnT. During hospitalization, 1.1% of the patients with troponin T <0.01 ng/mL died compared to 21% of those with troponin T ≥0.01 ng/mL (P <.0001). At 30 days, mortality was 18.6% in patients with elevations of cTnT and 1.5% in patients without elevations of cTnT (P <.0001). The Kaplan-Meier probability of survival at 1-year follow-up was 71.0%, at 2-year follow-up was 48.3%, and 3-year follow-up was 39.4% with troponin T ≥0.01 ng/mL and at 1-year follow-up was 98.8%, at 2-year follow-up was 97.2%, and at 3-year follow-up was 95.5% with troponin T <0.01 μg/L (P <.0001). After adjustment for severity of disease and baseline characteristics, cTnT levels remained associated with in-hospital, short-term and long-term mortality (P <.0001). CONCLUSIONS In patients admitted to the ICU for respiratory disorders, cTnT elevations are independently associated with in-hospital, short-term and long-term mortality.
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Affiliation(s)
- Vlad C Vasile
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
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Abstract
BACKGROUND High-sensitivity cardiac troponin assays will augment the frequency of increased results, making important the determination of reference change values to distinguish acute from chronic increases. We assessed short- and long-term biological variability of cardiac troponin T (cTnT) in healthy subjects with a novel high-sensitivity (hs) assay. METHODS We collected blood from 20 healthy volunteers at 5 time points for short-term study and biweekly at 4 times from the same volunteers for long-term study. We analyzed serum samples in duplicate with a hscTnT assay on the Roche Modular E170 and computed reference change values (RCVs) for analytical, intraindividual, interindividual, and total change values (CV(A), CV(I), CV(G), and CV(T), respectively) and the index of individuality (II). We calculated RCVs by using a log-normal approach, owing to the skewed results of the data. RESULTS Short- and long-term CV(A) values were 53.5% and 98%. CV(I) and CV(G) were 48.2% and 85.9%, respectively, for short-term studies and 94% and 94% for long-term studies. Mean delta values for the within-day study were 58% and -57.5%, and between-day mean delta values were 103.4% and -87%. Within- and between-day IIs were 0.8 and 0.14, respectively. CONCLUSIONS The biological variation demonstrated with the hscTnT assay is higher than prior data for cardiac troponin I. This may be attributed to differences in biology or assay imprecision at low concentrations. A short-term change (RCV log normal) of 85% and a long-term change of 315% is necessary to define a changing pattern.
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Affiliation(s)
- Vlad C Vasile
- Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic and Mayo Medical School, Rochester, MN 55905, USA
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16
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Vasile VC, Babuin L, Giannitsis E, Katus HA, Jaffe AS. Relationship of MRI-Determined Infarct Size and cTnI Measurements in Patients with ST-Elevation Myocardial Infarction. Clin Chem 2008; 54:617-9. [DOI: 10.1373/clinchem.2007.095604] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Vlad C Vasile
- Departments of Internal Medicine, Division of Cardiovascular Diseases, and Laboratory Medicine and Pathology, Mayo Clinic and Mayo Medical School, Rochester, MN
| | - Luciano Babuin
- Departments of Internal Medicine, Division of Cardiovascular Diseases, and Laboratory Medicine and Pathology, Mayo Clinic and Mayo Medical School, Rochester, MN
| | - Evangelos Giannitsis
- Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Allan S Jaffe
- Departments of Internal Medicine, Division of Cardiovascular Diseases, and Laboratory Medicine and Pathology, Mayo Clinic and Mayo Medical School, Rochester, MN
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Abstract
This review briefly synthesizes the molecular biology of troponin, which is currently the best biochemical marker for the detection of cardiac injury and, thus, acute myocardial infarction as well. Potential new uses for the marker based on these insights, with a specific interest in cardiac troponin fragments that potentially could be linked to distinct clinical conditions, are described. Some of the clinical problems clinicians are faced with including how to use the markers in renal failure and the difficulties associated with the heterogeneity of current troponin assays are also discussed. Finally, we present the possibility of specific cardiac troponin fragments resulting from modification or degradation, associated with distinct pathological processes, as new potential uses for this biomarker.
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Affiliation(s)
- Vlad C Vasile
- Mayo Clinic & Mayo Medical School, Department of Internal Medicine, Division of Cardiovascular Diseases & Department of Laboratory Medicine & Pathology, Rochester, Minnesota, USA
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18
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Rajamannan NM, Subramaniam M, Abraham TP, Vasile VC, Ackerman MJ, Monroe DG, Chew TL, Spelsberg TC. TGFbeta inducible early gene-1 (TIEG1) and cardiac hypertrophy: Discovery and characterization of a novel signaling pathway. J Cell Biochem 2007; 100:315-25. [PMID: 16888812 PMCID: PMC3927779 DOI: 10.1002/jcb.21049] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cellular mechanisms causing cardiac hypertrophy are currently under intense investigation. We report a novel finding in the TGFbeta inducible early gene (TIEG) null mouse implicating TIEG1 in cardiac hypertrophy. The TIEG(-/-) knock-out mouse was studied. Male mice age 4-16 months were characterized (N = 86 total) using echocardiography, transcript profiling by gene microarray, and immunohistochemistry localized upregulated genes for determination of cellular mechanism. The female mice (N = 40) did not develop hypertrophy or fibrosis. The TIEG(-/-) knock-out mouse developed features of cardiac hypertrophy including asymmetric septal hypertrophy, an increase in ventricular size at age 16 months, an increase (214%) in mouse heart/weight body weight ratio TIEG(-/-), and an increase in wall thickness in TIEG(-/-) mice of (1.85 +/- 0.21 mm), compared to the control (1.13 +/- 0.15 mm, P < 0.04). Masson Trichrome staining demonstrated evidence of myocyte disarray and myofibroblast fibrosis. Microarray analysis of the left ventricles demonstrated that TIEG(-/-) heart tissues expressed a 13.81-fold increase in pituitary tumor-transforming gene-1 (Pttg1). An increase in Pttg1 and histone H3 protein levels were confirmed in the TIEG(-/-) mice hearts tissues. We present evidence implicating TIEG and possibly its target gene, Pttg1, in the development of cardiac hypertrophy in the TIEG null mouse.
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Affiliation(s)
- Nalini M Rajamannan
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Vasile VC, Edwards WD, Ommen SR, Ackerman MJ. Obstructive hypertrophic cardiomyopathy is associated with reduced expression of vinculin in the intercalated disc. Biochem Biophys Res Commun 2006; 349:709-15. [PMID: 16949038 DOI: 10.1016/j.bbrc.2006.08.106] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 08/16/2006] [Indexed: 11/23/2022]
Abstract
Mutations in the cardiac-specific insert of vinculin, metavinculin, rarely cause hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM). Subsequently, a missense mutation in the ubiquitously expressed vinculin was discovered in a patient with obstructive HCM. Microscopic examination of both myectomy specimens from patients bearing genetic defects in metavinculin and vinculin showed a marked reduction of vinculin/metavinculin expression in the intercalated disc, but normal expression in the Z-disc. Given that distinct functional domains were altered by the metavinculin and vinculin mutations, we hypothesized that the intercalated disc-specific reduction of vinculin may stem from left ventricular tract obstruction in general rather than rarely observed perturbations in VCL-encoded vinculin. To test this hypothesis, we examined the localization of vinculin/metavinculin in hypertrophied human heart tissue from patients with cardiovascular conditions associated with obstruction and hemodynamic overload using an immunohistochemistry approach. Tissue specimens derived from patients with obstructive HCM and aortic stenosis (AS) showed a universal defect of vinculin/metavinculin expression in the intercalated disc but preserved expression in the cardiac Z-disc, whereas tissue specimens derived from patients with either DCM, hypertensive heart disease (HTN), or pulmonary hypertension (PHTN) exhibited normal expression of vinculin/metavinculin in both the Z- and the intercalated disc despite being associated with hypertrophy. Results of this study suggest that cardiac hypertrophy may be associated with different expression of the marker vinculin/metavinculin depending on the underlying pathophysiology; hemodynamic overload may not affect the localization whereas obstructive disease substantially reduces the expression of vinculin preferentially in the intercalated disc.
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Affiliation(s)
- Vlad C Vasile
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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20
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Vasile VC, Ommen SR, Edwards WD, Ackerman MJ. A missense mutation in a ubiquitously expressed protein, vinculin, confers susceptibility to hypertrophic cardiomyopathy. Biochem Biophys Res Commun 2006; 345:998-1003. [PMID: 16712796 DOI: 10.1016/j.bbrc.2006.04.151] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Accepted: 04/26/2006] [Indexed: 11/15/2022]
Abstract
The R975W mutation, in the alternatively spliced exon 19 of vinculin (VCL) which yields the isoform metavinculin, was associated previously with hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM), and shown to alter in vivo organization of intercalated discs. We tested the hypothesis that alterations in the ubiquitously expressed, VCL-encoded protein, vinculin, may provide a pathogenic substrate for HCM. Comprehensive mutational analysis of VCL's 22 translated exons was performed in a cohort of 228 unrelated patients with genotype negative HCM, having no identifiable mutations in 12 HCM-associated myofilament/Z-disc-encoding genes. A novel missense mutation, L277M-VCL, involving a conserved residue was identified in a patient with severely obstructive, mid-ventricular hypertrophy. This mutation was not detected in 400 reference alleles. Immunohistochemical analysis of the proband's myectomy specimen demonstrated markedly reduced vinculin levels in the intercalated discs. We provide the first report of a cardiomyopathy associated mutation in vinculin. Despite its ubiquitous expression, the HCM-associated VCL mutation clinically yielded a cardiac-specific phenotype.
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Affiliation(s)
- Vlad C Vasile
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Vasile VC, Will ML, Ommen SR, Edwards WD, Olson TM, Ackerman MJ. Identification of a metavinculin missense mutation, R975W, associated with both hypertrophic and dilated cardiomyopathy. Mol Genet Metab 2006; 87:169-74. [PMID: 16236538 DOI: 10.1016/j.ymgme.2005.08.006] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2005] [Accepted: 08/08/2005] [Indexed: 11/23/2022]
Abstract
We tested the hypothesis that perturbations in metavinculin may provide a pathogenic substrate for hypertrophic cardiomyopathy (HCM). HCM and dilated cardiomyopathy (DCM) are partially allelic disorders whereby identical genes have been implicated in the pathogenesis of both diseases. Mutations in metavinculin, a muscle-specific isoform of vinculin, were identified previously in DCM and shown to alter in vitro organization of actin filaments. Using denaturing high performance liquid chromatography and direct DNA sequencing, mutational analysis of the metavinculin-specific exon of vinculin (VCL, exon 19) was performed in a cohort of 389 unrelated patients with clinical HCM, previously genotyped for the 8 most common HCM-associated myofilament-encoding genes. Overall, 3 non-synonymous single nucleotide polymorphisms (A934V, P943A, and R975W) were detected in 4 patients. One patient with severely obstructive, mid-ventricular and apical hypertrophy harbored the previously published DCM-associated mutation, R975W. R975 is a highly conserved residue and R975W was absent in over 1400 reference alleles. Immunohistochemical analysis of the proband's myectomy specimen revealed a paucity of vinculin/metavinculin in the intercalated discs. Metavinculin mutations are pathogenic substrates for both HCM and DCM, further highlighting the allelic nature of these cardiomyopathies. Mutations in functionally distinct regions of certain cardiomyopathy-associated genes may have a dominant effect in determining a remodeling pathway of either maladaptive hypertrophy or dilation. However, this study demonstrates that the same fundamental mutation in humans can yield either cardiomyopathic phenotype, underscoring a critical role for modifier genes and/or environmental stressors in cardiac remodeling.
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Affiliation(s)
- Vlad C Vasile
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Van Driest SL, Vasile VC, Ommen SR, Will ML, Tajik AJ, Gersh BJ, Ackerman MJ. Myosin binding protein C mutations and compound heterozygosity in hypertrophic cardiomyopathy. J Am Coll Cardiol 2005; 44:1903-10. [PMID: 15519027 DOI: 10.1016/j.jacc.2004.07.045] [Citation(s) in RCA: 318] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2004] [Revised: 06/25/2004] [Accepted: 07/28/2004] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We sought to determine the frequency and phenotype of mutations in myosin binding protein C (MYBPC3) in a large outpatient cohort of patients with hypertrophic cardiomyopathy (HCM) seen at our tertiary referral center. BACKGROUND Mutations in MYBPC3 are one of the most frequent genetic causes of HCM and have been associated with variable onset of disease and prognosis. However, the frequency of mutations and associated clinical presentation have not been established in a large, unrelated cohort of patients. METHODS Using deoxyribonucleic acid from 389 unrelated patients with HCM, each protein coding exon of MYBPC3 was analyzed for mutations by polymerase chain reaction, denaturing high-performance liquid chromatography, and direct deoxyribonucleic acid sequencing. Clinical data were extracted from patient records blinded to patient genotype. RESULTS Of 389 patients with HCM, 71 (18%) had mutations in MYBPC3. In all, 46 mutations were identified, 33 of which were novel (72%). Patients with MYBPC3 mutations did not differ significantly from patients with thick filament-HCM, thin filament-HCM, or genotype-negative HCM with respect to age at diagnosis, degree of hypertrophy, incidence of myectomy, or family history of HCM or sudden death. Patients with multiple mutations (n = 10, 2.6%) had the most severe disease presentation. CONCLUSIONS This study defines the frequency and associated phenotype for MYBPC3 and/or multiple mutations in HCM in the largest cohort to date. In this cohort, unrelated patients with MYBPC3-HCM virtually mimicked the phenotype of those with mutations in the beta-myosin heavy chain. Patients with multiple mutations had the most severe phenotype.
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Affiliation(s)
- Sara L Van Driest
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Van Driest SL, Ommen SR, Will ML, Vasile VC, Chung S, Jamil Tajik A, Gersh BJ, Ackerman MJ. 839-3 Frequency, spectrum, and phenotype of hypertrophic cardiomyopathy patients with multiple sarcomeric mutations. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90914-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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