P25-10 High sensitive troponin-I can be an effective predictive marker for drug-induced myocardial injury

AbstractBackground:Cardiac troponin is the preferred biomarker of myocardial injury. High-sensitivity troponin assays allow measurement of very low levels of troponin with excellent precision. After the introduction of a high-sensitivity troponin I assay the laboratory began to receive enquiries from clinicians about clinically discordant elevated troponin I results. This led to a systematic investigation and characterisation of the cause.Methods:Routine clinical samples were measured by the Architect High Sensitive Troponin-I (hsTnI) and the VITROS Troponin I ES assays (VitrosTnI). Results that were elevated according to the Architect but not the VITROS assay (Group 1) or results elevated by both assays but disproportionately higher on the Architect (Group 2) were re-analysed for hsTnI after re-centrifugation, multiple dilutions, incubation with heterophilic blocking reagents, polyethylene glycol (PEG) precipitation, and Protein A/G/L treatment. Sephacryl S-300 HR gel filtration chromatography (GFC) was performed on selected specimens.Results:A high molecular weight complex containing immunoreactive troponin I and immunoglobulin (macrotroponin I) was identified in 5% of patients with elevated hsTnI. Patients with both macrotroponin and myocardial injury had higher and longer elevation of hsTnI compared with VitrosTnI with peaks of both macrotroponin and free troponin I-C complex on GFC.Conclusions:Circulating macrotroponin I (macroTnI) causes elevated hsTnI results with the Architect High Sensitive Troponin-I assay with the potential to be clinically misleading. The assay involved in this investigation may not be the only assay affected by macrotroponin. It is important for laboratories and clinicians to be aware of and develop processes to identify and manage specimens with elevated results due to macrotroponin.

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Misclassification of Myocardial Injury by a High-Sensitivity Cardiac Troponin I Assay

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2021.01.004 ◽

2021 ◽

Cited By ~ 1

Author(s):

Peter A. Kavsak ◽

Shawn Mondoux ◽

Andrew Worster ◽

Janet Martin ◽

Vikas Tandon ◽

...

Keyword(s):

Cardiac Troponin ◽

Myocardial Injury ◽

Troponin I ◽

High Sensitivity ◽

Cardiac Troponin I

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The role of neurohormonal blockers in the primary prevention of acute-, early-, and late-onset anthracycline-induced cardiotoxicity

The Egyptian Heart Journal ◽

10.1186/s43044-020-00090-0 ◽

2020 ◽

Vol 72 (1) ◽

Author(s):

Ahmed Ayuna ◽

Nik Abidin

Keyword(s):

Primary Prevention ◽

Myocardial Injury ◽

Troponin I ◽

Late Onset ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Main Body ◽

Converting Enzyme Inhibitors ◽

Ventricular Ejection Fraction

Abstract Background Anthracycline-induced cardiotoxicity has been classified based on its onset into acute, early, and late. It may have a significant burden on the quality and quantity of life of those exposed to this class of medication. Currently, there are several ongoing debates on the role of different measures in the primary prevention of cardiotoxicity in cancer survivors. Our article aims to focus on the role of neurohormonal blockers in the primary prevention of anthracycline-induced cardiotoxicity, whether it is acute, early, or late onset. Main body of the abstract PubMed and Google Scholar database were searched for the relevant articles; we reviewed and appraised 15 RCTs, and we found that angiotensin-converting enzyme inhibitors (ACEI) and B-blockers were the most commonly used agents. Angiotensin II receptor blockers (ARBs) and mineralocorticoid receptor antagonists (MRAs) were used in a few other trials. The follow-up period was on the range of 1–156 weeks (mode 26 weeks). Left ventricular ejection fraction (LVEF), left ventricular diameters, and diastolic function were assessed by either echocardiogram or occasionally by cardiac magnetic resonance imaging (MRI). The occurrence of myocardial injury was assessed by troponin I. It was obvious that neurohormonal blockers reduced the occurrence of LVEF and myocardial injury in 14/15 RCTs. Short conclusion Beta-blockers, especially carvedilol and ACEI, especially enalapril, should be considered for the primary prevention of acute- and early-onset cardiotoxicity. ARB and MRA are suitable alternatives when patients are intolerant to ACE-I and B-blockers. We recommend further studies to explore and establish the role of neurohormonal blockers in the primary prevention of the acute-, early-, and late-onset cardiotoxicity.

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Longitudinal obesity exposure over two decades is associated with subclinical myocardial injury: the Nord-Trondelag Health Study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2936 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M.N Lyngbakken ◽

H Rosjo ◽

K Hveem ◽

T Omland

Keyword(s):

Cardiac Troponin ◽

Myocardial Injury ◽

Troponin I ◽

Linear Increase ◽

Normal Weight ◽

Public Institution ◽

Health Study ◽

Funding Source ◽

Study Visit ◽

Increased Risk

Abstract Background Obesity is associated with subclinical myocardial injury as quantified by concentrations of cardiac troponin, but whether excess weight history is associated with increased cardiac troponin I (cTnI) remains unclear. We aimed to explore the association of obesity with cTnI using different indices of cumulative obesity exposure. Methods We analyzed cTnI with a high-sensitivity assay in 14,157 participants with follow-up over two decades in the prospective observational Nord-Trøndelag Health (HUNT) Study at study visit 4 (2017–2019). All subjects were free from known cardiovascular disease at baseline, and we excluded subjects with BMI <18.5 kg/m2. BMI was assessed at study visit 2 (1995–1997), 3 (2006–2008) and 4, and we categorized participants as normal weight (BMI <25), overweight (BMI ≥25 to <30) and obesity (BMI ≥30). At each study visit, BMI was designated a score of 0 (normal weight), 1 (overweight) or 2 (obesity), totaling a score from 0 to 6. Cumulative obesity exposure was calculated as average BMI above 25 kg/m2 between visits multiplied by the time between visits (excess BMI years, kg/m2 × years). Results Median age at visit 4 was 64.1 (range 40.9 to 101.5) years and 60% were women. Concentrations of cTnI were detectable in 77.2% of study participants, and were median 2.2 (1.3 to 3.9) ng/L. There was a linear increase in cTnI with increasing BMI score (p for trend <0.001) and increasing BMI score was associated with increased risk of high cTnI (p for trend <0.001; Table 1). For every 100 excess BMI years, there was a 15.6 (95% CI, 13.0 to 18.2) % increase in cTnI at study visit 4 (Figure 1). Conclusion Cumulative obesity exposure is associated with a linear increase in cTnI, a highly sensitive index of subclinical myocardial injury, reflecting the detrimental effect of long standing obesity on cardiovascular health. Figure 1. BMI years and cTnI Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority

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Elevations of Troponin I after interventional cardiac catheterization

Cardiology in the Young ◽

10.1017/s1047951101000476 ◽

2001 ◽

Vol 11 (4) ◽

pp. 375-378 ◽

Cited By ~ 6

Author(s):

Prince J. Kannankeril ◽

David F. Wax ◽

Elfriede Pahl

Keyword(s):

Cardiac Catheterization ◽

Cardiac Troponin ◽

Baseline Level ◽

Myocardial Injury ◽

Troponin I ◽

Cardiac Troponin I ◽

Specific Marker ◽

Before And After ◽

Baseline Sample

Background: Elevation of cardiac troponin I in the serum is a specific marker for myocardial injury. We measured levels of troponin I in the serum in children before and after cardiac catheterization to determine if this procedure was associated with an increase in levels of troponin. Methods: We enrolled patients under 21 years of age undergoing cardiac catheterization at our institution. A baseline sample of serum was drawn at the start of the procedure. Repeat samples were obtained immediately after, and six hours subsequent to the procedure. All samples were analyzed for cardiac troponin I using the Abbott AxSYM microparticle immunoassay system. Levels were considered normal (0–0.4 ng/ml) or elevated (>0.4ng/ml). Patients were excluded if the baseline level was elevated. Results: Levels of cardiac troponin I were elevated in the serum from 11 of 14 (79%) cases immediately after the procedure (p < 0.0001), and in 12 of 14 (86%) six hours later (p < 0.0001). Only 2 patients had recognized complications potentially causing myocardial injury. Conclusion: Levels of cardiac troponin I increase in the serum in a high proportion of children after cardiac catheterization. These elevations can be observed immediately, and are maintained for at least six hours. Our study suggests that cardiac catheterization, predominantly intervention, is associated with myocardial injury, even in the absence of complications.

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The predictive value of high-sensitive troponin I for perioperative risk in patients undergoing gastrointestinal tumor surgery

EClinicalMedicine ◽

10.1016/j.eclinm.2021.101128 ◽

2021 ◽

Vol 40 ◽

pp. 101128

Author(s):

Yitao Zhang ◽

Jiaojie Xue ◽

Ling Zhou ◽

Jinhong Si ◽

Shiyao Cheng ◽

...

Keyword(s):

Predictive Value ◽

Troponin I ◽

Perioperative Risk ◽

Tumor Surgery ◽

Gastrointestinal Tumor ◽

High Sensitive Troponin

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Evaluation of Myocardial Injury Following Repeated Internal Atrial Shocks by Monitoring Serum Cardiac Troponin I Levels

CHEST Journal ◽

10.1378/chest.118.2.342 ◽

2000 ◽

Vol 118 (2) ◽

pp. 342-347 ◽

Cited By ~ 29

Author(s):

Giuseppe Boriani ◽

Mauro Biffi ◽

Vittorio Cervi ◽

Gabriele Bronzetti ◽

Giorgia Magagnoli ◽

...

Keyword(s):

Cardiac Troponin ◽

Myocardial Injury ◽

Troponin I ◽

Cardiac Troponin I ◽

Serum Cardiac Troponin

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Abstract 14870: Clinical Significance of Troponin Elevation in a Contemporary Hospitalized Population: Endotypes, Morbidity and In-hospital Mortality

Circulation ◽

10.1161/circ.142.suppl_3.14870 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Michael Briscoe ◽

Robert A Sykes ◽

Thomas Krysztofiak ◽

Kenneth Mangion ◽

Oliver H Peck ◽

...

Keyword(s):

Clinical Significance ◽

Myocardial Injury ◽

Troponin I ◽

Coronary Revascularization ◽

High Sensitivity ◽

Hospitalized Patients ◽

Troponin Elevation ◽

Reference Limit ◽

Upper Reference Limit

Introduction: Unplanned hospitalizations are commonly associated with a circulating troponin concentration >99 th percentile upper reference limit (URL). In order to better understand the clinical significance of troponin elevation, we evaluated outcomes in hospitalized patients according to cardiac endotype. Methods: We prospectively screened consecutive hospitalized patients with elevated high-sensitivity troponin-I (hs-TnI) concentrations (Abbott ARCHITECT troponin-I assay; sex-specific URL, 99 th centile: male: >34ng/L; female: >16ng/L) within a regional cardiac care network (population 650,000). A cardiology clinical team adjudicated individual patient records and assigned endotypes by consensus agreement according to the Fourth Universal Definition of Myocardial Infarction (MI). Endotypes were sub-classified into etiological category by inciting event(s). Characteristics and comorbidity were compared and outcomes recorded on virtual follow-up until June 2 nd 2020. Results: A total of 390 consecutive patients with ≥1 hs-TnI value >URL between March 1-April 15, 2020, were evaluated; 44 patients were excluded ( Duplicates: 2; Missing data: 41; Research patient: 1 ). Of 346 who qualified for inclusion, an index diagnosis of Type 1 MI (T1MI), T2MI and myocardial injury were assigned in 115 (33.2%), 79 (22.8%) and 152 (43.9%) patients, respectively. Compared with T1MI, patients with T2MI and myocardial injury had lower peak hs-TnI values (median [IQR]: 86 [250-697] vs 5020 [853-7774]ng/L; p< 0.01), lower estimated 10-year survival (40.2% vs 53.4%; p=0.002), less frequently underwent coronary revascularization (1.4% vs 45.2%; p<0.0005) and had longer inpatient stay (13.0 vs 6.1 days). Inpatient and overall mortality rates from admission to follow-up (median [range]: 71 [0-151] days) were higher among patients with T2MI and myocardial injury (19.9% vs 7.8%; p=0.004; and 26.0% vs 11.3%; Log rank (Mantel-Cox) X 2 = 1.927; p=0.003) independent of similar cardiovascular risk profiles. Conclusions: Despite lower peak circulating troponin concentrations, patients with T2MI and myocardial injury had higher inpatient mortality, lower estimated 10-year survival and longer in-hospital stay compared to those with T1MI.

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Diagnoses and mortality in a population without acute myocardial infarction, but with elevated highsensitive troponin I – a retrospective register-based single center study

Acute Medicine Journal ◽

10.52964/amja.0838 ◽

2021 ◽

Vol 20 (1) ◽

pp. 18-24

Author(s):

Rasmus Søgaard Hansen ◽

◽

Jesper Revsholm ◽

Daniel Pilsgaard Henriksen ◽

Lars Christian Lund Lund ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Troponin I ◽

Inclusion Criteria ◽

Danish Population ◽

Medical Observation ◽

Single Center Study ◽

One Year ◽

High Sensitive Troponin ◽

Center Study

Aim: To explore, which differential diagnoses to consider in individuals with elevated troponins without acute myocardial infarction (AMI), and the mortality for those individuals. Methods: Retrospective, register-based study on a representative sample of the Danish population with the following inclusion criteria: High-sensitive troponin I (hs-TnI) ≥25 ng/L, age ≥18 years, and exclusion of AMI. Results: 3067 individuals without AMI but increased hs-TnI were included. Most frequent discharge diagnoses: Pneumonia (12.8%), Aortic valve disorder (11.3%), Medical observation (10.9%) and Heart failure (8.9%). The 30-days and one-year mortality was 15.8% and 32.0%, respectively. Conclusions: A selected number of alternative diagnoses must be considered in individuals with increased hs-TnI. Due to high mortality it is crucial to carefully evaluate these individuals despite the absence of AMI.

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Myocarditis case associated with Campylobacter jejuni

Turkish Journal of Biochemistry ◽

10.1515/tjb-2018-0125 ◽

2018 ◽

Vol 43 (5) ◽

pp. 568-570

Author(s):

Hakan Ayyildiz ◽

Mehmet Kalayci ◽

Nadire Cinkilinc ◽

Mahmut Bozkurt ◽

Makbule Kutlu Karadag

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Campylobacter Jejuni ◽

Bacterial Infections ◽

Troponin I ◽

Normal Sinus Rhythm ◽

Cardiac Enzymes ◽

Normal Sinus ◽

Anterior Hemiblock ◽

High Sensitive Troponin

Abstract Objective Myocarditis is an inflammatory disease of the heart caused by various agents and especially enteroviruses, and it is difficult to diagnose and treat. Myocarditis is rarely associated with bacterial infections. Although the most common bacterial infections are Salmonella spp. and Shigella spp., extremely rare cases of Myocarditis due to Campylobacter jejuni are also reported. Patient and methods A 17-year-old male patient with no previous chronic illness was admitted to our emergency department with complaints of abdominal pain, diarrhea, vomiting, and chest pain. He stated that symptoms began after eating a chicken burger a few days ago. Results In the laboratory tests performed, CK-MB and high sensitive Troponin I values were determined as 33.8 IU/L and 1816 ng/L, respectively. Electrocardiogram results revealed left axis left anterior hemiblock in the normal sinus rhythm as well as a ST-T change in the inferior and lateral derivations. Campylobacter jejuni was detected in the stool sample of the patient. Conclusion Myocarditis is one of the rare complications of C. jejuni infection. Bacterial myocarditis should be considered when troponin and cardiac enzymes are elevated in patients admitted to the emergency department with diarrhea and chest pain.

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