Detection of High-sensitivity Troponin T in Patients With Cardiovascular Risk

2017 ◽  
Vol 70 (7) ◽  
pp. 615
Author(s):  
Joaquín Velilla Moliner ◽  
Daniel Lahoz Rodríguez ◽  
Antonio Giménez Valverde ◽  
Eduardo Bustamante Rodríguez
2017 ◽  
Vol 70 (4) ◽  
pp. 261-266
Author(s):  
Isabel Álvarez ◽  
Luis Hernández ◽  
Héctor García ◽  
Vicente Villamandos ◽  
María Gracia López ◽  
...  

Author(s):  
Keita Negishi ◽  
Satoshi Hoshide ◽  
Masahisa Shimpo ◽  
Hiroshi Kanegae ◽  
Kazuomi Kario

Background Growth differentiation factor‐15 (GDF‐15) has emerged as a novel biomarker to predict all‐cause death in community‐dwelling individuals and patients with cardiovascular disease. We evaluated the prognostic value of GDF‐15 in outpatients with cardiovascular risk factors. Methods and Results GDF‐15 levels were measured in 3562 outpatients with cardiovascular risk factors in the J‐HOP (Japan Morning Surge‐Home Blood Pressure) study, a nationwide prospective study. Participants were stratified according to tertiles of GDF‐15 and followed up for all‐cause death and cardiovascular disease. During a mean follow‐up period of 6.6 years, there were 155 all‐cause deaths, 81 stroke events including cerebral infarction and intracranial hemorrhage, and 141 cardiac events including cardiac artery disease and heart failure. Patients with higher GDF‐15 levels were associated with risks of all‐cause death and stroke events (except for cardiac events) after adjustment for traditional risk factors and other prognostic biomarkers (NT‐proBNP [N‐terminal pro‐B‐type natriuretic peptide], high‐sensitivity troponin T; all‐cause death, hazard ratio, 2.38; 95% CI, 1.26–4.48; P =0.007; stroke events, hazard ratio, 2.93; 95% CI, 1.31–6.56, P =0.009; compared with the lowest tertile). Furthermore, incorporating GDF‐15 to the predictive models for all‐cause death improved discrimination and reclassification significantly. For stroke events, GDF‐15 showed similar diagnostic accuracy to NT‐proBNP and high‐sensitivity troponin T. Conclusions In Japanese outpatients with cardiovascular risk factors, GDF‐15 improves risk stratification for all‐cause death when compared with NT‐proBNP and high‐sensitivity troponin T. GDF‐15 was associated with increased risks of stroke events beyond conventional risk factors and other prognostic markers; however, the predictive ability for stroke events was equivalent to NT‐proBNP and high‐sensitivity troponin T. Registration URL: http://www.umin.ac.jp/ctr .; Unique identifier: UMIN000000894.


Vascular ◽  
2021 ◽  
pp. 170853812098629
Author(s):  
Bálint Nagy ◽  
Elettra Engblom ◽  
Marijana Matas ◽  
Péter Maróti ◽  
Tamás Kőszegi ◽  
...  

Objectives Perioperative stress affects the outcome of carotid endarterectomy performed under regional anesthesia. Here we aimed to explore the temporal profile of the stress marker cortisol and its relationship to high-sensitivity troponin-T, matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1, and S100B as an indicator of blood–brain barrier alteration in the systemic circulation. Methods Prospective part of the study: a total of 31 patients with significant carotid stenosis scheduled for carotid endarterectomy in regional anesthesia were enrolled. Follow-up part of the study and retrospective analysis of the outcome: each patient was followed up to five years and morbidity as well as mortality data were collected from an electronic database. Blood samples from each patient were serially taken; prior to surgery (T1), at the time of reperfusion (T2), 24 h (T3) and 72 h later postoperatively (T4), then the plasma concentration of each biomarker was measured. Besides, the clinical and surgical factors and perioperative adverse events were recorded. Results More positive correlations were found between: the early change of S100B (T2–T1) and late change in plasma cortisol level (T4–T3) (r = 0.403; p < 0.05); the early change of cortisol (T2–T1) and the early postoperative change of plasma matrix metalloproteinase-9 level (T3–T2) (r = 0.432; p = 0.01); the plasma concentration of tissue inhibitor of metalloproteinase-1 at 24 postoperative hours and the late change in plasma high-sensitivity troponin-T level (T4–T3) (r = 0.705; p < 0.001). Five patients needed an intraoperative shunt in whom the high-sensitivity troponin-T was elevated even prior to surgery, but definitive stroke never occurred. Plasma matrix metalloproteinase-9 concentration at reperfusion independently predicted the five-year mortality with a cut-off value of 456 ng/ml (sensitivity: 86%, specificity: 84%, area 0.887, p = 0.002). Conclusions A higher intraoperative change in S100B level reflecting carotid endarterectomy induced acute silent brain ischemia was associated with more pronounced post-operative change of cortisol. An early elevation of cortisol was found to be associated with a delayed increase of matrix metalloproteinase-9. Importantly, an increased high-sensitivity troponin-T even prior to carotid endarterectomy may predict clamp intolerance, and elevated matrix metalloproteinase-9 at reperfusion suggests a poor outcome.


2015 ◽  
Vol 45 (5) ◽  
pp. 1323-1331 ◽  
Author(s):  
Anja Kaeberich ◽  
Valerie Seeber ◽  
David Jiménez ◽  
Maciej Kostrubiec ◽  
Claudia Dellas ◽  
...  

High-sensitivity troponin T (hsTnT) helps in identifying pulmonary embolism patients at low risk of an adverse outcome. In 682 normotensive pulmonary embolism patients we investigate whether an optimised hsTnT cut-off value and adjustment for age improve the identification of patients at elevated risk.Overall, 25 (3.7%) patients had an adverse 30-day outcome. The established hsTnT cut-off value of 14 pg·mL−1 retained its high prognostic value (OR (95% CI) 16.64 (2.24–123.74); p=0.006) compared with the cut-off value of 33 pg·mL−1 calculated by receiver operating characteristic analysis (7.14 (2.64–19.26); p<0.001). In elderly (aged ≥75 years) patients, an age-optimised hsTnT cut-off value of 45 pg·mL−1 but not the established cut-off value of 14 pg·mL−1 predicted an adverse outcome. An age-adjusted hsTnT cut-off value (≥14 pg·mL−1 for patients aged <75 years and ≥45 pg·mL−1 for patients aged ≥75 years) provided additive and independent prognostic information on top of the simplified pulmonary embolism severity index (sPESI) and echocardiography (OR 4.56 (1.30–16.01); p=0.018, C-index=0.77). A three-step approach based on the sPESI, hsTnT and echocardiography identified 16.6% of all patients as being at higher risk (12.4% adverse outcome).Risk assessment of normotensive pulmonary embolism patients was improved by the introduction of an age-adjusted hsTnT cut-off value. A three-step approach helped identify patients at higher risk of an adverse outcome who might benefit from advanced therapy.


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