CARDIAC BIOMARKERS TROPONIN I AND CK-MB IN EWES AFFECTED BY PREGNANCY TOXEMIA

Abstract Background Acute respiratory distress syndrome (ARDS) is a leading cause of morbidity and mortality in the intensive care unit. Biochemical markers of cardiac dysfunction are associated with high mortality in many respiratory conditions. The aim of this systematic review is to examine the link between elevated biomarkers of cardiac dysfunction in ARDS and mortality. Methods A systematic review of MEDLINE, EMBASE, Web of Science and CENTRAL databases was performed. We included studies of adult intensive care patients with ARDS that reported the risk of death in relation to a measured biomarker of cardiac dysfunction. The primary outcome of interest was mortality up to 60 days. A random-effects model was used for pooled estimates. Funnel-plot inspection was done to evaluate publication bias; Cochrane chi-square tests and I2 tests were used to assess heterogeneity. Results Twenty-two studies were included in the systematic review and 18 in the meta-analysis. Biomarkers of cardiac stretch included NT-ProBNP (nine studies) and BNP (six studies). Biomarkers of cardiac injury included Troponin-T (two studies), Troponin-I (one study) and High-Sensitivity-Troponin-I (three studies). Three studies assessed multiple cardiac biomarkers. High levels of NT-proBNP and BNP were associated with a higher risk of death up to 60 days (unadjusted OR 8.98; CI 4.15-19.43; p<0.00001). This association persisted after adjustment for age and illness severity. Biomarkers of cardiac injury were also associated with higher mortality, but this association was not statistically significant (unadjusted OR 2.21; CI 0.94-5.16; p= 0.07). Conclusion Biomarkers of cardiac stretch are associated with increased mortality in ARDS.

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Assessing the Performance of a Novel Point-of-Care Qualitative Assay for Early Diagnosis of Acute Coronary Syndrome

Cardiology ◽

10.1159/000511435 ◽

2020 ◽

pp. 1-8

Author(s):

Ronny Alcalai ◽

Boris Varshisky ◽

Ahmad Marhig ◽

David Leibowitz ◽

Larissa Kogan-Boguslavsky ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Diagnostic Accuracy ◽

Diagnostic Performance ◽

Troponin I ◽

Point Of Care ◽

Final Diagnosis ◽

Cardiac Biomarkers ◽

Fatty Acid Binding ◽

Coronary Syndrome

Background: Early and accurate diagnosis of acute coronary syndrome (ACS) is essential for initiating lifesaving interventions. In this article, the diagnostic performance of a novel point-of-care rapid assay (SensAheart©) is analyzed. This assay qualitatively determines the presence of 2 cardiac biomarkers troponin I and heart-type fatty acid-binding protein that are present soon after onset of myocardial injury. Methods: We conducted a prospective observational study of consecutive patients who presented to the emergency department with typical chest pain. Simultaneous high-sensitive cardiac troponin T (hs-cTnT) and SensAheart testing was performed upon hospital admission. Diagnostic accuracy was computed using SensAheart or hs-cTnT levels versus the final diagnosis defined as positive/negative. Results: Of 225 patients analyzed, a final diagnosis of ACS was established in 138 patients, 87 individuals diagnosed with nonischemic chest pain. In the overall population, as compared to hs-cTnT, the sensitivity of the initial SensAheart assay was significantly higher (80.4 vs. 63.8%, p = 0.002) whereas specificity was lower (78.6 vs. 95.4%, p = 0.036). The overall diagnostic accuracy of SensAheart assay was similar to the hs-cTnT (82.7% compared to 76.0%, p = 0.08). Conclusions: Upon first medical contact, the novel point-of-care rapid SensAheart assay shows a diagnostic performance similar to hs-cTnT. The combination of 2 cardiac biomarkers in the same kit allows for very early detection of myocardial damage. The SensAheart assay is a reliable and practical tool for ruling-in the diagnosis of ACS.

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Short- and Long-term Biologic Variability of Galectin-3 and Other Cardiac Biomarkers in Patients with Stable Heart Failure and Healthy Adults

Clinical Chemistry ◽

10.1373/clinchem.2015.246553 ◽

2016 ◽

Vol 62 (2) ◽

pp. 360-366 ◽

Cited By ~ 24

Author(s):

Emily I Schindler ◽

Jeffrey J Szymanski ◽

Karl G Hock ◽

Edward M Geltman ◽

Mitchell G Scott

Keyword(s):

Heart Failure ◽

Troponin I ◽

Prognostic Biomarker ◽

High Sensitivity ◽

Cardiac Biomarkers ◽

Healthy Individuals ◽

Short Term ◽

Galectin 3 ◽

Short And Long Term

Abstract BACKGROUND Galectin-3 (Gal-3) has been suggested as a prognostic biomarker in heart failure (HF) patients that may better reflect disease progression than traditional markers, including B-type natriuretic peptide (BNP) and cardiac troponins. To fully establish the utility of any biomarker in HF, its biologic variability must be characterized. METHODS To assess biologic variability, 59 patients were prospectively recruited, including 23 male and 16 female patients with stable HF and 10 male and 10 female healthy individuals. Gal-3, BNP, and high-sensitivity cardiac troponin I (hs-cTnI) were assayed at 5 time points within a 3-week period to assess short-term biologic variability. Long-term (3-month) biologic variability was assessed with samples collected at enrollment and after 4, 8, and 12 weeks. RESULTS Among healthy individuals, mean short-term biologic variability, expressed as intraindividual CV (CVI), was 4.5% for Gal-3, 29.0% for BNP, and 14.5% for hs-cTnI; long-term biologic variability was 5.5% for Gal-3, 34.7% for BNP, and 14.7% for hs-cTnI. In stable HF patients, mean short-term biologic variability was 7.1% for Gal-3, 22.5% for BNP, and 8.5% for hs-cTnI, and mean long-term biologic variability was 7.7% for Gal-3, 27.6% for BNP, and 9.6% for hs-cTnI. CONCLUSIONS The finding that Gal-3 has minimal intraindividual biological variability adds to its potential as a useful biomarker in HF patients.

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Cardiac biomarkers as prognosticators among SARS-CoV-19 patients in a tertiary hospital in Philippines

European Heart Journal ◽

10.1093/eurheartj/ehab724.2494 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

R Ong ◽

C Chacon ◽

S Javier

Keyword(s):

Creatine Kinase ◽

Logistic Regression ◽

Hospital Mortality ◽

Roc Curve ◽

Predictive Value ◽

Troponin I ◽

Binary Logistic Regression ◽

High Sensitivity ◽

Cardiac Biomarkers ◽

Optimal Cutoff

Abstract Background There is overwhelming volume of confirmed cases of COVID-19, despite this numerous knowledge gaps remain in the diagnosis, management, and prognostication of this novel coronavirus infection, making prevention and control a challenge. Methods This retrospective cohort study included patients with real-time reverse transcriptase polymerase chain reaction (rRT-PCR)-confirmed COVID-19. Binary logistic regression was used to determine the association between the cardiac biomarkers and in-hospital mortality. ROC, AUC, and cutoff analyses were used to determine optimal cutoff values for the cardiac biomarkers. Results A total of 90 subjects with a complete panel of cardiac biomarkers out of the 224 rRT-PCR confirmed cases were included. The median age was 57 years (IQR, 47–67 years), majority were males. Sixty-six (77.6%) subjects survived while 19 (22.4%) expired. The most common presenting symptom was fever (75.6%), and the most common comorbidity was hypertension (67.8%). Spearman rho correlation analysis showed moderate positive association of high sensitivity troponin I (hsTnI) with in-hospital mortality (R, 0.434, p = <0.001). Multivariate binary logistic regression analysis showed that creatine kinase and hsTnI were independently associated with in-hospital mortality (OR, 4.103 [95% CI, 1.241–13.563], p=0.021; and OR, 7.899 [95% CI, 2.430–25.675], p=0.001, respectively). ROC curve analysis showed that hsTnI was a good predictor for in-hospital mortality (AUC, 0.829 [95% CI, 0.735–0.923], p = <0.001) and that creatine kinase was a poor predictor (AUC, 0.677 [95% CI, 0.531–0.823], p=0.018). Optimal cutoff point derived from the ROC curve for hsTnI was 0.010 ng/ml (J, 0.574) with a sensitivity of 84% (TPR, 0.842 [95% CI, 0.604–0.966]), specificity of 73% (TNR, 0.732 [95% CI, 0.614–0.386]), and an adjusted negative predictive value of 99% (Known prevalence*adjusted NPV, 0.989), a positive likelihood ratio of 20% (LR+, 3.147 [95% CI, 2.044–4.844]) and a negative likelihood ratio of 30% (LR−, 0.216 [95% CI, 0.076–0.615]). Conclusion High sensitivity troponin I level was a good tool with a very high negative predictive value in significantly predicting in-hospital mortality among rRT-PCR positive COVID-19 patients. FUNDunding Acknowledgement Type of funding sources: None. ROC Curve

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The Predictive Value of Myoglobin for COVID-19-Related Adverse Outcomes: A Systematic Review and Meta-Analysis

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.757799 ◽

2021 ◽

Vol 8 ◽

Author(s):

Chaoqun Ma ◽

Dingyuan Tu ◽

Jiawei Gu ◽

Qiang Xu ◽

Pan Hou ◽

...

Keyword(s):

Troponin I ◽

Meta Analysis ◽

Severe Disease ◽

Cardiac Injury ◽

Case Fatality ◽

Adverse Outcomes ◽

Cardiac Biomarkers ◽

Severe Illness ◽

Poor Outcomes ◽

Meta Analyses

Objective: Cardiac injury is detected in numerous patients with coronavirus disease 2019 (COVID-19) and has been demonstrated to be closely related to poor outcomes. However, an optimal cardiac biomarker for predicting COVID-19 prognosis has not been identified.Methods: The PubMed, Web of Science, and Embase databases were searched for published articles between December 1, 2019 and September 8, 2021. Eligible studies that examined the anomalies of different cardiac biomarkers in patients with COVID-19 were included. The prevalence and odds ratios (ORs) were extracted. Summary estimates and the corresponding 95% confidence intervals (95% CIs) were obtained through meta-analyses.Results: A total of 63 studies, with 64,319 patients with COVID-19, were enrolled in this meta-analysis. The prevalence of elevated cardiac troponin I (cTnI) and myoglobin (Mb) in the general population with COVID-19 was 22.9 (19–27%) and 13.5% (10.6–16.4%), respectively. However, the presence of elevated Mb was more common than elevated cTnI in patients with severe COVID-19 [37.7 (23.3–52.1%) vs.30.7% (24.7–37.1%)]. Moreover, compared with cTnI, the elevation of Mb also demonstrated tendency of higher correlation with case-severity rate (Mb, r = 13.9 vs. cTnI, r = 3.93) and case-fatality rate (Mb, r = 15.42 vs. cTnI, r = 3.04). Notably, elevated Mb level was also associated with higher odds of severe illness [Mb, OR = 13.75 (10.2–18.54) vs. cTnI, OR = 7.06 (3.94–12.65)] and mortality [Mb, OR = 13.49 (9.3–19.58) vs. cTnI, OR = 7.75 (4.4–13.66)] than cTnI.Conclusions: Patients with COVID-19 and elevated Mb levels are at significantly higher risk of severe disease and mortality. Elevation of Mb may serve as a marker for predicting COVID-19-related adverse outcomes.Prospero Registration Number:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020175133, CRD42020175133.

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Relationship between neutrophil gelatinase-associated lipocalin, cardiac biomarkers, inflammation index and renal parameters in cardiovascular disease

Archives of Biological Sciences ◽

10.2298/abs190604044c ◽

2019 ◽

Vol 71 (4) ◽

pp. 621-628

Author(s):

Jong Choi ◽

Moon Lee ◽

Tatsuyoshi Fujii

Keyword(s):

Kidney Function ◽

Troponin I ◽

Myocardial Dysfunction ◽

Cardiac Biomarkers ◽

Ngal Level ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Plasma Ngal ◽

Creatine Kinase Mb ◽

Index Ratio ◽

Neutrophil Gelatinase

The plasma neutrophil gelatinase-associated lipocalin (NGAL) level is elevated in myocardial infarction (MI) and affected by inflammation and kidney function. The aim of this study was to determine which of these conditions more critically affects the plasma NGAL level in MI. Patients with MI were evaluated by measuring the NGAL concentration and its corrected values. No significant association was observed between plasma NGAL concentration and cardiac biomarkers. However, the NGAL/inflammation index ratio (NGAL/Inf ratio) was positively correlated with troponin-I (r=0.289, p<0.001), and the NGAL/serum creatinine ratio (NGAL/sCr ratio) was significantly correlated with creatine kinase-MB (r=0.251, p<0.001). After adjusting for inflammation and kidney function, increased NGAL concentrations returned to baseline levels, which were not different from those of healthy individuals. The percent difference between NGAL and the NGAL/Inf ratio was 35.6%, significantly higher than that between NGAL and the NGAL/sCr ratio (15.4%; p<0.001). The severity of inflammation seems to play a more crucial role than renal and myocardial dysfunction in affecting plasma NGAL levels in MI. Plasma NGAL levels need to be corrected using the inflammation index and sCr levels for exactly evaluating patients with MI.

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Abstract 19143: Role of Cardiac Biomarkers in Diagnosing Takotsubo Cardiomyopathy from Left Anterior Descending Artery ST Elevation Myocardial Infarction

Circulation ◽

10.1161/circ.130.suppl_2.19143 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Ghulam Akbar ◽

Marwan Badri ◽

Catherine Prince ◽

Wajeeha Saeed ◽

Ghazi Mirrani ◽

...

Keyword(s):

Coronary Angiography ◽

Observational Studies ◽

Troponin I ◽

Cardiac Biomarkers ◽

Lv Function ◽

St Elevation ◽

Subsequent Improvement ◽

Echocardiographic Findings ◽

Rule Out

Introduction: Takostubo cardiomyopathy (TK) and STEMI in the proximal to mid LAD territory (LAD-S) may have similar clinical, ECG and echocardiographic presentation. The two can only be differentiated using coronary angiography. Hypothesis: We hypothesized that the ratio of serum BNP to troponin-I(TnI) will help in distinguishing TK from LAD-S. Previously it has been studied in TK and STEMI from any coronary artery lesion. This is the first study to tease out LAD-S and TK by using BNP/TnI ratio . Methods: We retrospectively compared patients who presented with LAD-S and patients with TK (confirmed with non-obstructive coronary angiography, classic echocardiographic appearance and subsequent improvement of LV function). Patients who did not have BNP and TnI available were excluded. Results: Out of 313 patients with LAD-S and 464 with possible TK, 39 and 62 patients were included respectively. Mean BNP and TnI levels were 788, 57.6ng/dl and 923, 3.4ng/dl in LAD-S and TK respectively. A BNP/TnI ratio of ≤6.4 was 100% sensitive and 41% specific to diagnose LAD-S, and therefore has 100% negative predictive value. A BNP/TnI ratio of ≥2388 was 80% sensitive and 93% specific for diagnosing TK. Conclusion: BNP/TnI ratio <6.4 is reliable to rule out TK and lead to the diagnosis of LAD-S in patients with typical echocardiographic findings. Further, larger observational studies are needed to validate the use of biomarkers for this purpose.

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Abstract 17331: Elevated Troponin Levels Predict Major Adverse Cardiovascular Outcomes and Mortality in COVID-19 Patients

Circulation ◽

10.1161/circ.142.suppl_3.17331 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Chirag Patel ◽

Farukh Ikram ◽

Nicholas Nguyen ◽

Hao Nguyen ◽

Priyanka Acharya ◽

...

Keyword(s):

Chest Pain ◽

Cardiovascular Events ◽

Troponin I ◽

Cardiovascular Complications ◽

Hospitalized Patients ◽

Cardiac Biomarkers ◽

Major Adverse Cardiovascular Events ◽

Care Hospital ◽

Elevated Troponin ◽

Chi Square

Introduction: Measurement of cardiac biomarkers such as troponin-I (TnI) are useful in assessing for the presence of cardiovascular events. Chest pain is often not a presenting complaint of COVID-19 patients, yet there have been many cases of patients experiencing possible cardiovascular complications. We sought to examine the value of elevated TnI in predicting the occurrence of major adverse cardiovascular events (MACE) and mortality in COVID-19 patients Methods: A retrospective review was performed on 225 hospitalized patients that tested positive for COVID-19 between March and May 2020 at our quaternary care hospital. Baseline characteristics and clinical outcomes of their disease course were identified. During the chart review, we documented the admission and peak TnI levels available in the medical record, and noted the occurrence of MACE (a composite of myocardial infarction, stroke, pulmonary embolism, deep venous thrombosis, or shock requiring vasopressor support) or death. Data were analyzed using Pearson’s chi square test and logistic regression to adjust for age. Results: Of the 225 hospitalized patients, only 31(14.83%) complained of chest pain on admission. Among patients with elevated TnI, 49.15% had MACE/ Mortality, compared to 21% with non-elevated TnI. Patients with elevated TnI were nearly 4 times more likely to have MACE/Mortality than patients with non-elevated TnI (p = 0.0001; OR = 3.97; 95% CI [1.88, 8.41]). They were also 3.63 times more likely to have MACE alone (p < 0.0001; OR = 3.63; 95% CI [1.70, 7.79]). Median peak TnI values were higher in patients who had a MACE compared to those who did not (0.0275 ng/mL [IQR 0.012-0.152] vs 0.012 ng/mL [IQR 0.012-0.152], p <0.05). For every one-unit increase in peak TnI levels, the age-adjusted odds of having MACE increased by a factor of 4468.37 (95% CI [9.07 2200316.00]; p = 0.008). Conclusions: Based on our data, elevated troponin-I levels predict the occurrence of MACE in patients who are hospitalized with COVID-19. Furthermore, there is an association between elevated troponin-I and eventual MACE, mortality, or both. This suggests that checking troponin-I levels in COVID-19 patients holds prognostic value, irrespective of the presence of chest pain as a presenting complaint.

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Abstract 2832: Which Cardiac Marker is Most Useful to Predict Final Infarct Size and Cardiac Function Following Primary Percutaneous Coronary Intervention For Acute Myocardial Infarction?

Circulation ◽

10.1161/circ.116.suppl_16.ii_630-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Stanley Chia ◽

O. Christopher Raffel ◽

Faisal Merchant ◽

Frans J Wackers ◽

Fred Senatore ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Infarct Size ◽

Troponin I ◽

Troponin T ◽

Coronary Intervention ◽

Left Ventricular ◽

Cardiac Biomarkers ◽

Primary Pci ◽

Percutaneous Coronary

Background: Assessment of cardiac biomarker release has been traditionally used to estimate the size of myocardial damage after acute myocardial infarction (AMI). However, the significance of cardiac biomarkers in the setting of primary percutaneous coronary intervention (PCI) has not been systematically studied in a large patient cohort. We evaluated the usefulness of serial and single time-point measures of various cardiac biomarkers (creatine kinase (CK), CK-MB, troponin T and I) in predicting infarct size and left ventricular ejection fraction (LVEF) after primary PCI. Methods: EVOLVE (Evaluation of MCC-135 for Left Ventricular Salvage in AMI) was a randomized double-blind, placebo-controlled trial comparing the efficacy of intracellular calcium modulator as an adjunct to primary PCI in patients with first large AMI. Levels of cardiac biomarkers (CK, CK-MB mass, troponin T and I) were determined in 375 patients at baseline before PCI and 2, 4, 12, 24, 48 and 72 hours thereafter. Single photon emission computed tomography imaging was performed to measure infarct size and LVEF on day 5. Results: Area under curve and peak concentrations of all cardiac markers: CK, CK-MB mass, troponin T and troponin I were significantly correlated with myocardial infarct size and LVEF determined on day 5 (Spearman correlation, all P< 0.001; Table ). Troponin I, however provided the best predictor and a single measure at 72 hr was a strong indicator of both infarct size and LVEF. Using receiver operator characteristics curve, troponin I cutoff value of >55 pg/mL at 72 hr has 90% sensitivity and 70% specificity for detection of large infarct size≥10% ( c =0.88; P< 0.001). Conclusions: Plasma levels of CK, CK-MB, troponin T and troponin I remain useful predictors of infarct size and cardiac function in the era of primary PCI for AMI. A single measurement of circulating troponin I at 72 hours can provide an effective and convenient indicator of infarct size and LVEF in clinical practice. Correlation of cardiac biomarkers with Day 5 SPECT determined infarct size and LVEF

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