scholarly journals High-sensitivity troponin I predicts major cardiovascular events after noncardiac surgery

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F.K Borges ◽  
E Duceppe ◽  
D Heels-Ansdell ◽  
S.N Ofori ◽  
M Marcucci ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Myocardial Injury ◽  
Troponin I ◽  
High Sensitivity ◽  
Noncardiac Surgery ◽  
Funding Source ◽  
Cardiac Events ◽  
Private Company ◽  
High Sensitivity Troponin ◽  
Increased Risk

Abstract Background Myocardial injury after noncardiac surgery (MINS) is common and is associated with postoperative major cardiac events and 30-day mortality. We have previously established the diagnostic criteria for MINS with the 4th-generation cardiac troponin T assay (TnT) and 5th-generation high-sensitivity TnT assay (hsTnT) based on prognostically relevant thresholds. Little is known about diagnostic criteria for MINS using the high-sensitivity troponin I (hsTnI) assay. Purpose To determine hsTnI thresholds associated with 30-day major cardiac events and death after noncardiac surgery. Methods We performed a nested prospective biobank cohort study of 4545 patients from the VISION Study. Patients were aged ≥45 years and underwent in-patient noncardiac surgery under regional or general anesthesia. Patients had samples collected and frozen preoperatively, and on postoperative days 1, 2 and 3. We measured hsTnI on thawed preoperative and postoperative samples. We used iterative Cox proportional hazard models to determine peak postoperative hsTnI thresholds independently associated with major cardiac events (i.e., composite of death, non-fatal cardiac arrest, congestive heart failure within 30 days and non-fatal myocardial infarction from postoperative days 4–30). Results Major cardiac events occurred in 89/4545 (2.0%) patients. Peak hsTnI values of <75 ng/L, 75 ng/L to <1000 ng/L, and ≥1000 ng/L were associated with an incidence of major cardiac events of 1.2% (95% CI 0.9–1.6), 7.1% (95% CI 4.8–10.5) and 25.9% (95% CI 16.3–38.4), respectively. Compared to peak hsTnI <75 ng/L (reference), hsTnI values 75 ng/L to <1000 ng/L and ≥1000 ng/L were associated with adjusted hazard ratios (aHR) of 4.53 (95% CI 2.75–7.48) and 16.17 (95% CI 8.70–30.07), respectively. No change from preoperative hsTnI to peak postoperative hsTnI significantly improved the model when included on top of the identified thresholds. Incidence of major cardiac events was 31/343 (9%) in patients with postoperative peak hsTnI ≥75 ng/L versus 52/4178 (1%) in patients with postoperative peak hsTnI <75 ng/L (aHR 5.76; 95% CI 3.64–9.11). A postoperative peak hsTnI ≥75 ng/L was associated with increased risk of major cardiac events either in the presence (aHR 9.35; 95% CI 5.28–16.55) or absence (aHR 3.99; 95% CI 2.19–7.25) of clinical features of myocardial injury (e.g., chest pain, ischemic electrocardiography changes). Conclusion A hsTnI elevation within the first 3 days after noncardiac surgery independently predicts major cardiac events at 30 days. A peak postoperative hsTnI ≥75 ng/L was associated with a 6-fold increase in the risk of subsequent major cardiac events at 30 days as compared to peak postoperative hsTnI<75 ng/L. This hsTnI threshold can be used to diagnose MINS. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Siemens Healthcare Diagnostics Inc. Canadian Institutes of Health Research

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

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

High incidence of macrotroponin I with a high-sensitivity troponin I assay

2016 ◽  
Vol 54 (11) ◽  
Author(s):  
Janet V. Warner ◽  
George A. Marshall
Keyword(s):  
Myocardial Injury ◽  
Troponin I ◽  
Protein A ◽  
Gel Filtration ◽  
High Sensitivity ◽  
Systematic Investigation ◽  
Clinical Samples ◽  
High Molecular Weight Complex ◽  
High Sensitivity Troponin ◽  
High Sensitive Troponin

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.

scholarly journals Is cardiac troponin elevation following strenuous exercise clinically relevant in healthy subjects?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Orn ◽  
T.H Melberg ◽  
T Omland ◽  
O Skadberg ◽  
M.F Bjorkavoll-Bergseth ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Healthy Subjects ◽  
Myocardial Injury ◽  
Troponin I ◽  
University Hospital ◽  
Strenuous Exercise ◽  
Funding Source ◽  
Increased Risk ◽  
Exercise Induced

Abstract Background Exercise causes an increase in cardiac troponin (cTn) levels. Exercise-induced myocardial injury (cTn > the 99th percentile) has been associated with adverse cardiovascular (CV) outcomes in older subjects with CV risk factors. The long-term clinical implications of exercise-induced cardiac troponin elevations in healthy individuals has not been determined. Purpose To assess the association between exercise-induced cardiac troponin increase above the 99th percentile and all-cause death, myocardial infarction, revascularization, sudden cardiac arrest, heart failure admission and stroke during 5-years follow-up in a large cohort of healthy recreational athletes. Methods 1002 healthy subjects that completed a 91-km bike race in 2014 were eligible. Follow-up data was available for 991 subjects (99%). High-sensitivity cardiac troponin I (cTnI) and T (cTnT) were obtained 24h prior to the race, and at 3h and 24h after the race in 2014. Results Median age was 46 (25th-75th percentile: 40–53) years at inclusion, and 776 (78%) were male. Race duration was 3.8 (3.4–4.3) hours. At 3-hours following the race 821 (82.8%) of subjects exceeded the sex-specific 99th percentile of the cTnI assay and 910 (91.8%) of the cTnT assay. At 24-hours following the race 168 (17%) of subjects exceeded the sex-specific 99th percentile of the cTnI assay and 263 (27%) of the cTnT assay. During 5 years of follow-up 12 subjects (1.2%) suffered a CV event. Exercise-induced cardiac troponin increase above the 99th percentile was not associated with increased risk of adverse CV events, neither at 3-hours nor at 24-hours following the race (Figure 1). This finding was further supported by no significant relationship between adverse CV events and cTnI or cTnT at any time-point, assessed as continuous variables. Conclusion Myocardial injury, defined as a cardiac troponin level above the 99th percentile, occurs frequently following strenuous exercise. In the present study, however, healthy subjects with cardiac troponin increase above the 99th percentile following strenuous exercise were not found to have an increased five-year risk of cardiovascular events. frequent occurrence following strenuous exercise. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Stavanger University Hospital, Abbott Diagnostics

scholarly journals Brain natriuretic peptide and high-sensitivity Troponin at 3 hours post emergency department attendance with unexplained syncope predict 90 day outcome

2018 ◽  
Vol 14 (2) ◽  
Author(s):  
Matthew James Reed ◽  
Hannah Brutin ◽  
Neil R. Grubb ◽  
Christopher C. Lang ◽  
Alasdair J. Gray ◽  
...  
Keyword(s):  
Emergency Department ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Troponin I ◽  
High Sensitivity ◽  
Predictive Marker ◽  
Cardiac Events ◽  
Cardiac Syncope ◽  
High Sensitivity Troponin ◽  
Unexplained Syncope

To investigate if Brain Natriuretic Peptide (BNP) and highsensitivity troponin I predict significant arrhythmia, symptomatic significant arrhythmia and 90-day death and/or Major Adverse Cardiac Event in Emergency Department (ED) unexplained syncope patients investigated with a 14-day ambulatory electrocardiogram (ECG) recorder. Single-centre, prospective, cohort study. Patients 16 years or over presenting within 6 hours of an episode of unexplained syncope were fitted with an ambulatory ECG recorder (Zio® XT monitor) and had high-sensitivity troponin I and BNP measured on ED admission and 3 hours later. Between 17/11/2015 and 13/06/2017, 86 patients were recruited. 24 had significant arrhythmia, 9 symptomatic significant arrhythmia and 26 patients had death and/or Major adverse cardiac events by 90 days. BNP at admission, three hours and change in BNP and high-sensitivity troponin I at three hours were associated with significant arrhythmia and serious outcome. BNP>20pg/mL and/or high-sensitivity troponin I above the 99% sex specific centile (M>34ng/L, F>16ng/L) at 3 hours had a sensitivity of 100% (21/21; 95% CI 81%-100%) and specificity of 43% (16/37; 28%-60%) for significant arrhythmia and a sensitivity of 100% (22/22; 95% CI 82%- 100%) and specificity of 44% (16/36; 28%-62%) for serious outcome both at 90 days. The combination of BNP and high-sensitivity troponin I at 3 hours shows promise as a potential predictive marker for serious arrhythmia and serious outcome at 90 days and deserves further exploration as a rule out test to enable safe discharge of patients from the ED who are at low risk of having cardiac syncope and subsequent adverse events.

Obesity predicts subclinical myocardial injury in men and women of all ages: the Nord-Trondelag Health Study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.N Lyngbakken ◽  
H Rosjo ◽  
K Hveem ◽  
T Omland
Keyword(s):  
Body Composition ◽  
Cardiac Troponin ◽  
Myocardial Injury ◽  
Troponin I ◽  
Harmful Effect ◽  
High Sensitivity ◽  
Fat Free Mass ◽  
Public Institution ◽  
Health Study ◽  
Funding Source

Abstract Background Obesity strongly associates with subclinical myocardial injury as quantified by concentrations of cardiac troponin. Body mass index (BMI) is the most commonly used index of obesity, but BMI does not take into account the different phenotypes that arise on the basis of age, sex and body composition. We aimed to investigate the influence of these factors on the association of obesity with subclinical myocardial injury. Methods We analyzed total body fat and fat-free mass by bioelectrical impedance analysis and cardiac troponin I (cTnI) with a high-sensitivity assay in 30,778 participants of the prospective observational The Nord-Trøndelag Health 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. Subgroup analyses were performed according to sex and age (<45 years, 45–59 years, ≥60 years). Adjustment was made for established cardiovascular risk factors and indices of body composition. Results Median age was 52.1 (range 16.5 to 98.9) years and 56% were women. Concentrations of cTnI were detectable in 60.6% of study participants, and were median 1.5 (0.6 to 2.9) ng/L. Median BMI was 26.7 (24.0 to 29.9) kg/m2. There was a strong and linear association between BMI and cTnI in adjusted models, with a 37.3 (95% CI, 27.6 to 46.9) % increase in concentrations of cTnI per 10 units of BMI (Figure 1). When adjusting for body composition, strong associations were observed for both sexes. The association between BMI and cTnI was stronger with increasing age (Table 1). Conclusion Obesity is strongly associated with subclinical myocardial injury. The associations are stronger with increasing age and persisted after adjustment for body composition, suggesting a harmful effect of obesity on the myocardium independently of different obesity phenotypes. Figure 1. Association between BMI and cTnI Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority

scholarly journals Identification of the optimal hsTnI cut-off value for risk stratification of normotensive patients with pulmonary embolism

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Ebner ◽  
N Guddat ◽  
K Keller ◽  
M.C Merten ◽  
M.H Lerchbaumer ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Troponin I ◽  
Adverse Outcome ◽  
High Sensitivity ◽  
Receiver Operating Curve ◽  
Funding Source ◽  
Prognostic Relevance ◽  
High Sensitivity Troponin ◽  
All Cause Mortality

Abstract Background/Introduction While numerous studies confirmed the prognostic role of high-sensitivity troponin T (hsTnT) in pulmonary embolism (PE), the prognostic relevance of high-sensitivity troponin I (hsTnI) is inappropriately studied and disease specific cut-off values remain undefined. Purpose To investigate the prognostic relevance of hsTnI in normotensive PE patients, establish the optimal cut-off value for risk stratification and compare the prognostic performances of hsTnI and hsTnT. Methods Consecutive PE patients enrolled in a prospective single-centre registry between 09/2008 and 04/2018 were studied. Using receiver operating curve analysis, an optimised hsTnI cut-off concentration was identified and the prognostic value for the prediction of in-hospital adverse outcomes (PE-related death, cardiopulmonary resuscitation or vasopressor treatment) and all-cause mortality analysed. Results We analysed data from 459 PE patients (age 69 [interquartile range (IQR) 57–77] years, 52% female). Patients who suffered an in-hospital adverse outcome (4.8%) had higher median hsTnI concentrations compared to those with a favorable clinical course (57 [IQR 22–197] vs. 15 [IQR 10–86] pg/ml, p=0.03). A hsTnI cut-off value of 16 ng/ml provided the best prognostic performance and predicted an in-hospital adverse outcome (Odds ratio [OR] 6.5, 95% confidence interval [CI] 1.9–22.4) and all-cause mortality (OR 3.7, 95% CI 1.0–13.3). Between female and male patients, no relevant differences in hsTnI concentrations (17 [IQR 10–97] vs. 17 [IQR 10–92] pg/ml, p=0.79) or optimized cut-off values (17 pg/ml and 19 pg/ml, respectively) were observed. Stratification of patients to risk classes according to the 2019 European Society of Cardiology (ESC) algorithm revealed no differences if calculated based on either hsTnI or hsTnT (Table). Conclusions Our findings confirm the prognostic relevance of hsTnI in normotensive PE. An optimal hsTnI cut-off value of 16 pg/ml predicted in-hospital adverse outcome and all-cause mortality. The use of sex specific cut-off values does not appear necessary. Importantly, our results suggest that hsTnI and hsTnT can be used interchangeably for risk stratification. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503). BRAHMS GmbH, part of Thermo Fisher Scientific, Hennigsdorf/Berlin, Germany provided financial support for biomarker measurements. The sponsor was neither involved in biomarker measurements, statistical analyses, writing of the abstract nor had any influence on the scientific contents.

scholarly journals Development of saliva-based cTnI point-of-care test: a feasibility study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Westreich ◽  
Y Neumann ◽  
O Deutsch ◽  
G Krief ◽  
R Stiubea-Choen ◽  
...  
Keyword(s):  
Myocardial Injury ◽  
Troponin I ◽  
Solid Phase ◽  
Point Of Care ◽  
Rapid Test ◽  
Detection Sensitivity ◽  
Funding Source ◽  
Private Company ◽  
Time Activity ◽  
Predictive Values

Abstract Background Cardiac troponin is the biomarker of choice for detection of myocardial injury. There is a great need for simple point of care troponin testing among patients with chest pain, mainly in the prehospital setting. In this preliminary study we evaluate the feasibility of a novel, saliva-based cTn test. Aim 1) To evaluate the presence of cTnI in saliva of patients with myocardial injury. 2) To explore the feasibility a saliva-based point-of-care cTn assay. Methods Saliva samples were collected from 32 patients with myocardial injury who tested positive for conventional cTnT blood tests, and from 13 healthy volunteers. 25 and 9 of these samples, respectively, were subjected to a series of advanced saliva processing procedures: “Amplification buffer” – A unique and complex composition which removes a broad spectrum of saliva inhibiting elements of physical, chemical and biological nature. “Hampering remover” – A device which specifically removes salivary alpha amylase that constitutes ∼50% of the total saliva protein content and therefore increases the detection sensitivity of less concentrated components. “Saliva Concentrator Cartridge” – based on the principles of solid phase extraction cartridges and allows rapid and easy analytes concentration. Processed and unprocessed samples were tested with blood cTnI RDT (Troponin I Rapid Test. specifications: detection limit 1ng/mL of whole-blood; Sensitivity: 95.8%; Specificity: 99.7%). Results were interpreted independently by two investigators and only concordant readouts were included in the analyses. Results were compared to blood cTnT levels Results Among the 25 positive samples subjected to advanced saliva processing procedures, 21 were confirmed positive by both investigators (sensitivities of 84%). All 4 negative saliva samples were obtained from patients with relatively low blood cTnT levels of 155 ng/L or less. Testing untreated samples, only 2 out of 32 were positive (sensitivities of 6.25%). In both processed and unprocessed samples no false positive results were seen among healthy individuals (0 out of 9 and 0 out of 13, respectively), corresponding to a specificity of 100% for both processed and unprocessed groups. The negative predictive values for processed and unprocessed groups were 69.23% and 30.23 respectively. Statistical accuracies were 88.24% for the processed group and 33.33% for the unprocessed group. Conclusion This preliminary work demonstrates for the first time the presence of cTnI in saliva of patients with myocardial injury and possible detection of cTnI in clinical saliva samples utilizing a commercial blood-RDT platform. Further research is needed to determine the time activity of troponin in saliva as well as its sensitivity and specificity for myocardial injury. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Salignostics LTD

Sign in / Sign up

Export Citation Format

Share Document