Relationship Between Myocardial Injury During Index Hospitalization for SARS‐CoV‐2 Infection and Longer‐Term Outcomes

Background Myocardial injury in patients with COVID‐19 is associated with increased mortality during index hospitalization; however, the relationship to long‐term sequelae of SARS‐CoV‐2 is unknown. This study assessed the relationship between myocardial injury (high‐sensitivity cardiac troponin T level) during index hospitalization for COVID‐19 and longer‐term outcomes. Methods and Results This is a prospective cohort of patients who were hospitalized at a single center between March and May 2020 with SARS‐CoV‐2. Cardiac biomarkers were systematically collected. Outcomes were adjudicated and stratified on the basis of myocardial injury. The study cohort includes 483 patients who had high‐sensitivity cardiac troponin T data during their index hospitalization. During index hospitalization, 91 (18.8%) died, 70 (14.4%) had thrombotic complications, and 126 (25.6%) had cardiovascular complications. By 12 months, 107 (22.2%) died. During index hospitalization, 301 (62.3%) had cardiac injury (high‐sensitivity cardiac troponin T≧14 ng/L); these patients had 28.6%, 32.2%, and 33.2% mortality during index hospitalization, at 6 months, and at 12 months, respectively, compared with 4.1%, 4.9%, and 4.9% mortality for those with low‐level positive troponin and 0%, 0%, and 0% for those with undetectable troponin. Of 392 (81.2%) patients who survived the index hospitalization, 94 (24%) had at least 1 readmission within 12 months, of whom 61 (65%) had myocardial injury during the index hospitalization. Of 377 (96%) patients who were alive and had follow‐up after the index hospitalization, 211 (56%) patients had a documented, detailed clinical assessment at 6 months. A total of 78 of 211 (37.0%) had ongoing COVID‐19–related symptoms; 34 of 211 (16.1%) had neurocognitive decline, 8 of 211 (3.8%) had increased supplemental oxygen requirements, and 42 of 211 (19.9%) had worsening functional status. Conclusions Myocardial injury during index hospitalization for COVID‐19 was associated with increased mortality and may predict who are more likely to have postacute sequelae of COVID‐19. Among patients who survived their index hospitalization, the incremental mortality through 12 months was low, even among troponin‐positive patients.

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Estimated Glomerular Filtration Rate is a Predictive Factor for High-Sensitivity Cardiac Troponin T in a Community-Based 4.8-year Prospective Study

10.21203/rs.3.rs-31724/v1 ◽

2020 ◽

Author(s):

Jie Han ◽

Xiaona Wang ◽

Ping Ye ◽

Ruihua Cao ◽

Wenkai Xiao ◽

...

Keyword(s):

Cardiac Troponin ◽

Filtration Rate ◽

Myocardial Injury ◽

Estimated Glomerular Filtration Rate ◽

Troponin T ◽

Cardiac Troponin T ◽

Community Based ◽

Highly Sensitive ◽

The Relationship

Abstract Objectives: Persistent elevation of cardiac troponin T (cTnT), which is considered as a sensitive and specific biomarker of myocardial injury, is frequently observed in patients with renal insufficiency. Meanwhile, estimated glomerular filtration rate (eGFR) is an independent risk factor of cardiovascular diseases. With a highly sensitive assay, the prevalence of detectable highly sensitive cTnT (hs-cTnT) is greatly improved even in general population. The aim of this study was to better understand the relationship between renal function (eGFR) and myocardial injury (hs-cTnT) in a community-based population.Methods: We analyzed the relationship between baseline eGFR and follow-up hs-cTnT, and the change of hs-cTnT in 1354 participants after 4.8 years follow-up.Results: In Pearson’s correlation analysis, baseline eGFR showed a negative relationship with follow-up hs-cTnT (r=-0.439; P < 0.001). In multiple linear regression analysis, baseline eGFR was independently and negatively associated with follow-up hs-cTnT (β=-0.310, P = 0.005). Stepwise logistic regression models revealed that baseline eGFR was significantly associated with the change in hs-cTnT after 4.8 years follow-up. However, the change in eGFR was not associated with the change in hs-cTnT.Conclusions: Baseline eGFR levels were independently and negatively associated with follow-up hs-cTnT. Furthermore, baseline eGFR levels were an independent predictor of the change in hs-cTnT 4.8 years follow-up, indicating a relationship between renal function and myocardial injury in a community-based population.

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PREDICTIVE VALUE OF HIGH-SENSITIVITY CARDIAC TROPONIN T, TROPONIN I, NT-PROBNP AND HIGH- SENSITIVITY CRP IN THE DETECTION OF MYOCARDIAL INJURY FOLLOWING ANTHRACYCLINE-BASED CHEMOTHERAPY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(15)60987-1 ◽

2015 ◽

Vol 65 (10) ◽

pp. A987

Author(s):

Shawn C. Pun ◽

Anh Nguyen ◽

Steven Ades ◽

John Storring ◽

Hings Ingrid ◽

...

Keyword(s):

Predictive Value ◽

Cardiac Troponin ◽

Myocardial Injury ◽

Troponin I ◽

Troponin T ◽

High Sensitivity ◽

Cardiac Troponin T

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Diagnostic and Prognostic Information Provided by a High Sensitivity Assay for Cardiac Troponin T

Journal of Medical Biochemistry ◽

10.2478/v10011-010-0041-8 ◽

2010 ◽

Vol 29 (4) ◽

pp. 274-281 ◽

Cited By ~ 3

Author(s):

Jochen Jarausch

Keyword(s):

Myocardial Infarction ◽

Cardiac Troponin ◽

Troponin T ◽

Cardiac Injury ◽

High Sensitivity ◽

Recent Experience ◽

Cardiac Troponin T ◽

Prognostic Information ◽

Coronary Syndrome ◽

Number Of Patients

Diagnostic and Prognostic Information Provided by a High Sensitivity Assay for Cardiac Troponin TCardiac troponins (cTns) are the preferred biomarkers for the diagnosis of acute myocardial infarction, assessment of risk and prognosis, and for determination of antithrombotic and revascularization strategy in patients with acute coronary syndromes. The implementation of high sensitivity cTn assays into the clinical routine has increased the number of patients diagnosed with myocardial infarction. In addition, the number of patients with elevated cTn levels that cannot be explained by acute ischemic injury was increased, which is observed in patients with chronic heart disease and other nonischemic cardiac injury or in patients with impaired renal function. The new definition of myocardial infarction provides support for the interpretation of elevated cTn measured with high sensitivity cTn assays in patients with suspected acute coronary syndrome. This review will summarize clinical studies with the recently introduced high sensitivity cTnT assay (TnT hs) with reference to recent experience with high sensitivity cTn assays in general.

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Release Kinetics of Cardiac Biomarkers in Patients Undergoing Transcoronary Ablation of Septal Hypertrophy

Clinical Chemistry ◽

10.1373/clinchem.2011.178129 ◽

2012 ◽

Vol 58 (6) ◽

pp. 1049-1054 ◽

Cited By ~ 30

Author(s):

Christoph Liebetrau ◽

Helge Möllmann ◽

Holger Nef ◽

Sebastian Szardien ◽

Johannes Rixe ◽

...

Keyword(s):

Cardiac Troponin ◽

Troponin T ◽

Release Kinetics ◽

High Sensitivity ◽

Cardiac Biomarkers ◽

Fourth Generation ◽

Cardiac Troponin T ◽

Creatine Kinase Mb ◽

Septal Hypertrophy ◽

Kinetics Of

Abstract BACKGROUND The release kinetics of cardiac troponin T measured with conventional vs high-sensitivity cardiac troponin T (hs-cTnT) assays in patients with acute myocardial infarction (AMI) is difficult to establish. METHODS We analyzed the release kinetics of cTnT measured by fourth generation and high-sensitivity assays, creatine kinase-MB (CK-MB), and myoglobin in patients with hypertrophic obstructive cardiomyopathy undergoing transcoronary ablation of septal hypertrophy (TASH), a model of AMI. Consecutive patients (n = 21) undergoing TASH were included. Serum and EDTA-plasma samples were collected before and at 15, 30, 45, 60, 75, 90, and 105 min, and 2, 4, 8, and 24 h after TASH. RESULTS cTnT concentrations measured by the hs assay were significantly increased at 15 min [21.4 ng/L, interquartile range (IQR) 13.3–39.7 ng/L vs 11.3 ng/L, IQR 6.0–18.8 ng/L at baseline; P = 0.031]. In comparison, cTnT concentrations measured by the conventional fourth generation assay increased significantly at 60 min (30.0 ng/L, IQR 20.0–30.0 ng/L vs <10.0 ng/L, IQR <10.0–10.0 ng/L; P < 0.01), CK-MB at 90 min (8.4 μg/L, IQR 6.9–14.4 μg/L vs 0.9 μg/L, IQR 0.4–1.1 μg/L; P < 0.01), and myoglobin at 30 min (188.0 μg/L, IQR 154.0–233.0 μg/L vs 38.0 μg/L, IQR 28.0–56.0; P < 0.01). CONCLUSIONS cTnT concentrations measured by the hs assay were significantly increased after TASH at all of the time points, with a doubling at 15 min after induction of AMI, confirming earlier evidence of myocardial injury compared to the fourth generation cTnT assay and CK-MB and myoglobin.

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Coronary angiography-related myocardial injury as detected by high-sensitivity cardiac troponin T assay

EuroIntervention ◽

10.4244/eijv12i3a54 ◽

2016 ◽

Vol 12 (3) ◽

pp. 337-344 ◽

Cited By ~ 3

Author(s):

Haitham Abu Sharar ◽

Daniel Wohlleben ◽

Mehrshad Vafaie ◽

Arnt V. Kristen ◽

H. Christian Volz ◽

...

Keyword(s):

Coronary Angiography ◽

Cardiac Troponin ◽

Myocardial Injury ◽

Troponin T ◽

High Sensitivity ◽

Cardiac Troponin T

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High-Sensitivity Troponin as a Predictor of Cardiac Events and Mortality in the Stable Dialysis Population

Clinical Chemistry ◽

10.1373/clinchem.2013.207142 ◽

2014 ◽

Vol 60 (2) ◽

pp. 389-398 ◽

Cited By ~ 31

Author(s):

Hicham Cheikh Hassan ◽

Kenneth Howlin ◽

Andrew Jefferys ◽

Stephen T Spicer ◽

Ananthakrishnapuram N Aravindan ◽

...

Keyword(s):

Cardiac Troponin ◽

Cardiac Event ◽

Clinical Utility ◽

Myocardial Injury ◽

Prospective Observational Study ◽

Troponin T ◽

High Sensitivity ◽

Cardiac Troponin T ◽

Cardiac Events ◽

Over Time

Abstract BACKGROUND High-sensitivity cardiac troponin T (hs-cTnT) is a biomarker used in diagnosing myocardial injury. The clinical utility and the variation of this biomarker over time remain unclear in hemodialysis (HD) and peritoneal dialysis (PD) patients. We sought to determine whether hs-cTnT concentrations were predictive of myocardial infarction (MI) and death and to examine hs-cTnT variability over a 1-year period. METHODS A total of 393 nonacute HD and PD patients (70% HD and 30% PD) were followed in a prospective observational study for new MI and death. RESULTS Median hs-cTnT was 57 ng/L (interquartile range, 36–101 ng/L) with no observed difference between HD and PD patients (P = 0.11). Incremental increases in mortality (P = 0.024) and MI (P = 0.001) were observed with increasing hs-cTnT quartiles. MI incidence increased significantly across quartiles in both HD and PD patients (P = 0.012 and P = 0.025, respectively), whereas mortality increased only in HD patients (P = 0.015). For every increase of 25 ng/L in hs-cTnT, the unadjusted hazard ratio (HR) was 1.10 for mortality in the whole group (95% CI, 1.04–1.16, P = 0.001) and 1.16 for MI (95% CI, 1.08–1.23, P < 0.001). Adjusted HR for mortality was 1.07 (95% CI, 1.01–1.15, P = 0.04) and 1.14 for MI (95% CI, 1.06–1.22, P < 0.001). Changes in hs-cTnT from baseline concentrations after 1 year were minimal (55 ng/L vs 53 ng/L, P = 0.22) even in patients who had an MI (P = 0.53). CONCLUSIONS hs-cTnT appears to have a useful role in predicting MI and death in the dialysis population. Over a 1-year period concentrations remained stable even in patients who sustained a new cardiac event.

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Relationships between renal function variations and relative changes in cardiac troponin T concentrations based on quantile generalized additive models (qgam)

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2020-0820 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Denis Monneret ◽

Matteo Fasiolo ◽

Dominique Bonnefont-Rousselot

Keyword(s):

Renal Function ◽

Cardiac Troponin ◽

Myocardial Injury ◽

Troponin T ◽

Generalized Additive Models ◽

Additive Model ◽

Additive Models ◽

Cardiac Troponin T ◽

Diagnosis Rate ◽

The Relationship

Abstract Objectives The relationship between high-sensitive cardiac troponin T concentration (hs-cTnT) and renal markers levels is known. However, the extent to which their variations are associated remains to be explored. Objective: model the relationship between relative changes in hs-cTnT (Δhs-cTnT) and variations in creatinine (Δcre) or estimated glomerular filtration rate (ΔeGFR), using a quantile generalized additive model (qgam). Methods Concomitant plasma Δhs-cTnT and Δcre from patients aged 18–100 years, selected with a time variation (Δtime) of 3 h–7 days, were collected over a 5.8-year period. Relationships between Δhs-cTnT and covariates Δcre (A) or ΔeGFR (B), including age, Δtime, hour of blood sampling (HSB) and covariates interactions were fitted using qgam. Results On the whole (n=106567), Δhs-cTnT was mainly associated with Δcre, in a positive and nonlinear way (−21, −6, +5, +20, +55% for −50, −20, +20, +50, +100%, respectively), but to a lesser extent with age (min −9%, max +2%), Δtime (min −4%, max +8%), and HSB (min −5%, max +7%). Δhs-cTnT was negatively associated with ΔeGFR (+46, +7, −5, −11, −20% for −50, −20, +20, +50, +100%, respectively). Classifying Δhs-cTnT as consistent or not with myocardial injury based on recommendations, an interpretation of Δhs-cTnT adjusted for model A or B led to statistically significant but small diagnostic discrepancies (<2%), as compared to an interpretation based on Δhs-cTnT only. Conclusions From a laboratory and statistical standpoint, considering renal function variations when interpreting relative changes in cardiac troponin T has a minor impact on the diagnosis rate of myocardial injury.

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High-sensitivity cardiac troponin T is more helpful in detecting peri-operative myocardial injury and apoptosis during coronary artery bypass graft surgery

CardioVascular Journal of Africa ◽

10.5830/cvja-2015-052 ◽

2015 ◽

Vol 26 (6) ◽

pp. 234-241 ◽

Cited By ~ 5

Author(s):

EF Kocak ◽

C Kocak ◽

A Aksoy ◽

OO Isiklar ◽

R Akcilar ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Cardiac Troponin ◽

Myocardial Injury ◽

Troponin T ◽

Artery Bypass ◽

Bypass Graft ◽

High Sensitivity ◽

Cardiac Troponin T ◽

Artery Bypass Graft

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The shocking lack of significant increases in high sensitivity troponin values after cardioversion

European Heart Journal ◽

10.1093/ehjci/ehaa946.0553 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Lobo ◽

R.D White ◽

L.J Donato ◽

Y.M Cha ◽

R.M Melduni ◽

...

Keyword(s):

Cardiac Troponin ◽

Myocardial Injury ◽

Troponin T ◽

High Sensitivity ◽

High Energy ◽

Funding Source ◽

Cardiac Troponin T ◽

Private Industry ◽

Cumulative Energy ◽

Dc Cardioversion

Abstract Background and introduction Cardioversion is commonly used to terminate cardiac arrhythmias. Some previous reports have suggested that cardioversion results in myocardial injury as evidenced by increased levels of cardiac troponin. However, many of these studies were done years ago with less sensitive troponin assays and monophasic waveform defibrillators. Purpose To determine if external direct current (DC) cardioversion with biphasic rectilinear waveform shocks results in myocardial injury as assessed by high sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI). Methods Patients scheduled for elective DC cardioversion for atrial fibrillation or atrial flutter were recruited. Plasma samples for measurement of hs-cTnT and hs-cTnI were obtained pre-cardioversion and as late as feasible but at least 6 hours post-cardioversion [median of 9 (7–11) hours]. Results A total of 96 patients were recruited. One patient was excluded because the pre-cardioversion sample was hemolysed. Median (25th–75th interquartile range) cumulative energy delivered was 121.6J (62.4–277.4J) and median highest energy individual shock was 121.0J (62.1–146.2J). A total of 39 (41.1%) patients received more than 1 shock, 23 (24.2%) patients received a cumulative energy of 300J or higher and 5 (5.3%) patients received a cumulative energy of 1,000J or more. The median pre-cardioversion hs-cTnT value was 11.48 (7.19–18.38) ng/L and the median hs-cTnI value was 5.1 (2.0–9.4) ng/L. Median post-cardioversion hs-cTnT value were 12.46 (7.98–20.28) ng/L and hs-cTnI value were 6.3 (3.5–10.0) ng/L. Wilcoxon-Signed ranks test showed a statistically significant change between the pre-and-post cardioversion hs-cTnT values (Z=−4.237, p<0.001) and hs-cTnI values (Z=−4.822, p<0.001). In only 5 (hs-cTnT) and 4 patients (hs-cTnI) was there an increase of >5 ng/L. There were 5 cases where the post-cardioversion values of both hs-cTnT and hs-cTnI were above the 50% reference change value. There was no relation between the change in hs-cTn values and sex, number of shocks, total energy delivered (even in those who received more than 1,000J), highest energy per shock, total current delivered, highest current delivered per shock or transthoracic impedance. Conclusion(s) There is a statistically significant but very small change in median hs-cTnT and hs-cTnI values (1 ng/L and 1.2 ng/L respectively) after DC cardioversion. The results were similar even in patients where high energy shocks were delivered and did not vary based on the pre cardioversion baseline value. Patients who have marked troponin elevations after cardioversion should be assessed for other causes of myocardial injury. It should not be assumed that they have myocardial injury from the cardioversion alone. Figure 1 Funding Acknowledgement Type of funding source: Other. Main funding source(s): Dr. Allan Jaffe has substantial research funds from both grants and private industry. Funds were used to pay for blood sample collection and analysis of high sensitivity cardiac troponin T at Mayo Clinic. Abbott Laboratories donated reagents for the high sensitivity cardiac troponin I analysis.

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