scholarly journals Troponin: the biomarker of choice for the detection of cardiac injury

2005 ◽  
pp. 1191-1202
Author(s):  
Luciano Babuin ◽  
Allan S. Jaffe
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Troponin I ◽  
Cardiac Injury ◽  
Transaminase Activity ◽  
Elevated Troponin ◽  
Critical Issues ◽  
European Society Of Cardiology

It has been known for 50 years that transaminase activity increases in patients with acute myocardial infarction. With the development of creatine kinase (CK), biomarkers of cardiac injury began to take a major role in the diagnosis and management of patients with acute cardiovascular disease. In 2000 the European Society of Cardiology and the American College of Cardiology recognized the pivotal role of biomarkers and made elevations in their levels the “cornerstone” of diagnosis of acute myocardial infarction. At that time, they also acknowledged that cardiac troponin I and T had supplanted CK-MB as the analytes of choice for diagnosis. In this review, we discuss the science underlying the use of troponin biomarkers, how to interpret troponin values properly and how to apply these measurements to patients who present with possible cardiovascular disease. Troponin is the biomarker of choice for the detection of cardiac injury. To use it properly, one must understand how sensitive the specific assay being used is for detecting cardiac injury, the fact that elevated troponin levels are highly specific for cardiac injury and some critical issues related to the basic science of the protein and its measurement. In this article, we review the biology of troponin, characteristics of assays that measure serum troponin levels and how to apply these measurements to patients who present with possible cardiovascular disease. We also discuss other clinical situations in which troponin levels may be elevated.

scholarly journals Pattern of serum cardiac troponin-I in symptomatic acute myocardial infarction patients in national institute of cardiovascular disease in Bangladesh

2014 ◽  
Vol 42 (1) ◽  
pp. 3-6
Author(s):  
SS Shahina ◽  
JU Ahmed ◽  
S Ahmed ◽  
E Shahriar ◽  
MN Uddin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Myocardial Injury ◽  
Troponin I ◽  
Clinical Symptoms ◽  
Cardiac Injury ◽  
Circadian Variation ◽  
Assay Method ◽  
Ctni Level

Troponin I (cTnI) isoform is cardiac muscle specific protein and shown to have several features as a preferred marker of myocardial injury. It rises early in acute myocardial infarction (AMI) and attains levels that are clearly separated from baseline values. It remains elevated for several days providing a long window for detection of cardiac injury. The objective of the study was to evaluate for the profile of cTnI level among symptomatic AMI patients. The study was conducted at National Institute of Cardiovascular Disease, Dhaka, Bangladesh from July 2007 to June 2008 and total 9552 patients with type 1 or type 2 MI were included. Blood Sample was taken within 3 days of symptoms and cTnI was measured by chemiluminescent immunometric assay method. cTnI was considered positive when the value was >1ng/ml and study population was divided as per age, sex and cTnI level. The mean (+ SD) age of all patients was 55(+ 12.8) years and majority was males (82.20%). Seasonal variation showed highest positive cases in winter. In case of circadian variation positive cTnI results were suggestive of morning peak of AMI. Positive results were obtained in 32.3% of Cases. cTnI is now considered as a better indicator of myocardial injury. Further study in depth is necessary to correlate with clinical symptoms and other diagnostic tests to make a complete profile of AMI according to the latest subtypes. DOI: http://dx.doi.org/10.3329/bmj.v42i1.18969 Bangladesh Med J. 2013 Jan; 42 (1): 3-6

Comparable detection of acute myocardial infarction by creatine kinase MB isoenzyme and cardiac troponin I

1994 ◽  
Vol 40 (7) ◽  
pp. 1291-1295 ◽  
Author(s):  
J E Adams ◽  
K B Schechtman ◽  
Y Landt ◽  
J H Ladenson ◽  
A S Jaffe
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Creatine Kinase ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Characteristic Curve ◽  
Cardiac Injury ◽  
Cardiac Troponin I ◽  
Creatine Kinase Mb ◽  
Coronary Care

Abstract Although measurement of cardiac troponin I (cTnI) is, in some situations, more specific for detection of cardiac injury than is measurement of the MB isoenzyme of creatine kinase (MBCK), its sensitivity and specificity relative to MBCK for detection of myocardial infarction has not been established. Accordingly, we studied prospectively 199 consecutive patients admitted to the coronary care unit. Values of MBCK and cTnI mass were determined in all samples. Of the 188 patients admitted with a suspicion of acute myocardial ischemia, 89 were diagnosed as having an acute myocardial infarction on the basis of the patterns of MBCK values. Eighty-six of these patients also had increased cTnI (concordance, 96.6%); three did not. Of the patients diagnosed as without infarction, five with unstable angina and symptoms in the day(s) prior to admission had increased cTnI, for a cTnI specificity of 94.9%. Receiver operating characteristic curve analysis indicated that cTnI and MBCK had statistically indistinguishable diagnostic accuracies for the detection of acute myocardial infarction.

Kinetics of high-sensitivity cardiac troponin T or troponin I compared to creatine kinase in patients with revascularized acute myocardial infarction

2015 ◽  
Vol 53 (5) ◽  
Author(s):  
Kamila Solecki ◽  
Anne Marie Dupuy ◽  
Nils Kuster ◽  
Florence Leclercq ◽  
Richard Gervasoni ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Troponin T ◽  
High Sensitivity ◽  
Cardiac Troponin T ◽  
Significant Difference ◽  
Kinetics Of

AbstractCardiac biomarkers are the cornerstone of the biological definition of acute myocardial infarction (AMI). The key role of troponins in diagnosis of AMI is well established. Moreover, kinetics of troponin I (cTnI) and creatine kinase (CK) after AMI are correlated to the prognosis. New technical assessment like high-sensitivity cardiac troponin T (hs-cTnT) raises concerns because of its unclear kinetic following the peak. This study aims to compare kinetics of cTnI and hs-cTnT to CK in patients with large AMI successfully treated by percutaneous coronary intervention (PCI).We prospectively studied 62 patients with anterior AMI successfully reperfused with primary angioplasty. We evaluated two consecutive groups: the first one regularly assessed by both CK and cTnI methods and the second group by CK and hs-cTnT. Modeling of kinetics was realized using mixed effects with cubic splines.Kinetics of markers showed a peak at 7.9 h for CK, at 10.9 h (6.9–12.75) for cTnI and at 12 h for hs-cTnT. This peak was followed by a nearly log linear decrease for cTnI and CK by contrast to hs-cTnT which appeared with a biphasic shape curve marked by a second peak at 82 h. There was no significant difference between the decrease of cTnI and CK (p=0.63). CK fell by 79.5% (76.1–99.9) vs. cTnI by 86.8% (76.6–92.7). In the hs-cTnT group there was a significant difference in the decrease by 26.5% (9–42.9) when compared with CK that fell by 79.5% (64.3–90.7).Kinetic of hs-cTnT and not cTnI differs from CK. The role of hs-cTnT in prognosis has to be investigated.

scholarly journals Using human genetics to understand the causes and consequences of circulating cardiac troponin I in the general population

2020 ◽  
Author(s):  
Marta R Moksnes ◽  
Helge Røsjø ◽  
Anne Richmond ◽  
Magnus N Lyngbakken ◽  
Sarah E Graham ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
General Population ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Mendelian Randomization ◽  
Cardiac Troponin I ◽  
Health Study

AbstractCirculating cardiac troponin proteins are associated with structural heart disease and predict incident cardiovascular disease in the general population. However, the genetic contribution to cardiac troponin I (cTnI) concentrations and its causal effect on cardiovascular phenotypes is unclear. We combine data from two large population-based studies, the Trøndelag Health Study and the Generation Scotland Scottish Family Health Study and perform a genome-wide association study of high-sensitivity cTnI concentrations with 48 115 individuals. We further used two-sample Mendelian randomization to investigate the causal effects of circulating cTnI on acute myocardial infarction and heart failure.We identified 12 genetic loci (8 novel) associated with cTnI concentrations. Associated protein-altering variants highlighted putative functional genes: CAND2, HABP2, ANO5, APOH, FHOD3, TNFAIP2, KLKB1 and LMAN1. Phenome-wide association tests in 1283 phecodes and 274 continuous traits in UK Biobank showed associations between a polygenic risk score for cTnI and cardiac arrhythmias, aspartate aminotransferase 1 and anthropometric measures. Excluding individuals with a known history of comorbidities did not materially change associations with cTnI. Using two-sample Mendelian randomization we confirmed the non-causal role of cTnI in acute myocardial infarction (5 948 cases, 355 246 controls). We found some indications for a causal role of cTnI in heart failure (47 309 cases and 930 014 controls), but this was not supported by secondary analyses using left ventricular mass as outcome (18 257 individuals).Our findings clarify the biology underlying the heritable contribution to circulating cTnI and support cTnI as a non-causal biomarker for acute myocardial infarction and heart failure development in the general population. Using genetically informed methods for causal inference of cTnI helps inform the role and value of measuring cTnI in the general population.

Intensive cardiovascular care units: structure, organization, and staffing

2021 ◽  
pp. 11-24
Author(s):  
Eric Bonnefoy-Cudraz ◽  
Tom Quinn
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Working Group ◽  
Life Threatening ◽  
Coronary Care ◽  
The 1960S ◽  
And Function ◽  
Cardiovascular Care

The nature and complexity of acute cardiovascular care has changed markedly since the early days of the coronary care unit (CCU), introduced in the 1960s to prevent and treat life threatening arrhythmias associated with acute myocardial infarction. In the present day, the patient population is older, has more multimorbidity, comprises a range of conditions alongside critical cardiovascular disease and associated multi-organ failure, requiring increasingly sophisticated management. To reflect this, the Acute Cardiovascular Care Association (ACCA) published a comprehensive update of recommendations in 2018, developed by a multinational working group of experts. These recommendations, which inform this chapter, address the definition, structure, organisation and function of the contemporary intensive cardiovascular care unit (ICCU). Reflecting the modern casemix, three levels of acuity of care are described, and corresponding requirements for ICCU organisation defined. Recommendations on ICCU staffing (medical, nursing and allied professions), equipment and architecture, are presented, alongside considerations of the role of the ICCU within the wider hospital and cardiovascular care network.

Role of Lactic Acid as Predictor of Mortality in Patients with Acute Myocardial Infarction

2021 ◽  
Vol 27 (2) ◽  
pp. 168
Author(s):  
Novi Khila Firani ◽  
Theresa Sugiarti Oetji
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Lactic Acid ◽  
Mortality Risk ◽  
Odds Ratio ◽  
Troponin I ◽  
Ratio Analysis ◽  
Research Subjects ◽  
Observational Cohort

The hypoxic-ischemic condition causes tissue metabolic abnormalities and organ dysfunction, characterized byelevated blood lactic acid levels. It is suspected that increased lactic acid in Acute Myocardial Infarction (AMI) patients couldincrease mortality risk. This study aimed to determine whether increased lactic acid levels could be used as a predictor ofmortality in AMI patients. The analytical observational-cohort study was performed on AMI patients who were admitted toDr. Saiful Anwar Malang Hospital from January 2018 to December 2019. Research subjects were divided into two groups, thegroup of deceased and living AMI patients, who were tested for lactic acid, troponin-I, CKMB, and creatinine levels atadmission. Diabetes mellitus and septic patients were excluded. For analysis of lactic acid as a predictor of mortality, ROCcurve analysis and odds ratio were used. There found that lactic acid levels in the deceased AMI patients group were highercompared to that of the living AMI patients (p < 0.05). The sensitivity and specificity values of lactic acid as a predictor ofmortality in AMI patients at a cut-off of 3.5 mmol/L were 66.7% and 80%, respectively. Odds ratio analysis showed that AMIpatients with lactic acid levels more than 3.5 mmol/L had 8 times greater mortality risk than those whose level less than 3.5mmol/L. It was concluded that lactic acid level can be used as an indicator to predict the mortality of AMI patients.

scholarly journals Elevated Troponin I Level on Admission Is Associated With Adverse Outcome of Primary Angioplasty in Acute Myocardial Infarction

Circulation ◽  
2000 ◽  
Vol 102 (14) ◽  
pp. 1611-1616 ◽  
Author(s):  
Shlomo Matetzky ◽  
Tali Sharir ◽  
Michelle Domingo ◽  
Marko Noc ◽  
Kuang-Yuh Chyu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Troponin I ◽  
Adverse Outcome ◽  
Primary Angioplasty ◽  
Elevated Troponin

scholarly journals Comparative sensitivity of cardiac troponin I and lactate dehydrogenase isoenzymes for diagnosing acute myocardial infarction

1996 ◽  
Vol 42 (11) ◽  
pp. 1770-1776 ◽  
Author(s):  
A S Jaffe ◽  
Y Landt ◽  
C A Parvin ◽  
D R Abendschein ◽  
E M Geltman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Lactate Dehydrogenase ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cardiac Injury ◽  
Myocardial Damage ◽  
Cardiac Troponin I ◽  
Retrospective Diagnosis ◽  
Creatine Kinase Mb

Abstract Criteria for the retrospective diagnosis of acute myocardial infarction rely heavily on increases in lactate dehydrogenase (LD) isoenzymes. However, increases of LD isoenzyme activities are not specific for myocardial injury. Recently, increased concentrations of cardiac troponin I (cTnI) have been shown to be highly specific for myocardial damage and to have sensitivity comparable with that of creatine kinase MB isoenzyme for detecting cardiac injury. Furthermore, increases of cTnI persist in plasma for at least several days. The present study was designed to determine the relative sensitivities of cTnI and LD isoenzymes over time for the diagnosis of infarction. The results indicate that cTnI values are at least as sensitive as LD isoenzymes: 90% of patients with myocardial infarction had above-normal concentrations of cTnI on the 4th day after admission to the coronary care unit. Criteria based on cTnI should improve the accuracy of retrospective diagnoses of acute myocardial infarction.

scholarly journals Studies towards hcTnI Immunodetection Using Electrochemical Approaches Based on Magnetic Microbeads

Sensors ◽  
2018 ◽  
Vol 18 (8) ◽  
pp. 2457 ◽  
Author(s):  
Alejandro Hernández-Albors ◽  
Gloria Colom ◽  
J.-Pablo Salvador ◽  
M.-Pilar Marco
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Gold Standard ◽  
Cardiac Troponin ◽  
Magnetic Beads ◽  
Troponin I ◽  
Magnetic Microbeads ◽  
Specific Antibodies ◽  
Paramagnetic Beads ◽  
European Society Of Cardiology

Different electrochemical strategies based on the use of magnetic beads are described in this work for the detection of human cardiac troponin I (hcTnI). hcTnI is also known as the gold standard for acute myocardial infarction (AMI) diagnosis according to the different guidelines from the European Society of Cardiology (ESC) and the American College of Cardiology (ACC). Amperometric and voltamperometric sandwich magnetoimmunoassays were developed by biofunctionalization of paramagnetic beads with specific antibodies. These bioconjugates were combined with biotinylated antibodies as detection antibodies, with the aim of testing different electrochemical transduction principles. Streptavidin labeled with horseradish peroxidase was used for the amperometric magnetoimmunoassay, reaching a detectability of 0.005 ± 0.002 µg mL−1 in 30 min. Cadmium quantum dots-streptavidin bioconjugates were used in the case of the voltamperometric immunosensor reaching a detectability of 0.023 ± 0.014 µg mL−1.

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