scholarly journals Non-coronarogenic causes of increased cardiac troponins in clinical practice

2020 ◽  
Vol 10 (4) ◽  
pp. 81-93 ◽  
Author(s):  
Aleksey M. Chaulin ◽  
Lilya S. Karslyan ◽  
Dmitry V. Duplyakov
Keyword(s):  
Myocardial Infarction ◽  
Skeletal Muscle ◽  
Pulmonary Embolism ◽  
Renal Failure ◽  
Myocardial Damage ◽  
Diagnostic Value ◽  
Elevated Troponin ◽  
Heterophilic Antibodies ◽  
Highly Sensitive ◽  
Cardiac Troponins

Cardiospecific isoforms of troponins are the most sensitive and specific biomarkers for the diagnosis of myocardial infarction. However, though elevated troponin levels indicate myocardial damage, they do not determine the cause and mechanism of the damage. With the new highly sensitive methods, very minor damages of the heart muscle can be detected. Myocardial damage can occur in many non-coronarogenic diseases. In this review, we discuss the mechanisms of elevation, the diagnostic value of cardiac troponins in the renal failure, tachyarrhythmias, endocarditis, myocarditis, pericarditis, sepsis, neurogenic pathologies (stroke), pulmonary embolism. In addition, we pay attention to the main reasons for a false-positive increase of the concentration of cardiac troponins: heterophilic antibodies, rheumatoid factor, alkaline phosphatase, cross-reactions with skeletal muscle troponins.

scholarly journals Post-infections and sepsis associated myocardial infarction: casuistic masks

2021 ◽  
Vol 16 (7-8) ◽  
pp. 106-109
Author(s):  
L.O. Malsteva ◽  
W.W. Nikonov ◽  
N.A. Kazimirova ◽  
A.A. Lopata
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricle ◽  
Task Force ◽  
Laboratory Data ◽  
Myocardial Damage ◽  
Time Frame ◽  
Diagnostic Value ◽  
Epidemiological Studies ◽  
Definition Of ◽  
Post Infectious

The review aims to present the chronological sequence of developing universal definitions of myocardial infarction, new ideas for improving the screening of post-infectious and sepsis-associated myocardial infarction (MI) (casuistic masks of myocardial infarction). The stages of the development of the common and global definition of myocardial infarction are outlined: 1 — by WHO working groups based on ECG for epidemiological studies; 2 — by the European Society of Cardiology and the American College of Cardio-logy using clinical and biochemical approaches; 3 — the Global Task Force consensus document of universal definition with subsequent classification of MI into five subtypes (spontaneous, dissonance in oxygen delivery and consumption; lethal outcome before the rise of specific markers of myocardial damage; PCI-associated; CABG- associated); 4 — review by the Joint Task Force of the above document based on the inclusion of more sensitive markers — troponins; 5 — the allocation of 17 non-ischemic myocardial damage, accompanied by an increase in the level of troponin; 6 — characteristic of the atrial natriuretic peptide from the standpoint of its synthesis, storage, release, diagnostic value as a biomarker of acute myocardial dama­ge; 7 — a clinical definition of myocardial infarction, presented in materials of the III Consensus on myocardial infarction 2017. The diagnosis of myocardial infarction using the criteria set in this document requires the integration of clinical data, ECG patterns, laboratory data, imaging findings, and, in some cases, pathological results, which are considered in the context of the time frame of the suspec­ted event. K. Thygesen et al. consider the additional use of: 1) cardiovascular magnetic resonance to determine the etiology of myocardial damage; 2) computer coronary angiography with suspected myocardial infarction. Myocardial infarction is a combination of specific cardio markers with at least one of the symptoms listed above. The formation of myocardial infarction can occur during/after acute respiratory infection. Causal relationships between these two states are established. Post-infectious myocardial infarction is strongly recommended to be individualized as a separate diagnostic entity. In sepsis, global myocardial ischemia with ischemic myocardial damage arises as a result of humoral and cellular factors, accompanied by an increase in troponins, a decrease in the ejection fraction of the left ventricle by 45 % and an increase in the final diastolic size of the left ventricle, the development of sepsis-associated multiple organ fai­lure, which is an unfavourable prognosis factor.

scholarly journals Cardiac Troponins: Analytical Characteristics and Diagnostic Capabilities of Modern (High-sensitive) Determination Methods

2021 ◽  
Author(s):  
Aleksey Michailovich Chaulin ◽  
Duplyakov V Dmitry
Keyword(s):  
Myocardial Infarction ◽  
Physiological State ◽  
Economic Damage ◽  
Routine Practice ◽  
Coronary Syndrome ◽  
Highly Sensitive ◽  
Sensitive Determination ◽  
Determination Methods ◽  
Cardiac Troponins

Cardiovascular diseases have a leading role in terms of morbidity, mortality, and disability of the population, causing significant socio-economic damage to all countries of the world. This circumstance requires researchers to constantly seek for new biomarkers and improve methods for determining existing biomarkers, and search for new therapeutic targets to improve diagnostic and treatment strategies. Recently, there have been some important changes in laboratory diagnostics of patients with acute coronary syndrome, due to the introduction into the routine practice of new high and ultrasensitive methods for the determination of biomarkers of injury, specific to cardiac muscle tissue, namely cardiac troponins. A key advantage of highly sensitive immunochemical assays is the ability to detect cardiac troponins in the early stages of myocardial infarction. This allows making the optimal decision on the early choice and conduct of reperfusion therapy, which significantly improves the further prognosis of patients. Among the most significant generally recognised disadvantages of highly sensitive determination methods are low specificity and a huge variety of troponin immunoassays. The decrease in specificity is reflected in the fact that cardiac troponins are no longer considered the “gold standard” of diagnosis related to Acute Myocardial Infarction (AMI) (irreversible ischaemic damage to cardiomyocytes). As a result, any damage to the myocardium, even insignificant and reversible under physiological state (physical activity, stress) and several pathological conditions, can lead to an increase in serum levels of cardiac troponins and affect the accuracy of the diagnosis. Each method for the determination of cardiac troponins, among the existing wide variety of troponin immunoassays, possesses different analytical characteristics, and detects different concentrations of troponins in the same patient. This article provides a view of current data on the biology of cardiac troponins, and defines the analytical characteristics of new high-sensitive methods for the determination of cardiac troponins.

scholarly journals Cardiac troponins in hypertension: mechanisms of increase and diagnostic value

2021 ◽  
Vol 27 (4) ◽  
pp. 390-401
Author(s):  
A. M. Chaulin ◽  
D. V. Duplyakov
Keyword(s):  
Cardiac Troponin ◽  
Prognostic Value ◽  
Biological Fluids ◽  
Diagnostic Value ◽  
Healthy Individuals ◽  
Pathological Conditions ◽  
Highly Sensitive ◽  
Protein Molecules ◽  
Diagnostic And Prognostic Value ◽  
Cardiac Troponins

The understanding of the diagnostic and prognostic value of many biomarkers of cardiovascular diseases (CVD), including cardiac troponins (cTnT and cTnI), is changing significantly with the development of methods for their determination. New highly sensitive immunoassays can detect minimal concentrations of cardiac troponin protein molecules in biological fluids (several ng/L or less), allowing the detection of cTnT and cTnI in all healthy individuals. Along with this, there are opportunities to use cTnT and cTnI both to assess the risk of developing CVD in healthy people, and to identify and monitor many early pathological conditions that pose a risk to the cardiovascular system and the life of patients. These pathological conditions include hypertension (HTN), which is the direct cause leading to coronary heart disease, acute myocardial infarction, stroke, and other CVD. A number of recent studies reported the possibility of using highly sensitive cTnT and cTnI in the management of HTN patients. In this article, we consider in detail the diagnostic and prognostic value of cardiac troponins in HTN, we also discuss the main possible mechanisms underlying the increase in cTnT and cTnI in human body fluids.

scholarly journals NILAI DIAGNOSTIK UJI TROPONIN I KUANTITATIF METODE IMMUNOKROMATOGRAFI

2018 ◽  
Vol 14 (1) ◽  
pp. 20
Author(s):  
Siti Fatonah ◽  
Anik Widijanti ◽  
Tinny Endang Hernowati
Keyword(s):  
Cardiac Troponin ◽  
Biochemical Markers ◽  
Acute Coronary Syndromes ◽  
Troponin I ◽  
Myocardial Damage ◽  
Diagnostic Value ◽  
Cardiac Troponin I ◽  
Coronary Syndromes ◽  
Sensitivity Specificity ◽  
Cardiac Troponins

Cardiac troponins are the most sensitive and specific biochemical markers of myocardial damage but there is no standardization of WHO for cardiac troponin I, resulting in a variability for diagnostic value. It is necessary to determine diagnostic value for a new kitof troponin I. To evaluate a new quantitative immunochromatography assay for troponin I at a various cut off level. A cross sectionalstudy was conducted in 64 patients with acute myocardial infarction (AMI) and 55 non-AMI as control from February to September2007. The level of cardiac troponin I (cTnI) was measured and determined it diagnostic value at a various cut off level. The sensitivity,specificity, PPV and NPV of this assay were 91%, 91%, 92% and 89% at cut off level of 1,0 ng/ml (according to the kit), respectively.The cut off of cTnI were divided into five levels: 0.8, 1.0, 1.2, 1.5, and 2.0 with the area under curve were 0.923, 0.908, 0.912, and0.897, respectively. The sensitivity were 94%, 91%, 86%, 81% and 72%, respectively, the specificity were 91%, 91%, 96%, 98% and98%, respectively. This rapid diagnostic test is sensitive and specific to diagnose an acute coronary syndromes.

scholarly journals Cardiac troponins: current information on the main analytical characteristics of determination methods and new diagnostic possibilities

Medwave ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. e002132-e002132
Author(s):  
Aleksey M. Chaulin
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Cross Reactivity ◽  
Current Data ◽  
Myocardial Infarctions ◽  
Low Sensitivity ◽  
Muscle Lesions ◽  
Cardiac Troponins

The methods used to diagnose cardiovascular diseases are constantly being improved, leading to an expanded perception of the diagnostic value of biomarkers and their new diagnostic possibilities. One striking example are the main biomarkers used to diagnose acute myocardial infarction: cardiac troponins. The first methods for determining cardiac troponins (proposed 30 years ago) were characterized by extremely low sensitivity. Therefore, they could only detect large acute myocardial infarctions. These methods were also characterized by low specificity, expressed as a high probability of cross-reactivity with skeletal troponin isoforms, which generated false-positive results in the presence of skeletal myopathies and skeletal muscle lesions. With the introduction of high-sensitivity cardiac troponins into clinical practice, the possibility of early diagnosis and exclusion of acute myocardial infarction by assessing troponin concentrations in the first few hours (from admission to the first hour, second hour, or third hour) has become more specific. Our knowledge about cardiac troponins has changed over the years and promising new medical uses have emerged. This paper reviews current data on the diagnostic value of cardiac troponins, the main methods used for their determination, and their analytical characteristics from historical and modern insights.

scholarly journals Cardiac troponins in hypertension: mechanisms of increase and diagnostic value

2021 ◽  
Vol 27 (4) ◽  
pp. 390-401
Author(s):  
A. M. Chaulin ◽  
D. V. Duplyakov
Keyword(s):  
Cardiac Troponin ◽  
Prognostic Value ◽  
Biological Fluids ◽  
Diagnostic Value ◽  
Healthy Individuals ◽  
Pathological Conditions ◽  
Highly Sensitive ◽  
Protein Molecules ◽  
Diagnostic And Prognostic Value ◽  
Cardiac Troponins

The understanding of the diagnostic and prognostic value of many biomarkers of cardiovascular diseases (CVD), including cardiac troponins (cTnT and cTnI), is changing significantly with the development of methods for their determination. New highly sensitive immunoassays can detect minimal concentrations of cardiac troponin protein molecules in biological fluids (several ng/L or less), allowing the detection of cTnT and cTnI in all healthy individuals. Along with this, there are opportunities to use cTnT and cTnI both to assess the risk of developing CVD in healthy people, and to identify and monitor many early pathological conditions that pose a risk to the cardiovascular system and the life of patients. These pathological conditions include hypertension (HTN), which is the direct cause leading to coronary heart disease, acute myocardial infarction, stroke, and other CVD. A number of recent studies reported the possibility of using highly sensitive cTnT and cTnI in the management of HTN patients. In this article, we consider in detail the diagnostic and prognostic value of cardiac troponins in HTN, we also discuss the main possible mechanisms underlying the increase in cTnT and cTnI in human body fluids.

scholarly journals Non-coronarogenic causes of increased cardiac troponins in the practice of physicians (literature review)

2020 ◽  
Vol 20 (1-2) ◽  
pp. 49-61
Author(s):  
Aleksey M. Chaulin ◽  
Yulia V. Grigorieva ◽  
Ivan N. Milutin ◽  
Dmitry V. Duplyakov
Keyword(s):  
Literature Review ◽  
Physical Exertion ◽  
Myocardial Damage ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Aortic Aneurysms ◽  
Cardiac Damage ◽  
Disease States ◽  
Myocardial Injuries ◽  
Cardiac Troponins

Cardiac isoforms of troponins are the most sensitive and specific biomarkers of myocardial damage and new high-sensitivity methods can reveal very minor damages on the heart muscle. However, elevated troponin levels indicate cardiac damage, but do not define the cause of the damage. Therefore, cardiac troponin elevations are common in many disease states and do not necessarily indicate the presence of acute myocardial infarction. In clinical practice, interpretation of positive troponins may be challenging. In our article, we consider the main non-coronarogenic causes of increased cardiac troponins. The first part of the review discusses the mechanisms of increase and the diagnostic value of cardiac troponins during physical exertion, inflammatory and toxic myocardial injuries (endocarditis, myocarditis, sepsis), and renal failure. The second part of the literature review describes the mechanisms of increase and the diagnostic value of troponins in pulmonary thromboembolism, dissecting aortic aneurysms, neurogenic pathologies (stroke, subarachnoid hemorrhages), and treatment with cardiotoxic drugs (chemotherapy). Special attention is paid to the false positive causes of elevation of troponins.

scholarly journals New Biomarkers of Cardiovascular Diseases (Literature Review). Part 1

2021 ◽  
Vol 7 (2) ◽  
pp. 130-151
Author(s):  
Chaulin
Keyword(s):  
Cardiovascular Diseases ◽  
Literature Review ◽  
Diagnostic Value ◽  
Myocardial Tissue ◽  
Comparative Aspect ◽  
Highly Sensitive ◽  
Laboratory Biomarkers ◽  
New Biomarkers ◽  
Cardiac Troponins

Laboratory biomarkers of cardiovascular diseases play a crucial role in confirming the diagnosis, establishing the prognosis of patients, and correcting therapy. Therefore, the search for new cardiovascular diseases biomarkers, as well as the study and clarification of their clinical and diagnostic value, is an important task of modern healthcare. This article discusses the clinical and diagnostic value of new cardiovascular diseases biomarkers. The classification of cardiovascular diseases biomarkers is given. In a comparative aspect, new markers specific to myocardial tissue (highly sensitive cardiac troponins) are considered. Some new non-myocardial tissue-specific markers, in particular myeloperoxidase, are also discussed.

Butyrylcholinesterase as an additional marker in the diagnostic network of acute myocardial infarction

2016 ◽  
Vol 40 (2) ◽  
Author(s):  
Ramazan Kocabaş ◽  
Ali Kemal Erenler ◽  
Mücahit Yetim ◽  
Tolga Doğan ◽  
Hacı Kemal Erdemli
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Healthy Subjects ◽  
Early Stage ◽  
Characteristic Curve ◽  
Myocardial Damage ◽  
Diagnostic Value ◽  
Coronary Syndrome ◽  
Additional Marker ◽  
Low Sensitivity

AbstractAcute coronary syndrome defines a broad spectrum of complaints from angina to irreversible myocardial damage. There is an ongoing need for a biomarker to predict and diagnose acute myocardial infarction (AMI) in the early stage. In this study, our aim was to reveal early diagnostic value of butyrylcholinesterase (BChE) in discrimination of healthy subjects and patients with AMI.Eighty-five patients admitted to our hospital due to AMI and 45 healthy subjects were involved in the study. Patients and controls were compared according to BChE, lipid profiles and biochemical parameters.The serum BChE activity was significantly lower in patients with AMI than in the controls (p<0.001). After correlation analysis, while a negative correlation was determined between the serum BChE concentrations and AMI presence (r=–0.363, p<0.001); a positive correlation was determined between the serum BChE and cholesterol (r=0.443, p<0.001), HDL (r=0.243, p=0.006) and LDL (r=0.369, p<0.001) levels. The data indicate that BChE is associated with AMI and a subsequent receiver operating characteristic curve (ROC) analysis revealed that BChE, as an independent indicator, may differentiate AMI patients from controls. A cut-off point set at ≤7.15 kIU/L, BChE showed a sensitivity of 51.2% and a specificity of 84.4% (AUC=0.719, p<0.001).Low BChE level was significantly associated with AMI when compared to healthy subjects. Even though it has low sensitivity, plasma levels of BChE might represent an additional marker in the diagnostic network of AMI.

scholarly journals Mechanisms for Cardiac Troponin Increase in Arterial Hypertension

2021 ◽  
Vol 11 (4) ◽  
pp. 397-402
Author(s):  
Aleksey Chaulin
Keyword(s):  
Arterial Hypertension ◽  
Scientific Literature ◽  
Myocardial Damage ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Cardiac Muscle Cells ◽  
Pathological Conditions ◽  
Moderate Sensitivity ◽  
Cardiac Troponins ◽  
Serum And Urine

Despite the fact that cardiac troponins (cTnI and cTnT) are cardiospecific, they can be elevated in many systemic and non-cardiac physiological and pathological conditions. The diagnostic value of cTnI and cTnT significantly depends on the method of their determination. Thus, previously used low- and moderate-sensitivity immunoassays detected only serious myocardial damage and did not determine troponins in patients suffering from certain chronic pathologies. High-sensitivity troponin assays can detect minor damage to cardiac muscle cells in many pathological conditions, and troponin levels have a high predictive value. Among the early pathological conditions requiring the attention of clinicians is arterial hypertension (AH), which is also accompanied by an increase in the levels of hsTn in serum and urine. Currently, mechanisms responsible for increased levels of cardiac troponins in the blood serum and urine in hypertension are not well covered in the scientific literature. This article discusses in detail the presumptive mechanisms that cause increased levels of cTnI and cTnT in AH.

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