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.

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 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 High-sensitivity cardiac troponins: detection and central analytical characteristics

2021 ◽  
Vol 20 (2) ◽  
Author(s):  
A. M. Chaulin ◽  
O. E. Abashina ◽  
D. V. Duplyakov
Keyword(s):  
Limit Of Detection ◽  
Biological Fluids ◽  
Myocardial Damage ◽  
High Sensitivity ◽  
Laboratory Diagnosis ◽  
Routine Practice ◽  
Metabolic Characteristics ◽  
Coronary Syndrome ◽  
Limit Of Quantitation ◽  
Cardiac Troponins

Recently, there have been some important changes in the laboratory diagnosis of patients with acute coronary syndrome, due to the introduction into routine practice of new high- and ultra-sensitive techniques for detection of myocardial damage biomarkers — cardiac troponins. Each method for cardiac troponins’ detection, among the existing wide variety of troponin immunoassays, has different analytical characteristics and allows the detection of different concentrations of troponins in the same patient. With an increasing number of companies developing high-sensitivity troponin immunoassays receiving regulatory approval, there is an urgent need for independent analytical and clinical evaluation of each method. This article discusses high- and ultrasensitive techniques for detection of cardiac troponins. The modern data on biochemical and metabolic characteristics of troponins, obtained using high- and ultra-sensitive techniques, are described: sex, age, circadian features and potential for detecting troponins in other biological fluids. Considerable attention is paid to the analytical characteristics of troponin immunoassays: limit of blank, limit of detection and limit of quantitation, coefficient of variation, as well as the 99th percentile and factors influencing it.

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 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 High-sensitivity cardiac troponins: circadian rhythms

2021 ◽  
Vol 20 (1) ◽  
pp. 2639
Author(s):  
A. M. Chaulin ◽  
D. V. Duplyakov
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiovascular Diseases ◽  
Myocardial Damage ◽  
High Sensitivity ◽  
Diurnal Variations ◽  
Reference Levels ◽  
Increased Sensitivity ◽  
Cardiac Troponins ◽  
Early Diagnostic

High-sensitivity cardiac troponins (hs-cTnI and hs-cTnT) contribute to a progression in the diagnosis and treatment of cardiovascular diseases: acceleration of diagnosis of acute myocardial infarction (early diagnostic algorithms: 0-1 h, 0-3 h), and earlier initiation of optimal treatment, expansion of diagnostic and prognostic potential (earlier detection of myocardial damage during chemotherapy, endocarditis, myocarditis and other diseases). However, increased sensitivity slightly reduced the specificity and created the need for a more thorough interpretation of elevated levels of hs-cTnI and hs-cTnT in a number of pathologies that damage cardiomyocytes. In addition, there was a need to introduce reference levels of hs-cTnI and hs-cTnT (99 percentile), taking into account sex. Recently, there has also been information about circadian (diurnal) variations in hs-cTnT and hs-cTnI levels. We analyze in detail the results of clinical studies that found circadian changes in hs-cTnI and hs-cTnT. Possible mechanisms underlying these changes in hs-cTnT and hs-cTnI concentrations are discussed.

A szívtroponinok laboratóriumi mérési módszereinek fő analitikai jellemzői: történeti és modern nézőpont

2022 ◽  
Vol 163 (1) ◽  
pp. 12-20
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Troponin ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Muscle Disease ◽  
Laboratory Methods ◽  
And Gender ◽  
Low Sensitivity ◽  
Cardiac Troponins

Összefoglaló. A cardialis troponinok biomarkerként való alkalmazása az akut myocardialis infarctus diagnosztikájában nagy múltra tekint vissza, és ez idő alatt jelentősen megváltoztak a cardialis troponinok diagnosztikai jelentőségével kapcsolatos elképzelések. Ez pedig a szívtroponinok és mindenekelőtt az érzékenység mérésére szolgáló laboratóriumi módszerek fejlődésének köszönhető. A legelső laboratóriumi módszerek, amelyeket több mint 30 évvel ezelőtt fejlesztettek ki a cardialis troponinok vérszérumban való kimutatására, még rendkívül alacsony érzékenységűek voltak, ezért csak 12–24 órával az akut myocardialis infarctus jelentkezése után tudták kimutatni a diagnózis felállításában jelentőséggel bíró troponinszintet. Ezenkívül a szívtroponin molekuláinak diagnosztikai reagensei nem specifikus módon kölcsönhatásba léphetnek a vázizombeli troponin molekuláival, ami a vázizmok betegségei és sérülései esetén a cardialis troponin koncentrációjának gyakori hamis pozitív növekedéséhez vezetett. Ahogy a cardialis troponinok mérési módszerei javultak, érzékenységük növekedésével (nagy érzékenységű cardialis troponinok) új lehetőségek nyíltak meg az akut myocardialis infarctus korai diagnózisának felállítására, és többek között modern diagnosztikai algoritmusokat is kifejlesztettek: 0–1 órás, 0–2 órás, 0–3 órás. Ez a korai diagnózis felállítását engedte meg azoknál a betegeknél, akiknek mellkasi fájdalmaik voltak, s ezzel korábban dönthettek a páciens gyógyításának optimális taktikájáról. Miután bevezetésre kerültek a cardialis troponin szintjének nagy érzékenységű mérési módszerei, a cardialis troponin molekuláinak biológiájával kapcsolatos elképzeléseink némileg megváltoztak, különösképpen, hogy innentől kezdve már nem tekinthetők szigorúan intracelluláris molekuláknak, mivel minden egészséges emberben kimutathatók, valamint nemi, életkori és cirkadián tulajdonságokat is felfedeztek a cardialis troponin koncentrációiban, amelyek ugyancsak szerepet játszhatnak az akut myocardialis infarctus diagnózisának felállításában. Arról nem is beszélve, hogy a nagy érzékenységű cardialis troponinok alkalmazási lehetőségei messze túlmutatnak az akut myocardialis infarctus diagnózisán. A jelen cikk egy történeti és egy modern perspektívát kíván bemutatni a cardialis troponinok legfontosabb analitikai jellemzőiről, érintve az azok biológiájára vonatkozó új adatokat és felhasználásuk új diagnosztikai lehetőségeit is. Orv Hetil. 2022; 163(1): 12–20. Summary. Throughout a very long history of using cardiac troponins in clinical practice as biomarkers of acute myocardial infarction, there have been significant changes in ideas about their diagnostic value. Such a circumstance is caused by the improvement of laboratory methods of cardiac troponin determination and, first of all, sensitivity. Thus, the very first laboratory methods designed to detect cardiac troponins in serum, developed over 30 years ago, had extremely low sensitivity, due to which they could detect diagnostically significant levels of troponins only 12–24 hours after the development of acute myocardial infarction. In addition, diagnostic antibodies directed against cardiac troponin molecules could interact nonspecifically with skeletal troponin molecules, leading to frequent false-positive increases in cardiac troponin concentrations in skeletal muscle disease and injury. As the methods of determining cardiac troponins improved, increasing their sensitivity (high-sensitivity cardiac troponins), the prospects for early diagnosis of acute myocardial infarction opened up, in particular, modern diagnostic algorithms: 0–1 hour, 0–2 hours, 0–3 hours. This allowed earlier diagnosis of patients who came with chest pain, and earlier decision-making on the choice of optimal tactics for the treatment of patients. With the introduction of high-sensitivity cardiac troponin assays, our understanding of the biology of cardiac troponin molecules has changed somewhat, in particular, they are no longer considered strictly intracellular molecules, as they are now detectable in all healthy individuals, and gender, age and circadian patterns in cardiac troponin concentrations have been discovered, which may have an impact on the diagnosis of acute myocardial infarction. Moreover, the possibilities of using highly sensitive cardiac troponins go far beyond the diagnosis of acute myocardial infarction. This article presents a view of the main analytical characteristics from a historical and contemporary perspective, covering some new data on the biology of cardiac troponins and new diagnostic possibilities for their use. Orv Hetil. 2022; 163(1): 12–20.

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