Editorial [Hot topic: Myocardial Damage: Not the Only Cause of Cardiac Troponin Release? (Guest Editor: Rob Shave)]

The aim of this study was to estimate the impact and prevalence of left ventricular geometric alterations and systolic and diastolic dysfunction in hemodialysis patients, as well as the relationship with cardiac troponin as a marker of myocardial damage. Methods: 31 patients (pts), 19 males and 12 females, age 58.1±16.4 (26 on hemodialysis, 5 on peritoneal dialysis) and 31 healthy normal controls were enrolled. Echocardiography measurements were carried out according to the American Society of Echocardiography recommendations. Left ventricular mass was calculated, according to the Devereux formula and indexed to height and weight 2.7. Doppler echocardiography was performed to study diastolic function by measurements of isovolumetric relaxation period (IVRT), E wave deceleretion time (DTE) and E/A ratio. Cardiac troponin was measured by a third generation electrochemiluminescence immunoassay. Statistical analysis was performed using the t-test for between-group comparisons and the Pearson and Spearman’s tests to investigate correlations; p values of <0.05 were considered statistically significant. Results: Eccentric hypertrophy was the most frequent pattern (n=17; 55%), followed by normal cardiac geometry (n=7; 23%), and concentric hypertrophy (n=5; 16%). Only 6% of pts (n=2) showed concentric remodelling. Systolic dysfunction was present in terms of endocardial parameters in 3 pts (9%) (fractional shartening <25%, EF<50%), but in terms of midwall myocardial shortening in 51% (n=16). Diastolic dysfunction was present in 87% (n=27) with a pattern of impaired relaxation (in 5 without left ventricular hypertrophy). E/A was negatively correlated with age (r=-0.41, p=0.02); DTE was positively correlated with posterior wall thickness (r=0.36, p=0.05) and interventricular septum thickness (r=0.45, p=0.01); cardiac troponin was positively correlated with age (r=0.50, p=0.00), left ventricular mass (r=0.41, p=0.02), posterior wall thickness (r=0.41; p=0.02) and interventricular septum thickness (r=0.39, p=0.03) but not with diastolic dysfunction parameters. No significant difference was found in terms of duration of dialysis between patients with normal left ventricular geometry and those with left ventricular hypertrophy, but a significant difference in age was found (p=0.03). Pts with diastolic dysfunction had more frequent hypotensive episodes during dialysis (p <0.01). Conclusion: Impaired geometry and cardiac function is frequently observed in pts undergoing hemodialysis. Diastolic dysfuction is associated to a geometric pattern of left ventricular hypetrophy, although it can be an isolated initial manifestation of myocardial damage. Depressed midwall myocardial shortening can discriminate left ventricular dysfunction better than traditional endocardial systolic indexes.

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Changes on Serum Troponin T Level before and after Taking Standard Therapy Medication in Heart Failure Patients

Folia Medica Indonesiana ◽

10.20473/fmi.v56i1.18444 ◽

2020 ◽

Vol 56 (1) ◽

pp. 4

Author(s):

Yen Yen Ari Indrawijaya ◽

Suharjono Suharjono ◽

Muhammad Aminuddin ◽

Endang Retnowati ◽

Gilang Mauladi Rahman

Keyword(s):

Heart Failure ◽

Cardiac Troponin ◽

Standard Therapy ◽

Troponin T ◽

Severe Heart Failure ◽

Myocardial Necrosis ◽

Myocardial Damage ◽

Symptom Improvement ◽

Before And After ◽

Difference Test

Patients with advanced heart failure (NYHA FC III and IV heart failure) had positive cardiac troponin levels in previous cohort studies. In heart failure, cardiac troponin T (cTnT) is a biomarker that is sensitive to myocardial damage, especially myocardial necrosis. However, there is still little information regarding changes in cTnT levels during standard therapy. This prospective observational study is aimed at evaluating changes in cTnT levels before and after the administration of standard therapy and evaluating symptom improvement before and after the administration of standard therapy in patients with severe heart failure. Measurement of cTnT levels and symptom improvement parameters before treatment was carried out on the first day of the inpatient and measurement after therapy was carried out on the last day of the inpatient. Sampling was done by consecutive sampling and found 30 patients in the inpatient room of the SMF Cardiovascular Disease, Dr. Soetomo Hospital, Surabaya during the months of May-July 2017. The results of the study obtained the average cTnT levels before therapy 33.48 + 31.88 pg/ml and the average cTnT levels after therapy 46.32 + 52.68 pg/ml. Based on the statistical difference test with the Wilcoxon sign-ranked test, there was no significant change in cTnT levels (p = 0.318). On the parameter of clinical symptom improvement, there was a significant decrease in pulse, respiratory rate, blood pressure, and mean arterial pressure before and after administration of therapy (p <0.05). There was no change in troponin T levels before and after the administration of therapy meant there was no worsening of myocardial necrosis.

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Frontal QRS-T angle as a predictive marker for myocardial damage in acute carbon monoxide poisoning

Human & Experimental Toxicology ◽

10.1177/09603271211043477 ◽

2021 ◽

pp. 096032712110434

Author(s):

Yusuf K Tekin ◽

Gülaçan Tekin ◽

Naim Nur ◽

İlhan Korkmaz ◽

Sefa Yurtbay

Keyword(s):

Carbon Monoxide ◽

Creatine Kinase ◽

Cardiac Troponin ◽

Troponin I ◽

Myocardial Damage ◽

Cardiac Troponin I ◽

Arterial Oxygen ◽

Co Poisoning ◽

Arterial Blood ◽

Creatine Kinase Mb

Introduction The present study was undertaken to investigate the prognostic value of the frontal QRS-T angle associated with adverse cardiac outcomes in patients with carbon monoxide (CO) poisoning in early stages in the emergency department. Materials and methods The data of 212 patients with CO poisoning who were admitted to the ED between January 2010 and May 2020 were retrospectively analyzed. The frontal QRS-T angle was obtained from the automatic reports of the EKG device. Results Compared to patients without myocardial damage, among patients with myocardial damage, statistically high creatinine, creatine kinase MB, cardiac troponin I, and frontal QRS-T angle values were found ( p < 0.001 for all parameters), while the saturation of arterial blood pH and arterial oxygen values were found to be lower ( p = 0.002 and p < 0.001, respectively). The frontal QRS-T angle values were correlated with creatine kinase, creatine kinase-MB, cardiac troponin I, and oxygen saturation (SpO2) in arterial blood (r = 0. 232, p = 0.001; r = 0. 253, p = < 0.001; r = 0. 389, p = < 0.001; r = −0. 198, p = 0.004, respectively). The optimum cut-off value of the frontal QRS-T angle was found to be 44.5 (area under the curve: 0.901, 95% confidence interval: 0.814–0.988, sensitivity: 87%, specificity: 84%). Conclusions The frontal QRS-T angle, a simple and inexpensive parameter that can be easily obtained from 12-lead surface electrocardiography, can be used as an early indicator in the detection of myocardial damage in patients with CO poisoning.

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Prognostic Value of Combination of Cardiac Troponin T and B-Type Natriuretic Peptide after Initiation of Treatment in Patients with Chronic Heart Failure

Clinical Chemistry ◽

10.1373/clinchem.2003.021311 ◽

2003 ◽

Vol 49 (12) ◽

pp. 2020-2026 ◽

Cited By ~ 66

Author(s):

Junnichi Ishii ◽

Wei Cui ◽

Fumihiko Kitagawa ◽

Takahiro Kuno ◽

Yuu Nakamura ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Cardiac Troponin ◽

Troponin T ◽

Myocardial Damage ◽

Left Ventricular ◽

Functional Class ◽

Cardiac Troponin T ◽

Cardiac Events ◽

Nyha Functional Class

Abstract Background: Recent studies have suggested that cardiac troponin T (cTnT) and troponin I may detect ongoing myocardial damage involved in the progression of chronic heart failure (CHF). This study was prospectively designed to examine whether the combination of cTnT, a marker for ongoing myocardial damage, and B-type natriuretic peptide (BNP), a marker for left ventricular overload, would effectively stratify patients with CHF after initiation of treatment. Methods: We measured serum cTnT, plasma BNP, and left ventricular ejection fraction (LVEF) on admission for worsening CHF [New York Heart Association (NYHA) functional class III to IV] and 2 months after initiation of treatment to stabilize CHF (n = 100; mean age, 68 years). Results: Mean (SD) concentrations of cTnT [0.023 (0.066) vs 0.063 (0.20) μg/L] and BNP [249 (276) vs 753 (598) ng/L], percentage increased cTnT (>0.01 μg/L; 35% vs 60%), NYHA functional class [2.5 (0.6) vs 3.5 (5)], and LVEF [43 (13)% vs 36 (12)%] were significantly (P <0.01) improved 2 months after treatment compared with admission. During a mean follow-up of 391 days, there were 44 cardiac events, including 12 cardiac deaths and 32 readmissions for worsening CHF. On a stepwise Cox regression analysis, increased cTnT and BNP were independent predictors of cardiac events (P <0.001). cTnT >0.01 μg/L and/or BNP >160 ng/L 2 months after initiation of treatment were associated with increased cardiac mortality and morbidity rates. Conclusion: The combination of cTnT and BNP measurements after initiation of treatment may be highly effective for risk stratification in patients with CHF.

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Effect of Exercise Intensity and Duration on Cardiac Troponin Release

Circulation ◽

10.1161/circulationaha.119.041874 ◽

2020 ◽

Vol 141 (1) ◽

pp. 83-85 ◽

Cited By ~ 3

Author(s):

Lucy Marshall ◽

Kuan Ken Lee ◽

Stacey D. Stewart ◽

Adam Wild ◽

Takeshi Fujisawa ◽

...

Keyword(s):

Exercise Intensity ◽

Cardiac Troponin ◽

Troponin Release

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Prolonged Elevated Cardiac Troponin After Marathon Running Is A Sign For Myocardial Damage

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000486928.36563.e4 ◽

2016 ◽

Vol 48 ◽

pp. 643

Author(s):

Johannes Scherr ◽

Fabien Hyafil ◽

Viola Grabs ◽

Bernhard Haller ◽

Siegmund Braun ◽

...

Keyword(s):

Cardiac Troponin ◽

Myocardial Damage ◽

Marathon Running

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Autoantibodies to Cardiac Troponin Associate with Higher Initial Concentrations and Longer Release of Troponin I in Acute Coronary Syndrome Patients

Clinical Chemistry ◽

10.1373/clinchem.2008.115469 ◽

2009 ◽

Vol 55 (5) ◽

pp. 938-945 ◽

Cited By ~ 40

Author(s):

Kim Pettersson ◽

Susann Eriksson ◽

Saara Wittfooth ◽

Emilia Engström ◽

Markku Nieminen ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cardiac Troponin ◽

Troponin I ◽

Myocardial Damage ◽

Prognostic Impact ◽

Serum Samples ◽

Igg Antibody ◽

Coronary Syndrome ◽

St Elevation ◽

Autoantibody Formation

Abstract Background: Cardiac troponin (cTn) is an established marker of myocardial infarction. Pronounced heterogeneity and the minute amounts released into the circulation constitute significant challenges for cTn detection. Recently, autoantibody formation to cTn was shown to be common and to interfere with immunoassay performance. In this study, we investigated cTn autoantibodies and cardiac troponin I (cTnI) in acute coronary syndrome (ACS) patients over a 1-year period after the index event. Methods: We used a second-generation cTnI assay designed to reduce the interference of cTn autoantibodies. The assay for cTn autoantibodies used 2 anti-cTnI antibodies to capture the ternary cTnI-complex, enabling unrestricted binding of the autoantibodies, which were detected with a labeled antihuman IgG antibody. We analyzed serum samples from 81 non–ST-elevation ACS patients taken at admission and after 1 week and 3 and 12 months. Results: We found 14 cTn autoantibody–positive patients (21%) among the 67 cTnI-positive and none among the 14 cTnI-negative patients. Nine were autoantibody-positive at admission, and 5 became positive at 1 week. Autoantibody signals significantly increased in the 1-week and 3-month samples. At all time points, cTnI was significantly increased in the autoantibody-positive group relative to the negative group. Persistent cTnI elevations at 3 and 12 months were seen in the patients already autoantibody positive at admission. Conclusions: During ACS, patients with cTn autoantibodies have higher cTnI release and therefore larger myocardial damage than patients without autoantibodies. Their cTnI release also lasts longer, at least months. The possible prognostic impact of these observations must be evaluated in larger clinical cohorts.

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Evaluation of Myocardial Damage After Electroconvulsive Therapy: Analyses of High-Sensitive Cardiac Troponin I and N-Terminal pro-B-type Natriuretic Peptide

Pharmacopsychiatry ◽

10.1055/a-0646-4278 ◽

2018 ◽

Vol 52 (02) ◽

pp. 92-93

Author(s):

Laura Kranaster ◽

Johanna Badstübner ◽

Suna Aksay ◽

Jan Bumb ◽

Rayan Suliman ◽

...

Keyword(s):

Natriuretic Peptide ◽

Electroconvulsive Therapy ◽

Cardiac Troponin ◽

Cardiovascular Events ◽

Troponin I ◽

Myocardial Damage ◽

Cardiac Troponin I ◽

Safe Procedure ◽

Increased Risk ◽

Before And After

AbstractElectroconvulsive therapy (ECT) is a remarkably safe procedure. However, there might exist a subgroup of patients with an increased risk for cardiovascular events. The cardiac-specific enzymes high-sensitive cardiac troponin I (hscTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were measured before and after ECT in 23 patients. No relevant increase of hscTnI after ECT was found. Mean NT-proBNP levels were higher after ECT and in three patients a new NT-proBNP elevation after ECT was identified. In conclusion, our small study did not find any evidence for myocardial damage due to ECT by measuring hsTnI, but an increase of NT-proBNP, whose clinical relevance could only be speculated, yet.

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Development of a Novel Sensor System Based on Magnetic Microspheres to Detect Cardiac Troponin T

International Journal of Polymer Science ◽

10.1155/2020/8855550 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Junrong Zhang ◽

Hongxiang Liu ◽

Baofeng Xu ◽

Sijun Huang ◽

Rui Liu ◽

...

Keyword(s):

Cardiac Troponin ◽

Troponin T ◽

Myocardial Damage ◽

Fluorescein Isothiocyanate ◽

High Specificity ◽

Magnetic Microspheres ◽

Cardiac Troponin T ◽

Serum Samples ◽

Magnetic Separator ◽

Specific Antibodies

Acute myocardial infarction (AMI) causes irreversible injury to cardiomyocytes in a short time and may result in various complications, severely threatening patient safety. Therefore, it is necessary to predict the possibility of AMI in the prophase. Prognostic detection of biomarkers that specifically reflect myocardial damage in a patient’s blood has become an essential mediating measure to prevent the serious occurrence of AMI. The present study is aimed at exploring a novel sensing system with high specificity and precision based on magnetic microspheres developed to detect cardiac troponin T (cTnT), which is the most specific diagnostic marker for AMI in cardiovascular diseases. Naive human cTnT protein in serum samples and antigens on functional magnetic microspheres will competitively bind with limited specific antibodies. After rapid removal of heterogeneous elements in the sera using a magnetic separator, fluorescein isothiocyanate-labeled immunoglobulin G is added to react with specific antibodies on the magnetic microspheres. Then, a flow cytometer is used to collect signals of different fluorescence intensities. The results show that the method is characterized by economy, high accuracy, and novelty. It can be used for the detection of cTnT in blood at 1.7–106.1 ng/mL, with a detection limit of 0.5 ng/mL. Thus, the proposed sensor improves the accuracy and efficiency of diagnosis before clinical deterioration of AMI.

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