Diagnostic Application of Postmortem Cardiac Troponin I Pericardial Fluid/Serum Ratio in Sudden Cardiac Death

In approximately 5% of unexpected deaths, establishing a conclusive diagnosis exclusively on the basis of anatomo-pathological findings in a classic autopsy is difficult. Postmortem biomarkers have been actively investigated as complementary indicators to help to reach valid conclusions about the circumstances of death. Several studies propose either the pericardial fluid or peripheral veins as a location for troponin determination, but the optimum sampling site is still a matter of debate. Our objective was to evaluate the association between the ratio of troponin values in the pericardial fluid and serum (determined postmortem) and the diagnosis of acute myocardial infarction (AMI) in the context of sudden cardiac death. We included 175 forensic cases. Two groups were established: AMI deaths (48; 27.4%) and the control group (127; 72.6%). The cardiac Troponin I (cTnI) values in the pericardial fluid and the troponin ratio were found to be associated with the cause of death. Univariate regression analyses showed that both age and the cTnI ratio were significantly associated with the diagnosis of AMI death. In a multivariate analysis, adjusting for confounding factors, the age and cTnI ratio were independent predictors of death from myocardial infarction. We performed a receiver operating characteristic (ROC) curve for the cTnI ratio for AMI death and selected a cut-off point. Our biomarker was found to be a valuable and highly effective tool for use in the forensic field as a complementary method to facilitate diagnosis in nonconclusive autopsies.

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Determinants of Levels of Cardiac Troponin I in Post-Mortem Blood Sample in Sudden Cardiac Death-An Autopsy Based Study

Medico-Legal Update ◽

10.5958/0974-1283.2019.00036.7 ◽

2019 ◽

Vol 19 (1) ◽

pp. 179

Author(s):

S Sharija ◽

A Sarathkumar ◽

K Sasikala

Keyword(s):

Sudden Cardiac Death ◽

Blood Sample ◽

Cardiac Troponin ◽

Cardiac Death ◽

Troponin I ◽

Cardiac Troponin I ◽

Post Mortem

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Diagnostic Roles of Postmortem cTn I and cTn T in Cardiac Death with Special Regard to Myocardial Infarction: A Systematic Literature Review and Meta-Analysis

International Journal of Molecular Sciences ◽

10.3390/ijms20133351 ◽

2019 ◽

Vol 20 (13) ◽

pp. 3351 ◽

Cited By ~ 4

Author(s):

Zhipeng Cao ◽

Mengyang Zhao ◽

Chengyang Xu ◽

Tianyi Zhang ◽

Yuqing Jia ◽

...

Keyword(s):

Myocardial Infarction ◽

Forensic Medicine ◽

Cardiac Troponin ◽

Cardiac Death ◽

Troponin I ◽

Troponin T ◽

Heart Diseases ◽

Meta Analysis ◽

Pericardial Fluid ◽

Diagnostic Biomarkers

Background: Cardiac troponin I (cTn I) and cardiac troponin T (cTn T) are currently widely used as diagnostic biomarkers for myocardial injury caused by ischemic heart diseases in clinical and forensic medicine. However, no previous meta-analysis has summarized the diagnostic roles of postmortem cTn I and cTn T. The aim of the present study was to meta-analyze the diagnostic roles of postmortem cTn I and cTn T for cardiac death in forensic medicine, present a systematic review of the previous literature, and determine the postmortem cut-off values of cTn I and cTn T. Methods: We searched multiple databases for the related literature, performed a meta-analysis to investigate the diagnostic roles of postmortem cardiac troponins, and analyzed the receiver operating characteristic (ROC) curve to determine their postmortem cut-off values. Results and Conclusions: The present meta-analysis demonstrated that postmortem cTn I and cTn T levels were increased in pericardial fluid and serum in cardiac death, especially in patients with acute myocardial infarction (AMI). We determined the postmortem cut-off value of cTn I in the pericardial fluid at 86.2 ng/mL, cTn I in serum at 9.5 ng/mL, and cTn T in serum at 8.025 ng/mL.

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Novel high-sensitivity cardiac troponin I assay in patients with suspected acute coronary syndrome

Heart ◽

10.1136/heartjnl-2018-314093 ◽

2018 ◽

pp. heartjnl-2018-314093 ◽

Cited By ~ 2

Author(s):

Andrew R Chapman ◽

Takeshi Fujisawa ◽

Kuan Ken Lee ◽

Jack Patrick Andrews ◽

Atul Anand ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Risk Stratification ◽

Cardiac Troponin ◽

Cardiac Death ◽

Troponin I ◽

High Sensitivity ◽

Cardiac Troponin I ◽

Coronary Syndrome ◽

Rule Out

BackgroundHigh-sensitivity cardiac troponin assays enable the early risk stratification of patients with suspected acute coronary syndrome to identify those at low risk of myocardial infarction or cardiac death. We evaluated the performance of a novel high-sensitivity cardiac troponin I assay in early rule out pathways.MethodsIn 1920 patients with suspected acute coronary syndrome, cardiac troponin was measured using the Siemens Atellica high-sensitivity cardiac troponin I assay (99th centile: 34 ng/L women, 53 ng/L men). We evaluated three pathways which use either low risk-stratification thresholds of cardiac troponin (High-SensitivityTroponin in the Evaluation of patients with Acute Coronary Syndrome (High-STEACS) and the European Society of Cardiology (ESC) 1 hour pathway) or the 99th centile diagnostic threshold (ESC 3 hour pathway) to rule out myocardial infarction.ResultsThe primary outcome of myocardial infarction or cardiac death at 30 days occurred in 14.4% (277/1920). The High-STEACS pathway ruled out 63% of patients (1218/1920), with five missed events for a negative predictive value (NPV) of 99.5% (95% CI (CI) 99.1% to 99.8%). Similar performance was observed for the ESC 1 hour pathway with an NPV of 99.0% (97.6% to 99.8%). In contrast, the ESC 3 hour pathway ruled out 65% of patients (1248/1920), but missed 25 events for an NPV of 98.0% (97.1% to 98.7%).ConclusionsA novel high-sensitivity cardiac troponin I assay can safely identify patients at low risk of myocardial infarction or cardiac death. Diagnostic pathways that use low cardiac troponin concentrations for risk stratification miss fewer events than those that rely on the 99th centile to rule out myocardial infarction.Trial registrationNCT1852123.

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Studies on Cardiac Troponin I in patients with Cardiogenic Shock

Journal of Dhaka National Medical College & Hospital ◽

10.3329/jdnmch.v18i2.16017 ◽

2013 ◽

Vol 18 (2) ◽

pp. 21-23 ◽

Cited By ~ 1

Author(s):

Muhammed Rukunuzzman ◽

Shah Abdul Latif ◽

Maruf-Ur Rahman ◽

Kalyan Kirtania ◽

Md Tauhidul Islam ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiogenic Shock ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

Control Group ◽

Case Group ◽

Dismal Prognosis ◽

Serum Cardiac Troponin

Despite recent advances in the care of patients with acute coronary disease and the benefits associated with the early use of reperfusion strategies, cardiogenic shock as a complication of acute myocardial infarction continues to be associated with a dismal prognosis. There is a strong relationship between serum cardiac troponin I with cardiogenic shock as a complication of acute myocardial infarction. A case control study was designed to see the association of serum cardiac troponin I with cardiogenic shock. The study was done from July 2008 to June 2009. Sixty subjects were selected as study population which were taken from department of Cardiology, Mymensingh Medical College hospital, Mymensingh. Among them 30 were diagnosed case of cardiogenic shock and 30 were age and sex matched control. It revealed that the mean cardiac troponin- I levels in case group were 15.998±28.31 ng/ml and control group were 0.065 ± 0.08 ng/ml respectively. The study suggest that serum cardiac troponin- I level is significantly associated with cardiogenic shock. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16017 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 21-23

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Role of Cardiac Troponin I Level in Predicting in Hospital Outcomes in Patients with ST-segment Elevation Myocardial Infarction in Erbil-Iraq

Diyala Journal of Medicine ◽

10.26505/djm.13013150123 ◽

2017 ◽

Vol 13 (1) ◽

pp. 1-7

Author(s):

Salam Naser Zangana ◽

◽

Abdul kareem A AL-Othman ◽

Namir G AL-Tawil ◽

Keyword(s):

Myocardial Infarction ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

Hospital Outcomes ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

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Faculty Opinions recommendation of One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725420089.793507697 ◽

2015 ◽

Author(s):

Patrick Ray

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Troponin ◽

Troponin I ◽

High Sensitivity ◽

Cardiac Troponin I ◽

Rule Out

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Postmortem Specificity of Troponin for Acute Miocard Infarction Diagnosis throug Qualitative Dosing from Pericardial Fluid

Revista de Chimie ◽

10.37358/rc.18.9.6559 ◽

2018 ◽

Vol 69 (9) ◽

pp. 2482-2486

Author(s):

Iuliana Hunea ◽

Simona Irina Damian ◽

Carmen Corina Radu ◽

Sorin Moldoveanu ◽

Tatiana Iov

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Disease ◽

Cardiac Death ◽

Troponin I ◽

Troponin T ◽

Morphological Changes ◽

Pericardial Fluid ◽

Histological Changes ◽

Lethal Arrhythmia ◽

Myocardial Lesions

Cardiac disease is the leading cause of death, and sudden cardiac death occupies the first place in sudden deaths of natural causes. Sudden cardiac death due to lethal arrhythmia may be the first manifestation of a cardiac disease, such cases becoming suspect dead, thus forensic cases. The autopsy performed in such cases may reveal important cardiovascular disease but not obvious macroscopic or histological changes of acute myocardial infarction (IMA), except for cases of survival for several hours after the onset of the symptomatology. Biochemical markers were used to test for myocardial lesions in the absence of morphological changes. Methods for determining myoglobin, CK-MB, troponin T (cTn T), troponin I (cTn I) were introduced to the clinic to diagnose the condition of patients with chest pain as early as the 1990s. The lack of pathognomonic elements in corps investigations, where part of the analysis cannot be carried out, requires verification of the value of the investigations that can be carried out, with reference to the biochemical in the present case, in establishing the diagnosis with certainty.

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Prussian blue-doped PAMAM dendrimer nanospheres for electrochemical immunoassay of human plasma cardiac troponin I without enzymatic amplification

New Journal of Chemistry ◽

10.1039/d1nj01506k ◽

2021 ◽

Author(s):

Fangfang Ma ◽

Gaoshun Ge ◽

Yizhen Fang ◽

Erru Ni ◽

Yuanyuan Su ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiac Troponin ◽

Troponin I ◽

Biological Fluids ◽

Pamam Dendrimer ◽

Cardiac Troponin I ◽

Electrochemical Immunoassay ◽

Accurate Identification ◽

Enzymatic Amplification ◽

Electrochemical Immunosensing

Rapid and accurate identification of cardiac troponin I (cTnl) in biological fluids is very essential for judging acute myocardial infarction (AMI). Herein, we constructed an enzyme-free electrochemical immunosensing system for...

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Abstract 2425: Absence of Auto-Antibodies against Cardiac Troponin I Predicts Improvement of Left Ventricular Function after Acute Myocardial Infarction

Circulation ◽

10.1161/circ.118.suppl_18.s_724-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Florian Leuschner ◽

Jin Li ◽

Stefan Göser ◽

Lars Reinhardt ◽

Renate Öttl ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Stroke Volume ◽

Antibody Titer ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

Igg Antibody ◽

Follow Up Study

Application of antibodies against cardiac troponin I (cTnI-Ab) can induce dilation and dysfunction of the heart in mice. Recently, we demonstrated that immunization with cTnI induces inflammation and fibrosis in myocardium of mice. Others have shown that autoanti-bodies to cTnI are present in patients with acute coronary syndrome. But little is known about the clinical relevance of detected cTnI-Ab. First, anti-cTnI and anti-cTnT antibody titers were measured in sera from 272 patients with dilated- (DCM) and 185 with ischemic- (ICM) cardiomyopathy. Secondly, 108 patients with acute myocardial infarction (AMI) were included for a follow-up study. Heart characteristics were determined by magnetic resonance imaging 4 days and 6 –9 months after AMI. Altogether, in 7,0% of patients with DCM and in 9,2% with ICM an anti-cTnI IgG antibody titer ≥1:160 was measured. In contrast, only in 1,7% of patients with DCM and in 0,5% with ICM an anti-cTnT IgG antibody titer ≥1:160 was detected. Ten out of 108 patients included in the follow-up study were tested positive for cTnI-Ab with IgG Ab titers ≥1:160. TnI-Ab negative patients showed a significant increase in LVEF and stroke volume 6 –9 months after AMI. In contrast, there was no significant increase in LVEF and stroke volume in TnI-Ab positive patients. We demonstrate for the first time that the prevalence of cTnI-Abs in patients with AMI has an impact on the improvement of the LVEF over a study period of 6 –9 months.

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