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.

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.

scholarly journals Diagnostic value of the Hs-cTnT/CysC ratio in patients with stage ≥3 CKD and acute myocardial infarction

2020 ◽  
Author(s):  
Lihua Yang ◽  
Cudan Cai ◽  
Hanfei Lin ◽  
Jianwei Peng ◽  
Yanqiang Peng ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Troponin T ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Epidermal Growth Factor Receptors ◽  
Pain Center ◽  
Epidermal Growth

Abstract Background: We investigated the diagnostic value of the ratio of high sensitivity troponin to cystatin C in CKD patients with stage ≥ 3 chronic kidney disease (CKD) and acute myocardial infarction. Methods: We retrospectively analyzed 401 patients with suspected acute myocardial infarction (AMI) who underwent coronary angiography in the chest pain center at our hospital during 2013–2019. Among the 196 patients studied, 113 were placed in an AMI group and 83 in a non-AMI group. Results: There were no significant differences in age, sex, or the presence of hypertension, diabetes, gout/hyperuricemia, stroke, tumor, or epidermal growth factor receptors between the two groups (P > 0.05). A correlation analysis showed that there was a positive correlation between CysC and Cr, with a correlation coefficient of 0.872 (P < 0.001). A receiver operating characteristic curve for the high-sensitivity cardiac troponin T (hs-cTnT)/CysC ratio showed an area under the curve value of 0.925 (P < 0.001), with sensitivity of 78.4% and specificity of 94.0%. Conclusion: The hs-TnT/CysC ratio can thus be used as an index to predict AMI in patients with stage≥ 3 CKD.

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 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.

scholarly journals A Novel Graphene-Based Nanomaterial Modified Electrochemical Sensor for the Detection of Cardiac Troponin I

2021 ◽  
Vol 9 ◽  
Author(s):  
Jing Li ◽  
Shenwei Zhang ◽  
Li Zhang ◽  
Yu Zhang ◽  
Hua Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Electrochemical Sensor ◽  
Cardiac Troponin ◽  
Myocardial Injury ◽  
Troponin I ◽  
High Sensitivity ◽  
High Specificity ◽  
Diagnostic Value ◽  
Cardiac Troponin I

Acute myocardial infarction has a high clinical mortality rate. The initial exclusion or diagnosis is important for the timely treatment of patients with acute myocardial infarction. As a marker, cardiac troponin I (cTnI) has a high specificity, high sensitivity to myocardial injury and a long diagnostic window. Therefore, its diagnostic value is better than previous markers of myocardial injury. In this work, we propose a novel aptamer electrochemical sensor. This sensor consists of silver nanoparticles/MoS2/reduced graphene oxide. The combination of these three materials can provide a synergistic effect for the stable immobilization of aptamer. Our proposed aptamer electrochemical sensor can detect cTnl with high sensitivity. After optimizing the parameters, the sensor can provide linear detection of cTnl in the range of 0.3 pg/ml to 0.2 ng/ml. In addition, the sensor is resistant to multiple interferents including urea, glucose, myoglobin, dopamine and hemoglobin.

scholarly journals Diagnostic Value of Soluble Urokinase-Type Plasminogen Activator Receptor in Addition to High-Sensitivity Troponin I in Early Diagnosis of Acute Myocardial Infarction

Biomolecules ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 108 ◽  
Author(s):  
Nils A. Sörensen ◽  
Günay Dönmez ◽  
Johannes T. Neumann ◽  
Julius Nikorowitsch ◽  
Nicole Rübsamen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Early Diagnosis ◽  
Troponin I ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
High Sensitivity Troponin ◽  
Type Plasminogen Activator ◽  
Urokinase Type Plasminogen Activator ◽  
Plasminogen Activator Receptor

The soluble urokinase-type plasminogen activator receptor (suPAR) is a new marker for immune activation and inflammation and may provide diagnostic value on top of established biomarkers in patients with suspected acute myocardial infarction (AMI). Here, we evaluate the diagnostic potential of suPAR levels on top of high-sensitivity troponin I (hs-TnI) in a cohort of patients with suspected AMI. A total of 1220 patients presenting to the emergency department with suspected AMI were included, of whom 245 were diagnosed with AMI. Median suPAR levels at admission were elevated in subjects with AMI compared to non-AMI (3.8 ng/mL vs 3.3 ng/mL, p = 0.001). In C-statistics, the area under the curve (AUC) regarding the diagnosis of AMI was low (0.57 at an optimized cut-off of 3.7 ng/mL). Moreover, baseline suPAR levels on top of troponin values at admission and hour 1 reduced the number of patients who were correctly ruled-out as non-AMI, and who were correctly ruled-in as AMI. Our study shows that circulating levels of suPAR on top of high-sensitivity troponin I do not improve the early diagnosis of AMI.

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