Diagnostic Value of High-Sensitivity Troponin T for Subclinical Left Ventricular Systolic Dysfunction in Patients with Sepsis

Background. Left ventricular systolic dysfunction (LVSD) is common in sepsis. Speckle-tracking echocardiography (STE) is a useful emerging tool for evaluating the intrinsic left ventricular systolic function. High-sensitivity cardiac troponin T (hs-cTnT) is the most sensitive biomarker of myocardial injury. However, there are limited data regarding the association between hs-cTnT level and left ventricular systolic dysfunction based on STE in septic patients. We performed this prospective study to evaluate the diagnostic value of hs-cTnT level for subclinical left ventricular systolic dysfunction measured by STE in septic patients according to the sepsis-3 definition. Methods. Patients with sepsis based on sepsis-3 definition admitted to the intensive care unit were prospectively performed STE and hs-cTnT level within 24 hours after the onset of sepsis. Baseline clinical and echocardiographic variables were collected. Left ventricular systolic dysfunction was defined as a global longitudinal strain of ≥−15%. Results. During a 19-month period, 116 patients were enrolled in the study. The elevated hs-cTnT level was seen in 86.2% of septic patients, and 43.1% of patients had LVSD on STE. The median hs-cTnT level and the proportion of elevated hs-cTnT level (>14 ng/L) were significantly higher in patients with LVSD than in patients without LVSD. The area under the ROC curves of hs-cTnT to detect LVSD was 0.73 ( P < 0.001). In the multivariate analysis, hs-cTnT (HR, 1.002; 95% CI, 1.000 to 1.004; P = 0.025) and septic shock (HR, 7.6; 95% CI, 2.25 to 25.76; P = 0.001) were independent predictors of LVSD. Conclusion. Our study indicated that the serum hs-cTnT level might be a useful biomarker for detecting LVSD in septic patients.

Abstract 17152: Artificial Intelligence ECG for the Detection of Cardiac Injury as Confirmed by High Sensitivity Cardiac Troponin T-Concentrations

Background: High-sensitivity cardiac troponin (hs-cTn) assays quantify cTn in patients at very low concentrations. Myocyte injury due to ischemia or other pathologies cause blood levels to increase, which is prognostic. A noninvasive, rapid, broadly available, home-based test to detect hs-cTn increases would facilitate risk-stratification. Since myocyte injury is associated with ECG changes, we hypothesized an artificial intelligence ECG (AI-ECG) could non-invasively predict current or impending hs-cTnT elevations. Objective: To develop an AI-ECG convolutional neural network (CNN) to detect an abnormal hs-cTnT (5 th Gen cTnT, Roche Diagnostics) concentration using a 12-lead ECG, and a single lead ECG (lead I), which would enable smartphone, home-based detection. Methods: We developed single lead and 12-lead ECG CNNs to detect a) hs-cTnT concentrations that were at or above the 6ng/L limit that can be reported b) above the 99 th percentile upper limits of >15ng/L for men and >10ng/L for women. All ECGs were recorded within one hour of the hs-cTnT measurements. We used 73,012 ECG and hs-cTnT pairs from 47,542 unique patients to train the network, 9031 ECGs from 5,811 patients for internal validation to optimize hyperparameters, and 18,276 ECG and hs-cTnT pairs from 11,904 different patients as a holdout test set to determine the area under the receiver-operator curve (AUC). Results: The mean age was 63.9±17.5 years, and 30,348 of the 59,446 patients (51%) were male. Of the 91,288 hs-cTnT pairs 73,271 (80.2%) were above 6ng/L and 50,799 (55.6%) are above the 99 th percentile. In the test set, the AUC for the detection of a hs-cTnT level higher than 6ng/L was 0.88 using the 12 lead ECG and 0.834 with the single lead. For the detection of hs-cTnT level above of 99 th percentile, the 12 lead ECG AUC was 0.853 and the single lead was 0.806. Conclusion: The AI-ECG permits detection of levels of hs-cTnT consistent with myocardial injury. This may allow a home-based, non-invasive test that would be massively scalable and could further enhance rapid-risk stratification and patient triage with potentially significant cost reductions and enable novel triage strategies at sites without hs-cTn assays.

Abstract 16397: Presence of Myocardial Injury on Admission is Associated With an Increase in All-cause Mortality in Patients With COVID-19

Introduction: COVID-19 has emerged as a global health crisis resulting in nearly half a million deaths worldwide to date. Patients with COVID-19 experience significant cardiovascular manifestations including myocardial injury. We sought to determine the risk of myocardial injury within 24 hours of admission on all-cause mortality in patients with COVID-19. Methods: This was a prospective cohort study of patients hospitalized with COVID-19 at a major academic medical center between March 1, 2020-June 1, 2020. The combination of cardiac troponin T (cTnT) elevation (defined as ≥0.01 ng/mL) within 24 hours of admission and an elevated NT-proBNP (defined as >450.0 pg/mL) on admission were used as biomarker surrogates for myocardial injury. Results: There were n = 415 consecutive patients who were hospitalized with COVID-19 with a median age of 68.5 years (IQR 58-81), 44.8% were women, a median BMI of 28.8 (IQR 24.6-35.6), 5.8% of patients had end-stage renal disease on dialysis, 21.6% had a prior diagnosis of coronary artery disease and 21.8% had a prior diagnosis of congestive heart failure. Among patients with at least one positive cTnT level within 24 hours of admission, the median cTnT level was 0.04 ng/mL (IQR 0.01-0.77 ng/mL). Among those with elevated BNP, the median BNP was 1930 pg/mL (IQR 799-5826 pg/mL) on admission. Patients with COVID-19 who had an elevation in both cardiac biomarkers on admission had higher all-cause mortality than patients with COVID-19 who had negative biomarkers (38.2% vs. 7.5%, respectively, p-value < 0.001), with nearly a 5-fold increase in mortality when adjusted for age, gender, BMI and renal dysfunction (adjusted OR 4.9, p-value: 0.003, 95% CI 1.7-13.9, See Figure) Conclusion: Myocardial injury is common in patients with COVID-19 and is associated with a significantly increased risk of death. Cardiac biomarkers on admission can serve as prognostic factors and may guide early management of COVID-19.

Change in high-sensitivity troponin t levels and 1-year outcomes in patients with acute heart failure: China PEACE prospective heart failure study

Background High-sensitivity cardiac troponin T (hs-cTnT) is an important prognostic marker in heart failure (HF). However, it is unclear whether the change of hs-cTnT levels can predict long-term clinical outcomes in patients with acute HF. Purpose To examine the association between change in hs-cTnT from hospital admission to 1-month after discharge and subsequent 1-year cardiovascular death or HF hospitalization in patients with acute HF. Methods We included patients hospitalized primarily for HF from 52 hospitals in China, who had central analysis of hs-cTnT at both admission and 1-month after discharge. Change in hs-cTnT was calculated as hs-cTnT level at 1-month minors that at admission. The composite outcome measure was cardiovascular death or HF hospitalization within 1 year after discharge. We tested the linearity assumption between change in hs-cTnT level and the composite events using restricted cubic splines. To further explore the quantitative association between change in hs-cTNT and the events, we also applied a Cox proportional hazards model using change in hs-cTNT as a continuous variable, adjusting for hs-cTnT level at admission (log transformed) and known prognostic variables. Results We included 2355 patients hospitalized primarily for HF. Median change in hs-cTnT from baseline was −2.7ng/L (IQR −9 to 0.7). 614 (26.1%) patients experienced the events of cardiovascular death or HF hospitalization within 1 year. Among patients with hs-cTnT &lt;14ng/L (the upper limit of the reference value) at admission, patients had low risk of the events regardless whether hs-cTNT ≥14ng/L at 1-month or not (20.2% vs. 14.1%, p=0.11). Among patients with hs-cTnT ≥14ng/L at admission, patients with hs-cTNT ≥14ng/L at 1-month had higher risk of the events than those with hs-cTnT &lt;14ng/L (36.4% vs. 18.6%, p&lt;0.0001). The association between change in hs-cTnT and the events was non-linear. When change in hs-cTnT was &lt;4ng/L and &gt;−4ng/L, per 1 ng/L decrease was associated with a 7% reduction in risk of the events [hazard ratio (HR) 0.93, 95% CI 0.88–0.99]. When change in hs-cTnT was &lt;−4ng/L, there was a levelling off in the reduced risk (HR: 0.99, 95% CI 0.99–1.00). While change in hs-cTnT was &gt;4ng/L, it was not significantly associated with the events any longer (Figure 1). Conclusion Among patients hospitalized for HF, changes in hs-cTnT from admission to 1 month can predict the risk of cardiovascular death and HF hospitalization. Funding Acknowledgement Type of funding source: Other. Main funding source(s): The National Key Research and Development Program from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science; the 111 Project from the Ministry of Education of China

Correlation of Serum Cardiac Markers with Acute Decompensating Events in Liver Cirrhosis

Background and Aim. Liver cirrhosis is often accompanied by insidious cardiac dysfunction. This retrospective cross-sectional study is aimed at exploring the correlation between serum cardiac markers and decompensating events in liver cirrhosis. Methods. Cirrhotic patients who were consecutively hospitalized between January 2016 and March 2019 were screened. Serum cardiac biomarkers at admission, including N-Terminal pro-B-type natriuretic peptide (NT-pro BNP), high-sensitivity cardiac troponin T (hs-cTnT), creatine kinase (CK), creatine kinase MB (CK-MB), and lactate dehydrogenase (LDH), were collected. Acute decompensating events at admission, primarily including ascites, acute gastrointestinal hemorrhage, and acute-on-chronic liver failure (ACLF), were recorded. Results. The NT-pro BNP level was significantly higher in cirrhotic patients with acute decompensating events than in those without any decompensating events (median: 140.75 pg/mL versus 41.86 pg/mL, P<0.001). The NT-pro BNP level significantly correlated with ascites, acute gastrointestinal hemorrhage, and ACLF. The hs-cTnT level was significantly higher in cirrhotic patients with acute decompensating events than in those without decompensating events (median: 0.008 ng/mL versus 0.006 ng/mL, P=0.007). The hs-cTnT level significantly correlated with acute gastrointestinal hemorrhage, but not ascites or ACLF. LDH (185.0 U/L versus 173.5 U/L, P=0.281), CK (71 U/L versus 84 U/L, P=0.157), and CK-MB (29.5 U/L versus 33.0 U/L, P=0.604) levels were not significantly different between cirrhotic patients with and without acute decompensating events. Conclusion. The elevated NT-pro BNP level seems to be closely related to the development of acute decompensating events in liver cirrhosis.

Ventricular function and high-sensitivity cardiac troponin T in preterm infants with neonatal sepsis

Background Hemodynamic instability in sepsis, especially in the neonatal population, is one of the leading causes of death in hospitalized infants. The major contribution for heart dysfunction in neonatal sepsis is the myocardial dysfunction that leads to decreasing of ventricular function. The combination of echocardiography and laboratory findings help us to understand the ventricular condition in preterm infants with sepsis.Objective To assess for a correlation between ventricular function and serum high-sensitivity cardiac troponin T (hs-cTnT) level in preterm infants with neonatal sepsis.Methods We prospectively studied 30 preterm infants with neonatal sepsis who were admitted to the neonatal intensive care unit (NICU) of Cipto Mangunkusumo Hospital from June 1 – August 31, 2013. The ventricular functions were measured using 2-dimensional echocardiography. The parameters of right ventricular (RV) function assessment were tricuspid annular plane systolic excursion (TAPSE) and RV myocardial performance index (MPI). For left ventricular (LV) performance, we assessed ejection fraction (EF), fractional shortening (FS), and LV-MPI. Serum hs-cTnT was measured and considered to be a marker of myocardial injury.Results Subjects had a mean gestational age of 31.5 (SD 2.18) weeks and mean birth weight of 1,525 (SD 437.5) g. The mean LV function measured by MPI was 0.281 (SD 0.075); mean EF was 72.5 (SD 5.09)%; and mean FS was 38.3 (SD 4.29)%. The RV function measured by TAPSE was mean 6.85 (SD 0.94) and that measured by MPI was median 0.255 (range 0.17-0.59). Serum hs-cTnT level was significantly higher in non-survivors than in survivors [282.08 (SD 77.81) pg/mL vs. 97.75 (24.2-142.2) pg/mL, respectively P =0.023]. There were moderate correlations between LV-MPI and hs-cTnT concentration (r=0.577; P=0.001), as well as between RV-MPI and hs-cTnT concentration (r=0.502; P=0.005). The positive correlation between LV and RV-MPI in neonatal sepsis was strong (r=0.77; P <0.001).Conclusion Left and right ventricular MPI show positive correlations with hs-cTnT levels. Serum hs-cTnT is significantly higher in non survivors. As such, this marker may have prognostic value for neonatal sepsis patients.

Estimation of age- and comorbidities-adjusted percentiles of high-sensitivity cardiac troponin T levels in the elderly

Cardiac troponin level measured by high-sensitivity assays (hs-cTn) in the elderly is frequently found higher than the 99th percentile upper reference limit, making the diagnosis of acute coronary syndromes (ACS) difficult. This study aimed at: 1) identifying determinants of hs-cTnT levels in an unselected population of elderly subjects; and 2) assessing the prognosis value of increased hs-cTnT in elderly people free of ACS.Hs-cTnT was measured in 591 individuals aged over 65 years without suspicion of ACS. Comorbidities were assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). C-reactive protein, αAge, gender, cardiac CIRS-G, estimated glomerular filtration rate (p<0.001 for all), albumin (p<0.028) and αHs-cTnT level is associated with inflammation and renal function in the elderly. Independently of comorbidities, hs-cTnT concentration increases exponentially with age after 65 years. Decision limits adapted to age and sex may be useful to patient management.

Sensitivity and specificity of troponin t in diagnosis of acute myocardial infarction

Lately, in the diagnosis of acute myocardial infarction (MI), special attention is paid to the study of small molecular weight proteins, representing the strucrutal components of cardial muscle controctile proteins, such as cardial troponin T (cTnT). Therefore, the aim of this study was to determine and compare the specificity and sensitivity of cTnT myoglobine and the activity of standard tested enzymes such as: creatine kinase (CK), CK MB isoenzymes and lactic delytrogenase (LDH) in early diagnosis of acute MI. The study concerned the four groups of patients. The first group consisted of healty blood donors (n = 105), the second of patients with verified acute MI (n = 30), the third of a patients with polytrauma (n = 30), and the fourth of patients with cardiovascular diseases with no proved MI (n = 30). For the determination of cTnT level, the commercial Eleccys Troponin T STAT test was used (third generation), Boehringer Mannheim company, based on ECLIA (tehnique of electrochemical luminiscent analysis), designated for the work with automated analysis Elecsys 2010. The concentration of myoglobine (Mi) was determined by immunoturbiometric method, while the activity of other enzymes was determined by the standard IFCC methods with biochemical analyser HITACHI 911, Boehringer Manheim, and with original test reagents. The reference values of blood donor individuals found in the blood ranged from 0.01 to 0.028 ng/mL. In the group of patients with acute MI, biochemical markers (cTnT, CK, CK MB, Mi and LDH) were determined as soon as the material was received by the 24 h service and 4, 8 16, 24, 48, 72, 96, 120, 144, 168, 192 and 216 hours later. In patients with polytrauma the markers were tested 8 hours after surgery and in patients with other cardiovascular deseases with non documented acute MI immediattely after admission, and 4, 8, 16 and 24 hours later. The level of cTnT in patients with proved acute MI was increased at the first testing after admission. The highest values were found at hour 16, gradually declining thereafter, but maintaining above the higher control level in the next 216 hours after admission. In patients with cardiovascular diseases and non documented acute MI the level of cTnT was unchanged. Comparison of results of these two groups of patients showed statistically significant differences in cTnT levels in patients with acute MI during all tested time intervals. In the group of patients with polytrauma only the value of cTnT was within the normal level. Diagnostic precision of tested cardiac markers was also tested by ROC analysis. According to the data obtained, only cTnT exhibited statistically significiant diagnostic precision immediately after the admission of patients with the following calculated ROC AUC: 0.855 for cTnT, 0.716 for CK, 0.503 for CK MB and 0.552 for LDH, respectively. According to the presented data, it can be concluded that cTnT was the most specific and the most sensitive marker in the diagnosis of acute MI.