Normal cTnT Levels Research Articles

NOTCH and Tumor Necrosis Factor-Alpha Converting Enzyme Levels Could be used in COVID-19 for Risk Stratification

Background: Novel coronavirus disease-2019 (COVID-19) has become a public emergency that is characterized by a dysregulated immune response and hypercoagulable state. The purpose of the present study was to evaluate NOTCH and tumor necrosis factor-alpha converting enzyme (TACE) levels in COVID-19-infected patients and assess their predictive value on the severity of the disease. Methods: A total of 116 severe-critical COVID-19 patients who were interned intensive care were included in the study. The severity of the disease was evaluated according to the WHO classification system. Patients were divided into two groups according to their cTroponin T (cTnT) levels. Patients who had cTnT levels at least five times the upper limit of normal constituted Group 1 (n = 58); patients who had normal cTnT levels constituted Group 2 (n = 58). Besides, 62 age- and sex-matched healthy controls, who applied to cardiology outward clinic were taken as a control group (Group 3). All patients underwent echocardiographic examination. NOTCH and TACE levels were assessed using enzyme-linked immunosorbent assay. Results: The average age of the patients was 59.96 ± 15.46 years, 92 (51.7%) were female and 86 (48.3%) were male. The mean length of hospital stay was 16.35 ± 10.97 days. NOTCH levels were significantly higher in Group 1 patients compared to Group 2 and control group of patients P = 0.001). NOTCH levels of Group 2 were significantly higher compared to the control group (P = 0.002). Similarly, the TACE levels of Group 1 were significantly higher than that of Group 2 and the control group (P = 0.001). Mortality and length of hospital stay were significantly higher in Group 1 patients compared to Group 2 patients (P = 0.002 and P = 0.004, respectively). TACE levels of deceased patients were significantly higher than that of live patients (P = 0.004). There was a positive relationship between the length of hospital stay and NOTCH levels in Group 1 patients (r = 0.527, P = 0.003). TACE and NOTCH levels were positively correlated with troponin levels (r = 0.627 and r = 0.671, respectively P < 0.001 for both). NOTCH value of 0.34 nmol/L and TACE value of 6.53 μg/mL predicted inhospital mortality with a sensitivity of 90.30% and 63.6% and specificity of 91.5% and 78.6%, respectively. Conclusion: Measurement of NOTCH and TACE levels during severe acute respiratory syndrome coronavirus infection could be helpful for risk stratification.

The role of cardiac troponin T in detection of cardiac damage and long term mortality in children with chronic renal disease.

Karadaş U, Özdemir Karadaş N, Bak M, Serdaroğlu E, Yılmazer MM, Meşe T. The role of cardiac troponin T in detection of cardiac damage and long term mortality in children with chronic renal disease. Turk J Pediatr 2019; 61: 873-878. In this study, we aimed to evaluate the role of cardiac troponin T (cTnT) in detecting myocardial involvement in children with chronic kidney disease (CKD) and to investigate whether it contributes to predicting cardiac involvement and mortality at follow-up. Echocardiographic evaluations were performed on a sample of 69 patients, of which 33 (47.8%) were female, with grade 3, 4 and 5 chronic renal failure and end-stage renal failure. Patients with normal cTnT levels and patients with high cTnT levels were compared. cTnT levels were observed to be high in 13 (19%) of the 69 patients. The comparison between the patients with normal cTnT levels and patients with high cTnT levels with regards to the echocardiographic findings revealed that in the latter group, the average ejection fraction and fractional shortening levels were lower (p=0.003 and p=0.013, respectively), the detection rate of left ventricular systolic dysfunction was 5.5 times higher and the rate of detection of left ventricular hypertrophy (LVH) was 3 times higher (p=0.004, p=0.011). In this study, it was shown that it is possible to obtain information about cardiac effects by examining the serum cTnT level before clinical symptoms occur in children with CKD, and that cTnT can be used for screening purposes.

Time course changes of cystatin C and inflammatory and biochemical markers in non-ST-elevation acute coronary syndromes

Serum cystatin C (Cys-C), a good marker of renal function, predicts prognosis in non-ST-elevation acute coronary syndromes (NSTE-ACS). However, no data are available on the time course of Cys-C values after discharge. In this study, Cys-C was measured during admission (ACS sample) and 6 weeks after discharge, and was correlated with troponin (c-TNT), high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6) and the N-terminal portion of the pro-brain natriuretic peptide (proBNP) peptide (NT-proBNP) in a highly selected homogeneous group of NSTE-ACS patients. In this prospective, multicentre study, patients with a first NSTE-ACS, single-vessel disease and successful percutaneous coronary interventions (PCIs) had their sera collected, aliquoted and stored at the enrolling site and then shipped for analysis to the clinical chemistry core laboratory. Cys-C values slightly, but significantly, increased from the ACS samples to the 6-week samples. In contrast, hsCRP, NT-proBNP and IL-6 values significantly decreased from the ACS to the 6-week sample. Patients with elevated c-TNT levels had higher hsCRP, NT-proBNP and IL-6 values than patients with normal c-TNT levels in the ACS sample, whereas Cys-C levels were similar in patients with and without elevated c-TNT. Cys-C was highly correlated with estimated glomerular filtration rate in both the ACS and 6-week samples. In contrast to inflammatory and biochemical stress markers, Cys-C is not affected by the occurrence of myocardial necrosis or by acute left-ventricular impairment, being a reliable marker of renal function during NSTE-ACS.

Serum Cardiac Troponin T, But Not Troponin I, Is Elevated in Idiopathic Inflammatory Myopathies: Figure 1.

To study the association of serum cardiac troponin T (cTnT) and cardiac troponin I (cTnI) with creatine kinase (CK) in patients with idiopathic inflammatory myopathies (IIM). We performed a retrospective study on patients with IIM followed by the rheumatology service of a county hospital from 2004 to 2008. Patients with myocardial ischemia and/or with renal failure were excluded. Clinical data including electromyogram, muscle biopsy, and CK, cTnT and cTnI were recorded. Patients who had simultaneous analysis of CK and cardiac troponin (cTnT or cTnI) levels were studied. CK levels were correlated with cTnT and cTnI by chi-square test and Spearman correlation. We identified 49 patients with IIM (69 observations) who satisfied our inclusion criteria. The primary diagnosis was polymyositis in 23, dermatomyositis in 16, and myositis associated with connective tissue disease in 10 patients. There were 33/49 women with average age 45.8 years. Twenty-eight patients with IIM had simultaneous CK and cTnT values assayed. Of those patients, 18/23 with elevated CK also had elevated cTnT, and 5/5 patients with normal CK levels had normal cTnT levels (p = 0.005). In 41 patients with IIM who had simultaneous CK and cTnI levels assayed, only 1/29 with elevated CK had elevated cTnI, and 12/12 patients with normal CK had normal cTnI (p = 0.5). CK correlated strongly with the cTnT (r = 0.62, p = 0.001) but did not correlate with cTnI. Elevated cTnT, but not cTnI, was highly associated with CK in patients with IIM despite the absence of myocardial ischemia.

Profiles of Serial Changes in Cardiac Troponin T Concentrations and Outcome in Ambulatory Patients With Chronic Heart Failure

The purpose of this study was to determine whether different profiles of cardiac troponin T (cTnT) values assessed over time would yield incremental prognostic information on clinically stable outpatients with heart failure (HF). cTnT levels were used to estimate prognosis in HF; however, most studies evaluated hospitalized patients using single measurements. A cohort of 172 New York Heart Association functional class III to IV outpatients was prospectively studied with serial cTnT measurements collected every 3 months over a 2-year period. The primary end point was death or cardiac transplantation, and secondary end points included HF hospitalization. Of the 172 patients, 22 (13%) died or underwent transplantation during the first year. Therefore, 150 patients were included in the second-year analysis of 3 pre-determined groups: 1) no serial cTnT elevations (defined as <0.01 ng/ml); 2) 1 or more, but not all cTnT values elevated > or =0.01 ng/ml; and 3) all cTnT values elevated during the first year. During the second year, 30 events occurred: 53 patients had persistently normal cTnT levels (<0.01 ng/ml) with 6 primary events (11%); 57 patients had 1 or more but not all cTnT levels elevated with 11 events (19%); 40 patients demonstrated persistently elevated cTnT levels with 13 (33%) primary events (odds ratio: 3.77; 95% confidence interval: 1.28 to 11.07, p = 0.02). Elevations in cTnT, even using a low threshold of 0.01 ng/ml, detected during routine clinical follow-up of ambulatory patients with HF, are highly associated with an increased risk of events, particularly with frequent or persistent cTnT elevations of > or =0.01 ng/ml. Therefore, the ability to monitor clinical change through serial cTnT measurements may add to risk assessment in the ambulatory HF population.

Cardiac troponin T is not increased in patients with hypothyroidism

Patients with hypothyroidism often have increased creatine kinase (CK) levels. It is possible that there is increased production of CK, but other mechanisms, such as an increased cell membrane permeability or decreased enzyme clearance were also proposed. Recently, troponins T and I have been extensively studied because of their cardiac specificity. Cardiac troponins are sensitive and specific markers of cardiac injury. The objective of the study was to measure cardiac troponin T (cTnT) levels in patients with hypothyroidism. Twenty-five patients with primary hypothyroidism were evaluated (thyroid-stimulating hormone (TSH) >30 mU/L and low FT(4)). In all patients thyrotropin (TSH), free thyroxine (FT(4)), CK, CK-MB and cTnT were measured.There were 3 men and 22 women with a mean age of 47.5 +/- 12.4 years. TSH levels ranged from 31 to 75 mIU/L and mean FT(4) levels were 4.5 +/- 1.9 pmol/L. CK was normal in 11 patients and increased in 14. CK levels ranged between 86 and 1221 U/L (normal levels <170 in women, <195 in men) with a mean of 322 U/L +/- 279. CK-MB was increased in 4 patients (16%) and normal in 21. All 25 patients had normal cTnT levels, < 0.01 ng/mL (normal levels 0-0.1 microg/L). Increase in CK and its MB fraction are common in patients with hypothyroidism but cTnT levels are not, even in patients with increased CK-MB. Therefore, cTnT is a reliable marker of cardiac injury even in the hypothyroid patient.

Increased levels of cardiac Troponin-T in outpatients with heart failure and preserved systolic function are related with worse clinical findings and adverse outcome

Background: Increased levels of cardiac troponin T (cTnT) have been reported in chronic heart failure with low ejection fraction, and this finding was associated with measures of disease severity and poor prognosis. However, the prevalence and prognostic usefulness of myocardial damage in the presence of diastolic dysfunction has been poorly evaluated. The hypothesis of this study was that many mechanism could trigger increasing of cTnT levels in HF patients with preserved systolic function, and it would be related with both disease severity and prognosis. Methods: Clinical, echocardiographic, 6 minute walk test distance, and laboratory data were prospectively obtained in 69 CHF outpatients with ejection fraction (EF) >=40%. Blood samples were assayed for cTnT with a 3rd generation immunoassay and values >=0.02 ng/mL were considered abnormal. Patients were followed-up during a mean of 6 months Results: Increased levels of cTnT at baseline, 3- and 6-months were found in 13%, 21% and 7% with mean cTnT value of 0.044±0.028 ng/mL, 0.048±0.042 ng/mL and 0.071±0.054 ng/mL. Thus, cTnT level >=0.02 ng/mL in at least one sample was found in 21 patients (34%, Group 1). Comparisons between Group 1 patients and those with normal cTnT levels (Group 2) are shown in the table 1. In a multiple regression analysis, hospital admissions during the previous year (p = 0.049, HR = 4.30, IC 1.01-18.37), low systolic blood pressure (p = 0.048, HR = 0.96, IC 0.93-0.99), and age (p = 0.045, HR = 1.07, IC 1.001-1.14) were independent predictors of myocardial damage. In patients with elevated and normal cTnT levels, the rates of death was 19 vs 0% (p = 0.002), and worsening- CHF was 52.4 vs. 18.8% (p = 0.005). Eight-month free CHF-hospitalization survival was 61% in Group 1 and. 96% in Group 2 (log rank test p = 0.0001). Conclusion: One third of CHF outpatients with preserved systolic function had increased cTnT levels and it correlated with clinical measures of disease severity. Previous clinical instability, low systolic pressure and aging were independent markers of elevated cTnT. Moreover, ongoing myocardial damage was associated with worse long term-prognosis suggesting a relationship with progression of heart failure.Table 1cTnT>=0.02 ng/mLCTnT<0.02 ng/mLp valueAge (years,SD)71.2±1064±12.50.024Prior hospital admission62%31.3%0.017Systolic blood pressure (mmHg,SD)128.1±21.3139.5±22.40.056Ischemic etiology57.1%43.8%NSNYHA class (means,SD)2.8±0.82.1±0.90.003LVEF (%,SD)53.3±9.653.9±8.5NS6 min walk test (meters,SD)328±110385±980.056Diabetes mellitus33.3%20.8%NS Open table in a new tab Background: Increased levels of cardiac troponin T (cTnT) have been reported in chronic heart failure with low ejection fraction, and this finding was associated with measures of disease severity and poor prognosis. However, the prevalence and prognostic usefulness of myocardial damage in the presence of diastolic dysfunction has been poorly evaluated. The hypothesis of this study was that many mechanism could trigger increasing of cTnT levels in HF patients with preserved systolic function, and it would be related with both disease severity and prognosis. Methods: Clinical, echocardiographic, 6 minute walk test distance, and laboratory data were prospectively obtained in 69 CHF outpatients with ejection fraction (EF) >=40%. Blood samples were assayed for cTnT with a 3rd generation immunoassay and values >=0.02 ng/mL were considered abnormal. Patients were followed-up during a mean of 6 months Results: Increased levels of cTnT at baseline, 3- and 6-months were found in 13%, 21% and 7% with mean cTnT value of 0.044±0.028 ng/mL, 0.048±0.042 ng/mL and 0.071±0.054 ng/mL. Thus, cTnT level >=0.02 ng/mL in at least one sample was found in 21 patients (34%, Group 1). Comparisons between Group 1 patients and those with normal cTnT levels (Group 2) are shown in the table 1. In a multiple regression analysis, hospital admissions during the previous year (p = 0.049, HR = 4.30, IC 1.01-18.37), low systolic blood pressure (p = 0.048, HR = 0.96, IC 0.93-0.99), and age (p = 0.045, HR = 1.07, IC 1.001-1.14) were independent predictors of myocardial damage. In patients with elevated and normal cTnT levels, the rates of death was 19 vs 0% (p = 0.002), and worsening- CHF was 52.4 vs. 18.8% (p = 0.005). Eight-month free CHF-hospitalization survival was 61% in Group 1 and. 96% in Group 2 (log rank test p = 0.0001). Conclusion: One third of CHF outpatients with preserved systolic function had increased cTnT levels and it correlated with clinical measures of disease severity. Previous clinical instability, low systolic pressure and aging were independent markers of elevated cTnT. Moreover, ongoing myocardial damage was associated with worse long term-prognosis suggesting a relationship with progression of heart failure.

C-reactive protein is a marker for a complex culprit lesion anatomy in unstable angina.

The putative theory is that the clinical syndrome of unstable angina is caused by rupture of the atherosclerotic plaque with superimposed thrombus formation. It is characterized by angiographically complex coronary lesions in the majority of patients. This study aimed at assessing the correlation between C-reactive protein (CRP) and the complexity of culprit coronary lesions in unstable angina. We identified culprit lesion complexity in 96 patients with unstable angina and normal creatine kinase (CK) and CK-MB mass. Serum concentrations of CRP (N < 5.0 mg/l) and cardiac troponin T (cTnT; N < 0.1 ng/ml) were measured on admission. There was a trend toward a higher grade of anatomical complexity of the culprit lesion in patients with elevated CRP (p = 0.007) and cTnT levels (p = 0.027). Patients who had intermediate- or high-grade lesion severity had a higher level of CRP (8.5 +/- 5.7 mg/l) and cTnT (0.118 +/- 0.205 ng/ml) on admission than those who had normal or low-grade lesions (5.7 +/- 4.0 mg/l, 0.017 +/- 0.021 ng/ml, respectively); Mann-Whitney U, p = 0.002 and p < 0.001, respectively. Furthermore, the likelihood of having intermediate- or high-grade complexity of the culprit lesion was higher when CRP levels were elevated in all patients (p = 0.007, odds ratio [OR] = 4.286; 95% confidence interval [CI] 1.492-12.310) and in those with normal cTnT levels (p = 0.025, OR = 3.876; 95% CI 1.185-12.678). Also, higher CRP levels strongly correlated with the need for revascularization interventions (p < 0.0005). Elevated CRP level on admission is a marker for anatomic complexity of culprit lesions and need for revascularization interventions in unstable angina.

Cardiac Troponin T in Patients With Clinically Suspected Myocarditis

Objectives. The present study investigated whether myocyte injury can be assessed sensitively by measurement of serum levels of cardiac troponin T (cTnT) in patients with clinically suspected myocarditis and whether cTnT levels may predict the results of histologic and immunohistologic analysis of endomyocardial biopsy specimens.Background. Conventionally used laboratory variables often fail to show myocyte injury in patients with clinically suspected myocarditis, possibly because of a low extent of myocardial injury in these patients. Sensitive variables for myocyte injury have not yet been investigated.Methods. Eighty patients with clinically suspected myocarditis were screened for creatine kinase (CK) activity, MB isoform of CK (CK-MB) activity and cTnT. Endomyocardial biopsy specimens were examined histologically and immunohistologically.Results. cTnT was elevated in 28 of 80 patients with clinically suspected myocarditis, CK in 4 and CK-MB in 1. Histologic analysis alone of the endomyocardial biopsy specimen revealed evidence of myocarditis in only five patients, all with elevated cTnT levels. Twenty-three of 28 patients with elevated cTnT levels had histologically negative findings for myocarditis. Additional immunohistologic analysis revealed evidence of myocarditis in 26 (93%) of 28 patients with elevated cTnT levels and in 23 (44%) of 52 patients with normal cTnT levels. Mean cTnT levels were higher in patients with myocarditis proved histologically or immunohistologically, or both, than in patients without myocarditis (0.59 ± 1.68 vs. 0.04 ± 0.05, p < 0.001).Conclusions. Measurement of serum levels of cTnT provides evidence of myocyte injury in patients with clinically suspected myocarditis more sensitively than does conventional determination of cardiac enzyme levels. Myocardial cell damage may be present even in the absence of histologic signs of myocarditis. Additional immunohistologic analysis often shows lymphocytic infiltrates in these patients. Elevated levels of cTnT are highly predictive for myocarditis in this group.