Troponin Concentrations Research Articles

Troponin level at presentation as a prognostic factor among patients presenting with non-ST-segment elevation myocardial infarction.

Timely reperfusion within 120 min is strongly recommended in patients presenting with non-ST-segment myocardial infarction (NSTEMI) with very high-risk features. Evidence regarding the use of high-sensitivity cardiac troponin (hs-cTn) concentration upon admission for the risk-stratification of patients presenting with NSTEMI to expedite percutaneous coronary intervention (PCI) and thus potentially improve outcomes is limited. All patients admitted to a tertiary care center ICCU between July 2019 and July 2022 were included. Hs-cTnI levels on presentaion were recorded, dividing patients into quartiles based on baseline hs-cTnI. Association between initial hs-cTnI and all-cause mortality during up to 3 years of follow-up was studied. A total of 544 NSTEMI patients with a median age of 67 were included. Hs-cTnI levels in each quartile were: (a) ≤122, (b) 123-680, (c) 681-2877, and (d) ≥2878 ng/L. There was no difference between the initial hs-cTnI level groups regarding age and comorbidities. A higher mortality rate was observed in the highest hs-cTnI quartile as compared with the lowest hs-cTnI quartile (16.2% vs. 7.35%, p = .03) with hazard ratio (HR) for mortality of 2.6 (95% confidence interval [CI]: 1.23-5.4; p = .012) in the unadjusted model, and HR of 2.06 (95% CI: 1.01-4.79; p = .047) with adjustment for age, gender, serum creatinine, and significant comorbidities. Patients with NSTEMI and higher hs-cTnI levels upon admission faced elevated mortality risk. This underscores the need for further prospective investigations into early reperfusion strategies' impact on NSTEMI patients' mortality, based on admission troponin elevation.

Role of Cardiac Troponins in Predicting Adverse Outcomes in Acute Coronary Syndrome With Renal Dysfunction.

A substantial global cause of mortality as well as disability is acute myocardial infarction (AMI). It is alsowidespread knowledge that patients with chronic kidney disease (CKD) possess greater mortality and cardiovascular disease risks than the rest of the population. A vital biomarker for the diagnosis of AMI is high-sensitive cardiac troponin T (hs-cTnT). Individuals afflicted with severe CKDfrequently exhibit increased hs-cTnTlevels, which can pose a significant diagnostic challenge in cases of non-ST elevation acute coronary syndrome (NSTE-ACS) necessitating revascularization. Alteration in kidney function exerts an impact on troponin levels, making a single value less useful. As the renal population has an increased risk of non-ST-segment elevation myocardial infarction (NSTEMI), serial tracking of cardiac biomarkers is essential to detect ACS in this population. Numerous studies using algorithmic remedies based on admission troponin and spontaneous variations in troponin concentration have been put forth by researchers to address these issues. A considerable majority of CKD patients can be accurately diagnosed or excluded from having AMI using the approach, which involves serial measures. Patients who suffer from kidney impairment exhibit lesser chances of undergoing angiography or revascularizationand receiving preventative therapies. Furthermore, their outcomes are comparatively poorer when compared to patients who possess normal kidney function. Despite studies indicating a higher risk of poor outcomes after AMI in this population, these patients are less likely to receive guideline-indicated care. In this study, we employed a systematic literature review (SLR) methodology to provide an account of the available studies and to draw attention to the importance of cardiac troponins in predicting unfavorable outcomes and algorithms in the prediction, diagnosis, and prognosis of patients with ACS and renal impairment. Eight papers were chosen for in-depth analysis after reviewing 86 articles from trusted publications between 2013 and August 3, 2023. The analysis considered factors such as sensitivity, severity of renal damage, algorithms used, the benefits of algorithms, and the challenges. One must examine the change in cardiac troponin (cTn) and take higher cut-off values into consideration in order to increase the sensitivity and specificity for the diagnosis of AMI. Higher levels of cTn have also been correlated prognostically to unfavorable outcomes like incident heart failure and death from cardiovascular causes. Also, raised troponin levels have been linked to all-cause and cardiovascular death in both dialysis patients and patients with CKD who did not receive dialysis. Future studies should concentrate on whether troponin testing can reclassify risk and provide treatment in people with CKD who are at the greatest threat of death. The clinical practice benefits of routinely measuring cardiac troponin concentrations are largely unknown. Future research should also concentrate on figuring out how troponin testing can influence clinical management and how to address the root reasons for chronic hs-cTnT elevation in patients with CKD, which may include elements like uremic toxicity, macrovascular or microvascular ischemia, anemia, as well as reduced renal clearance.

Asymptomatic troponin I elevation and acute myocarditis in the late period of gene replacement therapy with onasemnogene aberpavovec for patients with spinal muscular atrophy: literature review and clinical case series

Introduction. Spinal muscular atrophy (SMA) 5q is a rare genetically determined progressive neuromuscular disorder, is the most frequent cause of infant death not long ago. Nowadays onasemnogen abeparvovec as pathogenetic therapy is successfully used in clinical practice to combat this disease. Gene replacement therapy (GRT) with onasemnogen abeparvovec for SMA patients may come amid non-target changes in the cardiovascular system that require early diagnosis and monitoring.
 Objective. To present clinical reports considering children with genetically confirmed SMA and elevated troponin I levels after onasemnogen abeparvovec gene replacement therapy.
 Materials and methods. We monitored forty two children with genetically confirmed SMA who received gene replacement therapy with onasemnogen abeparvovec in the pediatric neurology department. All patients were tested for troponin I before and after the infusion, additional tests of N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP), creatine phosphokinase-MB (CPK-MB), electrocardiogram, echocardiography were made if needed.
 Results. In 11 (26.2%) of 42 SMA children troponin I was elevated and detected up to the eighth week after drug administration. At the same time, an increased concentration of troponin I in the majority of cases (41 out of 42 children) was not associated with clinically significant manifestations. There was only one case when acute myocarditis, confirmed by clinical and instrumental methods of investigation occurred. It was a girl with a long-term (10 months) elevation of troponin I, who had an intercurrent infection.
 Conclusions. Troponin I elevations detected after GRT with onasomnogene abeparvovec in SMA patients are often asymptomatic. This myocarditis case highlights the importance of longer cardiac monitoring of troponin I elevations, especially in the presence of intercurrent bacterial and viral infections.

FRI119 Cardiac Biomarkers In Fabry Disease Exhibit Distinct Associations With Cardiovascular Outcomes: A (Rare) Prism For Cardiovascular Endocrinology

Abstract Disclosure: E. Shemesh: None. R. Rusk: None. P. Feigin: None. P. Deegan: None. Background: Fabry disease (FD) (OMIM 301500) is a rare x-linked metabolic disorder. Cardiovascular involvement in this rare metabolic disorder is common, including hypertrophy, fibrosis, heart failure and arrythmias. Troponin concentrations are often continuously elevated in FD patients, which at times may lead to false assumptions and unnecessary invasive investigations. Furthermore, while nt-proBNP, another cardiac biomarker, is regarded by some as a valuable biomarker in FD, its concentrations might be falsely high due to renal involvement in the disease. We sought to explore the associations between these cardiac biomarkers with myocardial architecture and clinical outcomes in patients with FD. Hypothesis: Biomarkers in FD associate similarly with myocardial architecture and clinical outcomes. Results: 107 patients from a tertiary referral center in the United Kingdom were included in this study. Mean age at first visit was 44.5±17 years. Study population was composed of 40 males and 67 females. Twenty males and 43 females carried a classic mutation. At baseline, 27% had elevated troponin concentrations and 30% of patients had elevated nt-proBNP concentrations. Throughout follow-up, 17 cardiac-related hospitalizations were recorded, and 12 cardiac-related deaths occurred. While troponin and nt-proBNP concentrations at baseline were closely related (r= 0.5, p < 0.05), distinct associations with future occurrence of cardiac architecture pathologies were noted: elevated troponin concentrations associated with presence of late gadolinium enhancement and left ventricular hypertrophy in a statistically significant manner (late gadolinium enhancement: r=0.54, p<0.05; hypertrophy: r-0.45, p<0.05), but nt-proBNP did not. However, both biomarkers associated with adverse clinical outcomes, and nt-proBNP displayed stronger correlation with future heart failure events than troponin (r= 0.52, p<0.05 vs r=0.3, p<0.05). Neither troponin nor nt-proBNP baseline concentrations associated with the implantation of cardiac device (defibrillator or pacemaker). Conclusions: Cardiac biomarkers associate differently with myocardial architecture pathologies, but similarly with clinical outcomes in FD. Our results imply distinct roles for troponin and nt-proBNP in adverse cardiac events in FD. Presentation: Friday, June 16, 2023

A-015 Hemoglobin A1c Control is An Independent Predictor of Circulating Troponin Concentrations Using Machine Learning

Abstract Background Diabetes mellitus (DM) is associated with multiple comorbidities that may precipitate cardiac damage and elevated cardiac troponin (cTn) concentrations including renal failure, hyperlipidemia (HLD), hypertension (HTN), coronary artery disease (CAD), and congestive heart failure (CHF). Diabetics >70 years old have a higher likelihood of adverse outcomes including major cardiovascular events and cardiac mortality. However, the risk to younger diabetic patients and the precipitating factor(s) that facilitate cardiac injury in those with DM are unknown. The objective of this study was to investigate factors predictive of cTn concentrations in young, relatively healthy diabetic patients. Methods We collected 1533 remnant plasma samples from outpatients between 06/22–09/22 with physician ordered hemoglobin A1c testing. cTn was measured using the Abbott ARCHITECT High Sensitivity Troponin-I assay (limit of detection = 1.7 ng/L, imprecision = 4.76% at 50 ng/L). Demographic information (sex, race, BMI) and pertinent medical history (diabetes, HTN, HLD, CAD, CHF) were collected from the electronic medical record, along with estimated glomerular filtration rate (eGFR) and hemoglobin A1c. Exclusion criteria included: patients with missing laboratory data, those undergoing cancer treatment, or a history of myocardial infarction/cardiomyopathy/cardiac surgery. Troponin results were classified as normal- or high-risk using a cut-off of 10 ng/L for females and 12 ng/L for males, thresholds previously shown to correlate with incidence of cardiovascular disease risk within 15 years. Univariate statistics were calculated using Wilcoxon rank sum tests. An XGBoost model was trained to predict high-risk troponinemia, and summary statistics were calculated on a held-out test set. Results Of the 1135 patients that met inclusion criteria, 621 (54.7%) were female. The median age was 60 years (IQR: 49–69 years) and the median A1c was 6.2% (IQR: 5.8%–7.0%). A total of 746 patients (65.7%) had a prior diabetes diagnosis, with 156 patients (13.7%) having prediabetes, 42 patients (3.7%) having Type 1, and 548 patients (48.3%) having Type 2. Median troponin concentration for patients with an A1c <5.7% was 1.6 ng/L (IQR: 0.8–3.4), 5.7%–6.4% was 2.2 ng/L (IQR: 1.3–4.8), and ≥6.5% was 2.9 ng/L (IQR: 1.6–6.7). Univariate analysis demonstrated significant differences in troponinemia by age (CI of difference: 4.4–8.9 years), A1c (0.2%–0.7%), and eGFR (28–38 mL/min/1.73 m2). The machine learning model demonstrated strong predictive capacity (sensitivity: 0.74, specificity: 0.86, PPV: 0.5, NPV: 0.92, area under ROC curve: 0.91). The features with the greatest impact on area under the ROC curve when removed were eGFR, Age, A1c, and CHF. Conclusion A combination of clinical and laboratory variables can be used to predict circulating troponin concentrations in outpatients. A1c control was an independent contributor to cTn concentrations, both in univariate and multivariate analyses. This study provides evidence that glucose control may be associated with cardiac damage and future cardiovascular events, warranting longitudinal outcome studies.

Impacts of high sensitivity troponin T reporting on care and outcomes in clinical practice: Interactions between low troponin concentrations and participant sex within two randomized clinical trials

BackgroundThe impacts of high sensitivity cardiac troponin (hs-cTn) reporting on downstream interventions amongst suspected acute coronary syndrome (ACS) in the emergency department (ED), especially amongst those with newly identified hs-cTn elevations and in consideration of well-established sex-related disparities, has not been critically evaluated to date. This investigation explores the impact of hs-cTnT reporting on care and outcomes, particularly by participant sex. MethodsTwo similarly ED-based randomized controlled trials conducted between July 2011 to March 2013 (n = 1988) and August 2015 to April 2019 (n = 3378) were comparatively evaluated. Clinical outcomes were adjudicated to the Fourth Universal Definition of MI. Changes in practice were assessed at 30 days, and death or MI were explored to 12 months. ResultsThe HS-Troponin study demonstrated no difference in death or MI with unmasking amongst those with hs-cTnT <30 ng/L, whereas the RAPID TnT study demonstrated a significantly higher rate. In RAPID TnT, there was significant increase in death or MI associated with unmasking for females with hs-cTnT <30 ng/L (masked: 11[1.5%], unmasked: 25[3.4%],HR: 2.27,95%C.I.:1.87–2.77,P < 0.001). Less cardiac stress testing with unmasking amongst those <30 ng/L was observed in males in both studies, which was significant in RAPID TnT (masked: 92[12.0%], unmasked: 55[7.0%], P = 0.008). In RAPID TnT, significantly higher rates of angiography in males were observed with unmasking, with no such changes amongst females <30 ng/L (masked: 28[3.7%], unmasked: 51[6.5%],P = 0.01). ConclusionCompared with males, there were no evident impacts on downstream practices for females with unmasking in RAPID TnT, likely representing missed opportunities to reduce late death or MI.

THE EFFECT OF DRY WHITE MISTLETOE EXTRACT ON THE CHANGE IN THE RATIO OF MITOCHONDRIAL SUBPOPULATIONS IN THE MYOCARDIUM IN ANIMALS WITH ALCOHOLIC CARDIOMYOPATHY

The aim of the research was to study the cardioprotective effect of dry white mistletoe extract in the context of assessing its effect on changes in the activity of interfibrillary and subsarcolemmal mitochondrial subpopulations of the myocardium in experimental alcoholic cardiomyopathy. Materials and methods. Alcoholic cardiomyopathy was modeled in female Wistar rats by course administration of ethanol at the rate of 3 g of absolute ethanol per 1 kg of animal body weight. The studied extract of white mistletoe leaves and the comparison drug – Trimetazidine – were administered orally at doses of 100 mg /kg and 35 mg/kg, respectively. Changes in troponin I concentration and serum creatine phosphokinase activity, citrate synthase activity in mitochondrial subpopulations, and the content of apoptosis markers – apoptosis-inducing factor and caspase 3 in myocardial tissue homogenate were determined during the work. Results and their discussion. The analysis of the results revealed that in rats with alcoholic cardiomyopathy, but without treatment, there is an increase in the concentration of troponin I and creatine phosphokinase activity, accompanied by an increase in the intensity of apoptosis reactions and citrate synthase activity of interfibrillary mitochondria. The use of Trimetazidine and the extract under analysis contributed to a decrease in troponin I content by 19.1% (p &lt; 0.05) and 24.4%, respectively, and creatine phosphokinase activity by 19.8% (p &lt; 0.05) and 28.4% (p &lt; 0.05). It was also established that the activity of subsarcolemmal mitochondria in animals treated with Trimetazidine and white mistletoe extract increased by 121.9% (p &lt; 0.05) and 306.3% (p &lt; 0.05) with a decrease in the activity of citrate synthase of interfibrillary mitochondria by 27.6% (p &lt; 0.05) and 41.4% (p &lt; 0.05). It should be noted that administration of the comparative drug and the studied extract to rats resulted in a decrease in cardiomyocytes' apoptosis, expressed in a decrease in the concentration of apoptosis-inducing factor and caspase 3. Conclusions. In conditions of alcoholic cardiomyopathy, the negative interfibrillary phenotype of mitochondria prevails, which can contribute to the development of energy deficiency in the heart muscle, increasing the degree of myocardial damage. Based on the data obtained, it can be assumed that the extract of white mistletoe contains an active substance of cardioprotective activity associated with restoring the energy metabolism and suppression of apoptosis in the myocardium.

Cardiac Troponin I and Electrocardiographic Evaluation in Hospitalized Cats with Systemic Inflammatory Response Syndrome.

Several studies conducted on humans demonstrate the increase in cardiac troponins and the onset of arrhythmias in the course of systemic inflammatory response syndrome (SIRS). The aim of the current study was to assess the blood concentration of cardiac troponin I (cTnI) and electrocardiographic findings in SIRS-affected cats. Seventeen shorthair cats hospitalized with SIRS were enrolled (Group 1). SIRS diagnosis was performed based on the detection of at least two of the four criteria such as abnormal body temperature, abnormal heart rate (i.e., tachycardia or bradycardia), abnormal respiratory rate (i.e., tachypnea or bradypnea), and alterations of white blood cell number (i.e., leukocytes or band neutrophils). Ten cats screened for elective surgery such as neutering or dental procedures were evaluated as a control population (Group 2). They were considered healthy based on history, physical examination, hematological and biochemical profile, urinalysis, coprological exam, thyroxine assay, blood pressure measurement, and echocardiography. A physical examination, complete blood cell count, biochemistry test (including an electrolyte panel), electrocardiographic examination, and cTnI assay were carried out in each cat enrolled. Traumatic events, gastrointestinal, neoplastic, respiratory, and neurological disorders were identified as causes of SIRS in Group 1. In Group 1, a significantly higher concentration of cTnI than that in Group 2 was recorded (p = 0.004). In 37.5% of cats with SIRS, ventricular premature complexes occurring in couplets with multiform configuration were detected. Similarly, to humans, data herein reported would indicate possible cardiac damage present in cats with SIRS diagnosis.

Treadmill running intensity and post-exercise increase in plasma cardiac troponin I and T-A pilot study in healthy volunteers.

Plasma concentrations of cardiac troponins increase in healthy individuals after strenuous training, but the response to lower exercise intensities has not been characterized. To determine whether exercise at moderate intensity significantly increases plasma cardiac troponins measured with different assays in healthy recreational athletes. Twenty-four self-reported healthy volunteers were instructed to complete three 60-min bouts of treadmill running at variable intensities: High-intensity training (HIT) including a maximal exercise test and an anaerobic threshold test followed by training at 80%-95% of maximum heart rate (HRmax ), Moderate-intensity training (MIT) at 60%-75% of HRmax , and Low-intensity training (LIT) at 45%-55% of HRmax . Blood samples were collected before and at 2, 4, and 6 h after HIT and 4 h after MIT and LIT. Troponin I and T were measured in plasma samples with assays from Abbot, Siemens, and Roche. Plasma troponins measured with all assays were significantly increased compared to baseline after HIT but not after LIT. After HIT, the fraction of all participants with one or more values above the assay-specific 99th percentiles ranged from 13% to 61%. The biomarker criteria for acute myocardial injury were met after HIT for troponin T in 75% of female participants having no clinical evidence of coronary artery disease. High-intensity, but not moderate- or low-intensity, training for 60 min induced a potentially clinically significant increase in plasma cardiac troponins in healthy volunteers. Results exceeding the population 99th percentiles were most frequent with the troponin T assay.

Impacts of dietary lipids derived from animal or vegetable sources on healthy rats

ABSTRACT This study sought to assess the health impact of feeding adult healthy rats with either 7% (w/w) animal-derived fat (subcutaneous rump fat or peri-kidney fat) from domestic buffalo or vegetable oil (corn oil or olive oil) for 8 weeks on bioactivity; lipid profile; hepatic and cardiac histological changes. Twenty-four male albino rats were randomly categorized into four dietary groups (six rats/group): 1) diet contains 7% (w/w) corn oil; 2) diet contains 7% (w/w) olive oil; 3) diet contains 7% (w/w) subcutaneous rump fats and 4) diet contains 7% (w/w) Peri-kidney fats. Animal fats intake significantly increased serum total lipids (TL), triacylglycerol (TG), low-density lipoprotein cholesterol (LDLC), cardiac troponin-I (CTn-I) concentration as well as alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), creatine kinase MB (CK-MB) and lactate dehydrogenase (LDH) activities compared to vegetable oils intake. In histopathological research, liver and heart sections excised from rats consumed animal-derived fats showed several signs of extensive damage, including inflammation as well as fibrosis. Compared to animal-derived fats, vegetable oils consumption markedly increased serum high-density lipoprotein cholesterol (HDLC) concentration and exhibited a potential attenuation effect on liver and heart enzymes activities and a potential role in the reduction of TG in the bloodstream of rats as well as revealed normal liver and heart histopathological architectures. In conclusion, this study suggests that, replacing animal fats, especially peri-kidney fat with vegetable oils, particularly olive oil in diets, liver and heart can be protected.

Sustained Ventricular Tachycardia in Acute Coronary Syndrome with ST Segment Elevation: Incidence, Predictive Factors and Related Mortality.

Background: Sustained Ventricular Tachycardia is the most serious complication; in acute coronary syndrome with ST segment elevation, several international studies have reported incidence and predictive factors of severe ventricular arrhythmias, without identifying sustained ventricular tachycardia separately; also, its epidemiological data is lacking in Algeria. Aims: The main objective of our study is the determination of the frequency of sustained ventricular tachycardia in acute coronary syndrome with ST segment elevation, the secondary objective was the analysis of predictive factors of this arrhythmia, and related mortality. Methods and materials: In this prospective study, conducted in the cardiology department of Hussein Dey hospital (Algiers-Algeria), 467 patients with acute coronary syndrome with elevated ST segment (87 women and 380 men) were enrolled between 28 February 2014 and 16 July 2015. The average age is 60 ± 13 years; at admission, a Holter recorder was attached for continuous ECG monitoring during 48 hours Kruskal’s ANNOVA or H tests were used for comparison of quantitative variables, χ2 test or Fisher’s exact test, were used for qualitative variables, all tests were performed with 1st species risk of 5%. Results: The frequency of Sustained Ventricular Tachycardia is 3.6 % (17 patients), CI 95%: [1.9%-5.3%], multivariate analysis identified the following independent predictors: low diastolic blood pressure, severe coronary artery lesions, Elevated high sensitive troponin concentrations more than 5ng/ml. The risk of mortality expressed by Hazard Ration (HR) is 6. (CI95%: [1.7-21], p = 0.005); the predictors of mortality are: occurrence of ventricular fibrillation and low diastolic blood pressure. Conclusion: Sustained Ventricular tachycardia is the most serious complication during acute coronary syndrome with elevated ST segment, its predictive factors according to our study are: low diastolic blood pressure, severe coronary lesions, Elevated high sensitive troponin concentrations more than 5ng/ml, its occurrence increases the risk of hospital mortality.

Investigation of the cardiac effects of exercise testing on apparently healthy Boxer dogs.

Holter electrocardiographic monitoring is a cornerstone of diagnostic testing for arrhythmogenic cardiomyopathy (ACM) in Boxer dogs, but physical activity during monitoring is not controlled. In humans, exercise testing (ExT) can identify latent tachyarrhythmias associated with cardiomyopathy, and exercise increases serum cardiac troponin-I concentrations ([hs-cTnI]). These effects have not yet been investigated in Boxer dogs. Subjecting Boxer dogs to brief, moderate-intensity ExT can identify changes in Holter recordings and [hs-cTnI] compared to baseline results. Thirty overtly healthy, client-owned Boxer dogs. Prospective interventional study. Dogs underwent baseline diagnostic testing including 24-hour Holter monitoring and [hs-cTnI], followed by brief ExT (accompanied, brisk stair-climbing and -descending for <5 minutes). Eleven dogs (37%) had >100 premature ventricular complexes (PVCs)/24 hours at baseline (3), ExT (3), or both (5). After ExT, these dogs had more PVCs/24 hours and greater increases in [hs-cTnI] compared to those with ≤100 PVCs/24 hours. Dogs with the striatin mutation had more PVCs/24 hours and a greater increase in [hs-cTnI] after ExT than did dogs without the striatin mutation. Exercise testing may improve the binary classification of Boxer dogs with or without ACM by increasing the number of PVCs and [hs-cTnI] in affected dogs to a greater degree than in unaffected dogs. This effect also is associated with presence or absence of the striatin mutation. Exercise should be a controlled variable when screening Boxer dogs for ACM.

Hemodialysis and biomarkers of myocardial infarction- a cohort study.

End-stage renal disease is associated with a high risk of cardiovascular disease. We compared the concentration and prognostic ability of high sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) and cardiac myosin-binding protein C (cMyC) among stable hemodialysis patients. Patients were sampled before and after hemodialysis. We measured hs-cTnI, hs-cTnT and cMyC and used Cox regressions to assess the association between quartiles of concentrations and all-cause mortality and a combination of cardiovascular events and all-cause mortality during follow-up. A total of 307 patients were included, 204 males, mean age 66 years (SD 14). Before dialysis, 299 (99 %) had a hs-cTnT concentration above the 99th percentile, compared to 188 (66 %) for cMyC and 35 (11 %) for hs-cTnI. Hs-cTnT (23 %, p<0.001) and hs-cTnI (15 %, p=0.049) but not cMyC (4 %,p=0.256) decreased during dialysis. Follow-up was a median of 924days (492-957days); patients in the 3rd and 4th quartiles of hs-cTnT (3rd:HR 3.0, 95 % CI 1.5-5.8, 4th:5.2, 2.7-9.8) and the 4th quartile of hs-cTnI (HR 3.8, 2.2-6.8) had an increased risk of mortality. Both were associated with an increased risk of the combined endpoint for patients in the3rd and 4th quartiles. cMyC concentrations were not associated with risk of mortality or cardiovascular event. Hs-cTnT was above the 99th percentile in almost all patients. This was less frequent for hs-cTnI and cMyC. High cTn levels were associated with a 3-5-fold higher mortality. This association was not present for cMyC. These findings are important for management of hemodialysis patients.

Association between troponin level and medium-term mortality in 20 000 hospital patients

IntroductionCardiac troponin (cTn) concentrations above the manufacturer recommended upper limit of normal (ULN) are frequently seen in hospital patients without a clinical presentation consistent with type 1 myocardial infarction, and...

Prediction of perioperative myocardial infarction/injury in high-risk patients after noncardiac surgery.

Perioperative myocardial infarction/injury (PMI) is a surprisingly common, yet difficult to predict cardiac complication in patients undergoing non-cardiac surgery. We aimed to assess the incremental value of preoperative cardiac troponin (cTn) concentration in the prediction of PMI. Among prospectively recruited patients at high cardiovascular risk (age >65 years OR >45 years with pre-existing cardiovascular disease), PMI was defined as an absolute increase in high-sensitivity cTnT (hs-cTnT) concentration of ≥14ng/L (the 99th percentile) above the preoperative concentration. PMI was centrally adjudicated by two independent cardiologists using serial measurements of hs-cTnT. Using logistic regression, three models were derived: Model 1 included patient- and procedure-related information, Model 2 adding routinely available laboratory values, and Model 3 further adding preoperative hs-cTnT concentration. Models were compared also versus preoperative hs-cTnT alone. Findings were validated in two independent cohorts. Among 6'944 patients, PMI occurred in 1058 patients (15.2%). The predictive accuracy as quantified by the area under the receiver-operating characteristic curve was 0.73 (95%CI 0.71-0.74) for Model 1, 0.75 (95%CI 0.74-0.77) for Model 2, 0.79 (95%CI 0.77-0.80) for Model 3, and 0.74 for hs-cTnT alone. Model 3 included 10 preoperative variables: age, body-mass-index, known coronary artery disease, metabolic equivalent >4, risk of surgery, emergency surgery, planned duration of surgery, haemoglobin, platelet count and hs-cTnT. These findings were confirmed in both independent validation cohorts (n=722, n=966). Preoperative cTn adds incremental value above patient- and procedure-related variables as well as routine laboratory in the prediction of PMI.

The Effects of Statins on Cardiovascular and Inflammatory Biomarkers in Primary Prevention: A Systematic Review and Meta-Analysis.

Statins are well-established for their treatment of cardiovascular disease (CVD) due to their cholesterol-lowering effects and potential anti-inflammatory properties. Although previous systematic reviews demonstrate that statins reduce inflammatory biomarkers in the secondary prevention of CVD, none examine their effects on cardiac and inflammatory biomarkers in a primary prevention setting. We conducted a systematic review and meta-analysis to examine the effects of statins on cardiovascular and inflammatory biomarkers among individuals without established CVD. The biomarkers included are: cardiac troponin, N-terminal pro B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP), tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), soluble vascular cell adhesion molecule (sVCAM), soluble intercellular adhesion molecule (sICAM), soluble E-selectin (sE-selectin) and endothelin-1 (ET-1). A literature search was performed through Ovid MEDLINE, Embase and CINAHL Plus for randomised controlled trials (RCTs) published up to June2021. Overall, 35 RCTs with 26,521 participants were included in our meta-analysis. Data was pooled using random effects models presented as standardised mean differences (SMD) with 95% confidence intervals (CI). Combining 36 effect sizes from 29 RCTs, statin use resulted in a significant reduction in CRP levels (SMD -0.61; 95% CI -0.91, -0.32; P<0.001). This reduction was observed for both hydrophilic (SMD -0.39; 95% CI -0.62, -0.16; P<0.001) and lipophilic statins (SMD -0.65; 95% CI -1.01, -0.29; P<0.001). There were no significant changes in serum concentrations of cardiac troponin, NT-proBNP, TNF-α, IL-6, sVCAM, sICAM, sE-selectin and ET-1. This meta-analysis demonstrates that statin use reduces serum CRP levels in a primary prevention setting for CVD, with no clear effect on the other eight biomarkers studied.

High-Sensitivity Cardiac Troponin for Risk Assessment in Patients With Chronic Coronary Artery Disease

BackgroundCardiac troponin is used for risk stratification of patients with acute coronary syndromes; however, the role of testing in other settings remains unclear. ObjectivesThe aim of this study was to evaluate whether cardiac troponin testing could enhance risk stratification in patients with chronic coronary artery disease independent of disease severity and conventional risk measures. MethodsIn a prospective cohort of consecutive patients with symptoms suggestive of stable angina attending for outpatient coronary angiography, high-sensitivity cardiac troponin I was measured before angiography, and clinicians were blinded to the results. The primary outcome was myocardial infarction or cardiovascular death during follow-up. ResultsIn 4,240 patients (age 66 years [IQR: 59-73 years], 33% female), coronary artery disease was identified in 3,888 (92%) who had 255 (6%) primary outcome events during a median follow-up of 2.4 years (IQR: 1.3-3.6 years). In patients with coronary artery disease, troponin concentrations were 2-fold higher in those with an event compared with those without (6.7 ng/L [IQR: 3.2-14.2 ng/L] vs 3.3 ng/L [IQR: 1.7-6.6 ng/L]; P < 0.001). Troponin concentrations were associated with the primary outcome after adjusting for cardiovascular risk factors and coronary artery disease severity (adjusted HR: 2.3; 95% CI: 1.7-3.0, log10 troponin; P < 0.001). A troponin concentration >10 ng/L identified patients with a 50% increase in the risk of myocardial infarction or cardiovascular death. ConclusionsIn patients with chronic coronary artery disease, cardiac troponin predicts risk of myocardial infarction or cardiovascular death independent of cardiovascular risk factors and disease severity. Further studies are required to evaluate whether routine testing could inform the selection of high-risk patients for treatment intensification. (Myocardial Injury in Patients Referred for Coronary Angiography [MICA]; ISRCTN15620297)

Risk Factors of Suboptimal Coronary Blood Flow after a Percutaneous Coronary Intervention in Patients with Acute Anterior Wall Myocardial Infarction.

Primary percutaneous coronary intervention (PCI) is regarded as the most preferred strategy in ST-segment elevation myocardial infarction (STEMI). Thrombolysis in Myocardial Infarction (TIMI) flow grade has been an important and cohesive predictor of outcomes in STEMI patients. We sought to evaluate potential variables associated with the risk of suboptimal TIMI flow after PCI in patients with anterior wall STEMI. We evaluated 107 patients admitted to our hospital between 1 January 2019 and 31 December 2021 with a diagnosis of anterior wall STEMI treated with primary PCI. Suboptimal TIMI flow grade (≤2) after PCI occurred in 14 (13%) patients while grade 3 was found in 93 (87%) of them presenting with anterior wall STEMI. Failure to achieve optimal TIMI 3 flow grade after PCI was associated with lower TIMI grade prior to PCI (OR 0.5477, 95% CI 0.2589-0.9324, p = 0.02), greater troponin concentration before (OR 1.0001, 95% CI 1-1.0001, p = 0.0028) and after PCI (OR 1.0001, 95% CI 1-1.0001, p = 0.0452) as well as lower mean minimal systolic blood pressure (OR 0.9653, 95% CI 0.9271-0.9985, p = 0.04). Among predictors of suboptimal TIMI flow grade after PCI, we noted lower TIMI grade flow pre-PCI, greater serum troponin concentrations in the periprocedural period and lower mean minimal systolic blood pressure.

Clinical and Laboratory Parameters and Complication Rates In Patients With Myocardial Infarction Without Obstructive Coronary Artery Disease

To evaluate clinical, anamnestic and laboratory data and the incidence rate of complications in patients with myocardial infarction (MI) without obstructive coronary artery (CA) disease. This study included 158 patients with MI without obstructive CA disease (main group), 150 patients with MI and obstructive CA disease (comparison group), and 55 patients without documented ischemic heart disease (IHD) (control group). Clinical and anamnestic data, carbohydrate and lipid metabolism, concentrations of high-sensitivity troponin and C-reactive protein (CRP) were evaluated, and electrocardiography, Holter electrocardiogram monitoring, echocardiography, and coronary angiography were performed for all patients. The incidence rate of MI without obstructive CA disease was 1.9%, which was in general consistent with international data. Patients with MI without obstructive CA disease were somewhat younger than patients of the comparison group. Traditional risk factors, such as arterial hypertension (AH), acute cerebrovascular disease, diabetes mellitus (DM), and obesity were more frequently observed in patients with MI and obstructive CA disease, but the body weight index was significantly higher in MI patients without obstructive CA disease. The multivariate regression analysis identified the most significant factors associated with the development of MI in the group without obstructive CA disease: lipid metabolism disorders, AH, DM, male gender, smoking, and family history of IHD. Patients with MI without obstructive CA disease had a lower troponin level but a higher CRP level. Patients with MI without obstructive CA disease had a higher left ventricular (LV) ejection fraction (EF); acute heart failure (AHF), acute LV aneurism, and arrhythmias were the most frequent complication in this group. Patients with MI without obstructive CA disease had a higher LV EF, and their most frequent complications were AHF, acute LV aneurism, and arrhythmias.

Flexible-Interval High-Sensitivity Troponin Velocity for the Detection of Acute Coronary Syndromes

Many algorithms for emergency department (ED) evaluation of acute coronary syndrome (ACS) using high-sensitivity troponin assays rely on the detection of a "delta," the difference in concentration over a predetermined interval, but collecting specimens at specific times can be difficult in the ED. We evaluate the use of troponin "velocity," the rate of change of troponin concentration over a flexible short interval for the prediction of major adverse cardiac events (MACEs) at 30days. We conducted a prospective, observational study on a convenience sample of 821 patients who underwent ACS evaluation at a high-volume, urban ED. We determined the diagnostic performance of a novel velocity-based algorithm and compared the performance of 1- and 2-hour algorithms adapted from the European Society of Cardiology (ESC) using delta versus velocity. A total of 7 of 332 patients (2.1%) classified as low risk by the velocity-based algorithm experienced a MACE by 30days compared with 35 of 221 (13.8%) of patients classified as greater than low risk, yielding a sensitivity of 83.3% (95% confidence interval [CI] 68.6% to 93.0%) and negative predictive value (NPV) of 97.9% (95% CI 95.9% to 98.9%). The ESC-derived algorithms using delta or velocity had NPVs ranging from 98.4% (95% CI 96.4% to 99.3%) to 99.6% (95% CI 97.0% to 99.9%) for 30-day MACEs. The NPV of the novel velocity-based algorithm for MACE at 30days was borderline, but the substitution of troponin velocity for delta in the framework of the ESC algorithms performed well. In conclusion, specimen collection within strict time intervals may not be necessary for rapid evaluation of ACS with high-sensitivity troponin.