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Troponin Sensitive Diagnosis

A L Vilchez-Monge, I Garutti, C J Lisbona, L Olmedilla, J M Perez-Peña
Blood troponins are used to diagnose perioperative myocardial injury and infarction. During liver transplantation, a passive donor-recipient troponin transfer with the graft may result in an increase of troponins in the transplant recipient questioning the diagnosis of myocardial injury. We present a case of liver transplantation with sudden elevation of recipient's serum troponin levels immediately after graft reperfusion and its subsequent normalization in which myocardial damage and other non-ischaemic potential causes were ruled out...
December 2018: British Journal of Anaesthesia
Daniel Kraus, Beatrice von Jeinsen, Stergios Tzikas, Lars Palapies, Tanja Zeller, Christoph Bickel, Georg Fette, Karl J Lackner, Christiane Drechsler, Johannes T Neumann, Stephan Baldus, Stefan Blankenberg, Thomas Münzel, Christoph Wanner, Andreas M Zeiher, Till Keller
Background Patients with chronic kidney disease ( CKD ) are at high risk of myocardial infarction. Cardiac troponins are the biomarkers of choice for the diagnosis of acute myocardial infarction ( AMI ) without ST -segment elevation ( NSTE ). In patients with CKD , troponin levels are often chronically elevated, which reduces their diagnostic utility when NSTE - AMI is suspected. The aim of this study was to derive a diagnostic algorithm for serial troponin measurements in patients with CKD and suspected NSTE - AMI ...
October 2, 2018: Journal of the American Heart Association
Christian Widera, Evangelos Giannitsis, Matthias Mueller-Hennessen, Ines Reimann, Anja Guba-Quint, Ivonne Marquardt, Kerstin Bethmann, Sven Meyer
INTRODUCTION: Sex- and age-specifichigh-sensitivity Troponin T (hs-cTnT) cutpoints for the diagnosis and prognosis in acute coronary syndromes are not well established. We evaluated the use of such dichotomous thresholds for calculation of the GRACE score. METHODS: We analyzed a retrospective cohort study of 1146 patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Sex-dependenths-cTnT cutpoints comprised 15.5ng/L for men and 9.0ng/L for women, while the sex-/age-specific cutpoints comprised 17ng/L for 50-64-year-old men and ≥65-year-old women, 31ng/L for ≥65-year-old men and 14ng/L for the remainder of patients...
October 11, 2018: International Journal of Cardiology
Tar-Choon Aw, Wei-Ting Huang, Thu-Thao Le, Chee-Jian Pua, Briana Ang, Soon-Kieng Phua, Khung-Keong Yeo, Stuart A Cook, Calvin W L Chin
The 99th percentile upper reference limits (URL) of high-sensitivity cardiac troponin (hs-cTn) in healthy subjects are essential for diagnosis and management of cardiovascular diseases. Unless screened stringently, subclinical disease affects the derived URL. In 779 healthy subjects(49% males; 17-88 years) screened by cardiovascular magnetic resonance (CMR), the gold standard for assessing cardiac volumes and myocardial mass; and estimated glomerular filtration rate (eGFR), the 99th percentile URL of hsTnT (Roche) and hs-cTnI (Abbott) were similar to the published URL...
October 18, 2018: Scientific Reports
Serkan Ünlü, Serdar Gökhan Nurkoç, Burak Sezenöz, Mehmet Cingirt, Özlem Gülbahar, Adnan Abacı
BACKGROUND: High-sensitive cardiac troponin (hsTn) levels can be elevated due to non-pathological events such as strenuous exercise. However, the effect of statins on circulating hsTnT levels with moderate exercise is uncertain. Therefore, we evaluated the impact of statins on hsTnT level with moderate exercise. METHODS: We enrolled a total of 56 patients: 26 statin users and 30 non-users. All patients were shown to have no coronary artery disease before participating in the study...
October 17, 2018: Acta Cardiologica
Lindsay Reardon, William J Scheels, Adam J Singer, Robert F Reardon
BACKGROUND: Speckle tracking echocardiography (STE) is a novel technology that measures regional wall-motion abnormalities that may speed diagnosis and intervention of acute coronary occlusion in Emergency Department (ED) patients with non-ST elevation ACS (NSTE-ACS). STE provides an objective measurement of myocardial strain that is superior to visual assessment of wall motion when performed as part of a point-of-care (POC) echocardiogram. We determined the feasibility and preliminary accuracy of POC STE operated by emergency providers when compared to comprehensive echocardiography or final diagnosis of ACS...
September 4, 2018: American Journal of Emergency Medicine
Mingyang Yao, Linlin Zhao, Lili Wu, Wenbin Zhang, Yi Luan, Jiale Song, Guosheng Fu, Junhui Zhu
OBJECTIVE: It is controversial whether preprocedural elevated high sensitivity C-reactive protein (CRP) could increase the incidence of periprocedural myocardial infraction (PMI) of higher risk stratifications. The primary aim of this study was to evaluate whether preoperative elevated CRP level was related to the incidence of PMI in patients who underwent percutaneous coronary intervention (PCI). METHODS: A total of 4,426 patients [66 y (59, 75); 72.3% males] with normal preprocedural cardiac enzymes were prospectively divided into two groups; the elevated CRP group was defined as CRP >3 mg/L, which was approximately 30...
September 17, 2018: Anatolian Journal of Cardiology
Milos Tajsic, Rudolf Járai, Johannes Koch, Karl Stangl, Johann Wojta, Henryk Dreger, Kurt Huber
BACKGROUND: Mr-proANP is a biomarker produced in atrial and left ventricular myocardium. We investigated the effect of combined measurement of mr-proANP and high-sensitive cardiac Troponin I assay of the penultimate generation (s-cTnI) for an early type-1 and type-2 NSTE-ACS rule-out with emphasis on the very early presenters' subgroup with symptom onset time (SOT) ≤ 2 h. METHODS: This was a prospective cohort study of 311 consecutive patients admitted to ER with symptoms suggestive of an acute coronary syndrome (ACS)...
September 26, 2018: International Journal of Cardiology
Mladjan Golubovic, Dragana Stanojevic, Milan Lazarevic, Velimir Peric, Tomislav Kostic, Miodrag Djordjevic, Sasa Zivic, Dragan J Milic
Introduction: The Revised Cardiac Risk Index (RCRI) is an extensively used simple risk stratification tool advocated by the European Society of Cardiology and European Society of Anesthesiology (ESC/ESA). Purpose: The aim of this study was to find the best model for predicting 3-month cardiovascular complications in elective major vascular surgical patients using preoperative clinical assessment, calculation of the RCRI and Vascular Physiological and Operative Severity Score for the enumeration of mortality and morbidity (V-POSSUM) scores, and the preoperative levels of N-terminal brain natriuretic peptide (NT pro-BNP), high-sensitivity troponin I (hs TnI), and high-sensitivity C-reactive protein (hs CRP)...
2018: BioMed Research International
Ragna Elise Støre Govatsmark, Imre Janszky, Stig Arild Slørdahl, Marta Ebbing, Rune Wiseth, Bjørnar Grenne, Elisabeth Vesterbekkmo, Kaare Harald Bønaa
AIMS: Health registers are used for administrative purposes, disease surveillance, quality assessment, and research. The value of the registers is entirely dependent on the quality of their data. The aim of this study was to investigate and compare the completeness and correctness of the acute myocardial infarction (AMI) diagnosis in the Norwegian Myocardial Infarction Register and in the Norwegian Patient Register. METHODS: All Norwegian patients admitted directly to St Olavs hospital, Trondheim University Hospital, Trondheim University Hospital from 1 July to 31 December 2012 and who had plasma levels of cardiac troponin T measured during their hospitalization ( n=4835 unique individuals, n=5882 hospitalizations) were identified in the hospital biochemical database...
September 29, 2018: Scandinavian Journal of Public Health
Bashir Alaour, Felicity Liew, Thomas E Kaier
The definition of a high-sensitivity cardiac Troponin (cTn) assay describes the ability to quantify a cardiac biomarker level in at least 50% of healthy individuals. This advance in analytic sensitivity has come with a perceived loss of specificity in the most classic application - chest pain triage and the diagnosis of acute myocardial infarction (AMI). As cardiac Troponin can no longer be used as a dichotomous test, the medical field is increasingly moving towards a more granular interpretation. However, rapid rule-out/rule-in algorithms for AMI still rely on concrete thresholds for efficient triage, irrespective of the patient's comorbidities...
September 28, 2018: Annals of Medicine
Andrew McRae, Michelle Graham, Tasnima Abedin, Yunqi Ji, Hong Yang, Dongmei Wang, Danielle Southern, James Andruchow, Eddy Lang, Grant Innes, Isolde Seiden-Long, Lawrence DeKoning, Peter Kavsak
CLINICIAN'S CAPSULE What is known about the topic? Sex-specific, high-sensitivity cardiac troponin T (hs-cTnT) cut-offs increase the specificity of a myocardial infarction (MI) diagnosis. What did this study ask? Do sex-specific, hs-cTnT rule-out cut-offs enable ruling out MI in more patients while maintaining sensitivity? What did this study find? Sex-specific, hs-cTnT cut-offs ruled out MI in more patients than universal cut-offs; however, differences between sex-specific and universal cut-offs are small...
September 28, 2018: CJEM
Aitor Alquézar-Arbé, Juan Sanchís, Eva Guillén, Alfredo Bardají, Òscar Miró, Jordi Ordóñez-Llanos
Diagnosing or ruling out acute myocardial infarction (AMI) is a challenge faced daily in emergency departments. AMI evaluation usually requires the measurement of the cardiac troponin (cTn) concentration. The use of this biomarker improves AMI diagnosis provided the concentrations are properly interpreted in the context of the patient's condition and according to standard recommendations. This consensus statement was drafted by specialists in emergency medicine, cardiology and laboratory medicine. The authors recommend measuring the cTn concentration if AMI is suspected in emergency patients, whether the newest high-sensitivity cTn assays or the so-called contemporary ones are used...
October 2018: Emergencias: Revista de la Sociedad Española de Medicina de Emergencias
Ricardo Simões, Luciana Maria Silva, André Luiz Valle Mussi Cruz, Vanessa Gomes Fraga, Adriano de Paula Sabino, Karina Braga Gomes
The approach to breast cancer has changed in recent decades due to significant advances in screening, early diagnosis, and treatment; however, the risk of cardiovascular injury induced by chemotherapy has remained similar. Anthracyclines are the most common agents used in breast cancer treatment and may lead to cardiotoxicity, which appears to have a direct relationship with accumulated dose and duration of treatment. Therefore, the use of cardiac biomarkers derived from those used in cardiac disease diagnosis has been applied to the early identification, evaluation, and cardiotoxicity monitoring during chemotherapy...
November 2018: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
J Velilla Moliner, B Gros Bañeres, J Povar Marco, M Santaló Bel, J Ordoñez Llanos, A Martín Martín, F Temboury Ruiz
OBJECTIVE: To assess the diagnostic performance of high-sensitivity troponin T (hs-TnT) in patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS); confirm whether it shortens the time to diagnosis; and analyze the clinical consequences derived from its use. METHOD: A prospective, longitudinal observational study was carried out in 5 emergency care departments. Patients seen for chest pain with suspected of NSTE-ACS were consecutively included...
September 21, 2018: Medicina Intensiva
Anirban Sinha, Priya Gopinathan, Yi-Da Chung, Hsin-Ying Lin, Kuang-Hsien Li, Hsi-Pin Ma, Po-Chiun Huang, Shu-Chu Shiesh, Gwo-Bin Lee
As cardiovascular diseases (CVD) are responsible for millions of deaths annually, there is a need for rapid and sensitive diagnosis of CVD at earlier stages. Aptamers generated by systematic evolution of ligands by exponential enrichment (SELEX) processes have been shown to be superior to conventional antibody-based cardiac biomarker detection. However, SELEX is a complicated, lengthy procedure requiring multiple rounds of extraction/amplification and well-trained personnel. To circumvent such issue, we designed an automated, miniaturized SELEX platform for the screening of aptamers towards three protein biomarkers associated with CVDs: N-terminal pro-peptide of B-type natriuretic peptide, human cardiac troponin I, and fibrinogen...
December 30, 2018: Biosensors & Bioelectronics
Kai Hu, Dan Liu, Tim Salinger, Daniel Oder, Stefan Knop, Georg Ertl, Frank Weidemann, Stefan Frantz, Stefan Störk, Peter Nordbeck
Background: This study aimed to explore the value of cardiac biomarker [serum high sensitive troponin T (hs-TNT) and N-terminal pro-brain natriuretic peptide (NT-proBNP)] measurement in the differential diagnosis of infiltrative cardiomyopathy patients [Friedreich's ataxia (FA), Fabry disease (FD) and light-chain (AL) cardiac amyloidosis (CA)] with preserved left ventricular (LV) systolic function. Methods: Between 2012 and 2014, all consecutive patients presenting at our center with infiltrative cardiomyopathy and concomitant symmetrical LV hypertrophy as well as preserved LV systolic function were included in this study...
August 2018: Journal of Thoracic Disease
Richard Body
Chest pain accounts for approximately 6% of Emergency Department (ED) attendances and is the most common reason for emergency hospital admission. For many years, our approach to diagnosis has required patients to stay in hospital for at least 6-12 h to undergo serial biomarker testing. As less than one fifth of the patients undergoing investigation actually has an acute coronary syndrome (ACS), there is tremendous potential to reduce unnecessary hospital admissions. Recent advances in diagnostic technology have improved the efficiency of care pathways...
September 2018: Turkish Journal of Emergency Medicine
Manal Abd El Baky Mahmoud, Menat Allah Ali Shaaban, Ali Ali Ramzy
Objective: To assess the role of Copeptin in diagnosis of acute myocardial infarction in troponin-blind period. Subjects and methods: This study was conducted on 40 patients who presented to emergency department complaining of chest pain and were highly suspicious to have acute cardiac ischemia, in addition to 10 subjects serving as a healthy control group. Blood samples were collected for determination of CK-MB, cTnI and Copeptin. These were measured twice (in patients' group); at 3 h and then at 6-9 h from admission time...
September 2018: The Egyptian heart journal: (EHJ): official bulletin of the Egyptian Society of Cardiology
Anoop S V Shah, Atul Anand, Fiona E Strachan, Amy V Ferry, Kuan Ken Lee, Andrew R Chapman, Dennis Sandeman, Catherine L Stables, Philip D Adamson, Jack P M Andrews, Mohamed S Anwar, John Hung, Alistair J Moss, Rachel O'Brien, Colin Berry, Iain Findlay, Simon Walker, Anne Cruickshank, Alan Reid, Alasdair Gray, Paul O Collinson, Fred S Apple, David A McAllister, Donogh Maguire, Keith A A Fox, David E Newby, Christopher Tuck, Ronald Harkess, Richard A Parker, Catriona Keerie, Christopher J Weir, Nicholas L Mills
BACKGROUND: High-sensitivity cardiac troponin assays permit use of lower thresholds for the diagnosis of myocardial infarction, but whether this improves clinical outcomes is unknown. We aimed to determine whether the introduction of a high-sensitivity cardiac troponin I (hs-cTnI) assay with a sex-specific 99th centile diagnostic threshold would reduce subsequent myocardial infarction or cardiovascular death in patients with suspected acute coronary syndrome. METHODS: In this stepped-wedge, cluster-randomised controlled trial across ten secondary or tertiary care hospitals in Scotland, we evaluated the implementation of an hs-cTnI assay in consecutive patients who had been admitted to the hospitals' emergency departments with suspected acute coronary syndrome...
September 15, 2018: Lancet
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