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https://www.readbyqxmd.com/read/28087371/use-of-the-heart-pathway-with-high-sensitivity-cardiac-troponins-a-secondary-analysis
#1
Simon A Mahler, Jason P Stopyra, Fred S Apple, Robert F Riley, Gregory B Russell, Brian C Hiestand, James W Hoekstra, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, David M Herrington, Gregory L Burke, Chadwick D Miller
OBJECTIVES: The HEART Pathway combines a decision aid and serial contemporary cardiac troponin I (cTnI) measures to achieve >99% sensitivity for major adverse cardiac events (MACE) at 30days and early discharge rates >20%. However, the impact of integrating high-sensitivity troponin (hs-cTn) measures into the HEART Pathway has yet to be determined. In this analysis we compare test characteristics of the HEART Pathway using hs-cTnI, hs-cTnT, or cTnI. DESIGN & METHODS: A secondary analysis of participants enrolled in the HEART Pathway RCT was conducted...
January 10, 2017: Clinical Biochemistry
https://www.readbyqxmd.com/read/28062631/rule-in-and-rule-out-of-myocardial-infarction-using-cardiac-troponin-and-glycemic-biomarkers-in-patients-with-symptoms-suggestive-of-acute-coronary-syndrome
#2
Colleen Shortt, Jinhui Ma, Natasha Clayton, Jonathan Sherbino, Richard Whitlock, Guillaume Pare, Stephen A Hill, Matthew McQueen, Shamir R Mehta, P J Devereaux, Andrew Worster, Peter A Kavsak
BACKGROUND: Early rule-in/rule-out of myocardial infarction (MI) in patients presenting to the emergency department (ED) is important for patient care and resource allocation. Given that dysglycemia is a strong risk factor for MI, we sought to explore and compare different combinations of cardiac troponin (cTn) cutoffs with glycemic markers for the early rule-in/rule-out of MI. METHODS: We included ED patients (n = 1137) with symptoms suggestive of acute coronary syndrome (ACS) who had cTnI, high-sensitivity cTnI (hs-cTnI), hs-cTnT, glucose, and hemoglobin A1c (Hb A1c) measurements...
January 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28062627/association-of-repeatedly-measured-high-sensitivity-assayed-troponin-i-with-cardiovascular-disease-events-in-a-general-population-from-the-morgam-biomarcare-study
#3
Maria F Hughes, Francisco Ojeda, Olli Saarela, Torben Jørgensen, Tanja Zeller, Tarja Palosaari, Mark G O'Doherty, Anders Borglykke, Kari Kuulasmaa, Stefan Blankenberg, Frank Kee
BACKGROUND: High-sensitivity troponin I (hs-cTnI) concentrations reflect myocardial stress. The role of hs-cTnI in predicting long-term changes in the risk of cardiovascular disease (CVD) in general populations is not clearly defined. METHODS: We investigated whether the change in 3 repeated measures of hs-cTnI collected 5 years apart in a prospective Danish study (3875 participants, initially aged 30-60 years, 51% female, disease free at baseline) improves 10-year prediction of incident CVD compared to using a single most recent hs-cTnI measurement...
January 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28062612/cardiac-troponin-assays-guide-to-understanding-analytical-characteristics-and-their-impact-on-clinical-care
#4
REVIEW
Fred S Apple, Yader Sandoval, Allan S Jaffe, Jordi Ordonez-Llanos
BACKGROUND: Cardiac troponin I (cTnI) and cardiac troponin T (cTnT) determinations are fixtures in clinical practice and research. Cardiac troponin testing has been the standard of practice for the diagnosis of acute myocardial infarction (AMI), early rule-out, risk stratification, and outcomes assessment in patients presenting with acute coronary syndrome (ACS) and non-ACS myocardial injury. We recognize from reading the literature over the past several years how poorly understood the analytical characteristics are for cTnI and cTnT assays by laboratorians, clinicians, and scientists who use these assays...
January 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28029000/comparison-between-soluble-st2-and-high-sensitivity-troponin-i-in-predicting-short-term-mortality-for-patients-presenting-to-the-emergency-department-with-chest-pain
#5
Rossella Marino, Laura Magrini, Francesca Orsini, Veronica Russo, Patrizia Cardelli, Gerardo Salerno, Mina Hur, Salvatore Di Somma
BACKGROUND: High-sensitivity cardiac troponin I (hs-cTnI) and the soluble isoform of suppression of tumorigenicity 2 (sST2) are useful prognostic biomarkers in acute coronary syndrome (ACS). The aim of this study was to test the short term prognostic value of sST2 compared with hs-cTnI in patients with chest pain. METHODS: Assays for hs-cTnI and sST2 were performed in 157 patients admitted to the Emergency Department (ED) for chest pain at arrival. In-hospital and 30-day follow-up mortalities were assessed...
March 2017: Annals of Laboratory Medicine
https://www.readbyqxmd.com/read/27974385/simulation-models-of-misclassification-error-for-single-thresholds-of-high-sensitivity-cardiac-troponin-i-due-to-assay-bias-and-imprecision
#6
Andrew W Lyon, Peter A Kavsak, Oliver A S Lyon, Andrew Worster, Martha E Lyon
BACKGROUND: Clinical outcome studies for cardiac troponins (cTn) are expensive and difficult to design owing to variation in patients, in the assays, and in the incidence of different types of myocardial infarction (MI). To overcome these difficulties, simulation models were used to estimate the rate of misclassification error for MI and risk prediction resulting from assay bias and imprecision. METHODS: Finite mixture analysis of Abbott high-sensitivity cTnI (hs-cTnI) results at time 0 h in patients presenting early with acute coronary syndrome (ACS) symptoms to the emergency department (ED) [n = 145, Reducing the Time Interval for Identifying New Guideline (RING) study] allowed derivation of a simulation data set (n = 10000)...
December 14, 2016: Clinical Chemistry
https://www.readbyqxmd.com/read/27974383/high-sensitivity-troponin-t-vs-i-in-acute-coronary-syndrome-prediction-of-significant-coronary-lesions-and-long-term-prognosis
#7
Brede Kvisvik, Lars Mørkrid, Helge Røsjø, Milada Cvancarova, Alexander D Rowe, Christian Eek, Bjørn Bendz, Thor Edvardsen, Jørgen Gravning
BACKGROUND: High-sensitivity cardiac troponin (hs-cTn) T and I assays are established as crucial tools for the diagnosis of acute myocardial infarction (AMI), as they have been found superior to old troponin assays. However, eventual differences between the assays in prediction of significant coronary lesions and long-term prognosis in patients with acute coronary syndrome (ACS) have not been fully unraveled. METHODS: Serum concentrations of hs-cTnT (Roche), hs-cTnI (Abbott), and amino-terminal pro-B-type natriuretic peptide (NT-proBNP; Roche) in 390 non-ST-elevation (NSTE) ACS patients were evaluated in relation to significant coronary lesions on coronary angiography (defined as a stenosis >50% of the luminal diameter, with need for revascularization) and prognostic accuracy for cardiovascular mortality, all-cause mortality, as well as the composite end point of cardiovascular mortality and hospitalizations for AMI or heart failure...
December 14, 2016: Clinical Chemistry
https://www.readbyqxmd.com/read/27931558/time-to-shift-from-contemporary-to-high-sensitivity-cardiac-troponin-in-diagnosis-of-acute-coronary-syndromes
#8
REVIEW
Jamshed J Dalal, C K Ponde, Brian Pinto, C N Srinivas, Joy Thomas, Sunil Kumar Modi, Sanjay Mehta, Suvin Shetty, Manimarane, Bhupen Desai
Early rule-in and rule-out of non-ST-segment elevation myocardial infarction (NSTEMI) is a challenge. In patients with inconclusive findings on ECG, cardiac biomarkers play a crucial role in the diagnosis. The introduction of the new high-sensitive cardiac troponin test (hs-TnI assay) has changed the landscape of NSTEMI diagnosis. The new hs-TnI assay can detect troponin values at a lower level compared with a contemporary cardiac troponin (cTn) assay. The hs-cTnI assay has a coefficient of variation of ≤10%, well below the 99th percentile value...
November 2016: Indian Heart Journal
https://www.readbyqxmd.com/read/27879165/eahfe-tropica2-study-prognostic-value-of-troponin-in-patients-with-acute-heart-failure-treated-in-spanish-hospital-emergency-departments
#9
Javier Jacob, Alex Roset, Òscar Miró, Aitor Alquézar, Pablo Herrero, Francisco Javier Martín-Sanchez, Martin Möckel, Christian Müller, Pere Llorens
OBJECTIVE: Evaluate the use of different cardiac troponin (cTn) immunoassays and the prognostic value of increased cTn values in patients diagnosed with acute heart failure (AHF) in the emergency department (ED). METHOD: The EAHFE-TROPICA2 is a retrospective study including patients with AHF admitted in 34 Spanish EDs with cTn values determined in the ED. We studied the prevalence of elevated troponin (value above the established reference limit) for the different types of troponin...
November 23, 2016: Biomarkers: Biochemical Indicators of Exposure, Response, and Susceptibility to Chemicals
https://www.readbyqxmd.com/read/27815376/impact-of-smoking-on-circulating-cardiac-troponin-i-concentrations-and-cardiovascular-events-in-the-general-population-the-hunt-study-nord-tr%C3%A3-ndelag-health-study
#10
Magnus Nakrem Lyngbakken, Julia Brox Skranes, James A de Lemos, Ståle Nygård, Håvard Dalen, Kristian Hveem, Helge Røsjø, Torbjørn Omland
BACKGROUND: Both tobacco smoking and circulating cardiac troponin I (cTnI) levels are associated with the risk of acute myocardial infarction, heart failure, and cardiovascular death. However, whether cTnI levels differ according to smoking status and whether smoking modifies the prognostic relationship between cTnI and outcomes remain unclear. METHODS: Using data from a large, population-based cohort, we assessed the association between smoking and cTnI and the impact of smoking on the associations between cTnI levels and the incidence of acute myocardial infarction, heart failure, and cardiovascular death...
December 13, 2016: Circulation
https://www.readbyqxmd.com/read/27811209/discordance-between-icd-coded-myocardial-infarction-and-diagnosis-according-to-the-universal-definition-of-myocardial-infarction
#11
Jorge Díaz-Garzón, Yader Sandoval, Stephen W Smith, Sara Love, Karen Schulz, Sarah E Thordsen, Benjamin K Johnson, Brian Driver, Katherine Jacoby, Michelle D Carlson, Kenneth W Dodd, Johanna Moore, Nathaniel L Scott, Charles A Bruen, Ryan Hatch, Fred S Apple
BACKGROUND: International Classification of Diseases (ICD) coding is the standard diagnostic tool for healthcare management. At present, type 2 myocardial infarction (T2MI) classification by the Universal Definition of Myocardial Infarction (MI) remains ignored in the ICD system. We determined the concordance for the diagnosis of MI using ICD-9 coding vs the Universal Definition. METHODS: Cardiac troponin I (cTnI) was measured by both contemporary (cTnI) and high-sensitivity (hs-cTnI) assays in 1927 consecutive emergency department (ED) patients [Use of TROPonin In Acute coronary syndromes (UTROPIA) cohort] who had cTnI ordered on clinical indication...
January 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/27811206/economic-considerations-of-early-rule-in-rule-out-algorithms-for-the-diagnosis-of-myocardial-infarction-in-the-emergency-department-using-cardiac-troponin-and-glycemic-biomarkers
#12
Colleen Shortt, Feng Xie, Richard Whitlock, Jinhui Ma, Natasha Clayton, Jonathan Sherbino, Stephen A Hill, Guillaume Pare, Matthew McQueen, Shamir R Mehta, P J Devereaux, Andrew Worster, Peter Kavsak
BACKGROUND: We have previously demonstrated the utility of a rule-in/rule-out strategy for myocardial infarction (MI) using glycemic biomarkers in combination with cardiac troponin in the emergency department (ED). Given that the cost of assessing patients with possible MI in the ED is increasing, we sought to compare the health services cost of our previously identified early rule-in/rule-out approaches for MI among patients who present to the ED with symptoms suggestive of acute coronary syndrome (ACS)...
November 3, 2016: Clinical Chemistry
https://www.readbyqxmd.com/read/27811203/rapid-rule-out-of-acute-myocardial-injury-using-a-single-high-sensitivity-cardiac-troponin-i-measurement
#13
Yader Sandoval, Stephen W Smith, Anoop S V Shah, Atul Anand, Andrew R Chapman, Sara A Love, Karen Schulz, Jing Cao, Nicholas L Mills, Fred S Apple
BACKGROUND: Rapid rule-out strategies using high-sensitivity cardiac troponin assays are largely supported by studies performed outside the US in selected cohorts of patients with chest pain that are atypical of US practice, and focused exclusively on ruling out acute myocardial infarction (AMI), rather than acute myocardial injury, which is more common and associated with a poor prognosis. METHODS: Prospective, observational study of consecutive patients presenting to emergency departments [derivation (n = 1647) and validation (n = 2198) cohorts], where high-sensitivity cardiac troponin I (hs-cTnI) was measured on clinical indication...
January 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/27780745/cross-sectional-study-of-high-sensitivity-cardiac-troponins-t-and-i-in-a-hospital-and-community-outpatient-setting
#14
Julia M Potter, Aaron J Simpson, Jennifer Kerrigan, Emma Southcott, Marie M Salib, Gus Koerbin, Peter E Hickman
OBJECTIVES: Cardiac troponins are specific for the heart, but not for the acute coronary syndrome. We wanted to assess how common elevated cardiac troponin concentrations were, in a population with significant non-cardiac disease. DESIGN & METHODS: We measured both hs-cTnT and hs-cTnI on all samples submitted to the laboratory during one 24h period, and assessed the magnitude of the cTn concentration with the location and severity of disease of the patient. RESULTS: Community patients and patients from the maternity ward had the lowest cTn concentrations with results above the 99th percentile being only 0-2% of the total...
October 22, 2016: Clinical Biochemistry
https://www.readbyqxmd.com/read/27780717/high-sensitive-cardiac-troponin-t-hs-ctnt-assay-as-serum-biomarker-to-predict-cardiac-risk-in-myotonic-dystrophy-a-case-control-study
#15
Rea Valaperta, Maddalena Gaeta, Rosanna Cardani, Fortunata Lombardi, Benedetta Rampoldi, Claudia De Siena, Francesca Mori, Barbara Fossati, Paola Gaia, Ottavia Eleonora Ferraro, Simona Villani, Sara Iachettini, Marco Piccoli, Federica Cirillo, Enrico Pusineri, Giovanni Meola, Elena Costa
BACKGROUND: Myotonic dystrophy (DM) is a genetic disorder caused by nucleotide repeats expansion. Sudden death represents the main cause of mortality in DM patients. Here, we investigated the relationship between serum cardiac biomarkers with clinical parameters in DM patients. METHODS: Case-control study included 59 DM patients and 22 healthy controls. An additional group of 62 controls with similar cardiac defects to DM were enrolled. RESULTS: NT-proBNP, hs-cTnT and CK levels were significantly increased in DM patients compared to healthy subjects (p=0...
December 1, 2016: Clinica Chimica Acta; International Journal of Clinical Chemistry
https://www.readbyqxmd.com/read/27780552/relation-of-erectile-dysfunction-to-subclinical-myocardial-injury
#16
Torbjørn Omland, Anna Randby, Harald Hrubos-Strøm, Helge Røsjø, Gunnar Einvik
The circulating concentration of cardiac troponin I (cTnI) is an index of subclinical myocardial injury in several patient populations and in the general population. Erectile dysfunction is associated with greater risk for cardiovascular events, but the association with subclinical myocardial injury is not known. We aimed to test the hypothesis that the presence and severity of erectile dysfunction is associated with greater concentrations of cTnI in the general population. The presence and severity of erectile dysfunction was assessed by administering the International Index of Erectile Function 5 (IIEF-5) questionnaire to 260 men aged 30 to 65 years recruited from a population-based study...
September 13, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27754881/assessment-of-the-european-society-of-cardiology-0-hour-1-hour-algorithm-to-rule-out-and-rule-in-acute-myocardial-infarction
#17
John W Pickering, Jaimi H Greenslade, Louise Cullen, Dylan Flaws, William Parsonage, Sally Aldous, Peter George, Andrew Worster, Peter A Kavsak, Martin P Than
BACKGROUND: The new European Society of Cardiology guidelines to rule-in and rule-out acute myocardial infarction (AMI) in the emergency department include a rapid assessment algorithm based on high-sensitivity cardiac troponin and sampling at 0 and 1 hour. Emergency department physicians require high sensitivity to confidently rule-out AMI, whereas cardiologists aim to minimize false-positive results. METHODS: High-sensitivity troponin I and T assays were used to measure troponin concentrations in patients presenting with chest-pain symptoms and being investigated for possible acute coronary syndrome at hospitals in New Zealand, Australia, and Canada...
November 15, 2016: Circulation
https://www.readbyqxmd.com/read/27707754/diurnal-rhythm-of-cardiac-troponin-consequences-for-the-diagnosis-of-acute-myocardial-infarction
#18
Lieke J J Klinkenberg, Karin Wildi, Noreen van der Linden, Imre W K Kouw, Marijke Niens, Raphael Twerenbold, Maria Rubini Gimenez, Christian Puelacher, Jean Daniel Neuhaus, Petra Hillinger, Thomas Nestelberger, Jasper Boeddinghaus, Karin Grimm, Zaid Sabti, Judith A P Bons, Jeroen D E van Suijlen, Frans E S Tan, Joop Ten Kate, Otto Bekers, Luc J C van Loon, Marja P van Dieijen-Visser, Christian Mueller, Steven J R Meex
BACKGROUND: Interpretation of serial high-sensitivity cardiac troponin (hs-cTn) measurements for the diagnosis of acute myocardial infarction (AMI) assumes random fluctuation of hs-cTn around an individual's homeostatic set point. The aim of this study was to challenge this diagnostic concept. METHODS: Study 1 examined the presence of a diurnal hs-cTn rhythm by hourly blood sampling, day and night, in 24 individuals without a recent history of AMI. Study 2 assessed morning vs evening diagnostic accuracy of hs-cTnT and hs-cTnI in a prospective multicenter diagnostic study of 2782 unselected patients, presenting to the emergency department with acute chest pain...
December 2016: Clinical Chemistry
https://www.readbyqxmd.com/read/27705007/the-variation-in-high-sensitive-cardiac-troponin-concentration-during-haemodialysis-treatment-is-not-similar-to-the-biological-variation-observed-in-stable-end-stage-renal-disease-patients
#19
Øyvind Skadberg, Sverre Sandberg, Thomas Røraas, Per Hyltoft Petersen, Hilde Sellevoll, Einar Svarstad, Kristin Sæle, Kristin Moberg Aakre
BACKGROUND: Cardiovascular mortality is high in end stage renal disease (ESRD). This study aimed to: (1) calculate within-week within- and between-subject biological variation (CVI and CVG) for hs-cTn in ESRD; (2) determine the magnitude of hs-cTn concentration changes during haemodialysis (HD) treatment; and (3) compare the CVI and CVG to the within and between-subject variation of cTn concentration changes during HD treatments (CVDIFF-I and CVDIFF-G). METHODS: Serum samples were collected from 20 patients before and after 10 consecutive HD treatments...
December 2016: Scandinavian Journal of Clinical and Laboratory Investigation
https://www.readbyqxmd.com/read/27693077/impact-of-lipid-markers-and-high-sensitivity-c-reactive-protein-on-the-value-of-the-99th-percentile-upper-reference-limit-for-high-sensitivity-cardiac-troponin-i
#20
Magdalena Krintus, Marek Kozinski, Tomasz Fabiszak, Magdalena Kuligowska-Prusinska, Ewa Laskowska, Lieselotte Lennartz, Lena Nowak-Los, Jacek Kubica, Grazyna Sypniewska
OBJECTIVES: i) To assess the relationship between lipid markers and high-sensitivity C-reactive protein (hs-CRP), and high-sensitivity cardiac troponin I (hs-cTnI) in the reference population, and ii) to evaluate the impact of lipid markers and hs-CRP on the 99th percentile upper reference limit (URL) for hs-cTnI. METHODS: 531 questionnaire-identified presumably healthy individuals were enrolled in a single-center, cross-sectional study. Surrogate biomarkers for diabetes, myocardial and renal dysfunction were used to refine the healthy cohort (n=408)...
November 1, 2016: Clinica Chimica Acta; International Journal of Clinical Chemistry
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