Troponin T – ABC CARDIOL

ABC

Original Article

Diagnostic Performance of Coronary Tomography Angiography and Serial Measurements of Sensitive Cardiac Troponin in Patients With Chest Pain and Intermediate Risk for Cardiovascular Events

Alexandre de Matos Soeiro et al. Bruno Biselli Tatiana C.A.T. Leal Aline Siqueira Bossa … Maria Cristina César Sérgio Jallad Priscila Gherardi Goldstein Patrícia Oliveira Guimarães Carlos Vicente Serrano Jr Cesar Higa Nomura Débora Nakamura Carlos Eduardo Rochitte Paulo Rogério Soares Múcio Tavares de Oliveira Jr.

Abstract

Background

Coronary tomography angiography (CTA) has been mainly used for chest pain evaluation in low-risk patients, and few data exist regarding patients at intermediate risk.

Objective

To evaluate the performance of serial measures of sensitive troponin and CTA in intermediate-risk patients.

Methods

A total of 100 patients with chest pain, TIMI risk scores of 3 or 4, and negative troponin were prospectively included. All patients underwent CTA and those with coronary stenosis ≥ 50% were referred to invasive coronary angiography. Patients with coronary lesions <50% were discharged and contacted 30 days later by a telephone call to assess clinical outcomes. Outcomes were hospitalization, death, and myocardial infarction at 30 days. The comparison between methods was performed by Kappa agreement test. The performance of troponin measures and CTA for detecting significant coronary lesions and clinical outcomes was calculated. Results were considered statistically significant when p < 0.05.

Results

Coronary stenosis ≥ 50% on CTA was found in 38% of patients and significant coronary lesions on coronary angiography were found in 31 patients. Two clinical events were observed. Kappa agreement analysis showed low agreement between troponin measures and CTA in the detection of significant coronary lesions (kappa = 0.022, p = 0.78). The performance of CTA for detecting significant coronary lesions on coronary angiography or for predicting clinical events at 30 days was better than sensitive troponin measures (accuracy of 91% versus 60%).

Conclusion

CTA performed better than sensitive troponin measures in the detection of significant coronary disease in patients with chest pain and intermediate risk for cardiovascular events.

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IJCS

Original Article

The Correlation between Cardiac Enzymes and Cardiotrophin-1 Levels in Patients with Acute Coronary Syndrome

Ufuk Polat et al. Ali Aydinlar Serhat Caliskan Ferit Boyuk Orcun Unal

Abstract

Background

In the current era, there is always search for better cardiovascular biomarkers to early diagnose the disease.

Objectives

We aimed to investigate the association between a novel biomarker, cardiothropin-1 (CT-1), and standard markers of myocardial ischemia in patients with acute coronary syndrome (ACS) in Turkey.

Patients and Methods

In this prospective cohort study, patients who were admitted to our institution between July 2012 and July 2013 with the diagnosis of ACS were included. The standard markers of myocardial necrosis and CT-1 were evaluated at the time of admission and after 6 hours. Changes in laboratory parameters were statistically tested and correlated with routinely used markers of myocardial ischemia. The distribution of the data was analyzed by the Kolmogorov-Smirnov test. Proportional analysis and changes in laboratory parameters were evaluated with Chi-Square test and Fisher Exact test. Statistical significance was defined as p<0.05.

Results

The study enrolled 24 patients (14 male, 10 female) with ST-segment elevation myocardial infarction (STEMI) and 16 patients (9 male, 7 female) with non-ST-segment elevation myocardial infarction (NSTEMI) with elevated cardiac enzymes such as creatine kinase (CK), creatine kinase-MB (CK-MB) and Troponin-T (Tn-T). The average age of the patients was 61.45 ± 11.04 years. Increasing CT-1 levels were correlated with the increasing CK (p=0.035 and p=0.018, respectively), CK-MB (p=0.006 and p=0.096, respectively), and Tn-T (p=0.041 and p=0.000, respectively) at first and at the 6th hour measurements. The CT-1 values were found to be more increased in the STEMI group (p=0.0074).

Conclusion

CT-1 is one of the novel biomarkers for cardiac injury. It is correlated with standard markers of myocardial ischemia and the results suggest that CT-1 can be used as a new biomarker.

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ABC

Editorial

Cardiac Troponin as a Predictor of Myocardial Injury and Mortality from COVID-19

Jorge Henrique Paiter Nascimento et al. Bruno Ferraz de Oliveira Gomes Gláucia Maria Moraes de Oliveira

In Brazil, until August 1, 2020, 2,707,877 cases of COVID-19 were diagnosed, with 93,563 deaths. the lethality rate for the country, in this period, was 3.5% with mortality variable mortality depending on the region studied. It is the lowest in the South (11.1 deaths/100,000 inhabitants) and the highest in the North (60.2 deaths/100,000 inhabitants). Up to 20% of infected individuals require hospitalization and, of these, about 25% need to be taken to an intensive care unit (ICU). In severe cases of COVID-19, intense inflammatory response and hypercoagulability enhanced by hypoxemia justify the main clinical and laboratory findings.

In this population, the presence of Myocardial Injury (MI) is not uncommon, and increased cardiac troponin (cTn)I behaves as a predictor of in-hospital mortality. There is also a possibility of direct injury by a virus that could generate myocarditis. A necropsy study that documented the presence of a virus in 61.5% did not observe the inflow of inflammatory cells in the myocardium in the acute phase, and the long-term consequence of this cardiac infection is not yet known. However, the incidence of MI in patients admitted for this disease in Brazil is little known, and its prognostic impact is still poorly elucidated. A multicenter study with cardiac biomarkers is hampered by different laboratory tests between institutions.

[…]

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ABC

Editorial

Can Long-Distance Walking alter Cardiac Biomarkers and Echocardiographic Variables Related to Diastolic Function?

Leandro Franzoni

Walking is one of the most practiced physical activities worldwide. It is also included in physical exercise programs aiming at improving the health-related parameters in different populations.^, Therefore, the demand for amateur events encompassing walking has been increasing, especially those related to nature and the culture of a specific region. One of the best known amateur events in the world that involves walking is the “Camino de Santiago de la Compostela”. Moreover, here in Brazil, we have the “Rota das Missões”, located in the south of the country. The trajectories can have different distances, reaching nearly 40km of walking on the same day. These are two examples of activities that involve walking and add a cultural experience to the event.

In addition to the two abovementioned events, there are long-distance ecological hikes, where participants experience direct contact with nature, going through different terrain characteristics on the same day, reaching a total walking distance of up to 250 km during a 4-day event. We know that each individual responds differently to a certain stimulus; however, walking more than 50 km in one day going up and down slopes, on rough terrain, can have a negative physiological impact on any individual who undergoes this type of modality. In addition to the physiological damage, we are also concerned with the impact on the cardiovascular system in relation to the volume and intensity of this type of modality.^,

[…]

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ABC

Original Article

Prognostic Value of Troponin-T and B-Type Natriuretic Peptide in Patients Hospitalized for COVID-19

Gustavo Luiz Gouvêa de Almeida Junior et al. Fabricio Braga José Kezen Jorge Gustavo Freitas Nobre … Marcelo Kalichsztein Paula de Medeiros Pache de Faria Bruno Bussade Guilherme Loures Penna Vitor Oliveira Alves Marcella Alecrim Pereira Paula de Castro Gorgulho Milena Rego dos Santos Espelta de Faria Luis Eduardo Drumond Fabrini Batista Soares Carpinete Ana Carolina Lessa Brandão Neno Augusto César de Araújo Neno

Abstract

Background:

COVID-19 causes severe pulmonary involvement, but the cardiovascular system can also be affected by myocarditis, heart failure and shock. The increase in cardiac biomarkers has been associated with a worse prognosis.

Objectives:

To evaluate the prognostic value of Troponin-T (TNT) and natriuretic peptide (BNP) in patients hospitalized for Covid-19.

Methods:

This was a convenience sample of patients hospitalized for COVID-19. Data were collected from medical records to assess the association of TnT and BNP measured in the first 24 hours of hospital admission with the combined outcome (CO) of death or need for mechanical ventilation. Univariate analysis was used to compare the groups with and without the CO. Cox’s multivariate model was used to determine independent predictors of the CO.

Results:

We evaluated 183 patients (age = 66.8±17 years, 65.6% of which were males). The time of follow-up was 7 days (range 1 to 39 days). The CO occurred in 24% of the patients. The median troponin-T and BNP levels were 0.011 and 0.041ng/dL (p <0.001); 64 and 198 pg/dL (p <0.001), respectively, for the groups without and with the CO. In the univariate analysis, in addition to TnT and BNP, age, presence of coronary disease, oxygen saturation, lymphocytes, D-dimer, t-CRP and creatinine, were different between groups with and without outcomes. In the bootstrap multivariate analysis, only TnT (1.12 [95% CI 1.03-1.47]) and t-CRP (1.04 [95% CI 1.00-1.10]) were independent predictors of the CO.

Conclusion:

In the first 24h of admission, TnT, but not BNP, was an independent marker of mortality or need for invasive mechanical ventilation. This finding further reinforces the clinical importance of cardiac involvement in COVID-19. (Arq Bras Cardiol. 2020; 115(4):660-666)

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ABC

Original Article

Diastolic Function and Biomarkers of Long-Distance Walking Participants

Maicon Borges Euzebio et al. Priscila Valverde de O. Vitorino Watila Moura Sousa Milena Andrade Melo … Sérgio Henrique Nascente Costa Ana Luiza Lima Sousa Thiago de Souza Veiga Jardim Ana Carolina Arantes Paulo Cesar B. Veiga Jardim Weimar Kunz Sebba Barroso

Abstract

Background:

The effects of long-distance walking on the cardiovascular system have been little studied.

Objectives:

The general objective of this study was to verify these effects on the behavior of diastolic function and the cardiac biomarkers CK-MB (mass), troponin T, and NT-proBNP, in amateur athletes.

Method:

This longitudinal study, conducted in 2015, evaluated participants during the following 5 stages: E0 (baseline) before starting the trajectory and the others, E1, E2, E3, and E4, at the end of each day, totaling 244.7 km. At all stages, the biomarkers NT-proBNP, CK-MB (mass), and troponin T were measured. Echocardiogram was performed to analyze the E, A and E’ waves. P < 0.05 was adopted as significant.

Results:

The study evaluated 25 participants, with an average age of 46 ± 10.5 years and body mass index of 20.2 ± 2.3 kg/m2. Increased values were found for NT-proBNP from E0 to E1, E2, E3, and E4 (p < 0.001), CK-MB (mass) from E0 to E2 (p < 0.001), and E' wave from E0 to E1, E2, E3, and E4 (p < 0.001). Positive correlations were identified between the following: CK-MB (mass) and troponin T (E1: r = 0.524, p = 0.010; E4: r = 0.413, p = 0.044); CK-MB (mass) and NT-proBNP (E4: r = 0.539, p = 0.006); and E/A and E' (E0: r = 0.603, p < 0.001; E1: r = 0.639, p < 0.001; E4: r = 0.593, p = 0.002). A negative correlation was found between CK-MB (mass) and E/A (E1: r = −0.428, p = 0.041).

Conclusion:

The effects of intense, prolonged, and interspersed physical activity were verified based on significant variations in the behavior of CK-MB (mass), NT-proBNP, and the E’ wave. Notwithstanding the alterations found, there were no criteria suggestive of myocardial damage

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ABC

Original Article

Serial High-Sensitivity Troponin T in Post-Primary Angioplasty Exercise Test

Humberto Andres Vaz et al. Ana Paula Vanz Iran Castro

Abstract

Background:

The kinetics of high-sensitivity troponin T (hscTnT) release should be studied in different situations, including functional tests with transient ischemic abnormalities.

Objective:

To evaluate the release of hscTnT by serial measurements after exercise testing (ET), and to correlate hscTnT elevations with abnormalities suggestive of ischemia.

Methods:

Patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty were referred for ET 3 months after infarction. Blood samples were collected to measure basal hscTnT immediately before (TnT_0h), 2 (TnT_2h), 5 (TnT_5h), and 8 hours (TnT_8h) after ET. The outcomes were peak hscTnT, TnT_5h/TnT_0h ratio, and the area under the blood concentration-time curve (AUC) for hscTnT levels. Log-transformation was performed on hscTnT values, and comparisons were assessed with the geometric mean ratio, along with their 95% confidence intervals. Statistical significance was assessed by analysis of covariance with no adjustment, and then, adjusted for TnT_0h, age and sex, followed by additional variables (metabolic equivalents, maximum heart rate achieved, anterior wall STEMI, and creatinine clearance).

Results:

This study included 95 patients. The highest geometric means were observed at 5 hours (TnT_5h). After adjustments, peak hscTnT, TnT_5h/TnT_0h and AUC were 59% (p = 0.002), 59% (p = 0.003) and 45% (p = 0.003) higher, respectively, in patients with an abnormal ET as compared to those with normal tests.

Conclusion:

Higher elevations of hscTnT may occur after an abnormal ET as compared to a normal ET in patients with STEMI.

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ABC

Artigo Original

Moderate renal dysfunction is not associated with elevated Troponin T in acute coronary syndromes

Luis C. L. Correia et al. Carolina E. Barbosa Thais Cerqueira Ana Vasconcelos … Saulo Merelles Tiago Reis José C. Lima J. Péricles Esteves Marcela S. Teixeira

FUNDAMENTO: La interpretación de los resultados de troponina en pacientes con síndromes coronarias agudas (SCA) y enfermedad renal es dificultada debido al hecho de que la disfunción renal aumenta los niveles de troponina, independientemente de la necrosis miocárdica. Aunque se haya sido evidenciada la enfermedad renal en fase terminal está asociada con niveles elevados de troponina T cardíaca (TnT), aún no se conoce si este biomarcador es alterado por niveles menos severos de disfunción renal. OBJETIVOS: Evaluar si la disfunción renal moderada está asociada con la elevación de los niveles de TnT en pacientes con SCA. MÉTODOS: Un total de 145 individuos con SCA y clearance de creatinina > 30 ml/min fueron estudiados. El clearance de creatinina se estimó a través de la fórmula de Cockcroft-Gault y la TnT se midió en la admisión hospitalaria. Disfunción renal moderada se definió como clearance de creatinina de 30-59 ml/min y TnT positiva como niveles > 0,01 ug/L. RESULTADOS: No se observó alguna correlación entre el clearance de creatinina y TnT (r = – 0,06, P=0,45). Los niveles de TnT fueron similares entre individuos en el primero (mediana=0,05 ug/L), segundo (mediana=0 ug/L), tercero (mediana=0,07 ug/L) y cuarto cuartiles (mediana=0 ug/L) de clearance de creatinina – P=0,63. De forma similar, no hubo diferencia en los valores de troponina entre individuos con disfunción renal moderada (mediana=0,02 ug/L) y individuos con función renal normal/casi normal (mediana=0,03 ug/L) – P=0.63. La prevalencia de TnT positiva fue similar entre individuos con disfunción renal moderada y función renal normal/casi normal (55% vs 52%, P=0,65). CONCLUSIÓN: Disfunción renal moderada no está asociada con la elevación de los niveles de TnT en pacientes con SCA. (Arq Bras Cardiol 2010;95(5):600-605)

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Artigo Original

Single cardiac troponin T measurement predicts risk for adverse outcome in decompensated heart failure

Manoel D. C. Oliveira et al. Juliana Álvares Maria Consolação V. Moreira

BACKGROUND: The slight increase in cardiac troponin in the blood of patients with heart failure (HF) suggests that myofibrils are degraded in the myocardium and released in the circulation, reflecting a continuous and progressive injury process in the contractile system. OBJECTIVE: To correlate the serum levels of cardiac troponin T (TnT) at the hospital admission of patients with decompensated HF and prognosis. METHODS: A total of 79 consecutive patients, hospitalized due to decompensated HF, with LVEF 2.5 mg%, liver failure, or neuromuscular diseases. RESULTS: High levels of TnTc (>0.02 ng/ml) were detected in 37 patients (46.84%). The global mortality was 35.4%. In the groups with high TnT and low TnT levels (<0.02 ng/ml) there were, respectively, 19 versus 9 deaths (RR=2.4; 95%CI 1.24-4.63; p=0.011), 5 versus 4 heart transplants (RR=1,42; 95%CI 0.41-4.89; p=0.73), 11 versus 7 patients needed IV inotropic agents (RR=1.78; 95%CI 0.77-4.12; p=0.26) and 14 versus 10 patients were re-hospitalized (RR=1.85; 95%CI 0.95-3.6; p=0.10). Mean troponin levels were significantly higher in those individuals who died (0.071±0,119 vs 0.032±0.046; p=0.004). At the multivariate analysis, the persistence of the third sound and the need for IV inotropic agents showed to be independent predictors of death; however, we observed a higher tendency towards mortality for patients presenting high TnT when compared to those with low troponin levels (HR=2.64; 95%CI 0.91-7.63; p=0.07). CONCLUSION: The single troponin measurement at hospital admission in patients with decompensated HF predicts adverse outcomes and should be considered at the early stratification of long-term morbimortality.

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Artigo Original

Cardiac troponin T for risk stratification in decompensated chronic heart failure

Carlos Henrique Del Carlo et al. Antonio Carlos Pereira-Barretto Célia Maria Cassaro-Strunz Maria do Rosário Dias de Oliveira Latorre … Múcio Tavares de Oliveira Junior José Antonio Franchini Ramires

BACKGROUND: The cardiac troponins are highly sensitive and specific markers of myocardial injury. They have been detected in heart failure (HF) and are associated with a bad prognosis. OBJECTIVE: To evaluate the association of cardiac troponin T (cTnT) and its ranges with prognosis in decompensated HF. METHODS: A total of 70 patients with chronic HF worsening that needed hospitalization were studied. Cox model was used to evaluate the variables at admission capable of predicting the combined outcome that consisted of death or re-hospitalization due to HF worsening during a 1-year follow-up. RESULTS: During the follow-up, there were 44 deaths, 36 re-hospitalizations due to HF and 56 combined outcomes. At the multivariate analysis, the predictors of clinical events were the cTnT (cTnT >0.100 ng/mL; hazard ratio [HR] 3.95 95% confidence interval [CI]: 1.64-9.49, p = 0.002), left ventricular end diastolic diameter (LVDD >70 mm; HR 1.92, 95%CI: 1.06-3.47, p = 0.031) and serum sodium (Na <135 mEq/L; HR 1.79, 95%CI: 1.02-3.15, p = 0.044). To evaluate the association between the cTnT increase and the prognosis in decompensated HF, the patients were stratified in three groups: low-cTnT (cTnT 0.020 and 0.100 ng/ml, n = 12).The probabilities of survival and event-free survival were 54.2%, 31.5%, 16.7% (p = 0.020) and 36.4%, 11.5%, 8.3% (p = 0.005), respectively. CONCLUSION: The increase in cTnT is associated with a bad prognosis in decompensated HF and the degree of this increase can help the risk stratification.

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