-
1.
Assessment of ventricular dysfunction in Egyptian children with Beta-thalassemia major.
Deraz, SE, Abd El Naby, SA, Mahmoud, AA
Hematology/oncology and stem cell therapy. 2021;(3):206-213
Abstract
OBJECTIVE/BACKGROUND The purpose of this study was to evaluate serum cardiac troponin I and serum N-terminal (NT) pro-brain natriuretic peptide (pro-BNP) levels and the utility of tissue Doppler imaging in assessing cardiovascular changes following left ventricular (LV) dysfunction in children with beta-thalassemia major (β-TM). In children with β-TM who depend on regular blood transfusion, cardiac iron toxicity is a common serious complication. The most common cause of death among these patients is congestive heart failure. METHODS This is a cross-sectional study which included 50 patients with β-TM and 50 healthy controls. Tissue Doppler imaging was performed and levels of serum ferritin, cardiac troponin I, and NT pro-BNP were estimated for all included patients. RESULTS Serum NT pro-BNP and cardiac troponin (cTnI) showed a significant increase in patients with β-TM (p < .001). In patients with β-TM, LV dimensions (LV end systolic diameter) and (LV end diastolic diameter) were large (p < .01); LV mass (p < .01), E wave, and E/A ratio (p < .01) were high (p < .05); and deceleration time was short (p < .05). Besides, transmitral ratio (E/Em) (p < .05) and tricuspid valve velocity were higher (p < .05), and early diastolic velocity (Em) (p < .05) and systolic wave velocity (Sm) were lower in patients with β-TM (p < .05). A significant positive correlation was detected between the pro-BNP and E wave (r = 0.558, p < .001), E/A ratio (r = 0.403, p < .001), E/Em ratio (r = 0.576, p < .001), and ferritin (r = 0.545, p < .001). CONCLUSION Pulsed wave tissue Doppler imaging and NT pro-BNP had a significant role in the estimation of ventricular dysfunction in children with β-TM.
-
2.
Markers of Myocardial Stress, Myocardial Injury, and Subclinical Inflammation and the Risk of Sudden Death.
Everett, BM, Moorthy, MV, Tikkanen, JT, Cook, NR, Albert, CM
Circulation. 2020;(12):1148-1158
-
-
Free full text
-
Abstract
BACKGROUND The majority of sudden cardiac deaths (SCDs) occur in low-risk populations often as the first manifestation of cardiovascular disease (CVD). Biomarkers are screening tools that may identify subclinical cardiovascular disease and those at elevated risk for SCD. We aimed to determine whether the total to high-density lipoprotein cholesterol ratio, high-sensitivity cardiac troponin I, NT-proBNP (N-terminal pro-B-type natriuretic peptide), or high-sensitivity C-reactive protein individually or in combination could identify individuals at higher SCD risk in large, free-living populations with and without cardiovascular disease. METHODS We performed a nested case-control study within 6 prospective cohort studies using 565 SCD cases matched to 1090 controls (1:2) by age, sex, ethnicity, smoking status, and presence of cardiovascular disease. RESULTS The median study follow-up time until SCD was 11.3 years. When examined as quartiles or continuous variables in conditional logistic regression models, each of the biomarkers was significantly and independently associated with SCD risk after mutually controlling for cardiac risk factors and other biomarkers. The mutually adjusted odds ratios for the top compared with the bottom quartile were 1.90 (95% CI, 1.30-2.76) for total to high-density lipoprotein cholesterol ratio, 2.59 (95% CI, 1.76-3.83) for high-sensitivity cardiac troponin I, 1.65 (95% CI, 1.12-2.44) for NT-proBNP, and 1.65 (95% CI, 1.13-2.41) for high-sensitivity C-reactive protein. A biomarker score that awarded 1 point when the concentration of any of those 4 biomarkers was in the top quartile (score range, 0-4) was strongly associated with SCD, with an adjusted odds ratio of 1.56 (95% CI, 1.37-1.77) per 1-unit increase in the score. CONCLUSIONS Widely available measures of lipids, subclinical myocardial injury, myocardial strain, and vascular inflammation show significant independent associations with SCD risk in apparently low-risk populations. In combination, these measures may have utility to identify individuals at risk for SCD.
-
3.
Abnormal elevation of myocardial necrosis biomarkers after coronary artery bypass grafting without established myocardial infarction assessed by cardiac magnetic resonance.
Oikawa, FTC, Hueb, W, Nomura, CH, Hueb, AC, Villa, AV, da Costa, LMA, de Melo, RMV, Rezende, PC, Segre, CAW, Garzillo, CL, et al
Journal of cardiothoracic surgery. 2017;(1):122
Abstract
BACKGROUND The diagnosis of peri-procedural myocardial infarction is complex, especially after the emergence of high-sensitivity markers of myocardial necrosis. METHODS In this study, patients with normal baseline cardiac biomarkers and formal indication for elective on-pump coronary bypass surgery were evaluated. Electrocardiograms, cardiac biomarkers, and cardiac magnetic resonance imaging with late gadolinium enhancement were performed before and after procedures. Myocardial infarction was defined as more than ten times the upper reference limit of the 99th percentile for troponin I and for creatine kinase isoform (CK-MB) and by the findings of new late gadolinium enhancement on cardiac magnetic resonance. We assessed the release of cardiac biomarkers in patients with no evidence of myocardial infarction on cardiac magnetic resonance. RESULTS Of 75 patients referred for on-pump coronary bypass surgery, 54 (100%) did not have evidence of myocardial infarction on cardiac magnetic resonance. However, all had a peak troponin I above the 99th percentile; 52 (96%) had an elevation 10 times higher than the 99th percentile. Regarding CK-MB, 54 (100%) patients had a peak CK-MB above the 99th percentile limit, and only 13 (24%) had an elevation greater than 10 times the 99th percentile. The median value of troponin I peak was 3.15 (1.2 to 3.9) ng/mL, which represented 78.7 times the 99th percentile. CONCLUSION In this study, different from CK-MB findings, troponin was significantly increased in the absence of myocardial infarction on cardiac magnetic resonance. Thus, CK-MB was more accurate than troponin I for excluding procedure-related myocardial infarction. These data suggest a higher troponin cutoff for the diagnosis of coronary bypass surgery related myocardial infarction. CLINICAL TRIAL REGISTRATION http://www.isrctn.com/ISRCTN09454308 . Registered 08 May 2012.
-
4.
Comparative analysis of high-sensitivity cardiac troponin I and T for their association with coronary computed tomography-assessed calcium scoring represented by the Agatston score.
Rusnak, J, Behnes, M, Henzler, T, Reckord, N, Vogler, N, Meyer, M, Hoffmann, U, Natale, M, Hoffmann, J, Hamed, S, et al
European journal of medical research. 2017;(1):47
Abstract
BACKGROUND This study evaluates the association between high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) and coronary calcium concentration (CAC) detected by coronary computed tomography (CCT) and evaluated with the Agatston score in patients with suspected coronary artery disease (CAD). METHODS Patients undergoing CCT during routine clinical care were enrolled prospectively. CCT was indicated for patients with a low to intermediate pretest probability for CAD. Within 24 h of CCT examination, peripheral blood samples were taken to measure cardiac biomarkers hs-cTnI and hs-cTnT. RESULTS A total of 76 patients were enrolled including 38% without detectable CAC, 36% with an Agatston score from 1 to 100, 17% from 101 to 400, and 9% with values ≥ 400. hs-cTnI was increasing alongside Agatston score and was able to differentiate between different groups of Agatston scores. Both hs-cTn discriminated values greater than 100 (hs-cTnI, AUC = 0.663; p = 0.032; hs-cTnT, AUC = 0.650; p = 0.048). In univariate and multivariate logistic regression models, hs-cTnT and hs-cTnI were significantly associated with increased Agatston scores. Patients with hs-cTnT ≥ 0.02 µg/l and hs-cTnI ≥ 5.5 ng/l were more likely to reveal values ≥ 400 (hs-cTnT; OR = 13.4; 95% CI 1.545-116.233; p = 0.019; hs-cTnI; OR = 8.8; 95% CI 1.183-65.475; p = 0.034). CONCLUSION The present study shows that the Agatston score was significantly correlated with hs cardiac troponins, both in univariable and multivariable linear regression models. Hs-cTnI is able to discriminate between different Agatston values. The present results might reveal potential cut-off values for hs cardiac troponins regarding different Agatston values. Trial registration Cardiovascular Imaging and Biomarker Analyses (CIBER), NCT03074253 https://clinicaltrials.gov/ct2/show/record/NCT03074253.
-
5.
Relation of Left Ventricular Mass and Infarct Size in Anterior Wall ST-Segment Elevation Acute Myocardial Infarction (from the EMBRACE STEMI Clinical Trial).
Daaboul, Y, Korjian, S, Weaver, WD, Kloner, RA, Giugliano, RP, Carr, J, Neal, BJ, Chi, G, Cochet, M, Goodell, L, et al
The American journal of cardiology. 2016;(5):625-31
Abstract
Biomarker measures of infarct size and myocardial salvage index (MSI) are important surrogate measures of clinical outcomes after a myocardial infarction. However, there is variability in infarct size unaccounted for by conventional adjustment factors. This post hoc analysis of Evaluation of Myocardial Effects of Bendavia for Reducing Reperfusion Injury in Patients With Acute Coronary Events (EMBRACE) ST-Segment Elevation Myocardial Infarction (STEMI) trial evaluates the association between left ventricular (LV) mass and infarct size as assessed by areas under the curve for creatine kinase-MB (CK-MB) and troponin I release over the first 72 hours (CK-MB area under the curve [AUC] and troponin I [TnI] AUC) and the MSI. Patients with first anterior STEMI, occluded left anterior descending artery, and available LV mass measurement in EMBRACE STEMI trial were included (n = 100) (ClinicalTrials.govNCT01572909). MSI, end-diastolic LV mass on day 4 cardiac magnetic resonance, and CK-MB and troponin I concentrations were evaluated by a core laboratory. After saturated multivariate analysis, dominance analysis was performed to estimate the contribution of each independent variable to the predicted variance of each outcome. In multivariate models that included age, gender, body surface area, lesion location, smoking, and ischemia time, LV mass remained independently associated with biomarker measures of infarct size (CK-MB AUC p = 0.02, TnI AUC p = 0.03) and MSI (p = 0.003). Dominance analysis demonstrated that LV mass accounted for 58%, 47%, and 60% of the predicted variances for CK-MB AUC, TnI AUC, and MSI, respectively. In conclusion, LV mass accounts for approximately half of the predicted variance in biomarker measures of infarct size. It should be considered as an adjustment variable in studies evaluating infarct size.
-
6.
Effect of weight loss on subclinical myocardial injury: A clinical trial comparing gastric bypass surgery and intensive lifestyle intervention.
Lyngbakken, MN, Omland, T, Nordstrand, N, Norseth, J, Hjelmesæth, J, Hofsø, D
European journal of preventive cardiology. 2016;(8):874-80
Abstract
AIMS: To investigate the effect of weight loss induced by bariatric surgery and intensive lifestyle intervention on levels of circulating high-sensitivity cardiac troponin I. METHODS AND RESULTS We measured high-sensitivity cardiac troponin I concentrations pre- and 12 months post-intervention in 136 subjects with morbid obesity participating in a controlled clinical trial comparing the effect of intensive lifestyle intervention vs. Roux-en-Y gastric bypass. At baseline median (interquartile range) high-sensitivity cardiac troponin I levels were 2.40 (1.28-3.95) ng/L in the bariatric surgery group and 2.35 (1.38-4.40) ng/L in the intensive lifestyle intervention group (p = 0.736). The high-sensitivity cardiac troponin I concentration in a normal-weight control group was 0.90 (0.60-2.13) ng/L. During 12 months of follow-up, high-sensitivity cardiac troponin I decreased significantly more in the bariatric surgery group than in the intensive lifestyle intervention group (0.80 (0-1.80) vs. 0.15 (-0.50 to 1.00) ng/L; p = 0.002). In a multivariate logistic regression model, surgery emerged as a predictor of reduction in high-sensitivity cardiac troponin I levels (odds ratio 2.32; 95% confidence intervals 1.03-5.22; p = 0.041) independent of age, gender and other possible confounding baseline variables. In subsequent multivariate analyses, reductions in body weight and triglycerides emerged as possible mediators of reduction in circulating levels of high-sensitivity cardiac troponin I. CONCLUSION In patients with morbid obesity, bariatric surgery was associated with a significantly greater reduction in high-sensitivity cardiac troponin I, an index of subclinical myocardial injury, than intensive lifestyle intervention. The reduction appeared to be mediated by reductions in body weight and serum triglycerides. This suggests that weight loss following bariatric surgery may reduce cardiometabolic stress and subsequent risk of heart failure.
-
7.
Cardiomyocyte injury induced by hemodynamic cardiac stress: Differential release of cardiac biomarkers.
Irfan, A, Reichlin, T, Twerenbold, R, Fischer, C, Ballarino, P, Nelles, B, Wildi, K, Zellweger, C, Rubini Gimenez, M, Mueller, M, et al
Clinical biochemistry. 2015;(18):1225-9
Abstract
OBJECTIVE We explored whether hemodynamic cardiac stress leads to a differential release of cardiomyocyte injury biomarkers, used in the diagnosis of acute myocardial infarction (AMI). METHODS In an observational international multicenter study, we enrolled 831 unselected patients presenting with symptoms suggestive of AMI to the emergency department. The final diagnosis was adjudicated by two independent cardiologists. Hemodynamic cardiac stress was quantified by levels of B-type natriuretic peptide (BNP). Spearman's rho correlation was used to analyze the correlations between BNP and high-sensitivity cardiac troponin T (hs-cTnT), Siemens cTnI-Ultra (cTnI-ultra), CK-MB and Myoglobin. Patients were categorized according to the extent of hemodynamic cardiac stress as quantified by BNP tertiles. RESULTS Among all patients, the positive pair-wise correlation with BNP was strongest with hs-cTnT and cTnI-ultra (r=0.58 and 0.50, respectively), moderate for Myoglobin (r=0.43), and weakest with CK-MB (r=0.25; p<0.001 for each). Similar pattern of correlations was also observed among AMI patients. Among patients diagnosed with non-cardiac cause of chest pain (n=385, 46%) and cardiac but non-coronary (n=109, 13%), BNP had significant positive correlations with hs-cTnT, cTnI-ultra and Myoglobin (p<0.05), but not with CK-MB (p=NS). A similar pattern of stronger correlation between BNP and hs-cTnT, cTnI-ultra and Myoglobin as compared to that with CK-MB was also observed within the higher BNP tertile range. There was no correlation between BNP and other biomarkers within the 1st BNP tertile group. CONCLUSION Hemodynamic cardiac stress, as quantified by BNP, as a likely cause of cardiomyocyte injury, is more closely reflected by concentrations of hs-cTnT, cTnI-ultra and Myoglobin than CK-MB.
-
8.
The relationship between cardiotrophin-1 and troponin-i in coronary arterial bypass grafting on the beating heart: a prospective study.
Caliskan, S, Besli, F, Yildirim, A, Gungoren, F, Alisir, MF, Polat, U, Ozdemir, B, Bicer, M
The heart surgery forum. 2015;(4):E146-50
Abstract
OBJECTIVE Cardiotrophin-1 (CT-1) is closely associated with many cardiovascular diseases, such as hypertension, myocardial infarction (MI), and heart failure, and exhibits a cardioprotective effect in ischemia-reperfusion injury. The aim of this study was to evaluate the relationship between CT-1 and Troponin-I (Tn-I) in off-pump coronary artery bypass (OPCAB) grafting on the beating heart. METHODS Seventy-eight patients (mean age 60.8 ± 9.7 years, 79.5% male) undergoing elective OPCAB surgery were included in this study undertaken between July 1, 2012 and July 1, 2013 in the Department of Cardiology and Cardiac Surgery, University School of Medicine Hospital. Venous blood samples were collected 5 minutes before OPCAB surgery and 6 hours after surgery. Plasma CT-1 levels were measured using the ELISA method. RESULTS Compared to the preoperative period, Tn-I and CT-1 values were higher in the postoperative period [0.255 ng/mL (0.030-0.430) versus 0.045 ng/mL (0.005-0.090), P < .001; and 33.7 pg/mL (15.8-98.5) versus 8.7 pg/mL (0.68-25.4), P < .001]. There was also an elevation in white blood cells, aspartate aminotransferase, creatine kinase (CK), and creatine kinase MB (CK-MB) values, as well as a decrease in hemoglobin values (P < .001). When a correlation analysis for postoperative CT-1 was performed, there was a significant positive correlation between postoperative CK, CK-MB, and Tn-I levels (r = 0.250, P < .027; r = 0.270, P = .017; and r = 0.241, P < .034). CONCLUSION CT-1 was found to be associated with Tn-I, which is used to detect myocardial damage after OPCAB surgery. CT-1 may also be used to detect myocardial damage.
-
9.
The effect of exercise training on the course of cardiac troponin T and I levels: three independent training studies.
van der Linden, N, Klinkenberg, LJ, Leenders, M, Tieland, M, Verdijk, LB, Niens, M, van Suijlen, JD, de Groot, LC, Bekers, O, van Loon, LJ, et al
Scientific reports. 2015;:18320
Abstract
With the introduction of high-sensitive assays, cardiac troponins became potential biomarkers for risk stratification and prognostic medicine. Observational studies have reported an inverse association between physical activity and basal cardiac troponin levels. However, causality has never been demonstrated. This study investigated whether basal cardiac troponin concentrations are receptive to lifestyle interventions such as exercise training. Basal high-sensitive cardiac troponin T (cTnT ) and I (cTnI) were monitored in two resistance-type exercise training programs (12-week (study 1) and 24-week (study 2)) in older adults (≥65 years). In addition, a retrospective analysis for high sensitive troponin I in a 24-week exercise controlled trial in (pre)frail older adults was performed (study 3). In total, 91 subjects were included in the final data analyses. There were no significant changes in cardiac troponin levels over time in study 1 and 2 (study 1: cTnT -0.13 (-0.33-+0.08) ng/L/12-weeks, cTnI -0.10 (-0.33-+0.12) ng/L/12-weeks; study 2: cTnT -1.99 (-4.79-+0.81) ng/L/24-weeks, cTnI -1.59 (-5.70-+2.51) ng/L/24-weeks). Neither was there a significant interaction between training and the course of cardiac troponin in study 3 (p = 0.27). In conclusion, this study provides no evidence that prolonged resistance-type exercise training can modulate basal cardiac troponin levels.
-
10.
Hypotheses, rationale, design, and methods for prognostic evaluation of cardiac biomarker elevation after percutaneous and surgical revascularization in the absence of manifest myocardial infarction. A comparative analysis of biomarkers and cardiac magnetic resonance. The MASS-V Trial.
Hueb, W, Gersh, BJ, Rezende, PC, Garzillo, CL, Lima, EG, Vieira, RD, Garcia, RM, Favarato, D, Segre, CA, Pereira, AC, et al
BMC cardiovascular disorders. 2012;:65
Abstract
BACKGROUND Although the release of cardiac biomarkers after percutaneous (PCI) or surgical revascularization (CABG) is common, its prognostic significance is not known. Questions remain about the mechanisms and degree of correlation between the release, the volume of myocardial tissue loss, and the long-term significance. Delayed-enhancement of cardiac magnetic resonance (CMR) consistently quantifies areas of irreversible myocardial injury. To investigate the quantitative relationship between irreversible injury and cardiac biomarkers, we will evaluate the extent of irreversible injury in patients undergoing PCI and CABG and relate it to postprocedural modifications in cardiac biomarkers and long-term prognosis. METHODS/DESIGN The study will include 150 patients with multivessel coronary artery disease (CAD) with left ventricle ejection fraction (LVEF) and a formal indication for CABG; 50 patients will undergo CABG with cardiopulmonary bypass (CPB); 50 patients with the same arterial and ventricular condition indicated for myocardial revascularization will undergo CABG without CPB; and another 50 patients with CAD and preserved ventricular function will undergo PCI using stents. All patients will undergo CMR before and after surgery or PCI. We will also evaluate the release of cardiac markers of necrosis immediately before and after each procedure. Primary outcome considered is overall death in a 5-year follow-up. Secondary outcomes are levels of CK-MB isoenzyme and I-Troponin in association with presence of myocardial fibrosis and systolic left ventricle dysfunction assessed by CMR. DISCUSSION The MASS-V Trial aims to establish reliable values for parameters of enzyme markers of myocardial necrosis in the absence of manifest myocardial infarction after mechanical interventions. The establishments of these indices have diagnostic value and clinical prognosis and therefore require relevant and different therapeutic measures. In daily practice, the inappropriate use of these necrosis markers has led to misdiagnosis and therefore wrong treatment. The appearance of a more sensitive tool such as CMR provides an unprecedented diagnostic accuracy of myocardial damage when correlated with necrosis enzyme markers. We aim to correlate laboratory data with imaging, thereby establishing more refined data on the presence or absence of irreversible myocardial injury after the procedure, either percutaneous or surgical, and this, with or without the use of cardiopulmonary bypass.