Cardiac troponins

Sharma, Sanjay

doi:10.1136/jcp.2003.015420

Cited by 184 publications

(128 citation statements)

References 30 publications

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“…Thus far, the determination of cTnI with the highly sensitive second-generation AccuTnI assay is unique in detecting this cohort of subjects without known CVD but with this sign of myocardial damage because the determinations of cTnT in another large cohort of subjects free from clinical signs of CHD did not identify any measurable levels even among older subjects, 5 which precluded any calculations of associations to outcome. Whether these differences between generations of cTnI and cTnT assays are related to the fact that they measure different molecules with different kinetics and patterns of release from injured myocardium 26,27 or whether they are merely a matter of lack of sensitivity of the latter assay is unknown.…”

Section: Discussionmentioning

confidence: 99%

Troponin I as a Predictor of Coronary Heart Disease and Mortality in 70-Year-Old Men

2006

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Background— Cardiac troponin I (cTnI), a standard for detection of myocardial damage, has recently been reported to predict acute myocardial infarction or death in patients with unstable coronary heart disease (CHD). Cardiac TnI concentrations increase with age in subjects free from clinical signs of CHD, suggesting silent myocardial damage. We investigated the association between cTnI and future CHD and mortality in a community-based cohort of men. Methods and Results— A community-based study was conducted from August 1991 to May 1995 among 1203 men in Uppsala, Sweden, aged 70 years at baseline with a follow-up of up to 10.4 years with the use of registry data (National Board of Health and Welfare, Sweden). CHD was defined with the use of data taken from the Cause of Death Registry or from first-time hospitalization for CHD as recorded in the Hospital Discharge Registry. Cardiac TnI concentrations were measured blinded for outcome, in frozen baseline plasma samples, with the use of the AccuTnI from Beckman Coulter, Inc. Hazard ratios (HRs) from Cox proportional hazards are presented with 95% confidence intervals (CIs) for a 1-SD increase. In men free from cardiovascular disease (CVD), cTnI predicted death (HR, 1.26; 95% CI, 1.08 to 1.46; P =0.003) or first CHD event (HR, 1.31; 95% CI, 1.11 to 1.54; P =0.001) after adjustment for conventional risk factors: total and HDL cholesterol, plasma glucose, body mass index, smoking, and systolic blood pressure. Conclusions— In this first longitudinal report, cTnI was shown to predict death and first CHD event in men free from CVD at baseline, indicating the importance of silent cardiac damage in the development of CHD and mortality.

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Section: Discussionmentioning

confidence: 99%

Troponin I as a Predictor of Coronary Heart Disease and Mortality in 70-Year-Old Men

2006

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“…Cardiac isoform I is not expressed in human skeletal muscle during fetal development, after skeletal muscle trauma or during regeneration of this type of muscle, since it is not encoded by the same gene [69]. Because of this specificity, most authors point to cardiac isoform I as the marker that is closest to the ideal for evaluation of specific cardiac lesions in children and adults [70].…”

Section: Myocardial Markersmentioning

confidence: 99%

The Recent Advances in the Serological Detection of Acute Myocardial Infarction

Gh¹,

Ac²

2016

Clin Med Biochemistry

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Acute Myocardial Infarction (AMI) is one of the leading causes of morbidity and mortality worldwide. The greatest risk of fatality occurs within the first hours of initiation of AMI. Thus, the early diagnosis of cardiac ischemia is fundamental for the effective management of AMI patients. Inadequate diagnosis of patients with chest pain often leads to inadequate admission of patients without AMI and vice versa. In addition to the clinical history, physical examination, accurate electrocardiogram findings, and evaluation of cardiac biomarkers play an important role in the early diagnosis of acute ischemia. The present review discusses in detail the various cardiac biomarkers released during the event of an AMI.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

“…The troponin complex consists of three subunits: troponin C, troponin I, and troponin T. This complex is located on the myofibrillar thin (actin) filament of striated (skeletal and cardiac) muscle. The cardiac isoforms troponin T and I are only expressed in cardiac muscle [1].In the year 2007 a consensus statement from the Joint European Society of Cardiology and The American College of Cardiology committees redefined myocardial infarction (MI) as an elevation of cTnT or cTnI in conjunction with clinical evidence of myocardial ischemia [2]. They recommended highsensitivity cardiac troponin assays to rule out MI using a 3-hour pathway based on the 99 th percentile of the normal reference range [2].…”

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A Review of Cardiac and Non-Cardiac Causes of Troponin Elevation and Clinical Relevance Part I: Cardiac Causes

2017

JCCR

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IntroductionCardiac troponin T (cTnT) and troponin I (cTnI) are cardiac regulatory proteins that control the calcium mediated interaction between actin and myosin [1]. The troponin complex consists of three subunits: troponin C, troponin I, and troponin T. This complex is located on the myofibrillar thin (actin) filament of striated (skeletal and cardiac) muscle. The cardiac isoforms troponin T and I are only expressed in cardiac muscle [1].In the year 2007 a consensus statement from the Joint European Society of Cardiology and The American College of Cardiology committees redefined myocardial infarction (MI) as an elevation of cTnT or cTnI in conjunction with clinical evidence of myocardial ischemia [2]. They recommended highsensitivity cardiac troponin assays to rule out MI using a 3-hour pathway based on the 99 th percentile of the normal reference range [2]. Cardiac troponins are detected in the serum by the use of monoclonal antibodies to epitopes of cTnI and cTnT. These antibodies are highly specific for cardiac troponin but do not react with skeletal muscle troponins [3,4]. Troponin assays are quite sensitive and can detect <1 g of myocardial necrosis; therefore, the diagnosis of myocardial infarction requires that cTn must be above the 99 th percentile upper reference limit for the specific assay being used [5]. Some studies have reported that the 99 th percentile reference limit differs between men and women when measured with high-sensitivity assays for cardiac troponin [6].An elevation of cTn indicates the presence of, but not the underlying reason for, myocardial injury. Elevated troponins have been noted in several clinical conditions in addition to acute myocardial infarction (AMI). These conditions include pulmonary embolism, sepsis, heart failure, myocarditis, myocardial contusion, critical illness, cardio-toxic chemo, defibrillator shocks, atrial fibrillation, and end stage renal disease. Elevated cTnT and cTnI almost always imply a poor prognosis regardless of the mechanism by which troponins were released from cardiac myocytes into circulation. Ottani et al. found that the odds ratio for death and MI was 3.44-fold at 30 days in the cTnT-positive group compared to patients with unstable angina who did not have elevated troponins [7].The aim of this article is to highlight different conditions in which elevated troponins have been commonly noted, and to discuss the suggested mechanisms for elevated troponins in these patients. It is still unclear how to manage troponin elevation in clinical conditions other than AMI, but it is important to note the differential diagnosis for elevated troponins and the clinical significance of troponin elevation in each setting. Troponin elevation reflects acute or chronic myocardial damage but is not exclusive for ACS, thus causing some problems with interpretation of results. Differentiating elevated troponins due to non-coronary diseases is challenging; however, this differentiation is paramount in order to provide timely and appropriate treatment. This is a t...

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Cardiac troponins

Cited by 184 publications

References 30 publications

Troponin I as a Predictor of Coronary Heart Disease and Mortality in 70-Year-Old Men

Troponin I as a Predictor of Coronary Heart Disease and Mortality in 70-Year-Old Men

The Recent Advances in the Serological Detection of Acute Myocardial Infarction

A Review of Cardiac and Non-Cardiac Causes of Troponin Elevation and Clinical Relevance Part I: Cardiac Causes

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