Abstract:Laboratory diagnosis plays one of the key roles in the diagnosis of many diseases, including cardiovascular diseases (CVD). The methods underlying the in vitro study of many CVD biomarkers, including cardiac troponins (cTnI and cTnT), are imperfect and are continually being improved to enhance their analytical performance, with sensitivity and specificity being the most important. Recently developed improved cTnI and cTnT detection methods, referred to as highly sensitive methods (hs-cTnI, hs-cTnT), have chang… Show more
“…The cardiac isoforms of troponins T and I, due to their specificity, are the most common markers for the diagnosis of myocardial infarction [ 1 , 2 , 3 ]. An increase in cardiac troponins in biological fluids, in particular in blood, indicates reversible or irreversible damage to cardiomyocytes but does not explain the etiopathogenesis of this damage, peculiar for several other pathological processes not associated with myocardial infarction [ 1 , 2 , 4 , 5 ]. Moreover, in some cases (impaired renal filtration and false-positive results), cardiac troponin elevation can occur even in the absence of damage to cardiomyocytes [ 6 , 7 , 8 , 9 ].…”
Although cardiac troponins are considered the most specific biomarkers for the diagnosis of acute myocardial infarction (AMI), their diagnostic consideration goes far beyond the detection of this dangerous disease. The mechanisms of cardiac troponin elevation are extremely numerous and not limited to ischemic necrosis of cardiac myocytes. Practitioners should be well aware of the underlying pathological and physiological conditions that can lead to elevated serum levels of cardiac troponins to avoid differential diagnostic errors, which will be greatly increased if clinicians rely on laboratory data alone. This article presents a classification of the main causes of an elevation in cardiac troponins and discusses in detail the mechanisms of such elevation and the diagnostic consideration of cardiac troponins in some conditions not associated with AMI, such as physical exertion, inflammatory heart diseases (myocarditis and endocarditis), pulmonary embolism (PE), renal failure, and systemic inflammation (sepsis).
“…The cardiac isoforms of troponins T and I, due to their specificity, are the most common markers for the diagnosis of myocardial infarction [ 1 , 2 , 3 ]. An increase in cardiac troponins in biological fluids, in particular in blood, indicates reversible or irreversible damage to cardiomyocytes but does not explain the etiopathogenesis of this damage, peculiar for several other pathological processes not associated with myocardial infarction [ 1 , 2 , 4 , 5 ]. Moreover, in some cases (impaired renal filtration and false-positive results), cardiac troponin elevation can occur even in the absence of damage to cardiomyocytes [ 6 , 7 , 8 , 9 ].…”
Although cardiac troponins are considered the most specific biomarkers for the diagnosis of acute myocardial infarction (AMI), their diagnostic consideration goes far beyond the detection of this dangerous disease. The mechanisms of cardiac troponin elevation are extremely numerous and not limited to ischemic necrosis of cardiac myocytes. Practitioners should be well aware of the underlying pathological and physiological conditions that can lead to elevated serum levels of cardiac troponins to avoid differential diagnostic errors, which will be greatly increased if clinicians rely on laboratory data alone. This article presents a classification of the main causes of an elevation in cardiac troponins and discusses in detail the mechanisms of such elevation and the diagnostic consideration of cardiac troponins in some conditions not associated with AMI, such as physical exertion, inflammatory heart diseases (myocarditis and endocarditis), pulmonary embolism (PE), renal failure, and systemic inflammation (sepsis).
“…On the one hand this circumstance can complicate the differential diagnosis of AMI from these conditions, but on the other hand, it opens up additional diagnostic possibilities for use in practical medicine. 9 , 26–28 Currently all reasons of increased cardiac troponins that are not associated with AMI can be conditionally divided into three groups ( Figure 1 ). And it should be noted that just the highly sensitive methods for troponin determination revealed a significant part of these reasons of increased cTnT and cTnI.…”
Section: Introductionmentioning
confidence: 99%
“… Figure 1 The main reasons of increased blood serum cardiac troponins which may not be associated with AMI. 9 , 26–29 …”
Section: Introductionmentioning
confidence: 99%
“…The latest methods are ways to detect practically single molecules in the blood serum of all examined completely healthy patients that allows consideration cTnT and cTnI molecules as products of normal metabolism of cardiomyocytes. 9 , 29–31 However, this statement is only true if serum hs-cTnT and/or hs-cTnI levels are less than the 99th percentile (upper limit of normal) whereas above the 99th percentile, hs-cTnT and hs-cTnI levels may indicate the presence of any acute or chronic pathological process involving myocardial tissue. Highly sensitive immunoassays also revealed the dependence of hs-cTnT and hs-cTnI levels on the gender and age characteristics of patients that are proposed to be taken into account in modern algorithms for AMI diagnosis.…”
Section: Introductionmentioning
confidence: 99%
“…Highly sensitive immunoassays also revealed the dependence of hs-cTnT and hs-cTnI levels on the gender and age characteristics of patients that are proposed to be taken into account in modern algorithms for AMI diagnosis. 9 , 32–34 The information on the existence of circadian rhythms for hs-cTnT and hs-cTnI according to which morning concentrations are higher than evening ones 35–37 that some researchers consider to be due to increased activity of the sympathicoadrenal, hypothalamic-pituitary-thyroid and coagulation systems in the morning 36 which is an evolutionally developed adaptive mechanism for the waking period is quite remarkable. 37 , 38 At the same time, cases have been described according to which circadian fluctuations in hs-cTnT levels can even affect AMI diagnosis.…”
In modern laboratory diagnostics of cardiovascular diseases (CVD), there is a clear tendency toward an increase in the sensitivity of methods for determining key CVD biomarkers, among which highly sensitive cardiac troponins (hs-Tn) deserve special attention. The introduction of the latter into clinical practice made it possible not only to improve the early diagnosis of acute myocardial infarction but also to open up a number of additional valuable opportunities for the use of hs-Tn, including the assessment of the risk of developing CVD in a healthy population, detection and monitoring of early myocardial injuries in the early stages of CVD development (for example, with ischemic heart disease and arterial hypertension), with noncardiac pathologies (for example, sepsis, chronic obstructive pulmonary disease, chronic renal failure, stroke, cancer, etc), and diagnostics of CVD by using biological fluids that can be obtained by noninvasive methods. This article discusses in detail the diagnostic value of hs-Tn in serum and urine in cases of arterial hypertension. Also, the paper pays considerable attention to the consideration of the mechanisms underlying the increase in hs-Tn in serum and urine in cases of arterial hypertension.
This work reports the construction of a novel nanostructured immunosensor for detection of the troponin I biomarker (cTnI). Anti-troponin I antibody was anchored on the modified graphite electrode with reduced graphene oxide and polytyramine for detection of troponin I in serum samples. The performance of the electro-immunosensor was evaluated by differential pulse voltammetry. The immunosensor presented a wide work range, from 4 ng mL À1 to 4 pg mL À1 , whose detection limit (4 pg mL À1 ) is significantly lower than the basal level in human serum, and maintained 100% of response after 30 days of storage. Moreover, the immunosensor showed good selectivity for detection of cTnI in real sample containing interfering substances and specificity of response to cTnI in the serum of healthy and sick patients, and demonstrated the possibility of reuse for two consecutive analyses, in addition to using a simplified and inexpensive platform when compared to other devices, demonstrating them excellent potential for application in diagnosis in the early stages of acute myocardial infarction.
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