Clinical Interpretation of Serum Troponin in the Era of High-Sensitivity Testing

In cardiogenic shock, biomarkers should ideally help make the diagnosis, choose the right therapeutic options and monitor the patient in addition to clinical and echocardiographic indices. Among “old” biomarkers that have been used for decades, lactate detects, quantifies, and follows anaerobic metabolism, despite its lack of specificity. Renal and liver biomarkers are indispensable for detecting the effect of shock on organ function and are highly predictive of poor outcomes. Direct biomarkers of cardiac damage such as cardiac troponins, B-type natriuretic and N-terminal pro-B-type natriuretic peptides have a good prognostic value, but they lack specificity to detect a cardiogenic cause of shock, as many factors influence their plasma concentrations in critically ill patients. Among the biomarkers that have been more recently described, dipeptidyl peptidase-3 is one of the most interesting. In addition to its prognostic value, it could represent a therapeutic target in cardiogenic shock in the future as a specific antibody inhibits its activity. Adrenomedullin is a small peptide hormone secreted by various tissues, including vascular smooth muscle cells and endothelium, particularly under pathological conditions. It has a vasodilator effect and has prognostic value during cardiogenic shock. An antibody inhibits its activity and so adrenomedullin could represent a therapeutic target in cardiogenic shock. An increasing number of inflammatory biomarkers are also of proven prognostic value in cardiogenic shock, reflecting the inflammatory reaction associated with the syndrome. Some of them are combined to form prognostic proteomic scores. Alongside clinical variables, biomarkers can be used to establish biological “signatures” characteristic of the pathophysiological pathways involved in cardiogenic shock. This helps describe patient subphenotypes, which could in the future be used in clinical trials to define patient populations responding specifically to a treatment.

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Clinicolaboratory characteristics and one-year survival among group 1 pulmonary hypertension in a university hospital

Ahmed,

Tohamy,

Ali

et al. 2024

Preprint

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Background: Pulmonary arterial hypertension is a life-threatening disorder of the pulmonary vascular system that can lead to right-sided heart failure, respiratory failure, and death. Still, more knowledge is needed to understand this complex disease. The study objective is to evaluate the clinicolaboratory characteristics of group 1 pulmonary hypertension patients and their survival in Assiut University pulmonary hypertension Unit throughout the study time. Patients and methods: Consecutive patients referred to Assiut University Chest Department Pulmonary Hypertension unit in collaboration with cardiology department for diagnosis and management. Patients were diagnosed as group 1 pulmonary hypertension (PH) included in the study. Patients' demographic data, clinical presentation, electrocardiography, laboratory data, invasive and noninvasive hemodynamics at presentation were recorded. The patients were followed through the study time to identify their survival. Results: Out of 40 patients referred to the Pulmonary Hypertension unit throughout the study period, 29 patients have group 1 PH and were included. Their mean age was 44.10±15.14 years, most of them were females (86.2%), 44.8% of patients presented with WHO functional class II, 48.3% of patients with FC III, and 6.9% of patients with FC IV. The mean six minutes walking distance was 256.97±89.46 meters. Pulmonary artery catheterization hemodynamic parameters were mean pulmonary artery pressure 52.48±18.24 mmHg, pulmonary vascular resistance 13.32±7.31 WU, cardiac index 2.32±0.83 L/min/m2, and mixed venous oxygen saturation 59.6±7 %. The mean follow-up duration is 12.6 ± 8.8 months, and their survival at the end of study time was 82.35%. Serum uric acid, pulmonary vascular resistance, pulmonary artery systolic pressure, and age are predictors of disease progression and mortality. Conclusion: Group 1 pulmonary hypertension is an uncommon complex disease with a difficult early diagnosis. Its Clinical presentation varies from insidious breathlessness, syncope, palpitation, and obvious right heart failure. Some factors as serum uric acid, pulmonary vascular resistance, pulmonary artery systolic pressure, and age are associated with prognosis. 1-year survival was 82.35%. Trial registration: ClinicalTrials.gov ID: NCT0479145.

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Clinical Interpretation of Serum Troponin in the Era of High-Sensitivity Testing

Cited by 8 publications

References 245 publications

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Clinicolaboratory characteristics and one-year survival among group 1 pulmonary hypertension in a university hospital

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