Combining High-Sensitivity Cardiac Troponin I and Cardiac Troponin T in the Early Diagnosis of Acute Myocardial Infarction

Linden, Naomi van der; Wildi, Karin; Twerenbold, Raphael; Pickering, John W.; Than, Martin; Cullen, Louise; Greenslade, Jaimi; Parsonage, William; Nestelberger, Thomas; Boeddinghaus, Jasper; Badertscher, Patrick; Giménez, María Rubini; Klinkenberg, Lieke J.J.; Bekers, Otto; Schöni, Aline A.; Keller, Dagmar I.; Sabti, Zaid; Puelacher, Christian; Cupa, Janosch; Schumacher, Lukas; Kozhuharov, Nikola; Grimm, Karin; Shrestha, Samyut; Flores, Dayana; Freese, Michael; Stelzig, Claudia; Strebel, Ivo; Miró, Òscar; Rentsch, Katharina; Morawiec, Beata; Kawecki, Damian; Kloos, Wanda; Lohrmann, Jens; Richards, A. Mark; Troughton, Richard W.; Pemberton, Christopher J.; Oßwald, Stefan; Dieijen-Visser, Marja P. van; Mingels, Alma M.A.; Reichlin, Tobias; Meex, Steven J.R.; Müeller, Christian

doi:10.1161/circulationaha.117.032003

Cited by 76 publications

(33 citation statements)

References 62 publications

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“…In contrast to troponin I, troponin T measurements were less consistent and often elevated above ULN even before treatment. There are several pathophysiological and analytical differences between troponin I and T [18], but little is known about normal troponin values in healthy children [19,20] and in children with SMA [21,22]. Our data suggests that troponin I is more appropriate to monitor cardiotoxicity than troponin T. Whether troponin I values above a certain cut-off are indicative of cardiac tissue injury and should induce additional examinations or an escalation of immunosuppression remains unclear.…”

Section: Discussionmentioning

confidence: 82%

Safety Monitoring of Gene Therapy for Spinal Muscular Atrophy with Onasemnogene Abeparvovec –A Single Centre Experience

Friese

Holzwarth

Müller

et al. 2021

JND

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Background: Recently gene therapy with onasemnogene abeparvovec has been approved for the treatment of spinal muscular atrophy (SMA). As the experience from clinical trials is limited, there are still uncertainties for which patient population the treatment can be considered safe and effective. Methods: We report our experience with eight consecutive patients with SMA who were treated with the standard dose of onasemnogene abeparvovec (1.1×1014 vg/kg) at the University Hospital Bonn, Germany. All patients received prophylactic immunosuppression with 1 mg/kg/d prednisolone for four weeks starting on the day before gene therapy. Results: We treated eight patients (4 male, 4 female, age range 10–37 months) with a body weight between 7.1 and 11.9 kg. All patients had 2 or 3 copies of the SMN2-gene and were previously treated with nusinersen. Following treatment with onasemnogene abeparvovec all patients showed a temporary increase of the body temperature and an increase of transaminase levels. In all but one patient it was necessary to increase or prolong the standard steroid dose to control the immune response. In one severe case, liver damage was associated with impaired liver function. This patient received a steroid pulse therapy for five days. Blood counts revealed asymptomatic thrombocytopenia (<150×109/L) in 6/8 patients and a significant increase of monocytes following gene therapy. Liver values and blood counts returned to almost normal levels during the post-treatment observation period. Troponin I increased above normal limit in 4/8 patients but was not associated with any abnormalities on cardiac evaluation. Conclusions: In a broader spectrum of patients, treatment with onasemnogene abeparvovec was associated with a higher rate of adverse events. In our cases it was possible to control the immune response by close monitoring and adaptation of the immunosuppressive regimen. Further research is needed to better understand the immune response following gene therapy and ideally to identify patients at risk for a more severe reaction.

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Section: Discussionmentioning

confidence: 82%

Safety Monitoring of Gene Therapy for Spinal Muscular Atrophy with Onasemnogene Abeparvovec –A Single Centre Experience

Friese

Holzwarth

Müller

et al. 2021

JND

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“…Another interesting observation is that the ratio between troponin I and troponin T seems to be higher in patients with transmural AMI than after endurance exercise (35). However, the clinical implications still remain unclear (36).…”

Section: Troponin Profiles As a Tool To Differentiate Between Causes mentioning

confidence: 99%

Physical activity, exercise and cardiac troponins: Clinical implications

Aakre

Omland

2019

Progress in Cardiovascular Diseases

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“…However, differences in isotype specific release kinetics could translate into differences in earlier rule-out of MI, as cTnI appears to be a more sensitive marker of myocardial damage at an earlier time point than cTnT. [12,29] In our study, the magnitude of cTnI release in response to physiological stress was indeed significantly greater than that of cTnT, although this did not yield any additional diagnostic information. Whether this reflects true biological differences between the isotypes or if it is related to biochemical properties of the assays utilized in the study is unknown, but knowledge of the phenomenon could be useful for clinicians interpreting cTn concentrations in patients admitted with chest pain after physical activity.…”

Section: Isotype-dependent Ctn Kineticsmentioning

confidence: 58%

Differential associations of cardiac troponin T and cardiac troponin I with coronary artery pathology and dynamics in response to short-duration exercise

Tveit

Cwikiel

Myhre

et al. 2021

Clinical Biochemistry

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Background We aimed to assess the associations between cardiac troponin (cTn) T and I concentrations, physical exercise and the presence and severity of angiographic coronary artery disease (CAD) in patients evaluated for suspected chronic coronary syndrome (CCS). Methods and results All patients performed an exercise stress test on a bicycle ergometer and underwent invasive coronary angiography with weighted anatomical evaluation using the Gensini score. Blood samples were collected before and after exercise and analysed with high-sensitivity (hs) cTnT and cTnI assays. Of 297 patients (median age 62 (Quartile [Q]1-3 56-69) years, 35% female), 46% were categorized as "severe CAD" (Gensini score ≥20). Resting hs-cTnT and hs-cTnI concentrations were detectable in 88% and 100% of patients, with medians of 6 (Q1-3 4-9) ng/L and 1.5 (0.9-2.4) ng/L, respectively. In adjusted normalized linear regression analyses, higher resting concentrations were associated with increasing Gensini score (hs-cTnT: B 0.19, 95% Confidence Interval [CI]

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Combining High-Sensitivity Cardiac Troponin I and Cardiac Troponin T in the Early Diagnosis of Acute Myocardial Infarction

Abstract: URL (APACE): https://www.clinicaltrial.gov . Unique identifier: NCT00470587. URL (ADAPT): www.anzctr.org.au . Unique identifier: ACTRN12611001069943.

Cited by 76 publications

References 62 publications

Safety Monitoring of Gene Therapy for Spinal Muscular Atrophy with Onasemnogene Abeparvovec –A Single Centre Experience

Safety Monitoring of Gene Therapy for Spinal Muscular Atrophy with Onasemnogene Abeparvovec –A Single Centre Experience

Physical activity, exercise and cardiac troponins: Clinical implications

Differential associations of cardiac troponin T and cardiac troponin I with coronary artery pathology and dynamics in response to short-duration exercise

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