Elevated troponin predicts long-term adverse cardiovascular outcomes in hypertensive crisis

Pattanshetty, Deepak; Bhat, Pradeep; Aneja, Ashish; Pillai, Dilip

doi:10.1097/hjh.0b013e3283599b4f

Cited by 49 publications

(34 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a retrospective study, patients with hypertensive crises and elevated cardiac c-troponin-I (cTnI) had 2.7 times higher risk for the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) at 2 years follow-up compared to those with normal cTnI values. In patients with hypertensive crisis, elevated cTnI confers a significantly greater risk of long-term MACCE and is a strong predictor of obstructive coronary artery disease [14].…”

Section: Clinical Presentation and Evaluationmentioning

confidence: 99%

Cardiovascular Hypertensive Emergencies

et al. 2015

View full text Add to dashboard Cite

Inevitably, a small proportion of patients with systematic hypertension will develop hypertensive crisis at some point. Hypertensive crises can be divided into hypertensive emergency or hypertensive urgency according to the presence or lack of acute target organ damage. In this review, we discuss cardiovascular hypertensive emergencies, including acute coronary syndrome, aortic dissection, congestive heart failure, and sympathomimetic hypertensive crises, including those caused by cocaine use. Each presents in a unique fashion, although some hypertensive emergency patients report nonspecific symptoms. Treatment includes several effective and rapid-acting medications to safely reduce the blood pressure, protect remaining end-organ function, relieve symptoms, minimize the risk of complications, and thereby improve patient outcomes.

show abstract

Section: Clinical Presentation and Evaluationmentioning

confidence: 99%

Cardiovascular Hypertensive Emergencies

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Cardiac troponins (cTn) are highly specific biomarkers of myocardial cell damage, have been utilized widely in human and veterinary medicine, and play a role in helping to identify cardiac pathology in equids. They are central to the diagnoses of acute myocardial infarctions (AMI in humans), but increases in cTn also are apparent in conditions that result in cardiac stress in the absence of obstructive coronary disease . Meeting the stringent recommendations of the Clinical and Laboratory Standards Institute (CLSI), the National Academy of Clinical Biochemistry (NACB), and the American Society of Veterinary Clinical Pathology (ASVCP), the “high‐sensitivity” cTnT (hscTnT) assay recently has been validated for use in horses with total imprecision ≤10% at the 99th percentile and measurable cTn analyte concentrations obtained in >50% of the populations studied .…”

mentioning

confidence: 99%

24‐Hour Kinetics of Cardiac Troponin‐T Using a “High‐Sensitivity” Assay in Thoroughbred Chuckwagon Racing Geldings after Race and Associated Clinical Sampling Guidelines

Shields

Seiden‐Long

Massie

et al. 2017

Veterinary Internal Medicne

View full text Add to dashboard Cite

BackgroundA “high‐sensitivity” cardiac troponin‐T (hscTnT) assay recently has been validated for use in horses and is a specific biomarker of myocardial damage. Postexercise release kinetics of cTnT utilizing the hscTnT assay have yet to be established in horses.ObjectivesTo determine: (1) cTnT release kinetics in racing Thoroughbreds after a high‐intensity 5/8th mile Chuckwagon race; (2) the effects of age on pre‐ and postrace cTnT concentrations; and (3) sampling guidelines for clinicians evaluating horses presenting after exercise.AnimalsSamples were obtained from 38 Thoroughbred geldings aged 5–16 years before racing and immediately, 2, 3, 4, 6, 12, and 24 hour postrace.MethodsProspective, observational study with convenience sampling. A fifth‐generation hscTnT assay was used for plasma sample analysis, and concentrations were compared at all time‐points. Correlations were determined between cTnT concentrations and age. Biochemistry analysis was performed to assess rhabdomyolysis, renal failure, and exercise‐induced dehydration.ResultsAll horses with measureable cTnT concentrations had significant postexercise increases in cTnT with a median peak (8.0 ng/L) at 3‐hour postrace. All horses had peak postexercise cTnT concentrations 2‐ to 6‐hour postrace ≤ the 99th percentile upper reference limit of 23.2 ng/L, after which all cTnT concentrations decreased until returning to baseline by 12–24 hours. There was no correlation over time between cTnT concentrations and age.Conclusions and Clinical ImportanceIn racing Thoroughbreds completing short‐duration, high‐intensity Chuckwagon races, cTnT concentrations are expected to be increased 2‐ to 6‐hour postrace and to decrease by 12–24 hours while remaining ≤23.2 ng/L throughout. This study contributes to establishing guidelines for clinical use of the hscTnT assay in exercising horses.

show abstract

“…Most prior studies evaluating the short-term risk of hypertension in the ED have examined composite cardiovascular outcomes, particularly cardiac events, with some showing an increased risk in hypertensive ED patients. (13, 14, 21) In contrast, we chose to focus our study on ICH for two reasons: 1) it is one of the most feared complications of severe hypertension, resulting in death or severe disability in more than 50% of affected patients,(22, 23) and 2) we aimed to investigate recently published data suggesting that acute rises in blood pressure might precede the development of ICH. (15) Despite a sample size of over 500,000 patients, we did not find a significantly increased short-term risk of ICH in patients discharged from the ED with a primary diagnosis of hypertension.…”

Section: Discussionmentioning

confidence: 99%

Risk of Intracerebral Hemorrhage after Emergency Department Discharges for Hypertension

Navi

Parikh

Lerario

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

View full text Add to dashboard Cite

Background Recent literature suggests that acute rises in blood pressure may precede intracerebral hemorrhage. We therefore hypothesized that patients discharged from the emergency department with hypertension face an increased risk of intracerebral hemorrhage in subsequent weeks. Methods Using administrative claims data from California, New York, and Florida, we identified all patients discharged from the Emergency Department from 2005 through 2011 with a primary diagnosis of hypertension (ICD-9-CM codes 401-405). We excluded patients if they were hospitalized from the emergency department or had prior histories of cerebrovascular disease at the index visit with hypertension. We used the Mantel-Haenszel estimator for matched data to compare each patient's odds of intracerebral hemorrhage during days 8-38 after emergency department discharge to the same patient's odds during days 373-403 after discharge. This cohort-crossover design with a one-week washout period enabled individual patients to serve as their own controls, thereby minimizing confounding bias. Results Among 552,569 patients discharged from the emergency department with a primary diagnosis of hypertension, 93 (0.017%) were diagnosed with intracerebral hemorrhage during days 8-38 after discharge compared to 70 (0.013%) during days 373-403 (odds ratio 1.33, 95% confidence interval 0.96-1.84). The odds of intracerebral hemorrhage were increased in certain subgroups of patients (≥60 years of age and those with secondary discharge diagnoses besides hypertension), but absolute risks were low in all subgroups. Conclusions Patients with emergency department discharges for hypertension do not face a substantially increased short-term risk of intracerebral hemorrhage after discharge.

show abstract

Elevated troponin predicts long-term adverse cardiovascular outcomes in hypertensive crisis

Abstract: In patients with hypertensive crisis, elevated cTnI confers a significantly greater risk of long-term MACCE, and is a strong predictor of obstructive CAD.

Cited by 49 publications

References 15 publications

Cardiovascular Hypertensive Emergencies

Cardiovascular Hypertensive Emergencies

24‐Hour Kinetics of Cardiac Troponin‐T Using a “High‐Sensitivity” Assay in Thoroughbred Chuckwagon Racing Geldings after Race and Associated Clinical Sampling Guidelines

Risk of Intracerebral Hemorrhage after Emergency Department Discharges for Hypertension

Contact Info

Product

Resources

About