Increased Troponin Levels in Nonischemic Cardiac Conditions and Noncardiac Diseases

Gennaro, Luisa De; Brunetti, Natale Daniele; Cuculo, Andrea; Pellegrino, Pier Luigi; Izzo, Paolo; Roma, F; Biase, Matteo Di

doi:10.1111/j.1540-8183.2007.00336.x

Cited by 50 publications

(40 citation statements)

References 93 publications

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“…Measurement of cardiac troponins (cTns) has a pivotal role in acute coronary syndrome (ACS), and there is accumulating evidence of the usefulness of these markers in conditions other than ACS, including HF. 21 In acute kidney injury (AKI) and CKD, promising biomarkers, both in plasma and in urine, that have become useful for assessment and prognostication, include cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1, interleukin-18, asymmetric dimethylarginine, and liver-type fatty acid-binding protein. 22 In this review we focus on the current evidence about laboratory biomarkers in patients with HF or AKI/CKD, emphasizing the emerging cardiac biomarkers (ie, BNPs and cTns), and the biomarkers of renal injury (ie, cystatin C and NGAL).…”

Section: Biomarkersmentioning

confidence: 99%

Heart Failure, Chronic Kidney Disease, and Biomarkers - An Integrated Viewpoint -

Iwanaga

Miyazaki

2010

Circ J

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Chronic kidney disease (CKD) is frequently associated with a progressive decrease in the glomerular filtration rate, which leads to endstage renal disease (ESRD). Heart failure (HF) is a complex syndrome rather than a primary diagnosis, and considered as the endpoint of all cardiovascular disorders. It is the leading cause of death among the cardiovascular diseases in patients with CKD and ESRD. There is some interaction between the heart and kidney (the so-called "cardiorenal syndrome"), and HF patients with the complication of CKD or ESRD show a worse prognosis. Thus, early diagnosis and aggressive management of HF are needed in patients with CKD and ESRD. A number of biomarkers appear to have growing clinical importance and are reported for detection and stratification of HF. Although HF and CKD have a close interrelationship, the utility of the biomarkers has not been adequately studied with regard to the relationship with renal dysfunction. This paper reviews of the current evidence about laboratory biomarkers in patients with HF or CKD, emphasizing the emerging cardiac biomarkers (ie, BNPs and cardiac troponins), and the biomarkers of renal injury (ie, cystatin C and neutrophil gelatinase-associated lipocalin). Furthermore, it discusses the potential role of these markers in terms of heart -kidney interactions and their utility in the diagnostic and therapeutic strategies for cardiorenal syndrome. (Circ J 2010; 74: 1274 - 1282

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Section: Biomarkersmentioning

confidence: 99%

Heart Failure, Chronic Kidney Disease, and Biomarkers - An Integrated Viewpoint -

Iwanaga

Miyazaki

2010

Circ J

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“…Because of excellent cardiac specificity, they constitute near-ideal biomarkers of myocyte injury in acute coronary syndrome (ACS) when combined with information about patient symptoms and electrocardiograms. Yet it is important to note that several other non-ischemia-related conditions can give rise to increased concentrations of cTn (1,2 ). Because the amount of cTn released from necrotic cardiac tissue to circulation can be orders of magnitude smaller than creatine kinase MB (CK-MB) and myoglobin, achieving the full diagnostic potential of cTn demands tools of exquisite analytical sensitivity that are free from common sources of nonspecific interferences.…”

confidence: 99%

Autoantibodies to Cardiac Troponin Associate with Higher Initial Concentrations and Longer Release of Troponin I in Acute Coronary Syndrome Patients

Pettersson

Eriksson²,

Wittfooth

et al. 2009

Clinical Chemistry

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BACKGROUND: Cardiac troponin (cTn) is an established marker of myocardial infarction. Pronounced heterogeneity and the minute amounts released into the circulation constitute significant challenges for cTn detection. Recently, autoantibody formation to cTn was shown to be common and to interfere with immunoassay performance. In this study, we investigated cTn autoantibodies and cardiac troponin I (cTnI) in acute coronary syndrome (ACS) patients over a 1-year period after the index event.

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“…Elevated troponin levels are found in other conditions besides acute coronary syndromes, such as heart failure, pulmonary thromboembolism and renal impairment, and therefore care must be taken in interpreting positive troponin results. 16 Our data included some patients whose chest pain was associated with a tachyarrhythmia, and troponin can be elevated in such cases because of rate-related ischaemia rather than true acute coronary syndrome with plaque rupture. Nevertheless, such patients are still likely to require intensive monitoring and cardiology input, as raised troponin levels are known to carry increased mortality risk in critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

A clinical scoring system in undifferentiated chest pain predicting undetectable troponin concentration

Stirrat

Cameron

Mills

et al. 2013

Journal of Cardiovascular Disease Research

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a b s t r a c tBackground: Chest pain is the most common reason for emergency admission to hospital, but the majority of these are due to non-cardiac pain. We sought to determine which combination of clinical features is more likely to predict an undetectable troponin level in patients presenting with chest pain. Methods: We collected data over a two-month period on consecutive patients presenting acutely to hospital with chest pain and who had a troponin I measured. We recorded basic demographics, risk factors, pain distribution, associated symptoms, physical findings and ECG changes. The parameters significantly associated with troponin positivity were entered into a stepwise logistic regression analysis and the resulting model's coefficients were used to construct a simple clinical score to categorise patients into low, medium or high probability of having a positive troponin. Results: 26 of 157 (16.6%) patients had a positive troponin. The variables retained in the regression model were: age >65, heart rate >80, previous myocardial infarction, diabetes and pain radiating to either arm. The model showed good discrimination (area under ROC curve 0.869, 95% CI 0.806 e 0.917). Using the regression model's coefficients, patients were grouped into low, intermediate or high probability groups. Being in the low probability group had a negative predictive value of 97.8% and being in the high probability group had a positive predictive value of 65.2%. The majority (73.9%) of patients could be categorised as either low or high probability. Discussion: This simple scoring system, if prospectively validated, may be useful in identifying low risk patients with chest pain who are unlikely to have elevation of serum troponin concentration.

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Increased Troponin Levels in Nonischemic Cardiac Conditions and Noncardiac Diseases

Cited by 50 publications

References 93 publications

Heart Failure, Chronic Kidney Disease, and Biomarkers - An Integrated Viewpoint -

Heart Failure, Chronic Kidney Disease, and Biomarkers - An Integrated Viewpoint -

Autoantibodies to Cardiac Troponin Associate with Higher Initial Concentrations and Longer Release of Troponin I in Acute Coronary Syndrome Patients

A clinical scoring system in undifferentiated chest pain predicting undetectable troponin concentration

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