Is the true clinical value of high-sensitivity troponins as a biomarker of risk? The concept that detection of high-sensitivity troponin ‘never means nothing’

Hinton, Jonathan; Gabara, Lavinia; Curzen, Nick

doi:10.1080/14779072.2020.1828063

Cited by 8 publications

(5 citation statements)

References 139 publications

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“…The rising and/or falling cTn levels may differentiate acute myocardial injury from chronic cardiomyocyte damage, the likelihood of AMI being directly associated with the amplitude of cTn change. [5][6][7]…”

Section: Ctn Elevation In the Edmentioning

confidence: 99%

Cardiac Biomarkers in 2022 – a Vital Tool for Emergency Care

Benedek

Marton-Popovici

2022

Journal of Cardiovascular Emergencies

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The role of cardiac biomarkers in diagnosing acute myocardial infarction is undoubted. In the 2020 guidelines of the European Society of Cardiology, the measurement of cardiac peptides to gain prognostic information has a class IIa indication in all patients with ACS. In emergency care, ruling out a non-ST elevation myocardial infarction requires documentation of normal levels of cardiac biomarkers, which remain stable or have very small variations within several hours. This review aims to summarize the current knowledge and recent progresses in the field of cardiac biomarker discovery, from their routine use in emergency rooms to their prognostic roles in modern risk assessment tools. Integrated approaches combining cardiac troponin with other biomarkers of ventricular dysfunction or inflammation, or with modern cardiac imaging in emergency care are also presented, as well as the role of modern algorithms for serial troponin measurement in the modern management of emergency departments.

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Section: Ctn Elevation In the Edmentioning

confidence: 99%

Cardiac Biomarkers in 2022 – a Vital Tool for Emergency Care

Benedek

Marton-Popovici

2022

Journal of Cardiovascular Emergencies

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“…Interestingly, it was shown that exercise increased BNP plasma levels particularly in HCM patients with silent ischemia [75]. Importantly, BNP and cTn levels were also associated with fibrosis in HCM patients and cTn levels were predictive for the detection of extensive myocardial fibrosis in non-high risk patients with HCM [76,77]. Troponin measurements could therefore be used as a pretest to select patients for CMR imaging with LGE or T1 mapping to establish cardiac fibrosis.…”

Section: Nps and Troponins In Hcm Dcm And Acmmentioning

confidence: 99%

The Time Has Come to Explore Plasma Biomarkers in Genetic Cardiomyopathies

Stege

Boer

Berg

et al. 2021

IJMS

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For patients with hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) or arrhythmogenic cardiomyopathy (ACM), screening for pathogenic variants has become standard clinical practice. Genetic cascade screening also allows the identification of relatives that carry the same mutation as the proband, but disease onset and severity in mutation carriers often remains uncertain. Early detection of disease onset may allow timely treatment before irreversible changes are present. Although plasma biomarkers may aid in the prediction of disease onset, monitoring relies predominantly on identifying early clinical symptoms, on imaging techniques like echocardiography (Echo) and cardiac magnetic resonance imaging (CMR), and on (ambulatory) electrocardiography (electrocardiograms (ECGs)). In contrast to most other cardiac diseases, which are explained by a combination of risk factors and comorbidities, genetic cardiomyopathies have a clear primary genetically defined cardiac background. Cardiomyopathy cohorts could therefore have excellent value in biomarker studies and in distinguishing biomarkers related to the primary cardiac disease from those related to extracardiac, secondary organ dysfunction. Despite this advantage, biomarker investigations in cardiomyopathies are still limited, most likely due to the limited number of carriers in the past. Here, we discuss not only the potential use of established plasma biomarkers, including natriuretic peptides and troponins, but also the use of novel biomarkers, such as cardiac autoantibodies in genetic cardiomyopathy, and discuss how we can gauge biomarker studies in cardiomyopathy cohorts for heart failure at large.

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“…The increased sensitivity and usage of high sensitivity troponin (hs-cTn) assays has resulted in concentrations above the manufacturer defined upper limit of normal (ULN) being seen in a range of different clinical contexts not traditionally associated with myocardial infarction. 1–5 Furthermore, there is an accumulating body of evidence demonstrating that hs-cTn is associated with medium term outcomes in several disease groups. 6–14 Specifically, this research group showed that in a population of 20,000 consecutive patients undergoing a blood test for any reason, inpatient or outpatient, the hs-cTnI concentration was above the ULN in 1 in 20.…”

Section: Introductionmentioning

confidence: 99%

Is high sensitivity troponin, taken regardless of a clinical indication, associated with 1 year mortality in critical care patients?

Hinton

Augustine

Gabara

et al. 2023

Journal of the Intensive Care Society

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The aim of this study was to assess whether high sensitivity troponin (hs-cTnI) is associated with 1 year mortality in critical care (CC). One year mortality data were obtained from NHS Digital for a consecutive cohort of patients admitted to general CC unit (GCCU) and neuroscience CC unit (NCCU) who had hs-cTnI tests performed throughout their CC admission, regardless of whether the test was clinically indicated. Cox proportional hazards were used to estimate the risk of 1-year mortality. A landmark analysis was undertaken to assess whether any relationship at 1 year was driven by mortality within the first 30 days. A total of 1033 consecutive patients were included. At 1 year 254 (24.6%) patients had died. The admission log(10)hs-cTnI concentration in the entire cohort (HR 1.35 (95% CI 1.05–1.75) p = 0.009 with a bootstrap of 1000 samples) was independently associated with 1 year mortality. On landmark analysis the association with 1 year mortality was driven by 30 day mortality. These results indicate that admission hs-cTnI concentration is independently associated with 1 year mortality in CC and this relationship may be driven by differences in mortality at 30 days.

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Is the true clinical value of high-sensitivity troponins as a biomarker of risk? The concept that detection of high-sensitivity troponin ‘never means nothing’

Cited by 8 publications

References 139 publications

Cardiac Biomarkers in 2022 – a Vital Tool for Emergency Care

Cardiac Biomarkers in 2022 – a Vital Tool for Emergency Care

The Time Has Come to Explore Plasma Biomarkers in Genetic Cardiomyopathies

Is high sensitivity troponin, taken regardless of a clinical indication, associated with 1 year mortality in critical care patients?

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