The ratio of cardiac troponin T to troponin I may indicate non-necrotic troponin release among COVID-19 patients

Hammarsten, Ola; Ljungqvist, Pontus; Redfors, Björn; Wernbom, Mathias; Widing, Hannes; Lindahl, Bertil; Salahuddin, Sabin; Sammantar, Ruwyada; Jha, Sandeep; Ravn-Fisher, Annica; Brink, Magnus; Gisslén, Magnus

doi:10.1016/j.cca.2021.12.030

Cited by 8 publications

(5 citation statements)

References 52 publications

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“…The present investigation in contrast, applied a clinically more relevant approach by focusing on patients having elevated hs-cTn concentrations. This likely explains our more favorable results which corroborate with data from a smaller investigation in patients hospitalized for type 1 MI or COVID-19 infection [ 29 ]. Our findings are important since patients with an acute coronary cause of hs-cTn elevation (i.e.…”

Section: Discussionsupporting

confidence: 89%

Diagnostic and prognostic performance of the ratio between high-sensitivity cardiac troponin I and troponin T in patients with chest pain

Eggers

Hammarsten²,

Aldous³

et al. 2022

PLoS ONE

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Background Elevations of high-sensitivity cardiac troponin (hs-cTn) concentrations not related to type 1 myocardial infarction are common in chest pain patients presenting to emergency departments. The discrimination of these patients from those with type 1 myocardial infarction (MI) is challenging and resource-consuming. We aimed to investigate whether the hs-cTn I/T ratio might provide diagnostic and prognostic increment in this context. Methods We calculated the hs-cTn I/T ratio in 888 chest pain patients having hs-cTnI (Abbott Laboratories) or hs-cTnT (Roche Diagnostics) concentrations above the respective 99th percentile at 2 hours from presentation. All patients were followed for one year regarding mortality. Results The median hs-cTn I/T ratio was 3.45 (25th, 75th percentiles 1.80–6.59) in type 1 MI patients (n = 408 ☯46.0%]), 1.18 (0.81–1.90) in type 2 MI patients (n = 56 ☯6.3%]) and 0.67 (0.39–1.12) in patients without MI. The hs-cTn I/T ratio provided good discrimination of type 1 MI from no type 1 MI (area under the receiver-operator characteristic curve 0.89 ☯95% confidence interval 0.86–0.91]), of type 1 MI from type 2 MI (area under the curve 0.81 ☯95% confidence interval 0.74–0.87]), and was associated with type 1 MI in adjusted analyses. The hs-cTn I/T ratio provided no consistent prognostic value. Conclusions The hs-cTn I/T ratio appears to be useful for early diagnosis of type 1 MI and its discrimination from type 2 MI in chest pain patients presenting with elevated hs-cTn. Differences in hs-cTn I/T ratio values may reflect variations in hs-cTn release mechanisms in response to different types of myocardial injury.

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Section: Discussionsupporting

confidence: 89%

Diagnostic and prognostic performance of the ratio between high-sensitivity cardiac troponin I and troponin T in patients with chest pain

Eggers

Hammarsten²,

Aldous³

et al. 2022

PLoS ONE

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“…This outstanding and elegant research sheds light on the significant correlation between plasma histone levels and severity of COVID-19 infection, highly associated with severe coagulopathy, inflammation, and cardiac injury. In particular, the plasma levels of cardiac troponin were found to correlate with histone levels and were found to be significantly higher in COVID-19 patients who died compared to those who survived (median circulating histone levels in non-survivors vs. survivors: 29.6 μg/mL vs. 8.6 μg/mL, p = 0.002) [ 29 ], thus confirming literature data on both cytotoxic effects of extracellular histones on cardiomyocytes [ 25 ], and non-necrotic cardiac troponin release in COVID-19 patients [ 30 ].…”

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confidence: 69%

Do Circulating Histones Represent the Missing Link among COVID-19 Infection and Multiorgan Injuries, Microvascular Coagulopathy and Systemic Hyperinflammation?

Ligi

Maniscalco

Plebani

et al. 2022

JCM

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Several studies shed light on the interplay among inflammation, thrombosis, multi-organ failures and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Increasing levels of both free and/or circulating histones have been associated to coronavirus disease 2019 (COVID-19), enhancing the risk of heart attack and stroke with coagulopathy and systemic hyperinflammation. In this view, by considering both the biological and clinical rationale, circulating histones may be relevant as diagnostic biomarkers for stratifying COVID-19 patients at higher risk for viral sepsis, and as predictive laboratory medicine tool for targeted therapies.

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“…This is in line with earlier immunological results from our cohort, potentially suggesting persistence of the virus ( 34 ). In fact, COVID-19 seems able to induce enduring myocardial damage ( 35 ) and post-mortem analyses have shown quantifiable and persistent SARS-CoV-2 RNA in multiple organs, including the heart ( 36 ). This might also explain cases of myocarditis in COVID-19 patients ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

Mild COVID-19 induces early, quantifiable, persistent troponin I elevations in elder men

Bürgi¹,

Rösslein²,

Nolte³

et al. 2022

Front. Cardiovasc. Med.

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ImportanceElderly patients, especially men, are at risk of increased morbidity from coronavirus disease 2019 (COVID-19). Long-term data on troponin I levels in longitudinal observational studies of outpatients with mild to moderate COVID-19 are scarce.ObjectiveThis controlled cohort study aimed to evaluate the course of troponin I concentrations over a long period in convalescent COVID-19 outpatients with mild to moderate symptoms.Setting and participantsIn this cohort study, individuals with PCR-confirmed, mild to moderate SARS-CoV-2 infection as well as control individuals with confirmed negative PCR and negative SARS-CoV-2 serology were included. Study visits were performed from April 2020 through July 2021 (initialized during the first wave of the corona pandemic in Switzerland). A study visit in patients comprised blood draws every week in the first month and additionally after 8 weeks. This course was repeated in patients observed long-term.ResultsThis study enrolled 278 individuals from the Canton of St. Gallen, Switzerland, aged 12–92 years (59.5% women), who had mild to moderate COVID-19 symptoms (outpatients only) and a diagnosis confirmed by positive RT-PCR. Fifty-four of the participants with confirmed SARS-CoV-2 infection were followed for 14 months with repeat cycles of the testing protocol. In addition, 115 symptomatic patients that were PCR and serology negative were enrolled in the same time period as a control group. In COVID-19 patients, low-level troponin I concentrations (cTnI) were significantly increased from baseline until week 9 after positive RT-PCR diagnosis in men older than 54 years [ΔcTnI = 5.0 ng/L (median); 95% CI 4.1–6.0; p = 0.02]. The troponin I concentration remained elevated throughout 14 months in men older than 54 years within the cohort with a prolonged observation period. This statistically significant change in troponin I concentration was not dependent on co-morbidities in this group. ALT, Creatinine, BNP, and D-Dimer values after convalescence did not differ in comparison to the control cohort.ConclusionIn this analysis of individuals with confirmed SARS-CoV-2 infection, hs troponin I levels of men aged 54 or older significantly increased after infection. They remained elevated for at least 14 months after diagnosis. This suggests the possibility of an ongoing, long-term, low-grade myocardial injury. Further studies with focus on elderly patients and a prolonged observational period are necessary to elucidate whether the phenomenon observed is associated with detectable structural changes to the heart muscle or is without further clinical consequences.

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The ratio of cardiac troponin T to troponin I may indicate non-necrotic troponin release among COVID-19 patients

Cited by 8 publications

References 52 publications

Diagnostic and prognostic performance of the ratio between high-sensitivity cardiac troponin I and troponin T in patients with chest pain

Diagnostic and prognostic performance of the ratio between high-sensitivity cardiac troponin I and troponin T in patients with chest pain

Do Circulating Histones Represent the Missing Link among COVID-19 Infection and Multiorgan Injuries, Microvascular Coagulopathy and Systemic Hyperinflammation?

Mild COVID-19 induces early, quantifiable, persistent troponin I elevations in elder men

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