Troponin T measurement after myocardial infarction can identify left ventricular ejection of less than 40%

Rao, A C R; Collinson, Paul; Canepa‐Anson, R; Joseph, S P

doi:10.1136/hrt.80.3.223

Cited by 58 publications

(31 citation statements)

References 12 publications

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“…These results indicate that in patients with NSTE ACS, revascularization during index hospitalization attenuates the adverse prognostic importance of in-hospital peak troponin level, potentially at least, in part, by reduction in recurrent MI. Peak troponin levels during MI have been shown to correlate with infarct size and left ventricular ejection fraction, 2 which are major determinants of mortality after MI. 3 Although increased mortality at the highest levels of troponin might be a consequence of myocardial damage large enough to cause decreased left ventricular function, this cannot explain the greater risk of death in patients with only minor elevations of troponin where left ventricular function is preserved.…”

Section: Discussionmentioning

confidence: 99%

Magnitude of Troponin Elevation and Long-Term Clinical Outcomes in Acute Coronary Syndrome Patients Treated With and Without Revascularization

Bagai

Huang

Lokhnygina

et al. 2015

Circ: Cardiovascular Interventions

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Background— In patients with non–ST-segment–elevation acute coronary syndrome (NSTE ACS), elevated troponin levels identify patients at high risk for adverse outcomes; however, it is unknown whether the magnitude of troponin elevation during hospitalization remains predictive of subsequent events in patients undergoing coronary revascularization. Methods and Results— We studied 12 635 patients with NSTE ACS in the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) study with at least 1 troponin measurement during index hospitalization. Cox proportional hazards regression was used to examine the relationship between peak troponin level (standardized as the ratio of peak troponin value measured during hospitalization and local laboratory upper reference limit [URL]) and revascularization on all-cause mortality at 2 years. Revascularization (percutaneous coronary intervention or coronary artery bypass graft) was performed during index hospitalization in 8586 patients (68.0%); revascularized patients had higher peak troponin ratios (median, 23 versus 9.5× URL). Among patients that did not undergo revascularization, the mortality rate at 2 years increased in a curvilinear fashion with increasing levels of peak troponin. In contrast, the mortality rate at 2 years remained constant irrespective of peak troponin levels among revascularized patients ( P for interaction=0.004). This relationship was unchanged after multivariable adjustment. Conclusions— There is a differential relationship between the magnitude of troponin elevation and long-term mortality in ACS patients treated with and without revascularization. Although prognostically important in patients treated without revascularization, the prognostic implications of peak troponin level seem to be minimal in revascularized patients. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00527943.

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Section: Discussionmentioning

confidence: 99%

Magnitude of Troponin Elevation and Long-Term Clinical Outcomes in Acute Coronary Syndrome Patients Treated With and Without Revascularization

Bagai

Huang

Lokhnygina

et al. 2015

Circ: Cardiovascular Interventions

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“…Furthermore some patients may develop clinically important myocardial dysfunction due to sublethal injury that does not result in CK-MB release. The major advantage of cTnT over CK-MB is its ability to detect even minimal myocardial cell damage with high sensitivity and specificity that is undetectable by conventional enzyme methods (Mair 1997;Rao et al 1998;Jurlander et al 2000;Lindahl et al 2001).…”

Section: Methodsmentioning

confidence: 99%

“…The determination and urgent treatment of complications of stroke would prominently decrease morbidity and mortality due to stroke (Rao et al 1998). The mortality during the first days after stroke is generally due to brain damage, whereas in the following weeks deaths are due to stroke complications.…”

Section: )mentioning

confidence: 99%

Serum Cardiac Troponin T Levels as an Indicator of Myocardial Injury in Ischemic and Hemorrhagic Stroke Patients

Apak

İltümür

Tamam

et al. 2005

Tohoku J. Exp. Med.

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Many studies in the literature have clearly shown the increase in creatine kinase-myocardial subfraction (CK-MB) levels and changes in electrocardiography (ECG) after stroke. However, the studies on cardiac troponin T (cTnT) which is more sensitive and specific to myocardium after stroke are relatively scarce. Moreover, its associations with volume of stroke lesions and type of stroke have not been investigated thoroughly. Thus, the aims of this study were to investigate a predictive value of cTnT in assessing myocardial injury and cardiac dysfunction in different types of stroke (hemorrhagic or ischemic stroke) and its relationship with stroke size and volume. This study included 62 patients (30 males and 32 females) with acute stroke confirmed by computed tomography (CT). Blood samples were obtained within 24 hours of stroke onset to measure the serum levels of creatin kinase (CK), CK-MB, lactate dehydrogenate (LDH), and cTnT. ECG and echocardiography were performed to assess myocardial function and left ventricular ejection fraction (LVEF). Of all patients included in the study, 20 patients (32%) demonstrated elevations in cTnT, while 28 patients (45%) had increased CK-MB levels. Serum levels of cTnT were positively correlated with stroke volume (r = 0.65, p < 0.0001), while inversely correlated with LVEF (r = −0.53, p < 0001). Serum levels of both CK-MB and cTnT were higher in patients with hemorrhagic stroke than those with ischemic stroke but this difference was not significant (p > 0.05). As a conclusion, cTnT has a higher specificity and sensitivity in detecting myocardial injury after stroke of both ischemic and hemorrhagic origins. Measurement of the serum levels of cTnT is of clinical importance in evaluating myocardial injury and provides a useful aid in estimating the volume of stroke lesions. cardiac troponin T; creatine kinase-MB; stroke; myocardial injury; stroke volume © 2005 Tohoku University Medical PressStroke is defined as the primer pathology of brain vascular system that temporarily or permanently affects brain functions as a result of ischemia or hemorrhage. Due to consequent high mortality and morbidity rates, stroke is to become a major community health problem for whole

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“…Troponin measurement will also provide quantification of damage [61,62] . It can be shown that cardiac troponin measurements allow prediction of ejection fraction [63][64][65][66] and so quantification of infarct size [67] .…”

Section: Patients Presenting With Stemimentioning

confidence: 99%

Biomarkers of Cardiovascular Damage

Collinson¹,

Gaze²

2007

Med Princ Pract

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Acute coronary syndromes (ACS) are due to the rupture or erosion of atheromatous plaques. This produces, depending on plaque size, vascular anatomy and degree of collateral circulation, progressive tissue ischaemia which may progress to cardiomyocyte necrosis. This may then result in cardiac remodelling. Serum biomarkers are available which can be used for diagnosis of all of these stages. Markers to detect myocardial ischaemia at the pre-infarction stage are potentially the most interesting but also the most challenging. An ischaemia marker offers the opportunity to intervene to prevent progression to infarction. The problems with potential ischaemia markers are specificity and the reference diagnostic standard against which they can be judged. To date, only one, ischaemia-modified albumin®, has reached the point where clinical studies can be performed. The measurement of the cardiac troponins, cardiac troponin T and cardiac troponin I, have become recognised as the diagnostic reference standard for myocardial necrosis. The sensitive nature of these tests has also revealed that myocardial necrosis is also found in a range of other clinical situations, highlighting the need to use all clinical information for diagnosis of acute myocardial infarction. The measurement of B-type natriuretic peptides can be shown to be diagnostic and prognostic in both ACS and detecting the sequelae of post-infarction myocardial insufficiency. The role of the B-type natriuretic peptides in detection of cardiac failure, both acute and chronic, is well defined but remains the subject of further studies, in ACS.

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Troponin T measurement after myocardial infarction can identify left ventricular ejection of less than 40%

Cited by 58 publications

References 12 publications

Magnitude of Troponin Elevation and Long-Term Clinical Outcomes in Acute Coronary Syndrome Patients Treated With and Without Revascularization

Magnitude of Troponin Elevation and Long-Term Clinical Outcomes in Acute Coronary Syndrome Patients Treated With and Without Revascularization

Serum Cardiac Troponin T Levels as an Indicator of Myocardial Injury in Ischemic and Hemorrhagic Stroke Patients

Biomarkers of Cardiovascular Damage

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