Analytical performance of cardiac troponin assays – Current status and future needs

Aakre, Kristin Moberg; Saeed, Nasir; Wu, Alan H.B.; Kavsak, Peter A.

doi:10.1016/j.cca.2020.06.021

Cited by 9 publications

(4 citation statements)

References 65 publications

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“…RCV combine within-individual biological variation, analytical variation and a z-value to give an estimate of random variation when two consecutive results are compared. Earlier studies have shown that the long-term within-individual biological variation of troponins is approximately 15% (32). The analytical variation at the low concentrations measured in our study was approximately 10% (see above).…”

Section: Discussionsupporting

confidence: 61%

Gastric bypass surgery is associated with reduced subclinical myocardial injury and greater activation of the cardiac natriuretic peptide system than lifestyle intervention

Aakre

Omland

Nordstrand

et al. 2020

Clinical Biochemistry

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Aims: Morbid obesity is a risk factor for cardiovascular disease. The relative effects of Roux-en-Y gastric bypass surgery (GBS) and intensive lifestyle intervention (ILI) on subclinical myocardial injury, the activity of the cardiac natriuretic system, and systemic inflammation remain unclear.Methods: In a 59-week non-randomized clinical trial that included 131 patients with morbid obesity, we compared the effects of GBS and ILI on concentrations of cardiac troponin T (cTnT) and I (cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and C-reactive protein (CRP). Results:In the GBS and ILI group, median body mass index (BMI) was reduced by 14.4 kg/m 2 versus 3.9 kg/m 2 , respectively (p value < 0.001). Cardiac troponins decreased after GBS, p=0.014 (cTnT) and p=0.065 (cTnI) and increased significantly in those treated with ILI (p values ≤ 0.021) (between-group differences for deltas: p ≤ 0.003). NT-proBNP increased in both groups, but significantly more in the GBS than in the ILI group (between-group differences for deltas: p=0.008).CRP decreased significantly within the GBS and the ILI group, with this change significantly greater in the GBS group (between-group differences for deltas p < 0.001). The dominating mediator of the biomarker changes was weight loss. Prior coronary artery disease and diabetes were predictive of the magnitude of the changes in cTnI and NT-proBNP, respectively. Conclusion:Compared to ILI, GBS was associated with reduced subclinical myocardial injury and systemic inflammation, and enhancement of the cardiac natriuretic peptide system. The biomarker changes were predominantly mediated by weight loss.

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Section: Discussionsupporting

confidence: 61%

Gastric bypass surgery is associated with reduced subclinical myocardial injury and greater activation of the cardiac natriuretic peptide system than lifestyle intervention

Aakre

Omland

Nordstrand

et al. 2020

Clinical Biochemistry

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“…Along with the introduction and application of high-sensitivity assays with much lower detectable concentration capability, a higher proportion of athletes were detected or tested positive for elevations in high-sensitivity cardiac troponin (hs-cTn) prior to and following exercise (Gresslien and Agewall, 2016). Since hs-cTn has been interpreted as a quantitative assessment for cardiomyocyte damage (Collet et al, 2020), with even lowlevel elevations in healthy populations used to predict further cardiovascular risks associated with chronic myocardial injury (Seliger et al, 2017;Aakre et al, 2020), it is necessary to reconsider our understanding of the underlying mechanisms and clinical implications related to hs-cTn elevations following exercise in athletes.…”

Section: Introductionmentioning

confidence: 99%

Kinetics, Moderators and Reference Limits of Exercise-Induced Elevation of Cardiac Troponin T in Athletes: A Systematic Review and Meta-Analysis

Hopkins

Wang

et al. 2021

Front. Physiol.

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Background: Kinetics, moderators and reference limits for exercise-induced cardiac troponin T (cTnT) elevations are still unclear.Methods: A systematic review of published literature was conducted adhering to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Studies reporting high-sensitivity cardiac troponin T (hs-cTnT) concentrations before and after a bout of exercise in athletes were included and analyzed. The final dataset consisted of 62 estimates from 16 bouts in 13 studies of 5–1,002 athletes (1,421 in total). Meta-analysis was performed using general linear mixed modeling and Bayesian inferences about effect magnitudes. Modifying fixed-effect moderators of gender, age, baseline level, exercise duration, intensity and modalities were investigated. Simulation was used to derive 99th percentile with 95% limits of upper reference ranges for hs-cTnT of athletic populations.Results: The mean and upper reference limits of hs-cTnT before exercise were 4.4 and 19 ng.L−1. Clear increases in hs-cTnT ranging from large to very large (factor changes of 2.1–7.5, 90% compatibility limits, ×/÷1.3) were evident from 0.7 through 25 h, peaking at 2.9 h after the midpoint of a 2.5-h bout of running, when the mean and upper reference limit for hs-cTnT were 33 and 390 ng L−1. A four-fold increase in exercise duration produced a large clear increase (2.4, ×/÷1.7) in post-exercise hs-cTnT. Rowing exercise demonstrated an extremely large clear reduction (0.1 ×/÷2.4).Conclusions: The kinetics of cTnT elevation following exercise, the positive effect of exercise duration, the impact of exercise modality and 99th upper reference limits for athletic populations were reasonably well defined by this meta-analysis.

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“…Although the regulatory documents concerning the diagnostics and treatment of different forms of acute coronary syndrome and myocardial infarction contain clear recommendations on the time of troponin testing and decision-making levels, and the sensitivity and specificity of most immunoassays approximates 100%, there still remains a number of unsolved problems and issues relating to the application of these markers in clinical practice. Some of these problems are connected with the variety of troponin diagnostic agents, their unequal sensitivity and diagnostic accuracy, different susceptibility to cross-reactive substances (molecules), i.e., with different analytical characteristics of test systems [ 14 , 16 , 17 ]. Another range of issues results from the fact that the increase in cardiac troponin levels takes place in case of myocardial necrosis of any etiology and sometimes in the absence of irreversible myocardial injury (for instance, in case of reversible injury induced by physical exercises, renal failure, or the influence of false-positive factors) [ 18 – 24 ].…”

Section: Introductionmentioning

confidence: 99%

The Importance of Cardiac Troponin Metabolism in the Laboratory Diagnosis of Myocardial Infarction (Comprehensive Review)

Chaulin

2022

BioMed Research International

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The study of the metabolism of endogenous molecules is not only of great fundamental significance but also of high practical importance, since many molecules serve as drug targets and/or biomarkers for laboratory diagnostics of diseases. Thus, cardiac troponin molecules have long been used as the main biomarkers for confirmation of diagnosis of myocardial infarction, and with the introduction of high-sensitivity test methods, many of our ideas about metabolism of these cardiac markers have changed significantly. In clinical practice, there are opening new promising diagnostic capabilities of cardiac troponins, the understanding and justification of which are closely connected with the fundamental principles of the metabolism of these molecules. Our current knowledge about the metabolism of cardiac troponins is insufficient and extremely disconnected from various literary sources. Thus, many researchers do not sufficiently understand the potential importance of cardiac troponin metabolism in the laboratory diagnosis of myocardial infarction. The purpose of this comprehensive review is to systematize information about the metabolism of cardiac troponins and during the discussion to focus on the potential impact of cTns metabolism on the laboratory diagnosis of myocardial infarction. The format of this comprehensive review includes a sequential consideration and analysis of the stages of the metabolic pathway, starting from possible release mechanisms and ending with elimination mechanisms. This will allow doctors and researchers to understand the significant importance of cTns metabolism and its impact on the laboratory diagnosis of myocardial infarction.

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Analytical performance of cardiac troponin assays – Current status and future needs

Cited by 9 publications

References 65 publications

Gastric bypass surgery is associated with reduced subclinical myocardial injury and greater activation of the cardiac natriuretic peptide system than lifestyle intervention

Gastric bypass surgery is associated with reduced subclinical myocardial injury and greater activation of the cardiac natriuretic peptide system than lifestyle intervention

Kinetics, Moderators and Reference Limits of Exercise-Induced Elevation of Cardiac Troponin T in Athletes: A Systematic Review and Meta-Analysis

The Importance of Cardiac Troponin Metabolism in the Laboratory Diagnosis of Myocardial Infarction (Comprehensive Review)

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