Cardiac Troponin T for Prediction of Short- and Long-Term Morbidity and Mortality after Elective Open Heart Surgery

Lehrke, Stephanie; Steen, Henning; Sievers, Hans H.; Peters, Hanno; Opitz, Armin; Müller-Bardorff, Margit; Wiegand, Uwe K.H.; Katus, Hugo A.; Giannitsis, Evangelos

doi:10.1373/clinchem.2004.031468

Cited by 125 publications

(98 citation statements)

References 27 publications

(30 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…57 However, irrespective of the mechanism, the higher the value after surgery, the greater the damage 115,116 and the worse the prognosis. 117,118 Some have suggested that late-peaking elevations are indicative of graft occlusion, 119 but proof of this concept is unavailable. Eventually, the ability to monitor cardiac biomarkers should be a useful way to improve strategies for myocardial protection 120,121 and surgical approaches.…”

Section: Troponin After Percutaneous Coronary Interventionsmentioning

confidence: 99%

Troponin: the biomarker of choice for the detection of cardiac injury

Babuin¹

2005

Canadian Medical Association Journal

531

390

View full text Add to dashboard Cite

T roponin is the biomarker of choice for the detection of cardiac injury. To use it properly, one must understand how sensitive the specific assay being used is for detecting cardiac injury, the fact that elevated troponin levels are highly specific for cardiac injury and some critical issues related to the basic science of the protein and its measurement. In this article, we review the biology of troponin, characteristics of assays that measure serum troponin levels and how to apply these measurements to patients who present with possible cardiovascular disease. We also discuss other clinical situations in which troponin levels may be elevated. The biology of troponinThe 3-unit troponin complex (troponin I, T and C) along with tropomyosin is located on the actin filament and is essential for the calcium-mediated regulation of skeletal and cardiac muscle contraction. 1 There are tissue-specific isoforms of troponin I, T and C. 2,3 Because the cardiac isoform of troponin C is shared by slow-twitch skeletal muscles, troponin C does not have cardiac specificity and thus is not used in assays for the diagnosis of cardiac injury. 4 There is one cardiac troponin I (cTnI) isoform in myocardial tissue. 5 This isoform has a post-translational tail of 32 amino acids on the N-terminus. 6,7 This sequence and the 42% and 45% dissimilarity with sequences of the other isoforms 8 have made possible the generation of highly specific monoclonal antibodies without cross-reactivity with other noncardiac forms. 9 Three genes control cardiac troponin T (cTnT). 10 These genes and alternative mRNA splicing produce a series of isoforms 10,11 with variable sequences close to the regions of the N-terminus and C-terminus. 10,12 Human cardiac muscle contains 4 troponin T isoforms, but only one is characteristic of the normal adult heart. 13,14 Highly specific antibodies have been made to the N-terminus-specific sequence of this cTnT isoform. 15 The skeletal isoforms present in the fetal heart are replaced by cTnI and cTnT late during fetal development. 16,17 cTnI is not expressed in skeletal muscle or other tissues during development 17 or in response to degenerative or regenerative muscle disease processes. 18 Thus, it is unlikely to be reexpressed in damaged tissues. The situation is more complex for cTnT. Re-expression of fetal forms occurs in cardiac tissue 12 and in diseased skeletal muscle. 19 With the firstgeneration cTnT assay, this problem was compounded by a nonspecific tag antibody that cross-reacted with troponin T in skeletal muscle. 20 Once this antibody was replaced by one with high specificity, false-positive elevations from skeletal muscle were eliminated. 15 Studies using immunohistochemistry and polymerase chain reaction have confirmed that these fetal isoforms are not detected by the assay used today. 21,22 Thus, the assay used to measure cTnT levels has cardiac specificity equivalent to that of assays for cTnI. Characteristics of troponin assaysMost troponin is found in the 3-unit complex (troponin I, T and C) of the c...

show abstract

Section: Troponin After Percutaneous Coronary Interventionsmentioning

confidence: 99%

Troponin: the biomarker of choice for the detection of cardiac injury

Babuin¹

2005

Canadian Medical Association Journal

531

390

View full text Add to dashboard Cite

show abstract

“…36 , estudando os níveis de troponina T, consideraram que valores maiores ou iguais a 0,46 ng/mL nas 48 h de pós-operatório, revelou ser um bom preditor de mortalidade cardíaca em longo prazo, especialmente nos pacientes com tempo de anóxia superior a 65 minutos. Comparando com este estudo, pode-se sugerir que a utilização da Tmz, associada a um menor tempo de anóxia, poderia ter um impacto na mortalidade em longo prazo, visto que no grupo placebo foram observados valores de troponina T superiores a 0,46 nas 48 h em alguns pacientes, assim como o tempo de anóxia ultrapassou 65 minutos.…”

Section: Gráfico 2 -Creatinofosfoquinase-mb Ao Longo Do Tempo Segundounclassified

Trimetazidina na injúria de isquemia e reperfusão em cirurgia de revascularização do miocárdio

Martins¹,

Filho²,

Santos³

et al. 2011

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

ResumoFundamento: A injúria de isquemia e reperfusão constitui um mecanismo fisiopatológico frequente e de difícil controle durante a Cirurgia de Revascularização do Miocárdio (CRVM) com circulação extracorpórea, sendo o momento crítico o término da cirurgia, quando ocorre o desclampeamento da aorta e a liberação dos radicais hiperóxidos causadores da injúria.Objetivo: Avaliar, em estudo prospectivo, duplo-cego randomizado, controlado com placebo, os efeitos da Trimetazidina (Tmz) sobre a injúria de isquemia e reperfusão miocárdica, identificando a variação dos marcadores plasmáticos de agressão miocárdica (troponina T e CPK-Mb), e as alterações ecocardiográficas da função ventricular.Métodos: Foram estudados 60 pacientes, divididos em dois grupos (Placebo e Tmz) com, no máximo, disfunção ventricular leve, estratificados por ecocardiografia e recebendo medicação/placebo na dose -no pré-operatório sem medicação, 12 a 15 dias de medicação/placebo colhida cinco minutos após o desclampeamento aórtico, e nas 12, 24 e 48 horas seguintes. Resultados: Tanto a troponina T como a CPK-Mb atingiram valores altamente significativos (p = 0,0001) no grupo tratado em relação ao grupo controle nos quatro momentos analisados − 5 min, 12 h, 24 h e 48 h. As variáveis ecocardiográficas não evidenciaram mudanças evolutivas em cada grupo isoladamente e quando comparados em conjunto. Conclusão AbstractBackground: The ischemia and reperfusion ischemia is a common physiopathological mechanisms, which has difficult control during Coronary Artery Bypass Grafting (CABG) with cardiopulmonary bypass, the critical moment of which happening by the end of surgery, when there is declamping of aorta and release of hyperoxic radicals causing the injury.

show abstract

“…Its value in diagnosis of myocardial infarction is well known in clinical patients, but it is still under study in patients already grafted, [1,[3][4][5][6][7][8][9].…”

Section: Discussionmentioning

confidence: 99%

“…Among them, it emphasizes the myocardial infarction (AMI) due to its high incidence, which varies from 5% to 15%, according to the literature. [1][2][3][4][5] The consequences of peri-operative AMI can vary from minor enzyme elevations without clinical relevance to presentations of low cardiac output or malignant tachyarrhythmias, followed by death or reduced long-term survival, which explains the efforts made in trying to avoid such complication [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Importância da troponina I no diagnóstico do infarto do miocárdio no pós-operatório de cirurgia de revascularização

Oliveira¹,

Botelho²,

Brandi³

et al. 2009

Rev Bras Cir Cardiovasc

View full text Add to dashboard Cite

Importância da troponina I no diagnóstico do infarto do miocárdio no pós-operatório de cirurgia de revascularizaçãoThe importance of troponin I in the diagnosis of myocardial infarction in the postoperative of coronary artery bypass graft surgery Abstract Objective: The aim of this study is to establish a cut-off value for troponin I by correlating it to occurrence of postoperative myocardial infarction.Methods: 180 consecutive patients with coronary disease referred for surgery were included. The mean age of the patients were 60.6 (±9.3) years, with 119 (66.1%) males and 61 (33.9%) females. The patients were divided into two groups: group without myocardial infarction (A) -170 patients -and with myocardial infarction (B) -10 patients.The troponin I was collected from each patient at the beginning of anesthesia and on the second postoperative day by correlating it to presence or not of postoperative myocardial infarction. StatsDirect 1.6.0 for Windows was used for statistical analysis.Results: Preoperative troponin I was 1.0 (±6) ng/ml as mean. Univariate logistic regression showed correlation of troponin I of the second postoperative day with myocardial infarction (P=0.0005). ROC curve was used to define the cut-off value, and 6.1 ng/ml (sensitivity=90.0%, specificity=82.1%, OR=49.8 with CI=95% 6.1-410.4, P<0.0001) were found.Conclusion: The chance of a patient with postoperative myocardial infarction to present troponin I equal to or higher than 6.1 ng/ml is 49.8-fold higher than the chance of a patient without infarction to present troponin I higher than this value. Resultados: A troponina I pré-operatória apresentou uma

show abstract

Cardiac Troponin T for Prediction of Short- and Long-Term Morbidity and Mortality after Elective Open Heart Surgery

Abstract: A single postoperative cTnT measurement can be used to estimate myocardial cell injury that impacts long-term survival after open heart surgery. It adds independently to established risk indicators.

Cited by 125 publications

References 27 publications

Troponin: the biomarker of choice for the detection of cardiac injury

Troponin: the biomarker of choice for the detection of cardiac injury

Trimetazidina na injúria de isquemia e reperfusão em cirurgia de revascularização do miocárdio

Importância da troponina I no diagnóstico do infarto do miocárdio no pós-operatório de cirurgia de revascularização

Contact Info

Product

Resources

About