Circulating Cardiac Troponin T Exhibits a Diurnal Rhythm

Klinkenberg, Lieke J.J.; Dijk, Jan-Willem van; Tan, Frans E. S.; Loon, Luc J. C. van; Dieijen-Visser, Marja P. van; Meex, Steven J.R.

doi:10.1016/j.jacc.2014.01.040

Cited by 76 publications

(72 citation statements)

References 34 publications

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“…Recently it was shown that hs-cTnT concentrations display a diurnal variation, with peak hs-cTnT concentrations in the morning that gradually decrease during the day [10]. Herein, we found higher RR for hs-cTnT following 4-h HDF in comparison to 8-h HD.…”

supporting

confidence: 44%

Acute effects of conventional and extended hemodialysis and hemodiafiltration on high-sensitivity cardiac troponins

Cardinaels¹,

Cornelis²,

Sande³

et al. 2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Elevated concentrations of cardiac troponin T (cTnT; ±37 kDa) and I (cTnI; ±24 kDa), and the N-terminal fragment of the prohormone brain-type natriuretic peptide (NTproBNP; ±8.5 kDa) have been reported in end-stage renal disease patients and are associated with cardiovascular morbidity and mortality [1,2]. Also, cTnT, cTnI and NTproBNP correlate with glomerular filtration rate, suggesting a significant role of renal removal and consequences for the clinical interpretation of these cardiac markers [3]. The influence of hemodialysis (HD) on cardiac biomarkers itself remains contradictory. Previous studies have demonstrated intra-dialytic decreases [4] and increases in NTproBNP [5]. Also, significant reductions as well as increases in cTnT and cTnI concentrations have been reported following dialysis [5][6][7][8]. These differences can be attributed to the use of different dialysis modalities and membrane filters [5,8].Currently, most patients are treated with 4-h high-flux HD. However, it has been shown that uremic toxins were better removed when patients were treated with hemodiafiltration (HDF) and extended 8-h dialysis treatments resulted in more hemodynamic stability [9]. The aim of the present study was therefore to assess the acute effects of conventional and extended high-flux HD and HDF on cardiac biomarkers in the same population as previously described [9], especially focusing on high-sensitivity (hs-) cTnT and hs-cTnI results.Prevalent conventional HD patients were recruited receiving chronic conventional HD treatments, without residual urine production and acute illness, such as infection or cardiovascular events. All patients underwent one mid-week session in random order: 4-h HD (HD4), 8-h HD (HD8), 4-h online HDF (HDF4) and 8-h online HDF (HDF8) sessions; with a 2-week interval between the study sessions. Between the study sessions, these patients received conventional HD (HD4) treatments. All treatments were performed with the Fresenius 5008 Therapy System (Fresenius Medical Care). High-flux FX80 and FX800 dialysers (both Fresenius) were used for HD and HDF, respectively. Blood flow and dialysate flow were 300 and 600 mL/min, respectively. Substitution flow was 83.3 mL/min to achieve a total substitution volume of 15 L for HDF4 and 30 L for HDF8. Dialysate composition was 1.5 mmol/L calcium, 2 mmol/L potassium, 136-138 mmol/L sodium and 35-38 mmol/L bicarbonate and remain unchanged during the study period. This study (NL34908.068.10/MEC10-2-098) was approved by the Local Ethics Committee, and written informed consent was obtained from each patient.Blood was drawn from the inlet bloodlines in serum tubes, immediately before and after dialysis. Serum samples were aliquoted, stored at −80 °C and thawed prior to analysis. For HDF8, hs-cTnI and NTproBNP could not be measured in three patients due to a lack of

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supporting

confidence: 44%

Acute effects of conventional and extended hemodialysis and hemodiafiltration on high-sensitivity cardiac troponins

Cardinaels¹,

Cornelis²,

Sande³

et al. 2015

Clinical Chemistry and Laboratory Medicine (CCLM)

Self Cite

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“…Diurnal variability in cardiac troponin has been observed with moderately higher levels during the morning (49), and short-term variability was present both in those with and without known coronary artery disease (50). This biological variation will need to be explored further to inform selection of appropriate cutoffs for use in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

High-Sensitivity Cardiac Troponin Concentration and Risk of First-Ever Cardiovascular Outcomes in 154,052 Participants

Willeit¹,

Welsh

Evans

et al. 2017

Journal of the American College of Cardiology

231

162

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BackgroundHigh-sensitivity assays can quantify cardiac troponins I and T (hs-cTnI, hs-cTnT) in individuals with no clinically manifest myocardial injury.ObjectivesThe goal of this study was to assess associations of cardiac troponin concentration with cardiovascular disease (CVD) outcomes in primary prevention studies.MethodsA search was conducted of PubMed, Web of Science, and EMBASE for prospective studies published up to September 2016, reporting on associations of cardiac troponin concentration with first-ever CVD outcomes (i.e., coronary heart disease [CHD], stroke, or the combination of both). Study-specific estimates, adjusted for conventional risk factors, were extracted by 2 independent reviewers, supplemented with de novo data from PROSPER (Pravastatin in Elderly Individuals at Risk of Vascular Disease Study), then pooled by using random effects meta-analysis.ResultsA total of 28 relevant studies were identified involving 154,052 participants. Cardiac troponin was detectable in 80.0% (hs-cTnI: 82.6%; hs-cTnT: 69.7%). In PROSPER, positive associations of log-linear shape were observed between hs-cTnT and CVD outcomes. In the meta-analysis, the relative risks comparing the top versus the bottom troponin third were 1.43 (95% confidence interval [CI]: 1.31 to 1.56) for CVD (11,763 events), 1.67 (95% CI: 1.50 to 1.86) for fatal CVD (7,775 events), 1.59 (95% CI: 1.38 to 1.83) for CHD (7,061 events), and 1.35 (95% CI: 1.23 to 1.48) for stroke (2,526 events). For fatal CVD, associations were stronger in North American studies (p = 0.010) and those measuring hs-cTnT rather than hs-cTnI (p = 0.027).ConclusionsIn the general population, high cardiac troponin concentration within the normal range is associated with increased CVD risk. This association is independent of conventional risk factors, strongest for fatal CVD, and applies to both CHD and stroke.

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“…The reason for these discrepancies is not clear. Whether uncontrolled potential confounders, such as diurnal rhythm (Klinkenberg et al., ) and mental stress (Eggers, Venge, Lindahl, & Lind, ), might have influenced resting cTnT concentrations requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

Impact of high‐intensity interval training and moderate‐intensity continuous training on resting and postexercise cardiac troponin T concentration

Nie

Zhang

Kong

et al. 2018

Experimental Physiology

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We evaluated the influence of 12 weeks of high-intensity interval training [HIIT; repeated 4 min cycling at 90% of maximal oxygen uptake (V̇O2max) interspersed with 3 min rest, 200-300 kJ per session, 3 or 4 days each week] and work-equivalent moderate-intensity continuous training (MICT; continuous cycling at 60% V̇O2max) on resting cardiac troponin T (cTnT) and the appearance of exercise-induced cTnT. Forty-eight sedentary obese young women were randomly assigned to HIIT, MICT or a control group. The V̇O2max and body composition were measured before and after training. At baseline, cTnT was assessed using a high-sensitivity assay at rest and immediately, 2 and 4 h after 45 min cycling at 60% V̇O2max. After a 12 week training period, cTnT was assessed before and after 45 min cycling at the same relative and absolute intensities as before training. Training led to higher V̇O2max and lower fat mass in both HIIT and MICT groups (all P < 0.05). Before training, cTnT was significantly elevated in all three groups (by 35-118%, all P < 0.05) with acute exercise. After training, both resting and postexercise cTnT concentrations (same relative intensity) were similar to pretraining values. In contrast, postexercise cTnT (same absolute intensity, which represented a smaller exercise stimulus) was not elevated from rest in both HIIT and MICT groups. In conclusion, 12 weeks of either HIIT or MICT largely abolished the postexercise elevation of cTnT concentration when exercise was performed at the same absolute intensity. There was, however, no impact of training on resting cTnT or postexercise appearance of cTnT for exercise performed at the same relative intensity.

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Circulating Cardiac Troponin T Exhibits a Diurnal Rhythm

Cited by 76 publications

References 34 publications

Acute effects of conventional and extended hemodialysis and hemodiafiltration on high-sensitivity cardiac troponins

Acute effects of conventional and extended hemodialysis and hemodiafiltration on high-sensitivity cardiac troponins

High-Sensitivity Cardiac Troponin Concentration and Risk of First-Ever Cardiovascular Outcomes in 154,052 Participants

Impact of high‐intensity interval training and moderate‐intensity continuous training on resting and postexercise cardiac troponin T concentration

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