High Sensitivity Troponin in Cardiovascular Disease. Is There More Than a Marker of Myocardial Death?

Abstract

Cardiovascular disease is the leading cause of death worldwide and coronary artery disease is its most prevalent manifestation, associated with high mortality and morbidity. In clinical practice cardiac troponins (cTn) are the cornerstone of the diagnosis, risk stratification and thus selection of the optimal treatment strategy in patients with acute coronary syndrome. According to the third update of the universal definition of myocardial infarction (MI) cTn is the preferred cardiac biomarker of myocardial necrosis in the setting of acute myocardial ischemia. Over the last years newer high sensitivity cardiac troponin (hs-cTn) assays have been developed that are more sensitive than conventional assays, have low limit of detection, low imprecision and low reference limits, but due to variability, the deployment of a standardization and harmonization method is required before their wide use in clinical practice. Recent studies have shown that their utilization seems to improve the diagnostic accuracy detecting MI in patients presenting with chest pain. However, the improved sensitivity comes along with a decreased specificity, though serial cTn measurements and the detection of early changes could improve the specificity and the overall diagnostic performance. Moreover, apart from their use in the diagnosis and risk stratification of MI and acute coronary syndromes, hs-cTn assays seem to have a key role in risk stratification and short and long-term prognosis in a variety of cardiovascular modalities such as stable coronary disease, heart failure and acute pulmonary embolism. In addition, studies have suggested that cTns may be used as a biomarker in the primary prevention of cardiovascular disease leading to the identification of high-risk populations or individuals with silent heart disease.

Detection of early radiotherapy‐induced changes in intrinsic myocardial contractility by ultrasound tissue characterization in patients with early‐stage breast cancer

“…Our results indicate that the negative effects of RT on cardiac function in CVIBS were dose‐dependent. Also, elevated hsTnT and proBNP levels have been associated with poor prognosis in various cardiac diseases . Hence, the changes in hsTnT and proBNP in our patient population support the hypothesis that these early echocardiographic changes may later manifest as symptomatic RIHD.…”

“…In experimentalstudies,CVIBShasbeenshowntorespondfastertoischemia and reperfusion than any conventional contractility measurement 11. OurresultsindicatethatthenegativeeffectsofRToncardiacfunc-tioninCVIBSweredose-dependent.Also,elevatedhsTnTandproBNP levels have been associated with poor prognosis in various cardiac diseases 34. Hence, the changes in hsTnT and proBNP in our patient…”

Coronary Artery-Bypass-Graft Surgery Increases the Plasma Concentration of Exosomes Carrying a Cargo of Cardiac MicroRNAs: An Example of Exosome Trafficking Out of the Human Heart with Potential for Cardiac Biomarker Discovery

“…We reasoned that this clinical setting would allow the determination of whether cardiac exosomes are released in response to myocardial injury and if this is sufficient to significantly affect the abundance and cargo of the pool of exosomes circulating in the peripheral blood. Moreover, the potential of circulating exosomes as novel biomarker of heart injury could be assessed by correlating circulating exosomes and elements of their molecular cargo with cardiac troponins (cTns), the “gold standard” surrogate biomarkers of myocardial damage[ 26 ]. CTns are commonly employed in cardiac surgery practice and in clinical studies.…”

Pretreatment with β‐glucan attenuates isoprenaline‐induced myocardial injury in rats

“…Then the serum was harvested and stored at −80°C for biochemical assay. The diagnostic utility of the high‐sensitivity cardiac troponin T (hs‐cTnT) assay for myocardial infarction is superior to that of the traditional cTnT assay (Tsounis et al., ); therefore, cardiac troponin T levels were measured with the new hs‐cTnT assay. The hs‐cTnT assay was performed on a Cobas 8000/e602 analyser (Roche Diagnostics, Mannheim, Germany), and serum creatine kinase‐MB (CK‐MB) activity was measured with a Roche Cobas 8000, using the c702 module (Roche Diagnostics) according to the specifications of the manufacturer.…”