High-sensitivity troponin T predicts infarct scar characteristics and adverse left ventricular function by cardiac magnetic resonance imaging early after reperfused acute myocardial infarction

Nguyen, T.; Phan, J.; Hee, L.; Moses, Daniel; Otton, James; Terreblanche, Owen; Xiong, Jessica; Premawardhana, U.; Rajaratnam, R.; Juergens, C.; Dimitri, Hany; French, John K.; Richards, David; Thomas, Liza

doi:10.1016/j.ahj.2015.06.022

Cited by 36 publications

(32 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The myocardial scar is also a substrate for re-entry circuits and slow conduction areas, which may lead to life-threatening arrhythmias, altering the prognosis of these patients. 5,6 Clinical studies investigated the role of IL-6 in myocardial scar formation and demonstrated positive correlations between infarct size (IS) and circulating IL-6 levels after MI, possibly serving as a predictive biomarker. 7,8 Animal studies also demonstrated positive correlations between IS and IL-6 levels, and furthermore, the blocking of IL-6 was associated with less neutrophil infiltration in the infarcted area.…”

Section: Introductionmentioning

confidence: 99%

Association Between Acute Inflammatory Response and Infarct Size in Stemi Patients Undergoing Primary PCI

Morariu

Márton

Mester

et al. 2018

Journal of Cardiovascular Emergencies

View full text Add to dashboard Cite

Background: The inflammatory response of the immune system plays a major role in the period following an acute myocardial infarction (MI), as it coordinates the formation of the fibrous scar tissue that replaces the infarcted myocardial cells and ultimately leads to healing and remodeling of the affected zone. Along with other pro- and anti-inflammatory cytokines and acute phase proteins, interleukin-6 (IL-6) and C-reactive protein (CRP) are associated with the extent of the infarct size (IS) and may serve as predictors for remodeling and adverse left ventricular (LV) function. Material and methods: A single-center, non-randomized, observational prospective study was conducted, which included 75 patients with primary revascularized ST-elevation myocardial infarction (STEMI). High-sensitivity CRP (hs-CRP) serum levels were determined on day 1 and day 5 following the acute event. IL-6 was also determined on day 1. All patients underwent cardiac magnetic resonance imaging (CMR) at 1-month follow-up with determination of LV function and quantification of the scar tissue using late gadolinium enhancement imaging. The patients were divided into 2 groups based on baseline hs-CRP values. Results: Patients with higher baseline hs-CRP levels presented significantly higher infarct size (p = 0.0003), higher transmural extent (p <0.0001), lower LV ejection fraction (p = 0.0024), end-systolic (p = 0.0021) and end-diastolic (p = 0.0065) volumes. Small IS (<10%) recorded the lowest levels of hs-CRP, while IS >20% presented the highest levels of hs-CRP, at baseline and day 5 (p = 0.4 and 0.001). IL-6 levels were also associated with the magnitude of infarct scar: 2.17 pg/mL for IS <10%, 15.52 pg/mL for IS between 10% and 20%, and 24.52 pg/mL for IS >20%, p = 0.002. Conclusion: hs-CRP and IL-6 serum levels following an MI are correlated with IS, transmurality extent of the scar tissue, as well as with altered systolic and diastolic LV function determined by CMR at 1-month follow-up.

show abstract

Section: Introductionmentioning

confidence: 99%

Association Between Acute Inflammatory Response and Infarct Size in Stemi Patients Undergoing Primary PCI

Morariu

Márton

Mester

et al. 2018

Journal of Cardiovascular Emergencies

View full text Add to dashboard Cite

show abstract

“…These parameters are all recognized to correlate with extent of infarction and prognosis after symptomatic MI (8, 10, 22); however, we have demonstrated that they were insensitive for the detection of silent MI in type 2 diabetes and of limited value in this setting.…”

Section: Discussionmentioning

confidence: 71%

“…Several imaging and biomarker tests have been shown to be able to detect the presence and determine the extent of clinically recognized MI measured by LGE including Q waves on a 12-lead electrocardiogram (ECG) (7), ejection fraction (8), strain parameters (9), high sensitivity troponin (hs-cTnT) (10), and amino-terminal probrain natriuretic peptide (NT-proBNP) (11). However, the sensitivity and specificity of these tests to detect silent MI in type 2 diabetes is at present unknown.…”

mentioning

confidence: 99%

A Novel and Practical Screening Tool for the Detection of Silent Myocardial Infarction in Patients With Type 2 Diabetes

Swoboda

McDiarmid

Erhayiem

et al. 2016

The Journal of Clinical Endocrinology & Metabolism

View full text Add to dashboard Cite

Objective:Silent myocardial infarction (MI) is a prevalent finding in patients with type 2 diabetes and is associated with significant mortality and morbidity. Late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) is the most validated technique for detection of silent MI, but is time-consuming, costly, and requires administration of intravenous contrast. We therefore planned to develop a simple and low-cost population screening tool to identify those at highest risk of silent MI validated against the CMR reference standard.Methods:A total of 100 asymptomatic patients with type 2 diabetes underwent electrocardiogram (ECG), echocardiography, biomarker assessment, and CMR at 3.0T including assessment of left ventricular ejection fraction and LGE. Global longitudinal strain from two- and four-chamber cines was measured using feature tracking.Results:A total of 17/100 patients with no history of cardiovascular disease had silent MI defined by LGE in an infarct pattern on CMR. Only four patients with silent MI had Q waves on ECG. Patients with silent MI were older (65 vs 60, P = .05), had lower E/A ratio (0.75 vs 0.89, P = .004), lower GLS (–15.2% vs –17.7%, P = .004), and higher amino-terminal pro brain natriuretic peptide (106 ng/L vs 52 ng/L, P = .003). A combined risk score derived from these four factors had an area under the receiver operating characteristic curve of 0.823 (0.734–0.892), P < .0001. A score of more than 3/5 had 82% sensitivity and 72% specificity for silent MI.Conclusions:Using measures that can be derived in an outpatient clinic setting, we have developed a novel screening tool for the detection of silent MI in type 2 diabetes. The screening tool had significantly superior diagnostic accuracy than current ECG criteria for the detection of silent MI in asymptomatic patients.

show abstract

“…However, admission values only poorly correlate with IS [23]. Chia et al showed no association of hs-cTnT on admission and IS estimation whereas Nyguen et al described weak but significant relation between admission hs-cTnT and IS [23,24]. This very weak association might be explained by the delayed release kinetics of hs-cTnT [25].…”

Section: Predictive Value Of Biomarkersmentioning

confidence: 98%

Biomarker assessment for early infarct size estimation in ST-elevation myocardial infarction

Tiller

Reindl

Holzknecht

et al. 2019

European Journal of Internal Medicine

View full text Add to dashboard Cite

Background: High-sensitivity cardiac troponin T (hs-cTnT) represents the biomarker of choice for infarct size (IS) estimation in patients with acute ST-elevation myocardial infarction (STEMI). However, admission values of hs-cTnT are only weakly associated with IS. The aim of this study was to investigate the incremental value of different biomarkers measured on admission for IS estimation in STEMI patients. Methods: In this prospective observational study, we included 161 consecutive STEMI patients treated with primary percutaneous coronary intervention (pPCI). The following biomarkers were assessed on admission: hs-cTnT, N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and neutrophil/lymphocyte ratio (NLR). IS was determined by cardiac magnetic resonance (CMR) imaging 3 (Interquartile range [IQR] 2 to 4) days after the index event. Results: Patients with large IS (> 19% of left ventricular myocardium) showed significantly higher levels of admission hs-cTnT (399.6 vs. 53.4 ng/L, p < .001), NT-pro-BNP (140 vs. 86 ng/L, p = .008) and NLR (6.4 vs. 4.1, p < .001). The combination of hs-cTnT, NT-pro-BNP and NLR on admission resulted in a significantly higher area under the curve (0.78; 95% CI 0.704 to 0.838, (p = .01)) for the prediction of large IS than admission hs-cTnT alone (0.69; 95% CI 0.619 to 0.767). Conclusions: In STEMI patients undergoing pPCI, a comprehensive biomarker approach on admission including hs-cTnT, NT-pro-BNP and NLR was significantly better for immediate infarct severity estimation as compared to hs-cTnT alone.

show abstract

High-sensitivity troponin T predicts infarct scar characteristics and adverse left ventricular function by cardiac magnetic resonance imaging early after reperfused acute myocardial infarction

Cited by 36 publications

References 38 publications

Association Between Acute Inflammatory Response and Infarct Size in Stemi Patients Undergoing Primary PCI

Association Between Acute Inflammatory Response and Infarct Size in Stemi Patients Undergoing Primary PCI

A Novel and Practical Screening Tool for the Detection of Silent Myocardial Infarction in Patients With Type 2 Diabetes

Biomarker assessment for early infarct size estimation in ST-elevation myocardial infarction

Contact Info

Product

Resources

About