Improved detection of cardiac confusion with cardiac troponin I

Adams, Jesse E.; Dávila‐Román, Víctor G.; Bessey, Palmer Q.; Blake, David; Ladenson, Jack H.; Jaffe, Allan S.

doi:10.1016/s0002-8703(96)90359-2

Cited by 197 publications

(65 citation statements)

References 23 publications

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“…14 Elevated cardiac troponin I is known to be a marker of myocyte injury and is therefore a valuable tool for the diagnosis of myocardial infarction. 7,13,15,16 Elevated cardiac troponin I concentrations have also been observed in other clinical conditions such as reperfusion therapy monitoring, 17 myocarditis, and in patients with cardiac contusions, 18,19 thus confirming its cardiospecificity.…”

Section: Discussionmentioning

confidence: 88%

Elevated circulating cardiac troponin I in patients with cirrhosis

et al. 1999

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It has been shown that certain patients with cirrhosis have asymptomatic cardiac abnormalities that have not yet been explained. Thus, cardiac troponin I, a specific marker of myocardial injury, has been measured in patients with cirrhosis without previous cardiac disease. Thirty-two consecutive patients (age 49 ؎ 11) with cirrhosis and normal ECG were selected, 22 of which were alcoholic. Hemodynamic investigations were performed. Left ventricular function and mass were evaluated by echocardiography. Serum creatine kinase MB mass, myoglobin, and cardiac troponin I concentrations were measured. Cardiac troponin I concentrations were elevated in 10 patients (32%) (range 0.06-0.25 g/L) whereas creatine kinase MB mass and myoglobin were normal in all patients. Abnormal troponin I values were not related to the severity of cirrhosis, to the degree of portal hypertension, or to other hemodynamic values. In contrast, elevated serum cardiac troponin I concentrations were related to a decreased stroke-volume index (P F .05) and a decreased left ventricular mass (P F .05). These results show a high prevalence of slightly elevated serum cardiac troponin I in patients with cirrhosis, especially in those with alcoholic cirrhosis. Elevated troponin I is associated with subclinical left ventricular myocardial damage. These findings may be linked to a lack of left ventricular adaptation in certain patients with cirrhosis and alcoholic cardiomyopathy. (HEPATOLOGY 1999;29:640-643.)

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Section: Discussionmentioning

confidence: 88%

Elevated circulating cardiac troponin I in patients with cirrhosis

et al. 1999

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“…However, the use of this ratio markedly reduces sensitivity in patients with concurrent cardiac and skeletal muscle injury. 44,45 For all intents and purposes, cTnI and cTnT provide comparable information, except in patients with renal failure (see "Troponin and renal failure").…”

Section: Characteristics Of Troponin Assaysmentioning

confidence: 99%

“…Troponin elevations are highly specific and usually indicate cardiac trauma. 45,152 Elevations are usually modest; more extreme elevations may be due to concomitant coronary artery disease or coronary trauma. It is unclear whether troponin elevations can be used to predict complications or guide therapy.…”

Section: Other Clinical Situations In Which Troponin Levels May Be Elmentioning

confidence: 99%

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

Babuin¹

2005

Canadian Medical Association Journal

539

390

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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...

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“…Bertinchant et al concluded that troponins have improved specificity over CK and CKMB, but the sensitivity is low and they have low predictive value in diagnosing myocardial contusion [25]. Additional studies determined the sensitivity of troponin I in screening for BCI to be between 23 and 100 % [25,27]. However, the ability to isolate different isoforms of troponin I (Tn I), specifically the cardiac isoform (cTn I), has encouraged researchers to revisit the issue.…”

Section: Cardiac Enzymesmentioning

confidence: 99%

Cardiac Contusions

Brewer

Zarzaur

2015

Curr Trauma Rep

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Cardiac contusion has been one of the most discussed topics in the trauma community. The discussions are centered around appropriate nomenclature, screening mechanisms, diagnostic modalities, and ultimately management principles. Controversy over nomenclature exists because cardiac contusion has been used to describe an array of injuries ranging from a transient arrhythmia to free rupture of the myocardial wall. The mainstays of screening have been electrocardiograms and cardiac isoenzymes. Although there is a substantial body of literature, few other screening or diagnostic modalities have been widely accepted. Echocardiography has gained favor as a confirmatory test and to determine presence or extinct of structural damage. Management has traditionally been supportive including volume repletion, correcting arrhythmias, and repairing structural damage. Recently, there has been some promising alternative treatments including transcatheter closure of ventricular septal defects, anti-inflammatory agents, and post-injury therapeutic hypothermia. Although screening and diagnostic mechanism have remained relatively unchanged, it appears that innovative management of severe cardiac contusions has gained some momentum over the recent years.

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Improved detection of cardiac confusion with cardiac troponin I

Cited by 197 publications

References 23 publications

Elevated circulating cardiac troponin I in patients with cirrhosis

Elevated circulating cardiac troponin I in patients with cirrhosis

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

Cardiac Contusions

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