Kinetics of high-sensitivity cardiac troponin T and I differ in patients with ST-segment elevation myocardial infarction treated by primary coronary intervention

Laugaudin, Guillaume; Kuster, Nils; Petiton, Amael; Leclercq, Florence; Gervasoni, Richard; Macia, Jean‐Christophe; Cung, Thien Tri; Dupuy, Anne‐Marie; Solecki, Kamila; Lattuca, Benoît; Cade, Stéphane; Cransac, F.; Cristol, Jean‐Paul; Roubille, François

doi:10.1177/2048872615585518

Cited by 67 publications

(74 citation statements)

References 48 publications

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“…Furthermore, since cTnI and cTnT are present in the sarcomeric complex in a molecular ratio of 1:1, these differences between the circulating cTns are probably related to differences in intra- [130] or extra-cellular [131][132][133] catabolism and the peripheral turnover of cTnI and cTnT. A recent study [134] found that circulating levels of cTnT, unlike cTnI, have a diurnal rhythm, thus bearing out the hypothesis that there are some differences in the release from cardiomyocytes and/or peripheral turnover between cTnI and cTnT.…”

Section: Do Differences In Troponin-dependent 99th Url Values Depend mentioning

confidence: 99%

The 99th percentile of reference population for cTnI and cTnT assay: methodology, pathophysiology and clinical implications

Clerico

Zaninotto

Ripoli

et al. 2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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According to recent international guidelines, including the 2012 Third Universal Definiton of Myocardial Infarction by the Joint ESC/ACCF/AHA/WHF Task Force, an increase in cardiac troponin (cTn) levels over the 99th percentile upper reference limit (99th URL) should be considered clinically relevant, this cut-off being measured with an imprecision ≤10 CV%. In theory 99th URL values strongly depend not only on demographic and physiological variables (i.e. criteria for considering the reference population "healthy"), but also on the analytical performance of cTn methods and mathematical algorithms used for the calculation. The aim of the present article was therefore to review the methodological and pathophysiological factors affecting the evaluation and calculation of the 99th URL for cTn assay. The critical analysis made showed that no uniform procedure is followed, and nor have experts or regulatory bodies provided uniform guidelines for researchers or cTn assays manufacturers as an aid in "their quest to define normality". In particular, little attention has been paid to the way in which a healthy reference population is to be selected, or the criteria for calculating the 99th URL value for cTn assays, thus highlighting the need for international recommendations not only for demographic and physiological variables criteria for defining a healthy reference population, but also for calculating mathematical algorithms for establishing/ calculating clinical decision values. An expert consensus group, comprising laboratory and clinical scientists, biomedical statisticians, industrial and regulatory representatives, should be responsible for drawing up these guidelines.

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Section: Do Differences In Troponin-dependent 99th Url Values Depend mentioning

confidence: 99%

The 99th percentile of reference population for cTnI and cTnT assay: methodology, pathophysiology and clinical implications

Clerico

Zaninotto

Ripoli

et al. 2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…Heart Fatty Acid Binding Protein (H-FABP), a highly myocardium-specific protein [10] and early rise marker of ACS [11], is a potential candidate. Rising H-FABP is detectable within at least 30 min following the onset of AMI, with concentrations that peak at approximately 6–8 h [12, 13] compared to 10–13 h for hs-cTnI and hs-cTnT [14]. In addition, the recent availability of a commercial immunoturbidimetric assay for H-FABP overcomes issues with previous point of care tests and ELISA-based assays, and means this biomarker can now be measured more reliably using the main laboratory platform [15, 16], concurrently with hs-cTn assays, and generate results within 20 min from blood sampling.…”

Section: Introductionmentioning

confidence: 99%

Heart Fatty Acid Binding Protein and cardiac troponin: development of an optimal rule-out strategy for acute myocardial infarction

et al. 2016

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BackgroundImproved ability to rapidly rule-out Acute Myocardial Infarction (AMI) in patients presenting with chest pain will promote decongestion of the Emergency Department (ED) and reduce unnecessary hospital admissions. We assessed a new commercial Heart Fatty Acid Binding Protein (H-FABP) assay for additional diagnostic value when combined with cardiac troponin (using a high sensitivity assay).MethodsH-FABP and high-sensitivity troponins I (hs-cTnI) and T (hs-cTnT) were measured in samples taken on-presentation from patients, attending the ED, with symptoms triggering investigation for possible acute coronary syndrome. The optimal combination of H-FABP with each hs-cTn was defined as that which maximized the proportion of patients with a negative test (low-risk) whilst maintaining at least 99 % sensitivity for AMI. A negative test comprised both H-FABP and hs-cTn below the chosen threshold in the absence of ischemic changes on the ECG.ResultsOne thousand seventy-nine patients were recruited including 248 with AMI. H-FABP < 4.3 ng/mL plus hs-cTnI < 10.0 ng/L together with a negative ECG maintained >99 % sensitivity for AMI whilst classifying 40.9 % of patients as low-risk. The combination of H-FABP < 3.9 ng/mL and hs-cTnT < 7.6 ng/L with a negative ECG maintained the same sensitivity whilst classifying 32.1 % of patients as low risk.ConclusionsIn patients requiring rule-out of AMI, the addition of H-FABP to hs-cTn at presentation (in the absence of new ischaemic ECG findings) may accelerate clinical diagnostic decision making by identifying up to 40 % of such patients as low-risk for AMI on the basis of blood tests performed on presentation. If implemented this has the potential to significantly accelerate triaging of patients for early discharge from the ED.

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“…Our team showed that hs-T-troponin follows a specific kinetic characterized by a second peak [14] after STEMI by comparison to hs-TnI. While Troponin was strongly related to infarct size and prognosis after STEMI [15][16][17], the diagnosis performance of the second peak is unclear as regards the MVO determination.…”

Section: Introductionmentioning

confidence: 99%

“…Laugaudin et al [14] showed that the hs-TnT first phase of decay appeared between 24 and 48 h after pPCI, and the second peak (when present) around 72 h post MI. All those 3-time courses of blood test were systematically available in our patients, so as to systematically record a possible 2nd peak of hs-TnT.…”

Section: Limitationsmentioning

confidence: 99%

An hs-TNT Second Peak Associated with High CRP at Day 2 Appears as Potential Biomarkers of Micro-Vascular Occlusion on Magnetic Resonance Imaging after Reperfused ST-Segment Elevation Myocardial Infarction

Huet¹,

Akodad²,

Kuster³

et al. 2018

Cardiology

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Introduction: Micro-vascular occlusion (MVO) in a myocardial infarction (MI) is associated with an increased risk of heart failure and mortality. Hs-T-troponin has a double peak kinetic after MI. The aim was to determine if this kinetic was correlated to MVO evaluated by cardiac magnetic resonance imaging (MRI) after MI. Methods: This is a monocentric retrospective study. Inclusion criteria were hospitalization for MI, Thrombolysis In Myocardial Infarction flow 0 at coronary angiography, reperfusion within 12 h from the onset of chest pain, cardiac MRI within the first month, and a 5-days’ biological follow-up with at least hs-T-Troponin and C-reactive protein (CRP). Statistics were performed using the R software. Results: Ninety-eight patients were included. Fifty-three patients (54.1%) had MVO at MRI. The existence of MVO was associated with a trend of more kissing procedure during primary percutaneous coronary intervention (p = 0.06), a significantly more frequent second peak of troponin (p = 0.048), a significantly higher CRP level (p < 0.0001) and a longer time to balloon (p = 0.01). The association of CRP level above 40 mg/L at day 2 and the observation of a second peak of troponin were associated to 95% of MVO in ST-segment elevation MI patients. By contrast, in the absence of these 2 criteria, MVO was absent in 78% of the cases. This score was associated with a higher rate of hospitalisation at 2 years. Conclusion: A biological score integrating hs-TNT second peak and CRP might help to predict MVO and predict outcomes after reperfused MI in our population.

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Kinetics of high-sensitivity cardiac troponin T and I differ in patients with ST-segment elevation myocardial infarction treated by primary coronary intervention

Cited by 67 publications

References 48 publications

The 99th percentile of reference population for cTnI and cTnT assay: methodology, pathophysiology and clinical implications

The 99th percentile of reference population for cTnI and cTnT assay: methodology, pathophysiology and clinical implications

Heart Fatty Acid Binding Protein and cardiac troponin: development of an optimal rule-out strategy for acute myocardial infarction

An hs-TNT Second Peak Associated with High CRP at Day 2 Appears as Potential Biomarkers of Micro-Vascular Occlusion on Magnetic Resonance Imaging after Reperfused ST-Segment Elevation Myocardial Infarction

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