Painful and painless myocardial ischemia detected by elevated level of high-sensitive troponin in patients with hypertrophic cardiomyopathy

Gębka, Adam; Rajtar-Salwa, Renata; Dziewierz, Artur; Petkow−Dimitrow, Paweł

doi:10.5114/aic.2018.76413

Cited by 8 publications

(7 citation statements)

References 19 publications

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“…hsTnI is a precise and very useful biomarker for the detection of even small, focal, subendocardial myocardial injury caused by ischemia in patients with HCM. In recent investigations, measurements of hsTnI levels were synchronized with a noninvasive assessment of clinical and hemodynamic parameters within a short time, similar with previous studies [7–11]. We have documented that levels of both NT-proBNP and NT-proBNP/ULN were the highest in the most ischemic subgroup (painful angina pectoris; hsTnI+/AP+).…”

Section: Discussionsupporting

confidence: 79%

Hypertrophic Cardiomyopathy: The Time-Synchronized Relationship between Ischemia and Left Ventricular Dysfunction Assessed by Highly Sensitive Troponin I and NT-proBNP

et al. 2019

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The aim of this study was to compare NT-proBNP using the absolute values and NT-proBNP/ULN values that were standardized by age and gender between three subgroups: those without ischemia (negative hs-troponin I and no anginal pain (hsTnI-/AP-)), those with painless ischemia (hsTnI+/AP-), and those with painful ischemia (hsTnI+/AP+). Additionally, echocardiographic parameters were compared in these three subgroups. The absolute value of NT-proBNP was significantly higher in the painful ischemia subgroup (hsTnI-/AP- vs. hsTnI+/AP- vs. hsTnI+/AP+: 502 (174-833) vs. 969 (363-1346) vs. 2053 (323-3283) pg/ml; p=0.018 for the whole-model analysis). The standardized value of NT-proBNP/ULN was gradually increased (hsTnI-/AP- vs. hsTnI+/AP- vs. hsTnI+/AP+: 3.61+0.63 vs. 6.90+1.31 vs. 9.35+1.87; p=0.001 for the whole-model analysis). In the comparison between subgroups (hsTnI-/AP- vs. hsTnI+/AP- vs. hsTnI+/AP+), two echocardiographic parameters increased significantly. The left ventricular maximum wall thickness (LVMWT) at diastole was 1.99±0.08 cm vs. 2.28±0.13 cm vs. 2.49±0.15 cm (p=0.004 for the whole-model analysis). The maximal gradient of the provoked left ventricular outflow tract (LVOT) gradient increased significantly in only the painful-ischemia subgroup (11 (7-30) mmHg vs. 12 (9.35-31.5) mmHg vs. 100 (43-120) mmHg). In conclusion, both painless ischemia and painful ischemia are associated with a gradual, significant increase in NT-proBNP/ULN in comparison to the double-negative hsTnI/AP subgroup. In contrast, NT-proBNP is significantly higher in only the subgroup with painful ischemia.

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Section: Discussionsupporting

confidence: 79%

Hypertrophic Cardiomyopathy: The Time-Synchronized Relationship between Ischemia and Left Ventricular Dysfunction Assessed by Highly Sensitive Troponin I and NT-proBNP

et al. 2019

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“…Moreover, HCM patients showed larger carotid and brachial arterial wall thickness, and slower brachial artery peak blood flow response following forearm ischaemia [63]. It has been suggested that exercise might be contraindicated in HCM patients with painless and painful ischemia (i.e., positive hs-troponin at rest), where such a problem might be present in 50% of HCM patients and might be related with same abnormal echocardiography and Holter findings [64]. A decreased level of exercise capacity in these patients might be due to increased BMI [65].…”

Section: Discussionmentioning

confidence: 99%

Acute Responses of Novel Cardiac Biomarkers to a 24-h Ultra-Marathon

Żebrowska¹,

Waśkiewicz

Nikolaidis

et al. 2019

JCM

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The aim of the present study was to examine the acute effect of an ultra-endurance performance on N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac specific troponin T (cTnT), creatinine kinase-myocardial band (CK-MB), high sensitive C-reactive protein (hsCRP), ischemia modified albumin (IMA), heart-type fatty acid binding protein (H-FABP) and cardiovascular function. Cardiac biomarkers were evaluated in 14 male ultra-marathoners (age 40 ± 12 years) during a 24 h ultra-marathon at five points (i.e., Pre-race; Marathon, 12-h run, 24-h run, and 48-h post-race). All subjects underwent baseline echocardiography assessment at least 10 days prior to the ultra-marathon and 48 h post-race. The average distance covered during the race was 149.4 ± 33.0 km. Running the ultra-marathon led to a progressive increase in hsCRP and H-FABP concentrations (p < 0.001). CK-MB and cTnT levels were higher after a 24-h run compared to pre-race (p < 0.05). Diastolic function was altered post-race characterized by a reduction in peak early to late diastolic filling (p < 0.01). Running an ultra-marathon significantly stimulates specific cardiac biomarkers; however, the dynamic of secretion of biomarkers linked to myocardium ischemia were differentially regulated during the ultra-marathon race. It is suggested that both exercise duration and intensity play a crucial role in cardiovascular adaptive mechanisms and cause risk of cardiac stress in ultra-marathoners.

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“…If a final diagnosis of HCM is made, screening of the patient's family is recommended. During the evaluation, basic blood tests including high-sensitivity troponin and N-terminal pro B-type natriuretic peptide may be helpful to estimate the cardiac risk, based on the results of recent studies [4,5]. Echocardiography plays an important role in making a diagnosis and it provides information about hemodynamics.…”

Section: Discussionmentioning

confidence: 99%

Hypertrophic cardiomyopathy – symptomatic atrial fibrillation in a patient at high risk of sudden cardiac death (RCD code: V-2A.2)

Gębka¹,

Rajtar-Salwa²,

Jastrzębski

et al. 2019

Journal of Rare Cardiovascular Diseases

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We present the case of a young patient with significant left ventricular hypertrophy as a common representation of the hypertrophic cardiomyopathy (HCM) phenotype. The clinical presentation and diagnostic route of the disease (despite negative genotype), which can be found in everyday cardiology practice, are shown. Despite the presence of guidelines on this topic, each clinical case is demanding, especially during qualification for invasive procedures. Limited data about the periprocedural risk of catheter ablation and success rate in HCM makes physician decisions for this type of patient challenging. The importance of informed consent and how the patient's decisions affect further progress are also shown.

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Painful and painless myocardial ischemia detected by elevated level of high-sensitive troponin in patients with hypertrophic cardiomyopathy

Cited by 8 publications

References 19 publications

Hypertrophic Cardiomyopathy: The Time-Synchronized Relationship between Ischemia and Left Ventricular Dysfunction Assessed by Highly Sensitive Troponin I and NT-proBNP

Hypertrophic Cardiomyopathy: The Time-Synchronized Relationship between Ischemia and Left Ventricular Dysfunction Assessed by Highly Sensitive Troponin I and NT-proBNP

Acute Responses of Novel Cardiac Biomarkers to a 24-h Ultra-Marathon

Hypertrophic cardiomyopathy – symptomatic atrial fibrillation in a patient at high risk of sudden cardiac death (RCD code: V-2A.2)

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