The new definition of myocardial infarction and the impact of troponin determination on clinical practice

Panteghini, Mauro

doi:10.1016/j.ijcard.2005.01.046

Cited by 31 publications

(17 citation statements)

References 102 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Studies in normal laboratory animals and humans have established that cardiac troponin proteins, notably cTnI, are very low or below the level of detectability of most assays, but after myocyte damage are released into the circulation. 6 Measurement of cardiac troponins is presently regarded as the most cardiac specific of the currently available biochemical tests for the diagnosis of myocardial injury in humans. 6 Because sequence homology of canine and feline cTnI with human and rodent cTnI is very high, 7 several studies have examined cTnI concentrations in veterinary species using commercial assays principally developed for human medicine.…”

mentioning

confidence: 99%

Serum Cardiac Troponin I Concentrations in Cattle with Cardiac and Noncardiac Disorders

Mellanby

Henry²,

Cash

et al. 2009

Veterinary Internal Medicne

View full text Add to dashboard Cite

Background: Making a clinical diagnosis of pericarditis in cattle is difficult and additional diagnostic tests are needed to evaluate cattle with suspected pericarditis. Serum cardiac troponin I (cTnI) concentrations are increased in cattle with pericarditis, but the utility of measuring serum cTnI concentrations in cattle with suspected pericarditis in cattle remains unclear.Objectives: To determine if serum cTnI concentrations in cattle can be used to differentiate pericarditis from other cardiac disorders and noncardiac thoracic diseases.Animals: Seventy‐seven clinically diseased cattle and 19 healthy control cattle.Methods: Serum cTnI concentrations were measured using an Immunlite Troponin I immunometric chemiluminescent assay in consecutive cases of postmortem‐confirmed pericarditis (n = 18), endocarditis (n = 15), chronic suppurative pneumonia (n = 13), congenital heart disease (n = 10), reticulitis (n = 3), mediastinal abscess (n = 7), thymic lymphoma (n = 6), and caudal vena cava thrombosis (n = 5). Serum cTnI concentrations were measured in 19 healthy cattle.Results: Although serum cTnI concentrations were significantly higher in cattle with pericarditis compared with healthy cattle, they were not significantly different from concentrations in cattle with endocarditis, congenital cardiac disease, mediastinal abscess, reticulitis, caudal vena cava thrombosis, or chronic suppurative pneumonia.Conclusions: Serum cTnI cannot be used to distinguish cattle with pericarditis from cattle with other primary cardiac diseases. In addition, serum cTnI concentrations cannot distinguish between cattle with primary cardiac diseases and those with other noncardiac, intrathoracic disorders.

show abstract

mentioning

confidence: 99%

Serum Cardiac Troponin I Concentrations in Cattle with Cardiac and Noncardiac Disorders

Mellanby

Henry²,

Cash

et al. 2009

Veterinary Internal Medicne

View full text Add to dashboard Cite

show abstract

“…(26) Different timing of troponins increase panel A). (17) Conversely, in breast cancer patients treated with trastuzumab, we found that the first increase in troponin was most frequent soon after the first cycle of trastuzumab and occurred only in patients previously treated with AC ( Figure 3; panel B), suggesting a possible combined mechanism: TnI rise in these patients possibly reflects AC injury facilitated by trastuzumab, rather than a de-novo cardiac damage.…”

Section: Troponinsmentioning

confidence: 99%

Using biomarkers and early prophylactic treatment to prevent cardiotoxicity in cancer patients on chemotherapy

Bacchiani

Cardinale

2017

SAHJ

View full text Add to dashboard Cite

Using biomarkers and early prophylactic treatment to prevent cardiotoxicity in cancer patients on chemotherapy goal for both cardiologists and oncologists. The main strategy to prevent clinical cardiotoxicity is early detection and the initiation of prompt prophylactic therapy. EARLY DETECTION OF CARDIOTOXICITY Current approachPeriodic assessment for LVEF is the most widely used non-invasive method for detecting cardiotoxicity LVEF either via echocardiography or multigated acquisition scanning. Although several available guidelines exist none specify how often, by what means or how long cardiac function should be monitored during and after cancer treatment. The recommendations of these guidelines are not consistent and seem to be based on modest evidence. Though LVEF is a crude index of cardiac function, it is relatively insensitive in detecting anticancer drug-induced cardiotoxicity at an early stage. Usually there are compensatory mechanisms in place to ensure normal overall function in a patient despite an initial reduction in myocardial contractility. As a rule no considerable

show abstract

“…The universal definition of AMI, released 4 years before, indicated that, in these patients, a 3-fold increase above the 99th percentile limit of CK-MB/cTn (assuming a normal value at baseline) should, by convention, be defined as AMI (type 4a) [2]. Unfortunately, this was fully arbitrary and not supported by any scientific evidence or soundly anchored to outcome data [58]. Furthermore, the different analytical and clinical performances of biomarker assays were not considered, as it is clear that a CK-MB or a cTn 3-fold increase above the respective 99th percentile limits may reflect infarct sizes of a different degree that cannot be compared due to the huge difference in biomarker sensitivity for detecting myocardial damage [59].…”

Section: This Is Not the End: Other Pieces To The Puzzlementioning

confidence: 99%

Laboratory medicine as the science that underpins medicine: the “high-sensitivity” troponin paradigm

Ferraro¹,

Panteghini

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

Self Cite

View full text Add to dashboard Cite

Abstract:The availability of so-called high-sensitivity troponin assays (hsTn) has scored a compelling goal for laboratory medicine, allowing the safe clinical application of international recommendations for the definition of acute myocardial infarction (AMI). However, the introduction of hsTn has not been welcomed by clinicians, claiming an increase in false-positive results. Here we critically trace back the steps following the introduction of hsTn by referring to the 5-year practical experience in our academic hospital and to suitable information available in the literature. In agreement with published data, we found that hsTn introduction was associated with an increased number of AMI diagnoses, whereas the test volume, the revascularization rate, and the proportion of cases with negative angiography findings remained virtually unchanged. Fast-track protocols for ruling out AMI have been further optimized to recommend sampling at presentation and after 3 h only. We focus on a cost-effective use of hsTn that can account for all clinical variables increasing the pre-test probability in order to ensure that tests are ordered only for patients at medium to high risk for acute coronary syndrome (ACS). To guide interpretation of results, hsTn typical release patterns suggestive for AMI should be identified by evaluating the significance of concentration changes. hsTn have markedly shortened the time to rule out or rule in AMI and has the potential to improve the prognostic assessment of critical patients in clinical contexts different from ACS.

show abstract

The new definition of myocardial infarction and the impact of troponin determination on clinical practice

Cited by 31 publications

References 102 publications

Serum Cardiac Troponin I Concentrations in Cattle with Cardiac and Noncardiac Disorders

Serum Cardiac Troponin I Concentrations in Cattle with Cardiac and Noncardiac Disorders

Using biomarkers and early prophylactic treatment to prevent cardiotoxicity in cancer patients on chemotherapy

Laboratory medicine as the science that underpins medicine: the “high-sensitivity” troponin paradigm

Contact Info

Product

Resources

About