The trouble with troponin

Michel, Jeffrey B.; Schussler, Jeffrey M.

doi:10.1080/08998280.2018.1435121

Cited by 4 publications

(3 citation statements)

References 12 publications

(14 reference statements)

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“… 35 However, many factors impact troponin elevation and confound the clinical presentation, such as gender, age group, time of symptom onset, comorbidities, and biological variability. 36 , 37 , 38 Although we performed subgroup analysis to investigate any potential moderator effect of clinical variables, further studies will be needed for a more in-depth understanding of the impact of these factors on device performance.…”

Section: Discussionmentioning

confidence: 99%

A novel breakthrough in wrist-worn transdermal troponin-I-sensor assessment for acute myocardial infarction

Sengupta¹,

Biswal

Titus

et al. 2023

European Heart Journal - Digital Health

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Aims Clinical differentiation of acute myocardial infarction (MI) from unstable angina and other presentations mimicking acute coronary syndromes (ACS) is critical for implementing time-sensitive interventions and optimizing outcomes. However, the diagnostic steps are dependent on blood draws and laboratory turn-around-times. We tested the clinical feasibility of a wrist-worn transdermal infra-red spectrophotometric sensor (Transdermal-ISS) in clinical practice and assessed the performance of a machine-learning algorithm for identifying elevated high-sensitivity cardiac Troponin-I (hs-cTnI) levels in patients hospitalized with ACS. Methods and Results We enrolled 238 patients hospitalized with ACS at five sites. The final diagnosis of MI (with or without ST-elevation) and unstable angina was adjudicated using ECG, cTn, echocardiography (regional wall motion abnormality), or coronary angiography. A Transdermal-ISS-derived deep-learning model was trained (three sites) and externally validated with hs-cTnI (one site), and echocardiography and angiography (two sites), respectively. The Transdermal-ISS model predicted elevated hs-cTnI with the area under the receiver operator characteristics of 0.90 (95% confidence interval [CI], 0.84-0.94; sensitivity, 0.86; specificity, 0.82) and 0.92 (95% CI, 0.80-0.98; sensitivity, 0.94; specificity, 0.64), for internal and external validation cohorts, respectively. In addition, the model predictions were associated with regional wall motion abnormalities (Odds Ratio [OR], 3.37; CI, 1.02-11.15; p=0.046) and significant coronary stenosis (OR, 4.69; CI, 1.27- 17.26; p = 0.019). Conclusion A wrist-worn transdermal infrared spectrophotometric sensor is clinically feasible for rapid, bloodless prediction of elevated hs-cTnI in real-world settings. It may have a role in establishing a point-of-care biomarker diagnosis of myocardial infarction and impact triaging patients with suspected ACS.

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Section: Discussionmentioning

confidence: 99%

A novel breakthrough in wrist-worn transdermal troponin-I-sensor assessment for acute myocardial infarction

Sengupta¹,

Biswal

Titus

et al. 2023

European Heart Journal - Digital Health

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“…The state-of-the-art 4 troponin quantitation mechanism is based on immunoassays 5 involving the use of two or more antibodies, one of which is labeled, typically with a chemiluminescent tag, which adds another level of complexity 6 in the analysis. While immunoassays are highly developed and accurate, extensive sample preparation including cumbersome blood 7 draws are required. Furthermore, it mandates the logistics between physician and laboratory.…”

Section: Plain Language Summarymentioning

confidence: 99%

Development and preliminary validation of infrared spectroscopic device for transdermal assessment of elevated cardiac troponin

Titus¹,

Biswal³

et al. 2022

Commun Med

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Background The levels of circulating troponin are principally required in addition to electrocardiograms for the effective diagnosis of acute coronary syndrome. Current standard-of-care troponin assays provide a snapshot or momentary view of the levels due to the requirement of a blood draw. This modality further restricts the number of measurements given the clinical context of the patient. In this communication, we present the development and early validation of non-invasive transdermal monitoring of cardiac troponin-I to detect its elevated state. Methods Our device relies on infrared spectroscopic detection of troponin-I through the dermis and is tested in stepwise laboratory, benchtop, and clinical studies. Patients were recruited with suspected acute coronary syndrome. Results We demonstrate a significant correlation (r = 0.7774, P < 0.001, n = 52 biologically independent samples) between optically-derived data and blood-based immunoassay measurements with and an area under receiver operator characteristics of 0.895, sensitivity of 96.3%, and specificity of 60% for predicting a clinically meaningful threshold for defining elevated Troponin I. Conclusion This preliminary work introduces the potential of a bloodless transdermal measurement of troponin-I based on molecular spectroscopy. Further, potential pitfalls associated with infrared spectroscopic mode of inquiry are outlined including requisite steps needed for improving the precision and overall diagnostic value of the device in future studies.

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“…The harm of these interventions may be greater than the benefit considering contrast-mediated renal disease and antiplatelet therapy in an older population with renal insufficiency. The reference by Scallan et al suggests the lymphangion has cardiac cells that express troponin C and I as well as cardiac isoforms of tropomyosin [38][39]. In most clinical scenarios associated with a type 2 infarction, the lymphatic system is under considerable stress from infection, edema, and intravascular volume or pressure.…”

Section: Troponin Leaks Post-surgery With Sepsis Critical Illness -mentioning

confidence: 99%

Why We Fail at Heart Failure: Lymphatic Insufficiency Is Disregarded

Houck¹,

Dandapantula²,

Hardegree³

et al. 2020

Cureus

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Is the definition of heart failure too narrow, not allowing research into compensatory mechanisms, comorbidities, right heart function, and lymphatic function? A review of the absolute mortality of heart failure drugs and devices suggests a modest improvement in outcomes. Absolute mortality from common comorbidities, including renal insufficiency, arrhythmia, conduction deficits, pulmonary hypertension, anemia, obstructive sleep apnea, infection, inflammation, edema, ischemic heart disease, and diabetes II, is significant. The lymphatic function is involved in short, intermediate, and long-term compensation for a failing heart and plays a role in most of the comorbidities. A better definition of heart failure is: Heart failure is a complex clinical syndrome that results from any structural or functional impairment of right or left ventricular filling or ejection of blood and failure of peripheral compensatory mechanisms. Lymphatic function from the anatomic, fluid management, immune modification standpoints requires study. New therapies from this analysis will improve patients with congestive heart failure.

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The trouble with troponin

Cited by 4 publications

References 12 publications

A novel breakthrough in wrist-worn transdermal troponin-I-sensor assessment for acute myocardial infarction

A novel breakthrough in wrist-worn transdermal troponin-I-sensor assessment for acute myocardial infarction

Development and preliminary validation of infrared spectroscopic device for transdermal assessment of elevated cardiac troponin

Why We Fail at Heart Failure: Lymphatic Insufficiency Is Disregarded

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