Troponin T and I are not reliable markers of cardiac transplant rejection

Mullen, John C.; Bentley, Michael L.; Scherr, Kimberly; Chorney, S.G.; Burton, NelsonA.; Tymchak, Wayne; Koshal, Arvind; Modry, Dennis L.

doi:10.1016/s1010-7940(02)00293-2

Cited by 43 publications

(40 citation statements)

References 11 publications

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“…cTnI and cTnT levels have been shown to be elevated for 1 to 3 months after transplantation because of perioperative ischemia and injury, 9,15,25,26 thereby limiting the efficacy in assessing early rejection. However, the use of these biomarkers later in transplant seems more promising.…”

Section: Cardiac Troponin As a Potential Biomarker For Rejectionmentioning

confidence: 99%

High-Sensitivity Cardiac Troponin I Assay to Screen for Acute Rejection in Patients With Heart Transplant

Patel

Hill

Ayers

et al. 2014

Circ: Heart Failure

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Background— A noninvasive biomarker that could accurately diagnose acute rejection (AR) in heart transplant recipients could obviate the need for surveillance endomyocardial biopsies. We assessed the performance metrics of a novel high-sensitivity cardiac troponin I (cTnI) assay for this purpose. Methods and Results— Stored serum samples were retrospectively matched to endomyocardial biopsies in 98 cardiac transplant recipients, who survived ≥3 months after transplant. AR was defined as International Society for Heart and Lung Transplantation grade 2R or higher cellular rejection, acellular rejection, or allograft dysfunction of uncertain pathogenesis, leading to treatment for presumed rejection. cTnI was measured with a high-sensitivity assay (Abbott Diagnostics, Abbott Park, IL). Cross-sectional analyses determined the association of cTnI concentrations with rejection and International Society for Heart and Lung Transplantation grade and the performance metrics of cTnI for the detection of AR. Among 98 subjects, 37% had ≥1 rejection episode. cTnI was measured in 418 serum samples, including 35 paired to a rejection episode. cTnI concentrations were significantly higher in rejection versus nonrejection samples (median, 57.1 versus 10.2 ng/L; P <0.0001) and increased in a graded manner with higher biopsy scores ( P trend <0.0001). The c -statistic to discriminate AR was 0.82 (95% confidence interval, 0.76–0.88). Using a cut point of 15 ng/L, sensitivity was 94%, specificity 60%, positive predictive value 18%, and negative predictive value 99%. Conclusions— A high-sensitivity cTnI assay seems useful to rule out AR in cardiac transplant recipients. If validated in prospective studies, a strategy of serial monitoring with a high-sensitivity cTnI assay may offer a low-cost noninvasive strategy for rejection surveillance.

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Section: Cardiac Troponin As a Potential Biomarker For Rejectionmentioning

confidence: 99%

High-Sensitivity Cardiac Troponin I Assay to Screen for Acute Rejection in Patients With Heart Transplant

Patel

Hill

Ayers

et al. 2014

Circ: Heart Failure

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“…Regrettably, two cases of acute rejection were not reflected in elevations of either troponin T or I when assessed in a smaller subsequent cohort. 18 At this point measurement of tropinin isoenzymes cannot be recommended as a preoperative screening test for acute rejection (grade D).…”

Section: Is a Preoperative Troponin Measurement Useful?mentioning

confidence: 99%

Patient selection in ambulatory anesthesia — An evidence-based review: part I

et al. 2004

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P Pu ur rp po os se e: : To identify and characterize the evidence supporting decisions made in the care of patients with selected medical conditions undergoing ambulatory anesthesia and surgery. Conditions highlighted in this review include: the elderly, heart transplantation, hyper-reactive airway disease, coronary artery disease, and obstructive sleep apnea.S So ou ur rc ce e: : A structured search of MEDLINE (1966MEDLINE ( -2003 was performed using keywords for ambulatory surgery and patient condition. Selected articles were assigned a level of evidence using Centre for Evidence Based Medicine (CEBM) criteria. Recommendations were also graded using CEBM criteria. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The elderly may safely undergo ambulatory surgery but are at increased risk for hemodynamic variation in the operating room. The heart transplant recipient is at increased risk of coronary artery disease and renal insufficiency and should undergo careful preoperative evaluation. The patient with reactive airway disease is at increased risk of minor respiratory complications and should be encouraged to quit smoking. The patient with coronary artery disease and recent myocardial infarction may undergo ambulatory surgery without stress testing if functional capacity is adequate. The patient with obstructive sleep apnea is at increased risk of difficult tracheal intubation but the likelihood of airway obstruction and apnea following ambulatory surgery is unknown.C Co on nc cl lu us si io on n: : Ambulatory anesthesia is infrequently associated with adverse outcomes, however, knowledge regarding specific patient conditions is of generally low quality. Few prospective trials are available to guide management decisions. Objectif Source : Une recherche structurée dans MEDLINE (1966-2003) a été réalisée selon les mots clés pour la chirurgie ambulatoire et l'état du patient. Les articles choisis ont été cotés selon le niveau de preuve des critères du Centre for Evidence Based Medicine (CEBM). Les recommandations ont aussi été graduées selon les critères du CEBM. Constatations principales :

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“…However, other groups did not ¢nd any signi¢cant relationship between cTnT and the rejection grade of a cardiac transplantation. 9,10 Therefore, further investigations are still necessary in order to elucidate the potential utility of cTnT as a marker of the rejection grade in speci¢c groups of transplanted patients.…”

Section: Introductionmentioning

confidence: 99%

N-Terminal pro-Brain natriuretic peptide as a potential non-invasive marker of cardiac transplantation rejection

Avello

Molina

Llorente³

et al. 2007

Ann Clin Biochem

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Troponin T and I are not reliable markers of cardiac transplant rejection

Abstract: Troponin T and I are not useful indicators of cardiac rejection, but do correlate with donor heart ischemic injury.

Cited by 43 publications

References 11 publications

High-Sensitivity Cardiac Troponin I Assay to Screen for Acute Rejection in Patients With Heart Transplant

High-Sensitivity Cardiac Troponin I Assay to Screen for Acute Rejection in Patients With Heart Transplant

Patient selection in ambulatory anesthesia — An evidence-based review: part I

N-Terminal pro-Brain natriuretic peptide as a potential non-invasive marker of cardiac transplantation rejection

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