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Circulation Journal : Official Journal... Jan 2018Type 2 myocardial infarction (T2MI) refers to myocardial necrosis caused by an imbalance in myocardial oxygen supply and demand and in the absence of acute coronary... (Review)
Review
Type 2 myocardial infarction (T2MI) refers to myocardial necrosis caused by an imbalance in myocardial oxygen supply and demand and in the absence of acute coronary thrombosis. Despite growing recognition of this entity, there remains little understanding of the pathophysiology and uncertainty over the diagnostic criteria for this subtype of MI. Alarmingly, recent studies suggest that a diagnosis of T2MI pertains a prognosis similar to, if not worse than, type 1 MI. With increasing clinical use of high-sensitivity cardiac troponin assays, the frequency of recognition of T2MI is expected to increase. Yet, there remains a scarcity of prospective studies examining this cohort of patients, let alone randomized clinical trials identifying optimum treatment strategies. Further evaluation of the prevalence, pathophysiology and management of this patient cohort is warranted by the scientific community.
Topics: Disease Management; Myocardial Infarction; Prognosis; Troponin
PubMed: 29332909
DOI: 10.1253/circj.CJ-17-1399 -
Health Technology Assessment... Jun 2015Early diagnosis of acute myocardial infarction (AMI) can ensure quick and effective treatment but only 20% of adults with emergency admissions for chest pain have an... (Review)
Review
High-sensitivity troponin assays for the early rule-out or diagnosis of acute myocardial infarction in people with acute chest pain: a systematic review and cost-effectiveness analysis.
BACKGROUND
Early diagnosis of acute myocardial infarction (AMI) can ensure quick and effective treatment but only 20% of adults with emergency admissions for chest pain have an AMI. High-sensitivity cardiac troponin (hs-cTn) assays may allow rapid rule-out of AMI and avoidance of unnecessary hospital admissions and anxiety.
OBJECTIVE
To assess the clinical effectiveness and cost-effectiveness of hs-cTn assays for the early (within 4 hours of presentation) rule-out of AMI in adults with acute chest pain.
METHODS
Sixteen databases, including MEDLINE and EMBASE, research registers and conference proceedings, were searched to October 2013. Study quality was assessed using QUADAS-2. The bivariate model was used to estimate summary sensitivity and specificity for meta-analyses involving four or more studies, otherwise random-effects logistic regression was used. The health-economic analysis considered the long-term costs and quality-adjusted life-years (QALYs) associated with different troponin (Tn) testing methods. The de novo model consisted of a decision tree and Markov model. A lifetime time horizon (60 years) was used.
RESULTS
Eighteen studies were included in the clinical effectiveness review. The optimum strategy, based on the Roche assay, used a limit of blank (LoB) threshold in a presentation sample to rule out AMI [negative likelihood ratio (LR-) 0.10, 95% confidence interval (CI) 0.05 to 0.18]. Patients testing positive could then have a further test at 2 hours; a result above the 99th centile on either sample and a delta (Δ) of ≥ 20% has some potential for ruling in an AMI [positive likelihood ratio (LR+) 8.42, 95% CI 6.11 to 11.60], whereas a result below the 99th centile on both samples and a Δ of < 20% can be used to rule out an AMI (LR- 0.04, 95% CI 0.02 to 0.10). The optimum strategy, based on the Abbott assay, used a limit of detection (LoD) threshold in a presentation sample to rule out AMI (LR- 0.01, 95% CI 0.00 to 0.08). Patients testing positive could then have a further test at 3 hours; a result above the 99th centile on this sample has some potential for ruling in an AMI (LR+ 10.16, 95% CI 8.38 to 12.31), whereas a result below the 99th centile can be used to rule out an AMI (LR- 0.02, 95% CI 0.01 to 0.05). In the base-case analysis, standard Tn testing was both most effective and most costly. Strategies considered cost-effective depending upon incremental cost-effectiveness ratio thresholds were Abbott 99th centile (thresholds of < £6597), Beckman 99th centile (thresholds between £6597 and £30,042), Abbott optimal strategy (LoD threshold at presentation, followed by 99th centile threshold at 3 hours) (thresholds between £30,042 and £103,194) and the standard Tn test (thresholds over £103,194). The Roche 99th centile and the Roche optimal strategy [LoB threshold at presentation followed by 99th centile threshold and/or Δ20% (compared with presentation test) at 1-3 hours] were extendedly dominated in this analysis.
CONCLUSIONS
There is some evidence to suggest that hs-CTn testing may provide an effective and cost-effective approach to early rule-out of AMI. Further research is needed to clarify optimal diagnostic thresholds and testing strategies.
STUDY REGISTRATION
This study is registered as PROSPERO CRD42013005939.
FUNDING
The National Institute for Health Research Health Technology Assessment programme.
Topics: Adult; Chest Pain; Cost-Benefit Analysis; Hospital Costs; Humans; Myocardial Infarction; Troponin C
PubMed: 26118801
DOI: 10.3310/hta19440 -
Annals of Internal Medicine Oct 2014Clinicians face uncertainty about the prognostic value of troponin testing in patients with chronic kidney disease (CKD) without suspected acute coronary syndrome (ACS). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Clinicians face uncertainty about the prognostic value of troponin testing in patients with chronic kidney disease (CKD) without suspected acute coronary syndrome (ACS).
PURPOSE
To systematically review the literature on troponin testing in patients with CKD without ACS.
DATA SOURCES
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through May 2014.
STUDY SELECTION
Studies examining elevated versus normal troponin levels in patients with CKD without ACS.
DATA EXTRACTION
Paired reviewers selected articles for inclusion, extracted data, and graded strength of evidence (SOE). Meta-analyses were conducted when studies had sufficient homogeneity of key variables.
DATA SYNTHESIS
Ninety-eight studies met inclusion criteria. Elevated troponin levels were associated with all-cause and cardiovascular mortality among patients receiving dialysis (moderate SOE). Pooled hazard ratios (HRs) for all-cause mortality from studies that adjusted for age and coronary artery disease or a risk equivalent were 3.0 (95% CI, 2.4 to 4.3) for troponin T and 2.7 (CI, 1.9 to 4.6) for troponin I. The pooled adjusted HRs for cardiovascular mortality were 3.3 (CI, 1.8 to 5.4) for troponin T and 4.2 (CI, 2.0 to 9.2) for troponin I. Findings were similar for patients with CKD who were not receiving dialysis, but there were fewer studies. No study tested treatment strategies by troponin cut points.
LIMITATION
Studies were heterogeneous regarding assays, troponin cut points, covariate adjustment, and follow-up.
CONCLUSION
In patients with CKD without suspected ACS, elevated troponin levels were associated with worse prognosis. Future studies should focus on whether this biomarker is more appropriate than clinical models for reclassifying risk of patients with CKD and whether such classification can help guide treatment in those at highest risk for death.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality.
Topics: Acute Coronary Syndrome; Biomarkers; Cardiovascular Diseases; Humans; Prognosis; Renal Dialysis; Renal Insufficiency, Chronic; Risk; Troponin I; Troponin T
PubMed: 25111499
DOI: 10.7326/M14-0743 -
International Journal of Molecular... Jul 2019Cardiac troponin I (cTn I) and cardiac troponin T (cTn T) are currently widely used as diagnostic biomarkers for myocardial injury caused by ischemic heart diseases in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cardiac troponin I (cTn I) and cardiac troponin T (cTn T) are currently widely used as diagnostic biomarkers for myocardial injury caused by ischemic heart diseases in clinical and forensic medicine. However, no previous meta-analysis has summarized the diagnostic roles of postmortem cTn I and cTn T. The aim of the present study was to meta-analyze the diagnostic roles of postmortem cTn I and cTn T for cardiac death in forensic medicine, present a systematic review of the previous literature, and determine the postmortem cut-off values of cTn I and cTn T.
METHODS
We searched multiple databases for the related literature, performed a meta-analysis to investigate the diagnostic roles of postmortem cardiac troponins, and analyzed the receiver operating characteristic (ROC) curve to determine their postmortem cut-off values.
RESULTS AND CONCLUSIONS
The present meta-analysis demonstrated that postmortem cTn I and cTn T levels were increased in pericardial fluid and serum in cardiac death, especially in patients with acute myocardial infarction (AMI). We determined the postmortem cut-off value of cTn I in the pericardial fluid at 86.2 ng/mL, cTn I in serum at 9.5 ng/mL, and cTn T in serum at 8.025 ng/mL.
Topics: Autopsy; Biomarkers; Death; Humans; Myocardial Infarction; Myocardium; Postmortem Changes; ROC Curve; Troponin I; Troponin T
PubMed: 31288395
DOI: 10.3390/ijms20133351 -
Heart (British Cardiac Society) Aug 2020Coronavirus disease 2019 (COVID-19) has produced a significant health burden worldwide, especially in patients with cardiovascular comorbidities. The aim of this... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Coronavirus disease 2019 (COVID-19) has produced a significant health burden worldwide, especially in patients with cardiovascular comorbidities. The aim of this systematic review and meta-analysis was to assess the impact of underlying cardiovascular comorbidities and acute cardiac injury on in-hospital mortality risk.
METHODS
PubMed, Embase and Web of Science were searched for publications that reported the relationship of underlying cardiovascular disease (CVD), hypertension and myocardial injury with in-hospital fatal outcomes in patients with COVID-19. The ORs were extracted and pooled. Subgroup and sensitivity analyses were performed to explore the potential sources of heterogeneity.
RESULTS
A total of 10 studies were enrolled in this meta-analysis, including eight studies for CVD, seven for hypertension and eight for acute cardiac injury. The presence of CVD and hypertension was associated with higher odds of in-hospital mortality (unadjusted OR 4.85, 95% CI 3.07 to 7.70; I=29%; unadjusted OR 3.67, 95% CI 2.31 to 5.83; I=57%, respectively). Acute cardiac injury was also associated with a higher unadjusted odds of 21.15 (95% CI 10.19 to 43.94; I=71%).
CONCLUSION
COVID-19 patients with underlying cardiovascular comorbidities, including CVD and hypertension, may face a greater risk of fatal outcomes. Acute cardiac injury may act as a marker of mortality risk. Given the unadjusted results of our meta-analysis, future research are warranted.
Topics: Betacoronavirus; Biomarkers; COVID-19; Cardiovascular Diseases; Coronavirus Infections; Hospital Mortality; Humans; Pandemics; Pneumonia, Viral; SARS-CoV-2; Troponin
PubMed: 32461330
DOI: 10.1136/heartjnl-2020-317062 -
Journal of Sport and Health Science Mar 2021To finish an endurance race, athletes perform a vigorous effort that induces the release of cardiac damage markers. There are several factors that can affect the total... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To finish an endurance race, athletes perform a vigorous effort that induces the release of cardiac damage markers. There are several factors that can affect the total number of these markers, so the aim of this review was to analyze the effect of endurance running races on cardiac damage markers and to identify the factors that modify the levels of segregation of these cardiac damage markers.
METHODS
A systematic search of PubMed, Web of Science, and the Cochrane Library databases was performed. This analysis included studies where the acute effects of running races on cardiac damage markers (troponin I and troponin T) were analyzed, assessing the levels of these markers before and after the races.
RESULTS
The effects of running races on troponin I (mean difference = 0.0381 ng/mL) and troponin T (mean difference = 0.0256 ng/mL) levels were significant. The ages (R = 14.4%, p = 0.033) and body mass indexes (R = 14.5%, p = 0.045) of the athletes had a significant interaction with troponin I. In addition, gender, mean speed, time to finish the race, and type of race can affect the level of cardiac damage markers.
CONCLUSION
Endurance running races induce the release of cardiac-damage markers that remain elevated for at least 24 h after the races. In addition, young male athletes with high body mass indexes who perform races combining long duration and moderate intensity (i.e., marathons) release the highest levels of cardiac damage markers. Physicians should take into consideration these results in the diagnosis and treatment of patients admitted to the hospital days after finishing endurance running races.
Topics: Adolescent; Adult; Age Factors; Bias; Biomarkers; Body Mass Index; Confidence Intervals; Female; Humans; Male; Marathon Running; Middle Aged; Physical Endurance; Regression Analysis; Sex Factors; Troponin I; Troponin T; Young Adult
PubMed: 33742602
DOI: 10.1016/j.jshs.2019.10.003 -
JACC. Heart Failure Mar 2018The aim of this study was to systematically collate and appraise the available evidence regarding the association between high-sensitivity cardiac troponin (hs-cTn) and... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The aim of this study was to systematically collate and appraise the available evidence regarding the association between high-sensitivity cardiac troponin (hs-cTn) and incident heart failure (HF) and the added value of hs-cTn in HF prediction.
BACKGROUND
Identification of subjects at high risk for HF and early risk factor modification with medications such as angiotensin-converting enzyme inhibitors may delay the onset of HF. Hs-cTn has been suggested as a prognostic marker for the incidence of first-ever HF in asymptomatic subjects.
METHODS
PubMed, Embase, and Web of Science were systematically searched for prospective cohort studies published before January 2017 that reported associations between hs-cTn and incident HF in subjects without baseline HF. Study-specific multivariate-adjusted hazard ratios (HRs) were pooled using random-effects meta-analysis.
RESULTS
Data were collated from 16 studies with a total of 67,063 subjects and 4,165 incident HF events. The average age was 57 years, and 47% were women. Study quality was high (Newcastle-Ottawa score 8.2 of 9). In a comparison of participants in the top third with those in the bottom third of baseline values of hs-cTn, the pooled multivariate-adjusted HR for incident HF was 2.09 (95% confidence interval [CI]: 1.76 to 2.48; p < 0.001). Between-study heterogeneity was high, with an I value of 80%. HRs were similar in men and women (2.29 [95% CI: 1.64 to 3.21] vs. 2.18 [95% CI: 1.68 to 2.81]) and for hs-cTnI and hs-cTnT (2.09 [95% CI: 1.53 to 2.85] vs. 2.11 [95% CI: 1.69 to 2.63]) and across other study-level characteristics. Further adjustment for B-type natriuretic peptide yielded a similar HR of 2.08 (95% CI: 1.64 to 2.65). Assay of hs-cTn in addition to conventional risk factors provided improvements in the C index of 1% to 3%.
CONCLUSIONS
Available prospective studies indicate a strong association of hs-cTn with the risk of first-ever HF and significant improvements in HF prediction.
Topics: Aged; Biomarkers; Female; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Troponin
PubMed: 29331272
DOI: 10.1016/j.jchf.2017.11.003 -
The Journal of Invasive Cardiology Feb 2012The purpose of this study was to assess the effect of remote ischemic precondition (RIPC) on the incidence of myocardial and renal injury in patients undergoing... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The purpose of this study was to assess the effect of remote ischemic precondition (RIPC) on the incidence of myocardial and renal injury in patients undergoing cardiovascular interventions as measured by biomarkers. Clinical data were pooled to evaluate the usefulness of RIPC to benefit clinical outcomes.
BACKGROUND
Debate exists regarding the merit of using RIPC for patients undergoing cardiovascular interventions.
METHODS
Systematic review and meta-analysis of prospective randomized clinical trials of patients undergoing cardiovascular interventions who received RIPC versus control were performed. Two independent reviewers selected articles from MEDLINE, EMBASE, SCOPUS, Cochrane, ISI Web of Science, and BIREME, and through hand search of relevant reviews and meeting abstracts upon agreement. Surrogate markers of myocardial (troponin T or I and CK-MB) and renal (serum creatinine) injury for primary outcomes were abstracted.
RESULTS
Final pooled analysis from 17 clinical trials showed significant heterogeneity of results and no relevant publication bias. Patients receiving RIPC had lower levels of markers of myocardial injury in the first few days after surgery (standardized mean difference [SMD], 0.54; 95% confidence interval [CI], -1.01 to -0.08; P=.01) with highly heterogeneous results (I2 = 93%). A lower incidence of perioperative myocardial infarction (7.9% RIPC vs 13.9% placebo; RR, 0.56; 95% CI, 0.37-0.84; P=.005; I2 = 0%) was also noted. In patients undergoing abdominal aortic aneurysm repair, RIPC when compared to control also decreased renal injury (SMD, 0.28; 95% CI, -0.49 to -0.08; P=.007; I2 = 51%).
CONCLUSIONS
RIPC appears to be associated with a favorable effect on serological markers of myocardial and renal injury during cardiovascular interventions. Larger trials should be conducted to substantiate this initial impression.
Topics: Cardiovascular Surgical Procedures; Creatinine; Humans; Ischemic Preconditioning; Myocardial Reperfusion Injury; Randomized Controlled Trials as Topic; Renal Circulation; Reperfusion Injury; Troponin
PubMed: 22294530
DOI: No ID Found -
BMC Cardiovascular Disorders Feb 2024An early diagnosis of atherosclerosis, particularly in subclinical status, can play a remarkable role in reducing mortality and morbidity. Because of coronary artery...
An early diagnosis of atherosclerosis, particularly in subclinical status, can play a remarkable role in reducing mortality and morbidity. Because of coronary artery calcification (CAC) nature in radiation exposure, finding biomarkers associated with CAC could be useful in identifying individuals at high risk of CAC score. In this review, we focused on the association of cardiac troponins (hs-cTns) and CAC to achieve insight into the pathophysiology of CAC. In October 2022, we systematically searched Web of Science, Scopus, PubMed, and Embase databases to find human observational studies which have investigated the association of CAC with cardiac troponins. To appraise the included articles, we used the Newcastle Ottawa scale (NOS). Out of 520 records, 10 eligible studies were included. Based on findings from longitudinal studies and cross-sectional analyses, troponin T and I were correlated with occurrence of CAC and its severity. Two of the most important risk factors that affect the correlation between hs-cTns serum levels and CAC were age and gender. The elevation of cardiac troponins may affect the progression of CAC and future cardiovascular diseases. Verifying the association between cardiac troponins and CAC may lead to identify individuals exposed to enhanced risk of cardiovascular disease (CVD) complications and could establish innovative targets for pharmacological therapy.
Topics: Humans; Calcium; Cross-Sectional Studies; Coronary Vessels; Coronary Artery Disease; Cardiovascular Diseases; Risk Factors; Heart Diseases; Troponin; Vascular Calcification
PubMed: 38336618
DOI: 10.1186/s12872-024-03761-x -
Clinical Chemistry and Laboratory... Jun 2021Cardiac troponins (cTn) are the preferred biomarkers for the evaluation of myocardial injury and play a key role in the diagnosis of acute myocardial infarction (MI)....
Cardiac troponins (cTn) are the preferred biomarkers for the evaluation of myocardial injury and play a key role in the diagnosis of acute myocardial infarction (MI). Pre-analytical or analytical issues and interferences affecting troponin T and I assays are therefore of major concern given the risk of misdiagnosis. False positive troponin results have been related to various interferences including anti-troponin antibodies, heterophilic antibodies, or elevated alkaline phosphatase level. On the other hand, false negative results have been reported in the case of a large biotin intake. These interferences are characterized with erroneous but reproducible troponin results. Of interest, non-reproducible results have also been reported in the literature. In other words, if the sample is reanalyzed a second time, a significant difference in troponin results will be observed. These interferences have been named "fliers" or "outliers". Compared to the biotin interference that received major attention in the literature, troponin outliers are also able to induce harmful clinical consequences for the patient. Moreover, the prevalence of outliers in recent studies was found to be higher (0.28-0.57%) compared to the biotin interference. The aim of this systematic review is to warn clinicians about these non-reproducible results that may alter their clinical judgment. Four case reports that occurred in the Clinique of Saint-Luc Bouge are presented to attest this point. Moreover, we aimed at identifying the nature of these non-reproducible troponin results, determining their occurrence, and describing the best way for their identification.
Topics: Biomarkers; Biotin; Humans; Myocardial Infarction; Troponin I; Troponin T
PubMed: 33554552
DOI: 10.1515/cclm-2020-1564