Search Results (79)

Background: High-sensitivity cardiac troponin (hs-cTn) is useful for detecting acute myocardial infarction, but chronic hemodialysis patients often have elevated baseline levels that exceed the upper reference limit (URL). This study aimed to determine whether hs-cTnI levels in asymptomatic hemodialysis patients exceed the URL established for the general population, evaluate the impact of high-flux hemodialysis on hs-cTnI concentrations, and examine associations between hs-cTnI levels and subsequent hospitalization or mortality. Methods: A prospective, single-center cohort study was conducted at a tertiary care center from August 2023 to July 2024. Blood samples for hs-cTnI were collected from asymptomatic hemodialysis patients aged ≥ 40 years, measured before and after dialysis within one month. Patients were followed for up to 12 months. Results: Fifty-six patients were enrolled. The mean hs-cTnI levels were 28.4 ng/L pre-dialysis and 27.9 ng/L post-dialysis, with ranges of <6–223 ng/L and <6–187 ng/L, respectively. The mean hs-cTnI delta between pre- and post-dialysis was −0.5 ng/L, with 52% showing a negative delta, 30% no change, and 18% a positive delta. No association was found between baseline hs-cTnI levels and mortality or hospitalization during follow-up. Conclusions: Most asymptomatic hemodialysis patients had hs-cTnI levels in the “gray zone”, thus neither confirming nor excluding acute myocardial infarction. Dialysis did not significantly affect hs-cTnI levels, and elevated baseline hs-cTnI was not linked to increased mortality or hospitalization over 12 months. Full article

Background: In the emergency setting, many diagnostic pathways incorporate change in high-sensitivity cardiac troponin (hs-cTn) concentrations (i.e., the delta) to classify patients as low-risk (rule-out) or high-risk (rule-in) for possible myocardial infarction (MI). However, the impact of analytical variation on the delta for correct classification is unknown, especially at concentrations below and around the 99th percentile. Our objective was to assess the impact of delta variation for correct risk classification across the European Society of Cardiology (ESC 0/1 h and 0/2 h), the High-STEACS, and the common change criteria (3C) pathways. Methods: A yearlong accuracy study for hs-cTnT was performed where laboratories across Canada tested three patient-based samples (level 1 target value = 6 ng/L, level 2 target value = 9 ng/L, level 3 target value = 12 ng/L) monthly across 41 different analyzers. The assigned low-delta between levels 1 and 2 was 3 ng/L (i.e., 9 − 6 = 3 ng/L) and the assigned high-delta between levels 1 and 3 was 6 ng/L (i.e., 12 − 6 = 6 ng/L). The low- and high-deltas for each analyzer were determined monthly from the measured values, with the difference calculated from the assigned deltas. The obtained deltas were then assessed via the different pathways on correct classification (i.e., percent correct with 95% confidence intervals, CI) and using non-parametric analyses. Results: The median (interquartile range) difference between the measured versus assigned low-delta (n = 436) and high-delta (n = 439) was −1 ng/L (−1 to 0). The correct classification differed among the pathways. The ESC 0/1 h pathway yielded the lowest percentage of correct classification at 35.3% (95% CI: 30.8 to 40.0) for the low-delta and 90.0% (95% CI: 86.8 to 92.6) for the high-delta. The 3C and ESC 0/2 h pathways yielded higher and equivalent estimates on correct classification: 95.2% (95% CI: 92.7 to 97.0) for the low-delta and 98.2% (95% CI: 96.4 to 99.2) for the high-delta. The High-STEACS pathway yielded 99.5% (95% CI: 98.4 to 99.9) of correct classifications for the high-delta but only 36.2% (95% CI: 31.7 to 40.9) for the low-delta. Conclusions: Analytical variation will impact risk classification for MI when using hs-cTn deltas alone per the pathways. The 3C and ESC 0/2 h pathways have <5% misclassification when using deltas for hs-cTnT in this dataset. Additional studies with different hs-cTnI assays at concentrations below and near the 99th percentile are warranted to confirm these findings. Full article

Background/Objectives: The aim of this study is to identify markers and develop a multifactorial model for characterizing extensive scar tissue after revascularization in patients with myocardial infarction (MI). Methods: A total of 123 patients with MI were examined. The patients underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) with a 1.5 Tesla GE SIGNA Voyager (GE HealthCare, Chicago, IL, USA) on the 7th–10th days from the onset of the disease. At the first stage, we performed a comparative analysis and built a multifactorial model based on the examination results of 92 (75%) patients enrolled from April 2021 to October 2023. These patients formed the group used for model development, or the “modeling group”. The mass of the scar was calculated, including relative to the left ventricular (LV) myocardium mass (M_scar/LVMM, in %). Results: The first subgroup consisted of 36 (39%) patients with a large scar, denoted as “LS” (M_scar/LVMM > 20%). The second subgroup included 56 (61%) patients with a smaller scar, referred to as “SS” (M_scar/LVMM ≤ 20%). Logistic regression was used to identify independent factors affecting scar tissue size. A multifactorial model was created. This model predicts M_scar/LVMM > 20% on MRI. It uses readily available clinical parameters: high-sensitivity troponin I (HscTn I) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and LV relative wall thickness (RWT). We tested the multifactorial model on the “modeling group” (n = 31). The sensitivity was 63.6% and the specificity was 85.7%. Conclusions: These indicates the feasibility of its application in clinical practice. Full article

Background: The diagnostic accuracy of the exercise treadmill test (ETT) remains suboptimal in premenopausal women. Menstrual cycle phases display hormonal variations and biological effects in premenopausal women. The early and late follicular phases of the menstrual cycle demonstrate nearly four-fold differences in estrogen levels. Methods: This study assessed the variability in ETT results between the early and late follicular phases in premenopausal women. This study included premenopausal females with regular menstrual cycles and chest pain. As per the study protocol, patients underwent two separate ETTs at the early and late follicular phases of the menstrual cycle. Hormones and high-sensitivity cardiac troponin T (hs-cTnT) were measured. The primary endpoint was the ST segment/heart rate (HR) index. The secondary endpoints were maximum ST/HR slope, ST segment depression, HR and blood pressure (BP) response, exercise capacity, and hs-cTnT change after ETT. Results: False-positive ETT results were common in premenopausal women. The early follicular phase displayed significantly higher hs-cTnT and BP responses to ETT compared to the late follicular phase. This study reports that ETT results are similar between the early and late follicular phases of the menstrual cycle in premenopausal women. Biological variability is observed in the BP and hs-cTnT response to ETT between the two phases. Conclusions: The menstrual cycle phase (early versus late follicular phase) did not affect the ETT results. The consideration of estrogen and hormonal status when evaluating the diagnostic test results can improve our understanding of cardiovascular disease in women. Full article

(1) Background: Prompt acute coronary syndrome (ACS) recognition remains challenging. This study evaluated the diagnostic and prognostic performance of novel biomarkers for non-ST-elevation myocardial infarction (NSTEMI). (2) Methods: Patients with suspected ACS presenting to Heidelberg University Hospital’s Emergency Department between August 2014 and February 2023 were analyzed. The biomarker panel included high-sensitivity cardiac troponin T (hs-cTnT), cardiac myosin-binding protein C (cMyBP-C), pro-B-type natriuretic peptide (proBNP), total N-terminal pro-B-type natriuretic peptide (t-NtproBNP), Angiotensin II (Ang2), Bone morphogenetic protein 10 (BMP10), Endothelial cell-specific molecule 1 (ESM1), fatty acid-binding protein 3 (FABP3), Fibroblast growth factor 23 (FGF23), Growth differentiation factor 15 (GDF15), and Copeptin. Negative predictive values (NPVs), sensitivities, and area under the curve (AUC) values were calculated for NSTEMI discrimination. Effectiveness and prognostic performance were assessed based on cardiovascular events at 30 days and 1 year. (3) Results: Of 1765 patients, 212 (12%) were diagnosed with NSTEMI. The European Society of Cardiology (ESC) 0/1 h and 0/3 h algorithms achieved sensitivities of 100% and 96.8%, NPVs of 100% and 99.3%, and effectiveness values of 54.8% and 66.0%. Hs-cTnT (AUC: 0.922) and cMyBP-C (AUC: 0.917) exhibited the highest diagnostic accuracy, followed by FABP3 (AUC: 0.759) and Copeptin (AUC: 0.624). Other biomarkers had lower performance (AUC: 0.516–0.617). At 1 year, event rates ranged from 0.0% to 3.4%, with the ESC algorithms demonstrating superior prognostic performance (0.8%, 2.4%). (4) Conclusions: The ESC 0/1 h and 0/3 h algorithms remain the most effective NSTEMI diagnostic strategies, balancing high sensitivity, prognostic reliability, and effectiveness. Among novel biomarkers, only cMyBP-C demonstrated comparable accuracy to hs-cTnT, supporting its potential as an adjunct to troponin assays. Full article

A major adverse cardiac event (MACE) following non-cardiac surgery encompasses critical postoperative cardiovascular complications such as myocardial infarction or injury, cardiac arrest, or stroke that are associated with increased perioperative morbidity, mortality, and healthcare resource utilisation. Cardiac troponin (cTn), particularly high-sensitivity cardiac troponin (hs-cTn), has emerged as a key biomarker for prediction of MACE. Despite its recognised utility, there is no consensus on how cTn levels should be used for standardised postoperative surveillance. Interpretation of the cTn levels may vary depending on sex-specific reference values and baseline comorbidities such as chronic kidney disease, sepsis, critical illness, and non-ischaemic conditions. The balance between cost-effectiveness and clinical benefit in implementing universal versus targeted postoperative hs-cTn screening remains to be fully explored. This review examines the prognostic value of cardiac troponin (cTn) levels in predicting major adverse cardiovascular events (MACEs) in patients undergoing non-cardiac surgery, with a focus on perioperative cTn elevations—particularly those associated with myocardial injury after non-cardiac surgery (MINS)—as potential early indicators of increased cardiovascular risk. Full article

Background: International guidelines recommend the use of high-sensitivity cardiac troponin (hs-cTn) I and T methods for the detection of myocardial injury as a pre-requisite for the diagnosis of acute myocardial infarction (AMI) in patients admitted to the emergency department. Recently, Mindray (Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China) has introduced a new chemiluminescence immunoassay (CLIA) for the detection of the cTn complex. The present study aims to verify and validate the hs-cTnI Mindray assay on the new automated CL2600i analyzer compared to the routine Alinity-i series instrument by Abbott (Abbott, Chicago, IL, USA). Methods: This study evaluated linearity, precision through the 5 × 5 protocol, methodological comparison on plasma and serum matrices, hs-cTnI 99th percentile imprecision, and the hs-cTnI detection rate in a healthy population. Results: The results obtained proved that the performance of the Mindray hs-cTnI test on the CL2600i platform was closely comparable to the Abbott Alinity-i system (plasma R²: 0.974; serum R²: 0.995). The CVs were consistently low, and no significant differences were reported. Excellent analytical performance, with high sensitivity, was also observed in the healthy population (overall detection rate: 79%), as well as good linearity within the measuring range (R²: 0.994). Conclusions: The Mindray hs-cTnI test confirms its robustness and utility in routine practice as an advanced assay. The new technology, with more sensitive detection methods, may improve the accuracy and reliability of cardiac biomarker testing, ultimately leading to better outcomes in the management of patients with AMI and other cardiac conditions. Full article

The management of acute heart failure (AHF) is becoming increasingly complex, especially in patients with multiple comorbidities. Endothelin-1 (ET-1), a vasoconstrictive peptide, is an important mediator of neurohormonal activation, endothelial dysfunction, and cardiac remodeling—key processes involved in the pathogenesis of AHF. The aim of our study was to evaluate the diagnostic and prognostic performance of ET-1 in multimorbid AHF patients, compared to established markers such as amino terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-cTnI). We conducted a single-center prospective study including 76 patients; 54 with AHF and 22 serving as controls. Upon admission, all patients underwent a comprehensive clinical, echocardiographic, and laboratory evaluation, including plasma ET-1 measurement using the enzyme-linked immunosorbent assay (ELISA) method. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analysis were performed to assess the diagnostic and prognostic performance of ET-1 in comparison to NT-proBNP and hs-cTnI. ET-1 levels were considerably higher in AHF patients than in controls (p = 0.02), with an AUC of 0.954, showing comparable diagnostic accuracy with NT-proBNP (AUC = 0.997), alongside strong correlations with signs of systemic congestion, increased hospital stay, and ventricular dysfunction. ET-1 had the strongest predictive accuracy for in-hospital mortality (AUC = 0.781, p = 0.026), outperforming NT-proBNP and hs-cTnI. For 30-day mortality, ET-1 remained a reliable predictor (AUC = 0.784, p = 0.016). However, as the follow-up period extended to one year, its predictive power declined, confirming ET-1’s prognostic efficacy only for short-term outcomes. Moreover, ET-1 levels were not influenced by the presence of comorbidities, demonstrating its potential as an independent biomarker. Our findings support that ET-1 is a valuable biomarker for both diagnosis and short-term prognosis in the assessment of multimorbid AHF patients. Full article

Background/Objectives: Patients with atrial fibrillation (AF) often have symptoms and risk factors similar to those of patients with coronary artery disease (CAD). However, the clinical criteria for identifying AF patients who would benefit from coronary angiography (CA) remain vague. We evaluated the predictive value of cardiac troponin I (cTnI), high-sensitivity cardiac troponin T (hs-cTnT), and various clinical parameters for detecting significant coronary artery stenosis. Methods: We retrospectively analyzed symptomatic AF patients admitted to the University Hospital Bonn emergency department between 2015 and 2019 undergoing CA. Out of 183 AF patients, 93 were screened with cTnI and 90 with hs-cTnT. Results: A total of 47 out of 183 (26%) AF patients were diagnosed with significant coronary artery stenosis. The sensitivity for detecting CAD requiring intervention was 62.5% [95% CI, 40.6–81.2%] for cTnI and 100% [95% CI, 85.2–100%] for hs-cTnT. Median hs-cTnT concentrations were significantly higher in the “Revascularization-group” than in the “Non-Revascularization-group” (30.05 ng/L [95% CI, 26.5–54.8 ng/L], 23 patients vs. 15.3 ng/L [95% CI, 12.7–22.5 ng/L], 67 patients, p < 0.001). The calculated regression model that includes age, history of CAD, and hs-cTnT showed the best pretest performance with an AUC of 0.83, p = 0.008. Poor performance was observed for cTnI (AUC of 0.63, p = 0.098). Conclusions: This study demonstrates that the hs-cTnT assay is superior to the contemporary cTnI assay in predicting significant CAD requiring revascularization in patients hospitalized with AF. Older age, pre-existing CAD, impaired renal function, and a higher hs-cTnT cut-off showed the highest pretest probability of relevant CAD in patients hospitalized for AF. Full article

Background: Medical history, ECG findings and cardiac markers are used in the diagnosis of myocardial infarction (MI). Biomarkers used especially for the diagnosis of MI include high-sensitivity troponins (hsTns), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), myoglobin, cardiac myosin-binding protein C and new cardiac biomarkers. This study evaluated the levels of serum thrombomodulin (TM), heart-type fatty-acid-binding protein (H-FABP), pentraxin-3 (PTX-3) and galectin-3 (Gal-3) to determine their utility in distinguishing between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). Methods: This study included a total of 180 patients (90 patients with acute STEMI and 90 patients with NSTEMI) who presented to the Gaziosmanpaşa Training and Research Hospital, Cardiovascular Surgery and Emergency Department, with ischemic chest pain lasting longer than 30 min. Ninety healthy volunteers were included as the control group. Results: Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), TM, H-FABP, PTX-3 and Gal-3 were significantly different across the STEMI, NSTEMI and control groups (p < 0.001). Strong positive correlations were observed between NT-proBNP and TM, H-FABP, PTX-3 and Gal-3 in the STEMI group. ROC analysis demonstrated excellent diagnostic accuracy for these biomarkers in distinguishing STEMI from NSTEMI and control groups. Conclusions: Vascular inflammation plays an important role in the pathophysiology of STEMI and NSTEMI. A comprehensive cardiac biomarker panel enhances diagnostic accuracy and risk stratification, particularly when distinguishing between STEMI and NSTEMI. The biomarkers hs-TnI, CK-MB, NT-proBNP, TM, H-FABP, PTX-3 and Gal-3 offer complementary information when used together as a panel. Further research and validation are essential to establish standardized protocols for their widespread use. Full article

Background: Thanks to the evolution of laboratory medicine, point-of-care testing (POCT) for troponin levels in the blood (hs-cTn) has been greatly improved in order to quickly diagnose acute myocardial infarction (AMI) with an accuracy similar to standard laboratory tests. The rationale of the HEART POCT study is to propose the application of the 0/1 h European Society of Cardiology (ESC) algorithm in the pre-hospital setting using a POCT device (Atellica VTLi). Methods: This is a prospective study comparing patients who underwent pre-hospital point-of-care troponin testing (Atellica VTLi) with a control group that underwent standard hospital-based troponin testing (Elecsys). The primary objectives were to determine if the 0/1 h algorithm of the Atellica VTLi is non-inferior to the standard laboratory method for diagnosing AMI and to analyze rule-out/rule-in times and emergency department (ED) stay times. The secondary objective was to evaluate the feasibility of pre-hospital troponin testing. Results: The Atellica VTLi demonstrated reasonable sensitivity for detecting AMI, with sensitivity increasing from 60% at the first measurement (time 0) to 80% at the second measurement (time 1 h). Both the Atellica VTLi and the Elecsys method showed high negative predictive value (NPV), indicating that a negative troponin result effectively ruled out AMI in most cases. Patients in the Atellica VTLi group experienced significantly shorter times to diagnosis and discharge from the emergency department compared to the control group (Elecsys). This highlights a potential benefit of point-of-care testing: streamlining the diagnostic and treatment processes. Conclusions: POCT allows for rapid troponin measurement, leading to a faster diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI). This enables earlier initiation of appropriate treatment, potentially improving patient outcomes and the efficiency of emergency department operations. POCT could be particularly beneficial in pre-hospital settings, enabling faster triage and transportation of patients to appropriate care centers. Full article

In an era where childhood health is increasingly at risk, understanding the role of physical activity in promoting well-being is critical. The COR-School project investigates the impact of physical activity on cardiometabolic health in over 700 Spanish children and adolescents aged 8 to 16 years. Over three years, the study will conduct three assessments (baseline and two follow-ups) to evaluate peak post-exercise levels of high-sensitivity cardiac troponin T (hs-cTnT), a biomarker for cardiac stress, following a submaximal 20 m shuttle run test. Secondary objectives include examining the influence of maturational status, physical activity, and cardiorespiratory fitness on hs-cTnT. Participants will complete fitness tests, questionnaires on health habits, sleep, and diet, as well as anthropometric and body composition measurements. Blood samples collected at baseline and three hours post-exercise will measure cardiac biomarkers and lipid profiles. Cardiovascular responses will be tracked using heart rate monitors. Normal ranges of hs-cTnT will be determined using data distribution (percentiles or mean ± SD), stratified by age, sex, and maturational stage. Statistical analyses, including repeated measures ANOVA and Pearson correlation, will explore trends across time, sex, developmental stages, and other health-related outcomes. Beyond providing clinical insights by establishing reference values for hs-cTnT in healthy youth after exercise, findings will inform educational policies to promote physical activity in schools, emphasizing its role in improving fitness, health behaviors, and overall development. Full article

Laboratory-based high-sensitivity cardiac troponin testing has been the pillar for emergency stratification of suspected acute coronary syndrome for well over a decade. Point-of-care troponin assays achieving the requisite analytical sensitivity have recently been developed and could accelerate such assessment. This review summarises the latest assays and describes their potential diverse clinical utility in the emergency department, community healthcare, pre-hospital, and other hospital settings. It outlines the current clinical data but also highlights the evidence gap, particularly the need for clinical trials using whole blood, that must be addressed for safe and successful implementation of point-of-care troponin analysis into daily practice. Additionally, how point-of-care troponin testing can be coupled with advances in biosensor technology, cardiovascular screening, and triage algorithms is discussed. Full article

Introduction: Cardiac troponin I is routinely measured in patients with suspected acute coronary syndrome. However, when a high-sensitivity cardiac troponin I (hs-cTnI) test is ordered without a clear clinical indication, unexpectedly elevated levels can lead to unnecessary diagnostic workups and inappropriate management. This study aimed to investigate physicians’ rationale for performing hs-cTnI tests in an emergency department (ED). Methods: In this prospective study, 1890 patients who underwent hs-cTnI measurement during their stay in an ED were included. Upon arrival, patients were classified into two groups based on their chief complaints: cardiac (36.6%) and non-cardiac (63.4%). Forty-seven ED physicians were asked to complete a questionnaire to assess their perspectives on the use of high-sensitivity cardiac troponin I (hs-cTnI) testing in the ED. Results: Out of the 47 ED physicians who responded to the questionnaire (94% response rate), 97.9% indicated that the purpose of hs-cTnI testing in the ED was to diagnose an acute cardiac event. However, 38.3% reported ordering hs-cTnI tests in non-cardiac patients due to medicolegal concerns. Additionally, 53% admitted to working under medicolegal pressure, and 50% believe they would have ordered fewer hs-cTnI tests if not for this medicolegal threat. Conclusions: defensive medicine is prevalent among ED physicians, and routine use of hs-cTnI testing as part of an evaluation can be explained in part by concern about liability and defensive medicine. Full article

Background: Low but detectable cardiac troponin (cTn) concentrations may reflect cardiovascular (CV) risk in a primary prevention setting. Using previously described thresholds for CV risk stratification, we assessed the influence of sex and cardiometabolic risk factors on the concentrations of high-sensitivity cTn in presumably healthy subjects. Methods: The prospective study included 597 presumably healthy individuals (313 women, 284 men). In all participants, hs-cTnI, hs-cTnT, lipid profile, C-reactive protein, glycated hemoglobin, estimated GFR (eGFR) and B-type naturetic peptide (BNP) were measured. Subjects were categorized into two groups of CV risk, based on hs-cTn non sex-specific cut-off of 5.0 ng/L. For hs-cTnI, sex-specific cut-off values were also used: ≥4.0 ng/L for females and ≥6.0 ng/L for males. Results: Increased CV risk, indicated by hs-cTn concentrations ≥ 5.0 ng/L, was significantly associated with age > 40 years, male sex, obesity and BNP concentrations ≥ 35 ng/L. Using the same 5.0 ng/L threshold, hs-TnT classified approximately twice as many individuals into the CV subgroup compared to hs-cTnI, particularly in males (31% vs. 13%, respectively). After applying sex-specific cut-offs for hs-cTnI, the proportion of females and males with increased risk became similar (8% vs. 9%, respectively). In contrast, using non-sex-specific cut-offs for hs-cTnI resulted in a proportion of 6% for females and 13% for males. BNP and eGFR had significant impact on CV risk stratification using sex-specific cut-offs for hs-cTnI. Conclusions: Our findings suggest the necessity of using sex-specific cut-offs for hs-cTn as a cardiovascular risk marker, in addition to other cardiometabolic factors, in the general population. Full article