The Cardiac Troponin T and I are highly cardiac specific biochemical markers of myocardial injury. They are very sensitive markers to detect all kinds of myocardial injury, and are able to distinguish myocardial injury and skeletal injury. Furthermore, They are independent predictor of future cardiac events. Such markers are now widely used in the clinic practice. It is prospective to use them in Forensic Medical Science.
Biomarkers ; Forensic Medicine ; Humans ; Myocardial Infarction/blood* ; Myocardium/metabolism* ; Troponin I/blood* ; Troponin T/blood*

Cardiology ; Humans ; Myocardial Infarction ; blood ; diagnosis ; Sensitivity and Specificity ; Troponin ; blood

The diagnosis and management of patients with acute coronary syndrome (ACS) have evolved dramatically over the past decade. Biomarkers play an important role in the diagnosis of ACS, especially in unstable angina and non-ST-segment elevation myocardial infarction. Among these, cardiac troponin and creatine kinase appear to be the most sensitive and specific markers of myocardial injury. Recent studies have revealed several novel biomarkers. Elevated levels of C-reactive protein and interleukin-6 are strong independent markers of increased mortality among patients with ACS. However, the ideal biomarkers that offer early detection, risk stratification, selection of therapy, monitoring disease progression, and treatment efficacy remain to be elucidated. This review assesses limitations and contemporary needs for biomarkers in the context of diagnosis of ACS. It also discusses the newly developing technologies for novel biomarkers or novel biomarker protein signatures discovery, and importance of point-of-care testing for future management.
Acute Coronary Syndrome ; blood ; pathology ; Biomarkers ; blood ; Creatine Kinase ; blood ; Electrocardiography ; Humans ; Myoglobin ; blood ; Necrosis ; blood ; Oxidative Stress ; Platelet Activation ; Troponin I ; blood ; Troponin T ; blood

OBJECTIVEThe object of this study was to review the role of cardiac troponin as a prognostic factor in acute coronary syndrome patients of varying circumstances.

DATA SOURCESThe data used in this review were obtained mainly from the studies of cardiac troponin reported in pubmed from 1981 to 2006.

STUDY SELECTIONRelevant articles on studies of cardiac troponin were selected.

RESULTSElevated cardiac troponin in patients with ST elevation and non ST elevation myocardial infarction was associated with adverse outcomes, including a higher incidence of congestive heart failure, shock, and death. Patients with elevated cardiac troponin value seemed to benefit more from invasive strategies including a percutaneous coronary intervention and bypass surgery, but elevated cardiac troponin was also correlated with adverse outcomes, including a higher degree of failure, shock, and mortality in patients undergoing percutaneous coronary intervention; a higher degree of perioperative myocardial infarction, low cardiac output syndrome, cardiopulmonary resuscitation, and new-onset ventricular arrhythmia in patients undergoing bypass surgery were also observed. Elevated troponin after a percutaneous coronary intervention seemed to be associated with short-term adverse outcomes rather than long-term adverse outcomes, unless the elevation of the troponin post percutaneous coronary intervention was quite high (about 5 times above normal). On the contrary, elevated cardiac troponin after bypass surgery was more confusing to analyze since it happened in almost all patients. Furthermore, differences in cutoff values and time measurements in some studies add more confusion; thus, further research is warranted.

CONCLUSIONSThe prognostic value of cardiac troponin is demonstrated in almost all acute coronary syndrome patients. In addition to its high sensitivity and specificity, the prognostic value of cardiac troponin is another reason to make it the "golden cardiac marker" of this time.

Acute Coronary Syndrome ; blood ; therapy ; Biomarkers ; blood ; Humans ; Myocardial Infarction ; blood ; therapy ; Prognosis ; Troponin ; blood

OBJECTIVE: To investigate the association of myocardial blood flow (MBF) quantified by dynamic computed tomography (CT) myocardial perfusion imaging (MPI) with troponin level and left ventricle (LV) function in patients with ST-segment elevated myocardial infarction (STEMI). MATERIALS AND METHODS: Thirty-five STEMI patients who successfully had undergone reperfusion treatment within 1 week of their infarction were consecutively enrolled. All patients were referred for dynamic CT-MPI. Serial high-sensitivity troponin T (hs-TnT) levels and left ventricular ejection fraction (LVEF) measured by echocardiography were recorded. Twenty-six patients with 427 segments were included for analysis. Various quantitative parameters derived from dynamic CT-MPI were analyzed to determine if there was a correlation between hs-TnT levels and LVEF on admission and again at the 6-month mark. RESULTS: The mean radiation dose for dynamic CT-MPI was 3.2 ± 1.1 mSv. Infarcted territories had significantly lower MBF (30.5 ± 7.4 mL/min/100 mL versus 73.4 ± 8.1 mL/min/100 mL, p < 0.001) and myocardial blood volume (MBV) (2.8 ± 0.9 mL/100 mL versus 4.2 ± 1.1 mL/100 mL, p = 0.044) compared with those of reference territories. MBF showed the best correlation with the level of peak hs-TnT (r = −0.682, p < 0.001), and MBV showed a moderate correlation with the level of peak hs-TnT (r = −0.437, p = 0.026); however, the other parameters did not show any significant correlation with hs-TnT levels. As for the association with LV function, only MBF was significantly correlated with LVEF at the time of admission (r = 0.469, p = 0.016) and at 6 months (r = 0.585, p = 0.001). CONCLUSION: MBF quantified by dynamic CT-MPI is significantly inversely correlated with the level of peak hs-TnT. In addition, patients with lower MBF tended to have impaired LV function at the time of their admission and at 6 months.
Blood Volume ; Echocardiography ; Heart Ventricles ; Humans ; Infarction ; Myocardial Infarction ; Myocardial Perfusion Imaging ; Reperfusion ; Stroke Volume ; Troponin T ; Troponin

Myocardial infarction (MI) is the leading cause of death in the developed world. Biomarkers have an essential role in diagnosis, risk stratification, guiding management and clinical decision making in the setting of patients presenting with signs and symptoms of MI. Cardiac troponin (cTn) rose to prominence during the 1990s and has evolved to be the cornerstone for diagnosis of MI. The current criteria for MI diagnosis include a rise and/or fall in cTn with at least one value above the 99th percentile of the upper reference limit. Along with cTn, the natriuretic peptides B-type natriuretic peptide (BNP) and amino-terminal proBNP (NT-proBNP) have an important role in determining prognosis and guiding management. As assays for cTn have been evolved that are capable of reliably detecting smaller and smaller quantities in the blood, a dilemma has emerged as to how to use this new information. Several studies have attempted to answer this question and have shown that these lower concentrations of cTn have important prognostic significance and, more importantly, that intervention in these patients leads to improved clinical outcomes. New algorithms incorporating BNP, NT-proBNP, and more sensitive cTn assays hold promise for more rapid diagnosis or rule-out of MI, allowing for appropriate management steps to be initiated and more efficient and effective utilization of healthcare resources.
Biological Markers/*blood ; Humans ; Myocardial Infarction/*diagnosis/metabolism ; Natriuretic Peptide, Brain/blood ; Peptide Fragments/blood ; Prognosis ; Troponin/blood

OBJECTIVETo study the changes and significance of plasma cardiotrophin-1 (CT-1) in neonates with hypoxic-ischemic encephalopathy (HIE) complicated by myocardial ischemic injury.

METHODSForty-five neonates with HIE (15 mild cases, 24 moderate cases and 6 severe cases) were enrolled and divided into two subgroups based on the presence of myocardial injury (n=19) and not (n=26). Twenty healthy neonates were used as the control group. Plasma CT-1 levels were measured using double-antibody sandwich enzyme immunoassay method. Serum creatinine kinase MB (CK-MB) and cardiac troponin I (CTnI ) levels were also measured.

RESULTSPlasma CT-1 levels in the mild HIE (169±20 pg/mL) and moderate/severe HIE subgroups (287±44 pg/mL) were significantly higher than those in the control group (30±8 pg/mL), and plasma CT-1 levels were associated with the severity of HIE (P<0.01). Plasma CT-1 levels were positively correlated with serum CK-MB and CTnI levels in neonates with HIE in the acute phase (r=0.565 and 0.621 respectively; P<0.01). Plasma CT-1 levels in neonates with myocardial injury were significantly higher than those without myocardial injury (249 ±35 pg/mL vs 177±26 pg/mL; P<0.01). Plasma CT-1 levels were significantly reduced in neonates with myocardial injury in the convalescent phase (157±19 pg/mL) compared with those in the acute phase (249±35 pg/mL; P<0.01).

CONCLUSIONSDetection of plasma CT-1 levels may be useful in the diagnosis of myocardial ischemic injury and the severity evaluation of HIE.

Creatine Kinase, MB Form ; blood ; Cytokines ; blood ; Female ; Humans ; Infant, Newborn ; Male ; Myocardial Ischemia ; blood ; Troponin I ; blood

BACKGROUNDN-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) are excellent biomarkers for detecting heart failure and subclinical myocardial injury. However, it remains unclear whether subclinical myocardial injury is associated with NT-proBNP elevation in a community based population.

METHODSIn a community based study, levels of hs-cTnT and of NT-proBNP were determined in 1 497 participants older than 45 years. The lower detection limit of the hs-cTnT assay used in the present study was 0.003 ng/ml. The association of hs-cTnT levels and NT-proBNP levels was analyzed.

RESULTSWhen the subjects with undetectable (<0.003 ng/ml), intermediate (0.003-0.014 ng/ml), and elevated (≥0.014 ng/ml) levels of hs-cTnT were compared (r = 0.175, P < 0.001), a strong association between the hs-cTnT levels and NT-proBNP levels was observed (β = -0.206, P < 0.001; β = -0.118, P < 0.001, respectively). In multivariable analyses, older age and hs-cTnT were positively and independently associated with NT-proBNP levels (β = 0.341, P < 0.001; β = 0.143, P < 0.001, respectively), and male gender and the levels of eGFR were inversely and independently associated with NT-proBNP levels. When the subjects with normal or elevated NT-proBNP were analyzed separately, the hs-cTnT level was not an independent predictor for the NT-proBNP level in the normal NT-proBNP group, whereas the hs-cTnT level was the only independent predictor for NT-proBNP level in the elevated NT-proBNP group (β = 0.399, P < 0.01).

CONCLUSIONSIn this community based population, NT-proBNP elevation was common. In addition to female gender and older age, subclinical myocardial injury indicated by the hs-cTnT level was another important factor in NT-proBNP elevation.

Biomarkers ; analysis ; Female ; Humans ; Male ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood ; Troponin T ; blood

PURPOSE: Recent and numerous studies have indicated that cardiac biomarker elevation during acute pulmonary embolism (PE) predicts in-hospital death. However, the role of cardiac biomarkers for predicting the occurrence of hypotension is unknown. The aim of the present study was to evaluate whether increased levels of cardiac biomarkers can predict the occurrence of hypotension (sytolic blood pressure (SBP) <90 mmHg) within 24 hours in non-high-risk patients with acute PE. METHODS: Study subjects included all consecutive patients with acute PE, as diagnosed by chest computed tomographic angiography, in the emergency department (ED) from January 2009 through December 2011. All patients underwent tests for troponinI (TnI), creatinine kinase-MB isoenzyme (CK-MB), and brain natriuretic peptide (BNP) levels upon ED admission and were divided into two groups based on the occurrence of hypotension within 24 hours. RESULTS: Out of 196 stable patients with acute PE admitted to the ED during the study period, 154 patients were included. Within 24 hours of hospitalization, 13 (8.4%) patients developed hypotension. The mean values for serum TnI, CK-MB, and BNP were significantly higher in patients who developed hypotension than in patients who did not. The TnI value was the most accurate biomarker for predicting the occurrence of hypotension. Moreover, elevated levels of cTnI (>0.05 ng/mL) upon admission were an independent predictor for developing hypotension within 24 hours in patients with stable acute PE at the time of ED admission (odds ratio 11.0, 95% confidence interval (CI) 2.8-43.8, p=0.00). CONCLUSION: In stable patients with acute PE, an elevated TnI can predict the in-hospital development of hypotension within 24 hours. This finding is valuable for selecting patients who might benefit from intensive clinical surveillance and escalated treatment.
Angiography ; Biomarkers ; Blood Pressure ; Creatinine ; Emergencies ; Hospitalization ; Humans ; Hypotension ; Natriuretic Peptide, Brain ; Pulmonary Embolism ; Thorax ; Troponin

Hyperadrenocorticism (HAC) is a common endocrinopathy among dogs that causes multisystemic signs. This study was conducted to evaluate cardiocirculatory, biochemical, and hemostatic parameters in dogs with HAC at diagnosis, in addition to verifying whether abnormal parameters could be controlled by initial treatment with trilostane. Fifteen dogs with HAC were assessed by systolic blood pressure measurement, electrocardiography, Doppler echocardiography, serum concentration of troponin I, and biochemical and hemostatic profile at diagnosis and after trilostane therapy. Unlike biochemical parameters, hemostatic and cardiocirculatory parameters were not significantly influenced by the onset of treatment. The authors believe that clinical treatment with trilostane for 3 to 4 months might not be sufficient for the stabilization of cardiocirculatory abnormalities such as hypertension. Therefore, dogs with HAC must receive cardiocirculatory monitoring at diagnosis and during drug treatment.
Adrenocortical Hyperfunction* ; Animals ; Blood Pressure ; Cardiology ; Diagnosis* ; Dogs* ; Echocardiography, Doppler ; Electrocardiography ; Endocrinology ; Hypertension ; Troponin I