Humans ; Troponin I

BACKGROUND: The prognostic utility of cardiac biomarkers, high-sensitivity cardiac troponin I (hs-cTnI) and soluble suppression of tumorigenicity-2 (sST2), in non-cardiac surgery is not well-defined. We evaluated hs-cTnI and sST2 as predictors of 30-day major adverse cardiac events (MACE) in patients admitted to the surgical intensive care unit (SICU) following major non-cardiac surgery. METHODS: hs-cTnI and sST2 concentrations were measured in 175 SICU patients immediately following surgery and for three days postoperatively. The results were analyzed in relation to 30-day MACE and were compared with the revised Goldman cardiac risk index (RCRI) score. RESULTS: Overall, 30-day MACE was observed in 16 (9.1%) patients. hs-cTnI and sST2 concentrations differed significantly between the two groups with and without 30-day MACE (P < 0.05). The maximum concentration of sST2 was an independent predictor of 30-day MACE (odds ratio=1.016, P=0.008). The optimal cut-off values of hs-cTnI and sST2 for predicting 30-day MACE were 53.0 ng/L and 182.5 ng/mL, respectively. A combination of hs-cTnI and sST2 predicted 30-day MACE better than the RCRI score. Moreover, 30-day MACE was observed more frequently with increasing numbers of above-optimal cut-off hs-cTnI and sST2 values (P < 0.0001). Reclassification analyses indicated that the addition of biomarkers to RCRI scores improved the prediction of 30-day MACE. CONCLUSIONS: This study demonstrates the utility of hs-cTnI and sST2 in predicting 30-day MACE following non-cardiac surgery. Cardiac biomarkers would provide enhanced risk stratification in addition to clinical RCRI scores for patients undergoing major non-cardiac surgery.
Biomarkers ; Critical Care* ; Humans ; Prognosis ; Troponin I* ; Troponin*

PURPOSE: Cardiac troponin I (cTnI) is a highly sensitive and specific marker for myocardial injury, and is used to predict the outcomes in patients with acute coronary syndromes. Cardiovascular complications are the leading cause of morbidity and mortality in patients who underwent vascular surgical procedures. The aim of the study was to evaluate the association between the postoperative cTnI levels and a perioperative myocardial injury (MI) within 6 months after the vascular surgical procedures. METHODS: Eighty patients who underwent vascular surgery including an arterial bypass, amputation and a thrombectomy were included in this study. The blood samples were analyzed for cTnI immediately after surgery and 1, 2, and 3 days after surgery. RESULTS: An elevated cTnI was defined as a serum concentrations > 0.4 ng/ml in any of 4 samples. Seven patients (8.7%) had postoperative cTnI levels of > 0.4 ng/ml, which was associated with a higher risk of a postoperative cardiac event (P< 0.001) and 6 month mortality (P< 0.001). However, only 2 out of the 75 patients (91.3%) who had postoperative cTnI levels of < 0.4 ng/ml developed postoperative MI. CONCLUSION: A serum cTnI level > or =0.4 ng/ml may indicate myocardial damage after vascular surgical procedures. Therefore, the routine postoperative measurement of cTnI might be a useful predictive value of the postoperative cardiac events after vascular surgical procedures.
Acute Coronary Syndrome ; Amputation ; Humans ; Mortality ; Thrombectomy ; Troponin I* ; Troponin* ; Vascular Surgical Procedures*

PURPOSE: TURP(transurethral resection of prostate) is the standard surgical treatment for BPH. However, myocardial damage is the most serious complication and has been postulated to develop as a result of irrigating fluid absorption during TURP. The aim of this study is to evaluate the relationship between the amount of irrigating fluid absorption and myocardial damage, and the factors that affect irrigating fluid absorption. MATERIALS AND METHODS: From March 2002 to January 2003, 52 patients who had undergone TURP were evaluated. TURP was performed under epidural anesthesia and URIONE(R) solution was used as the irrigating fluid. The amount of absorbed irrigating fluid was measured and serum troponin I was checked as a marker of perioperative myocardial damage. Resection time, weight of resected prostatic tissue, and the amount of blood loss were evaluated as the factors that affect the irrigating fluid absorption. RESULTS: Weight of resected prostatic tissue(r=0.566, p=0.001) and blood loss(r=0.339, p=0.01) were found to have moderate correlation with the amount of absorbed irrigating fluid, whereas the amount of irrigating fluid(r=0.293, p=0.11) and resection time(r=0.296, p=0.062) had no correlation. Myocardial damage was observed in 2 out of the 52 patients(3.8%), whosepostoperative serum troponin I was higher than 0.4microgram/L, and absorbed irrigating fluid being more than 1,000ml. CONCLUSIONS: Therefore, in the case of large prostate volume and excessive blood loss, the use of diuretics during TURP is recommended to reduce the incidence of myocardial damage.
Absorption* ; Anesthesia, Epidural ; Diuretics ; Humans ; Incidence ; Prostate ; Transurethral Resection of Prostate* ; Troponin ; Troponin I

BACKGROUND: Cardiac troponin I (cTnI) is a specific marker of myocardial injury. It is known that a higher level of cTnI is associated with a poor clinical outcome in patients with acute coronary syndrome. An elevation in cTnI is also observed in various noncardiac critical illnesses. This study evaluated whether cTnI is useful for predicting the prognosis in noncardiac critically ill patients. METHODS: From June 2003 to July 2004 at Gyeongsang National University Hospital, we enrolled 215 patients (male:142, female:73, mean age:63+/-15 years ) who were admitted for critical illness other than acute coronary syndrome at the medical intensive care unit(ICU). The severity score of critical illness (SAPS II and SOFA) was determined and serum cTnI level was measured within 24 hours after admission to the ICU. The mortality rate was compared between the cTnI-positive (> or =0.1microgram/L) and cTnI-negative (cTnI<0.1microgram/L) patients at the 10th and 30th day after admission to the ICU. The mean cTnI value was compared between the survivors and non-survivors at the 10th and 30th day after admission to the ICU in the cTnI-positive patients. The correlation between cTnI and the severity of the critical illness score (SAPS II and SOFA) was also analyzed in cTnI-positive patients. RESULTS: 1) The number of cTnI-negative and positive patients were 95(44%) and 120(56%), respectively. 2) The mortality rate at the 10th and 30th day after admission to the ICU was significantly higher in the cTnI-positive patients (29%, 41%) than in the cTnI-negative patients (12%, 21%)(p<0.01). 3) In the cTnI-positive patients, the mean value of the cTnI at the 10th and 30th day after admission to the ICU was significantly higher in the non-survivors (4.5 +/- 9.2 microgram/L, 3.5 +/- 7.9 microgram/L) than in the survivors( 1.8 +/- 3.6 microgram/L, 2.0 +/- 3.9 microgram/L) (p < 0.05). 4) In the cTnI-positive patients, the cTnI level was significantly correlated with the SAPS II score (r=0.24, p<0.001) and SOFA score (r=0.30, p<0.001). CONCLUSION: The cTnI may be a useful prognostic marker in noncardiac critically ill patients.
Acute Coronary Syndrome ; Critical Illness* ; Humans ; Critical Care ; Mortality ; Prognosis ; Survivors ; Troponin I* ; Troponin*

PURPOSE: The major cause of cardiac dysfunction, after open heart surgery for congenital heart disease, is perioperative myocardial injury. Cardiac troponin I is found only within the myocardial cell, so it can be used as a biochemical marker of the myocardial injury. We performed this study to evaluate the worth of cardiac troponin I as a biochemical marker reflecting the extent of perioperative myocardial injury and recovery. METHODS: Thirty-four patients who had undergone elective open heart surgery of congenital heart disease(CHD) from April to July 2001 were enrolled in this study. We measured types of CHD, serial cardiac troponin I(baseline 1 day before operation, postoperative day 1, 2, 3, 7), duration of cardiopulmonary bypass(CPB), aortic cross clamping(ACC), intubation and postoperative hospital stay. RESULTS: Compared with the baseline before operation, there was a significant, increase of cardiac troponin I on the postoperative day 1 and a significant gradual decrease on the day 2, 3, 7. The levels of cardiac troponin I were the highest in the transposition of great artery(TGA) repair on the postoperative day 1 and high in the tetralogy of Fallot(TOF), atioventricular septal defect (AVSD), ventricular septal defect(VSD) and atrial septal defect(ASD) repair with decreasing sequence. The longer duration of CPB, ACC and intubation, the higher of cardiac troponin I, but there were no significant correlations between cardiac troponin I levels and duration of hospital stay. CONCLUSION: Because there was significant increases or decreases of cardiac troponin I according to the perioperative time and types of the congenital heart disease, it is a worthy biochemical marker which reflects the extent of perioperative myocardial injury and recovery after open heart surgery.
Biomarkers ; Heart Defects, Congenital ; Heart* ; Humans ; Intubation ; Length of Stay ; Thoracic Surgery* ; Troponin I* ; Troponin*

BACKGROUND: More than 90% of acute stroke patients have measurable cardiovascular sequelae, but we have been often overlooked in formal discussions of treatment. If we estimate the incidence of myocardial injury in patient with spontaneous SAH, we may figure the possibility of cardiac dysfunction in such patients. This study was designed to investigate the incidence of myocardial injury in patients with spontaneous SAH using cardiac troponin I(cTnI). METHODS: A prospective single emergency center study was performed to determined preoperative incidence of unrecognized cardiac injury in patients suffering spontaneous SAH. We include the spontaneous SAH patients who underwent serum measurements of the cardic troponin I immediately upon admission last six month period. ECG, CK, CK-MB and myoglobin were also performed at admission. We excluded the spontaneous SAH patients who had past history of myocardial ischemia and ECG abnormality. RESULTS: Fifty-two patients(34 females, 18 males) with spontaneous SAH were studied prospectively. 18 patients(34.6% of the total study population) had cTnI level above 0.5ng/ml. ECG was performed in 52 patients and was abnormal in 15 of the 52 patients(28.8%). CONCLUSION: The measurement of cTnI has provided physicians with a myocardial marker that has a cardiac sensitivity for cardiac injury equal to that of CK-MB yet with greater specificity. So, cardiac troponin I is useful to estimate the incidence of myocardial injury in patients with spontaneous SAH. And we may estimate the possibility of cardiac dysfunction in such patients. This knowledge will hopefully aid in the care and improve the outcome.
Electrocardiography ; Emergencies ; Female ; Humans ; Incidence* ; Myocardial Ischemia ; Myoglobin ; Prospective Studies ; Sensitivity and Specificity ; Stroke ; Troponin I* ; Troponin*

In order to construct and express human cardiac troponin C-linker-troponin I(P) [ cTnC-linker-TnI(P)] fusion protein, detect its activity and prepare lyophilized protein, we searched the CDs of human cTnC and cTnI from GenBank, synthesized cTnC and cTnI(30-110aa) into cloning vector by a short DNA sequence coding for 15 neutral amino acid residues. pCold I-cTnC-linker-TnI(P) was constructed and transformed into E. coli BL21(DE3). Then, cTnC-linker-TnI(P) fusion protein was induced by isopropyl-β-D-thiogalactopyranoside (IPTG). Soluable expression of cTnC-linker-TnI(P) in prokaryotic system was successfully obtained. The fusion protein was purified by Ni²⁺ Sepharose 6 Fast Flow affinity chromatography with over 95% purity and prepared into lyophilized protein. The activity of purified cTnC-linker-TnI(P) and its lyophilized protein were detected by Wondfo Finecare™ cTnI Test. Lyophilized protein of cTnC-linker-TnI(P) was stable for 10 or more days at 37 °C and 4 or more months at 25 °C and 4 °C. The expression system established in this research is feasible and efficient. Lyophilized protein is stable enough to be provided as biological raw materials for further research.
Escherichia coli ; Freeze Drying ; Humans ; Recombinant Fusion Proteins ; biosynthesis ; Troponin C ; biosynthesis ; Troponin I ; biosynthesis

Acute myocardial infarction is one of the most common causes of unexpected deaths, but there are limitations to its diagnosis in postmortem inspection. In this study, we aimed to investigate the usefulness of cardiac marker analysis for the diagnosis of acute myocardial infarction in postmortem inspection. This study was conducted on 30 postmortem inspection cases conducted by the National Forensic Service from 2016 to 2018. Tests for three myocardial enzymes (myoglobin, creatinine kinase-MB, and cardiac troponin I) were performed in each case, and the relationships between enzyme levels, cause of death, and factors affecting the postmortem tests were analyzed. Cardiac enzyme concentrations were not significantly different between the heart disease group and other disease groups, and the false-positive rate was increased due to postmortem changes. Therefore, we can conclude that it is not appropriate to use cardiac enzyme analysis for the diagnosis of acute myocardial infarction in postmortem inspection.
Cause of Death ; Creatinine ; Diagnosis ; Heart Diseases ; Myocardial Infarction ; Postmortem Changes ; Troponin ; Troponin I

OBJECTIVE: To evaluate the accuracy of cardiac troponin (cTn) levels in the diagnosis of acute myocardial infarction (AMI) in patients with chronic kidney disease (CKD) and explore a potential strategy for improving the diagnostic accuracy. METHODS: We retrospectively analyzed the data from patients with high-risk chest pain admitted in Zhujiang Hospital from January, 2018 to December, 2020, including 126 patients with and 272 patients without CKD, and 122 patients diagnosed to have AMI and 276 patients without AMI. The baseline clinical data of the patients and blood test results within 12 h after admission were collected. RESULTS: In patients without AMI, cTnT level was significantly higher in those with co-morbid CKD than in those without CKD (<i>Pi> < 0.001), and showed a moderate negative correlation with eGFR (<i>ri>_s=- 0.501, <i>Pi> < 0.001), while cTnI level did not differ significantly between the two groups (<i>Pi>=0.72). In patients with CKD, the optimal cutoff level was 0.177 μg/L for cTnT and 0.415 ng/mL for cTnI for diagnosis of AMI, for which cTnI had a higher specificity than cTnT. The diagnostic model combining both cTnT and cTnI levels [<i>Pi>=e^Y/(1+ e^Y), Y=6.928 (cTnT)-0.5 (cTnI)-1.491] had a higher AUC value than cTn level alone. CONCLUSION In CKD patients, the cutoff level of cTn is increased for diagnosing AMI, and cTnI has a higher diagnostic specificity than cTnT. The combination of cTnT and cTnI levels may further improve diagnostic efficacy for AMI.
Humans ; Retrospective Studies ; Myocardial Infarction/diagnosis* ; Comorbidity ; Troponin T ; Troponin I ; Renal Insufficiency, Chronic/diagnosis* ; Biomarkers