Elevace vysoce senzitivního troponinu u stavů mimo akutní koronární syndrom – výzva pro lékaře urgentního příjmu

Stáhnout PDF English version

Autoři: I. Romanko ¹; M. Matias ¹; M. Romanko Ingrischová ^1,2
Působiště autorů: Department of Anesthesiology and Intensive Care First Faculty of Medicine Charles University in Prague and General University Hospital in Prague ¹; Cardiology clinic, Medacor s. r. o. ²
Vyšlo v časopise: Anest. intenziv. Med., 31, 2020, č. 1-2, s. 37-41
Kategorie: Přehledové články

Souhrn

Vysoce senzitivní troponin (troponin I a troponin T) je sérový marker specifický pro myokardiální lézi. Zvýšenou hladinu vysoce senzitivního troponinu lze nalézt u akutního koronárního syndromu, ale také u řady jiných onemocnění. Diferenciální diagnostika zvýšených hodnot vysoce senzitivního troponinu představuje velkou výzvu pro lékaře urgentního příjmu. Kromě akutního koronárního syndromu se musí myslet i na další možné příčiny, například jiná kardiovaskulární onemocnění, infekce, onemocnění ledvin a také věk pacienta. Tento přehledový článek přináší náhled na zvýšení vysoce senzitivního troponinu z jiných než ischemických příčin a soustředí se na prognostický význam tohoto markeru.

Klíčová slova:

troponin I – prognóza – infekce – stárnutí – myokard – poranění

Zdroje

1. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). European Heart Journal 2016; 37(3): 267–315.

2. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction. European Heart Journal 2019; 40(3): 237–269.

3. Wildi K, Twerenbold R, Mueller Ch. How acute changes in cardiac troponin concentrations help to handle the challenges posed by troponin elevations in non-ACS- patients. Clin Biochem 2015; 48(4–5): 218–222.

4. Reichlin T, Hochholzer W, Bassetti S, Steuer S, Stelzig C, Hartwiger S, et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med 2009; 361(9): 858–867.

5. Keller T, Zeller T, Peetz D, Tzikas S, Roth A, Czyz E, et al. Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 2009; 361(9): 868–877.

6. Weber M, Bazzino O, Navarro Estrada JL, de Miguel R, Salzberg S, Fuselli JJ, et al. Improved diagnostic and prognostic performance of a new high-sensitive troponin T assay in patients with acute coronary syndrome. Am Heart J 2011; 162(1): 81–88.

7. Agewall S, Giannitsis E, Jernberg T, Katus H. Troponin elevation in coronary vs. noncoronary disease. Eur Heart J 2011; 32(4): 404–411.

8. Wu AH, Jaffe AS. The clinical need for high-sensitivity cardiac troponin assays for acute coronary syndromes and the role for serial testing. Am Heart J 2008; 155(2): 208–214.

9. Wu A, Lu QA, Todd J, Moecks J, Wians F. Short- and long-term biological variation in cardiac troponin I measured with a high-sensitivity assay: implications for clinical practice. Clin Chem 2009; 55(1): 52–58.

10. Saunders JT, Nambi V, de Lemos JA, Chambless LE, Virani SS, Boerwinkle E, et al. Cardiac troponin T measured by a highly sensitive assay predicts coronary heart disease, heart failure, and mortality in the Atherosclerosis Risk in Communities Study. Circulation 2011; 123(13): 1367–1376.

11. De Lemos J, Drazner MH, Omland T, Ayers CR, Khera A, Rohatgi A, et al. Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population. JAMA 2010; 304(22): 2503–2512.

12. Kawahara C, Tsutamoto T, Nishiyama K, Yamaji M, Sakai H, Fujii M, et al. Prognostic role of high-sensitivity cardiac troponin T in patients with nonischemic dilated cardiomyopathy. Circ J 2011; 75(3): 656–661.

13. Brichko L, Schneider HG, Chan W, Seah J, Smit V, Dart A, et al. Rapid and safe discharge from the emergency department: A single troponin to exclude acute myocardial infarction. Emerg Med Australas 2018; 30(4): 486–493.

14. Reiter M, Twerenbold R, Reichlin T, Haaf P, Peter F, Meissner J, et al. Early diagnosis of acute myocardial infarction in the elderly using more sensitive cardiac troponin assays. Eur Heart J 2011; 32(11): 1379–1389.

15. Reiter M, Twerenbold R, Reichlin T, Benz B, Haaf P, Meissner J, et al. Early diagnosis of acute myocardial infarction in patients with pre-existing coronary artery disease using more sensitive cardiac troponin assays. Eur Heart J 2011; 33(8): 988–997.

16. Hickman PE, Lindahl B, Cullen L, Koerbin G, Tate J, Potter JM. Decision limits and the reporting of cardiac troponin: Meeting the needs of both the cardiologist and the ED physician. Crit Rev Clin Lab Sci 2015; 52(1): 28–44.

17. Kozinski M, Krintus M, Kubica J, Sypniewska G. High-sensitivity cardiac troponin assays: From improved analytical performance to enhanced risk stratification. Crit Rev Clin Lab Sci 2017; 54(3): 143–172.

18. Bhoi S, Verma P, Vankar S, Galwankar S. High sensitivity troponins and conventional troponins at the bedside. Int J Crit Illn Inj Sci 2014; 4(3): 253–256.

19. Wu AH, Agee SJ, Lu QA, Todd J, Jaffe AS. Specificity of a high-sensitivity cardiac troponin I assay using single-molecule-counting technology. Clin Chem 2009; 55(1): 196–198

20. Sa-Ngasoongsong P, Thamyongkit S, Kulachote N, Luksameearunothai K, Ngamukos T, Suphachatwong C. Usefulness of Serum Cardiac Biomarkers for Predicting In-Hospital Cardiac Complications in Acute Hip Fracture: A Prospective Cohort in 20 High Surgical Risk patients with Age over 55 Years. Biomed Res Int 2018; 5: 3453652

21. Metkus TS, Guallar E, Sokoll L, Morrow DA, Tomaselli G, Brower R, et al. Progressive myocardial injury is associated with mortality in the acute respiratory distress syndrome. J Crit Care 2018; 48: 26–31.

22. Gohar A, Chong JPC, Liew OW, den Ruijter H, de Kleijn DPV, Sim D, et al. The prognostic value of highly sensitive cardiac troponin assays for adverse events in men and women with stable heart failure and a preserved vs. reduced ejection fraction. Eur J Heart Fail 2017; 19(12): 1638–1647.

23. Wallenborn J, Marx A, Störk S, Güder G, Brenner S, Ertl G, et al. Prognostic significance of serial high-sensitivity troponin I measurements following acute cardiac decompensation-correlation with longer-term clinical outcomes and reverse remodelling. Int J Cardiol 2017; 232: 199–207.

24. Korley FK, Schulman SP, Sokoll LJ, DeFilippis AP, Stolbach AI, Bayram JD, et al. Troponin Elevations Only Detected With a High sensitivity Assay: Clinical Correlations and Prognostic Significance. Acad Emerg Med 2014; 21(7): 727–735.

25. Lewis JR, Lim WH, Wong G, Abbs S, Zhu K, Lim EM, et al. Association Between High-Sensitivity Cardiac Troponin I and Cardiac Events in Elderly Women. J Am Heart Assoc 2017; 6(8).

26. Cavender MA, White WB, Jarolim P, Bakris GL, Cushman WC, Kupfer S, et al. Serial Measurement of High-Sensitivity Troponin I and Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus in the EXAMINE Trial (Examination of Cardiovascular Outcomes With Alogliptin Versus Standard of Care). Circulation 2017; 135(20): 1911–1921.

27. Motiwala SR, Gaggin HK, Gandhi PU, Belcher A, Weiner RB, Baggish AL, et al. Concentrations of highly sensitive cardiac troponin-I predict poor cardiovascular outcomes and adverse remodeling in chronic heart failure. J Cardiovasc Transl Res 2015; 8(3): 164–172.

28. Bonaca MP, O’Malley RG, Murphy SA, Jarolim P, Conrad MJ, Braunwald E, et al. Prognostic performance of a high-sensitivity assay for cardiac troponin I after non-ST elevation acute coronary syndrome: Analysis from MERLIN-TIMI 36. Eur Heart J Acute Cardiovasc Care 2015; 4(5): 431–440.

29. Liu T, Wang G, Li P, Dai X. Risk classification of highly sensitive troponin I predict presence of vulnerable plaque assessed by dual source coronary computed tomography angiography. Int J Cardiovasc Imaging 2017; 33(11): 1831–1839.

30. Samman Tahhan A, Sandesara P, Hayek SS, Hammadah M, Alkhoder A, Kelli HM, et al. High-Sensitivity Troponin I Levels and Coronary Artery Disease Severity, Progression, and Long-Term Outcomes. J Am Heart Assoc 2018; 7(5).

31. El-Menyar A, Sathian B, Al-Thani H.Elevated serum cardiac troponin and mortality in acute pulmonary embolism: Systematic review and meta-analysis. Respir Med. 2019 Aug 23; 157: 26–35.

32. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014 Nov 14; 35(43): 3033–3069, 3069a–3069k.

33. Gilje P, Koul S, Thomsen JH, Devaux Y, Friberg H, Kuiper M, et al. High-sensitivity troponin-T as a prognostic marker after out-of-hospital cardiac arrest - A targeted temperature management (TTM) trial substudy. Resuscitation. 2016 Oct; 107: 156–161.

34. Pretorius CJ, Tate JR, Wilgen U, Cullen L, Ungerer JPJ. A critical evaluation of the Beckman Coulter Access hsTnI: Analytical performance, reference interval and concordance. Clin Biochem 2018; 55: 49–55.

35. Collinson PO, Heung YM, Gaze D, Boa F, Senior R, Christenson R, et al. Influence of population selection on the 99th percentile reference value for cardiac troponin assays. Clin Chem 2012; 58: 219–225.

36. Niccoli T, Partridge L. Ageing as a risk factor for disease. Current Biology 2012; 22(17): 741–752.

37. Oliver DMA, Reddy PH. Molecular Basis of Alzheimer’s Disease: Focus on Mitochondria. J Alzheimers Dis. 2019; 22.

38. Cianflone E, Torella M, Chimenti C, De Angelis A, Beltrami AP, Urbanek K, et al. Adult Cardiac Stem Cell Aging: A Reversible Stochastic Phenomenon? Oxid Med Cell Longev 2019; 7: 5813147.

39. Nagel F, Santer D, Stojkovic S, Kaun C, Schaefer AK, Kršák M, et al. The impact of age on cardiac function and extracellular matrix component expression in adverse post-infarction remodeling in mice. Exp Gerontol 2019; 119: 193–202.

40. Boyle AJ, Shih H, Hwang J, Ye J, Lee B, Zhang Y, et al. Cardiomyopathy of aging in the mammalian heart is characterized by myocardial hypertrophy, fibrosis and a predisposition towards cardiomyocyte apoptosis and autophagy. Experimental Gerontology. 2011; 46(7): 549–559.

41. Dai D-F, Chen T, Johnson SC, Szeto H, Rabinovitch PS. Cardiac aging: from molecular mechanisms to significance in human health and disease. Antioxidants & Redox Signaling 2012; 16(12): 1492–1526.

42. Anttila E, Balzani D, Desyatova A, Deegan P, MacTaggart J, Kamenskiy A. Mechanical damage characterization in human femoropopliteal arteries of different ages. Acta Biomater 2019; 90: 225–240.

43. Dhesi S, Shanks M, Tymchak WJ. Troponin rise in hospitalized patients with nonacute coronary syndrome: retrospective assessment of outcomes and predictors. Can J Cardiol 2015; 31(3): 296–301.

44. Mueller M, Biener M, Vafaie M, Doerr S, Keller T, Blankenberg S. Absolute and relative kinetic changes of high-sensitivity cardiac troponin T in acute coronary syndrome and in patients with increased troponin in the absence of acute coronary syndrome. Clin Chem 2012; 58(1): 209–218.

45. Bjurman Ch, Petzold M, Venge P, Farbemo J, Fu M, Hammarsten O. High-sensitive cardiac troponin, NT-proBNP, hFABP and copeptin levels in relation to glomerular filtration rates and a medical record of cardiovascular disease. Clin Biochem 2015; 48(4–5): 302–307.

46. Piepoli MF, Hoes AW, Agewall S, Albus Ch, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts). European Heart Journal 2016; 37(29): 2315–2381.

47. Members KB. Chapter 4: other complications of CKD: CVD, medication dosage, patient safety, infections, hospitalizations, and caveats for investigating complications of CKD. Kidney Inter 2013; Suppl. 3.

48. Brack MC, Lienau J, Kuebler WM, Witzenrath M. Cardiovascular sequelae of pneumonia. Curr Opin Pulm Med 2019; 25(3): 257–262.

49. Musher DM, Abers MS, Corrales-Medina VF. Acute Infection and Myocardial Infarction. N Engl J Med 2019; 380(2): 171–176.

50. Harris JE, Shah PJ, Korimilli V, Win H. Frequency of troponin elevations in patients with influenza infection during the 2017-2018 influenza season. Int J Cardiol Heart Vasc 2019; 22: 145–147.

51. Jendoubi A, Jerbi S, Maamar E, Abbess A, Samoud Z, Kanzari L, et al. Prognostic Value of High-sensitivity Troponin I in Patients with Septic Shock: A Prospective Observational Study. Indian J Crit Care Med. 2019 Jul; 23(7): 320–325.

52. Su WL, Shui HA, Lan CC, Yang MC, Hsieh CA, Jang SJ, et al. Cardiovascular Parameters Associated With Troponin I as Indicators for 14-Day Mortality in Patients With Septic Shock. Am J Med Sci. 2018 Sep; 356(3): 244–253 .

53. Sedaghat-Hamedani F, Kayvanpour E, Frankenstein L, Mereles D, Amr A, Buss S, et al. Biomarker changes after strenuous exercise can mimic pulmonary embolism and cardiac injury--a metaanalysis of 45 studies. Clin Chem. 2015 Oct; 61(10): 1246–1255.

54. Shafuddin E, Chang CL, Cooray M, Tuffery CM, Hopping SJ, et al. Changes in biomarkers of cardiac dysfunction during exacerbations of chronic obstructive pulmonary disease. Respir Med. 2018 Dec; 145: 192–199.

55. Adamson PD, Anderson JA, Brook PR, Calverley PMA, Celli BR, Cowans NJ, et al. Cardiac Troponin I and Cardiovascular Risk in Patients With Chronic Obstructive Pulmonary Disease. J Am Coll Cardiol. 2018 Sep 4; 72(10): 1126–1137