Urine high-sensitive troponin I in children cannot offer an applicable alternative to serum.

Introduction: In children, congenital heart defects represent the primary cause of increased serum troponin I. The elimination process of cardiac troponin I from the bloodstream and the factors influencing this process remain unknown. The objective of this study was to explore the role of troponin I as an indicator of cardiac damage in children both in serum and urine, a concept previously investigated in adults. Methods: Our prospective study involved 70 children under 24 months of age. The first group underwent ventricular septal defect repair, while the second group involved children who had undergone partial cavopulmonary anastomosis. For these groups, urine and serum troponin I were assessed on four occasions. The third group, consisting of healthy children, underwent a single measurement of urine troponin I. Results: Serum troponin I values exhibited an expected elevation in the early postoperative period, followed by a return to lower levels. Significantly higher concentrations of serum troponin I were observed in the first group of children (p < 0.05). A positive correlation was found between troponin I in the first three measurements and cardiopulmonary bypass and aortic cross-clamping time. There was no discernible increase in urine troponin I directly related to myocardial damage; troponin I couldn't be detected in most urine samples. Discussion: The inability to detect troponin I in urine remains unexplained. Potential explanatory factors may include the isoelectric point of troponin I, elevated urinary concentrations of salts and urea, variations in urine acidity (different pH levels), and a relatively low protein concentration in urine.

Myocardial Work Indices in Patients Recently Recovered from Mild-to-Moderate COVID-19.

Background/Objectives: Persistent cardiovascular issues are common in COVID-19 survivors, making the detection of subtle myocardial injuries critical. This study evaluates myocardial work (MW) indices in patients recently recovering from mild-to-moderate COVID-19. Methods: A total of 105 recently recovered COVID-19 patients (who had a mean age of 52 years) underwent comprehensive laboratory testing and advanced echocardiographic assessments. The median time since their COVID-19 infections was 56 days (IQR: 42-71). The cohort was stratified based on high-sensitive troponin I (hs-TnI) levels: undetectable versus detectable. The echocardiographic analysis utilized pressure-strain loops to evaluate MW indices. Results: Detectable hs-TnI levels were observed in 42% of patients. The median values of MW indices for the entire group were slightly below normal values: global work index (GWI)-1834 mmHg% (IQR 1168-2054 mmHg%), global constructive work (GCW)-2130 mmHg% (IQR 2010-2398 mmHg%), global wasted work (GWW)-119 mmHg% (IQR 78-175 mmHg%), and global work efficiency (GWE)-94% (IQR 92-96%). Patients with detectable hs-TnI had higher GWW (168 vs. 97 mmHg%, p < 0.005) and lower GWE (93% vs. 95%, p < 0.005). In multiple regression analysis, strain dispersion (PSD) was the sole predictor for GWW (ß = 0.67, p < 0.001), while for GWE, PSD (ß = -0.67, p < 0.001) and LVEF (ß = 0.16, p = 0.05) were significant predictors. Conclusions: Among patients recently recovering from mild-to-moderate COVID-19, elevated hs-TnI levels are linked with a reduction in GWE and an increase in GWW. PSD is an important predictor of myocardial inefficiency and wasted work. In this group, disruptions in the timing and coordination of cardiac muscle contractions may play a key pathophysiological role in reducing the efficiency of the heart's performance.

The Role of N-Terminal-Pro-B-Type Natriuretic Peptide (NT-proBNP) and High-Sensitivity Troponin T (Hs-Troponin T) in the Evaluation of the Syntax Score in Patients With Acute Coronary Syndrome.

Background N-terminal-pro-B-type natriuretic peptide (NT-proBNP) is used to diagnose acute and chronic heart failure, but many studies show a strong and independent correlation between NT-proBNP serum levels and the severity and number of coronary artery damage. Meanwhile, the serum of high-sensitivity Troponin T (hs-Troponin T) has a very high prognostic value for the degree of coronary artery damage in patients with acute coronary syndrome. The SYNTAX score was developed to better predict the risks of percutaneous or surgical revascularization by considering the functional impact of the coronary circulation with all of its anatomic components, such as the presence of bifurcations, total occlusions, thrombus, calcification, and small vessels. Therefore, we conducted this study to understand the role of NT-proBNP and hs-troponin T in SYNTAX score evaluation in patients with acute coronary syndrome. Methodology A cross-sectional descriptive study of 86 patients diagnosed with acute coronary syndrome with indications for coronary angiography and intervention in the Department of Emergency and Interventional Cardiology, Cardiovascular Center, Hue Central Hospital, was conducted from June 2020 to May 2022. Results The mean age was 66.94 ± 10.61 years. The concentrations of NT-proBNP and hs-Troponin T in our study were 1115.9 ± 1623.3 pg/mL and 0.86 ± 1.55 ng/mL, respectively. The mean SYNTAX score in the study was 16.5 ± 7.5. There was a positive moderate correlation between the mean levels of NT-proBNP and the degree of coronary artery damage, as indicated by the SYNTAX score (P < 0.01, rho = +0.453). Conversely, there was a weak positive correlation between hs-Troponin T concentrations and the severity of coronary artery disease, based on the SYNTAX score (P < 0.01, rho = +0.387). The area under the curve (AUC) of the hs-Troponin T concentration value was 0.701, using a cutoff point of 0.109 ng/mL for hs-Troponin T concentration. This predicted the intermediate and high SYNTAX scores, with a sensitivity of 76% and a specificity of 59%. In comparison, the AUC of the NT-proBNP concentration value was 0.75, utilizing a cutoff point of 1120.5 pg/mL for NT-proBNP concentration. This predicted the intermediate and high SYNTAX scores, with a sensitivity of 60% and a specificity of 80.3%. Conclusions The levels of NT-proBNP had a positive moderate correlation with the degree of coronary artery damage according to the SYNTAX score in patients with acute coronary syndrome. Hs-Troponin T levels of 0.109 ng/mL had higher sensitivity (76%) but lower specificity (59%) in predicting intermediate and high SYNTAX scores in patients with acute coronary syndromes than those of NT-proBNP levels of 1120.5 pg/mL, with a sensitivity of 60% and a specificity of 80.3%.

Prognostic relationship between high sensitivity troponin I level, hematoma volume and glasgow coma score in patients diagnosed with spontaneous intracerebral hemorrhage.

BACKGROUND: Intracranial hemorrhages is one of the major causes of mortality and morbidity worldwide, and there is still no effective biomarker to predict prognosis. AIM: We aimed to determine the effectiveness of high sensitive troponin I (hs-cTn-I) levels to predict the prognosis of spontaneous intracerebral hemorrhage (sICH) by comparing Glasgow Coma Score (GCS) and hematoma volume with hs-cTn-I levels. METHODS: This study was planned as a retrospective observational study. Patients with available data, over 18 years old and sICH were included in the study. Cerebral computed tomography images were evaluated by a senior radiologist. Hematoma volume was calculated using the ABC/2 formula. RESULTS: The study comprised 206 individuals in total 78 (37.86%) women and 128 (62.13%) men. Forty-four (21.35%) of patients died. The sensitivity of GCS, hs-cTn-I, and hematoma volume values were 86.36%, 66.67%, and 59.46%, respectively, with corresponding specificities of 78.75%, 93.02%, and 87.58%. Patients with hs-cTn-I values over 26, GCS values of ≤ 9, and hematoma volume values above 44.16 were found to have higher risk of mortality (p = 0.011; p < 0.001; p < 0.001, respectively). The mortality rates were found to be increased 2.586 (IQR: 1.224-5.463) times in patients with hs-cTn-I values above 26, 0.045 times (IQR: 0.018-0.115) in patients with GCS values ≤ 9, and 7.526 times (IQR: 3.518-16.100) in patients with hematoma volume values above 44.16. CONCLUSIONS: Our findings suggest that hs-cTn-I values exceeding 26 units may serve as effective biochemical markers for predicting the prognosis of patients with sICH.

Evaluación de un nuevo algoritmo diagnóstico para el síndrome coronario agudo con determinación de troponina T de alta sensibilidad / Evaluation of a New Diagnostic Algorithm for Acute Coronary Syndrome Using High-Sensitivity Troponin T Assay

Introducción El dolor precordial representa el 5% al 10% de las consultas anuales en los departamentos de emergencias; su diagnóstico suele ser dificultoso y a ello se le suma el problema que implican la externación de pacientes con patología coronaria aguda o las internaciones innecesarias. Esto ha llevado al desarrollo de diferentes sistemáticas para la evaluación de estos pacientes. Objetivo Validar en términos de seguridad y tiempos de estadía hospitalaria un nuevo algoritmo incorporado en nuestro centro que incluye la medición de troponina T de alta sensibilidad en pacientes con sospecha de síndrome coronario agudo. Material y métodos Se incluyeron 528 pacientes que consultaron en el servicio de emergencias con sospecha de síndrome coronario agudo y se les realizó el protocolo de unidad de dolor. Se analizaron variables clínicas, de laboratorio y el resultado de las pruebas funcionales efectuadas. En todos los pacientes se efectuó seguimiento a los 30 días. Resultados El 90,7% de los pacientes fueron externados luego de la observación y al seguimiento el 1,25% había presentado un evento cardíaco, representado por angioplastia coronaria e internación por síndrome coronario agudo; la especificidad del algoritmo global para el diagnóstico de síndrome coronario agudo fue del 97% y el valor predictivo negativo fue del 99%. El tiempo de estadía en el servicio de emergencias del total de los pacientes fue de 4,5 ± 2,5 horas. Conclusión El nuevo algoritmo incorporado en nuestro centro con determinación de troponina T de alta sensibilidad en pacientes con sospecha de síndrome coronario agudo demostró que es seguro al evitar la externación de pacientes que cursaban un síndrome coronario agudo y, a la vez, requiere una corta estadía hospitalaria en el servicio de emergencias.

Introduction Chest pain represents 5 to 10% of annual visits to emergency departments. Its diagnosis is sometimes difficult, with the added problem of inappropriate discharge of patients with acute coronary syndrome or unnecessary hospitalizations. This has led to the development of different algorithms for the evaluation of these patients. Objective The aim of this study was to validate, in terms of safety and length of hospital stay, a novel algorithm incorporated in our center, which includes measurement of high-sensitivity troponin T in patients with suspected acute coronary syndrome. Methods The study included 528 consecutive patients attending the emergency department with suspected acute coronary syndrome and evaluated according to the chest pain unit protocol. Clinical and laboratory variables and functional tests were analyzed. Follow-up at 30 days was performed in all the patients. Results After observation, 90.7% of the patients were discharged and 1.25% presented a cardiovascular event during follow-up, represented by percutaneous coronary intervention and hospitalization due to acute coronary syndrome. The specificity of the global algorithm for the diagnosis of acute coronary syndrome was 97% with a negative predictive value of 99%. Emergency department length of stay was 4.5 ± 2.5 hours for all the patients. Conclusion The novel algorithm incorporated in our center with measurement of high-sensitivity troponin T in patients with suspected acute coronary syndrome has proved to be safe, as it prevents the discharge of patients with acute coronary syndrome and at the same time reduces emergency department length of stay.

Valor en la práctica diaria de la troponina T ultrasensible para el diagnóstico de infarto de miocardio / The value in daily practice of high sensitive troponin T for myocardial infarction diagnosi / Valor na prática diária da troponina T ultra-sensível para o diagnóstico de infarto do miocárdio

Introducción. La troponina T ultrasensible (TnTus) es un biomarcador útil para la valoración del dolor precordial. Sin embargo, es frecuente su incremento en pacientes sin diagnóstico de síndrome coronario agudo. El objetivo de este trabajo fue evaluar la utilidad de diferentes estrategias de uso de TnTus para el diagnóstico de infarto agudo de miocardio (IAM). Material y método. Estudio retrospectivo que incluyó 99 pacientes consecutivos con sospecha de IAM ingresados a la unidad coronaria, con al menos una determinación de TnTus dentro de las 4-6 horas del inicio del dolor o admisión. El diagnóstico final de IAM fue realizado por dos médicos expertos que analizaron los datos clínicos, laboratorio e imágenes. Resultados. La edad media fue de 64 años y el 75% fueron varones. De acuerdo al diagnóstico final se clasificaron como IAM: el 58%. La TnTus basal mostró un área bajo la curva COR de 0,86 y el punto de corte de 30 ng/L tuvo sensibilidad del 86% y especificidad del 71% para diagnóstico de IAM, mientras que para el valor >14 ng/L, la sensibilidad y especificidad fueron del 93 y 34%, respectivamente. Las áreas bajo la curva para la variación absoluta y porcentual de TnTus (basal y segunda determinación) fueron 0,69 y 0,68, identificándose puntos de corte de 10 ng/L y 15%, respectivamente (sensibilidad 60 y 63%, especificidad del 74 y 74%). Conclusiones. La medición temprana de TnTus>14ng/L muestra la mejor sensibilidad para el diagnóstico de IAM, mientras que un valor >30ng/L fue más específico. La medición repetida del biomarcador mostró menor utilidad.

Background. High-sensitive troponin T (hs-TnT) is a useful biomarker in the assessment of chest pain. However, it could be frequently elevated in patients without acute coronary syndrome. We sought to evaluate the usefulness of different strategies using hs-TnT for diagnosis of acute myocardial infarction (AMI). Material and method. Retrospective study including 99 consecutive patients with suspected AMI admitted to the coronary care unit with at least one determination of hs-TnT within 4-6 hours of onset of pain or admission. The final diagnosis of AMI was made by two medical experts who analyzed the clinical, laboratory and imaging. Results. The mean age was 64 years and 75% were male. According to the final diagnosis were classified as AMI 58%. The basal hs-TnT showed an area under the ROC curve of 0.86 and the cut-off of 30 ng/L had a sensitivity of 86% and specificity of 71% for diagnosis of AMI, whereas the value >14 ng/L had a sensitivity and specificity of 93 and 34%, respectively. The areas under the curve for the absolute and percentage changes of hs-TnT (basal and second determination) were 0.69 and 0.68, identifying cut-offs of 10 ng/L and 15%, respectively (sensitivity 60 and 63%, specificity of 74 and 74%). Conclusions. Early measurement hs-TnT>14ng/L shows the best sensitivity for the diagnosis of AMI, while a value >30ng/L was more specific. Repeated measurements of biomarker showed less useful.

Introdução. A troponina ultra-sensível (TnTus) é um biomarcador útil na avaliação de dor de peito. Além disso, seu crescimento é comum em pacientes sem diagnóstico da síndrome coronariana aguda. O objeto desta investigação foi avaliação da utilidade de diferentes estratégias de TnTus empregadas para o diagnóstico do infarto agudo do miocárdio (IAM). Material e método. Foi realizado um estudo retrospectivo incluindo 99 pacientes consecutivos com suspeita de IAM admitidos na unidade coronariana com pelo menos uma determinação TnTus dentro de 4-6 horas após o início da dor ou da admissão. O diagnóstico final de IAM foi conferido por dois médicos especialistas que analisaram o quadro clínico, laboratorial e de imagem. Resultados. A idade média foi de 64 anos, e 75% foram de sexo masculino. Cinqüenta e oito porcento dos IAM diagnosticado a traveis da TnTus foram conferidos pelos especialistas. A TnTus basal mostrou área embaixo da curva ROC de 0,86 e o corte de 30 ng/L com uma sensibilidade de 86% e especificidade de 71% para o diagnóstico de IAM, mas também o valor >14ng/L teve uma sensibilidade e especificidade de 93 e 34% respectivamente. As áreas sob a curva para o percentual absoluto e de mudança de TnTus (basal e segunda determinação) foram 0,69 e 0,68 com uma sensibilidade de 60 e 63% e especificidade de 74 e 74% respectivamente. Não só, os pontos de inflexão foram de 10 ng/L e 15%, respectivamente (sensibilidade de 60 e 63%, especificidade 74 e 74%). Conclusões. A medição precoce de TnTus >14ng/L mostrou a melhor sensibilidade para o diagnóstico de IAM, mais também um valor >30 ng/L teve mais especificidade em nossa série. As determinações repetidas não melhoraram a utilidade do biomarcador.