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Búsqueda Bibliografica: hs TROPONINAS – Parte I

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1.JAMA Cardiol. 2025 Dec 17. doi: 10.1001/jamacardio.2025.4661. Online ahead of print.
Clinical Decisions and Outcomes After Switching High-Sensitivity CardiacTroponin Assays in Suspected ACS: An Interrupted Time-Series Study.
Boeddinghaus J(1)(2), Li Z(1), Bularga A(1), Taggart C(1), Wereski R(1), Chapman AR(1), Lee KK(1), Tuck C(1), Gunn R(3), Jenks S(3), McCance K(3), Pattenden R(4), Malo J(3), Thurston AJF(1), Tew YY(1), McDermott M(1), Gray A(5)(6),Cruden NLM(7), Anand A(1), Kimenai DM(1), Mills NL(1)(6); TWITCH-ED Investigators.

 Author information:
(1)BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh United Kingdom.
(2)Cardiovascular Research Institute Basel (CRIB),Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
(3)Department Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh,United Kingdom.
(4)Department Clinical Biochemistry, Western General Hospital, Edinburgh, UnitedKingdom.
(5)Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh,United Kingdom.
(6)Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
(7)Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UnitedKingdom.

IMPORTANCE: High-sensitivity cardiac troponin T and I assays are considere equivalent for the diagnosis of myocardial infarction. However, the impact of transitioning from an assay measuring cardiac troponin I to one measuring cardiac troponin T on patient care and clinical outcomes is unknown.

OBJECTIVE: To evaluate the impact of transitioning from a high-sensitivity assay measuring cardiac troponin I to one measuring cardiac troponin T on the care and outcomes of consecutive patients with suspected acute coronary syndrome.

DESIGN, SETTING, AND PARTICIPANTS: This was a prospective, multicenter, interrupted time-series study conducted at 3 acute care centers. Consecutive patients presenting with suspected acute coronary syndrome to an acute care hospital were identified between October 2020 and October 2022.

INTERVENTIONS: All sites changed from an assay measuring cardiac troponin I to one measuring cardiac troponin T in October 2021.

MAIN OUTCOMES AND MEASURES: The primary outcome was hospital admission.

RESULTS: Among 25849 patients, 13146 (median [IQR] age, 60 [47-73] years; 6961 male [53%]) and 12703 (median [IQR] age, 60 [47-73] years; 6825 male [54%]) presented before and after the transition to cardiac troponin T, respectively.
The proportion of patients with myocardial injury increased from 21% (2800 of 13146 patients) to 38% (4781 of 12703 patients), and patients were more likely to be admitted to the hospital after the transition (odds ratio [OR], 2.24; 95% CI, 1.81-2.77; both P<.001). A 6-fold increase in serial testing was observed in patients undergoing a measure of cardiac troponin T compared with cardiac troponin I (OR, 6.03; 95% CI, 4.85-7.49; P<.001). Subsequent myocardial infarction, heart failure, or cardiovascular death at 1 year was comparable before and after the transition (OR, 0.83; 95% CI, 0.48-1.41;P.49).

CONCLUSIONS AND RELEVANCE: The transition from a high-sensitivity assay measuring cardiac troponin I to one measuring cardiac troponin T was associated with increased identification of myocardial injury, serial troponin measurements, and hospital admissions without evidence of improved cardiovascular outcomes at 1 year.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05748691.
DOI: 10.1001/jamacardio.2025.4661
PMID: 41405901

2. Vasc Health Risk Manag. 2025 Dec 10;21:1031-1046. doi: 10.2147/VHRM.S559031. eCollection 2025. H-FABP and Hs-cTnI Serum Concentrations Associate with the Development of Cardiovascular Events in Newly Diagnosed T2D, Pre-DM, and Normoglycemic Individuals.
Simon R(1), Hammoud T(2), Alsayed R(1).

Information Author:
1)Department of Biochemistry and Microbiology, Faculty of Pharmacy, Damascus University, Damascus, Syria.
2)Department of Physiology and Pharmacology, Faculty of Medicine, Damascus University, Damascus, Syria.

 BACKGROUND: CVD remains the leading global cause of mortality, especially in individuals with T2D and Pre-DM, where insulin resistance increase cardiometabolic risk and early myocardial injury often goes unrecognized. This study aimed to evaluate baseline serum concentrations of H-FABP and Hs-cTnI, biomarkers linked to myocardial injury, in newly diagnosed T2D, Pre-DM, and normoglycemic individuals, to assess their predictive value for CVEs and the association between H-FABP and HOMA-IR.
METHODS: In a prospective cohort study of 72 medication-free participants (25 T2D, 22 Pre-DM, 25 normoglycemic) without clinical myocardial symptoms, baseline anthropometric and biochemical measurements were obtained, including H-FABP, Hs-cTnI, HbA1c, fasting glucose, fasting insulin, and HOMA-IR was calculated.
Participants were followed one year to evaluate the occurrence of CVE.

RESULTS: Strong correlations between baseline H-FABP and Hs-cTnI across all glycemic groups (all p<0.01) with no significant intergroup differences. In abnormal weight T2D participants, baseline fasting insulin correlated moderately with baseline H-FABP (ρ=0.50, p=0.029) and strongly with baseline HOMA-IR (ρ=0.74, p<0.001). CVEs occurred in 33.3% of participants and were associated with elevated baseline H-FABP and Hs-cTnI (p<0.001 and p=0.001), alongside  strong biomarker inter-correlation (ρ=0.64 overall; ρ=0.84 in CVEs). Both biomarkers independently predicted CVEs; H-FABP had higher sensitivity and NPV, while Hs-cTnI showed greater specificity and PPV. Glycemic status was not statistically associated with CVE occurrence, although higher HOMA-IR and nsulin were observed in the CVE group (p=0.073 and p=0.054).

CONCLUSION: These findings support H-FABP as a cardiac biomarker for myocardial injury across normoglycemic, Pre-DM, and T2D groups. The link between H-FABP and insulin resistance in individuals with greater burden of metabolic disturbance highlights its role as a cardiometabolic indicator. Both biomarkers predicted  CVEs in asymptomatic individuals, with H-FABP potentially useful for early risk exclusion and Hs-cTnI for confirming high-risk status.
Simon et al.

DOI: 10.2147/VHRM.S559031
PMCID: PMC12703097
PMID: 41404162 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing interests. This declaration includes all financial and non-financial competing interests.

4. Medicine (Baltimore). 2025 Dec 12;104(50):e46726. doi:10.1097/MD.0000000000046726.
Systemic inflammatory response index in the differentiation of unstable angina pectoris and non-ST elevation myocardial infarction.
Akyel S(1), Yildiz A.

Author information:
(1)Department of Cardiology, Kastamonu University School of Medicine, Kastamonu, Turkey.

The systemic inflammatory response index (SIRI), calculated from routine complete blood count parameters, has emerged as a potential marker of inflammation and a predictor of prognosis in various cardiovascular conditions.        
This study aimed to evaluate the utility of SIRI in differentiating non-ST-elevation myocardial infarction (NSTEMI) from unstable angina pectoris (USAP) in patients presenting with acute chest pain. In this retrospective observational study, patients admitted to the emergency department with chest pain and subsequently diagnosed with USAP or NSTEMI were included. Only patients with negative high-sensitive troponin-I levels at the time of admission were enrolled in both groups. During follow-up, those who showed an increase in troponin levels were classified as NSTEMI, whereas patients without troponin elevation were classified as USAP. The SIRI was calculated using blood samples obtained at the time of admission to the emergency department by multiplying the neutrophil and monocyte counts and dividing by the lymphocyte count. Troponin positivity was used to distinguish NSTEMI from USAP. SIRI was assessed at admission in patients with chest pain and normal troponin. Higher SIRI levels in NSTEMI suggest its potential for early differentiation from USAP. Multivariate logistic regression analysis was performed to determine independent predictors of troponin positivity, and receiver operating characteristic curve analysis was used to assess diagnostic performance. A total of 151 patients were included in the analysis. Admission SIRI values were significantly higher in the troponin-positive (NSTEMI) group compared with the troponin-negative (USAP) group (P<.001). In multivariate analysis, higher admission SIRI levels independently predicted troponin positivity (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.17-1.84; P < .001). Receiver operating characteristic analysis revealed an area under the curve of 0.71 (95% CI 0.63-0.79, P<001). A cutoff value of 1.58 for SIRI demonstrated 72% sensitivity and 69% specificity in predicting troponin positivity. SIRI, a readily available, inexpensive, and rapidly obtainable index derived from standard complete blood count parameters, may serve as a valuable adjunctive tool for the early differentiation of NSTEMI from USAP in patients with acute chest pain. Its ease of calculation within minutes of admission makes it suitable in diverse healthcare settings.

DOI: 10.1097/MD.0000000000046726
PMID: 41398895 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no funding and conflicts of interest to disclose.

6. J Assoc Physicians India. 2025 Dec;73(12):23-26. doi: 10.59556/japi.73.1274.
Comparative Assessment of Cardiac Biomarkers and APACHE II Score for Prognostication in Septicemic Patients at a Tertiary Care Hospital.
Meena S(1), Nawal CL(2), Saini HL(3), Chejara RS(4), Singh A(5).

Author information:
(1)Junior Resident, Department of General Medicine, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
(2)Senior Professor, Department of General Medicine, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
(3)Associate Professor, Department of General Medicine, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
(4)Associate Professor, Department of General Medicine, Sawai Man Singh Medical College, Jaipur, Rajasthan, India, Corresponding Author.
(5)Professor, Department of General Medicine, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.

INTRODUCTION: Cardiac dysfunction is one of the major causes of mortality in patients with sepsis. The acute physiology and chronic health evaluation II (APACHE II), quick sequential organ failure assessment (qSOFA), and other prognostic scores for sepsis have established data regarding their accuracy in predicting mortality. We have assessed the prognostic role of cardiac biomarkers [creatine phosphokinase-myocardial band (CPK-MB), troponin I (Trop I), and probrain natriuretic peptide (proBNP)] in patients with sepsis and compared it with the APACHE II score.

MATERIALS AND METHODS: A total of 126 patients (63 in each group) participated in this case-control study in a large tertiary care teaching hospital. Patients with sepsis who required hospitalization were enrolled in the case group and compared with another group of nonsepticemic patients. They were taken for detailed evaluation and investigation on day 1 and day 3. Our study included proBNP, CPK-MB, Trop I, and APACHE II score.

RESULTS: Both the case and control groups comprised 63 patients each. It was observed that the cardiac biomarkers (proBNP, Trop I, CPK-MB) were markedly higher among cases than in controls. Similarly, these markers were also found markedly higher in fatal cases than survivors in the case group. Out of all three biomarkers, proBNP was correlated well with mortality as much as the APACHE II score. It was also observed that increasing trends in the levels of biomarkers depict prognosis more effectively than a single value.

CONCLUSION: We conclude that cardiac biomarkers can be routinely used as dynamic markers for the prediction of mortality and prognosis in patients with sepsis. ProBNP may be useful in predicting mortality in patients with sepsis.
Journal of The Association of Physicians of India 2025.
DOI: 10.59556/japi.73.1274   
PMID: 41391076 [Indexed for MEDLINE]

7. Anal Chem. 2025 Dec 13. doi: 10.1021/acs.analchem.5c06026. Online ahead of print.
A Novel Ficoll400-Based Signal Amplification Platform for High-Sensitive Cardiac Troponin I Immunoassay.
Guo C(1)(2), Liu M(1)(2), Li S(1)(2)(3), Xie L(3), Jin K(4), Sun Y(4), Nie J(1)(2), Bai Z(1)(2).

Author information:
(1)The Key Laboratory of Industrial Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, Wuxi214122, China.
(2)National Engineering Laboratory for Cereal Fermentation Technology, Jiangnan University, Wuxi214122, China.
(3)Jiangsu Baiming Biotechnology Co., Ltd., Yancheng224000, China.
(4)School of Life Sciences, Henan University, Kaifeng475004, China.

This study reports the development of a novel signal amplification carrier based on the soluble macromolecular polysaccharide Ficoll400 to enhance the sensitivity of chemiluminescent immunoassays (CLIA), with a particular focus on detecting low-abundance biomarkers, such as high-sensitivity cardiac troponin I (hs-cTnI). The carrier was constructed via the reductive amination of Ficoll400, followed by conjugation with streptavidin (SA), thereby generating dense SA binding sites capable of attaching numerous biotinylated horseradish peroxidase (Bio-HRP) molecules to amplify the chemiluminescent signal. Comparative analyses with other polysaccharides (Dextran T500 and hyaluronic acid) demonstrated that Ficoll400 conjugates, especially when aminated with l-lysine, provided superior signal enhancement with minimal background noise, improving the signal-to-noise ratio by up to 140-fold. Characterization by SDS-PAGE, dynamic light scattering, and transmission electron microscopy confirmed the formation of large macromolecular structures conducive to signal amplification. Optimization of experimental parameters, such as conjugation ratios, pH, buffer composition, and surfactant presence, further enhanced the assay performance. The developed hs-cTnI CLIA method exhibited excellent analytical sensitivity, with a limit of detection of 0.5 pg·mL-1 and a limit of quantitation of 0.9 pg·mL-1, alongside robust stability under accelerated and onboard conditions and high precision, with coefficients of variation below 10%. Clinical sample testing demonstrated strong correlation and consistency with a commercial hs-cTnI assay, confirming the method's reliability and potential for clinical application. Overall, the Ficoll400-SA amplification carrier provides a stable, biocompatible, and easily prepared platform that significantly enhances immunoassay sensitivity, with promising applications for the detection of various low-abundance biomarkers in vitro.

DOI: 10.1021/acs.analchem.5c06026
PMID: 41389219

8.J Appl Lab Med. 2025 Dec 12:jfaf181. doi: 10.1093/jalm/jfaf181. Online ahead of print.
Analytical Verification of a Point-of-Care High-Sensitivity Troponin I Assay.
Pickering JW(1)(2), du Toit S(3), Cheer S(3), Buchan V(4), Miller R(5)(6), Joyce LR(1)(7), Than M(1)(2)(8), Florkowski CM(4).

Author information:
(1)Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand.
(2)Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand.
(3)Waikato Hospital Laboratory, Health NZ, Hamilton, New Zealand.
(4)Canterbury Health Laboratories, Christchurch Hospital, Christchurch, New Zealand.
(5)Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand.
(6)Thames Hospital, Thames, New Zealand.
(7)Department of Surgery and Critical Care, University of Otago Christchurch, Christchurch, New Zealand.
(8)Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS, United States.

BACKGROUND: The QuidelOrtho TriageTrue® point-of-care (POC) high-sensitivity troponin I (hs-TnI) assay has been previously validated. We aimed to independently verify the assay's analytical performance and concordance with other assays and to verify secondary POC devices.

METHODS: Intra-assay precision: 5 whole blood samples spanning the measuring interval were analyzed up to 20 times in succession. Inter-analyzer and inter-lot precision studies were also carried out and a precision curve generated. Hemolysis was assessed by spiking 8 samples with concentrations from 2 to 320ng/L with hemolysate.Concordance between >200 TriageTrue samples and one other hs-TnI POC and 4 laboratory analyzers was assessed by Pearson correlation and kappa statistics at the limit of quantitation and upper reference limit. Paired measurements from 9 samples between a primary verified device and 8 secondary devices were compared against prespecified difference limits.

RESULTS: Intra-assay precision CVs were 25% and 12.2% at mean concentrations of 2.4ng/L and 8.5ng, respectively, and ranged from 2.8% to 15.9% at higher concentrations >10ng/L. There was minimal interference by hemolysis up to 10g/L, which exceeded the manufacturer's claim of 1.96g/L.Correlation coefficients were 0.89 to 0.99 with other assays with the exception of the Roche hs-TnT assay, where it was 0.79. These were similar to the laboratory assays. Of 116 comparisons with 8 secondary analyzers, all fell within acceptable limits.

CONCLUSIONS: The TriageTrue assay performed as reported in the package insert. The assay characteristics offer acceptable performance for use within the intended medical settings.

DOI: 10.1093/jalm/jfaf181
PMID: 41385353

9. Gynecol Oncol. 2025 Dec 10;204:210-217.doi:10.1016/j.ygyno.2025.12.003. Online ahead of print.
Evaluating the clinical utility and impact on healthcare utilization of serial troponin T monitoring in gynecologic cancer patients receiving immune checkpoint inhibitors - A single centre experience.
Fernandes I(1), Sachdeva A(2), Tavangar F(3), Lafreniere M(4), Yip P(4), Petrella T(1), Thavendiranathan P(5), MacKay H(6).

Author information:
(1)Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; University of Toronto, Toronto, Ontario, Canada.
(2)Sunnybrook Research Institute, Sunnybrook Health Science Centre, Canada;University of Toronto, Toronto, Ontario, Canada.
(3)Lawrence S. Bloomberg Faculty of Nursing, Canada; University of Toronto, Toronto, Ontario, Canada.
(4)Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Canada; University of Toronto, Toronto, Ontario, Canada.(5)Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, University Health Network, Canada; University of Toronto, Toronto, Ontario, Canada.
(6)Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; University of Toronto, Toronto, Ontario, Canada. Electronic address:

OBJECTIVES: The primary objective of this study was to report on the clinical utility of serial troponin T (cTnT) monitoring in patients with gynecological cancers receiving immune checkpoint inhibitors (ICIs). Secondary objectives were to describe the experience of a single centre within a public healthcare system and to discuss the associated increase in healthcare utilization resulting from this intense monitoring strategy.

METHODS: We conducted a retrospective cohort study of all patients with endometrial, cervical, and vaginal cancers treated with ICIs at Sunnybrook Health Sciences Centre, Toronto, Canada, until June 2024. Serial cTnT was measured at baseline and prior to each cycle. Comprehensive clinical data was collected. Associations between cTnT elevation and outcomes were analyzed.

RESULTS: Sixty-eight patients were included: 41 (60.3 %) with endometrial, 25 (36.8 %) with cervical, and 2 (2.9 %) with vaginal cancer. At baseline, 37.9 % had elevated cTnT. During therapy, 63.2 % experienced at least one troponin elevation above the upper normal limit. Troponin increases were associated with age, hypertension, and other immune-related adverse events, but not with overall survival. Two patients (2.9 %) developed confirmed ICI-induced myocarditis. In total, over 1400 cTnT assays were performed, leading to multiple downstream investigations and treatment delays without consistent clinical benefit.

CONCLUSIONS: Serial cTnT monitoring frequently identified biomarker elevations but was not associated with outcomes in gynecologic cancer patients receiving ICIs. Despite a 63.2 % rate of elevated troponin, ICI-induced myocarditis occurred in 2.9 %. These findings suggest the need for evidence-based guidelines that balance early toxicity detection with safety, treatment continuity, and resource stewardship.

DOI: 10.1016/j.ygyno.2025.12.003
PMID: 41380303

 10.JACC Case Rep. 2025 Dec 11:106488. doi: 10.1016/j.jaccas.2025.106488. Online ahead of print.
Successful Steroid Pulse Therapy in Suspected Immune Checkpoint Inhibitor-Associated Myocarditis With Isolated Troponin Elevation.
Okura Y(1), Bamba T(2), Kawasaki T(3), Asatani M(4), Aoki M(2), Nakagawa S(2), Takenouchi T(5), Tanaka H(6), Inomata T(7).

 Author information:
1)Department of Onco-Cardiology, Niigata Cancer Center Hospital, Niigata, Japan. 
(2)Department of Digestive Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
(3)Department of Pathology, Niigata Cancer Center Hospital, Niigata, Japan.
(4)Department of Radiology, Niigata Cancer Center Hospital, Niigata, Japan.
(5)Department of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan.
(6)Department of Respiratory Medicine, Niigata Cancer Center Hospital, Niigata, Japan.
(7)Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

BACKGROUND: The optimal timing and indications for corticosteroid therapy in patients with suspected immune checkpoint inhibitor (ICI)-associated myocarditis cardiac troponin (cTn) elevation remain unclear.
CASE SUMMARY: A 67-year-old man with recurrent esophageal cancer developed marked cTnI elevation (6,714 pg/mL) 3 weeks after the first nivolumab-ipilimumab cycle. The patient was asymptomatic but was suspected to have ICI-associated myocarditis. Steroid pulse therapy was promptly initiated, and after 5 days, cardiac magnetic resonance imaging confirmed myocarditis. His cTnI levels normalized within 2 weeks, and cardiac function was preserved.
DISCUSSION: This case highlights the potential benefits of immediate steroid pulse therapy in asymptomatic patients with suspected ICI myocarditis. Treatment before diagnostic confirmation may prevent disease progression.
TAKE-HOME MESSAGES: Even in asymptomatic patients, early corticosteroid therapy should be considered for isolated cTn elevation suggesting ICI-associated myocarditis. Institutional awareness and preparedness for early intervention are crucial for effective allocation of short-term intensive medical resources.

DOI: 10.1016/j.jaccas.2025.106488
PMID: 41379051

Conflict of interest statement: Funding Support and Author Disclosures Dr Takenouchi has received lecture fees from Bristol-Myers Squibb, MSD, and Ono Pharmaceuticals. Dr Tanaka has received lecture fees from AstraZeneca, Chugai Pharmaceutical, Eli Lilly, and Ono Pharmaceutical and research funding from Amgen, AstraZeneca, Chugai Pharmaceutical, Daiichi Sankyo, Eli Lilly, Janssen Pharmaceutical, MSD, and Ono Pharmaceutical. Dr Inomata has received lecture fees from AstraZeneca and Ono Pharmaceuticals. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

 11.Cureus. 2025 Nov 9;17(11):e96425. doi: 10.7759/cureus.96425. eCollection 2025 Nov.
Misleading Markers: Troponin-Positive Spontaneous Pneumomediastinum Masquerading as Acute Pericarditis in a Young Cannabis User.
Paing AB(1), Elsahy T(1), Shaik A(1), Kundu D(2), Iqbal M(1).

Author information:
(1)Acute Medicine, Peterborough City Hospital, Peterborough, GBR.
(2)General Medicine, Peterborough City Hospital, Peterborough, GBR.

Spontaneous pneumomediastinum (SPM) is defined as the presence of free air within the mediastinum without an apparent precipitating cause such as trauma, invasive procedures, or oesophageal rupture. SPM is typically benign and self-limiting but may mimic life-threatening conditions such as myocardial infarction, pulmonary embolism, or aortic dissection. The pathophysiology is most explained by the Macklin effect, where increased intra-alveolar pressure leads to alveolar rupture and dissection of air along bronchovascular sheaths nto the mediastinum. Recognized risk factors include intense physical exertion, vomiting, Valsalva manoeuvres, and recreational drug use such as cannabis and cocaine inhalation. Although SPM usually follows a benign course, prompt diagnosis is important to exclude secondary causes such as Boerhaave syndrome or tracheobronchial injury, which carry significant morbidity and mortality if missed. We report the case of a healthy 18-year-old male who developed extensive spontaneous pneumomediastinum shortly after smoking, with a background of prior cocaine use. This case highlights the importance of recognizing SPM in the differential diagnosis of acute chest pain in young adults and reinforces the value of conservative management following thorough exclusion of secondary causes.

DOI: 10.7759/cureus.96425
PMCID: PMC12687917
PMID: 41376758

Conflict of interest statement: Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships:

12. Int J Mol Sci. 2025 Dec 1;26(23):11655. doi: 10.3390/ijms262311655.
Elevated Cardiac Troponin in Non-Cardiac Conditions Unrelated to Acute Myocardial Infarction.
Savic L(1)(2), Stankovic S(3)(4), Antonijevic N(1)(2), Matic D(1)(2), Lasica R(1)(2), Krljanac G(1)(2), Asanin M(1)(2).

Author information:
(1)Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
(2)Cardiology Intensive Care Unit & Cardiology Clinic, Emergency Hospital, University Clinical Center of Serbia, 11000 Belgrade, Serbia.
(3)Center for Medical Biochemistry, University Clinical Center of Serbia, 11000 Belgrade, Serbia.
(4)Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia.

 Cardiac troponins (cTn) T and I are biochemical markers of myocardial injury. In this review article, we aim to summarize the mechanisms and significance of cardiac troponin (cTn) elevation unrelated to acute myocardial infarction (AMI) in the most frequently occurring non-cardiac conditions, where the accurate interpretation of elevated cTn levels is often challenging. Different mechanisms in non-cardiac conditions can cause non-ischemic myocardial injury.
Understanding the pathophysiology of cTn release is an essential precondition for minimizing unnecessary, costly, and potentially risky (cardiac)
interventions and for providing timely and appropriate medical care. Elevated cTn in critically ill patients and in patients with chronic disease/conditions is an independent predictor (risk factor) of cardiovascular and overall mortality. Treatment of underlying conditions is of primary importance, and close monitoring for the occurrence of cardiovascular complications during hospitalizations should be considered in these patients. Also, when the patient recovers from the underlying disease, clinical judgement should be employed to decide whether and to what extent further cardiological evaluation is indicated.

DOI: 10.3390/ijms262311655
PMCID: PMC12692183
PMID: 41373801 [Indexed for MEDLINE]

Conflict of interest statement: The authors report that there are no competing interests to declare.

 
13. Crit Rev Anal Chem. 2025 Dec 10:1-20. doi:10.1080/10408347.2025.2599306. Online ahead of print.
Emerging Electrochemical and Biosensing Platforms for Troponin I and B-Type Natriuretic Peptide: A Comprehensive Insight into Next-Generation Cardiac Diagnostics.
Meenakumari Gopakumar D(1), Meenakumari Gopakumar G(2).

Author information:
(1)Department of Electronics, Communication Engineering College of Engineering, Trivandrum, Kerala, India.
(2)Department of Chemistry, Amrita Vishwa Vidyapeetham, Kollam, Kerala, India.

Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, demanding rapid, sensitive, and cost-effective diagnostic technologies. For instance, Cardiac troponin I (cTnI) and B-type natriuretic peptide (BNP) are important myocardial infarction and heart failure biomarkers, respectively.
Traditional immunoassay-based methods, although accurate, often suffer from complex procedures, high cost, and delayed response times. In this context, hybrid nanocomposite-based electrochemical biosensors have emerged as powerful alternatives, integrating plasmonic nanostructures, graphene nanosheets, carbon nanotubes, and metal-organic or polymeric frameworks to enhance signal comprehensively discusses recent progress in label-free electrochemical platforms, including impedance spectroscopy, differential pulse voltammetry, and constant current techniques, alongside the role of bio-nanohybrid materials in amplifying sensitivity and selectivity. It dives into the constitutive elements of the devices, such as smartphone-based analytical systems and microfluidic and portable lab-on-chip devices, and outline the analytical parameters including detection in the femtogram ranges, diverse concentration ranges, and response time. The paper scrutinizes the level of selectivity to different samples of blood and urine and also discuss the practical aspects, including the low bioreceptor adsorption, control of random coupling, and administrative substances to limit fragmentation. Finally, emerging trends involving wireless arrays, multiplexed signal processing, and real-time monitoring are outlined, emphasizing future directions toward scalable, sustainable, and translational electrochemical biosensing systems for cardiovascular health management.

DOI: 10.1080/10408347.2025.2599306
PMID: 41369095

14. Biomed Environ Sci. 2025 Nov 20;38(11):1430-1443. doi: 10.3967/bes2025.120.
Air Pollution and Cardiac Biomarkers in Heart Failure: A Scoping Review.
Li G(1), Jia YH(2), Cui YS(3), Wu SW(4), Ma TY(5), Jiang YX(4), Xu HB(6), Zhang YH(7), Fox MA(8).

Author information:
(1)Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA;School of Medicine, Tsinghua University, Beijing 100084, China.
(2)Vanke School of Public Health, Tsinghua University, Beijing 100084, China.
(3)Chinese Center for Disease Control and Prevention, Beijing 102206, China.
(4)Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, Shaanxi, China;Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education of China, Xi'an 710061, Shaanxi,China.
(5)Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong 000000, China.
(6)Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300192, China.
(7)Heart Failure Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Fuwai Hospital, Beijing 100037, China.
(8)Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA;Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, Maryland 21205, USA..

Ambient air pollution is increasingly being recognized as a risk factor for heart failure; however, its effects on cardiac biomarkers remain unclear. This scoping review assessed the existing evidence on the association between air pollution and cardiac biomarkers in heart failure, described the key concepts, synthesized data, and identified research gaps. Following the PRISMA-ScR guidelines, PubMed, Embase, Web of Science, and CNKI databases were searched for studies on air pollution, heart failure, and biomarkers. A total of 765 records were screened, and 81 full texts were assessed for eligibility, resulting in 15 studies. The results showed that the exposure to particulate matter was associated with elevated N-terminal pro-B-type natriuretic peptide and troponin levels. Several studies have linked particulate matter exposure to a higher cardiovascular risk and heart failure biomarkers. Inflammatory and oxidative stress markers were consistently elevated across studies, supporting the biological relevance of these associations. However, few studies have focused specifically on populations with heart failure or clinically relevant biomarkers, and the evidence for gaseous pollutants remains inconclusive. These findings highlight the need to integrate environmental risk assessment into heart failure care and inform policy efforts to reduce the pollution-related cardiovascular burden. Further research should address these gaps through
improved exposure assessments and the integration of mechanistic evidence.

DOI: 10.3967/bes2025.120
PMID: 41368966 [Indexed for MEDLINE]

15. Medicine (Baltimore). 2025 Dec 5;104(49):e46444. doi: 10.1097/MD.0000000000046444.
Differential diagnosis in patients with both features of pneumonia and pulmonary edema on chest computed tomography.
Lee HJ(1), Kim M(2), Seo CO(2), Kim H(2), Kim HR(2), Kang MG(2), Cho YH(3), Jang JY(3), Ju S(4), Park JR(2), Cho YJ(4), Kim K(2).

Author information:

(1)Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
(2)Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
(3)Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.
(4)Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.

It is a common challenge for pneumonic consolidation and pulmonary edema/congestion to be presented simultaneously on computed tomography. However, there is a lack of research on the clinical features and differential diagnosis of patients suspected of heart failure (HF) and pneumonia (PN). Among patients presenting with dyspnea, chest computed tomography was performed, and those with pneumonia and pulmonary edema interpreted by radiologists were included for analysis. PN, HF, or HF with PN (HFPN) were categorized by the pulmonologist and cardiologist. Clinical features, c-reactive protein (CRP), procalcitonin, N-terminal pro-brain natriuretic peptide (NT-proBNP), and troponin I levels were collected. The study included 220 patients over 6 years, among whom 51.8% were ultimately confirmed as HFPN, with HF in 21.8% and PN in 26.4%. The HF group frequently exhibited cardiovascular risk factors, whereas the PN group showed no association with underlying pulmonary conditions. In multivariate analysis, independent biomarkers for HF diagnosis were NT-proBNP and CRP. The NT-proBNP was the only independent negative predictor for PN diagnosis. The combined model of CRP<91mg/dL and NT-proBNP>2677 pg/mL were showed the highest diagnostic value (AUC 0.772, P=.033) for identifying HF. Both the HF-only and HFPN groups had high rates of antibiotic prescription, but this was not associated with in-hospital mortality. In this study, the combination of elevated NT-proBNP and low CRP levels appeared to provide better clinical utility in identifying HFover pneumonia among patients with overlapping radiologic features. However, further validation in diverse populations is warranted.

DOI: 10.1097/MD.0000000000046444
PMCID: PMC12688999
PMID: 41366926 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no funding and conflicts of interest to disclose.

16. BMJ Open. 2025 Dec 8;15(12):e102962. doi: 10.1136/bmjopen-2025-102962.
Development and validation of a postoperative risk calculator (POP-score) for patients undergoing cardiac surgery: a retrospective cohort study.
PÃl L(1), Sutter C(1), Lohmann R(1)(2), Eder J(1), Ioannou-Nikolaidou M(1), Engler C(1), Graber M(1), Naegele F(3), Hirsch J(1), Maier S(4), Ulmer H(4),Mathis S(5), Reinstadler SJ(6), Grimm M(1), Bonaros N(1), Holfeld J(1), Gollmann-Tepekà (7).

Author information:
(1)Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.
(2)Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria.
(3)Medical University of Innsbruck, Innsbruck, Austria.
(4)Institute of Clinical Epidemiology, Public Health, Health Economics, Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria.
(5)Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.
(6)University Hospital of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria.
(7)Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria

OBJECTIVES: This study aimed to identify intraoperative and perioperative factors influencing 30-day mortality after cardiac surgery and to develop a risk score (POP-score) for its prediction.

DESIGN: Retrospective cohort study with multivariable regression analysis.

SETTING: A tertiary care cardiac surgery centre in Austria; data from consecutive patients undergoing cardiac surgery between 2010 and 2020 were analysed.

PARTICIPANTS: total of 8072 patients were included. The cohort was randomly divided into:derivation cohort (75%) and validation cohort (25%).

OUTCOME MEASURES: The primary outcome measure was 30-day mortality. We analysed associations between intraoperative and perioperative variables and 30-day mortality, assessed via multivariable regression analysis.

RESULTS: Several factors were significantly associated with 30-day mortality, including intraoperative RBC transfusion (OR 3.407 (95% CI 2.124-5.464)), postoperative high-sensitive cardiac troponin T cut-off levels (OR 2.856 (95% CI 1.958 to 4.165)), need for dialysis/haemofiltration (OR 2.958 (95% CI 2.013 to 4.348)) and temporary extracorporeal membrane oxygenation support (OR 5.218 (95% CI 3.329 to 8.179)) (p<0.001 for all). The newly developed POP-score demonstrated superior predictive performance for 30-day mortality compared with the EuroSCORE II alone (area under the ROC curve (AUC) 0.884 vs 0.800, p=0.013), based on peak troponin values assessed within the first 7 postoperative days. As 98% of peak troponin elevations occurred within 72 hours, the POP-score can be calculated at this earlier time point for clinical implementation.

CONCLUSIONS: The validated POP-score provides an improved tool for predicting 30-day mortality after cardiac surgery by incorporating intraoperative and perioperative factors alongside the EuroSCORE II. Although model performance was evaluated using 7-day peak troponin data, the score can be calculated within the first 72 hours postoperatively in most patients, supporting its clinical applicability for early decision-making, resource allocation and patient counselling. Further research is warranted to assess its clinical utility in diverse populations.

DOI: 10.1136/bmjopen-2025-102962

17.113411.
Troponin elevation in supraventricular tachycardia: A narrative review.
Özlek B(1), Tanık VO(2), Barutçu S(3).

 Author information:
(1)Department of Cardiology, School of Medicine, Mugla Sitki Kocman University, Mugla 48000, TÃ
(2)Department of Cardiology, Ankara Etlik City Hospital, Ankara 06100, 
(3)Department of Cardiology, Mugla Sitki Kocman University, Mugla 48000,

Supraventricular tachycardia (SVT) is a frequent cause of emergency presentations. Troponin elevation is common, but its clinical significance remains uncertain and may trigger unnecessary downstream testing. In this mini-review, we aimed to review the prevalence, mechanisms, prognostic relevance, and management of troponin elevation in adult paroxysmal SVT. A narrative review was conducted using PubMed and EMBASE (2000-2025) with MeSH terms related to SVT and troponin. Eligible studies included original research or registry analyses in adults with paroxysmal SVT. Pediatric and atrial fibrillation/flutter cohorts were excluded. Additional data were obtained from reference lists and expert commentaries. Troponin elevation occurs in approximately 30%-50% of adult SVT cases, primarily reflecting a tachycardia-induced supply-demand imbalance or myocardial stretch, rather than plaque rupture. Short-term registry data suggest potential prognostic associations, but long-term outcomes remain inconsistent and are largely determined by comorbidities and underlying coronary artery disease.
Troponin-driven management often leads to increased admissions, consultations, and additional testing without a demonstrable benefit. Troponin elevation in SVT is frequent but usually benign. Routine measurement in all patients is not justified. A selective, risk-based approach - focused on ischemic symptoms, electrocardiogram changes, or high-risk clinical features - offers more appropriate, efficient, and patient-centered care.

DOI: 10.4330/wjc.v17.i11.113411
PMCID: PMC12678887
PMID: 41356591

Conflict of interest statement: Conflict-of-interest statement: The authors declare that they have no conflict of interest.

18. BMJ Case Rep. 2025 Dec 3;18(12):e268111. doi: 10.1136/bcr-2025-268111.
Elevated troponin in a patient with pneumomediastinum and pneumothorax: a diagnostic challenge.
Jayawardena DMC(1), Suthar R(2), Sutton B(2), De Bono J(3).

Author information:
(1)Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK 
(2)Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
(3)Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

We present the case of a middle-aged man who was admitted with acute chest pain and markedly elevated troponin levels, initially raising concerns for acute coronary syndrome. Diagnostic evaluations revealed an apical pneumothorax, and pneumomediastinum, without evidence of dynamic ischaemic ECG changes. Despite the concerning elevation in troponin levels, minimal variation in serial measurements (<10%) indicated a non-ischaemic aetiology. The troponin elevation was attributed to stress from pneumomediastinum, localised inflammation and myocardial strain. This case highlights the importance of differentiating ischaemic and non-ischaemic causes of troponin elevation to avoid unnecessary interventions. Conservative management focused on diagnostic stewardship resulted in a favourable outcome. Given the rarity of such presentations, we aim to publish this case to enhance understanding and emphasise the importance ofconsidering pneumomediastinum in patients presenting with chest pain and elevated cardiac biomarkers.¯.

DOI: 10.1136/bcr-2025-268111
PMCID: PMC12683647
PMID: 41338912 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.

19.Eur Heart J Acute Cardiovasc Care. 2025 Dec 2:zuaf157. doi: 10.1093/ehjacc/zuaf157. Online ahead of print.
New pathways with high-sensitivity cardiac troponin testing at the point of care in the ambulance and primary care.
Johannessen TR(1)(2), Body R(3), Mair J(4), Mills NL(5), Cullen L(6); Study Group on Biomarkers of the ESC Association for Acute Cardiovascular Care. (Collaborators: Lindahl B, Boeddinghaus J, Cullen L, Daniels L, Hammarsten O, Huber K, Giannitsis E, Jaffe AS, Kimenai DM, Krychtiuk KA, Möckel M, Mueller C, Thielmann M, Thygesen K, Mair J, Mills NL.)

Author information:
(1)Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
(2)Department of Emergency General Practice, Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway.
(3)Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.
(4)Department of Internal Medicine III - Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
(5)BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh,United Kingdom.
(6)Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane,Australia.

DOI: 10.1093/ehjacc/zuaf157
PMID: 41329967

20.Physiol Res. 2025 Dec 2;74(5):885-889.
False-Positive Cardiac Troponin Elevations in Skeletal Muscle Disease: Clinical Relevance, Mechanisms, and Laboratory Approaches.Rajdl D(1), Šolcová M, Racek J, Suchý D, Vimmerová H, Broz P, Prokop P.

Author information:
(1)Department of Clinical Biochemistry and Hematology, University Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.

Cardiac troponins are indispensable biomarkers for the diagnosis of acute myocardial infarction, but false-positive elevations that contradict the clinical picture remain a significant challenge in laboratory medicine.
Analytical interferences may arise from macrotroponins, heterophile or anti-troponin antibodies, and the limited cardiac specificity of
high-sensitivity troponin T (hs-cTnT) in skeletal muscle disease. Recent studies show that hs-cTnT is elevated in up to two-thirds of patients with myopathies, while high-sensitivity troponin I (hs-cTnI) is largely unaffected, underscoring the diagnostic advantage of hs-cTnI in this setting. A pragmatic diagnostic approach should combine clinical plausibility with stepwise laboratory testing.
First, preanalytical factors such as sample mislabeling, fibrin clots, or hemolysis must be excluded and the measurement repeated. If the results remain incongruent, an alternative assay - ideally hs-cTnI - should be performed.
Further evaluation may include heterophile-blocking reagents, polyethylene glycol precipitation to screen for macro-analytes, and, where available, confirmatory techniques such as gel filtration chromatography or immunoglobulin depletion (protein A/G). Although these strategies can help identify assay interference, there is no universally accepted gold standard. Awareness of false-positive elevations, careful interpretation of discordant troponin results, and effective collaboration between laboratories and clinicians are essential to prevent misdiagnosis and unnecessary interventions. Clear documentation of confirmed interferences further ensures safe patient management and provides guidance on which assays are reliable for future tests. Key words
Cardiac troponin " Skeletal muscle disease " False-positive results " Analytical interference " Macrotroponin " Laboratory diagnostics.

 PMID: 41329544 [Indexed for MEDLINE]