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Búsqueda Bibliografica: hs TROPONINAS – Parte III

Pautas de búsqueda: Persona - Ingles – Trabajos 2025

 

35. Anal Chim Acta. 2026 Jan 1;1381:344793. doi: 10.1016/j.aca.2025.344793. Epub2025 Oct 16.

 

Signal-boosted Eu(2)O(3)-based time-resolved fluorescence immunosensor for the ultrasensitive detection of cardiac troponin T.

 Cheng F(1), Huang S(1), Zhai C(1), Li Q(2), Lv W(1), Zhao X(3), Huang B(4).

 

Author information:

(1)College of Life Sciences and Medicine, Zhejiang Sci-Tech University,Hangzhou, 310016, China.

(2)Department of Emergency, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China.

(3)College of Life Sciences and Medicine, Zhejiang Sci-Tech University,Hangzhou, 310016, China. 

(4)College of Life Sciences and Medicine, Zhejiang Sci-Tech University,Hangzhou, 310016, China. 

 

BACKGROUND: Time-resolved fluorescence immunoassays (TRFIA) have been extensively applied across various fields owing to their low background noise characteristics, particularly in disease diagnosis and prevention. Survival andprognosis of patients with acute myocardial infarction (AMI) are highly dependent on the rapid and accurate detection of myocardial damage. Troponin T(cTnT) is a primary diagnostic biomarker of AMI and is widely used in clinical practice. However, the current bioassays for cTnT detection are complex and time-consuming. Therefore, there is an urgent need for a sensitivity, and rapiddiagnostic approach for acute myocardial infarction.

RESULTS: Herein, we report a novel, sensitive, and specific cTnT detection approach using a unique nanoprobe dissolution-enhanced fluorescence amplification strategy. Eu2O3 nanocrystals, easily dissolvable in an acidicenhancer solution and transformed into many highly luminescent Eu3+ micelles, were utilized as nanoprobes. The released Eu3+ further activates thetime-resolved fluorescence system, which prevents autofluorescence interference and blood scattering, allowing for the accurate determination of cTnT levels in clinical serum samples. The demonstrated sensitivity of serum cTnT was high with a sensitivity of 3.86 ng·L-1. In addition, we developed a Eu2O3-based lateral flow immunochromatographic test strip for facile cTnT detection, with the sensitivity of 14.14 ng·L-1 and 6.31 ng·L-1 using smartphone-integrated app andcommercial analyzer respectively.

SIGNIFICANCE: This Eu2O3-nanocrystal-based dissolution-enhanced luminescent  bioassay has tremendous potential for ultrasensitive biomarker detection, enabling ultra-trace detection through lanthanide-specific dissolution. Moreover, the surface-functionalized nanocrystals could selectively recognize a variety of analytes, and have excellent photostability with minimal matrix interference, expanding the direction of lanthanide nanoprobes in multifunctional diagnostic and therapeutic areas.

 Copyright © 2025 Elsevier B.V. All rights reserved.

 DOI: 10.1016/j.aca.2025.344793

PMID: 41285532 [Indexed for MEDLINE]

 

 

36. Clin Res Cardiol. 2025 Nov 24. doi: 10.1007/s00392-025-02808-z.

 Time- and dose-dependent high-sensitivity cardiac troponin-T to improve outcome  prediction after TAVI: a multicenter cohort study.

 Stolte T(#)(1), Reichl JJ(#)(1), Lopez-Ayala P(1), Strebel I(1), GoetzingerF(1), Wagener M(1), Boeddinghaus J(1), Leibundgut G(1), Schmitt R(2), WestermannD(2), Hartikainen T(2), Mueller C(1), Mahfoud F(1), Ruile P(2), Breitbart P(2),Nestelberger T(3).

 Author information:

(1)Department of Cardiology and Cardiovascular Research Institute Basel (CRIB),University Hospital Basel, University of Basel, Basel, Switzerland.

(2)Department of Cardiology and Angiology, Medical Center, Faculty of Medicine,University of Freiburg, University of Freiburg, Südring 15, 79189, BadKrozingen, Germany.

(3)Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.

BACKGROUND: Pre- and post-procedural high-sensitivity cardiac troponin T (hs-cTnT) detects periprocedural myocardial injury (PPMI) and predicts adverse outcomes following transcatheter aortic valve implantation (TAVI). Current diagnosis of PPMI relies on fixed cutoffs, lacking the integration of time- anddose-dependent effects of hs-cTnT. This limits the precision of risk stratification and subsequent patient management. AIMS: To investigate the non-linear and time-dependent effects of pre- and  post-procedural hs-cTnT levels on outcomes after TAVI, these findings were compared to the dichotomized definition of PPMI proposed by the Valve Academic Research Consortium-3 (VARC-3).

METHODS: Consecutive patients undergoing TAVI between 2011 and 2024 at two tertiary university hospitals with available hs-cTnT measurements were enrolled. The primary outcome was all-cause mortality at 1 year. Multivariable Cox proportional hazards models were fitted. To relax the proportional hazards assumption, allowing for hazard ratios (HRs) to vary over time and across hs-cTnT values, a Royston-Parmar model was fitted.

RESULTS: Among 5158 patients, the HR for all-cause mortality at 1 year associated with VARC-3 defined PPMI was not statistically significant. Continuous variable analysis showed that both higher pre- and post-procedural hs-cTnT levels correlated with increased all-cause mortality risk at 1 year. Time-dependent models revealed the hazard to be greatest for higher hs-cTnT levels early post-procedurally and to decline over time.

CONCLUSIONS: The dichotomized VARC-3 definition of PPMI showed no prognostic  value. Modelling hs-cTnT as continuous and time-dependent revealed a dynamic risk trajectory after TAVI. Incorporating these non-linear and time-dependent effects into risk prediction models may improve clinical decision-making and personalize post-procedural surveillance. 

DOI: 10.1007/s00392-025-02808-z

PMID: 41284049

 

 

37. Clin Res Cardiol. 2025 Nov 24. doi: 10.1007/s00392-025-02789-z.

 Impact of subthreshold troponin levels and temporal trends on short term adverse cardiovascular outcomes in patients discharged from the emergency department: a RACE-IT trial substudy.

Qureshi MA(1), Cook B(2), Brennan B(2), Miller J(2), McCord J(2).

 Author information:
(1)Henry Ford Jackson Hospital, Jackson, MI, 49202, USA. ahmadqur267@gmail.com.

(2)Henry Ford Hospital, Detroit, MI, 48202, USA.

 BACKGROUND: High-sensitivity cardiac troponin I assays enable early exclusion of

myocardial infarction in the emergency department. However, the clinical

implications of detectable troponin values below the 99th percentile upper

reference limit (4-18 ng/L) remain unclear.

OBJECTIVE: To assess the association between subthreshold troponin levels and 30-day outcomes in patients from the RACE-IT trial, using exact troponin valueswhen available.

METHODS: This post-hoc analysis of the RACE-IT stepped-wedge randomized controlled trial included patients with troponin ≤ 18 ng/L across nine EDs. Patients were stratified by initial troponin, peak value, absolute change, and percent change. The primary outcome was a 30-day composite of all-cause death, acute MI, percutaneous coronary intervention, and coronary artery bypass grafting. Logistic regression analysis after adjusting for age, sex, race, and coronary artery disease was performed.

RESULTS: Among 19,194 patients with troponin ≤ 18 ng/L, 117 (0.6%) experienced the composite outcome. Higher troponin levels were associated with increased event rates in unadjusted analyses. Adjusted analyses showed no independent associations overall, though patients whose highest troponin values fell within the 18 ng/L range continued to demonstrate significantly worse outcomes than those with lower peak levels. Elevated troponin values correlated with older age, male sex, and greater comorbidity burden.

CONCLUSION: In this post-hoc analysis of patients with troponin values below the 99th percentile URL, absolute levels and temporal changes were not independently associated with 30-day adverse outcomes. These findings support the use of subthreshold troponin values in rapid rule-out protocols, emphasizing the need to consider clinical context and comorbidities in risk assessment.

DOI: 10.1007/s00392-025-02789-z

PMID: 41284048
 

38. Emerg Med Int. 2025 Nov 14;2025:5717892. doi: 10.1155/emmi/5717892. eCollection 2025.

Analytical and Clinical Performance of High-Sensitivity Cardiac Troponin Point-of-Care Assays as an Aid in the Diagnosis of Myocardial Infarction: A Narrative Review.

 Blanc L(1), Vaissaire A(2), Renard N(3), Vargmo C(2), Størvold GL(4), Bouhadef A(2), Claret PG(1)(5).

 Author information:

(1)Global Medical Affairs Department, bioMérieux S.A., Marcy-l'Étoile, France.

(2)Global Marketing Department, bioMérieux S.A., Marcy-l'Étoile, France.

(3)Immunoassay Research and Development Department, bioMérieux S.A., Marcy-l'Étoile, France.

(4)Global Clinical & Regulatory Affairs Department, bioMerieux S.A., Marci Ãoile, France.

(5)Hospices Civils de Lyon, Édouard Herriot University Hospital, Lyon, France.

 BACKGROUND: Acute coronary syndrome (ACS) poses a significant burden worldwide; however, the development of high-sensitivity cardiac troponin (hs-cTn) assays has greatly improved patient management by enabling the detection of very low levels of troponin. The objective of this review was to identify current hs-cTn point-of-care (POC) assays, describe their key features, and discuss their analytical and clinical performance.

METHODS: PubMed, MEDLINE, and Embase databases, as well as relevant web sources, were searched for publications up to April 10, 2025. The references included describe the main characteristics of POC hs-cTn assays and their companion instruments, as well as studies assessing their analytical or clinical performance in the context of acute myocardial infarction diagnosis.

RESULTS: In addition to information publicly available from the web, 27 publications were considered relevant for this review. From the retrieved sources, seven POC hs-cTn assays were identified as currently cleared by theUnited States Food and Drug Administration or CE-marked. Four additional POC hs-cTn assays, each evaluated for analytical or clinical performance, were identified as currently or previously under development. POC instruments differ in their key characteristics, many of which are crucial for ensuring their suitability in specific clinical settings and intended applications. Despite some variability in performance across different platforms, they are generally consistent with the high-sensitivity profile expected of cTn assays. Clinical performance indicators for hs-cTn assays align with European Society of Cardiology (ESC) recommendations, particularly when ESC-recommended diagnostic algorithms are applied. Reported sensitivity and negative predictive values exceed 99%, while positive predictive values are above 70%. Moreover, comparative studies of POC hs-cTn assays and laboratory-based hs-cTn tests have demonstrated no significant differences in diagnostic accuracy for ruling in or ruling out acute myocardial infarction.

CONCLUSION: POC hs-cTn assays represent a promising alternative to traditional laboratory testing, providing similar analytical and clinical performance while enabling faster diagnosis and management of ACS. Expanded use of hs-cTn assays in clinical practice could transform patient care pathways, especially in time-critical situations. Continued research and ongoing technological advancements are critical to ensure optimal use and widespread adoption in routine clinical settings.

DOI: 10.1155/emmi/5717892

PMCID: PMC12638167

PMID: 41280307 

39. Mayo Clin Proc Innov Qual Outcomes. 2025 Nov 7;9(6):100675. doi: 10.1016/j.mayocpiqo.2025.100675. eCollection 2025 Dec.

 Implementation of a High-Sensitivity Troponin Assay and Its Association With Resource Utilization in Patients With Suspected Acute Coronary Syndrome.

 Neicheril RK(1), Manla Y(1), Chacon D(2), Sarna K(3), Sonnino A(2), PiotrkowskiJ(2), Perry K(2), Snipelisky D(1).

 Author information:

(1)Department of Cardiology, Section of Heart Failure & Cardiac Transplant Medicine, Cleveland Clinic Florida, Weston, FL.

(2)Department of Internal Medicine, Cleveland Clinic Florida, Weston, FL.

(3)Center for Clinical Research, Cleveland Clinic Foundation, Cleveland Clinic Florida, Weston, FL.

 

OBJECTIVE: To examine the association between the implementation of high-sensitivity cardiac troponin (hs-cTn) and downstream resource utilization in patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS).

PATIENTS AND METHODS: We analyzed 461 ED encounters of patients with suspected ACS between January 1, 2022 and December 12, 2022. The final propensity score-matched analysis included 300 encounters in which the conventional cardiac troponin (c-cTn) assay (n=150) or hs-cTn assay (n=150) was used. Groups were compared for downstream resource utilization, including cardiology consults, cardiovascular imaging, disposition of care, ED length of stay, and 30-day outcomes, using appropriate statistical testing.

RESULTS: Compared with the c-cTn group, the hs-cTn group had a lower rate of requiring cardiology consults (6 [4%] vs 45 [30%]; P<.001) and reduced downstream utilization of echocardiograms (10 [6.7%] vs 59 [39.3%]; P<.001), nuclear stress tests (6 [4%] vs 27 [18%] P<.001), and cardiac catheterization (2[1.3%] vs 27 [18%]; P<.001). Significantly fewer patients were referred to observation (17 [11.3%] vs 96 [64%]; P<.001) or admitted (7 [4.7%] vs 42 [28%]; P<.001) in the hs-cTn assay group. In addition, the median ED length of stay was significantly shorter in the hs-cTn group (4 vs 28 hours; P<.001). The 30-day outcomes, including readmission for ACS (0 [0%] vs 0 [0%]; P>.99) or mortality (0 [0%] vs 1 [0.7%]; P>.99) rates, were comparable.

CONCLUSION: Implementing hs-cTn in the ED can significantly reduce downstream testing and hospital resource utilization. Wider adoption of hs-cTn assays could present an opportunity to optimize care of patients with suspected ACS. 

DOI: 10.1016/j.mayocpiqo.2025.100675

PMCID: PMC12639368

PMID: 41278393 

40. J Emerg Med. 2025 Sep 10;80:134-144. doi: 10.1016/j.jemermed.2025.09.011. 

Association of Troponin Elevation with Cardiovascular Event in Stable Supraventricular Tachycardia in the Emergency Department.

Khan M(1), Tzeng CT(2), Hsieh YL(3), Healy J(1), Lee C(1), Ku K(1), Shedd A(4), Bhakta T(4), Chou EH(5).

Author information:

(1)TCU Anne Marie Burnett School of Medicine, Fort Worth, Texas, USA.

(2)Department of Emergency Medicine, St Barnabas Hospital, Bronx, New York, USA;Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center, Fort Worth, Texas, USA.

(3)Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Internal Medicine, Harvard Medical School, Boston, Massachusetts, USA.

(4)TCU Anne Marie Burnett School of Medicine, Fort Worth, Texas, USA; Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center, FortWorth, Texas, USA.

(5)TCU Anne Marie Burnett School of Medicine, Fort Worth, Texas, USA; Departmentof Emergency Medicine, Baylor Scott and White All Saints Medical Center, Fort Worth, Texas, USA; Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.

BACKGROUND: Cardiac troponin is routinely measured in the emergency department (ED) to evaluate patients with chest discomfort or dysrhythmias. However, its prognostic value in patients presenting with stable supraventricular tachycardia (SVT) remains uncertain.

OBJECTIVES: To assess the prognostic value of troponin for 30-day major adverse cardiac events (MACE) in adult patients presenting with stable SVT in the ED.

METHODS: This was a retrospective, multi-center cohort study conducted in EDs in North Texas. Adult patients presenting with stable SVT in the ED were included. The primary endpoint was the occurrence of 30-day MACE, defined as a composite outcome of acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass surgery, and all-cause mortality.

RESULTS: A total of 493 patient encounters met inclusion criteria. Of these, 34 (6.9%) did not have troponin measured, 349 (70.8%) had non-elevated troponin levels, and 110 (22.3%) had elevated troponin levels. Patients who underwent troponin testing were at higher risk of MACE compared with those without testing (p < 0.001). Among patients with troponin testing, MACE occurred in 28.2% of those with elevated troponin versus 4.6% of those with non-elevated troponin (p < 0.001). Elevated troponin was associated with higher odds of 30-day MACE (OR 5.32, 95% CI: 1.92-14.7; p < 0.001). Compared to non-elevated troponin group, patients with elevated troponin had higher rates of ED SVT recurrence, hospital, and intensive care unit (ICU) admission.

CONCLUSION: Elevated troponin levels were associated with a significantly increased risk of 30-day MACE in our cohort. These findings highlight a potential role for troponin in identifying patients at higher risk for adverse short-term cardiac outcomes, even after successful rhythm conversion. 

DOI: 10.1016/j.jemermed.2025.09.011

PMID: 4127584

41. Cardiovasc Diabetol. 2025 Nov 21;24(1):443. doi: 10.1186/s12933-025-02979-z.

 Diabetes modifies the association between the triglyceride-glucose index and subclinical myocardial injury: A prospective cohort study.

Abudukeremu A(1)(2), Lv J(1), Liu W(1), Lu F(1), Huang T(3), Zhang J(4), Liu Y(1), Zhang Y(5), Liu X(6)(7), Yu P(8).

Author information:

(1)Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.

(2)Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China.

(3)Department of Pathophysiology, School of Basic Medical Sciences, Shenzhen University Medical School, Shenzhen, People's Republic of China.

(4)Department of Anesthesiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang , Jiangxi, China.

(5)Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China. zhyul@mail.sysu.edu.cn.

(6)Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China. 

(7)Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore. 

(8)Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.

 BACKGROUND: Triglyceride-glucose (TyG) index is considered an alternative indicator of insulin resistance and is associated with cardiovascular diseases. However, its association with subclinical myocardial injury in a general population without known cardiovascular disease has not been investigated, norhas the effect of diabetes.

METHODS: Individuals without known cardiovascular disease were included from the Atherosclerosis Risk in Communities (ARIC) cohort. The baseline TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The association between the baseline TyG index and subclinical myocardial injury high-sensitivity cardiac troponin T (hs-cTnT≥ 14 ng/L)] was assessed using both cross-sectional and prospective cohort designs.

RESULTS: A total of 11,478 participants were involved in the cross-sectional study (mean age, 56.78 years; 42.44% male) and 8801 participants were involved n the prospective cohort study (mean age, 56.57 years; 41.36% male). Both linear (râ=0.13, <0.001) and logistic regression analyses (adjusted odds ratio [OR]=1.33, p<0.001) showed a positive association between the TyG index and baseline hs-cTnT level, which was consistent in diabetic participants (OR=1.64, p=0.020) but not significant in non-diabetic participants (OR=0.89, p0.374). After a six-year follow-up, a U-shaped association between the TyG index and incidence of hs-cTnT elevation was observed among the overall participants. Further subgroup analyses showed an L-shaped (OR=0.72, p=0.006) and a J-shaped (OR=2.09, p<0.001) association between the TyG ndex and incidence of hs-cTnT elevation in participants without and with diabetes, respectively.

CONCLUSION: A U-shaped association between the TyG index and the incidence of subclinical myocardial injury was observed for the first time. Diabetes may be a critical modifier of the association between the TyG index and subclinical myocardial injury. Considering the risk stratification value of the TyG index based on diabetes status may hold significant clinical value.

DOI: 10.1186/s12933-025-02979-z

PMCID: PMC12639786

PMID: 41272633 [Indexed for MEDLINE] 

42. Inflamm Res. 2025 Nov 21;74(1):166. doi: 10.1007/s00011-025-02124-2.

 Periodontitis, subclinical myocardial injury, and cardiovascular mortality among US adults: a population-based study.

 Guo DC(#)(1)(2)(3)(4), He WB(#)(5), Chen ZT(5), Wang JF(5), Shen T(6)(7), Zhang HF(8), Liu DP(9)(10).

 Author information:

(1)Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing,China. 

(2)Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. 

(3)Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China. 

(4)The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing,China. 

(5)Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.

(6)Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.

(7)The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing,China.

(8)Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China. 

(9)Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China. 

(10)The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China. 

BACKGROUND: Periodontitis has been associated with an increased risk of  atherosclerotic cardiovascular disease; however, its association with subclinical myocardial injury remains scarce. The purpose of this study was to investigate the association between periodontitis, cardiac biomarkers of subclinical myocardial injury, and cardiovascular mortality in the general U.S.

METHODS: We analyzed data from 9202 participants initially free of cardiovascular disease in the 1999-2004 National Health and Nutrition
Examination Survey. The grade of periodontitis was categorized into normal,mild, and moderate-severe. Survey-weighted multiple linear regression model assessed the association between periodontitis and cardiac biomarkers, including high-sensitivity cardiac troponin (hs-cTn) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Survey-weighted multiple Cox regression model was utilized to estimate the association between periodontitis and cardiovascular disease mortality.

RESULTS: The mean age of participants was 40.65 ± 0.32 years, with 48.44% being men. The individuals with mild and moderate-severe periodontitis had significantly elevated hs-cTn and NT-proBNP, which indicated impaired cardiac structure and function, compared with non-periodontitis individuals. After controlling confounding covariates, moderate-severe periodontitis was significantly correlated with elevated hs-cTnT and NT-proBNP (β coefficients: 0.055, 95% CI 0.004 to 0.106; β coefficients: 0.188, 95% CI 0.077 to 0.300, respectively). Sensitivity analysis and subgroup analysis further verified the robustness of the results. Over a 17.5-year follow-up period, individuals with moderate-to-severe periodontitis exhibited a 44.9% higher risk of cardiovascular mortality compared to those without periodontitis (hazard ratio: 1.449, 95% CI: 1.027 to 2.044).

CONCLUSION: In individuals without established cardiovascular disease, moderate-severe periodontitis was associated with higher concentrations of hs-cTn and NT-proBNP, as well as an increased risk of cardiovascular mortality. These results emphasize the importance of maintaining optimal oral health. 

DOI: 10.1007/s00011-025-02124-2

PMID: 41266855 [Indexed for MEDLINE]
 

43. Front Immunol. 2025 Nov 4;16:1613603. doi: 10.3389/fimmu.2025.1613603. eCollection 2025.

 Combined complement and coagulation activation in ST-elevation myocardial infarction: associations with myocardial injury and dysfunction.

 Kluge KE(1)(2), Halvorsen S(1)(2), Andersen GØ(1), Hansen CH(1), Seljeflot I(1), Tønnessen T(2)(3), Lunde IG(1)(2)(4), Helseth R(1).

 Author information:

(1)Oslo Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.

(2)University of Oslo, Oslo, Norway.

(3)Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway.

(4)Kristian Gerhard Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway.

INTRODUCTION: Preclinical data indicates reciprocal activation of the complement system and the coagulation cascade. The magnitude of this interaction in patients with acute myocardial infarction is unknown. We aimed to determine associations between circulating markers of complement and coagulation activation in patients with acute ST-elevation myocardial infarction (STEMI), and explore a possible link to myocardial injury and left ventricular dysfunction.

MATERIALS AND METHODS: We included 864 patients with STEMI. Blood was drawn at a median of 18 hours after percutaneous coronary intervention. Complement activation was assessed by the terminal complement complex (TCC), and coagulation activation by prothrombin fragment 1 + 2 (F1 + 2), D-dimer and endogenous thrombin potential (ETP). Myocardial injury was estimated by peak troponin T (TnT), and left ventricular function was quantified on echocardiography by left ventricular ejection fraction (LVEF).

RESULTS: TCC was weakly correlated to F1 + 2 (r=0.086, p=0.012), D-dimer (r=0.176, p<0.001) and ETP (r=0.144, p<0.001). In multivariate binary logistic regression, there was no significant interaction between TCC and the coagulation markers on the risk of having high peak TnT or low LVEF.

CONCLUSION: In this STEMI cohort, complement activation as measured by TCC was weakly associated with markers of coagulation activation, but the measured markers had no combined relation with the risk of high peak TnT or low LVEF. These findings suggest that while simultaneous activation of complement and coagulation cannot be ruled out, combined high levels of TCC and coagulation markers do not mirror the extent of myocardial injury or dysfunction in STEMI.

DOI: 10.3389/fimmu.2025.1613603

PMCID: PMC12623171

PMID: 41262246 [Indexed for MEDLINE]

44. Braz J Cardiovasc Surg. 2026 Jan 1;41(1):e20240152. doi: 10.21470/1678-9741-2024-0152.

 Myocardial Damage and Inflammatory Response After Cardiac Surgical Revascularization on Beating and Arrested Heart.

 Bosnjak A(1), Rudez I(2), Galic G(1), Mikulic H(1), Mandic M(1), PetricevicJ(3).

 Author information:

(1)University Clinical Hospital Mostar Department of Cardiac Surgery Mostar Bosnia and Herzegovina Department of Cardiac Surgery, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina.

(2)Dubrava Clinical Hospital Department of Cardiac and Transplant Surgery Zagreb Zagreb Croatia Department of Cardiac and Transplant Surgery, Dubrava Clinical Hospital, Zagreb, Zagreb, Croatia.

(3)University Clinical Hospital Mostar Department of Pathology, Citology and Forensic Medicine Bosnia and Herzegovina Department of Pathology, Citology and Forensic Medicine, University Clinical Hospital Mostar, Bosnia and Herzegovina.

 INTRODUCTION: Coronary artery bypass grafting remains the preferred method for surgical myocardial revascularization. The use of extracorporeal circulation during surgery has been linked to myocardial damage and a systemic inflammatory response. To mitigate these adverse effects, off-pump coronary artery bypass grafting was introduced as an effective and safe alternative. However, the comparison between these two procedures has yielded ambiguous results. The aim of our study was to determine the differences in myocardial damage and the intensity of the inflammatory response by measuring concentrations of troponin, cardiac isoenzyme of creatine kinase, leukocytes, and C-reactive protein at multiple time points within the first 24 hours postoperatively.

METHODS: This single-center, prospective study involved 61 patients diagnosed with coronary artery disease and divided into two groups based on the type of surgery performed.

RESULTS: Our results indicated that coronary artery bypass grafting with extracorporeal circulation is associated with greater myocardial damage, as evidenced by higher levels of troponin and cardiac isoenzyme of creatine kinase. Additionally, extracorporeal circulation was linked to a more pronounced increase in leukocyte count postoperatively. Unexpectedly, C-reactive protein levels were higher in the off-pump coronary artery bypass grafting group. There were no significant differences in hospital stay or in-hospital mortality between the two groups.

CONCLUSION: Further research is necessary to clarify these controversies regarding the differences in systemic inflammatory responses between the two surgical approaches.

DOI: 10.21470/1678-9741-2024-0152

PMCID: PMC12661970

PMID: 41259214 [Indexed for MEDLINE]
 

45. Health Sci Rep. 2025 Nov 17;8(11):e71501. doi: 10.1002/hsr2.71501. eCollection 2025 Nov.

 COVID-19 Waves and Cardiac Health: An Investigative Analysis of Creatine Phosphokinase Levels and Troponin Status Using Machine Learning.

 Shahpar A(1), Zeinali Nezhad N(2), Farsiu N(1), Charostad M(3), Rezaei M(4), Salajegheh F(5), Pardeshenas M(6), Khoshnazar SM(1), Nakhaie M(7)(8).

 Author information:

(1)Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences Kerman University of Medical Sciences Kerman Iran.

(2)Physiology Research Center Kerman University of Medical Sciences Kerman Iran.

(3)Department of Biology, Faculty of Science Yazd University Yazd Iran.

(4)Research Center for Hydatid Disease in Iran Kerman University of Medical Sciences Kerman Iran.

(5)Research Center of Tropical and Infectious Diseases Kerman University of Medical Sciences Kerman Iran.

(6)Department of Microbiology, School of Medicine Kerman University of Medical Sciences Kerman Iran.

(7)Student Research Committee Kerman University of Medical Sciences Kerman Iran.

(8)Clinical Research Development Unit, Afzalipour Hospital Kerman University of Medical Sciences Kerman Iran.

 
BACKGROUND: This study explores the correlation between creatine phosphokinase (CPK) levels and cardiac troponin status with eight waves of COVID-19 and identifies the most significant biomarker for assessing disease severity.

METHODS: Participants were selected based on confirmed COVID-19 diagnoses using RT-PCR testing. Machine learning modeling with the PyCaret autoML library established a benchmark for classification models using variables such as age, gender, serum troponin, CPK, and COVID-19 waves. Rigorous evaluation metrics were employed to assess model performance.

RESULTS: The analysis included 1975 COVID-19 patients. Patient demographics showed a shift in age and gender distribution across different waves, with later waves characterized by younger patients and a greater proportion of females.
Mortality rates varied, peaking at 34.5% in the third wave and dropping to 0% in the eighth wave. CPK levels differed significantly among waves, with the third wave having the highest levels and later waves showing the lowest levels. However, troponin positivity rates did not differ significantly among waves. An extra trees classifier model achieved an overall accuracy, micro-average area under curve (AUC), sensitivity, and specificity of 0.79, 0.65, 0.79, and 0.89, respectively. CPK was identified as the most important predictor of patient outcome, followed by COVID-19 wave, age, and gender, while troponin status had the least importance.

CONCLUSION: These findings shed light on the potential relationship between CPK, troponin, and different waves of COVID-19 and their impact on disease severity. This understanding could significantly contribute to future research and clinical practices, aiding in the management and mitigation of COVID-19's cardiac implications.

DOI: 10.1002/hsr2.71501

PMCID: PMC12620659

PMID: 41255380

46. Intern Emerg Med. 2025 Nov 18. doi: 10.1007/s11739-025-04197-7. 

 Troponin predicts mortality in heart failure-related cardiogenic shock.

 Beer BN(1)(2)(3), Sundermeyer J(4)(5), Besch L(4)(5), Dettling A(4)(5), Kriz M(4), Kirchhof P(4)(5)(6), Blankenberg S(4)(5)(7), Bertoldi L(8), Dauw J(9), Westenfeld R(10), Horn P(10), Kelham M(11), Luedike P(12), Luesebrink E(13), Orban M(13), Scherer C(13), Mangner N(14), Morici N(15), Villanova L(16), Sramko M(17), Pazdernik M(17), Proudfoot A(18), Schwinger RHG(19), Wechsler A(19), Pauschinger M(20), Eckner D(20), Graf T(5)(21), Maniuc O(22), Nordbeck P(22), Moebius-Winkler S(23), Skurk C(24)(25), Thiele H(26), Westermann D(27), Schrage B(4)(5). 

Author information:

(1)Department of Cardiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. b.beer@uke.de.

(2)German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Germany. b.beer@uke.de.

(3)Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. b.beer@uke.de.

(4)Department of Cardiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.

(5)German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Germany.

(6)Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.

(7)Center for Population Health Innovation (POINT), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

(8)Cardio Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.

(9)Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium.

(10)Department of Cardiology, Pneumology and Angiology, Duesseldorf University Hospital, Duesseldorf, Germany.

(11)Barts Heart Centre, North Middlesex University Hospital NHS Trust, London,UK.

(12)Department of Cardiology and Angiology, University Hospital Essen, Essen, Germany.

(13)Department of Medicine I, University Hospital, LMU Munich, Munich, Germany.

(14)Department of Internal Medicine and Cardiology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany.

(15)IRCCS S. Maria Nascente - Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.

(16)ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.

(17)Department of Cardiology, IKEM, Prague, Czech Republic.

(18)Department of Perioperative Medicine, Barts Heart Centre, St. Bartholomew's Hospital, London, UK.

(19)Department of Internal Medicine II, Klinikum Weiden, Weiden, Germany.

(20)Department of Internal Medicine 8, Cardiology, Klinikum Nuremberg, Nuremberg, Germany.

(21)University Heart Center Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany.

(22)Department of Internal Medicine I, University Hospital Wuerzburg, Würzburg,Germany.

(23)Department of Internal Medicine I, University Hospital Jena, Jena, Germany.

(24)Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum Der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany.

(25)German Centre for Cardiovascular Research (DZHK), Partner Site, Berlin,Germany.

(26)Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany.

(27)Department of Cardiology and Angiology I, University Heart Center Freiburg, Bad Krozingen, Germany. 

BACKGROUND: In patients with cardiogenic shock (CS), predicting risk of mortality may improve treatment allocation beyond intensive care admission and thereby outcomes. Troponin appears to be a suitable biomarker but has primarily been evaluated in the setting of infarct-related CS, not in heart failure-related CS (HF-CS), which accounts for almost 50% of cases.

OBJECTIVES: To assess the association of Troponin T with shock severity and mortality in HF-CS patients.

METHODS: Heart failure-related CS patients treated in 15 tertiary care centres (5 European countries, 2016-2021) were retrospectively enrolled (NCT03313687).
Association of baseline high-sensitive Troponin T and its 24-h kinetics with shock severity according to the SCAI classification and with in-hospital mortality was assessed by fitting multivariable adjusted regression models.

RESULTS: N=477 patients (mean age 62 years, 30.2% women). High-sensitive Troponin T at baseline (median 164 ng/l) was significantly associated with  n-hospital mortality (HR 1.008, 95%CI 1.002-1.013, p<0.01). Increasing Troponin within 24 h from baseline indicated a 2.4-fold higher risk of death vs. decreasing Troponin levels (2.439, 95% CI 1.070-5.558, p=0.03). In addition, higher Troponin T levels correlate with higher SCAI stages (e.g., baseline Troponin T per 250 ng/l increase: OR 5.268, 95%CI: 1.637, 16.953, p<0.01 for SCAI stage D vs. C).

CONCLUSIONS: Troponin T, a marker of myocardial injury, associates with shock severity in patients with heart failure-related CS. It predicts mortality both with its baseline value as well as with its 24-h kinetics. Thus, Troponin may be a suitable marker to guide therapy or clinical trial enrolment in these patients.

DOI: 10.1007/s11739-025-04197-7

PMID: 41254464

47. Braz J Anesthesiol. 2025 Nov 15;76(1):844712. doi: 10.1016/j.bjane.2025.844712.

 Association between troponin and NT-proBNP levels, cytokines, and clinical outcomes in early sepsis response: a cohort study.

 Nedel W(1), Portela LV(2).

Author information:

(1)Grupo Hospitalar Conceiso, Unidade de Terapia Intensiva, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil.

(2)Universidade Federal do Rio Grande do Sul, Instituto de Ciências Básicas da Saúde, Laboratório de Neurotrauma e Biomarcadores, Porto Alegre, RS, Brazil.

 DOI: 10.1016/j.bjane.2025.844712

PMID: 41248828
 

48. JRSM Cardiovasc Dis. 2025 Nov 14;14:20480040251396246. doi:

10.1177/20480040251396246. eCollection 2025 Jan-Dec.

 Troponin at presentation: A key predictor of chronic myocardial impairment post-myocarditis-A prospective cohort study.

 Ayyad O(1), Goland S(1), Abu Hamdeh N(1), Haim A(1), Cohen R(2), Kirzhner A(3)(4)(5), Schiller T(4)(5), Sinnokrot Z(5), Besharieh F(1), Abu Teer M(1), Abu Khaled M(1), Sella G(1), Najajra D(1), Abu Slemy L(1), Alnees M(1)(6), Abu Khadija H(1).

 Author information:

(1)Heart Center, Kaplan Medical Center, affiliated with the Hebrew University, Rehovot, Jerusalem, Israel.

(2)Department of Internal Medicine B, Kaplan Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Rehovot, Israel.

(3)Department of Internal Medicine A, Kaplan Medical Center, Rehovot, Israel.

(4)Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.

(5)Department of Diabetes, Endocrinology and Metabolism, Kaplan Medical Center, Rehovot, Israel.

(6)Harvard Medical School, Postgraduate Medical Education, Global Clinical Scholars Research Training Program, Boston, USA.

 
OBJECTIVES: Myocarditis may lead to persistent myocardial impairment. We evaluated whether admission troponin I and inflammatory biomarkers predict one-year myocardial impairment using global longitudinal strain (GLS) as the reference outcome.

DESIGN: Prospective, single-center cohort study (2013-2023); approved by the Kaplan Medical Center Institutional Review Board (KMC-10-0068).

SETTING: Kaplan Medical Center, Israel.

PARTICIPANTS: A total of 115 patients were admitted with myocarditis, defined by ESC criteria.

MAIN OUTCOME MEASURES: Admission biomarkers included troponin I (pg/mL), white blood cells (WBC;109/L), C-reactive protein (CRP; mg/L), and erythrocyte sedimentation rate (ESR; mm/h). One-year myocardial function was assessed by speckle-tracking echocardiography. Impairment was defined as GLS>-19.5%.Predictive performance was evaluated with Firth logistic regression and ROC analysis.

RESULTS: Myocardial impairment occurred in 22.6% (26/115). Median troponin I was higher in impaired versus non-impaired patients (11,517 vs 5918 pg/mL; p<0.001). WBC was elevated (12.79 vs 9.90—109/L; p<0.001), with higher CRP (11.44 vs 9.05 mg/L; p=0.031) and ESR (36 vs 21mm/h; p=0.04). In multivariable models, troponin I (coefficient 0.000526; p<0.001), WBC (0.273; p=0.001), CRP (0.065; p=0.031), and LV E/E' lateral (0.347; p=0.009) remained independent predictors, while ESR trended (0.0178; p=0.057). Discrimination was strongest for troponin I (AUC 0.930, 95% CI 0.726-0.933), followed by WBC (0.756), CRP (0.756), and ESR (0.723).

CONCLUSIONS: Admission troponin I provides the strongest predictive value for one-year myocardial impairment in myocarditis, with complementary contributions from WBC, CRP, and LV E/E'. These accessible measures support early risk stratification where advanced imaging is limited. 

DOI: 10.1177/20480040251396246

PMCID: PMC12618808

PMID: 41245593

Conflict of interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
 

49. Arch Cardiovasc Dis. 2025 Oct 25:S1875-2136(25)00796-X. doi: 10.1016/j.acvd.2025.07.013. Online ahead of print.

 Predictive value of troponin T for short-term outcomes in patients with infective endocarditis.

 Che S(1), Li J(1), Lu J(1), Wu D(1), Xie Q(1), Yang J(1), Wei X(2), Yu D(3).

 Author information:

(1)Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 510080 Guangzhou, China.

(2)Department of Geriatric Intensive Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, 510080 Guangzhou, China. Electronic address: weixuebiao@163.com.

(3)Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 510080 Guangzhou, China.

 BACKGROUND: Elevated cardiac troponin T (cTnT) is a reliable biomarker of myocardial injury, but few studies have linked it to infective endocarditis (IE).

AIMS: To evaluate the prognostic value of cTnT in patients with IE.

METHODS: Consecutive patients with definite IE who met the inclusion criteria were included and divided into three groups based on the tertiles of cTnT at admission. Univariate and multivariable analyses were used to assess the value of cTnT in predicting the short-term prognosis of patients with IE.

RESULTS: A total of 1095 patients with definite IE were included, 368 with cTnT<12pg/mL, 362 with cTnT 12-42pg/mL and 365 with cTnT>42pg/mL. In-hospital and 6-month mortality were 6.8% and 9.8%, respectively. Patients with higher cTnT levels exhibited higher in-hospital mortality (0.3% vs 6.6% vs 13.7% across increasing cTnT tertiles; P<0.001). Multivariable logistic analysis indicated that log-transformed cTnT constituted an independent predictor of in-hospital mortality (adjusted odds ratio [OR] 2.780, 95% confidence interval [CI] 1.845-4.189; P<0.001). Receiver operating characteristic curve analysis indicated that the optimal cTnT cut-off was 22pg/mL (area under the curve 0.759, 95% CI 0.716-0.803; P<0.001). Kaplan-Meier analysis revealed that patients with cTnT>22pg/mL had a higher 6-month mortality than those with cTnT ≤22pg/mL (log-rank=68.5; P<0.001). In the multivariable Cox model, cTnT>22pg/mL remained an independent predictor of 6-month mortality (adjusted hazard ratio [HR] 5.032, 95% CI 2.745-9.225; P<0.001).

CONCLUSIONS: Elevated cTnT is associated with poorer short-term prognosis in patients with IE, suggesting its potential value as a prognostic biomarker for risk stratification in this population. 

DOI: 10.1016/j.acvd.2025.07.013

PMID: 41241610

 Conflict of interest statement: Disclosure of interest None.

50. Clin Biochem. 2025 Nov 13:111055. doi: 10.1016/j.clinbiochem.2025.111055. 

 Change in cardiac troponin T to differentiate acute from chronic myocardial injury in the Emergency Department.

 Lindahl B(1), Thurston AJ(2), Tew YY(2), McDermott M(2), Fujisawa T(2), Lynch S(3), Cooper JG(4), Gray AJ(5), Jernberg T(6), Mills NL(7); POC-ET investigators.

 Author information:

(1)Department of Medical Sciences, Uppsala University, Uppsala, Sweden.

(2)BHF Centre for Cardiovascular Science, University of Edinburgh, UK.

(3)St. John's Hospital, Livingston, UK.

(4)Aberdeen Royal Infirmary, Aberdeen, UK.

(5)Royal Infirmary of Edinburgh, Edinburgh, UK.

(6)Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.

(7)BHF Centre for Cardiovascular Science, University of Edinburgh, UK.

 INTRODUCTION: Persistently elevated cardiac troponin (cTn) values are observed  in many patients with suspected acute coronary syndrome (ACS) in the absence of  myocardial infarction and may reflect underlying cardiac disease. Chronic myocardial injury is defined where cTn values are elevated and vary by 20% on sequential measurements. We aimed to evaluate whether these criteria are reliable over short intervals applied in accelerated diagnostic pathways.

METHODS: In a secondary analysis of a prospective, multi-centre cohort study of patients with suspected ACS, cTnT was measured at presentation, 1, 2 and 6-36 h, and the final diagnosis adjudicated according to the Fourth Universal Definition of Myocardial Infarction. Two criteria for chronic myocardial injury were compared: a relative change in cTn 20% and an absolute change <3 ng/L, and the findings externally validated.

RESULTS: At presentation cTnT was elevated in 242 of 1,000 (25 %) patients (73 years, 42 % female), of whom 94/242 (39%), 13/242 (5%) and 137/242 (56%) had myocardial infarction, acute or chronic myocardial injury, respectively. A relative change of 20% misclassified 58 % (59/101) and 49 % (48/98) of patients with a final diagnosis of acute myocardial injury or infarction at 1 and 2, respectively, whereas an absolute change of <3 ng/L misclassified 22% (22/101) and 15% (15/98). In the validation cohort (n=621), the relative and absolute change criteria at one hour misclassified 43 % (13/30) and 17 % (5/30) of those with myocardial infarction.

CONCLUSIONS: Chronic myocardial injury cannot reliably be differentiated from acute myocardial injury or infarction by recommended criteria over short remeasurement intervals in the Emergency Department. Longer intervals between sampling and absolute rather than relative criteria may reduce the risk of misclassification. 

DOI: 10.1016/j.clinbiochem.2025.111055

PMID: 41241321