INTRODUCTION: High-sensitivity cardiac troponin assays have significantly improved the sensitivity of myocardial infarction detection by using cutoff values and early absolute changes. However, variation in repeated measures also depends on biological variability. This study aimed to assess the potential circadian component of this biological variability. METHODS: 17 healthy volunteers were recruited, and standardized conditions for physical activity, meals, exposure to light and duration of sleep were imposed. Blood samples were collected every 4 h and high-sensitivity troponin T assay with a limit of detection of 3 ng/l and a 99th percentile of 14 ng/l were used. Circadian variations were analyzed using the cosinor method. RESULTS: Statistically significant circadian variations were observed for body temperature, heart rate, and systolic/diastolic arterial blood pressures (p < 0.01 using both a non-adjusted cosinor model and a gender- and BMI-adjusted cosinor model). The amplitudes of the circadian variations were 18.93, 6, 15.35, and 1.92%, respectively. A statistically significant circadian biological variation of troponin blood concentrations was evidenced (p < 0.01 in both the non-adjusted cosinor model and the gender- and BMI-adjusted cosinor), with an amplitude of 20.5% (average: 4.39 ng/l; amplitude: 0.9 ng/l; peak at 06:00 and nadir at 18:00). DISCUSSION: This study demonstrates a circadian biological variation in blood troponin concentration in a healthy population. The amplitude of this variation challenges the cutoff value for instant rule-out of the rapid rule-in/rule-out of the recent European guidelines for the management of acute coronary syndromes. These findings deserve further investigation in a population at risk of myocardial infarction.
INTRODUCTION: High-sensitivity cardiac troponin assays have significantly improved the sensitivity of myocardial infarction detection by using cutoff values and early absolute changes. However, variation in repeated measures also depends on biological variability. This study aimed to assess the potential circadian component of this biological variability. METHODS: 17 healthy volunteers were recruited, and standardized conditions for physical activity, meals, exposure to light and duration of sleep were imposed. Blood samples were collected every 4 h and high-sensitivity troponin T assay with a limit of detection of 3 ng/l and a 99th percentile of 14 ng/l were used. Circadian variations were analyzed using the cosinor method. RESULTS: Statistically significant circadian variations were observed for body temperature, heart rate, and systolic/diastolic arterial blood pressures (p < 0.01 using both a non-adjusted cosinor model and a gender- and BMI-adjusted cosinor model). The amplitudes of the circadian variations were 18.93, 6, 15.35, and 1.92%, respectively. A statistically significant circadian biological variation of troponin blood concentrations was evidenced (p < 0.01 in both the non-adjusted cosinor model and the gender- and BMI-adjusted cosinor), with an amplitude of 20.5% (average: 4.39 ng/l; amplitude: 0.9 ng/l; peak at 06:00 and nadir at 18:00). DISCUSSION: This study demonstrates a circadian biological variation in blood troponin concentration in a healthy population. The amplitude of this variation challenges the cutoff value for instant rule-out of the rapid rule-in/rule-out of the recent European guidelines for the management of acute coronary syndromes. These findings deserve further investigation in a population at risk of myocardial infarction.
Authors: Jasper Boeddinghaus; Tobias Reichlin; Thomas Nestelberger; Raphael Twerenbold; Yvette Meili; Karin Wildi; Petra Hillinger; Maria Rubini Giménez; Janosch Cupa; Lukas Schumacher; Marie Schubera; Patrick Badertscher; Sydney Corbière; Karin Grimm; Christian Puelacher; Zaid Sabti; Dayana Flores Widmer; Nicolas Schaerli; Nikola Kozhuharov; Samyut Shrestha; Tobias Bürge; Patrick Mächler; Michael Büchi; Katharina Rentsch; Òscar Miró; Beatriz López; F Javier Martin-Sanchez; Esther Rodriguez-Adrada; Beata Morawiec; Damian Kawecki; Eva Ganovská; Jiri Parenica; Jens Lohrmann; Andreas Buser; Dagmar I Keller; Stefan Osswald; Christian Mueller Journal: Clin Res Cardiol Date: 2017-02-01 Impact factor: 5.460
Authors: Kristian Thygesen; Joseph S Alpert; Allan S Jaffe; Maarten L Simoons; Bernard R Chaitman; Harvey D White; Kristian Thygesen; Joseph S Alpert; Harvey D White; Allan S Jaffe; Hugo A Katus; Fred S Apple; Bertil Lindahl; David A Morrow; Bernard R Chaitman; Peter M Clemmensen; Per Johanson; Hanoch Hod; Richard Underwood; Jeroen J Bax; Jeroen J Bonow; Fausto Pinto; Raymond J Gibbons; Keith A Fox; Dan Atar; L Kristin Newby; Marcello Galvani; Christian W Hamm; Barry F Uretsky; Ph Gabriel Steg; William Wijns; Jean-Pierre Bassand; Phillippe Menasche; Jan Ravkilde; E Magnus Ohman; Elliott M Antman; Lars C Wallentin; Paul W Armstrong; Maarten L Simoons; James L Januzzi; Markku S Nieminen; Mihai Gheorghiade; Gerasimos Filippatos; Russell V Luepker; Stephen P Fortmann; Wayne D Rosamond; Dan Levy; David Wood; Sidney C Smith; Dayi Hu; Jose-Luis Lopez-Sendon; Rose Marie Robertson; Douglas Weaver; Michal Tendera; Alfred A Bove; Alexander N Parkhomenko; Elena J Vasilieva; Shanti Mendis; Jeroen J Bax; Helmut Baumgartner; Claudio Ceconi; Veronica Dean; Christi Deaton; Robert Fagard; Christian Funck-Brentano; David Hasdai; Arno Hoes; Paulus Kirchhof; Juhani Knuuti; Philippe Kolh; Theresa McDonagh; Cyril Moulin; Bogdan A Popescu; Zeljko Reiner; Udo Sechtem; Per Anton Sirnes; Michal Tendera; Adam Torbicki; Alec Vahanian; Stephan Windecker; Joao Morais; Carlos Aguiar; Wael Almahmeed; David O Arnar; Fabio Barili; Kenneth D Bloch; Ann F Bolger; Hans Erik Botker; Biykem Bozkurt; Raffaele Bugiardini; Christopher Cannon; James de Lemos; Franz R Eberli; Edgardo Escobar; Mark Hlatky; Stefan James; Karl B Kern; David J Moliterno; Christian Mueller; Aleksandar N Neskovic; Burkert Mathias Pieske; Steven P Schulman; Robert F Storey; Kathryn A Taubert; Pascal Vranckx; Daniel R Wagner Journal: J Am Coll Cardiol Date: 2012-09-05 Impact factor: 24.094
Authors: Fernando Friões; Patrícia Lourenço; Olga Laszczynska; Pedro-Bernardo Almeida; João-Tiago Guimarães; James L Januzzi; Ana Azevedo; Paulo Bettencourt Journal: Clin Res Cardiol Date: 2015-01-14 Impact factor: 5.460
Authors: Lieke J J Klinkenberg; Jan-Willem van Dijk; Frans E S Tan; Luc J C van Loon; Marja P van Dieijen-Visser; Steven J R Meex Journal: J Am Coll Cardiol Date: 2014-02-26 Impact factor: 24.094
Authors: M Odette Gore; Stephen L Seliger; Christopher R Defilippi; Vijay Nambi; Robert H Christenson; Ibrahim A Hashim; Ron C Hoogeveen; Colby R Ayers; Wensheng Sun; Darren K McGuire; Christie M Ballantyne; James A de Lemos Journal: J Am Coll Cardiol Date: 2014-02-12 Impact factor: 24.094
Authors: Aoife B Kilgallen; Frederieke van den Akker; Dries A M Feyen; Sandra Crnko; Christian J B Snijders Blok; Hendrik Gremmels; Bastiaan C du Pré; Robin Reijers; Pieter A Doevendans; Saskia C A de Jager; Joost P G Sluijter; Vasco Sampaio-Pinto; Linda W van Laake Journal: Front Pharmacol Date: 2022-05-25 Impact factor: 5.988
Authors: Margaret M Doyle; Terrence E Murphy; Margaret A Pisani; Henry K Yaggi; Sangchoon Jeon; Nancy S Redeker; Melissa P Knauert Journal: Comput Methods Programs Biomed Date: 2021-07-23 Impact factor: 7.027
Authors: Eslam Samaha; Audrey Avila; Mohammad A Helwani; Arbi Ben Abdallah; Allan S Jaffe; Mitchell G Scott; Peter Nagele Journal: J Am Heart Assoc Date: 2019-03-19 Impact factor: 5.501
Authors: Henning Jansen; Andrea Jaensch; Ben Schöttker; Dhayana Dallmeier; Roman Schmucker; Hermann Brenner; Wolfgang Koenig; Dietrich Rothenbacher Journal: J Am Heart Assoc Date: 2019-06-13 Impact factor: 5.501