Ásthildur Árnadóttir1, Sune Pedersen1, Rasmus Bo Hasselbalch1, Jens P Goetze2, Lennart J Friis-Hansen3, Anna-Marie Bloch-Münster4, Jan Skov Jensen1, Henning Bundgaard5, Kasper Iversen1. 1. Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark (A.A., S.P., R.B.H., J.S.J., K.I.). 2. Department of Clinical Biochemistry (J.P.G.), Rigshospitalet, Copenhagen, Denmark. 3. Department of Clinical Biochemistry, Nordsjællands Hospital, Hillerød, Denmark (L.J.F.-H.). 4. Department of Clinical Biochemistry, Sydvestjysk Syghus, Esbjerg, Denmark (A.-M.B.-M.). 5. Department of Cardiology (H.B.), Rigshospitalet, Copenhagen, Denmark.
Abstract
BACKGROUND: Cardiac troponins (cTns) are the cornerstone of diagnosing acute myocardial infarction. There is limited knowledge on the duration of ischemia necessary to induce a measurable release of cTns or the very-early-release kinetics of cTns after an ischemic event. Copeptin may have a supplementary role in ruling out myocardial infarction early. We investigated the release of cTns and copeptin in the first hours after experimental balloon-induced ischemia in humans. METHODS: Thirty-four patients (median age, 60 years [interquartile range, 51-64]; 15 men, 43%) with angiographically normal coronary arteries were randomly assigned into 4 groups with different durations of induced myocardial ischemia (0, 30, 60, 90 s). Ischemia was induced by inflating a balloon in the left anterior descending artery between the first and second diagonal branch. Blood was collected before balloon inflation (baseline) every 15 minutes for the first 3 hours, and every 30 minutes for the next 3 hours. The cTns were analyzed by 3 high-sensitivity (hs) cTn assays: hs-cTnT (Roche), hs-cTnI (Siemens), and hs-cTnI (Abbott). Copeptin was analyzed by a sandwich immunoluminometric assay. RESULTS: None of the patients had any complications. Increased cTn concentrations were detected by all 3 assays, and the magnitude of the increase was associated with the duration of ischemia. Increased hs-cTnI (Siemens) concentrations were first detectable 15 minutes after 90-s ischemia (median 43.7% increase) and increased more steeply and had a higher peak than the other assays. Copeptin levels did not significantly change. Using the cTnT, hs-cTnI (Siemens), and hs-cTnI (Abbott) concentrations at 0 and 180 minutes, 1 (11%), 0, and 0 patients from the 60-s ischemia group and 5 (63%), 2 (25%), and 1 (11%) from the 90-s ischemia group, respectively, fulfilled criteria for a biochemical myocardial infarction. CONCLUSIONS: This study is the first to report the early-release kinetics of cTn concentrations after different durations of experimental coronary balloon occlusion in humans. All assays detected a cTn increase after only 30 s of ischemia. hs-cTnI (Siemens) rose faster and reached a higher peak. Copeptin levels did not change significantly. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03203057.
BACKGROUND: Cardiac troponins (cTns) are the cornerstone of diagnosing acute myocardial infarction. There is limited knowledge on the duration of ischemia necessary to induce a measurable release of cTns or the very-early-release kinetics of cTns after an ischemic event. Copeptin may have a supplementary role in ruling out myocardial infarction early. We investigated the release of cTns and copeptin in the first hours after experimental balloon-induced ischemia in humans. METHODS: Thirty-four patients (median age, 60 years [interquartile range, 51-64]; 15 men, 43%) with angiographically normal coronary arteries were randomly assigned into 4 groups with different durations of induced myocardial ischemia (0, 30, 60, 90 s). Ischemia was induced by inflating a balloon in the left anterior descending artery between the first and second diagonal branch. Blood was collected before balloon inflation (baseline) every 15 minutes for the first 3 hours, and every 30 minutes for the next 3 hours. The cTns were analyzed by 3 high-sensitivity (hs) cTn assays: hs-cTnT (Roche), hs-cTnI (Siemens), and hs-cTnI (Abbott). Copeptin was analyzed by a sandwich immunoluminometric assay. RESULTS: None of the patients had any complications. Increased cTn concentrations were detected by all 3 assays, and the magnitude of the increase was associated with the duration of ischemia. Increased hs-cTnI (Siemens) concentrations were first detectable 15 minutes after 90-s ischemia (median 43.7% increase) and increased more steeply and had a higher peak than the other assays. Copeptin levels did not significantly change. Using the cTnT, hs-cTnI (Siemens), and hs-cTnI (Abbott) concentrations at 0 and 180 minutes, 1 (11%), 0, and 0 patients from the 60-s ischemia group and 5 (63%), 2 (25%), and 1 (11%) from the 90-s ischemia group, respectively, fulfilled criteria for a biochemical myocardial infarction. CONCLUSIONS: This study is the first to report the early-release kinetics of cTn concentrations after different durations of experimental coronary balloon occlusion in humans. All assays detected a cTn increase after only 30 s of ischemia. hs-cTnI (Siemens) rose faster and reached a higher peak. Copeptin levels did not change significantly. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03203057.
Entities:
Keywords:
copeptins; myocardial ischemia; troponin I; troponin T
Authors: Vincent L Aengevaeren; Aaron L Baggish; Eugene H Chung; Keith George; Øyunn Kleiven; Alma M A Mingels; Stein Ørn; Rob E Shave; Paul D Thompson; Thijs M H Eijsvogels Journal: Circulation Date: 2021-12-13 Impact factor: 29.690
Authors: Ingar Ziad Restan; Ana Yufera Sanchez; Ole-Thomas Steiro; Pedro Lopez-Ayala; Hilde L Tjora; Jørund Langørgen; Torbjørn Omland; Jasper Boeddinghaus; Thomas Nestelberger; Luca Koechlin; Paul Collinson; Rune Bjørneklett; Kjell Vikenes; Heidi Strand; Øyvind Skadberg; Øistein R Mjelva; Alf Inge Larsen; Vernon V S Bonarjee; Christian Mueller; Kristin M Aakre Journal: Eur Heart J Acute Cardiovasc Care Date: 2022-03-16
Authors: Johannes Mair; Allan Jaffe; Bertil Lindahl; Nicholas Mills; Martin Möckel; Louise Cullen; Evangelos Giannitsis; Ola Hammarsten; Kurt Huber; Konstantin Krychtiuk; Christian Mueller; Kristian Thygesen Journal: Biomarkers Date: 2022-05-26 Impact factor: 2.663
Authors: Heerajnarain Bulluck; Valeria Paradies; Emanuele Barbato; Andreas Baumbach; Hans Erik Bøtker; Davide Capodanno; Raffaele De Caterina; Claudio Cavallini; Sean M Davidson; Dmitriy N Feldman; Péter Ferdinandy; Sebastiano Gili; Mariann Gyöngyösi; Vijay Kunadian; Sze-Yuan Ooi; Rosalinda Madonna; Michael Marber; Roxana Mehran; Gjin Ndrepepa; Cinzia Perrino; Stefanie Schüpke; Johanne Silvain; Joost P G Sluijter; Giuseppe Tarantini; Gabor G Toth; Linda W Van Laake; Clemens von Birgelen; Michel Zeitouni; Allan S Jaffe; Kristian Thygesen; Derek J Hausenloy Journal: Eur Heart J Date: 2021-07-15 Impact factor: 29.983