Diurnal rhythm of cardiac troponin: Consequences for the diagnosis of acute myocardial infarction
| Autor: | Jasper Boeddinghaus, Karin Grimm, Jeroen D.E. van Suijlen, Raphael Twerenbold, Christian Puelacher, Otto Bekers, Marijke Niens, Frans E. S. Tan, Imre W. K. Kouw, Noreen van der Linden, Petra Hillinger, Joop ten Kate, Karin Wildi, Zaid Sabti, Maria Rubini Gimenez, Lieke J.J. Klinkenberg, Jean Daniel Neuhaus, Steven J.R. Meex, Judith A P Bons, Christian Mueller, Thomas Nestelberger, Marja P. van Dieijen-Visser, Luc J. C. van Loon |
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| Přispěvatelé: | MUMC+: DA CDL Algemeen (9), Promovendi NTM, RS: NUTRIM - HB/BW section A, RS: NUTRIM - R3 - Chronic inflammatory disease and wasting, RS: CAPHRI - R1 - Ageing and Long-Term Care, RS: SHE - R1 - Research (OvO), FHML Methodologie & Statistiek, MUMC+: DA CDL (5), Med Microbiol, Infect Dis & Infect Prev, RS: NUTRIM - R4 - Gene-environment interaction, Nutrition and Movement Sciences, RS: CARIM - R2.02 - Cardiomyopathy, Human Physiology and Sports Physiotherapy Research Group, Physiotherapy, Human Physiology and Anatomy |
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Evening Clinical Biochemistry Myocardial Infarction 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Troponin T Internal medicine Troponin I Medicine Humans 030212 general & internal medicine Myocardial infarction cardiovascular diseases health care economics and organizations Morning Aged business.industry Biochemistry (medical) Diurnal temperature variation medicine.disease Surgery Circadian Rhythm Acute Disease Cardiology Female Myocardial infarction diagnosis business Blood sampling |
| Zdroj: | Clinical Chemistry, 62(12), 1602-1611. American Association for Clinical Chemistry |
| ISSN: | 0009-9147 |
| Popis: | BACKGROUND Interpretation of serial high-sensitivity cardiac troponin (hs-cTn) measurements for the diagnosis of acute myocardial infarction (AMI) assumes random fluctuation of hs-cTn around an individual's homeostatic set point. The aim of this study was to challenge this diagnostic concept. METHODS Study 1 examined the presence of a diurnal hs-cTn rhythm by hourly blood sampling, day and night, in 24 individuals without a recent history of AMI. Study 2 assessed morning vs evening diagnostic accuracy of hs-cTnT and hs-cTnI in a prospective multicenter diagnostic study of 2782 unselected patients, presenting to the emergency department with acute chest pain. RESULTS In study 1, hs-cTnT, but not hs-cTnI, exhibited a diurnal rhythm, characterized by gradually decreasing concentrations throughout daytime, rising concentrations during nighttime, to peak concentrations in the morning (mean 16.2 ng/L at 8:30 AM and 12.1 ng/L at 7:30 PM). In study 2, the hs-cTnT rhythm was confirmed by higher hs-cTnT concentrations in early-morning presenters compared to evening presenters with an adjudicated diagnosis of noncardiac disease. The diagnostic accuracy [area under the receiver-operation characteristics curve (AUC)] of hs-cTnT at presentation, 1 h, and for the combination of absolute changes with presenting concentration, were very high and comparable among patients presenting early morning as compared to evening (all AUC >0.93). hs-cTnI exhibited no diurnal rhythm with no differences in AUC among early-morning and evening presenters. CONCLUSIONS Rhythmic diurnal variation of hs-cTnT is a general phenomenon that is not seen with hs-cTnI. While the diurnal hs-cTnT rhythm does not seem to affect the diagnostic accuracy of hs-cTnT for AMI, it should be considered when using hs-cTnT for screening purposes. Clinical Trial Registration 1. Circadian Variation of Cardiac Troponin, NCT02091427, www.clinicaltrials.gov/ct2/show/NCT02091427. 2. Advantageous Predictors of Acute Coronary Syndrome Evaluation (APACE) Study, NCT00470587, www.clinicaltrials.gov/ct2/show/NCT00470587. |
| Databáze: | OpenAIRE |
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