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Background and Objectives: Pulmonary embolism (PE) incidence has been increasing in the last 10 years. Computed thoracic pulmonary angiography (CTPA) had a major role in PE diagnosis and prognosis. The main purpose of this study was as follows: the prognostic value of a CTPA parameter, pulmonary artery obstruction index (PAOI), in PE risk assessment and the predictive accuracy of biomarkers, D-dimer and cardiac Troponin T (c-TnT), in 7-day mortality. A second objective of the research was to investigate the relationship between imaging by PAOI and these biomarkers in different etiologies of PE. Materials and Methods: This study comprised 109 patients with PE, hospitalized and treated between February 2021 and August 2022. They had different etiologies of PE: deep vein thrombosis (DVT); persistent atrial fibrillation (AF); chronic obstructive pulmonary disease (COPD) exacerbation; COVID-19; and cancers. The investigations were as follows: clinical examination; D-dimer testing, as a mandatory method for PE suspicion (values ≥500 µg/L were highly suggestive for PE); c-TnT, as a marker of myocardial injury (values ≥14 ng/L were abnormal); CTPA, with right ventricle dysfunction (RVD) signs and PAOI. Treatments were according to PE risk: systemic thrombolysis in high-risk PE; low weight molecular heparins (LWMH) in high-risk PE, after systemic thrombolysis or from the beginning, when systemic thrombolysis was contraindicated; and direct oral anticoagulants (DOAC) in low- and intermediate-risk PE. Results: PAOI had a high predictive accuracy for high-risk PE (area under curve, AUC = 0.993). D-dimer and cTnT had a statistically significant relationship with 7-day mortality for the entire sample, p < 0.001, and for AF, p = 0.0036; COVID-19, p = 0.003; and cancer patients, p = 0.005. PAOI had statistical significance for 7-day mortality only in COVID-19, p = 0.045, and cancer patients, p = 0.038. The relationship PAOI–D-dimer and PAOI–c-TnT had very strong statistical correlation for the entire sample and for DVT, AF, COPD, and COVID-19 subgroups (Rho = 0.815–0.982). Conclusions: PAOI was an important tool for PE risk assessment. D-dimer and c-TnT were valuable predictors for 7-day mortality in PE. PAOI (imaging parameter for PE extent) and D-dimer (biomarker for PE severity) as well as PAOI and c-TnT (biomarker for myocardial injury) were strongly correlated for the entire PE sample and for DVT, AF, COPD, and COVID-19 patients. [ABSTRACT FROM AUTHOR]

The sensitivity of cardiac troponin testing for diagnosing acute myocardial infarction （AMI） varies over time from chest pain onset. This study aimed to determine the diagnostic performance of point-of-care testing cardiac troponin T （POCT-cTnT） at different time intervals post-symptom onset to refine rapid rule-out approaches for AMI. Methods This retrospective study included 6，024 patients presenting with chest pain from January 2018 to December 2022. POCT-cTnT and central lab cTnI levels were measured on admission. Receiver operating characteristics analysis stratified by time windows assessed the accuracy of POCT-cTnT for diagnosing AMI. Results The overall AUC of POCT-cTnT for diagnosing AMI was 0.826 （95% CI:0.816 ~ 0.836）， with a sensitivity of 72.81% and a specificity of 86.26%. According to the time intervals of chest pain onset （< 3 hours， 3 ~ 6 hours， 6 ~ 12 hours， 12 ~ 24 hours， 24 ~ 72 hours， and ≥ 72 hours）， the AUC values for groups after 6 ~ 12 hours were 0.918， 0.928， 0.920 and 0.908， respectively， with no statistically significant difference （P > 0.05）， but all were higher than the groups within 6 hours （P < 0.001）. According to the time of chest pain onset， the AUC for the ≥8h group was 0.921， with a negative predictive value （NPV） of 98.1% and a negative likelihood ratio （-LR） of 0.11. Its AUC was higher than those of the ≥ 3 h， ≥ 2 h， ≥ 1 h， and overall groups （P < 0.05）， but there was no statistically significant difference compared with the groups after ≥ 4 h（ P > 0.05）. Conclusions Chest pain onset time has a certain impact on the performance of a single POCT-cTnT test for diagnosing AMI. The duration from chest pain onset to hospital admission combined with POCT-cTnT test may improve the reliability in diagnosing AMI. Specifically， a single POCT-cTnT test at four hours after chest pain onset， especially eight hours after chest pain onset， can diagnose or exclude AMI. [ABSTRACT FROM AUTHOR]

Measurement of cardiac troponin in serum is an essential part of diagnosing myocardial infarction in the emergency department. The guidelines suggest that high-sensitivity techniques should be used for measuring cardiac troponin I (cTnI) or cardiac troponin T (cTnT). The aim of our study was to correlate the values of both troponins, and to ascertain which type of troponin is more in agreement with the diagnosis. The patients were classified into four groups: 43 patients in non-ST-elevation myocardial infarction (NSTEMI), 7 in ST-elevation myocardial infarction (STEMI), 48 in Type 2 myocardial infarction, and 21 in the control group. A significant correlation between cTnI and cTnT was found in the NSTEMI (r = 0.70) and Type 2 (r = 0.75) groups while in the control group there was no association (r = −0.06). The ratios of cTnI and cTnT relative to their cut-off values were lower in Type 2 myocardial infarction compared to NSTEMI. This difference can be attributed to the pathophysiology of these two types of heart conditions. The ratio in the NSTEMI group was higher in female than in male patients (53.3 vs. 24.6 ng/L); the same difference was found for the ratio of cTnT (20.8 vs. 13.1 ng/L). In the same manner, the ratios in the Type 2 group were higher in female than in male patients for cTnI (25.6 vs. 12.7 ng/L) as well as for cTnT (19.0 vs. 6.73 ng/L). These differences could be due to biological differences, but they could also be influenced by other factors contributing to different damage responses. [ABSTRACT FROM AUTHOR]

Background: It has recently been shown that cardiac-specific troponin I concentrations in first morning urine samples can be measured with commercially available tests. Due to their accumulation in the first morning urine, scientific papers indicate a potential predictive value for cardiovascular diseases. Therefore, the aim of this study was to compare the concentration of cardiac troponin I in the first morning urine in patients with severe aortic stenosis and the healthy population. Patients and Methods: Blood and first morning urine samples were collected from 34 healthy individuals (17 female) at University Hospital Merkur and 25 patients with severe aortic stenosis (14 female) before surgical treatment at University Hospital Dubrava. Cardiac troponin I and T values were determined using high-sensitivity assays using commercially available Abbott and Roche tests. Results: Patients with severe aortic stenosis had significantly lower troponin I concentrations in the first morning urine samples (0.3 ng/L (0.1–0.6)) as compared to the healthy population (15.2 ng/L (8.4–19.9)) (p < 0.001). There was no statistically significant difference in troponin T concentrations between healthy individuals and patients with severe aortic stenosis. In parallel, both I and T plasma troponin concentrations were significantly higher in patients with severe aortic stenosis. Conclusions: In patients with severe aortic stenosis, cardiac troponin I values in the first morning urine are significantly lower than in healthy subjects. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of cardiovascular involvement, which is among the leading causes of morbidity and mortality worldwide. Echocardiography (ECHO) could be a reliable, non-invasive tool for predicting the risk of cardiovascular modalities in patients with COPD. Combining the ECHO parameters with highly selective cardiac troponin could predict the severity and outcome of patients with COPD. Methods: This prospective observational study was conducted at a tertiary care hospital in South India. All patients who met the criteria were included. Patients with other concomitant chronic lung diseases were excluded. An echocardiographic examination was performed, and blood samples for hs-Tnt were taken on admission for patients admitted with COPD. Categorical variables were analyzed using Pearson's Chi-square test, and the T-test was used to compare the means. One-way analysis of variance (ANOVA) followed by the Bonferroni multiple comparison tests was done to compare different echo parameters concerning COPD severity. Results: The mean tricuspid annulus plane systolic excursion (TAPSE) and right ventricle (RV) fraction area change (FAC) values were lower with the increase in the disease severity (P < 0.001). There was a significant increase in the mean systolic pressures in the right atrium and ventricle in patients with severe COPD (P < 0.001). The mean hs-TnT values were significantly higher in patients with severe COPD (18.86 ± 18.12) and correlated well with the increase in the severity of the disease (P < 0.001). Changes in the echo parameters, such as mean TAPSE and RV FAC values, negatively correlated with COPD severity. There was an increase in systolic pressure in both atria and ventricles with the progression of COPD. Troponin helped predict mortality during hospitalization. Conclusion: Comprehensive echocardiographic parameters, such as TAPSE and RV FAC, help assess the disease's severity, predict mortality, and evaluate whether the proper ventricular function is reliable. Troponin is a valuable adjunct that is an independent and strong predictor of overall mortality in patients with COPD. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of cardiovascular involvement, which is among the leading causes of morbidity and mortality worldwide. Echocardiography (ECHO) could be a reliable, non-invasive tool for predicting the risk of cardiovascular modalities in patients with COPD. Combining the ECHO parameters with highly selective cardiac troponin could predict the severity and outcome of patients with COPD. Methods: This prospective observational study was conducted at a tertiary care hospital in South India. All patients who met the criteria were included. Patients with other concomitant chronic lung diseases were excluded. An echocardiographic examination was performed, and blood samples for hs-Tnt were taken on admission for patients admitted with COPD. Categorical variables were analyzed using Pearson’s Chi-square test, and the T-test was used to compare the means. One-way analysis of variance (ANOVA) followed by the Bonferroni multiple comparison tests was done to compare different echo parameters concerning COPD severity. Results: The mean tricuspid annulus plane systolic excursion (TAPSE) and right ventricle (RV) fraction area change (FAC) values were lower with the increase in the disease severity (P < 0.001). There was a significant increase in the mean systolic pressures in the right atrium and ventricle in patients with severe COPD (P < 0.001). The mean hs-TnT values were significantly higher in patients with severe COPD (18.86 ± 18.12) and correlated well with the increase in the severity of the disease (P < 0.001). Changes in the echo parameters, such as mean TAPSE and RV FAC values, negatively correlated with COPD severity. There was an increase in systolic pressure in both atria and ventricles with the progression of COPD. Troponin helped predict mortality during hospitalization. Conclusion: Comprehensive echocardiographic parameters, such as TAPSE and RV FAC, help assess the disease’s severity, predict mortality, and evaluate whether the proper ventricular function is reliable. Troponin is a valuable adjunct that is an independent and strong predictor of overall mortality in patients with COPD.

Liang Deng, Xiaojun Liu, Wei Liu Departmental of Pediatric Intensive Care Unit, The First Affiliated Hospital of Shaoyang University, Shaoyang city, Hunan Province, 422000, People’s Republic of ChinaCorrespondence: Liang Deng, Department of Pediatric intensive care unit, The First Affiliated Hospital of Shaoyang University, 39 Tongheng Street, Shuangqing District, Shaoyang city, Hunan Province, People’s Republic of China, Email Syliangdd28@126.comObjective: To explore the application of serum cardiac troponin T (cTnT), brain natriuretic peptide (BNP) levels, and electrocardiogram changes in the treatment and prognosis evaluation of severe pneumonia in children.Methods: 120 children with severe pneumonia (severe group) admitted to our hospital from June 2020 to December 2022 were selected as the study subjects with prospective study. They were divided into survival group (n=78) and death group (n=42) based on their survival status; 120 children with mild pneumonia were selected as the control group. Compare the levels of serum cTnT and BNP, as well as the changes in electrocardiogram, to analyze their predictive value for the prognosis of pediatric patients and the influencing factors of prognosis.Results: The proportion of children with cTnT, BNP, and abnormal electrocardiogram after treatment was lower than before treatment (P< 0.05). The proportion of children with cTnT, BNP, and abnormal electrocardiogram in the severe group was higher than that in the mild group (P< 0.05). The proportion of children with serum cTnT, BNP levels, and abnormal electrocardiogram in the death group after treatment was higher than that in the survival group (P< 0.05). Bundle branch block, low or inverted T waves, cTnT, and BNP are prognostic factors for children with severe pneumonia (P< 0.05). The combined prediction of serum cTnT and BNP for the prognosis of severe pneumonia in children is better than that of single prediction (Z combined detection - cTnT=2.474, Z combined detection - BNP=2.494, P=0.013, 0.013).Conclusion: The proportion of abnormal cTnT, BNP, and electrocardiogram is increased in patients with severe pneumonia, and those with high expression and abnormalities have poor prognosis. cTnT and BNP have high predictive value for the prognosis of children with severe pneumonia.Keywords: cardiac troponin T, brain natriuretic peptide, severe pneumonia, changes in electrocardiogram, prognosis

To evaluate the analytical characteristics of a novel high-sensitivity cardiac troponin T (hs-cTnT) test on the automatic light-initiated chemiluminescent assay (LiCA®) system, and validated its diagnostic performance for non-ST-segment elevation myocardial infarction (NSTEMI). Studies included an extensive analytical evaluation and established the 99th percentile upper reference limit (URL) from apparently healthy individuals, followed by a diagnostic performance validation for NSTEMI. Sex-specific 99th percentile URLs were 16.0 ng/L (1.7 % CV: coefficient of variation) for men (21–92 years) and 13.4 ng/L (2.0 % CV) for women (23–87 years) in serum, and 30.6 ng/L (0.9 % CV) for men (18–87 years) and 20.2 ng/L (1.4 % CV) for women (18–88 years) in heparin plasma. Detection rates in healthy individuals ranged from 98.9 to 100 %. An excellent agreement was identified between LiCA® and Elecsys® assays with a correlation coefficient of 0.993 and mean bias of −0.7 % (−1.8–0.4 %) across the full measuring range, while the correlation coefficient and overall bias were 0.967 and −1.1 % (−2.5–0.3 %) for the lower levels of cTnT (10–100 ng/L), respectively. At the specific medical decision levels (14.0 and 52.0 ng/L), assay difference was estimated to be <5.0 %. No significant difference was found between these two assays in terms of area under curve (AUC), sensitivity and specificity, negative predictive value (NPV) and positive predictive value (PPV) for the diagnosis of NSTEMI. LiCA® hs-cTnT is a reliable 3rd-generation (level 4) high-sensitivity assay for detecting cardiac troponin T. The assay is acceptable for practical use in the diagnosis of NSTEMI. [ABSTRACT FROM AUTHOR]

Chronic myocardial injury (CMI) is defined as stable concentrations of cardiac troponin T or I (cTnT or cTnI) above the assay-specific 99th percentile upper reference limit (URL) and signals poor outcome. The clinical implications of diagnosing CMI are unclear. We aimed to assess prevalence and association of CMI with long-term prognosis using three different high-sensitivity cTn (hs-cTn) assays. A total of 1,292 hospitalized patients without acute myocardial injury had cTn concentrations quantified by hs-cTn assays by Roche Diagnostics, Abbott Diagnostics and Siemens Healthineers. The median follow-up time was 4.1 years. The prevalence of CMI and hazard ratios for mortality and cardiovascular (CV) events were calculated based on the URL provided by the manufacturers and compared to the prognostic accuracy when lower percentiles of cTn (97.5, 95 or 90), limit of detection or the estimated bioequivalent concentrations between assays were used as cutoff values. There was no major difference in prognostic accuracy between cTnT and cTnI analyzed as continuous variables. The correlation between cTnT and cTnI was high (r=0.724–0.785), but the cTnT assay diagnosed 3.9–4.5 times more patients with having CMI based on the sex-specific URLs (TnT, n=207; TnI Abbott, n=46, TnI Siemens, n=53) and had higher clinical sensitivity and AUC at the URL. The prevalence of CMI is highly assay-dependent. cTnT and cTnI have similar prognostic accuracy for mortality or CV events when measured as continuous variables. However, a CMI diagnosis according to cTnT has higher prognostic accuracy compared to a CMI diagnosis according to cTnI. [ABSTRACT FROM AUTHOR]

Abstract Background Recent advances in gene editing technology have opened up new avenues for in vivo gene therapy, which holds great promise as a potential treatment method for dilated cardiomyopathy (DCM). The CRISPR-Cas13 system has been shown to be an effective tool for knocking down RNA expression in mammalian cells. PspCas13b, a type VI-B effector that can be packed into adeno-associated viruses and improve RNA knockdown efficiency, is a potential treatment for diseases characterized by abnormal gene expression. Results Using PspCas13b, we were able to efficiently and specifically knockdown the mutant transcripts in the AC16 cell line carrying the heterozygous human TNNT2 R141W (hTNNT2 R141W ) mutation. We used adeno-associated virus vector serotype 9 to deliver PspCas13b with specific single guide RNA into the hTNNT2 R141W transgenic DCM mouse model, effectively knocking down hTNNT2 R141W transcript expression. PspCas13b-mediated knockdown significantly increased myofilament sensitivity to Ca2+, improved cardiac function, and reduced myocardial fibrosis in hTNNT2 R141W DCM mice. Conclusions These findings suggest that targeting genes through Cas13b is a promising approach for in vivo gene therapy for genetic diseases caused by aberrant gene expression. Our study provides further evidence of Cas13b’s application in genetic disease therapy and paves the way for future applicability of genetic therapies for cardiomyopathy.

Background and Objectives: Pulmonary embolism (PE) incidence has been increasing in the last 10 years. Computed thoracic pulmonary angiography (CTPA) had a major role in PE diagnosis and prognosis. The main purpose of this study was as follows: the prognostic value of a CTPA parameter, pulmonary artery obstruction index (PAOI), in PE risk assessment and the predictive accuracy of biomarkers, D-dimer and cardiac Troponin T (c-TnT), in 7-day mortality. A second objective of the research was to investigate the relationship between imaging by PAOI and these biomarkers in different etiologies of PE. Materials and Methods: This study comprised 109 patients with PE, hospitalized and treated between February 2021 and August 2022. They had different etiologies of PE: deep vein thrombosis (DVT); persistent atrial fibrillation (AF); chronic obstructive pulmonary disease (COPD) exacerbation; COVID-19; and cancers. The investigations were as follows: clinical examination; D-dimer testing, as a mandatory method for PE suspicion (values ≥500 µg/L were highly suggestive for PE); c-TnT, as a marker of myocardial injury (values ≥14 ng/L were abnormal); CTPA, with right ventricle dysfunction (RVD) signs and PAOI. Treatments were according to PE risk: systemic thrombolysis in high-risk PE; low weight molecular heparins (LWMH) in high-risk PE, after systemic thrombolysis or from the beginning, when systemic thrombolysis was contraindicated; and direct oral anticoagulants (DOAC) in low- and intermediate-risk PE. Results: PAOI had a high predictive accuracy for high-risk PE (area under curve, AUC = 0.993). D-dimer and cTnT had a statistically significant relationship with 7-day mortality for the entire sample, p < 0.001, and for AF, p = 0.0036; COVID-19, p = 0.003; and cancer patients, p = 0.005. PAOI had statistical significance for 7-day mortality only in COVID-19, p = 0.045, and cancer patients, p = 0.038. The relationship PAOI–D-dimer and PAOI–c-TnT had very strong statistical correlation for the entire sample and for DVT, AF, COPD, and COVID-19 subgroups (Rho = 0.815–0.982). Conclusions: PAOI was an important tool for PE risk assessment. D-dimer and c-TnT were valuable predictors for 7-day mortality in PE. PAOI (imaging parameter for PE extent) and D-dimer (biomarker for PE severity) as well as PAOI and c-TnT (biomarker for myocardial injury) were strongly correlated for the entire PE sample and for DVT, AF, COPD, and COVID-19 patients.

Cardiac contractions and hemodynamic forces are essential for organ development and homeostasis. Control over cardiac contractions can be achieved pharmacologically or optogenetically. However, these approaches lack specificity or require direct access to the heart. Here, we compare two genetic approaches to control cardiac contractions by modulating the levels of the essential sarcomeric protein Tnnt2a in zebrafish. We first recombine a newly generated tnnt2a floxed allele using multiple lines expressing Cre under the control of cardiomyocyte-specific promoters, and show that it does not recapitulate the tnnt2a/silent heart mutant phenotype in embryos. We show that this lack of early cardiac contraction defects is due, at least in part, to the long half-life of tnnt2a mRNA, which masks the gene deletion effects until the early larval stages. We then generate an endogenous Tnnt2a-eGFP fusion line that we use together with the zGRAD system to efficiently degrade Tnnt2a in all cardiomyocytes. Using single-cell transcriptomics, we find that Tnnt2a depletion leads to cardiac phenotypes similar to those observed in tnnt2a mutants, with a loss of blood and pericardial flow-dependent cell types. Furthermore, we achieve conditional degradation of Tnnt2a-eGFP by splitting the zGRAD protein into two fragments that, when combined with the cpFRB2-FKBP system, can be reassembled upon rapamycin treatment. Thus, this Tnnt2a degradation line enables non-invasive control of cardiac contractions with high spatial and temporal specificity and will help further understand how they shape organ development and homeostasis. [ABSTRACT FROM AUTHOR]

Background: Recent advances in gene editing technology have opened up new avenues for in vivo gene therapy, which holds great promise as a potential treatment method for dilated cardiomyopathy (DCM). The CRISPR-Cas13 system has been shown to be an effective tool for knocking down RNA expression in mammalian cells. PspCas13b, a type VI-B effector that can be packed into adeno-associated viruses and improve RNA knockdown efficiency, is a potential treatment for diseases characterized by abnormal gene expression. Results: Using PspCas13b, we were able to efficiently and specifically knockdown the mutant transcripts in the AC16 cell line carrying the heterozygous human TNNT2R141W (hTNNT2R141W) mutation. We used adeno-associated virus vector serotype 9 to deliver PspCas13b with specific single guide RNA into the hTNNT2R141W transgenic DCM mouse model, effectively knocking down hTNNT2R141W transcript expression. PspCas13b-mediated knockdown significantly increased myofilament sensitivity to Ca2+, improved cardiac function, and reduced myocardial fibrosis in hTNNT2R141W DCM mice. Conclusions: These findings suggest that targeting genes through Cas13b is a promising approach for in vivo gene therapy for genetic diseases caused by aberrant gene expression. Our study provides further evidence of Cas13b's application in genetic disease therapy and paves the way for future applicability of genetic therapies for cardiomyopathy. [ABSTRACT FROM AUTHOR]

Aim: The aim of this work was assessment of sepsis induced cardiac dysfunction (SIMD) in neonates with sepsis by 2-dimensional speckle tracking echocardiography, tissue Doppler as well as other conventional echocardiographic methods and its correlation with serum procalcitonin (PCT) and, cardiac troponin -T (cTnT). Methods: This study was prospective controlled cohort study that included 60 neonates with diagnosis of neonatal sepsis compared to 60 healthy newborns who were matching in age and sex. both groups was subjected to basic and advanced transthoracic echocardiography and some lab markers in order to assess sepsis induced cardiac dysfunction, and correlates the findings with serum procalcitonin, cardiac troponin -T. Results: Out of the enrolled 60 patients and 60 controls. Mean age of cases was 16.62±4.74 days and 14.85±5.88 days for controls. blood culture was positive in 48.3%; 65.5% was gram positive and 34.4% was gram negative, Median Procalcitonin among cases was 5.20 ng/ml compared to 0.22 among controls, median cTnT among cases was 0.27 compared to 0.03 among controls, LVGLS was -10.79±1.47 among cases vs -14.68±1.13 among controls, P value <0.001. mean EF was 46.03±6.93 among cases versus 62.58±5.69 among controls, P value <0.001, There was significant positive correlation between left ventricular global longitudinal strain (LV GLS) and PCT and cTnT levels. Conclusion. PCT is good markers of neonatal sepsis. cTnT is a good laboratory indicator for cardiac affection in neonatal sepsis. speckle tracking echocardiography is a promising tool in assessment of cardiac function PCT and cTnT were correlated with both LV and RV systolic dysfunction detected by tissue Doppler imaging (TDI) and STE, SIMD is very common comorbidity in neonatal sepsis, [ABSTRACT FROM AUTHOR]

Introduction: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) measurements are recommended in patients with acute dyspnea. We aimed to assess the prognostic merit of cTnT compared to NT-proBNP for 30-day readmission or death in patients hospitalized with acute dyspnea. Methods: We measured cTnT and NT-proBNP within 24 h in 314 patients hospitalized with acute dyspnea and adjudicated the cause of the index admission. Time to first event of readmission or death ≤30 days after hospital discharge was recorded, and cTnT and NT-proBNP measurements were compared head-to-head. Results: Patients who died (12/314) or were readmitted (71/314) within 30 days had higher cTnT concentrations (median: 32.6, Q1–Q3: 18.4–74.2 ng/L vs. median: 19.4, Q1–Q3: 8.4–36.1 ng/L; p for comparison <0.001) and NT-proBNP concentrations (median: 1,753.6, Q1–Q3: 464.2–6,862.0 ng/L vs. median 984, Q1–Q3 201–3,600 ng/L; for comparison p = 0.027) compared to patients who survived and were not readmitted. cTnT concentrations were associated with readmission or death within 30 days after discharge both in the total cohort (adjusted hazard ratio [aHR]: 1.64, 95% confidence interval [CI]: 1.30–2.05) and in patients with heart failure (HF) (aHR: 1.58, 95% CI: 1.14–2.18). In contrast, NT-proBNP concentrations were not associated with short-term events, neither in the total cohort (aHR: 1.10, 95% CI: 0.94–1.30) nor in patients with adjudicated HF (aHR: 1.06, 95% CI: 0.80–1.40). Conclusion: cTnT concentrations are associated with 30-day readmission or death in patients hospitalized with acute dyspnea, as well as in patients adjudicated HF. [ABSTRACT FROM AUTHOR]

Measurement of cardiac troponin in serum is an essential part of diagnosing myocardial infarction in the emergency department. The guidelines suggest that high-sensitivity techniques should be used for measuring cardiac troponin I (cTnI) or cardiac troponin T (cTnT). The aim of our study was to correlate the values of both troponins, and to ascertain which type of troponin is more in agreement with the diagnosis. The patients were classified into four groups: 43 patients in non-ST-elevation myocardial infarction (NSTEMI), 7 in ST-elevation myocardial infarction (STEMI), 48 in Type 2 myocardial infarction, and 21 in the control group. A significant correlation between cTnI and cTnT was found in the NSTEMI (r = 0.70) and Type 2 (r = 0.75) groups while in the control group there was no association (r = −0.06). The ratios of cTnI and cTnT relative to their cut-off values were lower in Type 2 myocardial infarction compared to NSTEMI. This difference can be attributed to the pathophysiology of these two types of heart conditions. The ratio in the NSTEMI group was higher in female than in male patients (53.3 vs. 24.6 ng/L); the same difference was found for the ratio of cTnT (20.8 vs. 13.1 ng/L). In the same manner, the ratios in the Type 2 group were higher in female than in male patients for cTnI (25.6 vs. 12.7 ng/L) as well as for cTnT (19.0 vs. 6.73 ng/L). These differences could be due to biological differences, but they could also be influenced by other factors contributing to different damage responses.

To date, hypolipidemic drugs of the statin group are among the most popular therapeutic agents used for the prevention and treatment of the most common worldwide atherosclerotic cardiovascular diseases (CVD). Therefore, considerable attention of researchers is focused on statins to study the additional effects of these drugs, which is accompanied by the discovery of new mechanisms of action and properties that should be taken into account to optimize the tactics of managing patients with CVD. In addition to the key lipid-lowering effect of statins associated with the inhibition of the ratelimiting enzyme (3-hydroxy-3-methylglutaryl-coenzyme A reductase), researchers report a variety of other properties of these drugs. Important circumstances contributing to the disclosure of new effects of statins are: improvement of research methods, and first of all, their sensitivity and specificity; the discovery of new molecules and molecular pathways that may be affected by statins. In general, the currently established numerous non-lipid effects of statin drugs can be divided into two groups: favorable and side effects, which must be taken into account when managing patients with CVD and comorbid diseases. Thanks to recent studies using modern clinical diagnostic cardiomarkers (highly sensitive cardiac troponins (CT)), molecular genetic and morphological methods, potential cardiotoxic properties of statin group drugs have been identified. Of particular concern are the data on a statininduced increase in the concentration of highly sensitive CT, which are a key and generally recognized criterion for myocardial damage. In this article we discuss possible mechanisms of increasing the concentration of CT and cardiotoxic effects when using statins.

BackgroundThe suggested threshold level of cardiac troponin T elevation after cardiac surgery is not very clear, and the values recommended by various guidelines and literature reports are quite different.MethodsIn this retrospective cohort study, we collected clinical data of patients who underwent heart surgery at Tsinghua University First Hospital between January 2015 and December 2022. Using the high-sensitivity cardiac troponin T levels (reference upper limit: 14 ng/L) measured at 1–3 days postoperation, the relationship between the cardiac troponin T level and the 30-day mortality risk was evaluated using Cox regression analysis.ResultsAmong the 3,128 patients included in this study, the types of operations mainly consisted of coronary artery bypass graft (CABG, 1,164, 37.2%), aortic valve replacement (AVR, 735, 23.5%), and other cardiac operations (1,229, 39.3%). Within 30 days postoperation, 57 patients (1.8%) died and 72 patients (2.3%) developed major vascular complications. In patients undergoing CABG or AVR, the cardiac troponin T threshold level measured within one day postoperation related to an increased 30-day mortality was determined to be 3,012 ng/L (95% CI: 1,435–3,578 ng/L), which is 218 times higher than the reference upper limit. In patients undergoing other cardiac operations, this threshold was 5,876 ng/L (95% CI: 2,458–8,119 ng/L), which is 420 times higher than the reference upper limit.ConclusionThe high-sensitivity cardiac troponin T level associated with an increased 30-day mortality risk after cardiac surgery is significantly higher than the current recommendations for defining clinically important perioperative myocardial injury.

Cardiac troponin T (cTnT) is a sensitive indicator of heart damage and an important clinical marker for acute myocardial infarction (MI). The recent development of a high-sensitivity cardiac troponin T (hs-cTnT) assay allows a more accurate diagnosis of serum cTnT level. There appears to be an association between Obstructive Sleep Apnea (OSA) and changes in serum cTnT level. However, existing research shows mixed results. Therefore, this meta-analysis was performed to evaluate the relationship between cTnT level and OSA. The Scopus, EMBASE, Web of Science, PubMed and Science Direct databases were searched without a lower time limit and until April 2020. In order to perform the meta-analysis, the heterogeneity of articles was examined using the I2 test, and subsequently a random effects model was applied. Data analysis was performed within the Comprehensive Meta-Analysis software (version 2). Six studies comprising of 1689 cases and 2171 controls were included in this meta-analysis. The odds ratio of cTnT level in patients with OSA is 1.25 (95% confidence interval: 0.97–1.61), indicating that OSA patients have 25% higher odds to develop cTnT level than people without OSA. Our study showed that OSA is associated with higher serum hs-cTnT level compared to individuals with no OSA. Given that elevated cTnT level can indicate cardiovascular disease, these individuals should be prioritized for screening, early detection and swift interventions. Further studies are needed to determine the causality of this association. [ABSTRACT FROM AUTHOR]

Left ventricular function is the best individual predictor of mortality after acute myocardial Infarction. After acute myocardial infarction (AMI), a patient’s prognosis is closely related to the extent of irreversibly damaged myocardium. The cardiac Troponin T (cTnT) has been found to have excellent sensitivity and specificity and is superior to creatine kinase–MB (CK-MB) as indicator of myocardial necrosis. The purpose of the study was to compare the QRS score with left ventricular ejection fraction, relate the score to clinical and biochemical estimates of LVEF. Material and Methods: The study was carried out in a study group of consecutive 88 patients admitted in ICCU. Serum troponin T concentration was measured between 12 - 48 hours after the onset of chest pain. Standard 12 lead electrocardiograms were recorded at a 25 mm paper speed for the patients who met the preceding entry criteria had a QRS score calculated from the discharge electrocardiogram on the basis of Q and R wave duration and R to Q and R to S amplitude ratios. Results: Mean age of the patients in present study was 52±12. Most of the patients in our study were in age group 41-60yrs (82.5%). 67% of patients had AWMI and 33% patients had IWMI, 60% patients had dyslipidaemia. There was a strong negative correlation between cTnT level and Echocardiographic LVEF. The relationships between QRS Score and the indices of LV function obtained by Echocardiography performed at the time of ICCU discharge, QRS Score was inversely correlated with LVEF. There was a negative correlation between QRS Score and LVEF. Conclusion: A strong negative correlation exists between the serum troponin T concentration and left ventricular ejection fraction following the occurrence of a first acute myocardial infarction. Therefore, using serum troponin T concentration can be an effective way to evaluate the LVEF in patients who have experienced their first myocardial infarction. [ABSTRACT FROM AUTHOR]

Introduction: Histone post-translational modification is one of the most studied factors influencing epigenetic regulation of protozoan parasite gene expression, which is mediated by histone deacetylases (KDACs) and acetyltransferases (KATs). Objective and methods: The present study investigated the role of resveratrol (RVT) as an activator of histone deacetylases in the control of various pathogenic Babesia sp. and Theileria equi in vitro, aswell as B. microti infected mice in vivo using fluorescence assay. Its role inmitigating the side effects associatedwith thewidely used antibabesial drugs diminazene aceturate (DA) and azithromycin (AZM) has also been investigated. Results: The in vitro growth of B. bovis, B. bigemina, B. divergens, B. caballi and Theileria equi (T. equi)was significantly inhibited (P < 0.05) by RVT treatments. The estimated IC50 values revealed that RVT has the greatest inhibitory effects on B. bovis growth in vitro, with an IC50 value of 29.51 ± 2.46 µM. Reverse transcription PCR assay showed that such inhibitory activity might be attributed to resveratrol's stimulatory effect on B. bovis KDAC3 (BbKADC3) as well as its inhibitory effect on BbKATS. RVT causes a significant decrease (P < 0.05) in cardiac troponin T (cTnT) levels in heart tissue of B. microtiinfected mice, thereby indicating that RVT may play a part in reducing the cardiotoxic effects of AZM. Resveratrol showed an additive effect with imidocarb dipropionate in vivo. Treatment of B. microti-infectedmice with a combined 5mg/kg RVT and 8.5mg/kg ID resulted in an 81.55% inhibition at day 10 postinoculation (peak of parasitemia). Conclusion: Our data show that RVT is a promising antibabesial pharmacological candidate with therapeutic activities that could overcome the side effects of the currently used anti-Babesia medications. [ABSTRACT FROM AUTHOR]

The International Federation of Clinical Chemistry and Laboarator Medicine (IFCC) Committee on Clinical Applications of Cardiac Bio-Markers (C-CB) has provided evidence-based educational resources to aid and improve the understanding of important analytical and clinical aspects of cardiac biomarkers. The present IFCC C-CB educational report focuses on recommendations for appropriate use, analytical performance, and gaps in clinical studies related to the use of cardiac troponin (cTn) by point of care (POC) measurement, often referred to as a point of care testing (POCT). The use of high-sensitivity (hs)-cTn POC devices in accelerated diagnostic protocols used in emergency departments or outpatient clinics investigating acute coronary syndrome has the potential for improved efficacy, reduction of length of stay and reduced costs in the health care system. POCT workflow integration includes location of the instrument, assignment of collection and testing responsibility to (non-lab) staff, instrument maintenance, in-service and recurrent training, quality control, proficiency assessments, discrepant result trapping, and troubleshooting and inventory management. [ABSTRACT FROM AUTHOR]

Abstract Background Recent literature reported the biological role of C-peptide, but this role is still controversial and unclear. The primary aim of this study was to investigate associations between C-peptide and cardiovascular biomarkers as well as events. Methods A total of 55636 participants who had a health examination from 2017 to 2021 were included. Of them, 6727 participants visited the hospital at least twice. Cardiovascular biomarkers like high-sensitivity C-reactive protein (hs-CRP) and high-sensitivity cardiac troponin T (hs-cTnT) were measured and their relationships with fasting C-peptide were evaluated for all participants. Cardiovascular events were obtained during the last visit and their associations with C-peptide were evaluated for those participants who visited the hospital at least twice. Results Among the included participants, 11.1% had a previous type 2 diabetes mellitus (T2DM). In the participants without previous T2DM, the relationships between fasting C-peptide and hs-CRP and hs-cTnT were negative if the value of fasting C-peptide was

Objective: Evaluation of the effect of 8 weeks of High-Intensity Interval Training (HIIT) on the serum level of cardiac troponin T (cTnT) in sedentary obese young men. Materials and Methods: Thirty sedentary men were randomly divided into 3 groups: the 30s HIIT training group (n=10), the 60s training group (n=10), and the control group (no exercise) (n=10). Interval training with 90 %VO2peak was done in 3 sessions for 8 weeks. cTnT was measured 5 times; pre-exercise, 4hrs, and 24hrs after the first session (4hF, 24hF), and 4hrs and 24hrs after the last training session (4hL, 24hL). ANOVA with repeated measures and Bonferroni post-hoc tests were used by SPSS 23 with a significance level of (P< 0.05). Results: The significant increase in serum levels of cTnT in the post-tests of the 60s HIIT compared to the first 24hrs and the last 24hrs (P= 0.0001). But in the 30s group it was not significant compared to the other measurements (P≥ 0/05). In the 2 training groups, serum levels of cTnT in the last 4hr post-tests of the last week were not significantly different from the 4hrs post-tests of the first week (P≥ 0.05). Conclusion: It seems that none of these activities cause heart damage sustained, and changes in cTnT levels in two 4hrs compared to the first and last 24hrs of the 60s group may be due to reversible leakage of cardiac cell membranes, and may continuous exercise will reduce this reduction.

Pulmonary embolism (PE) is a fatal condition particularly in critically ill patients. We determined the association among the cardiac troponin T (cTnT) level, acute physiologic and chronic health evaluation (APACHE III) scoring system, and in-hospital mortality in critically ill patients with acute PE. A total of 501 patients with PE were initially enrolled. According to the multivariable logistic regression model for in-hospital mortality, the odds ratio of the cTnT level and APACHE III score was 1.96 (95% confidence interval [CI] = 1.18–3.24, P = 0.008) and 1.03 (95% CI = 1.02–1.05, P < 0.001), respectively. The area under the curve (AUC) of cTnT and APACHE III score for in-hospital mortality was 0.630 (95% CI = 0.586–0.672, P = 0.03) and 0.740 (95% CI = 0.699–0.778, P = 0.02), respectively. The discriminatory cTnT and APACHE III threshold values for in-hospital mortality were 0.08 ng/L and 38 score, respectively; the sensitivities and specificities of cTnT were 46.48 and 83.10%, respectively, whereas those of the APACHE III score were 74.88 and 54.19%, respectively. The cTnT and APACHE III scores were combined in the logistic analysis model, and a regression equation was derived to calculate the in-hospital mortality. The AUC was found to increase to 0.788 (95% CI = 0.734–0.840, P = 0.025). The sensitivity and specificity increased to 84.5 and 71.4%, respectively. The cTnT and APACHE III scores exhibited a significant association with in-hospital mortality of critically ill patients with PE. In conclusion, these parameters in combination can significantly improve the in-hospital mortality prediction.

Background: Primary intracerebral hemorrhage is one of the most common forms of stroke producing major disability. Cardiac troponin T is used as an indicator of severity in patients with primary intracerebral hemorrhage. The association between cardiac troponin T and severity of intracerebral hemorrhage has been infrequently studied. Aim: to identify the relationship between cardiac troponin T and severity of the clinical condition in patients with primary intracerebral hemorrhage measured by National Institutes of Health Stroke Scale (NIHSS). Methods: 60 patients were recruited from Neurology department Intensive care and Stroke units, Zagazig University Hospital with first time ever primary intracerebral hemorrhage during the period from October 2020 till July 2021. Cardiac troponin T was measured upon admission. Severity was assessed upon admission by NIHSS. Results: 35 (58.3%) patients had moderate score (5-15) upon admission compared to 15 (25%) patients with extremely severe condition (21-42), whereas 7 (11.7%) patients had severe condition and 3 patients (5%) had minor condition. Conclusions: Cardiac troponin T level is a valuable biomarker correlated with severity of intracerebral hemorrhage. [ABSTRACT FROM AUTHOR]

Background & Aims: Although regular and moderate exercise reduces cardiovascular risk, recent studies have shown an increase in biomarkers compatible with heart damage (e.g., cardiac troponin T after prolonged periods of exercise in healthy individuals without cardiovascular disease) (1–3). Studies show that strenuous physical activity may cause acute cardiovascular and hemodynamic stress, which can be assessed through necrosis of myocytes and myocardial infarction. Research shows that exercise is an effective factor in changing the levels of indicators Heart damage includes cardiac troponin T.Prolonged exercise is associated with an acute increase in cardiac biomarkers. Cardiac troponin T is a very specific marker of myocardial damage. Which is released from the myocardium during different periods of stress and heart damage(9). Cardiac troponin I and cardiac troponin T are proteins present in the contractile system of heart cells and are very sensitive and specific indicators of cardiac cell necrosis.As a result, these indicators are a good tool for assessing the potential damage to heart muscle cells in athletes. Prolonged exercise also leads to increased plasma free fatty acid concentrations(10). The aim of this study was to explain Effect of physical activityon cardiac troponin T and free fatty acids. Methods: 20 professional Sky Running athletes with an average age of 27-37 years from Tehran participated in this competition voluntarily and purposefully. The race was held in the valleys of Central Alborz, the total distance traveled was 21 km and 200 m, the starting point was 1650 m above sea level and the maximum altitude was 3150 m. 5 ml of blood was taken from the subjects 30 minutes before the start of the race. Immediately after the race and 1 hour later, 5 ml of blood was taken from the subjects again. To isolate serum after blood sampling, blood was poured into sterile test tubes labeled with each sample that did not contain any anticoagulants and incubated at room temperature for 60 minutes. They were then centrifuged at 2000 rpm for 20 minutes. The clear supernatant (serum) was carefully separated by a sampler 1000 so that it did not mix with the red blood cells, and the serum was kept at -80 ° C until the experiment was performed. Cardiac troponin T was injected by ELISA with a highsensitive kit with1.56 ng / L sensitivity of Zellbio brand made in Germany and free fatty acids were measured by colorimetric method with a hypersensitive kit with a sensitivity of 5 µmol/ L by Zellbio brand made in Germany. Correlated t-test at the significance level of 0.05 alpha was used to evaluate the changes in the studied variables. Results: The amount of cardiac troponin T immediately after and one hour after the end of the race increased significantly compared to before the race (P <0.05). The amount of free fatty acids immediately and one hour after the end of the race increases significantly compared to before the race (P <0.05)Conclusion: The results of this study showed that immediately and 1 hour after the end of the Sky Running competition, the amount of cardiac troponin T increased significantly. These changes identified in our study are in accordance with the results of previous studies performed in athletes completing endurance competitions. Richardson et al. reported an increase in cardiac troponin T after the marathon, stating that an increase in cardiac troponin T was related to exercise intensity associated with ventilation threshold and maximal oxygen consumption, but it has nothing to do with a person's cardiovascular fitness, training status or exercise history(16). Similarly, Dapont et al. reported that cardiac troponin I was elevated in all marathon runners(17). Lagzaras et al. showed an increase in troponin levels in all participants in the triple race (18).While Kim et al. Moreover, Park et al. Did not observe a significant increase in cardiac troponin T after prolonged exercise(19,20). Physiological mechanisms of cardiac biomarker enhancement associated with endurance activities include increased permeability of the cardiomyocyte membrane, which causes the release of cardiac troponin T in the cytosol on a concentration gradient from intracellular to extracellular. The initial peak represents the release of cardiac troponin T through the sarcolemma membrane, the level of which decreases after 24 hours and reflects the half-life and subsequent clearance of cardiac troponin T subunits. It has been suggested that mechanical or oxidative stress through Transient disorder (wounding) of sarcolemma may be responsible for this increase in membrane permeability and increase troponin secretion(21).Therefore; it seems that the increase in troponin following exercise may be a reflection of the adaptation of cellular cascades seen in exercise-induced remodeling and cardiac hypertrophy. Another result observed in the present study was a significant increase in free fatty acids immediately and 1 hour after the race compared to before the race. Which was in line with previous studies in this field. Vincent et al. 2020 showed that long-term high-intensity exercise could deplete the heart fat basin(24). Waskiwisk et al. 2011 showed that prolonged exercise significantly increased free fatty acids immediately, 12 and 24 hours after competition(35). Pak and Walk 2019 showed that cardiac troponin T did not change significantly, but free fatty acids immediately after Completion of triple and triple ultra competitions increased significantly(20). Bilt et al. 2011 showed that a 2-hour cycle of fasting cycling in 11 men untrain, tripled plasma free fatty acid concentrations while increasing cardiac lipid content, but did not impair systolic function(36). Elevated cardiac troponin T and elevated free fatty acids can indicate a degree of "cardiac fatigue." Increased free fatty acids after competition and long-term exercise appear to play an important role in reducing cardiac inotropic.Due to the multifaceted nature of heart fatigue, two main hypotheses have been proposed: A reversible process of heart damage is often referred to as “stunning “; Myocardial injury can underlie left ventricular diastolic and systolic dysfunction; transient ischemia has a mechanism similar to cardiac fatigue, and can lead to a process called stunning, stunning theory because it leads to necrosis or injury.It does not become a permanent cell, it has a transient nature.It is called cardiac beta-adrenergic receptor desensitization. A wide range of studies have identified biomarkers of increased heart damage after prolonged exercise and have linked them to functional changes(29–32). Increased catecholamine concentrations, increased plasma free fatty acids, and accumulation of oxygen free radicals may lead to decreased blood flow to the heart through increased vascular tone and endothelial dysfunction(33). Physical activity increase heart injury biomarkers in professional athletes. Elevated cardiac troponin T and elevated free fatty acids can indicate a degree of "cardiac fatigue". Increased free fatty acids after competition and longterm exercise appear to play an important role in reducing cardiac inotropic. [ABSTRACT FROM AUTHOR]

Hypertrophic cardiomyopathy (HCM) is a heritable cardiomyopathy that is predominantly caused by pathogenic mutations in sarcomeric proteins. Here we report two individuals, a mother and her daughter, both heterozygous carriers of the same HCM-causing mutation in cardiac Troponin T (TNNT2). Despite sharing an identical pathogenic variant, the two individuals had very different manifestations of the disease. While one patient presented with sudden cardiac death, recurrent tachyarrhythmia, and findings of massive left ventricular hypertrophy, the other patient manifested with extensive abnormal myocardial delayed enhancement despite normal ventricular wall thickness and has remained relatively asymptomatic. Recognition of the marked incomplete penetrance and variable expressivity possible in a single TNNT2-positive family has potential to guide HCM patient care.

The introduction of high sensitivity measurement of cardiac troponin T (hs cTnT) and cardiac troponin I (hs cTnI) has given the laboratory the ability to measure very low levels of cardiac troponin. The limit of detection of these assays is well below the 99th percentile. These low levels can also be measured with small values of imprecision. A range of algorithms combining presentation measurement with repeat sample intervals of as little as one to 2 hours have been developed. These are able to predict with acceptable accuracy the diagnosis that would be achieved with continued repeat sampling out to six to 12 hours from presentation. In this article, we review the evidence for the diagnostic accuracy of these approaches and the practical aspects of implementation into routine clinical practice. [ABSTRACT FROM AUTHOR]

Keli Wen, Hu Du, Binfei Tang, Bin Xiong, An Zhang,&ast; Pengfei Wang&ast; Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: An Zhang; Pengfei Wang, Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400010, People’s Republic of China, Tel +86 23-63693452, Email zhangan@Hospital.cqmu.edu.cn; 13436027816@163.comPurpose: The purpose of our study was to explore the prognostic value of complete blood count and myocardial markers combination with Sequential Organ Failure Assessment (SOFA) score in predicting the 28-day mortality among sepsis patients.Patients and methods: A retrospective observational cohort study was performed. Three hundred and nineteen sepsis patients who were hospitalized at the Second Affiliated Hospital of Chongqing Medical University, China, from January 2019 to September 2021 were included. The clinical and laboratory data, the Acute Physiological and Chronic Health Evaluation II (APACHE II) score and SOFA score at the time of the initial sepsis diagnosis were collected, and the predictive values of the single and combination variables for 28-day mortality were compared.Results: The derivation cohort consisted of 221 patients and included 59 (26.7%) died. The area under the curve (AUC) [95% confidence interval (CI)] of RDW and cTnT were 0.735 (0.663– 0.807) and 0.753 (0.678– 0.827) for mortality, and the cut-off value were 14.05% and 0.039 ng/mL, respectively. The combination of RDW, cTnT and the SOFA score showed a better performance for the prediction of mortality, and the AUC was significantly higher than that of the SOFA score (0.791 vs 0.726, DeLong test: P=0.032). Multivariate Cox analysis identified that the combination of RDW, cTnT and the SOFA score (HR=6.133, P=0.004) and APACHE II score (HR=1.093, P< 0.001) were independent detrimental factors for 28-day mortality. The validation cohort consisted of 98 patients and included 23 (23.5%) died. Similarly, the AUC of the RDW, cTnT and the SOFA score combination is significantly higher than that of the SOFA score (0.821 vs 0.739, DeLong test: P=0.035).Conclusion: RDW and cTnT showed good performance in predicting 28-day mortality rates among patients with sepsis. Combined RDW and cTnT with the SOFA score can significantly improve the predictive value of SOFA score for the prognosis of sepsis.Keywords: sepsis, septic shock, Sequential Organ Failure Assessment score, red blood cell distribution width, cardiac troponin T, marker

Background: Biochemical analyses of N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT), and creatine kinase MB (CK-MB) have been reported to be valuable for the auxiliary diagnosis of sudden cardiac death (SCD) in previous forensic studies. Aims and Objectives: The present study aimed to evaluate the diagnostic efficiency of combined analyses of NT-proBNP, cTnT and CK-MB in the pericardial fluid for forensic diagnosis of SCD caused by ischemic heart disease. Materials and Methods: Levels of NT-proBNP, cTnT, and CK-MB in the pericardial fluid of 132 medicolegal autopsy cases were obtained through electrochemiluminescence method. Results: NT-proBNP, cTnT, and CK-MB levels were significantly elevated in SCD cases (P < 0.05). Receiver-operating characteristics (ROC) analysis showed that NT-proBNP, cTnT, and CK-MB have diagnostic value for the diagnosis of SCD: NT-proBNP, cutoff value of 2236 pg/ml; cTnT, cutoff value of 199.51 ng/ml; CK-MB: cutoff value of 2742.5 ng/ml, and the combined analyses of these three biomarkers have better diagnostic efficiency than each single biomarker alone. Moreover, the causes of SCD were sub-divided into acute ischemic heart disease, acute myocardial infarction (AMI), and recurrent myocardial infarction subgroups for further analysis, which revealed that the ratio of cTnT/CK-MB could be used to distinguish AMI with the cutoff value of 0.1085 estimated by ROC analysis. Conclusion: These observations suggested that the postmortem biochemical analyses of NT-proBNP, cTnT, and CK-MB in the pericardial fluid may assist to diagnose SCD in forensic practice, and the combined analyses of multiple biomarkers have better diagnostic efficiency than each single biomarker alone. On the basis of the postmortem biochemical analyses of NT-proBNP, cTnT and CK-MB, combining the ratio of cTnT/CK-MB could be used to distinguish AMI.

Objective: The elevation of troponin-T (Trop-T) or creatinine kinase myocardial isoform (CKMB) is very common during the percutaneous coronary intervention (PCI). A study was attempted to determine the correlation between elevated Trop-T or CKMB and the parameters of PCI by using multivariate analysis, especially principal component analysis (PCA). Materials and Methods: A prospective observational study was carried out among 100 patients who underwent PCI for stable coronary artery disease in which 31 and 37 patients were found to have elevated Trop-T and CKMB (>3 times) following PCI. The correlation was studied between Trop-T or CKMB (dependent variable) and different parameters, viz., total stent length (mm), fluoroscopy time (min), lesion strength, left ventricular (LV) function, procedural complications, type of lesions, vessels treated with drug eluting stent (DES), and major adverse cardiac events (MACE) as independent variables. Results: For Trop-T, the principal component (PC)-1 and PC-2 obtained 63.49% and 30.88% of the original variation. For PC-1 and PC-2, maximum positive loading was recorded for stent length followed by fluoroscopy time and for LV but negative loading for the type of lesion and type of stent (DES vs bare metal stent [BMS]). For CKMB, the PC-1 and PC-2 obtained 61.22% and 32.08% of the original variation. For PC-1 and PC-2, maximum positive loading was recorded for stent length and fluoroscopy time followed by vessel treated but negative loading for the type of stent and MACE, and maximum positive loading recorded for LV function but negative loading for the type of lesion. Conclusion: This study indicates which factors are most important in preventing periprocedural myocardial injury during PCI and may be a suitable tool to prevent myocardial injury and for subsequent less MACE and better patient outcomes.

Background: Recent literature reported the biological role of C-peptide, but this role is still controversial and unclear. The primary aim of this study was to investigate associations between C-peptide and cardiovascular biomarkers as well as events. Methods: A total of 55636 participants who had a health examination from 2017 to 2021 were included. Of them, 6727 participants visited the hospital at least twice. Cardiovascular biomarkers like high-sensitivity C-reactive protein (hs-CRP) and high-sensitivity cardiac troponin T (hs-cTnT) were measured and their relationships with fasting C-peptide were evaluated for all participants. Cardiovascular events were obtained during the last visit and their associations with C-peptide were evaluated for those participants who visited the hospital at least twice. Results: Among the included participants, 11.1% had a previous type 2 diabetes mellitus (T2DM). In the participants without previous T2DM, the relationships between fasting C-peptide and hs-CRP and hs-cTnT were negative if the value of fasting C-peptide was < 1.4 ng/mL and positive if the value was ≥ 1.4 ng/mL. These relationships remained significant after adjusting for hemoglobin A1c, insulin resistance index, and its interaction with C-peptide, even if the participants were stratified by glucose metabolism status or levels of insulin resistance index. Hazard ratios of cardiovascular events were first decreased and then increased with the increasing of baseline C-peptide levels, though these associations became unsignificant using the multivariate Cox regression model. Unlike the participants without previous T2DM, the associations of C-peptide with cardiovascular biomarkers and events were not significant in the patients with previous T2DM. Conclusions: The associations of C-peptide with cardiovascular biomarkers and events were different between the participants without previous T2DM and those with previous T2DM. The effect of C-peptide on cardiovascular risk may be bidirectional, play a benefit role at a low level, and play a harmful role at a high level in the nondiabetic adults and the patients with newly diagnosed T2DM. [ABSTRACT FROM AUTHOR]

Aim: Cardiovascular disease (CVD) is a leading cause of death in both men and women. Type 1 and 2 diabetes mellitus (DM1 and DM2) are well-known risk factors for CVD. In addition, gestational diabetes mellitus (GDM) is a female sex-specific risk factor for CVD. Here, we measure circulating concentrations of cardiac troponin T (cTNT), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and growth differentiation factor 15 (GDF-15) during pregnancy—a window of time often referred to as a cardiovascular stress test for women. Methods: This study utilized data from 384 pregnant women: 64 with DM1, 16 with DM2, 35 with GDM and 269 euglycemic controls. Blood was predominantly sampled within a week before delivery. Cardiovascular biomarker concentrations were measured in serum using electrochemiluminescence immunoassay. Result: Circulating cTnT levels were higher in women with DM1, DM2 and GDM as compared to controls, whereas NT-proBNP and GDF-15 levels were only increased in women with DM1. Glucose dysregulation, assessed by third trimester HbA1c levels, positively correlated with all three CVD biomarker levels, whereas pregestational body mass index correlated negatively with GDF-15. Conclusions: Our results support the presence of myocardial affection in women with diabetic disorders during pregnancy. Although pregestational DM1 in this study was associated with the most adverse CVD biomarker profile, women with GDM displayed an adverse cTnT profile similar to what we found in women with pregestational DM2. This supports that women with GDM should be offered long-term intensified cardiovascular follow-up and lifestyle advice following delivery, similarly to the well-established CV follow-up of women with pregestational DM. [ABSTRACT FROM AUTHOR]

Objective: Evaluation of the effect of 8 weeks of High-Intensity Interval Training (HIIT) on the serum level of cardiac troponin T (cTnT) in sedentary obese young men. Materials and Methods: Thirty sedentary men were randomly divided into 3 groups: the 30s HIIT training group (n=10), the 60s training group (n=10), and the control group (no exercise) (n=10). Interval training with 90 %VO2peak was done in 3 sessions for 8 weeks. cTnT was measured 5 times; pre-exercise, 4hrs, and 24hrs after the first session (4hF, 24hF), and 4hrs and 24hrs after the last training session (4hL, 24hL). ANOVA with repeated measures and Bonferroni post-hoc tests were used by SPSS 23 with a significance level of (P< 0.05). Results: The significant increase in serum levels of cTnT in the post-tests of the 60s HIIT compared to the first 24hrs and the last 24hrs (P= 0.0001). But in the 30s group it was not significant compared to the other measurements (P≥ 0/05). In the 2 training groups, serum levels of cTnT in the last 4hr post-tests of the last week were not significantly different from the 4hrs post-tests of the first week (P≥ 0.05). Conclusion: It seems that none of these activities cause heart damage sustained, and changes in cTnT levels in two 4hrs compared to the first and last 24hrs of the 60s group may be due to reversible leakage of cardiac cell membranes, and may continuous exercise will reduce this reduction. [ABSTRACT FROM AUTHOR]

Age-related muscle mass and strength decline (sarcopenia) impairs the performance of daily living activities and can lead to mobility disability/limitation in older adults. Biological pathways in muscle that lead to mobility problems have not been fully elucidated. Immunoglobulin G (IgG) infiltration in muscle is a known marker of increased fiber membrane permeability and damage vulnerability, but whether this translates to impaired function is unknown. Here, we report that IgG1 and IgG4 are abundantly present in the skeletal muscle (vastus lateralis) of ~ 50% (11 out of 23) of older adults (> 65 years) examined. Skeletal muscle IgG1 was inversely correlated with physical performance (400 m walk time: r = 0.74, p = 0.005; SPPB score: r = − 0.73, p = 0.006) and muscle strength (r = − 0.6, p = 0.05). In a murine model, IgG was found to be higher in both muscle and blood of older, versus younger, C57BL/6 mice. Older mice with a higher level of muscle IgG had lower motor activity. IgG in mouse muscle co-localized with cardiac troponin T (cTnT) and markers of complement activation and apoptosis/necroptosis. Skeletal muscle–inducible cTnT knockin mice also showed elevated IgG in muscle and an accelerated muscle degeneration and motor activity decline with age. Most importantly, anti-cTnT autoantibodies were detected in the blood of cTnT knockin mice, old mice, and older humans. Our findings suggest a novel cTnT-mediated autoimmune response may be an indicator of sarcopenia. [ABSTRACT FROM AUTHOR]

Cardiac troponin T (cTnT), a protein essential for calcium-regulated, myofibrillar ATPase activity, is extremely sensitive to the action of a significant number of intra- and extracellular enzymes, the action of which causes post-translational modifications (PTMs) of amino acid structure and functioning cTnT. PTMs of cTnT may play important roles in the regulation of cardiac contractility. The vast majority of cTnT modifications involve the phosphorylation by a variety of Ser/Thr kinases, including PKC. At the same time, the activity of cTnT phosphorylation can change under physiological conditions and in some CVDs, including HF, AMI, and arrhythmias. Along with cTnT phosphorylation, cTnT fragmentation occurs, the activity of which can also change. This article discusses the mechanisms of cTnT phosphorylation and fragmentation, discusses the important role of these processes in the pathophysiology and laboratory diagnosis of some CVD, and notes promising directions for further research.

Abstract Background Risk stratification of patients with prediabetes is an unmet clinical need. Here, we examine the utility of subclinical myocardial necrosis assessed by high-sensitivity cardiac troponin T (hs-cTnT) in predicting health outcomes in stable subjects with prediabetes. Methods hs-cTnT was analyzed by a high-sensitivity assay (Roche 5th generation) in 2631 stable subjects with prediabetes (HbA1c 5.7–6.4% or fasting glucose 100–125 mg/dL without previous diagnosis of diabetes or glucose-lowering therapy) who underwent elective coronary angiography for cardiac evaluation, and followed for major adverse cardiac events (MACE; death, myocardial infarction, stroke) over 3 years and all-cause mortality over 5 years. Results In our study cohort, hs-cTnT was highly prevalent with a median level of 13 ng/L (interquartile range 8.2–21.6 ng/L). Hs-cTnT was independently associated with incident MACE at 3 years (Q4 vs. Q1 adjusted hazard ratio (HR) 2.42 [95% CI 1.69–3.46], P

AimsThis study aims to assess left ventricular (LV) function in hypertrophic cardiomyopathy (HCM) patients with preserved left ventricular ejection fraction (LVEF) by LV strain patterns based on cardiac magnetic resonance feature tracking (CMR-FT) and to explore the relationships between LV strain patterns and cardiac biomarkers in these patients, such as cardiac troponin (cTnT) and N-terminal prohormone of the brain natriuretic peptide (NT-proBNP).MethodsA total of 64 HCM patients with preserved LVEF and 33 healthy people were included in this study. All subjects underwent contrast-enhanced CMR, and all patients took blood tests for cTnT and NT-proBNP during hospitalization.ResultsDespite the absence of a significant difference in LVEF between HCM patients and healthy controls, almost all global and segmental strains in radial, circumferential, and longitudinal directions in the HCM group deteriorated significantly as compared to controls (p < 0.05). Moreover, some global and segmental strains correlated significantly with NT-proBNP and cTnT in HCM patients, and the best correlations were global radial strain (GRS) (r = −0.553, p < 0.001) and mid-ventricular radial strain (MRS) (r = −0.582, p < 0.001), respectively, with a moderate correlation. The receiver operating characteristic (ROC) results showed that among the LV deformation parameters, GRS [area under the curve (AUC), 0.76; sensitivity, 0.49; specificity, 1.00], MRS (AUC, 0.81; sensitivity, 0.77; specificity, 0.79) demonstrated greater diagnostic accuracy to predict elevated NT-proBNP, and abnormal cTnT, respectively. Their cut-off values were 21.17 and 20.94%, respectively. Finally, all global strains demonstrated moderate, good, and excellent intra- and inter-observer reproducibility.ConclusionLV strain patterns can be used to assess the subclinical cardiac function of HCM patients on the merit of being more sensitive than LVEF. In addition, LV strain patterns can detect serious HCM patients and may be helpful to non-invasively predict elevated NT-proBNP and cTnT.

Ineffective stress-coping in Africans is associated with cardiac ischemia during acute mental stress. Ischemic conditions may be worsened by stress-induced release of glial-derived S100‑calcium-binding-protein β (S100B), which is pro-apoptotic for cardiomyocytes. Whether estradiol as coping regulator and cardio-protective factor will protect against pro-apoptotic effects, remains unclear. Therefore, we aimed to investigate stress-induced associations between cardiac troponin T/cTnT (cardiac ischemic marker), S100B and estradiol in a bi-ethnic cohort of defensive copers of both sexes. The target population study included African and Caucasian teachers of both sexes (n = 344; aged 20–65 years). The Stroop-color-word-conflict-test was administrated for 1 min to induce acute mental stress in the participants. A chronic stress risk phenotype score was obtained. The Coping Strategy Indicator determined habitual defensive/avoidance/seeking social support coping scores. Fasting blood samples were obtained prior to and 10 min post-Stroop-stress to assess cTnT, S100B and estradiol levels. An interaction between ethnicity, sex and defensive coping (p < 0.05) was found for acute stress-induced percentage changes in estradiol. In defensive coping African men, the Stroop-color-word-conflict-test elicited decreases in S100B and increases in estradiol. Again, in this group, S100B decreases were related to unchanged cTnT, a chronic stress risk phenotype and acute estradiol increases (p < 0.05). No associations among main markers were apparent in the African women or the Caucasian defensive copers of both sexes. In the defensive coping African men, the markers studied may play a relevant role in the brain-cardiovascular system interaction during stress exposure. Further research is needed to elaborate on potential mechanisms and to establish clinical relevance. • Stress-induced defensive coping in Africans has been related to cardiac ischemic responses. • Here we found that unchanged cardiac troponin T levels were accompanied by S100B decreases in defensive coping African men. • Decreases in S100B were also related to a chronic stress risk phenotype and acute stress increases in estradiol. • Harmful effects of S100B in the cardiovascular system may be counterbalanced by estradiol. • The markers studied may play a role in the brain-heart interaction during stress exposure, but further research is required. [ABSTRACT FROM AUTHOR]

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An electrochemical immunosensor based on a nanohybrid film of carboxylated polypyrrole and amine nanoclay was developed for label-free detection of the human cardiac troponin T (cTnT). The nanohybrid film was formed in situ on the surface of the glassy carbon electrode, followed by the covalent immobilization of anti-troponin T antibodies by glutaraldehyde. Morphological and chemical characterizations of the nanohybrid film were performed by scanning electron microscopy and Fourier-transform infrared spectroscopy. Under the optimized conditions, a calibration curve for cTnT in spiked serum was obtained by square wave voltammetry, and a low limit of detection and quantification was achieved (0.35 and 1.05 pg mL−1, respectively). This was the first time that this type of nanohybrid film was used in the development of an immunosensor for cTnT that proved to be a simple and efficient strategy for the manufacture of a label-free electrochemical device that could be applied in the diagnosis of acute myocardial infarction. [ABSTRACT FROM AUTHOR]

Yuying Gu,1,* Lingtong Shan,2,* Ban Liu,3,* Mengwei Lv,4 Xi Chen,4 Tao Yan,5 Yu Shi,4 Jiapeng Chen,6 Zhi Li,7 Yangyang Zhang4 1Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 2Department of Thoracic Surgery, Sheyang County People’s Hospital, Yancheng, Jiangsu, People’s Republic of China; 3Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 4Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 5Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 6Xinglin College, Nantong University, Nantong, Jiangsu, People’s Republic of China; 7Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yangyang ZhangDepartment of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, People’s Republic of ChinaTel +86 13818132320Email zhangyangyang_wy@vip.sina.comZhi LiDepartment of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of ChinaTel +86 13770606815Email zhili_cths@163.comBackground: Cardiac troponin T (cTnT) is currently one of the important indicators for clinical diagnosis of myocardial injury, which is inevitable in cardiac surgery, especially coronary artery bypass grafting (CABG). Describing the release profile of cTnT and finding out the risk factors of postoperative myocardial injury (PMI) are of great significance. The purposes of this study are to explore the release profile of cTnT in patients undergoing CABG and to search for independent risk factors of PMI.Methods: In this retrospective study, clinical data of CABG patients were collected. The cTnT was measured at 24 hours before and 6, 12, 24, 48, 72, 96 and 120 hours after operation separately. The release profiles and peak time of cTnT in total cohort and sub-cohorts were observed. Independent risk factors of PMI were explored via univariate and multivariate logistic regression analyses.Results: In total, 2084 patients were enrolled, including 998 patients in a cTnT group and 1086 patients in a high-sensitive cTnT (hs-cTnT) group. PMI was recognized in 797 patients. In both groups, cTnT showed a trend of rising first and then falling within 120 hours after operation. The peak cTnT appeared within 12– 24 hours after operation, while the peak hs-cTnT occurred mostly within 24– 48 hours after operation. Univariate logistic analysis showed that body mass index (BMI), New York Heart Association (NYHA) classification, coronary artery disease (CAD) classification, cerebrovascular disease, left ventricular ejection fraction, number of diseased vessels, valvular disease, intra-aortic balloon pump (IABP) implantation, chronic obstructive pulmonary disease, pulmonary hypertension, previous percutaneous coronary intervention (PCI), BMI, bypass graft number, cardiopulmonary bypass, and preoperative cTnT were related risk factors. Multivariate logistic regression analysis showed that NYHA classification, CAD classification, valvular disease, IABP implantation, pulmonary hypertension, previous PCI, bypass graft number, cardiopulmonary bypass, and preoperative cTnT were independent risk factors of PMI.Conclusion: NYHA classification, CAD classification, valvular disease, IABP implantation, pulmonary hypertension, previous PCI, bypass graft number, cardiopulmonary bypass, and preoperative cTnT are independent risk factors of PMI in patients undergoing CABG.Keywords: cardiac troponin T, coronary artery bypass grafting, myocardial injury

Ruijie Xie,* Qingui Chen,* Wanmei He, Mian Zeng Department of Medical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Mian ZengDepartment of Medical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong, 510080, People’s Republic of ChinaTel +86-20-87755766Email zengmian@mail.sysu.edu.cnPurpose: To investigate the association of cardiac Troponin T (cTnT) with prognosis in critically ill patients without myocardial infarction.Methods: Adult patients admitted to the intensive care units (ICUs) of the Beth Israel Deaconess Medical Center between 2008 and 2019 who were free of myocardial infarction with a length of ICU stay ≥ 24 hours and available cTnT records within 24 hours before and after ICU admission were included. The association between cTnT on ICU admission and hospital mortality was evaluated by multivariable logistic regression analysis. The discrimination capacity of cTnT on ICU admission for predicting hospital mortality was examined by receiver operating characteristic (ROC) analysis.Results: A total of 2960 patients were included. Elevated cTnT (> 0.01 ng/mL) was observed in 2730 (92.23%) patients with a higher hospital mortality compared to normal cTnT (11.21% versus 7.39%, P=0.075). There was no statistically significant association between elevated cTnT on ICU admission and hospital mortality (adjusted odds ratio 1.50, 95% confidence interval (CI) 0.88– 2.57). Poor discrimination capacity was found for cTnT on ICU admission to predict hospital mortality (area under the ROC curve 0.48, 95% CI 0.44– 0.53).Conclusion: cTnT on ICU admission has limited prognostic value in critically ill patients without myocardial infarction.Keywords: cardiac troponin T, prognosis, critical care

A cardiac immunosensor was developed to detect heart attacks (myocardial infarctions) at an early stage. This technique, utilizing carboxylic functionalized triangular carbon dots (caf-TCDs) combined with an antibody anti-cardiac Troponin T (anti-cTnT), proved to be a quick and sensitive method for detecting cardiac troponin T (cTnT) in both buffer solutions and biological fluids such as serum. The antibody for cardiac Troponin T (cTnT) was chemically linked to amphiphilic caf-TCDs using a carbodiimide coupling reaction. Exfoliated graphene oxide (GO) sheets effectively bind to anti-cTnT labeled caf-TCDs on their surface, resulting in a non-radiative energy transfer process where the fluorescence is suppressed. This interaction between caf-TCDs and GO follows a nonlinear and increasing Stern-Volmer relationship, indicating a combination of static and dynamic quenching. When antigen (cTnT) is present, the interaction between antibodies (anti-cTnT) and the cTnT molecules hinders the energy transfer process. This interaction also affects the positioning of the nano-couple and causes the detachment of CDs from the GO surface. As a result, the energy transfer process is impeded, leading to the restoration of fluorescence intensity. The sensor exhibits high specificity and low sensitivity to non-specific antigens. It shows a linear reaction to cTnT in the range of 0.05–50 ng mL-1, with a detection limit of 0.046 ng mL-1. Therefore, the anti-cTnT-caf-TCD/GO sensor offers a potential platform for detecting cTnT with increased sensitivity. • The solvothermal method was utilized to synthesize high color purity and narrow bandwidth emission triangle CDs. • Triangle CDs FRET-based sensor was established to detect Troponin T. • The carbodiimide coupling technique is employed to develop a promising fluorescent probe. • The limit of detection (LOD) was 0.046 ng mL-1, with a linear range of 0.05 ng to 50 ng mL-1. • The blue emissive property of caf-TCDs and anti-cTnT was employed to image A549 cells and their toxicity. [ABSTRACT FROM AUTHOR]

[Display omitted] • Review of the most specific cardiac biomarker, troponin I and T. • Introduction of SPR biosensors to detection the cardiac troponin I and T biomarker. • Immunosensor, aptasensor, and imprinting SPR based biosensor was introduced. • Expressing the SPR biosensors as a useful platform for early detection of troponin. Acute myocardial infarction (AMI) is one of the life-threatening causes that decrease blood flow to the heart, leading to increased mortality and related complications. Recently, the measure of blood concentration of cardiac biomarkers has been suggested to overcome the limitations of electrocardiography (ECG) analyses for early diagnosis of this disease. Troponins, especially cardiac troponin I and cardiac troponin T, with high sensitivity and specificity, are considered the gold standards in myocardial diagnosis. Recently, the use of new biosensors such as surface plasmon resonance (SPR) for early detection of these biomarkers has been greatly appreciated. Due to the rapid, sensitive, real-time, and label-free detection of SPR-based biosensors, they can be applied for selective and nonspecific absorption that is intended to be used as an in situ cardiac biosensor. Here, we exclusively discussed the updated developments of these valuable predictors for the possible occurrence of AMI detected by SPR. [ABSTRACT FROM AUTHOR]

Atrial dilation and atrial fibrillation (AF) are common in Hypertrophic CardioMyopathy (HCM) patients and associated with a worsening of prognosis. The pathogenesis of atrial myopathy in HCM remains poorly investigated and no specific association with genotype has been identified. By re-analysis of our cohort of thin-filament HCM patients (Coppini et al. 2014) AF was identified in 10% of patients with sporadic mutations in the cardiac Troponin T gene (TNNT2), while AF occurrence was much higher (25–75%) in patients carrying specific "hot-spot" TNNT2 mutations. To determine the molecular basis of arrhythmia occurrence, two HCM mouse models expressing human TNNT2 variants (a "hot-spot" one, R92Q, and a "sporadic" one, E163R) were selected according to the different pathophysiological pathways previously demonstrated in ventricular tissue. Echocardiography studies showed a significant left atrial dilation in both models, but more pronounced in the R92Q. In E163R atrial trabeculae, in line with what previously observed in ventricular preparations, the energy cost of tension generation was markedly increased. However, no changes of twitch amplitude and kinetics were observed, and there was no atrial arrhythmic propensity. R92Q atrial trabeculae, instead, displayed normal ATP consumption but markedly increased myofilament calcium sensitivity, as previously observed in ventricular preparations. This was associated with reduced inotropic reserve and slower kinetics of twitch contractions and, importantly, with an increased occurrence of spontaneous beats and triggered contractions that represent an intrinsic arrhythmogenic mechanism promoting AF. The association of specific TNNT2 mutations with AF occurrence depends on the mutation-driven pathomechanism (i.e., increased atrial myofilament calcium sensitivity rather than increased myofilament tension cost) and may influence the individual response to treatment. [ABSTRACT FROM AUTHOR]

Elevated circulating cardiac troponin T (cTnT) is frequent in septic shock patients. Signs of myocardial ischemia and myocyte necrosis are not universally present, but the precise mechanism for elevated cTnT is unknown. We investigated plasma and heart tissue metabolites concentration in six septic shock (SS) and three sham swine undergoing a protocol of polymicrobial septic shock and resuscitation, in order to highlight possible pathways and biomarkers involved in troponin release (high sensitive cardiac troponin T, hs-cTnT). The animals were divided into two groups: the high cTnT group (n = 3) were pigs showing a significantly higher concentration of cTnT and lactate after resuscitation; the low cTnT group (n = 6, three sham and three septic shock) characterized by a lower value of cTnT and a lactate level < 2 mmol/L. Spearman correlation was assessed on plasma fold-change of cTnT, cytokines (TNF-α and IL-10), and metabolites. Finally, the fold-change between the end of resuscitation and baseline values (Res./BL) of plasma metabolites was used to perform a partial least square discriminant analysis (PLS-DA) with three latent variables. Before building the model, the number of features was reduced by summing up the metabolites of the same class that resulted similarly correlated to cTnT fold-change. Proline and glycine were significantly higher in the high cTnT group at the end of experiment both in the myocardium and plasma analyses. Moreover, plasma proline fold-change was found to be positively correlated with cTnT and cytokine fold-changes, and trans-4-hydroxyproline (t4-OH-Pro) fold-change was positively correlated with cTnT fold-change. The PLS-DA model was able to separate the two groups and, among the first ranked features based on VIP score, we found sugars, t4-OH-Pro, proline, creatinine, total amount of sphingomyelins, and glycine. Proline, t4-OH-Pro, and glycine are very abundant in collagen, and our results may suggest that collagen degradation could represent a possible mechanism contributing to septic myocardial injury. The common phenotype of septic cardiomyopathy could be associated to dysregulated collagen metabolism and/or degradation, further exacerbated by higher inflammation and oxidative stress. [ABSTRACT FROM AUTHOR]