Circulation, Vol 88, 101-106, Copyright © 1993 by American Heart Association
JE Adams 3d, GS Bodor, VG Davila-Roman, JA Delmez, FS Apple, JH Ladenson and AS Jaffe
BACKGROUND. Levels of MBCK can be increased in patients with skeletal
muscle injury or renal failure in the absence of myocardial injury, causing
diagnostic confusion. This study was designed to determine whether
measurement of cardiac troponin I (cTnI), a myocardial regulatory protein
with comparable sensitivity to MBCK, has sufficient specificity to clarify
the etiology of MBCK elevations in patients with acute or chronic skeletal
muscle disease or renal failure. METHODS AND RESULTS. Of the patients (n =
215) studied, 37 had acute skeletal muscle injury, 10 had chronic muscle
disease, nine were marathon runners, and 159 were chronic dialysis
patients. Patients were evaluated clinically, by ECG, and by
two-dimensional echocardiography. Total creatine kinase (normal, < 170
IU/L) was determined spectrophotometrically, and cTnI (normal, < 3.1
ng/mL) and MBCK (normal, < 6.7 ng/mL) were determined with specific
monoclonal antibodies. Values above the upper reference limit were
considered "elevated." Elevations of total creatine kinase were common, and
elevations of MBCK occurred in 59% of patients with acute muscle injury,
78% of patients with chronic muscle disease and marathon runners, and 3.8%
of patients with chronic renal failure. Some of the patients were
critically ill; five patients were found to have had myocardial infarctions
and one had a myocardial contusion. cTnI was elevated only in these
patients. CONCLUSIONS. Elevations of cTnI are highly specific for
myocardial injury. Use of cTnI should facilitate distinguishing whether
elevations of MBCK are due to myocardial or skeletal muscle injury.
ARTICLES
Cardiac troponin I. A marker with high specificity for cardiac injury
Cardiovascular Division, Washington University School of Medicine, St Louis, MO 63110.
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A. Cerutti, L. Corsini, R. Finotto, and C. Perazzi Comparison of Cardiac Troponin I in Serum and Heparin Plasma with the Dimension RxL Assay Clin. Chem., May 1, 2002; 48(5): 790 - 791. [Full Text] [PDF]
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D. A. Colantonio, W. Pickett, R. J. Brison, C. E. Collier, and J. E. Van Eyk Detection of Cardiac Troponin I Early after Onset of Chest Pain in Six Patients Clin. Chem., April 1, 2002; 48(4): 668 - 671. [Full Text] [PDF]
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 I Weinberg, T Cukierman, and T Chajek-Shaul Troponin T elevation in lobar lung disease Postgrad. Med. J., April 1, 2002; 78(918): 244 - 245. [Abstract] [Full Text] [PDF]
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J. D. Douketis, M. A. Crowther, E. B. Stanton, and J. S. Ginsberg Elevated Cardiac Troponin Levels in Patients With Submassive Pulmonary Embolism Arch Intern Med, January 14, 2002; 162(1): 79 - 81. [Abstract] [Full Text] [PDF]
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 N.J. Alp, J.A. Bell, and M. Shahi A rapid troponin-I-based protocol for assessing acute chest pain QJM, December 1, 2001; 94(12): 687 - 694. [Abstract] [Full Text] [PDF]
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J. S. Raman, R. Bellomo, M. Hayhoe, M. Tsamitros, and B. F. Buxton Metabolic changes and myocardial injury during cardioplegia: a pilot study Ann. Thorac. Surg., November 1, 2001; 72(5): 1566 - 1571. [Abstract] [Full Text] [PDF]
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I. A. Khan, N. Wattanasuwan, N. J. Mehta, A. Tun, N. Singh, H. K. Singh, B. C. Vasavada, and T. J. Sacchi Prognostic value of serum cardiac troponin I in ambulatory patients with chronic renal failure undergoing long-term hemodialysis: A two-year outcome analysis J. Am. Coll. Cardiol., October 1, 2001; 38(4): 991 - 998. [Abstract] [Full Text] [PDF]
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P. Eigel, G. van Ingen, and S. Wagenpfeil Predictive value of perioperative cardiac Troponin I for adverse outcome in coronary artery bypass surgery Eur. J. Cardiothorac. Surg., September 1, 2001; 20(3): 544 - 549. [Abstract] [Full Text] [PDF]
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 M. C. Iliou, C. Fumeron, M. O. Benoit, P. Tuppin, C. L. Courvoisier, V. M. Calonge, N. Moatti, C. Buisson, and C. Jacquot Factors associated with increased serum levels of cardiac troponins T and I in chronic haemodialysis patients: Chronic Haemodialysis And New Cardiac Markers Evaluation (CHANCE) study Nephrol. Dial. Transplant., July 1, 2001; 16(7): 1452 - 1458. [Abstract] [Full Text] [PDF]
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B. W. Bottiger, S. Mobes, R. Glatzer, H. Bauer, A. Gries, P. Bartsch, J. Motsch, and E. Martin Astroglial Protein S-100 Is an Early and Sensitive Marker of Hypoxic Brain Damage and Outcome After Cardiac Arrest in Humans Circulation, June 5, 2001; 103(22): 2694 - 2698. [Abstract] [Full Text] [PDF]
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T. Petzold, P. Feindt, U. Sunderdiek, U. Boeken, Y. Fischer, and E. Gams Heart-type fatty acid binding protein (hFABP) in the diagnosis of myocardial damage in coronary artery bypass grafting Eur. J. Cardiothorac. Surg., June 1, 2001; 19(6): 859 - 864. [Abstract] [Full Text] [PDF]
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C. Rajnoch, J.-C. Chachques, A. Berrebi, P. Bruneval, M.-O. Benoit, and A. Carpentier Cellular therapy reverses myocardial dysfunction J. Thorac. Cardiovasc. Surg., May 1, 2001; 121(5): 871 - 878. [Abstract] [Full Text] [PDF]
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N. Guler, M. Bilge, B. Eryonucu, K. Uzun, M. E. Avci, and H. Dulger Cardiac Troponin I Levels in Patients with Left Heart Failure and Cor Pulmonale Angiology, May 1, 2001; 52(5): 317 - 322. [Abstract] [PDF]
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P. Venge, B. Lindahl, and L. Wallentin New Generation Cardiac Troponin I Assay for the Access Immunoassay System Clin. Chem., May 1, 2001; 47(5): 959 - 961. [Full Text] [PDF]
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E. M. Hoogerwaard, Y. Schouten, A. J. van der Kooi, J. P.M.C. Gorgels, M. de Visser, and G. T.B. Sanders Troponin T and Troponin I in Carriers of Duchenne and Becker Muscular Dystrophy with Cardiac Involvement Clin. Chem., May 1, 2001; 47(5): 962 - 963. [Full Text] [PDF]
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E. Vermes, M. Mesguich, R. Houel, C. Soustelle, P. Le Besnerais, M.-L. Hillion, and D. Loisance Cardiac troponin I release after open heart surgery: a marker of myocardial protection? Ann. Thorac. Surg., December 1, 2000; 70(6): 2087 - 2090. [Abstract] [Full Text] [PDF]
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M. C. Kontos, F. P. Anderson, R. Alimard, J. P. Ornato, J. L. Tatum, and R. L. Jesse Ability of troponin I to predict cardiac events in patients admitted from the emergency department J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1818 - 1823. [Abstract] [Full Text] [PDF]
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S. Dixit, M. Castle, R. P. Velu, L. Swisher, C. Hodge, and A. S. Jaffe Cardiac Involvement in Patients With Acute Neurologic Disease: Confirmation With Cardiac Troponin I Arch Intern Med, November 13, 2000; 160(20): 3153 - 3158. [Abstract] [Full Text] [PDF]
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T. Meyer, L. Binder, N. Hruska, H. Luthe, and A. B. Buchwald Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1632 - 1636. [Abstract] [Full Text] [PDF]
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N. Parekh, B. Venkatesh, D. Cross, A. Leditschke, J. Atherton, W. Miles, A. Winning, A. Clague, and C. Rickard Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1328 - 1335. [Abstract] [Full Text] [PDF]
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A. S. Jaffe, J. Ravkilde, R. Roberts, U. Naslund, F. S. Apple, M. Galvani, and H. Katus It's Time for a Change to a Troponin Standard Circulation, September 12, 2000; 102(11): 1216 - 1220. [Full Text] [PDF]
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G. Boriani, M. Biffi, V. Cervi, G. Bronzetti, G. Magagnoli, R. Zannoli, and A. Branzi Evaluation of Myocardial Injury Following Repeated Internal Atrial Shocks by Monitoring Serum Cardiac Troponin I Levels Chest, August 1, 2000; 118(2): 342 - 347. [Abstract] [Full Text] [PDF]
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C. A. Labarrere, D. R. Nelson, C. J. Cox, D. Pitts, P. Kirlin, and H. Halbrook Cardiac-Specific Troponin I Levels and Risk of Coronary Artery Disease and Graft Failure Following Heart Transplantation JAMA, July 26, 2000; 284(4): 457 - 464. [Abstract] [Full Text] [PDF]
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C. W. Hamm and E. Braunwald A Classification of Unstable Angina Revisited Circulation, July 4, 2000; 102(1): 118 - 122. [Abstract] [Full Text] [PDF]
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E. Bonnefoy, P. Godon, G. Kirkorian, M. Fatemi, P. Chevalier, and P. Touboul Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis Eur. Heart J., May 2, 2000; 21(10): 832 - 836. [Abstract] [PDF]
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 Y. Chen, R. C. Serfass, S. M. Mackey-Bojack, K. L. Kelly, J. L. Titus, and F. S. Apple Cardiac troponin T alterations in myocardium and serum of rats after stressful, prolonged intense exercise J Appl Physiol, May 1, 2000; 88(5): 1749 - 1755. [Abstract] [Full Text] [PDF]
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Chest pain with nondiagnostic electrocardiogram in the emergency department: a randomized controlled trial of two cardiac marker regimens Can. Med. Assoc. J., May 1, 2000; 162(11): 1561 - 1566.
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K. M. ver Elst, H. D. Spapen, D. N. Nguyen, C. Garbar, L. P. Huyghens, and F. K. Gorus Cardiac Troponins I and T Are Biological Markers of Left Ventricular Dysfunction in Septic Shock Clin. Chem., May 1, 2000; 46(5): 650 - 657. [Abstract] [Full Text] [PDF]
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 R. H. Mehta and K. A. Eagle Missed Diagnoses of Acute Coronary Syndromes in the Emergency Room -- Continuing Challenges N. Engl. J. Med., April 20, 2000; 342(16): 1207 - 1210. [Full Text]
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