Podwyższone stężenie troponiny bez ostrego zespołu wieńcowego Artykuł przeglądowy
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Opublikowane:
wrz 30, 2014
Słowa kluczowe:
podwyższone stężenie troponin, troponina I, troponina T, ostry zespół wieńcowy
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Abstrakt
Troponiny (Tn) sercowe są najbardziej czułymi i specyficznymi wskaźnikami uszkodzenia miokardium i stratyfikacji ryzyka sercowo-naczyniowego. Podwyższone stężenie Tn bez obecności ostrego zespołu wieńcowego jest markerem zwiększonej zachorowalności i śmiertelności ogólnej oraz z przyczyn sercowych. Przyczyną wzrostu stężenia troponin mogą być poważne stany kliniczne wymagające przeprowadzenia bardzo starannej diagnostyki i podjęcia zdecydowanych działań terapeutycznych. Obecnie nie ma wytycznych postępowania z pacjentami z podwyższonym stężeniem troponiny przy wykluczeniu choroby wieńcowej. Strategia postępowania w takich stanach klinicznych wymaga diagnostyki i leczenia leżących u podłoża przyczyn.
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Tymiński , S. (2014). Podwyższone stężenie troponiny bez ostrego zespołu wieńcowego . Kardiologia W Praktyce, 8(3), 34-41. Pobrano z https://journalsmededu.pl/index.php/kwp/article/view/1529
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Utwór dostępny jest na licencji Creative Commons Uznanie autorstwa – Użycie niekomercyjne – Bez utworów zależnych 4.0 Międzynarodowe.
Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
Bibliografia
1. Jaffe A.S., Vasile V.C., Milone M. et al.: Diseased skeletal muscle: a noncardiac source of increased circulating concentrations of cardiac troponin T. J. Am. Coll. Cardiol. 2011; 58: 1819.
2. Apple F.S., Collinson P.O.; IFCC Task Force on Clinical Applications of Cardiac Biomarkers: Analytical characteristics of high-sensitivity cardiac troponin assays. Clin. Chem. 2012; 58: 54.
3. Thygesen K., Alpert J.S., Jaffe A.S. et al.: Third universal definition of myocardial infarction. Circulation 2012; 126: 2020.
4. Anderson J., Adams C., Antman E. et al.: ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 2002 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, American College or Physicians, Society for Academic Emergency Medicine, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J. Am. Coll. Cardiol. 2007; 50: e1.
5. Wu A.H.: Increased troponin in patients with sepsis and septic shock: myocardial necrosis or reversible myocardial depression? Intensive Care Med. 2001; 27: 959.
6. Wallace T.W., Abdullah S.M., Drazner M.H. et al.: Prevalence and determinants of troponin T elevation in the general population. Circulation 2006; 113: 1958.
7. Smith S.C., Ladenson J.H., Mason J.W., Jaffe A.S.: Elevations of cardiac troponin I associated with myocarditis. Experimental and clinical correlates. Circulation 1997; 95: 163.
8. Logeart D., Beyne P., Cusson C. et al.: Evidence of cardiac myolysis in severe nonischemic heart failure and the potential role of increased wall strain. Am. Heart J. 2001; 141: 247.
9. Horwich T.B., Patel J., MacLellan W.R., Fonarow G.C.: Cardiac troponin I is associated with impaired hemodynamics, progressive left ventricular dysfunction, and increased mortality rates in advanced heart failure. Circulation 2003; 108: 833.
10. Nunes J.P., Mota Garcia J.M., Farinha R.M. et al.: Cardiac troponin I in aortic valve disease. Int. J. Cardiol. 2003; 89: 281.
11. Kupari M., Eriksson S., Turto H. et al.: Leakage of cardiac troponin I in aortic valve stenosis. Journal of Internal Medicine 2005; 258: 231-237.
12. Hijazi Z., Oldgren J., Andersson U. et al.: Cardiac biomarkers are associated with an increased risk of stroke and death in patients with atrial fibrillation: a Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) substudy. Circulation 2012; 125: 1605.
13. Kanjwal K., Imran N., Grubb B. et al.: Troponin elevation in patients with various tachycardias and normal epicardial coronaries. Indian Pacing and Electrophysiology Journal 2008; 8(3): 172.
14. Wang C.H., Kuo L.T., Hung M.J., Cherng W.J.: Coronary vasospasm as a possible cause of elevated cardiac troponin I in patients with acute coronary syndrome and insignificant coronary artery disease. Am. Heart J. 2002; 144: 275-281.
15. Tung P., Kopelnik A., Banki N. et al.: Predictors of neurocardiogenic injury after subarachnoid hemorrhage. Stroke 2004; 35: 548.
16. Naidech A.M., Kreiter K.T., Janjua N. et al.: Cardiac troponin elevation, cardiovascular morbidity, and outcome after subarachnoid hemorrhage. Circulation 2005; 112: 2851.
17. Hijazi Z., Oldgren J., Andersson U. et al.: Cardiac biomarkers are associated with an increased risk of stroke and death in patients with atrial fibrillation: a Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) substudy. Circulation 2012; 125: 1605.
18. Gianni M., Dentali F., Grandi A.M. et al.: Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur. Heart J. 2006; 27: 1523.
19. Nef H.M., Möllmann H., Kostin S. et al.: Tako-Tsubo cardiomyopathy: intraindividual structural analysis in the acute phase and after functional recovery. Eur. Heart J. 2007; 28: 2456.
20. Sharkey S.W., Windenburg D.C., Lesser J.R. et al.: Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy. J. Am. Coll. Cardiol. 2010; 55: 333.
21. Imazio M., Demichelis B., Cecchi E. et al.: Cardiac troponin I in acute pericarditis. J. Am. Coll. Cardiol. 2003; 42: 2144.
22. Bonnefoy E., Godon P., Kirkorian G. et al.: Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis. Eur. Heart J. 2000; 21: 832.
23. Lauer B., Niederau C., Kühl U. et al.: Cardiac troponin T in patients with clinically suspected myocarditis. J. Am. Coll. Cardiol. 1997; 30(5): 1354-9135.
24. Friedrich M.G., Sechtem U., Schulz-Menger J. et al.: Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J. Am. Coll. Cardiol. 2009; 53: 1475.
25. Becattini C., Vedovati M.C., Agnelli G.: Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation 2007; 116: 427-433.
26. Meyer T., Binder L., Hruska N. et al.: Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. J. Am. Coll. Cardiol. 2000; 36: 1632-1636.
27. Labugger R., Organ L., Collier C. et al.: Extensive troponin I and T modification detected in serum from patients with acute myocardial infarction. Circulation 2000; 102: 1221-1226.
28. Bodor G.S., Oakeley A.E., Allen P.D. et al.: Troponin I phosphorylation in the normal and failing adult human heart. Circulation 1997; 96: 1495-1500.
29. Ooi D.S., Isotalo P.A., Veinot J.P.: Correlation of antemortem serum creatine kinase, creatine kinase-MB, troponin I, and troponin T with cardiac pathology. Clin. Chem. 2000; 46: 338-344.
30. Kontos M., Anderson F., Alimard R.: Ability of troponin I to predict cardiac events in patients admitted from the emergency department. J. Am. Coll. Cardiol. 2000; 36: 1818-1823.
31. deFilippi C.R., Tocchi M., Parmar R.J.: Cardiac troponin T in chest pain unit patients without ischemic electrocardiographic changes. angiographic correlates and long-term clinical outcomes. J. Am. Coll. Cardiol. 2000; 35: 1827-1834.
32. Piechota W., Gielerak G., Ryczek R. et al.: Cardiac troponin I after external electrical cardioversion for atrial fibrillation as a marker of myocardial injury – a preliminary report. Kardiol. Pol. 2007; 65: 664.
33. La Gerche A., Burns A.T., Mooney D.J. et al.: Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. Eur. Heart J. 2012; 33(8): 998-1006.
34. O’Keefe J.H., Patil H.R., Lavie C.J. et al.: Potential adverse cardiovascular effects from excessive endurance exercise. Mayo Clin. Proc. 2012; 87(6): 587-595.
35. Cardinale D., Sandri M.T., Martinoni A.: Left ventricular dysfunction predicted by early troponin I release after high-dose chemotherapy. J. Am. Coll. Cardiol. 2000; 36: 517-522.
36. Sandri M.T., Cardinale D., Zorzino L.: Minor increases in plasma troponin I predict decreased left ventricular ejection fraction after high-dose chemotherapy. Clin. Chem. 2003; 49: 248-252.
37. Auner H.W., Tinchon C., Linkesch W.: Prolonged monitoring of troponin T for the detection of anthracycline cardiotoxicity in adults with hematological malignancies. Ann. Hematol. 2003; 82: 218-222.
38. Dispenzieri A., Gertz M.A., Kyle R.A.: Prognostication of survival using cardiac troponins and N-terminal pro-brain natriuretic peptide in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation. Blood 2004; 104: 1881-1887.
39. Gertz M., Lacy M., Dispenzieri A.: Troponin T level as an exclusion criterion for stem cell transplantation in light-chain amyloidosis. Leuk. Lymphoma 2008; 49: 36-41.
40. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm A.J., Kirchhof P., Lip G.Y. et al.: Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur. Heart J. 2010; 31(19): 2369-2429.
41. Peacock W.F.I.V., De Marco T., Fonarow G.C. et al.: Cardiac troponin and outcome in acute heart failure. N. Engl. J. Med. 2008; 358: 2117-2126.
42. Agewall S., Giannitsis E., Jernberg T., Katus H.: Troponin elevation in coronary vs non-coronary disease. Eur. Heart J. 2011; 32(4): 404-411.
2. Apple F.S., Collinson P.O.; IFCC Task Force on Clinical Applications of Cardiac Biomarkers: Analytical characteristics of high-sensitivity cardiac troponin assays. Clin. Chem. 2012; 58: 54.
3. Thygesen K., Alpert J.S., Jaffe A.S. et al.: Third universal definition of myocardial infarction. Circulation 2012; 126: 2020.
4. Anderson J., Adams C., Antman E. et al.: ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 2002 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, American College or Physicians, Society for Academic Emergency Medicine, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J. Am. Coll. Cardiol. 2007; 50: e1.
5. Wu A.H.: Increased troponin in patients with sepsis and septic shock: myocardial necrosis or reversible myocardial depression? Intensive Care Med. 2001; 27: 959.
6. Wallace T.W., Abdullah S.M., Drazner M.H. et al.: Prevalence and determinants of troponin T elevation in the general population. Circulation 2006; 113: 1958.
7. Smith S.C., Ladenson J.H., Mason J.W., Jaffe A.S.: Elevations of cardiac troponin I associated with myocarditis. Experimental and clinical correlates. Circulation 1997; 95: 163.
8. Logeart D., Beyne P., Cusson C. et al.: Evidence of cardiac myolysis in severe nonischemic heart failure and the potential role of increased wall strain. Am. Heart J. 2001; 141: 247.
9. Horwich T.B., Patel J., MacLellan W.R., Fonarow G.C.: Cardiac troponin I is associated with impaired hemodynamics, progressive left ventricular dysfunction, and increased mortality rates in advanced heart failure. Circulation 2003; 108: 833.
10. Nunes J.P., Mota Garcia J.M., Farinha R.M. et al.: Cardiac troponin I in aortic valve disease. Int. J. Cardiol. 2003; 89: 281.
11. Kupari M., Eriksson S., Turto H. et al.: Leakage of cardiac troponin I in aortic valve stenosis. Journal of Internal Medicine 2005; 258: 231-237.
12. Hijazi Z., Oldgren J., Andersson U. et al.: Cardiac biomarkers are associated with an increased risk of stroke and death in patients with atrial fibrillation: a Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) substudy. Circulation 2012; 125: 1605.
13. Kanjwal K., Imran N., Grubb B. et al.: Troponin elevation in patients with various tachycardias and normal epicardial coronaries. Indian Pacing and Electrophysiology Journal 2008; 8(3): 172.
14. Wang C.H., Kuo L.T., Hung M.J., Cherng W.J.: Coronary vasospasm as a possible cause of elevated cardiac troponin I in patients with acute coronary syndrome and insignificant coronary artery disease. Am. Heart J. 2002; 144: 275-281.
15. Tung P., Kopelnik A., Banki N. et al.: Predictors of neurocardiogenic injury after subarachnoid hemorrhage. Stroke 2004; 35: 548.
16. Naidech A.M., Kreiter K.T., Janjua N. et al.: Cardiac troponin elevation, cardiovascular morbidity, and outcome after subarachnoid hemorrhage. Circulation 2005; 112: 2851.
17. Hijazi Z., Oldgren J., Andersson U. et al.: Cardiac biomarkers are associated with an increased risk of stroke and death in patients with atrial fibrillation: a Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) substudy. Circulation 2012; 125: 1605.
18. Gianni M., Dentali F., Grandi A.M. et al.: Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur. Heart J. 2006; 27: 1523.
19. Nef H.M., Möllmann H., Kostin S. et al.: Tako-Tsubo cardiomyopathy: intraindividual structural analysis in the acute phase and after functional recovery. Eur. Heart J. 2007; 28: 2456.
20. Sharkey S.W., Windenburg D.C., Lesser J.R. et al.: Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy. J. Am. Coll. Cardiol. 2010; 55: 333.
21. Imazio M., Demichelis B., Cecchi E. et al.: Cardiac troponin I in acute pericarditis. J. Am. Coll. Cardiol. 2003; 42: 2144.
22. Bonnefoy E., Godon P., Kirkorian G. et al.: Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis. Eur. Heart J. 2000; 21: 832.
23. Lauer B., Niederau C., Kühl U. et al.: Cardiac troponin T in patients with clinically suspected myocarditis. J. Am. Coll. Cardiol. 1997; 30(5): 1354-9135.
24. Friedrich M.G., Sechtem U., Schulz-Menger J. et al.: Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J. Am. Coll. Cardiol. 2009; 53: 1475.
25. Becattini C., Vedovati M.C., Agnelli G.: Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation 2007; 116: 427-433.
26. Meyer T., Binder L., Hruska N. et al.: Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. J. Am. Coll. Cardiol. 2000; 36: 1632-1636.
27. Labugger R., Organ L., Collier C. et al.: Extensive troponin I and T modification detected in serum from patients with acute myocardial infarction. Circulation 2000; 102: 1221-1226.
28. Bodor G.S., Oakeley A.E., Allen P.D. et al.: Troponin I phosphorylation in the normal and failing adult human heart. Circulation 1997; 96: 1495-1500.
29. Ooi D.S., Isotalo P.A., Veinot J.P.: Correlation of antemortem serum creatine kinase, creatine kinase-MB, troponin I, and troponin T with cardiac pathology. Clin. Chem. 2000; 46: 338-344.
30. Kontos M., Anderson F., Alimard R.: Ability of troponin I to predict cardiac events in patients admitted from the emergency department. J. Am. Coll. Cardiol. 2000; 36: 1818-1823.
31. deFilippi C.R., Tocchi M., Parmar R.J.: Cardiac troponin T in chest pain unit patients without ischemic electrocardiographic changes. angiographic correlates and long-term clinical outcomes. J. Am. Coll. Cardiol. 2000; 35: 1827-1834.
32. Piechota W., Gielerak G., Ryczek R. et al.: Cardiac troponin I after external electrical cardioversion for atrial fibrillation as a marker of myocardial injury – a preliminary report. Kardiol. Pol. 2007; 65: 664.
33. La Gerche A., Burns A.T., Mooney D.J. et al.: Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. Eur. Heart J. 2012; 33(8): 998-1006.
34. O’Keefe J.H., Patil H.R., Lavie C.J. et al.: Potential adverse cardiovascular effects from excessive endurance exercise. Mayo Clin. Proc. 2012; 87(6): 587-595.
35. Cardinale D., Sandri M.T., Martinoni A.: Left ventricular dysfunction predicted by early troponin I release after high-dose chemotherapy. J. Am. Coll. Cardiol. 2000; 36: 517-522.
36. Sandri M.T., Cardinale D., Zorzino L.: Minor increases in plasma troponin I predict decreased left ventricular ejection fraction after high-dose chemotherapy. Clin. Chem. 2003; 49: 248-252.
37. Auner H.W., Tinchon C., Linkesch W.: Prolonged monitoring of troponin T for the detection of anthracycline cardiotoxicity in adults with hematological malignancies. Ann. Hematol. 2003; 82: 218-222.
38. Dispenzieri A., Gertz M.A., Kyle R.A.: Prognostication of survival using cardiac troponins and N-terminal pro-brain natriuretic peptide in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation. Blood 2004; 104: 1881-1887.
39. Gertz M., Lacy M., Dispenzieri A.: Troponin T level as an exclusion criterion for stem cell transplantation in light-chain amyloidosis. Leuk. Lymphoma 2008; 49: 36-41.
40. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm A.J., Kirchhof P., Lip G.Y. et al.: Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur. Heart J. 2010; 31(19): 2369-2429.
41. Peacock W.F.I.V., De Marco T., Fonarow G.C. et al.: Cardiac troponin and outcome in acute heart failure. N. Engl. J. Med. 2008; 358: 2117-2126.
42. Agewall S., Giannitsis E., Jernberg T., Katus H.: Troponin elevation in coronary vs non-coronary disease. Eur. Heart J. 2011; 32(4): 404-411.