scholarly journals Troponin elevation in patients with heart failure: on behalf of the third Universal Definition of Myocardial Infarction Global Task Force: Heart Failure Section

2012 ◽  
Vol 33 (18) ◽  
pp. 2265-2271 ◽  
Author(s):  
James L. Januzzi ◽  
Gerasimos Filippatos ◽  
Markku Nieminen ◽  
Mihai Gheorghiade
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Task Force ◽  
Troponin Elevation ◽  
The Third ◽  
Patients With Heart Failure ◽  
Universal Definition ◽  
Definition Of

scholarly journals Global Adoption of High-Sensitivity Cardiac Troponins and the Universal Definition of Myocardial Infarction

2018 ◽  
Author(s):  
Atul Anand ◽  
Anoop SV Shah ◽  
Agim Beshiri ◽  
Allan S Jaffe ◽  
Nicholas L Mills
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Troponin ◽  
High Sensitivity ◽  
Diagnosis And Management ◽  
Coronary Syndrome ◽  
The Third ◽  
Diagnostic Threshold ◽  
Serial Sampling ◽  
Universal Definition ◽  
Definition Of

AbstractImportanceThe third Universal Definition of Myocardial Infarction aimed to standardize the approach to the diagnosis and management of myocardial infarction. High-sensitivity cardiac troponin testing was recommended, as these assays have improved precision at low concentrations, but concerns over specificity may have limited implementation.ObjectiveTo determine the global adoption of high-sensitivity cardiac troponin assays and key recommendations from the Universal Definition.Design, Setting and ParticipantsGlobal survey of 1,902 medical centers across 23 countries evenly distributed across all five continents. Included respondents were involved in the diagnosis and management of patients with suspected acute coronary syndrome at their institutions.Main Outcomes and MeasuresStructured questionnaire detailing the primary biomarker used for myocardial infarction, diagnostic thresholds and critical elements of clinical pathways for comparison to the third Universal Definition recommendations.ResultsCardiac troponin was the primary diagnostic biomarker for myocardial infarction at 96% of all sites surveyed. Only 41% of centers had adopted high-sensitivity cardiac troponin assays, with wide variation from 7% in North America to 60% in Europe. Sites using high-sensitivity assays more frequently employed serial sampling pathways (91% vs. 78%) and the 99th percentile diagnostic threshold (74% vs. 66%) when compared to sites using the previous generation of troponin assays. Furthermore, sites using high-sensitivity assays more often used earlier serial sampling (≤3 hours) and accelerated diagnostic pathways. However, fewer than 1 in 5 sites using high-sensitivity assays had adopted sex-specific thresholds (18%).Conclusions and RelevanceProgress has been made in adopting the recommendations of the Universal Definition of Myocardial Infarction, particularly in the use of the 99th percentile diagnostic threshold and serial sampling. However, high-sensitivity assays are used in a minority of sites and sex-specific thresholds in even fewer. These findings highlight regions where additional efforts are required to improve the risk stratification and diagnosis of patients with myocardial infarction.

Cardiovascular Biomarkers

2014 ◽  
Author(s):  
Parul U Gandhi ◽  
James L Januzzi Jr
Keyword(s):  
Myocardial Infarction ◽  
Natriuretic Peptide ◽  
Amino Terminal ◽  
Coronary Syndrome ◽  
Patients With Heart Failure ◽  
Troponin Release ◽  
Universal Definition ◽  
Definition Of ◽  
Release Timing ◽  
Cardiovascular Biomarkers

The value of circulating biomarkers to care for patients with cardiovascular disease has grown significantly over the last few decades. The majority of clinical data focus on the use of natriuretic peptides (NPs) for the diagnosis, prognosis, and management of patients with heart failure (HF) and troponin measurements in patients with suspected or proven acute coronary syndrome (ACS). Part of the reason for the slow adoption of biomarkers beyond these two classes has been limitation in the optimal modes of application of new assays. Future studies are needed to clarify the use of biomarkers, with the ultimate goal of simplifying the diagnosis, prognosis, and patient care of complex cardiovascular conditions. This chapter reviews the use of established biomarkers for HF, ACS, and atrial fibrillation (AF). Tables include a summary of emerging and established cardiovascular biomarkers, characteristics of B-type natriuretic peptide and amino-terminal pro-B-type natriuretic peptide, cutoff points for NP measurement, differential diagnosis of elevated NP concentrations, biomarkers in HF with preserved ejection fraction, summary of NP management trials, third universal definition of myocardial infarction, and guidelines for recommendations of biomarkers in HF. Figures depict the various causes of NP release, the complex mechanism of troponin release in patients with HF, the ischemic and nonischemic etiologies of troponin release, timing of biomarker release during myocardial infarction, and the biomarkers involved in the pathogenesis of AF. Algorithms demonstrate evaluating outpatients with dyspnea in the clinic using NPs in their workup and the use of troponin to assist with determining an appropriate management strategy for a patient with ACS. This review contains 7 highly rendered figures, 8 tables, and 202 references.

Cardiovascular Biomarkers

2017 ◽  
Author(s):  
Parul U Gandhi ◽  
James L Januzzi Jr
Keyword(s):  
Myocardial Infarction ◽  
Natriuretic Peptide ◽  
Amino Terminal ◽  
Coronary Syndrome ◽  
Patients With Heart Failure ◽  
Troponin Release ◽  
Universal Definition ◽  
Definition Of ◽  
Release Timing ◽  
Cardiovascular Biomarkers

The value of circulating biomarkers to care for patients with cardiovascular disease has grown significantly over the last few decades. The majority of clinical data focus on the use of natriuretic peptides (NPs) for the diagnosis, prognosis, and management of patients with heart failure (HF) and troponin measurements in patients with suspected or proven acute coronary syndrome (ACS). Part of the reason for the slow adoption of biomarkers beyond these two classes has been limitation in the optimal modes of application of new assays. Future studies are needed to clarify the use of biomarkers, with the ultimate goal of simplifying the diagnosis, prognosis, and patient care of complex cardiovascular conditions. This chapter reviews the use of established biomarkers for HF, ACS, and atrial fibrillation (AF). Tables include a summary of emerging and established cardiovascular biomarkers, characteristics of B-type natriuretic peptide and amino-terminal pro-B-type natriuretic peptide, cutoff points for NP measurement, differential diagnosis of elevated NP concentrations, biomarkers in HF with preserved ejection fraction, summary of NP management trials, third universal definition of myocardial infarction, and guidelines for recommendations of biomarkers in HF. Figures depict the various causes of NP release, the complex mechanism of troponin release in patients with HF, the ischemic and nonischemic etiologies of troponin release, timing of biomarker release during myocardial infarction, and the biomarkers involved in the pathogenesis of AF. Algorithms demonstrate evaluating outpatients with dyspnea in the clinic using NPs in their workup and the use of troponin to assist with determining an appropriate management strategy for a patient with ACS. This review contains 7 highly rendered figures, 8 tables, and 202 references.

Republished: Clinical implications of the Third Universal Definition of Myocardial Infarction

2014 ◽  
Vol 90 (1067) ◽  
pp. 502-510 ◽  
Author(s):  
Harvey D White ◽  
Kristian Thygesen ◽  
Joseph S Alpert ◽  
Allan S Jaffe
Keyword(s):  
Myocardial Infarction ◽  
Clinical Implications ◽  
The Third ◽  
Universal Definition ◽  
Definition Of

scholarly journals Diagnosis of Type 1 and Type 2 Myocardial Infarction Using a High-Sensitivity Cardiac Troponin I Assay with Sex-Specific 99th Percentiles Based on the Third Universal Definition of Myocardial Infarction Classification System

2015 ◽  
Vol 61 (4) ◽  
pp. 657-663 ◽  
Author(s):  
Yader Sandoval ◽  
Stephen W Smith ◽  
Karen M Schulz ◽  
MaryAnn M Murakami ◽  
Sara A Love ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Classification System ◽  
Cardiac Troponin ◽  
Troponin I ◽  
High Sensitivity ◽  
The Third ◽  
Universal Definition ◽  
Definition Of

Abstract BACKGROUND The frequency and characteristics of myocardial infarction (MI) subtypes per the Third Universal Definition of MI (TUDMI) classification system using high-sensitivity (hs) cardiac troponin assays with sex-specific cutoffs is not well known. We sought to describe the diagnostic characteristics of type 1 (T1MI) and type 2 (T2MI) MI using an hs–cardiac troponin I (hs-cTnI) assay with sex-specific cutoffs. METHODS A total of 310 consecutive patients with serial cTnI measurements obtained on clinical indication were studied with contemporary and hs-cTnI assays. Ninety-ninth percentile sex-specific upper reference limits (URLs) for the hs-cTnI assay were 16 ng/L for females and 34 ng/L for males. The TUDMI consensus recommendations were used to define and adjudicate MI based on each URL. RESULTS A total of 127 (41%) patients had at least 1 hs-cTnI exceeding the sex-specific 99th percentiles, whereas 183 (59%) had hs-cTnI within the reference interval. Females had more myocardial injury related to supply/demand ischemia than males (39% vs 18%, P = 0.01), whereas males had more multifactorial or indeterminate injury (52% vs 33%, P = 0.05). By hs-cTnI, there were 32 (10%) acute MIs, among which 10 (3%) were T1MI and 22 (7%) were T2MI. T2MI represented 69% (22 out of 32) of all acute MIs, whereas T1MI represented 31% (10 out of 32). Ninety-five patients (31%) had an increased hs-cTnI above the 99th percentile but did not meet criteria for acute MI. The most common triggers for T2MI were tachyarrhythmias, hypotension/shock, and hypertension. By contemporary cTnI, more MIs (14 T1MI and 29 T2MI) were diagnosed. By contemporary cTnI, there were 43 MIs, 14 T1MI, and 29 T2MI. CONCLUSIONS Fewer MI diagnoses were found with the hs-cTnI assay, contrary to the commonly accepted idea that hs-cTnI will lead to excessive false-positive diagnoses.

3296Clinical application of the fourth universal definition of myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Hartikainen ◽  
N A Soerensen ◽  
P M Haller ◽  
A Gossling ◽  
S Blankenberg ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiovascular Events ◽  
Myocardial Injury ◽  
Troponin T ◽  
Chronic Injury ◽  
All Cause Mortality ◽  
Acute Myocardial Injury ◽  
Universal Definition ◽  
Definition Of

Abstract Background The recently released fourth version of the Universal Definition of Myocardial Infarction (UDMI) introduced substantial changes such as the implementation of the categories acute and chronic myocardial injury. It further recommends the use of sex-specific troponin cut-offs and consideration of absolute rather than relative changes of troponin concentrations for diagnosis of myocardial infarction (MI). Our aim was to apply the updated UDMI in patients with suspected MI to investigate its effect on diagnosis and prognosis. Methods We included 2'304 patients presenting to the emergency department with suspected MI. The final diagnosis was first adjudicated according to the 3rd UDMI by two physicians in a blinded fashion using all available medical records, laboratory findings including high-sensitivity troponin T results as well as clinical and imaging findings. Thereafter all patients were re-adjudicated based on the 4th UDMI, again all available information was used. Included patients were followed up to 4 years to assess all-cause mortality, incident nonfatal MI, revascularization and rehospitalization. Hazard ratios (HR) were calculated to investigate the effect of the diagnoses based on the 4th UDMI on prognosis. Results Out of 2'304 included patients, 708 got reclassified by the 4th UDMI. 442 (19.2%) were diagnosed as having MI compared to 504 (21.9%) based on the 3rd UDMI. Out of 1'862 non-MI patients, 74 (3.97%) patients had acute and 583 (31.3%) chronic myocardial injury (Figure 1). Patients with acute or chronic injury were older, more often female and had worse renal function than other non-MI patients. The most common causes for acute myocardial injury were heart failure, pulmonary embolism and takotsubo cardiomyopathy. For chronic myocardial injury hypertension, heart failure and non-obstructive coronary artery disease were the most frequent reasons. In cox regression analyses unadjusted HR for all-cause mortality in patients with acute or chronic myocardial injury was considerably higher when compared to patients with non-cardiac chest pain (HR 13.2 (confidence interval (CI) 6.7–26.3) (p<0.001) for acute myocardial injury and 7.2 (CI 4.2–12.5) (p<0.001) for chronic myocardial injury). After adjustment for age and gender, acute and chronic myocardial injury still strongly predicted a poorer outcome and higher rate of cardiovascular events compared to other non-MI patients. Patients with acute or chronic myocardial injury showed equally poor outcome as patients with MI. Figure 1. Re-adjudication Conclusion By introducing the categories of acute and chronic myocardial injury the 4th UDMI succeeds to identify non-MI patients with higher risk for cardiovascular events and poorer outcome and thus seems to improve risk assessment in this heterogeneous population. Prevention strategies for this specific population are yet to be investigated.

scholarly journals Value of the SYNTAX score for periprocedural myocardial infarction according to WHO and the third universal definition of myocardial infarction: insights from the TWENTE trial

2016 ◽  
Vol 12 (4) ◽  
pp. 431-440 ◽  
Author(s):  
Kenneth Tandjung ◽  
Ming Kai Lam ◽  
Hanim Sen ◽  
Frits H.A.F. de Man ◽  
J. (Hans) W. Louwerenburg ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Syntax Score ◽  
The Third ◽  
Periprocedural Myocardial Infarction ◽  
Universal Definition ◽  
Definition Of
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