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Unrecognized myocardial infarctions detected by cardiac magnetic resonance imaging are associated with cardiac troponin I levels
Örebro University, School of Health Sciences. Department of Cardiology.
Department of Radiology, Västerås Hospital, Västerås, Sweden; Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden.
Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden.
Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden.
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2016 (English)In: Clinica Chimica Acta, ISSN 0009-8981, E-ISSN 1873-3492, Vol. 455, 189-194 p.Article in journal (Refereed) Published
Abstract [en]

Background: Both unrecognized myocardial infarction (UMI) and elevated levels of biomarkers are common in patients with stable coronary artery disease (CAD). The objective of this study was to determine the association between levels of cardiac biomarkers, UMI and extent of CAD in patients with stable CAD.

Methods: A total of 235 patients (median age: 65years; 34% women) with stable CAD without previously known myocardial infarction were examined with late gadolinium enhancement cardiovascular magnetic resonance imaging and coronary angiography. Blood samples were drawn at enrolment and high sensitivity cardiac troponin I (cTnI), NT-proBNP and Galectin-3 were analyzed.

Results: UMI was detected in 58 patients (25%). The median levels of cTnI, NT-proBNP and Galectin-3 were significantly higher in patients with UMI compared to those without, (p<0.001, p=0.006 and p=0.033, respectively). After adjustment for cardiovascular risk factors, left ventricular ejection fraction and renal function, cTnI remained independently associated with the presence of UMI (p=0.031) and the extent of CAD (p=0.047). Neither NT-proBNP, nor Galectin-3, was independently associated with UMI or extent of CAD.

Conclusions: The independent association between levels of cTnI and UMI indicates a common pathophysiological pathway for the cTnI elevation and development of UMI.

Clinical trial registration: ClinicalTrials.gov (NCT01257282).

Place, publisher, year, edition, pages
Amsterdam, Netherlands: Elsevier, 2016. Vol. 455, 189-194 p.
Keyword [en]
Cardiac troponin, NT-proBNP, unrecognized myocardial infarction, coronary artery disease, cardiac magnetic resonance imaging
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:oru:diva-49645DOI: 10.1016/j.cca.2016.01.029ISI: 000373655100030PubMedID: 26828531Scopus ID: 2-s2.0-84961878512OAI: oai:DiVA.org:oru-49645DiVA: diva2:919135
Available from: 2016-04-13 Created: 2016-04-05 Last updated: 2016-05-02Bibliographically approved
In thesis
1. Unrecognized myocardial infarction and cardiac biochemical markers in patients with stable coronary artery disease
Open this publication in new window or tab >>Unrecognized myocardial infarction and cardiac biochemical markers in patients with stable coronary artery disease
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overarching aim of the thesis was to explore the occurrence and clinical importance of two manifestations of myocardial injury; unrecognized myocardial injury (UMI) and altered levels of cardiac biochemical markers in patients with stable coronary artery disease (CAD).

Methods: A prospective multicenter cohort study investigated the prevalence, localization, size, and prognostic implication of UMI in 235 patients with stable CAD. Late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) imaging and coronary angiography were used. The relationship between UMI and severe CAD and cardiac biochemical markers was explored. In a substudy the short- and longterm individual variation in cardiac troponins I and T (cTnI, cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were investigated.

Results: The prevalence of UMI was 25%. Subjects with severe CAD were significantly more likely to exhibit UMI than subjects without CAD. There was a strong association between stenosis ≥70% and presence of UMI in the myocardial segments downstream. The presence of UMI was associated with a significant threefold risk of adverse events during follow up. After adjustments UMI was associated with a nonsignificant numerically doubled risk. The levels of cTnI, NT-proBNP, and Galacin-3 were associated with the presence of UMI in univariate analyses. The association between levels of cTnI and presence of UMI remained significant after adjustment. The individual variation in cTnI, cTnT, and NT-proBNP in subjects with stable CAD appeared similar to the biological variation in healthy individuals.

Conclusions: UMI is common and is associated with significant CAD, levels of biochemical markers, and an increased risk for adverse events. A change of >50% is required for a reliable short-term change in cardiac troponins, and a rise of >76% or a fall of >43% is required to detect a long-term reliable change in NT-proBNP.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2016. 125 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 142
Keyword
Unrecognized myocardial infarction, Coronary artery disease, Prevalence, Prognosis, Troponin, NT-proBNP, Galectin-3
National Category
Family Medicine
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-48240 (URN)978-91-7529-125-3 (ISBN)
Public defence
2016-05-13, Universitetssjukhuset, hörsal C3, Södra Grev Rosengatan, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-02-15 Created: 2016-02-15 Last updated: 2016-04-21Bibliographically approved

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