Use of Highly Sensitive Cardiac Troponin I Test outside Acute Coronary Syndrome

typical changes in CK-MB and cardiac troponin in Acute Myocardial Infarction (Photo credit: Wikipedia)

Traditionally, Cardiac Troponin I and highly sensitive cardiac troponin T are used to support the diagnosis of acute coronary events, such as heart stroke or Myocardial Infarction.

A new study has found it’s role outside the Acute Coronary Syndrome (ACS), incase of otherwise stable patients of coronary artery disease (CAD).


Elevated concentrations of cardiac troponin I (cTnI) in patients with stable coronary artery disease (CAD) are associated with an increased risk of cardiovascular death or heart failure, as well as a significantly increased risk of nonfatal MI.
In this new analysis, increases in cTnI, detected using a highly sensitive assay, were associated with an 88% higher risk of cardiovascular death or heart failure and a 44% increased risk of nonfatal MI.
In this study, high-sensitivity cTnI levels were assessed in 3623 patients with stable CAD and preserved systolic function. Of these individuals, 98.5% had cTnI concentrations above the 1.2-pg/mL assay detection limit.

Abbreviations used for ACS (Acute coronary syndrome) (Photo credit: Wikipedia)

Now, as no strategy has been developed on how to utilize the results to modify such risks; it has not been recommended for universal use. But, it is a strong prognostic indicator.
The increase in the level of troponin may be due to stress in cardiac muscle or from stress related hypertrophy of cardiac muscle.

Fish Oils May Slow Aging

Tuna Fish

Telomere is the genetic material found in the tail piece of chromosomes, responsible for keeping the integrity of chromosome intact in the face of multiple cell divisions. It may shorten, thereby hampering the repair process. Researchers think that to be reason of aging, and postulate that fish oil containing omega3 fatty acids, may help in keeping the length of telomere intact. This might help in defying aging process.

clipped from drppanda.amplify.com Fish Oils May Slow Genetic Aging Studies have shown that omega-3s appear to be effective for patients with coronary artery disease. Yet the underlying mechanisms are not well understood. Some researchers think it may have something to do with anti-inflammatory, triglyceride-lowering, antihypertensive, antiplatelet, or antiarrhythimic effects. Research has shown that the length of telomeres — chromosome caps that have long been compared to the plastic ends of shoelaces — may be a marker of biological age. Biological age is independent of chronological age, and takes into account genetic and environmental stressors that may wreak havoc on cells. The researchers found that baseline omega-3 fatty acid levels were positively correlated with changes in telomere length over five years (P=0.001).

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ANGINA PECTORIS

Image via Wikipedia

Some eleven years back one known to me asked about his relative who was getting pain in his left shoulder and becoming breathless while walking.The presumptive diagnosis was somewhat straight forward.And an ECG revealed that he is suffering from Myocardial Ischaemia.The typical description of angina pectoris pain is a feeling of severe compression of chest ,a squeezing or a sharp pain in the left lower chest lasting for minutes and radiating to neck,shoulder tip,axilla,Lt. arm,back,right side of chest and upper abdomen.Unfortunately this typical description is lacking in many.

Other symptoms of Myocardial Ichaemia include sweating,breathlessness,stupor,fainting , vomiting and many other atypical ones.
But in a physically active person with regular brisk walk having some burning symptom of upper abdomen and normal ECG in two different occassions ,it is hard to digest that he is suffering from myocardial ischaemia.But later his description of this burning sensation and discomfort of upper abdomen while walking, compelling him to take breaks two to three times in about two kilometers distance should have given rise to suspicion of ischaemia.
Eventually an ECG on that day revealed a change in ECG prompting an urgent treatment.Further an angiography revealed narrowing in one of the branches of a main coronary artery and he was treated according.Also it was noticed that the artery in question was little less in caliber than usual.During review of literature in the Wiley Interscience database it was seen that narrow coronay may go for spasm.And I think this must be happening during an exercise while there is demand for more oxygen in the myocardium i.e. heart muscle.

But the lesson is that highest degree of suspicion till ischaemic heart disease is excluded 
 confidently.

Image via Wikipedia

This blog, the 100th post is dedicated to my senior colleague Dr.S.Patra and my elder son Sipun the author of techfusion.com.

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• Any Exercise Good After a Heart Attack (nlm.nih.gov)
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