The significance of lipid profile and positive troponin-I in predicting cardiac event
DOI:
https://doi.org/10.18203/2320-6012.ijrms20210419Keywords:
Troponin-I, Chest pain, Cardiac event, Lipid profileAbstract
Background: Diagnosis of acute cardiac event in the early stage of its onset is important in the treatment process. The development of highly sensitive and specific immunoassays for myocardial proteins such as cardiac troponin-I had made it possible. However troponin indicates cardiac events only after its onset or after cardiac tissue necrosis. Traditionally such high risk subjects were identified using lipid profiles. The identification of subjects with high risk of developing cardiac event in the future is more significant as it will provide time to prevent such incidents.
Methods: In this retrospective study data of the 250 patients presented to the emergency department with symptoms of cardiac ischemia who underwent both troponin-I and lipid profiles tests were compared with the lipid profiles of 100 normal healthy subjects (controls). The troponin-I was detected quantitatively when a specimen contains troponin-I above the 99th percentile (TnI >0.3 ng/ml). The total cholesterol, high density lipoproteins cholesterol, very low density lipoproteins cholesterol and triacylglycerol levels were also analyzed and low density lipoprotein cholesterol level was calculated using Friedewald’s formula.
Results: Patients with chest pain and positive troponin-I test (with confirmed cardiac event) were found to have significantly elevated levels of total cholesterol, triacylglycerols, low density lipoprotein cholesterol level and significantly reduced high density lipoproteins cholesterol levels when compared to the patients who experienced only chest pain with (negative troponin-I) and healthy controls.
Conclusions: An acute cardiac event is best diagnosed by highly sensitive and specific positive troponin-I test (by quantitative method). However, traditional lipid profile levels still can be used in screening the populations to identify those subjects with high risk of developing cardiac event, in those centres where troponin-I test facility is unavailable.
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References
Australian absolute cardiovascular disease risk calculator. Available at: http://www. cvdcheck.org.au/. Accessed on 20 November 2020.
New Zealand cardiovascular risk charts. Available at: http://www.health.govt.nz/system/files/ docum-ents/publications/090311_cvd_poster_final.pdf. Accessed on 20 November 2020.
Euroscore Available at: http://www.euroscore.org/ calc.html. Accessed on 20 November 2020.
Guidelines for the assessment of absolute cardiovascular disease risk. Available at: http://www.heartfoundation.org.au/SiteCollectionDocuments/ guidelines-Absolute-risk.pdf. Accessed on 20 November 2020.
Thygesen K, Alpert JS, White HD, Jaffe AS, Apple FS, Galvani M, et al. Universal definition of myocardial infarction. Circulation. 2007;116(22): 2634-53.
Thygesen K, Mair J, Katus H, Plebani M, Venge P, Collinson P, et al. Recommendations for the use of cardiac troponin measurement in acute cardiac care. Eur Heart J. 2010;31(18):2197-204.
Khan NA, Hemmelgarn BR, Tonelli M, Thompson CR, Levin A. Prognostic value of troponin T and I among asymptomatic patients with end stage renal disease: A meta-analysis. Circulation. 2005; 112(20):3088-96.
Needham DM, Shufelt KA, Tomlinson G, Scholey JW, Newton GE. Troponin I and T levels in renal failure patients without acute coronary syndrome: a systematic review of the literature. Can J Cardiol. 2004;20 (12):1212-8.
Latour-Perez J, Palencia-Herrejon E, Gordo-Vidal F, Sanchez-Artola YB. Prognostic value of troponin plasma levels in pulmonary thromboembolism: A systematic review and metal-analysis. Crit Care. 2005;29(6):329-37.
Lim W, Qushmaq I, Devereaux PJ, Heels-Ansdell D, Lauzier F, Ismaila AS, et al. Elevated cardiac troponin measurements in critically Ill patients. Arch Intern Med. 2006;166(22):2446-54.
Kerr G, Ray G, Wu O, Stott DJ, Langhorne P. Elevated troponin after stroke: A systematic review. Cerebrovasc Dis. 2009;28(3):220-6.
Levy M, Heels-Ansdell D, Hiralal R, Bhandari M, Guyatt G, Yusuf S, et al. Prognostic value of troponin and creatine kinase muscle and brain isoenzyme measurement after noncardiac surgery: a systematic review and meta-analysis. Anesthesiology. 2011;114(4):796-806.
Jimenez D UF, Otero R, Lobo JL, Monreal M, Martı´ D, Zamora J, et al. Troponin-based risk stratification of patients with acute non massive pulmonary embolism: systematic review and metaanalysis. Chest. 2009;136(4):974-82.
Croal BL, Hillis GS, Gibson PH, Fazal MT, El-Shafei H, Gibson G, et al. Relationship between postoperative cardiac troponin I levels and outcome of cardiac surgery. Circulation. 2006; 114(14):1468-75.
Kumar A, Sathian B. The clinical utility of lipid profile and positive troponin in predicting future cardiac events. Asian Pac J Trop Dis. 2012;2:66-9.
Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, et al. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American college of cardiology/American heart association task force on practice guidelines. Am Coll Cardiol. 2008;51:210-47.
Apple FS. High-sensitivity cardiac troponin assays: what analytical and clinical issues need to be addressed before introduction into clinical practice?. Clin Chem. 2010;56(6):886-91.
Macrae AR, Kavsak PA, Lustig V, Bhargava R, Vandersluis R, Palomaki GE, et al. Assessing the requirement for the 6 hour interval between specimens in the American Heart Association Classification of myocardial Infarction in epidemiology and clinical research studies. Clin Chem. 2006;52(5):812-8.
Alpert JS. Will the real myocardial infarction please stand up?. Clin Chem. 2006;52(5):795-96.
Alpert JS, Thygesen K, Jaffe A, White HD. The universal definitions of myocardial infractions please stand up?. ClinChem. 2006;52(5):1335-41.
Thygesen K, Alpert JS, Jaffe AS. Third universal definition of myocardial infarction. J Am Coll Cardiol. 2012;60:1581-98.
Morrow DA, Cannon CP, Rifai N, et al. Ability of minor elevations of troponins I and T to predict benefit from an early invasive strategy in patients with unstable angina and non-ST elevation myocardial infarction: results from a randomized trial. JAMA. 2001;286:2405-12.
Amsterdam EA, Wenger NK, Brindis RG. AHA/ACC Guideline for the management of patients with non-stelevation acute coronary syndromes: a report of the American college of cardiology/ American heart association task force on practice guidelines. J Am Coll Cardiol. 2014;64(24): e139-228.
Bhatt DL, Roe MT, Peterson ED. Utilization of early invasive management strategies for high-risk patients with non- ST-segment elevation acute coronary syndromes: results from the crusade quality improvement initiative. JAMA. 2004;292: 2096-104.
John KF, Harvey DW. Clinical implications of the new definition of myocardial infarction. Heart. 2004;90(1):99-106.
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clinical chemistry. 1972;18(6):499-502.
Guthrie R. Meeting lipid- lowering guidline with statin treatment. Available at: http://www.medscape. Com/vieewarticle1468097. Accessed on 20 November 2020.
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