Diurnal Rhythm of Cardiac Troponin: Consequences for the Diagnosis of Acute Myocardial Infarction
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Diurnal Rhythm of Cardiac Troponin: Consequences for the Diagnosis of Acute Myocardial Infarction. / Klinkenberg, Lieke J J; Wildi, Karin; van der Linden, Noreen; Kouw, Imre W K; Niens, Marijke; Twerenbold, Raphael; Rubini Gimenez, Maria; Puelacher, Christian; Daniel Neuhaus, Jean; Hillinger, Petra; Nestelberger, Thomas; Boeddinghaus, Jasper; Grimm, Karin; Sabti, Zaid; Bons, Judith A P; van Suijlen, Jeroen D E; Tan, Frans E S; Ten Kate, Joop; Bekers, Otto; van Loon, Luc J C; van Dieijen-Visser, Marja P; Mueller, Christian; Meex, Steven J R.
In: CLIN CHEM, Vol. 62, No. 12, 12.2016, p. 1602-1611.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Diurnal Rhythm of Cardiac Troponin: Consequences for the Diagnosis of Acute Myocardial Infarction
AU - Klinkenberg, Lieke J J
AU - Wildi, Karin
AU - van der Linden, Noreen
AU - Kouw, Imre W K
AU - Niens, Marijke
AU - Twerenbold, Raphael
AU - Rubini Gimenez, Maria
AU - Puelacher, Christian
AU - Daniel Neuhaus, Jean
AU - Hillinger, Petra
AU - Nestelberger, Thomas
AU - Boeddinghaus, Jasper
AU - Grimm, Karin
AU - Sabti, Zaid
AU - Bons, Judith A P
AU - van Suijlen, Jeroen D E
AU - Tan, Frans E S
AU - Ten Kate, Joop
AU - Bekers, Otto
AU - van Loon, Luc J C
AU - van Dieijen-Visser, Marja P
AU - Mueller, Christian
AU - Meex, Steven J R
N1 - © 2016 American Association for Clinical Chemistry.
PY - 2016/12
Y1 - 2016/12
N2 - BACKGROUND: Interpretation of serial high-sensitivity cardiac troponin (hs-cTn) measurements for the diagnosis of acute myocardial infarction (AMI) assumes random fluctuation of hs-cTn around an individual's homeostatic set point. The aim of this study was to challenge this diagnostic concept.METHODS: Study 1 examined the presence of a diurnal hs-cTn rhythm by hourly blood sampling, day and night, in 24 individuals without a recent history of AMI. Study 2 assessed morning vs evening diagnostic accuracy of hs-cTnT and hs-cTnI in a prospective multicenter diagnostic study of 2782 unselected patients, presenting to the emergency department with acute chest pain.RESULTS: In study 1, hs-cTnT, but not hs-cTnI, exhibited a diurnal rhythm, characterized by gradually decreasing concentrations throughout daytime, rising concentrations during nighttime, to peak concentrations in the morning (mean 16.2 ng/L at 8:30 AM and 12.1 ng/L at 7:30 PM). In study 2, the hs-cTnT rhythm was confirmed by higher hs-cTnT concentrations in early-morning presenters compared to evening presenters with an adjudicated diagnosis of noncardiac disease. The diagnostic accuracy [area under the receiver-operation characteristics curve (AUC)] of hs-cTnT at presentation, 1 h, and for the combination of absolute changes with presenting concentration, were very high and comparable among patients presenting early morning as compared to evening (all AUC >0.93). hs-cTnI exhibited no diurnal rhythm with no differences in AUC among early-morning and evening presenters.CONCLUSIONS: Rhythmic diurnal variation of hs-cTnT is a general phenomenon that is not seen with hs-cTnI. While the diurnal hs-cTnT rhythm does not seem to affect the diagnostic accuracy of hs-cTnT for AMI, it should be considered when using hs-cTnT for screening purposes.CLINICAL TRIAL REGISTRATION: 1. Circadian Variation of Cardiac Troponin, NCT02091427, www.clinicaltrials.gov/ct2/show/NCT02091427. 2. Advantageous Predictors of Acute Coronary Syndrome Evaluation (APACE) Study, NCT00470587, www.clinicaltrials.gov/ct2/show/NCT00470587.
AB - BACKGROUND: Interpretation of serial high-sensitivity cardiac troponin (hs-cTn) measurements for the diagnosis of acute myocardial infarction (AMI) assumes random fluctuation of hs-cTn around an individual's homeostatic set point. The aim of this study was to challenge this diagnostic concept.METHODS: Study 1 examined the presence of a diurnal hs-cTn rhythm by hourly blood sampling, day and night, in 24 individuals without a recent history of AMI. Study 2 assessed morning vs evening diagnostic accuracy of hs-cTnT and hs-cTnI in a prospective multicenter diagnostic study of 2782 unselected patients, presenting to the emergency department with acute chest pain.RESULTS: In study 1, hs-cTnT, but not hs-cTnI, exhibited a diurnal rhythm, characterized by gradually decreasing concentrations throughout daytime, rising concentrations during nighttime, to peak concentrations in the morning (mean 16.2 ng/L at 8:30 AM and 12.1 ng/L at 7:30 PM). In study 2, the hs-cTnT rhythm was confirmed by higher hs-cTnT concentrations in early-morning presenters compared to evening presenters with an adjudicated diagnosis of noncardiac disease. The diagnostic accuracy [area under the receiver-operation characteristics curve (AUC)] of hs-cTnT at presentation, 1 h, and for the combination of absolute changes with presenting concentration, were very high and comparable among patients presenting early morning as compared to evening (all AUC >0.93). hs-cTnI exhibited no diurnal rhythm with no differences in AUC among early-morning and evening presenters.CONCLUSIONS: Rhythmic diurnal variation of hs-cTnT is a general phenomenon that is not seen with hs-cTnI. While the diurnal hs-cTnT rhythm does not seem to affect the diagnostic accuracy of hs-cTnT for AMI, it should be considered when using hs-cTnT for screening purposes.CLINICAL TRIAL REGISTRATION: 1. Circadian Variation of Cardiac Troponin, NCT02091427, www.clinicaltrials.gov/ct2/show/NCT02091427. 2. Advantageous Predictors of Acute Coronary Syndrome Evaluation (APACE) Study, NCT00470587, www.clinicaltrials.gov/ct2/show/NCT00470587.
KW - Acute Disease
KW - Aged
KW - Circadian Rhythm/physiology
KW - Female
KW - Humans
KW - Male
KW - Myocardial Infarction/blood
KW - Troponin I/blood
KW - Troponin T/blood
U2 - 10.1373/clinchem.2016.257485
DO - 10.1373/clinchem.2016.257485
M3 - SCORING: Journal article
C2 - 27707754
VL - 62
SP - 1602
EP - 1611
JO - CLIN CHEM
JF - CLIN CHEM
SN - 0009-9147
IS - 12
ER -
