High-sensitivity cardiac troponins: circadian rhythms
https://doi.org/10.15829/1728-8800-2021-2639
Abstract
High-sensitivity cardiac troponins (hs-cTnI and hs-cTnT) contribute to a progression in the diagnosis and treatment of cardiovascular diseases: acceleration of diagnosis of acute myocardial infarction (early diagnostic algorithms: 0-1 h, 0-3 h), and earlier initiation of optimal treatment, expansion of diagnostic and prognostic potential (earlier detection of myocardial damage during chemotherapy, endocarditis, myocarditis and other diseases). However, increased sensitivity slightly reduced the specificity and created the need for a more thorough interpretation of elevated levels of hs-cTnI and hs-cTnT in a number of pathologies that damage cardiomyocytes. In addition, there was a need to introduce reference levels of hs-cTnI and hs-cTnT (99 percentile), taking into account sex. Recently, there has also been information about circadian (diurnal) variations in hs-cTnT and hs-cTnI levels. We analyze in detail the results of clinical studies that found circadian changes in hs-cTnI and hs-cTnT. Possible mechanisms underlying these changes in hs-cTnT and hs-cTnI concentrations are discussed.
About the Authors
A. M. Chaulin
Samara Regional Clinical Cardiology Dispensary
Russian Federation
Russian Federation
Aleksey Michailovich Chaulin
D. V. Duplyakov
Samara Regional Clinical Cardiology Dispensary; Samara State Medical University
Russian Federation
Russian Federation
Dmitry Viktorovich Duplyakov
References
1. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019;40(3):237-69. doi:10.1093/eurheartj/ehy462.
2. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267-315. doi:10.1714/2464.25804.
3. Chaulin AM, Duplyakov DV. Biomarkers of Acute Myocardial Infarction: Diagnostic and Prognostic Value. Part 1. Journal of Clinical Practice. 2020;11(3):75-84. (In Russ.) doi:10.17816/clinpract34284.
4. Myocardial infarction redefined-a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J. 2000;21(18):1502-13. doi:10.1053/euhj.2000.2305.
5. Garcia-Osuna A, Gaze D, Grau-Agramunt M, et al. Ultrasensitive quantification of cardiac troponin I by a Single Molecule Counting method: analytical validation and biological features. Clin Chim Acta. 2018;486:224-31. doi:10.1016/j.cca.2018.08.015.
6. Pervan P, Svagusa T, Prkacin I, et al. Urine high sensitive Troponin I measuring in patients with hypertension. Signa Vitae A Journal In Intensive Care And Emergency Medicine. 2017;13(Suppl 3):62-4. doi:10.22514/SV133.062017.13.
7. Mirzaii-Dizgah I, Riahi E. Salivary high-sensitivity cardiac troponin T levels in patients with acute myocardial infarction. Oral Diseases. 2013;19(2):180-4. doi:10.1111/j.16010825.2012.01968.x.
8. Chaulin AM, Karslyan LS, Grigorieva EV, et al. Clinical and Diagnostic Value of Cardiac Markers in Human Biological Fluids. Kardiologiia. 2019;59(11):66-75. (In Russ.) doi:10.18087/cardio.2019.11.n414.
9. Chaulin AM, Duplyakova PD, Bikbaeva GR, et al. Concentration of high-sensitivity cardiac troponin I in the oral fluid in patients with acute myocardial infarction: a pilot study. Russian Journal of Cardiology. 2020;25(12):3814. (In Russ.) doi:10.15829/1560-4071-2020-3814.
10. Chaulin AM, Duplyakov DV. Increased cardiac troponins, not associated with acute coronary syndrome. Part 1. Kardiologiya: novosti, mneniya, obuchenie [Cardiology: News, Opinions, Training]. 2019;7(2):13-23. (In Russ.) doi:10.24411/2309-1908-2019-12002.
11. Kontsevaya AV, Myrzamatova AO, Drapkina OM. Biomarkers in predicting cardiovascular risk: new prospects of troponin I. Cardiovascular Therapy and Prevention. 2020;19(3):2584. (In Russ.) https://doi.org/10.15829/1728-8800-2020-2584.
12. Chaulin AM, Duplyakov DV. Increased cardiac troponins, not associated with acute coronary syndrome. Part 2. Kardiologiya: novosti, mneniya, obuchenie [Cardiology: News, Opinions, Training]. 2019;7(2):24-35. (In Russ.) doi:10.24411/2309-1908-2019-12003.
13. Lazzarino AI, Hamer M, Gaze D, et al. The association between cortisol response to mental stress and high sensitivity cardiac troponin T plasma concentration in healthy adults. J Am Coll Cardiol. 2013;62(18):1694-701. doi:10.1016/j.jacc.2013.05.070.
14. Richardson AJ, Leckie T, Watkins ER, et al. Post marathon cardiac troponin T is associated with relative exercise intensity. J Sci Med Sport. 2018;21(9):880-4. doi:10.1016/j.jsams.2018.02.005.
15. Anand A, Shah ASV, Beshiri A, et al. Global Adoption of High-Sensitivity Cardiac Troponins and the Universal Definition of Myocardial Infarction. Clin Chem. 2019;65(3):484-9. doi:10.1373/clinchem.2018.298059.
16. Mazzoccoli G, Carughi S, Sperandeo M, et al. Neuro-endocrine correlations of hypothalamic-pituitary-thyroid axis in healthy humans. J Biol Regul Homeost Agents. 2011;25(2):249-57.
17. Tsareva YuO, Mayskova EA, Fedotov EA, et al. Circadian rhythms of thyroid hormones in patients with ischemic heart disease, arterial hypertension, and atrial fibrillation. Kardiologiia. 2019;59(3S):23-9. (In Russ.) doi:10.18087/cardio.2506.
18. Wu AH, Lu QA, Todd J, et al. Short- and long-term biological variation in cardiac troponin I measured with a high-sensitivity assay: implications for clinical practice. Clin Chem. 2009;55(1):52-8. doi:10.1373/clinchem.2008.107391.
19. Aakre KM, R0raas T, Petersen PH, et al. Weekly and 90-minute biological variations in cardiac troponin T and cardiac troponin I in hemodialysis patients and healthy controls. Clin Chem. 2014;60(6):838-47. doi:10.1373/clinchem.2013.216978.
20. Klinkenberg LJ, van Dijk JW, Tan FE, et al. Circulating cardiac troponin T exhibits a diurnal rhythm. J Am Coll Cardiol. 2014;63(17):1788-95. doi:10.1016/j.jacc.2014.01.040.
21. Gutenbrunner C. Circadian variations of the serum creatine kinase level — a masking effect? Chronobiol Int. 2000;17(4):583-90. doi:10.1081/cbi-100101065.
22. Klinkenberg LJ, Wildi K, van der Linden N, et al. Diurnal Rhythm of Cardiac Troponin: Consequences for the Diagnosis of Acute Myocardial Infarction. Clin Chem. 2016;62(12):1602-11. doi:10.1373/clinchem.2016.257485.
23. van der Linden N, Cornelis T, Klinkenberg LJ, et al. Strong diurnal rhythm of troponin T, but not troponin I, in a patient with renal dysfunction. Int J Cardiol. 2016;221:287-8. doi:10.1016/j.ijcard.2016.06.268.
24. Nelson W, Tong YL, Lee JK, et al. Methods for cosinor-rhythmometry. Chronobiologia. 1979;6(4):305-23.
25. Dubin RF, Li Y, He J, et al. Predictors of high sensitivity cardiac troponin T in chronic kidney disease patients: a crosssectional study in the chronic renal insufficiency cohort (CRIC). BMC Nephrology. 2013;14(1):229. doi:10.1186/1471236914229.
26. Reichlin T, Schindler C, Drexler B, et al. One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Arch Intern Med. 2012;172(16):1211-8. doi:10.1001/archinternmed.2012.3698.
27. Rubini Gimenez M, Twerenbold R, Jaeger C, et al. One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I. Am J Med. 2015;128(8):861-70.e4. doi:10.1016/j.amjmed.2015.01.046.
28. Wildi K, Singeisen H, Twerenbold R, et al. Circadian rhythm of cardiac troponin I and its clinical impact on the diagnostic accuracy for acute myocardial infarction. Int J Cardiol. 2018;270:14-20. doi:10.1016/j.ijcard.2018.05.136.
29. Zaninotto M, Padoan A, Mion MM, et al. Short-term biological variation and diurnal rhythm of cardiac troponin I (Access hs-TnI) in healthy subjects. Clin Chim Acta. 2020;504:163-7. doi:10.1016/j.cca.2020.02.004.
30. Aschoff J. Circadian rhythms in man. Science. 1965;148(3676):1427-32. doi:10.1126/science.148.3676.1427.
31. Doskin VA, Lavrent’eva NA. Sutochnye ritmy i ikh rol’ v fiziologii i patologii cheloveka [Circadian rhythms and their role in human physiology and pathology]. Sov Med. 1972;35(4):67-70.
32. Sato M, Matsuo T, Atmore H, Akashi M. Possible contribution of chronobiology to cardiovascular health. Front Physiol. 2014;4:409. doi:10.3389/fphys.2013.00409.
33. Panza JA, Epstein SE, Quyyumi AA. Circadian variation in vascular tone and its relation to alpha-sympathetic vasoconstrictor activity. New Engl J Med. 1991;325(14):986-90. doi:10.1056/nejm199110033251402.
34. Tofler GH, Brezinski D, Schafer AI, et al. Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N Engl J Med. 1987;316(24):1514-8. doi:10.1056/NEJM198706113162405.
35. Fearnley GR, Balmforth G, Fearnley E. Evidence of a diurnal fibrinolytic rhythm; with a simple method of measuring natural fibrinolysis. Clin Sci. 1957;16(4):645-50.
36. Chaulin AM, Duplyakov DV. MicroRNAs in Atrial Fibrillation: Pathophysiological Aspects and Potential Biomarkers. International Journal of Biomedicine. 2020;10(3):198-205. doi:10.21103/Article10(3)_RA3.
37. Ben Yedder N, Roux JF, Paredes FA. Troponin elevation in supraventricular tachycardia: primary dependence on heart rate. Can J Cardiol. 2011;27(1):105-9. doi:10.1016/j.cjca.2010.12.004.
38. Suarez-Barrientos A, Lopez-Romero P, Vivas D, et al. Circadian variations of infarct size in acute myocardial infarction. Heart. 2011;97(12):970-6. doi:10.1136/hrt.2010.212621.
39. Thornton SN. Overnight dehydration increases the risk of a morning infarct. Heart. 2011;97(16):1359; author reply 1359. doi:10.1136/heartjnl-2011-300325.
40. Arroyo Ucar E, Dominguez-Rodriguez A, Abreu-Gonzalez P. Influencia de la variabilidad diurna en el tamano del infarto agudo de miocardio [Influence of diurnal variation in the size of acute myocardial infarction]. Med Intensiva. 2012;36(1):11-4. doi:10.1016/j.medin.2011.07.002.
Supplementary files
Review
For citations:
Chaulin A.M., Duplyakov D.V. High-sensitivity cardiac troponins: circadian rhythms. Cardiovascular Therapy and Prevention. 2021;20(1):2639. (In Russ.) https://doi.org/10.15829/1728-8800-2021-2639
Views:
1310
Email this article 
