Half-Life and Clearance of Cardiac Troponin i and Troponin T in Humans

Jonas Henrik Kristensen; Rasmus Bo Hasselbalch; Nina Strandkjær; Nicoline Jørgensen; Morten Østergaard; Peter Hasse Møller-Sørensen; Jens Christian Nilsson; Shoaib Afzal; Pia Rørbæk Kamstrup; Morten Dahl; Mustafa Vakur Bor; Ruth Frikke-Schmidt; Niklas Rye Jørgensen; Line Rode; Lene Holmvang; Jesper Kjærgaard; Lia Evi Bang; Julie Forman; Kim Dalhoff; Allan S. Jaffe; Kristian Thygesen; Henning Bundgaard; Kasper Karmark Iversen

doi:10.1161/CIRCULATIONAHA.123.066565

Half-Life and Clearance of Cardiac Troponin i and Troponin T in Humans

Jonas Henrik Kristensen^*, Rasmus Bo Hasselbalch, Nina Strandkjær, Nicoline Jørgensen, Morten Østergaard, Peter Hasse Møller-Sørensen, Jens Christian Nilsson, Shoaib Afzal, Pia Rørbæk Kamstrup, Morten Dahl, Mustafa Vakur Bor, Ruth Frikke-Schmidt, Niklas Rye Jørgensen, Line Rode, Lene Holmvang, Jesper Kjærgaard, Lia Evi Bang, Julie Forman, Kim Dalhoff, Allan S. JaffeKristian Thygesen, Henning Bundgaard, Kasper Karmark Iversen

^*Corresponding author af dette arbejde

Institut for Klinisk Medicin - Hjertesygdomme

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

Abstract

BACKGROUND: Cardiac troponin (cTn) is key in diagnosing myocardial infarction (MI). After MI, the clinically observed half-life of cTn has been reported to be 7 to 20 hours, but this estimate reflects the combined elimination and simultaneous release of cTn from cardiomyocytes. More precise timing of myocardial injuries necessitates separation of these 2 components. We used a novel method for determination of isolated cTn elimination kinetics in humans. METHODS: Patients with MI were included within 24 hours after revascularization and underwent plasmapheresis to obtain plasma with a high cTn concentration. After at least 3 weeks, patients returned for an autologous plasma retransfusion followed by blood sampling for 8 hours. cTn was measured with 5 different high-sensitivity cTn assays. RESULTS: Of 25 included patients, 20 participants (mean age, 64.5 years; SD, 8.2 years; 4 women [20%]) received a retransfusion after a median of 5.8 weeks (interquartile range, 5.0-6.9 weeks) after MI. After retransfusion of a median of 620 mL (range, 180-679 mL) autologous plasma, the concentration of cTn in participants' blood increased 4 to 445 times above the upper reference level of the 5 high-sensitivity cTn assays. The median elimination half-life ranged from 134.1 minutes (95% CI, 117.8-168.0) for the Elecsys high-sensitivity cTnT assay to 239.7 minutes (95% CI, 153.7-295.1) for the Vitros high-sensitivity cTnI assay. The median clearance of cTnI ranged from 40.3 mL/min (95% CI, 32.0-44.9) to 52.7 mL/min (95% CI, 42.2-57.8). The clearance of cTnT was 77.0 mL/min (95% CI, 45.2-95.0). CONCLUSIONS: This novel method showed that the elimination half-life of cTnI and cTnT was 5 to 16 hours shorter than previously reported. This indicates a considerably longer duration of cardiomyocyte cTn release after MI than previously thought. Improved knowledge of timing of myocardial injury may call for changes in the management of MI and other disorders with myocardial injury.

Originalsprog	Engelsk
Tidsskrift	Circulation
Vol/bind	150
Nummer	15
Sider (fra-til)	1187-1198
Antal sider	12
ISSN	0009-7322
DOI	https://doi.org/10.1161/CIRCULATIONAHA.123.066565
Status	Udgivet - 8 okt. 2024

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10.1161/CIRCULATIONAHA.123.066565Licens: CC BY-NC-ND

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Kristensen, J. H., Hasselbalch, R. B., Strandkjær, N., Jørgensen, N., Østergaard, M., Møller-Sørensen, P. H., Nilsson, J. C., Afzal, S., Kamstrup, P. R., Dahl, M., Bor, M. V., Frikke-Schmidt, R., Jørgensen, N. R., Rode, L., Holmvang, L., Kjærgaard, J., Bang, L. E., Forman, J., Dalhoff, K., ... Iversen, K. K. (2024). Half-Life and Clearance of Cardiac Troponin i and Troponin T in Humans. Circulation, 150(15), 1187-1198. https://doi.org/10.1161/CIRCULATIONAHA.123.066565

@article{dad21d37646f436cb50dc5cf9284164f,

title = "Half-Life and Clearance of Cardiac Troponin i and Troponin T in Humans",

abstract = "BACKGROUND: Cardiac troponin (cTn) is key in diagnosing myocardial infarction (MI). After MI, the clinically observed half-life of cTn has been reported to be 7 to 20 hours, but this estimate reflects the combined elimination and simultaneous release of cTn from cardiomyocytes. More precise timing of myocardial injuries necessitates separation of these 2 components. We used a novel method for determination of isolated cTn elimination kinetics in humans. METHODS: Patients with MI were included within 24 hours after revascularization and underwent plasmapheresis to obtain plasma with a high cTn concentration. After at least 3 weeks, patients returned for an autologous plasma retransfusion followed by blood sampling for 8 hours. cTn was measured with 5 different high-sensitivity cTn assays. RESULTS: Of 25 included patients, 20 participants (mean age, 64.5 years; SD, 8.2 years; 4 women [20%]) received a retransfusion after a median of 5.8 weeks (interquartile range, 5.0-6.9 weeks) after MI. After retransfusion of a median of 620 mL (range, 180-679 mL) autologous plasma, the concentration of cTn in participants' blood increased 4 to 445 times above the upper reference level of the 5 high-sensitivity cTn assays. The median elimination half-life ranged from 134.1 minutes (95% CI, 117.8-168.0) for the Elecsys high-sensitivity cTnT assay to 239.7 minutes (95% CI, 153.7-295.1) for the Vitros high-sensitivity cTnI assay. The median clearance of cTnI ranged from 40.3 mL/min (95% CI, 32.0-44.9) to 52.7 mL/min (95% CI, 42.2-57.8). The clearance of cTnT was 77.0 mL/min (95% CI, 45.2-95.0). CONCLUSIONS: This novel method showed that the elimination half-life of cTnI and cTnT was 5 to 16 hours shorter than previously reported. This indicates a considerably longer duration of cardiomyocyte cTn release after MI than previously thought. Improved knowledge of timing of myocardial injury may call for changes in the management of MI and other disorders with myocardial injury.",

keywords = "biomarkers, myocardial infarction, pharmacokinetics, troponin",

author = "Kristensen, {Jonas Henrik} and Hasselbalch, {Rasmus Bo} and Nina Strandkj{\ae}r and Nicoline J{\o}rgensen and Morten {\O}stergaard and M{\o}ller-S{\o}rensen, {Peter Hasse} and Nilsson, {Jens Christian} and Shoaib Afzal and Kamstrup, {Pia R{\o}rb{\ae}k} and Morten Dahl and Bor, {Mustafa Vakur} and Ruth Frikke-Schmidt and J{\o}rgensen, {Niklas Rye} and Line Rode and Lene Holmvang and Jesper Kj{\ae}rgaard and Bang, {Lia Evi} and Julie Forman and Kim Dalhoff and Jaffe, {Allan S.} and Kristian Thygesen and Henning Bundgaard and Iversen, {Kasper Karmark}",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors. Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc.",

year = "2024",

month = oct,

day = "8",

doi = "10.1161/CIRCULATIONAHA.123.066565",

language = "English",

volume = "150",

pages = "1187--1198",

journal = "Circulation",

issn = "0009-7322",

publisher = "Lippincott Williams and Wilkins",

number = "15",

}

Kristensen, JH, Hasselbalch, RB, Strandkjær, N, Jørgensen, N, Østergaard, M, Møller-Sørensen, PH, Nilsson, JC, Afzal, S, Kamstrup, PR, Dahl, M, Bor, MV, Frikke-Schmidt, R, Jørgensen, NR, Rode, L, Holmvang, L, Kjærgaard, J, Bang, LE, Forman, J, Dalhoff, K, Jaffe, AS, Thygesen, K, Bundgaard, H & Iversen, KK 2024, 'Half-Life and Clearance of Cardiac Troponin i and Troponin T in Humans', Circulation, bind 150, nr. 15, s. 1187-1198. https://doi.org/10.1161/CIRCULATIONAHA.123.066565

TY - JOUR

T1 - Half-Life and Clearance of Cardiac Troponin i and Troponin T in Humans

AU - Kristensen, Jonas Henrik

AU - Hasselbalch, Rasmus Bo

AU - Strandkjær, Nina

AU - Jørgensen, Nicoline

AU - Østergaard, Morten

AU - Møller-Sørensen, Peter Hasse

AU - Nilsson, Jens Christian

AU - Afzal, Shoaib

AU - Kamstrup, Pia Rørbæk

AU - Dahl, Morten

AU - Bor, Mustafa Vakur

AU - Frikke-Schmidt, Ruth

AU - Jørgensen, Niklas Rye

AU - Rode, Line

AU - Holmvang, Lene

AU - Kjærgaard, Jesper

AU - Bang, Lia Evi

AU - Forman, Julie

AU - Dalhoff, Kim

AU - Jaffe, Allan S.

AU - Thygesen, Kristian

AU - Bundgaard, Henning

AU - Iversen, Kasper Karmark

PY - 2024/10/8

Y1 - 2024/10/8

N2 - BACKGROUND: Cardiac troponin (cTn) is key in diagnosing myocardial infarction (MI). After MI, the clinically observed half-life of cTn has been reported to be 7 to 20 hours, but this estimate reflects the combined elimination and simultaneous release of cTn from cardiomyocytes. More precise timing of myocardial injuries necessitates separation of these 2 components. We used a novel method for determination of isolated cTn elimination kinetics in humans. METHODS: Patients with MI were included within 24 hours after revascularization and underwent plasmapheresis to obtain plasma with a high cTn concentration. After at least 3 weeks, patients returned for an autologous plasma retransfusion followed by blood sampling for 8 hours. cTn was measured with 5 different high-sensitivity cTn assays. RESULTS: Of 25 included patients, 20 participants (mean age, 64.5 years; SD, 8.2 years; 4 women [20%]) received a retransfusion after a median of 5.8 weeks (interquartile range, 5.0-6.9 weeks) after MI. After retransfusion of a median of 620 mL (range, 180-679 mL) autologous plasma, the concentration of cTn in participants' blood increased 4 to 445 times above the upper reference level of the 5 high-sensitivity cTn assays. The median elimination half-life ranged from 134.1 minutes (95% CI, 117.8-168.0) for the Elecsys high-sensitivity cTnT assay to 239.7 minutes (95% CI, 153.7-295.1) for the Vitros high-sensitivity cTnI assay. The median clearance of cTnI ranged from 40.3 mL/min (95% CI, 32.0-44.9) to 52.7 mL/min (95% CI, 42.2-57.8). The clearance of cTnT was 77.0 mL/min (95% CI, 45.2-95.0). CONCLUSIONS: This novel method showed that the elimination half-life of cTnI and cTnT was 5 to 16 hours shorter than previously reported. This indicates a considerably longer duration of cardiomyocyte cTn release after MI than previously thought. Improved knowledge of timing of myocardial injury may call for changes in the management of MI and other disorders with myocardial injury.

AB - BACKGROUND: Cardiac troponin (cTn) is key in diagnosing myocardial infarction (MI). After MI, the clinically observed half-life of cTn has been reported to be 7 to 20 hours, but this estimate reflects the combined elimination and simultaneous release of cTn from cardiomyocytes. More precise timing of myocardial injuries necessitates separation of these 2 components. We used a novel method for determination of isolated cTn elimination kinetics in humans. METHODS: Patients with MI were included within 24 hours after revascularization and underwent plasmapheresis to obtain plasma with a high cTn concentration. After at least 3 weeks, patients returned for an autologous plasma retransfusion followed by blood sampling for 8 hours. cTn was measured with 5 different high-sensitivity cTn assays. RESULTS: Of 25 included patients, 20 participants (mean age, 64.5 years; SD, 8.2 years; 4 women [20%]) received a retransfusion after a median of 5.8 weeks (interquartile range, 5.0-6.9 weeks) after MI. After retransfusion of a median of 620 mL (range, 180-679 mL) autologous plasma, the concentration of cTn in participants' blood increased 4 to 445 times above the upper reference level of the 5 high-sensitivity cTn assays. The median elimination half-life ranged from 134.1 minutes (95% CI, 117.8-168.0) for the Elecsys high-sensitivity cTnT assay to 239.7 minutes (95% CI, 153.7-295.1) for the Vitros high-sensitivity cTnI assay. The median clearance of cTnI ranged from 40.3 mL/min (95% CI, 32.0-44.9) to 52.7 mL/min (95% CI, 42.2-57.8). The clearance of cTnT was 77.0 mL/min (95% CI, 45.2-95.0). CONCLUSIONS: This novel method showed that the elimination half-life of cTnI and cTnT was 5 to 16 hours shorter than previously reported. This indicates a considerably longer duration of cardiomyocyte cTn release after MI than previously thought. Improved knowledge of timing of myocardial injury may call for changes in the management of MI and other disorders with myocardial injury.

KW - biomarkers

KW - myocardial infarction

KW - pharmacokinetics

KW - troponin

UR - http://www.scopus.com/inward/record.url?scp=85204205467&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.123.066565

DO - 10.1161/CIRCULATIONAHA.123.066565

M3 - Journal article

C2 - 39253802

AN - SCOPUS:85204205467

SN - 0009-7322

VL - 150

SP - 1187

EP - 1198

JO - Circulation

JF - Circulation

IS - 15

ER -

Half-Life and Clearance of Cardiac Troponin i and Troponin T in Humans

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