RESUMO
The expansion and discovery of new diagnostic possibilities for the use of many biomarkers of cardiovascular diseases (CVDs), including cardiospecific troponin isoforms (cTnI, cTnT), is due to improved laboratory methods for their determination. Throughout a long history of the creation and improvement of immunochemical methods for the determination of cTnI and cTnT, significant changes were observed in the concept of biology and its diagnostic value as CVD biomarkers. The obsolete methods of detection of cTnI, cTnT, named low sensitivity and moderate, were distinguished by a relatively low sensitivity, which led to the confirmation late in the diagnosis of acute myocardial infarction (AMI) and, therefore, such methods were gradually replaced by new methods of high and moderate sensitivity, such as definitions of methods, ultra-sensitive (hs-cTnI, hs-cTnT). With the introduction of hs-cTnI and hs-cTnT in clinical practice, the possibility of early diagnosis and exclusion of AMI through the evaluation of the kinetics of the concentration of hs-cTnI and hs-cTnT in the first hours (0-1 hour, 0-2 hours, 0-3 hours) from the moment the patient enters the emergency room. In addition, some of our ideas about the biology of cardiac troponins have changed, and promising new opportunities for their use in medicine have emerged. This manuscript analyzes the key analytical characteristics of hs-cTnI and hs-cTnT detection methods compared to moderately sensitive methods, and reports on new biological data and some new diagnostic possibilities for the use of hs-cTnI and hs-cTnT in modern clinical practice.
La expansión y el descubrimiento de nuevas posibilidades de diagnóstico para el uso de muchos biomarcadores de enfermedades cardiovasculares (ECV), incluidas las isoformas de troponina cardioespecíficas (cTnI, cTnT), se debe a la mejora de los métodos de laboratorio para su determinación. A lo largo de una prolongada historia de la creación y mejora de métodos inmunoquímicos para la determinación de cTnI y cTnT, se observaron cambios significativos en el concepto de biología y su valor diagnóstico como biomarcadores de ECV. Los métodos obsoletos de detección de cTnI, cTnT, llamados de sensibilidad baja y moderada, se distinguieron por una sensibilidad relativamente baja, lo que llevó a la confirmación tardía del diagnóstico de infarto agudo de miocardio (IAM) y, por lo tanto, dichos métodos fueron reemplazados gradualmente por nuevos métodos de alta y moderada sensibilidad, como definiciones de métodos ultrasensibles (hs-cTnI, hs-cTnT). Con la introducción de hs-cTnI y hs-cTnT en la práctica clínica, la posibilidad de diagnóstico precoz y exclusión del IAM mediante la evaluación de la cinética de la concentración de hs-cTnI y hs-cTnT en las primeras horas (0-1 hora, 0-2 horas, 0-3 horas) desde el momento en que el paciente ingresa a urgencias. Además, algunas de nuestras ideas sobre la biología de las troponinas cardíacas han cambiado, y han surgido nuevas oportunidades prometedoras para su uso en medicina. En este artículo se discuten las características analíticas clave de los métodos de detección de hs-cTnI y hs-cTnT en comparación con métodos moderadamente sensibles, e informa sobre nuevos datos biológicos y algunas nuevas posibilidades de diagnóstico para el uso de hs-cTnI y hs-cTnT en la práctica clínica moderna.
Assuntos
Infarto do Miocárdio , Troponina T , Biomarcadores , Diagnóstico Precoce , Humanos , Infarto do Miocárdio/diagnóstico , Troponina IRESUMO
Chagas disease (ChD) and systemic arterial hypertension (SAH) are two severe comorbidities that lead to mortality and a reduction in people's quality of life, with an impact on public health. The aim of this study was to quantify the biomarkers of cardiac injury in patients with ChD and SAH. Eighty patients were divided into four groups: 20 hypertensive patients, 20 ChD-hypertensive patients, 20 ChD patients, and 20 normotensive volunteers; all of them came from outpatient's public health services. Among the evaluated markers for cardiac lesions (creatine kinase, creatine kinase-MB isoform, myoglobin, high-sensitive cardiac troponin T[hs-cTnT], B-type natriuretic peptide [BNP], and C-reactive protein), hs-cTnT and BNP were the most appropriate. Importantly, our results showed that the cut off point for hs-cTnT could be < 0.007 ng/mL, which could lead to the early detection of myocardial lesions. The BNP and hs-cTnT levels were high only in the ChD and ChD-hypertensive patient groups, suggesting that Chagas' disease may play an important role in the increase of these biomarkers. ChD patients, hypertensive or not, with cardiac or cardiodigestive involvement presented significantly higher values of hs-cTnT (p < 0.001) and BNP (p = 0.001) than ChD patients with indeterminate and digestive forms, which strengthens the validation of these markers for the follow-up of clinical cardiac form of ChD. This study suggests that the BNP and hs-cTnT can be used as possible indirect biomarkers of cardiac damage. In addition, the reference values of these biomarkers in Chagas and hypertensive cardiomyopathies should be better understood with further studies.