Hypothesis: troponin degradation is one of the factors responsible for deterioration of left ventricular function in heart failure.
A hypothesis is presented that explains one of the mechanisms by which a heart starts to fail. The hypothesis is that myocardial function of an overloaded or otherwise stressed heart may become impaired by cellular troponin degradation in vital cardiomyocytes. The troponins (I, T and C) regulate actin-myosin interaction, thereby controlling contraction and relaxation. Troponins have been shown to be targets of activated calpain I. This enzyme, that is activated by elevated intracellular Ca2+ concentrations, such as occurs during ischemia, degrades troponins, leading to impaired interaction between actin and myosin and, thereby, less contractile force. Several reports about troponin degradation in viable myocardium support this hypothesis. Also, results are discussed that demonstrate the presence of immunoreactive troponin fragments in plasma under conditions in which myocardial necrosis can be excluded or is unlikely. The hypothesis implicates that release of troponin and/or troponin degradation products is not specific for necrotic myocardium but may occur from viable myocardium as well. To test this hypothesis, several lines of research are suggested. If the hypothesis is not rejected in the near future, the concept that a positive troponin test reflects 'even microscopic zones of myocardial necrosis' as used by the Joint ESC/ACC Committee for the Redefinition of Myocardial Infarction [The Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction. 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 Eur Heart J 2000;21:1502-1513], should be withdrawn.
van der Laarse
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Department of Cardiology, C5-P, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands. a.van_der_laarse@LUMC.nl
D000818:Animals; D002118:Calcium / Q000378:metabolism*; D002154:Calpain / Q000378:metabolism; D004789:Enzyme Activation; D006333:Heart Failure / Q000150:complications / Q000378:metabolism*; D006801:Humans; D017682:Myocardial Stunning / Q000378:metabolism; D032383:Myocytes, Cardiac / Q000378:metabolism*; D010807:Physical Endurance / Q000502:physiology; D014336:Troponin / Q000378:metabolism*; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000378:metabolism*
D014336:Troponin; D002154:Calpain; D002118:Calcium