title: Cardiomyocyte injury induced by hemodynamic cardiac stress: Differential release of cardiac biomarkers.
abstract: OBJECTIVE
  We explored whether hemodynamic cardiac stress leads to a differential release of cardiomyocyte injury biomarkers, used in the diagnosis of acute myocardial infarction (AMI).
  
  
  METHODS
  In an observational international multicenter study, we enrolled 831 unselected patients presenting with symptoms suggestive of AMI to the emergency department. The final diagnosis was adjudicated by two independent cardiologists. Hemodynamic cardiac stress was quantified by levels of B-type natriuretic peptide (BNP). Spearman's rho correlation was used to analyze the correlations between BNP and high-sensitivity cardiac troponin T (hs-cTnT), Siemens cTnI-Ultra (cTnI-ultra), CK-MB and Myoglobin. Patients were categorized according to the extent of hemodynamic cardiac stress as quantified by BNP tertiles.
  
  
  RESULTS
  Among all patients, the positive pair-wise correlation with BNP was strongest with hs-cTnT and cTnI-ultra (r=0.58 and 0.50, respectively), moderate for Myoglobin (r=0.43), and weakest with CK-MB (r=0.25; p<0.001 for each). Similar pattern of correlations was also observed among AMI patients. Among patients diagnosed with non-cardiac cause of chest pain (n=385, 46%) and cardiac but non-coronary (n=109, 13%), BNP had significant positive correlations with hs-cTnT, cTnI-ultra and Myoglobin (p<0.05), but not with CK-MB (p=NS). A similar pattern of stronger correlation between BNP and hs-cTnT, cTnI-ultra and Myoglobin as compared to that with CK-MB was also observed within the higher BNP tertile range. There was no correlation between BNP and other biomarkers within the 1st BNP tertile group.
  
  
  CONCLUSIONS
  Hemodynamic cardiac stress, as quantified by BNP, as a likely cause of cardiomyocyte injury, is more closely reflected by concentrations of hs-cTnT, cTnI-ultra and Myoglobin than CK-MB.
authors.affiliation: Department of Cardiology, University Hospital Basel, Switzerland; Department of Cardiology, University of Louisville, KY, USA.
authors.forename: Affan
authors.initials: A
authors.lastname: Irfan
authors.affiliation: Department of Cardiology, University Hospital Basel, Switzerland; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.affiliation: Department of Cardiology, University Hospital Basel, Switzerland; Universitäres Herz-Zentrum Bad Krozingen, Germany.
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.affiliation: Department of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Clarissa
authors.initials: C
authors.lastname: Fischer
authors.affiliation: Emergency Department, Genova, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Ballarino
authors.affiliation: Department of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Berit
authors.initials: B
authors.lastname: Nelles
authors.affiliation: Department of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Karin
authors.initials: K
authors.lastname: Wildi
authors.affiliation: Department of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Christa
authors.initials: C
authors.lastname: Zellweger
authors.affiliation: Department of Cardiology, University Hospital Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Rubini Gimenez
authors.affiliation: Department of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Mira
authors.initials: M
authors.lastname: Mueller
authors.affiliation: Department of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Philip
authors.initials: P
authors.lastname: Haaf
authors.affiliation: Department of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Fischer
authors.affiliation: Laboratory Medicine, University Hospital Basel, Switzerland.
authors.forename: Heike
authors.initials: H
authors.lastname: Freidank
authors.affiliation: Department of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.affiliation: Department of Cardiology, University Hospital Basel, Switzerland. Electronic address: chmueller@uhbs.ch.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D052279:Creatine Kinase, MB Form / Q000097:blood; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D032383:Myocytes, Cardiac / Q000378:metabolism / Q000473:pathology*; D009211:Myoglobin / Q000097:blood*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013312:Stress, Physiological; D019210:Troponin I / Q000097:blood*; D020107:Troponin T / Q000097:blood*
chemical_list: D009211:Myoglobin; D019210:Troponin I; D020107:Troponin T; D020097:Natriuretic Peptide, Brain; D052279:Creatine Kinase, MB Form
keywords: BNP; Cardiac stress; Cardiomyocyte injury; Troponin