Abstract
Background: Cardiovascular disease (CVD) includes coronary artery disease (CAD), myocardial infarction, cerebrovascular disease, hypertension and peripheral artery disease .The mortality by acute myocardial infarction is approximately by 30%. In year 2009, approximately1 of every 25 patients die in the first year of acute MI and the survival is markedly reduced in elderly patients over the age of 75.Troponin I is contractile protein found solely myocardium. It is highly tissue specific and persists in circulation for days. Microalbuminuria is associated independently with cardiovascular morbidity and mortality. We aim to examine the relation of Troponin I and microalbuminuria in acute MI.
Aim: To estimate the level of Troponin I and Microalbuminuria along with their correlation in patients of acute myocardial infarction.
Material and Method: This hospital-based study was conducted on 50 diagnosed acute MI patients and 20 serves as age and gender matched controls. Blood sample was take in plain vial and Troponin I test was done on CTK Biotech cassette, CA(USA), whereas urine sample was taken in sterilized urine container and test for microalbuminuria was done by ELISA. Results were collected and analyses statically.
Result: Out of 50 patients Troponin I was positive in 47 and negative in 3. All the 20 controls were negative for Troponin I. The mean value of micro albuminuria in cases group and control group were 254.39±163.48 µgm/ml and 11.1± 3.94 µgm/ml respectively with p value of <0.001. On comparing both parameters with each other we find that out of 20 patients of control group, troponin I and microalbuminuria were in normal range of all cases. In study group, troponin I was positive in 47 cases and negative in 3 cases and microalbuminuria was raised (>25ug/ml) in 38 cases and within normal range (<25ug/ml) in 12 cases. This shows that serum Troponin I and micro albuminuria shows statically significant association.
Conclusion: It is concluded that when the role of cardiac troponin I is compared with microalbuminuria in the evaluation of acute myocardial infraction, both are equally recommended for the early prediction, diagnoses and prognosis of the AMI.
Keywords: Troponin I, Micro albuminuria, Myocardial Infarction.
References
- Gupta R, Mishra A, pais P, rastogi P, Gupta VP. Correlation of regional cardiovascular disease mortality in india with lifestyle and nutritional factors. International journal of cardiology 2006; 108 (3): 291-300
- Myocardial infraction. Updated, 2009.
- American diabetes association clinical recommendations 2001: diabetes nephopathy diabetes care 2001, 24(suppl 1) 569-572.
- Eisenman A. troponin assays for the diagnosis of myocardial infarction and acute coronary syndrome: where do we stand? Expert Rev cardiovascther 2006; 4(4): 509- 14.
- Aviles RJ, Askari AT, Lindahl B, wallentin L, Jia G, Ohman EM et al. Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction. N Engl J Med 2002;346 (26);2047-52.
- Mogensen CE. Micro albuminuria predicts clinical proteinuria and early mortality in maturity onset diabetes. N Engl J Med 1984; 310: 356-360.
- Bigazzi R, Bianchi S, Baldari D, Campese VM. Micro albuminuria predicts cardiovascular evenets and renal insuffiency in patients with essential hypertension. J Hypertens 1998;16:1325-33.
- Jensen JS, Feldt-Rasmussen B, Strandgaard S, Schroll M, Borch- Johnsen K. Arterial hypertension, micr albuminuria, and risk of ischemic heart disease. Hypertension 2000;35;898-903.
- Deckert T, Yokoyama H, Mathiesen E, Ronn B, Jensen T, Feldt-Rasmussen B et al. A cohort study on the predictive value of urinary albumin excretion for atherosclerotic vascular disease in patients with insulin dependent diabetes. Br Med J 1996;312:871-4.
- Youngerman S, caroline SR, Stephen F. cardiac enzyme studies 2005.
- Zeeuw DD, Parving HH, Henning RH. Microalbuminuria as an early marker for cardiovascular disease. J Am SocNephrol 2006; 17;2100-5.
- Berton G, Cordiano R, Palmieri R, Cucchini F, De Toni R Palatini P. microalbuminuria during acute myocardial infraction – A strong predictor for 1 year mortality. European Heart Journal 2001;22;1466-75.
- Holm J, Ravn J, Ingemann HS. Urinary excretion of alpha 1- microglobulin and albumin in acute myocardial infarction. Correlation with plasma concentrations of troponin I and C- reactive protein.Scand J UrolNephrol 2006; 40 (4): 339-44.
- Rubin E, Farber JL. Essential pathology 2nd Philadelphia: JB Lippincott Co.1995.
- Hooper J, Bangeet SK. Myocardial infarction. Clinical biochemistry; metabolic and clinical aspect. Churchill Livingstone1995;780.
- Miriam R, Tobias R, Raphael T, Christian M. Diagnosis of acute myocardial infarction using highly sensitive cardiac troponins assays. European cardiology2011:7(1):18-20.
- Kyung CP, David CG, Paul OC, Michael SM. Cardiac troponins: from myocardial infarction to chronic disease. Cardiovascular research2017;113:1708-18.
- Melissa AD, Allen J. THE utility of troponin measurement to detect myocardial infarction:review of current findings.Vascular health and risk managment2010;6:691-699.
- Berton G, Citro T, Palmieri R, Petucco S, De Toni R, Palatini P. Albumin excretion rate increases during acute myocardial infarction and strongly predicts early mortality. Circulation1997;96:3338-45.
- Loannis L et al. Prognostic significance of micro albuminuria in non diabetic patients with acute myocardial infarction. International Journal of cardiology 2016;106(2):218-223.
- Apostolovic S et al. Prognostic significance of micro albuminuria in patients with acute myocardial infarction. Clin lab2011;57(3-4):229-35.
- Matthew F et al. A prospective study of micro albuminuria and incident coronary heart disease and its prognostic significance in british population: The EPIC-Norfolk study. American journal of epidemiology2004;159:284-293.
Corresponding Author
Dr Tejinder Singh
Senior Resident, Department of Biochemistry
Government Medical College, Amritsar