When to intervene in aortic stenosis; can cardiac troponin I in the first morning urine be our guide?

IF 2.1 4区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL

Medical hypotheses Pub Date : 2024-11-01 DOI:10.1016/j.mehy.2024.111512

Tomo Svaguša , Marko Žarak , Ingrid Prkačin , Frane Paić

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Abstract

Aortic stenosis is one of the most prevalent acquired valvular diseases in the Western world. Despite its high incidence, timely intervention through valve replacement remains a diagnostic challenge. Recent studies suggest that measuring cardiac troponins in the first morning urine may have potential clinical applications. In healthy individuals, concentrations of troponin I in the first morning urine are several times higher than in plasma. Various conditions that damage the heart, such as arterial emergencies or cardiotoxic therapy, lead to an increased concentration of cardiac troponin I in the first morning urine. Conversely, in patients with severe aortic stenosis scheduled for operative treatment, concentrations of cardiac troponin I in the first morning urine are barely detectable. This phenomenon may result from myocardial remodeling and altered clearance of troponin I from the heart. We hypothesize that reduction in the concentration of troponin I in the first morning urine indicates the onset of cardiomyocyte necrosis, adverse myocardial remodeling, and myocardial fibrosis during the progression of aortic stenosis.

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何时干预主动脉瓣狭窄；晨尿中的心肌肌钙蛋白 I 能作为我们的指南吗？

主动脉瓣狭窄是西方国家最常见的后天性瓣膜疾病之一。尽管发病率很高，但通过瓣膜置换进行及时干预仍是一项诊断挑战。最近的研究表明，测量晨尿中的心肌肌钙蛋白可能具有潜在的临床应用价值。健康人晨尿中肌钙蛋白 I 的浓度比血浆中高数倍。各种损害心脏的情况，如动脉急症或心脏毒性治疗，都会导致晨尿中的心肌肌钙蛋白 I 浓度升高。相反，在计划接受手术治疗的严重主动脉瓣狭窄患者中，晨尿中几乎检测不到心肌肌钙蛋白 I 的浓度。这种现象可能是由于心肌重塑和心脏对肌钙蛋白 I 的清除发生了改变。我们推测，晨尿中肌钙蛋白 I 浓度的降低预示着主动脉瓣狭窄进展过程中心肌细胞坏死、心肌重塑和心肌纤维化的开始。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Medical hypotheses 医学-医学：研究与实验

CiteScore

10.60

自引率

2.10%

发文量

167

审稿时长

60 days

期刊介绍： Medical Hypotheses is a forum for ideas in medicine and related biomedical sciences. It will publish interesting and important theoretical papers that foster the diversity and debate upon which the scientific process thrives. The Aims and Scope of Medical Hypotheses are no different now from what was proposed by the founder of the journal, the late Dr David Horrobin. In his introduction to the first issue of the Journal, he asks ''what sorts of papers will be published in Medical Hypotheses? and goes on to answer ''Medical Hypotheses will publish papers which describe theories, ideas which have a great deal of observational support and some hypotheses where experimental support is yet fragmentary''. (Horrobin DF, 1975 Ideas in Biomedical Science: Reasons for the foundation of Medical Hypotheses. Medical Hypotheses Volume 1, Issue 1, January-February 1975, Pages 1-2.). Medical Hypotheses was therefore launched, and still exists today, to give novel, radical new ideas and speculations in medicine open-minded consideration, opening the field to radical hypotheses which would be rejected by most conventional journals. Papers in Medical Hypotheses take a standard scientific form in terms of style, structure and referencing. The journal therefore constitutes a bridge between cutting-edge theory and the mainstream of medical and scientific communication, which ideas must eventually enter if they are to be critiqued and tested against observations.