Circadian rhythm of cardiac troponin I and its clinical impact on the diagnostic accuracy for acute myocardial infarction.

Wildi, K; Singeisen, H; Twerenbold, R; Badertscher, P; Wussler, D; Klinkenberg, L J J; Meex, S J R; Nestelberger, T; Boeddinghaus, J; Miró, Ò; Martin-Sanchez, F J; Morawiec, B; Muzyk, P; Parenica, J; Keller, D I; Geigy, N; Potlukova, E; Sabti, Z; Kozhuharov, N; Puelacher, C; ... (2018). Circadian rhythm of cardiac troponin I and its clinical impact on the diagnostic accuracy for acute myocardial infarction. International journal of cardiology, 270, pp. 14-20. Elsevier 10.1016/j.ijcard.2018.05.136

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BACKGROUND High-sensitivity cardiac troponin T (hs-cTnT) blood concentrations were shown to exhibit a diurnal rhythm, characterized by gradually decreasing concentrations throughout daytime, rising concentrations during nighttime and peak concentrations in the morning. We aimed to investigate whether this also applies to (h)s-cTnI assays and whether it would affect diagnostic accuracy for acute myocardial infarction (AMI). METHODS Blood concentrations of cTnI were measured at presentation and after 1 h using four different cTnI assays: three commonly used sensitive (s-cTnI Architect, Ultra and Accu) and one experimental high-sensitivity assay (hs-cTnI Accu) in a prospective multicenter diagnostic study of patients presenting to the emergency department with suspected AMI. These concentrations and their diagnostic accuracy for AMI (quantified by the area under the curve (AUC)) were compared between morning (11 p.m. to 2 p.m.) and evening (2 p.m. to 11 p.m.) presenters. RESULTS Among 2601 patients, AMI was the final diagnosis in 17.6% of patients. Concentrations of (h)s-cTnI as measured using all four assays were comparable in patients presenting in the morning versus patients presenting in the evening. Diagnostic accuracy for AMI of all four (h)s-cTnI assays were high and comparable between patients presenting in the morning versus presenting in the evening (AUC at presentation: 0.90 vs 0.93 for s-cTnI Architect; 0.91 vs 0.94 for s-cTnI Ultra; 0.89 vs 0.94 for s-cTnI Accu; 0.91 vs 0.94 for hs-cTnI Accu). CONCLUSIONS Cardiac TnI does not seem to express a diurnal rhythm. Diagnostic accuracy for AMI is very high and does not differ with time of presentation. CLINICAL TRIAL REGISTRATION NCT00470587,

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Reichlin, Tobias Roman


600 Technology > 610 Medicine & health








Tobias Roman Reichlin

Date Deposited:

27 Feb 2019 10:37

Last Modified:

05 Dec 2019 09:46

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PubMed ID:


Uncontrolled Keywords:

Acute myocardial infarction Circadian rhythm Diagnosis High-sensitivity cardiac troponin I




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