{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T06:00:48Z","timestamp":1776405648889,"version":"3.51.2"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2016,12,1]],"date-time":"2016-12-01T00:00:00Z","timestamp":1480550400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100009709","name":"Stichting De Weijerhorst","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009709","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001316","name":"Abbott Laboratories","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001316","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008982","name":"National Science Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008982","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100002129","name":"Heart Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002129","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007478","name":"Cardiovascular Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007478","id-type":"DOI","asserted-by":"publisher"}]},{"name":"8sense"},{"DOI":"10.13039\/100007818","name":"Alere","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007818","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Brahms"},{"name":"B\u00fchlmann"},{"name":"Critical Diagnostics"},{"name":"Nanosphere"},{"DOI":"10.13039\/100004337","name":"Roche","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004337","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004830","name":"Siemens","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004830","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012324","name":"University Hospitals","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012324","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>BACKGROUND<\/jats:title>\n                  <jats:p>Interpretation of serial high-sensitivity cardiac troponin (hs-cTn) measurements for the diagnosis of acute myocardial infarction (AMI) assumes random fluctuation of hs-cTn around an individual's homeostatic set point. The aim of this study was to challenge this diagnostic concept.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Study 1 examined the presence of a diurnal hs-cTn rhythm by hourly blood sampling, day and night, in 24 individuals without a recent history of AMI. Study 2 assessed morning vs evening diagnostic accuracy of hs-cTnT and hs-cTnI in a prospective multicenter diagnostic study of 2782 unselected patients, presenting to the emergency department with acute chest pain.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>In study 1, hs-cTnT, but not hs-cTnI, exhibited a diurnal rhythm, characterized by gradually decreasing concentrations throughout daytime, rising concentrations during nighttime, to peak concentrations in the morning (mean 16.2 ng\/L at 8:30 AM and 12.1 ng\/L at 7:30 PM). In study 2, the hs-cTnT rhythm was confirmed by higher hs-cTnT concentrations in early-morning presenters compared to evening presenters with an adjudicated diagnosis of noncardiac disease. The diagnostic accuracy [area under the receiver-operation characteristics curve (AUC)] of hs-cTnT at presentation, 1 h, and for the combination of absolute changes with presenting concentration, were very high and comparable among patients presenting early morning as compared to evening (all AUC &amp;gt;0.93). hs-cTnI exhibited no diurnal rhythm with no differences in AUC among early-morning and evening presenters.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Rhythmic diurnal variation of hs-cTnT is a general phenomenon that is not seen with hs-cTnI. While the diurnal hs-cTnT rhythm does not seem to affect the diagnostic accuracy of hs-cTnT for AMI, it should be considered when using hs-cTnT for screening purposes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Trial Registration<\/jats:title>\n                  <jats:p>1. Circadian Variation of Cardiac Troponin, NCT02091427, www.clinicaltrials.gov\/ct2\/show\/NCT02091427. 2. Advantageous Predictors of Acute Coronary Syndrome Evaluation (APACE) Study, NCT00470587, www.clinicaltrials.gov\/ct2\/show\/NCT00470587.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1373\/clinchem.2016.257485","type":"journal-article","created":{"date-parts":[[2016,10,5]],"date-time":"2016-10-05T23:29:19Z","timestamp":1475710159000},"page":"1602-1611","source":"Crossref","is-referenced-by-count":79,"title":["Diurnal Rhythm of Cardiac Troponin: Consequences for the Diagnosis of Acute Myocardial Infarction"],"prefix":"10.1093","volume":"62","author":[{"given":"Lieke J J","family":"Klinkenberg","sequence":"first","affiliation":[{"name":"Department of Clinical Chemistry, Maastricht University Medical Center (MUMC), Maastricht, the Netherlands"},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC), the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Wildi","sequence":"first","affiliation":[{"name":"Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noreen","family":"van der Linden","sequence":"first","affiliation":[{"name":"Department of Clinical Chemistry, Maastricht University Medical Center (MUMC), Maastricht, the Netherlands"},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC), the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Imre W K","family":"Kouw","sequence":"first","affiliation":[{"name":"Department of Human Movement Sciences, School for Nutrition, Toxicology and Metabolism (NUTRIM), Maastricht University Medical Center (MUMC), Maastricht, the 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