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Clinical significance of unsuspected rise in cardiac troponin in the setting of falls in older people
  1. Sylvestre Maréchaux1,2,
  2. Rémy Lubret1,
  3. Pascal Delsart1,
  4. Medhi Hattabi1,
  5. Marie-Michèle Six-Carpentier1,
  6. Emilie Carpentier1,
  7. Véronique Coutant1,
  8. Claire Pinçon3,
  9. Thierry Le Tourneau1,2,
  10. François Puisieux2,4,
  11. Patrick Goldstein5,
  12. Philippe Asseman1,
  13. Pierre Vladimir Ennezat1,2
  1. 1Department of Cardiology and Intensive Care Unit, CHRU de Lille, Lille cedex, France
  2. 2Institut Fédératif de Recherche 114, EA 2693, Université de Lille 2 Nord de France, F-59000 Lille, and Faculté de Médecine, Lille F-59045, France
  3. 3Université de Lille, 2 Nord de France F-59000 Lille and UDSL, EA 2694, Department of Biostatistics, F-59000, Lille, France
  4. 4Geriatric Clinical Center, CHRU de Lille, Lille cedex, France
  5. 5Department of Emergency, CHRU de Lille, Lille cedex, France
  1. Correspondence to Dr Pierre Vladimir Ennezat, Intensive Cardiology Care Unit, Cardiology Hospital, Lille II University, Lille cedex 59037, France; ennezat{at}yahoo.com

Abstract

Objectives To assess the clinical significance of unsuspected rise in cardiac troponin I (cTnI) levels in elderly patients who have fallen.

Design Monocentre prospective observational pilot study

Participants Consecutive elderly patients (age >65 years) referred to the emergency department after being immobilised on the ground after a fall.

Measurements Clinical, laboratory and Doppler echocardiography data were collected on admission to assess the cardiac correlates of increased cTnI. The survival endpoint was a composite of death or cardiovascular event.

Results 60 patients were included in this study. Mean age was 81±8 years. Cardiac TnI was ≥0.05 ng/ml in at least one blood sample in 40 patients (67%). New diagnosis of cardiac disease was performed in 14 patients, 13 of them had cTnI ≥0.05 ng/ml. Transient apical ballooning was diagnosed in six patients. During a median follow-up of 92 (49–131) days death occurred in six patients, myocardial infarction in three, stroke in one and acute heart failure in five. Cardiac TnI ≥0.05 ng/ml was a predictor of these events (p=0.034).

Conclusion An unsuspected rise in cTnI correlates with new diagnosis of cardiac disease and is a potential marker of stress induced cardiomyopathy in elderly patients who fall. Cardiac TnI might be a strong predictor of outcome in these patients.

  • Fall
  • elderly people
  • cardiac troponin
  • prognosis
  • neurology, other

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Footnotes

  • Sponsor's role: the study was not supported by any sponsor.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; not externally peer reviewed.

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