Supraventricular tachycardia promotes release of troponin I in patients with normal coronary arteries

doi:10.1016/j.ijcard.2004.05.076

International Journal of Cardiology

Volume 102, Issue 3, 20 July 2005, Pages 521-522

https://doi.org/10.1016/j.ijcard.2004.05.076 Get rights and content

Abstract

Background

Troponin I and T are sensitive markers of myocardial injury. The presence of elevated troponin often prompts further investigation with coronary angiography.

Methods

We present a series of patients presenting to our unit with raised troponin I and supraventricular tachycardia (SVT) that prompted coronary angiography.

Results

All patients had normal epicardial vessels at angiogram, no evidence of muscle bridging or pulmonary embolism.

Conclusion

The presence of tachycardia sufficient to warrant hospital admission can raise troponin, and this should be viewed in context when a decision on angiography is to be taken.

Section snippets

Discussion

Our series supports the initial finding of Bakshi [2] and Zellweger [3] demonstrating normal coronary arteries in patients with SVT as their presenting event. Our cohort is the largest to date and confirms the ability of fast paroxysmal arrhythmia to result in modest troponin rise in normal hearts.

The duration of arrhythmia did not appear associated with the degree of troponin rise, however, significant heamodynamic compromise was evident in Case 2, and this was associated with a large troponin

References (6)

C.H. Wang et al.
Coronary vasospasm as a possible cause of elevated cardiac troponin I in patients with acute coronary syndrome and insignificant coronary artery disease
Am. Heart J.
(2002)
Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of...
T.K. Bakshi et al.
Causes of elevated troponin I with a normal coronary angiogram
Intern. Med. J.
(2002)

There are more references available in the full text version of this article.

Cited by (67)

Prognostic value of cardiac troponin in elderly patients with paroxysmal supraventricular tachycardia: A multicenter study
2023, American Journal of Emergency Medicine
An elevated level of cardiac troponin I (cTnI) frequently accompanies an episode of supraventricular tachycardia (SVT). However, the predictive value of cTnI in elderly SVT patients has not been examined.
We collected the electronic medical records of elderly SVT patients (over 65 years old) who visited four Taiwanese emergency departments over a 2-year period. The patients who underwent cTnI testing were included in the cohort and further categorized based on their cTnI results (positive or negative). The study's primary outcomes were the 5-year risks of major adverse cardiovascular events (MACE) and SVT recurrence.
One hundred and twenty-four patients met the inclusion criteria. Of these patients, 39 (31.5%) had a positive cTnI result, and 85 (68.5%) had a negative cTnI result. Patients with a positive cTnI result were older (p = 0.029) and had a longer hospital stay (p = 0.023) than those with a negative cTnI result. Multivariate analysis showed that age > 75 years (OR = 2.41; 95% CI 1.07–5.45; p = 0.034) was an independent predictor for cTnI elevation. In the survival analysis, no difference in the incidence of five-year MACE (p = 0.656) was observed between the cTnI-positive and cTnI-negative groups. Multivariate analysis revealed that a history of coronary artery disease was the only significant independent risk factor for MACE (HR = 4.30; 95% 95% CI 1.41–13.05; p = 0.010). For SVT recurrence, the multivariate analysis revealed that previous SVT (HR = 3.37; 95% CI 1.53–7.39; p = 0.002), smoking history (HR = 2.32; 95% CI 1.03–5.24; p = 0.043), and RFA treatment (HR = 0.20; 95% CI 0.06–0.65; p = 0.008) were significant independent predictors.
An increased cardiac troponin level may not effectively indicate the risk of MACE in elderly SVT patients. Physicians might want to be cautious when interpreting troponin test results for this specific patient group.
High-Sensitivity Troponin T For The Risk Assessment Of Patients With Acute Atrial Fibrillation
2022, Current Problems in Cardiology
Elevations of high-sensitivity troponin T (Hs-TnT) in the setting of acute atrial fibrillation (AF) are not clearly understood. This study evaluated factors associated with these elevations and its prognostic implication. We prospectively included 413 consecutive patients who presented to our institution with acute AF. The median Hs-TnT on admission was 12 ng/l and 39.4% had values above the 99th percentile. At 1-year, AF recurrence occurred in 38.3% of patients, and MACE in 5.6%. Hs-TnT levels were not associated with AF reversion (p 0.869) or with 1-year AF recurrence (p 0.132) but they were with MACE (12 vs 24 ng/l, p 0.001). Thus, Hs-TnT was a strong predictor of MACE (HR 3.486, 95% CI 1.256-5.379, p 0.009) in this population. In conclusion, Hs-TnT elevation was frequently observed in patients with acute AF, and although it was not associated with AF reversion or recurrence, it was highly predictive of MACE at 1-year.
Mitigating clinical waste in the trauma intensive care unit: Limited clinical utility of cardiac troponin testing for trauma patients with atrial fibrillation
2020, American Journal of Surgery
The clinical significance of obtaining cardiac troponin (cTn) levels among trauma patients with new onset arrhythmias is unknown. We aimed to assess whether cTn levels actually influence clinical decision making or represent an inappropriate use of resources.
Trauma patients admitted from 2013 to 2014 diagnosed with atrial fibrillation (AF) were retrospectively reviewed using the institutional trauma database. Demographics, cTn levels, and myocardial infarction (MI) diagnosis data were recorded. Standard univariate tests were used to compare data between patients with and without cTn.
There were 258 patients included of which 126 patients had cTn levels obtained (48.8%, TEST group). The remaining 132 patients (51.2%) were untested (noTEST group). Among TEST patients, use of echocardiography nearly doubled and cardiology consultations increased (all p < 0.05). No TEST patients suffered MI or PE.
Obtaining cTn values in trauma patients with new-onset AF resulted in increased resource utilization without clinical utility.
An emergency medicine approach to troponin elevation due to causes other than occlusion myocardial infarction
2020, American Journal of Emergency Medicine
Citation Excerpt :
Troponin elevation can be seen after supraventricular tachyarrhythmias (including supraventricular tachycardia [SVT] and atrial fibrillation[AF]), like due to shortened diastole and increased oxygen demand with subendocardial ischemia [4,5,45-48]. Troponin elevation may occur in 12–48% of patients with SVT, though this is typically not associated with coronary artery disease (CAD) [24,45-49]. The literature evaluating elevated troponin in patients with SVT is limited to case reports and series or small cohort studies, and most recommendations advise against the routine assessment of troponin in SVT [49-57].
Troponin is an integral component of the evaluation for acute coronary syndrome (ACS) and occlusion myocardial infarction (OMI). However, troponin may be elevated in conditions other than OMI.
This narrative review provides emergency clinicians with a focused evaluation of troponin elevation in patients with myocardial injury due to conditions other than OMI.
ACS includes the diagnosis of myocardial infarction (MI), which incorporates assessment for elevated troponin. Troponin I and T are the most common biomarkers used in assessment of myocardial injury and may be released with myocyte injury and necrosis, myocyte apoptosis and cell turnover, and oxygen supply demand mismatch. Troponin elevation is a reflection of myocardial injury, and many conditions associated with critical illness may result in troponin elevation. These include cardiac and non-cardiac conditions. Cardiac conditions include heart failure, dysrhythmia, and dissection, while non-cardiac causes include pulmonary embolism, sepsis, stroke, and many others. Clinicians should consider the clinical context, patient symptoms, electrocardiogram, and ultrasound in their assessment of the patient with troponin elevation. In most cases, elevated troponin is a marker for poor outcomes including increased rates of mortality.
Troponin can be elevated in many critical settings. The causes of troponin elevation include cardiac and non-cardiac conditions. Clinicians must consider the clinical context and other factors, as an inappropriate diagnosis of OMI may result in patient harm and misdiagnosis of another condition.
Assessment of the Utility of Ordering a Troponin in Low- and Intermediate-Risk Patients Presenting to the Emergency Department with Supraventricular Tachycardia: A Retrospective Chart Review
2018, Journal of Emergency Medicine
A troponin assay is commonly sent for patients presenting to emergency departments (EDs) with supraventricular tachycardia (SVT). Multiple studies suggest that elevated troponin levels do not predict coronary artery disease in these patients. Patients with elevated troponins are more likely to have additional cardiac testing, which can lead to increased health care costs and unnecessary invasive procedures.
Our objective was to evaluate low- to intermediate-risk patients (HEART [history, electrocardiography, age, risk factors and troponin] Score 1–6) presenting to the ED with SVT. Our hypothesis was that an elevated troponin would not predict major adverse cardiac events (MACE), but would be associated with increased hospital admission rates and lengths of stay.
This was a retrospective cohort study of adult patients who presented with SVT to a large, urban, academic hospital ED over 4 years who had a troponin result. A total of 46 patients were included in the study.
Patients with a positive troponin (>0.05 ng/mL) had a hospital admission rate of 86% versus 21% for patients with negative troponin (p = 0.006); rate of cardiology consult of 86% versus 21% (p < 0.001); and a mean total length of stay of 4157 min versus 1347 min (p = 0.04). At 3 months, none of the patients with a positive troponin had an MACE, death from any cause, or positive results of cardiac testing.
Patients with a positive troponin result had significantly more admissions, cardiology consults, and longer hospital stays. These patients did not have an increased prevalence of MACE.
High sensitivity troponin in the management of tachyarrhythmias
2018, Cardiovascular Revascularization Medicine
The introduction of the highly sensitive troponin (hs-trop) assays into clinical practice has allowed for the more rapid diagnosis or exclusion of type 1 myocardial infarctions (T1MI) by clinicians, in addition type 2 myocardial infarctions (T2MI) are now more frequently detected. Tachyarrhythmias are one of the common causes of T2MI, the medium and long term outcome for this cohort of T2MI is yet to be clarified.
Retrospective review of consecutive patients admitted with a diagnosis of either (a) non ST-elevation myocardial infarction (NSTEMI) or (b) tachyarrhythmia was performed. Data were collected on patient demographics and investigations. Patient mortality status was recorded through the Personal Demographics Service (PDS) via NHS Digital.
A total of 704 patients were eligible for inclusion to the study. 264 patients were included in the study with a final discharge diagnosis of NSTEMI and 440 patients with a final discharge diagnosis of tachyarrhythmia. There was a significantly higher peak troponin in NSTEMI patients compared to the tachyarrhythmia troponin positive group (4552 ng/L vs 571 ng/L, p < 0.001). Mortality was significantly higher in the troponin positive tachyarrhythmia patients than the troponin negative patients (54 vs 34, 26.2% vs 14.5%, log rank p = 0.003), furthermore, the mortality of NSTEMI and troponin positive tachyarrhythmia patients was similar (55 vs 54, 20.8% vs 26.2%, log rank p = 0.416). Only one patient (0.14%) was given a formal diagnosis of T2MI.
These data suggest that troponin positive tachyarrhythmia is not a benign diagnosis, and has a mortality rate similar to NSTEMI. Formal labeling as T2MI is rare in real life practice. More investigation into the detection and management of T2MI and troponin positive arrhythmia patients is now warranted.

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Letter to the EditorSupraventricular tachycardia promotes release of troponin I in patients with normal coronary arteries

Abstract

Background

Methods

Results

Conclusion

Section snippets

Discussion

Am. Heart J.

Causes of elevated troponin I with a normal coronary angiogram

Intern. Med. J.

Letter to the Editor
Supraventricular tachycardia promotes release of troponin I in patients with normal coronary arteries