Advances in the Value of Cardiac Troponin and ST Segment Depression in Predicting Coronary Artery Disease in Patients with Paroxysmal Supraventricular Tachycardia

Pan Yun,Chen Dongdong

doi:10.11648/j.ccr.20200403.18

Abstract

Paroxysmal supraventricular tachycardia (PSVT) is similar to coronary artery disease (CAD) in that it is often accompanied by chest pain, ST segment depression or elevated cardiac troponin in the electrocardiogram (ECG). Studies have shown that only 20%-40% of these patients are diagnosed with CAD by coronary angiography and even lower in foreign countries. Therefore, a noninvasive and simple method is urgently needed in practice to determine the high-risk population of PSVT patients with CAD, so as to avoid excessive examination and waste of medical resources. Cardiac troponin and ECG are favored in clinic because of their simple, economical and non-invasive detection methods. By analyzing the mechanism, it is concluded that elevated troponin and ST segment depression are of low predictive value for CAD diagnosis in PSVT patients, and it is necessary to further evaluate the risk factors for cardiovascular disease in these patients to determine whether coronary angiography is required. However, it is worth noting that ST segment depression in PSVT patients may be associated with coronary microcirculation lesions. Future research should also start from the pathogenesis, symptoms and characteristics of coronary microcirculation lesions to find more similarities and differences with PSVT combined with ST segment depression. This paper may contribute to a better understanding of troponin elevation and ST segment depression in PSVT patients.

Highlights

Paroxysmal supraventricular tachycardia (PSVT) is a common arrhythmia [1]
Some reports have shown that the incidence of coronary artery disease (CAD) in patients with PSVT combined with elevated cardiac troponin and/or depressed ST segment of ECG is 20%-40% in China, and even only 4% in foreign countries [4]
It is still controversial whether coronary angiography should be performed in patients with PSVT combined with elevated cardiac troponin and/or ST-segment depression

Summary

Introduction

Paroxysmal supraventricular tachycardia (PSVT) is a common arrhythmia [1]. Oreiarena retrospectively analyzed the cases diagnosed with PSVT from 1991 to 1993 in the Marshfield Epidemiology Study area in 1998 and concluded that Person-year incidence of PSVT was 36/100,000 [2, 3]. PSVT is more common in adolescents, and the incidence in females is about twice as high as that in males [3], which may be accompanied by chest pain or elevated cardiac troponin and/or depressed ST segment of ECG when seizure. The above ECG and cardiac troponin are more obvious when combined with CAD Most of these patients will choose to undergo coronary angiography to determine whether there is accompanied with CAD in clinical practice. Some reports have shown that the incidence of CAD in patients with PSVT combined with elevated cardiac troponin and/or depressed ST segment of ECG is 20%-40% in China, and even only 4% in foreign countries [4].

Cardiac Troponin

St Segment Depression

Findings

Conclusion and Prospect