Predictive Role of Cardiac Troponin I, Creatine Kinase-Mb and Electrocardiogram in Early Assessment of Acute Cardiotoxicity in Patients Poisoned by Cardiotoxic Drugs and Toxins

Abstract

Background: In spite speedy development of clinical toxicology researches and protocols cardiovascular failure in severe acute intoxication remains a leading cause of death. Early cardiovascular risk assessment in acutely intoxicated patients is a must nowadays.
 This study aims to evaluate the role of ECG, serum cardiac troponin I (cTnI) and creatine kinase myocardial band (CK-MB) for early detection of cardio-toxicity in acutely poisoned patients.
 Methods: Prospective study was carried on100 patients with acute cardiotoxicity by drugs and toxins known to cause cardiac injury admitted to Sohag University hospitals, informed written consent has been obtained from each patient; ECG and biochemical analysis of serum cTnI and CK-MB were estimated in all studied patients.
 Results: (90%) of studied patients had complete free recovery, (4%) discharged with complications and (6%) of patients died. ECG test can be used as a predictor of mortality and had sensitivity 100%, specificity 46.8% and negative predictive value (NPV) 100%. Serum cTnI was highly significantly increased with death hence could be used as predictors of outcome. While serum CK-MB couldn't be used as an outcome predictor. ROC curve analysis to assess serum cTnI as a predictor of mortality of acute cardiovascular toxicity with cut off > 1.0 ng/ml had sensitivity 100%, specificity 89.4% and NPV 100% with excellent diagnostic characteristic (accuracy rate 96.4%). There is no significant difference of serum CK-MB and serum cTnI among cardiac drugs toxicity patients and non-cardiac toxins patients.
 Conclusion: the study concluded that ECG and serum cTnI can be used as a predictor of mortality. Also, the protocol of management will be same in acute cardiotoxicity by cardiac drugs and non-cardiac drugs and toxins.
 Recommendation: the study recommends combining of ECG changes and serum cTnI as they can early detect acute cardiovascular effects in acutely poisoned patients.