Role of serum troponin-I in identifying left ventricular ejection fraction of

Abstract

To determine the serum levels of troponin-I in identifying left ventricular ejection fraction (LVEF) of <or= 40% in patients with first anterior ST Elevation Myocardial Infarction (STEMI). Case series. At the Tabba Heart Institute, Karachi, from May to November 2008. Consecutive patients presenting with first anterior STEMI were studied. Troponin-I concentration was measured by MEIA (microparticle enzyme immunoassay) method and LVEF was visually assessed. Analysis of relation between troponin-I levels and LVEF by the Receiver-Operator Characteristic (ROC) curve was performed to determine the cut off values of troponin-I in identifying LVEF of <or= 40% in patients, who had received streptokinase or undergone primary Percutaneous Coronary Intervention (PCI). Out of the 90 patients studied, 50 patients received streptokinase and the remaining 40 patients underwent primary PCI. Mean age was 54.6 +/- 9 years and 82% were male. Troponin-I levels of > 63.5 ng/ml predicted LVEF of <or= 40% with a sensitivity of 94% and specificity of 97% in patients receiving streptokinase, whereas in patients undergoing primary PCI, troponin-I levels of > 87.5 ng/ml predicted LVEF < 40% with a sensitivity of 86% and specificity of 100%. Troponin-I concentration of > 63.5 ng/ml and > 87.5 ng/ml can predict LVEF <or= 40% in patients treated with either streptokinase or primary PCI respectively for first anterior STEMI. Troponin-I can be used as a non-imaging tool to identify patients with LVEF <or= 40% who need early aggressive therapy.