Troponin Levels In Patients Research Articles

Cardiac Troponin Levels in Patients with Chronic Kidney Disease: "Markers of High Risk or Just Noise''?

Kidney disease is linked to the development of cardiovascular disorders, further increasing morbidity and mortality in this high-risk population. Thus, early detection of myocardial damage is imperative in order to prevent devastating cardiovascular complications within this patient group. Over the years, cardiac biomarkers have been identified and are now widely used in everyday clinical practice. More specifically, available data suggest that cardiac troponin and its regulatory subunits (TnT, TnI, and TnC) reflect the injury and necrosis of myocardial tissue. While cTnC is identical in cardiac and skeletal muscle, TnT and TnI constitute cardiac-specific forms of troponin, and, as such, they have been established by international societies as biomarkers of cardiac damage and diagnostic indicators for acute myocardial infarction. Elevations in the levels of both cardiac troponins (cTnT and cTnI) have been also reported in asymptomatic patients suffering from chronic kidney disease. Therefore, if abnormal, they often generate confusion among clinicians regarding the interpretation and clinical significance of their numerical values in emergency settings. The aim of this review is to explore the reasons behind elevated troponin levels in patients with chronic kidney disease and identify when these elevated levels of biomarkers indicate the need for urgent intervention, considering the high cardiovascular risk in this patient group.

Influences of V-A Mode Assisted ECMO Combined with Intra-Aortic Balloon Counterpulsation on Disease Outcome and Troponin Level in Patients with Acute Fulminant Myocarditis

Introduction: The acute fulminant myocarditis (AFM) is a special type of myocarditis, characterized by rapid onset, progression with abnormal hemodynamics causing high mortality. The combination of extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon counterpulsation (IABP) in these cases have improved the acute phase attacks resulting in increased survival of the effected individuals. To observe the effect of vein-artery (V-A) mode assisted ECMO combined with IABP on the disease outcomes and troponin level in patients with acute fulminant myocarditis (AFM). Methods: A total of 45 patients with AFM were admitted to our hospital from January 2016 to December 2021, they were divided into group A (21 patients, receiving traditional treatment) and group B (24 patients, receiving V-A mode assisted ECMO and IABP based on traditional treatment) according to the treatment plan. The hypersensitive troponin (hs-cTnI), B-type natriuretic peptide (BNP), arterial blood gas analysis index, multiple organ dysfunction score (MODS), simplified acute physiology score II (SAPS II), cardiac ultrasound index, and disease outcomes were compared between the two groups. Results: After treatment, the hs-cTnI, BNP, blood lactic acid, MODS score and SAPS score in both groups were lower than before treatment (p < 0.05), the arterial oxygen saturation (SaO2), left ventricular ejection fraction (LVEF) and cardiac index (CI) was higher than before treatment (p < 0.05), the hs-cTnI, BNP, blood lactic acid, MODS score and SAPS Ⅱ score in group B were lower than group A (p < 0.05), SaO2, LVEF and CI was higher than group A (p < 0.05). The in-hospital mortality of group B (9.52%, 2/21) was lower than group A (45.83%, 11/24) (χ2 = 7.188, p = 0.007). Among the recovered discharged patients, the length of stay in group B (19 patients, 14.42 ± 4.59 days) was shorter than group A (13 patients, 18.34 ± 5.72 days) (t = 2.147, p = 0.040). Conclusions: V-A mode assisted ECMO combined with IABP can improve the condition and arterial blood gas analysis index and cardiac function of AFM patients, alleviate myocardial injury, reduce mortality in the hospital, and shorten the hospitalization time of the recovered patients.

Altered Arterial Stiffness, Ventricular-Arterial Coupling and Troponin Levels in Patients with Systemic Lupus Erythematosus.

Introduction: Systemic Lupus Erythematosus (SLE) is an autoimmune disease associated with an increased risk of cardiovascular diseases (CVDs), leading to elevated mortality rates among patients. We aimed to evaluate the levels of cardio-ankle vascular index (CAVI), global longitudinal strain (GLS), ventricular-arterial coupling (VAC), and high-sensitivity cardiac troponin I (hsTnI) in SLE patients and to explore their relationship with clinical parameters. Methods: This cross-sectional study enrolled 82 SLE patients without evident cardiac or kidney impairment and 41 age- and sex-matched healthy controls. We comparatively evaluated CAVI, GLS, VAC, and hsTnI between SLE patients and controls, and we assessed their association among SLE patients with disease activity based on the SELENA-SLEDAI Activity Index. Multivariate regression analysis was performed to identify independent predictors of CAVI and hsTnI within the SLE cohort. Results: In comparison to healthy controls, SLE patients presented with significantly higher CAVI, GLS, and hsTnI levels, while VAC was significantly reduced (p < 0.001). Furthermore, SLE patients with active disease (SELENA-SLEDAI ≥ 4) exhibited higher levels of CAVI and troponin than those with inactive disease (p < 0.001). SLEDAI was an independent predictor of CAVI, while VAC and SLEDAI were independent determinants of hsTnI in the SLE cohort. Conclusions: SLE patients displayed abnormal levels of CAVI, VAC, GLS, and troponin compared to healthy individuals. Our findings implicate the potential of those CV novel CVD risk factors to refine screening and therapeutic strategies for this specific population.

PREDICTIVE VALUE OF FIBROSIS-4 INDEX FOR HIGHER TROPONIN LEVELS IN ACUTE CORONARY SYNDROME

Objective: Non-alcoholic fatty liver disease, a condition that affects nearly one-third of the population, is associated with cardiovascular disease and is the leading cause of death. Studies have found that peak troponin level is a strong predictor of all- cause death and infarct area width in the left ventricle after acute coronary syndrome. The fibrosis-4 (FIB-4) index is a noninvasive clinical tool that combines four laboratory parameters to measure liver fibrosis. The relationship between the FIB-4 index and peak troponin level is unclear. We speculated that a higher FIB-4 index might be associated with higher peak troponin levels, as it is linked to cardiovascular disease. We aimed to explore the relationship between peak troponin levels and the FIB-4 index in patients with acute coronary syndrome. Material and Methods: This was an observational, cross- sectional cohort study. A total of 302 inpatients with acute coronary syndrome admitted to our clinic between June and September 2023 were enrolled. The FIB-4 index and peak troponin levels were evaluated. The maximum mean troponin level was determined, and two patient groups were formed and compared according to whether it was below or above this level. Results: We demonstrated for the first time that the FIB-4 index is a strong indicator of peak troponin levels in patients with acute coronary syndrome (odds ratio: 2.301, 95% CI 1.667-3.172, p

Post-Coronary Artery Bypass Grafting Outcomes of Patients with/without Type-2 Diabetes Mellitus and Chronic Kidney Disease Treated with SGLT2 Inhibitor Dapagliflozin: A Single-Center Experience Analysis.

Increasingly, SGLT2 inhibitors save patients with heart failure and comorbidities such as type-2 diabetes mellitus (T2DM) and chronic kidney disease (CKD); the inhibition of sodium-glucose cotransporter 2 (SGLT2) was first studied in patients with diabetes as a solution to lower glucose levels by preventing glucose reabsorption and facilitating its elimination; in the process, researchers took notice of how SGLT2 inhibitors also seemed to have beneficial cardiovascular effects in patients with both diabetes and cardiovascular disease. Our single-center prospective study assesses outcomes of post-coronary artery bypass grafting (CABG) rehabilitation and SLGT2 inhibition in CABG patients with/without T2DM and with/without CKD. One hundred twenty consecutive patients undergoing CABG were included in the analysis. Patients were divided into four subgroups: diabetes patients with chronic kidney disease (T2DM + CKD), diabetes patients without chronic kidney disease (T2DM-CKD), prediabetes patients with chronic kidney disease (PreD+CKD), and prediabetes patients without chronic kidney disease (PreD-CKD). Echocardiographic and laboratory investigations post-surgery (phase I) and 6 months later (phase II) included markers for cardiac ischemia, glycemic status, and renal function, and metabolic equivalents were investigated. One hundred twenty patients participated, mostly men, overweight/obese, hypertensive, smokers; 65 had T2DM (18 with CKD), and 55 were prediabetic (17 with CKD). The mean ejection fraction increased by 8.43% overall but significantly more in the prediabetes group compared to the T2DM group (10.14% vs. 6.98%, p < 0.05). Overall, mean heart-type fatty-acid-binding protein (H-FABP) levels returned to normal levels, dropping from 68.40 ng/mL to 4.82 ng/mL (p = 0.000), and troponin data were more nuanced relative to an overall, strongly significant decrease of 44,458 ng/L (p = 0.000). Troponin levels in patients with CKD dropped more, both in the presence of T2DM (by 82,500 ng/L, p = 0.000) and in patients without T2DM (by 73,294 ng/L, p = 0.047). As expected, the overall glycated hemoglobin (HbA1c) levels improved significantly in those with prediabetes (from 6.54% to 5.55%, p = 0.000); on the other hand, the mean HbA1c changed from 7.06% to 6.06% (p = 0.000) in T2DM, and the presence or absence of CKD did not seem to make any difference: T2DM+CKD 7.01-6.08% (p = 0.000), T2DM-CKD 7.08-6.04% (p = 0.000), PreD+CKD 5.66-4.98% (p = 0.014), and PreD-CKD 6.03-4.94% (p = 0.00). Compared to an overall gain of 11.51, the GFRs of patients with CKD improved by 18.93 (68.15-87.07%, p = 0.000) in the presence of established diabetes and 14.89 (64.75-79.64%, p = 0.000) in the prediabetes group. Regarding the patients' cardiac statuses, the results from our single-center analysis revealed a significant decrease in ischemic risk (H-FABP and hs-cTnI levels) with improvements in mean ejection fraction, glycemic status, and renal function in patients post-CABG with/without T2DM, with/without CKD, and with SGLT2 inhibitor dapagliflozin treatment while undergoing cardiac rehabilitation.

Prognostic value and determinants of high sensitive cardiac Troponin levels in patients with a systemic right ventricle: insights from the SERVE-Trial

Abstract Background The prognostic value of high-sensitivity cardiac Troponin T (hs-cTnT) in patients with a systemic left ventricle is well-established. However, the determinants and prognostic value of hs-cTnT among patients with a systemic right ventricle (sRV) are largely unknown. Purpose We aimed to assessed the determinants and prognostic value of hs-cTnT among patients with sRV. Methods Ninety-eight patients from the randomized-controlled SERVE-trial were included. The correlation between baseline hs-cTnT concentrations and bi-ventricular volumes and function quantified by cardiac magnetic resonance was assessed by adjusted linear regression models. The prognostic value of hs-cTnT and other established prognostic markers were assessed by adjusted cox proportional hazards models, survival analysis and c-statistics. The primary outcome was the composite of clinically relevant arrhythmia, hospitalization for heart failure or all-cause death. Results Median age [interquartile range, IQR] was 39 [32, 48] years and 32% were female. Median hs-cTnT concentration was 7 [IQR, 4-11] ng/L. Coefficients of determination for the relationship between hs-cTnT concentrations and right ventricular end-systolic volume index, (RVESVi) and ejection fraction (RVEF) were +0.368, p=0.046; and -0.381, p=0.018, respectively. The sex and aged adjusted hazard ratio [95%, confidence interval, CI] of hs-cTnT at 2- and 4-times the reference level (5 ng/l) for the primary outcome were 2.89 [1.14-7.29] and 4.42 [1.21-16.15], respectively (Figure 1). Patients with hs-cTnT concentrations ≤7 ng/L (median) had better event-free survival (89% vs. 67%, p=0.004). The prognostic performance quantified by the C-statistics [95%, CI] for age and sex adjusted models based on hs-cTnT, RVEF, and peak VO2 predicted (%) were comparable: 0.71 [0.61-0.82], 0.72 [0.59-0.84], and 0.71 [0.59-0.83], respectively (Figure 2). Conclusion Hs-cTnT concentration was significantly correlated with RVEF and RVESVi in patients with a sRV. The prognostic accuracy of this biomarker was comparable to that of the current gold standards (RVEF and peak VO2 predicted).Figure 1Figure 2

Late Mortality After Myocardial Injury in Critical Care Non-Cardiac Surgery Patients Using Machine Learning Analysis

Myocardial injury after noncardiac surgery (MINS) increases mortality within 30days. We aimed to evaluate the long-term impact of myocardial injury in a large cohort of patients admitted to intensive care after noncardiac surgery. All patients who stayed, at least, overnight with measurement of high-sensitive cardiac troponin were included. Clinical characteristics and occurrence of MINS were assessed between patients who died and survivors using chi-square test and Student ttest. Variables with p<0.01 in the univariate model were included in the Cox regression model to identify predictor variables. Survival decision tree (SDT), a machine learning model, was also used to find the predictors and their correlations. We included 2,230 patients with mean age of 63.8±16.3years, with most (55.6%) being women. The prevalence of MINS was 9.4% (209 patients) and there were 556 deaths (24.9%) in a median follow-up of 6.7years. Univariate analysis showed variables associated with late mortality, namely: MINS, arterial hypertension, previous myocardial infarction, atrial fibrillation, dementia, urgent surgery, peripheral artery disease (PAD), chronic health status, and age. These variables were included in the Cox regression model and SDT. The predictor variables of all-cause death were MINS (hazard ratio [HR] 2.21; 95% confidence interval [CI] 1.77 to 2.76), previous myocardial infarction (HR 1.47; 95% CI 1.14 to 1.89); urgent surgery (HR 1.24; 95% CI 1.01 to 1.52), PAD (HR 1.83; 95% CI 1.23 to 2.73), dementia (HR 2.54; 95% CI 1.86 to 3.46) and age (HR 1.05; 95% CI 1.04 to 1.06). SDT had the same predictors, except PAD. In conclusion, increased high-sensitive troponin levels in patients who underwent noncardiac surgery raised the risk of short and late mortality.

The prognostic significance of early troponin levels in patients undergoing aortic ridge surgery.

Subaortic stenosis is a CHD that can lead to left ventricular hypertrophy, heart failure, and aortic valve damage if left untreated. The gold standard treatment for subaortic stenosis is septal myectomy. However, there is no clear consensus on the surgical margins required for adequate muscle resection. In this retrospective study, we reviewed the records of 83 patients who underwent subaortic stenosis surgery between 2012 and 2020 to investigate the effect of early troponin levels on prognosis. We excluded patients with additional cardiac pathologies, hypertrophic obstructive cardiomyopathy, and valvular aortic stenosis.Troponin levels were recorded in the early post-operative period, and patients were monitored for complications such as ventricular arrhythmia, left ventricular systolic dysfunction, infective endocarditis, and pacemaker implantation. The troponin levels were significantly higher in the patients who had septal myectomy. The degree of myectomy affected the risk of complications in the early post-operative period and recurrence in the later period. However, when the gradient was substantially or completely removed by myectomy, patients experienced significant symptom improvement in the early post-operative period, and their late survival was equivalent to that of healthy individuals of the same age.Our findings suggest that monitoring troponin levels in patients undergoing septal myectomy may be beneficial in predicting the risk of complications. However, further studies are needed to establish the optimal surgical technique and extent of muscle resection required for subaortic stenosis treatment. Our study adds to the existing knowledge of the benefits and risks associated with septal myectomy as a treatment option for subaortic stenosis.

Evolocumab has no effects on heart failure with reduced ejection fraction injury biomarkers: The EVO-HF trial.

Patients with heart failure with reduced ejection fraction (HFrEF) have not been shown to benefit from statins. We hypothesized that, by limiting disease progression in stable HFrEF of ischaemic etiology, the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor evolocumab could reduce circulating troponin levels, a surrogate biomarker of myocyte injury and atherosclerosis progression. The EVO-HF multicentre prospective randomized trial compared evolocumab (420 mg/month administered subcutaneously) plus guideline-directed medical therapy (GDMT; n = 17) versus GDMT alone (n = 22) for 1 year in patients with stable coronary artery disease and left ventricular ejection fraction (LVEF) <40%, ischaemic aetiology, New York Heart Association class II, N-terminal pro-B-type natriuretic peptide (NT-proBNP) ≥400 pg/ml, high-sensitivity troponin T (hs-TnT) >10 pg/ml, low-density lipoprotein cholesterol (LDL-C) ≥70 mg/dl. The primary endpoint was change in hs-TnT concentration. Secondary endpoints included NT-proBNP, interleukin-1 receptor-like 1 (ST2), high-sensitivity C-reactive protein (hs-CRP), LDL, low-density lipoprotein receptor (LDLR), high-density lipoprotein cholesterol (HDL-C), and PCSK9 levels at 1 year. Patients were mainly Caucasian (71.8%), male (79.5%), relatively young (mean age 68.1 ± 9.4 years), with a mean LVEF of 30.4 ± 6.5%, and managed with contemporary treatments. No significant changes in hs-TnT levels were observed in any group at 1 year. NT-proBNP and ST2 levels decreased in the GDMT plus evolocumab group (p = 0.045 and p = 0.008, respectively), without changes in hs-CRP, HDL-C, or LDLR. Total and LDL-C decreased in both groups, significantly higher in the intervention group (p = 0.003), and PCSK9 levels increased in the intervention group. This prospective randomized pilot trial, although with the limitation of the small sample size, does not support the benefit of evolocumab in reducing troponin levels in patients with elevated LDL-C levels, history of coronary artery disease, and stable HFrEF.

N-Terminal Pro-Bnp (NT-ProBNP) and High Sensitive Troponin Levels in Patients with Ischemic Dilated Cardiomyopathy and Idiopathic Dilated Cardiomyopathy

Background: The brain-type natriuretic peptides (BNP) and troponins levels can be used for the risk stratification of patients presenting with acute myocardial infarctions. Elevated levels of N-terminal pro-brain natriuretic peptide (NT-ProBNP) can be seen in patients with heart failure (HF) and atrial fibrillation. Objectives: The aim is to evaluate the NT-ProBNP levels and high-sensitive troponin-T (Trop T-HS) levels in patients with ischemic and nonischemic HF and to analyze its association with prognosis. Methods: This prospective observational study was conducted in a tertiary Centre over a period of 2 years. We analyzed NT-ProBNP and Trop T-HS levels of patients with HF, who were admitted to our cardiac intensive care unit. Patients with acute coronary syndrome, myocarditis, and renal failure were excluded from the study. The study population consists of 130 patients, of which 90 patients with ischemic dilated cardiomyopathy (ISDCM) and 40 patients with idiopathic dilated cardiomyopathy (IDCM). They belonged to the New York Heart Association functional classes 3 and 4. The diagnosis was made with the help of a coronary angiogram and transthoracic echocardiogram. We analyzed the NT-ProBNP levels and Trop T-HS of both groups of patients. Results: Males were predominant in both groups, i.e., 70 (77.8%) in the ISDCM patients and 26 (65%) in the IDCM patients. The NT-ProBNP levels were significantly higher among patients with ISDCM compared to patients with (IDCM) dilated cardiomyopathy (8648 ± 6207 pg/mL vs. 3100 ± 2906 pg/mL); P = 0.0008. We analyzed the NT-ProBNP levels of the survivors and nonsurvivors in each group separately. We found that there were significant differences in the levels of NT-ProBNP in the survivors and nonsurvivors in the ISDCM group (7061 ± 3663 vs. 18035 ± 4667 pg/mL); P = 0.0004. However, there was no significant difference between the survivors and nonsurvivors of IDCM patients (4701 ± 737 vs. 6821 ± 1212 pg/mL); P = 0.07. Like the previous analysis, higher levels of Trop T-HS levels were found in patients with ISDCM group compared with IDCM group (26.6 ± 8.5 ng/L vs. 16.3 ± 3.4 ng/L); P = 0.0002. There was also a significant raise of Trop T-HS in the nonsurvivors in the ISDCM group compared to the survivors (28.9 ± 16.3 vs. 65.5 ± 17.0 ng/L): P = 0.0003. Conclusion: In this study, we found that HF patients who were admitted with higher levels of NT-ProBNP and Trop T-HS had a poor prognosis.

Peak Troponin and CMR to Guide Management in Suspected ACS and Nonobstructive Coronary Arteries

BackgroundPatients presenting with acute coronary syndrome (ACS) and nonobstructive coronary arteries are a diagnostic dilemma. Cardiac magnetic resonance (CMR) has an overall diagnostic yield of ∼75%; however, in ∼25% of patients, CMR does not identify any myocardial injury. Identifying the underlying diagnosis has important clinical implications for patients’ management and outcome. ObjectivesThe authors sought to assess whether the combination of CMR and peak troponin levels in patients with ACS and nonobstructive coronary arteries would lead to increased diagnostic yield. MethodsConsecutive patients with ACS and nonobstructive coronary arteries without an obvious cause underwent CMR. The primary endpoint of the study was the diagnostic yield of CMR. The Youden index was used to find the optimal diagnostic cut point for peak troponin T to combine with CMR to improve diagnostic yield. Logistic or Cox regression models were used to estimate predictors of a diagnosis by CMR. ResultsA total of 719 patients met the inclusion criteria. The peak troponin T threshold for optimal diagnostic sensitivity and specificity was 211 ng/L. Overall, CMR has a diagnostic yield of 74%. CMR performed <14 days from presentation and with a peak troponin of ≥211 ng/L (n = 198) leads to an improved diagnostic yield (94% vs 72%) compared with CMR performed ≥14 days (n = 245). When CMR was performed <14 days and with a peak troponin of <211 ng/L, the diagnostic yield was 76% (n = 86) compared with 53% (n = 190) when performed ≥14 days. An increase in 1 peak troponin decile increases the odds of the CMR identifying a diagnosis by 20% (OR: 1.20; P = 0.008, 95% CI: 1.05-1.36). ConclusionsThe combination of CMR performed <14 days from presentation and peak troponin T ≥211 ng/L leads to a very high diagnostic yield (94%) on CMR. The diagnostic yield remains high (72%) even when CMR is performed ≥14 days from presentation, but reduces to 53% when peak troponin T was <211 ng/L.

MO445: Implications of Cardiac Biomarkers in Patients With Renal Insufficiency on Probability of Coronary Angiography and Subsequent Cardiovascular Outcomes

Abstract BACKGROUND AND AIMS Renal insufficiency is associated with an increased risk of cardiovascular morbidity and mortality. Although cardiac troponin remains essential marker for the diagnosis of myocardial injury in the general population, the diagnostic utility remains uncertain in patients with renal insufficiency. We examined the likelihood of coronary angiography and the risk of myocardial infarction after hospitalization with elevated troponin levels in patients with renal insufficiency. METHOD Based on data from multiple Danish nationwide healthcare registries, all hospitalized patients with elevated troponin I or T were identified between 2000 and 2021. Patients with age &amp;lt; 18 years, estimated glomerular filtration rate (eGFR) ≥60mL/min/1.73m2 and patients hospitalized with myocardial infarction &amp;lt; 30 days prior to the index were excluded. Renal function was calculated based on preceding plasma creatinine using the CKD-EPI equation. The probability of being referred for coronary angiography was computed across strata of renal insufficiency [eGFR (mL/min/1.73m2) 59–45, 44–30, 29–15 and &amp;lt; 15, respectively] based on multiple Cox regression calculating hazard ratios for 30-day likelihood of coronary angiography, with subsequent comparison of cumulative risk and hazard ratios for myocardial infarction using the Aalen-Johansen estimator and multiple Cox regression, respectively. RESULTS In total 57 044 patients were included in the study. Patients were predominantly male (53%, n = 30 222), with a median age of 81 years (IQR 74–87 years). eGFR strata (%): 59–45: 46.8%; 44–30: 30.6%; 29–15; 15.6%; &amp;lt;15: 7.%. Cardiovascular comorbidity was substantial; 47.1% of patients had a history of hypertension, 20.5%% of patients had a history of heart failure, 26.6% of patients had a history of diabetes and 25.3% of patients had a history of ischemic heart disease. Hazard ratios for 30-day likelihood of coronary angiography were 1.26 [95% confidence interval (CI) 1.10–1.44] for eGFR 15–29 mL/min/1.73m2, 2.00 (95% CI 1.77–2.25) for eGFR 30–44 mL/min/1.73m2 and 2.95 (95% CI 2.63–3.31) for eGFR 45–59 mL/min/1.73m2, using eGFR &amp;lt; 15 as reference. Subsequent cumulative risk of myocardial infarction is shown in Figure 1. Hazard ratios for risk of myocardial infarction were 0.86 (95% CI 0.71–1.03) for eGFR 15–29 mL/min/1.73m2, 0.58 (95% CI 0.49–0.69) for eGFR 30–44 mL/min/1.73m2 and 0.49 (95% CI 0.42–0.58) for eGFR 45–59 mL/min/1.73m2, using eGFR &amp;lt; 15 as reference. CONCLUSION In patients with elevated troponin levels, renal insufficiency is associated with an incrementally decreased probability of coronary angiography despite a graded proportional increase in the risk of subsequent myocardial infarction.

Elevation in troponin associated with COVID-19 is associated with an adverse long-term outcome

Abstract Funding Acknowledgements Type of funding sources: None. Aim Elevated troponin levels have been shown to predict in-hospital outcomes in patients with COVID-19. However, whether this relates to or predicts longer-term outcomes is unknown. We aimed to investigate the effect of troponin elevation in patients with COVID-19, looking at resource utilisation post discharge, re-hospitalisation and outcomes. Methods This was a prospective study of 7650 patients admitted from December 2019 to July 2020 across a large university hospital trust. Patients were stratified according to COVID-19 status and troponin values (elevated = troponin T ≥15 ng/mL). The primary outcome assessed was all-cause mortality. Results 1005 patients were COVID-19 positive and had elevated troponin levels, with the remaining patients troponin positive but COVID-19 negative. COVID+ patients were more likely to be older, and less likely to be Caucasian (35.7% vs 46.6%, p&amp;lt;0.0001), however, peak troponin did not differ significantly between the groups {54 (28-125) vs 47 (25-130) ng/mL, p=0.121}. Mortality before first discharge was four times more likely in COVID+ than COVID- patients with elevated troponins {389 (39%) vs 359 (9.9%); p&amp;lt;0.001}. This mortality rate was also significantly higher than in COVID-19 positive patients who were troponin negative (p=6%, P&amp;lt;0.0001). Post-discharge over a follow-up period of 365 days, in the discharged COVID-19 positive troponin positive group, a minority of patients (13.2%) were investigated with outpatient cardiac investigations (echocardiography, CTCA, coronary angiography and cardiac MRI) compared to the COVID-19 negative group (34.5%). Post-discharge mortality was significantly higher among the COVID+ cohort {63 (10.2%) vs COVID-19 negative troponin positive 103 (3.1%); p&amp;lt;0.001}. COVID+ patients who died post discharge were more likely to be Caucasian (55.4% vs 35.2%, p&amp;lt;0.05) and more likely to be older (81 (72-87.5) vs 67 (57-79), p&amp;lt;0.05) than COVID+ patients who survived post discharge. Conclusion Elevated troponin levels in patients with COVID-19 is associated with long-term mortality. Patients were unlikely to undergo cardiac investigations and the troponin rise likely reflects illness severity. Further data is needed in this area.

Electrocardiographic Changes and Serum Troponin Levels in Patients with Acute Stroke: A Prospective Cross-Sectional Study.

Electrocardiographic changes and elevated serum troponin are frequent findings in acute stroke. They may reflect what is known as the neurogenic myocardial injury. The aim of this study is to determine the electrocardiographic changes and serum troponin level in acute stroke patients and to correlate these changes to the anatomical location and pathological type of the stroke. A prospective cross-sectional study was conducted at the National Center of Neurological Science, from January to December 2019. Non-probability sampling with total coverage was considered. 50 patients with acute stroke were included in the study. Data were analyzed by using (SPSS) version 25. Standardized ECG was performed in the first hours of admission. 2 samples from each patient were obtained for serum troponin with at least 8 hours apart. All patients had wide variants of ECG changes. But tachycardia was the most frequent one identified in 54% of patients (n=50). Half of them were found to have an anterior circulation stroke. 14% of patients (n=50) have positive troponin; ECG changes are identified in all patients who represent positive troponin 100% (7 patients). Moreover, anterior circulation stroke was recognized in all patients with a positive troponin I marker. This study suggests that ECG abnormalities in patients with acute stroke are very common, especially tachycardia. The site of the lesion appears to play a major factor as a cause of the genesis of arrhythmia. Serum troponin elevation may play a role in diagnosing neurocardiogenic injury; nevertheless, ECG appears to be more sensitive and familial.

Troponin Levels and the Severity of COVID-19 Pneumonia.

IntroductionIn late 2019, a novel coronavirus was identified as the pathogen responsible for a cluster of pneumonia cases in Wuhan, a city in the Hubei Province of China. Elevated cardiac troponin is a marker of myocardial injury, which is commonly seen in hospitalized patients with COVID-19 due to unclear reasons. The frequency of elevated troponin levels in patients with COVID-19 is variable and is reported in up to 7-36% of patients. The troponin level may be associated with the severity of COVID-19, and mild cases of COVID-19 tend to have a normal troponin level. This study aims to determine the frequency of patients with COVID-19 who had elevated troponin levels on presentation to the ED and determine the factors associated with elevated troponin levels. Additionally, the study aims to identify the association of elevated troponin and the outcome of COVID-19.MethodologyA retrospective study wherein the factors associated with elevated troponin levels in COVID-19 pneumonia were evaluated. The study was conducted in King Fahd Hospital of the Imam Abdulrahman Bin Faisal University. The Hospital Information System was used to identify all visits to the ED from March 2020 to November 2020 for patients who tested positive for SARS-CoV-2. In addition, a structured data collection form was used to collect data from the electronic health records. The data collection was conducted by emergency medicine physicians who were given a detailed explanation of the purpose of the study and had training and supervision by the principal investigator.ResultsThe study involved 214 patients who presented to the ED and had positive results on the SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) test and had troponin-I levels measured. Patients with elevated troponin levels were more likely to require supplementary oxygen compared with those with normal troponin levels (88.0 vs. 58.5%; P < 0.01). In total, 36 (76.6%) patients with elevated troponin levels required admission to the ICU compared with 58 (45.0%) patients with normal troponin levels (P < 0.01). Multivariable binary logistic regression analysis was used to identify the predictors of elevated troponin levels on presentation. The model revealed that being admitted in the ICU was the single independent predictor (P = 0.02).ConclusionThe study demonstrated that the troponin level on presentation to the ED was a viable independent prognostic factor in COVID-19 pneumonia. However, further studies are needed to investigate targeted therapeutic interventions among patients with elevated troponin levels, such as cardioprotective therapies like corticosteroids, immunosuppressants, antivirals, or immunoglobulins.

STUDY OF TROPONIN-I LEVELS IN COVID-19 PATIENTS

BACKGROUND AND OBJECTIVES: Elevated Troponin-I levels either due to direct or indirect cardiac injury can present as asymptomatic to fulminant myocarditis and circulatory shock in COVID-19 patients. Our objective is to evaluate the Troponin-I levels in covid patients. AIM: To evaluate the possible myocardial involvement in covid-19 patients with the help of Troponin-I levels as an indicator of cardiac injury and its prognostic implication and significance as it is associated with increased mortality in patients with COVID-19. METHORDS: This was a both a prospective and retrospective cohort study done from 1st January 2021 to 1st July 2021. A total of 240 admitted patients were included and whose Troponin-I levels were evaluated and in a comparative analysis was performed for the demography, clinical features, biochemical markers and their outcome with their Troponin-I levels. RESULTS: Out of 250 covid-19 positive hospitalized patients, 15patients have elevated Troponin-I levels. Among these 15 patients 60% had preexisting co morbidities like hypertension, diabetes and history of cardiac disease. Patients with elevated troponin level had mean age of 61.1years, length of stay was &gt;14 days in 60% patients. In 46% patients Troponin-I levels were more than 200ng/L. These patients had a higher need for intensive care with mortality of 73%. CONCLUSION: Etiology of myocardial involvement is multifactorial. Our study also concluded that elevated troponin levels in patients with covid19 have high morality. Therefore, the measurement of cardiac biomarkers, including Troponin-I and brain natriuretic peptide (BNP), should be performed on admission.

Association between the magnitude of periprocedural myocardial injury and prognosis in patients undergoing elective percutaneous coronary intervention.

This study aimed to investigate the prognostic implications of increased post-procedural cardiac troponin levels in patients undergoing elective percutaneous coronary intervention (PCI) and to define the threshold of prognostically relevant periprocedural myocardial injury (PMI). A total of 3249 patients with normal baseline troponin levels referred for elective PCI were enrolled and followed up for a median period of 20months. The primary endpoint was major adverse cardiovascular events (MACEs) comprising all-cause death, myocardial injury (MI), and ischaemic stroke. Post-PCI high-sensitivity cardiac troponin T (hs-cTnT) >99% upper reference limit (URL) occurred in 78.3% of the patients and did not increase the risk of MACEs [adjusted hazard ratio (adHR) 1.00, 95% confidence interval (CI) 0.58-1.74, P = 0.990], nor did 'major PMI', defined as post-PCI hs-cTnT >5× URL (adHR 1.30, 95% CI 0.76-2.23, P = 0.340). Post-PCI troponin >8× URL, with an incidence of 15.2%, started to show an association with a higher risk of MACEs (adHR 1.89, 95% CI 1.06-3.37, P = 0.032), mainly driven by myocardial infarction (adHR 2.38, 95% CI 1.05-5.38, P = 0.037) and ischaemic stroke (adHR 3.35, 95% CI 1.17-9.64, P = 0.025). In patients with normal baseline troponin values undergoing elective PCI, PMI defined as hs-cTnT >8× URL after PCI was more appropriate for identifying patients with an increased risk of MACEs, which may help guide clinical practice in this population.

Electrocardiographic abnormalities and troponin levels provide insight on the prognosis of COVID-19 patients: A single center experience from Iran

Objective: Coronavirus disease 2019 (COVID-19) is an infection which can present itself by the involvement of various organs, but the most common manifestations are respiratory symptoms, fever and dyspnea with a high mortality rate. In order to study the prognosis of patients and also to determine the treatment plan, we need non-invasive methods which can be easily used in the triage of patients. In this study, we investigated the diagnostic value of electrocardiographic (ECG) changes and troponin levels in patients with this disease. Methods: This is a descriptive study. Confirmed COVID-19 patients participated in the present study. Data were collected by taking history and referring to medical records. We analyzed data by using chi square, t test and logistic regression through SPSS software version 22. Results: One hundred and five patients with COVID-19 disease were examined. Most patients were men (53.3%) and the mean age was 54.53 years. The most common underlying diseases were hypertension and diabetes mellitus. Ninety-five patients had abnormal electrocardiography including eleven with long QT; seven with arrhythmia; 78 with sinus tachycardia; 7 with hemi-block; 1 with hemi-block and first degree atrioventricular block; 4 with abnormal axis and 28 with ischemic changes. Eleven patients (10.5%) had positive troponin level, whose length of hospital stay was higher (12.73 vs. 12.07 days). Furthermore, their mean length of intensive care unit (ICU) stay was also higher. In addition, among the troponin-positive group, 100% had abnormal electrocardiography. Conclusion: The findings of the present study showed that ECG abnormalities and troponin levels could provide good information about the prognosis of patients. Moreover, it seems that ECG changes in COVID-19 patients, whether indicative of underlying heart disease or resulted from infection, can affect the prognosis of patients. Therefore, considering ECG findings and troponin levels can help select patients at a higher risk for triage.

Electrocardiographic changes and serum troponin levels in patients with acute stroke, a prospective Cohort study in Sudan

Electrocardiographic changes and elevated serum troponin are frequent findings in acute stroke. They may reflect what is known as the neuro-genic myocardial injury. However, as stroke and cardiac disease share the same risk factors. Coexistence of the two is highly susceptible. Our aim to determine the electrocardiographic changes and serum troponin level in acute stroke patients and to correlate these changes to the anatomical location and pathological type of the stroke.

IMPACT OF ADMISSION TROPONIN AND TROPONIN RISE DURING HOSPITALIZATION ON MORTALITY IN COVID-19 PNEUMONIA WITH ACUTE RESPIRATORY FAILURE

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: COVID-19 can cause multi-organ failure and death. Troponin levels may be elevated in such patients from demand ischemia due to hypoxia versus direct myocardial injury. The information regarding association between troponin levels and mortality is limited in COVID 19 patients. In our study, we specifically determined the correlation of admission troponin as well as troponin rise during hospitalization in COVID-19 patients with acute respiratory failure with mortality. METHODS: Medical records of seventy one (71) patients with COVID-19 pneumonia and acute respiratory failure were reviewed to determine demographic features, admission troponin, rise in troponin (peak troponin - admission troponin) and survival. Pearson’s correlation analysis was performed to evaluate the correlation between admission troponin, rise in troponin and mortality. Independent t-test was used to determine the impact of admission troponin on hospital mortality. P < 0.05 was deemed statistically significant. RESULTS: Seventy-three percent (73%) of studied patients were male. Average age was 47.7 ± 16.7 years. Twenty-two percent (22%) of patients expired. Mean admission troponin was: 0.18 ± 1.1 ng/mL. Mean troponin rise (peak troponin - admission troponin) during hospital stay was: 0.7 ± 3.18 ng/mL. Admission troponin in survivors was 0.03 ± 0.04 ng/mL and in non-survivors was: 0.9 ±2.6 ng/mL (p = 0.02, independent t-test). Troponin rise in survivors was 0.7 ± 3.5 ng/mL and in non-survivors was: 0.55 ± 1.6 ng/mL (p=0.8, independent t-test). Pearson’s correlation analysis showed significant correlation between admission troponin and mortality (r = -0.292, p= 0.028) but no correlation between troponin rise and mortality (r = 0.02;p= 0.83). CONCLUSIONS: A higher troponin at admission has a significant correlation with mortality in COVID19 patients with acute respiratory failure. However, there was no significant correlation between rise in troponin levels and mortality which may have been due to a small sample size in our study. CLINICAL IMPLICATIONS: Troponin levels on admission can be utilized to predict outcomes in patients with COVID-19 pneumonia and acute respiratory failure. Further studies need to be done to determine whether a rise in troponin levels can also be predictor of mortality. Future studies can also determine if increased mortality is seen at specific troponin levels in patients with COVID 19 pneumonia DISCLOSURES: No relevant relationships by Debapriya Datta, source=Web Response No relevant relationships by Manasvi Gupta, source=Web Response No relevant relationships by Gaurav Manek, source=Web Response No relevant relationships by Suong Nguyen, source=Web Response