Elevated troponin T concentrations in critically ill patients.
OBJECTIVE
To determine the incidence of troponin T elevations among a selected group of critically ill patients, to correlate these findings to electrocardiographs, and to compare troponin T-positive and T-negative patients in relation to clinical parameters.


METHODS
Prospective study.


METHODS
Mixed surgical and medical intensive care unit.


METHODS
Thirty-four consecutive critically ill patients who were mechanically ventilated or underwent thoracic or vascular surgery.


METHODS
Blood samples were collected at admission, the next morning, and 24 h after the second blood sampling. These samples were used for troponin T measurement and electrocardiographs were made when troponin T levels were elevated.


RESULTS
Eleven of 34 patients (32%) had elevated troponin T levels, which were already present upon admission in eight out of 11 patients (73%). Most patients underwent surgery prior to ICU admission (21 of 34 patients). Significantly ( P=0.0055) more troponin T-positive patients underwent acute surgery, and significantly more ( P=0.045) troponin T-positive patients suffered from hypotension. Only four of the troponin T-positive patients were diagnosed as suffering from an acute myocardial infarction based on electrocardiographs. All troponin T-positive patients had coronary artery disease: nine had a history of CAD and two had actual CAD. No difference in mortality rates was observed between troponin T-positive and T-negative patients.


CONCLUSIONS
An unexpectedly high percentage of included patients had troponin T elevations, which could be corroborated by electrocardiographs in only four cases suggesting that a high percentage of critically ill patients with a history of CAD suffer from clinically unrecognised (minor) myocardial damage.
Klein Gunnewiek
Jacqueline M T
JMT
Department of Clinical Chemistry, Canisius-Wilhelmina Hospital, P.O. Box 9015, 6500 GS, Nijmegen, The Netherlands. j.kleingunnewiek@akc.umcn.nl.
van de Leur
Joris J J P M
JJJPM
Department of Internal Medicine and Intensive Care Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
D018806:APACHE; D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000097:blood*; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood*; D012121:Respiration, Artificial; D020107:Troponin T / Q000097:blood*
D020107:Troponin T