Significance of serum troponin I elevation in patients with acute aortic dissection of the ascending aorta.
OBJECTIVE
This study evaluated the prevalence of increased cardiac troponin I (cTnI) in patients with acute aortic dissection of the ascending aorta (type A).


RESULTS
In 119 consecutive patients with type A acute aortic dissection, serum cardiac troponin I was measured along with clinical, haemodynamic, electrocardiographic and echocardiographic variables obtained on admission. Cardiac troponin I was positive in 28 patients (23.5%; mean +/- SD: 6.1 +/- 14.7 ng/ml) and above the myocardial infarction threshold (1.5 ng/ml) in 12 (10%). Catecholamine infusion (17.9% vs. 4.4%; p = 0.03) and higher value of creatinine (35.7% vs. 15.4%; p = 0.03) were more frequent in patients with elevated troponin. Total mortality was 29.7% (n = 35) and surgical mortality was 16.8% (n = 17). An increased troponin was discriminatory with respect to mortality (OR: 4.1 (1.6-9.9); p = 0.002) in univariate analysis. However, this association was lost when other markers of death (age, stroke, ST-segment elevation, tamponade, catecholamine infusion, renal failure) were added in a multivariate model (OR: 2.2 (0.7-7.4); p = 0.19) indicating that the myocardial loss associated with troponin increase is not in itself a factor of mortality.


CONCLUSIONS
Cardiac troponin I elevation is frequent in patients with type A aortic dissection. It might reflect a higher haemodynamic stress but does not necessarily reflect a negative prognosis.
Bonnefoy
Eric
E
Service de Cardiologie et Soins Intensifs, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France. eric.bonnefoy@chu-lyon.fr
Godon
Patrick
P
Kirkorian
Gilbert
G
Chabaud
Sylvie
S
Touboul
Paul
P
D000368:Aged; D000784:Aortic Dissection / Q000097:blood*; D001014:Aortic Aneurysm / Q000097:blood*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019210:Troponin I / Q000097:blood*
D019210:Troponin I