Role of serum troponin-I in identifying left ventricular ejection fraction of <or= 40% in patients with acute anterior ST Elevation Myocardial Infarction.
OBJECTIVE
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).


METHODS
Case series.


METHODS
At the Tabba Heart Institute, Karachi, from May to November 2008.


METHODS
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).


RESULTS
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%.


CONCLUSIONS
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.
Shaikh
Ayaz Hussain
AH
Department of Cardiology, Tabba Heart Institute, Karachi. ahsdr1977@yahoo.com
Hanif
Bashir
B
Lakhani
Muhammad Shakir
MS
Malik
Faiza
F
Qazi
Hammad Ali
HA
Mujtaba
Iqbal
I
D015906:Angioplasty, Balloon, Coronary; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013300:Streptokinase / Q000627:therapeutic use; D013318:Stroke Volume; D019210:Troponin I / Q000097:blood / Q000502:physiology*; D016277:Ventricular Function, Left
D005343:Fibrinolytic Agents; D019210:Troponin I; D013300:Streptokinase