title: Prognostic significance of cardiac troponin I levels in hospitalized patients presenting with supraventricular tachycardia.
abstract: Although cardiac troponin I (cTnI) elevation in patients presenting to the hospital with supraventricular tachycardia (SVT) is well recognized, the prevalence, predictors, and prognostic significance of cTnI elevation associated with SVT presentation are not known. We screened records of all patients presenting to 2 hospitals over a 4-year period with the diagnosis of SVT confirmed by 12-lead electrocardiogram, and who had at least 1 measured cTnI level and at least 1 year of follow-up after discharge. The primary endpoint was the occurrence of 1 of the following outcomes: death, myocardial infarction, or cardiovascular rehospitalization. Seventy-eight patients met the study criteria (54% female; mean age, 62.2 +/- 15.8 yr), and 29 patients (37.2%) had an elevated cTnI level of > or =0.06 ng/mL (range, 0.06-7.78 ng/mL). Univariate predictors of elevated cTnI included left ventricular ejection fraction (LVEF) <50%, renal dysfunction, ST-segment depression or left bundle branch block on the electrocardiogram, and moderate or severe regurgitation of any cardiac valve. Predictors of elevated cTnI after multivariate analysis included peak heart rate during SVT (per 15 bpm) (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.01-2.46; p = 0.04) and LVEF <50% (OR, 6.12; 95% CI, 1.40-26.7; p = 0.02). After multivariable adjustment, the presence of elevated cTnI with SVT was associated with increased risk of the primary endpoint of death, myocardial infarction, or cardiovascular rehospitalization (hazard ratio [HR], 3.67; 95% CI, 1.22-11.1; p = 0.02). Mild elevation of cTnI is common in patients presenting to the hospital with SVT, and is associated with increased risk of future cardiovascular events. Further study is needed to determine the mechanisms of SVT-related cTnI elevation and its association with elevated cardiovascular risk.
authors.affiliation: From Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Grant V
authors.initials: GV
authors.lastname: Chow
authors.forename: Glenn A
authors.initials: GA
authors.lastname: Hirsch
authors.forename: David D
authors.initials: DD
authors.lastname: Spragg
authors.forename: Jennifer X
authors.initials: JX
authors.lastname: Cai
authors.forename: Alan
authors.initials: A
authors.lastname: Cheng
authors.forename: Roy C
authors.initials: RC
authors.lastname: Ziegelstein
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Marine
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D004562:Electrocardiography; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D009206:Myocardium / Q000378:metabolism*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000175:diagnosis* / Q000378:metabolism* / Q000401:mortality; D019210:Troponin I / Q000378:metabolism*
chemical_list: D019210:Troponin I
references.citation: Agzew Y. Elevated serum cardiac troponin in non-acute coronary syndrome. Clin Cardiol. 2009;32:15-20.
references.citation: Alcalai R, Planer D, Culhaoglu A, Osman A, Pollak A, Lotan C. Acute coronary syndrome vs. nonspecific troponin elevation: clinical predictors and survival analysis. Arch Intern Med. 2007;167:276-281.
references.citation: Al-Mallah M, Zuberi O, Arida M, Kim HE. Positive troponin in diabetic ketoacidosis without evident acute coronary syndrome predicts adverse cardiac events. Clin Cardiol. 2008;31:67-71.
references.citation: Apple FS, Wu AH, Jaffe AS. European Society of Cardiology and American College of Cardiology guidelines for redefinition of myocardial infarction: how to use existing assays clinically and for clinical trials. Am Heart J. 2002;144:981-986.
references.citation: Baillard C, Boussarsar M, Fosse JP, Girou E, Le Toumelin P, Cracco C, Jaber S, Cohen Y, Brochard L. Cardiac troponin I in patients with severe exacerbation of chronic obstructive pulmonary disease. Intensive Care Med. 2003;29:584-589.
references.citation: Bakshi TK, Choo MK, Edwards CC, Scott AG, Hart HH, Armstrong GP. Causes of elevated troponin I with a normal coronary angiogram. Intern Med J. 2002;32:520-525.
references.citation: Becattini C, Vedovati MC, Agnelli G. Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation. 2007;116:427-433.
references.citation: Blendea D, Blendea M, Banker J, McPherson CA. Troponin T elevation after implanted defibrillator discharge predicts survival. Heart. 2009;95:1153-1158.
references.citation: Bonnefoy E, Godon P, Kirkorian G, Fatemi M, Chevalier P, Touboul P. Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis. Eur Heart J. 2000;21:832-836.
references.citation: Brekke PH, Omland T, Holmedal SH, Smith P, Soyseth V. Troponin T elevation and long-term mortality after chronic obstructive pulmonary disease exacerbation. Eur Respir J. 2008;31:563-570.
references.citation: Brekke PH, Omland T, Holmedal SH, Smith P, Soyseth V. Determinants of cardiac troponin T elevation in COPD exacerbation-a cross-sectional study. BMC Pulm Med. 2009;9:35.
references.citation: Elikowski W, Baszko A, Wroblewski D, Slomczynski M, Malek M. Supraventricular tachycardia as a cause of elevated troponin I in a patient with normal coronary arteries. Pol Merkur Lekarski. 2005;18:696-699.
references.citation: Favory R, Neviere R. Bench-to-bedside review: significance and interpretation of elevated troponin in septic patients. Crit Care. 2006;10:224-229.
references.citation: Fonarow GC, Peacock WF, Horwich TB, Phillips CO, Givertz MM, Lopatin M, Wynne J; ADHERE Scientific Advisory Committee and Investigators. Usefulness of B-type natriuretic peptide and cardiac troponin levels to predict in-hospital mortality from ADHERE. Am J Cardiol. 2008;101:231-237.
references.citation: Goette A, Bukowska A, Dobrev D, Pfeiffenberger J, Morawietz H, Strugala D, Wiswedel I, Rohl FW, Wolke C, Bergmann S, Bramlage P, Ravens U, Lendeckel U. Acute atrial tachyarrhythmia induces angiotensin II type 1 receptor-mediated oxidative stress and microvascular flow abnormalities in the ventricles. Eur Heart J. 2009;30:1411-1420.
references.citation: Henrikson CA, Howell EE, Bush DE, Miles JS, Meininger GR, Friedlander T, Bushnell AC, Chandra-Strobos N. Prognostic usefulness of marginal troponin T elevation. Am J Cardiol. 2004;93:275-279.
references.citation: Horwich TB, Patel J, MacLellan WR, Fonarow GC. Cardiac troponin I is associated with impaired hemodynamics, progressive left ventricular dysfunction, and increased mortality rates in advanced heart failure. Circulation. 2003;108:833-838.
references.citation: Hravnak M, Frangiskakis JM, Crago EA, Chang Y, Tanabe M, Gorcsan J III, Horowitz MB. Elevated cardiac troponin I and relationship to persistence of electrocardiographic and echocardiographic abnormalities after aneurysmal subarachnoid hemorrhage. Stroke. 2009;40:3478-3484.
references.citation: Jensen JK, Kristensen SR, Bak S, Atar D, Hoilund-Carlsen PF, Mickley H. Frequency and significance of troponin T elevation in acute ischemic stroke. Am J Cardiol. 2007;99:108-112.
references.citation: Kalla C, Raveh D, Algur N, Rudensky B, Yinnon AM, Balkin J. Incidence and significance of a positive troponin test in bacteremic patients without acute coronary syndrome. Am J Med. 2008;121:909-915.
references.citation: Khan NA, Hemmelgarn BR, Tonelli M, Thompson CR, Levin A. Prognostic value of troponin T and I among asymptomatic patients with end-stage renal disease: a meta-analysis. Circulation. 2005;112:3088-3096.
references.citation: Korff S, Katus HA, Giannitis E. Differential diagnosis of elevated troponins. Heart. 2006;92:987-993.
references.citation: Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461-470.
references.citation: Luna C, Adie MA, Tessler I, Acherman R. Troponin I elevation after supraventricular tachycardia in a child with hypertrophic cardiomyopathy. Pediatr Cardiol. 2001;22:147-149.
references.citation: Mahajan N, Mehta Y, Rose M, Shani J, Lichstein E. Elevated troponin level is not synonymous with myocardial infarction. Int J Cardiol. 2006;111:442-449.
references.citation: Middleton N, George K, Whyte G, Gaze D, Collinson P, Shave R. Cardiac troponin T release is stimulated by endurance exercise in healthy humans. J Am Coll Cardiol. 2008;52:1813-1814.
references.citation: Musuraca G, Imperadore F, Terraneo C, Vaccarini C, Prati D, Centonze M, Vergara G. Pheochromocytoma mimicking a non-ST elevation acute myocardial infarction. Cardiol J. 2009;16:355-357.
references.citation: Naidech AM, Kreiter KT, Janjua N, Ostapkovich ND, Parra A, Commichau C, Fitzsimmons BF, Connolly ES, Mayer SA. Cardiac troponin elevation, cardiovascular morbidity, and outcome after subarachnoid hemorrhage. Circulation. 2005;112:2851-2856.
references.citation: Redfearn DP, Ratib K, Marshall HJ, Griffith MJ. Supraventricular tachycardia promotes release of troponin I in patients with normal coronary arteries. Int J Cardiol. 2005;102:521-522.
references.citation: Robinson MR, Brown RA, Srivatsa U, Amsterdam EA. Over the speed limit. Am J Med. 2007;120:851-853.
references.citation: Roongsritong C, Warraich I, Bradley C. Common causes of troponin elevations in the absence of acute myocardial infarction: incidence and clinical significance. Chest. 2004;125:1877-1884.
references.citation: Salim A, Hadjizacharia P, Brown C, Inaba K, Teixeira PG, Chan L, Rhee P, Demetriades D. Significance of troponin elevation after severe traumatic brain injury. J Trauma. 2008;64:46-52.
references.citation: Serrano-Ostariz E, Legaz-Arrese A, Terreros-Blanco JL, Lopez-Ramon M, Cremades-Arroyos D, Alvarez-Izquierdo S, Boscos-Terraz P. Cardiac biomarkers and exercise duration and intensity during a cycle-touring event. Clin J Sport Med. 2009;19:293-299.
references.citation: Smellie WS, Shaw N, Bowley R, Stewart MF, Kelly AM, Twomey PJ, Chadwick PR, Houghton JB, Ng JP, McCulloch AJ. Best practice in primary care pathology: review 10. J Clin Pathol. 2007;60:1195-1204.
references.citation: Uettwiller-Geiger D, Wu AH, Apple FS, Jevans AW, Venge P, Olson MD, Darte C, Woodrum DL, Roberts S, Chan S. Multicenter evaluation of an automated assay for troponin I. Clin Chem. 2002;48:869-876.
references.citation: Zellweger MJ, Schaer BA, Cron TA, Pfisterer ME, Osswald S. Elevated troponin levels in absence of coronary artery disease after supraventricular tachycardia. Swiss Med Wkly. 2003;133:439-441.