title: Acute exacerbation of COPD is associated with fourfold elevation of cardiac troponin T.
abstract: OBJECTIVE
  To investigate if acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with myocardial injury, expressed as elevated high sensitive cardiac troponin T (hs-cTnT), and to identify determinants of hs-cTnT in chronic obstructive pulmonary disease (COPD) patients.
  
  
  METHODS
  In a cross-sectional study, hs-cTnT in patients hospitalised for AECOPD was compared with hs-cTnT in COPD patients in their stable state.
  
  
  METHODS
  The study was conducted at a teaching and a pulmonary rehabilitation clinic.
  
  
  METHODS
  Consecutive admissions to participating units for the years 2010-2011 meeting objective, standardised criteria for AECOPD and stable COPD.
  
  
  RESULTS
  Ratio of hs-cTnT in hospitalised AECOPD patients compared with stable COPD patients. Change in the ratio of hs-cTnT per unit increase of relevant covariables.
  
  
  RESULTS
  The geometric mean of hs-cTnT in the index group was 25.8 ng/l (95% CI 21.1 to 31.7) compared with 4.55 ng/l (95% CI 3.72 to 5.67) in the reference group. After inclusion of relevant covariables, multiple linear regression analyses showed that the ratio between hs-cTnT in AECOPD patients and the references was 4.26 (95% CI 3.02 to 6.00) and that hs-cTnT increased 1.41-fold (95% CI 1.20 to 1.68), for each quartile increase in leucocyte count in stable COPD but not in AECOPD. Higher hs-cTnT levels were also associated with the presence of pathological q-waves (p=0.012) and electrocardiographic left ventricular hypertrophy (p=0.039), long-term oxygen treatment (p=0.002) and decreasing forced expiratory volume in 1 s (p=0.014). A significant univariable association between cTnT and arterial hypoxaemia was also found but this association was attenuated almost to a zero effect after inclusion of relevant covariates.
  
  
  CONCLUSIONS
  AECOPD is associated with higher hs-cTnT as compared with stable COPD. In stable COPD, hs-cTnT appears to be positively associated with indices of COPD severity, whereas we were unable to identify significant determinants of hs-cTnT in AECOPD.
authors.affiliation: Department of Medicine, Akershus University Hospital, University of Oslo, Sykehusvn 25, Lørenskog 1478, Norway. vidar.soyseth@medisin.uio.no
authors.forename: Vidar
authors.initials: V
authors.lastname: Søyseth
authors.forename: Rahul
authors.initials: R
authors.lastname: Bhatnagar
authors.forename: Nils Henrik
authors.initials: NH
authors.lastname: Holmedahl
authors.forename: Anke
authors.initials: A
authors.lastname: Neukamm
authors.forename: Arne Didrik
authors.initials: AD
authors.lastname: Høiseth
authors.forename: Tor-Arne
authors.initials: TA
authors.lastname: Hagve
authors.forename: Gunnar
authors.initials: G
authors.lastname: Einvik
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Omland
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D009664:Norway / Q000453:epidemiology; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T