title: Troponin T elevation in acute aortic syndromes: Frequency and impact on diagnostic delay and misdiagnosis.
abstract: OBJECTIVE
  Despite troponin assay being a part of the diagnostic work up in many conditions with acute chest pain, little is known about its frequency and clinical implications in acute aortic syndromes (AASs). In our study we assessed frequency, impact on diagnostic delay, inappropriate treatments, and prognosis of troponin elevation in AAS.
  
  
  RESULTS
  Data were collected from a prospective metropolitan AAS registry (398 patients diagnosed between 2000 and 2013). Cardiac troponin test, using either standard or high sensitivity assay, was performed according to standard protocol used in chest pain units. Troponin T values were available in 248 patients (60%) of the registry population; the overall frequency of troponin positivity was 28% (ranging from 16% to 54%, using standard or high sensitivity assay respectively, p = 0.001). Troponin positivity was frequently associated with acute coronary syndromes (ACS)-like electrocardiogram findings, and with a twofold increased risk of long in-hospital diagnostic time (odds ratio (OR) 1.92, 95% confidence interval (CI) 1.05-3.52, p = 0.03). The combination of positive troponin and ACS-like electrocardiogram abnormalities resulted in a significantly increased risk of in-hospital delay/coronary angiography/antithrombotic therapy due to a misdiagnosis of ACS (OR 2.48, 95% CI 1.12-5.54, p = 0.02). However, troponin positivity was not associated with in-hospital mortality (OR 1.63, 95% CI 0.86-3.10, p = 0.131).
  
  
  CONCLUSIONS
  Troponin positivity was a frequent finding in AAS patients, particularly when a high sensitivity assay was employed. Abnormal troponin values were strongly associated with ACS-like electrocardiogram findings and with in-hospital diagnostic delay but apparently they did not influence in-hospital mortality.
authors.affiliation: 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Vagnarelli
authors.affiliation: 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Corsini
authors.affiliation: 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Bugani
authors.affiliation: 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Lorenzini
authors.affiliation: 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Longhi
authors.affiliation: 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Bacchi Reggiani
authors.affiliation: 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Biagini
authors.affiliation: 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Graziosi
authors.affiliation: 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Cinti
authors.affiliation: 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Norscini
authors.affiliation: 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
authors.forename: Nevio
authors.initials: N
authors.lastname: Taglieri
authors.affiliation: 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Semprini
authors.affiliation: 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
authors.forename: Samuele
authors.initials: S
authors.lastname: Nanni
authors.affiliation: 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Pasquale
authors.affiliation: 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Rocchi
authors.affiliation: 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Melandri
authors.affiliation: 2 Department of Cardiology, University of Perugia School of Medicine, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ambrosio
authors.affiliation: 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000175:diagnosis* / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D020107:Troponin T / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: Aortic dissection; delay; outcome; troponin T