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Evaluation of troponin I serum levels in patients with arrhythmias with and without coronary artery disease

Evaluation von Troponin-I-Serumspiegeln bei Patienten mit Arrhythmien mit und ohne Vorliegen einer koronaren Herzkrankheit

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Abstract

Background

Elevated levels of cardiac enzymes in the blood are an indicator of ongoing cardiac ischemia. Persistent tachycardia may lead to myocardial ischemia due to oxygen supply–demand mismatch.

Objectives

We sought to evaluate the probability of underlying coronary artery disease (CAD) in patients with symptomatic supraventricular (SVT) or ventricular tachyarrhythmias (VT) based on cardiac enzyme level fluctuation.

Materials and methods

Troponin I (TNI) levels were measured twice and coronary angiography was also performed in patients without a history of cardiovascular disease and symptomatic SVT or VT.

Results

Of the 114 (group A: CAD (n = 40), group B: no CAD (n = 74)) patients eligible for the study, 34 patients in group A and 64 patients in group B had SVT, while 6 patients in group A and 10 patients in group B had VT. All patients with underlying CAD developed a significantly elevated TNI level compared to baseline, irrespective of arrhythmia type (2.02 ± 7.98 ng/ml vs. 5.64 ± 13.38, p = 0.031). In patients without CAD, TNI level was not significantly elevated compared to the baseline level, irrespective of arrhythmia type (0.34 ± 1.38 ng/ml vs. 0.48 ± 1.48 ng/ml, p = 0.158). Most patients with normal TNI levels (46 of 47 patients; 98 %) had SVT. CAD was present in 13 of 47 patients (27 %) with tachycardia, despite normal TNI levels.

Conclusions

Elevated TNI levels are not helpful to discriminate between SVT and VT. An increase in TNI level in repeated blood sampling can help identify patients with higher probability of underlying CAD. Patients with VT demonstrated higher increases in TNI levels, compared to patients with SVT.

Zusammenfassung

Hintergrund

Ein Anstieg kardialer Enzyme ist ein Indikator einer kardialen Ischämie. Anhaltende Tachykardien können aufgrund eines Missverhältnisses zwischen Sauerstoffbedarf und -versorgung zu einer koronaren Ischämie führen.

Ziel der Arbeit

Die Studie untersucht die Wahrscheinlichkeit des Vorliegens einer koronaren Herzkrankheit (KHK) bei Patienten mit symptomatischen supraventrikulären (SVT) oder ventrikulären Tachyarrhythmien (VT) anhand der Fluktuation kardialer Enzyme.

Material und Methoden

Bei Patienten mit supraventrikulären oder ventrikulären Arrhythmien ohne eine kardiovaskuläre Anamnese wurde 2‑malig Troponin I (TNI) gemessen und es erfolgte eine Koronarangiographie.

Ergebnisse

Insgesamt 114 Patienten (Gruppe A: KHK [n = 40], Gruppe B: keine KHK [n = 74]) wurden eingeschlossen. Supraventrikuläre Tachykardien hatten 34 Patienten der Gruppe A und 64 Patienten der Gruppe B. Ventrikuläre Tachykardien fanden sich bei 6 Patienten der Gruppe A und bei 10 Patienten der Gruppe B. Alle Patienten mit einer KHK hatten unabhängig von der Art der Arrhythmie einen signifikanten TNI-Anstieg im Verlauf (2,02 ± 7,98 ng/ml vs. 5,64 ± 13,38, p = 0,031). Patienten ohne eine KHK hatten unabhängig von der Art der Arrhythmie im Verlauf keinen signifikanten TNI-Anstieg (0,34 ± 1,38 ng/ml vs. 0,48 ± 1,48 ng/ml, p = 0,158). Patienten mit normwertigem TNI hatten zu 98 % SVT (46/47 Patienten). Bei 27 % der Patienten mit Tachykardien (13/47 Patienten) lag trotz normwertigem TNI eine KHK vor.

Schlussfolgerung

Erhöhte TNI-Werte lassen keine Unterscheidung zwischen einer SVT und einer VT zu. Ein TNI-Anstieg in der Kontrolle identifiziert Patienten mit einer höheren Wahrscheinlichkeit für das Vorliegen einer KHK. Patienten mit VT zeigen einen höheren Anstieg von TNI als Patienten mit einer SVT.

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Author information

Authors and Affiliations

  1. Faculty of Medicine, Semmelweis University Campus Hamburg, Lohmühlenstraße 5/Haus P, 20099, Hamburg, Germany

    Dirk Bandorski FACC, FESC, MHBA

  2. Neurological Clinic Bad Salzhausen, Am Hasensprung 6, 63667, Nidda, Germany

    Dirk Bandorski FACC, FESC, MHBA

  3. St. Agnes-Hospital Bocholt Rhede, Medical Clinic, Cardiology/Electrophysiology, Klinikum Westmünsterland, Barloer Weg 125, 46397, Bocholt, Germany

    Reinhard Höltgen &  Marcus Wieczorek

  4. Medizinische Klinik und Poliklinik II, Universitätsklinikum Giessen, Klinikstraße 33, 35392, Giessen, Germany

    Hossein Ardeschir Ghofrani

  5. Department of Cardiology and Rhythmology, Ev. Krankenhaus Hagen, Brusebrinkstr. 20, 58135, Hagen, Germany

    Harilaos Bogossian &  Konstantinos Iliodromitis

  6. School of Medicine, Witten/Herdecke University, 58455, Witten, Germany

    Harilaos Bogossian &  Konstantinos Iliodromitis

Authors
  1. Dirk Bandorski FACC, FESC, MHBA
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  2. Reinhard Höltgen
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  5. Harilaos Bogossian
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  6. Konstantinos Iliodromitis
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Corresponding author

Correspondence to Dirk Bandorski FACC, FESC, MHBA.

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Conflict of interest

D. Bandorski, R. Höltgen, M. Wieczorek, H.A. Ghofrani, H. Bogossian and K. Iliodromitis declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Michael Buerke, Siegen

The authors Bogossian Harilaos and Iliodromitis Konstantinos contributed equally to the manuscript.

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Bandorski, D., Höltgen, R., Wieczorek, M. et al. Evaluation of troponin I serum levels in patients with arrhythmias with and without coronary artery disease. Med Klin Intensivmed Notfmed 119, 39–45 (2024). https://doi.org/10.1007/s00063-023-01011-0

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  • DOI: https://doi.org/10.1007/s00063-023-01011-0

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