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Elevated troponin T concentrations in critically ill patients

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To determine the incidence of troponin T elevations among a selected group of critically ill patients, to correlate these findings to electrocardiographs, and to compare troponin T-positive and T-negative patients in relation to clinical parameters.


Prospective study.


Mixed surgical and medical intensive care unit.


Thirty-four consecutive critically ill patients who were mechanically ventilated or underwent thoracic or vascular surgery.


Blood samples were collected at admission, the next morning, and 24 h after the second blood sampling. These samples were used for troponin T measurement and electrocardiographs were made when troponin T levels were elevated.

Main results

Eleven of 34 patients (32%) had elevated troponin T levels, which were already present upon admission in eight out of 11 patients (73%). Most patients underwent surgery prior to ICU admission (21 of 34 patients). Significantly (P=0.0055) more troponin T-positive patients underwent acute surgery, and significantly more (P=0.045) troponin T-positive patients suffered from hypotension. Only four of the troponin T-positive patients were diagnosed as suffering from an acute myocardial infarction based on electrocardiographs. All troponin T-positive patients had coronary artery disease: nine had a history of CAD and two had actual CAD. No difference in mortality rates was observed between troponin T-positive and T-negative patients.


An unexpectedly high percentage of included patients had troponin T elevations, which could be corroborated by electrocardiographs in only four cases suggesting that a high percentage of critically ill patients with a history of CAD suffer from clinically unrecognised (minor) myocardial damage.

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  1. Hamm CW, Ravkilde J, Gerhardt W, Jorgenson P, Peheim E, Ljungdahl L, Goldmann B, Katus H (1992) The prognostic value of serum troponin in unstable angina. N Engl J Med 327:146–150

    Article  CAS  Google Scholar 

  2. Ohmann EM, Armstrong PW, Christenson RH, Granger CB, Katus HA, Hamm CW, O’Hanesian M, Wagner GS, Kleiman NS, Harrell FE, Califf RM, Topol EJ, Lee KL (1996) Risk stratification with admission cardiac troponin T levels in acute myocardial ischemia. N Engl J Med 335:1333–1334

    Article  Google Scholar 

  3. Christensen RH, Duh SH, Newby LK, Ohman EM, Califf RM, Granger CB, Peck S, Pieper KS, Armstrong PW, Katus HA, Topol EJ (1998) Cardiac troponin T and cardiac troponin I: relative values in short-term risk stratification of patients with acute coronary syndromes. Clin Chem 44:494–501

    Google Scholar 

  4. Jaffe AS, Ravkilde J, Roberts R, Naslund U, Apple FS, Galvani M, Katus H (2000) It’s time for a change to a troponin standard. Circulation 102:1216–1220

    Article  CAS  Google Scholar 

  5. Adams JE, Bodor GS, Davilla-Roman VG, Delmez JA, Apple FS, Ladenson JH, Jaffe AS (1993) Cardiac troponin I: a marker with high specificity for cardiac injury. Circulation 88:101–106

    Article  Google Scholar 

  6. Katus HA, Remppis A, Neumann FJ, Scheffold T, Diederich VW, Vinar G, Noe A, Matern G, Kuebler W (1991) Diagnostic efficiency of troponin T measurements in acute myocardial infarction. Circulation 83:902–912

    Article  CAS  Google Scholar 

  7. O’Rourke RA, Hochman JS, Cohen MC, Lucore CL, Popma JJ, Cannon C (2001) New approaches to diagnosis and management of unstable angina and non-ST-segment elevation myocardial infarction. Arch Intern Med 161:674–682

    Article  Google Scholar 

  8. Lauer B, Niederau C, Kühl U, Schannwell M, Pauschinger M, Strauer B, Schultheiss H (1997) Cardiac troponin T in patients with clinically suspected myocarditis. J Am Coll Cardiol 30:1354–1359

    Article  CAS  Google Scholar 

  9. Smith SC, Ladenson JH, Mason JW, Jaffe AS (1997) Elevations of cardiac troponin I associated with myocarditis: experimental and clinical correlates. Circulation 95:163–168

    Article  CAS  Google Scholar 

  10. Sato Y, Yamada T, Taniguchi R, Nagai K, Makiyama T, Okada H, Kataoka K, Ito H, Matsumori A, Sasayama S, Takatsu Y (2001) Persistently increased serum concentrations of cardiac troponin T in patients with idiopathic dilated cardiomyopathy are predictive of adverse outcome. Circulation 103:369–374

    Article  CAS  Google Scholar 

  11. Herrmann J, Haude M, Lerman A, Schulz R, Volbracht L, Ge J, Schmermund A, Wieneke H, von Birgelen C, Eggebrecht H, Baumgart D, Heusch G, Erbel R (2001) Abnormal coronary flow velocity reserve after coronary intervention is associated with cardiac marker elevation. Circulation 103:2339–2345

    Article  CAS  Google Scholar 

  12. Swaanenburg JCJM, Loef BG, Volmer M, Boonstra PW, Grandjean JG, Mariani MA, Epema AH (2001) Creatine kinase MB, troponin I, and troponin T release patterns after coronary artery bypass grafting with or without cardiopulmonary bypass and after aortic and mitral valve surgery. Clin Chem 47:584–587

    Article  CAS  Google Scholar 

  13. Braun SL, Barankay A, Mazzitelli D (2000) Plasma troponin T and troponin I after minimally invasive coronary bypass surgery. Clin Chem 46:279–281

    Article  CAS  Google Scholar 

  14. Fernandez CJ, Akina N, Knobel E (1999) Cardiac troponin: a new serum marker of myocardial injury in sepsis. Intensive Care Med 25:1165–1168

    Article  Google Scholar 

  15. Turner A, Tsamitros M, Bellomo R (1999) Myocardial cell injury in septic shock. Crit Care Med 27:1775–1780

    Article  CAS  Google Scholar 

  16. Ver Elst KM, Spapen HD, Nguyen DN, Garbar C, Huyghens LP, Gorus FK (2000) Cardiac troponins I and T are biological markers of left ventricular dysfunction in septic shock. Clin Chem 46:650–657

    Article  Google Scholar 

  17. Ammann P, Fehr T, Minder EI, Günther C, Bertel O (2001) Elevation of troponin I in sepsis and septic shock. Intensive Care Med 27:965–969

    Article  CAS  Google Scholar 

  18. Spies C, Haude V, Fitzner R, Schröder K, Overbeck M, Runkel N, Schaffartzik W (1998) Serum cardiac troponin T as a prognostic marker in early sepsis. Chest 113:1055–1063

    Article  CAS  Google Scholar 

  19. Arlati S, Brenna S, Prencipe L, Marocchi A, Casella GP, Lanzani M, Gandini C (2000) Myocardial necrosis in ICU patients with acute non-cardiac disease: a prospective study. Intensive Care Med 26:31–37

    Article  CAS  Google Scholar 

  20. Alpert JS, Thygesen K, et al (2000) Myocardial infarction redefined—a consensus document of the joint European Society of Cardiology/American College of Cardiology Committee for the redifinition of myocardial infarction. J Am Coll Cardiol 36:959–969

    Article  CAS  Google Scholar 

  21. Guest TM, Ramanathan AV, Tuteur PG, Schechtman KB, Ladenson JH, Jaffe AS (1995) Myocardial injury in critically ill patients. A frequently unrecognized complication. JAMA 273:1945–1949

    Article  CAS  Google Scholar 

  22. Kollef MH, Ladenson JH, Eisenberg PR (1997) Clinically recognized cardiac dysfunction: an independent determinant of mortality among critically ill patients. Chest 111:1340–1347

    Article  CAS  Google Scholar 

  23. Frankel WL, Herold DA, Ziegler TW, Fitzgerald RL (1996) Cardiac troponin T is elevated in asymptomatic patients with chronic renal failure. Am J Clin Pathol 106:118–123

    Article  CAS  Google Scholar 

  24. Ooi DS, Zimmerman D, Graham J, Wells GA (2001) Cardiac troponin T predicts long-term outcomes in hemodialysis patients. Clin Chem 47:412–417

    Article  CAS  Google Scholar 

  25. Wu AHB (2001) Increased troponin in patients with sepsis and septic shock: myocardial necrosis or reversible myocardial depression? Intensive Care Med 27:959–961

    Article  CAS  Google Scholar 

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We would like to thank Dr. E. Lamferts for critical evaluation of the electrocardiographs.

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Correspondence to Jacqueline M. T. Klein Gunnewiek.

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Klein Gunnewiek, J.M.T., van de Leur, J.J.J.P.M. Elevated troponin T concentrations in critically ill patients. Intensive Care Med 29, 2317–2322 (2003).

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