Citation

AlQassas I, Hassan W, Sunni N, Lhmdi M, Nazzal A, et al. (2019) The Prognostic Significance of Elevated Cardiac Troponin in Non-Cardiac Medical Disorders. Pilot Study. Int J Clin Cardiol 6:136. doi.org/10.23937/2378-2951/1410136

Copyright

© 2019 AlQassas I, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

RESEARCH ARTICLE | OPEN ACCESSDOI: 10.23937/2378-2951/1410136

The Prognostic Significance of Elevated Cardiac Troponin in Non-Cardiac Medical Disorders. Pilot Study

Ibrahim AlQassas, MD, Walid Hassan, MD, MACP*, Nadia Sunni, MD, Mohammed Lhmdi, MD, Alaa Nazzal, MD, Mohammed J Mohamed, Farhan Dar, MD, Sahar Sharafeldin, MD, Amr Aljareh, MD, Hasan Balubaid, MD, Basema Alshengiti, MD, Ehab Hasan, MD, Heba Waez, MD, Sarah Bahnshal, MD, Momen Nassani, MD, Mohammed Al-Kulak, MD, Maha AlKudsi, MD, Hala Zein Elabidinm, MD and Ibrahim Mansour, MD

Department of Cardiovascular Disease, International Medical Center, Jeddah, Saudi Arabia

Abstract

Background

Several studies have linked elevated cardiac troponin to increased overall risk in patients with acute coronary syndrome but the prognostic significance of elevated troponin in non-cardiac conditions remains scanty.

Objectives

The primary aim of this study was to investigate the prognostic significance of elevated high sensitivity troponin T (TnT-HS) in non-cardiac disorders outside the remit of an acute coronary syndrome (ACS). Secondarily we aimed to investigate the impact of cardiovascular comorbidities and other clinical presentations in the release of cardiac biomarkers in non-cardiac disorders.

Methodology

This was a retrospective electronic patient record pilot review where all patients with elevated TnT-HS without acute coronary syndrome, recent angioplasty or heart failure within a three month period were enrolled into the study and subsequently followed for prospectively for a six month period. From January 1, 2016 to June 30, 2016, a total of 2535 patients were screened of which 306 patients had elevated TnT-HS and 162 patients met the study inclusion criteria.

Data were encrypted and collected in Google database format, exported into excel spreadsheet, analyzed and computed using SPSS (version 24) to identify clinical associations with increased values of TnT-HS.

Results

Most troponin TnT-HS samples (77.1%) were obtained from emergency room (ER) attendance and 63.4% of patients were male. The mean age was 72 years and no correlation was found between age and troponin levels (the statistical number r value needs to be put here). Although expectedly patients with diagnosis of acute coronary syndrome displayed TnT-HS values significantly higher than those of other groups, positivity to TnT-HS (> 40 ng/l) was also observed in patients with other clinical conditions. In multivariate analysis, baseline chronic kidney disease (CKD), acute infectious diseases mainly urinary tract infection and cerebrovascular events (CVA) were independently associated with TnT-HS positivity at admission. Observations from the cohort as a whole; TnT-HS positivity exhibited high sensitivity and negative predictive value, counterbalanced by low specificity and limited positive predictive value. Major adverse cardiac and cerebral events (MACCE) were significant within 6 months including; Death (13.7%), MI (3.9%), Stroke (ischemic 4.6%, hemorrhagic 2.3%, TIA 0.8%) - p value < 0.02.

Conclusions

TnT-HS positivity should be cautiously interpreted in patients exhibiting non-acute cardiac conditions associated CKD, infections, and CVAs. This troponin elevation in non_cardiac conditions still carries a significant adverse prognosis.

After adjusting for age and renal insufficiency, we can suggest a new cut off level of TnT-HS > 45 ng/l to have increased risk of MACCE within 180 days in non-cardiac conditions.