Elevated serum cardiac troponin in non-acute coronary syndrome Review article
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Published:
Sep 30, 2014
Keywords:
elevated troponin level, troponin I, troponin T, acute coronary syndrome
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Abstract
Cardiac troponins (CTn) are the most sensitive and specific markers of myocardial injury and cardiovascular risk stratification. Elevation of cTn in non-ACS is a marker of increased all-cause and cardiac morbidity and mortality. The cause of these elevations due to serious may involve serious medical conditions that require rigorous diagnostic evaluation and aggressive therapy. At present, there are no guidelines to treat patients with elevated troponin levels and no history of coronary disease. The proceeding strategy with elevated troponin and non-ACS involves diagnosis and treating the underlying causes.
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Tymiński , S. (2014). Elevated serum cardiac troponin in non-acute coronary syndrome. Cardiology in Practice, 8(3), 34-41. Retrieved from https://journalsmededu.pl/index.php/kwp/article/view/1529
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References
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8. Logeart D., Beyne P., Cusson C. et al.: Evidence of cardiac myolysis in severe nonischemic heart failure and the potential role of increased wall strain. Am. Heart J. 2001; 141: 247.
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12. Hijazi Z., Oldgren J., Andersson U. et al.: Cardiac biomarkers are associated with an increased risk of stroke and death in patients with atrial fibrillation: a Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) substudy. Circulation 2012; 125: 1605.
13. Kanjwal K., Imran N., Grubb B. et al.: Troponin elevation in patients with various tachycardias and normal epicardial coronaries. Indian Pacing and Electrophysiology Journal 2008; 8(3): 172.
14. Wang C.H., Kuo L.T., Hung M.J., Cherng W.J.: Coronary vasospasm as a possible cause of elevated cardiac troponin I in patients with acute coronary syndrome and insignificant coronary artery disease. Am. Heart J. 2002; 144: 275-281.
15. Tung P., Kopelnik A., Banki N. et al.: Predictors of neurocardiogenic injury after subarachnoid hemorrhage. Stroke 2004; 35: 548.
16. Naidech A.M., Kreiter K.T., Janjua N. et al.: Cardiac troponin elevation, cardiovascular morbidity, and outcome after subarachnoid hemorrhage. Circulation 2005; 112: 2851.
17. Hijazi Z., Oldgren J., Andersson U. et al.: Cardiac biomarkers are associated with an increased risk of stroke and death in patients with atrial fibrillation: a Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) substudy. Circulation 2012; 125: 1605.
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21. Imazio M., Demichelis B., Cecchi E. et al.: Cardiac troponin I in acute pericarditis. J. Am. Coll. Cardiol. 2003; 42: 2144.
22. Bonnefoy E., Godon P., Kirkorian G. et al.: Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis. Eur. Heart J. 2000; 21: 832.
23. Lauer B., Niederau C., Kühl U. et al.: Cardiac troponin T in patients with clinically suspected myocarditis. J. Am. Coll. Cardiol. 1997; 30(5): 1354-9135.
24. Friedrich M.G., Sechtem U., Schulz-Menger J. et al.: Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J. Am. Coll. Cardiol. 2009; 53: 1475.
25. Becattini C., Vedovati M.C., Agnelli G.: Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation 2007; 116: 427-433.
26. Meyer T., Binder L., Hruska N. et al.: Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. J. Am. Coll. Cardiol. 2000; 36: 1632-1636.
27. Labugger R., Organ L., Collier C. et al.: Extensive troponin I and T modification detected in serum from patients with acute myocardial infarction. Circulation 2000; 102: 1221-1226.
28. Bodor G.S., Oakeley A.E., Allen P.D. et al.: Troponin I phosphorylation in the normal and failing adult human heart. Circulation 1997; 96: 1495-1500.
29. Ooi D.S., Isotalo P.A., Veinot J.P.: Correlation of antemortem serum creatine kinase, creatine kinase-MB, troponin I, and troponin T with cardiac pathology. Clin. Chem. 2000; 46: 338-344.
30. Kontos M., Anderson F., Alimard R.: Ability of troponin I to predict cardiac events in patients admitted from the emergency department. J. Am. Coll. Cardiol. 2000; 36: 1818-1823.
31. deFilippi C.R., Tocchi M., Parmar R.J.: Cardiac troponin T in chest pain unit patients without ischemic electrocardiographic changes. angiographic correlates and long-term clinical outcomes. J. Am. Coll. Cardiol. 2000; 35: 1827-1834.
32. Piechota W., Gielerak G., Ryczek R. et al.: Cardiac troponin I after external electrical cardioversion for atrial fibrillation as a marker of myocardial injury – a preliminary report. Kardiol. Pol. 2007; 65: 664.
33. La Gerche A., Burns A.T., Mooney D.J. et al.: Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. Eur. Heart J. 2012; 33(8): 998-1006.
34. O’Keefe J.H., Patil H.R., Lavie C.J. et al.: Potential adverse cardiovascular effects from excessive endurance exercise. Mayo Clin. Proc. 2012; 87(6): 587-595.
35. Cardinale D., Sandri M.T., Martinoni A.: Left ventricular dysfunction predicted by early troponin I release after high-dose chemotherapy. J. Am. Coll. Cardiol. 2000; 36: 517-522.
36. Sandri M.T., Cardinale D., Zorzino L.: Minor increases in plasma troponin I predict decreased left ventricular ejection fraction after high-dose chemotherapy. Clin. Chem. 2003; 49: 248-252.
37. Auner H.W., Tinchon C., Linkesch W.: Prolonged monitoring of troponin T for the detection of anthracycline cardiotoxicity in adults with hematological malignancies. Ann. Hematol. 2003; 82: 218-222.
38. Dispenzieri A., Gertz M.A., Kyle R.A.: Prognostication of survival using cardiac troponins and N-terminal pro-brain natriuretic peptide in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation. Blood 2004; 104: 1881-1887.
39. Gertz M., Lacy M., Dispenzieri A.: Troponin T level as an exclusion criterion for stem cell transplantation in light-chain amyloidosis. Leuk. Lymphoma 2008; 49: 36-41.
40. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm A.J., Kirchhof P., Lip G.Y. et al.: Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur. Heart J. 2010; 31(19): 2369-2429.
41. Peacock W.F.I.V., De Marco T., Fonarow G.C. et al.: Cardiac troponin and outcome in acute heart failure. N. Engl. J. Med. 2008; 358: 2117-2126.
42. Agewall S., Giannitsis E., Jernberg T., Katus H.: Troponin elevation in coronary vs non-coronary disease. Eur. Heart J. 2011; 32(4): 404-411.
2. Apple F.S., Collinson P.O.; IFCC Task Force on Clinical Applications of Cardiac Biomarkers: Analytical characteristics of high-sensitivity cardiac troponin assays. Clin. Chem. 2012; 58: 54.
3. Thygesen K., Alpert J.S., Jaffe A.S. et al.: Third universal definition of myocardial infarction. Circulation 2012; 126: 2020.
4. Anderson J., Adams C., Antman E. et al.: ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 2002 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, American College or Physicians, Society for Academic Emergency Medicine, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J. Am. Coll. Cardiol. 2007; 50: e1.
5. Wu A.H.: Increased troponin in patients with sepsis and septic shock: myocardial necrosis or reversible myocardial depression? Intensive Care Med. 2001; 27: 959.
6. Wallace T.W., Abdullah S.M., Drazner M.H. et al.: Prevalence and determinants of troponin T elevation in the general population. Circulation 2006; 113: 1958.
7. Smith S.C., Ladenson J.H., Mason J.W., Jaffe A.S.: Elevations of cardiac troponin I associated with myocarditis. Experimental and clinical correlates. Circulation 1997; 95: 163.
8. Logeart D., Beyne P., Cusson C. et al.: Evidence of cardiac myolysis in severe nonischemic heart failure and the potential role of increased wall strain. Am. Heart J. 2001; 141: 247.
9. Horwich T.B., Patel J., MacLellan W.R., Fonarow G.C.: Cardiac troponin I is associated with impaired hemodynamics, progressive left ventricular dysfunction, and increased mortality rates in advanced heart failure. Circulation 2003; 108: 833.
10. Nunes J.P., Mota Garcia J.M., Farinha R.M. et al.: Cardiac troponin I in aortic valve disease. Int. J. Cardiol. 2003; 89: 281.
11. Kupari M., Eriksson S., Turto H. et al.: Leakage of cardiac troponin I in aortic valve stenosis. Journal of Internal Medicine 2005; 258: 231-237.
12. Hijazi Z., Oldgren J., Andersson U. et al.: Cardiac biomarkers are associated with an increased risk of stroke and death in patients with atrial fibrillation: a Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) substudy. Circulation 2012; 125: 1605.
13. Kanjwal K., Imran N., Grubb B. et al.: Troponin elevation in patients with various tachycardias and normal epicardial coronaries. Indian Pacing and Electrophysiology Journal 2008; 8(3): 172.
14. Wang C.H., Kuo L.T., Hung M.J., Cherng W.J.: Coronary vasospasm as a possible cause of elevated cardiac troponin I in patients with acute coronary syndrome and insignificant coronary artery disease. Am. Heart J. 2002; 144: 275-281.
15. Tung P., Kopelnik A., Banki N. et al.: Predictors of neurocardiogenic injury after subarachnoid hemorrhage. Stroke 2004; 35: 548.
16. Naidech A.M., Kreiter K.T., Janjua N. et al.: Cardiac troponin elevation, cardiovascular morbidity, and outcome after subarachnoid hemorrhage. Circulation 2005; 112: 2851.
17. Hijazi Z., Oldgren J., Andersson U. et al.: Cardiac biomarkers are associated with an increased risk of stroke and death in patients with atrial fibrillation: a Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) substudy. Circulation 2012; 125: 1605.
18. Gianni M., Dentali F., Grandi A.M. et al.: Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur. Heart J. 2006; 27: 1523.
19. Nef H.M., Möllmann H., Kostin S. et al.: Tako-Tsubo cardiomyopathy: intraindividual structural analysis in the acute phase and after functional recovery. Eur. Heart J. 2007; 28: 2456.
20. Sharkey S.W., Windenburg D.C., Lesser J.R. et al.: Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy. J. Am. Coll. Cardiol. 2010; 55: 333.
21. Imazio M., Demichelis B., Cecchi E. et al.: Cardiac troponin I in acute pericarditis. J. Am. Coll. Cardiol. 2003; 42: 2144.
22. Bonnefoy E., Godon P., Kirkorian G. et al.: Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis. Eur. Heart J. 2000; 21: 832.
23. Lauer B., Niederau C., Kühl U. et al.: Cardiac troponin T in patients with clinically suspected myocarditis. J. Am. Coll. Cardiol. 1997; 30(5): 1354-9135.
24. Friedrich M.G., Sechtem U., Schulz-Menger J. et al.: Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J. Am. Coll. Cardiol. 2009; 53: 1475.
25. Becattini C., Vedovati M.C., Agnelli G.: Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation 2007; 116: 427-433.
26. Meyer T., Binder L., Hruska N. et al.: Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. J. Am. Coll. Cardiol. 2000; 36: 1632-1636.
27. Labugger R., Organ L., Collier C. et al.: Extensive troponin I and T modification detected in serum from patients with acute myocardial infarction. Circulation 2000; 102: 1221-1226.
28. Bodor G.S., Oakeley A.E., Allen P.D. et al.: Troponin I phosphorylation in the normal and failing adult human heart. Circulation 1997; 96: 1495-1500.
29. Ooi D.S., Isotalo P.A., Veinot J.P.: Correlation of antemortem serum creatine kinase, creatine kinase-MB, troponin I, and troponin T with cardiac pathology. Clin. Chem. 2000; 46: 338-344.
30. Kontos M., Anderson F., Alimard R.: Ability of troponin I to predict cardiac events in patients admitted from the emergency department. J. Am. Coll. Cardiol. 2000; 36: 1818-1823.
31. deFilippi C.R., Tocchi M., Parmar R.J.: Cardiac troponin T in chest pain unit patients without ischemic electrocardiographic changes. angiographic correlates and long-term clinical outcomes. J. Am. Coll. Cardiol. 2000; 35: 1827-1834.
32. Piechota W., Gielerak G., Ryczek R. et al.: Cardiac troponin I after external electrical cardioversion for atrial fibrillation as a marker of myocardial injury – a preliminary report. Kardiol. Pol. 2007; 65: 664.
33. La Gerche A., Burns A.T., Mooney D.J. et al.: Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. Eur. Heart J. 2012; 33(8): 998-1006.
34. O’Keefe J.H., Patil H.R., Lavie C.J. et al.: Potential adverse cardiovascular effects from excessive endurance exercise. Mayo Clin. Proc. 2012; 87(6): 587-595.
35. Cardinale D., Sandri M.T., Martinoni A.: Left ventricular dysfunction predicted by early troponin I release after high-dose chemotherapy. J. Am. Coll. Cardiol. 2000; 36: 517-522.
36. Sandri M.T., Cardinale D., Zorzino L.: Minor increases in plasma troponin I predict decreased left ventricular ejection fraction after high-dose chemotherapy. Clin. Chem. 2003; 49: 248-252.
37. Auner H.W., Tinchon C., Linkesch W.: Prolonged monitoring of troponin T for the detection of anthracycline cardiotoxicity in adults with hematological malignancies. Ann. Hematol. 2003; 82: 218-222.
38. Dispenzieri A., Gertz M.A., Kyle R.A.: Prognostication of survival using cardiac troponins and N-terminal pro-brain natriuretic peptide in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation. Blood 2004; 104: 1881-1887.
39. Gertz M., Lacy M., Dispenzieri A.: Troponin T level as an exclusion criterion for stem cell transplantation in light-chain amyloidosis. Leuk. Lymphoma 2008; 49: 36-41.
40. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm A.J., Kirchhof P., Lip G.Y. et al.: Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur. Heart J. 2010; 31(19): 2369-2429.
41. Peacock W.F.I.V., De Marco T., Fonarow G.C. et al.: Cardiac troponin and outcome in acute heart failure. N. Engl. J. Med. 2008; 358: 2117-2126.
42. Agewall S., Giannitsis E., Jernberg T., Katus H.: Troponin elevation in coronary vs non-coronary disease. Eur. Heart J. 2011; 32(4): 404-411.