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PAPERS: P James, C J Ellis, R M L Whitlock, A R McNeil, J Henley, and N E Anderson Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study BMJ 2000; 320: 1502-1504 [Abstract] [Full text]

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Myocardial Injury and Cardiac Troponin

Nilesh Parekh   (8 June 2000)

Troponin I in patients with supraventricular tachycardia

My Svensson   (22 May 2001)

Myocardial Injury and Cardiac Troponin 8 June 2000
Nilesh Parekh, Specialist Registrar in Neurosurgical Intensive Care General Infirmary At Leeds Send response to journal: Re: Myocardial Injury and Cardiac Troponin	Cardiac troponins, both I and T, are more sensitive marker of myocardial injury and dysfunction. The incidence of such cardiac damage defined by elevated cardiac troponin is now increasingly reported and is unexpectedly high and frequently clinically unrecognised. This is particularly so in critical care setting where raised cardiac troponin is known to be associated with increased morbidity and mortality. Such patients are frequently haemodynaemically unstable, in need of mechanical ventilation and has longer intensive care unit stays (1). A raised cardiac troponin is even more significant in conditions like acute stroke, ruptured aneurysmal subarachnoid haemorrhage, cardiac contusion following chest trauma and perioperative myocardial infarction since CKMB as a marker of cardiac injury underestimates such event and doesnot have the same positive predictive value for cardiac dysfunction (2). 1. Guest TM et al. Myocardial Injury in Critically Ill Patients. A frequently unrecognised complication. JAMA 1995; 273:1945-49. 2. Parekh N et al. Indices of myocardial injury in aneurysmal subarachnoid haemorrhage: A prospective study. Intensive Care Medicine. 1999;25(sup1):S99.
Troponin I in patients with supraventricular tachycardia 22 May 2001
My Svensson, Registrar Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark Send response to journal: Re: Troponin I in patients with supraventricular tachycardia	EDITOR - We have read the article by James et al. (1) regarding the relation between troponin T concentration and mortality in patients with an acute stroke with great interest. Seventeen per cent of the patients had an elevated troponin T value; this was later related to a poor prognosis. No reference is made to the occurrence of atrial fibrillation in patients included in the study. It is assumed that 15-20% of all strokes are of cardio-embolic origin and there could be significant overlap between the groups. We have observed that there can be elevations of troponin I(TnI) in patients admitted with a recent onset of supraventricular tachycardia (<7 days). The medical records of 72 consecutive patients admitted with such were evaluated retrospectively. All patients had ECG documented tachycardia at admission. Atrial fibrillation/ flutter, was seen in 64 patients of whom 17 had an elevated TnI ( Axsym, Abbott diagnostics, TnI normal value 0.0-0.4 ug/l). Re-entry tachycardia was observed in 8 patients, three had an elevated TnI. The patients with elevated TnI were generally older(69.6+/-11.6 vs 62.4+/-13.6 years respectively, p<0.05, t-test), suffered a higher frequency of angina(75% vs 37%, respectively, p<0.01, chi-square test), as well as a higher frequency of significant ST-depression in ECG (55% vs 27%, respectively, p<0.05, t-test). These results indicate that elevation of TnI is a common phenomenon (28%) in cases of supraventricular tachycardia. It might be of prognostic value as troponin I and T are sensitive and specific markers of myocardial injury and it has been demonstrated that these are of prognostic importance in unstable angina (2), severe heart failure (3), pulmonary embolism (4), renal failure (5) and ischaemic stroke (1). Further prospective studies are therefore necessary to determine the role of cardiac markers in patients suffering from tachycardia. My Svensson 1 Kristian K. Thomsen 2 Jan Ravkilde 1 Egon Toft 1 1. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. 2. Department of Cardiology, Esbjerg Central Hospital, Esbjerg, Denmark. 1. James P, Ellis C, Whitlock RM, Mc Neil AR, Henley J, Anderson NE. Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study. BMJ 2000; 320: 1502- 04. 2. Ravkilde J. Creatine kinase isoenzyme MB mass, cardiac troponin T and myosin light chain isotype 1 as serological markers of myocardial injury and their prognostic importace in acute coronary syndrome. Dan Med Bull 1998 Feb; 45 (1): 34-50. 3. La Vecchia L, Mezzena G, Zanolla L et al. Cardiac troponin I as diagnostic and prognostic marker in severe heart failure. J Heart Lung Transplant 2000; 19: 644-652. 4. Giannitsis E, Muller-Bardoff M , Kurowski et al. Independent prognostic value of troponin T in patients with confirmed pulmonary embolism. Circulation 2000; 102: 211-217. 5. Ooi D, Veinot J, Wells G, House A. Increased mortality in hemodialyzed patients with elevated troponin T; a one-year outcome study. Clin Biochemistry 1999; 32: 647-652.