Cor Vasa 2011, 53(8-9):481-485 | DOI: 10.33678/cor.2011.118

Non-cardiac causes of cardiac troponin I elevation in the České Budějovice Hospital

Michal Šnorek^1,*, Miroslav Verner², František Toušek¹, Ladislav Pešl¹

¹ Kardiocentrum - kardiologické oddělení

² Centrální laboratoře, Nemocnice České Budějovice, a.s., České Budějovice, Česká republika

Introduction: Cardiac troponin assessment is an integral part of the evaluation of acute coronary syndromes. These markers of cardiac necrosis can be positive even in the presence of fixed coronary atherosclerotic lesion or in patients with normal findings on the coronary arteries. Many pathological cardiac and non-cardiac conditions may be responsible. Erroneous interpretation of laboratory findings can result in non-indicated intervention on coronary arteries and in harming the patient.

Aim: To analyze the causes of cardiac troponin I elevation in the České Budějovice Hospital outside the departments of cardiology and cardiac surgery, to define the most common non-cardiac causes of its elevation and to evaluate their prognostic significance.

Results: During the first three months of 2010, 4060 assessments of cardiac troponin I were performed in 2182 patients in the České Budějovice Hospital. Among 139 patients with cardiac troponin I elevation hospitalized outside the departments of cardiology and cardiac surgery, cardiac troponin I was elevated due to cardiac causes in 37%, due to sepsis in 21% and due to acute respiratory failure in 16% cases. Acute neurological condition was responsible for the given finding in 8%, pulmonary embolus in 6% and renal failure in 6% patients. Elevation of cardiac troponin I was also found in patients with polytrauma, anemia and hypothermia. Cardiac troponin I level was higher when elevated due to cardiac causes (12.6 ± 2.8 µg/l), compared to primarily non-cardiac causes (3.6 ± 0.9 µg/l; p < 0.05). The hospitalization was terminated by death in 37% patients with primarily non-cardiac causes of cardiac troponin I elevation.

Conclusion: Cardiac troponins have high negative predictive value and thus can help to exclude acute myocardial infarction. Lower positive predictive value of cardiac troponins calls for prudent evaluation of their increased values that are present in a wide spectrum of pathological conditions without any significant coronary lesions. Elevation of cardiac troponins in such cases is associated with worse prognosis.

Keywords: Cardiac troponin I; Non-cardiac condition; Acute coronary syndrome

Published: August 1, 2011  Show citation