Cardiac Troponin Release is Associated with Biomarkers of Inflammation and Ventricular Dilatation During Critical Illness

Abstract

Introduction:Troponin release is common during critical illness. We hypothesized that there was an association between cardiac troponin T (cTnT) and biomarkers of systemic inflammation and ventricular dilatation.Methods:In an observational prospective cohort study, we enrolled consecutive adult patients admitted for noncardiac reasons to the intensive care unit (ICU) in two tertiary care centers. We measured cTnT, C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), and N-terminal pro brain natriuretic peptide (NT-proBNP) daily in the first week, and on alternate days in the second week. Using a peak cTnT cutoff ≥15 ng/L and concomitant changes on electrocardiogram, patients were categorized as “definite myocardial infarction (MI),” “possible MI,” “cTnT rise only,” or “no cTnT rise.” Within each group, associations between CRP, IL-6, PCT, NT-proBNP, and cTnT were investigated using mixed effect models.Results:One hundred seventy-two patients were included in the analysis of whom 84% had a cTnT rise ≥15 ng/L. Twenty-one patients (12%) had a definite MI, 51 (30%) had a possible MI, and 73 (42%) had a cTnT rise only. At the time of peak cTnT, 71% of patients were septic and 67% were on vasopressors.Multivariable analysis showed a significant association between cTnT and IL-6 in all patients with a cTnT rise independent of age, gender, renal function, and cardiovascular risk factors. In patients without a definite MI, cTnT levels were significantly associated with PCT and NT-proBNP values. In patients without elevated cTnT levels, there was no associated NT-proBNP rise.Conclusions:In ICU patients admitted for non-cardiac reasons, serial cTnT levels were independently associated with markers of systemic inflammation and NT-proBNP.

Non‐coronary predictors of elevated high‐sensitive cardiac troponin T (hs‐cTnT) levels in an unselected emergency patient cohort

“…In line with former findings, inflammatory states are independently associated with higher cTnT, as described before . In this current study CRP levels above the URL (> 5 mg/L URL) were associated with a 3‐fold increased risk for elevated cTnT levels.…”

Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy: a review of the literature

“…Some of this variability may be due to the fact that cardiac biomarker concentrations above the reference range are common in sepsis, with prevalence as high as 84% for cTnT [ 77 ], 98% for NT-proBNP [ 75 ], and 100% for hsTnT [ 70 ]. Existing data are limited by residual confounding from clinical contributors, including age, disease severity, comorbidities (including flow-limiting CAD), and treatment.…”

Sensitive detection of cardiac troponin T based on superparamagnetic bead-labels using a flexible micro-fluxgate sensor

“…3,4 Acute events in cardiovascular diseases have been successfully diagnosed by monitoring established biochemical markers, such as creatine kinase MB, myoglobin, and cardiac troponins I and T. [2][3][4][5][6] Cardiac troponin T (cTnT) is widely used as a specic biomarker for myocardial tissue and is considered as the "gold standard" for the serological diagnosis and prognosis of AMI due to its high sensitivity and specicity. [6][7][8] During myocardial infarction, cTnT is immediately released into the bloodstream. Therefore, the rapid and accurate monitoring of this biomarker could improve the quality of patient care.…”