Electrocardiography changes in acute aortic dissection—association with troponin leak, coronary anatomy, and prognosis

Pourafkari, Leili; Tajlil, Arezou; Ghaffari, Samad; Chavoshi, Mohammadreza; Kolahdouzan, Kasra; Parvizi, Rezayat; Parizad, Raziyeh

doi:10.1016/j.ajem.2016.04.024

Cited by 17 publications

(15 citation statements)

References 24 publications

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“…More importantly, in both of those groups cTn levels may be increased. In addition, studies showed that the frequency of cTn elevation is similar in AAAD patients with and without ECG abnormalities [4]. All of these features may imply diagnostic problems of AAAD.…”

Section: Letter To the Editormentioning

confidence: 92%

“…STE was observed in 8% of ECGs. Those findings indicate that abnormalities in ECG in patients with AAAD can either be caused by acute dissection involving coronary arteries ostia, total occlusion by tear of the vessel wall, hematoma compression or can result from chronic underlying diseases such as hypertension or coronary artery disease, existing long before the acute condition [4]. More importantly, in both of those groups cTn levels may be increased.…”

Section: Letter To the Editormentioning

confidence: 92%

See 1 more Smart Citation

Suspected case of subacute stent thrombosis referred for coronary angiography turns out to be unusual aortic dissection presentation

Rzepa

Walczewski

Fojt

et al. 2020

kitp

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Section: Letter To the Editormentioning

confidence: 92%

Section: Letter To the Editormentioning

confidence: 92%

Suspected case of subacute stent thrombosis referred for coronary angiography turns out to be unusual aortic dissection presentation

Rzepa

Walczewski

Fojt

et al. 2020

kitp

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“…Almost 90% of the patients with aortic dissection (AD) have abnormal ECG with 25%–35% having ACS-like ECG features resembling NSTEMI and 4%–16% have ECG findings of STEMI (57-60). Troponin positivity was reported from 16% to 33% with standard assays and 54% to 61% with hs assay with no difference between type A and type B dissection.…”

Section: Aortic Dissectionmentioning

confidence: 99%

Turkish Society of Cardiology Consensus Paper onThe Rational Use of Cardiac Troponins in Daily Practice

Okyay

Sadıç²,

Şahinarslan³

et al. 2019

Anatol J Cardiol

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“…Atrial fibrillation is the most common tachyarrhythmia, effecting about 25% of subjects aged 40 years and older [47]. The elevation in troponin occurs because of a mismatch between oxygen demand and supply.…”

Section: Arrhythmiasmentioning

confidence: 99%

“…There are few studies that have identified the prognostic role of elevated troponins in the setting of AAD. Bonnefy et al [46] studied a group of 28 patients with type A aortic dissection with an elevated troponin and found that an elevated troponin may be an indicator of increased hemodynamic stress, but in multivariate analysis, it did not increase overall mortality [46,47]. Vrsalovic et al [45] completed a systemic review and meta-analysis of 4 studies to evaluate the role of elevated cardiac troponins in AAD.…”

Section: Aortic Dissectionmentioning

confidence: 99%

A Review of Cardiac and Non-Cardiac Causes of Troponin Elevation and Clinical Relevance Part I: Cardiac Causes

2017

JCCR

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IntroductionCardiac troponin T (cTnT) and troponin I (cTnI) are cardiac regulatory proteins that control the calcium mediated interaction between actin and myosin [1]. The troponin complex consists of three subunits: troponin C, troponin I, and troponin T. This complex is located on the myofibrillar thin (actin) filament of striated (skeletal and cardiac) muscle. The cardiac isoforms troponin T and I are only expressed in cardiac muscle [1].In the year 2007 a consensus statement from the Joint European Society of Cardiology and The American College of Cardiology committees redefined myocardial infarction (MI) as an elevation of cTnT or cTnI in conjunction with clinical evidence of myocardial ischemia [2]. They recommended highsensitivity cardiac troponin assays to rule out MI using a 3-hour pathway based on the 99 th percentile of the normal reference range [2]. Cardiac troponins are detected in the serum by the use of monoclonal antibodies to epitopes of cTnI and cTnT. These antibodies are highly specific for cardiac troponin but do not react with skeletal muscle troponins [3,4]. Troponin assays are quite sensitive and can detect <1 g of myocardial necrosis; therefore, the diagnosis of myocardial infarction requires that cTn must be above the 99 th percentile upper reference limit for the specific assay being used [5]. Some studies have reported that the 99 th percentile reference limit differs between men and women when measured with high-sensitivity assays for cardiac troponin [6].An elevation of cTn indicates the presence of, but not the underlying reason for, myocardial injury. Elevated troponins have been noted in several clinical conditions in addition to acute myocardial infarction (AMI). These conditions include pulmonary embolism, sepsis, heart failure, myocarditis, myocardial contusion, critical illness, cardio-toxic chemo, defibrillator shocks, atrial fibrillation, and end stage renal disease. Elevated cTnT and cTnI almost always imply a poor prognosis regardless of the mechanism by which troponins were released from cardiac myocytes into circulation. Ottani et al. found that the odds ratio for death and MI was 3.44-fold at 30 days in the cTnT-positive group compared to patients with unstable angina who did not have elevated troponins [7].The aim of this article is to highlight different conditions in which elevated troponins have been commonly noted, and to discuss the suggested mechanisms for elevated troponins in these patients. It is still unclear how to manage troponin elevation in clinical conditions other than AMI, but it is important to note the differential diagnosis for elevated troponins and the clinical significance of troponin elevation in each setting. Troponin elevation reflects acute or chronic myocardial damage but is not exclusive for ACS, thus causing some problems with interpretation of results. Differentiating elevated troponins due to non-coronary diseases is challenging; however, this differentiation is paramount in order to provide timely and appropriate treatment. This is a t...

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Electrocardiography changes in acute aortic dissection—association with troponin leak, coronary anatomy, and prognosis

Cited by 17 publications

References 24 publications

Suspected case of subacute stent thrombosis referred for coronary angiography turns out to be unusual aortic dissection presentation

Suspected case of subacute stent thrombosis referred for coronary angiography turns out to be unusual aortic dissection presentation

Turkish Society of Cardiology Consensus Paper onThe Rational Use of Cardiac Troponins in Daily Practice

A Review of Cardiac and Non-Cardiac Causes of Troponin Elevation and Clinical Relevance Part I: Cardiac Causes

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