Elevated high-sensitivity troponin does not indicate the presence of coronary artery disease in patients presenting with supraventricular tachycardia

Murer, Martin; Cuculi, Florim; Toggweiler, Stefan; Weberndörfer, Vanessa; Young, Mabelle; Kobza, Richard

doi:10.5603/cj.a2017.0058

Cited by 8 publications

(8 citation statements)

References 22 publications

(27 reference statements)

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“…The prevalence of acute coronary syndrome in patients complaining of chest discomfort during SVT referred for coronary angiography is very low, even when elevations in troponin levels or ST segment depression are detected. 18 , 19 , 20 , 21 , 22 Predicting models may better estimate the pretest probability for coronary artery disease in individuals with acute chest discomfort during SVT and would help to conduct these scenarios more appropriately. 23 Although we claim that chest pain favors a coronary disease work up bias, we lack any objective data to support it and we recognize that the cognitive bias hypothesis is speculative and should be evaluated in future studies.…”

Section: Discussionmentioning

confidence: 99%

Underuse of Catheter Ablation as First‐Line Therapy for Supraventricular Tachycardia

Oliveira

Viana

Luize

et al. 2022

JAHA

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Background Catheter ablation (CA) is a safe, effective, cost‐effective technique and may be considered a first‐line strategy for the treatment of symptomatic supraventricular tachycardias (SVT). Despite the high prospect of cure and the recommendations of international guidelines in considering CA as a first‐line treatment strategy, the average time between diagnosis and the procedure may be long. The present study aims to evaluate predictors related to non‐referral for CA as first‐line treatment in patients with SVT. Methods and Results The model was derived from a retrospective cohort of patients with SVT or ventricular pre‐excitation referred for CA in a tertiary center. Clinical and demographical features were used as independent variables and non‐referral for CA as first‐line treatment the dependent variable in a stepwise logistic regression analysis. Among 20 clinical‐demographic variables from 350 patients, 10 were included in initial logistic regression analysis: age, women, presence of pre‐excitation on ECG, palpitation, dyspnea and chest discomfort, number of antiarrhythmic drugs before ablation, number of concomitant symptoms, symptoms’ duration and evaluations in the emergency room due to SVT. After multivariable adjusted analysis, age (odds ratio [OR], 1.2; 95% CI 1.01–1.32; P =0.04), chest discomfort during supraventricular tachycardia (OR, 2.7; CI 1.6–4.7; P <0.001) and number of antiarrhythmic drugs before ablation (OR, 1.8; CI 1.4–2.3; P <0.001) showed a positive independent association for non‐referral for CA as SVT first‐line treatment. Conclusions The independent predictors of non‐referral for CA as first‐line treatment in our logistic regression analysis indicate the existence of biases in the decision‐making process in the referral process of patients who would benefit the most from catheter ablation. They very likely suggest a skewed medical decision‐making process leading to catheter ablation underuse.

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Section: Discussionmentioning

confidence: 99%

Underuse of Catheter Ablation as First‐Line Therapy for Supraventricular Tachycardia

Oliveira

Viana

Luize

et al. 2022

JAHA

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“…CAD is a rare comorbidity in PSVT patients, who often have a low pretest probability and low prevalence of CAD. 11,16 Cardiovascular risk profile, and not c-Tn itself, should guide the physician to investigate for ischemic heart disease in a patient admitted to ED for a symptomatic episode of PSVT. 4 However, the measurement of c-Tn could be useful for assessing the prognosis, especially in the long term, in a subgroup of patients, ie those with an elevated cardiovascular risk.…”

Section: Discussionmentioning

confidence: 99%

Troponin Testing in Adult Patients Presenting to the Emergency Department for Paroxysmal Supraventricular Tachycardia: A Review

Gabrielli

Cucurachi

Lamendola

et al. 2022

Cardiology in Review

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International guidelines define paroxysmal supraventricular tachycardia (PSVT) as all supraventricular tachyarrhythmias other than atrial flutter and atrial fibrillation. Associate symptoms, such as chest pain and dyspnea, and possible ECG changes during arrhythmia, such as ST depression, may suggest to the emergency physician a diagnosis of acute coronary syndrome (ACS), and thus lead to a request for troponin (cTn) level. Here, we provide a comprehensive synthesis covering published literature on the diagnostic and prognostic role of cTn in patients admitted to Emergency Department (ED) for an episode of PSVT. We performed an extensive evaluation article written in English and available in PubMed and Web of Science by using the following Medical Subject Headings (MeSH): “paroxysmal supraventricular tachycardia” AND/OR “supraventricular tachycardia” AND “Troponin” AND “Emergency Department” AND/OR “coronary artery disease”. We also performed hand searching of reference lists of selected articles. A total of 17 articles were finally included. There was great variability about study design, setting and criteria for the definition of PSVT and/or type of troponin. Troponin levels were measured frequently (up to 79%) in patients admitted to ED for PSVT. About 30% of them showed cTn elevation. This elevation appears not to be associated with the presence of CAD. However, c-Tn measurements could retain utility in stratifying those with poorer prognosis among PSVT patients with an elevated cardiovascular risk profile.

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“…One pediatric study illustrated a prevalence of 29% in patients with SVT at the time of the index ED presentation, which showed a similar proportion of elevated troponin levels [5]. It is not uncommon that troponin elevation occurs in the absence of coronary artery disease after SVT presentation [10,11,[14][15][16]. However, the utility of troponin in patients with SVT is still debated [17].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Cardiac Troponin and Risk Assessment in Pediatric Supraventricular Tachycardia

Yen

Chen

Chaou

et al. 2021

JCM

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Cardiac troponin I (cTnI) elevation is common in an acute episode of supraventricular tachycardia (SVT). However, there is limited evidence regarding the prognostic value of cTnI and the predictors of SVT recurrence in pediatric patients. We screened the electronic medical records of all pediatric patients presenting to the emergency departments at five Taiwanese hospitals from 1 January 2010 to 31 May 2021. Our primary outcomes were the occurrence of major adverse cardiac events (MACEs) during the follow-up period and 30-day SVT recurrence. A total of 112 patients were included in our study. Of these, 29 (25.9%) patients had positive cTnI values. Patients with cTnI elevation had significantly more complaints of dyspnea (27.6% vs. 7.2%, p = 0.008) and gastrointestinal discomfort (24.1% vs. 4.8%, p = 0.006). There were significantly more intensive care unit admissions (41.4% vs. 16.9%, p = 0.007) among the cTnI-positive group. One MACE was found in the cTnI-negative group. For 30-day SVT recurrence, the cTnI-positive group had a higher recurrence rate, without a statistically significant difference (20.7% vs. 7.2%, p = 0.075). Multivariable logistic regression analysis showed hypotension as an independent predictor of 30-day SVT recurrence (OR = 4.98; Cl 1.02–24.22; p = 0.047). Troponin had low value for predicting the outcomes of pediatric patients with SVT. The only significant predictor for recurrent SVT was initial hypotension.

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Elevated high-sensitivity troponin does not indicate the presence of coronary artery disease in patients presenting with supraventricular tachycardia

Abstract: (Cardiol J 2017; 24, 6: 642-648)

Cited by 8 publications

References 22 publications

Underuse of Catheter Ablation as First‐Line Therapy for Supraventricular Tachycardia

Underuse of Catheter Ablation as First‐Line Therapy for Supraventricular Tachycardia

Troponin Testing in Adult Patients Presenting to the Emergency Department for Paroxysmal Supraventricular Tachycardia: A Review

Prognostic Value of Cardiac Troponin and Risk Assessment in Pediatric Supraventricular Tachycardia

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