Correlation of troponin-I level with left ventricular systolic dysfunction after first attack of non-ST segment elevation myocardial infarction

Mahmood H. Khan; Mirza Md. Nazrul Islam; Md. Shafiqul Islam; Kaisar Nasrullah Khan; Shamim Chowdhury; Reazur Rahman

doi:10.18203/2320-6012.ijrms20191623

Authors

Mahmood H. Khan Department of Clinical & Interventional Cardiology, Apollo Hospitals Dhaka, Bangladesh
Mirza Md. Nazrul Islam Department of Cardiology, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh
Md. Shafiqul Islam Department of Epidemiology, National Institute of Preventive & Social Medicine (NIPSOM), Dhaka, Bangladesh
Kaisar Nasrullah Khan Department of Cardiology, United Hospital Limited, Dhaka, Bangladesh
Shamim Chowdhury Department of Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
Reazur Rahman Department of Cardiology, United Hospital Limited, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20191623

Keywords:

Acute coronary syndrome, Coronary heart disease, Left ventricular dysfunction, LVEF, NSTEMI, Troponin-I

Abstract

Background: Coronary Heart Disease (CHD) is the most common category of the heart disease and is found to be the single most important cause that leads to premature death in the developed world. Recognizing a patient with ACS is important because the diagnosis triggers both triage and management. cTnI is 100% tissue-specific for the myocardium and it has shown itself as a very sensitive and specific marker for AMI. Ventricular function is the best predictor of death after an ACS. It serves as a marker of myocardial damage and provides information on systolic function as well as diagnosis and prognosis. The study aimed at investigating the impact of LVEF on elevated troponin-I level in patients with first attack of NSTEMI.

Methods: This cross-sectional analytical study was conducted in the department of cardiology in Mymensingh Medical College Hospital from December, 2015 to November, 2016. Total 130 first attack of NSTEMI patients were included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group-I: Patients with first attack of NSTEMI with LVEF: ≥55%. Group-II: Patients with first attack of NSTEMI with LVEF: <55%. Then LVEF and troponin-I levels were correlated using Pearson’s correlation coefficient test.

Results: In this study mean troponin-I of group-I and group-II were 5.53±7.43 and 16.46±15.79ng/ml respectively. It was statistically significant (p<0.05). The mean LVEF value of groups were 65.31±10.30% and 40.17±4.62% respectively. It was statistically significant (p<0.05). The echocardiography showed that patients with high troponin-I level had low LVEF and patients with low troponin-I level had preserved LVEF. Analysis showed that patients with highest level of troponin-I had severe left ventricular systolic dysfunction (LVEF <35%) and vice versa-the patients with the lowest levels of troponin-I had preserved systolic function (LVEF ≥55%). In our study, it also showed that the levels of troponin-I had negative correlation with LVEF levels with medium strength of association (r= -0.5394, p=0.001). Our study also discovered that Troponin-I level ≥6.6ng/ml is a very sensitive and specific marker for LV systolic dysfunction.

Conclusions: The study has enabled the research team to conclude that the higher is the Troponin-I level the lower is the LVEF level and thus more severe is the LV systolic dysfunction in first attack of NSTEMI patients.

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References

Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. Third universal definition of myocardial infarction. Circulation. 2012;126:2020-35.

Anderson JL, Adams AD, Antman SM, Bridges CR, Califf RM, Casey DE, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction): Developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation. 2007;116:e148-e304.

O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, De Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61:e78-e140.

Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics-2013 update: A report from the American Heart Association. Circulation. 2013;127:e6-e245.

Mair J, Friendrich L, Galzolari C. cTnI release correlates with myocardial infarct size. Eur J Clin Biochemistry. 1996;335(18):1342-9.

Geltman EM, Ehanni AA, Campbell MK. The influence of location and extent of myocardial infarction on long term ventricular contractile dysfunction and mortality. Circulation. 1976;60:805-14.

Rao AC, Collinson PO, Canepa-Anson R, Joseph SP. Troponin T measurement after myocardial infarction can identify left ventricular ejection of less than 40%. Heart. 1998;80:223-5.

Antman EM. Troponin measurements in ischemic heart disease: more than just a black and white picture. J Am Coll Cardiol. 2001;38:987-90.

Katus HA, Schoffold T, RemppisA, Comples. Lab Med. 1992;23:311-7.

Paul RJ, Ferguson DG, Heiny JA. Muscle Physiology-Molecular Mechanism in Physiology Ed. Nocholas S, Robert O, Banks; 1993.

Solaro RJ, Van Eyk J. Altered interactions among thin filament proteins modulate cardiac function. J Mol Cell Cardiol. 1996;28:217-30.

Cummins B, Auckland ML, Cummins P. Cardiac-specific troponin-I radioimmunoassay in the diagnosis of acute myocardial infarction. Am Heart J. 1987;113:1333-44.

Larue C, Calzolari C, Bertinchant JP, Leclercq F, Grolleau R. Cardiac-specific immunoenzymometric assay of troponin I in the early phase of acute myocardial infarction. Clin Chem. 1993;39:972-9.

Somani D, Gahlot RS, Lakhotia M, Choudhary CR, Sangavi S. Troponin I measurement after myocardial infarction and its correlation with left ventricular ejection fraction: a prospective study. JIACM. 2005;6(1):38-41.

Barakat K, Wilkinson P, Deaner K. How should age affect management of acute myocardial infarction? A prospective cohort study. Lancet. 1999;353:955-9.

Balarajan R. Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales. BMJ. 1991;302:560-4.

Solomon D, Wu J, Gillam L. Echocardiography. In: DL. Mann, DP Zipes, P Libby, RO Bonow, 10th Edition; Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. Philadelphia: Elsevier; 2015:179- 90.

Patwary MSR, Reza AQM, Mohibullah AKM. Prolonged QRS duration of AMI patients indicative of left ventricular systolic dysfunction. Chest and Heart J. 2008;31:36-9.

Timmer JR, Van der Horst IC, Ottervanger JP. Prognostic value of admission glucose in non-diabetic patients with myocardial infarction. Am Heart J. 2004;148:399-404.

Ahmad MI, Yadaw BK, Sharma N, Varshney AK, Sharma L. Cardiac troponin I level in STEMI and clinical correlation with left ventricular dysfunction in Indian population. J Cardiovas Dis Diag. 2013;1:116.

Ascione R, Narayan P, Rogers CA. Early and midterm clinical outcome in patients with severe left ventricular dysfunction undergoing coronary artery surgery. Annals Thoracic Surg. 2003;76:793-9.

Loutfi M. Identification of high-risk patients with non-ST segment elevation myocardial infarction using strain doppler echocardiography: correlation with cardiac magnetic resonance imaging. Clinical Medicine Insights: Cardiology. 2016;10:51-9.