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

Abstract

Background Aim of this study was to evaluate the predictors of hs‐cTnT in a non‐ACS patient cohort admitted to the emergency department. Hypothesis Atrial fibrillation and hypertension may not always be sufficient for elevation for hs‐cTnT. Methods We performed a retrospective, single center study encompassing in total 1003 patients. Individuals were retrospectively divided in ACS‐ and non‐ACS patients by two independent investigators reviewing the medical records. In order to identify predictors of hs‐cTnT elevation hazard ratios were calculated for age, gender, vital signs, cardiovascular risk factors, LVEF, serum levels of CRP, hemoglobin, and creatinine. Elevation of hs‐cTnT was defined by exceeding 14 ng/L (upper reference limit [URL]). Results About 987 patients were included while 25 patients were excluded because of missing data. 307 patients (31.4%) met the current guideline requirements of diagnosing an ACS, whereas 671 patients (68.6%) were hospitalized with excluded ACS. In the multivariate analysis age, anemia, CRP, creatinine, and reduced systolic left ventricular ejection fraction were independent predictors of elevated troponin T levels in the non‐ACS group. However, hypertensive systolic blood pressure, atrial fibrillation and tachycardia were not predictive for Troponin T elevation in non‐ACS patients in this multivariate analysis. Conclusions In an unselected, non‐ACS patient cohort age, chronic renal failure, inflammatory state, and reduced left ventricular systolic function were associated with hs‐cTnT levels above the upper reference limit. Rather, often supposed predictors as atrial fibrillation, hypertension, and tachycardia cannot sufficiently explain increased hs‐cTnT in our study. Hence, further studies are needed to assess whether isolated hypertension, tachycardia, or atrial fibrillation sufficiently explain elevated hs‐cTnT.

High-Sensitivity Cardiac Troponin T and the Diagnosis of Cardiovascular Disease in the Emergency Room: The Importance of Combining Cardiovascular Biomarkers with Clinical Data

“…In the literature, two studies also showed that the set of clinical-instrumental variables had the best capabilities of predicting an ACS diagnosis, although no data regarding cTn were reported [26,27]. On the other hand, other studies aimed to evaluate which factors were associated with an increase in hs-cTnT value and for this reason they differ from ours [28,29]. To the best of our knowledge, only Alcalai et al [30] attempted to determine which were the clinical-laboratory predictors of ACS in the presence of abnormal hs-cTnT values, and for these characteristics, our study may be partially similar.…”

The Role of Coronary Computed Tomography Angiography in Evaluation of High Troponin Patients with Narrow-Complex Supraventricular Tachycardia

“…These non-ACS troponin elevations can be related to cardiac causes (such as acute myocarditis, stress (Takotsubo) cardiomyopathy, tachycardia, or dilated cardiomyopathy) or due to noncardiac causes (such as trauma, exertion, chronic kidney disease, anemia, sepsis, or pulmonary embolism). [ 2 8 9 ]…”