Prognostic Significance of Raised Cardiac Troponin T in Patients Presenting with Acute Limb Ischaemia

Abstract

Objective. To study the relation between serum cardiac troponin T (cTnT) and mortality in patients presenting with acute limb ischaemia secondary to an embolism. Material and methods. A two years prospective study of all patients admitted to the vascular unit with a diagnosis of acute limb ischaemia secondary to an embolism. On admission all patients had an ECG. A blood sample was taken for measurement of cTnT, CRP, serum biochemistry, full blood count and clotting. All embolectomies were performed under local anaesthesia. Patients were followed until discharge from hospital and up to twelve months after surgery. Results. There were 37 patients with lower limb and 2 patients with upper limb ischaemia. Twenty four patients were female and fifteen were male, with the mean age of 76 years (50e95) for women and 84 years (77e90) for men. Seventeen patients (44%) had a raised cTnT. The patients with raised cTnT were older than those with normal cTnT [86y (77e92) vs 77y (51e95), p ¼ 0.01, t test]. The mean cTnT was 0.20 mg/L (range: 0.11e0.27). Only two patients with raised cTnT gave a history of chest pains. All of the patients with an elevated cTnT had also raised CRP. There was no significant difference in the serum creatinine in the group of patients with elevated cTnT compared to those with normal cTnT [112 mmol/ L (range 98e159) vs 119 mmol/L (range: 47e177), p ¼ ns]. The cumulative survival for cTnTþ patients at 7 days was 53% and that of cTnTÿ patients was 100%. The cumulative survival for cTnTþ and cTnTÿ patients was statistically different (p ¼ 0.0000, c 2 ¼ 13.1, Log Rank test). Using regression analysis, an elevated cTnT was found to be an independent predictor of outcome. Conclusion.A significant proportion of patients presenting with an acutely ischaemic limb have an elevated cTnT. An elevated cTnT may be an early marker of overall disease severity and a predictor of outcome.

Elevated cardiac troponin T contributes to prediction of worse in-hospital outcomes after endovascular therapy for acute limb ischemia

“…In another investigation, Rittoo et al 10 found a high prevalence of elevated cTnT among 39 patients (44%) with ALI. 10 Cumulative survival rates after 7 days were 53% for cTnT-positive patients and 100% for cTnT-negative patients. In contrast to our study results, no association was found between the presence of CAD or higher CRP values and death.…”

“…Cytokine liberation, leukocyte activation, prothrombotic eicosanoid production, activation of the compartment cascade, and formation of toxic oxygen metabolites are consequences of these changes that lead to the clinical manifestation of SIRS. 10,29,30 SIRS may contribute to cardiac and renal dysfunction and lead to multiorgan failure. Remarkably, the cause of death for 8 of 10 patients in our cohort was progressive ischemia, septicemia, and multiorgan failure.…”

“…[9][10][11] However, many PAOD patients have impaired renal function, and cardiac troponins often increase with declining glomerular filtration rate (GFR). Moreover, CKD itself is associated with increased cardiovascular death.…”

An elevated neutrophil-lymphocyte ratio independently predicts mortality in chronic critical limb ischemia

“…The impact of an elevated troponin on survival in patients with noncardiac disease has been reported in hemodialysis patients 21 and CLI by several groups, including our own. [22][23][24] Statins have an important protective role for mortality and major cardiovascular events (stroke, MI) in patients with peripheral arterial disease; no specific protective effect has been demonstrated in amputation-free survival in recent literature. [25][26][27][28][29] The impact of an elevated NLR and its relation to mortality has not been reported before in this patient set.…”

High-sensitivity cardiac troponin T in patients with intermittent claudication and its relation with cardiovascular events and all-cause mortality – The CAVASIC Study

“…One quite small crosssectional study described an elevation of cTnT levels in PAD patients with Fontaine stage II to IV and a relation to N-terminal pro-B-type natriuretic peptide (NT-proBNP) [25]. A small prospective study and one of moderate size in patients with acute limb ischemia found elevated cTnT to be a predictor of worse outcome [26,27]. A more recent report in symptomatic PAD patients with Fontaine stage IIb to IV described cTnT levels to be elevated and associated with all-cause mortality and higher amputation rates [28].…”