Troponin Testing in Patients With Supraventricular Tachycardia—Are We Overtesting?

Allen, Robert W.; deSouza, Ian S.

doi:10.1001/jamainternmed.2021.0266

Cited by 8 publications

(14 citation statements)

References 6 publications

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“…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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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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“…[8] Routine troponin exam in PSVT patients with low risk for coronary artery disease may lead to prolonged length of ED stay, unnecessary exam, and hospitalization. [8][9][10][11][12] However, 1 retrospective study showed elevated troponin I level appear to be associated with adverse outcomes in SVT patients with a history of CAD. [13] This produces doubts as to the prognostic significance of troponin in patients with a huge burden of cardiovascular disease.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of cardiac troponin in dialysis patients with paroxysmal supraventricular tachycardia

et al. 2022

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A rise in cardiac troponin I (cTnI) is common in supraventricular tachycardia (SVT). While troponin elevation in SVT is thought to be a predictor of future adverse events in patients with prior coronary artery disease, the prognostic significance of cTnI in endstage kidney disease (ESKD) patients with SVT are not known. We aimed to examine the prognostic significance of cTnI in ESKD patients presenting with SVT in the emergency department. This was a retrospective, multiple-center observational study utilizing regularly collected electronic medical records. We screened electronic medical records of all dialysis patients presenting to the emergency departments in 5 hospitals over 12 years with SVT. These patients were divided into whether cTnI was tested, and were further stratified into the cTnI-positive and cTnI-negative groups. The primary outcome of the study was the 3-year risk of major adverse cardiovascular events (MACE). Sixty-two patients were qualified for inclusion. Fifty-seven patients (91.9%) were tested for cTnI, and 5 patients were not. Patients with the cTnI test were older (P = .03) and had a longer length of hospital stay (P < .001). Forty-seven patients (82.5%) had a positive result, and 10 (17.5%) had a negative result. A history of hypertension (P = .013) and decreased left ventricular ejection fraction (P = .048) were the independent predictors of cTnI elevation. After a mean follow-up period of 20.6 ± 14.7 months, there were no differences in 3-year MACE between patients with or without elevated cTnI levels in Kaplan-Meier analysis (P = .34). A history of coronary artery disease was the only independent predictor of 3-year MACE (P = .017). Through the subgroup analysis, a history of coronary artery disease (HR 2.73; CI 1.01-7.41; P = .049) remained an independent risk factor for 3-year MACE in patients with elevated cTnI levels. A large proportion (82.5%) of troponin elevation was observed in ESKD patients with SVT, but it had a poor correlation with MACE.

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“…The case reported by Allen and deSouza emphasizes why troponin testing should only be ordered when type 1 myocardial infarction is suspected on clinical grounds. That is because patients with plaque rupture benefit from targeted therapies, such as dual antiplatelet therapy, statins, and revascularization.…”

mentioning

confidence: 99%

“…Drs Allen and deSouza present the case of a middle-aged man with palpitations and chest pain in the setting of supraventricular tachycardia (SVT). The symptoms resolved when the tachycardia stopped, but a troponin test ordered as part of the initial workup returned elevated results.…”

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confidence: 99%

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Updating Our Thinking on Troponin Use and Interpretation

Foy

Mandrola

2021

JAMA Intern Med

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Troponin Testing in Patients With Supraventricular Tachycardia—Are We Overtesting?

Cited by 8 publications

References 6 publications

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

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

Prognostic value of cardiac troponin in dialysis patients with paroxysmal supraventricular tachycardia

Updating Our Thinking on Troponin Use and Interpretation

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