Troponins in scuba divers with immersion pulmonary edema

Abstract

Immersion pulmonary edema (IPE) is a serious complication of water immersion during scuba diving. Myocardial ischemia can occur during IPE that worsens outcome. Because myocardial injury impacts the therapeutic management, we aim to evaluate the profile of cardiac markers (creatine phosphokinase (CPK), brain natriuretic peptide (BNP), highly sensitive troponin T (TnT-hs) and ultrasensitive troponin I (TnI-us) of divers with IPE. Twelve male scuba divers admitted for suspected IPE were included. The collection of blood samples was performed at hospital entrance (T0) and 6 h later (T0 + 6 h). Diagnosis was confirmed by echocardiography or computed-tomography scan. Mean ± S.D. BNP (pg/ml) was 348 ± 324 at T0 and 223 ± 177 at T0 + 6 h (P<0.01), while mean CPK (international units (IUs)), and mean TnT-hs (pg/ml) increased in the same times 238 ± 200 compared with 545 ± 39, (P=0.008) and 128 ± 42 compared with 269 ± 210, (P=0.01), respectively; no significant change was observed concerning TnI-us (pg/ml): 110 ± 34 compared with 330 ± 77, P=0.12. At T0 + 6 h, three patients had high TnI-us, while six patients had high TnT-hs. Mean CPK was correlated with TnT-hs but not with TnI-us. Coronary angiographies were normal. The increase in TnT during IPE may be secondary to the release of troponin from non-cardiac origin. The measurement of TnI in place of TnT permits in some cases to avoid additional examinations, especially unnecessary invasive investigations.

Galectin-3 and Cardiovascular Biomarkers Reflect Adaptation Response to Scuba Diving

“…Several studies have ob-served a significant increase in the plasma level of N-terminal prohormone of brain natriuretic peptide (NT-proBNP), a myocardial stress/stretching biomarker, after diving at low depths (10 or 15 meters) during 30-60 min [6][7][8]. However, cardiac troponin-I (TnI), a myocardial injury biomarker, level has only been measured in patients with decompression sickness [9] or immersion pulmonary edema [9,10]. A study on the effects of technical diving, which differs from rSCUBA diving because it allows dives deeper than 40 m with an obligatory decompression stop [11,12], on the vascular antioxidant system detected the decrease in endothelin-1 (ET-1) and increase in vascular endothelial growth factor (VEGF) immediately after diving [13].…”

Snorkeling Induced Pulmonary Edema: A Case Report and Review of the Literature

“…An increase in troponin T level has been seen in IPE attributed to reversible myocardial ischemia [30]. Since therapeutic management is impacted by myocardial injury hence cardiac biomarkers may contribute to screening of patients with IPE [31]. IPE can be differentiated from decompression sickness (DCS) by the levels of cardiac markers as shown by Louge et al [32].…”

“…IPE can be differentiated from decompression sickness (DCS) by the levels of cardiac markers as shown by Louge et al [32]. They founded that copeptin (a surrogate marker for antidiuretic hormone and a stress marker), ischemia-modified albumin (an ischemia/hypoxia marker), BNP (a marker of heart failure) and ultrasensitive-cardiac troponin-I (cTnI) are elevated in IPE versus DCS [12,31]. It is important to differentiate SIPE from DCS as a hyperbaric chamber, used for the treatment of DCS, is not indicated and could cause more harm in SIPE [12].…”

Fatal diving: could it be an immersion pulmonary edema? Case report

“…The occurrence of IPE is favored by cold water, hypertension, strenuous exercise, and thigh wetsuits. Its incidence is estimated at 1.1% of all diving accidents [3,[7][8][9][10]. However, IPE is largely underdiagnosed, since it can remain asymptomatic, and is often underrecognized by medical and forensic practitioners [6].…”

“…Symptoms often develop within 10 min after immersion and worsen during ascent [ 6 , 12 ]. Patients classically experience dyspnoea, frothy sputum, and/or haemoptysis, with possible dizziness, loss of consciousness, and even death [ 3 , 4 , 7 , 8 , 10 ].…”