1Universitätsklinikum Leipzig Klinik und Poliklinik für Kardiologie Leipzig, Deutschland
Background:
Highly sensitive cardiac troponin T (hs-cTnT) is an essential biomarker in the detection of myocardial injury. Elevated serum concentrations in hospitalized patients are frequent and often measured in elderly patients without typical cardiac symptoms. The clinical meaning of elevated hs-cTnT in this population is unknown. Previous studies on hospitalized and population-based cohorts showed significantly higher hs-cTnT serum concentrations in hospitalized patients but are hampered by retrospective design and selection bias. We aimed to prospectively evaluate the impact of hospitalization on hs-cTnT serum concentrations in three well-defined non-cardiac diseases of different severity. We hypothesized, that especially painful conditions with possible circulatory effects were associated with elevated hs-cTnT values, which decrease after recovery.
Methods:
We prospectively included 173 patients aged above 50 years with unplanned hospitalization due to one of three non-cardiac diseases with different pain levels and circulatory effects. Group A (no pain, no circulatory effect): 70 patients with acute ablatio retinae, group B (pain, mild circulatory effect): 21 patients with acute painful gastrointestinal conditions without bleeding or shock, and group C (pain and moderate circulatory effect): 82 patients with fracture of one extremity. We used the numerical rating scale (NRS) to classify the pain at the time of hospitalization. Hs-cTnT was measured twice: at hospitalization (t1) and in the ambulatory setting, minimal 60 days after recovery (t2). 99 patients were reevaluated at t2 (A: 55; B: 12; C: 32). Differences between the groups were computed using the Mann-Whitney U test, between t1 and t2 using the Wilcoxon Rank test (jamovi 2.4, p<0.05 considered statistically significant).
Results:
We found significant differences in baseline characteristics between groups (table). We saw higher proportions of patients with hs-cTnT values above the assay’s upper reference limit of 14 ng/L in groups B and C (t1 and t2). At hospitalization and follow up, the hs-cTnT values were significantly higher for groups B and C compared to group A. Within the groups we could find significant differences in the hs-cTnT values between t1 and t2 which are shown in the table.
|
time |
|
group A (ophthalmology) |
group B (gastroenterology) |
group C (trauma surgery) |
|
t1 (hospitalization, all patients) |
n |
70 |
21 |
82 |
|
age (mean±SD) |
62.7 ± 7.7 |
62.1 ± 9.8 |
70.7 ± 10.4 | |
|
female n (%) |
25 (36) |
9 (43) |
45 (55) | |
|
hs-cTnT in ng/L (median, IQR) |
6.6, 4.5 – 9.3 |
6.7, 5.5 – 14.5 |
12.2, 7.1 – 17.7 | |
|
n >14 ng/L (%) |
3 (4) |
6 (29) |
33 (40) | |
|
pain (NRS) (mean±SD) |
0.5 ± 1.4 |
8.3 ± 2.7 |
7.4 ± 2.5 | |
|
patients with troponin at both timepoints (t1 + t2) |
n (%) |
55 (79) |
12 (57) |
32 (39) |
|
age (mean+SD) |
63.3 ± 7.8 |
65.8 ± 10.0 |
68,4 ± 9.8 | |
|
female n (%) |
20 (36) |
5 (42) |
17 (53) | |
|
hs-cTnT in ng/L t1 (median, IQR) |
6.5, 4.5 – 9.3 |
10.3, 5.7 – 20.8 |
10.4, 6.5 – 14.0 | |
|
hs-cTnT in ng/L t2 (median, IQR) |
7.2, 5.2 – 9.0 |
9.5, 6.7 – 16.1 |
11.8, 9.1 – 16.5 | |
|
n >14 ng/L (%) t1 |
3 (5) |
5 (42) |
8 (25) | |
|
n >14 ng/L (%) t2 |
4 (7) |
4 (33) |
14 (44) | |
|
comparison t1 vs. t2 |
hs-cTnT |
p=0.001 |
p=0.6 |
p=0.003 |
Conclusion:
Between 4 and 44 % of patients had elevated hs-cTnT values and the acute illnesses leading to hospitalization had no major impact on hs-cTnT. Elevated hs-cTnT likely reflects underlying cardiovascular disease but is not relevantly aggravated by the acute illness. Current reference values for hs-cTnT might be too low for an elderly and comorbid population.