open access
Vol 24, No 6 (2017)
Original articles — Clinical cardiology
Submitted: 2016-12-16
Accepted: 2017-05-02
Published online: 2017-05-19
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Elevated high-sensitivity troponin does not indicate the presence of coronary artery disease in patients presenting with supraventricular tachycardia
1, 1, 1, 1, 1, 1
Affiliations- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
open access
Vol 24, No 6 (2017)
Original articles — Clinical cardiology
Submitted: 2016-12-16
Accepted: 2017-05-02
Published online: 2017-05-19
Abstract
Background: Patients with supraventricular tachycardia (SVT) and patients with coronary artery disease (CAD) often present with similar symptoms (chest pain, shortness of breath), similar electrocar¬diographic changes and elevated high-sensitivity troponin (Tn). It is not clear whether troponin reflects critical CAD or is elevated due to other causes in patients presenting with SVT. The aim of this study was to assess the role of elevated troponin in patients presenting with SVT.
Methods: Patients undergoing radiofrequency ablation (RFA) for SVT and simultaneous coronary an¬giography at the Heart Centre Lucerne, Switzerland between January 2010 and October 2014 were in¬cluded in this analysis. Significant CAD was defined as diameter-stenosis ≥ 75% in vessels > 2.0 mm. The level of Tn was compared between patients with the presence or absence of CAD on coronary angi¬ography. A Tn value of ≥ 0.014 μg/L was considered as elevated.
Results: During the study period a total of 473 patients underwent RFA for SVT. The study population consisted of 326 patients (69%, mean age 60 ± 12 years) who underwent invasive coronary angiogra¬phy during the same session. The prevalence of significant CAD was 14% (45/326 patients). The highest prevalence of CAD was found in patients with atrial flutter (35%, 18/45 patients). Tn was elevated in 83% (10/12 patients) with significant CAD and in 47% (26/55 patients) without CAD.
Conclusions: The prevalence of CAD is low in patients with SVT, which questions the role of routine invasive coronary angiography during RFA. Tn measurement did not reliably exclude or confirm CAD in these patients.
Abstract
Background: Patients with supraventricular tachycardia (SVT) and patients with coronary artery disease (CAD) often present with similar symptoms (chest pain, shortness of breath), similar electrocar¬diographic changes and elevated high-sensitivity troponin (Tn). It is not clear whether troponin reflects critical CAD or is elevated due to other causes in patients presenting with SVT. The aim of this study was to assess the role of elevated troponin in patients presenting with SVT.
Methods: Patients undergoing radiofrequency ablation (RFA) for SVT and simultaneous coronary an¬giography at the Heart Centre Lucerne, Switzerland between January 2010 and October 2014 were in¬cluded in this analysis. Significant CAD was defined as diameter-stenosis ≥ 75% in vessels > 2.0 mm. The level of Tn was compared between patients with the presence or absence of CAD on coronary angi¬ography. A Tn value of ≥ 0.014 μg/L was considered as elevated.
Results: During the study period a total of 473 patients underwent RFA for SVT. The study population consisted of 326 patients (69%, mean age 60 ± 12 years) who underwent invasive coronary angiogra¬phy during the same session. The prevalence of significant CAD was 14% (45/326 patients). The highest prevalence of CAD was found in patients with atrial flutter (35%, 18/45 patients). Tn was elevated in 83% (10/12 patients) with significant CAD and in 47% (26/55 patients) without CAD.
Conclusions: The prevalence of CAD is low in patients with SVT, which questions the role of routine invasive coronary angiography during RFA. Tn measurement did not reliably exclude or confirm CAD in these patients.
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Keywords
coronary artery disease, prevalence of coronary artery disease, supraventricular tachycardia, high-sensitivity troponin, radiofrequency ablation
About this articleTitle
Elevated high-sensitivity troponin does not indicate the presence of coronary artery disease in patients presenting with supraventricular tachycardia
Journal
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642-648
Published online
2017-05-19
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DOI
Pubmed
Bibliographic record
Cardiol J 2017;24(6):642-648.
Keywords
coronary artery disease
prevalence of coronary artery disease
supraventricular tachycardia
high-sensitivity troponin
radiofrequency ablation
Authors
Martin Murer
Florim Cuculi
Stefan Toggweiler
Vanessa Weberndoerfer
Mabelle Young
Richard Kobza
References (26)- Blomström-Lundqvist C, Scheinman MM, Aliot EM, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias). Circulation. 2003; 108(15): 1871–1909.
- Camm AJ, Lip GYH, De Caterina R, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012; 33(21): 2719–2747.
- Orejarena LA, Vidaillet H, DeStefano F, et al. Paroxysmal supraventricular tachycardia in the general population. J Am Coll Cardiol. 1998; 31(1): 150–157.
- Sclarovsky S, Bassevich R, Klainman E, et al. Unstable angina with tachycardia: clinical and therapeutic implications. Am Heart J. 1988; 116(5 Pt 1): 1188–1193.
- Gassenmaier T, Buchner S, Birner C, et al. High-sensitive Troponin I in acute cardiac conditions: implications of baseline and sequential measurements for diagnosis of myocardial infarction. Atherosclerosis. 2012; 222(1): 116–122.
- Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Eur Heart J. 2012; 33(20): 2551–2567.
- Reichlin T, Hochholzer W, Bassetti S, et al. Early Diagnosis of Myocardial Infarction with Sensitive Cardiac Troponin Assays. New England Journal of Medicine. 2009; 361(9): 858–867.
- Rubin Gimenez M, Twerenbold R, Jaeger C, et al. One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I. Am J Med. 2015; 128(8): 861–870.e4.
- Korff S, Katus HA, Giannitsis E. Differential diagnosis of elevated troponins. Heart. 2006; 92(7): 987–993.
- Miranda RC, Machado MN, Takakura IT, et al. Elevated troponin levels after prolonged supraventricular tachycardia in patient with normal coronary angiography. Cardiology. 2006; 106(1): 10–13.
- Yeo KK, Cruz L, Hong R. Tachycardia-induced elevations in cardiac troponin in the absence of coronary artery disease. Hawaii Med J. 2006; 65(3): 86–87.
- Redfearn DP, Ratib K, Marshall HJ, et al. Supraventricular tachycardia promotes release of troponin I in patients with normal coronary arteries. Int J Cardiol. 2005; 102(3): 521–522.
- Kappetein AP, Dawkins KD, Mohr FW, et al. Current percutaneous coronary intervention and coronary artery bypass grafting practices for three-vessel and left main coronary artery disease. Insights from the SYNTAX run-in phase. Eur J Cardiothorac Surg. 2006; 29(4): 486–491.
- Latini R, Masson S, Anand IS, et al. Val-HeFT Investigators. Prognostic value of very low plasma concentrations of troponin T in patients with stable chronic heart failure. Circulation. 2007; 116(11): 1242–1249.
- SalimRezaie G. Do Elevated Troponins during Supraventricular Tachycardia (SVT) Predict the Presence of Coronary Artery Disease? Emergency Medicine: Open Access. 2013; 03(04).
- Chow GV, Hirsch GA, Spragg DD, et al. Prognostic significance of cardiac troponin I levels in hospitalized patients presenting with supraventricular tachycardia. Medicine. 2010; 89(3): 141–148.
- Fonarow G, Peacock W, Horwich T, et al. Usefulness of B-Type Natriuretic Peptide and Cardiac Troponin Levels to Predict In-Hospital Mortality from ADHERE. Am J Cardiol. 2008; 101(2): 231–237.
- Henrikson CA, Howell EE, Bush DE, et al. Prognostic usefulness of marginal troponin T elevation. Am J Cardiol. 2004; 93(3): 275–279.
- Horwich TB, Patel J, MacLellan WR, et al. Cardiac troponin I is associated with impaired hemodynamics, progressive left ventricular dysfunction, and increased mortality rates in advanced heart failure. Circulation. 2003; 108(7): 833–838.
- Khan NA, Hemmelgarn BR, Tonelli M, et al. Prognostic value of troponin T and I among asymptomatic patients with end-stage renal disease: a meta-analysis. Circulation. 2005; 112(20): 3088–3096.
- Alcalai R, Planer D, Culhaoglu A, et al. Acute coronary syndrome vs nonspecific troponin elevation: clinical predictors and survival analysis. Arch Intern Med. 2007; 167(3): 276–281.
- Waxman DA, Hecht S, Schappert J, et al. A model for troponin I as a quantitative predictor of in-hospital mortality. J Am Coll Cardiol. 2006; 48(9): 1755–1762.
- Moore JP, Arcilla L, Wang S, et al. Characterization of Cardiac Troponin Elevation in the Setting of Pediatric Supraventricular Tachycardia. Pediatr Cardiol. 2016; 37(2): 392–398.
- Lim C, Gaal Wv, Testa L, et al. With the “Universal Definition,” Measurement of Creatine Kinase-Myocardial Band Rather Than Troponin Allows More Accurate Diagnosis of Periprocedural Necrosis and Infarction After Coronary Intervention. Journal of the American College of Cardiology. 2011; 57(6): 653–661.
- Lloyd-Jones D, Wilson P, Larson M, et al. Framingham risk score and prediction of lifetime risk for coronary heart disease. The American Journal of Cardiology. 2004; 94(1): 20–24.
- Diez M, Talavera ML, Conde DG, et al. High-sensitivity troponin is associated with high risk clinical profile and outcome in acute heart failure. Cardiol J. 2016; 23(1): 78–83.
