Korean J Med.  2005 Nov;69(5):487-492.

Causes of elevated cardiac troponin I in patients with normal coronary angiogram

• Bae WH
• Chun KJ
• Oh JH
• Lee DW
• Ahn BJ
• Kim SH
• Lee JS
• Kim MY
• Lee HG
• Ko WS
• Park YH
• Kim J
• Kim JH
• Hong TJ
• Shin YW

Abstract

BACKGROUND: Cardiac troponin I (cTnI) is most recently described and has nearly absolute myocardial tissue specificity, as well as high sensitivity. But an increased value for cTnI that indicates myocardial injury is not always synonym of myocardial infarction or ischemia due to coronary artery disease.
METHODS
Retrospective follow-up study for whom underwent coronary angiography for suspected coronary artery disease was done if they had an elevated cTnI value and angiographically normal or minimal disease.
RESULTS
33 patients were qualified. Cut-off value for elevated cTnI was 0.06 ng/mL. Increased cTnI values were attributed to severe congestive heart failure in 7 patients, variant angina in 7 patients, myocarditis in 5 patients, pericarditis in 1 patient, severe myocardial bridge in 1 patient, rhabdomyolysis in 1 patient and cerebral infarction in 1 patient. Tachycardia was precipitating cause in 4 patients (sinus tachycardia, paroxysmal supraventricular tachycardia, paroxysmal atrial fibrillation and sustained ventricular tachycardia for each), two of whom had hemodynamic compromise. 2 of 33 patients had no identifiable cause for a rise in cTnI value. There was no acute myocardial infarction at 42+/-34 weeks follow-up.
CONCLUSIONS
Although cTnI is a sensitive and specific marker of myocardial injury, an elevation of cTnI value may have a cause other than myocardial infarction or ischemia and may occur without significant angiographic coronary artery disease.

Keyword

Coronary angiography; Myocardial infarction; Troponin; Troponin I

MeSH Terms

Atrial Fibrillation
Cerebral Infarction
Coronary Angiography
Coronary Artery Disease
Follow-Up Studies
Heart Failure
Hemodynamics
Humans
Ischemia
Myocardial Infarction
Myocarditis
Organ Specificity
Pericarditis
Retrospective Studies
Rhabdomyolysis
Tachycardia
Tachycardia, Paroxysmal
Tachycardia, Supraventricular
Tachycardia, Ventricular
Troponin I*
Troponin*
Troponin
Troponin I