Korean Circ J.  2014 May;44(3):141-147. 10.4070/kcj.2014.44.3.141.

Association between Cardiac Troponin Level and Coronary Flow Reserve in Patients without Coronary Artery Disease: Insight from a Thermodilution Technique Using an Intracoronary Pressure Wire

• Park K
• Kim M
• Cho YR
• Park JS
• Park TH
• Kim MH
• Kim YD

• KMID: 2145474
• DOI: http://doi.org/10.4070/kcj.2014.44.3.141

Abstract

BACKGROUND AND OBJECTIVES
Cardiac troponins are associated with increased mortality, even among patients with no coronary artery disease. Elevated cardiac troponin levels are frequently observed in patients without significant coronary lesions, although the mechanism underlying this finding is unclear. The aim of our study was to evaluate the association between the levels of cardiac troponin and coronary flow reserve (CFR).
SUBJECTS AND METHODS
We evaluated serum cardiac troponin-I in 19 patients (9 female; age 61.9+/-10.9 year-old). All patients had an ejection fraction >40% and angiographically normal coronary arteries. Simultaneous measurements of fractional flow reserve (FFR), the index of microcirculatory resistance (IMR), and CFR measurements using an intracoronary temperature- and pressure-sensing guidewire under basal conditions and during maximal hyperemia were performed in three vessels: the left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA).
RESULTS
All patients were followed for a median of 13 months. FFR, IMR, and CFR measurements were performed successfully in all subjects. Mean CFRs of LAD, LCX, and RCA were 1.98+/-1.20, 2.75+/-2.11, and 4.44+/-2.51, respectively. Mean IMRs of LAD, LCX and RCA were 33.28+/-18.78, 29.11+/-26.70, and 30.55+/-23.65, respectively. There was a poor correlation between CFR and troponin-I values in each vessel. In selecting the lowest value of CFR in each patient as the corresponding value, the lowest CFR was not associated with troponin-I levels (r=-0.219, p=0.367).
CONCLUSION
In patients without significant coronary lesions, the correlation between CFR and troponin-I level was not significant using a thermodilution technique. Further study of a larger population with longer-term follow-up may be needed to more fully understand microvascular dysfunction.

Keyword

Myocardiol coronary flow reserve; Troponin; Vascular resistance; Microvessels

MeSH Terms

Arteries
Coronary Artery Disease*
Coronary Vessels
Female
Follow-Up Studies
Humans
Hyperemia
Microvessels
Mortality
Thermodilution*
Troponin I
Troponin*
Vascular Resistance
Troponin
Troponin I

Figure

• 

  Fig. 1 Study design.

• 

  Fig. 2 Scatterplot of troponin-I versus CFR in LAD (A), LCX (B), and RCA (C). CFR: coronary flow reserve, LAD: left anterior descending artery, LCX: left circumflex artery, RCA: right coronary artery.

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  Fig. 3 Correlation between the lowest CFR value measured by thermodilution and cardiac troponin-I (CFR: horizontal axis; cardiac troponin-I: vertical axis). CFR: coronary flow reserve.

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  Fig. 4 Scatterplot of troponin-I versus IMR in LAD (A), LCX (B), and RCA (C). IMR: index of microcirculatory resistance, LAD: left anterior descending artery, LCX: left circumflex artery, RCA: right coronary artery.

• 

  Fig. 5 Correlation between the highest IMR value measured by thermodilution and cardiac troponin-I (IMR: horizontal axis; cardiac troponin-I: vertical axis). IMR: index of microcirculatory resistance.

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