Elevated cardiac troponin I (cTnI) levels had prognostic value for paroxysmal supraventricular tachycardias (PSVT) only when the condition was associated with a history of coronary artery disease, according to a study published in the Journal of Electrocardiology.
In this retrospective, single-center, observational study, the data of 165 patients (mean age 55 ± 17 years; 60% men) who presented to the emergency department with an acute episode of regular supraventricular tachyarrhythmia (based on American College of Cardiology criteria) between January 2014 and December 2016 were examined. Of these patients, 131 had ≥1 serum cTnI value measured. Patients were categorized according to their cTnI level: 57 had a positive result (ie, cTnI >0.028 ng/dL), and 74 patients had a negative result.
A heart rate >150 beats per minute at admission (odds ratio [OR], 3.9; 95% CI 1.1.6-9.5; P <.003) and a history of CAD (OR, 3.4; 95% CI 1.2-10.1; P =.026) were found to be the only independent predictors of cTnI elevation in a multivariate analysis.
After a mean follow-up of 23±7 months, the combined primary outcome of death, percutaneous coronary intervention, or myocardial infarction occurred in 7 patients (12.3%) with positive cTnI and in none of the patients with negative cTnI (P =.002). Elevated cTnI at admission was found to be an independent predictor of adverse outcomes only in patients with known CAD (hazard ratio, 3.3, P = .05) in Cox proportional hazards modeling.
Study limitations include its retrospective design, the small number of patients, and the limited follow-up time which may have limited the ability to detect some outcomes.
“In troponin-positive patients at elevated risk [for] underlying coronary artery disease, a noninvasive coronary assessment seems reasonable,” noted the investigators. “Based on our findings, we believe it is prudent to measure cTnI in [patients with] PSVT on a selective basis, such as in patients with symptoms of ischemic chest pain and a considerable pretest likelihood of having coronary artery disease.”
Ghersin I, Zahran M, Azzam ZS, et al. Prognostic value of cardiac troponin levels in patients presenting with supraventricular tachycardias. J Electrocardiol. 2020;62:200-203.