Usefulness of an elevated troponin-I in predicting clinical events in patients admitted with acute heart failure and acute coronary syndrome (from the RITZ-4 trial)

AbstractTakotsubo cardiomyopathy (TCM) is triggered by multiple physical and psychological stressors and frequently mimics acute coronary syndrome. Acute alcohol intoxication as a trigger for TCM has been rarely reported as TCM is usually associated with alcohol withdrawal, not intoxication. The authors report a 41-year-old woman with polysubstance and alcohol abuse history, who presented with acute alcohol intoxication and electrocardiogram demonstrating ventricular tachycardia with syncope. Laboratory parameters revealed elevated Troponin-I and metabolic acidosis. Coronary angiogram was unrevealing for coronary atherosclerosis and she was managed conservatively for acute heart failure from TCM.

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Risk Stratification for Heart Failure and Death in an Acute Coronary Syndrome Population Using Inflammatory Cytokines and N-Terminal Pro-Brain Natriuretic Peptide

Clinical Chemistry ◽

10.1373/clinchem.2007.090613 ◽

2007 ◽

Vol 53 (12) ◽

pp. 2112-2118 ◽

Cited By ~ 41

Author(s):

Peter A Kavsak ◽

Dennis T Ko ◽

Alice M Newman ◽

Glenn E Palomaki ◽

Viliam Lustig ◽

...

Keyword(s):

Heart Failure ◽

Acute Coronary Syndrome ◽

Risk Stratification ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Troponin I ◽

Significant Risk ◽

Risk Of Death ◽

Coronary Syndrome

Abstract Background: Inflammation in acute coronary syndrome (ACS) can identify those at greater long-term risks for heart failure (HF) and death. The present study assessed the performance of interleukin (IL)-6, IL-8, and monocyte chemoattractant protein-1 (MCP-1) (cytokines involved in the activation and recruitment of leukocytes) in addition to known biomarkers [e.g., N-terminal pro-brain natriuretic peptide (NT-proBNP)] for predicting HF and death in an ACS population. Methods: In a cohort of 216 ACS patients, NT-proBNP (Elecsys®; Roche) and IL-6, IL-8, and MCP-1 (evidence investigator™; Randox) were measured in serial specimens collected early after symptom onset (n = 723). We collected at least 2 specimens from each participant: an early specimen (median 2 h; interquartile range 2–4 h) and a later specimen (9 h; 9–9 h), and used the later specimens’ biomarker concentrations for risk stratification. Results: An increase in both IL-6 and NT-proBNP was observed but not for IL-8 or MCP-1 early after pain onset. Kaplan–Meier analysis demonstrated that individuals with increased NT-proBNP (>183 ng/L) or cytokines (IL-6 > 6.4 ng/L; above upper limit of normal for IL-8 or MCP-1) had a greater probability of death or HF in the following 8 years (P <0.05). In a Cox proportional hazard model adjusted for both CRP and troponin I, increased IL-6, MCP-1, and NT-proBNP remained significant risk factors. Combining all 3 biomarkers resulted in a higher likelihood ratio for death or HF than models restricted to any 2 of these biomarkers. Conclusion: IL-6, MCP-1, and NT-proBNP are independent predictors of long-term risk of death or HF, highlighting the importance of identifying leukocyte activation and recruitment in ACS patients.

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