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Elevated Troponin I in patients with no or non-obstructive coronary arterial disease; Characterization by Cardiac MRI

Introduction

Patients with elevated Troponin I (Tn-I) are frequently referred for cardiac catheterization, but the absence of obstructive coronary arterial disease leads to diagnostic questions. Cardiac MRI (cMRI) is a powerful tool for characterizing myocardial abnormalities, and the use of contrast-enhanced techniques can determine the underlying pathology.

Purpose

cMRI can define the etiology of elevated Tn-I in patients with non-obstructive disease, and may help define prognosis.

Methods

All patients with non-obstructive CAD by coronary angiography (<50% luminal stenosis) and an elevated Tn-I who were referred for contrast-enhanced cMRI were retrospectively identified for the period of 11/29/2004-6/28/2008. Patients were subdivided based on cMRI findings: 1)Normal, 2)Ischemic Disease, 3)Myocarditis, 4)Tako-tsubo, and 5)Non-Ischemic Cardiomyopathy (NICM). Clinical characteristics (age, sex), Tn-I level, and ejection fraction (EF) were reviewed, as well as survival using the social security death index.

Results

53 patients met the inclusion criteria. Twenty had normal angiograms, 33 had non-obstructive disease. Six (11%) had Normal cMRI parameters, 12(23%) had Ischemic disease, 12(23%) Myocarditis, 14(26%) Tako-Tsubo, and 9(17%) NICM. There was no significant difference in age (standard deviation (SD) in parentheses) 44.4(14.7), 56.1(7.5), 49.2(18.5), 57.0(11.8), and 54.4(15.1) respectively and Tn-I, 3.6(2.5), 26.2(48.1), 11.7(17.3), 2.6(2.1), and 2.5(2.5). The EF did vary in the groups (p < 0.05), 67.5(10.5), 59.8(14.2), 51.0(15.3), 50.6(10.8), and 39.1(8.8) respectively. Patients were followed up for 2.1 ± 1.0 years. There were 6 deaths [3 in the NICM group, 2 in myocarditis, and 1 in the normal group (P = 0.16)], Table 1.

Table 1 Table 1

Conclusion

Contrast enhanced cMRI is a useful modality in differentiating the conditions causing elevated Troponin I in setting of a non-obstructive coronary angiogram. Further follow-up is needed to ascertain the prognostic significance of cMRI findings.

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Correspondence to Bharat Singh.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Singh, B., Fuisz, A.R. & Weissman, G. Elevated Troponin I in patients with no or non-obstructive coronary arterial disease; Characterization by Cardiac MRI. J Cardiovasc Magn Reson 12, P298 (2010). https://doi.org/10.1186/1532-429X-12-S1-P298

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Keywords

  • Ejection Fraction
  • Cardiomyopathy
  • Myocarditis
  • Coronary Angiogram
  • Elevated Troponin