Open Access Review Article

Interpreting Troponin Elevation in The Setting of Infective Endocarditis: Causes and Prognostic Value

Ronan Canitrot1, Clement Delmas1, Clémence Delon1, Caroline Biendel1, Lydie Porte2, Fréderic Bouisset1, Clémence Laperche1, François Labaste3, Meyer Elbaz1, Didier Carrié1, Michel Galinier1, Yoan Lavie Badie1,4,5 and Jérôme Roncalli1*

1Department of Cardiology, Institute Cardiomet, University Hospital of Toulouse, France

2Department of Infectious Diseases, University Hospital of Toulouse, Toulouse, France

3Department of Anesthesiology, University Hospital of Toulouse, Toulouse, France

4Department of Nuclear Medicine, University Hospital of Toulouse, France

5Heart Valve Center, University Hospital of Toulouse, France

Corresponding Author

Received Date:June 21, 2022;  Published Date:July 08, 2022

Abstract

Background: Measurement of cardiac troponin (cTn) levels in blood is standard for diagnosis and risk stratification in cardiac emergencies. Our aim is to investigate the causes, the link with the underlying coronary artery disease and prognostic value of cTn release in infective endocarditis (IE).

Method: Eighty-six consecutive patients hospitalized for acute IE, with at least one cTn drawn and a coronary angiogram performed, were reviewed retrospectively. Factors related to the increase of cTn above the 99th percentile or above 10 times normal (>10N), as well as their prognostic impact, were assessed.

Results: The mean patient age was 63 +/ 14 years, the majority were men (n=68, 79%) with staphylococcus IE (n=34, 40%). Cardiac troponins were elevated above the 99th percentile for 74 (86%) patients and >10 N for 25 (29%) patients. There was no statistically significant correlation between elevated cTn and the presence of an underlying coronary artery disease. Cardiac troponin elevation above the 99th percentile was significantly associated with impaired renal function (p=0.04) and staphylococcus infection (p=0.02). A rise of cTn >10N was significantly associated with acute pulmonary edema (p=0.001), myocardial abscess (p=0.01), staphylococcus (p=0.0004), streptococcus (p=0.008), and renal function (p=0.0001). The average follow-up period was 919+/-816 days, and an elevation of cTn>10 N had a clear prognostic impact (HR 2.38, 95%CI 1.18-4.84, p=0.01).

Conclusion: Troponin elevation in IE is frequent and appears to be related to direct and indirect myocardial injury. It is associated with a poor prognosis.

Keywords:Coronary artery disease; Cardiac troponin; Infective endocarditis

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