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Published on: February 28, 2012
Troponin T elevation after implanted defibrillator discharge predicts survival
D Blendea1, M Blendea, J Banker
1Department of Medicine, Cardiac Electrophysiology Service, Bridgeport Hospital, Yale University School of Medicine, Bridgeport, CT 06610, USA. dblendea@me.com
Insights
Elevated cardiac troponin T (cTnT) after implantable cardioverter-defibrillator (ICD) discharges indicates a higher risk of mortality. This finding is independent of other known survival predictors in patients receiving ICD therapy.
Area of Science:
- Cardiology
- Electrophysiology
- Biomarkers
Background:
- Cardiac troponin T (cTnT) elevations are observed post-implantable cardioverter-defibrillator (ICD) discharge.
- The prognostic value of these cTnT elevations remains unclear.
Purpose of the Study:
- To determine if cTnT elevations after ICD discharges impact patient survival.
- Investigate the independent prognostic significance of post-discharge cTnT levels.
Main Methods:
- Prospective observational study of 174 patients undergoing spontaneous or induced ICD discharges.
- Measured cTnT levels 12-24 hours post-discharge; assessed relationship with all-cause mortality via univariate and multivariate analyses.
Main Results:
- A median follow-up of 41.8 months revealed 56 deaths.
- Patients with cTnT levels ≥0.05 ng/ml exhibited significantly worse survival.
- The association between elevated cTnT and mortality persisted after adjusting for clinical factors.
Conclusions:
- Elevated cTnT after ICD discharge is an independent risk factor for mortality.
- This risk is present even after device testing and is not explained by common clinical predictors.
Background:
Cardiac troponin T (cTnT) elevations have been reported to occur after implantable cardioverter-defibrillator (ICD) discharges, but their prognostic significance is unknown.
Objective:
To evaluate whether cTnT elevations occurring after ICD discharges have an impact on survival.
Design:
Prospective observational study.
Patients:
174 patients (mean (SD) age 68 (12) years, 32 women) who received spontaneous (n = 66) or induced (n = 108) ICD discharges were studied. The mean (SD) left ventricular ejection fraction was 29 (11)%.
Main Outcome Measures:
Troponin T was measured between 12 and 24 h after ICD discharge. Patients received between 1 and 19 discharges (mean (SD) 2.4 (2.4)), with total delivered energy ranging from 6 to 288 J (mean (SD) 41 (63) J). The relationship between cTnT levels and all-cause mortality was assessed in univariate and multivariate analyses.
Results:
During a median follow-up period of 41.8 months (range 3-123), 56 patients died. Patients with a post-discharge cTnT level of >/=0.05 ng/ml had worse survival than those with cTnT <0.05 ng/ml. The significant relationship between raised cTnT and survival was retained in Cox multivariate analysis adjusted for total ICD energy delivered during an arrhythmia episode, age, sex, presence of coronary artery disease, left ventricular ejection fraction and serum creatinine.
Conclusions:
Elevation of troponin T after ICD discharge, even when it occurs after device testing, is a risk factor for mortality that is independent of other common clinical factors that predict survival in such patients.
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