High sensitive troponin-I in patients with slow coronary flow pattern
Mehmet Erturk1, Fatma Nihan Caglar, Ozgur Surgit
1Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey. drerturk@gmail.com.
Insights
High-sensitive cardiac troponin-I (HsTn-I) is not elevated in patients with slow coronary flow (SCF) despite its detectability. This finding differentiates SCF from coronary artery disease (CAD) in chest pain evaluations.
Area of Science:
- Cardiology
- Biomarkers
- Diagnostic Medicine
Background:
- Slow coronary flow (SCF) is a condition characterized by delayed distal embolization in epicardial coronary arteries despite the absence of obstructive coronary artery disease.
- Elevated cardiac biomarkers, such as high-sensitive cardiac troponin-I (HsTn-I), are typically indicative of myocardial injury.
- The role of HsTn-I in patients with SCF pattern remains incompletely understood.
Purpose of the Study:
- To investigate the hypothesis that HsTn-I levels are elevated in patients diagnosed with SCF.
- To compare HsTn-I levels in patients with SCF, coronary artery disease (CAD), and normal coronary arteries.
Main Methods:
- Coronary angiography (CAG) was performed on 97 patients presenting with chest discomfort and indications for the procedure.
- Patients were categorized into three groups: SCF pattern (n=39), CAD (n=28), and normal coronary arteries (n=30).
- Plasma HsTn-I levels were measured and compared across the groups, along with an analysis of cardiovascular risk factors and TIMI frame count.
Main Results:
- TIMI frame count was significantly higher in the SCF group compared to both CAD and normal coronary artery groups (p < 0.001).
- HsTn-I positivity did not differ significantly between the SCF and normal coronary artery groups (p = 0.512).
- HsTn-I positivity was significantly higher in the CAD group compared to the SCF and normal coronary artery groups (p < 0.001).
Conclusions:
- HsTn-I may be detectable in patients with SCF, but its levels are not significantly elevated compared to individuals with normal coronary arteries.
- The findings suggest that elevated HsTn-I is not a characteristic feature of the SCF pattern itself, distinguishing it from obstructive CAD.
Hypothesis:
We examined the hypothesis that a specific myocardial injury marker, namely high sensitive cardiac troponin-I (HsTn-I), is elevated in patients with slow coronary flow (SCF) pattern.
Aim:
To examine the above hypothesis by studying a group of patients who had undergone coronary angiography for the detection of their chest pain aetiology with SCF pattern despite an angiographically normal coronary arteriogram.
Methods:
We evaluated and performed coronary angiography (CAG) of 97 patients with chest discomfort. The indication forCAG was at least Canada class 3 angina and/or proven myocardial ischaemia according to noninvasive diagnostic tests. We further divided patients into three subgroups according to CAG images and compared HsTn-I plasma levels in 39 patients with SCF pattern, 28 patients with coronary artery disease (CAD), and 30 patients with normal coronary arteries. We researched the association between qualitative HsTn-I positivity and demographic features including cardiovascular risk factors, inflammation markers and TIMI frame count for each of the epicardial coronary arteries.
Results:
TIMI frame count for each epicardial coronary artery was significantly higher in patients with SCF pattern than in patients with CAD and normal coronary arteries (p < 0.001). HsTn-I positivity was not statistically different between patients with SCF pattern and normal coronary arteries (p = 512), but it was significantly higher in the CAD group than the other two group of patients (p < 0.001).
Conclusions:
In patients with SCF, HsTn-I may be detectable, but it is not elevated as in patients with normal coronary arteries.
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