Clinical Determinants of Myocardial Injury, Detectable and Serial Troponin Levels among Patients with Hypertensive
Giancarlo Acosta1, Ahmed Amro1, Rodrigo Aguilar2
1Cardiology, Marshall University, Huntington, USA.
Insights
Hypertensive crisis often presents with detectable troponin, but myocardial injury is less common. Low body mass index (BMI) is paradoxically linked to higher troponin levels in these patients.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Biochemistry
Background:
- Hypertensive crisis frequently co-occurs with myocardial injury, indicated by elevated cardiac troponin.
- Risk factors for troponin elevation and myocardial injury in hypertensive crisis are not well-defined.
Purpose of the Study:
- To identify predictors of myocardial injury (troponin elevation >99th percentile URL), detectable troponin (>0.015 ng/ml), and increased serial troponin levels in patients with hypertensive crisis.
Main Methods:
- Retrospective study of 467 patients diagnosed with hypertensive crisis (ICD-10-CM codes) between 2016-2018.
- Logistic regression analysis was employed to determine significant risk factors.
Main Results:
- 15% of patients experienced myocardial injury; risk factors included congestive heart failure (CHF) and prior aspirin use, while lower BMI (<30 kg/m2) was protective.
- 35% had detectable troponin; associated factors were CHF, elevated creatinine, and younger age (<61 years), with lower BMI being protective.
- Factors for increased serial troponin included CHF, coronary artery disease (CAD), and non-Caucasian race; lower BMI was again protective.
Conclusions:
- A significant proportion of hypertensive crisis patients have detectable troponin, but fewer meet criteria for myocardial injury.
- Lower BMI is paradoxically associated with higher troponin levels, an 'obesity paradox,' particularly in females and older individuals.
- Congestive heart failure and coronary artery disease are key indicators for troponin elevation in hypertensive crisis.
Abstract:
Introduction There is a high prevalence of hypertensive crisis with myocardial injury, as evidenced by elevation in cardiac troponin levels. The risk factors predisposing patients to developing a myocardial injury, detectable troponin, and increase in serial troponin in this population are not known. Methods A retrospective study was designed to include all patients, presenting to the emergency room, diagnosed with hypertensive crisis, using International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes between 2016-2018 (n=467). Logistic regression was used to determine the important predictors of myocardial injury evidenced by troponin elevation >99th percentile of upper reference level (URL), detectable troponin (> 0.015 ng/ml), and increase in serial troponin levels. Results The 99th percentile of the initial troponin level among all patients was 0.433 ng/ml. A total of 15% had a myocardial injury, and the significant risk factors associated with it were body mass index (BMI) < 30 kg/m2 (odds ratio [OR] 0.50, confidence interval [CI] 0.28-0.89), congestive heart failure (CHF; OR 4.28, CI 2.21-8.25) and prior use of aspirin (OR 1.98, CI 1.08-3.63). About 35% had detectable troponin, and BMI < 30 kg/m2 (OR 0.62, CI 0.40-0.97), CHF (OR 3.49, CI 2.06-5.9), elevated creatinine (OR 1.17, CI 1.02-1.34) and age <61 years (OR 0.59, CI 0.38-0.94) were associated with it. The factors associated with an increase in serial troponin were BMI < 30 Kg/m2 (OR 0.56, CI 0.36-0.87), CHF (OR 1.78, CI 1.06-3.0), coronary artery disease (CAD; OR 2.08, CI 1.28-3.36) and non-Caucasian race (OR 0.52, CI 0.29-0.93). Conclusion About one-third of patients with the hypertensive crisis have detectable troponin. Still, among these, less than half have troponin levels >99th percentile URL, and the majority of these patients have minimal changes in serial troponin. Low BMI was associated with higher initial and serial troponin levels, and this obesity paradox was stronger among females and older patients.
More Related Videos
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
10:12A Sensitive and Specific Quantitation Method for Determination of Serum Cardiac Myosin Binding Protein-C by Electrochemiluminescence Immunoassay
Published on: August 8, 2013
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations