Cardiac troponin T in patients with clinically suspected myocarditis
1Herzzentrum Leipzig, Universitätsklinik für Kardiologie, Leipzig, Germany. e.und.b.lauer@t-online.de
Insights
Serum cardiac troponin T (cTnT) is a sensitive indicator of myocyte injury in suspected myocarditis, often detecting damage missed by traditional enzyme tests. Elevated cTnT levels strongly predict myocarditis, even when initial biopsies are inconclusive.
Area of Science:
- Cardiology
- Biochemistry
- Immunology
Background:
- Conventional lab tests often fail to detect myocyte injury in suspected myocarditis due to low injury extent.
- Sensitive biomarkers for myocardial injury in this context remain under-investigated.
Purpose of the Study:
- To assess cardiac troponin T (cTnT) as a sensitive marker for myocyte injury in suspected myocarditis.
- To determine if cTnT levels can predict endomyocardial biopsy results.
Main Methods:
- Eighty patients with suspected myocarditis were tested for cTnT, CK, and CK-MB.
- Endomyocardial biopsy specimens were analyzed using histological and immunohistological methods.
Main Results:
- cTnT was elevated in 28/80 patients, while CK and CK-MB were elevated in only 4 and 1, respectively.
- Histology alone identified myocarditis in 5 patients (all with elevated cTnT).
- Immunohistology revealed myocarditis in 93% of patients with elevated cTnT versus 44% with normal cTnT. Mean cTnT levels were significantly higher in patients with confirmed myocarditis (0.59 vs. 0.04, p < 0.001).
Conclusions:
- Serum cTnT is a more sensitive indicator of myocyte injury in suspected myocarditis than conventional cardiac enzymes.
- Myocardial damage can exist without histological evidence of myocarditis; immunohistology often reveals lymphocytic infiltrates.
- Elevated cTnT levels are highly predictive of myocarditis in this patient group.
Objectives:
The present study investigated whether myocyte injury can be assessed sensitively by measurement of serum levels of cardiac troponin T (cTnT) in patients with clinically suspected myocarditis and whether cTnT levels may predict the results of histologic and immunohistologic analysis of endomyocardial biopsy specimens.
Background:
Conventionally used laboratory variables often fail to show myocyte injury in patients with clinically suspected myocarditis, possibly because of a low extent of myocardial injury in these patients. Sensitive variables for myocyte injury have not yet been investigated.
Methods:
Eighty patients with clinically suspected myocarditis were screened for creatine kinase (CK) activity, MB isoform of CK (CK-MB) activity and cTnT. Endomyocardial biopsy specimens were examined histologically and immunohistologically.
Results:
cTnT was elevated in 28 of 80 patients with clinically suspected myocarditis, CK in 4 and CK-MB in 1. Histologic analysis alone of the endomyocardial biopsy specimen revealed evidence of myocarditis in only five patients, all with elevated cTnT levels. Twenty-three of 28 patients with elevated cTnT levels had histologically negative findings for myocarditis. Additional immunohistologic analysis revealed evidence of myocarditis in 26 (93%) of 28 patients with elevated cTnT levels and in 23 (44%) of 52 patients with normal cTnT levels. Mean cTnT levels were higher in patients with myocarditis proved histologically or immunohistologically, or both, than in patients without myocarditis (0.59 +/- 1.68 vs. 0.04 +/- 0.05, p < 0.001).
Conclusions:
Measurement of serum levels of cTnT provides evidence of myocyte injury in patients with clinically suspected myocarditis more sensitively than does conventional determination of cardiac enzyme levels. Myocardial cell damage may be present even in the absence of histologic signs of myocarditis. Additional immunohistologic analysis often shows lymphocytic infiltrates in these patients. Elevated levels of cTnT are highly predictive for myocarditis in this group.
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