Comparison of Outcome of Normal Versus Raised Cardiac Troponin in Patients with Supraventricular Tachyarrhythmia

Abstract

Background: Acute coronary syndromes encompass a wide range of clinical disorders, spanning from unstable angina pectoris to acute ST-elevation myocardial infarction. Chest pain is typically the primary manifestation of atherosclerotic heart disease. However, accurately determining the origin of chest pain can be difficult, particularly in the emergency department, due to the vague manner in which some patients describe their symptoms. ¹

Objective: To evaluate the results of patients with supraventricular tachyarrhythmia who have normal levels of cardiac troponin with those who have elevated levels. Supraventricular tachycardia (SVT) is the predominant category of abnormal heart rhythms in adults.

Materials and Methods: Total 234 patients were enrolled from the Department of Emergency. The participants were categorized into two groups i.e, Group-A consists of individuals with normal troponin levels and Group-B consists of individuals with elevated troponin levels. The primary diagnosis of tachyarrhythmia were encompass supraventricular tachycardia (SVT) and were verified using a 12-lead ECG. The analysis of cTnI levels was done using the identical immunoassay techniques (cTnI-Ultra Siemens) at the exact same facility. Cardiac troponin I (cTnI) levels were assessed upon admission and again 6 hours later. The study measured the occurrences of readmission for heart failure and myocardial infarction. The determination of qualitative data such as gender, heart failure admission, and myocardial infarction was accomplished through the utilization of frequency and percentages. On the other hand, the determination of quantitative data such as age, blood pressure, and troponin levels was achieved by employing mean and standard deviation. The chi-square test was employed to compare the outcome in both groups. A p-value less than or equal to 0.05 was considered statistically significant.

Results: In Group-A (Normal Troponin Level), the mean age of participants was 46.96 ± 12.06, while in Group-B (Raised Troponin Level), the mean age was 56.97 ± 11.38. The current research included 133 males, accounting for 56.8% of the total enrollment, and 101 females, accounting for 43.2%. Upon admission, the research participants' vital signs were recorded. In group A, the heart rate (bpm) was measured to be 88.11±30.21, while in group B it was 90.23±28.43. The systolic blood pressure (mmHg) in group A was 143.22±5.00, whereas in group B it was 147.67±9.78. The SaO2 levels were observed to be 63.21±00 in group A and 60.89±0.56 in group B, with p-values of 0.001 and 0.000 respectively. After 30 days, the follow-up assessment of the research participants found that there was one case (0.9%) of re-admission for myocardial infarction in both Group A (Normal Troponin Level) and Group B (Raised Troponin Level). The p-value of 0.751 indicated that this difference was not statistically significant. The re-admission rate for heart failure (HF) was 0% in Group-A (Normal Troponin Level), but it was 4.30% in Group-B (Normal Troponin Level), with a significant p-value of 0.03.

Conclusion: Elevated levels of cardiac troponin may not reliably indicate the occurrence of complications such as readmission for myocardial infarction and heart failure in individuals with supraventricular tachycardia. Physicians should exercise caution when interpreting troponin test results for this particular group of patients.