Citation Information :
Gupta K, Kiran M, Chhabra S, Mehta M, Kumar N. Prevalence, Determinants and Clinical Significance of Cardiac Troponin-I Elevation among Individuals with Hypertensive Emergency: A Prospective Observational Study. Indian J Crit Care Med 2022; 26 (7):786-790.
Introduction: Cardiac troponin-I (cTnI) elevation release during hypertensive emergencies (HEs) is a frequent epiphenomenon that may tangle management of individuals being treated for HEs. The primary objective of this study was to determine the prevalence, determinants, and clinical significance of cTnI elevation and secondary objective was to find out the prognostic significance of cTnI elevation in patients admitted for HE in the emergency department (ED) of a tertiary care hospital.
Methodology: The investigator has employed the quantitative research approach with a prospective observational descriptive design. The population of this study comprised of 205 adults, which included both males and females, who were more than or 18 years of age. The subjects were selected by non-probability purposive sampling technique. The study was conducted from August 2015 to December 2016 (16 months). Ethical permission was obtained from the Institutional Ethics Committee (IEC), Max Super Speciality Hospital, Saket, New Delhi and well-informed written consents were taken from the subjects. The analysis of data was done with the help of SPSS, version 17.0.
Results: Out of 205 patients in the study, cTnI elevation was found in 102 patients (49.8%). Moreover, there was increased duration of stay in the hospital in patient with elevated cTnI level with mean duration stay 1.55 ± 0.82 (p <0.001). In addition, cTnI elevation was associated with increased mortality, 11 out of 102 in an elevated cTnI group (10.8%) with p <0.002.
Conclusion: It was found that cTnI elevation in individuals affected by various clinical factors. The authors highlighted a high frequency of mortality among the individuals presented with HE with elevated cTnI level, whereas the presence of cTnI was associated with greater odds of death.
Aggarwal M, Khan IA. Hypertensive crisis. Hypertensive emergencies and urgencies. Cardiol Clin 2006;24(1):135–146. DOI: 10.1016/j.ccl.2005.09.002.
Ramawat Y, Kumar N, Kumar V, Pareek S. Prevalence and disease burden of hypertension in OPD department: a tertiary center study. Int J Recent Sci Res 2020;11(02):37457–37460. http://dx.doi.org/10.24327/ijrsr.2020.1102.5112.
Pareek S, Kumar V, Roy SS, Pareek S, Pareek A. Hypertension and diabetes mellitus among the Northern Railway employees: a descriptive study. World J Adv Healthcare Res 2019;3(3):15–18.
Zampaglione B, Pascale C, Marchisio M, Cavallo–Perin P. Hypertensive urgencies and emergencies. Prevalence and clinical presentation. Hypertension 1996;27(1):144–147. DOI: 10.1161/01.hyp.27.1.144.
Yu SH, Whitworth IA, Kincaid–Smith PS. Malignant hypertension: aetiology and outcome 83 patients. Clin Exp Hypertens A 1986;8(7): 1211–1230. DOI: 10.3109/10641968609045483.
Amit K, Vasileios P, Benjamin G, Jim D, Abdulrahim M, Kerrie W, et al. Association of troponin level and age with mortality in 250,000 patients: cohort study across five UK acute care centres. Br Med J 2019;367:l6055. DOI: 10.1136/bmj.l6055.
Neogi SS, Kapoor RK. hsTropI: an early biomarker of acute coronary syndrome & MI. Int J Med Res Rev 2017;5(01):80–87. DOI:10.17511/ijmrr.2017.i01.12.
Lee KK, Ala N, Amar V, Matthew G, Megan G, Chapman AR, et al. Prevalence, determinants, and clinical associations of high-sensitivity cardiac troponin in patients attending emergency departments. Am J Med 2019;132(1):110.e8–110.e21. DOI: 10.1016/j.amjmed.2018.10.002.
Ahmed AN, Blonde K, Hackam D, Iansavichene A, Mrkobrada M. Prognostic significance of elevated troponin in non-cardiac hospitalized patients: a systematic review and meta-analysis. Annals Med 2014;46(8):653–663. DOI: 10.3109/07853890.2014.959558.
AlQassas I, Hassan W, Sunni N, Lhmdi M, Nazzal A, Mohamed MJ, et al. The prognostic significance of elevated cardiac troponin in non-cardiac medical disorders: pilot study. Int J Clin Cardiol 2019;6:136. DOI: 10.23937/2378-2951/1410136.
Jaakkola S, Paana T, Nuotio I, Kiviniemi TO, Pouru JP, Porela P, et al. Etiology of minor troponin elevations in patients with atrial fibrillation at emergency department–Tropo-AF Study. J Clin Med 2019;8(11):1963. DOI: 10.3390/jcm8111963.
Soeiro A, Gualandro DM, Bossa AS, Zullino CN, Biselli Bruno, Soeiro MC, et al. Sensitive troponin I assay in patients with chest pain: association with significant coronary lesions with or without renal failure. Arq Bras Cardiol 2018;110(1):68–73. DOI: 10.5935/abc.20170182.
Afonso L, Bandaru H, Rathod A, Badheka A, Kizilbash MA, Zmily H, et al. Prevalence, determinants, and clinical significance of cardiac troponin-I elevation in individuals admitted for a hypertensive emergency. J Clin Hypertens (Greenwich) 2011;13(8):551–556. DOI: 10.1111/j.1751-7176.2011.00476.x.
Giancarlo A, Ahmed A, Rodrigo A, Waiel A, Niharika B, George AK, et al. Clinical determinants of myocardial injury, detectable and serial troponin levels among patients with hypertensive crisis. Cureus 2020; 12(1):e6787. DOI: 10.7759/cureus.6787.
Stelzle D, Shah ASV, Anand A, Strachan FE, Chapman AR, Denvir M, et al. High-sensitivity cardiac troponin I and risk of heart failure in patients with suspected acute coronary syndrome: a cohort study. Eur Heart J Qual Care Clin Outcomes 2018;4(1):36–42. DOI: 10.1093/ehjqcco/qcx022.
Lee KK, Ferry AV, Anand A, Strachan FE, Chapman AR, Kimenai DM, et al. Sex-specific thresholds of high-sensitivity troponin in patients with suspected cute coronary syndrome. J Am Coll Cardiol 2019;74(16):2032–2043. DOI: 10.1016/j.jacc.2019.07.082.
Taniguchi R, Sato Y, Nishio Y, Kimura T, Kita T. Measurements of baseline and follow-up concentrations of cardiac troponin-T and brain natriuretic peptide in patients with heart failure from various etiologies. Heart Vessels 2006;21(6):344–349. DOI: 10.1007/s00380-006-0909-1.
Mahajan N, Mehta Y, Rose M, Shani J, Lichstein E. Elevated troponin level is not synonymous with myocardial infarction. Int J Cardiol 2006; 111(3):442–449. DOI: 10.1016/j.ijcard.2005.08.029.
Alcalai R, Planer D, Culhaoglu A, Osman A, Pollak A, Lotan C. Acute coronary syndrome vs nonspecific troponin elevation: clinical predictors and survival analysis. Arch Intern Med 2007;167(3):276–281. DOI: 10.1001/archinte.167.3.276.
Korff S, Katus HA, Giannitsis E. Differential diagnosis of elevated troponins. Heart 2006;92(7):987–993. DOI: 10.1136/hrt.2005.071282.
Houston MC. Pathophysiology, clinical aspects, and treatment of hypertensive crises. Prog Cardiovasc Dis 1989;32(2):99–148. DOI: 10.1016/0033-0620(89)90022-4.
Patel HP, Mitsnefes M. Advances in the pathogenesis and management of hypertensive crises. Curr Opin Pediatr 2005;17: 210–214. DOI: 10.1097/01.mop.0000150769.38484.b3.
Sechi LA, Novello M, Colussi GL, Di Fabio A, Chiuch A, Nadalini E, et al. Relationship of plasma renin with a prothrombotic state in hypertension: relevance for organ damage. Am J Hypertens 2008;21:1347–1353. DOI: 10.1038/ajh.2008.293.
Marie C, Jerome A, Caroline B, Dorothée V, David V, Olivier M, et al. Determinants and prognosis of high-sensitivity cardiac troponin T peak plasma concentration in patients hospitalized for non-cardiogenic shock. SAGE Open Medi 2018;6:2050312118771718. DOI: 10.1177/2050312118771718.
Khan MH, Islam MMN, Islam MS, Khan KN, Chowdhury S, Rahman R. Correlation of troponin-I level with left ventricular systolic dysfunction after first attack of non-ST segment elevation myocardial infarction. Int J Res Med Sci 2019;7(5):1392–1398. DOI: 10.18203/2320-6012.ijrms20191623.
Dal Bianco JP, Jaffe AS, Bell MR, Oh JK. Cardiac function and brain natriuretric peptide in first time flash pulmonary edema. Mayo Clin Proc 2008;83(3):289–296. DOI: 10.4065/83.3.289.
Feng J, Schaus BJ, Fallavollita JA, Lee TC, Canty JM Jr. Preload induces troponin I elevation independently of myocardial ischemia. Circulation 2001;103(16):2035–2037. DOI: 10.1161/01.cir.103.16.2035.