Copyright © 2000 by the European Society of Cardiology.
Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis
Service de Reanimation et Soins Intensifs de Cardiologie, Hopital Louis Pradel, Lyon, France
revised August 13, 1999; accepted August 18, 1999
Abstract
Objective ST-segment elevation in acute pericarditis is believed to be caused by superficial myocardial inflammation or epicardial injury. We used cardiac troponin I, a sensitive and specific marker of myocardial injury, to assess myocardial lesions in idiopathic acute pericarditis and its relationship to ST-segment elevation.
Patients and Methods Sixty-nine consecutive patients (53 men, 48±17 years) with idiopathic acute pericarditis were included. We used an enzymoimmunoflurometric method to measure serum cardiac troponin I on admission (myocardial infarction threshold was 1·5ng.ml–1).
Results Cardiac troponin I was detectable in 34 patients (49%) and was beyond the 1·5ng.ml–1threshold in 15 (22%). Coronary angiography performed in seven of these 15 patients was normal in all of them. ST-segment elevation was observed in 93% of the patients with cardiac troponin I >1·5ng.ml–1vs 57% of those without (P<0·01). Sensitivity of ST-segment elevation to detect myocardial injury was 93% and specificity 43%. Patients with a cardiac troponin I increase higher than 1·5ng.ml–1were more likely to have had a recent infection (66% vs 31%;P=0·01) and were younger (37±14 vs 52±16 years;P=0·002). There was no significant relationship with other parameters such as pericardial friction rub, fever, PR segment abnormalities, echocardiographic findings or C-reactive protein.
Conclusion In patients with idiopathic acute pericarditis, an increase in cardiac troponin I is frequently observed, especially in younger patients and those with a recent infection. Although ST-segment elevation does not reliably indicate myocardial injury, a significant cardiac troponin I increase is only seen in these patients.
Key Words: Acute pericarditis, cardiac troponin I, myocarditis, troponins, ST-segment elevation
f1 Correspondence: P. Touboul, MD, Hôpital Cardio-vasculaire et Pneumologique Louis Pradel, BP Lyon-Montchat 69394 Lyon Cedex 03, France.
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