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European Heart Journal 2000 21(3):245-253; doi:10.1053/euhj.1999.1745
Copyright © 2000 by the European Society of Cardiology.
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Serum troponins T and I after elective cardioversion

M Lunda, J.K Frencha, R.N Johnsonb, B.F Williamsa and H.D Whitea,f1

a Cardiovascular Research Unit, Cardiology Department, Green Lane Hospital, Auckland, New Zealand
b Department of Clinical Biochemistry, Green Lane Hospital, Auckland, New Zealand

revised May 25, 1999; accepted May 26, 1999

Abstract

Aims To describe the pattern of release of five myocardial proteins after elective cardioversion.

Methods and Results We measured serum levels of the myocardial proteins creatine kinase, creatine kinase MB mass, myoglobin, troponin T and troponin I serially from baseline to 24h after 72 elective cardioversion attempts. The total energy used for attempted cardioversion was 408±318J (range 50 to 1280J). Maximal creatine kinase levels (median 232IU.l–1, interquartile range 91 to 1152IU.l–1) occurred at 24h and correlated with the total energy delivered (r=0·75, P<0·0001). The peak creatine kinase MB mass levels exceeded the discrimination level for myocardial injury (≥5µg.l–1) in seven patients (10%). The peak myoglobin levels were elevated (>85µg.l–1) in 40 patients (56%) and correlated with the peak creatine kinase levels (r=0·83, P<0·0001). Troponin T reached the discrimination level (0·10µg.l–1) in one patient with a serum creatinine level of 0·16mmol.l–1and severe left ventricular impairment. Twelve patients had baseline troponin I levels above our prespecified discrimination level of 0·4µg.l–1(range 0·4 to 3·1µg.l–1), which did not increase after cardioversion. In two patients the levels rose from <0·4µg.l–1to 0·5µg.l–1and 0·6µg.l–1respectively.

Conclusions Troponin T levels do not rise after elective cardioversion. The minor increases in troponin I may reflect our choice of discrimination level. Cardiac troponins are useful in determining whether arrhythmias requiring emergency cardioversion are primary or secondary to myocardial infarction.

Key Words: Cardioversion, CKMB (mass), myocardial proteins, troponin I, troponin T

f1 Correspondence: Professor Harvey White, Cardiology Department, Green Lane Hospital, Private Bag 92 189, Auckland 1030, New Zealand.


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