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Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis

E. Bonnefoy , P. Godon , G. Kirkorian , M. Fatemi , P. Chevalier , P. Touboul
DOI: http://dx.doi.org/10.1053/euhj.1999.1907 832-836 First published online: 2 May 2000

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.

  • Acute pericarditis, cardiac troponin I, myocarditis, troponins, ST-segment elevation