| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 1997;95:163-168.)
© 1997 American Heart Association, Inc.
Articles |
Elevations of Cardiac Troponin I Associated With Myocarditis
Experimental and Clinical Correlates
the Washington University School of Medicine, Department of Medicine, Cardiovascular Division, St Louis, Mo.
Correspondence to Allan S. Jaffe, SUNY Health Science Center, 750 E Adams St, Syracuse, NY 13210. E-mail JAFFEA@VAX.CS.HSCSYR.EDU.
Background Endomyocardial biopsy is currently the standard method used to diagnose myocarditis. However, it is invasive and has a low diagnostic yield. Because the histological diagnosis of myocarditis requires the presence of myocyte injury, we sought to determine whether measurement of cardiac troponin I (cTnI), which is a serum marker with high sensitivity and specificity for cardiac myocyte injury, could aid in the diagnosis of myocarditis.
Methods and Results To validate this approach, cTnI values were first measured in mice with autoimmune myocarditis. cTnI values were elevated in 24 of 26 mice with myocarditis but were not elevated in any of the control animals (P<.001). Next, cTnI values were measured in the sera from 88 patients referred to the Myocarditis Treatment Trial and were compared with creatine kinase–MB (CK-MB) values measured in the same patients. cTnI values were elevated in 18 (34%) of 53 patients with myocarditis and in only 4 (11%) of 35 patients without myocarditis (P=.01). In contrast, CK-MB values were elevated in only 3 (5.7%) of 53 patients with myocarditis and 0 of 35 patients without myocarditis (P=.27). Thus, elevations of cTnI occurred more frequently than did elevations of CK-MB in patients with biopsy-proven myocarditis (P=.001). Importantly, elevations of cTnI in patients with myocarditis were significantly correlated with 
1 month duration of heart failure symptoms (P=.02), suggesting that the majority of myocyte necrosis occurs early, and thus the window for diagnosis and treatment may be relatively brief.
Conclusions cTnI was superior to CK-MB for detection of myocyte injury in myocarditis, and cTnI elevations were substantially more common in the first month after the onset of heart failure symptoms.
Key Words: myocarditis • cardiac troponin I • creatine kinase • diagnosis
This article has been cited by other articles:
 |
|
 |
|
  L. T. Cooper Jr. Myocarditis N. Engl. J. Med., April 9, 2009; 360(15): 1526 - 1538. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Yuan, Z. Liu, T. Lim, H. Zhang, J. He, E. Walker, C. Shier, Y. Wang, Y. Su, A. Sall, et al. CXCL10 Inhibits Viral Replication Through Recruitment of Natural Killer Cells in Coxsackievirus B3-Induced Myocarditis Circ. Res., March 13, 2009; 104(5): 628 - 638. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Lippi, G. L. Salvagno, and G. C. Guidi Cardiac Troponins in Pediatric Myocarditis Pediatrics, April 1, 2008; 121(4): 864 - 864. [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Mellanby, J. P. Henry, R. Cash, S. W. Ricketts, J. R. D. Bexiga, and D. J. Mellor Serum cardiac troponin I concentrations in cattle with pericarditis Vet Rec., September 29, 2007; 161(13): 454 - 455. [Full Text] [PDF]
|
|
|
|
|
|
M. T. Thanjan, P. Ramaswamy, W. W. Lai, and I. D. Lytrivi Acute Myopericarditis After Multiple Vaccinations in an Adolescent: Case Report and Review of the Literature Pediatrics, June 1, 2007; 119(6): e1400 - e1403. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. D. Lewis, C. B. Holmes, G. Holmvang, and J. R. Butterton Case 8-2007 -- A 48-Year-Old Man with Chest Pain Followed by Cardiac Arrest N. Engl. J. Med., March 15, 2007; 356(11): 1153 - 1162. [Full Text] [PDF]
|
|
|
|
 |
|
 B. Geny, H. Khun, C. Fitting, L. Zarantonelli, C. Mazuet, N. Cayet, M. Szatanik, M.-C. Prevost, J.-M. Cavaillon, M. Huerre, et al. Clostridium sordellii Lethal Toxin Kills Mice by Inducing a Major Increase in Lung Vascular Permeability Am. J. Pathol., March 1, 2007; 170(3): 1003 - 1017. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Alcalai, D. Planer, A. Culhaoglu, A. Osman, A. Pollak, and C. Lotan Acute Coronary Syndrome vs Nonspecific Troponin Elevation: Clinical Predictors and Survival Analysis Arch Intern Med, February 12, 2007; 167(3): 276 - 281. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. N. Skouri, G. W. Dec, M. G. Friedrich, and L. T. Cooper Noninvasive Imaging in Myocarditis J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2085 - 2093. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Magnani and G. W. Dec Myocarditis: Current Trends in Diagnosis and Treatment Circulation, February 14, 2006; 113(6): 876 - 890. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Babuin and A. S. Jaffe Troponin: the biomarker of choice for the detection of cardiac injury Can. Med. Assoc. J., November 8, 2005; 173(10): 1191 - 1202. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Abdel-Aty, P. Boye, A. Zagrosek, R. Wassmuth, A. Kumar, D. Messroghli, P. Bock, R. Dietz, M. G. Friedrich, and J. Schulz-Menger Diagnostic Performance of Cardiovascular Magnetic Resonance in Patients With Suspected Acute Myocarditis: Comparison of Different Approaches J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1815 - 1822. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Jeremias and C. M. Gibson Narrative Review: Alternative Causes for Elevated Cardiac Troponin Levels when Acute Coronary Syndromes Are Excluded Ann Intern Med, May 3, 2005; 142(9): 786 - 791. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. J. Leeper, L. S. Wener, G. Dhaliwal, S. Saint, and R. M. Wachter One Surprise after Another N. Engl. J. Med., April 7, 2005; 352(14): 1474 - 1479. [Full Text] [PDF]
|
|
|
|
|
|
D. C. Cassimatis, J. E. Atwood, R. M. Engler, P. E. Linz, J. D. Grabenstein, and M. N. Vernalis Smallpox vaccination and myopericarditis: a clinical review J. Am. Coll. Cardiol., May 5, 2004; 43(9): 1503 - 1510. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Roongsritong, I. Warraich, and C. Bradley Common Causes of Troponin Elevations in the Absence of Acute Myocardial Infarction: Incidence and Clinical Significance Chest, May 1, 2004; 125(5): 1877 - 1884. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. B. Wallace, E. Hausner, E. Herman, G. D. Holt, J. T. Macgregor, A. L. Metz, E. Murphy, I.Y. Rosenblum, F. D. Sistare, and M. J. York Serum Troponins as Biomarkers of Drug-Induced Cardiac Toxicity Toxicol Pathol, January 1, 2004; 32(1): 106 - 121. [PDF]
|
|
|
|
 |
|
 J. Kamblock, L. Payot, B. Iung, P. Costes, T. Gillet, C. Le Goanvic, P. Lionet, B. Pagis, J. Pasche, C. Roy, et al. Does rheumatic myocarditis really exists? Systematic study with echocardiography and cardiac troponin I blood levels Eur. Heart J., May 1, 2003; 24(9): 855 - 862. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. T. Sandri, D. Cardinale, L. Zorzino, R. Passerini, P. Lentati, A. Martinoni, G. Martinelli, and C. M. Cipolla Minor Increases in Plasma Troponin I Predict Decreased Left Ventricular Ejection Fraction after High-Dose Chemotherapy Clin. Chem., February 1, 2003; 49(2): 248 - 252. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Greaves, J. S. Oxford, C. P. Price, G. H. Clarke, and T. Crake The Prevalence of Myocarditis and Skeletal Muscle Injury During Acute Viral Infection in Adults: Measurement of Cardiac Troponins I and T in 152 Patients With Acute Influenza Infection Arch Intern Med, January 27, 2003; 163(2): 165 - 168. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. W. Hamm, E. Giannitsis, and H. A. Katus Cardiac Troponin Elevations in Patients Without Acute Coronary Syndrome Circulation, December 3, 2002; 106(23): 2871 - 2872. [Full Text] [PDF]
|
|
|
|
|
|
M. E. Bertrand, M. L. Simoons, K. A.A. Fox, L. C. Wallentin, C. W. Hamm, E. McFadden, P. J. De Feyter, G. Specchia, and W. Ruzyllo Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation Eur. Heart J., December 1, 2002; 23(23): 1809 - 1840. [Full Text] [PDF]
|
|
|
|
 |
|
 A. van der Laarse Hypothesis: troponin degradation is one of the factors responsible for deterioration of left ventricular function in heart failure Cardiovasc Res, October 1, 2002; 56(1): 8 - 14. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Colantonio, W. Pickett, R. J. Brison, C. E. Collier, and J. E. Van Eyk Detection of Cardiac Troponin I Early after Onset of Chest Pain in Six Patients Clin. Chem., April 1, 2002; 48(4): 668 - 671. [Full Text] [PDF]
|
|
|
|
 |
|
 N.J. Alp, J.A. Bell, and M. Shahi A rapid troponin-I-based protocol for assessing acute chest pain QJM, December 1, 2001; 94(12): 687 - 694. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Azpitarte, O. Baun, E. Moreno, R. Garcia-Orta, J. Sanchez-Ramos, and L. Tercedor In Patients With Chronic Atrial Fibrillation and Left Ventricular Systolic Dysfunction, Restoration of Sinus Rhythm Confers Substantial Benefit Chest, July 1, 2001; 120(1): 132 - 138. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Feldman and D. McNamara Myocarditis N. Engl. J. Med., November 9, 2000; 343(19): 1388 - 1398. [Full Text] [PDF]
|
|
|
|
 |
|
 C. M Oakley GENERAL CARDIOLOGY: Myocarditis, pericarditis and other pericardial diseases Heart, October 1, 2000; 84(4): 449 - 454. [Full Text]
|
|
|
|
|
|
C. W. Hamm and E. Braunwald A Classification of Unstable Angina Revisited Circulation, July 4, 2000; 102(1): 118 - 122. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Bonnefoy, P. Godon, G. Kirkorian, M. Fatemi, P. Chevalier, and P. Touboul Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis Eur. Heart J., May 2, 2000; 21(10): 832 - 836. [Abstract] [PDF]
|
|
|
|
|
|
K. M. ver Elst, H. D. Spapen, D. N. Nguyen, C. Garbar, L. P. Huyghens, and F. K. Gorus Cardiac Troponins I and T Are Biological Markers of Left Ventricular Dysfunction in Septic Shock Clin. Chem., May 1, 2000; 46(5): 650 - 657. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Assadnia, J. P. Rapp, A. L. Nestor, T. Pringle, G. J. Cerilli, W. T. Gunning III, T. H. Webb, M. Kligman, and D. C. Allison Strain Differences in Neointimal Hyperplasia in the Rat Circ. Res., June 11, 1999; 84(11): 1252 - 1257. [Abstract] [Full Text] [PDF]
|
|