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Serum Troponin-I Levels in the Differential Diagnosis of Pulmonary Hypertention Dyspnea Patients: Is It of Value? FREE TO VIEW

Ioannis Angomachalelis, PhD; George Kyriazis, PhD; Nestor Angomachalelis, PhD
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Aristotle University of Thessaloniki School of Medicine,Department of Medicine,Clinical Pulmonology,Heart-Lung Section, "G.Papanickolaou" General Hospital, Thessaloniki, Greece

Chest. 2013;144(4_MeetingAbstracts):863A. doi:10.1378/chest.1704179
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Pulmonary Hypertention (PH) dyspnea is of controversial origin,depending on various etiology.This study evaluates serum Troponin-I (Tr-I) to discriminate dyspnea cause and select proper therapy,avoiding not only expensive but also possibly risking overtreatement.

METHODS: Echocardiography, pulmonary function tests(PFTs) and arterial blood gasses(ABGs), serum Biomarkers,including mainly Tr-I or other indices of dysfunction,inflammation or apoptosis were examined in 55 PH dyspnea patients(Pts),34 males and 21 females (mean age 68.5±14 years), without clinical history of other cardiac pathology and 33,matched control,normal subjects.All data underwent statistical analysis

RESULTS: Examination data demonstrated mean values 1) Echocardiographic RVSP = 53 mm Hg , EF = 57%,LAD = 4.8 cm and ASH =1.5 2) [P(A-a)O2] = 49 mm Hg,hypoxemia and respiratory impairment of mixed type. 3) Serum Tr-I = 1.2 ng/ml ,increased NT-ProBNP, TNF-a, IL-6, IL-1a and downwards marginal Carnitine levels. 4) Significant correlation of Tr-I with NT-ProBNP (r = 0.573), EF (r = -0.464) ,Carnitine (r = 0.530 ),IL-6 ( r= -0.400 ), TNF-a (r = -0.400 ) ,MMP-2 (r = 0.390), Na (r = -0.382), Cr (r = 0.351).

CONCLUSIONS: 1) Significant correlations of Tr-I with EF and NT-ProBNP,considering also increased RVSP, [P(A-a)O2 and LAD, combined with mixed respiratory impairment ,discriminate mainly PH dyspnea pathophysiology of cardiac origin. 2) Increased values of cytokines TNF-a, IL-6 and IL-1a, correlated with Tr-I, contribute an inflammatory cellular dysfunction, 3) Tr-I and MMP-2, as consequent values of myocardial apoptosis and cell damage, express cardiovascular remodeling,demanding selection of proper pharmacotherapy in PH Pts, due to cardiac pathology. 4) PFTs and ABGs do not correlate significantly with Tr-I values.However,they remain independent factors of PH dyspnea . 5) Tr-I levels and correlations is ,for sure,of great value in the diagnosis of PH, regarding coincident dyspnea of cardiac pathophysiology.

CLINICAL IMPLICATIONS: Further investigation should be made to involve detailed study on the role of serum Tr-I values in the differential diagnosis of PH dyspnea Pts and selection of proper pharmacotherapy, avoiding expensive and perhaps risking overtreatment.

DISCLOSURE: The following authors have nothing to disclose: Ioannis Angomachalelis, George Kyriazis, Nestor Angomachalelis

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