Clinical Significance of High Troponin T with Normal Creatine Kinase Levels on Ventricular Function in Acute Coronary Syndromes

Alfredo César Piombo, Jorge Lax, Tomás Cianciulli, Juan Gagliardi, Elisabet Ulmete, Francisco Gadea



The role of elevated troponins to predict changes on ventricular

function in patients with high creatine kinase (CK) levels

has been well established; yet, little is known about the clinical

significance of high troponin levels with normal CK levels.


To analyze the relation between Troponin T (TnT) levels and

global and regional left ventricular function in patients with acute

coronary syndromes (ACS) with normal CK and CK-MB levels.

Material and Methods

We included patients admitted to the coronary care unit due to

ACS within 48 hours from symptoms onset with elevated TnT

levels measured by quantitative determination and normal CK

and CK-MB levels. Biomarkers were measured at baseline, 24

and 48 hours. Left ventricular function was analyzed by two-dimensional

echocardiography at admission and before discharge,

and compared with the highest levels of the biomarkers. Ejection

fraction, regional wall motion and global systolic longitudinal

strain based on speckle-tracking technique were evaluated.


Thirty patients with ACS were included. The highest median

value of TnT was 0.13




High TnT values in ACS with normal CK levels do not modify

global or regional left ventricular function assessed by conventional

echocardiography. The evaluation of systolic strain using

a more sensitive technique detects transient abnormalities.

These findings might question the definition of acute myocardial

infarction based on high troponin levels, considering that

the classical definition is based on elevated CK values which

are associated with changes in ventricular function.

g/L (interquartile range, 0.07-0.25)


measured 24 hours after admission. Left ventricular ejection

fraction was 62.9%±10% at admission and 62.8%±10.3% before

discharge. Wall motion index was 1.04±0.1 and 1.03±0.1,

respectively. Systolic strain at admission was 14.93±3 and

improved before discharge 16.51±3.33 (p = 0.0003).


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