Acute exacerbation of COPD is associated with fourfold elevation of cardiac troponin T

• Published in: Heart (British Cardiac Society) Vol. 99; no. 2; pp. 122 - 126
• Main Authors: Søyseth, Vidar, Bhatnagar, Rahul, Holmedahl, Nils Henrik, Neukamm, Anke, Høiseth, Arne Didrik, Hagve, Tor-Arne, Einvik, Gunnar, Omland, Torbjørn
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.01.2013; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Biological and medical sciences; Biomarkers - blood; Cardiology. Vascular system; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Cross-Sectional Studies; Disease; Disease Progression; Embolisms; Ethics; Female; Follow-Up Studies; Heart attacks; Heart failure; Heart rate; Hospitals; Humans; Incidence; Laboratories; Leukocytes; Male; Medical sciences; Middle Aged; Mortality; Myocardial Ischemia - blood; Myocardial Ischemia - epidemiology; Myocardial Ischemia - etiology; Norway - epidemiology; Pneumology; Prognosis; Pulmonary Disease, Chronic Obstructive - blood; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - physiopathology; Retrospective Studies; Risk Assessment - methods; Risk Factors; Smoking; Troponin T - blood; Norway; Heart; Lung disease; Chronic; Respiratory disease; Acute; Bronchus disease; Chronic obstructive pulmonary disease; Circulatory system; Obstructive pulmonary disease; Cardiology; Troponin T
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2012-302685

Objective To investigate if acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with myocardial injury, expressed as elevated high sensitive cardiac troponin T (hs-cTnT), and to identify determinants of hs-cTnT in chronic obstructive pulmonary disease (COPD) patients. Design In a cross-sectional study, hs-cTnT in patients hospitalised for AECOPD was compared with hs-cTnT in COPD patients in their stable state. Setting The study was conducted at a teaching and a pulmonary rehabilitation clinic. Participants Consecutive admissions to participating units for the years 2010–2011 meeting objective, standardised criteria for AECOPD and stable COPD. Main outcomes Ratio of hs-cTnT in hospitalised AECOPD patients compared with stable COPD patients. Change in the ratio of hs-cTnT per unit increase of relevant covariables. Results The geometric mean of hs-cTnT in the index group was 25.8 ng/l (95% CI 21.1 to 31.7) compared with 4.55 ng/l (95% CI 3.72 to 5.67) in the reference group. After inclusion of relevant covariables, multiple linear regression analyses showed that the ratio between hs-cTnT in AECOPD patients and the references was 4.26 (95% CI 3.02 to 6.00) and that hs-cTnT increased 1.41-fold (95% CI 1.20 to 1.68), for each quartile increase in leucocyte count in stable COPD but not in AECOPD. Higher hs-cTnT levels were also associated with the presence of pathological q-waves (p=0.012) and electrocardiographic left ventricular hypertrophy (p=0.039), long-term oxygen treatment (p=0.002) and decreasing forced expiratory volume in 1 s (p=0.014). A significant univariable association between cTnT and arterial hypoxaemia was also found but this association was attenuated almost to a zero effect after inclusion of relevant covariates. Conclusions AECOPD is associated with higher hs-cTnT as compared with stable COPD. In stable COPD, hs-cTnT appears to be positively associated with indices of COPD severity, whereas we were unable to identify significant determinants of hs-cTnT in AECOPD.