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British Journal of Anaesthesia, Vol 82, Issue 1 41-46, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia

CLINICAL INVESTIGATIONS

Troponin I and myocardial injury in the ICU

J. S. Noble, A. M. Reid, LVM. Jordan, ACA. Glen and JAH. Davidson
Department of Anaesthesia, Victoria Infirmary, Langside Road, Glasgow, G42 9TY, UK; Department of Clinical Chemistry, Victoria Infirmary, Langside Road, Glasgow, G42 9TY, UK

Cardiac troponin I (cTnI) is a protein that is specific to heart muscle. Increased concentrations appear in serum after myocardial cell injury. cTnI was compared with creatinine kinase MB (CK MB), myoglobin and the 12-lead ECG for detection of myocardial injury in an unselected series of 109 medical and surgical ICU patients. Clinical observations and daily 12-lead ECG were recorded prospectively. Samples for cTnI, myoglobin and CK MB serum analysis were collected each day. Increased serum cTnI concentrations (> 0.1 microgram litre-1) were observed in 70.6% (n = 77) of the ICU group. Tachycardia, arrhythmia, hypotension and treatment with inotropic drugs were associated with higher concentrations. The standardized mortality ratio by APACHE III for the ICU sample was 0.98. All subjects in an unmatched control group of 98 medical unit emergency admissions without a primary cardiac diagnosis had serum cTnI concentrations < 0.1 microgram litre-1. We conclude that increased serum cTnI concentrations occur frequently in the ICU suggesting that there is a high incidence of cardiac injury in these patients.
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