Correlation of Troponin-I Level with Left Ventricular Ejection Fraction and In-hospital outcomes after First Attack of Non-ST Segment Elevation Myocardial Infarction.

Coronary heart disease (CHD) is the most common cause of heart disease and is the single most important cause of premature death in developed world. Recognizing a patient with ACS is important because the diagnosis triggers both triage and management. cTnI is 100% tissue-specific for the myocardium and it has been shown to be a very sensitive and specific marker for acute myocardial infarction (AMI). Ventricular function is the best predictor of death after an acute coronary syndrome. It serves as a marker of myocardial damage, provides information on systolic function as well as diagnosis and prognosis. The study aimed at investigating the impact of elevated Troponin-I level on LV ejection fraction and in-hospital outcomes in patients with first attack of Non ST-segment Elevation Myocardial Infarction (NSTEMI). This prospective analytical study was conducted in the Department of Cardiology in Mymensingh Medical College Hospital from December 2015 to November 2016. Total 130 first attack of NSTEMI patients were included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group I - Patients with first attack of NSTEMI with good LV function (LVEF: ≥55%). Group II - Patients with first attack of NSTEMI with LV systolic dysfunction (LVEF: <55%). Then Troponin-I and LVEF levels were correlated using Pearson's correlation coefficient test. In this study mean Troponin-I of Group I and Group II were 5.53±7.43 and 16.46±15.79ng/ml respectively. It was statistically significant (p<0.05). Echocardiography showed that patients with high Troponin-I level had low ejection fraction (LVEF) and patients with low Troponin-I level had preserved ejection fraction (LVEF). Analysis showed that patients with severe left ventricular systolic dysfunction (LVEF <35%) had the highest level of Troponin-I with worse in-hospital outcomes and vice versa-the patients with the preserved systolic function (LVEF ≥55%) had the lowest levels of Troponin-I with better in-hospital outcomes. In our study, it also showed that the levels of Troponin-I had negative correlation with LV ejection fraction levels, with medium strength of association (r= -0.5394, p=0.001). The study enabled us to conclude that, the higher was the Troponin-I level, the lower was the LV ejection fraction level and thus worse in-hospital outcomes in first attack of NSTEMI patients.