Aletras Georgios, Koutalas Emmanuel, Bachlitzanaki Maria, Stratinaki Maria, Bachlitzanaki Irene, Stavratis Spyridon, Garidas Gerasimos, Pitarokoilis Michael, Foukarakis Emmanuel
Department of Cardiology, Venizelio General Hospital of Heraklion, 71409 Heraklion, Greece.
School of Medicine, University of Crete, 70013 Heraklion, Greece.
J Clin Med. 2025 Aug 9;14(16):5644. doi: 10.3390/jcm14165644.
Elevated cardiac troponin (cTn) levels in patients with paroxysmal supraventricular tachycardia (PSVT) often prompt coronary artery disease evaluation, though the clinical relevance of this finding remains unclear. This study aimed to identify risk factors for cTn elevation after a PSVT episode and assess its clinical significance, including the role of coronary artery disease (CAD) and long-term outcomes. We retrospectively collected data on demographics, presenting symptoms, comorbidities, chronic antiarrhythmic medication use, tachycardia duration, admission systolic blood pressure (SBP), heart rate (HR), laboratory findings, and cardioversion method in patients presenting to the Emergency Department (ED) with PSVT over a 4-year period. Patients were stratified into two groups based on the presence or absence of troponin elevation. Individuals with elevated cTn levels and at least one cardiovascular risk factor were further evaluated for CAD. One-year outcomes included SVT recurrence, rehospitalization, ablation, and mortality. Among 120 patients with PSVT, 58 (48.3%) exhibited elevated cardiac troponin (cTn) levels. Independent predictors of cTn elevation included retrosternal chest pain, absence of prior SVT history, higher admission HR, and lower SBP. A heart rate cut-off of 165 bpm was identified as optimal for predicting cTn elevation (sensitivity 62.1%, specificity 72.6%). Of the 58 cTn (+) patients, 25 underwent CAD evaluation, with only 1 case (4%) confirming significant coronary disease. At one-year follow-up (n = 118), troponin elevation was not associated with increased SVT recurrence, rehospitalization, ablation, or mortality. Similarly, CAD evaluation in troponin-positive patients did not predict outcomes. Troponin elevation after PSVT is frequent but not prognostically significant. It is likely due to transient myocardial stress rather than CAD, supporting a conservative, individualized approach to further testing.
阵发性室上性心动过速（PSVT）患者的心脏肌钙蛋白（cTn）水平升高常常促使对冠状动脉疾病进行评估，尽管这一发现的临床相关性仍不明确。本研究旨在确定PSVT发作后cTn升高的危险因素，并评估其临床意义，包括冠状动脉疾病（CAD）的作用和长期预后。我们回顾性收集了4年间因PSVT就诊于急诊科（ED）的患者的人口统计学数据、出现的症状、合并症、慢性抗心律失常药物使用情况、心动过速持续时间、入院时收缩压（SBP）、心率（HR）、实验室检查结果以及复律方法。根据肌钙蛋白升高与否将患者分为两组。cTn水平升高且至少有一个心血管危险因素的个体进一步评估是否患有CAD。一年的预后指标包括室上性心动过速复发、再次住院、消融和死亡率。在120例PSVT患者中，58例（48.3%）心脏肌钙蛋白（cTn）水平升高。cTn升高的独立预测因素包括胸骨后胸痛、无既往室上性心动过速病史、较高的入院心率和较低的SBP。确定心率临界值为165次/分钟最适合预测cTn升高（敏感性62.1%，特异性72.6%）。在58例cTn（+）患者中，25例接受了CAD评估，只有1例（4%）确诊为严重冠状动脉疾病。在一年的随访中（n = 118），肌钙蛋白升高与室上性心动过速复发、再次住院、消融或死亡率增加无关。同样，对肌钙蛋白阳性患者进行CAD评估也不能预测预后。PSVT后肌钙蛋白升高很常见，但对预后无显著意义。这可能是由于短暂的心肌应激而非CAD所致，支持采用保守、个体化的方法进行进一步检查。
