Relationship of Myocardial Ischemia and Injury to Coronary Artery Disease in Patients With Supraventricular Tachycardia

      Increase of serum troponin I and ST-segment depression are objective markers of myocardial ischemia/injury. Abnormalities of the 2 indicators have been associated with supraventricular tachycardia (SVT) but their relevance for diagnosing acute coronary syndrome and the presence of coronary artery disease (CAD) in this setting have not been clarified. Therefore, we sought to evaluate the frequency of CAD based on increased troponin I and ST-segment depression during SVT. During a 5-year period, 104 patients were admitted with a diagnosis of SVT, 80 of whom had troponin I testing, and 70 of these patients could be assessed for ST-segment changes. Thirty-seven patients (48%) had increased troponin I (mean 1.54 ± 2.7 ng/dl, normal ≤0.07 ng/dl) and 46 patients (57%) had ST-segment depression ≥1.0 mm. There were no significant differences in baseline characteristics and clinical presentation of patients with and without troponin I increase or ST-segment depression. There was no difference in the diagnosis of CAD by noninvasive or invasive testing in patients with and without increased troponin I. More patients with than without ST-segment depression had evidence of CAD (22% vs none, p = 0.01), but after adjusting for covariates, ST-segment depression was not a significant predictor of CAD. In conclusion, increased troponin I and ST-segment depression are not significant markers of acute coronary syndrome in patients with SVT.
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        • Bakshi T.
        • Choo M.
        • Edwards C.
        • Scott A.G.
        • Hart H.H.
        • Armstrong G.P.
        Causes of elevated troponin I with a normal coronary angiogram.
        Intern Med J. 2002; 32: 520-525
        • Mahajan N.
        • Mehta Y.
        • Rose M.
        • Shani J.
        • Lichstein E.
        Elevated troponin level is not synonymous with myocardial infarction.
        Int J Cardiol. 2006; 111: 442-449
        • Zellweger M.
        • Schaer B.
        • Cron T.
        • Pfisterer M.
        • Osswald S.
        Elevated troponin levels in absence of coronary artery disease after supraventricular tachycardia.
        Swiss Med Wkly. 2003; 133: 439-441
        • Redfearn D.
        • Ratib K.
        • Marshall H.
        • Griffith M.
        Supraventricular tachycardia promotes release of troponin I in patients with normal coronary arteries.
        Int J Cardiol. 2005; 102: 521-522
        • Robinson M.
        • Brown R.
        • Srivatsa U.
        • Amsterdam E.A.
        Over the speed limit.
        Am J Med. 2007; 120: 851-853
        • Yeo K.
        • Cruz L.
        • Hong R.
        Tachycardia-induced elevations in cardiac troponin in the absence of coronary artery disease.
        Hawaii Med J. 2006; 65: 86-87
        • Dorenkamp M.
        • Zabel M.
        • Sticherling C.
        Role of coronary angiography before radiofrequency ablation in patients presenting with paroxysmal supraventricular tachycardia.
        J Cardiovasc Pharmacol Ther. 2007; 12: 137-144
        • Petsas A.
        • Anastassiades L.
        • Antonopoulos A.
        Exercise testing for assessment of the significance of ST segment depression observed during episodes of paroxysmal supraventricular tachycardia.
        Eur Heart J. 1990; 11: 974-979
        • Nelson S.
        • Kou W.
        • Annesley T.
        • de Buitleir M.
        • Morady F.
        Significance of ST segment depression during paroxysmal supraventricular tachycardia.
        J Am Coll Cardiol. 1988; 12: 383-387
        • Gulec S.
        • Erta F.
        • Karaoouz R.
        • Guldal M.
        • Alpman A.
        • Oral D.
        Value of ST-segment depression during paroxysmal supraventricular tachycardia in the diagnosis of coronary artery disease.
        Am J Cardiol. 1999; 83: 458-460
        • Takayanagi K.
        • Hoshi H.
        • Shimizu M.
        • Inoue T.
        • Sakai Y.
        • Morooka S.
        • Takabatake Y.
        Pronounced ST-segment depression during paroxysmal supraventricular tachycardia.
        Jpn Heart J. 1993; 34: 269-278
        • Kim Y.
        • Sousa J.
        • el-Atassi R.
        • Calkins H.
        • Langberg J.J.
        • Morady F.
        Magnitude of ST segment depression during paroxysmal supraventricular tachycardia.
        Am Heart J. 1991; 122: 1486-1487
        • Imrie J.R.
        • Yee R.
        • Klein G.J.
        • Sharma A.D.
        Incidence and clinical significance of ST segment depression in supraventricular tachycardia.
        Can J Cardiol. 1990; 6: 323-326
        • Kontos M.C.
        • Fratkin M.J.
        • Jesse R.L.
        • Anderson F.P.
        • Ornato J.P.
        • Tatum J.L.
        Sensitivity of acute rest myocardial perfusion imaging for identifying patients with myocardial infarction based on a troponin definition.
        J Nucl Cardiol. 2004; 11: 12-19