Evaluation of troponin-I as an indicator of cardiac dysfunction after thermal injury

Joseph T. Murphy, Jureta W. Horton, Gary F. Purdue, John L. Hunt

Research output: Contribution to journalArticle

57 Scopus citations

Abstract

Background: Biochemical serum markers commonly used to assess human cardiac injury (creatinine phosphokinase, creatine phosphokinase-MB) have been shown to have diminished specificity for detection of cardiac injury in the setting of burn-related soft-tissue and skeletal muscle injury. Laboratory studies have demonstrated that severe cutaneous thermal injury is associated with cardiac contractile dysfunction and a corresponding elevation in serum cardiac troponin-I (cTn-I) in several species. Methods: Twenty- three patients admitted to a tertiary care burn referral center were evaluated. Patients were monitored with pulmonary artery catheters, and creatinine phosphokinase, creatine phosphokinase-MB, and cTn-I levels were determined for 24 hours. Using a database, 6,722 burn patients were reviewed to determine the incidence of preexisting cardiac disease and postburn cardiac complications. Results: All patients had persistent sinus tachycardia (>115 beats per minute) without obvious electrical anomalies. All patients centrally monitored with a pulmonary artery catheter (n = 20) maintained a cardiac index of greater than 3.0 L · min-1.m-2. cTn-I was present (>0.3 ng/mL) within 3.0 hours and elevated (>0.55 ng/mL) at 24 hours for all burns of more than 18% total body surface area. Historically, although only 5% of all admissions manifest acute postburn cardiac complications, 94% of these patients presented with preexisting heart disease. Conclusion: Severe thermal injury was associated with a mild elevation in serum troponin-I; however, this did not correlate with overt cardiac morbidity or mortality. Postburn elevation of cTn-I suggested that a subtle degree of cardiac injury was present after a severe thermal injury despite hyperdynamic cardiac function during resuscitation.

Original languageEnglish (US)
Pages (from-to)700-707
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume45
Issue number4
DOIs
StatePublished - Oct 1 1998

Keywords

  • Cardiac dysfunction
  • Thermal injury
  • Troponin-I

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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