Troponin-T Elevation After Implanted Defibrillator Discharge Predicts Survival

Dan Blendea ^1*, Mihaela C Blendea ², Jeffrey Banker ¹ and Craig A McPherson ¹

¹ Bridgeport Hospital - Yale University School of Medicine, United States
² University of Massachusetts Medical School, United States

^* To whom correspondence should be addressed. E-mail: dblendea{at}mac.com.

Accepted 17 March 2009

Abstract

Objective: Cardiac troponin-T (cTnT) elevations have been reported to occur after implantable cardioverter defibrillator (ICD) discharges, but their prognostic significance is unknown.

The aim of this study was to evaluate whether cTnT elevations occurring after ICD discharges impact survival.

Design: Prospective observational study.

Patients: We studied 174 patients (age 68±12, 32 women) who received spontaneous (N=66) or induced (N=108) ICD discharges. The mean left ventricular ejection fraction was 29±11%.

Main outcome measures: Troponin-T was measured between 12 and 24h after ICD discharge. Patients received between 1 and 19 discharges (mean 2.4±2.4), with total delivered energy ranging from 6 to 288 J (mean 41±63J). The relationship between cTnT levels and all cause mortality was assessed in univariate and multivariate analyses.

Results: During a median follow-up period of 41.8 months (range 3 – 123 months), 56 patients died. Patients with a post-discharge cTnT level of 0.05 ng/ml had worse survival than those with cTnT <0.05 ng/ml. The significant relationship between elevated cTnT and survival was retained in Cox multivariate analysis adjusted for total ICD energy delivered during an arrhythmia episode, age, sex, presence of coronary artery disease, left ventricular ejection fraction, and serum creatinine.

Conclusions: Elevation of troponin-T after ICD discharge, even when it occurs following device testing, is a risk factor for mortality that is independent of other common clinical factors that predict survival in such patients.