Etiology of elevated cardiac troponin levels in patients with acute respiratory disease

master's thesis

• Title (croatian): Etiologija povišenog kardijalnog troponina u bolesnika s akutnom respiratornom bolešću
• Author: Ilya Gurman
• Mentor: Gordana Pavliša (mentor)
• Committee member: Gordana Pavliša (predsjednik povjerenstva)
• Committee member: Sanja Popović-Grle (član povjerenstva)
• Committee member: Marko Jakopović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Cardiac troponins are specific biomarkers of myocardial injury. Elevated cardiac troponin has long been considered to be a specific hallmark of myocardial infarction. Increasing evidence of myocardial injury in the absence of coronary artery disease has
led to the need to review the classification of myocardial injury and infarction, as nonischemic causes have been clearly observed as being able to raise cardiac troponin levels as well. Cardiac troponin elevation is a frequent finding in patients with respiratory diseases such as pneumonia, acute respiratory distress syndrome, sepsis, acute exacerbation of chronic obstructive pulmonary disease, pulmonary hypertension and pulmonary embolism. Several different mechanisms have been proposed to explain this phenomenon including an oxygen supply and demand mismatch, inflammation - induced coronary plaque rupture and subsequent myocardial necrosis, right ventricular dysfunction, subendocardial ventricular ischemia, direct myocarditis as well as previously undiagnosed coronary artery disease. However, regardless of the underlying etiology, elevated cardiac troponin in respiratory disease is associated with increased disease severity, risk of complicated hospital stay, need for cardiac interventional procedures, as well as increased fatal outcome. The measurement of cardiac troponin poses significant usefulness in the management of severe respiratory disease and therefore should be considered as routine for patients admitted on account of acute respiratory disease. This would help in early identification of myocardial injury and categorization of more at-risk patients, in order to allow for more aggressive and targeted therapy and by doing so, improve outcomes.

Abstract (croatian)

Srčani troponini specifični su biomarkeri ozljede miokarda. Povišeni srčani troponin dugo se smatrao specifičnim obilježjem infarkta miokarda. Sve više dokaza o ozljedama miokarda u odsutnosti bolesti koronarnih arterija dovelo je do potrebe za
revidriranjem klasifikacije ozljeda i infarkta miokarda jer su jasno uočeni neishemijski uzroci koji također mogu povisiti razinu srčanog troponina. Povišenje srčanog troponina čest je nalaz u bolesnika s respiratornim bolestima kao što su upala pluća, sindrom akutnog respiratornog distresa, sepsa, akutno pogoršanje kronične opstruktivne plućne bolesti, plućna hipertenzija i plućna embolija. Nekoliko različitih mehanizama predloženo je za objašnjenje ovog fenomena. Oni uključuju:
neusklađenost opskrbe i potražnje kisika, ruptura koronarnih plakova potaknuta upalom i posljedična nekroza miokarda, disfunkcija desne klijetke, subendokardijalna ventrikularna ishemija, izravni miokarditis kao i predhodno nedijagnosticirana bolest koronarnih arterija. Bez obzira na temeljnu etiologiju, povišeni srčani troponin u respiratornim bolestima povezan je s povećanim rizikom kompliciranog boravka u bolnici, težim oblikom bolesti, potrebom za intervencijama na koronarnim arterijama i povećanim rizikom smrtnog ishoda. Pokazano je da mjerenje srčanog troponina predstavlja značajnu korist u liječenju teških respiratornih bolesti, pa bi stoga trebalo smatrati rutinskim postupkom u bolesnika primljenih radi akutne respiratorne bolesti. Ono može pomoći u ranoj identifikaciji ozljede miokarda i kategorizaciji rizičnih bolesnika kako bi se omogućila agresivnija i ciljana terapija, a time poboljšali ishodi.

• Keywords: cardiac troponin; mechanisms; myocardial injury; acute respiratory disease
• Keywords (croatian): kardijalni troponin; mehanizmi; ozljeda miokarda; akutna respiratorna bolest
• Language: english
• URN:NBN: urn:nbn:hr:105:140872
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-12-21 09:08:59