Question:

What might explain my elevated Troponin level?

My troponin T level was .44 in May of this year. Six hours later, it dropped below .10. The hospital stated I did not have a heart attack. Echocardiogram and Cardiac CT were normal. I have read that because my Troponin level was slightly raised that I have a high chance of mortality within 1-3 years. I’ve had heart attack symptoms. (intermittent central chest pain/aches/bilateral arm pains and aches/shortness of breath/palpitations/back ache and jaw pain) since end of March this year. I did have laparoscopic surgery a month before the troponin elevation. Can you explain my risk of a higher mortality?

Submitted by Izzie from England on 10/01/2014

It must first be determined whether you had a coronary event with or without an actual heart attack. Since you had cardiac symptoms, an elevated troponin would usually lead to an invasive evaluation to include angiography of your coronary arteries. I will assume for this question that this was done and that no significant coronary artery disease was found. In less aggressive centers, a non-invasive strategy might be considered if you are otherwise low risk and if stress testing was negative or if cardiac CT included high resolution coronary angiography that provided diagnostic images to rule out coronary artery disease. I will also assume that your symptoms have resolved.

Troponin elevation in isolation does not confer a high mortality rate. However, the presence of increased troponin is one marker of severity of underlying illness and as such has been used to identify people at higher risk of bad outcomes. This is felt to be related to severe cardiac strain related to the underlying illness or possibly to microvascular disease in the heart. The key is in treating the underlying illness and in the absence of CAD, the troponin should not carry a lingering elevation of mortality. It is important to remember that this is a single clue in the overall evaluation and cannot be interpreted in isolation for an individual. The statistics that are associated with elevated mortality are valid only when applied to a large group of patients. Unexplained and apparently unimportant troponin elevations occur frequently in medicine and the meaning of them remains unclear.