Troponins in Chronic Left Ventricular Dysfunction

Journal of Clinical and Basic Cardiology 2006; 9 (1-4): 19-22

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Keywords: diastolischer Blutdruck,  Herzinsuffizienz,  linksventrikuläre Dysfunktion,  diastolic blood pressure,  heart failure,  left ventricular dysfunction

Background: Troponins (I and T) are considered a marker of myocardial ischemic damage. We decided to investigate their meaning in patients with left ventricular dysfunction. We studied 59 patients (ranging from 40 to 80 years; mean age 64 years; SD 9) with left ventricular dysfunction from dilated cardiomyopathy, valvular heart disease and chronic ischemic cardiomyopathy. These patients were compared to 30 healthy persons and 15 patients with acute myocardial infarction. Troponins and several biochemical parameters of endothelial dysfunction, of inflammation and of cellular death were analyzed and correlated to echocardiographic index of left ventricular impairment. Results: I and T troponins were increased in all patients and showed a significantly positive correlation, except in the group of valvular heart disease. Moreover, a statistically significant negative correlation between the levels of troponins and the diastolic blood pressure was observed in chronic patients (TNI: r = –0.235, p = 0.037; TNT: r = –0.223, p = 0.044), contrary to the significantly positive correlation with both systolic and diastolic blood pressure recorded in acute myocardial infarction. Troponins were the only biochemical marker we studied that correlate with diastolic blood pressure. Conclusions: We believe that an excessively low level of the diastolic blood pressure in chronic patients with left ventricular dysfunction can provoke damage of the myocardium, thus inducing the increase of the circulating troponins. Therefore, we suggest to establish in the protocol of treatment of left ventricular dysfunction with ACE inhibitors, other vasodilators and beta-blockers a cut-off limit for diastolic blood pressure.