The impact of predictors used in differentiation between paroxysmal supraventricular tachycardia and ischemic heart disease in young patients with elevated high-sensitive troponin

Cardiac troponin T (cTnT) is a highly sensitive and specific biomarker for the diagnosis of acute myocardial infarction (AMI). However, elevated cTnT is also seen in other cardiac and noncardiac conditions. This phenomenon potentially leading to mismanagement of PSVT cases. Therefore, it becomes crucial to delineate the kinetic effects of cTnT elevation. This understanding is imperative for ensuring an accurate clinical diagnosis and effectively differentiating PSVT-related troponin elevation from underlying ischemic conditions.The aim of this study is to determine the pattern of changes in hs-cTnT levels in patients under 50 years of age with low risk of cardiovascular disease PSVT patients, who had elevated hs-cTnT levels upon presentation at the emergency department.

A total of 116 patients, under the age of 50, with low cardiovascular disease risk and admitted to the emergency department with chest pain and cTnT elevation during follow-up were analyzed. We subsequently assessed the presence of IHD in patients exhibiting elevated cTnT levels, and compared the variations in cTnT levels between those with IHD and PSVT. The presence of IHD was evaluated by means of diagnostic coronary angiography (CA) or cardiac computed tomographic angiography (CTA) after biomarker sampling. Electrophysiological study (EPS) was performed in patients whose CA or CTA did not reveal significant coronary artery stenosis. Pre-procedural transthoracic echocardiography was performed on all patients

In 99 out of the 116 patients included in the study, a coronary artery lesion responsible for infarction was detected on CA or CTA. Seventeen patients, who did not have a coronary artery lesion responsible for infarction, underwent EPS. Among these patients, atrioventricular nodal reentrant tachycardia was induced in 13, atrioventricular reentrant tachycardia in 2, and atrial tachycardia in the remaining 2 during EPS. In the patient group where PSVT, the coexistence of chest pain with palpitation symptoms was significantly more observed compared to the NSTEMI group (58,8 pg/ml vs 14,4 pg/ml, p<0.001). The troponin value at admission and the peak troponin value were found to be significantly higher in the NSTEMI group compared to the PSVT group (70 pg/ml vs 155,5 pg/ml, p=0.030 and 118 pg/ml vs 329 pg/ml, p=0.027). The time to peak troponin, on the other hand, was significantly earlier in the PSVT group compared to the NSTEMI group (3h vs 7h, p=0.037). No significant difference was observed between the two groups in the analysis of echocardiographic data.

We found that despite a higher likelihood of elevated enzyme levels, the admission and maximum cTnT levels were higher in patients with IHD. However, the time to peak troponin was significantly earlier in patients with PSVT. Further studies with a larger population are necessary to elucidate the exact changes in cardiac enzyme elevation in PSVT patients.