Clinical characteristics
Clinical characteristics of the examined group are presented in Table 6. Patients were of the average age of 35 ± 14 years with considerable predominance of males (24 males and 6 females). The only statistically significant characteristic when comparing groups Trop I + and Trop I – was the age of patients when patients in Trop I – were older.
Incidence of diagnoses in anamnesis of patients: 2 ulcerative colitis, 1 asthma bronchiale, 1 allergic rhinitis, 1 relapsing tonsillitis, 1 relapsing rhinitis, 1 infectious mononucleosis, 2 vertebrogenic painful syndrome, 1 myocarditis (without documented heart function damage), 2 sarcoidosis, 6 arterial hypertension, 1 rheumatic fever, 1 pyelonephritis, 1 asymptomatic infection of urinary tract, 1 diabetes mellitus I, 1 diabetes mellitus II, 1 thyroid gland stroma (pharmacologically compensated), 1 chronic venous insufficiency of lower limbs (pharmacologically compensated).
————————————————————————————————————————————————————————————————————————————–
| Characteristic | Examined group (n = 30) | Trop I –
(n = 7) |
Trop I +
(n = 23) |
Unit | p-value |
| Age | 35 ± 14 | 49 ± 19 | 31 ± 9 | years | 0,03318 |
| Females | 6 (20%) | 3 | 3 | – | 0,1201 |
| Weight | 81 ± 18 | 73 ± 23 | 84 ± 16 | kg | 0,4354 |
| Height | 177 ± 9 | 171 ± 12 | 178 ± 8 | cm | 0,11642 |
| BMI | 26 ± 5 | 25 ± 7 | 26 ± 5 | kg/m² | 0,97606 |
| BP systolic | 127 ± 19 | 133 ± 12 | 126 ± 21 | mmHg | 0,29372 |
| BP diastolic | 77 ± 12 | 80 ± 8 | 76 ± 14 | mmHg | 0,32708 |
| Heart rate | 85 ± 23 | 93 ± 27 | 83 ± 20 | beats/min | 0,4593 |
| Smokers | 9 (30%) | 2 | 7 | – | 1,0000 |
| Hosp. duration | 7 ± 4 | 7 ± 3 | 7 ± 4 | days | 0,77182 |
————————————————————————————————————————————————————————————————————————————–
Table 6: Clinical characteristics of the examined group.
Subjective symptoms and objective findings
The most frequent subjective symptoms were chest pain (70 %), chest pressure (37 %), shortness of breath (37 %), running temperature/fever (30 %), propagation of the pain in upper limb/jaw/back (23 %) and diarrhoea (20 %). History of recent or acute infection stated 43 % of patients. Statistical significance was reached in the chest pain when in Trop I + group it was recorded in 87 % of cases (20 patients). On the other hand, chest pan stated just 1 patient from Trop I – group. Other findings may be found in table 7.
————————————————————————————————————————————————————————————————————————————–
| Characteristic | Examined group (n = 30) | Trop I –
(n = 7) |
Trop I +
(n = 23) |
p-value |
| Chest pain | 21 (70%) | 1 | 20 | 0,0009 |
| Shortness of breath | 11 (37%) | 3 | 8 | 1,0000 |
| Fever/running temper. | 9 (30%) | 2 | 7 | – |
| Pain propagation | 7 (23%) | 0 | 7 | 0,1536 |
| Chest pressure | 11 (37%) | 1 | 10 | 0,2146 |
| Rash | 0 (0%) | 0 | 0 | – |
| Headache | 3 (10%) | 0 | 3 | 1,0000 |
| Symptoms/anamnesis of and infection | 13 (43%) | 4 | 9 | 0,6656 |
| Vomiting | 3 (10%) | 1 | 2 | 1,0000 |
| Diarrhoea | 6 (20%) | 0 | 6 | 0,2901 |
| Paleness | 1 (3%) | 0 | 1 | 1,0000 |
| Pre-collapse state | 2 (7%) | 0 | 2 | 1,0000 |
| Nausea | 2 (7%) | 1 | 1 | 0,4184 |
| Fatigue | 3 (10%) | 1 | 2 | 1,0000 |
| Peripheral swelling | 2 (7%) | 1 | 1 | 0,4184 |
| Palpitation | 2 (7%) | 1 | 1 | 0,4184 |
————————————————————————————————————————————————————————————————————————————–
Table 7: Subjective symptoms recorded in the examined group.
Normal objective finding was present in 57 %. Signs of the heart failure were recorded in 4 patients (13 %). Statistical significance was reached in the characteristic paleness and tachypnoea with the exclusive representation in Trop I–. Characteristic of tachycardia was reaching the statistical significance level. Other findings may be found in table 8.
————————————————————————————————————————————————————————————————————————————–
| Characteristic | Examined group (n = 30) | Trop I –
(n = 7) |
Trop I +
(n = 23) |
p-value |
| Heart failure/insufficiency | 4 (13%) | 2 | 2 | 0,2245 |
| Picture of coronary artery disease | 1 (3%) | 0 | 1 | 1,0000 |
| Normal | 17 (57%) | 3 | 14 | 0,6656 |
| Paleness | 3 (10%) | 3 | 0 | 0,0086 |
| Fever/running temper. | 1 (3%) | 0 | 1 | 1,0000 |
| Shortness of breath | 2 (7%) | 1 | 1 | 0,4184 |
| Jugular vein distention | 3 (10%) | 2 | 1 | 0,1276 |
| Hepatomegaly | 1 (3%) | 1 | 0 | 0,2333 |
| Ascites | 0 (0%) | 0 | 0 | – |
| Tachypnoea | 2 (7%) | 2 | 0 | 0,0483 |
| Tachycardia | 5 (17%) | 3 | 2 | 0,0679 |
| Irregular heart action | 2 (7%) | 0 | 2 | 1,0000 |
| Weakening of the 1st heart sound (HS) | 0 (0%) | 0 | 0 | – |
| 3rd of 4th HS | 1 (3%) | 0 | 1 | 1,0000 |
| Mitral (apex) murmur | 2 (7%) | 0 | 2 | 1,0000 |
| Pulmonary murmur | 1 (3%) | 0 | 1 | 1,0000 |
| Tricuspid murmur | 0 (0%) | 0 | 0 | – |
| Aortic murmur | 1 (3%) | 0 | 1 | 1,0000 |
| Pericardial effusion | 0 (0%) | 0 | 0 | – |
| Pleural effusion | 0 (0%) | 0 | 0 | – |
| Lung base crackles | 2 (7%) | 1 | 1 | 0,4184 |
| Rash | 1 (3%) | 0 | 1 | 1,0000 |
| Peripheral swelling | 2 (7%) | 1 | 1 | 0,4184 |
| Palpation – heart enlargement | 2 (7%) | 1 | 1 | 0,4184 |
————————————————————————————————————————————————————————————————————————————–
Table 8: Objective findings of the examined group.
ECG
Abnormal heart rhythm (AHR) was present in 40 %. The most frequent AHRs were tachycardia (6 patients), bradycardia (2 patients), atrial fibrillation (3 patients), atrial flutter (1 patient), junctional rhythm (1 patient), nonspecific disorder of the inner ventricular line (1 patient) and AV block of the 2nd degree (1 patient). AHR reached statistical significance (present in 6 from 7 individuals in Trop I –, including 2 cases of atrial fibrillation and 1 case of atrial flutter). Elevation of the ST-T segment or flat/inverted T wave were present in most of the patients from Trop I + group, however, did not reach statistical significance level when comparing with Trop I –. Generally, the elevation of ST segment was present in 47 % of patients and inversion/flat T waves in 63 %. Other findings are summarized in table 9.
————————————————————————————————————————————————————————————————————————————–
| Characteristic | Examined group (n = 30) | Trop I –
(n = 7) |
Trop I +
(n = 23) |
p-value |
| Abnormal heart rhythm | 12 (40 %) | 6 | 6 | 0,0086 |
| Bradycardia | 2 (7%) | 1 | 1 | 0,4184 |
| Tachycardia | 6 (20%) | 3 | 3 | 0,1201 |
| Atrial flutter | 1 (3%) | 1 | 0 | 0,2333 |
| Atrial fibrillation | 3 (10%) | 2 | 1 | 0,1276 |
| Junctional rhythm | 1 (3%) | 0 | 1 | 1,0000 |
| Ventricular line disorder | 1 (3%) | 0 | 1 | 1,0000 |
| AV block I/II/III degree | 0/1/0 (0/3/0%) | 0/0/0 | 0/1/0 | 1,0000 |
| ST segment depression | 2 (7%) | 1 | 1 | 0,4184 |
| ST segment elevation | 14 (47%) | 1 | 13 | 0,0860 |
| Inversion/flat T waves | 19 (63%) | 3 | 16 | 0,3717 |
| LBBB | 1 (3%) | 1 | 0 | 0,2333 |
| RBBB + iRBBB | 3 (10%) | 0 | 3 | 1,000 |
| Lower voltage in limb leads | 0 (0%) | 0 | 0 | – |
| QS swing | 3 (10%) | 2 | 1 | 0,1276 |
| Normal finding | 2 (7%) | 1 | 1 | 0,4184 |
| LV hypertrophy | 1 (3%) | 1 | 0 | 0,2333 |
| Transitional zone shift | 4 (13%) | 0 | 4 | 0,5476 |
————————————————————————————————————————————————————————————————————————————–
Table 9: ECG findings of the examined group (LV – left ventricular/ventricle, LBBB – left bundle branch block, RBBB – right bundle branch block, iRBBB – incomplete right bundle branch block, AV – atrioventricular)
ECHO
Characteristics of moderate or severe tricuspid and mitral regurgitation reached statistical significance with the exclusive representation in Trop I – (Table 7). Characteristic of severe systolic dysfunction (SD) reached statistical significance with the prevalence in Trop I –. Characteristic of LV EF lower 35 % was reaching statistical significance level with prevalence in Trop I – group. Finding of LV kinetics disorder and LV EF lower 55 % was documented in 47 % of patients. Dilatation or borderline dimension of the LV was present in 33 %. LV kinetics disorder and systolic dysfunction was present in 4 from 7 patients in Trop I – group in both cases, including 3 patients where systolic dysfunction was determined sever and or significant and LV EF was under 35 %. Signs of PH were present in 20 % of patients. Other findings are stated in table 10.
————————————————————————————————————————————————————————————————————————————–
| Characteristic | Examined group (n = 30) | Trop I –
(n = 7) |
Trop I +
(n = 23) |
p-value |
| Tricuspid regurgitation (TR) | 5 (17%) | 2 | 3 | 0,5650 |
| Mild TR | 3 (10%) | 0 | 3 | 1,000 |
| Moderate and severe TR | 2 (7%) | 2 | 0 | 0,0483 |
| Mitral regurgitation (MR) | 5 (17%) | 2 | 3 | 0,5650 |
| Mild MR | 3 (10%) | 0 | 3 | 1,000 |
| Moderate and severe MR | 2 (7%) | 2 | 0 | 0,0483 |
| Pulmonary regurgitation (PR) | 2 (7%) | 1 | 1 | – |
| Mild PR | 2 (7%) | 1 | 1 | 0,4184 |
| Moderate and severe PR | 0 (0%) | 0 | 0 | – |
| Aortic regurgitation (AR) | 0 (0%) | 0 | 0 | – |
| Mild AR | 0 (0%) | 0 | 0 | – |
| Moderate and severe AR | 0 (0%) | 0 | 0 | – |
| Pericardial effusion | 3 (10%) | 0 | 3 | 1,0000 |
| Pericardial separation | 3 (10%) | 1 | 2 | 1,0000 |
| LV hypertrophy | 1 (3%) | 1 | 0 | 0,2333 |
| LV kinetics disorder | 14 (47%) | 4 | 10 | 0,6746 |
| Diffuse hypokinesia | 11 (37%) | 3 | 8 | 1,0000 |
| Regional hypokinesia | 3 (10%) | 1 | 2 | 1,0000 |
| Systolic dysfunction (SD) | 10 (33 %) | 4 | 6 | 0,1813 |
| Decreased/mild SD | 6 (20%) | 1 | 5 | 1,0000 |
| Severe SD | 4 (13%) | 3 | 1 | 0,0307 |
| Thrombus | 2 (7%) | 0 | 2 | 1,0000 |
| Dilatation/marginal dimension of LV | 10 (33%) | 4 | 6 | 0,1813 |
| Marginal dimension | 3 (10%) | 0 | 3 | 1,0000 |
| Mild dilatation | 3 (10%) | 2 | 1 | 0,1276 |
| Moderate and severe dilatation | 4 (13%) | 2 | 2 | 0,2245 |
| LV EF under 55 % | 14 (47%) | 5 | 9 | 0,2040 |
| EF 45-55 % | 6 (20%) | 1 | 5 | 1,0000 |
| EF 36-44 % | 3 (10%) | 1 | 2 | 1,0000 |
| EF 35 % and lower | 5 (17%) | 3 | 2 | 0,0679 |
| RV dilatation | 2 (7%) | 1 | 1 | 0,4184 |
| RV function disorder | 2 (7%) | 1 | 1 | 0,4184 |
| LA dilatation | 4 (13%) | 2 | 2 | 0,2245 |
| LA function disorder | 0 (0%) | 0 | 0 | – |
| RA dilatation | 2 (7%) | 1 | 1 | 0,4184 |
| RA function disorder | 0 (0%) | 0 | 0 | – |
| Pulmonary hypertension signs | 6 (20%) | 3 | 3 | 0,1201 |
————————————————————————————————————————————————————————————————————————————–
Table 10: ECHO findings of the examined group (TR – tricuspid regurgitation, MR – mitral regurgitation, PR – pulmonary regurgitation, AR – aortic regurgitation, LV – left ventricular/ventricle, SD – systolic dysfunction, EF – ejection fraction, RV – right ventricle, LA – left atrium, RA – right atrium)
X-RAY
X-Ray examination findings were normal in 53 % of cases (n = 15). Heart dilatation was positive in 33 %. In 20 % of cases, the examination confirmed pulmonary circulation congestion. Characteristic of normal finding with exclusive prevalence in Trop I + groups was reaching statistical significance level. In Trop I – group, just 3 patients underwent X-Ray examination. Other findings are in table 11.
————————————————————————————————————————————————————————————————————————————–
| Characteristic | Examined group (n = 15) | Trop I –
(n = 3) |
Trop I +
(n = 12) |
p-value |
| Normal findings | 8 (53%) | 0 | 8 | 0,0769 |
| Dilatation/widened heart shade | 5 (33%) | 2 | 3 | 0,2418 |
| Pericardial effusion | 0 (0%) | 0 | 0 | – |
| Hyperaemia/pulmonary circulation congestion | 3 (20%) | 1 | 2 | 0,5165 |
| Other findings | 2 (13%) | 1 | 1 | 0,3714 |
| Bronchopneumonia | 1 (7%) | 0 | 1 | 1,0000 |
| Accentuation of lung markings | 1 (7%) | 1 | 0 | 0,2000 |
————————————————————————————————————————————————————————————————————————————–
Table 11: X-Ray findings of the examined group
CMRI
Normal dimensions and kinetics of heart chambers were confirmed in 58 % (n =12), (Table 9). LGE finding was present in 67 % with the prevalence in Trop I + (7 from 8 patients with positive LGE). In one case, there were found 2 thrombi in the LV. LV EF, EDV and ESV could not be statistically evaluated because of a low number of patients in Trop I – group (n = 2), Other findings are in table 12.
————————————————————————————————————————————————————————————————————————————–
| Characteristic | Examined group (n = 12) | Trop I –
(n = 2) |
Trop I +
(n = 10) |
p-value |
| Normal dimensions and kinetics | 7 (58%) | 1 | 6 | 1,0000 |
| Decreased LV kinetics | 5 (42%) | 1 | 4 | 1,0000 |
| LV dilatation | 3 (25%) | 0 | 3 | 1,0000 |
| LV EF | 58,3 ± 15,7 | 57,5 ± 10,6 | 58,5 ± 17,0 | – |
| LV EDV | 152,5 ± 31,6 | 137,0 ± 49,5 | 156,4 ± 29,1 | – |
| LV ESV | 67,2 ± 42,4 | 61,0 ± 35,4 | 68,8 ± 46,0 | – |
| Pericardial effusion | 0 (0%) | 0 | 0 | – |
| LGE | 8 (67%) | 1 | 7 | 1,0000 |
| Myocardial edema | 4 (33%) | 0 | 4 | 0,5152 |
| Thrombi | 1 (8%) | 0 | 1 | 1,0000 |
————————————————————————————————————————————————————————————————————————————–
Table 12: Cardiac magnetic resonance imaging findings of the examined group (LV – left ventricular, EF – ejection fraction, EDV – end-diastolic volume, ESV – end-systolic volume, LGE – late gadolinium enhancement)
Cardiac catheterization
Cardiac catheterization was normal in 58 % (n = 19). LV hypokinesis was detected in 37 % (n = 7). In 2 cases, narrowing/stenosis of one of the coronary arteries was found (in one case of ACD, in another one of RIA), however, both did not exceed the level of 50% stenosis. Other findings are summarized in table 13.
————————————————————————————————————————————————————————————————————————————–
| Characteristic | Examined group (n = 19) | Trop I –
(n = 5) |
Trop I +
(n = 14) |
p-value |
| Normal finding | 11 (58%) | 2 | 9 | 0,6027 |
| Pericardial effusion | 1 (5%) | 0 | 1 | 1,0000 |
| RCA hypoplasia | 3 (16%) | 1 | 2 | 1,0000 |
| Dilatation/marginal dimension of LV | 3 (16%) | 1 | 2 | 1,0000 |
| LV hypokinesia | 7 (37%) | 1 | 6 | 0,6027 |
| RV hypokinesia | 1 (5%) | 1 | 0 | 0,2632 |
| Mitral regurgitation | 2 (11%) | 1 | 1 | 0,4678 |
| CA changes < 50 % | 2 (11%) | 1 | 1 | 0,4678 |
————————————————————————————————————————————————————————————————————————————–
Table 13: Cardiac catheterization findings of the examined group (LV – left ventricular, RV – right ventricular, RCA – right coronary artery, CA – coronary artery)
Laboratory examination
Iontogram, creatinine and uric acid levels were normal in the majority of patients. Lower levels were detected in sodium (5 patients), potassium (9 patients), chlorides (2 patients), uric acid (8 patients) and creatinine (2 patients). Apart creatinine, where the representation of lower level was same in Trop I + and – groups, the lower level of these substances was detected primarily in patients in Trop I + group. Higher levels of ALT and AST were recorded at 43 % and 67 % of patients with the prevalence in Trop I +, but they did not reach the statistical significance. From inflammation markers, leucocytosis was present in 30 % with prevalence in Trop I +. The neutrophil level was elevated in 8 cases (7 from Trop I +), basophils were increased in 3 cases, monocytes in 4 and lymphocytes in 1 case. Eosinophils were, by contrast, decreased in 47 % of cases. Erythrocytes sedimentation ratio was increased in 47 % (n = 24) and CRP was increased in 80 % with the prevalence in Trop I + and reached statistical significance when comparing Trop I + and – groups. From biomarkers of myocardial damage, troponin I was increased in 77 %, CK-MB in 67 % (including 2 patients in Trop I –). Both characteristics reached statistical significance. The creatine kinase was increased in 63 % (including 1 patient in Trop I –), myoglobin was increased just in 36 % (n = 22), all of them in Trop I +. NT-proBNP was increased in 14 patients including 3 in Trop I –.
Other results of the blood count (haemoglobin, erythrocytes, haematocrit, thrombocytes) were elevated just exceptionally, rather they were under the low reference value (7 patients at haemoglobin, 10 at haematocrit).
Coagulation parameter APTT was increase in 10 patients (n = 25), QUICK just slightly (until 0,10 under the reference values) in 3 patients (n = 25). D dimers were positive in 3 patients. Other results may be found in table 14.
————————————————————————————————————————————————————————————————————————————-
| Characteristic | Examined group (n = 30) | Trop I –
(n = 7) |
Trop I +
(n = 23) |
p-value |
| Sodium | 137,87 ± 3,25 | 139,00 ± 2,94 | 137,52 ± 3,31 | 0,62414 |
| Potassium | 3,86 ± 0,47 | 3,96 ± 0,37 | 3,83 ± 0,49 | 0,8181 |
| Chlorides | 103,77 ± 4,04 | 105,29 ± 4,68 | 103,30 ± 3,82 | 0,36282 |
| Uric acid | 3,90 ± 1,98 | 5,26 ± 2,55 | 3,49 ± 1,63 | 0,04136 |
| Creatinine | 80,27 ± 13,43 | 79,43 ± 15,71 | 80,52 ± 13,04 | 0,90448 |
| ALT | 0,95 ± 0,92 | 1,22 ± 1,13 | 0,86 ± 0,86 | 0,64552 |
| AST | 0,98 ± 0,66 | 0,57 ± 0,28 | 1,10 ± 0,69 | 0,60306 |
| Kreatinekinasis | 9,66 ± 16,47 | 1,81 ± 1,32 | 12,04 ± 18,21 | 0,44726 |
| Haemoglobin | 144,13 ± 13,40 | 140,14 ± 11,58 | 145,35 ± 13,91 | 0,29372 |
| Erythrocytes | 4,84 ± 0,42 | 4,65 ± 0,31 | 4,90 ± 0,44 | 0,72786 |
| Haematocrit | 0,43 ± 0,04 | 0,42 ± 0,03 | 0,43 ± 0,05 | 0,81034 |
| Thrombocytes | 241,70 ± 90,37 | 270,00 ± 73,43 | 233,09 ± 94,67 | 0,11184 |
| Leucocytes | 8,94 ± 3,44 | 8,83 ± 3,18 | 8,98 ± 3,58 | 0,14706 |
| Troponin I | 7,43 ± 9,22 | 0,04 ± 0,01 | 9,68 ± 9,45 | ˂ 0,001 |
| CK-MB | 32,43 ± 36,24 | 2,16 ± 2,17 | 42,06 ± 36,71 | ˂ 0,001 |
| CRP | 44,14 ± 57,01 | 9,14 ± 12,64 | 54,79 ± 61,10 | ˂ 0,001 |
| Characteristic | Examined group (n = 24) | Trop I –
(n = 5) |
Trop I +
(n = 19) |
p-value |
| ESR 1 hour | 30,96 ± 26,82 | 28,00 ± 28,61 | 31,74 ± 27,10 | – |
| ESR 2 hour | 49,25 ± 33,48 | 45,00 ± 39,10 | 50,37 ± 32,96 | – |
| Characteristic | Examined group (n = 24) | Trop I –
(n = 4) |
Trop I +
(n = 20) |
p-value |
| Neutrophils | 63,17 ± 10,98 | 62,70 ± 8,11 | 63,26 ± 11,65 | – |
| Eosinophils | 1,40 ± 1,08 | 1,08 ± 0,70 | 1,47 ± 1,14 | – |
| Basophils | 0,47 ± 0,62 | 0,33 ± 0,46 | 0,50 ± 0,66 | – |
| Monocytes | 7,53 ± 2,67 | 6,05 ± 1,69 | 7,83 ± 2,76 | – |
| Lymphocytes | 23,10 ± 11,38 | 26,30 ± 10,27 | 22,47 ± 11,73 | – |
| Characteristic | Examined group (n = 25) | Trop I –
(n = 5) |
Trop I +
(n = 20) |
p-value |
| Characteristic | Examined group (n = 25) | Trop I –
(n = 5) |
Trop I +
(n = 20) |
p-value |
| APTT | 1,58 ± 1,83 | 1,09 ± 0,10 | 1,70 ± 2,04 | 0,9124 |
| QUICK | 1,09 ± 0,10 | 1,14 ± 0,14 | 1,08 ± 0,09 | 0,92034 |
| Characteristic | Examined group (n = 22) | Trop I –
(n = 7) |
Trop I +
(n = 15) |
p-value |
| Myoglobin | 94,85 ± 105,52 | 30,14 ± 20,18 | 125,05 ± 116,00 | 0,4009 |
| Characteristic | Examined group (n = 16) | Trop I –
(n = 4) |
Trop I +
(n = 12) |
p-value |
| NT BNP | 248,25 ± 376,07 | 94,25 ± 71,55 | 299,58 ± 424,22 | – |
————————————————————————————————————————————————————————————————————————————–
Table 14: Laboratory findings of the examined group ((ALT – alanine transaminase, AST – aspartate aminotransferase, ESD – erythrocytes sedimentation rate, APTT – activated partial thromboplastin time, QUICK – prothrombin time, CK-MB – creatine kinase muscle/brain, CRP – C reactive protein, NT BNP – N-terminal brain natriuretic peptide)
Author of the opening picture: Deedster