Troponin Elevation in Supraventricular Tachycardia: Primary Dependence on Heart Rate

Background: It is known that some patients with supraventricular tachycardia (SVT) could have increased troponin levels without coronary artery disease. Objectives: To compare the cardiovascular risk of patients admitted with SVT with troponin T elevation (T+ patients) versus those without (T-patients), to determine if the rise in troponin levels could be predicted, and to identify the right approach in T+ patients. Methods: Retrospective database search of patients with SVT from 2002 to 2007 either with or without troponin T elevation at admission. Results: Of the 73 study patients, there were 24 (32.9%) T+ patients and 49 (67.1%) T-patients. All except 5 T+ patients underwent either a stress test/MIBI or a coronary angiogram. Two noninvasive tests were positive and only 1 patient needed an angiogram and percutaneous coronary intervention; none of the other angiograms triggered any further treatment. Of the 49 T-patients, 11 had a noninvasive stress test; none of these tests was positive or triggered any further treatment. Compared with that of T-patients, the maximum heart rate was significantly higher in T+ patients (190.8 versus 170.3 beats per minute, P = .008). A correlation was found between the maximal heart rate during SVT and the level of troponin elevation (r = 0.637, P = .001). Conclusions: SVT could be associated with a troponin elevation without any severe coronary artery disease. In most patients, either conservative management or noninvasive stratification seems to be sufficient; an invasive strategy could then be reserved only for high-risk patients who tested positive. The only clinical variable correlated with the troponin rise was a higher maximal heart rate during the SVT episode.