TROPONIN-T MEASUREMENT AFTER MYOCARDIAL-INFARCTION CAN IDENTIFY LEFT-VENTRICULAR EJECTION OF LESS-THAN 40-PERCENT

Aim-To determine whether measurement of serum troponin T concentration after first acute myocardial infarction can be used to identify patie nts with a left ventricular ejection fraction of < 40%, who have an ad verse prognosis. Methods-Troponin T concentration was measured, and co ronary and left ventriculography performed in 50 consecutive patients with acute myocardial infarction. Angiographic left ventricular ejecti on fraction was compared with serum troponin T concentration. Patients with previous myocardial infarction were excluded. Results-There was a strong negative correlation between left ventricular ejection fracti on and troponin T concentration. Spearman's rank correlation coefficie nt (corrected for ties) was -0.72 (95% confidence intervals (CI) -0.55 to -0.83; p < 0.0001). Analysis by receiver operator characteristic c urve produced an area under the curve of 0.9773 (95% CI 0.9409 to 1.01 36). A troponin T concentration of > 2.8 mu g/l predicted a left ventr icular ejection fraction of < 40% with a sensitivity of 100% (CI 84.6 to 100.0) and specificity of 92.9% (CI 76.5 to 99.1). Exclusion of pat ients who did not receive thrombolytic treatment did not significantly affect the results. Conclusion-Serum troponin T concentration measure d 12-48 hours after admission for first myocardial infarction is a rel iable, simple, quick, inexpensive, noninvasive method for identifying patients with a left ventricular ejection fraction of < 40% for whom t here is a poor prognosis.