THE IMPORTANCE OF TROPONIN-I AS A PREDICTOR OF CARDIAC INJURY CAUSED BY CARBON MONOXIDE POISONING
To the Editor,
We read the article (Serum Levels of NT-ProBNP as an Early Cardiac Marker of Carbon Monoxide Poisoning) by Davutoglu et al. (volume 18, 155–158, 2006) with great interest. In this report a well-designed, case-controlled, original study focusing on investigating the relationship between plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiotoxicity of carbon monoxide poisoning (COP) was first reported in the literature. As a summary, statistically significant high levels of serum NT-proBNP and carboxyhemoglobin (COHb) in the study group, compared to controls, were detected, whereas no differences in creatine kinase-MB (CK-MB) and cardiac troponin-T (CTT) levels between groups were detected. We would like to vigorously emphasize that cardiac troponin-I (CTI) has an undeniable importance in detecting the cardiac injury, caused by COP.
Myocardial injury was found to be a significant predictor of mortality related to COP (Henry et al., Citation2006; Satran et al., Citation2005). It was represented that myocardial injury, assessed by CK-MB or CTI elevation, occurred in 44% of patients with biomarkers drawn (Satran et al., Citation2005). Electrocardiograph (ECG) findings and/or elevation of serum CTI and/or CK-MB levels were underscored as integral criteria for the assessments of cardiac injuries caused by COP (Henry et al., Citation2006; Satran et al., Citation2005). Our clinical experiences were also relevant to these observations.
In this regard, it is confusing that, serum levels of CTT were normal in the study group, wherea, one patient in the study group had presented ST depression on ECG and decreased left ventricular systolic function (EF < 40%).
As a conclusion, we would like to emphasize regarding the article by Davutoglu et al. that early detection of myocardial injury caused by COP is crucial. Further studies focusing on comparisons of the predictive values of CTI/CTT and NT-proBNP for the cardiotoxicity of COP seem to be necessary.
Related Research Data
REFERENCES
- Davutoglu V., Gunay N., Kocoglu H., Gunay N. E., Yildirim C., Cavdar M., Tarakcioğlu M. Serum levels of NT-ProBNP as an early cardiac marker of carbon monoxide poisoning. Inhal. Toxicol. 2006; 18: 155–158
- Henry C. R., Satran D., Lindgren B., Adkinson C., Nicholson C. I., Henry T. D. Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. J. Am. Med. Assoc. 2006; 295: 398–402
- Satran D., Henry C. R., Adkinson C., Nicholson C. I., Bracha Y., Henry T. D. Cardiovascular manifestations of moderate to severe carbon monoxide poisoning. J. Am. Coll. Cardiol. 2005; 45: 1513–1516