Raised troponin without infarction: CT angiography plus late iodine enhancement

Design

Prospective single-centre consecutive cohort

Population

191 emergency patients with raised troponin, acute symptoms and no infarction criteria

Primary outcome

Change in working diagnosis after CT

Effect

Diagnosis changed in 48%; agreement with discharge diagnosis 0.94 (95% CI 0.89–0.97)

This prospective single-centre Italian study enrolled 191 consecutive emergency patients with acute chest pain or equivalent, raised troponin and no criteria for myocardial infarction, excluding prior revascularisation. All had coronary CT angiography; those without obstructive disease had late iodine enhancement imaging and, if negative, extracellular volume measurement.

Obstructive coronary disease was found in 40%. Of the remaining 106, tissue imaging was positive in 55%: myocarditis in 30%, Takotsubo in 13%, infarction with non-obstructive coronary arteries in 8%, amyloidosis in 3% and dilated cardiomyopathy in 1%. CT changed the working diagnosis in 48% of all patients and agreed with the final discharge diagnosis 94% of the time. Among patients whose whole protocol was negative, no major adverse cardiac events occurred over a median of 24 months.

This offers emergency departments a single scan that both rules out obstructive coronary disease and characterises the myocardium, where many units would otherwise wait for cardiac MRI. It comes from one experienced centre, without a comparison group, and the negative-scan safety rests on small numbers. It is a reason to discuss a combined protocol with cardiology, not to replace MRI where that is readily available.

• Consider adding late iodine enhancement to coronary CT angiography for raised troponin without infarction.
• Agree the protocol with cardiology, including when to add extracellular volume measurement.
• Report myocarditis, Takotsubo and amyloid patterns specifically when present.
• Treat a fully negative combined scan as reassuring, while noting the small numbers behind that finding.
• Keep cardiac MRI as the reference test where it is quickly available.

Why it matters

It turns a common diagnostic dead end into a same-day answer for many patients.

Don't overread it

This was a single-centre study without a comparison arm; the negative-scan safety rests on few patients.

The statistics, in plain English

Agreement of 0.94 with the discharge diagnosis means CT reached the same conclusion as full standard workup in about 94 of 100 patients. No events after a negative scan is reassuring but, with about 48 such patients, a low event rate cannot be excluded.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.