Measurement of cardiac troponin-I in the diagnosis of infective endocarditis

Eoin Kilkenny*, Claire Watson, Joanna Dukes McEwan, Elizabeth Bode, Melanie J Hezzell, Jessie Rose Payne, Kieran Borgeat

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background: Infective endocarditis (IE) in dogs is associated with significant morbidity and mortality but often presents with non-specific clinical signs.
Hypothesis/Objectives: Cardiac troponin-I (cTnI) concentration is elevated in patients with IE and can differentiate IE patients from those with other diseases with similar clinical features. Concentration of cTnI is negatively correlated with survival time in IE patients.
Animals: Seventy-two client-owned dogs; 29 with IE, 27 with stage B myxomatous mitral valve disease (MMVD) and 16 with immune-mediated disease (IMD). 

Methods: Retrospective clinical cohort study. Cardiac troponin-I concentration was measured in all patients at time of diagnosis. Clinical findings and echocardiographic interpretation were also recorded. Statistical analyses included Kruskal-Wallis test, pairwise Mann-Whitney U tests and receiver operator characteristic. Cox proportional hazards was used to investigate the association between cTnI and survival time.

Results: Concentration of cTnI was significantly higher in the IE group (0.69 ng/mL (0.03-80.8)) than in the MMVD (0.05 ng/mL (0.02-0.11), P<0.001) and IMD groups (0.05 ng/mL (0.03-0.57), P<0.001). Increased cTnI was a moderately accurate predictor of IE (AUC 0.857 (95%CI 0.745-0.968, P<0.001). A cTnI cut-off of 0.625 ng/mL had 100% specificity (95%CI 90-100%) and 52% sensitivity (95%CI 33-70%) in this population. There was no association between cTnI concentration and survival time in IE patients (P=0.201).

Conclusions and clinical importance: Cardiac troponin-I concentrations are higher in dogs with IE compared to dogs with preclinical MMVD or IMD. In patients with a compatible clinical presentation, cTnI concentrations >0.625 ng/mL are supportive of IE.
Original languageEnglish
JournalJournal of Veterinary Internal Medicine
Publication statusAccepted/In press - 5 Jun 2021

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