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Should You Check Troponin in SVT?

פוסט זה זמין גם ב: עברית

Written by Caitlin Nicholson


This meta-analysis of 500 patients with supraventricular tachycardia (SVT) found that while 46% had elevated troponin levels, only a small proportion experienced major adverse cardiac events (MACE) or required additional cardiac testing.

SVT +/- troponin…
This meta-analysis included 7 studies, 500 patients, with a mean age of 56 years. 46% of patients with SVT had elevated serum troponin. The pooled prevalence of MACE in SVT patients was 6%, increasing to 11% in those with elevated troponin. 7% of SVT patients had downstream cardiac testing, rising to 16% among those with elevated troponin. Age was positively correlated with elevated troponin. Sensitivity analyses indicated no outlying studies that would affect the overall findings. 93% of the variability in effect sizes across the studies was due to differences between studies, not random sampling error, indicating significant heterogeneity (I² = 93%). Overall, this meta-analysis suggests that while elevated troponin affects nearly half of SVT patients, a minority experience MACE or undergo significant additional cardiac testing. These findings emphasize the importance of clinical judgment in managing these patients, as troponin elevation often does not correlate with poor outcomes.

How will this change my practice?
In the emergency department, routine troponin testing for stable SVT patients after conversion to sinus rhythm, without concerning cardiac symptoms, is generally not necessary. Overuse of troponin can lead to unnecessary additional testing and potential harm through false positives and downstream interventions. I will continue to rely on clinical judgment – a thorough history, physical exam, and ECG – to guide the decision to order a troponin in these patients.

Editor’s note: Amal Mattu doesn’t routinely check troponin in SVT patients. For more teaching pearls from Dr. Mattu, check the Top Picks video series for Gold Spoon subscribers. Also, the newest videos by Mattu and colleagues will drop in 2025! ~Clay Smith

Source
The Role of Troponin Testing in Patients with Supraventricular Tachycardia, Systematic Review and Meta-Analysis. J Emerg Med. 2024 Nov;67(5):e402-e413. doi: 10.1016/j.jemermed.2024.05.010. Epub 2024 May 19. PMID: 39242347

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