L'élévation des troponines dans les rhabdomyolyse du sujet âgé, repère bibliographique

Publications scientifiques intéressantes en gériatrie et psychogériatrie

Le présent article présente les publications en lien avec la recherche signalée dans le titre. Les repères bibliographiques comprennent :
  • une phrase de recherche PubMed,
  • entre 6 et 10 références intéressantes.
La rhabdomyolyse est un syndrome clinico-biologique secondaire à la lyse des fibres musculaires squelettiques dont le contenu est libéré dans le secteur circulant et les liquides extracellulaires. La compression prolongée des membres est la cause la plus connue, mais les rhabdomyolyses positionnelles, d’effort ou d’origine toxique existent. Chez la personne âgée, elle est souvent consécutive à une chute avec un séjour au sol prolongé. Les éléments biologiques sont encore discutés, en particulier les valeurs au-delà desquelles le syndrome est établi. L’augmentation du taux de créatine phosphokinase (CPK), proportionnelle à l’importance de la lyse musculaire, pose le diagnostic. La gravité du syndrome est variable, allant de l’élévation isolée de la CPK à un tableau grave avec hyperkaliémie, hypocalcémie, insuffisance rénale aiguë, CIVD et désordres électrolytiques majeurs.

Des études suggèrent qu’elle puisse provoquer une troponine cardiaque I faussement élevée dans 20 à 50% des cas. Repères bibliographiques.

Mots clés et recherche sur PubMed :

  • Finsterer Josef, Stöllberger Claudia. Where does troponin I derive from in rhabdomyolysis?. Am J Emerg Med. 2006 Jul;24(4):509-10; author reply 510-1. PMID : 16787819
    Résumé non disponible.
    FR PMID : 16787819 10.1016/j.ajem.2006.03.020
  • Thygesen Kristian, Alpert Joseph S, Jaffe Allan S, Simoons Maarten L, Chaitman Bernard R, White Harvey D. Third universal definition of myocardial infarction. Glob Heart. 2012 Dec;7(4):275-95. PMID : 25689940
    Résumé non disponible.
    FR PMID : 25689940 10.1016/j.gheart.2012.08.001
  • Nallet O, Gouffran G, Lavie Badie Y. [Troponin elevation in the absence of acute coronary syndrome]. Ann Cardiol Angeiol (Paris). 2016 Nov;65(5):340-345. PMID : 27693169
    Cardiac troponins are the most sensitive and specific markers of myocardial injury. Cardiac troponin elevation are common in many diseases and do not necessarily indicate the presence of a thrombotic acute coronary syndrome. In clinical practice, interpretation of dynamic changes of troponin may be challenging. Troponin evaluation should be performed only if clinically indicated and must be interpreted in the context of clinical presentation, ECG changes, troponin level and kinetic. In the absence of thrombotic acute coronary syndrom, troponin retains a prognostic value. Its practical interest as a risk criteria is limited to a few situations like pulmonary embolism, pericarditis an myocarditis.
    FR PMID : 27693169 10.1016/j.ancard.2016.09.006
  • Wongrakpanich Supakanya, Kallis Christos, Prasad Prithiv, Kanjanahattakij Napatt, Sirinvaravong Natee, Rangaswami Janani, Rosenzweig Andrew. Prevalence of false positive troponin I in elderly patients with rhabdomyolysis. Geriatr Gerontol Int. 2017 07;17(7):1137-1140. PMID : 28741884
    Résumé non disponible.
    FR PMID : 28741884 10.1111/ggi.13021
  • Masri Wafa, Le Guillou Edouard, Hamdi Eya, Ghazal Khaldoun, Lebigot Elise, Cosson Claudine, Cynober Françoise Blonde, Therond Patrice. Troponin elevation in other conditions than acute coronary syndromes. Ann Biol Clin (Paris). 2017 Aug 01;75(4):411-419. PMID : 28751286
    Troponin is a specific cardiac infarction isoform (TnIc, TnTc) and its determination is used for the diagnosis of myocardial infarction even with normal Electrocardiography. The increase of cardiac troponins occurs in a variety of clinical situations without an acute coronary syndrome (ACS), cardiologists and emergency physicians are often confronted with positive troponins that are difficult to interpret. Few data exist about the occurrence, the clinical characteristics and the predictive value in case of absence of ACS. The objective of this study is to present the main extracardiac causes responsible of the increase of TnIc. We present some clinical cases that illustrate this diagnostic problem. A troponin elevation is observed in myopericarditis, renal failure, heart failure, pulmonary embolism, septic shock, rhabdomyolysis, stroke and others where there is a myocardial damage unrelated to coronary occlusion. Many cases of false positives, which raise the possibility of analytical interferences, must be identified.
    FR PMID : 28751286 10.1684/abc.2017.1262
  • No author listed. Corrigendum. Geriatr Gerontol Int. 2017 09;17(9):1338. PMID : 28960708
    Résumé non disponible.
    FR PMID : 28960708 10.1111/ggi.13203
  • du Fay de Lavallaz Jeanne, Zehntner Tibor, Puelacher Christian, Walter Joan, Strebel Ivo, Rentsch Katharina, Boeddinghaus Jasper, Nestelberger Thomas, Twerenbold Raphael, Mueller Christian. Rhabdomyolysis: A Noncardiac Source of Increased Circulating Concentrations of Cardiac Troponin T?. J Am Coll Cardiol. 2018 12 11;72(23 Pt A):2936-2937. PMID : 30522657
    Résumé non disponible.
    FR PMID : 30522657 10.1016/j.jacc.2018.09.050
  • Long Brit, Long Drew A, Tannenbaum Lloyd, Koyfman Alex. An emergency medicine approach to troponin elevation due to causes other than occlusion myocardial infarction. Am J Emerg Med. 2019 Dec 09;:. PMID : 31864875
    INTRODUCTION: Troponin is an integral component of the evaluation for acute coronary syndrome (ACS) and occlusion myocardial infarction (OMI). However, troponin may be elevated in conditions other than OMI.
    OBJECTIVE: This narrative review provides emergency clinicians with a focused evaluation of troponin elevation in patients with myocardial injury due to conditions other than OMI.
    DISCUSSION: ACS includes the diagnosis of myocardial infarction (MI), which incorporates assessment for elevated troponin. Troponin I and T are the most common biomarkers used in assessment of myocardial injury and may be released with myocyte injury and necrosis, myocyte apoptosis and cell turnover, and oxygen supply demand mismatch. Troponin elevation is a reflection of myocardial injury, and many conditions associated with critical illness may result in troponin elevation. These include cardiac and non-cardiac conditions. Cardiac conditions include heart failure, dysrhythmia, and dissection, while non-cardiac causes include pulmonary embolism, sepsis, stroke, and many others. Clinicians should consider the clinical context, patient symptoms, electrocardiogram, and ultrasound in their assessment of the patient with troponin elevation. In most cases, elevated troponin is a marker for poor outcomes including increased rates of mortality.
    CONCLUSIONS: Troponin can be elevated in many critical settings. The causes of troponin elevation include cardiac and non-cardiac conditions. Clinicians must consider the clinical context and other factors, as an inappropriate diagnosis of OMI may result in patient harm and misdiagnosis of another condition.
    FR PMID : 31864875 10.1016/j.ajem.2019.12.007




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