Key result
High-sensitivity troponin I and CK-MB outperformed BNP in identifying CO-induced cardiomyopathy, with initial hsTnI >0.01 ng/mL and CK-MB >1.5 ng/mL each yielding 95% sensitivity and 97% NPV.
Why the study?
Myocardial dysfunction due to acute carbon monoxide poisoning is common and linked to poor outcomes, but the role of cardiac markers in identifying CO-induced cardiomyopathy required evaluation.
Do cardiac biomarkers (hsTnI, CK-MB, BNP) identify CO-induced cardiomyopathy in adult patients with acute carbon monoxide poisoning?
Cohort (n=850)
No
Do cardiac biomarkers (hsTnI, CK-MB, BNP) identify CO-induced cardiomyopathy in adult patients with acute carbon monoxide poisoning?
Effect estimate: AUC 0.894 for hsTnI, 0.864 for CK-MB, 0.796 for BNP
p-value: p=< 0.01
Initial hsTnI and CK-MB levels are highly sensitive screening tools for identifying CO-induced cardiomyopathy in patients with acute carbon monoxide poisoning.
May support early screening for CO-induced cardiomyopathy; hypothesis-generating and requires prospective validation before practice change.
Myocardial dysfunction due to acute carbon monoxide (CO) poisoning is common and associated with poor outcomes. The role of cardiac markers, including creatine kinase-myocardial band (CK-MB), high-sensitivity troponin I (hsTnI), and brain natriuretic peptide (BNP), in identifying patients with CO-induced cardiomyopathy were evaluated. This single-center, retrospective cohort study included 905 consecutive adult patients in the CO poisoning registry from February 2009 to December 2019. Cardiomyopathy was defined as any abnormality on transthoracic echocardiography (TTE), including left ventricular systolic and diastolic dysfunction, right ventricular dysfunction, and wall motion abnormalities. The areas under receiver operating curves (AUCs) for biomarkers were compared. Of the 850 included patients, 101 (11.9%) had CO-induced cardiomyopathy. Initial and peak hsTnI and CK-MB concentrations, and initial BNP concentrations were significantly higher in patients with than without cardiomyopathy (all P-values < 0.01), but the AUCs were higher for hsTnI (0.894) and CK-MB (0.864) than for BNP (0.796). Initial TnI > 0.01 ng/mL and CK-MB > 1.5 ng/mL each had 95% sensitivity and 97% negative predictive value for CO-induced cardiomyopathy. Higher hsTnI or CK-MB levels on admission can identify patients at high-risk of CO-induced cardiomyopathy and can be a screening tool for CO poisoning.
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Kim et al. (2020) conducted a cohort in Carbon monoxide poisoning (n=850). High-sensitivity troponin I (hsTnI) and creatine kinase-myocardial band (CK-MB) vs. Brain natriuretic peptide (BNP) was evaluated on CO-induced cardiomyopathy (AUC 0.894 for hsTnI, 0.864 for CK-MB, 0.796 for BNP, p=< 0.01). High-sensitivity troponin I and CK-MB outperformed BNP in identifying CO-induced cardiomyopathy, with initial hsTnI >0.01 ng/mL and CK-MB >1.5 ng/mL each yielding 95% sensitivity and 97% NPV.
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