Dynamic Changes of Troponin and Creatinine Phosphokinase in Myocarditis (Myo-PACE Study)

Background: Myocarditis and Acute Myocardial Infarction share clinical similarity. Current Guidelines recommend using cardiac MRI or endomyocardial biopsy for definite diagnosis, but this is rarely done. Biomarker, especially Troponin and Creatinine Phosphokinase (CPK) are usually elevated in blood serum but lack of sensitivity or specificity. We analyzed the dynamic changes of these common biomarkers in myocarditis.

Method: We conducted a retrospective cohort study from 1/2011 to 12/ 2016. A total of 193 pts were classified into 2 Groups, Myocarditis (n=133, 67%) and acute myocardial infarction (AMI) (n=33, 33%).

Results: AMI Patients were statistically significantly older (Mean age 68.7 and, 35.6 respectively, p<.001). Flue like symptoms, and especially fever were highly prevalence in myocarditis group (p<.001). Median time from symptoms to chest pain was 3 days. Median Troponin & CPK level was significantly higher in myocarditis (p<.001). The Slop curve of troponin in myocarditis was lower while CPK slop was higher (p<.002, p<.04, respectively) Troponin to CK ratio was lower within the first 48 hours from admission.

Conclusion: Dynamic changes of Troponin and CPK differ significantly in myocarditis and acute myocardial infarction. Troponin and CPK rise slowly and moderately to higher peak. The ratio between them, within 48 hours, is lower comparing to Myocardial Infarction. Knowing these dynamic pattern may help in discriminate between these similar entities.