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Cardiac involvement in acute thrombotic thrombocytopenic purpura: association with troponin T and IgG antibodies to ADAMTS 13 Hughes C; McEwan JR; Longair I; Hughes S; Cohen H; Machin S; Scully MJ Thromb Haemost 2009[Apr]; 7 (4): 529-36INTRODUCTION: Evidence for cardiac involvement in thrombotic thrombocytopenic purpura (TTP) is uncommonly described. METHODOLOGY: We retrospectively reviewed 41 patients assessing troponin T as a marker for cardiac involvement in acute TTP with clinical symptoms, electrocardiograms (ECG) and echocardiograms. A histopathological review of five patients who died of acute TTP was also undertaken. RESULTS: In 54% (22/41) of patients, troponin T was >or=0.05microg L(-1) (normal range 0-0.01 microg L(-1)). Half (12/22) had cardiac symptoms and 8/22 with a raised troponin T reported chest pain. ECG changes were present in 62% of patients with a raised troponin T. Median anti-ADAMTS 13 IgG antibody was significantly higher (P=0.018) in patients with troponin T>or=0.05 microg L(-1) (58.5% (range 17-162%), compared with patients with troponin T<0.05 microg L(-1) (35%, range 9-134%). Patients who died had higher troponin T levels (median 0.305 microg L(-1)) and raised anti-ADAMTS 13 IgG (median 66.5%). On admission, there were no deaths in those with troponin Tor=0.05 microg L(-1)) signify myocardial necrosis associated with microvascular thrombi. Mortality and acute morbidity was associated with higher admission troponin T and raised IgG antibody (>67%) to ADAMTS 13.|ADAM Proteins/*immunology[MESH]|ADAMTS13 Protein[MESH]|Acute Disease[MESH]|Autoantibodies/*blood[MESH]|Biomarkers/blood[MESH]|Heart Diseases/*diagnosis/mortality[MESH]|Humans[MESH]|Immunoglobulin G[MESH]|Morbidity[MESH]|Mortality[MESH]|Purpura, Thrombotic Thrombocytopenic/*complications/epidemiology/mortality[MESH]|Retrospective Studies[MESH]|Troponin T/*blood[MESH] |
