Is high sensitive-troponin I a reliable biomarker for cardiac injury in methadone toxicity? A prospective cross-sectional study

Abstract

Background Methadone is a synthetic opioid mostly used for detoxification therapy, as its use increases; the possibility for methadone-induced cardiotoxicity may rise. The aim of this study was to determine the association of high-sensitivity troponin I levels as a predictor of cardiac injury in methadone toxicity. Methods Sixty methadone toxicity patients included in this prospective cross-sectional study from October 2018-November 2020. High-sensitivity troponin I level and electrocardiogram were assessed in patients at admission. All patients underwent echocardiography at admission and 30 days later and compared this finding between two groups based on high-sensitivity troponin I results. Results Mean age of the patients was 34.5 +/- 11.1 years (males: 67). Twenty (20) patients had positive high sensitive-troponin results. Long QT interval and inverted T in precordial leads were mostly observed in individuals with positive high-sensitivity troponin I (75 vs. 35, P = 0.013 and 83 vs. 16, P < 0.001, respectively). Patients with elevated troponin had reduced left ventricular ejection fraction in comparison to normal group during admission (43.1 +/- 15.4 vs. 55, P < 0.001) and this left ventricular ejection fraction remained abnormal after 30 days (43.7 +/- 21.6). Patients in positive high-sensitivity troponin I group had higher regional wall motion abnormality frequency both at admission and 30 days later compared to the other group (0 day: 42 vs. 0, P < 0.001, 30th days: 25 vs. 4, P = 0.020). Conclusion Patients with simultaneous methadone toxicity and positive high-sensitivity troponin I had worse cardiac outcomes and this biomarker could be probably used for better implementation of therapeutic interventions and prognosis.