Myocardial injury in thrombotic thrombocytopenic purpura: A frequent, perplexing complication

BackgroundAlthough thrombotic thrombocytopenic purpura (TTP) typically involves the heart, angina and myocardial injury are uncommonly reported; fatal cardiogenic shock is exceptional.MethodsWe analyzed 26 patients with TTP who had objective evidence of myocardial injury.ResultsMyocardial injury was evident in 6 patients. None had coronary disease. Mean age was 43.6 years; four patients (66%) were female. Mean troponin, creatinine and hemoglobin levels were 7.82 ng/dL (≤ 2.1); 2.63 mg/dL and 7.1 g/dL, respectively. Three patients (50%) expired during the index hospitalization; one as a consequence of massive ST-segment elevation myocardial infarction.ConclusionsMyocardial injury frequently complicates the TTP syndrome and associated mortality is substantial. In survivors, enduring left ventricular failure is plausible. Widely accepted therapies for myocardial ischemia are not consistently efficacious in the setting of TTP.