Troponin release and mechanism-dependent myocardial injury in a lightning-induced mass casualty incident.

Authors

Marcin Waligóra, Tomasz Sanak, Maciej Mikiewicz, Ryan Blumenthal, Klaudia Zaczyńska, Sylweriusz Kosiński, Giewont’2019 MCI Review Group

Published in

Communications medicine. Jul 03, 2026. Epub Jul 03, 2026.

Abstract

Systematic data on cardiac involvement after lightning strikes are limited and mostly derived from case reports. On 22 August 2019, a cloud-to-ground lightning event on Mt. Giewont (Poland) caused a mass casualty incident, providing a unique opportunity to characterize myocardial injury in a large cohort. This study aimed to quantify high-sensitivity cardiac troponin (hs-cTnT) release after lightning strike and its relationship with injury mechanisms.
Individuals from the MT Giewont incident with available troponin measurements were analyzed. Injury mechanisms were predefined, and the location on the trail at the time of the strike was determined. Peak hs-cTnT measured in the emergency department was the primary biomarker of myocardial injury. Among 131 exposed hikers, 59 underwent hs-cTnT testing. The cohort comprised 27 (45.8%) females, and median age of individuals was 29.5 years (IQR 23-41).
Overall, 27 (45.8%) exceeded the upper reference limit of hs-cTnT (URL; 14 ng/L). Median peak hs-cTnT was 13 ng/L (IQR 7.6-25.6). Individuals with direct strike/side-flash exposure had significantly greater troponin levels (median 25.6 vs 10.7 ng/L; p = 0.004). In multivariable analysis, direct/side flash exposure was the only independent predictor of increased troponin (β = 0.90 p = 0.014; relative change +146%). Contact injury, ground current, and blast injury were not significant. ECG abnormalities were uncommon despite frequent biomarker elevation. Individuals with hs-cTnT above the upper reference limit were more frequently admitted to hospital (63% vs 34.4%; p = 0.03), with a 60% increase in odds of admission per doubling of troponin (95% CI 1.01-2.5; p = 0.048). Discrimination for admission was moderate (AUC 0.66, 95% CI 0.52-0.78); a threshold >16 ng/L provided 53.6% sensitivity and 77.4% specificity.
Among individuals who underwent cardiac troponin testing, nearly half demonstrated elevated hs-cTnT levels. Troponin release was significantly greater in individuals exposed to direct strike/side flash.

PMID:
42399375
Bibliographic data and abstract were imported from PubMed on 04 Jul 2026.

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