Elevated high‐sensitive troponin T in negative stress test individuals

Brzezinski, Rafael Y.; Fisher, Eyal; Ehrenwald, Michal; Shefer, Gabi; Stern, Naftali; Shapira, Itzhak; Zeltser, David; Berliner, Shlomo; Shenhar‐Tsarfaty, Shani; Milwidsky, Assi; Rogowski, Ori

doi:10.1111/eci.12930

Cited by 10 publications

(7 citation statements)

References 29 publications

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“…Likewise, Magioni et al, found hs-cTnT >6 ng/L to be an independent risk factor for CAD in patients with low risk for CAD (27). In a recent publication, Brzezinski et al explored resting troponin levels in relation to exercise stress test in a large cohort of healthy individuals (28). Although their findings propose an insignificant relation of troponin levels and positive or negative stress test results, this healthy and supposedly asymptomatic population is generally not of concern in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

High-sensitive cardiac Troponin T and exercise stress test for evaluation of angiographically significant coronary disease

Cwikiel

Seljeflot²,

Fagerland³

et al. 2019

International Journal of Cardiology

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Background: Exercise stress test (EST) has a moderate precision for diagnosis of CAD and could potentially obtain improved accuracy if adding a reliable cardiac biomarker to the test. Objective: We aimed to investigate resting levels and change in hs-cTnT during EST in patients with and without angiographically significant CAD. Moreover, we intended to explore the additive value of hs-cTnT to EST results in diagnosis of stable CAD. We hypothesized that hs-cTnT would be higher in CAD patients and increase diagnostic precision of EST. Method: Patients presenting with symptoms of stable CAD, performed a maximal EST on a bicycle ergometer. Venous blood samples were taken at rest and within 5 min postexercise. All patients underwent coronary angiography. Significant CAD was defined as having 75% stenosis in one or more segments of the coronary arteries. Results: Out of the 297 participants, significant CAD was found in 111 (37%) patients. Patients with significant CAD compared to without, had higher resting levels of hs-cTnT (median 8.1 vs 5.0 ng/L) and no significant difference in exercise-induced change (median 0.5 vs 0.3 ng/L), p<0.001 and p=0.086 respectively. Combined resting hs-cTnT with EST had higher predictive value for significant CAD than EST alone, AUC=0.751 vs. AUC=0.637. In an adjusted multivariable regression analysis, resting hs-cTnT >6.0 ng/L was predictive for having significant CAD, OR 2.55 (CI 95% 1.40, 4.65 p=0.002). Conclusion: In patients with suspected stable CAD, hs-cTnT has a predictive value alone, as well as added to a diagnostic EST for CAD.

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Section: Discussionmentioning

confidence: 99%

High-sensitive cardiac Troponin T and exercise stress test for evaluation of angiographically significant coronary disease

Cwikiel

Seljeflot²,

Fagerland³

et al. 2019

International Journal of Cardiology

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“…A power calculation with an alpha risk of 0.05 and a power of 0.80 was performed. In studies including individuals without suspicion of CAD the prevalence of unknown significant CAD has been reported to be 7% [ 17 ] and the incidence of pathological stress test has been reported to be 8% [ 18 ]. Based on this we estimated the incidence of pathological stress test to approximately 7% in the control group and we assumed a clinically highly relevant incidence of 30% in the case group.…”

Section: Methodsmentioning

confidence: 99%

Low risk patients with acute atrial fibrillation and elevated high-sensitivity troponin do not have increased incidence of pathological stress tests

Thelin

Gerward

Melander

2021

Scandinavian Cardiovascular Journal

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Objectives: Many patients with atrial fibrillation (AF) or atrial flutter (AFL) and rapid ventricular response (RVR) have elevated high-sensitivity troponin T (hsTnT) values. Elevated hsTnT is an independent risk marker for cardiovascular events and mortality. The aim was to examine if AF/AFL patients with RVR and elevated hsTnT have an increased incidence of pathological cardiac stress tests, indicating need of further evaluation for coronary artery disease (CAD). Design: We prospectively included 90 AF/AFL patients without known heart failure and CAD presenting with AF/AFL and RVR. Half of the patients had elevated hsTnT (cases) and half had levels below the 99th percentile (controls). All patients were discharged in sinus rhythm. After approximately one week in sinus rhythm a new hsTnT was analysed and the patients performed a bicycle exercise stress test within the 30 day follow-up. The primary endpoint was a pathological stress test confirmed by a pathological SPECT myocardial perfusion imaging or a coronary angiography. Results: None of the controls reached the primary endpoint. Two patients (4%) out of the 45 cases reached the primary endpoint (p ¼ .49 vs controls), but only one was found to have significant CAD at subsequent coronary angiography. Conclusion: Patients with paroxysmal AF/ AFL, without a history of CAD and heart failure, who present with a RVR and minor hsTnT elevations were not found to have an increased incidence of pathological stress tests compared to patients with hsTnT values below the 99th percentile.

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“…We prospectively enrolled consecutive patients attending a routine annual health survey at the Tel-Aviv Medical Center Inflammation Survey (TAMCIS), a registered databank of the Israeli Ministry of Justice [12][13][14][15][16]. Subjects underwent a physician's interview and examination, blood and urine tests, and an exercise stress test.…”

Section: Study Cohortmentioning

confidence: 99%

Exercise-induced albuminuria increases over time in individuals with impaired glucose metabolism

Brzezinski

Friedensohn

Shapira

et al. 2020

Cardiovasc Diabetol

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Background: Exercise induced albuminuria (EiA) is elevated in patients with metabolic dysfunction and diabetes, and may serve as an early biomarker for endothelial dysfunction and "kidney reserve". However, the change in EiA levels over time and its interaction with metabolic dysfunction and glucose metabolism has never been studied. Therefore, we sought to determine EiA levels over time in a cohort of individuals attending a routine annual health survey. Methods: We prospectively enrolled 412 patients attending an annual healthy survey at our Medical Center. We collected urine samples for albumin and creatinine measurements before and immediately after completing an exercise stress test, along with multiple physiologic and metabolic parameters. Participants returned to a second follow up visit after a mean follow up period of 3 years (± 1.7 SD). Results: Patients with diagnosed diabetes and subjects with HbA1c ≥ 6.5% significantly increased their EiA over time (median [IQR] change between visits = 19.5 [− 10.4-56.1] vs. − 1.1 [− 12.7-4.9] (p = 0.049) for diabetics vs non-diabetics respectively). Moreover, a diabetes diagnosis was significantly associated with a high increase in EiA over time (top 10th percentile) even after adjusting for age, BMI, eGFR, METs, self-reported history of heart disease, systolic and diastolic blood pressure; OR = 4.4 (1.01-19.3 95% CI) (p = 0.049). Finally, elevated fasting blood glucose (≥ 100 mg/dl) was the strongest and only significant predictor for a greater increase in EiA over time after adjusting for all five metabolic syndrome components; blood glucose, waist circumference, blood triglycerides, HDL cholesterol, and BP criteria; OR = 4.0 (1.6-9.8 95% CI) (p < 0.01). Conclusions: Patients with diabetes and/or elevated fasting blood glucose increase their exercise-induced urinary albumin excretion over time. The ability of EiA to predict major clinical outcomes in patients with and without diabetes needs to be determined in future studies.

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Elevated high‐sensitive troponin T in negative stress test individuals

Abstract: Among subjects referred for EST as part of an annual health survey, we found no significant association between EST results to hs-cTnT detection.

Cited by 10 publications

References 29 publications

High-sensitive cardiac Troponin T and exercise stress test for evaluation of angiographically significant coronary disease

High-sensitive cardiac Troponin T and exercise stress test for evaluation of angiographically significant coronary disease

Low risk patients with acute atrial fibrillation and elevated high-sensitivity troponin do not have increased incidence of pathological stress tests

Exercise-induced albuminuria increases over time in individuals with impaired glucose metabolism

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