High‐Sensitivity Cardiac Troponin T in Stable Patients Undergoing Pharmacological Stress Testing

Abstract

Background: Acute changes in high-sensitivity troponin T (hs-TnT) are induced by myocardial ischemia during exercise stress testing, but there are no reports of pharmacological stress testing. Hypothesis: The pattern of troponin release by myocardial ischemia-induced pharmacological stress testing differs according to the ischemic burden in stable patients. Methods: In total, 250 patients with suspected coronary artery disease underwent pharmacological stress magnetic resonance imaging (MRI). The amount and degree of myocardial ischemia on MRI and ischemic outcomes at 6 months were determined. hs-TnT levels were measured at baseline and 1 and 3 hours after testing. The 6-month clinical outcome was prespecified. Results: Fifty-one patients had moderate to severe myocardial ischemia (group A), and 199 patients had no or mild myocardial ischemia (group B). hs-TnT levels were significantly higher in group A than B at baseline (11 vs 8 pg/mL, P = 0.016) and at 1 hour (12 vs 8 pg/mL, P = 0.009) and 3 hours after testing (12 vs 9 pg/mL, P = 0.012). Baseline hs-TnT levels of ≥14 pg/mL showed a 43% sensitivity and 77% specificity in predicting moderate to severe ischemia by MRI (P = 0.03; area under the curve: 0.608, P = 0.017). Patients administered dobutamine had a higher acute change in hs-TnT levels 3 hours after testing than did those administered adenosine (21 vs 0 pg/mL, P < 0.001). There was a trend toward a higher incidence of myocardial infarction in patients with baseline hs-TnT levels of ≥14 pg/mL. Conclusions: hs-TnT levels are significantly higher in patients with moderate to severe than no or mild myocardial ischemia.

High sensitivity cardiac troponins: Can they help in diagnosing myocardial ischaemia?

“…In our real-world, non-selected cohort of patients with normal or slightly increased levels of hs-cTnT, submitted for diagnostic purposes to an exercise or a pharmacological stress test, we documented a significant release of the biomarker that was not limited to patients with stress-induced ischaemia and obstructive CAD, but that also occurred in patients with negative tests and normal coronary arteries. In agreement with a previous report, 19 troponin release was more pronounced after exercise and dobutamine stress, responsible for a greater increase in heart rate, blood pressure and cardiac inotropism, as compared with dipyridamole stress, mainly acting by a mechanism of inappropriate vasodilation. CAD enhanced myocardial release of troponin, which, however, was documented also in patients without significant CAD.…”

High‐Sensitivity Cardiac Troponin After Cardiac Stress Test: A Systematic Review and Meta‐Analysis

“…After screening titles and abstracts of articles, 57 records were reviewed with full texts. Finally, 11 studies were included in the meta-analysis, 3,5,6,[10][11][12][13][14][15][16][17] and 46 were excluded because of incomplete or overlapping data. The Figure shows details of the selection process for studies.…”

Serial High-Sensitivity Troponin T in Post-Primary Angioplasty Exercise Test

“…History of diabetes, CAD, lower creatinine clearance and ejection fraction were more frequently found in patients with moderate-to-severe ischemia. 16 Other studies demonstrating cTnI release in individuals with heart failure 31 submitted to exercise or in marathon runners with exercise-induced high blood pressure 32 could also indicate a role for the presence of those markers in different left ventricular overload situations.…”

“…One important topic is their elevation in transient ischemia during physical or pharmacological stress tests. 12 - 16 The present study was aimed at assessing the kinetics of high-sensitivity troponin T (hscTnT) by use of serial measurements after an exercise test (ET) performed in ST-segment elevation myocardial infarction (STEMI) patients, and at comparing the changes in that biomarker levels on abnormal versus normal tests.…”