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.

• Authors: Nattawut Wongpraparut, Sudarat Piyophirapong, Adisak Maneesai, Kosit Sribhen, Rungroj Krittayaphong, Rungtiwa Pongakasira, Harvey D White
• Journal: Clinical cardiology (Clin Cardiol) Vol. 38 Issue 5 Pg. 293-9 (May 2015) ISSN: 1932-8737 [Electronic] United States
• PMID: 25955350 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 Wiley Periodicals, Inc.

Chemical References

• Adrenergic beta-1 Receptor Agonists
• Troponin T
• Vasodilator Agents
• Dobutamine
• Adenosine

Topics

• Adenosine (administration & dosage)
• Adrenergic beta-1 Receptor Agonists (administration & dosage)
• Aged
• Cohort Studies
• Dobutamine (administration & dosage)
• Exercise Test
• Female
• Humans
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Myocardial Ischemia (blood, diagnosis)
• Myocardial Perfusion Imaging (methods)
• Prospective Studies
• Sensitivity and Specificity
• Troponin T (blood)
• Vasodilator Agents (administration & dosage)