Open AccessHigh‐Sensitivity Cardiac Troponin T in Stable Patients Undergoing Pharmacological Stress Testing
Author(s) -
Wongpraparut Nattawut,
Piyophirapong Sudarat,
Maneesai Adisak,
Sribhen Kosit,
Krittayaphong Rungroj,
Pongakasira Rungtiwa,
White Harvey D.
Publication year - 2015
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22392
Subject(s) - medicine , ischemia , myocardial infarction , stress testing (software) , cardiology , troponin t , coronary artery disease , troponin , dobutamine , hemodynamics , computer science , programming language
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.