INTRODUCTION: Due to the systemic nature of atherosclerosis, the prevalence of coronary artery disease (CAD) is high in patients with peripheral arterial disease (PAD). A biochemical assay for assessing cardiac risk might improve clinical evaluation of PAD patients. The aim of this study was to investigate whether a new high-sensitivity cardiac Troponin T (hs-cTnT) assay can predict exercise-induced myocardial ischemia in PAD patients without clinical signs of CAD. METHODS: Sixty-eight ambulatory patients with Fontaine stage II PAD underwent treadmill stress testing to maximum walking distance. Myocardial ischemia was assessed using a 2-lead Holter ECG and ST-segment depression of ≥ 0.2 mV was considered significant. Hs-cTnT was measured from serum samples taken at baseline as well as 5, 10 and 30 min after exercise. RESULTS: Hs-cTnT baseline levels were significantly higher (19.3 ng/L (5.0; 20.2 ng/L) vs. 6.6 ng/L (4.4; 9.4 ng/L); p=0.037) and increase of serum levels 5 min after cessation of exercise was more pronounced (1.09 ng/L (0.23; 1.80 ng/L) vs. 0.22 ng/L (-0.1; 0.65 ng/L), p=0.032) in ECG positive patients compared to individuals with normal ECG. Logistic regression analysis identified the baseline hs-cTnT serum level as an independent risk factor for developing significant exercise-induced ST-segment depression (odds ratio 1.2 per 1-unit increase, p=0.015). CONCLUSIONS: In patients with PAD, exercise-induced myocardial ischemia is associated with elevated baseline levels and a significant early increase of hs-cTnT serum levels.
INTRODUCTION: Due to the systemic nature of atherosclerosis, the prevalence of coronary artery disease (CAD) is high in patients with peripheral arterial disease (PAD). A biochemical assay for assessing cardiac risk might improve clinical evaluation of PAD patients. The aim of this study was to investigate whether a new high-sensitivity cardiac Troponin T (hs-cTnT) assay can predict exercise-induced myocardial ischemia in PAD patients without clinical signs of CAD. METHODS: Sixty-eight ambulatory patients with Fontaine stage II PAD underwent treadmill stress testing to maximum walking distance. Myocardial ischemia was assessed using a 2-lead Holter ECG and ST-segment depression of ≥ 0.2 mV was considered significant. Hs-cTnT was measured from serum samples taken at baseline as well as 5, 10 and 30 min after exercise. RESULTS: Hs-cTnT baseline levels were significantly higher (19.3 ng/L (5.0; 20.2 ng/L) vs. 6.6 ng/L (4.4; 9.4 ng/L); p=0.037) and increase of serum levels 5 min after cessation of exercise was more pronounced (1.09 ng/L (0.23; 1.80 ng/L) vs. 0.22 ng/L (-0.1; 0.65 ng/L), p=0.032) in ECG positive patients compared to individuals with normal ECG. Logistic regression analysis identified the baseline hs-cTnT serum level as an independent risk factor for developing significant exercise-induced ST-segment depression (odds ratio 1.2 per 1-unit increase, p=0.015). CONCLUSIONS: In patients with PAD, exercise-induced myocardial ischemia is associated with elevated baseline levels and a significant early increase of hs-cTnT serum levels.
Authors: Renata J M Engler; Michael R Nelson; Limone C Collins; Christina Spooner; Brian A Hemann; Barnett T Gibbs; J Edwin Atwood; Robin S Howard; Audrey S Chang; Daniel L Cruser; Daniel G Gates; Marina N Vernalis; Marguerite S Lengkeek; Bruce M McClenathan; Allan S Jaffe; Leslie T Cooper; Steve Black; Christopher Carlson; Christopher Wilson; Robert L Davis Journal: PLoS One Date: 2015-03-20 Impact factor: 3.240
Authors: Muhammad Hammadah; Jeong Hwan Kim; Ayman Samman Tahhan; Bryan Kindya; Chang Liu; Yi-An Ko; Ibhar Al Mheid; Kobina Wilmot; Ronnie Ramadan; Ayman Alkhoder; Fahad Choudhary; Mohamad Mazen Gafeer; Naser Abdelhadi; Pratik Pimple; Pratik Sandesara; Bruno B Lima; Amit J Shah; Laura Ward; Michael Kutner; J Douglas Bremner; David S Sheps; Paolo Raggi; Laurence S Sperling; Viola Vaccarino; Arshed A Quyyumi Journal: Ann Intern Med Date: 2018-11-06 Impact factor: 25.391