BACKGROUND: The aim of this study was to investigate the value of a novel high-sensitivity cardiac troponin I measurement to rule out exercise-induced myocardial ischemia in patients without known coronary artery disease. METHODS: We included 714 patients without previously known coronary artery disease who were referred for rest/stress myocardial perfusion single photon emission tomography. All clinical information available to the treating cardiologist was used to quantify the clinical judgment regarding the presence of exercise-induced myocardial ischemia using a visual analogue scale twice: once before and once after bicycle exercise stress testing. High-sensitivity cardiac troponin I measurements were obtained before stress testing in a blinded manner. The presence of exercise-induced myocardial ischemia was adjudicated on the basis of myocardial perfusion single photon emission tomography combined with coronary angiography findings. RESULTS: Exercise-induced myocardial ischemia was detected in 167 participants (23.4%). High-sensitivity cardiac troponin I levels were significantly higher in patients with exercise-induced myocardial ischemia (4.0 ng/L [95% confidence interval, 2.8-8.6] vs 2.6 ng/L [95% confidence interval, 1.8-4.1], P < .001) and remained an independent predictor of ischemia in multivariable analysis (P < .001). Combining clinical judgment before exercise testing with high-sensitivity cardiac troponin I levels increased diagnostic accuracy as quantified by the area under the receiver operating curve from 0.64 to 0.73 (P < .001), which also tended to be superior to clinical judgment after exercise testing (0.69, P = .056). A single resting high-sensitivity cardiac troponin I measurement provided similar diagnostic accuracy as integrated clinical judgment after exercise testing including work load, as well as symptoms and electrocardiogram changes (0.70 vs 0.69, P = not significant). CONCLUSIONS: High-sensitivity cardiac troponin I measurements seem to complement noninvasive clinical assessment in patients with suspected coronary artery disease.
BACKGROUND: The aim of this study was to investigate the value of a novel high-sensitivity cardiac troponin I measurement to rule out exercise-induced myocardial ischemia in patients without known coronary artery disease. METHODS: We included 714 patients without previously known coronary artery disease who were referred for rest/stress myocardial perfusion single photon emission tomography. All clinical information available to the treating cardiologist was used to quantify the clinical judgment regarding the presence of exercise-induced myocardial ischemia using a visual analogue scale twice: once before and once after bicycle exercise stress testing. High-sensitivity cardiac troponin I measurements were obtained before stress testing in a blinded manner. The presence of exercise-induced myocardial ischemia was adjudicated on the basis of myocardial perfusion single photon emission tomography combined with coronary angiography findings. RESULTS: Exercise-induced myocardial ischemia was detected in 167 participants (23.4%). High-sensitivity cardiac troponin I levels were significantly higher in patients with exercise-induced myocardial ischemia (4.0 ng/L [95% confidence interval, 2.8-8.6] vs 2.6 ng/L [95% confidence interval, 1.8-4.1], P < .001) and remained an independent predictor of ischemia in multivariable analysis (P < .001). Combining clinical judgment before exercise testing with high-sensitivity cardiac troponin I levels increased diagnostic accuracy as quantified by the area under the receiver operating curve from 0.64 to 0.73 (P < .001), which also tended to be superior to clinical judgment after exercise testing (0.69, P = .056). A single resting high-sensitivity cardiac troponin I measurement provided similar diagnostic accuracy as integrated clinical judgment after exercise testing including work load, as well as symptoms and electrocardiogram changes (0.70 vs 0.69, P = not significant). CONCLUSIONS: High-sensitivity cardiac troponin I measurements seem to complement noninvasive clinical assessment in patients with suspected coronary artery disease.
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Authors: Tom Kai Ming Wang; Clementina Dugo; Yvonne Gillian; Wynne Yvonne; Semple Heather; Smith Kevin; Cleave Peter; Christiansen Jonathan; To Andrew; Amir Nezar; Tony Scott; Boswell Ross; Gladding Patrick Journal: Med Sci (Basel) Date: 2018-02-15
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Authors: Melissa Amrein; Xinmin S Li; Joan Walter; Zeneng Wang; Tobias Zimmermann; Ivo Strebel; Ursina Honegger; Kathrin Leu; Ibrahim Schäfer; Raphael Twerenbold; Christian Puelacher; Noemi Glarner; Thomas Nestelberger; Luca Koechlin; Benjamin Ceresa; Philip Haaf; Adam Bakula; Michael Zellweger; Stanley L Hazen; Christian Mueller Journal: Clin Res Cardiol Date: 2022-02-26 Impact factor: 6.138
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