Nattawut Wongpraparut1, Sudarat Piyophirapong2, Adisak Maneesai1, Kosit Sribhen2, Rungroj Krittayaphong1, Rungtiwa Pongakasira3, Harvey D White4. 1. Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj hospital, Mahidol University, Bangkok, Thailand. 2. Department of Clinical Pathology, Faculty of Medicine Siriraj hospital, Mahidol University, Bangkok, Thailand. 3. Her Majesty Cardiac Center, Faculty of Medicine Siriraj hospital, Mahidol University, Bangkok, Thailand. 4. Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
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.
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: Eslam Samaha; Audrey Avila; Mohammad A Helwani; Arbi Ben Abdallah; Allan S Jaffe; Mitchell G Scott; Peter Nagele Journal: J Am Heart Assoc Date: 2019-03-19 Impact factor: 5.501
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