High‐Sensitivity Cardiac Troponin T in Stable Patients Undergoing Pharmacological Stress Testing

• Published in: Clinical cardiology (Mahwah, N.J.) N.J.), 2015-05, Vol.38 (5), p.293-299
• Main Authors: Wongpraparut, Nattawut, Piyophirapong, Sudarat, Maneesai, Adisak, Sribhen, Kosit, Krittayaphong, Rungroj, Pongakasira, Rungtiwa, White, Harvey D.
• Format: Article
• Language: English
• Subjects: Adenosine - administration & dosage; Adrenergic beta-1 Receptor Agonists - administration & dosage; Aged; Cardiovascular disease; Clinical Investigations; Cohort Studies; Dobutamine - administration & dosage; Electrocardiography; Exercise Test; Female; Humans; Ischemia; Magnetic Resonance Imaging - methods; Male; Middle Aged; Myocardial Ischemia - blood; Myocardial Ischemia - diagnosis; Myocardial Perfusion Imaging - methods; NMR; Nuclear magnetic resonance; Prospective Studies; Sensitivity and Specificity; Troponin T - blood; Vasodilator Agents - administration & dosage
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.22392

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.