High-Sensitivity Cardiac Troponin After Cardiac Stress Test

A Systematic Review and Meta-Analysis

Eslam Samaha, Audrey Avila, Mohammad A. Helwani, Arbi Ben Abdallah, Allan S Jaffe, Mitchell G. Scott, Peter Nagele

Research output: Contribution to journalArticle

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Abstract

Background The recent introduction of high-sensitivity cardiac troponin (hs-cTn) assays has allowed clinicians to measure hs-cTn before and after cardiac stress testing, but the hs-cTn release pattern and potential utility in identifying inducible myocardial ischemia are unclear. We thus conducted a systematic review and meta-analysis to improve our understanding of hs-cTn release associated with exercise and pharmacological stress testing. Methods and Results Studies published between January 2008 and July 2016 that reported hs-cTn change values (high-sensitivity cardiac troponin T [hs-cTnT] or high-sensitivity cardiac troponin I [hs-cTnI]) in relation to cardiac stress testing were searched and reviewed by 2 independent screeners. Primary outcomes were pooled estimates of absolute and relative hs-cTn changes after cardiac stress test, stratified by the presence of inducible myocardial ischemia. This meta-analysis included 11 studies (n=2432 patients). After exercise stress testing, hs-cTnT increased by 0.5 ng/L or 11% (6 studies, n=406) and hs-cTnI by 2.4 ng/L or 41% (4 studies, n=365) in patients with inducible myocardial ischemia versus hs-cTnT by 1.1 ng/L or 18% (8 studies, n=629; P=0.29) and hs-cTnI by 1.8 ng/L or 72% (4 studies, n=831; P=0.61) in patients who did not develop inducible myocardial ischemia. After pharmacological stress test, hs-cTnT changed by -0.1 ng/L or -0.4% (6 studies, n=251) and hs-cTnI by 2.4 ng/L or 32% (2 studies, n=108) in patients with inducible myocardial ischemia versus hs-cTnT by 0.7 ng/L or 11% (5 studies, n=443, P=0.44) and hs-cTnI by 1.7 ng/L or 38% (2 studies, n=116; P=0.62) in patients who did not develop inducible myocardial ischemia. Conclusions hs-cTn rising patterns after exercise and pharmacological stress testing appear inconsistent and comparably small, and do not appear to be correlated with inducible myocardial ischemia.

Original languageEnglish (US)
Pages (from-to)e008626
JournalJournal of the American Heart Association
Volume8
Issue number6
DOIs
StatePublished - Mar 19 2019

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Troponin
Exercise Test
Myocardial Ischemia
Troponin T
Meta-Analysis
Troponin I
Pharmacology
Exercise

Keywords

  • myocardial ischemia
  • stress echocardiography
  • stress testing
  • troponin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

High-Sensitivity Cardiac Troponin After Cardiac Stress Test : A Systematic Review and Meta-Analysis. / Samaha, Eslam; Avila, Audrey; Helwani, Mohammad A.; Ben Abdallah, Arbi; Jaffe, Allan S; Scott, Mitchell G.; Nagele, Peter.

In: Journal of the American Heart Association, Vol. 8, No. 6, 19.03.2019, p. e008626.

Research output: Contribution to journalArticle

Samaha, Eslam ; Avila, Audrey ; Helwani, Mohammad A. ; Ben Abdallah, Arbi ; Jaffe, Allan S ; Scott, Mitchell G. ; Nagele, Peter. / High-Sensitivity Cardiac Troponin After Cardiac Stress Test : A Systematic Review and Meta-Analysis. In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 6. pp. e008626.
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T2 - A Systematic Review and Meta-Analysis

AU - Samaha, Eslam

AU - Avila, Audrey

AU - Helwani, Mohammad A.

AU - Ben Abdallah, Arbi

AU - Jaffe, Allan S

AU - Scott, Mitchell G.

AU - Nagele, Peter

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N2 - Background The recent introduction of high-sensitivity cardiac troponin (hs-cTn) assays has allowed clinicians to measure hs-cTn before and after cardiac stress testing, but the hs-cTn release pattern and potential utility in identifying inducible myocardial ischemia are unclear. We thus conducted a systematic review and meta-analysis to improve our understanding of hs-cTn release associated with exercise and pharmacological stress testing. Methods and Results Studies published between January 2008 and July 2016 that reported hs-cTn change values (high-sensitivity cardiac troponin T [hs-cTnT] or high-sensitivity cardiac troponin I [hs-cTnI]) in relation to cardiac stress testing were searched and reviewed by 2 independent screeners. Primary outcomes were pooled estimates of absolute and relative hs-cTn changes after cardiac stress test, stratified by the presence of inducible myocardial ischemia. This meta-analysis included 11 studies (n=2432 patients). After exercise stress testing, hs-cTnT increased by 0.5 ng/L or 11% (6 studies, n=406) and hs-cTnI by 2.4 ng/L or 41% (4 studies, n=365) in patients with inducible myocardial ischemia versus hs-cTnT by 1.1 ng/L or 18% (8 studies, n=629; P=0.29) and hs-cTnI by 1.8 ng/L or 72% (4 studies, n=831; P=0.61) in patients who did not develop inducible myocardial ischemia. After pharmacological stress test, hs-cTnT changed by -0.1 ng/L or -0.4% (6 studies, n=251) and hs-cTnI by 2.4 ng/L or 32% (2 studies, n=108) in patients with inducible myocardial ischemia versus hs-cTnT by 0.7 ng/L or 11% (5 studies, n=443, P=0.44) and hs-cTnI by 1.7 ng/L or 38% (2 studies, n=116; P=0.62) in patients who did not develop inducible myocardial ischemia. Conclusions hs-cTn rising patterns after exercise and pharmacological stress testing appear inconsistent and comparably small, and do not appear to be correlated with inducible myocardial ischemia.

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KW - myocardial ischemia

KW - stress echocardiography

KW - stress testing

KW - troponin

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