High-sensitivity cardiac troponin T increases after stress echocardiography

Eslam Samaha, Jamie Brown, Frank Brown, Sara C. Martinez, Mitchell Scott, Allan S Jaffe, Victor G. Davila-Roman, Peter Nagele

Research output: Contribution to journalArticle

Abstract

Introduction: Exercise (ESE) and dobutamine stress echocardiography (DSE) have high sensitivity and specificity to detect inducible myocardial ischemia in patients with significant coronary artery disease (CAD). High-sensitivity cardiac troponin (hs-cTn) assays detect troponin concentrations in the ng/L range. The aim of this study was to determine the kinetics of hs-cTnT in patients undergoing ESE and DSE and possible association of hs-cTnT with inducible myocardial ischemia. Methods: In this prospective study adult patients undergoing ESE/DSE were enrolled. Peripheral blood samples were obtained before, and 30 min, 1, 2, and 4–6 h after completion of ESE/DSE. Hs-cTnT was measured on a Roche Diagnostics Elecsys 2010 analyzer. Results: We enrolled 48 patients (33 ESE and 15 DSE); 11 patients (23%) had elevated baseline hs-cTnT concentrations >14 ng/L (99th percentile URL); 31/48 (65%) developed an hs-cTnT increase after ESE/DSE (peak 4–6 h post stress test), but only three patients (all in ESE group) had a positive stress test. Absolute and relative hs-cTnT increases were higher after DSE (median Δhs-cTnT +9.7 ng/L [IQR 4.5, 27.2]; +123% [IQR 49, 271]) compared to ESE (median Δhs-cTnT +2.3 ng/L [IQR 1, 4.9]; +37% [IQR 9.1, 221]). Conclusions: One in four patients undergoing ESE/DSE had increased hs-cTnT values prior to stress testing. Hs-cTnT increased above the upper limit of normal occurred commonly after ESE/DSE but was more pronounced after DSE. Increases in hs-cTn did not appear to be associated with inducible myocardial ischemia. These findings may have important implications for the clinical use of hs-cTnT within 6 h after ESE/DSE.

Original languageEnglish (US)
Pages (from-to)18-23
Number of pages6
JournalClinical Biochemistry
Volume63
DOIs
StatePublished - Jan 1 2019

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Echocardiography
Stress Echocardiography
Troponin T
Dobutamine
Exercise
Troponin
Myocardial Ischemia
Exercise Test
Coronary Artery Disease

Keywords

  • Coronary artery disease
  • High-sensitivity cardiac troponin T
  • Myocardial ischemia
  • Stress echocardiography

ASJC Scopus subject areas

  • Clinical Biochemistry

Cite this

High-sensitivity cardiac troponin T increases after stress echocardiography. / Samaha, Eslam; Brown, Jamie; Brown, Frank; Martinez, Sara C.; Scott, Mitchell; Jaffe, Allan S; Davila-Roman, Victor G.; Nagele, Peter.

In: Clinical Biochemistry, Vol. 63, 01.01.2019, p. 18-23.

Research output: Contribution to journalArticle

Samaha, E, Brown, J, Brown, F, Martinez, SC, Scott, M, Jaffe, AS, Davila-Roman, VG & Nagele, P 2019, 'High-sensitivity cardiac troponin T increases after stress echocardiography', Clinical Biochemistry, vol. 63, pp. 18-23. https://doi.org/10.1016/j.clinbiochem.2018.11.013
Samaha, Eslam ; Brown, Jamie ; Brown, Frank ; Martinez, Sara C. ; Scott, Mitchell ; Jaffe, Allan S ; Davila-Roman, Victor G. ; Nagele, Peter. / High-sensitivity cardiac troponin T increases after stress echocardiography. In: Clinical Biochemistry. 2019 ; Vol. 63. pp. 18-23.
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abstract = "Introduction: Exercise (ESE) and dobutamine stress echocardiography (DSE) have high sensitivity and specificity to detect inducible myocardial ischemia in patients with significant coronary artery disease (CAD). High-sensitivity cardiac troponin (hs-cTn) assays detect troponin concentrations in the ng/L range. The aim of this study was to determine the kinetics of hs-cTnT in patients undergoing ESE and DSE and possible association of hs-cTnT with inducible myocardial ischemia. Methods: In this prospective study adult patients undergoing ESE/DSE were enrolled. Peripheral blood samples were obtained before, and 30 min, 1, 2, and 4–6 h after completion of ESE/DSE. Hs-cTnT was measured on a Roche Diagnostics Elecsys 2010 analyzer. Results: We enrolled 48 patients (33 ESE and 15 DSE); 11 patients (23{\%}) had elevated baseline hs-cTnT concentrations >14 ng/L (99th percentile URL); 31/48 (65{\%}) developed an hs-cTnT increase after ESE/DSE (peak 4–6 h post stress test), but only three patients (all in ESE group) had a positive stress test. Absolute and relative hs-cTnT increases were higher after DSE (median Δhs-cTnT +9.7 ng/L [IQR 4.5, 27.2]; +123{\%} [IQR 49, 271]) compared to ESE (median Δhs-cTnT +2.3 ng/L [IQR 1, 4.9]; +37{\%} [IQR 9.1, 221]). Conclusions: One in four patients undergoing ESE/DSE had increased hs-cTnT values prior to stress testing. Hs-cTnT increased above the upper limit of normal occurred commonly after ESE/DSE but was more pronounced after DSE. Increases in hs-cTn did not appear to be associated with inducible myocardial ischemia. These findings may have important implications for the clinical use of hs-cTnT within 6 h after ESE/DSE.",
keywords = "Coronary artery disease, High-sensitivity cardiac troponin T, Myocardial ischemia, Stress echocardiography",
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T1 - High-sensitivity cardiac troponin T increases after stress echocardiography

AU - Samaha, Eslam

AU - Brown, Jamie

AU - Brown, Frank

AU - Martinez, Sara C.

AU - Scott, Mitchell

AU - Jaffe, Allan S

AU - Davila-Roman, Victor G.

AU - Nagele, Peter

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Exercise (ESE) and dobutamine stress echocardiography (DSE) have high sensitivity and specificity to detect inducible myocardial ischemia in patients with significant coronary artery disease (CAD). High-sensitivity cardiac troponin (hs-cTn) assays detect troponin concentrations in the ng/L range. The aim of this study was to determine the kinetics of hs-cTnT in patients undergoing ESE and DSE and possible association of hs-cTnT with inducible myocardial ischemia. Methods: In this prospective study adult patients undergoing ESE/DSE were enrolled. Peripheral blood samples were obtained before, and 30 min, 1, 2, and 4–6 h after completion of ESE/DSE. Hs-cTnT was measured on a Roche Diagnostics Elecsys 2010 analyzer. Results: We enrolled 48 patients (33 ESE and 15 DSE); 11 patients (23%) had elevated baseline hs-cTnT concentrations >14 ng/L (99th percentile URL); 31/48 (65%) developed an hs-cTnT increase after ESE/DSE (peak 4–6 h post stress test), but only three patients (all in ESE group) had a positive stress test. Absolute and relative hs-cTnT increases were higher after DSE (median Δhs-cTnT +9.7 ng/L [IQR 4.5, 27.2]; +123% [IQR 49, 271]) compared to ESE (median Δhs-cTnT +2.3 ng/L [IQR 1, 4.9]; +37% [IQR 9.1, 221]). Conclusions: One in four patients undergoing ESE/DSE had increased hs-cTnT values prior to stress testing. Hs-cTnT increased above the upper limit of normal occurred commonly after ESE/DSE but was more pronounced after DSE. Increases in hs-cTn did not appear to be associated with inducible myocardial ischemia. These findings may have important implications for the clinical use of hs-cTnT within 6 h after ESE/DSE.

AB - Introduction: Exercise (ESE) and dobutamine stress echocardiography (DSE) have high sensitivity and specificity to detect inducible myocardial ischemia in patients with significant coronary artery disease (CAD). High-sensitivity cardiac troponin (hs-cTn) assays detect troponin concentrations in the ng/L range. The aim of this study was to determine the kinetics of hs-cTnT in patients undergoing ESE and DSE and possible association of hs-cTnT with inducible myocardial ischemia. Methods: In this prospective study adult patients undergoing ESE/DSE were enrolled. Peripheral blood samples were obtained before, and 30 min, 1, 2, and 4–6 h after completion of ESE/DSE. Hs-cTnT was measured on a Roche Diagnostics Elecsys 2010 analyzer. Results: We enrolled 48 patients (33 ESE and 15 DSE); 11 patients (23%) had elevated baseline hs-cTnT concentrations >14 ng/L (99th percentile URL); 31/48 (65%) developed an hs-cTnT increase after ESE/DSE (peak 4–6 h post stress test), but only three patients (all in ESE group) had a positive stress test. Absolute and relative hs-cTnT increases were higher after DSE (median Δhs-cTnT +9.7 ng/L [IQR 4.5, 27.2]; +123% [IQR 49, 271]) compared to ESE (median Δhs-cTnT +2.3 ng/L [IQR 1, 4.9]; +37% [IQR 9.1, 221]). Conclusions: One in four patients undergoing ESE/DSE had increased hs-cTnT values prior to stress testing. Hs-cTnT increased above the upper limit of normal occurred commonly after ESE/DSE but was more pronounced after DSE. Increases in hs-cTn did not appear to be associated with inducible myocardial ischemia. These findings may have important implications for the clinical use of hs-cTnT within 6 h after ESE/DSE.

KW - Coronary artery disease

KW - High-sensitivity cardiac troponin T

KW - Myocardial ischemia

KW - Stress echocardiography

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