scholarly journals Cardiac troponin T levels and exercise stress testing in patients with suspected coronary artery disease: the Akershus Cardiac Examination (ACE) 1 study

2012 ◽  
Vol 122 (12) ◽  
pp. 599-606 ◽  
Author(s):  
Ragnhild Røysland ◽  
Gunnhild Kravdal ◽  
Arne Didrik Høiseth ◽  
Ståle Nygård ◽  
Pirouz Badr ◽  
...  
Keyword(s):  
Myocardial Ischaemia ◽  
Cardiac Troponin ◽  
Stress Testing ◽  
Acute Exercise ◽  
Troponin T ◽  
Suspected Coronary Artery Disease ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Peak Exercise ◽  
Post Exercise

Whether reversible ischaemia in patients referred for exercise stress testing and MPI (myocardial perfusion imaging) is associated with changes in circulating cTn (cardiac troponin) levels is controversial. We measured cTnT with a sensitive assay before, immediately after peak exercise and 1.5 and 4.5 h after exercise stress testing in 198 patients referred for MPI. In total, 19 patients were classified as having reversible myocardial ischaemia. cTnT levels were significantly higher in patients with reversible myocardial ischaemia on MPI at baseline, at peak exercise and after 1.5 h, but not at 4.5 h post-exercise. In patients with reversible ischaemia on MPI, cTnT levels did not change significantly after exercise stress testing [11.1 (5.2–14.9) ng/l at baseline compared with 10.5 (7.2–16.3) ng/l at 4.5 h post-exercise, P=0.27; values are medians (interquartile range)]. Conversely, cTnT levels increased significantly during testing in patients without reversible myocardial ischaemia [5.4 (3.0–9.0) ng/l at baseline compared with 7.5 (4.6–12.4) ng/l, P<0.001]. In conclusion, baseline cTnT levels are higher in patients with MPI evidence of reversible myocardial ischaemia than those without reversible ischaemia. However, although cTnT levels increase during exercise stress testing in patients without evidence of reversible ischaemia, this response appears to be blunted in patients with evidence of reversible ischaemia. Mechanisms other than reversible myocardial ischaemia may play a role for acute exercise-induced increases in circulating cTnT levels.

Effect of Atrial Fibrillation on Outcome in Patients With Known or Suspected Coronary Artery Disease Referred for Exercise Stress Testing

2010 ◽  
Vol 105 (9) ◽  
pp. 1207-1211 ◽  
Author(s):  
Alberto Bouzas-Mosquera ◽  
Jesús Peteiro ◽  
Francisco J. Broullón ◽  
Nemesio Álvarez-García ◽  
Victor X. Mosquera ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stress Testing ◽  
Suspected Coronary Artery Disease ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Artery Disease

scholarly journals Troponin I Measured by a High-Sensitivity Assay in Patients with Suspected Reversible Myocardial Ischemia: Data from the Akershus Cardiac Examination (ACE) 1 Study

2012 ◽  
Vol 58 (11) ◽  
pp. 1565-1573 ◽  
Author(s):  
Helge Røsjø ◽  
Gunnhild Kravdal ◽  
Arne Didrik Høiseth ◽  
Marit Jørgensen ◽  
Pirouz Badr ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Cardiac Troponin ◽  
Stress Testing ◽  
Troponin I ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Left Ventricular Ejection ◽  
Reversible Ischemia

BACKGROUND Whether cardiac troponin concentrations are increased by reversible myocardial ischemia is controversial. Differences in the structure of cardiac troponin I (cTnI) and cTnT may have implications for diagnostic utility. METHODS cTnI was measured with a prototype high-sensitivity (hs) assay in 198 patients referred for myocardial perfusion imaging (MPI) before exercise stress testing, immediately after, and 1.5 and 4.5 h later. We categorized patients according to MPI results and compared hs-cTnI concentrations with hs-cTnT concentrations. RESULTS Baseline hs-cTnI was higher in patients with reversible myocardial ischemia (n = 19) vs the other patients (n = 179): median 4.4 (quartiles 1–3: 2.3–7.1) vs 2.5 (1.4–4.3) ng/L, P = 0.003. Baseline hs-cTnI and hs-cTnT concentrations were correlated (r = 0.46, P &lt; 0.001) and the areas under the ROC curve for hs-cTnI and hs-cTnT in diagnosing reversible ischemia were similar: 0.71 vs 0.69, P = 0.77. Whereas hs-cTnI increased immediately after exercise (P &lt; 0.001 vs baseline measurements) in patients without ischemia, it increased after 4.5 h in patients with reversible ischemia (P = 0.01). The increment in hs-cTnI concentrations was comparable between groups; thus, measuring hs-cTnI after exercise stress testing did not improve diagnostic accuracy over baseline measurements, and hs-cTnI concentrations were not found to be associated with reversible myocardial ischemia in multivariate analysis. By linear regression analysis, age, male sex, history of hypertension, angiotensin-converting enzyme inhibitor use, and lower left ventricular ejection fraction were associated with higher baseline hs-cTnI concentrations. CONCLUSIONS In patients referred to MPI, hs-cTnI concentrations were not closely associated with reversible myocardial ischemia, but rather were influenced by variables associated with structural alterations of the myocardium.

scholarly journals Impact of clinical introduction of high-sensitive cardiac troponin assays on incidence of coronary angiography and exercise stress testing

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P4047-P4047
Author(s):  
R. Twerenbold ◽  
M. Mueller ◽  
R. Hoeller ◽  
T. Reichlin ◽  
P. Haaf ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Cardiac Troponin ◽  
Stress Testing ◽  
Exercise Stress ◽  
Exercise Stress Testing

scholarly journals Incremental value of high-frequency QRS analysis for diagnosis and prognosis in suspected exercise-induced myocardial ischaemia

2019 ◽  
Vol 9 (8) ◽  
pp. 836-847 ◽  
Author(s):  
Nicolas Schaerli ◽  
Roger Abächerli ◽  
Joan Walter ◽  
Ursina Honegger ◽  
Christian Puelacher ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Myocardial Ischaemia ◽  
High Frequency ◽  
Stress Testing ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Deviation Analysis ◽  
Nuclear Myocardial Perfusion Imaging ◽  
Exercise Induced ◽  
Rule Out

Aim: Exercise stress testing is used to detect myocardial ischaemia, but is limited by low sensitivity and specificity. The authors investigated the value of the analysis of high-frequency QRS components as a marker of abnormal depolarization in addition to standard ST-deviations as a marker of abnormal repolarization to improve the diagnostic accuracy. Methods and results: Consecutive patients undergoing bicycle exercise stress nuclear myocardial perfusion imaging were prospectively enrolled. Presence of myocardial ischaemia, the primary diagnostic endpoint, was adjudicated using MPI and coronary angiography. Automated high-frequency QRS analysis was performed in a blinded fashion. The prognostic endpoint was major adverse cardiac events (MACEs) during two years of follow-up. Exercise-induced ischaemia was detected in 147/662 patients (22%). The sensitivity of high-frequency QRS was similar to ST-deviations (46% vs. 43%, p=0.59), while the specificity was lower (75% vs. 87%, p<0.001). The combined use of high-frequency QRS and ST-deviations classified 59% of patients as ‘rule-out’ (both negative), 9% as ‘rule-in’ (both positive) and 32% in an intermediate zone (one test positive). The sensitivity for ‘rule-out’ and the specificity for ‘rule-in’ improved to 63% and 97% compared with ST-deviation analysis alone (both p<0.001). MACE-free survival was 90%, 80% and 42% in patients in the ‘rule-out’, intermediate and ‘rule-in’ groups ( p<0.001). After adjustment for age, gender, ST-deviations and clinical post-test probability of ischaemia, high-frequency QRS remained an independent predictor for the occurrence of MACEs. Conclusion: The use of high-frequency QRS analysis in addition to ST-deviation analysis improves the diagnostic accuracy during exercise stress testing and adds independent prognostic information.

scholarly journals Standard exercise stress testing attenuates peripheral microvascular function in patients with suspected coronary microvascular dysfunction

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Massimo Nardone ◽  
Steven Miner ◽  
Mary McCarthy ◽  
Heather Edgell
Keyword(s):  
Stress Testing ◽  
Acute Exercise ◽  
Reactive Hyperemia ◽  
Microvascular Dysfunction ◽  
Microvascular Function ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Coronary Microvascular Dysfunction ◽  
Vascular Assessment ◽  
Flow Reserve

Abstract Background The effect of exercise on the microvasculature of patients with suspected coronary microvascular dysfunction (CMD), assessed by reactive hyperemia peripheral arterial tonometry (RH-PAT; EndoPAT), is unknown. The present study aimed to determine if standard clinical exercise stress testing (GXT) affected peripheral microvascular function, as determined by the reactive hyperemia index (RHI and LnRHI), in patients with suspected CMD. Methods In a cross-sectional study, patients (n = 76) were grouped based on whether the GXT was performed; 1) prior to (exercisers; n = 30), or 2) after the vascular assessment (non-exercisers; n = 46). Patients with an adenosine index of microvascular resistance > 25, adenosine coronary flow reserve (CFR) < 2.0, and/or acetylcholine CFR < 1.5 were considered to have CMD (n = 42). RHI and LnRHI quantified finger pulse amplitude hyperemia following 5 min of forearm ischemia. Results LnRHI was lower in patients with CMD compared to patients without CMD, while LnRHI was also lower in exercisers compared to non-exercisers (LnRHI: CMD Non-Exercisers: 0.63 ± 0.25; CMD Exercisers: 0.54 ± 0.19; No CMD Non-Exercisers: 0.85 ± 0.23; No CMD Exercisers: 0.63 ± 0.26; Condition and Exercise Main Effects: Both P < 0.01). In patients who did not exercise prior to the vascular assessment, the receiver operating characteristic curve (ROC) for LnRHI to predict CMD was 0.76 (95% CI: 0.62–0.91; P < 0.01). However, in patients who performed exercise prior to the vascular assessment, the ROC for LnRHI to predict CMD was 0.60 (95% CI: 0.40–0.81; P = 0.34). Conclusions CMD is associated with impaired peripheral microvascular function and preceding acute exercise is associated with further reductions of LnRHI. Further, acute exercise abolished the capacity for RH-PAT to predict the presence of CMD in patients with chest pain and non-obstructive coronary arteries. RH-PAT measurements in patients with suspected CMD should not be conducted after exercise has been performed.

Sign in / Sign up

Export Citation Format

Share Document