scholarly journals 236 Variation in cardiac troponin I serum levels after ECG exercise stress test in patients with microvascular angina

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Saverio Tremamunno ◽  
Chiara Carabotta ◽  
Alessandro Telesca ◽  
Tamara Felici ◽  
Antonietta Belmusto ◽  
...  
Keyword(s):  
Stable Angina ◽  
Healthy Subjects ◽  
Troponin I ◽  
Stress Test ◽  
Venous Blood ◽  
Peak Level ◽  
Serum Levels ◽  
Exercise Stress ◽  
Microvascular Angina ◽  
Group 3

Abstract Aims Cardiac troponin I (cTnI) is considered a marker of myocardial necrosis. However, several studies have shown that cTnI increases also after short episodes of myocardial ischaemia. Nevertheless, it is unknown whether the changes in cTnI show differences according to the cause of myocardial ischaemia. Thus, our study aimed to evaluate cTnI response to ischaemia in patients with stable coronary artery disease (CAD), patients with microvascular angina (MVA), and transient ischaemia induced during percutaneous coronary intervention (PCI). Methods and results We studied four groups of patients: (1) patients with stable angina and obstructive CAD (coronary stenosis ≥50% and/or fractional flow reserve <0.80) (Group 1, n = 8); (2) patients with stable angina but no obstructive CAD and a final diagnosis of MVA according to positive intracoronary acetylcholine provocation test and/or coronary flow velocity reserve assessment with transthoracic Doppler echocardiography (Group 2, n = 20); (3) patients with stable angina and obstructive CAD undergoing PCI (Group 3, n = 10); (4) a control group of healthy subjects, with no history of cardiovascular disease (CVD) (Group 4, n = 20). Patients in groups 1, 2, and 4 underwent ECG exercise stress test (EST) according to a standard treadmill Bruce protocol. Peripheral venous blood samples were collected immediately before, at the end and 1, 3, and 24 h after test ending. Patients in group 3 underwent PCI with at least one drug-eluting stent implantation. Peripheral venous blood samples were collected immediately before, at the end and 1, 3, and 24 h after PCI ending. High-sensitivity cTnI (hs-cTnI) levels were measured by chemiluminescent microparticle immunoassay (CMIA). The main results of hs-cTnI in the four groups of patients are summarized in the table. Basal hs-cTnI serum levels were significantly higher in group 3, while there were no significant differences among groups 1, 2, and 4. Hs-cTnI serum levels significantly increased in all groups in response to the procedure (EST or PCI). A greater increase of hs-cTnI was found in group 3 (peak level at 24 h) compared to the other groups (peak level at 3 h). Furthermore, among patients undergoing EST, a significantly higher hs-cTnI increase was found in healthy subjects, compared to patients with CAD and MVA. Heart rate (HR) during stress test (both as an absolute value and predicted maximal HR for age) was the only variable statistically predictive of hs-cTnI increase during EST (HRmax: r 0.289, P 0.04; %HRmax: r 0.307; P 0.03). On the other hand, no clinical and laboratory variable was associated to hs-cTnI response after PCI. Conclusions Hs-cTnI serum levels increase after EST, both in patients with obstructive CAD and coronary microvascular dysfunction (CMD), but a similar increase is also observed in healthy subjects. More consistent hs-cTnI level increase with later peak-level is observed in patients with obstructive CAD after transient ischaemia induced during PCI.

CHANGES OF SERUM CARDIAC TROPONIN I IN EXERCISE STRESS TEST AND AFTER EXERCISE

2021 ◽  
Vol 27 (7) ◽  
pp. 689-691
Author(s):  
Dinghong Mu ◽  
Jingjing Feng ◽  
Fangxia Sun
Keyword(s):  
Exercise Training ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Organ Specificity ◽  
Level Of Evidence

ABSTRACT Introduction: Cardiac Troponin (CTN) has a strong organ specificity, which indicates that myocardial injury is present. However, it is worth noting that the increase does not suggest that the myocardium necessarily presents ischemic necrosis. Objective: To observe the changes in serum kerocalin I (CTNI) content after exercise, explore the effects of exercise training on hematocytes and that cause damage to myocardial cell stimulation. Methods: 18 rats were divided into three groups in this study, and three exercises were conducted separately. Results: After 6 weeks of exercise training, the number of red blood cells increased and the content of troponin I (CTNI) in the serum also significantly increased. The serum CTNI of the disposable large strength group was significantly higher than that of the quiet group (P <0.001). The serum CTNI in the 6-week exercise group was significantly higher than that of the quiet group (P <0.001), but the serum CTNI level between the two sports groups was not different. Conclusions: The motion training model used in this study can improve the number of red blood cells in the blood, improve synchronous blood capacity, and help the body's aerobic capacity increase. Level of evidence II; Therapeutic studies - investigation of treatment results.

scholarly journals Microvascular Angina　― Long-Term Exercise Stress Test Follow-up ―

2018 ◽  
Vol 82 (4) ◽  
pp. 1070-1075 ◽  
Author(s):  
Gaetano A. Lanza ◽  
Monica Filice ◽  
Antonio De Vita ◽  
Angelo Villano ◽  
Laura Manfredonia ◽  
...  
Keyword(s):  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Microvascular Angina

scholarly journals Assessment of Inflammatory and Cardiac Status of Echis ocellatus Snake-bite Victims in Jos Metropolis, Plateau State, Nigeria

2020 ◽  
pp. 20-30
Author(s):  
P. O. Manafa ◽  
G. C. Jackson Njoku ◽  
C. C. Onyenekwe ◽  
O. Ekuma-Okereke ◽  
E. E. Nnadi ◽  
...  
Keyword(s):  
Total Cholesterol ◽  
Troponin I ◽  
Venous Blood ◽  
Serum Levels ◽  
Snake Bite ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Subjects ◽  
The Mean ◽  
Plateau State ◽  
Cardiac Status

Background: This study was designed to evaluate the inflammatory and cardiac status of snakebite victims using serum levels of C-reactive protein (CRP), troponin-I (TnI), total cholesterol (TC) and triglycerides (TG) as markers in Echis ocellatus snakebite victims before and after administration of EchiTAb-G antivenom. Materials and Methods: A total of 80subjects (40 Echis ocellatus bite victims and 40 apparently healthy indivuals as test and control subjects respectively) were purposively recruited for this study. Venous blood samples were collected within 4hours after bite. The whole blood clotting time (WBCT20) was determined immediately. Another batch of samples were collected from same snakebite victims, 2days post administration of the anti-venom. CRP and Troponin-I levels were evaluated using the enzyme linked immunosorbent assay technique while serum total cholesterol, and triglyceride levels were assayed spectrophotometrically. Results: The mean serum levels of troponin-I (2.98±5.75) and CRP (36.64±29.01) were significantly higher in Echis ocellatus bite victims before administration of anti-venom compared with control subjects (0.007±0.3 and 0.99±0.28) and after post administration of anti-venom (0.16±1.39 and 15.96±17.36) (P<0.05) respectively. Conversely, the mean plasma levels of total cholesterol and triglyceride were significantly lower (p<0.05) in snake bite subjects before anti-venom administration when compared with control and snake bite subjects after post administration of anti-venom. Furthermore, the mean serum levels of troponin-I and CRP correlated significantly positive when correlated between snake bite subjects before (r=0.498, p=0.001) and after (r=0.430, p=0.006) anti-venom administration respectively. Conclusion: The research findings therefore suggest that Echis ocellatus envenomation triggers inflammatory reaction which could be the reason behind the alteration in cardiac markersas evidenced by the significant elevations in serum troponin-I and CRP levels amongst snake bite victims compared to the non-snake bite control groups thus, could cause cardiac arrest before anti-venom administration.

Lack of Effect of Nitrates on Exercise Stress Test Results in Patients with Microvascular Angina

2013 ◽  
Vol 27 (3) ◽  
pp. 229-234 ◽  
Author(s):  
Giulio Russo ◽  
Antonino Di Franco ◽  
Priscilla Lamendola ◽  
Pierpaolo Tarzia ◽  
Roberto Nerla ◽  
...  
Keyword(s):  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Test Results ◽  
Microvascular Angina

scholarly journals The effectiveness of the method of external counterpulsation in patients with chronic stable angina

2020 ◽  
Vol 101 (2) ◽  
pp. 165-174
Author(s):  
R H Alakbarov
Keyword(s):  
Quality Of Life ◽  
Angina Pectoris ◽  
Stable Angina ◽  
Stress Test ◽  
Main Group ◽  
Functional Class ◽  
Exercise Stress ◽  
Control Group ◽  
External Counterpulsation

Aim. To assess the effectiveness of the complex treatment of patients with stable angina pectoris using the method of external counterpulsation (ECP). Methods. 92 patients with chronic stable angina were included in the comparative analysis, which divided into 2 groups: 57 patients received one course of treatment using the ECP method (main group), 35 patients received only drug treatment (control group). Before and after the therapy, a general clinical examination (including determining the functional class of angina pectoris and the need to use nitroglycerin preparations), coronary angiography, echocardiography, exercise stress test (stress ECG), and quality assessment using the Seattle Angina Questionnaire (SAQ) was performed. Results. The decrease in the average functional class of angina was more significant in the main group compare to the control group from 2.280.73 to 0.930.80 (p 0.05) versus from 2.340.73 to 1.830.71 (p 0.05). A decrease of at least 1 functional class more often occurred in the main group 78.9% of patients versus 57.1% (p=0.0258). The use of nitroglycerin sharply decreased after treatment in the group, that use the ECP method (by 51.6%; p=0.002), whereas in the control group, despite a slight decrease (by 22.7%), the changes did not reach statistical significance (p=0.0736). Both groups showed similar dynamics of changes in echocardiography. The differences were obtained only for the dynamics of the ejection fraction of the left ventricle (LVEF), which was greater in the main group an increase of 4.695.56% versus 1.755.15% (p=0.0448). The dynamics of all indicators of exercise stress test significantly differ between groups, and if for the main group it is positive, in the control group it is negative. Some indicators of quality of life change insignificant and similar for both groups (for example, on the scale for limiting physical exertion), and on some scales (stability scales for attacks and the frequency of angina attacks), the improvement in the main group is much more significant in comparing with the control group: 3037 points versus 1213 points, respectively (p 0.0001). The overall quality of life assessment score improved more in the group, that use the ECP method: +96.1040.73 versus +45.3135.06 the control group (p 0.0001). Conclusion. The method of external counterpulsation (ECP) can be used in clinical practice as part of a comprehensive treatment of patients with stable angina pectoris; it can significantly reduce the class of angina pectoris and the need to use nitroglycerin preparations, improve a number of indicators of echocardiography, electrocardiography with exercise and quality of life indicators.

Clinical detection of myocardial ischemia

2020 ◽  
pp. 32-35
Keyword(s):  
Myocardial Ischemia ◽  
Stress Test ◽  
Obstructive Coronary Artery Disease ◽  
Exercise Stress Test ◽  
Holter Monitoring ◽  
Regional Wall Motion ◽  
Exercise Stress ◽  
Stress Tests ◽  
Microvascular Angina ◽  
Provocation Tests

Myocardial ischemia involves several pathophysiologic mechanisms. To assess suspected myocardial ischemia in relation to obstructive coronary artery disease (CAD)—the most frequent case—the reference test would be an electrocardiogram (ECG) exercise stress test; in the event of inconclusive results, an imaging (either radionuclide or echocardiographic) stress test can be indicated. Pharmacologic stress tests with imaging are indicated in patients unable to exercise. The same tests can be applied in patients with suspected microvascular angina; in such patients, a diagnostic clue would be induced angina and ECG changes in the absence of regional wall motion abnormalities on echocardiographic stress testing. Spasm provocation tests using either acetylcholine or ergonovine might be necessary to detect myocardial ischemia in patients in whom this is caused by coronary epicardial, or even microvascular, spasm. ECG Holter monitoring can be helpful to identify and characterize myocardial ischemic episodes that occur during daily life.

Poor Tolerance and Limited Effects of Isosorbide-5-Mononitrate in Microvascular Angina

Cardiology ◽  
2015 ◽  
Vol 130 (4) ◽  
pp. 201-206 ◽  
Author(s):  
Monica Wu ◽  
Angelo Villano ◽  
Giulio Russo ◽  
Antonino Di Franco ◽  
Alessandra Stazi ◽  
...  
Keyword(s):  
Stress Test ◽  
Clinical Status ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Microvascular Angina ◽  
Poor Tolerance ◽  
Β Blocker ◽  
Artery Flow

Objectives: To assess the effects of isosorbide-5-mononitrate (ISMN) in patients with microvascular angina (MVA). Methods: We randomized 20 MVA patients, treated with a β-blocker or a calcium antagonist, to 60 mg slow-release ISMN (halved to 30 mg if not tolerated) or placebo once a day for 4 weeks; the patients were then switched to the other treatment for another 4 weeks. Their clinical status was assessed with the Seattle Angina Questionnaire (SAQ) and the EuroQoL score for quality of life. The exercise stress test (EST), coronary blood flow (CBF) response to nitrate and the cold pressor test (CPT), brachial artery flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) were also assessed. Results: Nine patients (45%) did not complete the ISMN phase due to side effects; 2 patients refused a follow-up. Nine patients completed the study. The SAQ and EuroQoL scores were significantly better with ISMN than with placebo, although the differences were small. No differences were found between the treatments in the EST results, CBF response to nitroglycerin (p = 0.55) and the CPT (p = 0.54), FMD (p = 0.26) and NMD (p = 0.35). Conclusions: In this study, a high proportion of MVA patients showed an intolerance to ISMN; in those tolerating the drug, significant effects on their angina status were observed, but the benefit appeared to be modest and independent of effects on coronary microvascular function.

scholarly journals Heart rate variability and turbulence to determine true coronary artery disease in patients with ST segment depression without angina during exercise stress testing

2011 ◽  
Vol 34 (6) ◽  
pp. 349 ◽  
Author(s):  
Atac Celik ◽  
Ahmet Ozturk ◽  
Kerem Ozbek ◽  
Hasan Kadi ◽  
Fatih Koc ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Heart Rate ◽  
Coronary Artery ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Diabetic Patients ◽  
St Segment ◽  
Group 3 ◽  
Artery Disease

Purpose: ST segment depression without angina during an exercise stress test causes diagnostic problems, particularly in non-diabetic patients. Heart rate variability (HRV) and heart rate turbulence (HRT) are used to evaluate the changes in cardiac autonomic functions and are also both decreased in patients with coronary artery disease. The aim of this study was determine the values of HRV and HRT that discriminate true coronary artery disease from false positive stress test results. Methods: Ninety non-diabetic patients who underwent diagnostic coronary angiography (CA) due to suspected coronary artery disease after ST segment depression without angina during an exercise stress test were enrolled in the study. Prior to CA, 24 hour ambulatory electrocardiogram recordings were taken and HRV and HRT parameters were calculated. Results: Patients were divided into three groups according to the severity of their coronary lesions: (group 1 normal, group 2 non-obstructive and group 3 obstructive. There were no differences among the groups with regards to age, sex, medical history, medications, systolic and diastolic blood pressures, body mass index, fasting glucose, anemia and thyroid status, lipid profile and creatinine clearance. HRV parameters and turbulence slope (TS) were significantly lower while turbulence onset (TO) was significantly higher in group 3 than groups 1 and 2. According to the cut-off values calculated using ROC analysis, SDNN≤69.63 msec, TO > 0.14%, and TS≤2.78 msec/RR have high diagnostic accuracy for predicting obstructive coronary artery disease. Conclusion: HRV and HRT parameters may provide additional information for discriminating between patients who do and do not truly need CA.

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