scholarly journals Highly Sensitive Cardiac Troponin T Values Remain Constant after Brief Exercise- or Pharmacologic-Induced Reversible Myocardial Ischemia

2008 ◽  
Vol 54 (7) ◽  
pp. 1234-1238 ◽  
Author(s):  
Kerstin Kurz ◽  
Evangelos Giannitsis ◽  
Joerg Zehelein ◽  
Hugo A Katus
Keyword(s):  
Myocardial Ischemia ◽  
Cardiac Troponin ◽  
Troponin T ◽  
Stress Test ◽  
Photon Emission ◽  
Fourth Generation ◽  
Emission Computed Tomography ◽  
Cardiac Troponin T ◽  
Median Baseline ◽  
Nuclear Stress Testing

Abstract Background: Using a new precommercial high-sensitivity cardiac troponin T (hsTnT) assay, we evaluated whether hsTnT increases after reversible myocardial ischemia. Methods: In 195 patients undergoing nuclear stress testing (ST) using single-photon emission computed tomography (SPECT) for suspected ischemic heart disease, we measured hsTnT before and 18 min, 4 h, and 24 h after the stress test. Thirty patients were excluded before ST because of cardiac troponin T (cTnT) >30 ng/L (0.03 μg/L) as measured by the fourth-generation commercial test. Another 65 patients were excluded because of a combination of fixed and reversible perfusion defects (PDs) after SPECT. Results: We studied 18 patients with reversible PDs, 41 patients with fixed PDs, and 41 patients without any PDs. Of these 100 patients, 61 received dynamic ST and 39 pharmacological ST. Median baseline hsTnT concentrations (25th, 75th percentile) were comparable in patients with reversible, fixed, and no PDs [5.57 (2.47, 12.60), 8.01 (4.55, 12.44), and 6.90 (4.63, 10.59) ng/L, respectively]. After ST, median hsTnT concentrations did not change in the reversible, fixed, or no PD groups from baseline to 18 min [−0.41 (−0.81, 0.01), 0.01 (−0.75, 0.79), and 0.36 (−0.42, 1.01) ng/L] or from baseline to 4 h [−0.56 (−1.82, 0.74), 0.24 (−0.60, 1.45), and 0.23 (−0.99, 1.15) ng/L]. Median baseline hsTnT concentrations tended to be higher in patients undergoing pharmacological vs dynamic ST; however, there were no significant increases in hsTnT concentrations after either type of ST. Conclusions: Elevation of cTnT is rather a consequence of irreversible myocyte death than reversible myocardial ischemia after exercise or pharmacologic myocardial ischemia.

scholarly journals High-sensitive cardiac troponin T is not always heart - Paraneoplastic systemic sclerosis simulated myocardial ischemia

Cor et Vasa ◽  
2018 ◽  
Vol 60 (6) ◽  
pp. e645-e648
Author(s):  
Johannes Mierke ◽  
Stefanie Jellinghaus ◽  
Anna Selle ◽  
Hagen Schroetter ◽  
David M. Poitz ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Myocardial Ischemia ◽  
Cardiac Troponin ◽  
Troponin T ◽  
Cardiac Troponin T

scholarly journals Direct comparison of cardiac troponin I and cardiac troponin T in the detection of exercise-induced myocardial ischemia

2016 ◽  
Vol 49 (6) ◽  
pp. 421-432 ◽  
Author(s):  
Seoung Mann Sou ◽  
Christian Puelacher ◽  
Raphael Twerenbold ◽  
Max Wagener ◽  
Ursina Honegger ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Troponin T ◽  
Cardiac Troponin I ◽  
Cardiac Troponin T ◽  
Exercise Induced

Serum Cardiac Troponin T, But Not Troponin I, Is Elevated in Idiopathic Inflammatory Myopathies: Figure 1.

2009 ◽  
Vol 36 (12) ◽  
pp. 2711-2714 ◽  
Author(s):  
ROHIT AGGARWAL ◽  
DOROTA LEBIEDZ-ODROBINA ◽  
ALPANA SINHA ◽  
AUGUSTINE MANADAN ◽  
JOHN P. CASE
Keyword(s):  
Myocardial Ischemia ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Troponin T ◽  
Primary Diagnosis ◽  
Idiopathic Inflammatory Myopathies ◽  
Cardiac Troponin T ◽  
Inflammatory Myopathies ◽  
Chi Square ◽  
Serum Cardiac Troponin

Objective.To study the association of serum cardiac troponin T (cTnT) and cardiac troponin I (cTnI) with creatine kinase (CK) in patients with idiopathic inflammatory myopathies (IIM).Methods.We performed a retrospective study on patients with IIM followed by the rheumatology service of a county hospital from 2004 to 2008. Patients with myocardial ischemia and/or with renal failure were excluded. Clinical data including electromyogram, muscle biopsy, and CK, cTnT and cTnI were recorded. Patients who had simultaneous analysis of CK and cardiac troponin (cTnT or cTnI) levels were studied. CK levels were correlated with cTnT and cTnI by chi-square test and Spearman correlation.Results.We identified 49 patients with IIM (69 observations) who satisfied our inclusion criteria. The primary diagnosis was polymyositis in 23, dermatomyositis in 16, and myositis associated with connective tissue disease in 10 patients. There were 33/49 women with average age 45.8 years. Twenty-eight patients with IIM had simultaneous CK and cTnT values assayed. Of those patients, 18/23 with elevated CK also had elevated cTnT, and 5/5 patients with normal CK levels had normal cTnT levels (p = 0.005). In 41 patients with IIM who had simultaneous CK and cTnI levels assayed, only 1/29 with elevated CK had elevated cTnI, and 12/12 patients with normal CK had normal cTnI (p = 0.5). CK correlated strongly with the cTnT (r = 0.62, p = 0.001) but did not correlate with cTnI.Conclusion.Elevated cTnT, but not cTnI, was highly associated with CK in patients with IIM despite the absence of myocardial ischemia.

scholarly journals High-sensitive cardiac Troponin T and exercise stress test for evaluation of angiographically significant coronary disease

2019 ◽  
Vol 287 ◽  
pp. 1-6 ◽  
Author(s):  
Joanna Cwikiel ◽  
Ingebjørg Seljeflot ◽  
Morten W. Fagerland ◽  
Kristian Wachtell ◽  
Harald Arnesen ◽  
...  
Keyword(s):  
Coronary Disease ◽  
Cardiac Troponin ◽  
Troponin T ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Cardiac Troponin T

Using Incremental High-Sensitive Cardiac Troponin T to Increase the Diagnostic Accuracy of Exercise Stress Test

2021 ◽  
Vol 104 (2) ◽  
pp. 169-175
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Cardiac Troponin ◽  
Troponin T ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Cardiac Troponin T ◽  
Delta Change ◽  
Artery Disease

Background: Exercise stress test (EST) is the most practical method to diagnose coronary artery disease (CAD). Although it has a high negative predictive value (NPV), the positive predictive value (PPV) is low. Objective: To increase the diagnostic accuracy of EST by combining the results with the delta change of high-sensitive cardiac troponin T (hscTnT) levels during stress exercise. Materials and Methods: The authors conducted a diagnostic study in patients presenting with chest pain and having intermediate pretest probability of CAD who underwent EST at Queen Sirikit Heart Center of the Northeast in Khon Kaen, Thailand, between July 2018 and January 2019. Two blood samples were collected to measure hs-cTnT at 5-minute before and at 1-hour after exercise. The diagnosis of CAD was made from the coronary angiography (CAG) or coronary computed tomography angiography (CCTA) result. The authors created a ROC curve from the hs-cTnT delta change, selected a value that had high sensitivity, and combined it with EST results to enhance the PPV predicting CAD. Results: Eighty-one patients were included in the present study. Thirty-one (38.3%) had positive EST, 47 (58.0%) had negative EST, and three (3.7%) had inconclusive results. To confirm the diagnosis of significant CAD, CAG was performed in 33 (40.7%) patients, and CCTA was performed in seven (8.6%) patients. Forty-two (51.8%) patients were determined not to have significant CAD based solely on negative EST results. Sixteen (19.8%) patients were in the CAD group and 65 (80.2%) in the non-CAD group. The average hs-cTnT at baseline, at 1-hour after EST, and delta change of patients in the CAD group were greater than those in the non-CAD group (7.81±3.62 ng/L and 4.83±2.97 ng/L, p<0.001, 9.21±4.41 ng/L and 4.94±2.92 ng/L, p<0.001, 17.99% and 9.18%, p=0.09, respectively). When the authors used a hs-cTnT delta-change of 3% as a cutoff point and combined this with the EST results, the PPV increased from 48% when using the EST alone to 63.2%. Conclusion: Combining hs-cTnT delta change during an EST with EST results could raise the PPV of CAD diagnosis in patients with chest pain who had intermediate CAD pretest probability. Keywords: Exercise stress test, Coronary artery disease, High-sensitive cardiac troponin T

scholarly journals Release Kinetics of Cardiac Biomarkers in Patients Undergoing Transcoronary Ablation of Septal Hypertrophy

2012 ◽  
Vol 58 (6) ◽  
pp. 1049-1054 ◽  
Author(s):  
Christoph Liebetrau ◽  
Helge Möllmann ◽  
Holger Nef ◽  
Sebastian Szardien ◽  
Johannes Rixe ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Troponin T ◽  
Release Kinetics ◽  
High Sensitivity ◽  
Cardiac Biomarkers ◽  
Fourth Generation ◽  
Cardiac Troponin T ◽  
Creatine Kinase Mb ◽  
Septal Hypertrophy ◽  
Kinetics Of

Abstract BACKGROUND The release kinetics of cardiac troponin T measured with conventional vs high-sensitivity cardiac troponin T (hs-cTnT) assays in patients with acute myocardial infarction (AMI) is difficult to establish. METHODS We analyzed the release kinetics of cTnT measured by fourth generation and high-sensitivity assays, creatine kinase-MB (CK-MB), and myoglobin in patients with hypertrophic obstructive cardiomyopathy undergoing transcoronary ablation of septal hypertrophy (TASH), a model of AMI. Consecutive patients (n = 21) undergoing TASH were included. Serum and EDTA-plasma samples were collected before and at 15, 30, 45, 60, 75, 90, and 105 min, and 2, 4, 8, and 24 h after TASH. RESULTS cTnT concentrations measured by the hs assay were significantly increased at 15 min [21.4 ng/L, interquartile range (IQR) 13.3–39.7 ng/L vs 11.3 ng/L, IQR 6.0–18.8 ng/L at baseline; P = 0.031]. In comparison, cTnT concentrations measured by the conventional fourth generation assay increased significantly at 60 min (30.0 ng/L, IQR 20.0–30.0 ng/L vs &lt;10.0 ng/L, IQR &lt;10.0–10.0 ng/L; P &lt; 0.01), CK-MB at 90 min (8.4 μg/L, IQR 6.9–14.4 μg/L vs 0.9 μg/L, IQR 0.4–1.1 μg/L; P &lt; 0.01), and myoglobin at 30 min (188.0 μg/L, IQR 154.0–233.0 μg/L vs 38.0 μg/L, IQR 28.0–56.0; P &lt; 0.01). CONCLUSIONS cTnT concentrations measured by the hs assay were significantly increased after TASH at all of the time points, with a doubling at 15 min after induction of AMI, confirming earlier evidence of myocardial injury compared to the fourth generation cTnT assay and CK-MB and myoglobin.

scholarly journals Direct Comparison of Cardiac Troponin T and I Using a Uniform and a Sex-Specific Approach in the Detection of Functionally Relevant Coronary Artery Disease

2018 ◽  
Vol 64 (11) ◽  
pp. 1596-1606 ◽  
Author(s):  
Deborah Mueller ◽  
Christian Puelacher ◽  
Ursina Honegger ◽  
Joan E Walter ◽  
Patrick Badertscher ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Cardiac Troponin ◽  
Troponin T ◽  
High Sensitivity ◽  
Emission Computed Tomography ◽  
Cardiac Troponin T ◽  
Artery Disease

Abstract BACKGROUND We aimed to directly compare high-sensitivity cardiac troponin I (hs-cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) in the detection of functionally relevant coronary artery disease (fCAD). METHODS Consecutive patients referred with clinical suspicion of fCAD and no structural heart disease other than coronary artery disease were included. The presence of fCAD was based on rest/stress myocardial perfusion single-photon emission computed tomography/computed tomography and coronary angiography. hs-cTnI and hs-cTnT concentrations were measured in a blinded fashion. Diagnostic accuracy was quantified using the area under the ROC curve (AUC) and evaluated both for uniform use in all patients and for sex-specific use in women and men separately. The prognostic end point was major adverse cardiac events (MACEs; cardiovascular death or myocardial infarction) within 2 years. For the prognostic performance, we used a multivariable model comparison with the Akaike information criterion (AIC). RESULTS fCAD was detected in 613 of 2062 patients (29.7%) overall, 112 of 664 of women (16.9%), and 501 of 1398 of men (35.8%). hs-cTnI and hs-cTnT had comparable diagnostic accuracy when assessed for uniform use in all patients (AUC, 0.68 vs 0.66; P = 0.107) and separately in women (AUC, 0.68 vs 0.63; P = 0.068) and men (AUC, 0.65 vs 0.64; P = 0.475). However, women required lower rule-out cutoffs to achieve high sensitivity, and men needed higher rule-in cutoffs to achieve high specificity. hs-cTnI and hs-cTnT were strongly and independently associated with MACE within 2 years (P &lt; 0.001), with comparable prognostic accuracies by the AIC. CONCLUSIONS hs-cTnI and hs-cTnT provide moderate and comparable diagnostic accuracy. Sex-specific cutoffs may be preferred. The prognostic utility of both troponins is comparable.

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