Dipyridamole Stress Echocardiography Does Not Trigger Release of Highly-Sensitive Troponin I and T

Abstract

SummaryBackground: The patients with episodes of chest pain and no electrocardiographic or biomarker abnormalities are currently monitored and subjected to non-invasive testing. Stress echocardiography is one of the most often used provocative tests, being the most cost-and risk-effective imaging technique. Some concerns about this technique have been raised regarding potential drug-induced myocardial injury. Our study hence aimed to establish whether or not dipyridamole stress echocardiography elicits release of troponin I (TnI) and T (TnT), as reliable biomarkers of myocardiocyte injury. Methods: Thirty-two patients, after exclusion of ongoing acute coronary syndrome (ACS) during evaluation in the emergency department (ED), were studied with echocardiography both at the baseline and after pharmacological stress with dipyridamole. Results: All subjects had biomarkers assessment immediately before the stress-test (T1), 1 h from conclusion of the test (T2), and 6 h afterwards (T3). Cardio specific troponins were assessed with one contemporary-sensitive (TnI) and two highly-sensitive (HS) methods (HS-TnI and HS-TnT). The concentration of TnI, HS-TnI and HS-TnT did not differ throughout the three time points. At no time point the concentration of either HS-TnI or HS-TnT was significantly different among patients with negative or positive stress test.

Cardiac Troponin I Is Increased in Patients with Polytrauma and Chest or Head Trauma. Results of A Retrospective Case-Control Study

“…One included 125 consecutive blood donors who participated in the definition of the local reference range for the cTnI immunoassay, as described elsewhere ( 13 ). The other population (i.e., ED patients with no trauma) consisted of 25 consecutive patients admitted to the local observation unit for evaluation of chest pain at moderate-to-high probability, who had negative results of dipyridamole-atropine echocardiography, as also described elsewhere ( 14 ).…”

Myocardial injury in stress echocardiography: Comparison of dobutamine, dipyridamole and dynamic stressors–single center study

“…48 Our findings in the DIP group are consistent with previously published studies showing no hsTnT release following a dipyridamole challenge, which is probably due to the absence of adrenergic stimulation and resulting increased wall stress observed during the ExSE and DSE. 15,16,49,50…”

“…This is similar to previously published studies. [9][10][11][12][13][14][15][16][17] During the study enrolment period, CTAg was not available in our hospital, and performing invasive coronary angiograms on patients with a low PTP of obstructive IHD with a negative result of SE, was not found to being justifiable. On the other hand, all stress echo modalities are reported to have similar levels of accuracy and sensitivity 4 which is a potential mechanism behind the increase in hsTnT, was not systematically studied.…”

“…14 Studies on DIP mostly show no or only mild increases in hsTnT. 15,16 However, the characteristics of the patients in most of these studies were not homogeneous with the inclusion of the patients with known IHD, heart failure, diabetes, or increased baseline hsTnT levels in various proportions. 9,10,12,13,16 The authors of the recent meta-analysis concluded that the increases in hsTnT after exercise and pharmacological stress testing appeared inconsistent and comparably small and did not appear to be correlated with inducible ischaemia.…”

Bezpieczeństwo pacjentów poddawanych badaniu scyntygrafii perfuzyjnej mięśnia sercowego po obciążeniu dipirydamolem

“…The authors reported all AEs regardless of their severity. In the literature, we found reports of the occurrence of AE after intravenous administration of dipyridamole in 40 to nearly 70% of patients [19,20].…”