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

Kurz, Kathinka D.; Giannitsis, Evangelos; Zehelein, Joerg; Katus, Hugo A.

doi:10.1373/clinchem.2007.097865

Cited by 83 publications

(59 citation statements)

References 19 publications

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“…Our results also corroborate the previous findings of Kurz et al who, although limiting the measurement to a prototype HS-TnT, failed to observe any significant release of protein after physical exercise or pharmacologic stress with dipyridamole (29). At variance with these findings, Siriwardena et al recently found a significant increase of HS-TnT after dobutamine stress echocardiography in 10 healthy volunteers and 16 patients with CAD.…”

Section: Discussionsupporting

confidence: 92%

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

Cervellin¹,

Robuschi²,

Scioscioli³

et al. 2014

Journal of Medical Biochemistry

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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.

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Section: Discussionsupporting

confidence: 92%

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

Cervellin¹,

Robuschi²,

Scioscioli³

et al. 2014

Journal of Medical Biochemistry

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“…hs-cTnT measurements were performed with an experimental assay that has since become available commercially (Roche Diagnostics) on an Elecsys 2010 platform. A value of 13 pg/mL has recently been reported to represent the 99th percentile in a healthy reference population (20 ). The interassay CVs were 3.6% and 2.9% at concentrations of 42 and 2.82 pg/mL, respectively.…”

Section: Biochemical Analysesmentioning

confidence: 91%

Copeptin Does Not Add Diagnostic Information to High-Sensitivity Troponin T in Low- to Intermediate-Risk Patients with Acute Chest Pain: Results from the Rule Out Myocardial Infarction by Computed Tomography (ROMICAT) Study

Karakas

Januzzi²,

Meyer

et al. 2011

Clinical Chemistry

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PURPOSE:Copeptin, a stable peptide derived from the AVP precursor, has been linked to presence and severity of myocardial ischemia. We sought to evaluate the predictive value of copeptin and its incremental value beyond that of high-sensitivity cardiac troponin T (hscTnT) in patients with acute chest pain and low to intermediate risk for acute coronary syndrome (ACS). METHODS:We recruited patients who presented with acute chest pain to the emergency department and had a negative initial conventional troponin T test (Ͻ0.03 g/L). In all patients, hs-cTnT and copeptin measurements were taken. Each patient also underwent cardiac computed tomography (CT) and coronary angiography. RESULTS:Baseline copeptin concentrations, in contrast to hs-cTnT, were not significantly higher in patients with ACS than in those without (P ϭ 0.24). hs-cTnT showed an earlier rise in patients with ACS than copeptin, when analyses were stratified by time. A copeptin concentration Ն7.38 pmol/L had a negative predictive value (NPV) of 94% and a sensitivity of 51%, whereas hs-cTnT (Ն13.0 pg/mL) had a NPV of 96% and a sensitivity of 63%. The combination of copeptin and hscTnT resulted in a lower diagnostic accuracy than hs-cTnT alone. Finally, on cardiac CT, copeptin concentrations were not associated with coronary artery morphology, although they were related to the presence of left ventricular dysfunction (P ϭ 0.02). CONCLUSIONS:Among patients with acute chest pain and low to intermediate risk for ACS, copeptin concentrations are not independently predictive of ACS and do not add diagnostic value beyond that of hs-cTnT measurements. © 2011 American Association for Clinical ChemistryA substantial proportion of patients presenting to the emergency department (ED) 6 with acute chest discomfort have normal electrocardiograms (ECGs) and initially reassuring conventional cardiac troponin concentrations, but still subsequently develop myocardial infarction (MI) (1 ). Because early-invasive strategies for acute coronary syndrome (ACS) management have been shown to be associated with significantly better patient outcome in higher-risk patients, additional biochemical measures for diagnosis and initial risk stratification of patients presenting with chest pain are needed (2 ).The role of the antidiuretic and vasoconstricting hormone arginine-vasopressin (AVP) in myocardial ischemia is still unclear. Copeptin, the C-terminal part of the AVP prohormone, is a stable peptide derived from the AVP precursor, thereby monitoring AVP levels (3 ). Secretion of copeptin is prompted by individual stress and seems to mirror moderate levels of stress even more subtly than cortisol (4 ). Copeptin concentrations are associated with measures of insulin resistance and metabolic syndrome in hypertensive adults

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“…Some of the aforementioned mechanisms are controversial, however (25 ). A rapid ventricular rhythm also may lead to myocyte necrosis (26 ).…”

Section: Hs-ctnt and Prognosis In Stable Chdmentioning

confidence: 99%

Cardiac Troponin T Measured by a High-Sensitivity Assay Predicts Recurrent Cardiovascular Events in Stable Coronary Heart Disease Patients with 8-Year Follow-up

et al. 2012

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BACKGROUND The clinical relevance of slightly increased circulating troponin concentrations in patients with stable coronary heart disease (CHD) several weeks after an acute event or CABG has not been fully evaluated. METHODS Baseline plasma concentrations of troponin T were measured with a high-sensitivity assay (hs-cTnT) (Roche Elecsys) in a cohort of 1050 CHD patients from 30 to 70 years of age. The prognostic value of hs-cTnT on a combined cardiovascular disease (CVD) end point after adjustment for covariates was determined with Cox proportional hazards modeling. RESULTS The median hs-cTnT concentration was 10.9 ng/L (interquartile range, 5.1–18.9 ng/L). Increased hs-cTnT concentrations were associated with an older age, history of hypertension and diabetes, more advanced coronary artery disease, and other CHD risk factors. Furthermore, hs-cTnT concentration was strongly correlated with N-terminal pro–B-type natriuretic peptide (NT-proBNP) and cystatin C (ρ = 0.61, and ρ = 0.32, respectively; both P values <0.0001). During a median follow-up of 8.1 years, 150 patients (14.3%) experienced a secondary CVD event. In a multivariate model, hs-cTnT was associated with a hazard ratio (HR) for secondary events of 2.83 (95% CI, 1.68–4.79) when the extreme quartiles were compared. Further adjustment for cystatin C, NT-proBNP, and C-reactive protein attenuated this association only slightly (HR, 2.27; 95% CI, 1.31–3.95); P for trend < 0.002). ROC curve analysis of a clinical model that added hs-cTnT to a baseline model showed nonsignificant improvement in the area under the curve (0.69 vs 0.67), whereas the net reclassification improvement was 17.2% (P = 0.029). CONCLUSIONS Slightly increased hs-cTnT concentrations in stable CHD patients are associated with several cardiovascular disorders and predict long-term CVD events.

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

Abstract: BACKGROUND:Using a new precommercial high-sensitivity cardiac troponin T (hsTnT) assay, we evaluated whether hsTnT increases after reversible myocardial ischemia.

Cited by 83 publications

References 19 publications

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

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

Copeptin Does Not Add Diagnostic Information to High-Sensitivity Troponin T in Low- to Intermediate-Risk Patients with Acute Chest Pain: Results from the Rule Out Myocardial Infarction by Computed Tomography (ROMICAT) Study

Cardiac Troponin T Measured by a High-Sensitivity Assay Predicts Recurrent Cardiovascular Events in Stable Coronary Heart Disease Patients with 8-Year Follow-up

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