Clinical benefit of high-sensitivity cardiac troponin I in the detection of exercise-induced myocardial ischemia
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Clinical benefit of high-sensitivity cardiac troponin I in the detection of exercise-induced myocardial ischemia. / Lee, Gino; Twerenbold, Raphael; Tanglay, Yunus; Reichlin, Tobias; Honegger, Ursina; Wagener, Max; Jaeger, Cedric; Rubini Gimenez, Maria; Hochgruber, Thomas; Puelacher, Christian; Radosavac, Milos; Kreutzinger, Philipp; Stallone, Fabio; Hillinger, Petra; Krivoshei, Lian; Herrmann, Thomas; Mayr, Romy; Freese, Michael; Wild, Damian; Rentsch, Katharina M; Todd, John; Osswald, Stefan; Zellweger, Michael J; Mueller, Christian.
In: AM HEART J, Vol. 173, 03.2016, p. 8-17.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Clinical benefit of high-sensitivity cardiac troponin I in the detection of exercise-induced myocardial ischemia
AU - Lee, Gino
AU - Twerenbold, Raphael
AU - Tanglay, Yunus
AU - Reichlin, Tobias
AU - Honegger, Ursina
AU - Wagener, Max
AU - Jaeger, Cedric
AU - Rubini Gimenez, Maria
AU - Hochgruber, Thomas
AU - Puelacher, Christian
AU - Radosavac, Milos
AU - Kreutzinger, Philipp
AU - Stallone, Fabio
AU - Hillinger, Petra
AU - Krivoshei, Lian
AU - Herrmann, Thomas
AU - Mayr, Romy
AU - Freese, Michael
AU - Wild, Damian
AU - Rentsch, Katharina M
AU - Todd, John
AU - Osswald, Stefan
AU - Zellweger, Michael J
AU - Mueller, Christian
N1 - Copyright © 2015 Elsevier Inc. All rights reserved.
PY - 2016/3
Y1 - 2016/3
N2 - BACKGROUND: A pilot study using a novel high-sensitivity cardiac troponin I (hs-cTnI) assay suggested that cTnI might be released into blood during exercise-induced myocardial ischemia. We investigated the potential clinical value of this signal.METHODS: We included 819 patients with suspected exercise-induced myocardial ischemia referred for rest/bicycle myocardial perfusion single-photon emission computed tomography. The treating cardiologist used all available clinical information to quantify clinical judgment regarding the presence of myocardial ischemia using a visual analog scale twice: prior and after stress testing. High-sensitivity cTnI measurements were obtained before, immediately after peak stress, and 2 hours after stress testing in a blinded manner. Myocardial ischemia was adjudicated using perfusion single-photon emission computed tomography and coronary angiography findings.RESULTS: Exercise-induced myocardial ischemia was detected in 278 (34%) patients. High-sensitivity cTnI levels were significantly higher at all time points in patients with myocardial ischemia as compared with those without (P < .001 for all). Combining clinical judgment prior exercise testing with baseline hs-cTnI levels increased diagnostic accuracy as quantified by the area under the receiver operating characteristics curve (AUC) from 0.672 to 0.757 (P < .001). Combining clinical judgment after exercise testing (AUC 0.704) with baseline or poststress hs-cTnI levels also increased the diagnostic accuracy (AUC 0.761-0.771, P < .001 for all). In contrast, exercise-induced changes in hs-cTnI during exercise did not seem useful, as they were small and similar in patients with or without myocardial ischemia.CONCLUSIONS: High-sensitivity cTnI concentrations at rest and after exercise, but not its exercise-induced changes, provide substantial incremental value to clinical judgment including exercise electrocardiography regarding the presence of myocardial ischemia.
AB - BACKGROUND: A pilot study using a novel high-sensitivity cardiac troponin I (hs-cTnI) assay suggested that cTnI might be released into blood during exercise-induced myocardial ischemia. We investigated the potential clinical value of this signal.METHODS: We included 819 patients with suspected exercise-induced myocardial ischemia referred for rest/bicycle myocardial perfusion single-photon emission computed tomography. The treating cardiologist used all available clinical information to quantify clinical judgment regarding the presence of myocardial ischemia using a visual analog scale twice: prior and after stress testing. High-sensitivity cTnI measurements were obtained before, immediately after peak stress, and 2 hours after stress testing in a blinded manner. Myocardial ischemia was adjudicated using perfusion single-photon emission computed tomography and coronary angiography findings.RESULTS: Exercise-induced myocardial ischemia was detected in 278 (34%) patients. High-sensitivity cTnI levels were significantly higher at all time points in patients with myocardial ischemia as compared with those without (P < .001 for all). Combining clinical judgment prior exercise testing with baseline hs-cTnI levels increased diagnostic accuracy as quantified by the area under the receiver operating characteristics curve (AUC) from 0.672 to 0.757 (P < .001). Combining clinical judgment after exercise testing (AUC 0.704) with baseline or poststress hs-cTnI levels also increased the diagnostic accuracy (AUC 0.761-0.771, P < .001 for all). In contrast, exercise-induced changes in hs-cTnI during exercise did not seem useful, as they were small and similar in patients with or without myocardial ischemia.CONCLUSIONS: High-sensitivity cTnI concentrations at rest and after exercise, but not its exercise-induced changes, provide substantial incremental value to clinical judgment including exercise electrocardiography regarding the presence of myocardial ischemia.
KW - Aged
KW - Biomarkers/blood
KW - Coronary Angiography
KW - Electrocardiography
KW - Exercise
KW - Exercise Test/adverse effects
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Ischemia/blood
KW - Myocardium/metabolism
KW - Pilot Projects
KW - Prognosis
KW - Reproducibility of Results
KW - Retrospective Studies
KW - Tomography, Emission-Computed, Single-Photon
KW - Troponin I/blood
U2 - 10.1016/j.ahj.2015.11.010
DO - 10.1016/j.ahj.2015.11.010
M3 - SCORING: Journal article
C2 - 26920591
VL - 173
SP - 8
EP - 17
JO - AM HEART J
JF - AM HEART J
SN - 0002-8703
ER -
