Clinical benefit of high-sensitivity cardiac troponin I in the detection of exercise-induced myocardial ischemia

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• 作者：Gino Lee ; MD^a ; ^b ; Raphael Twerenbold ; MD^a ; ^b ; Yunus Tanglay ; MD^a ; ^b ; Tobias Reichlin ; MD^a ; ^b ; Ursina Honegger ; MSc^a ; ^b ; Max Wagener ; MD^a ; ^b ; ^c ; Cedric Jaeger ; MD^a ; ^b ; Maria Rubini Gimenez ; MD^a ; ^b ; Thomas Hochgruber ; MD^a ; ^b ; ^c ; Christian Puelacher ; MD^a ; ^b ; Milos Radosavac ; MD^a ; ^b ; Philipp Kreutzinger ; MD^a ; ^b ; Fabio Stallone ; MD^a ; ^b ; Petra Hillinger ; MD^a ; ^b ; Lian Krivoshei ; MD^a ; ^b ; Thomas Herrmann ; MD^a ; ^b ; Romy Mayr ; MS^b ; Michael Freese ; RN^a ; ^b ; Damian Wild ; MD^d ; Katharina M. Rentsch ; PhD^e ; John Todd ; PhD^f ; Stefan Osswald ; MD^a ; ^b ; Michael J. Zellweger ; MD^a ; ^b ; Christian Mueller ; MD^a ; ^b ; ^{christian.mueller@usb.ch" class="auth_mail" title="E-mail the corresponding author}
• 刊名：American Heart Journal
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：173
• 期：Complete
• 页码：8-17
• 全文大小：485 K

文摘

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.