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The relationship between coronary artery disease and hs-troponin T changing during exercise stress test

Year 2021, Volume: 3 Issue: 4, 156 - 163, 29.10.2021
https://doi.org/10.46310/tjim.875638

Abstract

Background The aim of this study was to investigate the relationship between coronary artery disease and changing of high sensitivity troponin T (hs-TnT) values during exercise stress test (EST) in patients with suspected coronary artery disease.
Material and Methods We included 68 patients who underwent coronary angiography after positive EST. The hs-TnT values of all patients were measured before EST and at 4 hours after EST. Patients with coronary artery stenosis of 50% or more were divided into two groups [CAD (+)] and those without [CAD (-)].hs-TnT values measured before and after EST were compared.
Results Among the 68 patients evaluated, 26 patients (39.3%) were identified as CAD (-) and 42 patients (61.7) as CAD (+).There was no significant difference between the two groups in the hs-TnT values before and after EST. There was a significant correlation between hs-TnT before exercise and pre-EST systolic blood pressure (SBP) (r = 0.313, p = 0.009) and hs-TnT before exercise and peak SBP during EST (r=0.241, p=0.038), anda also we found a correlation between hs-TnT after EST and peak SBP during EST (r = 0.398, p = 0.001). However, a strong negative correlation was found between the Duke treadmill score (DTS) calculated by the exercise test parameters and the Syntax score, which indicates the extent and severity of coronary artery disease (r =-0.521, p = 0.0001).
Conclusions As a result of our study, it was observed that hs-TnT values did not contribute to the diagnosis of coronary artery disease. However, DTS evaluation performed before invasive coronary angiography can provide important information about coronary artery lesion complexity.

References

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  • 2. Cassar A, Holmes DR, Rihal CS, Gersh BJ. Chronic coronary artery disease: diagnosis and management. Mayo Clin Proc. 2009;84(12):1130-1146. doi:10.4065/mcp.2009.0391
  • 3. Reeh J, Therming CB, Heitmann M, Højberg S, Sørum C, Bech J, Husum D, Dominguez H, Sehestedt T, Hermann T, Hansen KW, Simonsen L, Galatius S, Prescott E. Prediction of obstructive coronary artery disease and prognosis in patients with suspected stable angina. Eur Heart J. 2019;40(18):1426-1435. doi:10.1093/eurheartj/ehy806
  • 4. Hochholzer W, Reichlin T, Twerenbold R, Stelzig C, Hochholzer K, Meissner J, Haaf P, Schaub N, Steuer S, Bassetti S, Reiter M, Roost K, Freidank H, Winkler K, Mueller C. Incremental value of high-sensitivity cardiac troponin T for risk prediction in patients with suspected acute myocardial infarction. Clin Chem. 2011;57(9):1318-1326. doi:10.1373/clinchem.2011.162073
  • 5. Hochholzer W, Valina CM, Stratz C, Amann M, Schlittenhardt D, Büttner HJ, Trenk D, Neumann FJ. High-sensitivity cardiac troponin for risk prediction in patients with and without coronary heart disease. Int J Cardiol. 2014;176(2):444-449. doi:10.1016/j.ijcard.2014.07.094
  • 6. Vavik V, Pedersen EKR, Svingen GFT, Tell GS, Schartum-Hansen H, Aakre KM, Nygård O, Vikenes K. Usefulness of Higher Levels of Cardiac Troponin T in Patients With Stable Angina Pectoris to Predict Risk of Acute Myocardial Infarction. Am J Cardiol. 2018;122(7):1142-1147. doi:10.1016/j.amjcard.2018.06.027
  • 7. Lear SA, Brozic A, Myers JN, Ignaszewski A. Exercise stress testing. An overview of current guidelines. Sports Med Auckl NZ. 1999;27(5):285-312. doi:10.2165/00007256-199927050-00002
  • 8. Farooq V, Brugaletta S, Serruys PW. The SYNTAX score and SYNTAX-based clinical risk scores. Semin Thorac Cardiovasc Surg. 2011;23(2):99-105. doi:10.1053/j.semtcvs.2011.08.001
  • 9. Omland T, de Lemos JA, Sabatine MS, Christophi CA, Rice MM, Jablonski KA, Tjora S, Domanski MJ, Gersh BJ, Rouleau JL, Pfeffer MA, Braunwald E; Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial Investigators. A sensitive cardiac troponin T assay in stable coronary artery disease. N Engl J Med. 2009;361(26):2538-2547. doi:10.1056/NEJMoa0805299
  • 10. Mingels AM, Joosen IA, Versteylen MO, Laufer EM, Winkens MH, Wildberger JE, Van Dieijen-Visser MP, Hofstra L. High-sensitivity cardiac troponin T: risk stratification tool in patients with symptoms of chest discomfort. PloS One. 2012;7(4):e35059. doi:10.1371/journal.pone.0035059
  • 11. Ndrepepa G, Braun S, Schulz S, Mehilli J, Schömig A, Kastrati A. High-sensitivity troponin T level and angiographic severity of coronary artery disease. Am J Cardiol. 2011;108(5):639-643. doi:10.1016/j.amjcard.2011.04.012
  • 12. Mingels A, Jacobs L, Michielsen E, Swaanenburg J, Wodzig W, van Dieijen-Visser M. Reference population and marathon runner sera assessed by highly sensitive cardiac troponin T and commercial cardiac troponin T and I assays. Clin Chem. 2009;55(1):101-108. doi:10.1373/clinchem.2008.106427
  • 13. Middleton N, George K, Whyte G, Gaze D, Collinson P, Shave R. Cardiac troponin T release is stimulated by endurance exercise in healthy humans. J Am Coll Cardiol. 2008;52(22):1813-1814. doi:10.1016/j.jacc.2008.03.069
  • 14. Fu FH, Nie J, George K, Tong TK, Lin H, Shi Q. Impact of a 21-km Run on Cardiac Biomarkers in Adolescent Runners. J Exerc Sci Fit. 2010;8(2):61-66. doi:10.1016/S1728-869X(10)60009-3
  • 15. König D, Neubauer O, Nics L, Kern N, Berg A, Bisse E, Wagner KH. Biomarkers of exercise-induced myocardial stress in relation to inflammatory and oxidative stress. Exerc Immunol Rev. 2007;13:15-36.
  • 16. Kurz K, Giannitsis E, Zehelein J, Katus HA. Highly sensitive cardiac troponin T values remain constant after brief exercise- or pharmacologic-induced reversible myocardial ischemia. Clin Chem. 2008;54(7):1234-1238. doi:10.1373/clinchem.2007.097865
  • 17. Axelsson A, Ruwald MH, Dalsgaard M, Rossing K, Steffensen R, Iversen K. Serial measurements of high-sensitivity cardiac troponin T after exercise stress test in stable coronary artery disease. Biomark Biochem Indic Expo Response Susceptibility Chem. 2013;18(4):304-309. doi:10.3109/1354750X.2013.776635
  • 18. Ellis SG, Chew D, Chan A, Whitlow PL, Schneider JP, Topol EJ. Death following creatine kinase-MB elevation after coronary intervention: identification of an early risk period: importance of creatine kinase-MB level, completeness of revascularization, ventricular function, and probable benefit of statin therapy. Circulation. 2002;106(10):1205-1210. doi:10.1161/01.cir.0000028146.71416.2e
  • 19. Van Gaal WJ, Ponnuthurai FA, Selvanayagam J, Testa L, Porto I, Neubauer S, Banning AP. The Syntax score predicts peri-procedural myocardial necrosis during percutaneous coronary intervention. Int J Cardiol. 2009;135(1):60-65. doi:10.1016/j.ijcard.2008.03.033
  • 20. Mark DB, Shaw L, Harrell FE Jr, Hlatky MA, Lee KL, Bengtson JR, McCants CB, Califf RM, Pryor DB. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991;325(12):849-853. doi:10.1056/NEJM199109193251204
Year 2021, Volume: 3 Issue: 4, 156 - 163, 29.10.2021
https://doi.org/10.46310/tjim.875638

Abstract

References

  • 1. Capewell S, Morrison CE, McMurray JJ. Contribution of modern cardiovascular treatment and risk factor changes to the decline in coronary heart disease mortality in Scotland between 1975 and 1994. Heart Br Card Soc. 1999;81(4):380-386. doi:10.1136/hrt.81.4.380
  • 2. Cassar A, Holmes DR, Rihal CS, Gersh BJ. Chronic coronary artery disease: diagnosis and management. Mayo Clin Proc. 2009;84(12):1130-1146. doi:10.4065/mcp.2009.0391
  • 3. Reeh J, Therming CB, Heitmann M, Højberg S, Sørum C, Bech J, Husum D, Dominguez H, Sehestedt T, Hermann T, Hansen KW, Simonsen L, Galatius S, Prescott E. Prediction of obstructive coronary artery disease and prognosis in patients with suspected stable angina. Eur Heart J. 2019;40(18):1426-1435. doi:10.1093/eurheartj/ehy806
  • 4. Hochholzer W, Reichlin T, Twerenbold R, Stelzig C, Hochholzer K, Meissner J, Haaf P, Schaub N, Steuer S, Bassetti S, Reiter M, Roost K, Freidank H, Winkler K, Mueller C. Incremental value of high-sensitivity cardiac troponin T for risk prediction in patients with suspected acute myocardial infarction. Clin Chem. 2011;57(9):1318-1326. doi:10.1373/clinchem.2011.162073
  • 5. Hochholzer W, Valina CM, Stratz C, Amann M, Schlittenhardt D, Büttner HJ, Trenk D, Neumann FJ. High-sensitivity cardiac troponin for risk prediction in patients with and without coronary heart disease. Int J Cardiol. 2014;176(2):444-449. doi:10.1016/j.ijcard.2014.07.094
  • 6. Vavik V, Pedersen EKR, Svingen GFT, Tell GS, Schartum-Hansen H, Aakre KM, Nygård O, Vikenes K. Usefulness of Higher Levels of Cardiac Troponin T in Patients With Stable Angina Pectoris to Predict Risk of Acute Myocardial Infarction. Am J Cardiol. 2018;122(7):1142-1147. doi:10.1016/j.amjcard.2018.06.027
  • 7. Lear SA, Brozic A, Myers JN, Ignaszewski A. Exercise stress testing. An overview of current guidelines. Sports Med Auckl NZ. 1999;27(5):285-312. doi:10.2165/00007256-199927050-00002
  • 8. Farooq V, Brugaletta S, Serruys PW. The SYNTAX score and SYNTAX-based clinical risk scores. Semin Thorac Cardiovasc Surg. 2011;23(2):99-105. doi:10.1053/j.semtcvs.2011.08.001
  • 9. Omland T, de Lemos JA, Sabatine MS, Christophi CA, Rice MM, Jablonski KA, Tjora S, Domanski MJ, Gersh BJ, Rouleau JL, Pfeffer MA, Braunwald E; Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial Investigators. A sensitive cardiac troponin T assay in stable coronary artery disease. N Engl J Med. 2009;361(26):2538-2547. doi:10.1056/NEJMoa0805299
  • 10. Mingels AM, Joosen IA, Versteylen MO, Laufer EM, Winkens MH, Wildberger JE, Van Dieijen-Visser MP, Hofstra L. High-sensitivity cardiac troponin T: risk stratification tool in patients with symptoms of chest discomfort. PloS One. 2012;7(4):e35059. doi:10.1371/journal.pone.0035059
  • 11. Ndrepepa G, Braun S, Schulz S, Mehilli J, Schömig A, Kastrati A. High-sensitivity troponin T level and angiographic severity of coronary artery disease. Am J Cardiol. 2011;108(5):639-643. doi:10.1016/j.amjcard.2011.04.012
  • 12. Mingels A, Jacobs L, Michielsen E, Swaanenburg J, Wodzig W, van Dieijen-Visser M. Reference population and marathon runner sera assessed by highly sensitive cardiac troponin T and commercial cardiac troponin T and I assays. Clin Chem. 2009;55(1):101-108. doi:10.1373/clinchem.2008.106427
  • 13. Middleton N, George K, Whyte G, Gaze D, Collinson P, Shave R. Cardiac troponin T release is stimulated by endurance exercise in healthy humans. J Am Coll Cardiol. 2008;52(22):1813-1814. doi:10.1016/j.jacc.2008.03.069
  • 14. Fu FH, Nie J, George K, Tong TK, Lin H, Shi Q. Impact of a 21-km Run on Cardiac Biomarkers in Adolescent Runners. J Exerc Sci Fit. 2010;8(2):61-66. doi:10.1016/S1728-869X(10)60009-3
  • 15. König D, Neubauer O, Nics L, Kern N, Berg A, Bisse E, Wagner KH. Biomarkers of exercise-induced myocardial stress in relation to inflammatory and oxidative stress. Exerc Immunol Rev. 2007;13:15-36.
  • 16. Kurz K, Giannitsis E, Zehelein J, Katus HA. Highly sensitive cardiac troponin T values remain constant after brief exercise- or pharmacologic-induced reversible myocardial ischemia. Clin Chem. 2008;54(7):1234-1238. doi:10.1373/clinchem.2007.097865
  • 17. Axelsson A, Ruwald MH, Dalsgaard M, Rossing K, Steffensen R, Iversen K. Serial measurements of high-sensitivity cardiac troponin T after exercise stress test in stable coronary artery disease. Biomark Biochem Indic Expo Response Susceptibility Chem. 2013;18(4):304-309. doi:10.3109/1354750X.2013.776635
  • 18. Ellis SG, Chew D, Chan A, Whitlow PL, Schneider JP, Topol EJ. Death following creatine kinase-MB elevation after coronary intervention: identification of an early risk period: importance of creatine kinase-MB level, completeness of revascularization, ventricular function, and probable benefit of statin therapy. Circulation. 2002;106(10):1205-1210. doi:10.1161/01.cir.0000028146.71416.2e
  • 19. Van Gaal WJ, Ponnuthurai FA, Selvanayagam J, Testa L, Porto I, Neubauer S, Banning AP. The Syntax score predicts peri-procedural myocardial necrosis during percutaneous coronary intervention. Int J Cardiol. 2009;135(1):60-65. doi:10.1016/j.ijcard.2008.03.033
  • 20. Mark DB, Shaw L, Harrell FE Jr, Hlatky MA, Lee KL, Bengtson JR, McCants CB, Califf RM, Pryor DB. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991;325(12):849-853. doi:10.1056/NEJM199109193251204
There are 20 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section Original Articles
Authors

İsmail Gürbak 0000-0001-8466-4354

Musatafa Tarık Ağaç 0000-0002-4748-2532

Şükrü Çelik This is me 0000-0002-9586-8712

Publication Date October 29, 2021
Submission Date February 6, 2021
Acceptance Date May 29, 2021
Published in Issue Year 2021 Volume: 3 Issue: 4

Cite

EndNote Gürbak İ, Ağaç MT, Çelik Ş (October 1, 2021) The relationship between coronary artery disease and hs-troponin T changing during exercise stress test. Turkish Journal of Internal Medicine 3 4 156–163.

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