Myocardial Ischemia on Exercise Stress Echocardiography Testing Is Not Associated with Changes in Troponin T Concentrations
Abstract
Background: Some posit that any amount of myocardial ischemia can be detected by high-sensitivity
cardiac troponin assays. We hypothesized that patients with myocardial ischemia induced
by exercise stress would have significantly higher increases in high-sensitivity cardiac
troponin T (hs-cTnT) concentrations than patients without ischemia.Methods: We prospectively
recruited for a biorepository 317 adult patients who presented to an academic hospital
emergency department for evaluation possible ischemic symptoms and who were scheduled
for exercise echocardiography. Blood samples were obtained before stress testing and
2-h post-testing. For this study, plasma hs-cTnT (Roche Diagnostics) concentrations
were determined in a core laboratory blinded to clinical status. Absolute and relative
changes between baseline and 2-h post-stress measurements were compared between patients
with and without ischemia induced by stress testing.Results: The median age was 51
(44.0, 60.0) years, 45.9% were male, and 37.8% were African American. In total, 26
patients (8.1%) had myocardial ischemia induced by exercise. Median baseline, 2-h
post-stress, and absolute δ concentrations were, respectively, 6.0, 8.0, and 0.2 ng/L
for patients with evidence of ischemia; 3.8, 4.6, and 0.0 ng/L for those without;
and 3.9, 4.9, and 0.0 ng/L overall. Baseline and 2-h hs-cTnT concentrations were higher
among patients with abnormal stress tests (all P <=0.05), but absolute and relative
changes in hs-cTnT concentrations were not significantly different between individuals
with ischemia and individuals without.Conclusions: There was no evidence of change
in hs-cTnT values in response to exercise stress testing, regardless of the presence
of myocardial ischemia.
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https://hdl.handle.net/10161/17308Published Version (Please cite this version)
10.1373/jalm.2016.021667Publication Info
Limkakeng, Alexander T; Drake, Weiying; Lokhnygina, Yuliya; Meyers, Harvey P; Shogilev,
Daniel; Christenson, Robert H; & Newby, L Kristin (2017). Myocardial Ischemia on Exercise Stress Echocardiography Testing Is Not Associated
with Changes in Troponin T Concentrations. The Journal of Applied Laboratory Medicine, 1. pp. 532-543. 10.1373/jalm.2016.021667. Retrieved from https://hdl.handle.net/10161/17308.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Alexander Tan Limkakeng Jr.
Professor of Emergency Medicine
My personal research interest is finding new ways to diagnose acute coronary syndrome.
In particular, I am interested in novel biomarkers and precision medicine approaches
to this problem. I also have an interest in sepsis and empirical bioethics. As Vice
Chair of Clinical Research for the Duke University Department of Emergency Medicine,
I also work with researchers from many fields spanning global health, innovation,
clinical trials, basic discovery, and trans
Yuliya Vladimirovna Lokhnygina
Associate Professor of Biostatistics & Bioinformatics
Statistical methods in clinical trials, survival analysis, adaptive designs, adaptive
treatment strategies, causal inference in observational studies, semiparametric inference
Laura Kristin Newby
Professor of Medicine
Research Description General Focus: Clinical investigation the process and treatment
of acute and chronic coronary artery disease and systems issues for delivery of care
to patients with these illnesses. Particular interests include management of patients
with chest pain and unstable angina, evaluation of the use of biochemical markers
other than CK-MB for diagnosis and risk stratification in these patients, issues related
to coronary artery disease in women, and systems issues rega
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