Detection of acute changes in circulating troponin in the setting of transient stress test-induced myocardial ischaemia using an ultrasensitive assay: Results from TIMI 35

Marc S. Sabatine, David A. Morrow, James A de Lemos, Petr Jarolim, Eugene Braunwald

Research output: Contribution to journalArticle

215 Citations (Scopus)

Abstract

Aims: To determine whether an ultrasensitive assay can permit quantification of changes in circulating cardiac troponin (Tn) in the setting of stress test-induced myocardial ischaemia. Methods and results: Blood samples were obtained before, immediately after, and 2 and 4 h after stress testing with nuclear perfusion imaging in 120 patients. Troponin was measured using commercial assays as well as with a novel, ultrasensitive cardiac TnI assay with a limit of detection of 0.2 pg/mL. Using the ultrasensitive assay, TnI was detectable in all patients before stress testing (median 4.4 pg/mL, interquartile range 3.1-8.6 pg/mL). By 4 h, troponin levels were unchanged in patients without ischaemia, whereas circulating levels had increased by a median of 1.4 pg/mL (24% increase) in patients with mild ischaemia (P = 0.002) and by 2.1 pg/mL (40% increase) in patients with moderate-to-severe ischaemia (P = 0.0006). In contrast, changes in troponin levels across patients in different ischaemic categories were indistinguishable using commercial troponin assays. When added to clinical factors, a >1.3 pg/mL increase in TnI using the ultrasensitive assay was an independent predictor of ischaemia (odds ratio 3.54, P = 0.007). Conclusion: Transient stress test-induced myocardial ischaemia is associated with a quantifiable increase in circulating troponin that is detectable with a novel, ultrasensitive TnI assay.

Original languageEnglish (US)
Pages (from-to)162-169
Number of pages8
JournalEuropean Heart Journal
Volume30
Issue number2
DOIs
StatePublished - Jan 2009

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Troponin
Exercise Test
Myocardial Ischemia
Ischemia
Perfusion Imaging
Limit of Detection
Odds Ratio

Keywords

  • Myocardial ischaemia
  • Stress test
  • Troponin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Detection of acute changes in circulating troponin in the setting of transient stress test-induced myocardial ischaemia using an ultrasensitive assay : Results from TIMI 35. / Sabatine, Marc S.; Morrow, David A.; de Lemos, James A; Jarolim, Petr; Braunwald, Eugene.

In: European Heart Journal, Vol. 30, No. 2, 01.2009, p. 162-169.

Research output: Contribution to journalArticle

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abstract = "Aims: To determine whether an ultrasensitive assay can permit quantification of changes in circulating cardiac troponin (Tn) in the setting of stress test-induced myocardial ischaemia. Methods and results: Blood samples were obtained before, immediately after, and 2 and 4 h after stress testing with nuclear perfusion imaging in 120 patients. Troponin was measured using commercial assays as well as with a novel, ultrasensitive cardiac TnI assay with a limit of detection of 0.2 pg/mL. Using the ultrasensitive assay, TnI was detectable in all patients before stress testing (median 4.4 pg/mL, interquartile range 3.1-8.6 pg/mL). By 4 h, troponin levels were unchanged in patients without ischaemia, whereas circulating levels had increased by a median of 1.4 pg/mL (24{\%} increase) in patients with mild ischaemia (P = 0.002) and by 2.1 pg/mL (40{\%} increase) in patients with moderate-to-severe ischaemia (P = 0.0006). In contrast, changes in troponin levels across patients in different ischaemic categories were indistinguishable using commercial troponin assays. When added to clinical factors, a >1.3 pg/mL increase in TnI using the ultrasensitive assay was an independent predictor of ischaemia (odds ratio 3.54, P = 0.007). Conclusion: Transient stress test-induced myocardial ischaemia is associated with a quantifiable increase in circulating troponin that is detectable with a novel, ultrasensitive TnI assay.",
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