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

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.

Keywords

• hs-troponin T
• exercise stress testing
• coronary artery disease
• syntax score

References

1. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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