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

作者：Lee Gino; Twerenbold Raphael; Tanglay Yunus; Reichlin Tobias; Honegger Ursina; Wagener Max; Jaeger Cedric; Gimenez Maria Rubini; Hochgruber Thomas; Puelacher Christian; Radosavac Milos; Kreutzinger Philipp; Stallone Fabio; Hillinger Petra; Krivoshei Lian; Herrmann Thomas; Mayr Romy; Freese Michael; Wild Damian; Rentsch Katharina M; Todd John; Osswald Stefan; Zellweger Michael J; Mueller Christian^*

来源：American Heart Journal, 2016, 173: 8-17.

DOI：10.1016/j.ahj.2015.11.010

Background 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.

• 出版日期2016-3