Evaluation of Serial High Sensitivity Troponin T Levels in Individuals Without Overt Coronary Heart Disease Following Exercise Stress Testing
Detectable levels of high sensitivity (cardiac) troponin T (HsTnT), occur in the majority of patients with stable coronary heart disease (CHD), and often in ‘healthy’ individuals. Extreme physical activity may lead to marked elevations in creatine kinase MB and TnT levels. However, whether HsTnT ele...
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| Published in | Heart, lung & circulation Vol. 26; no. 7; pp. 660 - 666 |
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| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Australia
Elsevier B.V
01.07.2017
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1443-9506 1444-2892 |
| DOI | 10.1016/j.hlc.2016.11.004 |
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| Abstract | Detectable levels of high sensitivity (cardiac) troponin T (HsTnT), occur in the majority of patients with stable coronary heart disease (CHD), and often in ‘healthy’ individuals. Extreme physical activity may lead to marked elevations in creatine kinase MB and TnT levels. However, whether HsTnT elevations occur commonly after exercise stress testing (EST), and if so, whether this has clinical significance, needs clarification.
To determine whether HsTnT levels become elevated after EST (Bruce protocol) to ≥95% of predicted maximum heart rate in presumed healthy subjects without overt CHD, we assayed HsTnT levels for ∼5h post-EST in 105 subjects (median age 37 years).
Pre-EST HsTnT levels <5 ng/L were present in 31/32 (97%) of females and 52/74 (70%) of males. Post-EST, 13 (12%) subjects developed HsTnT levels >14 ng/L, with troponin elevation occurring at least three hours post-EST. Additionally, a detectable ≥ 50% increase in HsTnT levels (4.9→9ng/L) occurred in 28 (27%) of subjects who during EST achieved ≥ 95% of their predicted target heart rate. The median age of the subjects with HsTnT elevations to > 14ng/L post-EST was higher than those without such elevation (42 and 36 years respectively; p=0.038). At a median follow-up of 13 months no adverse events were recorded.
The current study demonstrates that detectable elevations occur in HsTnT post-EST in ‘healthy’ subjects without overt CHD. Future studies should evaluate the clinical significance of detectable elevations in post-EST HsTnT with long-term follow-up for adverse cardiac events. |
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| AbstractList | Detectable levels of high sensitivity (cardiac) troponin T (HsTnT), occur in the majority of patients with stable coronary heart disease (CHD), and often in ‘healthy’ individuals. Extreme physical activity may lead to marked elevations in creatine kinase MB and TnT levels. However, whether HsTnT elevations occur commonly after exercise stress testing (EST), and if so, whether this has clinical significance, needs clarification.
To determine whether HsTnT levels become elevated after EST (Bruce protocol) to ≥95% of predicted maximum heart rate in presumed healthy subjects without overt CHD, we assayed HsTnT levels for ∼5h post-EST in 105 subjects (median age 37 years).
Pre-EST HsTnT levels <5 ng/L were present in 31/32 (97%) of females and 52/74 (70%) of males. Post-EST, 13 (12%) subjects developed HsTnT levels >14 ng/L, with troponin elevation occurring at least three hours post-EST. Additionally, a detectable ≥ 50% increase in HsTnT levels (4.9→9ng/L) occurred in 28 (27%) of subjects who during EST achieved ≥ 95% of their predicted target heart rate. The median age of the subjects with HsTnT elevations to > 14ng/L post-EST was higher than those without such elevation (42 and 36 years respectively; p=0.038). At a median follow-up of 13 months no adverse events were recorded.
The current study demonstrates that detectable elevations occur in HsTnT post-EST in ‘healthy’ subjects without overt CHD. Future studies should evaluate the clinical significance of detectable elevations in post-EST HsTnT with long-term follow-up for adverse cardiac events. BACKGROUNDDetectable levels of high sensitivity (cardiac) troponin T (HsTnT), occur in the majority of patients with stable coronary heart disease (CHD), and often in 'healthy' individuals. Extreme physical activity may lead to marked elevations in creatine kinase MB and TnT levels. However, whether HsTnT elevations occur commonly after exercise stress testing (EST), and if so, whether this has clinical significance, needs clarification.METHODSTo determine whether HsTnT levels become elevated after EST (Bruce protocol) to ≥95% of predicted maximum heart rate in presumed healthy subjects without overt CHD, we assayed HsTnT levels for ∼5h post-EST in 105 subjects (median age 37 years).RESULTSPre-EST HsTnT levels <5 ng/L were present in 31/32 (97%) of females and 52/74 (70%) of males. Post-EST, 13 (12%) subjects developed HsTnT levels >14 ng/L, with troponin elevation occurring at least three hours post-EST. Additionally, a detectable ≥ 50% increase in HsTnT levels (4.9→9ng/L) occurred in 28 (27%) of subjects who during EST achieved ≥ 95% of their predicted target heart rate. The median age of the subjects with HsTnT elevations to > 14ng/L post-EST was higher than those without such elevation (42 and 36 years respectively; p=0.038). At a median follow-up of 13 months no adverse events were recorded.CONCLUSIONThe current study demonstrates that detectable elevations occur in HsTnT post-EST in 'healthy' subjects without overt CHD. Future studies should evaluate the clinical significance of detectable elevations in post-EST HsTnT with long-term follow-up for adverse cardiac events. Background Detectable levels of high sensitivity (cardiac) troponin T (HsTnT), occur in the majority of patients with stable coronary heart disease (CHD), and often in ‘healthy’ individuals. Extreme physical activity may lead to marked elevations in creatine kinase MB and TnT levels. However, whether HsTnT elevations occur commonly after exercise stress testing (EST), and if so, whether this has clinical significance, needs clarification. Methods To determine whether HsTnT levels become elevated after EST (Bruce protocol) to ≥95% of predicted maximum heart rate in presumed healthy subjects without overt CHD, we assayed HsTnT levels for ∼5 h post-EST in 105 subjects (median age 37 years). Results Pre-EST HsTnT levels <5 ng/L were present in 31/32 (97%) of females and 52/74 (70%) of males. Post-EST, 13 (12%) subjects developed HsTnT levels >14 ng/L, with troponin elevation occurring at least three hours post-EST. Additionally, a detectable ≥ 50% increase in HsTnT levels (4.9→9ng/L) occurred in 28 (27%) of subjects who during EST achieved ≥ 95% of their predicted target heart rate. The median age of the subjects with HsTnT elevations to > 14ng/L post-EST was higher than those without such elevation (42 and 36 years respectively; p=0.038). At a median follow-up of 13 months no adverse events were recorded. Conclusion The current study demonstrates that detectable elevations occur in HsTnT post-EST in ‘healthy’ subjects without overt CHD. Future studies should evaluate the clinical significance of detectable elevations in post-EST HsTnT with long-term follow-up for adverse cardiac events. |
| Author | Idris, Hanan Juergens, Craig P. Rajaratnam, Rohan Thomas, Liza French, John K. Shugman, Ibrahim M. Saad, Yousef M.E. Leung, Dominic Y.C. Mussap, Christian Kadappu, Krishna K. |
| Author_xml | – sequence: 1 givenname: Yousef M.E. surname: Saad fullname: Saad, Yousef M.E. organization: Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia – sequence: 2 givenname: Hanan surname: Idris fullname: Idris, Hanan organization: Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia – sequence: 3 givenname: Ibrahim M. surname: Shugman fullname: Shugman, Ibrahim M. organization: Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia – sequence: 4 givenname: Krishna K. surname: Kadappu fullname: Kadappu, Krishna K. organization: Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia – sequence: 5 givenname: Rohan surname: Rajaratnam fullname: Rajaratnam, Rohan organization: Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia – sequence: 6 givenname: Liza surname: Thomas fullname: Thomas, Liza organization: Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia – sequence: 7 givenname: Christian surname: Mussap fullname: Mussap, Christian organization: Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia – sequence: 8 givenname: Dominic Y.C. surname: Leung fullname: Leung, Dominic Y.C. organization: Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia – sequence: 9 givenname: Craig P. surname: Juergens fullname: Juergens, Craig P. organization: Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia – sequence: 10 givenname: John K. surname: French fullname: French, John K. email: j.french@unsw.edu.au organization: Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28087154$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1111_echo_15411 crossref_primary_10_2147_CIA_S248868 crossref_primary_10_1016_j_cotox_2017_07_002 crossref_primary_10_1016_j_hlc_2017_05_112 crossref_primary_10_1111_imj_14614 |
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| Keywords | Exercise stress testing Coronary heart disease High-sensitivity troponin T |
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Analytical characteristics of high-sensitivity cardiac troponin assays. Clin Chem |
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| Snippet | Detectable levels of high sensitivity (cardiac) troponin T (HsTnT), occur in the majority of patients with stable coronary heart disease (CHD), and often in... Background Detectable levels of high sensitivity (cardiac) troponin T (HsTnT), occur in the majority of patients with stable coronary heart disease (CHD), and... BACKGROUNDDetectable levels of high sensitivity (cardiac) troponin T (HsTnT), occur in the majority of patients with stable coronary heart disease (CHD), and... |
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| SubjectTerms | Adult Cardiovascular Coronary Disease - blood Coronary heart disease Exercise stress testing Exercise Test Female High-sensitivity troponin T Humans Male Middle Aged Prospective Studies Troponin T - blood |
| Title | Evaluation of Serial High Sensitivity Troponin T Levels in Individuals Without Overt Coronary Heart Disease Following Exercise Stress Testing |
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