title: Cardiac troponin T levels and exercise stress testing in patients with suspected coronary artery disease: the Akershus Cardiac Examination (ACE) 1 study.
abstract: Whether reversible ischaemia in patients referred for exercise stress testing and MPI (myocardial perfusion imaging) is associated with changes in circulating cTn (cardiac troponin) levels is controversial. We measured cTnT with a sensitive assay before, immediately after peak exercise and 1.5 and 4.5 h after exercise stress testing in 198 patients referred for MPI. In total, 19 patients were classified as having reversible myocardial ischaemia. cTnT levels were significantly higher in patients with reversible myocardial ischaemia on MPI at baseline, at peak exercise and after 1.5 h, but not at 4.5 h post-exercise. In patients with reversible ischaemia on MPI, cTnT levels did not change significantly after exercise stress testing [11.1 (5.2-14.9) ng/l at baseline compared with 10.5 (7.2-16.3) ng/l at 4.5 h post-exercise, P=0.27; values are medians (interquartile range)]. Conversely, cTnT levels increased significantly during testing in patients without reversible myocardial ischaemia [5.4 (3.0-9.0) ng/l at baseline compared with 7.5 (4.6-12.4) ng/l, P<0.001]. In conclusion, baseline cTnT levels are higher in patients with MPI evidence of reversible myocardial ischaemia than those without reversible ischaemia. However, although cTnT levels increase during exercise stress testing in patients without evidence of reversible ischaemia, this response appears to be blunted in patients with evidence of reversible ischaemia. Mechanisms other than reversible myocardial ischaemia may play a role for acute exercise-induced increases in circulating cTnT levels.
authors.affiliation: Division of Medicine, Akershus University Hospital, 1478 Lørenskog, Norway.
authors.forename: Ragnhild
authors.initials: R
authors.lastname: Røysland
authors.forename: Gunnhild
authors.initials: G
authors.lastname: Kravdal
authors.forename: Arne Didrik
authors.initials: AD
authors.lastname: Høiseth
authors.forename: Ståle
authors.initials: S
authors.lastname: Nygård
authors.forename: Pirouz
authors.initials: P
authors.lastname: Badr
authors.forename: Tor-Arne
authors.initials: TA
authors.lastname: Hagve
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Omland
authors.forename: Helge
authors.initials: H
authors.lastname: Røsjø
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis*; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000473:pathology; D010477:Perfusion; D012306:Risk; D012307:Risk Factors; D013997:Time Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T