Serial High-Sensitivity Troponin T in Post-Primary Angioplasty Exercise Test

Vaz, Humberto Andres; Vanz, Ana Paula; Castro, Iran

doi:10.5935/abc.20160029

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Original Articles • Arq. Bras. Cardiol. 106 (04) • Apr 2016 • https://doi.org/10.5935/abc.20160029 copy

Serial High-Sensitivity Troponin T in Post-Primary Angioplasty Exercise Test

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

The kinetics of high-sensitivity troponin T (hscTnT) release should be studied in different situations, including functional tests with transient ischemic abnormalities.

Objective:

To evaluate the release of hscTnT by serial measurements after exercise testing (ET), and to correlate hscTnT elevations with abnormalities suggestive of ischemia.

Methods:

Patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty were referred for ET 3 months after infarction. Blood samples were collected to measure basal hscTnT immediately before (TnT_0h), 2 (TnT_2h), 5 (TnT_5h), and 8 hours (TnT_8h) after ET. The outcomes were peak hscTnT, TnT_5h/TnT_0h ratio, and the area under the blood concentration-time curve (AUC) for hscTnT levels. Log-transformation was performed on hscTnT values, and comparisons were assessed with the geometric mean ratio, along with their 95% confidence intervals. Statistical significance was assessed by analysis of covariance with no adjustment, and then, adjusted for TnT_0h, age and sex, followed by additional variables (metabolic equivalents, maximum heart rate achieved, anterior wall STEMI, and creatinine clearance).

Results:

This study included 95 patients. The highest geometric means were observed at 5 hours (TnT_5h). After adjustments, peak hscTnT, TnT_5h/TnT_0h and AUC were 59% (p = 0.002), 59% (p = 0.003) and 45% (p = 0.003) higher, respectively, in patients with an abnormal ET as compared to those with normal tests.

Conclusion:

Higher elevations of hscTnT may occur after an abnormal ET as compared to a normal ET in patients with STEMI.

Keywords:
Troponin T; Ischemia; Myocardial Infarction; Exercise Test; Angioplasty

Characteristics	abnormal ET (n=13)	normal ET (n=82)
Anthropometric
Age (years)	59±12	54±10
Male sex n (%)	12 (92)	65 (79)
BMI (kg/m²)	28±3	27±5
Risk factors (%)
Current or previous smoking	9 (70)	53 (65)
Systemic arterial hypertension	9 (70)	65 (80)
Family history of CAD	2 (15)	30 (37)
Diabetes	1 (8)	13 (15)
Dyslipidemia	7 (54)	62 (76)
Acute myocardial infarction
Time until treatment (hours)	5 (2 - 6)	4 (2 - 5)
Anterior wall location n (%)	3 (23)	44 (53)
Number of vessels affected n (%)
1	8 (61)	64 (78)
≥2	5 (38)	18 (22)
Stents n (%)
1	9 (70)	68 (80)
2	4 (30)	14 (17)
1st stent length (mm)	27±8	21±7
2nd stent length (mm)	19±10	18±8
ET: additional parameters
% of maximum HR achieved	79±12	80±12
Double product (x10³)	22±5	22±6
METS	8±2	8±2
Biochemistry
Creatinine clearance (mL/min)	90±25	100±30
TnT_0h	6.7 (4.7 - 7.4)	5.4 (3 - 9.5)

			Non-adjusted analysis		Adjusted analysis for TnT_0h, age and sex		Analysis with additional adjustment^† † additional adjustment for baseline troponin T (TnT0h), metabolic equivalent, percentage of maximum heart rate reached, anterior wall infarction and creatinine clearance (Cockcroft-Gault method).
Outcome	Abnormal ET^* *Data are presented as geometric means; CI: confidence interval; p: statistical significance; ET: treadmill exercise test; TnT: high-sensitivity troponin T; AUC: area under the curve; (n = 13)	Normal ET^* *Data are presented as geometric means; CI: confidence interval; p: statistical significance; ET: treadmill exercise test; TnT: high-sensitivity troponin T; AUC: area under the curve; (n = 82)	geometric mean ratio (95% CI)	p	geometric mean ratio (95% CI)	p	geometric mean ratio (95% CI)	p
Primary
peak TnT (ng/L)	13.15	7.69	1.71 (1.07 - 2.73)	0.025	1.54 (1.14 - 2.07)	0.003	1.59 (1.17 - 2.15)	0.002
Secondary
TnT_5h/TnT_0h	1.90	1.22	1.56 (1.16 - 2.10)	0.004	1.51 (1.11 - 2.04)	0.008	1.59 (1.17 - 2.15)	0.003
AUC (ng/L)²	84.3	55.0	1.54 (0.98 - 2.39)	0.058	1.39 (1.10 - 1.77)	0.007	1.45 (1.14 - 1.85)	0.003

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E-mail: revista@cardiol.br

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[1] Mailing Address: Humberto Andres Vaz, Instituto de Cardiologia do Rio Grande Do Sul. Avenida Princesa Isabel 395, bairro Santana, Postal Code 90620-000, Porto Alegre, RS – Brazil. E-mail: humbertovaz@cardiol.br; humbertovaz@hotmail.com