Direct comparison of cardiac troponin I and cardiac troponin T in the detection of exercise-induced myocardial ischemia

被引：20

作者：

Sou, Seoung Mann ^{[1
,2
]}

Puelacher, Christian ^{[1
,2
]}

Twerenbold, Raphael ^{[1
,2
]}

Wagener, Max ^{[1
,2
]}

Honegger, Ursina ^{[2
]}

Reichlin, Tobias ^{[1
,2
]}

Schaerli, Nicolas ^{[1
,2
]}

Pretre, Gil ^{[1
,2
]}

Abaecherli, Roger ^{[1
,2
]}

Jaeger, Cedric ^{[1
,2
]}

Gimenez, Maria Rubini ^{[1
,2
]}

Wild, Damian ^{[3
]}

Rentsch, Katharina M. ^{[4
]}

Zellweger, Michael J. ^{[1
,2
]}

Mueller, Christian ^{[1
,2
]}

机构：

[1] Univ Basel Hosp, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland

[2] Univ Basel Hosp, CRIB, CH-4031 Basel, Switzerland

[3] Univ Basel Hosp, Div Nucl Med, CH-4031 Basel, Switzerland

[4] Univ Basel Hosp, Dept Lab Med, CH-4031 Basel, Switzerland

来源：

CLINICAL BIOCHEMISTRY | 2016年 / 49卷 / 06期

基金：

瑞士国家科学基金会;

关键词：

Exercise-induced myocardial ischemia; CORONARY-ARTERY-DISEASE; EMISSION COMPUTED-TOMOGRAPHY; INCREMENTAL PROGNOSTIC VALUE; HEART-ASSOCIATION; AMERICAN-COLLEGE; TASK-FORCE; ASSAY; RISK; DIAGNOSIS; STRATIFICATION;

D O I：

10.1016/j.clinbiochem.2015.12.005

中图分类号：

R446 [实验室诊断]; R-33 [实验医学、医学实验];

学科分类号：

1001 ;

摘要：

Background: It is unknown, whether cardiac troponin (cTn) I or cTnT is the preferred biomarker in the detection of exercise-induced myocardial ischemia. Methods: We investigated patients with suspected myocardial ischemia referred for exercise or pharmacological rest/stress myocardial perfusion single-photon emission computed tomography (SPECT) to directly compare the diagnostic accuracy of high-sensitivity cTnI (hs-cTnI) and hs-cTnT. Diagnostic performance was analyzed separately according to stress modality. Hs-cTnI and hs-cTnT were measured before, immediately after, as well as 2 h and 4 h after maximal exercise in a blinded fashion. Further, all clinical information available to the treating cardiologist was used to quantify the clinical judgment regarding the presence of myocardial ischemia using a visual analog scale twice: once prior and once after stress-testing. The presence of stressinduced myocardial ischemia was adjudicated using SPECT combined with coronary angiography findings. Result: A total of 403 consecutive patients were enrolled in our study, of which 229 underwent exercise stress and 174 patients pharmacological stress. Exercise-stress-induced myocardial ischemia was detected in 90 patients (39.3% of 229). Levels of hs-cTnI and hs-cTnT were both significantly higher at all time-points examined in patients with exercise-induced myocardial ischemia as compared to patients without myocardial ischemia (all p < 0.001). Correlation of hs-cTnI and hs-cTnT was high in direct comparison of time-points (Spearman's rho all >= 0.7). The AUCs for baseline/peak/2 h/4 h for hs-cTnI and hs-cTnT were 0.71/0.71/0.72/0.69 vs. 0.74/0.73/0.71/0.72, respectively (all p=ns for hs-cTnI versus hs-cTnT). In patients undergoing pharmacological stress, the AUCs for baseline/peak/2 h/4 h for hs-cTnI and hs-cTnT were 0.66/0.66/0.68/0.67 and 0.61/0.62/0.64/0.59, respectively (all p = ns for hs-cTnI versus hs-cTnT). Also the combinations including clinical judgment or changes during serial sampling were similar for hs-cTnI and hs-cTnT (all p = ns). Conclusions: Hs-cTnI and hs-cTnT provide comparable diagnostic information regarding exercise-induced myocardial ischemia. Overall, their diagnostic accuracy seems moderate. (C) 2015 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

引用

页码：421 / 432

页数：12

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